A matter of life and death

The correct recollection of first aid training can save lives. So the
teaching and reinforcement of these skills should be a high priority for all
employers, by David Arnold

It’s 3:37 in the afternoon; Jane, the accountant, is sitting in an
overly-warm office fighting to keep focused on the latest management figures,
when the door flies open.

"John’s having a heart attack!" yells a pale messenger.

Jane’s workplace rarely sees more than the odd painful paper cut. Today,
however, is different. Jane is going to forgo her roll as an accountant and
recall the skills she learned on a first-aid course just over two years ago –
John’s life depends on it.

This scenario illustrates the importance of first aid as a
highly-responsible activity, and the challenge of retaining first aid

First aid is defined as the initial assistance given to a casualty for the
treatment of any sudden injury or illness, until professional help arrives.

The provision of first aid is a legal requirement under the Health & Safety
(First Aid) Regulations 1981. The degree of this provision is based on a
workplace assessment carried out by the employer. It should not only takes into
account workplace hazards and risks, but also such factors as out of hours work
or shift variations, and the unscheduled or annual leave of first aiders.

Guidance on this can be found in a HSE associated Approved Code of Practice
(ACoP) publication1.

The three most frequently cited obstacles to assessing and implementing
first aid requirements are shown in the box on page 22.

Training requirements

At a minimum, an ‘appointed person’ (AP) is selected to take charge in an
emergency situation, and to summon the emergency services where required.

The HSE recommends that an AP is given some first aid training. This,
however, is not a statutory requirement, and even with this training, an AP is
not a qualified first aider.

Larger organisations, or firms where the risks are greater, require
person(s) holding a valid First Aider in the Workplace qualification (FAW).
This qualification is obtained by attending a four-day course delivered by a
HSE-approved training provider.

Other training may also be undertaken to address more specific company
hazards or requirements. Such courses will not be HSE approved, as approval is
limited to the FAW course itself.

Training must be considered as on-going. After obtaining the initial FAW
qualification, re-qualification is required every three years by attending a
re-qualification course. This course not only refreshes skills, but also covers
any new procedures that may have since been introduced2.

Costs and benefits

No specific figures are available as to the actual costs to employers of
first aid provision. However, making basic assumptions based on the number of
employees in the UK, the cost of establishing and maintaining first aid cover
is in the region of £82m-£88m a year. With the additional cost of first aid
kits, refills and so on, this adds up to a total industry cost of approximately
£100m a year.

The cost for a first aider, however – based on a six-year period which
includes initial and refresher courses, and taking into account typical
employee costs per hour – is just £505 a year, or £128 a year for an appointed

These figures do not take into account the consequential disruptions that
may occur when an employee is absent on training. There is likely to be a
further additional cost for first aiders of up to £80 for insurance, as
employers’ liability insurance is unlikely to cover medical malpractice – an
area which needs to be clarified if you are unsure.

Benefits to employer

First aid intervention should hopefully reduce or limit the severity of the
illness or injury, which in turn is likely to reduce the duration of the
employee’s absence. This can be readily calculated and compared against the
cost of the first aid provision (above). Additionally, less tangible benefits
arise – for example, an improved workplace reputation.


First aid is a life skill and not limited to the workplace. Being able to
effectively administer CPR to a family member must surely be considered
priceless. For a more tangible financial consideration, first aiders tend to be
rewarded a token amount, say £100 a year by their employers, but this is far
from universal.

Training providers

In the first instance, one might think of the big three Voluntary Aid
Services (VAS) when seeking training – St. John Ambulance, Red Cross and St

However, there are 1,500 other HSE approved providers, some offering a more
personal or broader service, for example health & safety training.

When selecting a provider, discuss your requirements, talk to the trainer(s)
and check their experience. Trainers tend to originate from the VAS, but some
may have experience more closely related to your own industry – an obvious
benefit, especially if you are considering a broader spectrum of training.

Training course prices will also vary, but keep in mind that the cost of
training is only a fraction of the overall cost when considering a three- or
six-year cycle of provision. Addresses of training providers can be supplied by
contacting the HSE or at www.FirstAidCafe.co.uk,
which holds a searchable directory of more than 1,500 providers.

Retention of knowledge and ‘skill-fade’

The prime reason for the FAW re-qualification course, which is required
every three years, is to refresh the first aiders’ skills and knowledge. The three-year
duration between courses, however, is often considered excessive – especially
if you consider the skills may not have been exercised during that period.

Videos, workbooks and internet sites are available to assist with knowledge
retention. Some workplaces take training further to reduce skill-fade by
increasing the frequency of the courses.

In all cases, it is based on a balance between costs, probability and
severity of an illness or injury.

First Aider in the Workplace Training Course

The First Aid at Work (FAW) course is the only course approved and monitored
by the HSE. Quality assurance, course content, trainer qualifications and
experience are closely checked to ensure a high standard and consistent level
of training.

The initial FAW course is typically a four-day course and covers the
following main skill areas:

– Managing an incident

– Resuscitation and recovery

– Wounds and bleeding

– Burns and scalds

– Unconsciousness and shock

– Fractures

The FAW re-qualification course covers the same subject areas, but is
designed to refresh and update the first aiders’ knowledge. As the course is
based on the trainee having successfully completed the initial FWA course, this
course only lasts three days.

It should be noted, however, that this course must be taken before the first
aiders FAW qualification has expired (three years), otherwise the initial FAW
course would need to be retaken.

Appointed Person Training Course

Not covered by the HSE, the Appointed Person course content is less rigid
than the FAW. A typical one-day AP course is likely to cover the following

– Incident management

– Casualty care/management


– Bleeding

Further training

First aid training is not limited to the FAW, re-qualification and AP courses.

Technological developments in first aid equipment in recent years,
specifically the automatic external defibrillators (AED) have produced training
courses for their application and use.

AEDs, used to treat sudden cardiac arrest, are becoming a reality outside of
the hospital environment. Their ease of use and reduction in cost have made
them available in many public places including airports, train stations and
shopping complexes.

It is expected that as the cost of AEDs fall, more and more workplaces will
hold them as part of their first aid provision, especially in light of an
ageing workforce population.

Because retention of knowledge and ‘skill-fade’ during the three-year
re-qualification period is a significant concern, annual refresher courses are
commonly available and taken up by many employers. These courses however, do
not extend or affect the FAW qualification.

HSE-funded report

The HSE has recently released a funded report3 aimed at evaluating The
Health & Safety (First Aid) Regulation 1981 and the effectiveness of the
ACoP and Guidance.

With the regulations now more than 20 years old, the report takes into
account the changing workforce, technology and application.

The report, some 90 pages in length, is difficult to summarise in just a few

However, a few relevant recommendations made in the report are worth noting:

– To achieve greater proportionality to the assessed risk, the introduction
of a more basic first aid level to that of the full current first aider is

– The use of HSE approved trainers for Appointed Person and Basic Level
(above) courses

– To address ‘skill-fade’ by increasing the frequency and duration of
additional training. (The report further states that this should be the subject
of review and should not seek to increase the cost burden on employers

– Improve the current guidance, specifically the Approved Code of Practice

– Improve guidance in the application of the regulations to companies with
less than five employees and ‘small’ companies


The HSE-funded report will certainly produce interesting changes in the

This, together with technology and research, should make first aid more
effective and relevant to the workplace. First aid training courses will filter
these advances and changes to the first aiders.

However, for this to happen, employers must be committed to ongoing
training, and where possible, in excess to that of the legal requirements.


1. HSE Approved Code of Practice and Guidance 74 1997 ISBN 0 7176 1050 0

2: Arnold D (2002) First Aid Changes Occupational Health 54 (9) 12

3. Health & Safety (First Aid) Regulations 1981 & Guidance
Evaluation – Final Report (4270/R58.060)

www.hse.gov.uk – The HSE website is a
good reference, but does not cover any medical information

www.FirstAidCafe.co.uk  – A community of 1,500 first aid training

Obstacles to assessing & implementing first aid

– Providing first aid cover for
shifts, long working hours, out of hours work or shift variations

– Providing first aid cover across diverse workplaces, work
services, working practices, work buildings and on sites with wide geographical

– Obtaining enough volunteer employees to take up a first aid
role and/or finding the right calibre of staff for the role

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