A co-worker summons you to the shop floor. The first trained person on the scene, you find a man lying on the floor, bleeding from the mouth and face. Vomit and blood are visible all around him. "He hit his head on the press when he fell" a bystander says. He does not appear to be breathing. How would you respond?

When I presented this scenario at a recent Red Cross first aid course, more than half the participants admitted they would hesitate to respond to this scenario. The most common response was "What if I catch something?" A solid understanding of how diseases are transmitted, and how proper procedures and equipment will protect against them, can counter this fear among first aid responders.

How Diseases Spread

The disease process begins when a pathogen (germ) enters the body. There are a number of different pathogens, but the most common are bacteria and viruses. The human body is normally well protected against these pathogens. However, sometimes our skin is damaged, or a pathogen finds another way into the body-through the mouth, lungs, or sexual organs for example. Diseases that can be passed from one person to another are commonly called infectious diseases. Diseases spread when a pathogen is transmitted from an infected carrier to another uninfected person through air, water, food, insects, bodily fluids or human contact.

Disease transmission is like a puzzle. In order for a disease to be passed from one person to another, four conditions - representing four different pieces of a puzzle - must be in place:

1. A pathogen must be present
2. There must be enough of the pathogen present to cause disease
3. A person must be susceptible to the pathogen
4. The pathogen must enter the person's body

If any one of these conditions is missing, an infection cannot occur. That means, assuming the first three conditions are met, the pathogen must still enter the uninfected person's body in order to cause disease. It could potentially do this in one of four ways: direct contact, indirect contact, airborne or vector-borne.

Diseases of Concern

Different diseases cause concern in different regions around the world. Here in Canada, only five are of any real concern to Canadian first aiders. They are Herpes, Meningitis, Tuberculosis, Hepatitis and HIV/Aids. (Contact local health authorities to identify any other diseases of particular concern in your region.)

Guidelines for First Aiders

For most first aiders, the risk of disease transmission is already low. By following these simple precautions, however, they can usually eliminate at least one of the four conditions necessary for disease transmission to occur, reducing the risk even further.

• Always wear disposable rubber or latex gloves.
• Remove gloves by turning them inside out, beginning at the wrist and peeling them off.
• Dispose of used gloves immediately.
• Avoid handling personal items such as pens and combs while wearing soiled gloves.
• Change gloves every time you come into contact with a different casualty.
• Avoid direct mouth-to-mouth contact for resuscitation. Use a pocket mask or shield.
• Wash your hands with soap and hot water immediately after providing first aid.
• Remove and wash any soiled clothing immediately.
• Get immunized against childhood and other common diseases as recommended.

Guidelines for Employers

Employers can help ensure the safety of first aiders by providing two of the most effective weapons against disease transmission: protective equipment and education. Protective equipment includes all equipment and supplies that protect the user from direct contact with infected body fluids or other materials. This includes, but is not restricted to, disposable gloves, face masks or shields, and resuscitation devices. Education includes those initiatives that will help workers assess the risks in a given situation, to use protective equipment appropriately, and to alleviate their fear of responding.

First Aid Follow-up: Equipment Cleaning and Disinfecting

Because some diseases are easily transmitted through indirect contact, it is important that any equipment and work surfaces which may have come into contact with blood or other body fluids are properly cleaned and disinfected following a first aid response. This can be done by following these procedures:

• Clean up spills and disinfect soiled equipment as quickly as possible.
• Wear gloves and other protective clothing while cleaning and disinfecting.
• Sop up any liquids with paper towels or other absorbent materials. Then...
• Scrub soiled equipment and work surfaces vigorously with hot water and soap. Rinse.
• Soak washed and rinsed equipment for at least 10 minutes in bleach and water solution.
• Flood washed and rinsed work surfaces and floors with bleach solution and let stand for 10 minutes. Clean up with paper towels or other absorbent materials.
• Place all disposable items - used gloves, cleaning supplies etc. - in leakproof, puncture-proof containers and label clearly as hazardous material. Dispose of immediately.

If an Exposure Occurs

If you suspect that you may have been exposed to an infectious disease and no protocol exists in your workpiace, follow these steps:

• Wash the affected area immediately and write down what happened.
• Notify your supervisor immediately.
• Request that the material you were exposed to be tested immediately to determine if it was in fact infected.
• Get a physical examination as soon as possible, including appropriate tests for infectious diseases, post exposure counselling and possibly vaccinations.
• Have your supervisor or medical personnel notify any other employees who may have been exposed.

In Closing

While it is safest for a first aider to assume that all blood and body fluids from all casualties are potentially infected, and, therefore, pose a risk of disease transmission, everyone who responds an emergency situation must be guided by his or her own moral and ethical values and knowledge of the risks involved. Education, training, and some old-fashioned common sense will help first aiders to assess the risk and make the best decisions possible.

I recently presented the same scenario I described at the beginning of this article during a subsequent Red Cross first aid course. This time, however, I also gave them this article to read. After some discussion, everyone in the room said without hesitation: "Yes, I want to help. I would provide first aid". How would you respond?

*Alice d'Anjou is an instructor trainer for the Canadian Red Cross based in Ottawa.
*Reproduced by kind permission of the Canadian Red Cross.

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