Appendix V to Part 1918 - Basic Elements of a First Aid Training Program (Non-mandatory)
29:7.1.1.1.7.10.6.7.11 : Appendix V
Appendix V to Part 1918 - Basic Elements of a First Aid Training
Program (Non-mandatory) Note:
This appendix is non-mandatory and provides guidelines for small
businesses, institutions teaching first aid, and the recipients of
first aid training.
General Program Elements A. Teaching Methods
1. Trainees should develop “hands on” skills through the use of
manikins and trainee partners during their training.
2. Trainees should be exposed to acute injury and illness
settings as well as the appropriate response to those settings
through the use of visual aids, such as video tape and slides.
3. Training should include a course workbook which discusses
first aid principles and responses to settings that require
interventions.
4. Training duration should allow enough time for particular
emphasis on situations likely to be encountered in particular
workplaces.
5. An emphasis on quick response to first aid situations should
be incorporated throughout the program.
B. Principles of Responding to a Health Emergency
The training program should include instruction in:
1. Injury and acute illness as a health problem.
2. Interactions with the local emergency medical services
system. Trainees have the responsibility for maintaining a current
list of emergency telephone numbers (police, fire, ambulance,
poison control) easily accessible to all employees.
3. The principles of triage.
4. The legal aspects of providing first aid services.
C. Methods of Surveying the Scene and the Victim(s)
The training program should include instruction in:
1. The assessment of scenes that require first aid services
including:
a. general scene safety.
b. likely event sequence.
c. rapid estimate of the number of persons injured.
d. identification of others able to help at the scene.
2. Performing a primary survey of each victim including airway,
breathing, and circulation assessments as well as the presence of
any bleeding.
3. The techniques and principles of taking a victim's history at
the scene of an emergency.
4. Performing a secondary survey of the victim including
assessments of vital signs, skin appearance, head and neck, eye,
chest, abdomen, back, extremities, and medical alert symbols.
D. Basic Adult Cardiopulmonary Resuscitation (CPR)
Basic adult CPR training should be included in the program.
Retesting should occur every year. The training program should
include instruction in:
1. Establishing and maintaining adult airway patency.
2. Performing adult breathing resuscitation.
3. Performing adult circulatory resuscitation.
4. Performing choking assessments and appropriate first aid
interventions.
5. Resuscitating the drowning victim.
E. Basic First Aid Intervention
Trainees should receive instruction in the principles and
performance of:
1. Bandaging of the head, chest, shoulder, arm, leg, wrist,
elbow, foot, ankle, fingers, toes, and knee.
2. Splinting of the arm, elbow, clavicle, fingers, hand,
forearm, ribs, hip, femur, lower leg, ankle, knee, foot, and
toes.
3. Moving and rescuing victims including one and two person
lifts, ankle and shoulder pulls, and the blanket pull.
F. Universal Precautions
Trainees should be provided with adequate instruction on the
need for and use of universal precautions. This should include:
1. The meaning of universal precautions, which body fluids are
considered potentially infectious, and which are regarded as
hazardous.
2. The value of universal precautions for infectious diseases
such as AIDS and hepatitis B.
3. A copy of OSHA's standard for occupational exposure to
bloodborne pathogens or information on how to obtain a copy.
4. The necessity for keeping gloves and other protective
equipment readily available and the appropriate use of them.
5. The appropriate tagging and disposal of any sharp item or
instrument requiring special disposal measures such as blood soaked
material.
6. The appropriate management of blood spills.
G. First Aid Supplies
The first aid provider should be responsible for the type,
amount, and maintenance of first aid supplies needed for their
particular worksite(s). These supplies need to be stored in a
convenient area available for emergency access.
H. Trainee Assessments
Assessment of successful completion of the first aid training
program should include instructor observation of acquired skills
and written performance assessments. First aid skills and knowledge
should be reviewed every three years.
I. Program Update
The training program should be periodically reviewed with
current first aid techniques and knowledge. Outdated material
should be replaced or removed.
Specific Program Elements A. Type of Injury Training 1. Shock
Instruction in the principles and first aid intervention in:
a. shock due to injury.
b. shock due to allergic reactions.
c. the appropriate assessment and first aid treatment of a
victim who has fainted.
2. Bleeding
a. the types of bleeding including arterial, venous, capillary,
external, and internal.
b. the principles and performance of bleeding control
interventions including direct pressure, pressure points,
elevation, and pressure bandaging.
c. the assessment and approach to wounds including abrasions,
incisions, lacerations, punctures, avulsions, amputations, and
crush injuries.
d. the principles of wound care including infection precautions,
wounds requiring medical attention, and the need for tetanus
prophylaxis.
3. Poisoning
Instruction in the principles and first aid intervention of:
a. alkali, acid and systemic poisons. In addition, all trainees
should know how and when to contact the local Poison Control
Center.
b. inhaled poisons including carbon monoxide, carbon dioxide,
smoke, and chemical fumes, vapors and gases as well as the
importance of assessing the toxic potential of the environment to
the rescuer and the need for respirators.
Trainees should be instructed in the acute effect of chemicals
utilized in their plants, the location of chemical inventories,
material safety data sheets (MSDS's), chemical emergency
information, and antidote supplies.
c. topical poisons including poison ivy, poison sumac, poison
oak, and insecticides.
d. drugs of abuse including alcohol, narcotics such as heroin
and cocaine, tranquilizers, and amphetamines.
4. Burns
Instruction in the principles and first aid intervention of:
a. assessing the severity of the burn including first degree,
second degree, and third degree burns.
b. differentiating between the types of third degree burns
(thermal, electrical, and chemical) and their specific
interventions. Particular attention should be focused upon chemical
burns, and the use of specific chemicals in the workplace which may
cause them.
5. Temperature Extremes
Instruction in the principles and first aid intervention of:
a. exposure to cold including frostbite and hypothermia.
b. exposure to heat including heat cramps, heat exhaustion, and
heat stroke.
6. Musculoskeletal Injuries
The training program should include instruction in the
principles and first aid intervention in:
a. open fractures, closed fractures, and splinting.
b. dislocations, especially the methods of joint dislocations of
the upper extremity. The importance of differentiating dislocations
from fractures.
c. joint sprains.
d. muscle strains, contusions, and cramps.
e. head, neck, back, and spinal injuries.
7. Bites and Stings
Instruction in the principles and first aid intervention in:
a. human and animal (especially dog and snake) bites.
b. bites and stings from insects (spiders, ticks, scorpions,
hornets and wasps). Interventions should include responses to
anaphylactic shock; other allergic manifestations; rabies and
tetanus prophylaxis.
8. Medical Emergencies
Instruction in the principles and first aid intervention of:
a. heart attacks
b. strokes
c. asthma attacks
d. diabetic emergencies including diabetic coma, insulin shock,
hyperglycemia, and hypoglycemia.
e. seizures including tonic-clonic and absence seizures.
Importance of not putting gags in mouth.
f. pregnancy including the appropriate care of any abdominal
injury or vaginal bleeding.
9. Confined Spaces
a. the danger of entering a confined space to administer first
aid without having the appropriate respiratory protection.
b. if first aid personnel will be required to assist evacuations
from confined spaces, additional training will be needed.
B. Site of Injury Training
Instruction in the principles and first aid intervention of
injuries to the following sites:
1. Head and Neck
a. including skull fractures, concussions, and mental status
assessments with particular attention to temporary loss of
consciousness and the need for referral to a physician.
b. including the appropriate approach to the management of the
individual who has suffered a potential neck injury or
fracture.
2. Eye
a. foreign bodies, corneal abrasions and lacerations.
b. chemical burns and the importance of flushing out the
eye.
c. the importance of not applying antibiotics without physician
supervision.
3. Nose
a. nose injuries and nose bleeds.
4. Mouth and Teeth
a. oral injuries, lip and tongue injuries, and broken and
removed teeth. The importance of preventing inhalation of blood and
teeth.
5. Chest
a. rib fractures, flail chest, and penetrating wounds.
6. Abdomen
a. blunt injuries, penetrating injuries, and protruding
organs.
7. Hand, Finger, and Foot Injuries
a. finger/toe nail hematoma, lacerations, splinters, finger nail
avulsion, ring removal, and foreign bodies.
b. the importance of identifying amputation care hospitals in
the area. When an amputation occurs, appropriate handling of
amputated fingers, hands, and feet during the immediate
transportation of the victim and body part to the hospital.
Editor's Note:At 85 FR 8733, Feb. 18, 2020, appendix V was amended;
however, the amendatory instruction could not be followed.