First Aid Awareness

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Welcome to First Aid Awareness

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Introduction

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At the end of this course you will be able to:
Name 3 ways to protect yourself when administering first aid.
Identify 3 common components of a first aid kit.
Explain 3 requirements for maintaining first aid kits.
Name 3 concerns of a medical scene.
Explain 3 steps to take in an emergency.
List 3 ways you can communicate your medical conditions.

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All workplaces in Canada are required to provide some level of first aid to their workers. First aid helps injured workers to receive limited medical attention that can help minimize their injuries and bring comfort.
The training and equipment required depends on:
How many workers are at the site,
The types of hazards present, and
How far away professional medical assistance is.

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This course includes:
Module 1, which will describe first aid requirements in Canada.
Module 2 explains routine practices for responders.
Module 3 details the requirements for first aid equipment.
Module 4 explains scene management.
You will have a short quiz after each module and a final quiz at the end of the course.

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Here are definitions of a few words that we will be using in this course:
An AED, or automated external defibrillator, is a portable electric device that can diagnose arrhythmias and treat them through electrical therapy (defibrillation) which stops the issue so the heart can reestablish a proper rhythm.
CPR, or cardiopulmonary resuscitation, is an emergency procedure performed to try to preserve brain function until help arrives. It involves chest compressions.
First aid is care given to a person in an emergency situation. First aid minimizes injury and disability and may prevent death.
A first aid attendant, or first-aider, is a person who is trained based on governmental regulations and who is assigned to perform first aid duties in the workplace

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Module 1: First Aid Requirements

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After this module, you should be able to
List 3 activities or materials that a regulation might require for first aid.
Provide 3 examples of information to be documented during a first aid event.
Identify the reason to perform a hazard assessment of a workplace.

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Each province or territory has specific regulations that detail first aid requirements for the geographical area.
The specifics will be in regard to:

If, and how many first aid attendants are required by shift;
What training is required of first aid attendants;
Where first aid kits are required, and what should be in them;
The type of medical facilities are needed;
What notices must be posted;
The access to emergency transportation and
Documentation and reporting of accidents and incidents.

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Workplaces are required to provide training in first aid to a certain number of people depending on the province and site population. The number of hours required varies according to the geographical area as well. Certified instructors create coursework that complies with the regulatory requirements so that workers are certified to the proper levels of training.
The listed provinces in the chart do not specify the number of hours for the different levels of First Aid training.
In the chart, you can see that the basic emergency course is a one-day time length at the Federal level. The provinces focus more on the topics needing to be covered instead of a set number of training hours.
In some cases, they do reference a requirement to comply with a St. John Standard or Advanced Certificate or an equivalent acceptable to the regulatory agency of reference.

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The provinces shown on the slide have similar names for the training required, but the amount of time varies. For the first level, emergency first aid, the classes must be 6.5 to 7 hours long to comply with the regulations in the provinces listed.
For standard first aid, the requirement is 13 hours for the provinces listed, except for British Columbia, which requires 36 hours at this level.
In British Columbia, a unique course- Occupational First Aid – Level 2 is specified between standard and advanced first aid.

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Manitoba and Saskatchewan have their own naming process for roughly equivalent training levels compared to the other provinces.
British Columbia, Alberta, Saskatchewan, Manitoba and the Yukon have agreed to similar and minimum standards for the advanced, standard and emergency training qualifications. However, Saskatchewan does not recognize the emergency first aid level of training.

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To make certification more portable for workers who move from province to province, a certificate approved in one province is recognized in the new province. However, the worker must learn and become competent in any differing requirements in the new province. Employers must ensure theses workers know and apply the correct legal requirements.

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No matter which province is reviewed, each has a segment that covers basic life saving measures such as CPR and the use of an AED for first aid attendants. More advanced levels cover care in more depth and give attendants the ability to provide more intense and invasive assistance. Common topics of an emergency first aid training class are listed on the slide.

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Whether or not workers will be administering first aid, they should know some basic information about how to respond during an emergency such as an injury. Foremost, they should know that if they are not trained in first aid procedures, they should not attempt to administer care.
Workers should be trained on:
What to do in case of injury- who to call and where the list of attendants is located;
Where first aid can be given (if there is a room) and where first aid kits are and
Information about local medical facilities.

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First aid kits are required by all provinces, in varying numbers depending on site population, distance from medical services and other factors.
Specific first aid kit contents may be specified by provincial regulations. We will examine this in more detail in Module 3.

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Most jurisdictions require documentation to be kept for injuries and first aid treatment. These documents are also useful for later medical concerns with the treated worker, as well as for training purposes for first aid responders.
Documentation should include:
•	The name of the worker who treated and received treatment;
•	The injury specifics- date, time, location, any details and the cause if known;
•	What treatment was provided and when;
•	The signature of the worker treated;
•	The first aid attendant's signature and
•	When the injury was reported and who received the report.
The documentation must have a secure and standard storage location for future reference.

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Some provinces require an employer to conduct a hazard assessment for first aid, but it is prudent for all sites to do so.
A hazard assessment looks at what types of hazards are present in the workplace and the probability that certain types of injuries will happen, and prepare first aid supplies for that situation. If the assessment is not complete, the first aid supplies may not be targeted to the types of injuries that workers have and the supplies will not be useful.
For example, if workers handle hydrofluoric acid, the first aid supplies should include calcium gluconate cream to apply to workers with suspected exposure. Workers handling other chemicals might need other equipment such as safety showers or eye washes.

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Module 1 focused on the basic regulations that may apply to first aid. We looked at what kind of first aid kits might be needed and what documentation should be maintained for injuries. We also looked at the value of hazard assessments in regard to first aid.
Now we’ll have a brief quiz to review what you have learned.

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Module 2: Routine Practices

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After this module, you should be able to:
Name 3 ways to protect yourself when administering first aid.
Describe 3 types of bodily fluids that workers need protection from.
Explain 3 times that hand hygiene is required.

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What is meant by the term “routine practices?” This refers to the way in which workers behave in order to prevent infection from the bodily fluids and waste products of others.
What types of bodily fluids do workers need protection from?
Blood;
Secretions;
Excretions;
Mucous membranes (commonly the nose and mouth);
Damaged, cut or abraded skin and
Items soiled with potentially infectious materials.
These practices, while mainly adopted by healthcare providers, apply to all professions in which workers may become exposed to infectious microorganisms through contact with blood and body fluids. Examples of these professions include police officers, trauma/crime scene cleanup crew, zookeepers, laboratory technicians, and embalmers.

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Contact with bodily fluids can expose workers to infectious diseases and blood borne pathogens.
Examples are:
Human Immunodeficiency Virus (HIV), the virus that causes AIDS, and
Hepatitis A, B (HBV) and C.
A worker requiring first aid may be ill and be infected with the flu, cold or other serious diseases, so precautions must always be taken.

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You may have heard about different kinds of precautions that are used in the medical world.  They are not all the same.
Here are the 3 kinds of precautions you may have heard of:
•	Universal precautions;
•	Substance Isolation and
•	Routine practices.

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Universal precautions apply to the prevention of transmission of blood borne pathogens.
Pathogens are basically germs that carry disease, and because of the way the pathogens are transmitted, universal precautions focus on blood and fluids that may contain blood. Some examples are cerebrospinal fluid (fluid from the spine) , pleural fluid, and amniotic fluid.

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Body substance isolation, or just substance isolation, applies to materials secreted from the body. Examples are urine, tears, vomit, feces, or sputum.

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Routine practices or standard practices  apply the practices of universal precautions and substance isolation. Following routine practices will help protect attendants from any and all types of disease and infection transmission during first aid.


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Because worker safety is required in all fourteen jurisdictions in Canada, all workers must be protected while performing first aid. Regulations and practices on worker protection during medical contacts vary slightly in some provinces so each first aid course will be tailored to that region’s requirements.

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In order to maintain the highest level of attendant safety, routine practices should be used.
We will look at the five components of routine practices:
Risk assessment;
Hand hygiene;
Personal protective equipment;
Environmental controls and
Administrative controls.

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As a first aid attendant, you will always want to do a quick risk assessment of the patient and the situation before any action is taken.
Here are a few questions you should ask yourself before assisting:
1. What am I going to do? What procedure is required?
2. Will I expose myself to bodily fluids, non-intact skin, mucous membranes or other body based materials?
3. Am I trained and confident I can complete the procedure or task?
4. Is the patient willing to let me perform this procedure?

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Once you have determined that you are able to carry out a procedure, and the patient is willing, you will need to take measures to protect yourself. Personal protective equipment or PPE must be selected.
Depending on the status of the patient, you may need gloves, gowns, lab coats, shoe covers, goggles, safety glasses with side shields, or protective masks. When the patient has bodily fluids that are spraying, splashing or otherwise leaving their body, the attendant must be aware of this. Select the PPE designed to protect them that specific hazard. If a patient is spraying blood, for example, a pair of goggles and face shield might be suitable. The eyes, mouth and nose are common routes of transmission of disease and infection.
PPE does not just protect the attendant though. It also protects the patient. By changing PPE between injured parties you reduce the risk of spreading infection between patients and even from yourself.

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Gloves are used to protect the attendant as well as the patient from infection transmission.
They should only be used one time, and disposed of after use.
Hand hygiene measures should be used every time gloves are put on and removed, and the removal should always limit the ability of materials from touching your skin.
Gloves should be rolled off and only the clean inside of the glove should touch hands at any time.
Gloves need to be changed before treating new patients, and they need to be removed when they are heavily soiled.
It is important to change gloves even if they don’t look dirty if you are going to wear them for an extended period of time. Gloves make your hands sweaty and the moist environment can cause issues with cracked skin, contact dermatitis, eczema or even fungal issues.



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Hand hygiene is the most important routine practice that you can use. Cleaning hands properly with soap and water or an alcohol based hand sanitizer (of 60-90% alcohol) will prevent much of the possibility of infection transmission during a first aid event.
Utilize hand hygiene:
Before and after any first aid or other assistance is given even if gloves are worn;
Before doing invasive procedures (mouth, eyes, nose or other exposed body parts);
Between first aid procedures;
Perform hand hygiene before touching hands or face;
After contacting anything contaminated with chemicals;
Before eating or preparing to eat, including the use of gum, nicotine products, etc.;
Before and after removing gloves in case there is lingering bodily material and
After sneezing, blowing nose, coughing, or any toilet activities.

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Face protection is used to protect attendants from being exposed to contaminants through the eyes, nose and mouth.
 Your workplace may offer a:
Half face mask to be worn with safety glasses or goggles;
Full face shield to be worn with safety glasses or goggles or
Mask with an attached visor to be worn with safety glasses or goggles.
Note- if you wear corrective eyeglasses, you may need to test the fit with the selected PPE to ensure it will provide you proper protection in a first aid event.  You may need special equipment.

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As a first aid attendant, you have some environmental controls that you can apply in regards to waste.
All first aid waste must go in containers designed and labeled for that use.
All sharps – including needles, broken glass, and other sharp materials – must be put in special sharps containers designed to protect workers.

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Administrative controls are the non-physical controls that are used to help protect workers involved in first aid to carry out routine practices.
Common controls are:
Training for first aid attendants and regular workers;
Supervisor awareness of first aid risks;
Immunization (usually in a medical setting, although some workplaces may offer flu or hepatitis shots for high risk workers);
Cough etiquette (to minimize the spread of mucous); and
Policies and standard operating procedures.

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Module 2 focused on routine practices. We looked at proper hand hygiene and PPE to minimize exposure. You learned about the different ways in which PPE like gloves and the use of administrative and environmental controls help protect attendants from infection during first aid events
Now we’ll have a brief quiz to review what you have learned.


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Module 3: First Aid Equipment

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At the end of this module you should be able to:
Identify 3 common components of a first aid kit.
Describe 3 requirements for federal first aid rooms.
Explain 3 requirements for maintaining first aid kits.

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Canada Labour code, which applies to Federal workers, requires that first aid stations are provided in a signed, nearby location in every workplace. Additionally, a worker must be within 2 stories of a station in their workplace, and it must be available during working hours. All of the contents of the station must be inspected monthly to verify that all components are usable and not expired.
Another example is the Ontario code which requires first aid stations in workplaces with more than 5 workers.  Rules are similar over all, but may have specific rules on what is stocked, and how signage is placed.

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First aid kits must be:
Maintained in a fresh and usable state at all times;
Appropriate to the types of hazards in the workplace;
Inspected and meet the regulations for the area and
Located where people that need them can find them.

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The Labour Code is very specific about what is needed for different workplaces. There are 4 basic types of first aid kits described in the code- A, B, C and D.
Type A is required for workplaces with 2-5 workers.
Type B is required for workplaces with 6 or more workers and the first aid attendant must have a basic first aid certificate.
Type C is also required for 6 or more workers, but the attendant must have a standard first aid certificate.
Type D is required where the workers are in a remote area, or when there are 1-3 workers that travel by snowmobiles or other small vehicles (not cars, vans or trucks.)
Each province has a very detailed set of parameters for workplaces in their boundaries that can be more restrictive than these.

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Each level of kit has specific items to be stocked, and minimum levels are listed.
For example, adhesive bandages must be available, and the chart adapted from the Labour Code, shows the quantity of bandages the Federal government requires to be available at all times.
Additional items are required for remote sites such as emesis bags, containers of baking soda and sugar in sealed bags.

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Each province has specific guidelines on the quantity and type of first aid kit needs to be kept on-site. As an example, Prince Edward Island and the Yukon area have 3 basic types of kits, and similar requirements based on the workplace population.

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Other areas are less specific in their requirements. Quebec allows employers to stock a “reasonable” number of kits.

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An example list for Prince Edward Island shows some of the materials required to be on-site, and how the different types of kits are stocked. When workers are trained to their level of expertise, they will cover the type of first aid kits will be used in the event of emergencies at their workplaces.

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First aid kits are only useful if they are well stocked for the emergencies that can occur in a workplace. A person must be placed in charge of the process to ensure that the supplies are restocked on a regular basis, and that the materials have not expired or become unusable. A monthly inspection is required in some provinces, and is a good practice, even in areas that it is not.
A written inventory should be maintained. Suppliers should be identified for the purchase of materials, and a method of payment must also be identified in advance.

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Many workplaces have the potential for skin or eye injury. Regulations in most provinces specify that shower facilities are available for workers to use to remove contaminants immediately. Portable shower and eyewash systems are also permissible and PPE can be used in cases where weather or other emergencies make it impossible to provide the facilities.

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As an example of a requirement that may apply to you, when a federally regulated  workplace has over 200 workers on site and does not have a medical center, a well marked first aid room is required that meets strict standards.
Each workplace must determine the requirement for the province that they do business in.  As we saw earlier, Saskatchewan, for example, requires a first aid room for 100 workers on site.

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Federal first aid rooms must contain the following items:
•	Washbasin with cold water and hot water;
•	A cupboard and caounter;
•	A cubicle or closed area with a cot or bed with a waterproof mattress and pillows;
•	A table and two or more chairs;
•	A phone, or other communication such as a 2 way radio;
•	A list of emergency contacts and
•	First aid supplies and equipment

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Employers must ensure that injured workers can access medical care after first aid if it is required. Employers must verify that an ambulance or other service can transport injured workers in an emergency. This service must be set up before workers report to the workplace. Depending on the distance or time to the nearest medical facility, an employer may need to set up special procedures for injured workers. This may include maintaining an ambulance type vehicle on site, or arranging for air transport as a part of emergency planning.

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Module 3 focused on rules related to first aid kits. We looked at first aid rooms and requirements for emergency transportation.
Now we’ll have a brief quiz to review what you have learned.

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Module 4: Scene Management

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By the end of this module you should be able to:
Name 3 concerns of a medical scene.
Explain 3 steps to take in an emergency.
List 3 ways you can communicate your medical conditions.

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When emergencies happen in the workplace, there are some basic concerns to consider.
An injured worker or multiple workers- can you help them?
If you have first aid training, the answer is probably yes. At the least, you can get help.
An unsafe environment like a chemical spill, water on the floor where electrical devices are present, or workplace violence- Can you stop the hazard?
Are you able to remain safe?
If there is an uncontrolled event or a situation where a person is beyond your ability to help, you may need to get outside help and wait.
Over the next slides we will look at this in more detail.

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When emergencies occur workers who are not directly involved in first aid may be curious about what is going on with the injured or ill worker. These other workers may have valuable information about what has occurred, but once their information is obtained they should be cleared from the area if not needed.
It is important that first aid attendants are trained to deal not only with the patient, but also the on-lookers. First aid administration will often reveal medical information that non involved parties should not be a witness too. Patients may be reluctant to continue care or experience embarrassment or stress that can cause a condition to worsen.
To the extent possible, clear the area near the patient. Move the patient to a more secure area if that is possible.
All site workers, attendants or others should be instructed to vacate an area once their help is no longer required.

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When workers are not trained in first aid procedures but come across an injured worker in need of assistance, the first thing to should do is remain calm and try to get help. Employers are required to inform workers on the site procedures for emergency notification. There may be an in-house contact to call, or workers may be directed to call for external assistance in some circumstances.
Take a quick look at the patient and try to determine if there is a medical bracelet or other identification that may provide information about existing conditions- if you see those, be sure to communicate that to the person who is coming to provide additional help.
Once additional help is on the way, stay with they injured person if it is safe to do so, and try to keep them calm.

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Even if a person has had no formal certified training they can do simple things to help until assistance arrives.
Never place yourself in danger and add a victim to the recovery efforts!
If there are immediate dangers to a person that you can safely stop- do so.
Power to a tool may be shut off, water turned off, traffic stopped- do these things as long as you can remain safe.
If it is possible,  check for a pulse and breathing.
A person who is not breathing or has no pulse can be helped by chest compressions

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Performing chest compressions may be scary if you are untrained, but The American Heart Association advises that even an untrained person performing compressions can be the difference between life or death in the event of a cardiac event. Chest compressions keep blood moving in the body, even if it is not oxygenated blood from breathing.
Here are the steps to take after calling for assistance:
Make sure the person is lying flat on their back.
Push hard and fast in the middle of the chest with your fingers interlaced and your palm down;
Perform this action continuously, until help arrives, you can no longer do so, or the person revives.
Ideally 100 pushes a minute should occur, with pressure that makes the chest go down two inches.
(If you know the song “Staying Alive” by the Bee Gees- this is the correct pace to push.”
It is possible that you may break a person’s ribs. This is not uncommon, and should not stop the process. A person can survive broken ribs, but will not survive without a heartbeat.

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If you come across someone choking, you may not have time to call for help in order to save a person’s life.
After asking them if they are choking:
Deliver 5 blows to the back the shoulder blades, using the heel of your hand.
If this does not dislodge the material, perform five abdominal thrusts (the Heimlich maneuver.)

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Stand behind the patient, with your arms around their waist, tip them forward slightly
Make a fist with one hand and place it above the person's navel.
Grasp your fist with your other hand, and press into the abdomen with a hard upward motion. It may feel as though you are trying to lift them
Do this 5 times.
If the object is not dislodged, perform the sequence again.
Alternate between 5 blows and 5 thrusts until the blockage is dislodged.
If the person becomes unconscious, perform chest compressions until help arrives.

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Take measures to avoid unprotected contact with any bodily fluids.
If there is bleeding, and it is feasible you can try to elevate that body part, or have the patient use their own hand to cover the wound with light pressure to slow bleeding.
 Never attempt to remove an object from a person if they are injured with it. It can cause damage and possibly fatal bleeding.
It is crucial that if you are not trained that you do not perform advanced procedures that you are not qualified to do. It may harm the person further.

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If you are a person with a pre-existing medical condition, or a life threatening allergy, be certain to wear or carry something that will alert attendants of this fact. A medical alert bracelet is easy to wear and can communicate your condition when you otherwise cannot. Some workplaces have identification badges with codes on the front of them that let other workers know that there is a condition of concern to look for. To protect privacy, the condition will be on the back of the badge.
Even if you have no known conditions it is becoming more common to use your cell phone as a method to alert attendants. Many people have an emergency contact listed as “ICE” in their contacts list. This indicates to a responder “in case of emergency” to call that person on your behalf.  There may be valuable information to exchange in the event of a head injury etc.
Workplaces will usually request an emergency contact to be listed in personnel files. Be sure that the contact is up to date at all times.

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You are walking through the factory and you see a co-worker lying on the floor, passed out, with a rod through their arm. There is a lot of blood. You notice a medical bracelet is on the person.
What can you do?
[Pause 3-5 seconds]
Call for more help immediately.
Check that medical bracelet to see what information is on it.
Try to awaken the person if possible.
Do not remove object, but try to see if you can raise the arm safely- avoiding contact with the blood.
Wait for help.

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Module 4 focused on concerns when you come upon a medical emergency. We looked at what to do in emergencies, including a brief introduction to chest compressions, choking, bleeding and how to communicate for medical conditions.
Now we’ll have a brief quiz to review what you have learned.

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Course Summary

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In this course you learned about very basic actions to take in a medical emergency. We looked at requirements for first aid and first aid equipment, and some basic practices to help you should you come across an emergency.
Let’s go on to the final quiz.

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Congratulations! You have completed the First Aid Awareness course.
We hope you will use what you have learned to protect yourself and others on the job, and continue to work safely throughout your life.