Significant changes ahead?

With the first-aid regulations now more than two decades
old, the HSE is looking to update. We explore the proposed changes and how they
may affect first-aid provision, by David Arnold

More than 20 years ago, the Health and Safety (First-Aid) Regulations 1981
came into force. Since then, large manufacturing plants, once so common, have
made way for smaller businesses. Hazardous working environments have been
replaced with health and safety-conscious workforces, and prescriptive policies
have been superseded by needs assessments.

So are the regulations still relevant? To find out, the HSE commissioned
research, resulting in a discussion document to move first aid forward and to
align first-aid provision with today’s needs.1,2,3

If fully implemented, the proposals would affect first aid in every
workplace. However, this is a discussion document and as such, allows your
input to shape first-aid provision for the future (The First Aid Café website
is currently collecting views for the HSE3).

The new training model

To understand any changes, we need to make a comparison with the legislation
as it stands today.

All workplaces require, at a minimum, an appointed person (AP). Although
training is available, training is not a legal requirement as an AP’s main duty
is only to call the emergency services, plus a few other non-medical

For workplaces requiring a first aider (normally for organisations employing
50 people or more), he/she must be qualified. The qualification requires a
four-day training course presented by an HSE-approved provider.

The first aider must also take a refresher course every three years for the
qualification to remain valid.

The commissioned report found support for:

– Shorter first-aid courses, as it reduced the burden on employers to
release staff for training

– More frequent refresher courses, as it addresses skill-fade

– More ‘basic first aiders’ trained in emergency training, as this improves
first-aid provision at a reduced cost.

These proposals should not increase the burden on employers, although there
will be financial winners and losers. Any increased costs, however, will be
offset by increased benefits.

The HSE proposes three levels:

– Appointed person – no training

– First aider – six hours training

– First aider – 16 hours training.

These three levels will enable employers to match more accurately, and cost
effectively, the legal directives with requirements.

The new training courses will concentrate more on life-threatening injuries
or illnesses and remove the more non-essential detail, making the training less
complex and more focused.

The six-hour emergency first-aid course will include:

– What to do in an emergency

– Cardiopulmonary resuscitation

– First aid for the unconscious casualty

– First aid for the wounded or bleeding.

The 16-hour first-aid at work course will include:

– Emergency first aid (as a short course)

– Provision of appropriate first aid to a casualty who:

– is suffering from broken bones/spinal injuries

– s suffering from shock

– as been burned

– has an eye injury

– has been poisoned

– Recognition of common major illnesses and provision of appropriate first

– Importance of personal hygiene in first-aid procedures

– Use of first-aid equipment

– Maintenance of simple factual records.

First aid for the public

Although it is currently recommended that visitors, customers and other
non-employees should be included, they do not yet form a legal part of the

The proposal here is to change this recommendation to become compulsory.
However, by including the public, certain needs-assessment outcomes may change
– for example, a supermarket has customers of all ages and the likelihood of
cardiac arrest increases with age.

Because of these changes, automatic external defibrillators (AEDs) –
including training – may be considered a necessary part of first-aid provision.
This change may also burden the smaller business, for example, small retail

Skill fade

Research has found that some individuals cannot adequately perform basic
life support within two months of training. After three years, the results are
generally very poor, so the current three-year period between refresher courses
has always been considered excessive. It is proposed that a refresher course be
undertaken every year.

Training for the above courses will be restricted to HSE-approved training
providers. There will, however, be first aiders that need further, more
specific training, but this type of training will remain unchanged and outside
the responsibility of the HSE.

Training providers

First-aid training providers also form an integral part of the discussion
document. Briefly, the changes that are proposed range from approving courses
instead of training providers, and holding a register of suitably-qualified

First aid kits

What should go into a first-aid kit? This is a common question and has led
to the availability of the ‘HSE-approved kit’. Surprisingly, there is no such
item. The HSE does not approve the content or the kits. Contents should be
related to a first-aid needs assessment. The HSE is trying to clarify the
situation by either making the content mandatory or by offering examples based
on different workplaces. Medicines, paracetamol etc, also form part of the

Have your say

Some of the issues raised, if implemented, would require an amendment in
legislation, while others can be more readily introduced within the current
framework. Any changes will be wide reaching, and once implemented, could
remain with us for a further 20 years. It is therefore important that people’s
opinions are presented and acted upon. The discussion document allows this to
be realised.


1. Casella Report, Arnold D (2003) – A matter of life and death.
Occupational Health 55 (3) 21

2. HSE discussion document – A Review and evaluation of the effectiveness of
the Health and Safety (First-Aid) Regulations 1982

3.First Aid Café,

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