Accidents and First Aid
The primary aim of this manual is to assist those working in dental environments to manage health and safety by assessing risks and implementing reasonable control measures which are aimed at preventing accidents and cases of ill health. It is generally considered that dental settings, in particular, general dental practices, are relatively low-risk environments if we compare them with other industry sectors such as construction sites or factories. However, a proactive approach to accident prevention is vital for the following reasons:
- Ethical – employers have a moral duty of care to protect employees and others.
- Legal – employers and employees must demonstrate compliance with legislation.
- Organisational – health and safety policies and procedures should be a condition of employment.
- Financial – it makes economic sense to reduce workdays lost from accidents and ill health.
The cost of workplace accidents can have a detrimental effect on the business as well as on the injured party and their immediate family. In order to successfully prevent accidents everyone must first have an understanding of how they are caused, the accident types and what procedure to follow if an accident happens.
- Health and Safety at Work etc. Act 1974:
Employers shall ensure, so far as is reasonably practicable, the health, safety and welfare at work of their employees and anyone else who may be affected by their business activities in order to prevent accidents.
- Management of Health and Safety at Work Regulations 1999:
Employers must undertake suitable and sufficient assessments of risks to the health and safety of employees and implement reasonable controls in order to prevent accidents. Investigating the causes of accidents is an essential part of good health and safety management and assists with reviewing risk assessments.
- Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR):
Employers are required to report certain specified accidents and dangerous occurrences to the enforcing authority, via the HSE’s incident contact centre, if they arise out of or in connection with work activities.
- Health and Safety (First Aid) Regulations 1981:
Employers should make an assessment of first-aid needs appropriate to the circumstances of the workplace and make available equipment and facilities enabling first-aid to be rendered.
- The Social Security (Claims and Payments) Amendment (No 2) Regulations 2006:
Employers are required to investigate the circumstances of every accident that is reported and record the circumstances if there is a discrepancy between what was initially reported and the investigation findings.
- Employers’ Liability (Compulsory Insurance) Regulations 1998:
Employers must have sufficient insurance which ensures that if employees are injured or made ill at work they are able to make a civil claim against their employer.
The latest accident statistics (2007–2008) produced by the Health and Safety Executive (HSE) show that there has been a reduction in workplace accidents. This could be as a result of employers communicating health and safety more effectively, so that employees are more safety conscious or because under-reporting exists. Under-reporting is a factor that must be considered when relying on statistics to inform us on health and safety at work. In this chapter, we will address the range of requirements to report workplace accidents in order to ensure that statistics provide reliable information.
It is important to understand what the term accident actually means as there are a number of variations. The most common definition is ‘an unplanned, uncontrolled event which has the potential to cause injury’. The word potential is vitally important in the definition as it helps us to appreciate that not all accidents result in injury. However, all accidents need to be addressed as part of accident prevention. Accidents are sometimes divided into five categories as follows:
1. Death or major injury – reportable to enforcing authority
2. Over 3-day injury – reportable to enforcing authority
3. Minor injury – not reportable to enforcing authority
4. Dangerous occurrence – no injury but reportable to enforcing authority
5. Near miss – no injury, not reportable to enforcing authority if it does not fall under categories 1, 2 and 4
The above-mentioned categories link to accident reporting, which will be addressed later in this chapter. As you will notice from the above categories, not all accidents result in injury. However, today’s accident, if it recurs, has the potential to cause injury tomorrow if not addressed.
Accidents do not just happen. There are underlying causative factors that bring about the situation in the first place. It may not be possible to prevent all accidents but if we have a general understanding of what can cause them to happen we are better equipped to implement accident prevention measures. Accidents are usually caused by the following four factors.
- Human – people behave unsafely or forget to do something; unsafe acts or omissions.
- Occupational – relating to dentistry; for example, we are exposed to harmful substances, we use hazardous equipment and some activities are potentially risky.
- Environmental – workplace conditions could pose a risk, for example, extremes of temperature or poor housekeeping.
- Organisational – health and safety is not managed effectively or efficiently.
Accidents do not usually happen as a result of one factor. They occur as a result of a chain of events. This chain of events is illustrated in the following list of possible causes of accidents that take the above four factors to the next level of understanding.
- Management control – management systems, policies and procedures are inappropriate or out of date, or delegation is ineffective.
- Health and safety culture – the organisation permits risk taking; there is a lack of health and safety training or no system of communicating information.
- Unsafe acts/unsafe conditions – unsafe equipment or substances, unsafe systems of work which create unsafe working practices.
- Accidents – that go unrecognised or unreported and are therefore not investigated.
- Injuries – resulting in various types of injuries from minor to severe.
As you can see from the above illustration there is a chain of events that has a knock-on effect resulting in an accident. The causative factors have the potential to result in a range of accident types from the most severe which result in death or major injury to the less severe which result in minor injury or no injury. It is usually the less severe that go unreported. However, these can provide valuable information in accident prevention as they help to reduce the risk of something more serious occurring.
All chapters within this manual are aimed at preventing accidents and include the physical workplace, work equipment, hazardous substances, management systems and working practices. The list below specifically addresses the causative factors mentioned earlier.
- Management control – appropriately designed health and safety policy which reflects the needs of the organisation clearly shows lines of responsibility and accountability and has adequate arrangements in place. Policy is consulted on and communicated, reviewed at planned intervals and revised as necessary.
- Health and safety culture – everyone is committed to making the policy work, capabilities are assessed and training needs identified and there exists an open communication process where people speak freely about concerns and comments.
- Unsafe acts/unsafe conditions – systems are in place which identify and assess hazardous situations, controls are implemented before something goes wrong and safe operating procedures exist for all at-risk activities.
- Accidents – all accidents are reported, recorded and investigated, including near misses.
- Injuries – the more severe injuries are reduced and appropriate first aid is provided based on an assessment of need.
Evidence shows that there are more near-miss accidents than those that result in major injury. In order to reduce the risk of the near misses moving up the scale to something more serious, it is important to report and record each and every accident that happens.
Accident reporting and recording is essential in order to meet organisational and legislative requirements. Specific reasons are as follows:
- Identify the underlying causes and implement preventive measures.
- Prevent a similar occurrence.
- Identify patterns and trends which could indicate a failure in the management systems.
- Demonstrate compliance with the policy for reporting and recording if there is a litigation claim.
- Comply with legal requirements for certain types of accidents (see section Reporting procedures).
- Reporting provides national statistics to enforcement agencies in order to issue guidance, revise legislation and target resources more effectively.
All organisations, regardless of the size, should have a responsible person for employees to report to if an accident occurs. This person will be named in Part 2 of the Health and Safety Policy. The named person will then record the particulars of the accident, ensuring that sufficient detail is obtained; Figure 1.1 provides an example of what is meant by sufficient detail. This form also complies with The Social Security (Claims and Payments) Amendment Regulations 2006 which requires employers, where 10 or more people are employed, to record all accidents at work. Alternatively, employers may choose to use the Accident Book B1510 obtained from HSE. The named person will then determine if there is a legal requirement to report to the enforcing authority under Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR).
Reporting Under RIDDOR
Any of the following arising out of, or in connection with, work activities must be reported to the Incident Contact Centre (ICC) or the local HSE. The reporting procedures vary according to the type of accident/incident; however, in all cases this should be done as soon as possible using Form F2508 for injuries or F2/>