First Aid Fundamentals

The ISEA First Aid Product Group's members are now working on the 2014 edition of the American national standard specifying minimum requirements for the contents of workplace first aid kits.

• By Jerry Laws
• Apr 01, 2013

First aid training for the workplace begins with three fundamental standards affecting general industry. ANSI/ISEA Z308.1-2009 is the American national standard specifying minimum requirements for the contents of workplace first aid kits, setting a baseline of items that should enable someone in a small workplace to deal with injuries that might occur there. The OSHA standard, 29 CFR 1910.151, has three elements, including one (1910.151(c)) requiring emergency eyewash and showers within a work area where someone could be exposed to corrosive materials. The third key standard is 1910.1030, bloodborne pathogens. It's the first one mentioned in OSHA's Best Practices Guide about first aid program fundamentals because it applies to any employee who is expected to render first aid as part of his or her job duties, and it includes a list of training that must be provided when that worker is initially assigned and at least annually after that. At a minimum, according to 1910.1030(g)(2)(vii), these must be included in this training:

• An accessible copy of the text of the bloodborne pathogens standard and an explanation of its contents
• Explanations of the epidemiology and symptoms of bloodborne diseases and the modes of transmission of bloodborne pathogens
• An explanation of the employer's exposure control plan and how the employee can obtain a copy of the written plan
• An explanation of the appropriate methods for recognizing tasks and other activities that may involve exposure to blood and other potentially infectious materials
• An explanation of the use and limitations of methods that will prevent or reduce exposure, including engineering controls, work practices, and PPE
• Information on the types, proper use, location, removal, handling, decontamination, and disposal of PPE and an explanation of the basis for selection of PPE
• Information on the appropriate actions to take and people to contact in an emergency involving blood or other potentially infectious materials
• An explanation of the procedure to follow if an exposure incident occurs, including the method of reporting the incident and the medical follow-up that will be made available
• Information on the post-exposure evaluation and follow-up the employer is required to provide for the employee following an exposure incident
• An opportunity for interactive questions and answers with the person conducting the training session

AEDs and CPR Training
OSHA and the American Red Cross also recommend creating an automated external defibrillator (AED) program and providing related training in AED use and CPR to employees. The Red Cross Ready Reference document for adult first aid/CPR/AED is a simple, step-by-step guide for helping an injured or unconscious person, a burn victim, a person who is bleeding, or someone who is choking and cannot breathe. The document is available at http://www.redcross.org/images/MEDIA_CustomProductCatalog/m4240170_Adult_ready_reference.pdf.

The OSHA Best Practices Guide discusses various teaching methods, along with an extensive list of elements to include in a first aid training program. It suggests emphasizing skills training and confidence building over classroom lectures and recommends having trainees develop hands-on skills through practice with partners and manikins. This combination of knowledge and skills prepares them to respond to life-threatening emergencies (including chest pain, stroke, breathing problems, anaphylactic reactions, seizures, unconsciousness, and other emergencies).

In addition, the guide recommends designing the training program for the specific work site and including first aid instruction for managing non-life-threatening emergencies (specifically wounds; thermal, electrical, or chemical burns; musculoskeletal injuries; exposure to temperature extremes; and eye injuries). The guide is available at http://www.osha.gov/Publications/OSHA3317first-aid.pdf.

Revising the Z308.1-2009 Standard
While it seems clear enough, OSHA has compiled a small library of interpretation letters explaining when employers are required to provide first aid kits. One of these from 2007 quoted 1910.151(b), which says, "In the absence of an infirmary, clinic, or hospital in near proximity to the workplace which is used for treatment of all injured employees, a person or persons shall be adequately trained to render first aid. Adequate first aid supplies shall be readily available." In this 2007 letter, OSHA's Richard Fairfax explained the provision means employers "may elect not to provide first aid services if all such services will be provided by a hospital, infirmary, or clinic in near proximity to the workplace. If the employer has persons who are trained in first aid, then adequate first aid supplies must be readily available for use. Therefore, employers are required to provide first aid supplies that are most appropriate to respond to incidents at their workplaces. OSHA allows employers to provide first aid supplies specific to the needs of their workplace."

There is no requirement to obtain a consulting physician's approval of a workplace first aid kit’s contents, but whoever selects these should be competent in first aid and knowledgeable about the hazards present in the workplace.

Safety managers can consult the Z308.1-2009 standard, Minimum Requirements for Workplace First Aid Kits and Supplies, to find the recommended contents for a basic kit as well as the optional items to augment the basic list. Kits should be inspected regularly to ensure they remain stocked and that the contents still meet the needs of the workplace.

David L. Lapp, North by Honeywell's senior product manager, first aid, chairs the ISEA First Aid Product Group, whose members are now working on the 2014 edition of the standard. "We're just at the beginning of the process to try to come up with an agreed format, if you will, to make sure we are covering all of our bases," he said during a Feb. 21 interview. "Our main concern is that in today's environment, the current ANSI standard is a pretty minimal standard. There's not a whole lot to it. It effectively is a personal or just a small-office type of kit that doesn't really address industrial needs or even larger facilities. The problem is that when it comes to OSHA compliance, you'll have a company that might have 50, 70, 100 people on an industrial floor of some kind -- it could be manufacturing, assembly, whatever that industrial setting might be, a construction site -- and they will ask for and buy an ANSI-compliant kit. And that's it, they think they're covered. The reality is that doesn't cover a lot of injuries, especially for the number of people they're trying to help. It's just not sufficient."

For example, there is no burn dressing in a kit that strictly complies with the Z308.1-2009 standard, nor is there a cold pack, Lapp said. "Don't you think of an instant cold pack as being a standard first aid item? A contusion that requires swelling reduction, whenever you bump yourself -- the first thing you do is grab some ice. The standard ANSI first aid kit has nothing cold in it," he said.

Rather than a complete rewrite, the 2014 revision will be "an expansion of the standard based on current industrial environments," he said. "I'm really thinking about this in terms of worker safety and not in terms of sales. This is not going to increase my sales. What this will do is make sure that people out there in workplaces that have hazards and dangers are going to be protected. That's the main goal of this ANSI standard."

He said the five members of the committee working on the standard want to make sure they do the right research as they develop it, in order to ensure that managers who buy first aid supplies have a standard that meets their needs. The committee's meetings about the revision have begun, and its members probably will convene again at the ASSE Safety 2013 conference in Las Vegas in June 2013, Lapp said.

This article originally appeared in the April 2013 issue of Occupational Health & Safety.