The Do's & Don'ts of First Aid Compliance

What is OSHA First Aid? Compliance can be easy. Non-compliance can be costly.

• By Matthew Marc Henry, EMT
• Jul 01, 2006

WHAT exactly is "OSHA First Aid," and what do you need to do to comply with regulations for your industry?

That is a big question, one that is often answered incorrectly. The OSHA guidelines can be a bit contradictory. Suppliers will often try to sell you what they offer, rather than what you need, and you, as either an employer or a supervisor, can be held both criminally and civilly liable if your workplace is not in compliance. Medical and first aid issues are the 19th most frequently cited of all OSHA violations.¹ As the saying goes, "ignorance of the law is no excuse."

What Can You Do?
Let's look at areas you will need to address. You will need to know what specific requirements apply to your location and industry. You will need to know what materials and supplies are required to meet OSHA guidelines. You will need to have your personnel properly trained and informed. We will take these issues one at a time.

What Are Your Requirements?
The most important step in OSHA compliance for any business is to determine which regulations apply to them and which authority governs their compliance.

OSHA is a sub-agency of the U.S. Department of Labor. It issues standards to segments of the workforce and polices these regulations with a staff of inspectors who make periodic work site checks. The purpose of these standards is to ensure workplace safety. Fines are imposed if repeated infractions are noted.

Although federal OSHA sets national standards, many states have their own OSHA equivalent. You should be concerned with OSHA compliance on both a federal and state level. Many states follow the federal OSHA regulations, while others follow a regulation that combines the federal standard and imposes an individualized (state by state) requirement.

Some of these local governing bodies, such as California's Cal/OSHA, have significantly more stringent and specific requirements. Check your state's Department of Labor Web site, as well as www.osha.gov, for guidance in this area. Federal and state regulations have separate, distinct regulations for general industry versus construction and electrical safety orders. Some businesses may overlap the two and require compliance with both sets of codes.

Once you have determined who sets the rules for your business and industry, get some quick reference. OSHA standards are about as close to undecipherable as they could possibly be. Since being written, the OSHA codes (CFR 1910/1926, etc.) and their state equivalents have been modified, amended, and revised beyond recognition and nearly beyond comprehension. After all, it is "law."

As a direct result, several publishers offer "OSHA Books" to help guide you through the morass of OSHA compliance. Unlike the OSHA standards themselves, most of these private-sector published guides and books offer easy reading with cross references to other relevant sections. They also present interpretations of the intent of the regulations and ideas for implementation. This is a key factor because many OSHA standards are performance-based standards that can easily be misunderstood or might be interpreted to imply more or less gravity than may truly exist in the code.

These books vary drastically in both price and content, but several are available for well under $100. Be sure the book you choose is clearly indexed and provides easy guides and diagrams. Many publishers also offer CD-ROM versions, update services, and state-specific editions. A thorough but inexpensive OSHA book or CD could be one of the wisest investments of your career. OSHA codes are a "know-no": Know them. . . no fines.

What Do You Need?
Based on federal OSHA Standard 1910.151(b): "Adequate first aid supplies shall be readily available." This rule applies to treatment of minor injuries that occur in the workplace. Appendix A states that an example of the minimal contents of a generic first aid kit is described in American National Standard (ANSI) Z308.1-1978 (updated by ANSI in 2003). The contents of the kit listed in the ANSI standard should be adequate for small work sites.

When larger or multiple operations are being operated at the same location, employers should determine the need for additional kits, additional types of first aid equipment and supplies, and enhanced kits for unique or changing first aid needs. If it is reasonably anticipated that employees will be exposed to blood or other potentially infectious materials while using first aid supplies, employers are required to provide personal protective equipment in compliance with OSHA's 1910.1030(d)(3).²

OSHA Interpretation:
"There are no exemptions from 1910.151 due to a company's size. . . . All industries are required to comply with 1910.151 regardless of the type of work performed . . . the employer's first aid program must correspond to the hazards which can be reasonably expected to occur. . . ."

John B. Miles, Jr., Director
Directorate of Compliance Programs
Occupational Health and Safety Administration ³

'OSHA-Approved': Don't Believe It
Do not be misled. If you are looking for an "OSHA Approved First Aid Kit" or an "OSHA Certified First Aid Kit," there is no such thing. OSHA sets forth first aid kit guidelines for general industry, construction, and industry-specific first aid requirements, but OSHA does not "approve" any manufacturer's products. It is up to the manufacturer to ensure the kits fulfill the OSHA first aid kit requirements and thereby state that the kits are "OSHA compliant" or that the kit "meets OSHA First Aid Kit Guidelines."

Make sure that the first aid kits you put at your workplace meet or exceed OSHA first aid guidelines for the purposes they are defined as suiting. Look for industry-specific first aid kits. You will be surprised by how many are out there. If you are in a specific field with specialized OSHA first aid requirements, don't "guess" whether or not a kit meets your needs; find one designed specifically for you.

There are OSHA-compliant first aid kits on the market specifically designed for a myriad of fields. Try an Internet search and you will find commercial and fleet vehicle first aid kits, trucker first aid kits, restaurant first aid kits, landscaper first aid kits, pool and lifeguard first aid kits, welder first aid kits, logger's first aid kits, even contractors' first aid/construction first aid kits. Let the specialists design it and guarantee it so you don't have to.

Is an OSHA-compliant first aid kit or cabinet enough? No. While most safety managers can muddle their way through finding an OSHA-compliant first aid kit, they forget about bloodborne pathogens and PPE. While first aid is in the top 20 OSHA violations, PPE violations rank ninth and bloodborne pathogens citations rank tenth.¹

PPE does not just mean hard hats, gloves, and safety vests. In a first aid environment, an employer must provide adequate protection to rescuers who may come into contact with blood or other potentially infectious materials (OPIM.) This means that next to each first aid kit, cabinet, or station, there should be a bodily fluid pickup kit or personal protection kit. These kits usually contain eye and hand protection, fluid absorbents, sanitizing and disposal products, and a CPR mask. Some first aid manufacturers pre-package these with first aid kits and sell them as "OSHA First Aid Compliance Packages."

AEDs
Many states have implemented laws requiring automated external defibrillators in gyms, restaurants, and other "public" places. The trend is sweeping the nation, and with good reason. Survival rates for out-of-hospital cardiac arrests are estimated to be as low as 1 to 5 percent. When early defibrillation is administered within the first few minutes of cardiac arrest, survival rates increase to an astonishing 62 to 98 percent.

AEDs are in what I like to call the "microwave stage": They keep getting smaller, more advanced, and less expensive. Sales competition for AEDs is fierce, keeping the costs low for the time being while the big contenders are sorting themselves out. There are even corporate- and manufacturer-sponsored grant funds available for businesses and individuals that reduce the cost of an AED to under $1,000, which is a small price to pay for even one saved life.

Now is the perfect time to equip your business with AEDs. You can acquire one inexpensively. Good Samaritan legislation in most states has removed any concern of employer liability (in fact, some companies have been held liable for not having AEDs available), and it is a very visible way to boost morale and show your employees you are concerned about their safety. Furthermore, AED deployment in the workplace goes a long way toward meeting your OSHA first aid response requirements.

What Do Your Employees Need to Know?
OSHA 1910.151, Medical Services and First Aid, states: (a) The employer shall ensure the ready availability of medical personnel for advice and consultation on matters of plant health, and (b) In the absence of an infirmary, clinic, or hospital in near proximity to the workplace which is used for the treatment of all injured employees, a person or persons shall be adequately trained to render first aid.

OSHA Interpretation:
"In areas where accidents resulting in suffocation, severe bleeding, or other life threatening injury or illness can reasonably be expected, a 3 to 4 minute response time, from time of injury to time of administering first aid, is required. . . . where a life-threatening injury is an unlikely outcome . . . a 15 minute response time is acceptable."

Roger A. Clark, Director
Directorate of Compliance Programs
Occupational Health and Safety Administration⁴

Given the potential positive impact first aid care can provide, several OSHA standards have included first aid provisions: general industry (CFR 1910.151), construction (CFR 1926.50), shipyards (CFR 1915.98), longshoring (CFR 1918.96), diving (CFR 1910.410), Hazardous Waste Operations and Emergency Response (CFR 1910.120), temporary labor camps (CFR 1910.142), and first aid and lifesaving facilities (CFR 1917.26). Although these standards require first aid training, they do not specify what constitutes "adequate training."

What does this mean to you as an employer or safety manager? It means you need to train at least part of your staff in first aid. Rare is the operation with no life-threatening potential. Cases have been filed alleging negligence in office situations where employers did not consider the age of employees; slips, trips, and falls; and environmental hazards. Training is inexpensive and can be offered on a company-paid but voluntary basis, providing an opportunity for improved employee morale and serving as an employment benefit. Making it voluntary should provide you with an adequate number of trained personnel on staff; it also removes the onus of "required training" and the potential liability associated with a designated First Aid Response Team.

Other Training Issues
OSHA defines specific "first aid" skills that must be taught, but it also includes CPR and universal precautions (bloodborne pathogens and PPE) in the guidelines for "OSHA First Aid." Specifically, it requires that the training include responding to a health emergency, surveying the scene, basic adult cardiopulmonary resuscitation, basic first aid intervention, universal precautions, first aid supplies, and trainee assessments.⁵

You should always train your employees in a combination course including CPR, OSHA first aid, and bloodborne pathogens. And if you have an AED at your facility, be sure to include automated external defibrillation training. Most private training organizations offer time- and cost-saving options when teaching these subjects together, and some of the public non-profit groups will combine the courses if you ask them. You can accomplish all this training in a half-day with a private group, and the certifications usually are valid for two years.

Corporate America is leaning more and more toward private training providers because they can provide the same OSHA-compliant training at your own place of business, at a fraction of the price, and in a fraction of the time. There are even centrally managed national training groups that can schedule your training anywhere in the country trough one central instructor coordinator, enabling multi-state or multi-city companies to set up all of their training at one time without dealing with multiple chapters. This also allows for consistency and a uniform set of rules and pricing.

Should You Volunteer for an OSHA Inspection?
This may sound crazy, especially coming from an author who is paid for OSHA compliance consulting and training, but one of your best options for ensuring your OSHA compliance and avoiding OSHA violations is to request a voluntary inspection. Federal OSHA and most state equivalents have consulting divisions that are distinct from the enforcement divisions. These consulting divisions can review your first aid training, equipment, and supplies and can help you determine what steps you should take and what equipment you should purchase. More importantly, they can tell you what you don't need.

This is a great way to curb your expenses. Later on down the line, you will have your review from OSHA to refer to should an accident or violation rear its ugly head.

Think ahead: Spend a little, save a lot. Don't wait until you have an accident, inspection, or citation. Do a little research, find yourself an economical but thorough OSHA book or CD, equip your facility with adequate and appropriate first aid and safety equipment, and schedule some fun and inexpensive lifesaving training for your staff. Do the Do's, Don't do the Don'ts, and remember: OSHA first aid compliance can be easy and affordable.

References

1. Citation frequency rates are based on filed OSHA citations from October 2003 through September 2004.
2. Mancomm's Federal OSH/29 CFR Standards--1910 OSHA General Industry Regulations Book, ISBN 1-932249-61-3.
3. In a letter dated July 24, 1995, to Villanova University.
4. In a letter dated Nov. 19, 1992, to County Fresh Environmental.
5. Department of Labor OSHA DIRECTIVE NUMBER: CPL 2-2.53.

This article appeared in the July 2006 issue of Occupational Health & Safety.

This article originally appeared in the July 2006 issue of Occupational Health & Safety.