The Injury Response SOP
Purpose
When someone is hurt, the people nearby lack assignments more than knowledge. Two techs kneel beside the injured helper, each assuming the other called 911; nobody goes to the street; the office hears about it from the customer an hour later. This SOP gives every person a job in the first minute, so care, the call, the street guide and the word to the office happen at once, and it closes with the scene record the shop needs afterward.
Scope
Covers: an injury to a crew member, from the moment someone sees it to the hand-off to responders or clinic, plus the same-day scene record. Crews of one, two and three or more each get a role split below.
Does not cover: why the first-minute actions come in the order they do (see related: The First Five Minutes After Someone Is Hurt); the 911 call script (see related: Calling 911 From a Job Site So They Find You); fires, gas releases and crashes with no injury (see related: The Safety Incident Response SOP); the written report, OSHA log and comp claim (Accident and Incident Reporting SOP); a hurt customer (see related: How to Respond When a Customer Is Hurt in Your Work Area). Nobody gives care beyond their training and the dispatcher's directions; hands-on first aid and CPR certification is what makes a responder.
Roles and responsibilities
| Role | Owns | Hands off to |
|---|---|---|
| Scene checker (first person to see it) | Step 1; names the roles out loud at step 2 | Caregiver, once the scene is safe to approach |
| Caller | Step 3; stays on the line | Street guide, with the expected arrival |
| Caregiver (the designated responder if one is on site) | Steps 4 and 6 | Responders, at step 6 |
| Street guide | Step 5 | Caregiver, by walking responders to the patient |
| Crew lead | Steps 7 and 8 | Office manager |
| Office manager | Step 9 | Owner, for corrective action |
Two people: the uninjured one checks, calls on speaker beside the patient and gives care; the customer is asked to be street guide. Solo tech hurt: they call 911 if able and ask the customer to meet responders; the office check-in is the backstop (see related: Working Alone: Staying Safe When No One Is Watching). Three or more: one role each, the crew lead taking what is left.
Procedure
Stop at the edge and check the scene before you go to the person. What hurt them is still there: an energized conductor, a gas smell, a running machine, a roof edge, traffic, bad air in a crawlspace. Control it only with an action you are trained and allowed to take (open the breaker you know feeds it, shut the appliance gas valve, stop the machine), or keep everyone out. Acceptance: the hazard is named aloud and either controlled or declared "not approachable," within about 30 seconds of seeing the person. Wrong looks like: a coworker running into a crawlspace after a collapsed tech, or grabbing a person still in contact with a conductor. Stop rule: if the hazard cannot be controlled from outside it, nobody goes in; tell 911 what the hazard is and wait for responders (see related: Rescuing Without Becoming the Second Victim). Hazard: at a gas odor, nobody operates switches, starts a truck or uses a phone inside the building; the call is made from outside.
Name the roles out loud, by name. The scene checker says it in one breath: "Marcus, call 911. I've got him. Dana, go to the street." Use names, not "somebody." Acceptance: caller and caregiver each named within 60 seconds of reaching the person, and the caller answers "calling." Wrong looks like: two people working on the patient and nobody with a phone to their ear. Stop rule: if 60 seconds pass with no confirmed caller, whoever is not touching the patient calls now, and the scene checker repeats the assignment louder; on a two-person crew the caregiver puts the phone on speaker and calls while giving care. Hazard: none from the assignment itself; the caregiver stays clear of the hazard named in step 1.
The caller calls 911 if any 911 sign is present, and otherwise calls the office for a clinic run. 911 signs: not breathing normally, unresponsive, severe bleeding, chest pain, a fall with neck or back pain, a head strike with a red flag, a shock across the chest, an amputation. Give the street address from the work order, the cross street, how to reach the patient ("side gate, then the crawlspace hatch at the back"), and the callback number. Stay on the line on speaker. Acceptance: the dispatcher has read back the address, or if the call is a clinic run, the office has named the clinic and confirmed it can take the patient. Wrong looks like: "the Johnson job" as the address. Stop rule: if unsure whether it is a 911 case, it is; see related: When to Go to the ER Versus Urgent Care. Hazard: the caller stands somewhere they can hear, off the roadway and out of the hazard zone.
The caregiver does only the few things that change the outcome now. Gloves on first. Firm pressure on severe bleeding, a tourniquet if pressure fails and you are trained; CPR and the AED if they are not breathing normally; cool running water on a burn; flush a chemical eye; keep the head still after a fall. Everything else waits. Acceptance: one of those actions started within 2 minutes of reaching the person, or the caregiver states "breathing, talking, no severe bleeding, watching." Wrong looks like: walking a fall victim to the truck. Stop rule: past your training, follow the dispatcher and nothing else. Hazard: blood and body fluids; gloves and the CPR barrier from the kit, and hands washed after (see related: Bloodborne Pathogens and Helping a Bleeding Coworker). Do not lift the patient alone.
The street guide goes to where the ambulance will turn in and clears the path. Stand at the curb, or where a private lane meets the public road, truck flashers on. On the way, open the gate, shut pets in, move a blocking van. Acceptance: guide is at the road before the dispatcher's estimated arrival, and the path from road to patient has no locked gate, loose dog or blocked door. Wrong looks like: responders driving past the house looking for numbers. Stop rule: if the guide cannot see the road from the drive entrance, they walk to where they can and tell the caller to relay that to dispatch. Hazard: stand off the traveled lane, facing traffic, in a high-visibility vest after dark or in rain.
The caregiver hands off to responders in under a minute. Say what happened and when, what you did and when (tourniquet time, AED shocks, flush duration), and what the emergency card says (medications, allergies). Acceptance: responders have the times, and any tourniquet time is written on the tourniquet or the patient's skin. Wrong looks like: "he fell, I think around ten." Stop rule: no crew member drives behind the ambulance with lights on; one person follows later at normal speed if the patient wants company. Hazard: step back once responders take over; a crowded patient is harder to treat and to move.
The crew lead calls the office as soon as the patient is handed off. Who, what, where, which hospital or clinic, and who from the crew is with them. The office reaches the emergency contact from the employee file. Acceptance: the office has the hospital name and the time of the hand-off, and the emergency contact is reached, or a voicemail is left and a next try time is set. Wrong looks like: the office learning of it from the customer. Stop rule: if no hand-off has happened within 15 minutes because it is a clinic case, the lead calls the office at the 15-minute mark anyway. Hazard: nobody makes this call while driving.
Hold the scene, make the scene record, and do not resume work until the cause is controlled. Before anything is moved, photograph the area from four sides, the tool or ladder involved, and the floor or ground; note measurements (ladder height, fall height); collect witness names and numbers. Tag the involved tool or ladder out of service. Acceptance: at least 4 wide photos plus 1 of each involved item, witness list written, item tagged. Wrong looks like: the ladder back on the truck before the photos. Stop rule: anything moved during care is noted as moved, not put back. Hazard: resuming is where the second injury happens. A breaker opened at step 1 stays open and locked until the fault is found and a qualified person proves the circuit before re-energizing; a ladder that failed does not get climbed again; blood in a customer's home is cleaned up under the cleanup card (see related: How to Clean Up Blood in a Customer Home).
The office opens the incident record the same day. File it under the Accident and Incident Reporting SOP, attach the step 8 photos and the times from steps 3 to 7, and decide the reporting. Acceptance: record opened before the end of the business day. Wrong looks like: "he's fine, we'll write it up Monday." Stop rule: a work-related fatality must be reported to OSHA within 8 hours, and an in-patient hospitalization, an amputation or the loss of an eye within 24 hours, under 29 CFR 1904.39; the clock starts when the employer learns of it, so the office checks admission status the same day. Hazard: none at this step; it is done at a desk.
The record this produces
One incident entry per event, started by the crew lead, completed by the office:
- Times: injury, call, first care action, responder arrival, hand-off, office notified, emergency contact reached.
- Roles and steps: who held each role; each step done, done late (how late against its acceptance) or not performed.
- Scene: photo set, measurements, witness list, item tagged out and where it is stored.
- Outcome and reporting: transported, clinic or released; admitted or not; 1904.39 report yes or no.
The owner reads the late and unfilled lines as the next safety meeting's agenda; the insurer and any inspector read the times and photos.
Worked pass: a fall from a stepladder
Setting. A three-person plumbing crew: lead, tech and a second-month apprentice. A garage water heater swap, a Tuesday at 10:15 am. The tech is on a 6-foot stepladder pulling the vent connector when the ladder kicks out; he lands on the concrete on his right side and hits his head.
| Step | What happened | Result |
|---|---|---|
| 1 | Lead sees it from the doorway at 10:15. Names the hazard: "ladder's down, nothing live, gas valve to the old heater already off." | Pass, under 30 seconds |
| 2 | Lead and apprentice both drop beside the tech. At 10:16:10 (70 seconds) nobody has a phone out. Lead takes the stop rule: "Ana, call 911, now. Tell them a fall and a head hit." Ana answers "calling." | Fail, stop rule taken, 10 seconds late |
| 3 | 10:16:20, Ana reads the address and cross street off the work order, "garage door is open." Dispatcher reads it back. Speaker on. | Pass |
| 4 | Lead gloves up. The tech is talking, says his neck hurts. Lead kneels at his head and holds it still, tells him not to move. "Breathing, talking, no bleeding, neck pain, holding head." | Pass, inside 2 minutes |
| 5 | With the injured tech out, only two crew remain, so the customer volunteers as guide at 10:17 and shuts the dog in on the way. Dispatcher says 9 minutes. | Pass |
| 6 | 10:25, responders arrive. Lead: "Fell off the ladder at 10:15, hit his head, neck pain, hasn't moved." | Pass |
| 7 | 10:31, lead calls the office: transported to the regional hospital. Office reaches his wife at 10:38. | Pass |
| 8 | 4 wide photos of the garage plus the ladder and its feet, customer named as witness, ladder tagged out on the truck. The swap waits for tomorrow; the old heater's gas valve stays off. | Pass |
| 9 | Record opened 1:10 pm. Admitted overnight for observation, an in-patient admission, so the office reported to OSHA at 4:30 pm, inside the 24 hours. | Pass |
Corrective action: the late caller at step 2. The lead now names the caller before kneeling.
References
- 29 CFR 1904.39, reporting fatalities, hospitalizations, amputations and losses of an eye to OSHA.
- American Red Cross and American Heart Association, current first aid and CPR guidance.
- See related: Accident and Incident Reporting SOP; The First Five Minutes After Someone Is Hurt; Calling 911 From a Job Site So They Find You; First Aid + AED on the Jobsite.