(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.