- Standard Number:
OSHA requirements are set by statute, standards and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at https://www.osha.gov.
U.S. Department of Labor Occupational Safety and Health Administration
MAR 14 1990
Ms. Sally Humphrey Coordinator, Occupational Service Delnor Community Health System 110 Fulton Street Geneva, Illinois 60134
Dear Ms. Humphrey:
This responds to your letter of February 12, addressed to Kenneth J. Yotz, Area Director in North Aurora, Illinois, regarding the request for certification of a first aid course the Delnor Community Health System has compiled.
Enclosed is a draft copy of the guidelines by which the adequacy of the first aid training will be evaluated by our compliance officers in the context of specific workplace inspections. The Agency has ceased the evaluation of the first aid courses in its National Office. Workplace hazards should be evaluated by a competent professional and the first aid training provided to employees must be tailored to the specific needs of the workplace conditions.
Thank you for your interest in occupational safety and health. If we may be of further assistance, please contact us.
Sincerely,
Patricia K. Clark Director Designate Directorate of Compliance Programs
Enclosure
I. BACKGROUND
OSHA has received numerous requests regarding the training of employees in first aid. These questions have focused on the minimum requirements of a first aid training program.
There are several OSHA Standards that refer to those individuals trained in first aid. General Industry Standard 1910.151(b) and Construction Standard 1926.50(c) refer to an individual "trained" in first aid procedures. Both Shipyard Standard 1915.98(a) and Longshoring Standard 1918.96(a) refer to a "qualified attendant." The Diving Standard 1919.410(a)(3) refers to the "American Red Cross Standard Course or equivalent" as fulfilling the required first aid training of dive team members.
The aforementioned standards fail to provide specific guidelines for the adequate evaluation of first aid training programs. The aim of this guideline is to provide the suggested elements in a first aid training program and the means to evaluate the adequacy of first aid training programs.
II. INTRODUCTION
Injuries may represent the single most important public health problem in the United States. Its cost, both personally and monetarily, is staggering. Estimates of injury fatalities exceed 140,000 people in the USA each year, while 1 in 3 people suffer from nonfatal injuries. The direct and indirect costs range from some 75-100 billion dollars per year. These statistics are emphasized here to appreciate the potential impact that trained first aid personnel may have on these outcomes.
Training of individuals in first aid in the united States 15 carried out through a variety of mechanisms. The American Red Cross, through its many local chapters, offers standard and Advanced First Aid courses. The National Safety Council, through Jones and Bartlett Publishers, provides educational materials to train individuals in basic first aid knowledge and skills. Private training programs also exist to train people in first aid. It is hoped that this guideline will help establish the essentials of training programs that should be considered in fulfilling OSHA First Aid requirements.
III. GENERAL COMPONENTS OF A FIRST AID TRAINING PROGRAM
A. Trainees should develop "hands on" skills through the use of manikins and trainee partners during their training.
B. Trainees should be exposed to acute injury and acute illness settings as well as the appropriate response to those settings through the use of visual aids, such as video tape and slides.
C. Training should include a course workbook which discusses first aid principles and first aid responses to settings that require first aid interventions.
D. Assessment of successful completion of the first aid training program should include instructor observed demonstration of acquired skills and written performance assessments.
E. Training duration should allow enough time for particular emphasis on first aid situations likely encountered in particular workplaces.
F. An emphasis on the response to first aid situations should be incorporated throughout the "book knowledge" acquisition process.
G. Basic Adult cardiopulmonary Resuscitation training should be included in the first aid training program.
H. Periodic review and demonstration of first aid skills and knowledge should be done at least as frequently as every three years.
I. Trainees should be provided with adequate instruction on the need for and use of Universal Precautions. This should include:
1) the use of universal precautions for infectious diseases such as AIDS and hepatitis B.
2) a copy of the OSHA standard for blood borne pathogens or information on how to obtain a copy.
3) the meaning of universal precautions, which body fluid are considered potentially infectious, and which are regarded as hazardous.
4) the necessity of keeping gloves readily available and the appropriate use of gloves and other protective equipment.
5) the appropriate disposal of any sharp items or instruments or other items requiring special disposal measures such as blood stained material.
J. Trainees should receive instruction in the principles and performance of:
1) bandaging of the head, chest, shoulder, arm, leg, wrist, elbow, foot, ankle, fingers, toes, and knee.
2) splinting of the arm, elbow, clavicle, fingers, hand, forearm, ribs, hip, femur, lower leg, ankle, knee, foot, and toes.
3) moving and rescuing victims including one and two person lifts, ankle and shoulder pulls, and the blanket pull.
IV. SPECIFIC COMPONENTS
A. Principles of responding to a health emergency
2) interactions with the local emergency medical services system.
3) the principles of triage.
B. Survey of the scene and the victim The training program should include instruction in:
1) the assessment of scenes that require first aid services including general scene safety, likely event sequence, numbers of injured persons, and identification of others able to help at the scene.
2) performing a primary survey of the victim including airway, breathing, and circulation assessments as well as the presence of any bleeding.
3) the techniques and principles of taking a victim history at the scene of an emergency.
4) performing a secondary survey of the victim including assessments of vital signs, skin appearance, head and neck, eye, chest, abdomen, back, extremities, and medical alert symbols.
C. Resuscitation Skills for Aiding the Conscious and Unconscious Victim
4) performing choking assessments and appropriate first aid interventions.
5) assessment of the possibility of a heart attack in a victim and appropriate first aid interventions.
6) the principles of cardiac arrest and the appropriate first aid interventions including performance of cardiopulmonary resuscitation, including the use of face masks normally used by non-medical personnel.
D. Shock and Fainting
The training program should include instruction in the principles and first aid intervention in:
1) shock due to injury. 2) shock due to allergic reactions. 3) the appropriate assessment and first aid treatment of a victim who has fainted.
E. Bleeding and Wounds
1) the types of bleeding including arterial, venous, capillary, external, and internal bleeding.
2) the principles and performance of bleeding control interventions including direct pressure, pressure points, elevation, and pressure bandaging.
3) the assessment and approach to wounds including abrasions, incisions, lacerations, punctures, avulsions, amputations, and crush injuries.
4) the principles of wound care including infection precautions, wounds requiring medical attention, and the need for tetanus injection.
F. Burns
1) the principles of burn assessment and first care, including first degree, second degree, third degree, minor, moderate, and major burn assessments and first aid interventions.
2) the types of burns and the performance of appropriate first aid interventions for these burns. This should include the differentiation of thermal, electrical, and chemical burns and their specific interventions.
Particular attention should be focused upon chemical burns and their first aid care.
G. Specific Injury Sites
The training program should include instruction in the principles and first aid intervention of injuries to the following sites:
1) Head and Neck
a) including skull fractures, concussions, and mental status assessments with particular attention to temporary loss of consciousness and the need for referral to a physician.
b) including the appropriate approach to the management of the individual who has suffered a potential neck injury or fracture.
2. Eye
a) including foreign bodies, and corneal abrasions and lacerations.
b) including chemical burns and the importance of flushing out the eye.
c) including the importance of not applying antibiotics without physician supervision.
3. Nose
4. Mouth and Teeth
a) including oral injuries, lip and tongue injuries, and broken and removed teeth.
5. Chest
a) including rib fractures, flail chest, and penetrating wounds.
6. Abdomen
a) including blunt injuries, penetrating injuries, and protruding organs.
a) including finger/toe nail hematoma, lacerations, splinters, finger avulsion, ring removal, and foreign bodies.
b) including the appropriate handling of amputated fingers, hands, and feet and the need for immediate transfer to appropriate amputation care facilities.
8. Pregnancy
a) including appropriate care for abdominal injury and vaginal bleeding of the pregnant individual.
9. Foreign Objects
a) including the eyes, ears, nose, mouth, cheek, chest, and abdomen.
H. Musculoskeletal Injuries
The training program should include instruction in the principles and first aid interventions of:
1) fractures including open fractures, closed fractures, and the splint of fractures.
2) dislocations, especially of the joints of the upper extremity.
3) joint sprains.
5) the aforementioned musculoskeletal injury instructions should focus on the shoulder, wrist, hand, finger, arm, hip, leg, knee, ankle, and foot.
I. Bites and Stings
The training program should include instruction in the principles and first aid intervention of:
1) bites including human bites, animal bites including rabies, and snake bites.
2) insect bites and stings including spider bites, scorpion stings, tick bites, and hornet and wasp stings.
J. Poisoning
The training program should include instruction in the principles and first aid intervention of:
1) swallowed poisons including interaction with the local Poison Control Center.
2) inhaled poisons including carbon monoxide, carbon dioxide, smoke, and chemical fumes and gases as well as the importance of assessing the toxic potential of the environment to the rescuer and the need for respirators.
This should also include appropriate instruction in the principles of cyanide toxicity.
3) topical poisons including poison ivy, poison sumac, poison oak, and insecticides.
4) drugs of abuse including alcohol, narcotics, cocaine, tranquilizers, and amphetamines.
K. Temperature Extremes
The training program should include instruction in the principles and first aid intervention of:
2) exposure to heat including heat cramps, heat exhaustion, and heat stroke.
L. Medical Emergencies
The training program should include instruction in the principles and first aid intervention of:
1) strokes.
2) diabetic emergencies including diabetic coma, insulin shock, and hypoglycemia.
3) asthma.
M. Evaluation
The training program should have in place a mechanism to evaluate its effectiveness in successfully teaching trainees the course material, such as precourse and postcourse assessments of knowledge and skills.
N. Program Update
The training program must be periodically reviewed with current first aid techniques and knowledge incorporated, and out of date information and procedures deleted. Such a review and revision mechanism must be a part of any satisfactory first aid training program.