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close this bookThe Organization of First Aid in the Workplace (ILO, 1999, 70 p.)
View the document(introduction...)
View the documentPreface
Open this folder and view contents1. Why first aid and the organization of first aid?
View the document2. What first aid must do
Open this folder and view contents3. Responsibilities and participation
Open this folder and view contents4. How first aid is organized
Open this folder and view contents5. The training of first-aid personnel
View the document6. Relation to other health-related services
Open this folder and view contentsAnnexes
View the documentOccupational Safety and Health Series
View the documentBack cover

(introduction...)

OCCUPATIONAL SAFETY AND HEALTH SERIES No. 63


INTERNATIONAL LABOUR OFFICE · GENEVA

Copyright © International Labour Organization 1999
First published 1989
Second impression 1999

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ILO; Dieterich, B.H.
Organization of first aid in the workplace
Geneva, International Labour Office, 1989. (Occupational Safety and Health Series, No. 63.)
/Guide/,/First aid/,/Occupational health service/,/Safety committee’s/,/Industrial physician’s/,/Medical equipment/,/Training of first-aid/medical personnel/,/Germany, Federal Republic/,/New Zealand/,/UK/,/Reference’s/. 13.04.2
ISBN 92-2-106440-9
ISSN 0078-3129

ILO Cataloguing in Publication Data

The designations employed in ILO publications, which are in conformity with United Nations practice, and the presentation of material therein do not imply the expression of any opinion whatsoever on the part of the International Labour Office concerning the legal status of any country, area or territory or of its authorities, or concerning the delimitation of its frontiers.

The responsibility for opinions expressed in signed articles, studies and other contributions rests solely with their authors, and publication does not constitute an endorsement by the International Labour Office of the opinions expressed in them.

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Printed by the International Labour Office, Geneva, Switzerland

______________________________________________________________________

The International Programme for the Improvement of Working Conditions and Environment (PIACT) was launched by the International Labour Organization in 1976 at the request of the International Labour Conference and after extensive consultations with member States.

PIACT is designed to promote or support action by member States to set and attain definite objectives aiming at “making work more human”. The Programme is thus concerned with improving the quality of working life in all its aspects: for example, the prevention of occupational accidents and diseases, a wider application of the principles of ergonomics, the arrangement of working time, the improvement of the content and organization of work and of conditions of work in general, and a greater concern for the human element in the transfer of technology. To achieve these aims, PIACT makes use of and coordinates the traditional means of ILO action, including:

- the preparation and revision of international labour standards;

- operational activities, including the dispatch of multidisciplinary teams to assist member States on request;

- tripartite meetings between representatives of governments, employers and workers, including industrial committees to study the problems facing major industries, regional meetings and meetings of experts;

- action-oriented studies and research; and

- clearing-house activities, especially through the International Occupational Safety and Health Information Centre (CIS) and the Clearing-house for the Dissemination of Information on Conditions of Work.

This publication is the outcome of a PIACT project.

______________________________________________________________________

Preface

The incidence of occupational injury or illness has remained high throughout the world in spite of efforts to make work increasingly safe and healthy. In 1997 it was estimated that each year 330,000 workers meet their deaths and 250 million are injured in occupational accidents, while in the late 1980s it had been estimated that 180,000 workers were killed and 110 million injured. The human suffering, the social problems and the economic costs implicit in these figures are very large. However, the figures can hardly express the consequences of an accident for the worker and his or her family. If first aid is immediately available following an accident, these consequences can be reduced. Effective first aid can enhance the chances for survival, minimize the duration of medical treatment and reduce permanent health impairment.

The Occupational Safety and Health Convention (No. 155), and Recommendation (No. 164), adopted by the International Labour Conference in 1981, are major instruments for making work safer. The Occupational Health Services Convention (No. 161), and Recommendation (No. 171), both adopted in 1985, provide for the progressive development of occupational health services for all workers. First-aid and emergency treatment in cases of accident and indisposition of workers at the workplace are listed as an important part of the functions of these services.

National legislation concerning first aid, and institutional arrangements to supervise its implementation in all enterprises, are essential. While the responsibility for organizing first aid lies with the employer, it is necessary that the workers should participate. This aspect of participation should be seen in the context of primary health care, which gives the individual an important role in the protection and the promotion of his or her own health.

First aid is part of total health care for workers. In practice, it will depend to a large extent on persons available in the immediate vicinity of the accident, and who have been trained to perform specific first-aid tasks, supported by medical resources whenever necessary. This concept, which is also consistent with the principle of primary health care, assumes that first aid is an immediate, though initial, intervention followed by specialized medical care whenever needed.

As many countries have organized first aid over a long period, substantial experience of its technical, medical and organizational aspects is available. This monograph shows, in the light of this experience, how first aid may be organized, and reviews how an organization for first aid may be designed taking into account the many factors involved. Information is also provided on first-aid personnel, including training; the necessary equipment, supplies and facilities; and the arrangements required beyond first aid for accidents that call for specialized medical care.

The International Labour Office wishes to thank Dr. B. H. Dieterich for his contribution to the preparation of this monograph. It was prepared with the intention of providing information, guidance and basic reference materials to public authorities, employers, workers, safety and health committees and in general to all persons in charge of occupational safety and health at the enterprise level.

1.1. What is first aid?

The most common view holds that first aid is the immediate and temporary care given to a victim of an accident, before a physician or other qualified health personnel arrives to provide treatment. The best example of first aid in the light of this definition is the care provided to the victim of a traffic accident with the objective of saving the life of the injured person. This involves rapid and simple measures, such as clearing the air passageway or stopping severe bleeding which might otherwise lead to death. However, in occupational health practice, first aid covers more than the immediate aid to a person in a life-threatening situation. Although saving lives will always be its primary purpose, the broader view of first aid will be presented in this document, since it corresponds to the practice in many countries.

The first aid administered to the victim of a serious accident at work is no different from that administered to the victim of a serious traffic accident. First aid is the immediate and temporary care to the victim of an accident, with the aim of preventing or reducing an acute threat to the life or health of the victim. First aid in this case is the application of immediate measures on the accident site by a person who may not be a physician but is trained in first aid, has access to the necessary equipment and supplies, and knows what must be done to ensure that professional medical care will follow his or her intervention. The immediate availability of a physician or otherwise medically qualified person would of course be highly desirable in the case of a severe injury; in reality, however, there is usually little likelihood of this. Even where highly mobile emergency services have been established, their arrival on the scene of the accident may simply take too long to be able to cope with acute life-threatening situations.

When a severe accident happens, the first few minutes may be decisive for survival (see figure 1). For instance, where respiratory arrest follows an electric shock, there is still, after three minutes, a 75 per cent chance of complete recovery if artificial respiration is established. After four minutes, the chances are only 50 per cent, and after five minutes no more than 25 per cent.1 The sooner help is available, the greater the chance of complete recovery and the prevention of possible sequelae. Likewise, the sooner help is provided, the shorter the treatment. The chances of survival drop rapidly if immediate care is not administered after vital functions have been impaired, following an accident or sudden illness. First aid can prevent this from happening.


Figure 1. Relationship between the survival rate and the time elapsed until first aid after the arrest of vital functions or their severe impairment

Source: Klaus J. Gatz: Erste Hilfe im Betrieb, Hauptverband der gewerblichen Berufsgenossenschaften, Zentralstelle fallverhund Arbeitsmedizin (Cologne, Carl Heymanns Verlag KG, 1985).

1.2. The need to prevent accidents

We must keep in mind that the effective approach to the protection of the health and life of workers against the consequences of an accident at work is the prevention of the accident.

Prevention is always better than cure: a widow’s pension cannot replace the dead husband, nor will any compensation restore sight to a person who remains blind following an accident at work. Yet accidents cannot be completely ruled out, and first aid should be considered an integral part of the overall approach to safeguarding the lives of workers and to reducing their residual health impairment or disability to the lowest possible level.

In accident prevention, management’s involvement and workers’ participation are essential to reducing the frequency and severity of accidents. All workers should be given information on hazards at work and on their prevention. This information must be provided by the employer, and workers must observe and comply with safety instructions given to them. Progress towards the prevention of accidents rests on a combination of preventive measures taken by the employer and of safe behaviour by workers.

This monograph will not describe what accidents are, and how they occur, nor what is safe or what is a hazard or a risk at work. It is nevertheless noteworthy from various sources2 that accidents at work claim many lives each year and cause severe loss of income and production. The causes, frequency and severity of accidents vary greatly among industries, occupations and countries, and between industrialized and developing countries. Accidents in general are more frequent in smaller enterprises than in larger ones; accident rates are higher in developing than in industrialized countries; and more accidents are reported in construction, mining, diving, fishing and agriculture than in manufacturing.

1.3. If an accident occurs

Despite preventive action, accidents do happen. This is unfortunate, but true at many workplaces. Most injuries at work are not severe or life-threatening. This fact should not be overlooked when first aid is discussed. It is clear that when a hand is severed in an accident with a chainsaw, rapid first aid to stop the bleeding and deal with shock is imperative, and further emergency treatment should follow as soon as possible. However, for one such case there are many minor cases, for example, persons suffering simple cuts or contusions which need unsophisticated treatment (for example, disinfection, sterilized dressing, checking that immunization against tetanus is valid). Immediately available first aid is an essential service in situations where no health personnel are available. However, it must be emphasized that professional medical care may still be needed on the day or the days that follow. First-aid personnel must clearly point out that injured persons should always take it upon themselves to consult a physician so that the necessary treatment is given under medical supervision.

The case described in the preceding paragraph is consistent with the primary health care approach referred to in the preface.3 This involves the treatment of a common injury by an immediately available first-aider, health education and the acceptance by the individual of responsibility for his or her own health, including possible referral for more advanced medical care. The approach emphasizes the need to combine the delivery of first aid with advice and information to the worker on follow-up actions and professional medical care required.

Some generalizations may be made regarding accidents at work and the severity of injuries. It appears that the most common causes of injuries are found in rather ordinary events like stumbling, falling, the handling of materials, the use of tools or being struck by falling objects. However, when planning for first aid, primary attention should be paid to manifestations in the victims of an accident rather than the accident itself. These include, in particular, crushed and broken bones and joints, bleeding, shock, respiratory arrest, cardiac arrest, burns including chemical burns, other skin injuries or eye injuries. Therefore, first aid needs specific knowledge about these common manifestations.

1.4. An organized approach to first aid

First aid cannot be planned in isolation. Other measures to protect and promote the health and safety of the workers must be taken into account. Consideration must be given to the availability and proximity of medical resources. First aid requires an organized approach involving people, equipment and supplies, facilities, support and arrangements for the removal of victims and non-victims from the site of an accident to safe shelter.

Sometimes the question is raised: What else can first aid do? Being part of workers’ total health care in an enterprise, should first aid also deal with minor illnesses? Should it provide workers with essential information on their health and safety? Should it help in identifying workplaces where accidents are most likely to occur? If an occupational health service exists, these will be part of its functions. If none exists, other arrangements will be necessary to fulfil these and other functions. This is particularly important in small enterprises and isolated workplaces. Trained first-aiders will be of great help in cases of common injury or illness. In some countries, first-aid personnel may provide essential treatment of minor indispositions which would otherwise receive no treatment.

The organization of first aid in small enterprises is a topical subject which raises a variety of issues. Efforts should be made to clarify it, even though this may be difficult.

From a medical and from an ethical point of view, a burn, a broken leg or a myocardial infarction needs the same care irrespective of whether it happens in a large or in a small enterprise. From a practical point of view, it is obvious that the manner in which assistance is provided will be different. How can the ethical and the practical points of view be reconciled?

One approach, which is described in this publication, is to recognize that there is a continuum leading from the knowledge of the occupational hazards, their prevention, first aid, emergency treatment, further medical care and specialized treatment, and through to readaptation and reinsertion at work. First aid itself should be seen as a process which includes:

(a) the identification of the harm incurred: How serious is the injury? For example, does the pain correspond to a muscular strain which will disappear in a few hours or does it suggest a hernia which will need a rapid surgical operation?

(b) first aid itself: What should be done now? In an emergency the reply may be straightforward, but in most cases it is not obvious; a very cautious attitude is necessary;

(c) call(s) for further assistance:

(i) means of communication and transport: Contact the right person(s) promptly;

(ii) pre-arranged “referral system”: Who should be contacted in which case? This is one of the main issues.

Although the quality of the assistance given to those taken ill or injured at work in a large or a small enterprise should not be different, it seems acceptable that the part of the means for assistance which should be readily available in the enterprise, and the part which should be made available through a pre-arranged “referral system”, may very well depend on the estimated frequency of accidents and their potential severity.

An example will clarify this point: fire explosion and severe burns may occur in a refinery, as well as in the workshop of a baker with one apprentice. In the case of a refinery or of a chemical plant with several thousand workers, there will be a doctor or a nurse on shift and an ambulance may be on stand-by. In the case of a bakery, there should be a telephone with telephone numbers of the fire brigade, an ambulance service and the police (who are often qualified first-aiders). If there is no telephone, it may be the baker’s wife who receives instructions to send one of the children to call a friend who can ensure rapid transportation to the nearest clinic.

Whatever the degree of sophistication or the absence of facilities, first aid should be organized. This means that the sequence of actions to be taken in the case of an unforeseen event (and in the case of an emergency in particular) must be determined in advance. This must be done taking due account of existing and potential occupational and non-occupational hazards or occurrences, as well as ways of obtaining immediate and appropriate assistance. There is a very wide range of situations which varies not only with the size of the enterprise but also with its location (in a town or a rural area) and with the development of the health system and of labour legislation at the national level. If nobody in the enterprise is qualified, the worker should be taken to a nurse, a doctor, or the hospital, or a doctor or a nurse should be called for (decision based on common sense). If a trained first-aider (or a traditional healer trained in first aid) is available, the following choices are possible:

(a) serious cases: the first-aider acts according to the training received and ensures that medical assistance is provided in the shortest possible time (he or she accompanies the patient);

(b) minor cases: the first-aider acts within the limits set during training and advises systematically whether medical advice should be sought;

(c) many cases are neither major nor minor - and here lies the difficulty. It is advisable neither to dramatize the situation (people will not take further advice seriously) nor to take it lightly; the first-aider should never be a substitute for the doctor; advice to seek further medical assistance (including arranging an appointment with a doctor as appropriate) should be systematic, and this points to the need for an appropriate pre-established “referral system”.

In order to promote the organization of first aid in small-scale enterprises, several approaches can be used. In particular, the problem should be approached from two angles:

(a) public health: it would be an advantage if a large proportion of the population were to be familiar with life-saving practices such as the mouth-to-mouth resuscitation method and how to control bleeding; this can be promoted in various ways (even in developing countries) including the use of the media (e.g. newspapers, radio and television), primary health-care networks, and maternal and child health care, making a first-aid course compulsory when obtaining a driving licence, etc. The public health approach may also be used to immunize workers against tetanus and to inform them of health risks due to infection;

(b) labour regulations: as soon as an enterprise is of a certain size, labour regulations may make compulsory the presence of a person trained in first aid (examples are given in the following chapters); this person will then act according to instructions given during training. To have trained first-aiders available in enterprises where 20 workers or more are present seems a suitable objective; this would represent a network of knowledgeable persons which could even be used by smaller enterprises located in the vicinity.

As regards the organization of first aid, the main issue is to plan in advance who should be called, when and how. This is a basic question, and there is no excuse for not answering it. It is not a technical matter, there are plenty of opportunities to get advice and there is time to plan in advance. The reply may be very simple: a telephone and a few telephone numbers posted prominently next to it. It may be more sophisticated: the telephone number of the nurse, the doctor, the fire brigade, the electrical department, the hospital, a poison control centre, a specialized centre for severed fingers or for hand surgery, the ambulance service (including a specially equipped ambulance in case of a cardiac arrest), and so on.

Furthermore, some countries have established an emergency network accessible through a single standardized telephone number for the whole country. The call to this number is usually free of charge. In addition to its simplicity and rapidity, this type of organization has the advantage of quickly mobilizing appropriate assistance from a variety of bodies and emergency services (fire brigades, police, poison centres, hospitals, ambulances, etc.).

The system may include both services within the enterprise and bodies outside it. There are several critical points:

- when to call (instructions to a sufficient number of persons, verbally and in writing);

- where to call (instructions given clearly and posted in a prominent place);

- how to call (preferably several alternative methods should be arranged).

This may be called a pre-established “referral system”. It must be planned irrespective of the size of the enterprise. Such a system should also exist at the level of the family.

Unfortunately, people tend to think that “accidents happen to others”. The question “What should I do in the case of an accident?” is not raised, and consequently there is no reply. When an accident does occur, there is no pre-established system and first aid cannot be provided in an optimal manner. Then come the excuses: the small size of the enterprise, the lack of resources, the lack of qualified personnel, the lack of medical facilities, and so on.

To sum up, it is essential to ask the question “What will I do if an accident happens?” and to write down the reply or give verbal instructions (if the person cannot write) to ensure appropriate action in an emergency.

Notes

1 Klaus J. Gatz: Erste Hilfe im Betrieb, Hauptverband der gewerblichen Berufsgenossenschaften, Zentralstelle fallverhund Arbeitsmedizin (Cologne, Carl Heymanns Verlag KG, 1985).

2 ILO: World Labour Report 2 (Geneva, 1985). Editor’s note: A more recent estimate is provided in Kofi A. Annan: “Occupational health and safety: A high priority on the global, international and national agenda”, in Asian-Pacific Newsletter on Occupational Health and Safety (Bangkok, ILO), 1997, No. 4, p. 59.

3 World Health Organization: Primary health care, Report of the International Conference on Primary Health Care, Alma Ata, USSR, 1978 (Geneva, 1978).

2. What first aid must do

In Chapter 1, the need for first aid and for an organized approach to first aid was discussed. No matter how satisfactory the working conditions, there will always be the possibility that an accident will occur and that immediate help will be needed before the arrival of medically qualified persons. The frequency of accidents will depend on many factors, including the number of workers and the standard of safety in the enterprise, and the occupational hazards at the workplace. Other factors should also be taken into account in the organization of first aid: the type of work, the operations carried out and the kinds of injury encountered; the size and layout of the enterprise; the availability and the capacity of the occupational health service and the public health service. This will be discussed in Chapter 4.

It is expected that “what first aid must do” will vary from country to country, because of differences in labour laws, health care systems, occupational health infrastructure, and so on. Requirements concerning first aid and programmes to train first-aid personnel also differ. Based on the experience available, the tasks to be performed by first aid may be summarized as follows:

(a) to protect the victim against further harm;

(b) to make a quick initial assessment of the need to call for further help and medical assistance, and to ascertain that this need is fulfilled as rapidly as possible;

(c) to provide immediate and temporary care with the aim of saving life and minimizing the consequences of injury until help from medically qualified personnel is available;

(d) to provide essential treatment of minor injuries which would otherwise receive no treatment.

In the light of these tasks, a number of requirements must be met. First aid should:

(a) be available and operate at the worksite;

(b) be based on human resources and equipment, supplies and facilities available in or near the locations with a high potential for accidents;

(c) have access to means of communication and emergency transportation;

(d) be recorded and reported so as to provide information for follow-up medical care, improvement of safety conditions at work and workers’ compensation;

(e) contribute to the health and safety behaviour of workers and thus the prevention of accidents.

(introduction...)

First aid must be considered as part of working conditions and sound management, just as making work safe is an essential measure in this respect. The employer must be responsible for organizing first aid and ensuring that it is provided. There may, however, be special situations where other forms of organization may derive from existing patterns of the health services. Each country will have to choose the best method of defining this responsibility and of setting out specific requirements.

Experience in countries where first aid is strongly established suggests that the best way to ensure an effective system is to make it mandatory by legislation. In countries which have chosen this approach, the main requirements are set out in specific first-aid legislation or, more commonly, in national labour codes or similar regulations. In these cases, subsidiary regulations contain more detailed provisions. In most cases, the overall responsibility of the employer for providing and organizing first aid is laid down in the basic enabling legislation. Some examples of first-aid legislation are given in Annex I. Unfortunately, still today, the legal basis for organizing and providing first aid is weak in many countries. This should be corrected.

The responsibility of the employer needs definition in specific terms. Subsections 3.1.1 to 3.1.3 list the principal responsibilities which the employer is usually asked to meet (more details are contained in Chapters 4 and 5).

3.1.1. Equipment, supplies and facilities

(1)

Equipment to rescue the victim at the site of the accident so as to prevent further harm (e.g. in the case of fires, gasing, electrocution).



(2)

First-aid boxes, first-aid kits or similar containers, with a sufficient quantity of the materials and appliances required for the delivery of basic first aid.



(3)

Specialized equipment and supplies which may be required in enterprises presenting specific or unusual risks at work.



(4)

An adequately identified first-aid room or a similar facility where first aid can be administered.



(5)

Provision of means of evacuation and emergency transportation of the injured persons to the first-aid facility or the sites, where further medical care is available.



(6)

Means of giving an alarm and communicating an alert.

3.1.2. Human resources

(1)

Selection, training and retraining of suitable persons for administering first aid, their appointment and location at critical sites throughout the enterprise, and the assurance that they are permanently available and accessible.



(2)

Retraining, including practical exercises simulating emergency situations, with due account given to specific occupational hazards in the enterprise.

3.1.3. Other

(1)

Establishment of a plan, including links between the relevant health or public health services, with a view to the delivery of medical care following first aid.



(2)

Education and information of all workers concerning the prevention of accidents and injuries, and the actions workers must themselves take following an injury, e.g. an immediate shower after a chemical burn.



(3)

Information on the arrangements for first aid, and the periodic updating of this information.



(4)

Posting of information, visual guides, (e.g. posters) and instructions about first aid, and plans with a view to the delivery of medical care after first aid.

The employer must seek advice in organizing first aid, especially from the occupational health and public health services, the labour inspectorate, plant managers and relevant non-governmental organizations, as well as from the workers themselves, who in many cases can provide essential information or sound opinions on the likelihood of accidents in specific situations.

The employer should also study the potential risks to which workers are exposed and should analyse the potential for accidents as a basis for planning and organizing first aid (see Chapter 4). The employer may be required to file a specific report on the provisions made for first aid,1 or to submit to the verification of conformity with rules for first aid, although, as may be expected, the specific arrangements for this vary greatly from one country to another. The labour inspectorate is usually involved either directly or through existing institutions which may act on its behalf.

3.2. Workers’ participation

Without full participation of the workers, first aid cannot be effective. Workers’ participation can take many forms, some of which are as follows:

Workers may need to cooperate in rescue and first-aid operations, if this is demanded by rescue or first-aid personnel or by occupational safety and health staff. They should, in particular, assist in transporting victims as required. Workers do not usually consider that such participation is beyond their duty.

All workers should be informed about first-aid arrangements. The employer should organize briefings for all workers. The following are essential parts of the briefing:

- the organization of first aid in the enterprise;

- colleagues who have been appointed as first-aid personnel;

- ways in which information about an accident should be communicated, and to whom;

- location of the first-aid box;

- location of the first-aid room;

- location of the rescue equipment;

- what the workers must do in case of an accident;

- location of the escape routes;

- workers’ actions following an accident;

- ways of supporting first-aid personnel in their task.

Written instructions about first aid, preferably in the form of posters, should be displayed by the employer at strategic places within the enterprise. Workers should read these instructions carefully and seek clarification if the information provided is unclear or seemingly inadequate. They should make suggestions, based on their knowledge of the workplace, as to what additional information may usefully be communicated to all workers.

Usually many workers are willing to be trained in first aid and to be registered or appointed as first-aid personnel. However, some have reasons not to do so because of their own health, or because of emotional problems when dealing with the casualty of an accident. The employer should explain to the workers the reasons why they are being selected for first aid. Persons selected have a right to insist that, if they are appointed, the employer must do whatever necessary to protect their health and safety from any hazards to which they may be exposed as first-aid personnel under conditions of higher, unusual or special risks.2

Workers should report any accident to which they are exposed, irrespective of how serious the injury seems to be at first sight. All employees should adopt safe behaviour standards at work, and make use of the information provided to them by the employer on occupational safety and health, including first aid, with a view to contributing to the prevention of future accidents.

Notes

1 P. Barr“Le secourisme en milieu de travail”, in Cahiers de Notes Documentaires - Sritt hygi du travail (Paris), No. 96, 1979.

2 For example, guidelines for AIDS and first aid in the workplace are being prepared by the World Health Organization in cooperation with the ILO. Editor’s note: Guidelines on AIDS and first aid in the workplace, WHO AIDS Series No. 7 (Geneva, WHO, 1990) has since been published.

(introduction...)

It has been pointed out that employers, as part of their duty to provide and organize first aid, must decide on the first-aid facilities which each situation may require. This decision can only be based on an assessment of the potential risks of each workplace, considering all factors which may contribute to the need for, and the effectiveness of, first aid (see subsections 4.1.1 to 4.1.4). There is no substitute for such an assessment.

As regards this assessment, the employer could benefit from advice received from the parties involved, such as the public health and occupational health services, the health and safety committee and the safety representatives, the labour inspectorate, managers and the workers themselves.

4.1.1. Type of work and associated risks

The risks of injury vary greatly from one enterprise and from one occupation to another. Even within a single enterprise, such as a metalworking firm, different risks will exist depending on whether the worker is engaged in the handling and cutting of metal sheets (where cuts are frequent), welding (with the risk of burns and electrocution), the assembly of parts, or metal plating (which has the potential for poisoning and skin injury). The risks associated with one type of work will vary according to many other factors, such as the design and the age of the machinery used, the maintenance of the equipment, the safety measures applied and their regular control.

The ways in which the type of work or the associated risks influence the organization of first aid have been fully recognized in most legislation concerning first aid. The equipment and supplies required for first aid, or the number of first-aid personnel and their training, may vary in accordance with the type of work and the associated risks.

Countries use different models for classifying the type of work and the associated risks for the purpose of planning first aid and deciding whether higher or lower requirements are to be set. A distinction is sometimes made between the type of work and the specific potential risks. Some of the legislation listed in Annex I may serve as examples.

Type of work or enterprise

A distinction may be made between:

- low risk, e.g. in offices or shops;

- higher risk, e.g. in warehouses, farms and in some factories and yards;

- specific or unusual risks, e.g. in steel making (especially when working on furnaces), coking, non-ferrous smelting and processing, forging, foundries; shipbuilding, quarrying, mining or other underground work; work in compressed air and diving operations; construction, lumbering and woodworking; abattoirs and rendering plants; transportation and shipping; most industries involving harmful or dangerous substances.

Potential risks

Even in enterprises which seem clean and safe, many types of injuries can occur. Serious injuries may result from falling, striking against objects or contact with sharp edges or moving vehicles. All these may be found even in small enterprises, and the organization of first aid is necessary at all workplaces.

The specific requirements for first aid will vary depending on whether the following might be expected (see also Chapter I):

- falls;
- serious cuts, the severing of limbs;
- crushing injuries and entanglements;
- high risks of spreading fire and explosions;
- intoxication by chemicals at work;
- other chemical exposure;
- electrocution;
- exposure to excessive heat or cold;
- lack of oxygen;
- exposure to infectious agents, animal bites and stings.

The above is only a general guide. The detailed assessment of the potential risks in the working environment helps greatly to identify the need for first aid.

4.1.2. Size and layout of the enterprise

First aid must be available in every enterprise, regardless of size, taking into account that the frequency rate of accidents is often inversely related to the size of the enterprise and that high-risk activities are not characteristic of larger enterprises alone.

In larger enterprises, the planning and the organization of first aid can be more systematic. This is because individual workshops have distinct functions and the workforce is more specifically deployed than in smaller enterprises. Therefore the equipment, supplies and facilities for first aid, and first-aid personnel and their train- ing, can normally be organized more precisely in response to the expected risks in a large enterprise than in a smaller one. The size of the enterprise also influences the cost of first aid per worker, as well as the preparations for evacuation and the transportation of injured persons when subsequent medical care is required.

Nevertheless, first aid can also be effectively organized in smaller enterprises. This important issue was examined in some detail in Chapter 1, and Annex II gives further details.

Countries use different criteria for the planning of first aid in accordance with the size of the enterprise, and no general rule can be established because of the many other variables which must be considered simultaneously. In the United Kingdom,1 enterprises with fewer than 150 workers and involving low risks or enterprises with fewer than 50 workers with higher risk are considered small, and different criteria for the planning of first aid are applied in comparison with enterprises where the number of workers present at work exceeds these limits. In the Federal Republic of Germany,2 the approach is different: whenever there are fewer than 20 workers expected at work, one set of criteria would apply; if the number of workers exceeds 20, other criteria will be used. In Belgium,3 one set of criteria applies to industrial enterprises with fewer than 20 workers, a second to those with between 20 and 500 workers and a third to those with 500 workers and more. These three sets of criteria apply to non-industrial establishments with fewer than 50, between 50 and 1,000, and 1,000 workers or more, respectively.

4.1.3. Other enterprise characteristics

The configuration of the enterprise (i.e. the site or sites where the workers are at work) is an important variable in the planning and organization of first aid. An enterprise might be located at one site or spread over several sites either within a town or a region, or even a country. Workers may be assigned to areas away from the enterprise’s central establishment, such as in agriculture, lumbering, construction or other trades. They will then work on different sites and may work either individually or in smaller or larger groups. These factors will influence the provision of equipment and supplies, the number and distribution of first-aid personnel, and the means for the rescue of injured workers and their transportation to more specialized medical care.

Some enterprises are temporary in nature, or undertake seasonal or temporary work. This implies that some workplaces exist only temporarily, or that in one and the same place of work some functions will be performed only at certain periods of time, whereas at other times work will have ceased or changed and may therefore involve different risks. First aid must be available whenever needed, irrespective of the changing situation.

In some situations, employees of more than one employer work together in joint ventures or in an ad hoc manner, such as in building and construction. In such cases the employers may make arrangements to pool their provision of first aid. This may be more economical and effective. A clear allocation of responsibilities is necessary, as well as a clear understanding by the workers of each employer as to how first aid is provided. The employers must ensure that the first aid organized for this particular situation is as simple as possible. The pooling of first-aid resources at a common site should not fail to provide immediate care by qualified individuals to victims of accidents.

4.1.4. Availability of other health services

The level of training and the extent of organization for first aid may be influenced by the proximity to the enterprise of readily available health services. These health services may be the occupational health services themselves or the public or private general health services. More will be said about this in section 4.2.

(introduction...)

The need for a safety and health organization in every enterprise is universally accepted, though in practice the availability and effectiveness of these organizations may leave much to be desired. The provision of first aid should always have a direct relationship to the general safety and health organization, because first aid will not itself handle more than a small part of workers’ total care.

Any comprehensive occupational safety and health programme includes first aid, which contributes to minimizing the consequences of accidents and is therefore one of the components of tertiary prevention. Historically, the provision of, or regulations on, the organization of first aid are usually the most long-standing and the most widespread. Later on they may be incorporated in laws and regulations on accident prevention or the protection of health at work, although they may also remain separate.

4.2.1. Occupational health services

In 1985 the International Labour Conference adopted the Occupational Health Services Convention (No. 161), providing that occupational health services shall be progressively developed for all workers, and the Occupational Health Services Recommendation (No. 171), specifying as to how this may be done. Both Convention No. 161 and Recommendation No. 171 call for consultation with the most representative organizations of employers and workers on the measures to be taken to give effect to the provisions of these international instruments.

Occupational health services may be organized either by enterprises themselves (or groups of enterprises, as appropriate), public authorities or services, social security institutions, other authorized bodies or a combination of these, depending on national conditions and practices. Their functions vary widely, of course, and include, as appropriate, the identification and assessment of health risks at work, the surveillance of factors in the working environment, and the monitoring of the health of workers and others. Occupational health services participate in the analysis of work-related accidents and diseases and advise on their prevention. Among their functions, the organization of first aid and emergency treatment is listed in Article 5 of Convention No. 161.

Unfortunately, even today, the availability and effectiveness of occupational health services are inadequate in many cases. Even if occupational health services are adequately staffed, their staff may not be on the scene when serious injury or illness occurs. They may arrive too late to intervene in life-threatening situations. Convention No. 161 and Recommendation No. 171 clearly stipulate that the occupational health services have certain roles in the organization of first aid and emergency treatment. First, these services must be a source of advice and technical supervision and, secondly, they must be operationally linked with first aid to:

- provide medical care following first aid;

- make, or help make, referrals to specialized medical care; and

- participate in the post-accident evaluation, which should always include an evaluation of the adequacy and effectiveness of first aid.

When the establishment of occupational health services is promoted at the national level, special attention should be paid to the specific problems encountered by small-scale enterprises. Rigid regulations will not help; flexible solutions exist and are practised in a number of countries. Some examples may be given. In Belgium the occupational health services of large firms may provide assistance as appropriate, including first aid, to the small enterprises which usually work for them (repair workshops, garages, painters, etc.). In Canada occupational health services may be annexed to local hospitals or clinics; the objective is to create a network of occupational health services serving all enterprises, including small ones. In Cuba occupational health centres may be linked to community health centres which serve both large and small enterprises in a given area. In Sri Lanka occupational health care is provided by autonomous services in large enterprises or by the network of public health medical centres for the rest. There are examples of occupational health services which provide services to an industrial estate or which are organized by a national occupational safety and health institute. Innovative approaches exist, and they should be encouraged and more widely applied. Efforts in this respect need to be pursued.

4.2.2. Safety and health committees and safety delegates

Safety and health committees are established to promote safety through cooperation between the employer and workers.4 In some countries they are required by law, while in others they are voluntary. They normally consist of representatives of both parties, and the employers’ representatives include those managers and staff who have direct operational responsibility for safety at work. Safety delegates may play an important role as regards first aid. They may be first-aiders themselves or they may help workers to obtain appropriate first aid and seek medical advice as necessary. It is not always easy to convince people of the importance of obtaining appropriate first aid.

Although safety and health committees are not directly involved in providing first aid, they can make important contributions as regards, for example, the identification of hazards and of first-aid requirements. They may give advice on the organization of first aid and assist in the selection of first-aiders.

It should be noted that in almost all countries, safety and health committees are not mandatory for small enterprises of a size below a certain limit. Therefore more emphasis should be placed on the role of safety delegates (who may exist in enterprises which are not big enough to have a safety and health committee) and on the voluntary role that can be played by workers who have followed a first-aid course on their own.

4.2.3. The labour inspectorate

Labour inspectorates enforce laws and regulations, including those covering first aid. They can provide positive advice. The employer should always endeavour to involve the labour inspectorate in the process of planning and organizing first aid.

Small-scale enterprises represent a difficult issue since their number as compared with the number of labour inspectors usually means that a visit by an inspector will occur infrequently. To overcome this difficulty there are various possibilities. For example, the first-aid regulations may be completed by annexes on the contents of first-aid boxes and guidance on their use in the treatment of the various ailments and injuries which may occur at the workplace (Belgium). Sometimes the labour authority issues and widely distributes codes of practice, or guidelines or leaflets on first aid (Australia, India).

4.2.4. Other institutions

There are many other institutions which may play a role, such as industrial and trade associations, safety associations, insurance companies, standards organizations, trade unions and other non-governmental organizations. Some of these organizations may be knowledgeable about occupational safety and health, and they can be a valuable resource in the planning and organization of first aid. Employers should learn about the capacity of these institutions to support first aid, or to accept certain functions in actually providing first aid. Safety organizations and certain industrial or trade associations in a number of countries have accepted tasks which the employer would otherwise fulfil, such as the formulation of technical guidelines for first aid, the training of first-aid personnel, the elaboration of specifications for first-aid equipment, supplies and facilities, and the periodic surveillance of first-aid preparedness in the enterprise.

(introduction...)

When the need for first aid arises, first-aid personnel must be near the scene and initiate immediate action. Although in the light of their tasks they do not need medical qualifications, they must be trained in first aid. The employer should select and appoint an adequate number of first-aid personnel, and ensure their training and availability. National legislation or regulations often prescribe minimum standards in this respect (see Annex I).

Four aspects concerning first-aid personnel require particular attention: their functional tasks, the type and number of people required, the technical advice they need, and their status and operational supervision. The functional tasks must be defined before training programmes can be designed, and the two are therefore inextricably linked. Functional tasks are defined below, while the training of first-aid personnel is dealt with in Chapter 5.

4.3.1. Functional tasks

The arrangements for first aid must be practical. There is no merit in insisting that first-aid personnel be medically qualified. It is impossible to have medically qualified persons standing by on sites of potential accidents until the accidents occur. On the other hand, human life and health cannot be left to just anybody who happens to be at the site of an accident.

The concept of first-aid personnel implies that a person on the scene, usually a worker familiar with the specific conditions of work, is trained and prepared to perform specific tasks. The first-aider is provided with adequate equipment and supplies and with access to back-up medical services and facilities. Ultimately, the tasks of the first-aider, and accordingly the training, supervision and advice required, must be determined in the light of the specific situation in the enterprise. Yet there will be tasks common to many situations and they should be considered the basis for further refinement.

The following description of functional tasks is therefore intended to indicate what first-aid personnel must be able to do; it does not include all the actions which the first-aider will take. Books have been written and many guidelines exist on precisely how first aid should be given; some are referred to in Chapter 5 (footnote 1). These books should be consulted once the assessment of the potential needs for first aid have been made. From this assessment will emerge the precise nature and depth of the training for first-aid personnel, as well as the type and quantity of equipment and supplies which should always be ready in close proximity to the sites where accidents are likely to occur.

General tasks

1.

Assess the situation, the magnitude and severity of the injury, and the need for urgent additional medical care.



2.

Protect the victim against further injury by eliminating or reducing factors which may further aggravate his or her condition. If the victim is in danger, remove him or her from the site of the accident. (The classic examples are fire, electrocution or exposure to a toxic gas. The electric current must be switched off; the person exposed to toxic gases must be removed to prevent further gassing; etc. The first-aider must pay attention and take necessary measures to avoid becoming a victim of the same hazard. He or she must be instructed during training on the measures to be taken.)



3.

Assess the victim’s vital functions, i.e.:






- Is the victim conscious? Can the victim talk or not? Is the air passageway clear?



- Is the victim breathing?



- Is the victim’s heart beating?



- Is there severe bleeding?



- Is the victim in shock?



4.

Give the alarm and call for medical help. If clearly indicated by the victim’s condition, help transport him or her to the appropriate medical care facility. The alarm must include the following information:






- the name of the person giving the alarm, indicating the place from which it originates (telephone number);



- the exact location of the accident;



- the nature of the accident;



- the number of victims;



- the assessment of the victim’s vital functions (see above); the need for specific rescue equipment, if necessary.



5.

Provide the first aid (see below).



6.

Keep a record of the actions taken.

Provision of first aid in case of injury

The major situations to which the first-aider will usually respond include respiratory arrest, cardiac arrest, bleeding, shock, various burns including chemical burns, crushed or broken bones and joints, eye injuries, other skin injuries and infections. The first-aider must be provided with clear instructions in response to these situations:

- Unconsciousness: the first-aider must give priority to preserving vital functions; he or she will keep the airway open, clear the mouth and ensure that the tongue does not block the back of the throat, and carefully place the casualty in a recovery position while considering the possibility of hidden injuries.

- Respiratory arrest: the first-aider must start resuscitation and maintain it until the victim’s breathing is restored or until relieved by a qualified health professional.

- Cardiac arrest: as instructed, the first-aider must immediately initiate cardio-pulmonary resuscitation and continue until the victim’s breathing is restored or until relieved by a qualified health professional.

- Severe external bleeding, following cuts or the severing of limbs: the first-aider will apply direct pressure to the wound or, if that does not control the bleeding, apply pressure to the supplying artery; or, should both fail, apply a tourniquet which should later only be released by medical personnel. The first-aider should be prepared to respond to shock.

- Spinal injury: the first-aider should ask the victim whether he or she is able to move extremities; if not, in doubtful cases or when there are indications of a neck or back injury, the first-aider should always assume that there is a spinal injury; the victim should only be handled in accordance with instructions given for such cases; the spinal column should be kept in a straight position and never rotated.

- Crushed or broken bones or joints: the first-aider’s major concern will be (i) the immobilization of the broken or crushed bone or joint; (ii) treatment for shock; and (iii) attending to open wounds.

- Chemical eye injuries: unless it is clearly indicated to the contrary, the first-aider will flush the eye at once with clean, cool water and continue to do so for several minutes; he or she will then take the victim for subsequent medical examination.

- Burns: the burnt area of the body should be placed in cool, clean water, and a moist sterilized dressing subsequently applied. Resuscitation or rehydration may be necessary. The first-aider will watch for symptoms of shock and respiratory arrest. Appropriate medical care and follow-up should be ensured.

- Chemical burns: assuring his or her own safety, the first-aider will immediately flush the area with cool, clean water unless otherwise indicated, and remove contaminated clothing, unless it sticks to the skin. He or she will apply sterilized dressings to exposed and damaged skin and clean towels to damaged areas where the clothing cannot be removed. Appropriate medical care and follow-up should be ensured.

- Electric shock: the first-aider will ensure that the current is switched off and help in freeing the person. He or she will watch for respiratory or cardiac arrest and, where necessary, start and maintain resuscitation until medical personnel can take over.

4.3.2. Type and number of first-aid personnel required

The type and number of first-aid personnel required in an enterprise are determined by the variables previously discussed. Among them the type of work and the associated risks, and the size and configuration of the enterprise are the most important. The type of first-aid personnel relates to the specific tasks which may be performed and, accordingly, to the level of training, and depends primarily on the risks at work. The number of first-aid personnel required is mainly dependent on the size and configuration of the enterprise, but the potential risk at work and some other factors will also be determinants.

National regulations for first aid vary in respect of both the type and number of first-aid personnel required. In some countries the emphasis is on the number of persons employed in the workplace. In other countries, the overriding criteria are the potential risks at work. In yet others, both of these factors are taken into account. In countries where occupational safety and health is more advanced and the frequency of accidents is generally lower, more attention is usually given to the type of first-aid personnel. In countries where first aid is not regulated, emphasis is normally placed on numbers of first-aid personnel. The following four examples are indicative of the differences in approach used in determining the type and number of first-aid personnel in different countries:

The United Kingdom5

- If the work involves relatively low hazards only, no first-aid personnel are required unless there are 150 or more workers present at work; in this case a ratio of one first-aider per 150 workers is considered adequate. Even if fewer than 150 workers are at work, the employer should nevertheless designate an “appointed person” at all times when workers are present.

- Should the work involve higher risk, one first-aider will normally be required when the number of workers at work is between 50 and 150. If more than 150 workers are at work, one additional first-aider for every 150 will be required and, if the number of workers at work is less than 50, an “appointed person” should be designated.

- If the potential risk is unusual or special, there will be a need, in addition to the number of first-aid personnel already required under the criteria set out above, for an additional type of person who will be trained specifically in first aid in case of accidents arising from these unusual or special hazards (the occupational first-aider).

Belgium6

- One first-aider is usually required for every 20 workers present at work. However, a full-time occupational health staff member is required if there are special hazards and if the number of workers exceeds 500, or in the case of any enterprise where the number of workers at work is 1,000 or more.

- Some degree of flexibility is possible in accordance with particular situations, or if other specific measures are taken to cope with the immediate consequences of accidents at work.

Federal Republic of Germany7

- One first-aider is required if there are 20 or fewer workers present at work.

- If more than 20 workers are present, the number of first-aiders should be 5 per cent of those at work in case of offices or in general trade, or 10 per cent in all other enterprises. Depending on other measures which may have been taken by the enterprise to deal with emergencies and accidents, these numbers may be revised.

- If work involves unusual or specific risks (for instance, if hazardous substances are involved), a special type of first-aid personnel needs to be provided and trained; no specific number is stipulated for such personnel, i.e. the above-mentioned numbers apply.

- If more than 500 workers are present and if unusual or special hazards exist (burns, poisonings, electrocution, impairment of vital functions such as respiratory or cardiac arrest), specially trained full-time personnel must be made available to deal with cases where a delay in arrival of no more than 10 minutes may be allowable. This provision will apply in most cases of larger construction sites where a number of enterprises often employ a workforce of several hundred workers.

New Zealand8

- If more than five workers are present, a person employed at the enterprise is appointed and put in charge of the equipment, supplies and facilities for first aid.

- If more than 50 persons are present, the person appointed must be either a registered nurse or the holder of a certificate (issued by the St. John’s Ambulance Association or the New Zealand Red Cross Society).

Summary overview

In summary, the following principles regarding the type and number of first-aid personnel may be established:

(a) Type

A distinction may be made in practice between two types of first-aid personnel:

- The basic-level first-aider, who will receive basic training outlined in Chapter 5. This type of first-aid personnel will qualify for appointment where the potential risk at work is low.

- The advanced-level first-aider, who will receive the basic and advanced training outlined in Chapter 5, and will qualify for appointment where the potential risk is higher, special or unusual.

First-aid personnel should be available in any enterprise irrespective of its size. In the case of very small enterprises, and if the potential risk at work is low, the designation of an “appointed person” by the employer may suffice. The “appointed person” will be informed about the equipment and supplies provided by the employer and their location, and will be responsible for their maintenance. He or she will also be made aware of all other arrangements for medical care if needed (i.e. the alert and the referral to suitable medical facilities).

(b) Number

- One basic-level first-aider with basic training is often considered sufficient if the number of workers present does not exceed a range between 50 and 100, and if potential risks at work are low. In some countries this number is 20.

- In the case of small enterprises, the presence of a first-aider is always recommended, although this is not often made compulsory; there are sometimes alter- natives such as the need to nominate a person in charge of the first-aid box (careful custody and appropriate use) in all enterprises (Belgium).

- If the potential risks are higher, unusual or special, advanced first-aiders (in numbers as given above) should be required, with advanced training in respect of the specific needs established for the enterprise.

- Larger enterprises with 500 or more workers present and where the potential risks are higher, unusual or special, should, in addition, require permanent occupational health staff (one for every 500) to back up the first-aid personnel referred to above at relatively short notice (five to ten minutes).

The numbers set out above should be applied flexibly, depending on the specific circumstances of the enterprise, the first-aid needs assessment made by the employer and the level of safety in the enterprise.

4.3.3. Advice to, and supervision of, first-aid personnel

The provision of first aid is a responsibility of the employer, who is also responsible for ensuring that the system established for first aid will function when the need arises. In addition to the need for “managerial” supervision deriving from this principle, it is also necessary to provide first-aid personnel with adequate technical advice (backstopping). This should come from the occupational health service. If an occupational health service does not exist, the employer should locate and consult any other medically qualified source of advice for this purpose.

The “managerial” supervision of first-aid personnel will, in many cases, be entrusted to the person or persons with responsibility for safety in the enterprise (a specifically identified safety officer, a plant manager or any other person appointed by the employer) or to the occupational health service, where this exists. By implication, compliance with first-aid regulations and the proper functioning of first aid will be supervised by the labour inspectorate or other institutions as part of their supervisory role in conformity with safety and health regulations.

4.4. The role of the occupational health physician or nurse

First aid and its organization are part of the functions of occupational health services, where they exist. In addition, these services provide, or help to obtain, further or specialized medical care, if this is needed. They also provide professional back-up to first-aid personnel. In particular, they participate in organizing first aid, training or advising on the training of first-aid personnel, and advising on the evaluation of the manner in which first aid is organized and delivered.

There are several important roles that occupational health services could play as regards first aid, accident prevention, treatment, readaptation and reinsertion in work.

First, it is not infrequent that several small incidents or minor accidents take place before a severe accident occurs. Accidents requiring only first aid represent a signal which should be heard and should be used to guide and promote the preventive action.

Secondly, occupational health services should ensure follow-up of the injured worker from the medical and social points of view, starting with help in receiving appropriate and rapid medical treatment and then in obtaining assistance in social security, readaptation, compensation and finally reinsertion in active life. This represents a continuum, as there is sometimes a long, hard way between the accident and resuming work. The injured worker needs assistance in many respects - medical, psychological and social - to help to restore him or her to health in the best conditions, and this is far from always being the case. It is unacceptable that workers should lose their health because of their job and then lose their job because their health is impaired by their work, and this without proper compensation or alternative employment or even without mechanisms to impart new skills and retraining. In some countries this problem has received special attention. More efforts should be made to provide for follow-up of injured workers.

Finally, it should not be forgotten that the conditions in which first aid is administered may have a real impact on the final outcome of the injury: recovery or disability. Physicians and nurses should receive proper information and training on organizing first aid, planning for a sequence of events and administering first aid in an adequate manner and within the purview of an overall health approach. Where applicable, information and training on intervention in an emergency situation, emergency medicine and planning in the case of major hazards should be included.

(introduction...)

First-aid personnel must be provided with adequate equipment, supplies and facilities. The type and quantity of equipment, supplies and facilities should be determined in the light of the assessment made by the employer in planning and organizing first aid. This should take into account the regulatory and other standards. The employer is responsible for providing equipment, supplies and facilities.

4.5.1. Rescue equipment

In some emergency situations, specialized rescue equipment to remove or disentangle an accident victim may be necessary. Although it may not be easy to predict, certain work situations (such as working in confined space, at heights or above water) may have a high potential for this type of incident. When the possible need for rescue exists, special equipment should be provided and first-aid personnel should be trained to use it.

Rescue equipment may include items such as protective clothing, blankets for fire-fighting, fire extinguishers, respirators, self-contained breathing apparatus, cutting devices, and mechanical or hydraulic jacks, as well as equipment such as ropes, harnesses and specialized stretchers to move the victim. It must also include any other equipment required to protect the first-aid personnel against becoming casualties themselves in the course of delivering first aid. More information on this is contained in Annex III.

Although initial first aid should be given before moving the patient, simple means should also be provided for transporting an injured or sick person from the scene of the accident to the first-aid facility. Stretchers should always be kept available and easily accessible.

4.5.2. First-aid boxes, first-aid kits and similar containers

The materials included in first-aid boxes, kits and containers must be suitable and sufficient in number for delivering basic first aid, especially for attending to bleeding, broken or crushed bones, simple burns, eye injuries and minor indispositions.

In some countries, only the principal requirements are set out in regulations, e.g. that adequate amounts of suitable materials and appliances are included, and that the employer must determine what precisely may be required and in which quantity, depending on the type of work, the associated risks and the configuration of the enterprise. In most countries, however, more specific requirements have been set out, with some distinction made as to the size of the enterprise and the type of work and potential risks involved.

The contents of these containers must obviously match the skills of the first-aid personnel, the availability of a factory physician or other health personnel, and the proximity of an ambulance or emergency service. The more elaborate the tasks of the first-aid personnel, the more complete must be the contents of the containers. Annex II gives further information on first aid and first-aid boxes, and this may be especially useful for small-scale enterprises.

A relatively simple first-aid box will usually include the following items:

- individually wrapped sterile adhesive dressing;
- bandages (and haemostat bandages, where appropriate);
- a variety of dressings;
- sterile sheets for burns;
- sterile eye pads;
- triangular bandages;
- safety pins;
- a pair of scissors;
- antiseptic solution;
- cotton wool balls;
- a card with first-aid instructions.

First-aid boxes should always be easily accessible and should be located near areas where accidents could occur. They should be able to be reached within as short a delay as possible (one to two minutes). They should be made of suitable materials, and should protect the contents from heat, humidity, dust and abuse. They need to be identified clearly as first-aid material; in most countries, they are marked with a white cross or a white crescent, as applicable, on a green background with white borders.

If the enterprise is subdivided into departments or shops, at least one first-aid box should be available in each unit. However, the actual number of boxes required will be determined on the basis of the needs assessment made by the employer. In some countries the number of containers required, as well as their contents, has been established by law.

Soap and clean water and disposable drying materials should also be readily available. If possible, there should be a water tap within reach or, if this is not available, water should be kept in disposable containers near the first-aid box for eye wash and irrigation.

Small first-aid kits should always be available where workers are away from the establishment in such sectors as lumbering, agricultural work or construction; where they work alone, in small groups or in isolated locations; where work involves travelling to remote areas; or where very dangerous tools or pieces of machinery are used. The contents of such kits, which should also be readily available to self-employed persons, will vary according to circumstances, but they should always include:

- a few medium-sized dressings;
- a bandage;
- a triangular bandage;
- safety pins.

Examples of first-aid boxes, first-aid kits and similar containers required in a number of countries are listed in Annex IV.

4.5.3. Specialized equipment and supplies

Further equipment may be needed for the provision of first aid where there are unusual or specific risks. This applies specifically to situations where first-aid personnel are expected to assist in the case of shock, respiratory and cardiac arrest, electrocution, serious burns and especially chemical burns, and poisonings. Equipment for resuscitation is of particular importance.

This equipment and material should always be located near the site or sites of a potential accident, and in the first-aid room (see subsection 4.5.4). Transporting the equipment from a central location (such as an occupational health service facility) to the site of the accident may take too long. If the equipment and supplies are located on site, they will be ready and available upon the arrival of the physician or the nurse according to a plan which the employer must devise in advance.

If poisonings are a possibility, antidotes must be immediately available in a separate container, though it must be made clear that their application is subject to medical instruction. Long lists of antidotes exist, many for specific situations. Only the assessment of the potential risks involved will indicate which antidotes are needed. Annex V lists some important antidotes and the chemicals in relation to which they might be used.

4.5.4. The first-aid room

A room or a corner, prepared for administering first aid, should be available. Such facilities are required by regulations in many countries. Normally, first-aid rooms are mandatory when there are more than 500 workers at work or when there is a potentially high or specific risk at work. In other cases, some facility must be available, even though this may not be a separate room, e.g. a prepared corner with at least the minimum furnishings of a full-scale first-aid room, or even a corner of an office with a seat, washing facilities and a first-aid box in the case of a small enterprise.

Whatever the specific requirements in a given enterprise, a first-aid room or other facility should meet the following requirements:

- It should be easily accessible taking into account that the casualty may arrive on a stretcher or by some other means of transportation, and must have easy access for removing the victim to an ambulance or other means of transportation to a hospital.

- It should be large enough to hold a couch with space for people to work around it.

- It should be kept clean, well ventilated, well lit and maintained in good order.

- It should be reserved for the administration of first aid.

- It must be clearly identified as a first-aid facility and appropriately marked (in most countries with a white cross or white crescent on a green background) and should be under the responsibility of first-aid personnel.

- There should be clean running water, preferably both hot and cold, soap and a nail brush.

- There should be towels, pillows and blankets, clean clothing for use by the first-aid personnel, and a refuse container.

4.5.5. Means for communicating the alert

Following an accident or sudden illness, it is important that immediate contact can be made with the first-aid personnel. This requires means of communication between work areas, the first-aid personnel and the first-aid room. Communications by telephone may be preferable, especially if distances are more than 200 metres, but this will not be possible in all establishments. Acoustic means of communication such as a hooter or a buzzer may serve as a substitute as long as it can be ensured that the first-aid personnel arrive at the scene of the accident rapidly.

Lines of communication should be pre-established. Requests for advanced or specialized medical care, or an ambulance or emergency service, are normally made by telephone. The employer should ensure that all relevant addresses, names and telephone numbers are clearly posted throughout the enterprise and in the first-aid room, and that they are always available to the first-aid personnel.

4.6. Planning for access to additional care

The need for a referral of the victim to more advanced or specialized medical care must always be foreseen. The employer should have plans for such a referral, so that when the case arises everybody involved will know exactly what to do. However, it is not sufficient merely to prepare a plan. The plan must be updated and all persons concerned must know and understand the plan and how to implement it.

The first question to be considered in the preparation of the plan relates to the possible need for referral. This can be derived from (i) the assessment by the employer of the potential risks at work and the type and severity of the injuries which might be incurred, and (ii) the capacity of the first-aid system devised on the basis of this assessment. Once the possible needs for referral are established, the relevant medical facilities must be identified and located, and their specific capacity and assigned roles recorded in the plan.

In some cases the plan will be rather simple, but in others it may be elaborate, especially where unusual or special risks are involved at work and when accidents with complex or serious implications cannot be ruled out. In the construction industry, for instance, referral may be required after serious falls or crushings, and the end-point of referral will most probably be a general hospital, with adequate orthopaedic or surgical facilities. In the case of a chemical works, the end-point of referral will be a poison centre or a hospital with adequate facilities for the treatment of poisoning. No uniform pattern will exist. Each referral plan will be tailored to the needs of the enterprise under consideration, especially if higher, specific or unusual risks are involved. This referral plan is an important part of the emergency plan of the enterprise.

The referral plan must be supported by a system of communication and means for transporting casualties. In some cases, this may involve communication and transport systems organized by the enterprise itself, especially in the case of larger or more complex enterprises. In smaller enterprises, transport of the victim may need to rely on outside capacity such as public transport systems, public ambulance services, taxis, and so on. Careful planning is indispensable, and stand-by or alternative systems should be set up in case public facilities do not always function for one reason or another. Employers must foresee such possibilities in their own emergency planning. For instance, if there is a likelihood that public telephones will not work at the time they are needed, they must have other means of alerting the relevant medical facility. To avoid delays in communication and transport of casualties, the plan should list and exhibit all relevant addresses, names, telephone numbers and optimal routes of transportation.

The plan established to meet emergency conditions must be communicated to all concerned, including first-aiders, safety officers, occupational health services, the health service facilities to which victims may be referred, and all other institutions which may be involved, including those that play a role in communications and the transport of casualties (e.g. telephone services, ambulance services, taxi companies, etc.). The plan must be communicated and explained further to all workers as part of their overall briefing on health and safety, and first aid. It is not enough simply to post it in strategic locations (although this should always be done). Communicating the plan to all concerned must be made through individual briefings, and even these must be repeated from time to time.

4.7. Records

All first-aid treatment should be recorded in a first-aid book, which is kept by the first-aid personnel. The information to be recorded includes:

(a) the accident (time, location, occurrence);
(b) the type and severity of the injury;
(c) the first aid delivered;
(d) the additional medical care requested;
(e) the name of the victim;
(f) the names of witnesses and of other workers involved, especially in the transporting of the victim.

The first-aid record does not normally replace the report which the safety official will establish on the accident. The latter is intended for review by both management and the labour inspectorate, or its representative, whereas the first-aid treatment record is an internal report which will provide information concerning the health of the victim, as well as contributing to safety at work.

Notes

1 United Kingdom, Health and Safety Executive: “Approved code of practice for the Health and Safety (First Aid) Regulations, 1981”, in First aid at work, Health and Safety Series booklet HS(R) 11 (London, Her Majesty’s Stationery Office, 1981).

2 Unfallverhvorschrift (UVV): Erste Hilfe (VBG 109). Editor’s note: This book was written before German reunification, but references to the Federal Republic are generally correct for Germany after reunification as well.

3 Belgium, Minist de l’Emploi et du Travail: Rement gral pour la protection du Travail (RGPT) (periodically updated publication).

4 See ILO: Accident prevention (Geneva, 2nd edition, 1983), pp. 129-132.

5 United Kingdom, Health and Safety Executive: “Approved code of practice for the Health and Safety (First Aid) Regulations, 1981”, op. cit., p. 5.

6 Belgium, Minist de l’Emploi et du Travail: RGPT, op. cit., s. III.

7 UVV: Erste Hilfe, op. cit., p. 4. Editor’s note: see also note 2 above.

8 Government of New Zealand: The Factories and Commercial Premises (First Aid) Regulations 1985 (Wellington, Government Printer, 1985).

5.1. General considerations

It has previously been noted that first-aid personnel are people on the spot, generally workers who are familiar with the specific conditions of work, and that they are not medically qualified but must be trained and prepared to perform very specific tasks. Besides the selection of the people to be appointed, the training of first-aid personnel is the single most important factor determining the effectiveness of organized first aid.

Not every worker will be suitable to be trained for providing first aid. Potential first-aiders should be motivated, and should possess a high level of comprehension and an ability to make decisions. They should be emotionally stable and able to cope with human beings in a crisis situation. They must be reliable. Employers must carefully and responsibly select first-aid personnel in accordance with these criteria. In the process they should seek cooperation and advice from the occupational health physician or nurse, if available, from the health and safety committee and, as appropriate, from outside physicians or other health personnel.

Training first-aid personnel once is not enough. Refresher training will be necessary from time to time. All this will take time and cost money. A prerequisite for success is that the persons selected are willing to give at least some of their free time. However, most of the time needed for training and retraining first-aid personnel, and the time spent on drills and other activities related to first aid, is usually made part of working time.

Training programmes will depend on many factors, including the variables discussed in section 4.1, especially the type of work and the associated risk involved. Ultimately, however, the programmes must respond to the functional tasks to be fulfilled by first-aid personnel.

A distinction was made in subsection 4.3.2 between two types of first-aid personnel (basic and advanced), depending on the likely complexity and severity of the situations they may have to deal with. This implies that their training also involved two levels:

(a) a basic programme of training adapted to the needs of all first-aiders, which will normally suffice for situations involving low risks at work;

(b) an advanced programme of training for situations involving higher, unusual or special risks. This programme would address the tasks of the advanced-level first-aider and would be a supplement to, and not a substitute for, the basic programme of training.

(introduction...)

Basic programmes of training usually require around ten hours. This is a minimum. Programmes can be divided into two parts, dealing respectively with the general task to be performed, and the actual delivery of first aid. Accordingly, they will cover the subject areas outlined below:

5.2.1. General

The objective is to inform the trainee and to ensure that he or she has the capability to perform the general tasks of a first-aider:

(a) how first aid is organized;

(b) how to assess the situation, the magnitude and severity of the injuries, and the need for additional medical help;

(c) how to protect the casualty against further injury without creating a risk for oneself; the location and use of the rescue equipment;

(d) how to observe and interpret the general condition of the victim (e.g. unconsciousness, respiratory and cardiovascular distress, bleeding, shock);

(e) the location, use and maintenance of the first-aid equipment and facilities;

(f) the plan for access to additional care;

(g) what must be done in conjunction with delivering first aid and thereafter.

5.2.2. Delivery of first aid

The objective is to provide basic knowledge and to ensure the capability to deliver first aid. At the basic level, this would include in particular:

- external wounds;
- bleeding;
- fractured bones or joints;
- crushing injury (e.g. to the thorax or abdomen);
- unconsciousness, especially if accompanied by respiratory difficulties or arrest;
- eye injuries;
- burns;
- shock;
- personal hygiene in dealing with wounds.

Depending on circumstances within the enterprise, the basic programme of training may be adjusted by the addition of other topics.

5.3. Advanced training

The aim of advanced training is specialization rather than comprehensiveness. It will be of particular importance in relation to the following types of situations (though specific programmes will normally deal only with some of these, in accordance with needs, and their duration will vary considerably):

- cardiopulmonary resuscitation;
- poisoning (intoxication);
- injuries caused by electric current;
- severe burns;
- severe eye injuries;
- skin injuries;
- contamination by radioactive material (internal and skin or wound contamination);
- heat and cold stress.

5.4. Training material and institutions

A wealth of literature is available on programmes of training for first aid. The national Red Cross or Red Crescent Societies and various organizations in many countries have issued material which will cover much of the basic programme of training referred to above.1 This material should be consulted in the design of actual training programmes, though it may need adaptation to the specific requirements of first aid at work (in contrast with first aid after traffic accidents, for instance). Safety associations, industrial or trade associations, health institutions, certain non-governmental organizations and the labour inspectorate (or their subsidiary bodies) may contribute to the design of the training programme to suit specific situations.

Training programmes should be approved by the competent authority or a technical body authorized to do so.

There is a need for approval from the institutions charged to carry out the training of first-aid personnel. In many cases, this may be the national Red Cross or Red Crescent Society or related institutions. In others, it may be various types of training institutions, or health or occupational health institutes. Sometimes, occupational health services run training courses for first-aiders or ensure refresher courses or specific training in relation to the occupational hazards in the enterprise. Approval to train first-aid personnel should be made dependent on the overall standing of the institution and on the availability of training staff experienced in the theoretical and practical aspects of first aid and in the general aspects of occupational safety and health.

5.5. Certification

The authority which authorizes the programmes of training and the training institutions should also be responsible for carrying out examinations of first-aid personnel upon completion of their training. Examiners, independent of the training programmes should be designated. Implicit in this authorization is also the authorization of the programme of examination itself.

Upon successfully completing the examination, the candidates should be awarded a certificate upon which the employer or enterprise will base their appointment. Certificates should be made obligatory and should also be issued following refresher training, other instruction or participation in field work or demonstrations.

Note

1 St. John Ambulance Association: Occupational first aid (London, Macmillan Journals, 1973); American National Red Cross: First aid and personal safety (Garden City, New York, Doubleday, 1975); Manuel pratique de secourisme, tion conforme au programme du brevet national de secourisme (Paris, France-Selection, 1988); Canadian Red Cross Society: First aid (Toronto, 1982); Jean-Charles Hachet: Urgences en mcine du travail (Paris, Masson, 1982); David Werner: Where there is no doctor: A village health care handbook (Palo Alto, California, Hesperian Foundation, 1985 - revised edition, 1992); Moya McTanney: Learning first aid (Geneva, League of Red Cross and Red Crescent Societies, 1986).

6. Relation to other health-related services

It has been stressed throughout this monograph that first aid is the immediate intervention following an accident or in case of an indisposition at work, and that there will be cases in which specialized medical care will be required. The possible listing of institutions which may exist and provide such care include the following:

(a) the occupational health service of the enterprise itself or other occupational health entities;

(b) other institutions which may provide services, such as:

- ambulance services;
- public emergency and rescue services;
- hospitals, clinics and health centres, both public and private;
- private physicians;
- poison centres;
- civil defence;
- fire departments; and
- police.

Each of these institutions will have a variety of functions, capabilities and facilities, but it must be understood that what applies to one type of institution, say a poison centre in one country, may not necessarily apply to a poison centre in another country. An assessment must therefore be made by the employer of the institutions in the vicinity of the enterprise, in consultation with the factory physician and, if applicable, outside medical advisers, to ensure that the capabilities and facilities of these institutions are adequate to deal with the injuries expected in the event of serious accidents. This assessment is the basis for deciding which institutions will be entered into the referral plan discussed in section 4.6.

The cooperation of these related services is very important in providing proper first aid, particularly for small enterprises. Many of them may provide advice on the organization of first aid and on planning for emergencies. Enterprises may very often rely on them for the services they need in case of emergency, and this will be particularly efficient if it is planned in advance. There are good practices which are very simple and effective; for example, even a shop or a small enterprise may invite the fire brigade to visit its premises. Such a practice will have several advantages because the employer or owner will receive advice on fire prevention, fire control, emergency planning, extinguishers, the first-aid box, and so on. In addition, the fire brigade will know the enterprise and will be ready to intervene more rapidly and more efficiently.

The issue can be seen in even broader terms of relationships between fire-fighters, the police, the emergency and intervention services and the public. Is their potential for assisting the public sufficiently known? Are contacts made easier? Are such contacts planned systematically outside emergency situations (courtesy visits, conferences, contacts with children, etc.)? It is obvious that much remains to be done and that sometimes the overall approach is missing. This is linked to the need for development of public services as a true “service to the public”. When such an approach is followed, it should be possible for small-scale enterprises, small shops, families and individuals (including old persons living alone) to make arrangements for facing emergencies.

One of the aims of organizing first aid is that everyone, employer or worker, will be able to answer the question: “What will I do now if an accident happens now?” Emergency preparedness is one of the important features of organizing first aid. It will contribute to the development of a spirit of prevention and may lead to an improvement of occupational safety and health in all occupations.

1. New Zealand

The Factories and Commercial Premises (First Aid) Regulations 1985

1. Title and commencement - (1) These regulations may be cited as the Factories and Commercial Premises (First Aid) Regulations 1985.

(2) These regulations shall come into force on the 1st day of July 1985.

2. Interpretation - In these regulations, unless the context otherwise requires:

- “first-aid cabinet” means a box or cabinet in which first-aid supplies are kept;
- “first-aid supplies” means articles that are first-aid appliances or first-aid requisites;
- “the principal Act” means the Factories and Commercial Premises Act 1981.

3. First-aid supplies in undertakings - (1) The occupier of an undertaking shall:

(a) ensure that first-aid supplies are provided for persons who may be injured in that undertaking; and

(b) take all reasonable steps to ensure every person injured in that undertaking is, if first-aid treatment is necessary or desirable for that person, given adequate first-aid treatment without delay.

(2) Except as otherwise required by these regulations, the first-aid supplies required by subclause (1)(a) of this regulation to be provided in an undertaking shall be as specified in the Schedule to these regulations. [Editor’s Note: The Schedule is reproduced on p. 52 of this book.]

(3) Subclauses (1) and (2) of this regulation shall apply to any shop where first-aid supplies are kept for sale as if those supplies were provided for persons who may be injured in that shop.

4. First-aid supplies to be properly maintained - The occupier of an undertaking shall ensure that the first-aid supplies provided in that undertaking are:

(a) kept clean and tidy; and

(b) readily available for the treatment of injured persons at all times when workers are working in that undertaking.

5. First-aid cabinets - (1) Subject to subclauses (2) and (3) of this regulation, the occupier of an undertaking shall ensure that:

(a) the first-aid supplies required by regulation 3 of these regulations to be provided in that undertaking are kept in dustproof boxes or dustproof cabinets:

(i) in which nothing other than first-aid supplies is kept; and

(ii) each of which either is made of an easily cleaned material with a smooth impervious surface, or is painted or enamelled inside and outside with a gloss paint or enamel; and

(iii) the outside surface of the lid or door of each of which is marked clearly with the words “FIRST AID” and the name of the person for the time being appointed under regulation 7 of these regulations in respect of that cabinet;

(b) the number and positions of first-aid cabinets in that undertaking are, in the opinion of an Inspector, reached after having regard to the layout of that undertaking and the nature of the work carried on in it, likely to enable compliance with regulation 3 of these regulations in respect of that undertaking;

(c) every first-aid cabinet in that undertaking is kept clean and tidy, and is replenished at least once a month.

(2) Where there is provided in any undertaking a room that complies with the requirements of subclause (1) of regulation 9 of these regulations (whether or not the occupier of that undertaking is required by that subclause to ensure that such a room is provided), it shall, to the extent that any first-aid supplies required by regulation 3 of these regulations to be provided in that undertaking are kept in that room, be a sufficient compliance with subclause (1)(a) of this regulation if those supplies are kept in cupboards.

(3) Nothing in subclause (1) of this clause shall require the occupier of a shop where any first-aid supplies are kept for sale to keep any of those supplies in a cabinet.

6. Location of first-aid cabinets - (1) The occupier of an undertaking shall ensure that:

(a) subject to subclause (2) of this regulation, every first-aid cabinet in that undertaking is in a position that is well lit, and close to a wash-hand basin with hot and cold running water, soap, a nail brush, and clean towels;

(b) where any first-aid cabinet in that undertaking is not conspicuous, its location is clearly indicated by a sign with the words “FIRST AID” placed conspicuously near that location.

(2) An Inspector, having regard to the layout of any undertaking and the nature of the work carried on in it, may exempt its occupier from all or any of the requirements of sub-clause (1)(a) of this regulation, either unconditionally or subject to any conditions that the Inspector thinks fit; and until the exemption concerned is amended or revoked by any Inspector, these regulations shall apply accordingly.

7. Occupier to appoint person in charge - The occupier of an undertaking at which more than five workers are usually employed at any one time shall ensure that a person engaged at that undertaking is put in charge of all first-aid supplies, first-aid cabinets, and first-aid rooms in that undertaking; and where shifts are worked in that undertaking shall ensure that another such person is appointed that first-mentioned person’s deputy in respect of each shift on which that first-mentioned person is not engaged and that other person is engaged.

8. Undertakings employing more than 50 workers to have a trained person in charge of first aid - (1) Subject to subclause (2) of this regulation, the occupier of an undertaking at which more than 50 workers are usually employed at any one time shall ensure that at all times the person put in charge of first-aid supplies in that undertaking under regulation 7 of these regulations is:

(a) a registered nurse; or

(b) the holder of a certificate (being a certificate that was issued or renewed not more than three years ago) issued by the St. John Ambulance Association or the New Zealand Red Cross Society (Incorporated).

(2) The occupier of an undertaking is not failing to comply with subclause (1) of this clause if for the time being no person described in paragraph (a) or paragraph (b) of that subclause is in charge of first-aid supplies in that factory under regulation 7 of these regulations but:

(a) such a person was so in charge not more than six months ago;

(b) that occupier is taking all reasonable steps to:

(i) employ such a person; or

(ii) arrange for a person engaged at that undertaking to become such a person.

9. Undertakings employing more than 100 workers to have first-aid rooms - (1) The occupier of an undertaking at which more than 100 workers are usually employed at any one time shall ensure that there is provided in that undertaking, and used exclusively for the giving of first-aid treatment, a room:

(a) with a floor area of at least 10 m2;

(b) with walls and ceiling of a smooth impervious surface painted in light colours;

(c) with a floor surface of a durable and easily cleaned material;

(d) capable of being lit, heated, and ventilated, to the satisfaction of an Inspector;

(e) provided with a wash-hand basin with hot and cold running water, soap, a nail brush, and clean towels;

(f) fitted with cupboards for the storage of first-aid supplies;

(g) furnished with a chair, a couch, a pillow, and a blanket.

(2) The occupier of an undertaking required by subclause (1) of this regulation to ensure that a room is provided in that undertaking shall take all reasonable steps to ensure that that room and the first-aid supplies and other articles contained in it are properly maintained and kept clean and tidy.

10. Register of first-aid treatments - The occupier of an undertaking shall keep in that undertaking, together with or as part of the register of accidents required to be kept by section 53(1) of the principal Act, a record of:

(a) the nature of every first-aid treatment given in that undertaking; and
(b) the date on which it was given; and
(c) the name of the person to whom it was given; and
(d) the nature of the injury or illness in respect of which it was given.

11. Inspector may grant exemptions - An Inspector who is satisfied that, by reason of exceptional circumstances or the nature of the work carried on in an undertaking, all or any of the requirements of regulations 7 to 9 of these regulations need not apply in respect of that undertaking may by notice in writing served on the occupier of that undertaking exempt that occupier from all or any of those requirements in respect of that undertaking for two years or such lesser period as is specified in that notice, either unconditionally or subject to any conditions that the Inspector thinks fit; and until the exemption concerned expires, or is amended or revoked by any Inspector, these regulations shall apply to that undertaking accordingly.

12. No derogation from other provisions - These regulations are in addition to, and shall not derogate from, any award.

13. Appeals against decisions of Inspectors (...)

14. Offences (...)

15. Revocations - The following regulations are hereby consequentially revoked: (...)

SCHEDULE
Minimum scales of first-aid appliances and requisites.
[The Schedule is reproduced on p. 52 of this book.]

2. United Kingdom

The Health and Safety (First Aid) Regulations 1981

Citation and commencement

1. These regulations may be cited as the Health and Safety (First Aid) Regulations 1981 and shall come into operation on 1 July 1982.

Interpretation

2. (1) In these regulations, unless the context otherwise requires:

- “first aid” means:

(a) in cases where a person will need help from a medical practitioner or nurse, treatment for the purpose of preserving life and minimizing the consequences of injury and illness until such help is obtained, and

(b) treatment of minor injuries which would otherwise receive no treatment or which do not need treatment by a medical practitioner or nurse;

- “mine” means a mine within the meaning of section 180 of the Mines and Quarries Act 1954(a).

(2) In these regulations, unless the context otherwise requires, any reference to:

(a) a numbered Regulation or Schedule is a reference to the Regulation of, or Schedule to, these Regulations bearing that number;

(b) a numbered paragraph is a reference to the paragraph bearing that number in the Regulation in which the reference appears.

Duty of employer to make provision for first aid

3. (1) An employer shall provide, or ensure that there are provided, such equipment and facilities as are adequate and appropriate in the circumstances for enabling first aid to be rendered to his employees if they are injured or become ill at work.

(2) Subject to paragraphs (3) and (4), an employer shall provide, or ensure that there is provided, such number of suitable persons as is adequate and appropriate in the circumstances for rendering first aid to his employees if they are injured or become ill at work; and for this purpose a person shall not be suitable unless he has undergone:

(a) such training and has such qualifications as the Health and Safety Executive may approve for the time being in respect of that case or class of case, and

(b) such additional training, if any, as may be appropriate in the circumstances of that case.

(3) Where a person provided under paragraph (2) is absent in temporary and exceptional circumstances it shall be sufficient compliance with that paragraph if the employer appoints a person, or ensures that a person is appointed to take charge of:

(a) the situation relating to an injured or ill employee who will need help from a medical practitioner or nurse, and

(b) the equipment and facilities provided under paragraph (1) throughout the period of any such absence.

(4) Where having regard to:

(a) the nature of the undertaking,

(b) the number of employees at work, and

(c) the location of the establishment,

it would be adequate and appropriate if instead of a person for rendering first aid there was a person appointed to take charge as in paragraph (3)(a) and (b), then instead of complying with paragraph (2) the employer may appoint such a person, or ensure that such a person is appointed.

Duty of employer to inform his employees of the arrangements made in connection with first aid

4. An employer shall inform his employees of the arrangements that have been made in connection with the provision of first aid, including the location of equipment, facilities and personnel.

Duty of self-employed person to provide first-aid equipment

5. A self-employed person shall provide, or ensure that there is provided, such equipment, if any, as is adequate and appropriate in the circumstances to enable him to render first aid to himself while he is at work.

Power to grant exemptions

6. (1) Subject to paragraph (2), the Health and Safety Executive may, by a certificate in writing, exempt any person or class of persons, from any of the requirements imposed by these Regulations, and any such exemption may be granted subject to conditions and to a limit of time and may be revoked at any time.

(2) The Executive shall not grant any such exemption unless, having regard to the circumstances of the case, and in particular to:

(a) the conditions, if any, which it proposes to attach to the exemption, and

(b) any other requirements imposed by or under any enactment which apply to the case, it is satisfied that the health, safety and welfare of employees and self-employed persons and the health and safety of other persons who are likely to be affected by the exemption will not be prejudiced in consequence of it.

Cases where these regulations do not apply

7. (...)

Application to miscellaneous mines

8. (...)

Application offshore

9. (...)

Repeals, revocations and modification

10. (...)

3. Federal Republic of Germany

Federation of Occupational Insurance Associations
[Hauptverband der gewerblichen Berufsgenossenschaften]

Accident prevention regulations of the occupational insurance associations

First aid (VBG 109) of 1 April 1979

Scope

Article 1. These accident prevention regulations apply to first aid and to action to be taken in the event of occupational accidents.

Definitions

Article 2. 1. For the purpose of these accident prevention regulations, the term “facilities” means all the materials employed in member companies for first aid and for rescue from dangers to life and health.

2. Alarm facilities are communication installations by means of which a call for help can be made.

3. First-aid rooms are rooms in which first aid or initial medical care is given in the event of an accident or sickness occurring in the plant.

4. First-aid material refers to bandaging materials, all miscellaneous auxiliary materials and medical equipment, as well as medicaments used for first aid.

5. Rescue equipment covers all technical equipment for rescuing persons from a danger to life or health, such as fire-smothering blankets, rescue belts, respiratory protective equipment, cutting equipment.

6. Rescue transport equipment covers devices by which it is possible to correctly carry out any necessary transport of persons, such as stretchers, stretcher sledges, rescue nets.

7. First-aid workers are persons who have received training as a first-aid worker in a place recognized by the Berufsgenossenschaften for training in first aid.

8. A plant nursing aid is a person who has received specialist training in nursing aid in a place recognized by the Berufsgenossenschaften.

General obligations of the employer

Article 3. (1) The employer shall ensure:

1. the availability of the facilities necessary for first aid, and in particular alarm devices, first-aid rooms, first-aid material and rescue transport equipment;

2. the availability of the facilities required for rescue from situations endangering life and health, and in particular rescue equipment;

3. the availability of the personnel necessary for the implementation of first aid and for rescuing persons from situations endangering life and health (first-aid workers, plant nursing personnel); and

4. that in the event of an occupational accident, first aid is carried out immediately and that, in particular, any necessary medical treatment is initiated.

(2) The facilities that the employer is required to make available under article 3.(1) above shall be in line with the provisions of the accident prevention regulations and other generally recognized technical, medical and hygienic requirements.

Alarm equipment and measures

Article 4. The employer shall ensure, by means of alarm devices and organizational measures, that it is possible to call and bring in the necessary assistance to the site of an accident without delay, with due regard to the conditions at the premises, such as their extent and structure.

First-aid rooms

Article 5. (1) At least one first-aid room or a comparable facility shall be available if:

1. more than 1,000 insured persons are employed; or

2. a special accident hazard can be envisaged, and more than 100 insured persons are employed.

(2) Where more than 50 insured persons are employed on a building site, there shall be at least one first-aid room or a comparable facility.

(3) The rooms or facilities shall be readily accessible for a stretcher. They shall be equipped with the facilities required for first aid and initial medical care; the rooms and facilities must be of a suitable size.

First-aid material

Article 6. The first-aid material shall be at all times readily accessible and protected against deleterious factors and, in particular, against pollution, humidity and high temperatures; it shall be available in adequate quantities, and supplemented and renewed as necessary.

Rescue equipment

Article 7. To the extent that special knowledge is required for handling the rescue equipment, the employer is required to ensure that specially trained personnel are available.

First-aid workers

Article 8. (1) The employer shall ensure that the following minimum numbers of first-aid workers are available for first aid:

1. one first-aid worker for up to 20 insured persons present;
2. where there are more than 20 insured persons:

(a) in administrative and commercial premises, 5 per cent of them;
(b) in other premises, 10 per cent of them.

In the case of premises under section 2 above, it is possible, in agreement with the Berufsgenossenschaften - taking into account the organization of the in-plant rescue facilities and the hazards encountered - to diverge from the number of first-aid workers indicated.

(2) If, depending on the type of work being done - in particular when handling hazardous substances - it is estimated that special first-aid measures would be required that do not form part of the general training for first-aid workers under article 2, section 7, above, then the employer shall provide the necessary additional first-aid training. This also applies to work on live electrical installations and for other work in which, in the event of an occupational accident, it may be necessary to carry out cardiac and pulmonary resuscitation.

(3) The employer shall be required to ensure that first-aid workers undergo further training at suitable intervals.

Nursing aid

Article 9. The employer shall also ensure that in plants employing more than 500 insured persons, there are plant nursing aids, provided that the type, severity and number of occupational accidents require their action.

Instructions

Article 10. (1) The employer shall instruct the insured persons on the action to be taken in the event of occupational accidents. The instructions should be repeated at suitable intervals, but at least once per year.

(2) First-aid instructions, recognized by the Berufsgenossenschaften, should be displayed at suitable places depending on the nature of the hazard. The relevant posters should at least contain information about calling for help, first-aid facilities and personnel, physicians and hospitals. This information should be kept up to date. Every bandage box and bandage cupboard should be equipped with first-aid instructions approved by the Berufsgenossenschaften.

Labelling

Article 11. First-aid facilities and storage areas for first-aid material, rescue equipment and rescue transport devices shall be made clearly and permanently recognizable by a white cross marked on a square or rectangular green background with a white border.

Interruption of work

Article 12. The employer shall ensure that in the event of an accident, the insured casualty interrupts the work at least until first aid is administered.

Medical care and rescue transport

Article 13. (1) Any insured casualty shall be immediately presented to a physician, in cases when the nature and extent of the injury or the health impairment seem to indicate the need for medical care. The patient must be presented to a directing physician if the injury indicates a possibility of unfitness for work. In the event of severe injuries, the victim should be transported to an emergency hospital. If it is apparent that there is only an eye, throat, nose or ear injury, then the insured casualty should be transported to the nearest available physician specializing in the relevant discipline unless such presentation has been made unnecessary by appropriate first aid.

(2) The employer shall ensure the provision of suitable transport to the physician or the hospital.

Recording of first-aid administration

Article 14. The employer shall ensure that each case of first-aid administration be recorded and the record maintained for five years. The record shall contain data on the time, place (part of the enterprise) and the circumstances of the accident or of the injury to health, the type and nature of the injury or the disease, the time, type and nature of the first-aid measures as well as the name of the insured casualty, the witnesses and the persons who provided the first aid.

General obligations of insured persons

Article 15. Insured persons shall support the measures relating to first aid.

Article 16. The insured person shall accept to undergo training as a first-aid worker and to take part in further training at suitable intervals provided he/she has no personal reasons for refusing to do so. After the training, the insured person shall offer to provide first aid.

Reporting obligation

Article 17. The insured person shall be required to report immediately to the appropriate office in the enterprise any injury and any health damage resulting from an occupational accident; should he/she not be in a position to do so, then this obligation to report shall fall on the employee of the enterprise who first learns of the accident.

Violations of the regulations

Article 18. (...)

Transitory and closing provisions

Article 19. (...)

Annex II. Be ready for emergencies1

1 J.E. Thurman, A.E. Louzine and K. Kogi: Higher productivity and a better place to work: Practical ideas for owners and managers of small and medium-sized industrial enterprises, Action manual (Geneva, ILO, 1988), pp. 74-75.

Accidents happen. Emergencies can include cuts and bruises, eye injuries, burns, poisoning and electric shocks. Even in enterprises which seem safe, many types of injury (such as falls) can occur. Every enterprise should therefore have a well-stocked first-aid box and at least one person present at all times of operation who knows what to do in emergencies.

First-aid boxes should be clearly marked and located so that they are readily accessible in an emergency. They should not be more than 100 m from any worksite. Ideally, such kits should be near a wash-basin and in good lighting conditions. Their supplies need to be regularly checked and replenished. The contents of a first-aid box are often regulated by law, with variations according to the size and likely industrial hazards of the enterprise. A typical basic kit may include the following items in a dustproof and waterproof box:

- sterile bandages, pressure bandages, dressings (gauze pads) and slings. These should be individually wrapped and placed in a dustproof box or bag. You will need small, medium and large sizes. Be sure to have sufficient quantities, especially of the commonly used sizes. Small cuts and burns should not go untreated. You will also need medical adhesive tape (strip plaster) for fixing bandages and dressings;

- cotton wool for cleaning wounds;

- scissors, tweezers (for splinters) and safety pins;

- an eye bath and eye wash bottle;

- ready-to-use antiseptic solution and cream;

- simple over-the-counter medicines such as aspirin and antacids; and

- a booklet or leaflet giving advice on first-aid treatment.

A portable first-aid kit may be useful when work is done outside the factory. It should contain cotton wool, adhesive dressing strips, sterile wound dressings, gauze bandages, triangular bandages, antiseptic cream, safety pins and small scissors.

First aid requires some training, but this is not difficult to arrange in most places. The names and location (including telephone number) of first-aiders should be put on a notice-board. Workers in remote or isolated areas should be given additional training in first aid to take account of the probable long delays in obtaining medical aid in the event of an emergency.

The procedure for obtaining medical assistance in an emergency should be known by all workers. Small establishments without their own facilities should keep contact with a nearby clinic or hospital so that the time between the occurrence of an accident and medical assistance is very short, preferably much less than 30 minutes. Transport to the clinic or hospital should also be prearranged. An outside ambulance may be called in, if necessary. It is always desirable to have a stretcher.

Annex III. Rescue equipment: An example

- Rescue nets to the requirements of DIN 14151, Part 1, “Firemen’s rescue net devices: General requirements and testing” and to the requirements of DIN 14151, Pan 2, “Firemen’s rescue equipment: Firemen’s rescue nets”.

- Fire extinguishing blankets to the requirements of DIN 14155, “Fire extinguishing blankets”.

- Elevator rescue vehicles to the requirements of DIN 14701, Part 1, “Elevator rescue vehicles: Purpose, definitions, safety equipment, requirements” and to the requirements of DIN 14701, Part 2, “Elevator rescue vehicles: Mechanically powered rotating ladders, DL 23-12 and DLK 23-12”.

- Spreaders to the requirements of DIN 14751, Part 1, “Hydraulically operated rescue devices for the fire brigade: Spreaders”.

- Cutting equipment to the requirements of DIN 14751, Part 2, “Hydraulically operated rescue devices for the fire brigade: Cutting devices”.

- Breaking tools to the requirements of DIN 14901, “Breaking devices, multi-part, with carrying holsters”.

- Rescue belts.

- Eye-douching devices to prevent corrosive injury by acids, alkalis, etc.

- Showers for extinguishing persons whose clothes have been set on fire.

- Self-rescuing respiratory protective equipment.

Equipment which can be used as rescue equipment such as, for example:

- halon fire extinguishers when used for extinguishing persons whose clothes have caught fire;

- one-man motor saws for freeing persons who have been jammed or locked in;

- portable angle grinders for releasing persons who have been jammed or locked in.

Source: Hauptverband der gewerblichen Berufsgennossenschaften: “Erste Hilfe (VBG 109) vom 1. April 1979”, section 2, No. 5; section 3, para. 1, No. 2; and section 7, quoted in Klaus J. Gatz: Erste Hilfe im Betrieb (Sankt Augustin, Germany, April 1985), pp. 31-32.

1. Belgium

(Royal Decree 25 October 1971, article 6) - Contents of medicine chests or first-aid kits as well as the individual kits prescribed by article 178 of the present section.

I. Minimum contents of medicine chests or first-aid kits

a. Articles in fixed numbers

1. Elastic tourniquet (width 5 cm): one.
2. Airway: one.
3. Stainless steel scissors (length 14 cm): one pair.
4. Instructions: “Emergency care before the doctor arrives”.

b. Articles in variable numbers

Depending on the nature of the work and the number of workers, per fraction or multiple of:

- ten industrial workers, with a maximum of three multiples;
- fifty non-industrial workers with a maximum of two multiples.

1. Packets of sterile bandage:

- two packets with bands of gauze measuring 2 m by 5 cm and pads measuring 10 cm by 7 cm;

- one packet with a gauze band measuring 2 m by 7 cm and a pad measuring 14 cm by 12 cm.

2. Triangular sterile bandage:

- one with dimensions of 90, 90 and 127 cm.

3. Strips of light cambric:

- two with a minimum length of 5 m and a width of 5 cm;
- two with a minimum length of 5 m and a width of 7 cm.

4. Compressed absorbent cotton:

- two packages with a net weight of 20 grams.

5. Silk adhesive bandage:

- one roll with a minimum length of 5 m and a width of 2.5 cm;
- one roll with a minimum length of 5 m and a width of 1.25 cm.

6. Sterile prepared bandage:

- either one strip with a minimum length of 1 m and a width of 6 cm or an assortment of various widths with a total length of 1 m.

7. Antiseptic solution:

- 1 per cent of iodine or at least 50 vol. per cent alcoholic chlorhexidine digluconate or any solution considered equivalent: 30 ml in one or more sealed bottles or ampoules (with file).

8. Stainless steel safety pins:

- ten (boxed or on a card).

II. Minimum contents of the individual first-aid kit

1. Packets of sterile dressing, with absorbent gauze strips at least 2 m long and 7 cm wide: two.

2. Triangular sterile dressing: one with dimensions of 90, 90 and 127 cm.

III. Remark

The articles enumerated under 1 and II above as well as their packaging shall satisfy the requirements of the Belgian Pharmacopoeia (5th edition).

2. India

First-aid appliance - The first-aid boxes or cupboards shall be distinctively marked with a red cross on a white background and shall contain the following equipment:

(A) For factories in which the number of persons employed does not exceed ten, or (in the case of factories in which mechanical power is not used) does not exceed 50 persons - each first-aid box or cupboard shall contain the following equipment:

(i)

six small size sterilized dressings;

(ii)

three medium size sterilized dressings;

(iii)

three large size sterilized dressings;

(iv)

three large size sterilized burn dressings;

(v)

one (60 ml) bottle of cetrimide solution (1 per cent) or a suitable antiseptic solution;

(vi)

one (60 ml) bottle of mercurochrome solution (2 per cent) in water;

(vii)

one (30 ml) bottle containing sal volatile having the doses and mode of administration indicated on the label;

(viii)

one pair of scissors;

(ix)

one roll of adhesive plaster (2 cm ' 1 m);

(x)

six pieces of sterilized eye-pads in separate sealed packets;

(xi)

a bottle containing 100 tablets (each of 5 grains) of aspirin or any other analgesic;

(xii)

ointment for burns;

(xiii)

polythene wash bottle (1 litre, i.e. 1,000 cc) for washing eyes;

(xiv)

a snake-bite lancet;

(xv)

one (30 ml) bottle containing potassium permanganate crystals;

(xvi)

one copy of the first-aid leaflet issued by the Directorate-General of Factory Advice Service and Labour Institutes, Government of India, Bombay.



(B) For factories in which mechanical power is used and in which the number of persons employed exceeds ten but does not exceed 50 - each first-aid box or cupboard shall contain the following equipment:

(i)

twelve small size sterilized dressings;

(ii)

six medium size sterilized dressings;

(iii)

six large size sterilized dressings;

(iv)

six large size sterilized burn dressings;

(v)

six (15 g) packets of sterilized cotton wool;

(vi)

one (120 ml) bottle of cetrimide solution (1 per cent) or a suitable antiseptic;

(vii)

one (120 ml) bottle of mercurochrome solution (2 per cent) in water;

(viii)

one (60 ml) bottle containing sal volatile having the doses and mode of administration indicated on the label;

(ix)

one pair of scissors;

(x)

two rolls of adhesive plaster (2 cm ' 1 m);

(xi)

eight pieces of sterilized eye-pads in separate sealed packets;

(xii)

one tourniquet;

(xiii)

one dozen safety pins;

(xiv)

a bottle containing 100 tablets (each of 5 grains) of aspirin or any other analgesic;

(xv)

ointment for burns;

(xvi)

one polythene wash bottle (½ litre, i.e. 500 cc) for washing eyes;

(xvii)

a snake-bite lancet;

(xviii)

one (30 ml) bottle containing potassium permanganate crystals;

(xix)

one copy of the first-aid leaflet issued by the Directorate-General of Factory Advice Service and Labour Institutes, Government of India, Bombay.


(C) For factories employing more than 50 persons - each first-aid box or cupboard shall contain the following equipment:

(i)

twenty-four small sterilized dressings;

(ii)

twelve medium size sterilized dressings;

(iii)

twelve large size sterilized dressings;

(iv)

twelve large size sterilized burn dressings;

(v)

twelve (15 g) packets of sterilized cotton wool;

(vi)

one (200 ml) bottle of cetrimide solution (1 per cent) or a suitable antiseptic;

(vii)

one (200 ml) bottle of mercurochrome solution (2 per cent) in water;

(viii)

one (120 ml) bottle containing sal volatile having the doses and mode of administration indicated on the label;

(ix)

one pair of scissors;

(x)

one roll of adhesive plaster (6 cm ' 1 m);

(xi)

two rolls of adhesive plaster (2 cm ' 1 m);

(xii)

twelve pieces of sterilized eye-pads in separate sealed packets;

(xiii)

a bottle containing 100 tablets, (each of 5 grains) of aspirin or any other analgesic;

(xiv)

one polythene wash bottle (500 cc) for washing eyes;

(xv)

twelve roller bandages 10 cm wide;

(xvi)

twelve roller bandages 5 cm wide;

(xvii)

six triangular bandages;

(xviii)

one tourniquet;

(xix)

a supply of suitable splints;

(xx)

two packets of safety pins;

(xxi)

a kidney tray;

(xxii)

a snake-bite lancet;

(xxiii)

one (30 ml) bottle containing potassium permanganate crystals;

(xxiv)

ointment for burns;

(xxv)

one copy of the first-aid leaflet issued by the Directorate-General of Factory Advice Service and Labour Institutes, Government of India, Bombay.



Provided that items (xiv) to (xxi) inclusive need not be included in the standard first-aid box or cupboard (a) where there is a properly equipped ambulance room, or (b) if at least one box containing such items and placed and maintained in accordance with the requirements of section 45 is separately provided.

(D) In lieu of the dressings required under items (i) and (ii), there may be substituted adhesive wound dressings approved by the Chief Inspector of Factories and other equipment or medicines that may be considered essential and recommended by the Chief Inspector of Factories from time to time.

Source: Labour Law Agency: Rules prescribed under sub-section 1 of section 45 of the Factories Act, 1948, with the Maharashtra Factories Rules. 1963 (Bombay, Labour Law Agency, 1987).

3. New Zealand

Minimum scales of first-aid appliances and requisites

Factories

Number of persons usually engaged at any one time


5 or
fewer

6-25

26-50

51-75

76-100

101-250

251 or
more

Other undertakings

25 or
fewer

26-50

-





Triangular bandages

2

2

2

4

4

6

6

Roller bandages (including crepe bandages - 50 mm and 75 mm sizes)

3

5

7

9

12

16

24

Sterile dressings (75 mm x 75 mm packets)

2

5

5

10

10

15

15

Adhesive wound dressing strip (100 mm packets)

1

1

2

2

3

3

5

Waterproof adhesive plaster (50 mm wide reels)

1

1

1

1

1

2

2

Paraffin gauze (100 mm x 100 mm packets)

5

5

5

5

10

10

10

Sterile eye-pads

1

2

2

4

4

6

6

Container for use in pouring water over the eye (e.g., plastic squeeze bottle)

1

1

1

1

1

1

1

Receptacle for soiled dressings (e.g., bucket with foot-operated lid)

-

-

-

1

1

1

1

Antiseptic liquid approved by the Medical Officer of Health

125 ml

2 x
125 ml

2 x
250 ml

2 x
250 ml

2 x
250 ml

4 x
250 ml

4 x
250 ml

Antiseptic cream (25 g tube)

1

1

1

1

1

2

2

Safety pins

1 card

1 card

1 card

1 card

1 box

1 box

1 box

Scissors (surgical or equivalent - stainless steel)

1 pair

1 pair

1 pair

1 pair

1 pair

2 pairs

2 pairs

Splinter forceps, fine point (stainless steel)

1

1

1

1

1

1

1

Accident register and pen or pencil

1

1

1

1

1

1

1

First-aid booklet (issued by the Departments of Labour and Health or Red Cross/St. John)

1

1

1

1

1

1

1

Card listing local emergency numbers

1

1

1

1

1

1

1

Source: Schedule to the Factories and Commercial Premises (First Aid) Regulations, 1985.

4. United Kingdom

Item

Number of employees


1-5

6-10

11-50

51-100

101-150

Guidance card

1

1

1

1

1

Individually wrapped sterile adhesive dressings

10

20

40

40

40

Sterile eye-pads, with attachment

1

2

4

6

8

Triangular bandages

1

2

4

6

8

Sterile coverings for serious wounds (where applicable)

1

2

4

6

8

Safety pins

6

6

12

12

12

Medium-sized sterile unmedicated dressings

3

6

8

10

12

Large sterile unmedicated dressings

1

2

4

6

10

Extra large sterile unmedicated dressings

1

2

4

6

8

Source: Health and Safety Executive: “Guidance notes for Health and Safety (First Aid) Regulations, 1981”, in First aid at work (London, Her Majesty’s Stationery Office, 1981).

Annex V. Antidotes: Some useful examples

Antidote

Chemical

Ascorbic acid (vitamin C)

Chromium VI compounds (chromium trioxide, zinc chromate, alkaline chromates, etc.)

Atropine sulphate (1% solution)

Cholinesterase inhibitor (phosphoric acid esters, insecticides, alkyl phosphates)

BAL (dimercaptopropanol)

Antimony, arsenic, chromium, gold, cobalt, copper, manganese, nickel, mercury, bismuth

Calcium gluconate

Fluorine, hydrochloric acid and its salts, oxalic acid

Ca Na2 EDTA

Lead, chromium, iron, cobalt, copper, uranium, vanadium, zinc

Dexamethasone-spray

Irritant gases

4-dimethyl aminophenol (4-DMAP)

Cyanide, hydrogen cyanide, hydrogen sulphide

DMPS (sodium-dimercaptopropane sulphate, BAL sulphonic acid)

Organic and inorganic mercury compounds and other indications for BAL

DTPA (calcium trisodium pentetate, ditripentate)

Lead, cadmium, chromium, iron, manganese, zinc and in the event of the incorporation of radioactive isotopes

Ethanol (vodka, kirsch)

Methanol

Isotomic eye drops

Eye injuries, due in particular to acids and alkalis

Charcoal

Absorbent for ingested water-soluble poisons

N acetylcysteine

Acrylonitrile

Sodium bicarbonate

Methanol, aldehydes, chlorates, salicylic acid, alkyl phosphates

Sodium thiosulphate

Cyanides, hydrogen cyanide - immediately after 4-DMAP, chlorine, bromine, iodine, nitrogen oxides, aliphatic and aromatic nitro compounds, aromatic amines and alkylating agents

Paraffin oil

Absorbent for ingested oil-soluble substances

Pencillamine

Lead, gold, cobalt, copper, mercury, zinc

Polyethylene glycol 400

Cleansing skin of cutaneously absorbable poisons such as aniline, phenol

Toluidine blue

Aniline, chromates, nitrates, nitrites, nitro-benzene and in the event of overdoses of 4-DMAP

Antidotes should be stored in such a way that they are immediately available in the event of an emergency. They should be protected against misuse.

Source: Hauptverband der gewerblichen Berufsgenossenschaften: “Erste Hilfe (VBG 109) vom 1. April 1979”, section 6, quoted in Klaus J. Gatz: Erste Hilfe im Betrieb (Sankt Augustin, Germany, April 1985), pp. 28-29.

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Back cover

First aid is part of total health care for workers. If it is immediately available following an accident the human, social and economic consequences may be reduced. Effective first aid can enhance the chances for survival, minimize the duration of medical treatment and reduce permanent health impairment.

This publication is intended for public authorities, employers, workers, safety and health committees, and all persons in charge of occupational safety and health at the enterprise level. In the light of the substantial experience gained by many countries, it shows in detail how first aid may be organized in the workplace, especially in small enterprises It also provides information on the duties and training of first aid personnel, the necessary equipment, supplies and facilities, and the arrangements required beyond first aid for accidents demanding specialized medical care.

ISBN 92-2-106440-9