4.6. Planning for access to additional care

The need for a referral of the victim to more advanced or specialized medical care must always be foreseen. The employer should have plans for such a referral, so that when the case arises everybody involved will know exactly what to do. However, it is not sufficient merely to prepare a plan. The plan must be updated and all persons concerned must know and understand the plan and how to implement it.

The first question to be considered in the preparation of the plan relates to the possible need for referral. This can be derived from (i) the assessment by the employer of the potential risks at work and the type and severity of the injuries which might be incurred, and (ii) the capacity of the first-aid system devised on the basis of this assessment. Once the possible needs for referral are established, the relevant medical facilities must be identified and located, and their specific capacity and assigned roles recorded in the plan.

In some cases the plan will be rather simple, but in others it may be elaborate, especially where unusual or special risks are involved at work and when accidents with complex or serious implications cannot be ruled out. In the construction industry, for instance, referral may be required after serious falls or crushings, and the end-point of referral will most probably be a general hospital, with adequate orthopaedic or surgical facilities. In the case of a chemical works, the end-point of referral will be a poison centre or a hospital with adequate facilities for the treatment of poisoning. No uniform pattern will exist. Each referral plan will be tailored to the needs of the enterprise under consideration, especially if higher, specific or unusual risks are involved. This referral plan is an important part of the emergency plan of the enterprise.

The referral plan must be supported by a system of communication and means for transporting casualties. In some cases, this may involve communication and transport systems organized by the enterprise itself, especially in the case of larger or more complex enterprises. In smaller enterprises, transport of the victim may need to rely on outside capacity such as public transport systems, public ambulance services, taxis, and so on. Careful planning is indispensable, and stand-by or alternative systems should be set up in case public facilities do not always function for one reason or another. Employers must foresee such possibilities in their own emergency planning. For instance, if there is a likelihood that public telephones will not work at the time they are needed, they must have other means of alerting the relevant medical facility. To avoid delays in communication and transport of casualties, the plan should list and exhibit all relevant addresses, names, telephone numbers and optimal routes of transportation.

The plan established to meet emergency conditions must be communicated to all concerned, including first-aiders, safety officers, occupational health services, the health service facilities to which victims may be referred, and all other institutions which may be involved, including those that play a role in communications and the transport of casualties (e.g. telephone services, ambulance services, taxi companies, etc.). The plan must be communicated and explained further to all workers as part of their overall briefing on health and safety, and first aid. It is not enough simply to post it in strategic locations (although this should always be done). Communicating the plan to all concerned must be made through individual briefings, and even these must be repeated from time to time.