HR Magazine - November 2000: The Difference Between Life And Death

By Kathryn Tyler Nov 1, 2000
HR Magazine,   July 2000Vol. 45, No. 9

Offering first aid training presents employers with a host of benefits -- inluding compliance with OSHA regulations.

That coordinated, rapid response was no accident. It was the result of having a first aid and cardiopulmonary resuscitation (CPR) training program in place for more than 15 years. Baltimore Aircoil’s program lasts one full day and is open to all employees. About 10 percent of the company’s 200 employees have been trained.

"Typically, once employees get into the program, very few drop out," says Orwig. "Most employees get recertified. There seems to be a feeling of responsibility and commitment by the people who go through the training."

The Whys of First Aid Training

Workplace injuries such as the one at Baltimore Aircoil are far from uncommon. In 1998, 5.9 million employee injuries and illnesses were reported—which translates to 6.7 incidents for every 100 full-time employees. And although work injury deaths declined in 1999, there were still about 17 fatal injuries each day, according to the U.S. Department of Labor.

In light of statistics such as these, it shouldn’t be surprising to learn that employers are required by the Occupational Safety and Health Administration (OSHA) to provide immediate access to medical personnel for their workers. Specifically, OSHA regulation standard 29 CFR 1910.1519(b) states: "In the absence of an infirmary, clinic or hospital in near proximity to the workplace...persons shall be adequately trained to render first aid. Adequate first aid supplies shall be readily available."

For OSHA, the definition of "near proximity" varies according to the potential for serious injury, says René Carter, occupational safety and health specialist for the directorate of compliance programs in OSHA’s Washington, D.C., office. "In areas where accidents resulting in suffocation, severe bleeding or other life-threatening or permanently disabling injury or illness can be expected, a three- or four-minute response time—from the time of injury to the time of administering first aid—is required," says Carter. "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."

OSHA requires care within three to four minutes because that is the maximum amount of time the brain can survive without oxygen before serious damage occurs. Under this standard, even employers located near hospitals would be prudent to train employees in first aid.

The Benefits

Providing first aid training to employees provides several big benefits, says Barbara Caracci, master trainer at the First Aid Institute for the National Safety Council, a nonprofit organization in Itasca, Ill. "From a humanistic perspective, it’s the right thing to do," says Caracci. She adds that providing timely first aid to employees can mean the difference between life and death, between a short recovery and a long recovery, between a temporary disability and a permanent one.

Such training also can have positive results on employee morale by demonstrating that the company cares for employees’ well being.

For example, take a look at Taconic, a Copperclad Laminates manufacturer in Petersburgh, New York, that has offered first aid and CPR training to employees since 1997. "The most easily recognized benefit [of the training] can be seen on the production floor," says HR director Melissa Hartshorne. "The employees are proud of their training and satisfied with their added ability to contribute to the overall safety of our workforce. Once a company has absorbed the initial training costs, the impact on a company and its employees can be only positive."

Cathy Mueller, loss prevention manager for the eastern region for Missouri Employers Mutual (MEM) Insurance in Chesterfield, Mo., agrees: "It shows that we care about our employees and their safety."

Of course, first aid training also has several bottom-line advantages, such as ensuring compliance with OSHA regulations, reducing insurance costs and ensuring that injured workers enjoy a speedy recovery—and a speedy return to productive work.

When "you’ve got valuable employees, you like them to be there every day," points out Thomas M. Anderson, JD, SPHR, an HR director with a county government and chairman of the Society for Human Resource Management’s (SHRM) Workplace Health and Safety Committee. If a worker has a heart attack or a serious cut but receives prompt first aid, "that person will [probably] be back to work again. And you won’t lose a valuable employee."

What to Include in the Training

OSHA does not dictate what should be included in first aid training courses. Employers are required to assess the safety risks of each workplace and respond accordingly.

To that end, Carter recommends that employers ask themselves the following questions:

  • What are our work processes that could cause illness or injury to employees?

  • What type of accidents have we experienced in the past? What type of accident are we likely to encounter in the future?

  • Are employees exposed to falls, hazardous machinery or harmful chemicals? ("For example," says Carter, "the first aid training for a workplace or industry with a history of electrical shock injuries will differ from that of an office environment.")

In general, there are two levels of first aid training: standard first aid and first responder. Standard first aid courses include information on recognizing emergencies, summoning help, caring for sudden illnesses and injuries, and handling breathing and cardiac emergencies (which include administering CPR). Standard first aid courses take approximately seven hours.

First responder courses, which require 40-50 hours, include all of the information in the standard course as well as information on triage, oxygen administration, bloodborne pathogens, operating automated external defibrillators (AEDs) and preventing disease transmission.

Even if you offer only the standard first aid course, Caracci strongly recommends purchasing an AED—a machine that shocks the heart back to a normal rhythm—and training employees to use it. "If someone’s heart goes into an abnormal rhythm, CPR puts you in a holding pattern. It provides the minimum amount of oxygen to keep the brain alive."

But an AED can "get the heart rhythm back to where it should be. Every minute [a cardiac victim is] without an AED decreases the chances of survival by 10 percent. They are easy-to-use machines. Don’t stop at CPR and first aid—include AED training," implores Caracci. (For more information on defibrillators in the workplace, see the June 1999 HR Magazine agenda "Is an AED in Your Company’s Future?")

Whatever content you provide in your safety training programs, be sure to reinforce it through other means, recommends Connie Harvey, senior associate of the communications and program administration at the American Red Cross in Washington, D.C. "Emergency procedures should be posted throughout the workplace where employees gather, such as copy rooms. They also should be included in employee manuals." She adds: "Periodic drills are helpful to ensure that all employees are familiar with emergency action plans."

Who Should Be Trained

OSHA does not set specific requirements for the number of employees trained because "no single ratio works for every workplace," explains Carter. "It depends largely on the size of the workplace and type of operations. However, employees who are adequately trained to render first aid are required to be available for each shift. Employees trained in first aid should be designated, and other workers should know who they are and how to contact them so they can respond within the required time."

Says Caracci, "It would be ideal to train all employees, but that is not very" realistic. Instead, she recommends looking for volunteers. "Then, look for even coverage. You need to have a first aid rescuer within three minutes of any victim. You don’t want to have [all the trained employees] in one department."

Many companies, such as MEM, offer first aid and CPR training to all interested employees. "We have 250 employees. Currently 67, or approximately 25 percent, are certified," says Mueller. "Costs are allocated out of the company’s safety budget, not each department budget." This ensures that no employee is denied the opportunity to attend due to departmental budgetary constraints.

In addition to volunteers, some companies, such as Taconic, also designate certain employees as first aid responders. "Maintenance personnel are Taconic’s designated first aid responders. Training in both CPR and first aid is required as part of their job description," says Hartshorne. "We also have a fitness center located on site and require employees to be trained in first aid and CPR before participating."

It is important to note that if you designate employees who are paid to perform first aid, you must also comply with OSHA’s bloodborne pathogen exposure regulations. (Bloodborne pathogens are diseases such as Hepatitis B that are transmitted mainly through contact with blood products.) This means that if employees have a reasonable chance of being exposed to blood, you must, among other things, provide training on how to avoid infection. "Bloodborne pathogen regulations are constantly being updated. The program requires that we make available the necessary training to keep our employees’ certification current," says Hartshorne.

The Red Cross recommends that all employees receive first aid training and that a select group of employees—a response team—be given additional training. "The employees trained in the standard course would be able to respond to an emergency, activate your action plan and provide emergency care. The emergency response-trained employees would be able to continue providing care at a more advanced level until EMS arrives and takes over," says Harvey.

The initial costs of first aid and CPR training are low—about $60 per person. The more advanced first responder courses range from $224 to $346 per person. However, Caracci reminds HR professionals that these costs are on-going because trainees must be recertified regularly. So, budget accordingly.

Additionally, most companies, such as Baltimore Aircoil, pay employees to attend training during work hours. As a result, the employees "take it very seriously," says Orwig. "People are proud and confident that they have the capability to save someone."

How to Find a Training Provider

Dozens of organizations offer first aid and CPR training, including the American Red Cross, National Safety Council, American Heart Association, fire departments, clinics, hospitals and first aid suppliers.

Some employers—such as those in the construction industry—are essentially required to use the Red Cross for training. That’s because these employers must have on hand individuals who are certified in all aspects of first aid, and the Red Cross is the only organization that provides this certification. Most employers are not required to provide this level of training. But those that do will get an added bonus because the Red Cross "certification is widely respected," according to Hartshorne.

Caracci recommends looking for a program that is "flexible enough to accommodate the needs of the corporation and does not require you to go through every single chapter whether it is germane or not. The program should be tailored to the corporation."

Mueller agrees: "When choosing an instructor, it is best to find someone who is familiar with your operation and the hazards that your company faces. In addition, it is nice if the instructor has some real-world experience, not just book experience."

Refresher Courses

First aid and CPR training teaches skills that are not used regularly. As a result, people must be retrained often to maintain proficiency, says Anderson. For example, American Red Cross CPR certification must be renewed annually, and the first aid certification must be renewed every three years.

Mueller explains that employees can be recertified by passing a written test and a skills test, without repeating the class. "Some of our employees have taken advantage of this benefit to renew their certifications," she says. "Other employees enjoy the class and learn so much that they go ahead and take the entire class over again. We offer both options."

To reduce retraining costs, Anderson recommends looking for an employee volunteer to become certified as a first aid trainer. This makes it much easier to offer convenient, on-site courses. "If you can do it internally, it’s better, even if costs a little bit [initially] to get that person trained," says Anderson.

That’s what MEM does. A company employee is a certified American Red Cross first aid and CPR instructor. As a result, the course costs the company only $20 per person for books and supplies. "The supplies include bandages, certification cards and lungs for the mannequins," says Mueller. "To help us keep our costs down, we have purchased our own training supplies, which include the training videos ($49 each) and the CPR mannequins ($170 a piece)," instead of renting them every time.

Legal Liability

Many people hesitate to respond in emergency situations for fear of being sued. However, most of these fears are unfounded. "Most states have Good Samaritan statutes. A lot of states have defibrillator statutes. These laws offer some immunity," says attorney David E. Jones, a partner with Ogletree, Deakins, Nash, Smoak, & Stewart P.C., a labor and employment law firm in Atlanta.

However the protection provided by these laws is not without limits. "Good Samaritan laws vary from state to state. They require the use of common sense and a reasonable level of skill, not to exceed the scope of the individual’s training in emergency situations," says Harvey.

"You have to follow the first aid guidelines learned in class," agrees Caracci. "We tell our students that Good Samaritan laws are not a substitute for keeping within the scope of your training. Don’t do more than you are trained to do."

Caracci adds that Good Samaritan laws generally provide immunity when three basic conditions are met:

You act during an emergency.

You act in good faith.

You are not getting paid.

MEM addressed its legal concerns by ensuring that everyone who provides first aid or CPR receives Red Cross certification.

Mueller also explains that MEM makes sure that its employees "do not meet the definition of a first responder in the state of Missouri. In Missouri, if you have first responders—typically people who have at least a first response level of training and/or certification as an EMT (emergency medical technician)—you now have a duty to act and respond to a workplace emergency. Our training is solely as an employee benefit. Because of this, our training and any employee who would provide assistance fall under the Missouri Good Samaritan law."

While employers need to take legal concerns into account, they shouldn’t allow these issues to discourage them from offering training entirely. Says Carter: "Rapid intervention of CPR and first aid greatly improves a patient’s chances of survival. A patient with no pulse or severe bleeding cannot wait for help to arrive. Properly administered first aid care can mean the difference between life and death."

Kathryn Tyler, M.A., is a freelance writer and former HR generalist and trainer in Wixom, Mich. She may be contacted via her web site at


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