Today’s correspondent poses a scenario and questions about doing CPR without a face mask. The scenario is:
… a child is unconscious not breathing, childcare educator attempts CPR without any PPE i.e. Face shield. Educator contracts communicable disease.
- Are there any consequences related to work cover?
- Is a faceshield required to be used under WHS?
The Australian and New Zealand Resuscitation Councils, In ANZCOR Guideline 5 – Breathing (January 2016) say (p. 4; references omitted):
No human studies have addressed the safety, effectiveness, or feasibility of using barrier devices to prevent person-to-rescuer contact during rescuer breathing. Nine clinical reports advocate the use of barrier devices to protect the rescuer from transmitted disease: three studies showed that barrier devices can decrease transmission of bacteria in controlled laboratory settings.
The risk of disease transmission is very low and need not deter rescue breathing without a barrier device. If available, rescuers should consider using a barrier device.
In ANZCOR Guideline 8 – Cardiopulmonary Resuscitation (CPR) (January 2016) they say (p. 3; references omitted):
The risk of disease transmission during training and actual CPR performance is very low. A systematic review found no reports of transmission of hepatitis B, hepatitis C, human immunodeficiency virus (HIV) or cytomegalovirus during either training or actual CPR when high-risk activities, such as intravenous cannulation were not performed. If available, the use of a barrier device during rescue breathing is reasonable. After resuscitating a person, the rescuer should reassess and reevaluate for resuscitation-related injuries
Work Health and Safety law (eg Work Health and Safety Act 2011 (NSW) s 19) requires a person conducting a business or undertaking to:
… ensure, so far as is reasonably practicable, the health and safety of:
(a) workers engaged, or caused to be engaged by the person, and
(b) workers whose activities in carrying out work are influenced or directed by the person,
while the workers are at work in the business or undertaking.
In determining what is ‘reasonably practicable’ regard must be had to (s 18):
(a) the likelihood of the hazard or the risk concerned occurring, and
(b) the degree of harm that might result from the hazard or the risk, and
(c) what the person concerned knows, or ought reasonably to know, about:
(i) the hazard or the risk, and
(ii) ways of eliminating or minimising the risk, and
(d) the availability and suitability of ways to eliminate or minimise the risk, and
(e) after assessing the extent of the risk and the available ways of eliminating or minimising the risk, the cost associated with available ways of eliminating or minimising the risk, including whether the cost is grossly disproportionate to the risk.
We can see that the risk of contracting a communicable disease has been determined to be ‘very low’. That is relevant under s 18(a). The consequences of contracting a communicable disease, the consequence if the very low risk occurs would be high. The use of a ‘barrier device during rescue breathing’ has been assessed as a ‘reasonable’ response to the risk and no doubt is not very expensive.
Amongst other things a PCBU has to provide relevant equipment including first aid equipment (Work Health And Safety Regulation 2017 (NSW) r 42) and training (Work Health and Safety Act 2011 (NSW) s 19(3)(f)). The Safe Work Australia Model Code of Practice: First aid in the workplace (July 2019) recommends that every work place first aid kit contains ‘Resuscitation face mask or face shield’
If a ‘childcare educator’ is expected to provide first aid to a child in their care that training would or should be at least a course in ‘Provide First Aid’ that would, from my experience, include some training in the need for hygiene and the use of barriers in performing CPR. With that training and the low risk it is then up to rescuers to decide if they are willing to perform mouth-to-mouth, mouth-to-nose or mouth-to-stoma resuscitation.
Let me then turn to the questions:
- Are there any consequences related to work cover [if a childcare educator attempts CPR without any PPE i.e. Face shield]?
Assuming that it is part of the person’s duties to care for the child (which seems axiomatic) then they contracted the disease at work and would be eligible for no-fault workers compensation. That is not an issue.
In terms of the criminal offence of a PCBU failing to provide measures to manage the risk to employees there could be an issue. As noted, there is a low risk of transmission, but the consequences may be dramatic and the cost of providing face shields is low. Equally people expected to do first aid should have some training and most first aid kits have a barrier for the purpose. If the PCBU has failed to ensure that people are trained so the rescuer can honestly say “I didn’t know of such risks or of such barriers” (eg the PCBU provides in house CPR rather than getting an RTO to provide a first aid course) or the PCBU fails to provide standard first aid kits so the rescuer doesn’t have the option of a barrier if he or she wanted to use one, then yes there could be an issue.
- Is a faceshield required to be used under WHS?
I think that would probably be too strong given the risks identified by ANZCOR and of course the risk to the patient if there is no effective CPR. I would think the strongest one could say is that faceshields should be made available to staff (eg in first aid kits) and staff should be trained in their use (as they should be trained in all first aid equipment). I think it would go too far to say that the use is mandatory such that the PCBU or the staff member commits an offence if they fail to use one.