While every employer must ensure that employees receive medical attention for workplace injuries, many common injuries don’t require professional medical treatment. Instead, these injuries are often treated by fellow workers trained in first-aid. Who trains these workers, and how much first-aid training do they really need?

Let’s first look at the difference between first-aid and medical treatment. OSHA generally defines “first-aid” as treatment using a nonprescription medication at nonprescription strength, using bandages and gauze pads, applying hot or cold therapy, using finger guards and splints, and other one-time treatments that do not usually require follow-up professional care. Cardiopulmonary resuscitation (CPR) is often taught to first-aid providers in case professional services are not immediately available.

“Medical treatment” means the management and care of a patient to combat disease or disorder. This includes treatment of puncture wounds, fractures, infections and second- and third-degree burns.

First-aid training requirements

Every employer has to provide first-aid and medical treatment. In general industry workplaces, whoever provides first-aid must be trained to administer it (29 CFR 1910.151). Employers at construction sites where a physician or infirmary, clinic or hospital is not reasonably accessible have to make sure someone certified in first-aid training is available at the worksite (29 CFR 1926.50).

Does this mean that employees have to be trained to administer first-aid? Not necessarily. A general guideline is that if there is a hospital, clinic or infirmary for treating injured employees in close proximity (within 15 minutes for injuries that are other than life-threatening), there is no requirement to train employees to provide first-aid. If the close proximity requirement can’t be met, someone (or several people) in the workplace has to be adequately trained to provide first-aid; it can be an employee or a contract service provider.

Find out which employees already have proper first-aid training; for example, any volunteer fire personnel, Coast Guard auxiliary, or auxiliary police officers. Assign this duty to them, provided they are willing.

For most workplaces, OSHA does not specify how many employees should be trained. For fixed power generation, transmission, and distribution facilities, however, there must be enough trained first-aid providers to make sure that each employee exposed to electric shock can be reached within four minutes by a trained person. If this requirement can’t be met (at a remote substation, for example), all employees at the work location have to be trained (29 CFR 1910.269(b)).

First-aid providers in most cases must also be trained to comply with the requirements of the bloodborne pathogens standard (29 CFR 1910.1030).

Essential training elements

The following guidelines describe what OSHA considers the essential elements of a first-aid training program.

Determine delivery method and format. A classroom or worksite setting works well, with participants working in pairs and/or with manikins. Participants should be given a workbook that contains basic first-aid principles and procedures to follow during an emergency. Place emphasis on quick response.

Explain the principles of responding to a health emergency. The trainer should explain:

• Injury and acute illness as a health problem.
• The responsibility to maintain up-to-date contacts with emergency response organizations (e.g., fire, police, ambulance, poison control) and make sure all employees have easy access to the emergency contact list.
• Principles of triage.
• Legal aspects of performing first-aid services.

Survey the scene. Tell or show participants how to assess emergency situations that require first-aid services by determining:

• The general safety conditions at the site (e.g., whether hazardous or dangerous materials are present).
• The likely sequence of events that led to the emergency or injury.
• A quick estimate of the number of persons injured.
• The identities of others able to help at the scene.

Include basic adult CPR. CPR training takes about four hours. Retesting should occur every year.

Describe basic first-aid intervention. Describe and show participants the principles and performance of:

• Bandaging the head, chest, shoulder and extremities (e.g., arm, foot, fingers, toes).
• Splinting the extremities.
• Moving and rescuing victims, including one- and two-person lifts, ankle and shoulder pulls, and the blanket pull.

Follow universal precautions. Participants should know how to follow “universal precautions,” which are methods to protect themselves from exposure to disease spread by blood and other bodily fluids. Training that complies with OSHA’s bloodborne pathogens rule may be required. Training for universal precautions should include:

• The meaning and types of universal precautions, especially their value in protecting against infectious diseases such as AIDS and hepatitis B.
• A review of the OSHA bloodborne pathogens rule or information on how to obtain a copy.
• The necessity of protective equipment and how to use it.
• The appropriate tagging and disposal of any sharp item or blood-soaked material that requires special disposal measures.
• The appropriate management of blood spills.

Maintain first-aid supplies. Make sure each participant understands that he or she might be responsible for the type, amount and maintenance of first-aid supplies.

Evaluate and review. Observe the actions and behavior of each participant during a training exercise or, if possible, during a real emergency. Review first-aid skills and knowledge every three years.

Update. Avoid using outdated material, and keep your program current with the latest first-aid techniques and equipment.

Bloodborne pathogens training

OSHA sets strict guidelines for the handling of human blood to prevent the spread of disease via bloodborne pathogens. Bloodborne pathogens training must be given to all employees with a reasonably anticipated risk of exposure to blood. Designated first-aid providers may reasonably anticipate exposure to blood.

Trainer qualifications. Examples of professionals qualified to give bloodborne pathogens training include infection control practitioners, nurse practitioners, and registered nurses. Non-healthcare professionals include industrial hygienists, epidemiologists, or professional trainers who can demonstrate evidence of specialized training in the area of bloodborne pathogens.

Recordkeeping. The training record for bloodborne pathogens has to contain the dates of the training, the contents or a summary of the training sessions, the names and job titles of all persons attending the training, and the names and qualifications of the persons conducting the training.

SIDEBAR: Training providers

The American Red Cross and many municipal fire, ambulance, or police departments provide first-aid training for private businesses and other employers.