Introduction to First Aid:

It is a requirement of OSHA that employees be given a safe and healthy workplace that is reasonably free of occupational hazards. However, it is unrealistic to expect accidents not to happen. Therefore, employers are required to provide medical and first aid personnel and supplies commensurate with the hazards of the workplace. The details of a workplace medical and first aid program are dependent on the circumstances of each workplace and employer. The intent of this page is to provide general information that may be of assistance. If additional information is required, an Occupational Health Professional should be contacted.

Medical and first aid services are addressed in specific standards for the general industry, shipyard employment, marine terminals, longshoring, and the construction industry.

OSHA Standards

This section highlights OSHA standards, directives (instructions for compliance officers), and standard interpretations (official letters of interpretation of the standards) related to medical and first aid.

Note: Twenty-five states, Puerto Rico and the Virgin Islands have OSHA-approved State Plans and have adopted their own standards and enforcement policies. For the most part, these States adopt standards that are identical to Federal OSHA. However, some States have adopted different standards applicable to this topic or may have different enforcement policies.General Industry (29 CFR 1910)1910.151, Medical services and first aid 1910.266, Logging operations [related topic page] 1910.266(d)(2), First-aid kits Appendix A, First-aid kits (Mandatory) Appendix B, First-aid and CPR training (Mandatory) 1910.269, Electric power generation, transmission, and distribution [related topic page] 1910.269(b), Medical services and first aid 1910.421, Pre-dive procedures [related topic page]

Shipyard Employment (29 CFR 1915)1915.98, First aid

Marine Terminals (29 CFR 1917)1917.26, First aid and lifesaving facilities

Longshoring (29 CFR 1918)1918.97, First aid and lifesaving facilities (see appendix V of this part)

Construction Industry (29 CFR 1926)1926.23, First aid and medical attention 1926.50, Medical services and first aid

DirectivesInspection Procedures for 29 CFR 1910.120 and 1926.65, Paragraph (q): Emergency Response to Hazardous Substance Releases. CPL 02-02-073, (2007, August 27). Also available as a 444 KB PDF, 119 pages. Updates enforcement procedures for compliance officers who need to conduct inspections of emergency response operations. It defines additional terms and expands on training requirements for emergency responders and other groups such as skilled support personnel. This OSHA instruction revises CPL 02-02-059, issued April 24, 1998. Logging Operations, Inspection Procedures and Interpretive Guidance Including Twelve Previously Stayed Provisions. CPL 02-01-022 [CPL 2-1.22], (1996, September 27). Logging Operations, Inspection Procedures and Interpretive Guidance. CPL 02-01-019 [CPL 2-1.19], (1995, March 17). Exposure Control Plan for OSHA Personnel with Occupational Exposure to Bloodborne Pathogens. CPL 02-02-060 [CPL 2-2.60], (1994, March 7). 29 CFR 1910.151(c), Medical Services and First Aid; 29 CFR 1926.50 and .51, Medical Service and First Aid, and .... STD 01-08-002 [STD 1-8.2], (1982, March 8). American Red Cross Agreement. CPL 02-00-002 [CPL 2.2], (1978, October 30). Provides information regarding first aid training requirements and courses. 29 CFR 1910.401-1910.441, Subpart T -- Commercial Diving Operations. STD 01-17-001 [STD 1-23.2], (1978, October 30). Search all available directives.

Standard InterpretationsInterpretation of the First Aid standard. (1996, December 11). OSHA first aid standard. (1996, March 18). Discusses frequency of training. Clarification of training requirements under 1910.151, (Medical Services and First Aid). (1995, July 24). Medical and First Aid standards. (1994, July 26). Discusses whether full face shields and access to a water hose can be used as a substitute for a commercially available eye wash facility. Clarification on first aid requirements for hazardous waste sites. (1993, April 20). Successful completion of a first aid course demonstrated by means other than a written knowledge test. (1992, September 2). When a lifesaving skiff is to be considered as being "immediately available". (1991, December 6). Standard for medical services and first aid. (1991, July 2). First Aid treatment required within 3 to 4 minutes of injury. (1990, June 13). First Aid Training. (1976, January 27). The following interpretations are applicable to eyewash and body flushing facilities:
Requirements for emergency eyewash stations in retail autoparts stores. (1994, August 11). Standard requirements for eyewash and shower equipment, personnel and other protective equipment and air circulation fans, used in an automotive battery charging area. (1994, March 31). The following interpretations demonstrate the application of the bloodborne pathogens standard to first aid providers:
Most frequently asked questions concerning the bloodborne pathogens standard. (1993, February 1). Bloodborne pathogens impact on non-health care industries. (1992, December 15). Applicability of Bloodborne Pathogens Standard to emergency responders, decontamination, housekeeping, and good samaritan acts. (1992, December 4). Applicability of bloodborne pathogens standard to first aid providers at electric cooperatives. (1992, October 23). Applicability of bloodborne pathogens standard to first aid providers at drilling operations. (1992, October 22). Bloodborne pathogen standard's applicability to employees of summer camps and conference/retreat centers. (1992, October 1). Bloodborne pathogens standard's relationship to employees trained in first aid around electrical lines. (1992, September 4). Search all available standard interpretations.

What is first aid?

First aid refers to medical attention that is usually administered immediately after the injury occurs and at the location where it occurred. It often consists of a one-time, short-term treatment and requires little technology or training to administer. First aid can include cleaning minor cuts, scrapes, or scratches; treating a minor burn; applying bandages and dressings; the use of non-prescription medicine; draining blisters; removing debris from the eyes; massage; and drinking fluids to relieve heat stress. OSHA's revised recordkeeping rule, which went into effect January 1, 2002, does not require first aid cases to be documented. For example: A worker goes to the first-aid room and has a dressing applied to a minor cut by a registered nurse. Although the registered nurse is a health care professional, the employer does not have to report the accident because the worker simply received first aid. The selected references below provide more information on first aid.Medical and First Aid - OSHA Standards. OSHA Safety and Health Topics Page. Provides formal OSHA definitions of first aid and related requirements. First Aid. National Ag Safety Database (NASD). Provides links to a variety of first aid topics primarily related to the agriculture industry. Basic First Aid: Script. Intended to be used as a refresher safety awareness session. Basic First Aid. Provides basic first aid response procedures. Job Injuries and First Aid Training Guide. Electronic Library of Construction Occupational Safety and Health (eLCOSH), (1994). Provides teaching guidelines and basic first aid questions aimed at recognizing hazards and controls in the workplace. First Aid. Mayo Clinic. Includes information for handling a variety of emergency care situations.

First Aid Programs

First aid training is primarily received through the American Red Cross, the National Safety Council (NSC), and private institutions. The American Red Cross and NSC offer standard and advanced first aid courses via their local chapter/training centers. After completing the course and successfully passing the written and practical tests, trainees receive two certificates; (adult CPR and first aid). An emphasis on quick response to first aid situations is incorporated throughout the program. Other program elements include: basic first aid intervention, basic adult cardiopulmonary resuscitation (CPR), and universal precautions for self-protection. Specific program elements include training specific to the type of injury: shock, bleeding, poisoning, burns, temperature extremes, musculoskeletal injuries, bites and stings, medical emergencies, and confined spaces. Instruction in the principles and first aid intervention of injuries will cover the following sites: head and neck, eye, nose, mouth and teeth, chest, abdomen, and hand, finger, and foot injuries. Employers are responsible for the type, amount, and maintenance of first aid supplies needed for their particular program. The training program should be periodically reviewed with current first aid techniques and knowledge. Basic adult CPR retesting should occur every year and first aid skills and knowledge should be reviewed every three years. The references below provide further fundamentals to help develop and maintain first aid program and skills.

Definition of First Aid:

GET MEDICAL ATTENTION FOR ALL INJURIES

It is very important for you to get immediate treatment for every injury, regardless how small you may think it is. (See Figure 1.) Many cases have been reported where a small unimportant injury, such as a splinter wound or a puncture wound, quickly led to an infection, threatening the health and limb of the employee. Even the smallest scratch is large enough for dangerous germs to enter, and in large bruises or deep cuts, germs come in by the millions. Immediate examination and treatment is necessary for every injury.

What is first aid? It is simply those things you can do for the victim before medical help arrives. The most important procedures are described below.

CONTROL BLEEDING WITH PRESSURE

Bleeding is the most visible result of an injury. Each of us has between five and six quarts of blood in our body. Most people can lose a small amount of blood with no problem, but if a quart or more is quickly lost, it could lead to shock and/or death. One of the best ways to treat bleeding is to place a clean cloth on the wound and apply pressure with the palm of your hand until the bleeding stops. You should also elevate the wound above the victim's heart, if possible, to slow down the bleeding at the wound site. (See Figure 2.) Once the bleeding stops, do not try to remove the cloth that is against the open wound as it could disturb the blood clotting and restart the bleeding. If the bleeding is very serious, apply pressure to the nearest major pressure point, located either on the inside of the upper arm between the shoulder and elbow, or in the groin area where the leg joins the body. Direct pressure is better than a pressure point or a tourniquet because direct pressure stops blood circulation only at the wound. Only use the pressure points if elevation and direct pressure haven't controlled the bleeding. Never use a tourniquet (a device, such as a bandage twisted tight with a stick, to control the flow of blood) except in response to an extreme emergency, such as a severed arm or leg. Tourniquets can damage nerves and blood vessels and can cause the victim to lose an arm or leg.

TREAT PHYSICAL SHOCK QUICKLY

Shock can threaten the life of the victim of an injury if it is not treated quickly. (See Figure 3.) Even if the injury doesn't directly cause death, the victim can go into shock and die. Shock occurs when the body's important functions are threatened by not getting enough blood or when the major organs and tissues don't receive enough oxygen. Some of the symptoms of shock are a pale or bluish skin color that is cold to the touch, vomiting, dull and sunken eyes, and unusual thirst. Shock requires medical treatment to be reversed, so all you can do is prevent it from getting worse. You can maintain an open airway for breathing, control any obvious bleeding and elevate the legs about 12 inches unless an injury makes it impossible. You can also prevent the loss of body heat by covering the victim (over and under) with blankets. Don't give the victim anything to eat or drink because this may cause vomiting. Generally, keep the victim lying flat on the back.

A victim who is unconscious or bleeding from the mouth should lie on one side so breathing is easier. Stay with the victim until medical help arrives.

MOVE THE INJURED PERSON ONLY WHEN ABSOLUTELY NECESSARY

Never move an injured person unless there is a fire or when explosives are involved. The major concern with moving an injured person is making the injury worse, which is especially true with spinal cord injuries. If you must move an injured person, try to drag him or her by the clothing around the neck or shoulder area. If possible, drag the person onto a blanket or large cloth and then drag the blanket. (See Figure 4.)

PERFORM THE HEIMLICH MANEUVER ON CHOKING VICTIMS

Ask the victim to cough, speak, or breathe. If the victim can do none of these things, stand behind the victim and locate the bottom rib with your hand. Move your hand across the abdomen to the area above the navel then make a fist and place your thumb side on the stomach. Place your other hand over your fist and press into the victim's stomach with a quick upward thrust until the food is dislodged. (See Figure 5.)

FLUSH BURNS IMMEDIATELY WITH WATER

There are a many different types of burns. They can be thermal burns, chemical burns, electrical burns or contact burns. Each of the burns can occur in a different way, but treatment for them is very similar. For thermal, chemical or contact burns, the first step is to run cold water over the burn for a minimum of 30 minutes. (See Figure 6.) If the burn is small enough, keep it completely under water. Flushing the burn takes priority over calling for help. Flush the burn FIRST. If the victim's clothing is stuck to the burn, don't try to remove it. Remove clothing that is not stuck to the burn by cutting or tearing it. Cover the burn with a clean, cotton material. If you do not have clean, cotton material, do not cover the burn with anything. Do not scrub the burn and do not apply any soap, ointment, or home remedies. Also, don't offer the burn victim anything to drink or eat, but keep the victim covered with a blanket to maintain a normal body temperature until medical help arrives.

If the victim has received an electrical burn, the treatment is a little different. Don't touch a victim who has been in contact with electricity unless you are clear of the power source. If the victim is still in contact with the power source, electricity will travel through the victim's body and electrify you when you reach to touch. Once the victim is clear of the power source, your priority is to check for any airway obstruction, and to check breathing and circulation. Administer CPR if necessary. Once the victim is stable, begin to run cold water over the burns for a minimum of 30 minutes. Don't move the victim and don't scrub the burns or apply any soap, ointment, or home remedies. After flushing the burn, apply a clean, cotton cloth to the burn. If cotton is not available, don't use anything. Keep the victim warm and still and try to maintain a normal body temperature until medical help arrives.

USE COOL TREATMENT FOR HEAT EXHAUSTION OR STROKE

Heat exhaustion and heat stroke are two different things, although they are commonly confused as the same condition. Heat exhaustion can occur anywhere there is poor air circulation, such as around an open furnace or heavy machinery, or even if the person is poorly adjusted to very warm temperatures. The body reacts by increasing the heart rate and strengthening blood circulation. Simple heat exhaustion can occur due to loss of body fluids and salts. The symptoms are usually excessive fatigue, dizziness and disorientation, normal skin temperature but a damp and clammy feeling. To treat heat exhaustion, move to the victim to a cool spot and encourage drinking of cool water and rest. (See Figure 7.)

Heat stroke is much more serious and occurs when the body's sweat glands have shut down. Some symptoms of heat stroke are mental confusion, collapse, unconsciousness, fever with dry, mottled skin. A heat stroke victim will die quickly, so don't wait for medical help to arrive--assist immediately. The first thing you can do is move the victim to a cool place out of the sun and begin pouring cool water over the victim. Fan the victim to provide good air circulation until medical help arrives.

RESPOND APPROPRIATELY TO THE FORM OF POISONING

The first thing to do is get the victim away from the poison. Then use provide treatment appropriate to the form of the poisoning. (See Figure 8.) If the poison is in solid form, such as pills, remove it from the victim's mouth using a clean cloth wrapped around your finger. Don't try this with infants because it could force the poison further down their throat. If the poison is a gas, you may need a respirator to protect yourself. After checking the area first for your safety, remove the victim from the area and take to fresh air. If the poison is corrosive to the skin, remove the clothing from the affected area and flush with water for 30 minutes. Take the poison container or label with you when you call for medical help because you will need to be able to answer questions about the poison. Try to stay calm and follow the instructions you are given. If the poison is in contact with the eyes, flush the victim's eyes for a minimum of 15 minutes with clean water.

KEEP A FIRST AID KIT CHECKLIST

In order to administer effective first aid, it is important to maintain adequate supplies in each first aid kit. (See Figure 9.) First aid kits can be purchased commercially already stocked with the necessary supplies, or one can be made by including the following items: Adhesive bandages: available in a large range of sizes for minor cuts, abrasions and puncture wounds Butterfly closures: these hold wound edges firmly together. Rolled gauze: these allow freedom of movement and are recommended for securing the dressing and/or pads. These are especially good for hard-to-bandage wounds. Nonstick Sterile Pads: these are soft, super absorbent pads that provide a good environment for wound healing. These are recommended for bleeding and draining wounds, burns, infections. First Aid Tapes: Various types of tapes should be included in each kit. These include adhesive, which is waterproof and extra strong for times when rigid strapping is needed; clear, which stretches with the body's movement, good for visible wounds; cloth, recommended for most first aid taping needs, including taping heavy dressings (less irritating than adhesive); and paper, which is recommended for sensitive skin and is used for light and frequently changed dressings. Items that also can be included in each kit are tweezers, first aid cream, thermometer, an analgesic or equivalent, and an ice pack.

REPORT ALL INJURIES TO YOUR SUPERVISOR

As with getting medical attention for all injuries, it is equally important that you report all injuries to your supervisor. (See Figure 10.) It is critical that the employer check into the causes of every job-related injury, regardless how minor, to find out exactly how it happened. There may be unsafe procedures or unsafe equipment that should be corrected.