Document mdaD67j7JkN9jX0EGzpr1Dz0

1 Industrial Nursing ill ; s-; WEDNESDAY AFTERNOON SESSION October 6,1943 i4 Presiding---lin. Christian Seabrook, R. N., Local Group Nursing Supervisor, Metropolitan Life Insurance Co., Chicago, and Chairman, Industrial Nursing Section, N.O.P.H.N. Becords--the "Seeing Bye" of Industrial Medidne ^ BY WILLIAM J. PULTON, MJ>. Medical Director, Eastern Aircraft Division, General Motors Corp., Baltimore, Md. . Starting point number, one--and the one case for every fifteen employees work point os which all to follow hinges--is ing win seek some form of service. the adequate manning of an industrial medical department to give prompt and efficient service, and to.maintain records that meet minimum standards. This second general rule (one case per fifteen persons per shift) leads to another conclusion; namely, that 41 times 15, or 615 employees, working on any one shift, We will briefly review the services of an industrial medical department, occlu sive of physical examinations or phys ician's ..time, and call them the' direct service items. . ^ ft . The tone required to attend to the wants of each, of these patients varies with different types of service, and each service calls for many timings In order to arrive at an over-all average. Analysis of ten thousand stop watch studies of all types of plant hospital service resulted in an average of 11.57 minutes. We feel con will produce sufficient direct service cases to keep one plant dispensary nurse or at tendant completely occupied. The number of cases per day produced by 615 em ployees will range from 32 to 50. Consider that this service is required only for the cases that come through your doors, and that we have left out physical examinations which, exclusive of phys ician's time, require from ten to seventeen minutes of hospital personnel time. Add this consideration >vto toe. foregoing, and we have a basis for calculating toe neces-sary hospital personnel to give adequate fident ft is applicable to the great majority service and produce records of the type of medium type industries, such as air that we are going to discuss. plane and automobile assembly plants. 11.57 minutes will go into an eight hour Cost of Under-Manned Staff day (480 minutes) a fraction over :41 times, which leads to toe 'conclusion that one nurse can take, care of the direct and indirect services to not more than 41 cases per day--if those sendees and records are to be of good quality. A startling amount of production time can be lost through toe inefficiency of an under-manned medical department, to say nothing of the costs and poor quality of service." Every penny's worth of bad medlcine that results from under-manning will Two other general rales may be bid be multiplied to a dollar's worth of bad dpwh; here; namely, first, that where personnel relations.. shiftsfare eight or more hours in duration, Finally, if industrial medidne is to get a cas$ seeking one of the items of direct out of the flat cost bracket and is to enter service just outlined will come through toe field , of practical applied prevention, youf doors for every 120 man hours it must be additionally manned. It is only worked; second, during any single shift, in toe range above personnel adequate to *\ ^ CrOf'd. ?{\e Hft `SSI su.Al \1| * m '.Jr) PLAINTIFF'S EXHIBIT I1 PLAINTIFF'S EXHIBIT I1 aflSS-oi: 96 V 32nd National Safety Congress, 1943 care for the direct service that industrial 2. The exact time and date of the management is justified in expecting re initial report by the patient turns on medical investments in reduction of accidents, occupational hazards, sick absenteeism and insurance premium, and an improvement in personnel relations and environmental hygiene. 3. Meticulous recording of the em ployee's statement m his own words and, preferably, in his presence. The reverse side holds the ' record of subsequent redressings or treatments. Foundation of 'Records Now let us start our industrial patients through the dispensary and lay the foun dation of our records. Here is a 3x5 form, carried in pads by the foreman. Emer gencies excepted, all must present it It is made in duplicate. An automatic time clock stamps the time of dispensary ar rival and departure. The duplicate is re turned by the patient to the foreman. On A few remarks sure in order here on the tendency to highlight the importance of potential legal defense in the malting of medical records. Ascertaining the true facts regarding injury or illness is more important medically than legally. Make good medical records and any need for legal application will be met automatic ally. Radnsaiac Stott this pass the foreman has noted the name, To facilitate the recording of redress clock number, time of the accident and ings in a busy dispensary, each staff mem indicated by an "X" the exact spot in the ber has a redressing sheet for each shift. plant where the injury occurred. The dis On it, they record the time, name, clock pensary personnel adds the following data. number, treatment and progress note, of In the upper left corner, the anatomy, each case handled. These are subse such as face, arm, eye; cornea, leg, etc., quently entered by the same staff member in the upper right corner, the type of in on the reverse side of the surgical card, jury, such as laceration, puncture wound, and.checked off on the redressing sheet burn, fracture, embedded foreign body, These sheets lend themselves; readily to etc., and, across the top, the date is summing up the total number of revisits stamped. These slips are sorted and filed at the end of the shift ' as to type of injury. . We call this the ' accident prevention file. It is kept up to This 3x5 card holds the record of each initial medical complaint: the diagnosis, date and at all times is at the disposal of the director of safety. The use of this treatment and the final disposition of the case: When the severity of the symptoms pass as an instrument of accident pre` vention. will be demonstrated later. warrants sending the patient home, a duplicate pass home for sickness is made Aside from safety, this pass has several out One copy is attached to this card other attributes worth mentioning. It pre and the other passes through the person vents waste of production, time by loiter nel department These , cards are filed ing. It partially, regulates the flow of alphabetically in a permanent yearly file. surgical redressings and minor complaints ; When an-employee is absent from work through the plant dispensary. dr late, the clodc card is replaced with a red "absent report" card. If the absence Stngical Card or lateness is due to any type of physical Here is the 5x8 surgical card, on which is recorded the complete history of any injury, from admission to discharge. This, and all similar forms have been whittled' by experience to a point that will satisfy maximum simplicity and practical ade condition, the employee must plus through the dispensary for a check-up before be ing; allowed to return to work. This is obviously a valuable safety and health protective measure. The dispensary staff indicates the ability or inability: to return to work on this card and returns it, along quacy. Three points should be stressed: with the employee, to the personnel de 1. The exact time and date of the oc partment. In order to keep-track of the currence of the accident or onset of number of these absentee .cases, a tally the complaint sheet for each shift is kept near the files. 98 32nd National Safety Congress, 1943 lost is recorded in calendar days and 4. The ground work for research in air working days. most any form- of occupational hazard is We are not going to discuss pre-em made available--research by gronps, ages, ployment and periodic physical examina occupations, eta tions in detail in this presentation. They . 5. Data' covering a cross-section of the should be mentioned, however, to com* population, for a long period of time, is -plete our individual record. The examina made available for all forms of industrial, tion form has been greatly simplified, and. local, and national statistical research. folds to a 5x8 size. All practical data de 6. The actual degree,of hazard to health rived from each examination, that is of and safety of any operation, process, occu value in proper placement, together with pation, material or group of materials can medical department ratings, eta, is for be accurately measured and compared. warded to the employment and personnel 7. The safety' factor relevant to any departments on the request for physical Operation analysis can be accurately com examination form. puted. These three records (physical examina 8. The relation (if any) between rich tion, index and absent) are kept together ness and accidents can be established... as one unit in a pocket The pockets are filed alphabetically in. trays. Rating and Comparing Records Value of Individual Records Our individual records are irow con-' Here should be stressed the importance of keeping medical records active and upto-date. To do this, it inessential that.the medical department receive routinely the .daily report of the employment depart densed into a simple, ^accessible unit. Be fore a fair and practical individual applica tion can be realized, some base line or standard for measure and comparison must be made. To establish our ^ase 'line for measuring and comparing, we ftivide the ment to management 'This type of report contains--new hires, lay-offs, transfers and total number of each of our three recorded items--namely,. injuries, medical com various leaves of absence,-eta, including names and dates. Failure to keep your plaints, and side absenteeism--by the aver age number of employees working.. This files cleared, by this means, will soon find produces a table of averages which may be them hopelessly cluttered .with inactive, records, and your alt important record of used as a standard of measure or'to com pare the individual employee with/his fel periods of employment will be lost Ron-' tine file clearance is especially important lows. We have used two periods to illustrate how the standard may vary, by . in times of a high rate of employee turn sex; in proportion to length of the work over. week, or under conditions of-peace or of A discussion of all of the values and turmoil. . varieties of application of this combination of individual records would .take thrice our present allotted time. We can only enu merate a few points. Our standard is now set by which the medical department may rate fairly and compare accurately an employee's status . in safety, medical complaints while on the L In dealing with , large numbers, the efficiency of individual application is en hanced and the personal relationship of medicine to patient is markedly improved. 2. The time.and labor saved in review ing individual histories is tremendous. job, and number ;of ride absenteeisms. Farther, these visible^ condensed records paint a day-to-day, ever-changugr picture of each individual,- continually singling tint those who need attention in some phase of safety and health. '3. The value of any therapeutic or safety measure can be swiftly and accurately eval The Problem Group t uated, individually or collectively, the con Before we go on to the method of ap clusions having the added weight of large' plication and the measure of its success numbers, backed by records of other.in .or failure,' some further general truths dividuals that constitute controls. should be stated--general truths tbat have Industrial Nursing 99 come from repeated mass analysis of these within this group that we find the pre records over a period of years and from ponderance of neurotics, indigents, irre recorded observation of those who have sponsible, and otherwise below par broth made these records. Repeated analyses of ers and sisters. . the index record of plant dispensary serv The foregoing conclusions and observa ice over an eight year period invariably tions add up to this--environment, occupa lead to the same basic conclusion: tion, physical condition, eta, play the PER CENT AGE PER Accidental CENT Injuries AGE and of Medical Total Complaints Employees 80 to 85% are produced by 30% 15 to 20% . are produced by 60% 0% are produced by 10% minor role in the incidence of injury and physical complaints' during working time. The major role is played, by what we term "the human factor." A safe and an un safe worker retains the same status re- . gardless of environment and occupation. We do not intend to conmy the idea that the status never changes. It does. We do, however, point out that, with extremely few exceptions, the status of those indi viduals who make up our baric 30% group never changes so long as they are left to .100% 100% There are some observations pertinent to this baric conclusion that , should be their own devices. When a change for the better does occur, the reason,can almost always be traced to some personal atten tion paid directly to the individual. reco-rded. , t Some comfort may be derived from these a. Not only do the mathematical per conclusions in the realization that at least centages remain constant, but the indi 70% of our industrial family is composed vidual employees within the percentage of good, average, safe and relatively groups, to a large extent, remain the same healthy American citizens. This empha individuals. This holds' true regardless of sizes foe point that "an industrial medical length of service, transfers among occupa department, manned only to take care of tions that are hazardous by varying de direct dispensary service, is at best realiz- grees, location in the factory, etc. There . ing but 40% of its potential value to in / are, of course, employees who. pass bade dustry." Our. safety, personnel and medi and forth from one group to another, but cal departments foould be sufficiently . they form a minority ineach group. manned to do more for otir dependable V- There is jib consistent connection majority. Too often they are truly "the between the physical condition of an em forgotten men." ployee as determined fay pre-employment and periodic physical examination and the Applying the Records plant dispensary record that the employee accumulates.. We find no evidence to sup port the theory that employees who, at pre-employment physical . examination, were found to have major physical dis abilities add were classified, as physically below average are any more prone to in jury, sickness on the job, or rick absentee ism than are those who were judged to be physically above average. We are now in a position to make our records live, and to apply them. JLet us outline the machinery of application, fol low-up, and evaluation. Every visit to the dispensmy affects someone's record in some way. The members of the dispensary staff snaking.the entry on the index or absent record are familiar with the basis of measure. Trained to recognize, devia tion from the average, or untisuai depar c. Comparison of theplant dispensary ture from the. past record of the- indi record ynth that of the personnel depart- vidual, they are expected to act immedi meiit;demoJ!5trates that a majority of those ately on these occasions.' Where accidental malpng up our:baric-30%.group produce injury is the offender, the case should be the majority of problems .for supervisors, referred to the safety director. Medical personud and safety departments. It is complaints and sick absenteeism are ini- 100 32nd National Safety Congress, tially medical problems, and are bandied " elective Study by the plant physician, the head nurse, or . other staff members that they may desig- . ow we leave the individual and go nate. Frequently, cases turn out to be ,nto the collective study of accidents. In distinctly personnel problems. Lastly, some ? doing, we hope to demonstrate that may become the problem of superintendent industrial medical records, applied co- or higher management operatively, serve to further safety and act as its guide and measure. What we have Let us take a look at a typical case, to say here deals specifically with acci- This employee has worked only three and dental physical injury, but bear in mind one-half days, yet already has suffered that such studies are'likewise applicable three accidental injuries and registered to all phases of industrial hygiene^ one medical complaint. This is distinctly a case for the director of safety. The Kept hanging near the surgical 'treat- nurse immediately sees to it that the index ment booths in the dispensary is a simple record, together with any pertinent obser- mimeographed form that we call the vations and remarks, is transcribed on a medical log. A dean sheet is begun each form and to this is attached a 3 x 5 per- shift Immediately following the care and sonal contact record card. Both are for- recording of a new injury on the surgical warded to the director of safety. The card, this data is transferred to the medical nurse enters the code' symbol on this em- log by means of pencil marks.. The entry ployee's index record to indicate this requires but a few seconds, personal contact After the safety di- ' rector makes whatever investigation he This log record is at all times accessible deems necessary, he records his findings to the safety staff, and places in their and action on the personal contact card, hands an ever present mint of material and returns it to the hospital file. This is that automatically serves as an .instrument the record of the entire transaction--in- to direct numerous attacks at the source eluding the notes by the safety department of accidents. Observing a rise in any type and the request for follow-up in thirty of injury, die safety director can refer to days. The investigation by the safety de- the accident prevention file, spot the in- partment located the underlying cause of dividuals and' locations immediately, and these accidents--"horseplay"--and correc- put control measures in motion without tive measures are being taken. The date undue delay. This type of accessible co- for follow-up .of the case is set and noted operative record also saves much time that on the hospital calendar. When the follow- would otherwise be required of medical up date is reached, a glance at the in- and safety personnel to make many in dividual's record will serve to measure the dividual queries and investigations. It has effect by comparing the recorded items one more point worthy of note--namely, after the date of the personal- contact it takes from other than professional per- with those before. This appraisal will sonnet the necessity or excuse for general determine what future action may be access to medical records that are properly necessary. accepted as being confidential When the appraisal indicates that definite improvement has taken place, you are faced with the most important follow-up of all; namely, to call the individual in and tell him about it. I know of no maneuver that better promotes morale and if omitted, creates a more subtly damaging psychological effect This same routine of find-the-case, action, record, 'follow-up, measure, and evaluate is carried out in all such persona] contact cases. At the end of the day or shift,_the pencil marks on our medical log are totalled and can be permanently recorded. Here we build the material for research too comprehensive to discuss in detail. The weather reports, absenteeism, and many other items may be correlated with it Here, hour by hour, is the bedside accident chart of our collective patientT the baroxn- eter of injury, and the hidden answer to many unsolved problems. Industrial Nursing 101 Anatomical Distribution The final portion of our one minute and ten seconds is spent on the entry made on the anatomical distribution of injury form. At the end'of the day the surgical cards are entered with small pencil marks. It can be done quite rapidly. This form serves as a cross study of types of injury (horizontal columns) with anatomy (per pendicular columns). Each month, or at ahy other desired period, the pencil marks are added and the totals recorded. By dividing the total of any column into the grand total of injuries, we may get a ratio index for each horizontal or perpendicular item. A year or more of such a study establishes a standard for each type of injury or anatomical part. We have learned from long observation of this ratio index that certain types of injuries, like many diseases, are epidemic and that sea sonal variations are almost constant. The same is true-of injuries to certain parts of the body. This type of study is of more than academic interest. It is capable of numerous practical applications and is an instrument that indicates the optimum time to "bear-down'* if you would prevent a 'recurrence of undesirable past experi ences. The anatomical distribution record is, like the medical log, accessible to the director of safety, and can be applied much the same way. We deem an injury severe if it reduces the; efficiency of the patient fifty percent or more for any period over four hours. We express severity by the factor result ing from dividing the number of injuries we . deem severe into the total number of new compensable Injuries. This measure has`been watched over a period of years and proves to be an accurate and valuable measure and prognosticator. It is a simple measure and easily understood by manage ment Corrective Measures What is done when our-measure spots a rise in any particular type of injury? We know from past experience that if some thing is not done, severe 1 injuries soon occur. Let us use eye injuries as an ex ample. A sudden rise in the frequency or severity is noted. The last hundred passes to the hospital,. filed under eye injuries, are taken from the file and beginning with the remote date, they are rapidly plotted on the factory map with tacks'. No timeconsuming plant inspection by safety com mittees is necessary. Two closely grouped tack areas disclose and eliminate the haz ards responsible for the epidemic Thus we begin and end our study of accidents with the little pass to the hospi tal. It is the Alpha and Omega, and fur nishes the five "W's" of safety--who-- where--when--what and why. Thus we conclude, leaving it to you to decide whether or not the information accumulated in our one minute and ten seconds of extra recording per case will prove to be a worthwhile investment. Our aims are set forth, and the basis for realizing them made concrete through the planning of various types of records. Our "seeing eye" is now ready to function. It warns of danger, the presence of unsus pected and alien influences; it automati cally records and reveals data which en able us to improve the whole society of industry in health, safety, and mental hygiene. The "seeing eye" is a miracle ot electrical engineering; records--our "seeing eye"--open the door to vast op portunities in human engineering. Dreams and medicine -may not sound like a prac tical combination, but if you would make progress, do not be afraid to see visions and work toward their fulfillment A last thought--to its patients and to the nation industrial medicine has much to givenothing to sell! 102 32nd National Safety Congress, 1943 THURSDAY AFTERNOON SESSION October 7, 1943 Presiding--Joanna M. Johnson, R.N* Supvr, Industrial Nursing Dfo, Employers Mutuals, Wausau, Wis. Nurse's Part In Physical Examination Program: By H. GLBNN GARDINER, 1LD. r. Medical Director, Foote Brother* Gear a Machine Corporation, Chicago, There has been a change of recent ori Much of the effectiveness in beating the gin in the part the nurse plays in a physi desired impression upon the incoming ap cal examination program. plicant and in determining his decorum as The changes in status have, in certain instances, not been simply those of pri vileging ourselves, to nse the nurse in creasingly in the simple mechanics of the examinations, but in the interpretation of findings as welL There is no question that there is a con siderable lack of competent available phy sicians which is a challenge to use in the manner of utmost efficiency the tone of those we do have. It does not require any great'amount of initiative to set np a pro cedure so that one physician assisted by two or three nurses can,, without difficulty, examine 100 or more examinees in an a worthwhile employee is effected by let ting him know that his employer thinks enough of him to provide for Imn in many ways. The first example he meets is the dignity, care and consideration at the time of the. preemployment examination. Thus, -he will cany the memory of his reception in the medical department as the representative attitude. of the company with which he is affiliating fchnsrif. Dividends of many typed* are to be ex pected if these impressions are what they should be. They may. be minimized by any apparent lack of attention1such as that of an examination without a physician. ordinary working day. The quality of this In these days of war.there is a perfectly examination can be far better than today's natural coincidence, lending material aid average and is completely adequate for to the cause for the use of nurses'in the today's needs. We7 simply substitute a physical examination program. Most of streamlined means of examining which is our nurses are female and our present necessary for the duration, yet contains great influx of workers in industry are the essentials found apropos in our peace female too. time activities. ~ Another important factorin facilitating The nurse can call for the physician tp a- maximum number of reasonably com double check any of the obvious abnor plete examinations in .the, minimum time malities detected, bat what of the border possible--and thus the most efficient line or hidden cases in which the training' modus operand!--is that of,'the physical and experience of a physician are often layout of the examination and. dressing timed to detect and interpret? Certainly rooms used. If a large number of eatui> the nurses* training and experience are not nations are tq be done routinely, or if the such that they can be expected to display' examinations dre done on both , sexes, it such achievement Yet these are the very is almost a must that two examination cases which have, in many instances, rooms be used.. -shifted the scale to a .proven economic Each examination room should have two advantage to industry of a physical domi dressing rooms attached--each having.^ nation program. No matter how willing . door opening into the examination' room and well meaning the nurses may be to proper and another door opening, into the accept it, we are not playing the game exit hall In addition, these dressing rooms fairly when -we thrust such responsibilities should contain facilities for obtaining urine , on their shoulders. samples as well as for dressing, with hooks VI n v S 'c ft a t v t Industrial Nursing 103 for clothing, a place to ait while waiting, a mirror, etc. Each examining room should have doors permitting the coining and going of the physicians and nurses without going through the dressing rooms. . Perhaps the best-way to bring- out just what is our conception of the part a nurse takes .in a modern, comprehensive physical examination program is to give a general putlineof procedure. For convenience, we will suppose the examinee is feminine and enters the examination routine fresh from her interviews in the employment depart ment After recording her name* she is given a preliminary eye'test--preferably by orthorater which has been selected for its speed and efficiency, and is operated by a lay technician. - A nurse tjien records the age, sex, ad dress, manpil state, color, number of chil dren and their ages, etc, and includes a careful history of serious illness and in juries, operations, menstruation, admitted defects, deformities, or weaknesses, pre vious occupations and the position sought now. If these findings are to be of' full valne the-nurse must not only have a general' knowledge of such procedures coupled with morethan a little tact and 'friendliness, but a special knowledge in the art of developing the loose ends of a his tory, into a lucid revelation of conditions which may materially influence the atti tude of the physician in classifying the ^examinee and-in placement recommenda tions. The examinee is then escorted to a dressing room where she changes to an ' examination gown. While she is waiting for her examination a urine sample is obtained and blood pressure, temperature, pulse and hearing records are taken by the nurse. During the examination the nurse records the findings as dictated by the examining physician. Additional labora tory tests, if indicated, are then made be fore the examinee is allowed to dress in street .dothes. In many instances the laboratory technician is a nurse who if not too busy may function in addition as one of the nurses helping in the examina tion routine. As the need arises, the nurse may en large her activities to indude more de tailed histories such as vaccination, family history, etc, being limited only by the degree of exhaustiveness the director of the examinations sees fit to request. In summarizing, let me call attention to the. fact that although the scope of the nurses activities has been broadened im mensely, it has not put her in a position of rendering opinions. She has made cer tain technical and factual records, largely a mechanical activity---but in no way an unimportant procedure. The interprefatiomand analysis of these findings is still left to the physician who. is. In the logical position to accept the responsibility for presenting the official opinion, and for making recommendations regarding placement, need for care, etc. There is every reason to suppose that this rationalized concept of the part of the Nursein a physical examination program will continue after the present- urgencies have subsided to normalcy. - >/ ft: jr.v: IK [j;; - Si! ; 104 32nd National Safety Congress, 1943 New Trends in the Treatment of Industrial Iniurtee By HENRY H. RUBIN, M. D. Industrial Surgeon and PhysidaivChicafo r New trends in the treatment of industrial sists'of keeping toe patient in a darkened injuries incline toward conservatism, and room or having him wear dark glasses, ' a greater consideration of physiological cold applications to the eyes, a| local anes principles. This has resulted in improved thetic in water solution as butyn or ponto- care. But the primary concern should be caine for immediate relief, and in oint prevention and control of injury and dis ment base--asbutyn or holocaine at night ease. -The means of accomplishment are while attempting to sleep, and a vasocon through safety educational programs in strictive drag such as adrenalin. Anal industry regarding safe practices and the gesics and sedatives nay be required in use of protective equipment A good severe cases. work environment is essential. Good vision, proper nutrition, and the avoidance Wbands of fatigue are requisites for the worker. Physical examination and medical super vision are also of importance in the pro gram. To guard against infection and promote primary healing is the objective in the treatment of wounds. The broken skin admits bacteria and it has been found that Psychological Aid it takes about six hours for them to mul In ministering to the injured workman it is not enough.to bind his wounds ac cording to toe modern precepts of first aid. Psychological aid1 is just as essential. In approaching toe injured person, one must gain his confidence through words of reassurance and sympathy and by one's own composure. Recovery will be hastened tiply and invade toe tissues. Thus it is seen that prompt care is of toe essence if bacterial invasion is to be prevented. The simple abrasion is cleansed and an antiseptic,-sudi as mild tincture, of iodine is. applied, covering with a sterile dressing. The small incised' wound is cleansed with white soap and water and the edges by gentleness of handling the patient as are brought together with flamed tape, well as by gentleness 'in handling the small skin clips, or non-absorbable sutures, wound. Keeping him quiet in the first aid whichever is indicated. room, rather than rushing him to toe The contused, lacerated and penetrating doctor's office or to toe hospital will do wounds may be more extensive and may much to allay his mental anguish. In most be complicated by toe entrance of the instances, it would be better for toe attend wound into tendons, muscles, -joints, or ant to seek the doctor's advice over the .to fractured bones. These wounds are telephone or to have toe doctor go to toe .cleansed thoroughly with a mild soap and patient water. The. operator should be capped , Byes and masked and wear sterile gloves and gown. Irrigation with sterile saline solu "Arc flash" conjunctivitis is a condition tion follows the soap and water cleansing. quite prevalent .among electric arc AS torn, ragged and damaged, tissue is welders.* It is caused by exposure to excised and bleeding is controlled. ultra-violet or actinic rays and is charac The extent of debridement should be to terized by delayed onset self-limited the point where the tissue looks normal, course of twenty-four hours, swelling of bleeds freely, and the muscle fibres con toe lids, photophobia, and sandy feeling tract. Tendons, nerves, and large blood in the eyes. Prevention is effected through vessels most be spared. This ^repair. is educational pamphlets and personal in done within the six horn period. The struction in protection by flash goggles wound may be closed by primary suture with side pieces, helmets, welding cloth and covered with a copious fluffed gauze ing, and screens. Active treatment con pressure bandage. If the "golden period" 106 32nd Nationei Safety Congress, 1943 deep skin grafts ^ which jae covered by The.practice of overheating patients in vaseline gauze orraoist fluffed gauze and shock has been found harmful? Experi- an Ace bondage. jmental studies on the effect of various - Traumatic Shock "external temperatures in shocked animals * The treatment of shock is dependent on the various types of injury which it may foUow. More than one factor may be present, shock being due'to crushing in jury or hemorrhage which may accom pany the injury. reveal that cold and heat proved danger ous to life. There is a loss of energy to the shock victim at a time when he heeds every bit of it.to keep alive. He will do best if wrapped in blankets and kept com fortably warm at room temperature; - The treatment of shock following hem REFERENCES . orrhage is blood transfusion given as quickly as possible and in adequate amounts. 1. Bdtns. S. R-: Stogie*! Eaetfeudes. Indus trial Sled. 12:431, JnJjr, 1943. _ 2. Riekt, F. E.: -Are Fit*" Conjtmetmti*, J-AJAA^ 122:734, July, 1943. In shock following bums the treatment 3. Cole sad Poestow: First Aid (Appleton- is blood plasma given in amounts of from 200 c.c. to 500 c.c. every hour and Ceatary Co.) 1942. 4. Koch, S. E-: Tendon Suturing. Iodnstrial Med., 11:327. July, 1942. . from 1,000 cc. to 5,000 c.c. for' twenty- . S. Mooriiead, J. J.: T*d ia War Sazsery. four hours, depending bn the severity of Snrg. CUa. N. K, 23:313. April, 1943. - the shock. This and the withholding of _ 6. Gehfcard, U. E-t Common Iodnstrial Injuries. Indtutrial Med., 11:32$, July, 1942. water oppose the concentration of the 7.* Scbaar, C M., Kraut, F. P., sad Tsl D, blood, and have been successful in the treatment of bum shock.1* T.: Fractures of the Tikis sad Fibula. SanfTcUo. N. A^ 23(2) :599, April, 1943. 8. McClure, R. D, sad Lam, CB.;A Statisti In shock following crushing injuries cal Study of Miaor Industrial Bums. JAVA, there is a loss of serum and plasma into the tissues and (he treatment is the ad 122:909, July, 1943. 9. Child, C G.t Traumatic Stock; Its Frens- tioa and Treatment. Stag; Clin. N. A~ 23:321, ministration of plasma. April, 1943. ; Ii : The treatment of shock following injury . l(k Gatek, W. ft: Disturbance* of the Peri pheral Ctrcclation--Considerations on the Defini to the soft parts is whole blood or plasma tion of Shock. 01. Med Jour., 14:12, July, 1943. to replace that which is lost as a result of the condition. II. Waking K. G.: The effect'ofExtemal Tea* peratare on Shock. J.AJLA* llldU, March. 1943. Th^Nurse's Part In A Program of Industrial Safety & Hygiene CLARK D, BRIDGES Industrial Hygienist, National Safety Council, Chicago When your Chairman and program onstrafod. In 1941,the National Asaocommittee suggested this topic several cation of Manufacturers conducted a months ago, it was readily accepted be- survey to determine tiie results obtained cause of my conviction of many years by its member firms from such activities, standing that the nurse is a vitally im- | This report -disclosed the following highly portant cog in the gears of the efficient significant results: . industrial organization. Or it' might be stated this way--and this is particularly Seduction fa Accident Frequency........44-9% . " * Oepfftl3W*ee true in the smaller plants--the nurse per- forms so many functions to aid management and employees that her real value .WY.'.W'.29 " " iCompamtion iwmwuce j fwuuuuj........2&s% . -Is often not'recognized until the plant, - -The report, also ..indicated, that, the through accident or design, tries to get along without her.' ... . Monetaxy Value average actual savings.in a 500*man plant amounted to; over $5,000 annually. This report contains other.valuable-information and is recommended to all who are in- The actual dollar value of effective forested in getting the most but of their health and safety programs has been dem- safety and health programs, f r Industrial 'Nursing 107 In reprint'No. 1765, of the U. S. Public cruses of accidents and give them a knowl Health; Service, published in 1936, it was edge of . effective measures which can be estimated that the minimum monetary taken to combat them: She will meet value to: industry of medical and engi other men and women concerned .with the neering services for. the development of- same problems and with whom she can healtb and safety programs is $18,800 discuss, her own problems with benefit annually,per thousand employees. Also of She will learn sources of information and interest in this connection is the study of expert help. These courses are usually made several years ago by the American ' 96 hours in length and are tuition-free. College of Surgeons, which disclosed that In some parts of the country similar per capita medical costs are higher in courses are given in industrial hygiene small plants than in large ones--one of the and occupational diseases. Anyone inter-, i& reasons being the lack of programs of ested in this general problem should take itx*, prevention. ;. advantage of the training offered by these courses. tost* afti rcnowMi tor xTognuTi It is simple enough to recite these bene fits and the methods by which they may References and Exchange of Idea* It is very desirable that the nurse attend r. be obtained. The real problem in many the local and national meetings onindnsplants is locating persons with the neces* trial health and safety. Host progressive ie*. sary training and enthusiasm to convince communities have safety councils which D. management, of the benefits of such a meet periodically where many valuable & program, the ability to pat it into effect ideas may be obtained and experiences mA.-, and carry It through; The nurse is often exchanged. She should have available for in an ideal position to bring this about, reference the Safe Practices and Health 31- . M. inasmuch as many firms do not.have full- Practices Pamphlets of the National Safe tinte safety, engineers or industrial hy ty Council applying to the processes and gienists bnt must depend upon only occa hazards in her plant. She should read ri- *! sional service of this nature from their in . regularly the periodicals in the medical surance carrier, and the doctor is usually and safe^r fields. a*- on a part time basis. Even in the larger She should, as one of her very first h. organizations, where full-time medical and duties, make a thorough inspection of the safety personnel are employed, the nurse entire plant in order to become familiar can . be "of immense benefit to the entire with the processes and materials used and program through her interest and partici obtain a general knowledge of the opera pation, tions. She shotdd also accompany tire Spedri Training Needed Graduate nurses find that there are many phases to industrialnursing for which theirprevious training has not-prepared them. It behooves them, therefore, to take.'advantage of all the special train? ing they can obtain, if they are to enhance their position and increase their value beyond that of simple first-aid service. Even though nurses generally do not have fundamental engineering training, they can obtain instruction in fundamental safety inspection committee on their peri odic inspections and investigations of acci dents. Through familiarity with the plant processes, the hazards involved add the corrective measures necessary for their proper control, the nurse can do a good deal of effective.safety work while rite is .faking care of minor injuries in the .firstaid room by questioning employees regard ing tite cause of their injuries and what to do to prevent a repetition. Accident Records principles of. accident prevention by .at The importance of accident and first-aid tending the war training classes being con records will assume.new meaning after the ducted by the various engineering colleges nurse has completed her course of instruc throughout the United States as a part of tion in safety engineering. She will realize tint training program of the United States the importance of watching frequency Office of Education. These classes teach trends, the importance of detecting indi the Student to understand the fundamental viduals or departments or operations s|. . t: * 6 108 32nd National Safety Congress, 1943 which are responsible tor more than their there are, definitely two schools of thought due share of injuries. The cause of the on this subject--nurses should know the accident will be emphasized in her record industrial significance of defective physical rather than the nature of the injury as conditions. These may affect the acHdent probably was the case before her realiza . proneness or be aggravated by injuries tion that the keystone of prevention is a which may be suffered or health hazardous knowledge of the causes of accidents; materials, and^ processes to which the therefore, her periodic summaries of cases Worker may be'exposed. The nurse should handled will include more valuable infor maintain check records to see that periodic mation for the use of the safety committee. examinations are made promptly. Further I believe the nurse belongs on the - safety committee as a permanent member of it, possibly as secretary if her duties permit her this much time for the keeping of these records also. Through her ac-. qtiired familiarity with the plant processes more, those employees who appear to be accident prone and those who are. habitual callers atthe first-aid room for aspirin and similar medication can 'be detected and referred to the doctor for spedal exam ination. and appreciation of the importance of accident records just mentioned, she is in Other Functions a position to be of definite assistance to With the increasing employment of the safety committee. .women in industry, experience has shown the desirability of having a women's coun Treatment and Examination First-aid treatment of industrial injuries by the nurse under the standing orders of the physician should also encompass in telligent evaluation of the nature and ex tent of the injuries to the end that em ployees may be returned to their own work just as soon as possible, consistent with the condition and ability of the patient, to reduce lost time from work. Where a- variety of operations are per formed in a plant, it is usually possible to find some kind of productive activity which employees with minor injuries can perform without loss of income to them selves or productive capacity to the em ployer. Such procedures, when properly handled, are beneficial to all concerned. Nurses can be of more -than ordinary assistance in the physical examination program. Many doctors, in these days of shortages of medical personnel, find it 'desirable to take rite time to train capable ijprses in .methods by which they can aid in the screening process, thereby reducing the amount>of time which the doctor must spend with each individual. Nurses can be taught to recognize significant conditions and bring them to the attention of the physician for his expert examination and decision. selor in every plant where any. appreciable number of women are employed. The nurse is in an excellent position to perform these functions. By special study of the rapidly accumulating literature relative to induction, training, susceptibility to indus trial poisons and the peculiar health and safety problems of women,& most effective program can be developed. There'are a number of other functions the industrial nurse can perform for the benefit of the general program. She can supervise sanitation facilities such as toilets, lockers and locker rooms, wash rooms, drinking fountains and the drink ing water; supply. The field of health edu cation offers great opportunity for improvement of employees' off-the-job health. Early detection of non-industrial illnesses and diseases' will prompt refer ence to a`physician reduces lost time due to these conditions. Supervision of the canteen or cafeteria, with emphasis on proper nutrition, is another field of en deavor which can show paying results. ^ In summary,'it is 'apparent that the in dustrial mirse ran be one of. the very im portant factors in the production of and maintenance of a smoothly and effectively operating industrial organization. One word of caution, hdwever, these results are not achieved overnight; in fact; it may Whether such a -program is in .effect or take years to do it It's hard work but not--and it should be stated here that don't give up.