How many are waiting to happen in your workplace?

Industrial Safety & Hygiene News workers weighed down by increasing job pressures are potential health time bombs. You can save a life if you plan ahead.

By Shahla Siddiqi, <%=company%>

Heart attacks, like injuries and accidents can stop you dead in your tracks anywhere, anytime, even at work.

When Skip, an employee at the Aurora Packing Company in North Aurora, Ill. walked out of the plant into the parking lot after work, he didn't know that he would never make it to his car that evening. He dropped in his tracks, struck down by a heart attack. The odds of coping with a heart attack in your workplace are rising given today's aging workforce plus the added burden of job-related stress and strain.

"Half of the heart attacks take place at work and many of these occur in the early hours of the morning between 6 and 10 a.m.," says Dr. Raymond Bahr, medical director of the Paul Dudley White Coronary System, St. Agnes Hospital, Baltimore Md. "It's an accident ready to happen and it will either take the worker out completely or it will take him out for at least three months."

Skip was fortunate that Mike Fagel, Aurora Packing's safety director, is a trained emergency medical technician. "The doctor said he would not have survived had we not been trained and had a nurse and ambulance on standby," Fagel says. "With 10,000 ambulance calls under my belt, I carry my emergency gear around like I wear my shoes and socks - a belt torch, a two-way radio, a pager, a CPR mask and gloves."

Heart attacks remain the number one killer of both adult men and women in the U.S. because most people are not as prepared as Mike Fagel, say medical and health professionals. Americans suffer 4,100 heart attacks every day and 600,000 annually, reports Early Heart Attack Care, a clinical information Web site maintained by St. Agnes Hospital in Baltimore, Md. And about 250,000 people per year die within one hour of the onset of symptoms and before they reach a hospital, says the American Heart Association.

That's why being able to identify the symptoms and having an appropriate emergency response plan are crucial to saving a co-worker's life.

Aging and stress

This is particularly true given trends in the workplace. In 1996, the median age of the American worker was 38.2 years, according to the Bureau of Labor Statistics. In 2006, it is expected to rise to 40.6 years. Last year, the percentage of total workers over age 45 was 33.6. In 2006, it is projected to rise to 39 percent.

Add increased work pressures to the aging workforce and you can have potential health time bombs on the job. A study appearing in the November-December 1998 issue of Psychosomatic Medicine showed job-related pressure as a risk factor in developing hypertension, a key contributor to a heart attack. The study, which looked at men working in both skilled and unskilled jobs, says that men with high-strain jobs had significantly high blood pressure readings both at work and at home.

Among fire fighters, heart attacks continue to be the leading cause of on-duty fatalities, according to the National Fire Protection Association. From 1984 through 1993, almost 50 percent of fire fighter fatalities were the result of heart attacks and most of these were due to overexertion or strain, according to the NFPA.

Most fire fighters are volunteers in their late '50s and '60s, and a large number of those have been previously diagnosed with some kind of heart ailments and are more susceptible, says Gary Tokle, assistant vice president of NFPA's Public Fire Protection Division.

The 'golden hour'

"As you age, you develop atherosclerosis - the hardening of the blood vessels," says Dr. Bahr. That makes you vulnerable. Heart attacks remain the number one killer because we've allowed it to be number one, he emphasizes. "We wait till the symptoms become severe before coming to the emergency room."

"Timing is critical," agrees Dr. Syed A. Subzposh, of the Heart Care Group, P.C. in Allentown, Pa. "If you can get the patient into the ER and treated within that first 70 to 80 minutes, the prognosis is excellent - 2 percent mortality rate - versus 20 percent for the rest."

"The importance of that first hour cannot be over-emphasized," say Julie John Zerwic and Marilyn A. Prasun, in their article, "Acute Myocardial Infarction in the Workplace," published in the April 1998 issue of the Journal of American Association of Occupational Health Nurses.

What you can do

Since the major portion of those first crucial minutes is taken up in interpreting symptoms and making the decision to seek the appropriate treatment, the workplace health and safety people play a pivotal role in assessing and managing the situation.

According to Zerwic and Prasun, when confronted with an employee who complains of chest pains, the questions you need to ask are:

• Where do you feel the pain? (location)
• What does it feel like? (quality)
• How long does it last? (duration)
• When did it begin? (chronology)
• What were you doing when it started? (aggravating/alleviating factors)
• Are there any other symptoms? (associated findings)
• Have you tried anything and has it helped? (treatment sought and effect)

Getting this information helps make an informed decision. It also helps medical personnel once the victim enters the emergency medical system.

In fact, the role of the first responder is now seen to be so important that the American Red Cross is partnering with the <%=company%> to conduct training on how to use automated external defibrillators, or AEDs. At a cost of approximately $3,000, these easy-to-use portable machines can "really turn the patient around," says Barbara Caracci, master trainer for NSC's First Aid Institute. AEDs deliver an electric shock that jumpstarts the heart's coordinated regular rhythm. "One per workplace is not too much to ask," Caracci says.

What you must not do:

Experts urge first responders and others who may be involved not to:

• Wait till the next day before seeking medical attention;
• Have the individual driven to the hospital by a co-worker or spouse;
• Go to the ER and wait in line to be seen;
• Call his or her family doctor;
• Make an appointment with the family doctor for a couple of days later;
• Ignore the pain.
• Be prepared

Have a game plan. Call 911 immediately and get an ambulance. But in the meantime, experts offer this advice:

1. .Have an employee ready to meet the emergency medical team at the entrance and guide them to your location

2. .Maintain an open airway and administer oxygen

3. .Monitor vital signs

4. .Get a history, if possible

5. .Loosen tight clothing

6. .Do not leave the individual unattended and do not allow him or her to drive

7. .Be prepared to do CPR

8. .Contact family members and inform them of the hospital location where the individual has been transported

From the trenches

Here's how Industrial Safety & Hygiene News readers plan for heart attacks - and try to prevent them:

• "In all our facilities we are required to have a trained and Red Cross-certified (or equivalent) on-site person, usually a supervisor, available at all times while the facility is in operation. This has provided an extra sense of security for all our employees.
• In addition, all our paper mills have wellness programs offering full blood screenings, cholesterol and liver function check, etc. Our Wellness Committees - 18 in all - have discovered life threatening diseases in early stages.
• I have experienced situations where heart attacks have occurred, and others that were prevented by quick recognition and referral to a clinic or hospital." - Steve Hess, assistant human resource manager, Smurfit Stone Container Corporation, Missoula, Mont.

"We conduct medical education training for our Emergency Medical Response Team members. We've purchased two AEDs and have trained them on it.

In addition, I do one-on-one counseling with employees where I use educational materials on heart attack symptoms, cardiac risk factors, blood pressure, nutrition, cholesterol and exercise.

Magnetic refrigerator posters with the signs and symptoms of a heart attack and stroke are posted on all cabinets throughout the plant." - Elaine Wolfe, occupational health nurse, Texas Petrochemical Corporation, Houston, Texas.

"We offer BCLS (basic cardiac life support) and first aid classes. In addition, during the lunch hour employees can attend health promotion and disease prevention classes free of charge.

Every employee receives an individual risk assessment and counseling at his or her annual physical examination along with follow-up assessments and counseling, as needed.

"A free on-site fitness center is staffed and open 6 a.m. to 7 p.m. daily. Employee-based First Responder Team Members are located strategically throughout the worksite and identified by first aid signs in their work areas. Normally, they are introduced during department and safety meetings." - Debbie Donau, occupational health nurse supervisor, at a pharmaceutical research and development company, on the east coast,(Donau declined to mention her company's name).