Most arborists are aware of the Z133 American National Standard for Arboricultural Operations – Safety Requirements. This standard is our road map for safely navigating through the numerous hazards associated with arboricultural operations. It is a living standard, one that is periodically reviewed and updated as our gear evolves and our knowledge of the work and risks expands.

The current Z133 was published in 2017. The next revision is out for review now. Once the review process is completed, the new revision will be published. The Z133 revisions come out about every six years.
The Z133 standard is not our only guide. Knowledge and skills in first aid are also an essential part of arboriculture.

Per the Z133, every field crew of two or more workers shall – with “shall” meaning it is mandatory – have two workers trained in first aid/CPR. An exception is allowed for only one trained worker on site if the company trains all workers in first aid/CPR within three months of hire.

We follow the Z to reduce the risk of an incident. We follow first aid/CPR to improve the outcome of an incident.

First-aid/CPR requirement revisions

Like the Z133, first-aid/CPR requirements also are periodically reviewed and revised. The first-aid/CPR revisions are on a five-year cycle. There are similarities between the two review processes. Both review new technologies and changes in scientific knowledge to help guide their reviews and updating. They both often begin an adaptation of a tool or technique by recommending it in one revision, then moving it to a requirement in a later revision.

The newest American Heart Association and American Red Cross guidelines for first aid have some changes that are of particular interest to arborists. Arborists who just completed their first-aid/CPR training should be aware of these changes. For all other arborists, here are some important updates for the first-aid skills we most frequently apply in the field.

Bleeding

The most common injury to arborists is laceration. A laceration is defined as a smooth or jagged open wound. Lacerations can be caused by chain-saw teeth, chipper knives, cut branches and a multitude of other objects. An open wound can result in hemorrhaging, the discharging of blood from a vessel.
Our lacerations can be long, jagged and deep, cutting through numerous vessels, including arteries. Arterial bleeding can be a serious first-aid emergency. Arteries are under higher pressure than veins, as the blood is being pushed out of the heart. This makes arterial bleeding slower to clot and harder to control.

The adult human body will not tolerate an acute blood loss greater than about 20% of the total blood volume. This 20% is about a liter of blood loss. Uncontrolled bleeding from chain-saw lacerations has resulted in a loss of more than two liters. Uncontrolled bleeding is the primary cause of death in about one-third of trauma incidents, and often occurs before emergency medical services arrive. All arborists need to know how to control bleeding.

First aid for deep lacerations

The first aid for deep lacerations to extremities – a chain-saw cut to the leg, for example – is to apply manual pressure with a dressing and use a tourniquet as soon as one is available. Tourniquets are now considered the initial treatment for life-threating extremity bleeding. These are manufactured tourniquets – the ones everyone should have in their first-aid kits and have been trained on in their application. Since a tourniquet is in the first-aid kit, hopefully it is applied within the first minute of the injury. Note for all climbers and lift operators – I carry my tourniquet with me when aloft.

If a tourniquet is not available, direct manual pressure should continue, along with a hemostatic dressing. Manual pressure and hemostatic dressing also are used for bleeding where tourniquets are not practical or appropriate – a laceration of the shoulder or neck, for example. Manual pressure applies more pressure than a pressure dressing, so pressing and holding the dressing on the wound with a hand or two fingers is still the key to controlling bleeding.

A hemostatic dressing has gauze impregnated with chemicals designed to promote rapid blood coagulation, and these should be used. An important note, however, is that hemostatic dressings are still adjuncts, additional treatment to manual pressure, not a replacement. An important reminder – application of a tourniquet means calling emergency medical service immediately.

Heat-related emergencies

Another emergency that saw an increase in incidents this year was hyperthermia, or heat stroke. The combination of extremely high temperatures and high humidity overwhelms the heat-regulating mechanisms of the human body. The body cannot rid itself of excess heat. The normal body temperature of 98.6 degrees Fahrenheit begins to climb. An increase from 100 F to 103 F can result in heat exhaustion.

Heat exhaustion

Heat exhaustion is a common heat-related disorder experienced in the field. It can develop over long days of working under hot and humid conditions, or quickly if overexerting during these weather conditions. Heat exhaustion may present with frontal headaches, nausea, lightheadedness and reduced urine output (also darker). Profuse sweating is common, along with pale and clammy skin.

Heat exhaustion and the more serious heat stroke are hard to distinguish in the field. An internal temperature that rises to 104 F or higher becomes heat stroke – a serious emergency. Too often the initial signs of a heat-related disorder are ignored. The worker quickly succumbs to heat stroke, only to die at the hospital.

A conservative approach is to consider heat stroke in workers who present with the symptoms mentioned earlier and their condition does not improve quickly (within an hour) after moving them to cooler air and having them sip cool drinks. If the skin becomes hot and dry or the worker is vomiting, assume heat stroke.

Heat stroke

Heat stroke requires a rapid cooling of the body to lower its temperature before organ failure or death occurs. Active cooling, in which the whole body (neck down) is immersed in cool to cold water (34 F to 79 F), is best. But arborists are not able to apply this treatment in the field.

Instead, move the worker to a cool environment, loosen clothing (it traps heat) and use cool packs on the side of the neck, in the groin area and under the armpits – locations where large blood vessels lie close to the skin. These actions will not cool as rapidly as whole-body immersion, so the first-aid/CPR update points to calling emergency medical services while initiating these treatments. Heat stroke requires medical attention. It needs to be managed by professionals.

Avulsed tooth

An avulsed tooth, a tooth dislodged from its socket, is an occasional injury associated with arboricultural operations. These injuries have occurred when climbers fall from trees or workers have been struck by falling branches. The first-aid treatment for this injury is not to fix the tooth on site but to get the tooth to a dental professional as soon as possible. This will increase the odds of a successful replantation.

Time is critical. If the tooth loses too many viable cells, the probability of successful replantation decreases. Most guides recommend getting the patient and tooth to a dental professional within 30 to 60 minutes of the injury.

The tooth should not be transported in water, even bottled water. The ideal is a salt solution designed to keep cells in a viable state, such as Hanks’ Balanced Salt Solution (HBSS). These are not likely to be carried by tree crews, though they can be added to a first-aid kit.

Wrapping the tooth in cling film can improve cell survival if a solution is not available. If cling film is not available, a small sterile container or bag containing saliva from the injured worker will work. Even cow’s milk can be an acceptable storage medium for a quick trip to the dental professional.

Conclusion

These are some of the trauma-related first-aid updates. One reason first-aid/CPR training needs to be repeated is so everyone is made aware of changes in treatments. A final reminder – first-aid/CPR cards do have a shelf life. The training must be repeated every two years.

John Ball, Ph.D., BCMA, CTSP, A-NREMT (Advanced-National Registry of Emergency Medical Technicians), is a professor of forestry at South Dakota State University.