First aid at work and the law

First aid is the immediate help given to a person who is injured or suddenly ill, using simple techniques and basic supplies, until professional medical care takes over or the person recovers. It is not a lesser form of medicine. In the first few minutes after a serious injury or sudden illness, what the people nearby do often matters more than anything that happens later in hospital. A person who is bleeding heavily can lose a life-threatening amount of blood in a few minutes. A person whose airway is blocked has only minutes before the brain is damaged. A person having a stroke loses brain cells every minute that treatment is delayed. In each case, a co-worker who recognizes the problem, calls for help quickly and gives simple care can change the outcome.

This course is an awareness course. It explains what first aid is, how workplace first aid is organized and what the main techniques aim to do. In the US, recognized first aid courses are offered by organizations such as the American Red Cross, the American Heart Association, the National Safety Council and the Health and Safety Institute, and OSHA expects designated first aid providers to be trained in a program that includes hands-on practice. If your role requires you to be a designated first aid provider, complete such a course, practice the skills and keep the certificate current.

Cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator (AED) are covered in a separate course, HSE-111. In this course you will learn to recognize cardiac arrest and to call for help and an AED, but the techniques themselves are left to that course and to certified training.

The aims of first aid

First aid has a small number of clear aims, often remembered as the three Ps. The first is to preserve life: to deal first with the problems that kill quickly, such as a blocked airway, absent breathing, cardiac arrest and severe bleeding. The second is to prevent the condition from getting worse: for example, by stopping bleeding, keeping a person with a suspected spinal injury still, cooling a burn or keeping a person warm. The third is to promote recovery: to reassure the person, make them comfortable, protect their dignity and privacy, and hand them over to professional care with accurate information about what happened.

Some trainers add a fourth P: protect yourself and others. A first aider who becomes a second casualty helps nobody. Scene safety, infection control and knowing your limits are part of first aid, not optional extras.

What first aid is not

First aid is limited in scope, and staying within that scope protects both the casualty and the first aider. A first aider does not diagnose illnesses, prescribe or give medication other than in the narrow cases covered by training (such as helping a person use their own prescribed epinephrine auto-injector or inhaler, or giving naloxone where it is available and the first aider is trained), perform invasive procedures, or decide that a person does not need further medical care when the signs suggest otherwise. When in doubt, the right choice is to call emergency services or advise the person to see a health care provider.

First aid also differs from the treatment given by an occupational health nurse, a paramedic or a physician. Those professionals work under their own laws and scopes of practice. In some workplaces, especially large or remote ones, first aid programs include an occupational health nurse or an advanced first aid attendant. This course concentrates on what any trained co-worker, supervisor or designated first aider is expected to do.

Why workplace first aid matters

Workplace injuries are common. US private-industry employers report more than 2.5 million recordable nonfatal injuries and illnesses each year to the Bureau of Labor Statistics, and many more injuries require only first aid. Most first aid cases are minor cuts, strains, burns and eye irritations. A smaller number are life-threatening emergencies such as heavy bleeding, crush injuries, electrical contact, falls from height or sudden cardiac arrest. A first aid program has to handle both: the routine cuts that happen every week and the rare event that tests everyone's preparation.

Good first aid also has business benefits that are easy to overlook. Prompt care for minor injuries reduces infection and complications, and so reduces lost time. Accurate first aid records reveal patterns, such as repeated hand cuts at one machine, that point to hazards needing control. Workers who see that their employer takes first aid seriously are more likely to report injuries early and to trust the safety program.

The legal framework

In the US, the main federal rule is 29 CFR 1910.151, Medical services and first aid. It requires employers to ensure that medical personnel are readily available for advice and consultation, and that where there is no infirmary, clinic or hospital in near proximity to the workplace, a person or persons are adequately trained to render first aid, with adequate first aid supplies readily available. Construction has a parallel rule at 29 CFR 1926.50, and some industries have specific requirements, such as logging at 1910.266 and electric power work at 1910.269, which require trained first aid and CPR responders on the crew.

OSHA does not prescribe the exact contents of a first aid kit, but its appendix to 1910.151 points to the national consensus standard ANSI/ISEA Z308.1, Minimum Requirements for Workplace First Aid Kits and Supplies. The current edition, ANSI/ISEA Z308.1-2021, defines Class A kits for common workplace injuries and Class B kits with a broader range and quantity of supplies for more complex or higher-risk environments. OSHA's 1910.151 appendix and its guidance documents also describe what a good first aid program includes, and several states with their own OSHA-approved plans, such as California and Washington, add further detail.

Employers also have duties to record and report injuries. Records of first aid given are valuable for prevention even when they are not legally required, and the distinction between a first aid case and a more serious injury matters for reporting, as Lesson 12 explains.

Good Samaritan laws and the duty to help

Outside work, people sometimes hesitate to help because they fear being sued. Every state has a Good Samaritan law that protects people who give emergency care in good faith, without expecting payment, from civil liability for ordinary negligence. The details vary: some states protect only trained people or certain settings, and a few, such as Vermont, Minnesota and Rhode Island, also impose a duty to give reasonable assistance or call for help. Most states also have overdose Good Samaritan laws that give some protection from drug charges to people who call 9-1-1 for an overdose.

At work, the situation is different. A designated first aider is acting as part of their job, and the employer is responsible for the first aid program. Workers' compensation and the employer's liability arrangements usually cover a first aider acting within their training. What protects a first aider in practice is acting reasonably: staying within their training, getting consent, calling for help early, recording what they did and handing over properly.

Consent

Before you touch a casualty, you need their consent. A conscious adult who is able to make decisions has the right to accept or refuse first aid. Identify yourself, say that you are trained in first aid (or that you can help), explain what you would like to do and ask whether they want help. Consent can be spoken or shown by gesture, such as a nod or holding out an injured arm. If the person refuses, respect the decision, stay nearby if it is safe, call emergency services if the situation is serious and record the refusal.

Implied consent applies when a person is unresponsive or so confused that they cannot make a decision: the law assumes that a reasonable person would want life-saving help. For a child, ask a parent or guardian if one is present; if none is present and the situation is urgent, implied consent applies. Respect cultural and personal preferences where you can, for example by explaining before you need to touch someone or by asking a co-worker of the same gender to help when that is possible and does not delay care.

Knowing your limits

A trained first aider is expected to do what their training covers and to do it well, not to improvise beyond it. If a situation is beyond your training, the best first aid is often to keep the scene safe, call emergency services, give simple care such as reassurance and keeping the person still and warm, and hand over to people with more training. It is also normal to feel shaken after an emergency. Lesson 12 covers support for first aiders after a serious incident.