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First Up in First Aid

Suppose one of your workers collapsed or was involved in an accident and was bleeding profusely. What would you or your workers do? Of course, you would call for emergency help-but, then what? Vital minutes are ticking away while you are waiting for the arrival of emergency medical personnel. During this time, the first-aid actions taken can be critical in preventing serious complications or even death.

That is why OSHA encourages, and in some cases requires, employers to train at least some of their employees in first-aid techniques. If your workplace is located far away from a hospital or similar facility, OSHA says you must have someone on staff who can perform first aid.

Most companies, though, do have access to a local hospital. Do you still need trained first aid responders in this case? The answer depends on the type of workplace and the hazards typically found there. OSHA uses the following rule of thumb:

If life-threatening injuries can reasonably be expected, trained personnel must be available within four minutes. What this means is that community emergency medical services (EMS) cannot be relied on, since their response time is usually greater than four minutes. In other words, you would need to have trained first-aid responders on staff in most cases.

If serious injuries (not life threatening) can be expected, the response time for trained personnel is extended to 15 minutes. Here is where you must evaluate the availability of local EMS in determining your needs.

Designated first-aid responder

If you determine that you do need a trained first-aid responder, assign those duties to someone on your staff, and make sure that the other employees know who he or she is. The designated first-aid responder must have a current first-aid certificate. Large companies will often maintain a full-time medical staff, while smaller firms will assign these duties to an employee as a secondary job function. OSHA recommends that more than one employee be trained in case the primary responder is unavailable.

Since your first-aid responders will probably be in contact with blood and other bodily fluids, they must be trained in universal precautions and other requirements of OSHA's bloodborne pathogen rule (Sec. 1910.1030). You also need to offer them the hepatitis B vaccination, even if the employee is only performing the first-aid function part-time.

Medical musts

Your first-aid responders should have a well-stocked first-aid kit available at the worksite. OSHA says that you should determine the contents by consulting with a physician. Some industries have specific guidelines for first aid kit locations and contents. Make sure that an inventory of the contents is taken at regular intervals so that supplies don't run out during an emergency.

Sufficient ambulance service should be available to handle any emergency. It is best to plan this ahead of time with your community EMS by having them visit the facility to familiarize themselves with the plant location and access routes. Make sure to have emergency telephone numbers conspicuously located by each telephone.

If corrosive materials, such as acids, are used at your workplace, you must have eyewashes and perhaps even showers available. This equipment should provide large quantities of clean water. Standards for emergency eyewash and shower equipment are governed by ANSI Standard Z358.1-1990.

Training topics

OSHA doesn't mandate specific topics to cover in first-aid training because it will depend on the particular circumstances at your workplace. However, the Agency does offer these guidelines on the elements a compliance officer may look for during an inspection:

• Treatment of shock due to injury or allergic reactions and treatment of a victim who has fainted
• Instruction in types of bleeding and control interventions
• Poisoning principles and treatment, chemical emergency information and antidotes, how and when to contact the nearest poison control center
• Assessing severity of burns and determining intervention for the different types of third-degree burns (especially chemical burns)
• Treatment for temperature extremes-exposure to cold (frost bite and hypothermia) and heat (heat cramps, exhaustion, and stroke)
• Musculoskeletal injury treatment including fractures; dislocations; sprains, strains and cramps; and head, neck, back, and spinal injuries
• Treatment for bites and stings from humans, animals, and insects-including responses to anaphylactic shock
• Handling other medical emergencies, such as heart attack, strokes, asthma attacks, diabetic emergencies, seizures, and emergency pregnancy situations
• Confined space first-aid procedures
• Site of injury training-head and neck, eye, nose, mouth and teeth, chest, abdomen, head, finger, and feet
• While the OSHA regulation simply states that your first aid responders should be “adequately trained,” the Agency expects that you conduct CPR retesting every year and testing of first-aid skills every three years. If you cannot provide the training yourself, there are many community groups, such as the Red Cross, that offer first-aid certification courses. The ultimate goal, of course, is to provide the best interim care for your sick or injured employees until professional help arrives.