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October 31, 2012

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Emergency services and first aid – Cut to the quick

Understanding where first aid fits into the changing regulatory landscape is necessary to help businesses plan and manage their provision. While the dust is yet to settle in this area, Clive James attempts to provide some clarity for employers and reminds them that issues such as training and having in place formal processes to assess the first-aid needs of their workplaces should not be taken lightly.

The world of first aid can be one of contradictions. On one side, you have the comic image that we often see on television programmes of the company first-aider, fussing and nagging colleagues with tips on health and safety; on the other side, we read horror stories in the media of ‘good Samaritans’ getting sued after attempting to save the life of a colleague, or a stranger in need.

The sad fact is that both cases are inaccurate, but these misconceptions can put people off volunteering as the office first-aider, or taking the steps to learn life-saving first-aid skills. With up to 140,000 people dying every year in situations where first aid could have saved their life,1 there is still much to be done to tackle the challenges around first-aid adoption.

The current role of the first-aider

Some people would argue that the priority of any business should be to minimise the risk of accidents happening in the first place, rather than getting their staff trained in first aid. But no amount of planning or education can guarantee that an incident will never occur. This is where first aid really can make the difference between a life lost and a life saved – by acting as a secondary safety net to minimise the impact of an incident, should it occur.

If we consider an incident like choking or cardiac arrest, a person can only survive without oxygen for about four minutes. In certain industries – farming, notably – work largely takes place in remote locations, sometimes miles away from the nearest ambulance station, or hospital. In these instances, the presence on site of a trained first-aider, who is able to unblock airways or carry out emergency resuscitation, is vital.

It’s also important to note that first aid is not just about saving lives. With 26.4 million working days lost owing to work-related illness and workplace injury,2 businesses can’t afford to ignore first aid, as it is vital in helping reduce the extent of staff injuries and getting them back to work as soon as possible.

Regulatory impact

One of the biggest points of confusion for many workplaces is health and safety regulation and understanding where first aid fits in. Moreover, the current regulatory landscape is undergoing major upheaval, driven, in large part, by Professor Löfstedt’s review of the UK’s health and safety regime, and his subsequent proposals.

From a first-aid perspective, there have already been some recommendations made as part of the review – although, for the time being, the HSE is keen to stress that the existing first-aid regulations remain unchanged. Once the recommendations are adopted, it is expected that the HSE will no longer ‘approve’ first-aid training organisations, although the Executive will continue to manage the standard for first aid against which all courses should be set. The aim of this change is to give employers greater flexibility in choosing a first-aid training supplier, so that they can make more appropriate choices based on the requirements of their workforce.

But whether it is lack of time to spare employees to undertake first-aid training, or a perceived lack of need, many organisations tend to opt for the one-day Emergency First Aid at Work course, which covers core first-aid treatments and information, such as heart attacks and resuscitation, as well as need-to-know regulations. While this course provides good basic first-aid training, it doesn’t cover other common conditions, such as asthma, allergic reactions and low blood sugar, which are taught on the three-day First Aid at Work course.

Businesses have not just had to keep up with the Löfstedt review. In April this year, the accident-reporting requirements under RIDDOR also changed. Where previously a business had to report an injury that resulted in the employee needing to take more than three days off, there is now no need to report unless absence exceeds seven days (not counting the day on which the accident happened). Again, this change was pushed through with the aim of simplifying the accident-reporting process.

While simplification of processes is good for businesses, employers can’t afford to assume that just because fewer accidents need reporting, their business has become safer. All employers still need to consider ways to reduce accident rates and also ensure that they have the right first-aid procedures in place to minimise the impact of any incidents that do occur.

Changing expectations

It is not just legal requirements that are transforming the role of the first-aider; the treatments they have to administer in the workplace are also changing. While some people require first-aid treatment on account of injuries sustained in their working environment – for example, treating burns from spilt chemicals, or something as simple as bandaging a sprained ankle after tripping over a wire – there is also an increasing need for first-aiders to treat non work-related illnesses, such as heart attacks, or allergies.

Take one of the most common illnesses in the UK, asthma, as an example. Around 4.3 million adults in the UK suffer from asthma, or, put another way, one in 12.3 A person suffering a severe asthma attack has great difficulty in communicating, so it is most important that the first-aider can properly identify the condition and respond correctly. Here are the key asthma symptoms to look out for:

  • colleague may feel tight-chested;
  • their breathing may become wheezy, especially when exhaling;
  • their skin may become pale or, in severe cases, their lips may develop a blue tinge; and
  • they may feel dizzy or faint, and, in extreme cases, they may actually stop breathing.

If one of your colleagues shows these signs, the best course of action is:

  • remove them from the cause of the attack – if it is dust, for example, take them outside for fresh air;
  • keep them relaxed and calm, and sitting upright to help their breathing;
  • if they have medication in their possession, make sure they take it;
  • listen to them – they will know if it is a ‘normal’ attack, or if they need to go to hospital; and
  • if their condition doesn’t improve once they’ve taken their medicine, you may want to consider calling an ambulance, or taking them to hospital.

Another common illness is stroke. It is estimated that about 1.5 million people in the European Union suffer a stroke each year and this number will continue to rise.4 Strokes can hit at any time and in any location, including the workplace. Symptoms can vary greatly from person to person but some key signs to watch out for include:

  • colleague may have a headache, which could come on quite suddenly;
  • they could have impaired speech;
  • they may be confused and not be able to make themselves understood;
  • they may have facial weakness, which makes it look like their face has dropped on one side; or, alternatively,
  • this may impact their body, so the person is slower, or unable to move on one side.

If your colleague is demonstrating any of these symptoms you should use the ‘FAST’ test to help confirm if it is likely to be a stroke:

  • Face: Has their face dropped on one side?
  • Arms: If they raise both arms, are they unable to move them in unison?
  • Speech: Has their speech become slurred?
  • Time: Time to call for an ambulance if you suspect a stroke.

Unlike accidents, dealing with illnesses in the workplace is more about stabilisation – either helping someone to treat their own illness, such as by ensuring they use their inhaler, or, if it is more serious, such as a stroke, keeping them as safe as possible before an ambulance arrives. Businesses and their first-aiders can help prepare themselves for any eventuality by finding out if any colleagues have pre-existing conditions, such as allergies or heart problems, and ensuring they have the right equipment, such as a defibrillator, to hand.

Where does this leave businesses?

Regulatory changes and staffing pressures can be daunting for any business, but especially for small companies, which maybe don’t have dedicated HR teams or facilities managers to handle first-aid provision. Research suggests that businesses are being put off and that many do not fully understand the importance of first aid, with 50 per cent not having a formal process for assessing first-aid needs.5

However, getting this process right and fully operational is key to protecting employees and customers. The first step for businesses is to undertake a thorough risk assessment of their workplace – not just of the working environment but also of the people working there to see what additional needs they might have. While the first-aid procedures remain the same, irrespective of industry, some organisations may have special requirements owing to their location, or the industry in which they operate, or because they employ certain individuals for whom first-aiders need to learn particular skills.

Businesses should not only take into account the area in which their business works but also the risks that might be associated with any neighbouring businesses, or organisations. Take the Buncefield explosion as an example: in 2005, when one of the UK’s largest oil-products storage depots exploded, it not only impacted the immediate site but substantial damage was also inflicted on businesses and organisations in the local area. While many of these businesses will have had first-aiders in place, it is less likely that they were prepared for this kind of situation. This is, of course, an extreme example and being close to an oil depot is not a risk that most companies need to take into account, but it does illustrate the importance of knowing the geographical area in which you work and compensating for any unusual risks it might pose.


The first-aider’s environment is always going to change, whether due to new laws, or simply new people joining the company. If mismanaged, finding, training and equipping a workplace first-aider can seem daunting, and the risk is that rather than tackle these challenges, businesses will simply go without – and that’s a risk no one can afford to take.

1    Analysis of Office of National Statistics death registration data (2010):
4    European Commission ‘Research and Innovation – health’ project –
5    St John Ambulance research, 2010

Clive James is training development manager at St John Ambulance.

Approaches to managing the risks associated Musculoskeletal disorders

In this episode of the Safety & Health Podcast, we hear from Matt Birtles, Principal Ergonomics Consultant at HSE’s Science and Research Centre, about the different approaches to managing the risks associated with Musculoskeletal disorders.

Matt, an ergonomics and human factors expert, shares his thoughts on why MSDs are important, the various prevalent rates across the UK, what you can do within your own organisation and the Risk Management process surrounding MSD’s.

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11 years ago

I used to work for a Company with a subsidiary in Libya. Owing to the poor ambulance services available and the low number of employees, we decided that a higher level of First Aid should be available to the staff. All staff were First Aid trained and 1 in 3 were ‘Advanced’ First Aiders. The Advance Course was based around the US ‘Wilderness First Aid’ Syllabus plus intubation, drips (we had very large first aid kits in all cars) and analgesia.

11 years ago

First Aid saves lives. if that does not sell it nothing will?

If you operate a business that has the potential for risk of serious injury to employees or others affected by your activities you should not need to be instructed by regulatory compliance, your own risk assessment should demonstrate the requirement for competent first aid.

Commercially it reduces impact, it can signifcantly reduce post incident trauma, reduces ill health effects, and can aid speeding up recovery.

11 years ago

What is your view on multinational companies, where first aid provision is given in one country, eg UK but not in another operating region eg US. Is there room for an internal policy on provision of first aiders as a good practice vs legal provision and protection of “first aider” from litigation ?

11 years ago

I am concerned with some of the above comments as the Emergency First Aid at Work Course I teach does cover diabetes, asthma, strokes, head.injuries, anaphylactic shock, berns et al. This curriculum had to be registered with the HSE.
If this is the case what are others teaching?