(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.