National Guidelinesfor First Aid Trainingin OccupationalSettingsAfter more than two years in development, The National Guidelines for First AidTraining in Occupational Settings (NGFATOS) document has been completed.The document is being published on the Internet to encourage widespreaddissemination.The NGFATOS document and its supplements are non-proprietary, publicdomain material. They are not the property of any individual or organization. TheNGFATOS document was produced through a voluntary consensus processincluding expert and public peer-review. It is not the product of any individualNAB Member or Investigator. There are no trademarks, license agreements orcopyrights associated with the document or its supplements.The Project Management Team encourages you to distribute and cite thedocument without restriction.
National Guidelines forFirst Aid Training inOccupational SettingsA course development guideline containing the essentialelements of what can be considered safe, helpful andeffective first aid training in occupational settings.Intended for use by first aid program developers, institutionsteaching first aid courses, regulatory agency personnel whoreview and/or approve first aid courses and the consumers ofthese courses.
The Project Management Team in association with the National Advisory Board(NAB) provides these National Guidelines for First Aid Training in OccupationalSettings. They have been conceived and are offered in the spirit ofconscientious and voluntary cooperation with the sole purpose of fostering safe,helpful and proper training programs in first aid for those with an occupationalrequirement to learn these self-preserving or life-supporting skills.These guidelines and their associated enrichment programs, are nonproprietary, public domain materials. They are not the property of any individualor organization. The documents were produced through a voluntary consensusprocess including expert and public peer-review. These documents are not theproduct of any individual National Advisory Board (NAB) participant orInvestigator. There are no trademarks, license agreements or copyrightsassociated with the documents. Each NAB participant and organizationserved the project in an advisory fashion. Their representation does notnecessarily constitute endorsement.The Project Management Team, National Advisory Board or Peer Reviewers donot collectively endorse first aid training programs, products, or manufacturersand assume no liability for its contents or the use thereof.Example form of reference for authors citing this publication:National Guidelines for First Aid Training in Occupational Settings, First Aid Provider CoreElements, Course Guide. November 1998, pg. 3 [Online]. Available:www.pitt.edu/ cemwp/education/ngfatos/ngfatos.htm [Access date].November 1998Copy Editing Graciously Donated byBRADYSimon & Schuster Education Group
Project Management TeamPrincipal InvestigatorWalt Stoy, PhD, EMT-PProject Medical DirectorTheodore Delbridge, MD MPHCo-InvestigatorsCraig Aman, FF/NREMT-PRalph M. Shenefelt, FF/NREMT-PEMS Curriculum LiaisonGregg Margolis, MS, REMT-P
National Advisory BoardRole and RecognitionFrom the very beginning of this project, investigators relied on the knowledge, attitudes, andskills of the National Advisory Board (NAB). Individual participants sought their own level ofinvolvement and contribution toward accomplishing the goals of this project. These contributionsvaried from individual to individual, and regardless of the level of involvement, everyone playeda significant role in the development of these guidelines. It is important to make clear that thenature of the consensus process is one of general - not undivided agreement. Each NABparticipant and organization served the project in an advisory fashion. Theirrepresentation does not necessarily constitute endorsement.To ensure the validity and strength of the document, medical or educational recommendationsfrom the NAB had to be supported by authoritative sources and/or scientific evidence whenavailable. However, there is a tremendous lack of meaningful, objective, measurable dataavailable for analysis in regard to first aid. Persuasive recommendations based upon soundclinical practice or expert opinion were made that could not be supported by objective evidence.As a result, anecdotal evidence, in the absence of hard science, played a role in thedevelopment of these guidelines. All input was tabulated according to it’s support (literature, text,clinical practice and expert opinion), and presented to the National Advisory Board with the goalof consensus – the general agreement to change (or not to change) the document based on theweight of the evidence. Consequently, the goal of devising safe, helpful and effective nationalguidelines for first aid training in occupational settings using a non-governmental, voluntary, selfsupported consensus process based on objective evidence and expert input presented aformidable challenge – but has been achieved. The final review round of the document ended inOctober 1997 without further input from the NAB.It is essential that NAB participants and organizations be acknowledged for their efforts. Eachhas voluntarily assisted in shaping safe, effective guidelines to help assure that a First AidProvider has the appropriate core knowledge, skills and attitudes to provide emergency care forinjury or sudden illness in an occupational setting before professional emergency medical care isavailable.National Advisory Board Peer ReviewersDuring the project each NAB member was invited to select peer-reviewers for the document. Itwas preferred, though not required, that peer-reviewers be selected from persons outside theorganization represented by the NAB member. Peer-reviewers were under no obligation tocomment officially. However, those who did were required to provide medical or educationalrecommendations supported by authoritative sources and/or scientific evidence when available.In addition to NAB-selected peer-review, the document was available for public peer-review andcomment on the Internet for a six-month period, courtesy of the US Department ofTransportation, United States Coast Guard, National Maritime Center. For all who commentedofficially and unofficially during the peer-review and public comment period, thank you forsharing your concerns and ideas. Each of you has contributed to this long-overdue documentand to the safety and health of working Americans.
National Advisory BoardAmerican Association of OccupationalHealth NursesKay Liusey, BSN, MPH, RNDebbie Donau, RN, COHN-SAmerican College of Occupational &Environmental MedicineLeslie M.Yee, MD MPHAmerican Heart Association Murray Lorance, EMT-DAmerican Red CrossElizabeth White, M.Ed.Ronda StarrJose Salazar, MPH, NREMT-PAmerican Safety and Health InstituteTimothy EimanAssociated California LoggersDon Milani, EMTBoeing CorporationEric Hisken, MDDivers Alert Network (DAN)William Clendenen, BA, EMTEllis & AssociatesDean Wolanyk, MDEmergency Nurses AssociationJean Will, RNEmergency & Safety Programs, Inc.Frank Poliafico, RNEMSSTAR Group LLCJohn L. Chew, Jr.International Association of Fire FightersLori Moore, MPHMaine Maritime AcademySarah Hudson, NREMTMedic First Aid , EMP InternationalMaryl Barker, BSNational Association of EMS EducatorsMike Smith, EMT-PNational Academy of Emergency MedicalDispatchJeff Clawson, MDNational Association of EMSPhysiciansGary Gambill, MDNational Association of School Nurses, Inc.Celine Bakkala, RN, MA, CSNNational EMSC Resource AllianceDeborah P. Henderson, RN, PhDNational Safety CouncilDonna SeigfriedRobb Rehberg, ATC, EMTProfessional Assoc. of Diving InstructorsJulie Taylor ShreevesDrew Richardson, B.Sc., MBARichmond Ambulance AuthorityGloria Jaeger, M.Ed., EMT-PSave-A-Life FoundationCarol SpizzuriSOS TechnologiesLarry Starr, PhDUS Department of LaborOccupational Safety and HealthAdministrationRalph Yodaiken, MDRosemary Sokas, MDUS Department of TransportationNational Highway Traffic SafetyAdministrationDavid W. BrysonUS Department of TransportationUnited States Coast GuardChristine MeersYMCA of AmericaLaura Slane, BS
National Advisory Board Peer ReviewersTodd H. Chaffin, MDRockford Memorial HospitalRockford, ILPeter Goldman, MDProgressive Medical Applications Corp.Allentown, PARonald L. Meadors, EMT-PRockford Memorial HospitalRockford, ILArt Proust, MDRockford Memorial HospitalRockford, ILEvelyne J. Tunley, PhDAct FastAnchorage, AKThe investigators would also like to recognize the following individualsand/or organizations for their assistance with and/or essentialcontributions to this project:Al Kalbach, EMT-PPresidentSafetyWatch , Inc.Susan B. KatzVice President, PublisherPatrick WalshManaging EditorPH Education, Career & TechnologyBRADYSimon & Schuster Education GroupKathleen Stage-KernExecutive DirectorNational Association of EMS EducatorsChief Gerald P. Miante, Captain BennettU.S. Department of TransportationUnited States Coast GuardNational Maritime CenterJeff Michael, PhDU.S. Department of TransportationNational Highway Traffic SafetyAdministrationEMS DivisionPaul Paris, MDChief Medical OfficerCenter for Emergency MedicineWilliam Thies, PhDFmr. Director, ECC ProgramsAmerican Heart AssociationSteven Witt, Steven MallingerDirectorate of Technical SupportU.S. Department of LaborOccupational Safety and HealthAdministration
Table of ContentsPrefaceIntroduction and Background . iFirst Aid Training in Occupational Settings . iiDefinition of a First Aid Provider .iiiProcess. vBasic Life Support/Cardiopulmonary Resuscitation . vRisk Factors and Prudent Heart Living . vIntegration with the National EMS Education and Practice Blueprint . vAutomated External Defibrillation . viFirst Aid Oxygen Administration . viFirst Aid Program Development . viiImplementation . viiCourse GuideHistory . 2Goal. 3Tool Box Concept . 3First Aid Provider Core Elements. 3Skill Practice . 4Barriers to Action in an Emergency . 4Bloodborne Pathogens and First Aid Training in Occupational Settings. 4Course DesignLength and Depth of First Aid Training Programs . 9Supplemental and Enrichment Programs. 11How to Use the Modules. 12Recommended Time to Complete . 13Presentation and Application . 13Testing and Evaluation of First Aid Training Course Participants . 14InstructorsAssessing Student Achievement. 16Successful Completion . 16Program Developer . 16Instructor Supervision. 16Several Characteristics of Adult Learners . 17Gain and Maintain the Attention of the First Aid Student. 18Conducting Emergency Care Scenarios in the Classroom . 18Retraining. 18StudentsDescription—First Aid Provider. 19EnvironmentEducational Environment .Maintaining Records.Equivalency and Reciprocity .Program Evaluation.Facilities.2020202021Tables & DiagramsTable 1:Continuity of Care Model for Emergency Medical Services System. ivDiagram 1: Diagram of Instructional Model . 6Table 2: First Aid Provider Core Elements . 10
ModulesModule 1: PreparatoryLesson 1-1 Introduction . 1-1Lesson 1-2 The Well-Being of the First Aid Provider . 1-7Lesson 1-3 Legal and Ethical Issues. 1-13Lesson 1-4 Moving and Positioning Injured or Ill Persons . 1-19Module 2: AirwayLesson 2-1 Airway . 2-1Module 3: AssessmentLesson 3-1 Ill or Injured Person Assessment . 3-1Module 4: CirculationLesson 4-1 Circulation . 4-1Module 5: Illness and InjuryLesson 5-1 Medical Emergencies . 5-1Lesson 5-2 Bleeding, Shock, and Soft-Tissue Injuries. 5-9Lesson 5-3 Injuries to Muscles and Bones . 5-19Module 6: ChildrenLesson 6-1 Infants and Children . 6-1AppendicesWashington State First Aid Training Task Force, Guidelines Development Group . AWashington State First Aid Training Task Force, Peer Reviewers .B
National Guidelines For First Aid Training in Occupational SettingsPrefaceNational Guidelines forFirst Aid Training inOccupational SettingsPrefacei
National Guidelines For First Aid Training in Occupational SettingsPrefaceIntroductionIn the United States, traditional or formal first aid training (classroom instruction supervised by aqualified instructor) is available through national and local organizations, which design andproduce first aid training courses for use in an occupational setting. Although many possess along-standing history in first aid program development, none of these organizations creates firstaid standards and/or guidelines. Rather, these organizations translate the consensus of medicaland educational science into standardized first aid training programs to reflect up-to-dateinformation and techniques.The American Heart Association (AHA) is the organizer of national conferences fordevelopments in cardiopulmonary resuscitation and emergency cardiac care. The resultingguidelines are translated into educational programs in emergency cardiac care for the generalpublic and health care professionals.1 Unlike the Guidelines for Cardiopulmonary Resuscitationand Emergency Cardiac Care, national, consensus-built, peer-reviewed first aid trainingguidelines did not exist (prior to the release of this document) for those persons with anoccupational requirement to be first aid trained. Providing a “source authority” for occupationalfirst aid program content is the purpose of these National Guidelines for First Aid Training inOccupational Settings.BackgroundThe First Aid Provider is an important part of the Emergency Medical Services (EMS) System.Therefore, these guidelines are designed to integrate the First Aid Provider into the EMS systemby helping him or her to learn the same priorities of care and general approach to the patientused by professional responders. The result is a continuity of care as the ill or injured person ispassed from layperson to professional.National guidelines for training professional emergency responders are the responsibility of theNational Highway Traffic Safety Administration (NHTSA) established by the Highway Safety Actof 1966 (amended). NHTSA is the producer of the Emergency Medical Technician Basic:National Standard Curriculum and First Responder: National Standard Curriculum. Thesecourses are part of the National EMS education program for professional out-of-hospital care asoutlined by the National EMS Education and Practice Blueprint.Additionally, NHTSA is the producer of the National Standard Curriculum For Bystander Care(DOT HS 807 872 October 1992). This report describes a program to promote more effectivebystander actions in rural highway crashes. This bystander care program explores how the laypublic—bystanders and passersby—could learn to provide very basic life-saving care to respondto the most critical needs of the seriously injured victims. The purpose of this project was todetermine how laypersons could best be taught how to call EMS, manage the airway, controlbleeding, and avoid getting hurt. Unlike other approaches, the Bystander Care Project focuseson the front end of the continuum of emergency care—the “Six Simple Steps for Saving Lives”:184.108.40.206.5.Recognizing the emergency,Deciding to help,Contacting the EMS system,Preventing further injuries,Assessing the victim, andEmergency Cardiac Care Committee and Subcommittees, American Heart Association . Guidelines forcardiopulm
effective first aid training in occupational settings. Intended for use by first aid program developers, institutions teaching first aid courses, regulatory agency personnel who review and/or approve first aid courses and the consumers of these courses. National Guidelines
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Foreign aid has various different forms; economic aid, social aid and "other aid" components are the main ones. Economic aid is a form of physical capital, aid to both infrastructure and the production stage, social aid refers to aid in form of human capital whereas other aid components entail food and emergency aid (Akramova 2012, 119-120).
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