• Several OSHA regulations require first-aid training.
• OSHA says that first-aid courses should be individualized to the needs of the workplace, and the agency offers a list of principles and topics that should be in a first-aid training program.
• Assessment of successful completion of first-aid training should include instructor observation of acquired skills and written performance assessments.
• Instructor-lead retraining for life-threatening emergencies should occur at least annually, according to OSHA, but skills review and practice for CPR and AED skills is suggested every six months.

Sudden injuries or illnesses, some of which may be life-threatening, occur at work. The OSHA Medical Services and First Aid standard at 29 CFR 1910.151 requires trained first-aid providers at all workplaces of any size if there is no “infirmary, clinic, or hospital in near proximity to the workplace which is used for the treatment of all injured employees.”

The standard does not require an employer to designate any employee to render first aid. As presently worded, the standard does not explicitly require that an employee or employees be both trained AND required by the employer to render first aid. OSHA has chosen to interpret the standard as imposing a training requirement but not a designation requirement. Refer to the May 25, 2004, OSHA letter of interpretation for more information.

In addition to first-aid requirements of 1910.151, several OSHA standards also require training in cardiopulmonary resuscitation (CPR) because sudden cardiac arrest from asphyxiation, electrocution, or exertion may occur. CPR may keep the victim alive until emergency medical services arrive to provide the next level of medical care. The OSHA standards requiring CPR training are:

• 1910.146 — Permit-required confined spaces;
• 1910.266 Appendix B — Logging operations – First-aid and CPR training (mandatory);
• 1910.269 — Electric power generation, transmission, and distribution; and
• 1910.410 — Qualifications of dive team.

If an employee is expected to render first aid as part of his or her job duties, the employee is covered by the requirements of the Bloodborne Pathogens standard (1910.1030). This standard also includes specific training requirements.

First-aid Training Program

Training for first aid is offered by nationally recognized and private educational organizations. OSHA does not teach first-aid courses or certify first-aid training courses for instructors or trainees.

OSHA says that first-aid courses should be individualized to the needs of the workplace. Some of the noted program elements may be optional for a particular plant or facility. On the other hand, unique conditions at a specific worksite may necessitate the addition of customized elements to a first-aid training program.

Training programs should incorporate the following principles:

• Basing the curriculum on a consensus of scientific evidence where available;
• Having trainees develop “hands-on” skills through the use of mannequins and partner practice;
• Having appropriate first-aid supplies and equipment available;
• Exposing trainees to acute injury and illness settings as well as to the appropriate response through the use of visual aids;
• Including a course information resource for reference both during and after training;
• Allowing enough time for emphasis on commonly occurring situations;
• Emphasizing skills training and confidence-building over classroom lectures;
• Emphasizing quick response to first-aid situations.

First-aid Training Program Topics

The training program should include instruction or discussion in the following:

• Preparing to Respond to a Health Emergency:
  • Prevention as a strategy in reducing fatalities, illnesses and injuries;
  • Interacting with the local emergency medical services (EMS) system;
  • Maintaining a current list of emergency telephone numbers (police, fire, ambulance, poison control) accessible by all employees;
  • Understanding the legal aspects of providing first-aid care, including Good Samaritan legislation, consent, abandonment, negligence, assault and battery, state laws and regulations;
  • Understanding the effects of stress, fear of infection, and panic; how they interfere with performance; and what to do to overcome these barriers to action; and
  • Learning the importance of universal precautions and body substance isolation to provide protection from bloodborne pathogens and other potentially infectious materials. Learning about personal protective equipment (gloves, eye protection, masks, and respiratory barrier devices). Appropriate management and disposal of blood-contaminated sharps and surfaces and awareness of OSHA’s Bloodborne Pathogens standard.

• Assessing the Scene and the Victim(s):
  • Assessing the scene for safety, number of injured, and nature of the event;
  • Assessing the toxic potential of the environment and the need for respiratory protection;
  • Establishing the presence of a confined space and the need for respiratory protection and specialized training to perform a rescue;
  • Prioritizing care when there are several injured;
  • Assessing each victim for responsiveness, airway blockage, breathing, circulation, and medical alert tags;
  • Taking a victim’s history at the scene, including determining the mechanism of injury;
  • Performing a logical head-to-toe check for injuries;
  • Stressing the need to continuously monitor the victim;
  • Emphasizing early activation of EMS;
  • Indications for and methods of safely moving and rescuing victims; and
  • Repositioning ill/injured victims to prevent further injury.

• Responding to Life-threatening Emergencies:
  • Establishing responsiveness;
  • Establishing and maintaining an open and clear airway;
  • Performing rescue breathing;
  • Treating airway obstruction in a conscious victim;
  • Performing CPR;
  • Using an automated external defibrillator (AED);
  • Recognizing the signs and symptoms of shock and providing first aid for shock due to illness or injury;
  • Assessing and treating a victim who has an unexplained change in level of consciousness or sudden illness;
  • Controlling bleeding with direct pressure;
  • Poisoning:
    • Ingested poisons (alkali, acid, and systemic poisons) and role of the Poison Control Center (1-800-222-1222);
    • Inhaled poisons (carbon monoxide; hydrogen sulfide; smoke; and other chemical fumes, vapors, and gases) and assessing the toxic potential of the environment and the need for respirators;
    • Knowledge of the chemicals at the worksite and of first aid and treatment for inhalation or ingestion; and
    • Effects of alcohol and illicit drugs so that the first-aid provider can recognize the physiologic and behavioral effects of these substances;
  • Recognizing asphyxiation and the danger of entering a confined space without appropriate respiratory protection (additional training is required if first-aid personnel will assist in the rescue from the confined space); and
  • Responding to Medical Emergencies:
    • Chest pain;
    • Stroke;
    • Breathing problems;
    • Anaphylactic reaction;
    • Hypoglycemia in diabetics taking insulin;
    • Seizures;
    • Pregnancy complications;
    • Abdominal injury;
    • Reduced level of consciousness; and
    • Impaled object.

• Responding to Non-Life-Threatening Emergencies:
  • Wounds:
    • Assessment and first aid for wounds including abrasions, cuts, lacerations, punctures, avulsions, amputations, and crush injuries;
    • Principles of wound care, including infection precautions; and
    • Principles of body substance isolation, universal precautions, and use of personal protective equipment.
  • Burns:
    • Assessing the severity of a burn;
    • Recognizing whether a burn is thermal, electrical, or chemical and the appropriate first aid; and
    • Reviewing corrosive chemicals at a specific worksite, along with appropriate first aid.
  • Temperature Extremes:
    • Exposure to cold, including frostbite and hypothermia; and
    • Exposure to heat, including heat cramps, heat exhaustion, and heat stroke.
  • Musculoskeletal Injuries:
    • Fractures;
    • Sprains, strains, contusions, and cramps;
    • Head, neck, back, and spinal injuries; and
    • Appropriate handling of amputated body parts.
  • Eye Injuries:
    • First aid for eye injuries; and
    • First aid for chemical burns.
  • Mouth and Teeth Injuries:
    • Oral injuries; lip and tongue injuries; broken and missing teeth; and
    • The importance of preventing aspiration of blood and/or teeth.
  • Bites and Stings:
    • Human and animal bites; and
    • Bites and stings from insects and instruction in first-aid treatment of anaphylactic shock.

First-aid Training Assessments and Updates

Assessment of successful completion of the first-aid training program should include instructor observation of acquired skills and written performance assessments.

First-aid responders may have long intervals between learning and using CPR and AED skills. Numerous studies have shown a retention rate of six to twelve months of these critical skills. OSHA says it is encouraged that a skills review and practice sessions occur at least every six months for CPR and AED skills. Instructor-led retraining for life-threatening emergencies should occur at least annually, according to the agency. Retraining for non-life-threatening response should occur periodically.