First Aid is a strange thing isn’t it? The image is all wrong – a bit nerdy and silly; the slightly more socially engaged form of train spotting. Then the legal aspects are confusing: who should be trained? Can they be taken to court if they get it wrong? Then there is the whole thing about equipment – are those small First Aid Kits that they sell in the local pharmacy OK? Or do I need to go as far as getting my own defibrillator? On top of that there isn’t a simple one-stop-shop for understanding any of it. In the UK, the Health and Safety Executive (HSE) advise on bits, Ofsted have a huge input around children, and other professionals add their opinions freely.
So where does this leave us? Let’s deal with the image problem. First Aid is defined as:
“Where a person will need help from a medical practitioner or nurse, treatment for the purpose of preserving life and minimising the consequences of injury and illness until such help is obtained, and treatment of minor injuries which would otherwise receive no treatment or which do not need treatment by a medical practitioner or nurse.”
That comes from the Health and Safety (First-Aid) Regulations 1981, so we can be confident that it is right. It basically says that life-saving treatment whilst waiting for qualified clinical help, or the treatment of more minor injuries counts as first aid. So it isn’t nerdy at all. It is about having a skill-set that helps people when they might otherwise suffer and potentially die. Who wouldn’t want that? Even if you only think about your own friends and family, wouldn’t we want to be in a position to help them if they suffered a heart attack? Or even a sprained ankle? It can sound amusing until you’re in the position where you are facing the problem.
The legal issues are confusing – but when you straighten them out, the whole thing is really quite simple. Like most other Health and Safety legislation, first aid is based on risk assessment. What issues are you likely to have to face? The HSE guidance is really quite useful for most workplaces, and it includes hazards, number and experience of employees, working arrangements and accident history. Once you have done your risk assessment, then act appropriately. You need the right number of first aiders, trained to the appropriate level.
The HSE guidance bases training on four levels:
- appointed person (AP). An individual looking after the first-aid equipment and facilities and calling the emergency services when required;
- emergency first aid at work (EFAW). A first-aider to give emergency first aid to someone who is injured or becomes ill while at work;
- first aid at work (FAW). A first aider trained to EFAW standards plus the application of first aid to a range of specific injuries and illnesses;
- additional training. First aiders additionally trained in specific workplace hazards relevant to a specific environment, process, chemical or other factor in the workplace.
First Aid Requirements
There are a host of professional inputs into first aid requirements. In the UK the most significant in relation to the number of people that it affects, is the input into education and childcare by Ofsted. The requirements for under 5s is in the Statutory Framework for the Early Years Foundation Stage and it states that first aiders must be trained in paediatric first aid. For the standards, the guidance refers to two specific suppliers of first aid training and says that the training must cover the same course content as for these providers and must be renewed every three years.
This seems problematic to me in two ways – it outsources the standard to someone who is not accountable to Ofsted and it says nothing about the experience of the instructor. I believe that Ofsted should set its own standards, and it should insist that instructors should be more than passing on theoretical knowledge learned only by attending a course and practicing with a small plastic manikin. Incidents involving children can be scary, it is good to be able to discuss these things with people who have been there, seen it and had to act. For paediatric courses I would look for EPLS or APLS qualifications, or at least some evidence of dealing with paediatric emergencies.
Are we likely to be sued?
So what about the nasty stories in the press that if we use a plaster on someone to help, and they are allergic to plasters, we will be sued from here to kingdom come? Do we really want all that? Well… no we don’t, and there is no evidence that we will get it. There are lots of complications here but in simple terms:
- We should ask a casualty if they are happy being touched and are happy with the treatment provided, this constitutes consent and is an absolute defense against common assault.
- If the casualty is unconscious, and cannot respond, then the law recognises that treatment to save life is acceptable, and the consent issue will not arise. It is also likely that without intervention they would get worse and, in the event of a cardiac arrest for example, could die. Appropriate first aid is unlikely to make the situation worse.
- Remain within your competence and training, this is the standard to which any first aider will be held.
- If the casualty is a child, then a parent or appropriate adult should give consent.
To date no one in the UK has been sued for administering life-saving first aid.
First Aid Equipment
Equipment is another thorny issue. There is even a British Standard on what should be in a first aid box. “BS8599-1:2011 Workplace first aid kits Part 1: Specification for the contents of workplace first aid kits”. This suggests that the content of a first aid kit should be:
- Guidance leaflet
- Contents list
- Medium sterile dressing
- Large sterile dressing
- Triangular bandage
- Safety pins
- Eye pad sterile dressing
- Sterile adhesive dressings
- Alcohol free moist cleansing wipes
- Adhesive tape
- Nitrile disposable gloves
- Finger sterile dressing
- Resuscitation face shield
- Foil blanket
- Eye wash
- Burn dressing
- Conforming bandage
This is a minimum standard, and other materials should be considered. For example, saline and gauze for cleaning cuts or safety shears (for cutting bandage or clothing). There are many other recommendations for inclusion, such as on www.nhs.uk.
How do we choose?
Again, all equipment should be based on a risk assessment. The need to have a defibrillator is covered in The Resuscitation Council UK and the British Heart Foundation guidance on Automated External Defibrillators (AEDs).
Whilst this guidance does not specifically recommend having an AED on site, it is made clear that cardiac arrest is a leading cause of premature death and that immediate treatment saves lives.
An AED is no longer a huge expense. Whilst an AED should be properly maintained (under the Provision and Use of Workplace Equipment Regulations, as well as basic common sense), they are simple to use and First Aiders are an obvious group to operate the equipment. Resuscitation Council UK guidance allows an AED in a public place (e.g. a railway station) to be operated by anyone using the audiovisual instructions from the AED, even if they are untrained in the use of AEDs.
So the recommendation is to have the equipment that you need. Do not to be afraid of having a defibrillator if you believe that you could have a situation where a person on your site could go into cardiac arrest.
What should we do?
To conclude, first aid is a fundamental set of skills that everyone should have. The standards for workplaces are set out in law and are based on the hazards and risks. Some workplaces have specific guidance and this should be used to determine your first aid requirements. If you follow your training (including the bits about asking permission), you are not going to be accused of negligence or assault. Have the equipment you need in your first aid kit and if this includes a defibrillator, then go for it.
Perhaps a New Year resolution could be to do a First Aid course – have a look at ours at synergypartnership.co.uk. It is a good skill set to have, and may help save a life. Surely a nerdy reputation and legal confusion wouldn’t stop us doing that, would it?