Lux in tenebris - Mines rescue and pre-hospital care

On the 23rd of March 1962, Sister Maud Waggett the resident nurse of Hapton Valley Colliery donned overalls and a helmet to make her way into the darkness after a terrible explosion. Displaying the utmost bravery and compassion the nurse provided aid and morphine to the injured, trapped and dying. ?

In recognition of the nurses actions a commendation for bravery from the Queen was issued along with a disciplinary notice from her employer for breaking the rules - it was illegal for women to work down a mine at this time!

With the advent of the industrial revolution people were being exposed to chemicals, processes, and machinery which profoundly affected their physical health and wellbeing.

As the societal cost of frequent injury and illnesses increased, pressure was applied for the protection of workers nationally and parliament started to legislate.

The focus soon shifted to the terrible working conditions and tragedies of the mining industry and in the 1840’s a Royal Commission was established to investigate.

Local doctors sympathetic to the struggles of miners would provide a level of care observing changes unique to other industries, such, musculoskeletal changes, lung conditions, sight issues.

There are many examples of doctors coming to the aid of miners during the aftermath of an incident, such as Doctor Blackburn and his assistant along with Doctor’s Smith senior and junior attended the injured at the Oaks Colliery pit head after the disaster in Barnsley 1866.

Forward thinking owners started to employ doctors and nurses to support the general health and wellbeing of their workers and voluntary organisations started to mobilise.

“The first St John Ambulance brigade unit was at Tibshelf and Clay Cross in 1873. Remedies taught were: camomile tea for stomach and headaches, sennapods for use as a laxative, marshmallow to apply to cuts at the coal face (to prevent blue marks) and lard with mustard for chest complaints”

Source: https://www.healeyhero.co.uk/rescue/individual/Bob_Bradley/Bk-2/Bk2-1873-P1.html

By 1902 the first formal mines rescue station was formed in Tankersley, near Barnsley and the advent of mining pre-hospital care started to become organised.

‘Brigadesmen’ were provided vital training in the first aid treatments of the day, including bandaging, splinting and medical air. Often these techniques were utilised in a 'snatch and grab' fashion whilst operating under breathing apparatus, such as the 'Proto' in irrespirable atmospheres.

When this first aid knowledge was mixed with the teams ‘pit sense’ on geology, environmental considerations, such as humidity and toxic gas it created a potent mix for a rescue team, which was seen as elite at that time.

As general knowledge increased among the workforce, most would realise the importance of clean breathable air, recognise symptoms of hypoxia and the absolute importance of stopping a bleed if one was occurring.?

Techniques were developed over time, but improvements came by learning lessons from the Great War with reciprocal knowledge shared between the industry and the military gas exposure, trauma and blast injuries.

A trickle of new ideas around splinting, bandaging, pain relief and CPR as seen in the image depicting the Nielsen technique, which involved almost vertical pressure being exerted onto the casualties back to force gases out of the lungs, note the use of medical air from an early reviver.

The biggest threat to underground workers in coal mines was Carbon Monoxide (Co) and the potential for asphyxiation and it was with the introduction of the General Regulations (Rescue) 1928, that it became a legal requirement for medical air to be available at the collieries and with the rescue teams.

"Cumulative effect Carbon Monoxide %vol:

0.02% exposure mild headache in two hours with exertion

0.1% exposure causes complete disablement in 45 minutes with exertion

1.0% exposure causes unconsciousness in 1 minute

1.0% would be 10,000ppm!!

Casualties of Co are described as having a cherry red complexion, with impaired judgement and obstructive unco-operative behaviour".

Source: St John Ambulance Mining Supplement 1965

The reviver proved useful as no reliable self rescuer was developed to protect against Carbon Monoxide until 1967 with the advent of MSA230, which offered around 11 hours protection against this toxic gas.

Prior to this the miner may have relied on an anchor chief at best, so the fitting of a reviver by the rescue team gave them a real chance by treating hypoxia and starting the process of removing Carbon Monixide (Co) and getting them out alive.

The teams would often utilise postural drainage to maintain an open airway before the advent of other medical devices to assist with this purpose.

We'll see that the miners were likely ahead of their time as the application of medical air in a controlled way was seen to be useful in other illnesses and trauma cases.

Sadly the mining industry had many opportunities to learn and refine its craft when it came to treatment below ground.

Training would become commonplace ensuring most miners had some degree of first aid training, with some officials qualified to administer morphine or pethidine, which was kept under lock and key.

What’s changed? Technology and techniques may alter, but the principle of being able to breath and maintain an open airway will always be a lifesaving intervention.

Like many industries we are more and more informed about the importance of recognising and controlling a catastrophic haemorrhage at all levels of pre-hospital care training and modern thinking is still feeding in.

Trauma Triad

When damage occurs to the body cells are potentially starved of oxygen as a result leading to symptoms of hypoxia, which can include:

·???????Breathing difficulty

·???????Confusion

·???????Blueness to skin

·???????Rapid heart rate

·???????Headache

·???????Rapid breathing

Without oxygen cells start to burn glucose in a process called anaerobic metabolism leading to the production of a byproduct called lactic acid (acidosis).

This has a negative effect on the proteins used to promote blood clotting making it difficult for the body to naturally control bleeding by forming clots – this is known as ‘Coagulopathy’.

The casualty is in a downward spiral as more damage occurs to tissue due to blood loss and an increased demand for oxygen, which the body cannot fulfil.

The body ‘shunts’ available oxygen rich blood to the vital organs, but by now the casualty is presenting in ‘shock’ and is gravely ill.

With the heart rate increasing demand, breathing increases and the body temperature will also start to drop due to:

·???????Expelled warm air when breathing

·???????Lost blood volume

·???????Environmental factors

The casualty is now wandering dangerously into hypothermia and further complications as cold acidic blood doesn’t clot well. The spiral continues as bleeding increases, ultimately leading to death without positive intervention.

Mines, confined spaces, off shore, wilderness there are many people who work in difficult to reach areas and people are often generous with their knowledge in forums and online - ultimately we can help buy valuable time.

Modern employee training for hazardous environments has evolved to include :

·???????Haemorrage control

·???????Airway management

·???????Chest injury

·???????Basic observations

·???????Splinting

·???????Maintaining body temperature

·???????Monitoring oxygen

·???????Pain relief

Additional self and team rescue is not uncommon to include work at height rescue from high angle areas, such as wind turbines and an expectation that the employer can recover an employee from the confined space they deployed them to in an emergency.

There is a general duty under the Health and Safety at Work Act 1974 to provide a healthy and safe working environment, which is quite a broad brush statement.

The Management of Health and Safety at Work Regulations 1999, Reg 8, 1(a) provides additional detail 'Every employer shall establish and where necessary give effect to appropriate procedures to be followed in the event of serious and imminent danger'.

The Health and Safety (First Aid) Regulations 1981, installs a legal duty for an employer to provide adequate and appropriate equipment, facilities, and personnel to ensure their employees receive immediate attention if they are injured or taken ill at work.

How do you know what equipment, facilities, and personnel you need?

It’s all based on a needs assessment of the hazards and risks you expose your employees to. For example, if you operate under the Confined Space Regulations 1997:

Regulation 5, Emergency arrangements Summary:

“No one should enter or work in a confined space unless there are emergency arrangements in place that are appropriate for the level of risk involved. These should include making provision for extracting workers from the confined space and making provision for first aid equipment (including resuscitation equipment) where the need can be foreseen”.

If you have identified Asphyxiation during your risk assessment process, which is one of the five specified risks, does this mean ‘the risk has been foreseen?’ I would humbly suggest yes.

With the advent of technology, such as AI, drones and robotics maybe some of these conversations like the coal industry may be consigned to the past, but until then..... ww.hse.gov.uk