CHAPTER 4 - FIRST AID TRAINING
1.
Employers have a
duty under FAW to carry out an assessment of first aid needs in their workplace,
to identify what facilities, equipment and personnel are required to provide
first aid to employees who are injured or become ill at work. If first-aiders
are needed appropriate training must be considered. Under current HSE requirements,
to become a first-aider in the workplace, an individual must have successfully
completed a 24-contact-hours course in first aid at work. In addition, refresher
training (12 contact hours) must be undertaken every 3 years. Training providers
offering these courses must be approved by HSE for this purpose.
2.
Where the employer’s
assessment of first aid needs finds that a qualified first-aider is not necessary
then the minimum legal requirement is to appoint a person to take charge of
the first aid arrangements. This includes looking after the facilities and
equipment and calling the emergency services when required. These “appointed
persons” are not necessary where there is an adequate number of first-aiders.
3.
It is important
to remember that appointed persons are not first-aiders and they should not
attempt to give first aid for which they have not been trained.
However, HSE strongly advises employers to consider the need for emergency
training for appointed persons. Such courses normally last a minimum of four
hours and include training in cardiopulmonary resuscitation (CPR), first aid
to an unconscious casualty and dealing with severe bleeding – procedures that
are potentially life saving. Training providers offering these courses do
not currently require HSE approval.
First aid Training Arrangements
4.
HSE aims to promote
a regulatory regime which ensures employers are able to make the most effective
first aid provision in their workplace. This provision should be proportional
to identified needs.
| In analysing current practice, the research identified
several areas for further consideration:
·
Small companies
find it difficult to release employees to attend initial 4 day first
aid at work courses
·
Many training
providers and first-aiders consider the current 3-year period
between the initial 4-day course and subsequent refresher training
is too long as skill decay may occur. This is compounded in many cases
by the absence of self-learning or additional training that could
help improve skill and knowledge retention.
·
A number
of alternative training regimes were suggested, generally centred
on reducing the duration of the initial 4-day course and making refresher
training more frequent.
·
The role
of the appointed person was considered valid, particularly for small,
low risk organisations. However, in many cases there was confusion
between the role of appointed persons and that of first-aiders. Some
organisations are using appointed persons as first-aiders after they
have completed a one-day first aid course.
·
Some organisations
have sent employees on a one-day training course in first aid and
use such personnel as “basic first-aiders”. This approach may be
considered more proportional to the needs of smaller organisations
where only low risk activities are carried out.
·
There was
support for compulsory training of appointed persons, increasing the
validity of the role. Ideally, this would extend HSE’s approval role
to cover appointed person first aid training. |
5.
The issue of skill
and knowledge retention has been examined in more detail by HSE in a literature
review. A copy can be obtained by e-mailing: mark.woods@hse.gsi.gov.uk.
6.
The key features
emerging from this literature review were:
·
the ability to perform
basic life support/ first aid may be influenced by a number of factors including
the competence of instructors, training methods used, criteria applied to
assess performance and motivation of study subjects.
·
it cannot be assumed
that dealing with actual first aid incidents will keep all skills fresh.
·
some individuals
cannot adequately perform basic life support within 2 months of training and
after 3 years the results are generally very poor.
·
the
published literature strongly suggests that first-aiders in the workplace
should undertake refresher training more frequently than every 3 years.
A New Training Model
7.
The content of current
first aid at work courses is perhaps over-influenced by the historical predominance
of heavy industry with attendant risks of major injury. Most first-aiders
probably now work in service industries where any injuries are more likely
to be minor, although sudden, serious illness could still occur. Some skills
taught on current courses, such as stabilisation of fractures, are probably
of little benefit where professional ambulance services are rapidly available.
8.
Overall, it appears
there is little support for maintaining the current training arrangements
in their existing format. However, there is support for:
·
Shorter first aid
courses
·
More frequent refresher
training
·
More ‘basic first-aiders’
trained in emergency first aid
9.
We have developed
the following proposal for a new pattern of first aid training to address
these concerns:
·
The categories of
appointed person and first-aider are retained but their roles
are more clearly distinguished. The training of first-aiders will be geared
more to the needs of business with two main training options available.
·
The
role of the appointed person will be restricted to taking charge of the first-aid
arrangements, including looking after the facilities and equipment and calling
the emergency services when required. Therefore, appointed persons may be
appropriate in low risk industries with a small number of employees.
·
Where
an employer’s assessment of first aid needs indicates one or more first-aiders
should be available, it is proposed that two first aid training options be
considered – either a 6-hour emergency first aid course, or a more detailed
16 hour course. Both would require annual refresher training.
·
The duty of the employer to carry out an assessment
of their first aid needs will not change.
Figure 1. Current and proposed first aid
training arrangements
Course Content
10.
It is generally
accepted that training should focus primarily on first aid to be given to
casualties with life threatening injuries or illness – ie, where it is critical
for the survival of casualties prior to the arrival of expert medical assistance.
11.
Successful completion
of training in either emergency first aid or first aid at work would lead
to a qualification in first aid. The new first aid at work course will include
emergency first aid as a core component as well as most of the elements of
the current first aid at work course. However, compared with the current
course, it will be shorter in duration and require more frequent refresher
training. The new course will have a greater emphasis on first aid to be
given to casualties with life threatening injuries or illness, where it is
critical for the survival of casualties prior to the availability of expert
medical assistance. This, together with removal of non-essential detail,
will help simplify training and make it more focused.
12.
Whilst both courses
would require the first-aider to be competent in treating minor injuries,
it is proposed that the main elements and duration of these courses would
be as follows:
6 hour Emergency first aid course
- · What to do in an emergency
- · Cardiopulmonary resuscitation
- · First aid for the unconscious casualty
- · First aid for the wounded or bleeding
Training would be carried out over one day (6 contact hours), including
actual teaching time and final assessment time. Once qualified, the
first-aider would attend an annual refresher course of similar duration
|
16 hour First aid at work course
- · Emergency first aid (as short course)
- · Provision of appropriate first aid to a casualty who:
- is suffering from broken bones/ spinal injuries
- is suffering from shock
- has been burned
- has an eye injury
- has been poisoned
- · Recognition of common major illnesses and provision
of appropriate first aid
- · Importance of personal hygiene in first aid procedures
- · Use of first aid equipment
- · Maintenance of simple factual records
|
4.
It is envisaged
that 16-hour first aid at work training could be completed over 2-3 days,
including both actual teaching time and final assessment time. Alternatively,
the contact hours could be spread over a longer period, to be completed
within 3 months. First-aiders would attend annual refresher training
carried out over a single day (6-8 contact hours). The refresher course
would have a particular emphasis on the emergency first aid component, but
candidates could be assessed on all aspects. Both the proposed
new courses would be subject to the first aid training approvals arrangements
(see Chapter 5).
Additional Training
5.
There may be particular
groups of first-aiders who need more specific training in certain areas
and this could be delivered as additional, separate modules. For example,
first-aiders in remote locations may need to learn how to stabilise broken
bones in more detail and how to safely transport casualties over distance.
This is not dissimilar to the approach for first-aiders who already
take additional training in treating casualties with cyanide or hydrofluoric
acid poisoning or in using a defibrillator. Currently, providers offering
additional training courses do not have to be approved by HSE for this purpose.
HSE is not seeking to change this position.
6.
This model is
compatible with the research findings. It increases the options employers
have for providing qualified first-aiders, if required, and helps to ensure
that first aid provision is proportional to the needs of the workplace.
Alternative Forms of Training
7.
In general, first
aid training courses are completed and assessed through face-to-face sessions
between trainer and trainee (described as “contact hours”). Other forms
of training, computer-based, use of videos, or distance learning may also
have a place, at least in part, in first aid at work training.
Options
8.
To
summarise, we would welcome views on the following three options for first
aid training:
Option 1 Retain the current system: where no first-aider is required
then an appointed person is needed to call emergency services if required
and who may be trained in emergency first aid (optional). If the need for
first-aiders is identified then they must successfully complete a 24 hour
first aid at work course with 3 yearly refresher training.
Option 2 Change
to the proposed model described above (para 51 et seq)
Appointed person as basic requirement, or to meet employers identified need
successful completion of the following new first aid courses:
·
A 6
hour emergency first aid course with annual refresher training; or
·
A 16-hour
first aid at work course with annual refresher training.
Option 3 All workplaces to have at least one
qualified first-aider, who has completed
an emergency first aid course. This would then become the minimum provision,
even in workplaces with low risks and small numbers of employees. The role
of the appointed person would be redundant. This option would require a
change to the current regulations.
Question
Q8. Which option do you think will help employers provide
the most appropriate first-aider skills in their workplace? We would appreciate
your comments on this and/or the other options.
Training Standards: Options
9.
Training standards
was not an issue raised in our research specification but nevertheless we
would like to take the opportunity to explain the current system and outline
the options available.
10.
HSE guidance requires
that first aid training courses are taught and assessed in accordance with
currently accepted first aid practice in the United Kingdom. At present
HSE accepts the first aid management of injuries and illness, in as far
as they relate to topics to be covered in a FAW training course, as laid
down:
·
by the UK Resuscitation
Council guidelines;
·
by the European
Resuscitation Council (ERC) where that agrees with the UK Resuscitation
Council;
·
in the current
edition of the Voluntary Aid Societies – St John Ambulance, St Andrew’s
Ambulance Association and the British Red Cross;
·
in
other publications, provided they are based on sound medical, scientific
research or are in line with the three above.
11.
This gives special
prominence to the publications of the Resuscitation Councils (RC) and the
Voluntary Aid Societies (VAS). The following discussion will explain the
reasons for this and clarify the position of training organisations that
choose to adopt different standards.
12.
The ERC is comprised
of representatives from several national expert bodies on resuscitation,
including the RC (UK). The ERC sets model standards generally acceptable
to all the member organisations, but the detailed interpretation of these
standards is a matter for the relevant national bodies. Thus the RC (UK)
should be regarded as the leading source of information on resuscitation
standards in the UK. The current RC (UK) and ERC guidelines on adult resuscitation
are essentially identical, and the 8th edition of the VAS manual
has been brought into line with those guidelines. As far as HSE is aware all the currently approved independent
FAW training organisations are teaching resuscitation skills to one of these
published standards.
13.
On other aspects
of first aid HSE accepts the standards laid down in the VAS manual because
it is widely accepted throughout the UK as an authoritative reference text
on first aid. It has been used as such in legal proceedings, and there is
a system of expert review in place to ensure that it is updated in line
with current medical opinion and practice. HSE does, however, recognise
that independent training organisations will not necessarily want to use
the VAS manual as a teaching aid, and we also recognise that the VAS manual
is not the only authoritative publication on first aid. Therefore HSE has
made provision for trainers to base their standards on other publications
as described in the guidance. HSE has accepted the listed standards for
many years but as part of the review of the Regulations has considered other
options for ensuring they meet the requirements of employers and training
providers as follows:
Option 1 The current system should
continue.
Option 2 Reduce the number of standards
accepted by only accepting those of the Resuscitation Council (UK) and the
Voluntary Aid Societies.
Option 3 Accept a wider range of
standards accepted to include, for example, those from ambulance authorities
or medical Royal Colleges.
Option 4 Encourage the first aid
training industry to develop its own standard setting body for first aid
at work, perhaps as a collaborative venture between the voluntary and independent
sectors.
Questions
Q9. Would there be any benefit to employers or training
organisations in changing training standards currently accepted?
Q10. If yes, which would be your preferred option?
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