Page 60 - Occupational Health & Safety, April 2017

HEALTH CARE
understand the form.
The proper documentation of refusal
for medical care is no less important at facilities that don’t have a Medical Depart- ment. All supervisors in addition to the safety manager should be trained in what to do and what to document in these events. Let’s go back to Emily, our third shift press operator. Although there are no quali- fied or licensed health care professionals in your operation, a layman can generally determine when an employee is acutely ill or injured. In essence, our Emily probably looks very sick, possibly to the point of be- ing “death warmed over.” Most likely she is ashen, gasping for air with sweat pour- ing down her, and only able to speak two or three words at a time without stopping for air. The company still needs to have a Refusal of Medical Care form in the su- pervisor’s toolbox for situations like this, although by her presentation she may be unable and unwilling to sign a form. Prop- er documentation is still needed to protect the supervisor and the company from a wrongful death lawsuit. Emily’s supervi- sor needs to complete a detailed incident report, including similar information that the Medical Department collected on Paul, including:
■ Date and time of the incident
■ Nature of the incident
■ Observation and findings of injury
or illness
■ Patient’s level of consciousness
■ Documentation of the patient’s re-
fusal
■ Documentation of the Supervisor or
Safety Manager’s efforts to inform the em- ployee of the dangers of refusing care
■ Witness statements and signatures
■ Employee’s signature on an ap- proved Refusal of Medical Care Against Medical Advice form
The supervisor should document in clear, concise, and easy-to-understand terms, painting a word picture of the event. Unless the supervisor is medically trained, he or she should refrain from using medi- cal terms and try to document in a layman’s manner the event, his or her observations, and the course of action taken
What Else Can We Do
to Protect Ourselves?
In Paul’s case, little more can be done be- yond the documentation. A determina-
tion of workers’ compensation benefits will most likely include the documentation your Medical Department made. In citing Emily as our model, an additional step can be taken when an employee is acutely ill or injured and may die or have serious long- term effects from the illness or injury. In Emily’s case, the supervisor should still ac- tivate the 911 system, even if Emily objects.
Paramedics, fire rescue, and first re- sponders across the United States operate under printed Standard Operating Proce- dures (SOP) enacted by their governing Medical Control Authority (MCA). Among these SOPs is included an SOP regarding refusal of medical care. These highly trained emergency medical service (EMS) per- sonnel deal daily with persons who refuse treatment or transportation to the hospital. By following their SOP, they can provide a level of protection from liability in an orga- nization without a Medical Department by simply documenting that your supervisor did everything humanely possible for Em- ily, up to and including calling EMS. If Em- ily refuses medical care or transportation at this level, your supervisor should document in the incident report that he or she called EMS, what time they arrived, and that Em- ily refused their services.
The EMS personnel, on arrival, will talk with Emily and most likely provide her with an assessment of her condition. In addition, the EMS personnel are in two- way communication with an emergency center physician at their base hospital who can talk to Emily over the cell phone or ra- dio speaker and give a medical opinion of her condition and why she needs to go to the hospital. In many cases, the employee relents in the presence of EMS and agrees to transport. In the event that Emily con- tinues to refuse, your supervisor has docu- mented that everything possible was done for Emily by your company and the EMS crew follows their SOP for documentation of refusal.
But isn’t this buck passing? Although at first glance this may appear as an abuse of the EMS system, almost every emergency health care provider will graciously re- spond to your call. Professional paramedics and fire rescue personnel understand that your supervisors are not qualified health care personnel. They also understand that not everyone wants to go to the hospital or be transported by ambulance. This is
a daily occurrence for them, and they are highly skilled in informed medical refusal and will do their best to convince an em- ployee to seek treatment after your efforts have failed. Moreover, this is a part of the duty they are sworn to perform, and they will do everything to help your ill or in- jured employee. Exhaust every resource at your disposal, but don’t be afraid to use the trained medical professionals who still make house calls.
Summary
Whether your operation is large, medium, or small, it needs to have an SOP regard- ing employee refusal of medical care. Ac- cidents, illnesses, and injuries are often unpredictable, and planning ahead for re- fusal of care is just as important as planning ahead for any other incident that may oc- cur at your operation. Medical, Safety, and Legal should meet to draw up an SOP and a standardized Refusal of Medical Care form that is readily accessible to supervisors in operations without a Medical Department. The plant medical director should regularly review the plant’s SOP regarding refusal of care and hold updates with Safety and Legal as needed.
Remember that all life-threatening emergencies require 911. Strive for consis- tency to avoid confusion when emergencies occur. Debrief and analyze how an emer- gency was handled and whether the appro- priate methods for handling refusal of care were used. Refine your plan as needed and clarify any confusing points or issues. Work with the outside providers—the fire chief, the ambulance company’s operations man- ager, the Medical Control Authority, and your local emergency department—and re- vise your plan again if needed. And always keep those in your company who need to be informed up to date on your operations. You may find yourself lowering your liabil- ity risks and overall improving the health and safety of your workforce.
James Dziendziel, RN, COHN, EMT-P (Ret), CSMP, CESCO, RWCS, is a Board Certified Occupational Health Nurse and retired paramedic with more than 33 years of related experience. He is a Board Certi- fied Safety Management Practitioner and a Board Certified Environmental Safety and Compliance Officer, and also a Behav- ior Based Safety Specialist and a Registered
54 Occupational Health & Safety | APRIL 2017
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