Eye injuries can occur as the result of many causes, though foreign body is a particularly common mechanism. According to the Bureau of Labor Statistics, 25,290 eye injuries occurred on the job in the United States in 2013; a rate of 2.4 injuries for every 10,000 full-time workers.[1]
Routine use of recommended personal protective equipment (PPE) can protect an employee from a potentially career-ending and disabling injury. We reviewed common medical PPE in ‘dispatched for a sick teenager,’ but it is important to remember that EMS providers, particularly those who fulfill multiple roles (including firefighting and rescue) are exposed to more hazards than just bodily fluids and substances during the course of their job duties.
Federal requirements for PPE
The Occupational Safety and Health Administration (OSHA), a division of the U.S. Department of Labor, publishes a variety of rules related to workplace safety. These rules include the use of PPE based on the anticipated hazards in a given environment. Hazards such as flying debris, liquid chemicals and chemical vapors are assessed and recommendations for PPE are issued as a result. [2]
Additionally, the federal guidelines dictate that employers must provide required PPE free of charge to employees with the exception of steel-toe boots and prescription eyewear. In cases where employees must wear prescription glasses, the interpretation of the law is that the employer shall provide PPE which can be worn over the glasses. Employers must also ensure that employees are trained in the use of PPE, including when to use protective equipment, what equipment is appropriate in a given situation and how to properly don and doff the PPE. [3]
Personal protection standards
While OSHA dictates what PPE should be worn based on a given hazard in the environment, the specific physical qualities of that PPE are based on industry guidelines developed by the American National Standards Institute (ANSI). The ANSI standard evaluates minimums for impact, splash protection and dust, among others.[4] Safety equipment which meets the minimum standard will be marked accordingly. The most recent ANSI standard for eye and face protection is Z87.1-2010.
Foreign body removal from the eye
In order to determine the proper treatment for a patient with a foreign body in the eye, the extent of involvement must first be assessed. Visualize the globe of the eye for obvious trauma to develop a treatment plan. For patients suffering from specks of dust or other small irritants, simply rinsing the eye with sterile saline may be enough to flush the particles out. If a patient appears to have a foreign body embedded in the globe, however, you should refrain from flushing the eye and transport the patient to the nearest, appropriate facility for additional evaluation and treatment.
For exposure to chemical irritants, the eye should be flushed with copious amounts of water or saline. If the call occurs at an industrial location, there may be an eye wash station available for your use. The Morgan Lens is an excellent tool for eye irrigation for EMS providers that are authorized and trained in its use.
Treatment of the injured firefighter
After assessing Frank you note that there appear to be several small particles of plaster in his eye and no obvious signs of trauma, just redness and irritation. You instruct Frank to lie back on the stretcher and to keep from rubbing his eyes. With a fresh bottle of sterile saline you gently irrigate both eyes while instructing Frank to blink frequently. After several minutes of flushing, Frank reports that the sensation of “something” in his eye has passed. You confirm that the redness in his eyes is improving and Frank confirms that his vision is normal.
After reporting your findings and treatment to the on scene safety officer, you contact your medical control physician who states that Frank should follow up with the department’s occupational health provider before returning to active duty. Frank’s battalion chief says that he will drive Frank over for further evaluation. You also recommend that Frank, as well as the other firefighters, utilize safety glasses when performing overhaul.
References
1. Bureau Of Labor Statistics. (2014, December 16). Nonfatal occupational injuries and illnesses requiring days away from work, 2013.
2. Occupational Safety and Health Administration. (2009, September 9). Eye and face protection. Retrieved from Occupational Safety and Health Standards website.
3. Occupational Safety and Health Administration. (2011, June 8). General requirements. Retrieved from Occupational Safety and Health Standards website.
4. International Safety Equipment Association. (n.d.). American national standard for occupational and educational eye and face protection devices.
