Posted By jma
Hi everyone,
I wondered if anyone could give me some information on first aiders and hydrocortisone (1%) cream. We manufacture a specific chemical which on contact with the skin will cause redness, tingling and then a chemical burn.

In the past when operators/fitters have been subject to chemical contact our first aiders provided (though not administered!) hydrocortisone cream to the injured party to prevent the "rash" becoming worse and blistering etc. The cream has been provided only after the skin area has been irrigated for 15 minutes or more.

We now have a new occupational nurse who is questioning whether a trained first aider should provide such cream, arguing that the person should go to A&E, GP or a drop in centre. The counter argument is that time is of the essence and that the application of the cream after extensive irrigation can substantially reduce the extent of the burn/skin damage.

I hasten to add that the number of incidents when this cream is applied is low, probably a couple of times per year. I know about the "skin thinning" properties of this type of cream and do not believe this would be an issue as the number of incidences is low and it is not the same person affected each time.

Obviously the work equipment is cleaned as far as possible, assessments and other controls are in place and all the workforce wear the required PPE but there are occasions where contact can occur.

I need to establish whether it is acceptable that first aiders provide the cream (preferably with references)for the person to apply or whether they should not be doing so at all, anyone had a similar situation at work?

Any help/comments much appreciated.

Regards Michael

Posted By W P F
Careful consideration should be given. Is the Occ. Health nurse not able to administer herself? Obviously not in times when he/she isn't there but as a nurse one would suggest she could complete this task, obviously ensuring that they don't suffer from any known allergy etc.

I suggest you write a policy on this as 1st aiders are not allowed to administer any drug, cream etc. e.g. like paracetomol

WPF

Posted By Adam Worth
Hi

In my experience i have seen first aiders administer additional treatments to conventional.

This was authorised by an EMAS Doctor and the first aiders were subject to extra training.

L74 refers to specific training where risk assessment deems it necessary and is very much focused on risk assessment!

It's difficult to comment on self administration of the cream. It's generally accepted that if I help myself to a colleagues pain killers that is my choice, not sure if that is the case with the cream? Is it prescription only? I think the Nurse is right to be cautious!

I would suggest you call a first aid provider such as St John Ambulance or contact EMAS

http://www.hse.gov.uk/pubns/hse5.pdf

Hope that helps.

Posted By Dave Merchant
Provided the cream isn't POM/PM then why not simply sell them a new tube - that way it's not a FAAW provision.

You cannot supply an opened tube to two people; as I've said before that breaches the Medicines Act, so the company must be "selling" the patient a sealed carton as they'd get over the counter. You can sell them for a penny a tube if you want to, it's the act of "sell" as opposed to "administer" which decides on the FAAW definition.

(Of course someone's going to point out that if you have people "injured" then that still has to go in the accident book, and so there may be a point in not getting contact with the chemical in the first place.)

Posted By Chris Packham
Without knowing the chemical and thus the exact nature of the skin reaction it is simply impossible to comment.

Hydrocortisone cream is intended to act as an antihistamine treatment and as such is usually only administered to reduce the symptoms of an allergic skin reaction. If the chemical merely is capable of causing irritation or, in this case, what has been described as a skin burn, then I would question the suitability of this product for the purpose. There are other products more suitable for treatment of skin burns.

If the reaction is immediate and an allergic one, then this will probably be a type I response. This could possibly result is the person suffering anaphylaxis and this could be life threatening.

In any event, one has to ask if in the case of exposure such as to cause this type of reaction was it investigated so as to ascertain the reason for the exposure? What was then done to prevent this from occurring again? If this has not been done and someone then suffers a skin reaction that is diagnosed by a registered medical practitioner as occupational contact dermatitis ( and note there is no requirement in this case for time off work, merely the diagnosis is sufficient) this would have to be reported under RIDDOR.

I would not wish then to have to defend the employer who has permitted accidental exposures to occur on an on-going basis, even if the occurrences are fairly rare.

One final point. If it does this to the skin, what could it do to mucous membranes, eyes, etc.? The consequences could be very much more severe.

Chris

Posted By jma
Once again thank you for all your thoughts, a couple of points:

My question was really directed as to whether it is appropriate that we as an employer provide Hydrocortisone cream and permit first aiders to allow someone who has had contact with the skin to administer it to themselves, rather than whether the cream itself is appropriate for use with the chemical we manufacture (which it is as determined by the occupational health doctor).

"I would not wish then to have to defend the employer who has permitted accidental exposures to occur on an on-going basis, even if the occurrences are fairly rare".

Chris I can assure you that neither I nor my employer permits chemical exposure or any other form of injury. Without wanting to turn this into an argument resulting in tit for tat remarks, to suggest that we do (or that any other organisation that sustains an injury does)is rather offensive.

I have spoken to an Occupational Health Inspector at the HSE today and been advised of the steps to follow to allow first aiders to continue to "provide" the cream should it be required. In the meantime we will continue to do all we can to prevent chemical contact or any other occupational injury, but should it occur I do believe that having this facility will greatly reduce the adverse effects.

Once again thanks for all your comments.

Posted By Crim
The difference is that it takes longer for an injured person to open a package and read all instructions before deciding to do the right thing. If a trained first aider handed me a package of cream as a treatment for injury I would assume that it is a recommended treatment and apply it on that basis.

What if it is an urgent need for the cream to be applied, should the injured person wait for the injury to worsen before applying the cream?

My view of some first aiders is that they should not be first aiders if they are not confident enough to apply first aid.

The other side of the coin of course is for non trained persons to carry out first aid because they will not be in danger of being sued.

Like I say "what a load of tosh".

Posted By Dave Merchant
Crim - I do understand your argument (I have it on every course) but "first aid" is not, and I'd stress in big, glittery letters if the forum let me, NOT "treatment". Never is, never should be.

First aid is solely about stabilisation and immediate support of life and limb - anything beyond that, INCLUDING applying a topical antiseptic or antihistamine cream, is outside the remit of first aid (and into occupational nursing or general medicine). A workplace first aider is trained never to administer any medicine other than with the sole and immediate effect of saving life (epipens, oxygen etc.) and rightly so - they cannot be trained to understand the implications of administering a medicine, and are certainly not insured for it.


Phil - it depends on the case (and the preferences of the A&E team), but burns dressings are extremely valuable, in that you can begin transport while they're still acting. You can't hold someone's arm under a tap for ten minutes AND drive them to hospital, unless you have a particularly long hosepipe. There are also many workplaces where running water is simply not available (construction/forestry/utilities work etc.) and burns dressings are the only option for casualties on those sites. Yes, they make your casualty a bit gucky, but that's why we invented saline and swabs.