First- Aid Courses

Training for first aid is offered by the American Heart Association,
the American Red Cross, the National Safety Council, and other
nationally recognized and private educational organizations. OSHA
does not teach first-aid courses or certify first-aid training courses
for instructors or trainees.

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.

There are a number of elements to include when planning a firstaid
training program for a particular workplace. These recommendations
are based on the best practices and evidence available at
the time this guide was written. Statistical information is available
from BLS to help assess the risks for specific types of work.
Program elements to be considered are:
1.Teaching Methods
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.
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2. Preparing to Respond to a Health Emergency
The training program should include instruction or discussion in
the following:
Prevention as a strategy in reducing fatalities, illnesses and
injuries;
Interacting with the local 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, panic; how
they interfere with performance; and what to do to overcome
these barriers to action;
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.
3. Assessing the Scene and the Victim(s)
The training program should include instruction in the following:
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 patency
(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;
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Stressing the need to continuously monitor the victim;
Emphasizing early activation of EMS;
Indications for and methods of safely moving and rescuing
victims;
Repositioning ill/injured victims to prevent further injury.
4. Responding to Life-Threatening Emergencies
The training program should be designed or adapted for the specific
worksite and may include first-aid instruction in the following:
Establishing responsiveness;
Establishing and maintaining an open and clear airway;
Performing rescue breathing;
Treating airway obstruction in a conscious victim;
Performing CPR;
Using an 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. Role of
the Poison Control Center (1-800-222-1222);
• Inhaled poisons: carbon monoxide; hydrogen sulfide; smoke;
and other chemical fumes, vapors, and gases. 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;
• 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.
Responding to Medical Emergencies
• Chest pain;
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• Stroke;
• Breathing problems;
• Anaphylactic reaction;
• Hypoglycemia in diabetics taking insulin;
• Seizures;
• Pregnancy complications;
• Abdominal injury;
• Reduced level of consciousness;
• Impaled object.
5. Responding to Non-Life-Threatening Emergencies
The training program should be designed for the specific worksite
and include first-aid instruction for the management of the following:
Wounds
• Assessment and first aid for wounds including abrasions, cuts,
lacerations, punctures, avulsions, amputations and crush injuries;
• Principles of wound care, including infection precautions;
• 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;
• Reviewing corrosive chemicals at a specific worksite, along
with appropriate first aid.
Temperature Extremes
• Exposure to cold, including frostbite and hypothermia;
• 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;
• Appropriate handling of amputated body parts.
Eye injuries
• First aid for eye injuries;
• First aid for chemical burns.
Mouth and Teeth Injuries
• Oral injuries; lip and tongue injuries; broken and missing teeth;
• The importance of preventing aspiration of blood and/or teeth.
Bites and Stings
• Human and animal bites;
• Bites and stings from insects; instruction in first-aid treatment
of anaphylactic shock.

Automated External Defibrillators

With recent advances in technology, automated external defibrillators
(AEDs) are now widely available, safe, effective, portable, and
easy to use. They provide the critical and necessary treatment for
sudden cardiac arrest (SCA) caused by ventricular fibrillation, the
uncoordinated beating of the heart leading to collapse and death.
Using AEDs as soon as possible after sudden cardiac arrest, within
3-4 minutes, can lead to a 60% survival rate.3 CPR is of value
because it supports the circulation and ventilation of the victim
until an electric shock delivered by an AED can restore the fibrillating
heart to normal.
All worksites are potential candidates for AED programs
because of the possibility of SCA and the need for timely defibrillation.
Each workplace should assess its own requirements for an
AED program as part of its first-aid response.
A number of issues should be considered in setting up a
worksite AED program: physician oversight; compliance with local,
state and federal regulations; coordination with local EMS; a
quality assurance program; and a periodic review, among others.
The OSHA website at www.osha.gov or the websites of the
American College of Occupational and Environmental Medicine at
www.acoem.org, the American Heart Association at www.americanheart.
org, the American Red Cross at www.redcross.org,
Federal Occupational Health at www.foh.dhhs.gov, and the
National Center for Early Defibrillation at www.early-defib.org can
provide additional information about AED program development.
10.

First- Aid Supplies

It is advisable for the employer to give a specific person the responsibility
for choosing the types and amounts of first-aid supplies and
for maintaining these supplies. The supplies must be adequate,
should reflect the kinds of injuries that occur, and must be stored in
an area where they are readily available for emergency access. An
automated external defibrillator (AED) should be considered when
selecting first-aid supplies and equipment.
A specific example of the minimal contents of a workplace firstaid
kit is described in American National Standards Institute ANSI
Z308.1 - 2003, Minimum Requirements for Workplace First Aid Kits.
The kits described are suitable for small businesses. For large
operations, employers should determine how many first-aid kits
are needed, and if it is appropriate to augment the kits with
additional first-aid equipment and supplies.
Employers who have unique or changing first-aid needs should
consider upgrading their first-aid kits. The employer can use the
OSHA 300 log, OSHA 301 reports or other records to identify the
first-aid supply needs of their worksite.Consultation with the local fire and rescue service or emergency medical professionals may be
beneficial. By assessing the specific needs of their workplaces,
employers can ensure the availability of adequate first-aid supplies.
Employers should periodically reassess the demand for these
supplies and adjust their inventories.

The Risks

There were 5,703 work-related fatalities in private industry in 2004.
In that same year there were 4.3 million total workplace injuries
and illnesses, of which 1.3 million resulted in days away from
work.
Occupational illnesses, injuries and fatalities in 2004 cost the
United States’ economy $142.2 billion, according to National
Safety Council estimates. The average cost per occupational
fatality in 2004 exceeded one million dollars. To cover the costs to
employers from workplace injuries, it has been calculated that
each and every employee in this country would have had to
generate $1,010 in revenue in 2004.2
Sudden cardiac arrest (SCA) may occur at work. According to
recent statistics from the American Heart Association, there are
250,000 out-of-hospital SCAs annually. The actual number of SCAs
that happen at work are unknown. If an employee collapses
without warning and is not attended to promptly and effectively,
the employee may die. Sudden cardiac arrest is caused by
abnormal, uncoordinated beating of the heart or loss of the
heartbeat altogether, usually as a result of a heart attack.
Workplace events such as electrocution or exposure to low oxygen
environments can lead to SCA. Overexertion at work can also
trigger SCA in those with underlying heart disease.
The outcome of occupational illnesses and injuries depends on
the severity of the injury, available first-aid care and medical
treatment. Prompt, properly administered first aid may mean the
difference between rapid or prolonged recovery, temporary or
permanent disability, and even life or death.

Obtaining and evaluating information about the injuries, illnesses
and fatalities at a work site are essential first steps in planning a
first-aid program. Employers can use the OSHA 300 log, OSHA
301 forms, their Workers’ Compensation insurance carrier reports
or other records to help identify the first-aid needs for their
businesses. For risk assessment purposes, national data for
injuries, illnesses and fatalities may be obtained from the Bureau
of Labor Statistics (BLS) website at www.bls.gov/iif.