First aid at work

Obligations and organization

Article 20 of Law 31/1995 requires that the organization of first aid take into account the size and activity of the company and the possible presence of outsiders; that the designated personnel be sufficient, have the necessary training and appropriate equipment; and that relationships with external services be organized, particularly regarding first aid, emergency medical assistance, rescue, and firefighting. INSST Technical Note 458 elaborates on the organizational criteria: number of first responders based on the workforce, risks, and the distribution of facilities; initial and refresher training; first aid equipment and facilities; signage; and procedures for action and notification.

Annex VI of Royal Decree 486/1997 establishes that every workplace must have, at a minimum, a portable first-aid kit with the basic contents (authorized disinfectants and antiseptics, sterile gauze, absorbent cotton, bandages, adhesive tape, adhesive dressings, scissors, tweezers, and disposable gloves), which must be checked and replenished periodically. Workplaces with more than 50 employees must have a room designated for first aid and other potential healthcare needs, an obligation that the labor authority may extend to workplaces with more than 25 employees depending on the hazardous nature of the activity and the difficulty of accessing the nearest healthcare facility. These rooms must include a first-aid kit, a stretcher, and a drinking water source, be located near the workstations, and be easily accessible for stretchers. The equipment and the rooms themselves must be clearly marked.

Regarding automated external defibrillators, Royal Decree 365/2009 establishes the minimum conditions for their use outside the healthcare setting, and regional regulations determine the spaces required to have them and the staff training requirements; many companies incorporate them voluntarily based on risk assessment, staffing levels, and the response time of emergency services.

Emergency response: protect, warn, assist

• Protect. Secure the area before intervening: eliminate or control the hazard (cut off the power, stop the machines, put up signs), protect the injured person and the rescuer.
• Notify. Activate the internal emergency system and call 112, indicating the location, number of victims, condition and circumstances, and facilitate access to external services.
• Provide assistance. Assess the person’s condition (consciousness, breathing), apply the first aid techniques for which you have been trained, and do not perform unnecessary maneuvers or move the person unless there is imminent danger.
• Basic life support. Recognition of cardiac arrest, cardiopulmonary resuscitation and use of the defibrillator when available, in accordance with NTP 605 and the recommendations of the Spanish Council of Cardiopulmonary Resuscitation.
• Common situations. Wounds and bleeding, burns, bruises and fractures, foreign bodies, poisoning and contact with chemicals, heat stroke, electrocution, choking and fainting spells.
• Specific risks. Protocols adapted to the risks of the center: showers and eyewash stations for chemical products, antidotes or special measures when the risk assessment justifies it, procedures for confined spaces or work at height.
• Registration and monitoring. Recording of the action taken, communication to the mutual insurance company or the medical service and notification as a work accident when appropriate.

Elements of the first aid system

• Designated personnel. Sufficient lifeguards on all shifts and at all centers, with initial training and periodic refresher courses, identified and known by the staff.
• Training. First aid and basic life support course taught by qualified personnel, with practical exercises and periodic updates; training in the use of the defibrillator where available.
• Equipment. First aid kits with the minimum contents of Annex VI of Royal Decree 486/1997, adapted to the risks, checked and replaced; stretchers, blankets, eyewash stations and emergency showers where appropriate.
• Premises. First aid premises in the required centers, with adequate equipment, access and signage.
• Procedure. Written instructions for action and notification, visible emergency telephone numbers, and coordination with external services and the mutual insurance company.
• Signage. Rescue and first aid signs in accordance with Royal Decree 485/1997 for first aid kits, premises, showers and eyewash stations.
• Integration. Inclusion in the emergency or self-protection plan, in information to workers and in drills .

Organizational application: how to organize first aid in the company

1. Analyze foreseeable emergency situations based on risk assessment, staffing, shifts, center dispersion, and emergency service response time.
2. Designate the necessary number of lifeguards per center and shift, train them in first aid and basic life support with periodic refresher training, and communicate their identity to the staff.
3. Provide first aid kits with the minimum contents and additional items required by the risks, and enable the first aid room when mandatory; signpost everything in accordance with Royal Decree 485/1997.
4. Assess the installation of defibrillators according to regional regulations and risk assessment, and train staff in their use.
5. Draft the action and notification procedure (protect, notify, assist), with visible emergency telephone numbers and coordination with 112, the mutual insurance company and the health services.
6. Integrate first aid into the emergency or self-protection plan, into information for workers and into drills, and review the equipment periodically.
7. Record actions, analyze events, and review the organization after each real or simulated emergency.

Preventive management software allows you to manage the designation and training of lifeguards with their expiration dates, the inventory and reviews of first aid kits and equipment, emergency procedures by center and the record of actions and drills with traceability.

Limits and common mistakes

1. Entrusting the response to a single lifeguard without coverage from all shifts and centers.
2. Failure to update training means skills are lost over time.
3. Incomplete first aid kits, with expired material or with medicines not provided for in the regulations.
4. Ignorance of the obligation to have a first aid station in centers with more than 50 workers or when required by the labor authority.
5. Failure to adapt resources to specific risks (showers and eyewash stations, antidotes, rescue equipment).
6. Not integrating first aid into the emergency plan or practicing it in drills.

The technical criteria are detailed in NTP 458 and 605 of the INSST and in Annex VI of Royal Decree 486/1997; this sheet is for informational purposes.

Regulatory and reference framework

• Law 31/1995, of November 8. Law on Prevention of Occupational Risks; emergency measures and first aid (article 20).
• Royal Decree 486/1997, of April 14. Minimum safety and health provisions in the workplace; Annex VI, first aid materials and premises.
• Royal Decree 39/1997, of January 17. Regulation of Prevention Services; participation of healthcare personnel in the organization of first aid.
• Royal Decree 485/1997, of April 14. Safety and health signage at work; rescue and first aid signs.
• Royal Decree 365/2009, of March 20. Minimum conditions and requirements for the use of automatic and semi-automatic external defibrillators outside the healthcare setting.
• NTP 458. First aid in the company: organization . Criteria for organization, personnel, training and material.
• NTP 605. First aid: primary assessment and basic life support . Initial assessment and basic cardiopulmonary resuscitation.

Regional regulations mandate the presence of defibrillators in certain areas and provide training for their use, and the recommendations of the Spanish Council for Cardiopulmonary Resuscitation update life support techniques.