Wednesday, October 10, 2012

First Aid Training and Maintenance of Medical Records

February 5, 2007

Dear Mr. Sutherland:

Thank you for your letter to the Occupational Safety and Health Administration (OSHA). Your letter asked for clarification of the requirements for provision of first aid training to employees as well as on the maintenance of medical records under OSHA's bloodborne pathogens standard, 29 CFR 1910.1030. We apologize for the delay in addressing your concerns. This letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any question not delineated within your original correspondence. Your question is restated below, followed by OSHA's response.

Scenario: The facility, a clinical laboratory, is located an average of four minutes away from a fire department that provides first aid assistance.

Question 1: Would it be acceptable under 29 CFR 1910.151(b) in Subpart K, "Medical and First Aid," for the facility to rely on the fire department and avoid having employees trained in first aid to address emergency situations on site?

Response 1: The OSHA standard at 29 CFR 1910.151(b) states: "In the absence of an infirmary, clinic, or hospital in near proximity to the workplace which is used for the treatment of all injured employees, a person or persons shall be adequately trained to render first aid . . . ." The primary requirement addressed by this standard is that an employer must ensure prompt first aid for injured employees, either by providing for the availability of a trained first aid provider at the worksite, or by ensuring that emergency treatment services are within reasonable proximity to the worksite. The basic purpose of this standard is to assure that adequate first aid is available in the critical minutes between the occurrence of an injury and the availability of physician or hospital care for the injured employee.

One option this standard provides employers is to ensure that a member of the workforce has been trained in first aid. This option is, for most employers, a feasible and low-cost way to protect employees, as well as putting the employer in compliance with the standard. The other option for employers is to rely upon the reasonable proximity of an infirmary, clinic, or hospital. OSHA has consistently taken the view that the reasonable availability of a trained emergency service provider, such as fire department paramedics or EMS responders, would be equivalent to the "infirmary, clinic, or hospital" specified by the literal wording of the standard. Emergency medical services can be provided either onsite or by evacuating the employee to an off-site facility in cases where that can be done safely.

An employer who contemplates relying on assistance from outside emergency responders as an alternative to providing a first-aid trained employee must take a number of factors into account. The employer must take appropriate steps prior to any accident (such as making arrangements with the service provider) to ascertain that emergency medical assistance will be promptly available when an injury occurs. While the standard does not prescribe a number of minutes, OSHA has long interpreted the term "near proximity" to mean that emergency care must be available within no more than 3-4 minutes from the workplace. This interpretation generally has been upheld by the Occupational Safety and Health Review Commission, an independent tribunal that decides OSHA cases, and by federal courts.

Medical literature establishes that for serious injuries, such as those involving stopped breathing, cardiac arrest, or uncontrolled bleeding, first aid treatment must be provided within the first few minutes to avoid permanent medical impairment or death. Accordingly, in workplaces where serious accidents, such as those involving falls, suffocation, electrocution, or amputation are possible, emergency medical services must be available within 3-4 minutes if there is no employee on the site who is trained to render first aid. Since your facility is an average of 4 minutes from the fire department and thus possibly more than 4 minutes away from the fire station in reality, you may not rely on its emergency service providers to fulfill your obligation under the standard if such serious injuries are possible at your workplace. As a matter of enforcement discretion, OSHA recognizes that a somewhat longer response time of up to 15 minutes may be reasonable in workplaces, such as offices, where the possibility of such serious work-related injuries is more remote. If that is the case in your workplace, you are allowed to rely on the fire department, which is an average of 4 minutes away from your workplace.

Question 2: Is it acceptable for the employer to provide training on first aid, including CPR, as well as first aid supplies, to employees who are not officially responsible for performing first aid, including CPR, and who would be responding on a voluntary basis?

Response 2: The OSHA standard, 1910.151(b), does not prohibit employers from providing first aid training to employees, even when the employees will not be expected to respond in workplace emergencies. However, if the company does not plan to designate employees as first aid responders, then OSHA would recommend that employees who participate in company-provided first aid training (including CPR) should be made aware of the company's plan for addressing all workplace medical emergencies.

Question 3: Under 29 CFR 1910.1030, may a company use employee numbers in place of social security numbers in the company's medical record file when the company only maintains declination forms, dates of vaccination, titer results, and dates of treatment? All other medical records and information regarding employee's medical examinations are maintained by the healthcare professional where treatment is provided.

Response 3: Section 1910.1030(h)(1)(ii)(A) of the bloodborne pathogens standard requires that employee medical records shall include the name and social security number of the employee.

Medical records must be ". . . provided upon request for examination and copying to the subject employee, to anyone having written consent of the subject employee, to the Director of the National Institute of Occupational Safety and Health [NIOSH] and to the Assistant Secretary of Labor [OSHA]."

if a company chooses to keep a second set of records which are identified by employee numbers in place of social security numbers, it may do so. However, whenever a record is requested by an employee, a designated employee representative, or representatives of the OSHA or NIOSH, the employer must assure access to the records containing the employee's social security number within a reasonable time, place, and manner.

Thank you for your interest in occupational safety and health. We hope this provides the clarification you were seeking. OSHA requirements are set by statute, standards and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. 


Richard E. Fairfax
Directorate of Enforcement Programs

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