Wednesday, October 30, 2013

First Aid, CPR & BBP training at various workplaces

January 16, 2007

Front Royal, VA

Dear Mr. B***:

Thank you for your August 16, 2005, letter to the Occupational Safety and Health Administration (OSHA). We apologize for the delay in our response. You sent some questions regarding OSHA's standards on first aid, including CPR and bloodborne pathogens. This reply letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any question not detailed in your original correspondence. Your paraphrased questions and our replies are below.

Questions: You wrote that you teach first aid, including CPR, in the Winchester, VA, area. You have been asked by several employers what OSHA's standards are for first aid, including CPR and bloodborne pathogens. Your clients are employed at various workplaces, including, but not limited to, doctors' offices, construction companies, daycare facilities, and retirement homes. Does everyone have to be trained in first aid, including CPR and bloodborne pathogens? What if there is a career rescue squad within five miles of the workplace?

Replies: OSHA's standard for first aid training in general industry, 29 CFR 1910.151(b), provides:

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. Adequate first aid supplies shall be readily available.
In the construction industry, 29 CFR 1926.50(c) provides:
In the absence of an infirmary clinic, hospital, or physician, that is reasonably accessible in terms of time and distance to the worksite, which is available for the treatment of injured employees, a person who has a valid certificate in first-aid training from the U.S. Bureau of Mines, the American Red Cross, or equivalent training that can be verified by documentary evidence, shall be available at the worksite to render first aid.
The primary requirement addressed by these standards is that an employer must ensure prompt first aid treatment 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 of the worksite. The basic purpose of these standards 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 these standards provide 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 putting the employer clearly in compliance with the standards. OSHA recommends, but does not require, that every workplace include one or more employees who are trained and certified in first aid, including CPR.

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 standards. Emergency medical services can be provided either on-site or by evacuating the employee to an off-site facility in cases where that can be done safely.

However, the requirements that emergency medical services must be "reasonably accessible" or "in near proximity to the workplace" are stated only in general terms. 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 standards do 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, an interpretation that has been upheld by the Occupational Safety and Health Review Commission 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. OSHA exercises discretion in enforcing the first aid requirements in particular cases. 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.

The first aid training standards at 29 CFR 1910.151 and 1926.50(c) generally apply throughout the industries that they cover. Other standards which apply to certain specific hazards or industries make employee first aid training mandatory, and reliance on outside emergency responders is not an allowable alternative. For example, see 29 CFR 1910. 266(i)(7) (mandatory first aid training for logging employees), and 29 CFR 1910.269(b) (requiring persons trained in first aid at work locations in the electric power industry).

The bloodborne pathogens standard at 29 CFR 1910.1030(g)(2) requires employers to provide training to any employees who have occupational exposure to blood or other potentially infectious materials, such as employees assigned medical or first aid duties by their employers. The standard at 29 CFR 1910.1030(b) defines "occupational exposure" as "reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties." If an employee is trained in first aid and identified by the employer as responsible for rendering medical assistance as part of his/her job duties, that employee is covered by the bloodborne pathogens standard.

You may find these standards on OSHA's website, by following the link to "standards" and searching for "first aid," "bloodborne pathogens," "logging," etc. In addition, you may purchase a printing copy of the regulations by visiting

Friday, October 18, 2013

Interpretation of the First Aid Standard

December 11, 1996

Mr. Gregory M. F***,

This letter is a follow-up to the conversation that a member of my staff had with Ms. Karol Copper-Boggs, of your firm, regardingthe Occupational Safety and Health Administration's (OSHA) interpretation of the First Aid standard, 29 CFR 1910.151.

Ms. Boggs explained to [my staff] that a client of your firm had some concerns regarding OSHA's interpretation of 29 CFR 1910.151. [The] recollection of the questions asked of [my staff] by Ms. Boggs is as follows:

Question 1: "Must an employer have individuals trained to render first aid?"

Answer: [No.] The OSHA requirement 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. [Adequate] [f]irst aid supplies approved by the consulting physician shall be readily available." [emphasis added]
[This document was edited on 8/19/1999 to strike information that no longer reflects OSHA policy.]

OSHA's regulation does not set specific response time requirements for the term "near proximity", however, in areas where accidents resulting in suffocation, severe bleeding, or other life-threatening or permanently disabling injury or illness are likely, a 3 to 4 minute response time, from time of injury to time of administering first aid, is required. In other circumstances, i.e., where a life-threatening or permanently disabling injury is an unlikely outcome of an accident, a longer response time, such as 15 minutes, is acceptable. The rationale for requiring a 4 minute response time is brain death when the heart or breathing has stopped for that period of time.
[This letter was edited on 6/12/2002 to strike information that no longer reflects current OSHA policy. Please see the
1/16/2007 letter to Mr. Brogan for the current policy.]

Question 2: "If an emergency situation were to occur where first aid was necessary and a trained employee were to panic, forgetting all of their training, and no first aid or improper first aid was administered could the employer be cited?"

Answer: If a trained employee were to panic in an emergency situation and not administer first aid or administer improper first aid, OSHA would not cite the employer. The employer would have met his obligation under the standard by having individuals trained to render first aid. The standard only requires employees to be trained in first aid, but does not address the actual performance of first aid in an emergency situation. Please note, however, that OSHA would conduct an investigation, if deemed necessary, to ensure that proper training certification, e.g., First Aid and CPR certificates were in order.

Question 3: "Would an employer be in violation of OSHA's First Aid standard if the employer were to issue a policy which recommends that employees call "911" in emergency situations?"

Answer: The purpose of first aid is to give injured employees some level of medical attention as quickly as possible to bridge the gap between the accident and full medical treatment. Therefore, the rendering of first aid should be encouraged by trained employees in addition to calling "911." Thus, an employer would not be in violation of OSHA's First Aid standard by issuing such a policy statement as long as the policy does not discourage the rendering of first aid by trained employees.

I hope this letter is responsive to your concerns. If we can be of further assistance please contact [the Office of General Industry Enforcement at (202) 693-1850].


Raymond E. Donnelly, Director
[Office of General Industry Enforcement]

[Corrected 05/31/2007]

November 19, 1996

Ms. Renee C***

Re: First Aid Training Statute 29 CFR 1910.151

Dear Ms. C***:

Recently, Karla Cooper-Boggs of my office discussed with you the Occupational Safety and Health Administration's ("OSHA") interpretation of the first aid training statute, 29 CFR 1910.151. Outlined below is our understanding of that conversation.

You indicated that an employer must ensure that a number of its employees are trained in accordance with 29 CFR 1910.151, but that the employer is not required to ensure that the trained employee actually performs first aid. You stated that OSHA would not issue citations to the employer if its trained employee(s) rendered first aid improperly, or not at all.

It is also our understanding that an employer will not violate OSHA regulations by issuing a policy which recommends that employees call "911" in emergency situations, and that trained employees should attempt to administer first aid at their discretion so long as such a policy does not discourage the rendering of first aid by a trained employee.

Friday, October 11, 2013

ANSI Z358.1 as guidance to comply with OSHA 29 CFR 1910.151

Dear Mr. K***:

Thank you for your letter to the Occupational Safety and Health Administration (OSHA). You requested an interpretation of 29 CFR 1910.151, Medical Services and First Aid, specifically, section (c) regarding, "suitable facilities for quick drenching or flushing of the eyes and body." Your question has been restated below for clarity. Please accept our apology for the delay in this response.

Background: Your company, a large manufacturer and distributor of sulfuric acid, requires the services of many third party terminals and distributors to assist with the handling of your product. You have specific criteria when acquiring a new terminal that it must meet before a contract is signed. One of these requirements is the need for safety showers that meet or exceed OSHA requirements; OSHA has quoted ANSI Z358.1-1990 in several letters of interpretation. However, there is a new ANSI Z358.1-1998 standard that goes into much more detail and would require some facilities to make a significant capital expenditure to comply.

Question: Which ANSI standard does OSHA enforce?

Answer: ANSI standards become mandatory OSHA standards only when, and if, they are adopted by OSHA; ANSI Z358.1 was not adopted by OSHA. In comparison with the OSHA standard at 29 CFR 1910.151(c), however, ANSI Z358.1 provides detailed information regarding the installation and operation of emergency eyewash and shower equipment. OSHA, therefore, has often referred employers to ANSI Z358.1 as a recognized source of guidance for protecting employees who are exposed to injurious corrosive materials.

OSHA would also take the ANSI standard into consideration when evaluating the adequacy of the protection provided by an employer. OSHA recognizes that there are differences between the 1990 and 1998 versions of ANSI Z358.1, and is planning to develop a compliance directive addressing this issue to ensure uniform and consistent enforcement of 29 CFR 1910.151(c). In the meantime, employers should assess the specific conditions in the workplace and determine whether compliance with the 1998 version of the ANSI Z358.1 will provide protection for employees that compliance with the 1990 version would not.

Monday, October 7, 2013

The Risks: Injuries, Illnesses and Fatalities

There were 5,703 work-related fatalities in private industry in 2004. In that same year there were 4.3 million total workplace injuries and illnesses, of which 1.3 million resulted in days away from work.

Occupational illnesses, injuries and fatalities in 2004 cost the United States’ economy $142.2 billion, according to National Safety Council estimates. The average cost per occupational fatality in 2004 exceeded one million dollars. To cover the costs to employers from workplace injuries, it has been calculated that each and every employee in this country would have had to generate $1,010 in revenue in 2004.2

Sudden cardiac arrest (SCA) may occur at work. According to recent statistics from the American Heart Association, there are 250,000 out-of-hospital SCAs annually. The actual number of SCAs that happen at work are unknown. If an employee collapses without warning and is not attended to promptly and effectively, the employee may die. Sudden cardiac arrest is caused by abnormal, uncoordinated beating of the heart or loss of the heartbeat altogether, usually as a result of a heart attack. Workplace events such as electrocution or exposure to low oxygen environments can lead to SCA. Overexertion at work can also
trigger SCA in those with underlying heart disease.

The outcome of occupational illnesses and injuries depends on the severity of the injury, available first-aid care and medical treatment. Prompt, properly administered first aid may mean the difference between rapid or prolonged recovery, temporary or permanent disability, and even life or death.