Beyond Injury Prevention

That’s glaringly true in the case of electrical injuries, especially those involving contact with energized electric conductors or circuit parts that can deliver lethal shock or serious burns. Incidents like those demand strict adherence to a response protocol that both ensures timely aid to victims and protects potentially vulnerable responders from a similar fate. That dual mandate, though — attending to the injured and avoiding injuries to others — is complicated by the often unseen and unknown danger that lurks in electric power.

Indeed, electrical injury incidents have tricky dimensions that put a high premium on the ability of individual employees to both act quickly and follow procedures. Life and death outcomes can hang in the balance to the degree that workplaces are able to ensure responses to electrical injuries are swift, safe, and smart. Prevention, however, continues to get the lion’s share of attention in electrical safety circles — and for good reason. Years of painstaking work to make electrical workers aware of dangers, enforce strict limits on the practice of working on energized circuits, and develop detailed procedures for working safely have produced results.

“There was a time that we were having, on average, one fatality a day in industry from electrical shock, and that was partly the result of too many people taking shortcuts in their work,” says Dennis Neitzel, director emeritus at AVO Training Institute, a Dallas-based electrical training company. “Those numbers are down dramatically over the last decade, to just over 100 a year now.”

Ritually following guidelines developed by OSHA and those incorporated into NFPA 70E, Standard for Electrical Safety in the Workplace, more electrical workers have cut the risk of coming into contact with potentially lethal voltage. That progress can obscure the need to also pay attention to injury response, but it can be hard to argue with a “prevention-first” stance.

“Emergency response [to an injury] should never have to happen because so much time is spent on emphasizing the need to work safely,” says Neitzel, who sits on the committee charged with keeping NFPA 70E current. “There was a time when most of the industry never heard of 70E. Now, when I hold up a copy, 95% say they’re familiar with it. So we’re continuing to gain dramatically on the education front.”

Fine-tuning response

Yet effective injury incident response may be drawing more attention. However, much death and serious injury from contact with dangerous levels of voltage have been reduced, the potential for workers coming into contact with it is ever present, and injuries remain all too commonplace. The conundrum is that electrical injuries are among the least likely to be sustained, but potentially the most lethal.

Given the nature of the hazard, it’s hard to argue with a zero-tolerance policy for electrical injuries. But an equally important aim may be ensuring that injuries get the response they demand; outcomes are strongly linked to the quality of response. Consensus workplace safety standards and electrical safety training programs have evolved to address that, and the process of refining, updating, and tweaking them continues.

In the 2015 Edition of NFPA 70E, for instance, a new wrinkle in the requirement for training potential responders in victim contact release — a tricky maneuver to dislodge a person who may be muscle-locked on to a conductor — was added. While earlier editions of the standard required that all employees exposed to shock hazards simply be trained in the procedure, the 2015 edition specified that refresher training be done annually.

The change reflected a growing recognition in the electrical safety community of the advisability of regular refresher training in all aspects of electrical injury response. The reason: the ability to effectively respond to them demands an almost automatic response. Knowing quickly what to do and how to do it is key.

Since everyone is a potential first responder in a workplace, all employees should be aware of the potential risk of approaching someone who’s suffered an electrical-related injury, says Hugh Hoagland, senior partner with e-Hazard.com, a Louisville, Ky., electrical safety training company.

“The first instinct is to reach out and help the victim, but sometimes that’s the worst thing you can do,” he says. “It’s important to assume that it’s a shock incident and to not attempt a rescue if you’re not trained in those. And if you are, use the proper method.”

Staying sharp

Initial training is rarely sufficient, however. Regular in-depth follow-up training involving procedure review or, even better, hands-on drills can help keep potential responders sharp.

“There are a lot of factors that go into determining how much training is needed and how often, but it’s probably safe to say that if you haven’t performed a procedure in a year or so, some retraining might be advisable,” Neitzel says.

In the case of victim contact release, the ability to swing into action and follow a set of procedures is especially critical. If not done correctly, precious time can be lost aiding the victim, and the risk of responders getting shocked by making physical contact with a downed worker is ever present.

While time is of the essence in electrical injury response, assessment is equally critical. In his work training fire and ambulance first responders, Al Havens, another e-Hazard.com partner, says he teaches the “three fives” concept to emphasize prudence: step 5 feet back, take 5 minutes to assess, and identify 5 possible hazards. That may not translate easily to workplace injury situations, but it illustrates the importance of evaluating a scene — a practice that can be honed with regular follow-up training.

NFPA 70E, however, doesn’t detail how the refresher training should be done or by whom, only that such persons “shall be trained in methods of safe release of victims from contact with exposed energized electrical conductors or circuit parts.”

The clearest part of the 70E contact release training guideline might be the provision for annual follow-up training, says Doug Tellin, a consultant and project manager with Electrical Safety Specialists LLC, Louisburg, Kan. While the training recommendation is clearly well-intentioned and essential, he says, it leaves a lot open to interpretation.

“One problem employers run into is that there is not a lot of information available on exactly how to train these employees,” he says.

Moreover, confusion persists about the best ways to deal with a contact release situation, and experience suggests many workplaces lack the knowledge and tools needed to perform the task, Tellin adds. For example, there’s widespread and mistaken belief that a simple 2×4 can be used to release a victim. “Imagine placing a 200-pound sand bag on the floor and trying to hit it away with a piece of wood.”

A Shepherd’s Hook tool remains the best option for safely moving victims. While more workplaces have added them, Tellin says, they’re too often in short supply due to cost, and frequently stored in main electrical rooms that aren’t always accessible; they’re often kept locked and can be far from where incidents occur.

“Electrical workers could be exposed to shock hazards in the production areas on a daily basis,” he says. “If a company can’t budget to place enough hooks throughout the facility, other ways to release victims from energized parts have to be considered.”

Those can include using non-conductive items such plastic trash cans, air hoses, leather belts, extension cords, rope, or sleeved shirts to move an immobile person away from voltage contact, he says. Such alternatives should be identified as part of any formal energized work plan.

A procedural playbook

While moving the victim away quickly and as safely as possible is key, locating the power source and cutting it is equally urgent. In most cases, that should even take priority, unless the nearest disconnect is too far away. In that event, moving the victim away should be the first response. Knowing the location of the nearest disconnect panel is essential and should be covered in training.

“Part of the energized work plan is knowing where the power is fed from,” he says. “In these cases, seconds count.”

Shutting off the power and clearing the victim is only the first of several steps in responding to voltage-contact incidents. Responders also must be able to initiate first aid because the victim’s life could be in imminent danger.

A series of steps should ensue, starting with alerting designated first responders trained in the delivery of qualified medical attention. Depending on the environment, that aid can arrive quickly from on-site personnel or more slowly from external responders. Consequently, serious situations involving ultrahigh-voltage shock or burns also call for those on the scene initially to render care, starting with a check of vital signs. Responders may even have to deliver CPR or use an automated external defibrillator (AED) to stabilize the victim.

Even in situations where apparent shock victims appear to be unhurt, follow-up medical attention is usually advised, says Randy Barnett, program manager with NTT Training, a Denver-based electrical safety training company.

“If someone seems to recover from a small initial shock the temptation is to say ‘you look fine and ready to go back to work,’” he says. “That’s not always the case.”

Whatever the prospective scenario, some level of initial training is mandatory for potential first responders, and they should receive regular refresher instruction to help ensure competency. NFPA 70E has long referenced the need for first aid training, but only for employees designated as responsible for responding to medical emergencies. They must not only know first aid, but also CPR. And in cases where AEDs are included in an employer’s emergency response plan, they must know how to use the device to shock the heart back into rhythm.

Expert guidance

In recent revisions, the 70E standard added language about refresher training for CPR and AED, requiring that it occur annually for those covered employees. That’s due to change, however, in the coming 2018 70E standard, says Neitzel. Assuming adoption, follow-up training going forward will occur on a timetable recommended by the body that certifies personnel, typically the American Red Cross for CPR and the American Heart Association for AEDs.

The change, Neitzel says, is a recognition that those organizations are better positioned to advise on training techniques and schedules. Additionally, employer rules on who should be certified vary, as does the extent to which AEDs are expected to be used. Therefore, they, in conjunction with certifying bodies, should make the call on refresher training frequency.

“Different industries take different views on how often follow-up training should be done, and whether that’s annual, semi-annual, or whatever should be up to them,” Neitzel says. “Our original intent was to ensure everyone’s training was current, and now it’s clear that people may read something different into that.”

NFPA 70E also does not explicitly mandate the presence of AEDs in work environments where electric shock may be a hazard. That partly stems from OSHA’s refusal to require them in workplaces because it’s unclear how different storage and maintenance practices can affect their operational reliability.

Still, the ability to administer CPR — and to a lesser degree AED — should be central to any workplace plan designed to reliably respond to electrical injury situations, Tellin argues. The more who are trained and capable, the better, but it’s especially important to qualify those who service, maintain, or otherwise regularly work around high-voltage equipment.

“Someone who works around energized parts is much more likely to have their heart interrupted due to electric shock,” he says. “We suggest everyone working around electrical hazards be trained because they’re more likely to be in the vicinity.”

That’s a safer approach, he says, than simply relying on a handful of designated first responders, such as security personnel or supervisors. Because their availability isn’t always assured, it’s ideal to prepare each electrical worker to deliver at least some level of aid quickly. And that entails regular refresher training — yearly at minimum, he says.

While every workplace injury response scenario is unique, and none can afford to be addressed casually, preparation for electrical injuries demands a high and unique level of vigilance on the part of employers. Avoidable as they’ve become, the specter of electrical injuries challenges organizations to invest in the development of comprehensive response plans that ensure damage is contained. As all electrical workers learn early on, electricity commands respect. So, too, do electrical injuries.

“The key is to teach people that electrical injury is different than any other type of accident,” says Barnett.        

Zind is a freelance writer based in Lees Summit, Mo. He can be reached at [email protected].

SIDEBAR: Injury Drills: Taking Electrical Injury Response to the Next Level

Drill, baby, drill… That’s the message of a paper presented at the 2017 IEEE IAS Electrical Safety Workshop earlier this year — one that makes a strong case for using drills to prepare for coming to the aid of workers who stumble into encounters with electric shock and arc flash.

The presentation, by engineers with DuPont Co., reviewed drills conducted at three industrial manufacturing plants. The results, while a mixed bag, suggested ample room for improvement in preparing to respond to electrical injuries. Yet they also appear to support the paper’s thesis: that electrical injury response demands expertise, and drills are invaluable in assessing readiness, formulating best practices, and keeping employees trained.

The review, “Electrical Injury Drills: Approaches, Learnings and Best Practices,” dissected the results of simulations performed at facilities where they had never before been staged. Each was a distinct drill type organized around a different hypothetical injury scenario — one a simplified “table-top” review; another a more detailed “functional” walk-through; the third a “full-scale” simulation.

In each, teams of prospective responders were tasked to demonstrate their readiness to come to the aid of an injured worker. They were observed and judged on whether their responses were appropriate and timely, delivering aid to the fallen worker while also protecting responders from injury. By extension, the facility’s overall emergency response plan and resources were also under the microscope.

While the paper did not issue a definitive verdict on performance, it portrayed facilities as having a fair amount of work to do to better train and prepare responders, establish formal procedures, and provide the needed emergency response resources and infrastructure.

The drills exposed the good and the bad. While numerous examples of laudable and correct actions were cited, significant missteps and gaps that could have further endangered both victims and responders were flagged. The review noted deficiencies in a range of key areas, from slow response times, lack of coordination and communications breakdowns to insufficient CPR training, a shortage of readily accessible rescue hooks and disregarding potential secondary shock risks.

But the paper’s overarching message is that electrical injury drills are worthwhile. Done correctly — carefully scripted and given a thorough post-mortem — they shine a light on problem areas that can be addressed to ensure that downed workers are attended to quickly and that responders can render aid effectively and safely. At each site profiled, the drills resulted in changes designed to improve response.

In their conclusion, the engineers forcefully recommend drills because they help workplaces prepare for “low-frequency/high-consequence” events that require prompt and effective response.

“Regularly performing electrical injury drills is a good way to combat complacency and reinforce proper emergency response to electrical injuries,” reads the paper’s conclusion. “Careful planning, execution, documentation, and follow-up to these drills will help establish a fruitful learning experience for all involved.”

Such drills are probably not common in workplaces, but they certainly should be, says Randy Barnett, program manager with NTT Training, a Denver-based electrical safety training company.

“Getting everyone coordinated and letting the adrenaline start pumping creates the sense of urgency that you can’t get in a classroom setting,” he says.

Ruben Bera, director of safety for Commonwealth Electric Company of the Midwest, Lincoln, Neb., says he’s not seeing evidence of more workplace drills, as such, but does sense growing recognition of the need to put meat on the bones of emergency response plans.

“A method-of-procedure approach to work, or a job-hazard analysis, often brings in the safety department of companies, and an outline of how to respond to injuries is developed,” he says.