(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.