In Randy Beaver's 30 years as a safety professional, he has encountered many workplaces without first aid programs. That always has surprised Beaver, president of Barron and Associates Inc., a safety consulting firm in West Lafayette, Ind., because first aid is a required element in a safety and health program.
Prompt, properly administered first aid care can mean the difference between life and death, rapid vs. prolonged recovery and temporary vs. permanent disability. Still, some employers ignore the need to have a first aid program. One reason, Beaver admits, is they do not take OSHA's medical services and first aid standard (29 CFR 1910.151) seriously because it contains barely 100 words:
"The employer shall ensure the ready availability of medical personnel for advice and consultation on matters of plant health. In the absence of an infirmary, clinic or hospital in near proximity to the workplace that is used for the treatment of all injured employees, a person or persons shall be adequately trained to render first aid. Adequate first aid supplies shall be readily available. Where the eyes or body of any person may be exposed to injurious corrosive materials, suitable facilities for quick drenching or flushing of the eyes and body shall be provided within the work area for immediate emergency use."
Employers also are not swayed by relatively insignificant penalties when OSHA cites 1910.151. Of 540 citations in manufacturing from October 2000 through September 2001, the average fine was $665.
As an expert in first aid and CPR, with experience as a paramedic and firefighter, Beaver reminds employers that a first aid program is essential in ensuring that their workers receive immediate medical treatment.
While OSHA's medical and first aid standard is brief, the agency does provide guidance on what should be in a first aid program. Circumstances and hazards in each workplace should determine program details. Among the factors to consider:
- Location and availability of medical facilities or emergency
- services, including response time for external services (should be no more than 4 minutes for life-threatening situations in lieu of on-site responders);
- Accessibility of medical personnel to consult on occupational health issues;
- Types of accidents that could reasonably occur in the workplace;
- Number and location of employees at the plant;
- Industry or local government requirements and other OSHA standards, such as bloodborne pathogens (1910.1030) and first aid in construction (1926.50);
- The level of first aid training employees should receive and which employees should be trained; and
- The first aid supplies that should be available, determined in consultation with an occupational health professional.
First aid/CPR training is available from the American Red Cross, National Safety Council, American Heart Association and other vendors. In addition, Beaver stresses the need for site-specific training for particular hazards and first aid situations.
According to OSHA CPL 2-2.53, "Guidelines for First Aid Training Programs," trainees should have "hands on" skills to quickly respond to acute injury and illness settings likely encountered in their workplaces, such as shock, bleeding, poisoning, burns, temperature extremes, musculoskeletal injuries, bites and stings, medical emergencies (heart attacks, etc.) and confined spaces.
Even if a workplace is in "near proximity" (4 minutes or less) to external emergency services, Beaver suggests that companies have employees trained in first aid and CPR.
"What's amazing to me is the number of calls I get with people asking, 'How do I get out of having to train my people in first aid?' That just irritates me because you are talking about human lives," he says. "You should have somebody capable [of administering first aid]. I don't care how close you are to the fire station or the hospital."
Although OSHA's first aid standard does not specifically mention it, an employer with more than one shift should have someone trained in first aid on each shift. Heidi Eldridge, RN, an occupational health nurse at the 1,600-employee Caterpillar Large Engine Center in Lafayette, Ind., says her plant has 15 to 20 first responders dispersed throughout three shifts. These employees report in when they arrive to work so security knows whom to page in case of an emergency.
An important aspect of training, Beaver says, is learning to make correct decisions during an emergency, including not rendering aid beyond one's training. He suggests that companies hold drills at least once a year for first responders. "They're going to be the leaders the rest of the facility will look to for decision-making in these emergencies."
First Aid Supplies
Employers must determine the type, amount and maintenance of first aid supplies needed at a plant. Store these supplies in a convenient area available for emergency access.
Guidance on first aid kits is available in the American National Standard Institute's (ANSI) Z308.1-1998, "Minimum Requirements for Workplace First Aid Kits." It specifies a "basic fill" of eight items for a first aid kit (see "First Aid Kit Requirements" on page 46) and provides minimum performance criteria for items in the kit, such as cold packs and roller bandages.
ANSI Z308.1-1998, in its performance requirements for containers, describes three types of approved first aid kits. Type I kits are intended for stationary, indoor applications and must provide a means to be mounted in a fixed position. Type II containers are intended for portable indoor use and must have a carrying handle. Type III kits are intended for portable use outdoors and in the mobile industries. Type III containers should be moisture- and corrosion-resistant, have a carrying handle and provide a means to be mounted in a fixed position.
David Carnow, M.D., a consultant in Rockville, Md., who frequently audits medical and occupational safety and health units, suggests that employers inspect each first aid kit at least once a week to ensure that it is in its assigned site and that used, damaged or out-of-date items are replaced. "It is very common for employees to see the medicine cabinet as a place to get free stuff," Carnow says. Some employers have resorted to locking first aid kits to reduce pilfering, he added, but this leaves supplies unavailable until a worker finds the key, wasting valuable time.
The Caterpillar plant has a trauma first aid kit at every fire extinguisher that contains such items as a CPR mask, gloves and a biohazard cleanup kit, Eldridge says. "We don't have a lot of bandages available because it discourages people from coming in and reporting their injuries. It's not that we don't want the employee to have bandages, but it helps when they have to come to us to get them so we can see what's going on with them."
Workplace Guidelines for AED Use
The use of automated external defibrillators (AEDs) is becoming more common as part of workplace medical and first aid programs - and for good reason. About 400 deaths from sudden cardiac arrest are reported to OSHA annually. Administered within 3 minutes, the electric shock of an AED restores the normal rhythm to the victim's heart and can increase survival rates from less than 5 percent to nearly 75 percent, according to OSHA.
The American College of Occupational and Environmental Medicine recommends that employer-sponsored AED programs include several elements:
Establishment of a centralized management system. Use a centralized management system within each organization to determine clear lines of responsibility.
Medical direction and control. Place all programs under the direction and control of an appropriately qualified physician. Ensure compliance with medical control requirements of the administrative code of the state for each site. The program medical director should help develop and approve medical aspects of the program, including providing the written authorization required in most locations to acquire an AED, ensuring provisions are made for appropriate initial and continued training, preparing a written document of program elements and performing a case-by-case review each time an AED is used at the site.
Coordination with local emergency medical services. Communicate information about the program to community emergency medical services providers.
Integration with an overall emergency response plan for each work site. The AED program should be a component of a more general medical emergency response plan, rather than a freestanding program. Inform all employees about the plan, including the proper means for notifying trained internal and community emergency responders in the event of a suspected cardiac arrest.
Assessment of the proper number and placement of AEDs and supplies. When practical, place AEDs in locations throughout a workplace that will allow initiation of resuscitation and use of the AEDs within 5 minutes of recognized cardiac arrest. In addition to the AED, other supplies include bloodborne pathogens responder and clean-up kits, CPR barrier masks with oxygen port, AED responder kits, appropriate portable emergency oxygen equipment and a CPR audio prompting device, all of which should be maintained in optimal working condition.