How will you manage risks of staffing pressures, disruption and NHS strikes this winter?

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With a new strike planned by NHS ambulance staff on Monday 6 February, Chris Green, Health, Safety and Environment Partner at legal firm Keoghs LLP, gives advice to employers on managing accidents, injuries and risks given current pressures on NHS and emergency services as well as planned strikes.

The Government recently urged us all not to take part in “risky activities” while NHS ambulance services are subject to ongoing industrial action. But the current demand for ambulance services, and levels of general hospital admissions, means employers need to consider how far the NHS can respond to an incident, whether or not it is on a designated strike day.

So, knowing the usual help may not be at hand, how should we as employers adapt our response plans, and how far can we go in providing assistance while emergency help may be hours away?  

Chris Green, Health, Safety and Environment Partner at legal firm Keoghs LLP speaking at British Safety Council's annual conference.

Although our obligation as employers to provide first aid does not automatically require any provision to customers who are not our employees, the guidance from the Health and Safety Executive (HSE) recommends that businesses consider having first aid available more widely and to assess the ratios they would ideally like to have on hand.

Rail strikes, winter flu viruses, Covid and other transport disruption may mean staffing numbers are already reduced, sometimes with very little notice, which may make it more difficult to ensure first aiders are provided in normal ratios, if at all.

A good place to start are ambulance service websites, which publish how they categorise the most serious incidents to prioritise their response times. Trained first aiders in all workplaces might want to familiarise themselves with those categories to inform their own response to an incident and to determine how long they may have to administer first aid while awaiting the arrival of the emergency services.

In food, hospitality and leisure businesses for example, who clearly want to look after their customers, it is easy to imagine some employees having to attend to guests for longer and possibly giving more care and treatment than ideally they would normally provide.

Staff might try to move an injured guest or, knowing that an ambulance might not arrive, perhaps not even bother calling 999 for some of the less serious incidents. Some guests may already have existing breathing difficulties, or be suffering from one of the current bouts of respiratory infections, and in these instances, some businesses might decide to drive a guest directly to A&E rather than wait for paramedics to arrive.

Of course, it is the natural for any business to want to look after the customer, but employees in any sector are advised to call 999 and ask the call-handler some specific questions first about what they should and should not be doing with the patient. Specifically:

  1. Ask expressly if the patient should be moved.
  2. Check how long it is expected to be until an ambulance would arrive.
  3. Ask whether it is OK for the patient to be taken to A&E directly, rather than wait for an ambulance.

Employees should ensure that all actions taken are entirely in line with the advice given. Also, that the customers or staff being treated know that this is the advice given by the NHS experts and that the company first aiders cannot go behind anything that the 999 call handlers have told them.

By their very nature, some of the decisions first aiders have to make can be dynamic but in the event of a patient being injured or delays resulting from 999 being called or attending at this time, these days claimant lawyers and Environmental Health Officers might expect that all businesses have reviewed their risk assessments, considered the impact of the current industrial action and briefed out at least some form of brief documented procedures to staff about what to do and what not to do.

There is a possible chance that this may lead to a bit more risk aversion, even fear of trying to assist a customer or guest, or criticism for deciding not to take action. Everyone must try to avoid scenarios where customers do not get the treatment they need from anyone, whether basic first aid by the company or from the emergency services at this time.

In the food, hospitality and leisure sector, the irony may be that, because businesses in some areas are currently quieter due to the ongoing rail dispute, at least the likelihood of an incident arising in the first place may be somewhat reduced.


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