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.

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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).