Pressure on to improve jetting injury care

Water jetting is used thousands of times a day across many industries and commercial premises for surface cleaning, hydrodemolition and precision material cutting. Associated risks have been known for a long time. There is, however, no room for complacency. 

Best practice health and safety seeks to prevent incidents from occurring. Knowing how to respond quickly and effectively if they do is also vital. The unique nature of water jet injuries makes this critical to both life and limb. 

Step-by-step guidance

That is why the Water Jetting Association (WJA) commissioned a team of eminent medical professionals to carry out research into the management of water jet injuries.

Their research paper has now been published in the European Journal of Trauma and Emergency Surgery (see link below). It includes an algorithm detailing the optimum way to treat patients from the first response at the scene of an incident, through emergency care at hospital to ongoing treatment. 

For the first time, employers, paramedics and hospital emergency teams have clear step-by-step guidance on the treatment of water jet injuries.

This algorithm is now a key element of our updated ‘Water Jetting Injury Management Guidelines’ in our Codes of Practice – blue for high and ultra-high-pressure water jetting and red for water jetting in drains and sewers.

As well as reviewing previous scientific research, the researchers were given access to the WJA’s database of advisory alerts detailing adverse incidents from around the world. We also helped them contact people who have experienced relevant injuries.

Dr Sancho Rodriguez-Villar, an intensive care consultant at Kings College Hospital, London, who led the research team, is clear about what they found: “Without early and correct intervention, the evidence shows that the outcome for those injured is often catastrophic, including death, loss of limbs and long-term disability.

“We strongly advise all parties involved to observe the WJA’s newly updated guidelines for the management of high-pressure injection injuries.”

Injuries underestimated

Hydraulic injection can occur at pressures as low as 40 bar (580 pounds per square inch), far lower than many over-the-counter pressure washers. Ultra-high-pressure water jetting can exceed 2,500 bar, or 36,259 psi.

The research points out that water jet injuries commonly have a very small entrance wound and no exit wound which can mask the “extensive disruption” of deeper tissues.

This can contribute to GPs and emergency medical teams underestimating the significance of the injuries, leading to delays in the provision of specialist treatment.

Debris and bacteria can be also carried far into the body by the fluid jet, increasing the risk of serious infection and medical complications.

Access to trauma kits

Key recommendations made by Dr Rodriguez-Villar and his team include:

• As part of their first aid response, operational water jetting teams should have access to trauma kits specifically to prevent blood loss
• All water jet injuries should be treated as severe traumas in a tertiary specialist hospital whenever possible
• Evacuation by air ambulance to a trauma centre with surgical facilities must be considered in the early stages
• Early access to CT and MRI scans should be obtained to assess internal injuries, and the patient should be kept under observation
• All wounds should be treated as if they are contaminated – so kept open and surgically cleaned, in stages if necessary 
• Wound swabs and tissue samples should be taken as soon as possible and sent for microbiological and histological examination.

Thanks to the high health and safety standards observed by our members, underpinned by WJA Codes of Practice, and supported by our training, water jetting injuries are not common.

However, if they do occur, they can clearly cause serious trauma, which is why this new research, and the recommendations that follow, is so significant.

Management of industrial high-pressure fluid injection injuries (HPFII): the Water Jetting Association (WJA) experience with water-driven injuries.

[https://link.springer.com/article/10.1007/s00068-019-01106-4]

www.waterjetting.org.uk