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British Heart Foundation Hands Only CPR

The new campaign recently launched by the British Heart Foundation (BHF) to encourage "Hands Only CPR" is an attempt to encourage the untrained bystander to at least "have a go". Alot of people may be put off attempting CPR as they don't wish to give rescue breaths, this way they will be giving the patient more of a chance than if nothing at all is done. Click here to view the full video (opens in new window).

The "Gold Standard" remains, of course, using a combination of 30 chest compressions, at the rate of at least 100 to 120 compressions per minute (or to the beat of Stayin' Alive) pushing down at least 5cm in the centre of the chest, then giving 2 rescue breaths. This must be continued until the Ambulance arrives, the patient starts breathing normally, or the rescuer is too exhausted to carry on.

New British Standard Workplace First Aid Kit BS8599

Don't be fooled, the HSE will NOT be making the new BS8599 first aid kit mandatory

The British Standards Institute produced the above new standard for first aid kits in June 2011.

First of all don't panic, your existing first aid kit does NOT need to be replaced if it is currently meeting your needs.

Despite the hype, there is no such thing as a HSE approved first aid kit, even though first aid suppliers tend to sell them as such. The contents of these are simply based on HSE recommendations, as stated in the Health and Safety (First Aid) Regulations 1981, and are not meant to be mandatory.

The HSE are deliberately non-prescriptive on the contents. It is the employers' responsibility to determine what is suitable. This, like all first aid provision is based on the hazards in the workplace taking into account past injuries, number of employees etc., therefore this can be determined following the First Aid Needs Assessment:

For example, if you handle rough cut wood, splinters and small cuts may be commonplace, in which case you may need a larger number of plasters.
Or say in a restaurant where small burns are common, here you may need to seek other burn relief products.

Because it is the employer who determines the contents, the HSE will not be making the new BS8599 first aid kit mandatory. It is also unlikely that they will even amend their current recommendations.

However, the BS8599 is a more extensive first aid kit and contains additional items such as adhesive tape, shears, foil emergency blanket, mouth to mouth resuscitation device etc. Overall, this is a much better first aid kit for the workplace but it is up to the employer to decide if the increased costs are worth it.

The HSE will be releasing a newsletter on their website soon. However a copy of their wording is as follows:

"First Aid Kits and British Standard 8599

There is a British Standard BS 8599 for first aid kits, it is not a regulatory requirement under the Health and Safety (First-Aid) Regulations 1981 to purchase kits that comply with this standard. Instead the contents of a first aid box is dependent on an employers first aid needs assessment.

This means for employers following a needs assessment the options are:

1. Within your workplace you have access to a first aid kit whose contents complies with BS 8599 and matches your needs assessment;
or
2. Within your workplace you have access to a first aid kit whose contents matches your needs assessment but does not comply with the requirements of BS 8599. "

Andrew Moore PhD
FAAMS, HSE, Corporate Medical Unit, Merton Rd , Bootle L20 7HS

Changes to Resuscitation 2010

The changes to UK resuscitation were announced in October 2010. The International Liaison Committee on Resuscitation (ICOR) released the guidelines to the various resuscitation councils. They are commonly available to the public on their websites. In the UK this is primarily on the Resuscitation Council's website www.Resus.org.uk.

The changes made to resuscitation have not been vast or complicated. The main changes have been to the depth of compressions, now 5 - 6 cm, and to the rate, now between 100 - 120 compressions per minute. Rescue breaths will still continue to be given.

First Aiders qualifications continue to be valid in the normal way, and they should continue to practice first aid to the method they were taught, until they either requalify or undertake a skills update course.

Changes to First Aid

The First Aid at Work Guidelines for Employers from the Health and Safety Executive came into effect from 1st October 2009.

The First Aid Needs Assessment will identify what type of first aid training your First Aiders will require, how many First Aiders you will need and where they should be located.

The First Aid Needs Assessment should consider the following:

The nature of the work, the hazards and the risks
The nature of the workforce
The organisation's history of accidents and illness
The needs of travelling, remote and lone workers
Work patterns, such as shifts
The distribution of the workforce
The remoteness of the site from emergency medical services
Employees working on shared or multi-occupied sites
Annual leave and other absences of First Aiders
First aid provision for non-employees
The size of the organisation.

The nature of the work, the hazards and the risks:

One of the more complicated areas of the First Aid Needs Assessment is considering the nature of the work, the hazards and the risks. You should consider the risks and identify what possible injuries could occur in order to ensure sufficient first aid provision is available.

The following table (using information from the HSE) identifies some common workplace risks and the possible injuries that could occur:

Risk or hazard

Possible injuries requiring first aid

Manual handling

Fractures, lacerations, sprains and strains

Slips and trips

Fractures, lacerations, sprains and strains

Machinery

Crush injuries, amputation, fractures, lacerations, eye injuries

Working at height

Head injuries, loss of consciousness, spinal injuries, fractures, sprains and strains

Workplace transport

Crush injuries, spinal injuries, fractures, sprains and strains

Electricity

Electric shock, burns

Chemicals

Poisoning, burns, eye injuries, loss of consciousness

The table does not cover all the risks that could occur in a workplace, and is not exhaustive. You should assess each area of the workplace and record the risks and possible injuries that could occur.

One reason for this is to ensure you provide the correct type of first aid cover. There will be two levels of workplace First Aider:

Emergency First Aider at Work (EFAW) - 6 hour course
First Aider at Work (FAW) - 18 hour course

You should ensure that your First Aiders are trained to deal with the injuries and illnesses that could occur. The table below will help match your requirements to the appropriate course:

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Emergencies First Aiders trained to deal with

EFAW 6 hours

FAW 18 hours

Acting safely, promptly and effectively in an emergency

Y

Y

Cardio Pulmonary Resuscitation (CPR)

Y

Y

Treating and unconscious casualty (including seizure)

Y

Y

Choking

Y

Y

Wounds and bleeding

Y

Y

Shock

Y

Y

Minor injuries

Y

Y

Preventing cross infection, recording incidents and actions and the use of available equipment

Y

Y

Fractures, Sprains and Strains

Y

Spinal injuries

Y

Chest injuries

Y

Severe burns and scalds

Y

Eye injuries

Y

Poisoning

Y

Anaphylaxis

Y

Heart attack

Y

Stroke

Y

Epilepsy

Y

Asthma

Y

Diabetes

Y

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Where subjects are not included in the EFAW course, and the risks do occur in the workplace, it is strongly recommended the FAW course is undertaken. Extra, specialised training and provision may be needed for hazards such as chemicals, dangerous machinery, working in confined spaces, etc. You should also consider possible illnesses that could occur in the workplace and ensure you have adequate provision.

The nature of the workforce:

You should consider the needs and health of all workers and ensure that First Aiders are available and trained to deal with specific health needs. You should consider:

The young
The elderly
Specific health problems, e.g., heart conditions, diabetes, asthma, etc
Disabilities

The organisation's history of accidents and illness:

You should look at the organisation's history of accidents and illness to try to identify any needs or trends that may influence the location or type of First Aider. Different levels of provision may be required in different areas of the workplace.

The needs of travelling, remote and lone workers:

First aid should be available wherever people work so you may need to consider providing personal first aid kits or training to travelling, remote or lone workers.

Work patterns such as shifts:

Adequate first aid cover should be available whenever people are at work. There may be circumstances when a higher level of cover is needed when less people are at work, such as overnight maintenance work in a normally low risk environment.

The distribution of the workforce:

First Aiders should be able to reach the scene of an incident quickly. Consider extra First Aiders on large sites, sites with multiple buildings or buildings with multiple floors.

Remoteness to the site from emergency medical services:

If the workplace is remote from emergency medical services you may need to make special transport arrangements should an incident occur. Consider how employees will summon help – do they have access to a phone? Even in urban areas you should be aware that it often takes more than 10 minutes for an ambulance crew to reach a casualty, so the correct provision of first aid is a vital link in reducing the effects of illness or injury.

Employees working on shared or multi-occupied sites:

On shared work sites it may be possible to share first aid provision, such as the security team providing first aid cover at a large shopping centre. It is important to fully exchange details of the hazards and risks so that adequate first aid cover is provided. Make agreements in writing to avoid misunderstandings.

Annual leave and other foreseeable absences:

You should ensure that adequate first aid cover is available at all times, including when a First Aider is on annual leave, a training course, a lunch break or other foreseeable absences. This generally means that workplaces need more than one First Aider to ensure that cover is maintained. If your first aid needs assessment identifies the need for a First Aider at Work (18 hour course), it is not acceptable to provide an Emergency First Aider at Work (6 hour course) to cover foreseeable absences. You should also consider what cover is needed for non-planned absences such as sick leave.

First aid provision for non-employees:

The HSE recommend that you include non-employees in your first aid needs assessment. You should consider the duty of care that you assume when a non-employee visits your site. This is particularly relevant if you provide a service for others such as schools, places of entertainment, shops etc. Consider both the injuries and illnesses that could occur. For large events such as concerts, organisers have a duty of care to ensure that adequate medical, ambulance and first aid cover is available. Organisers of such events should refer to The Event Safety Guide, published by HSE books, for further information.

The size of the organisation:

Employee numbers should no longer be the primary basis for determining an employer’s first aid needs; all the areas of the new first aid needs assessment should be carefully considered. However, in general terms the larger your organisation is, the more first aiders you will need.

For ‘non-manual’, very low risk workplaces (such as shops, offices, libraries etc.) the HSE recommend a minimum of one extra first aider on duty at all times per 100 people (or part thereof).

For ‘manual’ workplaces (light assembly work, warehousing, food processing etc.) or higher risks, the HSE recommend a minimum of one extra first aider on duty at all times per 50 people (or part thereof).

Reviewing the First Aid Needs Assessment:

You should review your first aid needs from time to time, particularly if you have operational changes in your workplace. It is recommended that a record is kept of incidents dealt with by first aiders to assist in this process.

Annual refresher training:

Due to the wealth of evidence on the severity of first aid skill fade, the HSE now recommend that all First Aiders and Emergency First Aiders attend annual refresher training.

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The flowchart shows the course to be completed over a 3 year certification period. To avoid skills fade, as identified by the HSE as a significant problem, it is recommended a yearly Skills Update is undertaken.

First Aid Flow Chart

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