Aid comes first

Minimum requirements and best practices for first aid programs

The person with the least amount of tenure could save the life of someone that’s been here the longest.”

Jeffrey Lancaster, founder of Lancaster Safety Consulting Inc., said this is one of the reasons why every employee at the Mars, PA-based firm is trained in first aid, CPR and the use of automated external defibrillators on their first day. “Prevention’s key, but incidents happen so you must be prepared to respond,” he said.

OSHA requires every U.S. workplace to provide first aid access to injured employees regardless of the number of workers within the organization. However, more rigorous best practices, such as the placement of AEDs in facilities, have the potential to save even more lives, according to Barbara Caracci, director of program development and training, First Aid Programs, at the National Safety Council.

Kits and trained personnel

OSHA also requires all workplaces to have readily available first aid kits that fulfill the minimum requirements of ANSI/ISEA Z308.1-2009. Beyond the minimum requirements, employers must supplement the kits with added materials based on hazards present in the workplace. “Looking at [your] OSHA 300 logs is a good place to start identifying additional items to put in the first aid kit,” Caracci said in a recent webinar.

The OSHA Medical Service and First Aid Standard (1910.151) states that employers must have adequately trained first aid practitioners present at all times at a worksite if the risk of serious injury exists and the worksite is not near a hospital, infirmary or clinic. According to a 2007 OSHA standard interpretation: “In workplaces where serious accidents such as those involving falls, suffocation, electrocution or amputations are possible, emergency medical services must be available within three to four minutes, if there is no employee on the site who is trained to render first aid.”

However, at worksites where “the possibility of such serious work-related injuries is more remote,” such as an office setting, OSHA allows up to 15 minutes of response time before trained first aid personnel must be present, the interpretation states.

Some employers fulfill or supplement OSHA requirements by training employee volunteers in basic first aid, as well as CPR and AED use. CPR can help keep a person alive before emergency medical services arrive by providing a victim with oxygen and continued blood flow to the brain.

Caracci recommends the following as best practices for an organization’s volunteer emergency response team:

  • Have one trained emergency response volunteer for every 10 employees.
  • Each area of a worksite should be accessible by a volunteer within three to four minutes.
  • Arrange replacements for first aid volunteers who are out sick or on vacation.
  • Consider the number of shifts at each worksite to ensure each is sufficiently covered.

Drills are an important aspect of successful volunteer emergency response teams, Caracci said. An emergency response team leader should conduct and observe a drill and record the time it takes for each responder to reach the scene of the incident. After, the team leader should debrief the members and provide feedback on what was done correctly or incorrectly, including ways to improve. “Errors during a drill are excellent opportunities for learning,” she said. Drills should be conducted at least once a year, but quarterly drills are considered a best practice, Caracci added.


If a worker experiences sudden cardiac arrest – a condition where the heart unexpectedly stops beating – the sooner someone trained in using an AED uses the device to attempt to restore the victim’s normal heart rhythm, the better the victim’s outcome may be. According to the American Heart Association’s 2010 Guidelines for CPR and Emergency Cardiovascular Care, a sudden cardiac arrest victim’s chance of survival decreases by 7 to 10 percent every minute between collapse and receiving AED and CPR first aid. OSHA recommends employers evaluate each worksite’s need for AEDs and learn the local, state and federal AED regulations for each site.

The number of AEDs that should be included in each building depends on the size of the building and the proximity of employees to the devices – not on how many employees are in the organization, Caracci said. The best practice is to have one AED per every one-and-a-half minutes of walking distance to any area of the jobsite, she said.

Organizations should make sure they check their AEDs as frequently as the manufacturer’s instructions recommend – or more. Depending on the equipment, the batteries, pads or entire device may need to be replaced. “AEDs do not last forever – you need to check the batteries and document like any other equipment to make sure it is ready for usage,” Lancaster noted.

Bloodborne pathogens

Some first aid responders also must be provided with supplies and training related to preventing the transmission of bloodborne pathogens. According to OSHA’s Bloodborne Pathogens Standard (1910.1030), any employee with “reasonably anticipated contact” with blood as part of his or her job duties must be provided with bloodborne pathogen training. This includes registered nurses, physicians, janitors, school teachers and child care workers. Other employees who may come in contact with blood but are not required to provide assistance, such as an office worker or camp counselor, do not require training, but providing them with training is considered a best practice, Caracci said.

Eldridge Elaine, manager of safety, health, and environment at Hasbro in Springfield, MA, said employees at her company keep first aid and exposure control instruction cards at their desk as reminders. If an employee comes in contact with a co-worker’s blood, they will know what to do and what number to call based on the card, she said. “This provides employees with a sense of security,” she said.

Starting a first aid program

If safety professionals want to develop a first aid program, where should they start?

“Very often, we as safety professionals are most comfortable in the regulations, policies, procedures and training programs,” said J.A. Rodriguez Jr., senior manager of environmental health and safety at Raytheon Technical Services Co. LLC, a company that provides training and other services to federal employees at its facility in Dulles, VA. “Instead, the place to start having an effective program is to achieve buy-in from your leadership so that there is a total organizational commitment to this program.” To achieve this, Rodriguez said, a safety professional must be able to sell leadership on the importance of keeping employees safe by implementing a first aid program. “You need to be able to sell leadership on the promise of the future, and employees are the future of the company,” he said. After achieving buy-in, Rodriguez said, developing the program, providing training and implementing it will be easier.

If employees are actively participating in first aid, it can help gauge the effectiveness of your organization’s entire safety and health program, Rodriguez said.

“If you have the employee population volunteering, then they are buying [your program],” he said. “If they are buying it, they are more apt to comply and are more apt to work and operate safer.”

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