First Aid Training Standards in North America

It isn’t simple, but it is a good idea.

By Randy Duvall

First aid training for employees can provide a number of benefits while producing safer employees and a safer work environment. Under regulatory agencies, such as the Occupational Safety & Health Administration (OSHA), the Mine Safety & Health Administration, and Canada’s Workplace Safety and Insurance Board, having employees who can respond quickly to a workplace emergency is not only important, it is required by law. Additional benefits include the trained employee’s ability to better protect and respond to family or work-related emergencies and the potential lowering of insurance costs to the employer.

First aid training is an important and reasonably inexpensive way to increase the safety awareness of employees while ensuring prompt emergency care in the event of an injury or sudden illness in the workplace. The training increases the employee’s safety awareness by illustrating the types of injury that can occur at work and make the employee more likely to recognize and correct identified hazards. This leads to a reduction in the likelihood of injuries and teaches employees to make better choices.

While taking a relatively safe person and enhancing his or her safety awareness through first aid training, it is important to repeat the training and find ways to keep it fresh. This can be done by making the first aid trainer a member of the safety team or committee, participating in observations of work practices, conducting safety training sessions for other employees and periodically conducting first aid response drills.

High-quality presentation materials and an effective trainer are critical factors in employee learning and retention of first aid techniques.

From a performance perspective, a rapid response by trained personnel to life-threatening injuries increases the survival rate of the injured person. Response to non-life-threatening injuries (lacerations, avulsions, fractures, etc.) by trained personnel also directly improves the healing and recovery process for the injured employee. This allows their return to work to be quicker and treatment time and costs to be reduced. Therefore, a proper and rapid response can also provide savings in workers’ compensation claims, treatment costs and production loss.

With first aid-trained employees in place, many insurance companies provide additional discounts in workers’ compensation and risk costs. That savings alone often is enough to offset the cost of the training. Check with your insurance provider to discuss or negotiate a discount.

During the 1980s and 1990s, the fear of contracting life-threatening diseases through first aid contact was a significant factor. Over time, that fear factor has decreased with additional knowledge of how such diseases actually spread and the universal precautions that are now readily accepted to protect both the responder and the injured person. Principally, there are two kinds of people undertaking first aid training – those who truly have an interest in safety and their fellow co-workers who want to help, and those who are “assigned” the response role as part of their job duties without a real personal interest in the subject. The latter group is hard to keep motivated; the former is already motivated.

While the benefits of first aid training of employees are obvious, it is also important to understand the compliance standards of the government, whether in the United States or Canada. For example, OSHA and its sister agency, the Mine Safety and Health Administration (MSHA), each require a rapid first aid response.

British Columbia has its Health Emergency Act and Emergency Medical Assistants regulations that outline the requirements for first responders and industrial first aid training with various levels of competency. Each has its own standards and its own time-oriented limits (rather than performance-oriented) for certification or completion.

A six- to eight-hour basic first aid course every three years is practical. This minimum-skill course provides a solid base from which to build more advanced training programs.
Performance-oriented training criteria could be used for “refresher” or renewal classes rather than repeating another complete class every three years, based on the person’s response history. However, for a person who has not used the skills or knowledge within the three years, the basic first aid course should be repeated in its entirety. First aid performance can be maintained by conducting annual drills or competency tests between recertification periods. Practical skills assessment may be enough of a refresher for a person who is active on a response team at work. Once you make the investment to train responders, it is often more cost-effective to allow them to maintain current standards and practice than to have to retrain them again from the beginning.

Overall, the intent of the regulatory requirement is to ensure timely and rapid response to anyone injured in the workplace. OSHA requires that there be a three- to four-minute response time to any emergency on site. It can be by outside agencies if the response time can be met. Otherwise, OSHA requires the employer to train employees to respond.

Training hours vary. OSHA does not directly require CPR training as part of the first aid outline, but the standard states that “in the absence of an infirmary, clinic, or hospital in near proximity (three minutes) 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.” It then becomes obvious that CPR is a necessary part of the training package.

To address the training requirements, including CPR, the training must follow nationally recognized standards, such as those defined by the American Red Cross or the National Safety Council. This places the training at a minimum of eight hours. The American Red Cross has modular courses available (CPR in four hours, which includes conducting an initial assessment, and choking assessment and treatment of injuries in the last four hours). The modules are not recognized by OSHA unless the full course is taken.

The quality of first aid training is an issue through the instructor selection process by the varying agencies. It is possible for designated “commercial” instructors to have varying levels of proficiency in skills, whether in first aid response or communication skills in a classroom. Some instructors are trained emergency medical technicians or paramedics and run calls with local rescue agencies. Some are simply “certified” by a certifying agency.
Compliance is enforced through OSHA during regular or random inspections and may be checked if an injury or fatality has occurred.

As the quality of the trainer determines the success of the first aid program, the monitoring of trainer standards is very important. There are requirements specified for trainers by the various agencies, but rarely are the certifying agencies able to monitor trainer compliance successfully.

An instructor can be “disbarred” if complaints are filed to the certifying agency. An investigation by the agency will determine whether the complaint is valid. This is the most effective and most likely means of having an instructor’s certification pulled. The American Heart Association has an active list of instructors with regular/required instructor updates for CPR training. Noncompliance with these updates can result in being removed from the instructor list. This prevents the instructor from issuing AHA cards, as the cards can only be obtained through AHA after an instructor submits completed course rosters to the organization.

First aid training in the United States is very competitive. Everyone charges fees and almost all are within a few dollars of each other. Some certifying agencies require instructors to purchase and use their specific materials in order to provide a certificate. Some agencies certify the skills of the person and allow the instructor to obtain materials.
The employer must find an instructor based on instructor credentials, knowledge and skill level. The instructor may be dynamic or may be a “snoozer” that issues a certification card from a sponsoring agency simply because they’re certified by that agency. For this reason, many employers assign one of their own employees to become credentialed so training can be done at their convenience, with their own quality standards in place, at a cost of materials only.

Although many employers prefer to use certified instructors only, numerous independent instructors provide classes with their own designed course completion cards based on nationally recognized standards. They become instructors based on their own merits, experience and other certifications (such as Emergency Medical Technician) or others that show knowledge (or assume knowledge) of the subject. It is for these reasons that the quality of instruction is emphasized. Good quality instruction translates into competent testing and performance of those being certified in first aid. Many non-certified instructors have a far greater success rate and better quality course offerings than those who are technically certified.

As long as the instructor is aware of and meets the industry requirements for which they’re providing first aid training, the opportunities for compliance are well within the reach of employers. Issues such as cost, quality and materials vary greatly among instructors, and going through a certifying agency is no guarantee the employer will get what it wants in these areas. If an employer does a little homework, there could easily be qualified instructors within the community that will provide the level of skills, knowledge and ability necessary to conduct a quality course. With a quality instructor, the employer gains direct and indirect benefits far greater than the cost of conducting the training to meet compliance requirements.

Having employees certified in first aid can offer regulatory relief, greater safety awareness in the workplace, better responses during emergencies and monetary discounts from insurance providers. What is required in first aid training depends on which regulatory agency your work site is under. The times, subjects and quality in delivery all vary, so as an employer, you’ll get your biggest bang for your training buck if you spend a little time up front doing your homework.­