WSR 97-17-079

PROPOSED RULES

DEPARTMENT OF

LABOR AND INDUSTRIES

[Filed August 19, 1997, 10:56 a.m.]

Original Notice.

Preproposal statement of inquiry was filed as WSR 96-12-071.

Title of Rule: First aid.

Purpose: First aid, chapter 296-24 WAC, General safety and health standards, in response to requests from the business and emergency health care community, a first aid task force comprised of emergency medical care representatives and business, labor, and Department of Labor and Industries representatives was formed. The task force met for over a year to draft and reach consensus on these new rules. The primary difference between the proposed rules vs. the existing rules is that they are performance-based rules rather than specification rules. However, nonmandatory appendices have been included to provide guidance to business in development of first aid plans. In addition, the new rules have been "clear rule written" for clarity and ease of presentation. The proposed rules give the employer greater flexibility in ensuring that first aid services are readily available to all employees. The significant changes include:

A new requirement to prepare a first aid response plan,

Changes in the information to be covered in first aid training,

Less rigidity in the requirements for who must be trained,

Less rigidity in the requirements for the contents of first aid kits,

Elimination of the requirement for a first aid room for employers with more than 200 employees,

Requiring successful completion of first aid training (which includes CPR) every two years instead of one year for CPR and three years for first aid.

Existing WAC Sections Proposed to be Repealed:

WAC 296-24-060 First aid training and certification. This section is proposed to be repealed and will be replaced by the four new sections indicated below:

WAC 296-24-06125 How many employees must be trained in first aid?

WAC 296-24-06130 What must first aid training cover?

WAC 296-24-06135 How often must employees complete first aid training?

WAC 296-24-06140 How must an employer document first aid training?

WAC 296-24-065 First aid kit. This section is proposed to be repealed and replaced by a new section, WAC 296-24-06145 How must an employer store first aid supplies?

WAC 296-24-067 First aid station. This section is proposed to be repealed and replaced by a new section, WAC 296-24-06150 Which employers must have first aid stations?

WAC 296-24-070 First aid room. This section is proposed to be repealed and will not be replaced by a new section. First aid rooms will no longer be required in the General Safety Standards.

Proposed New Sections:

WAC 296-24-061 First aid requirements. This new section identifies that the requirements in the WAC 296-24-061 section series pertain to first aid.

WAC 296-24-06105 What work places does this rule apply to? This new section states that the rule applies to all work places except for the specific ones listed and identified by rule title and chapter number.

WAC 296-24-06110 What is the purpose of this rule? This new section describes the purpose of the standard and replaces similar language found at the beginning of current section WAC 296-24-060.

WAC 296-24-06115 What definitions apply to this section? This new section gives definitions of several words or terms used in the standard. The current standard has no word or phrase definitions.

WAC 296-24-06120 What are the requirements for a first aid response plan? This new section requires employers to prepare a first aid response plan which addresses first aid training, first aid kits, emergency medical services availability and availability of first aid trained employees. This is a new requirement not found in the current standard.

WAC 296-24-06125 How many employees must be trained in first aid? This new section requires employers:

Determine how many employees must be trained in first aid,

To assess their workplace based on six listed factors, and

To use that assessment to determine how many employees must be first aid trained.

WAC 296-24-06130 What must first aid training cover? This new section identifies the 17 core elements that must, at a minimum, be included in first aid training. It includes some of the same elements of the existing standard and some new elements.

WAC 296-24-06135 How often must employees complete first aid training? This new section requires that the first aid training occur every two years and that employees demonstrate skill and knowledge in the core elements outlined in WAC 296-24-06130.

WAC 296-24-06140 How must employers document first aid training? This new section requires employers to document first aid training with training rosters, certificates, or successful completion cards.

WAC 296-24-06145 How must an employer store first aid supplies? This new section requires that first aid supplies:

Be readily available,

Be stored in protective containers,

Are appropriate to the workplace setting, and

Can be moved to injured employees.

This section allows the employer to determine the contents of the kit depending on the occupational setting rather than specifying in detail the contents as required in the current standard.

WAC 296-24-06150 Which employers must have first aid stations? This new section requires:

That a first aid station be established if there are 50 or more employees at a work site,

That the station is well marked, and

That the station has at least one portable first aid kit.

This section removes the requirement for wool blankets and stretcher, a roster of doctors, hospitals and ambulances and at least two first aid kits, as required in the current standard.

WAC 296-24-06155 Appendix 1 Evaluation worksheet for the first aid response plan. This is a nonmandatory appendix to provide guidance. This new section contains a questionnaire that is designed to be used by employers to assess the need for first aid trained employees. The questionnaire can be used to assess multiple locations or types of work.

WAC 296-24-06160 Appendix 2 Recommended contents of first aid kits. This is a nonmandatory appendix to provide guidance. This new section lists recommended minimum contents and optional contents for work place first aid kits.

Statutory Authority for Adoption: Chapter 49.17 RCW.

Statute Being Implemented: RCW 49.17.040, [49.17].050, [49.17].060.

Summary: See Purpose above.

Name of Agency Personnel Responsible for Drafting: Tracy Spencer, 7273 Linderson Way, Tumwater, WA, (360) 902-5530; Implementation and Enforcement: Michael A. Silverstein, 7273 Linderson Way, Tumwater, WA, (360) 902-5495.

Name of Proponent: Department of Labor and Industries, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: See Purpose above.

Proposal Changes the Following Existing Rules: See Purpose above.

No small business economic impact statement has been prepared under chapter 19.85 RCW. A small business economic impact statement is not required. The department has determined that the proposed rule will reduce the overall economic burden on business, and not place more than minor economic impact on business.

Section 201, chapter 403, Laws of 1995, applies to this rule adoption. The proposed rule is considered a "significant" rule because it significantly amends a regulation.

Hearing Location: On September 30, 1997, at 3:00 p.m. and 7:00 p.m., at the Labor and Industries Service Center, 3001 West Broadway, Moses Lake, WA; on October 2, 1997, at 1:00 p.m. and 6:00 p.m., at the Burlington Community Center (corner of Regent and Greenleaf streets), Burlington, Washington; and on October 7, 1997, at 9:30 a.m., at the Department of Labor and Industries Building, Auditorium, 7273 Linderson Way, Tumwater, WA.

Assistance for Persons with Disabilities: Contact Linda Dausener by September 20, 1997, (360) 902-5516.

Submit Written Comments to: Tracy Spencer, Standards Manager, WISHA Services Division, P.O. Box 44620, Olympia, WA 98507-4620, by October 14, 1997.

In addition to written comments, the department will accept comments submitted to FAX (360) 902-5529. Comments submitted by FAX must be ten pages or less.

Date of Intended Adoption: January 20, 1998.

August 19, 1997

Gary Moore

Director

NEW SECTION

WAC 296-24-061 First-aid requirements.

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NEW SECTION

WAC 296-24-06105 What work places does this rule apply to? This rule applies to all work places, except for the ones listed below. They are, instead covered by separate individual rules (vertical standards):

Rule Title Chapter

Agriculture 296-307 WAC

Compressed Air Work 296-36 WAC

Construction 296-155 WAC

Electrical Workers 296-45 WAC

Fire Fighters 296-305 WAC

Logging 296-54 WAC

Longshoring/Stevedoring 296-56 WAC

Sawmills 296-78 WAC

Shipbuilding and Repairing 296-304 WAC

Ski Area Facilities 296-59 WAC

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NEW SECTION

WAC 296-24-06110 What is the purpose of this rule? This rule ensures quick and effective first aid for all employees of the state, in case an injury or acute illness occurs on the job.

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NEW SECTION

WAC 296-24-06115 What definitions apply to this section? "Emergency medical service" means medical treatment and care given at the scene of any medical emergency or while transporting any victim to a medical facility.

"First aid" is immediate emergency care for injuries or acute illness before emergency medical treatment is available.

"First-aid station" is a well marked location where first-aid kits and supplies are stored and phone numbers of hospitals or clinics and emergency medical services are posted.

"First-aid kit" is an unlocked container holding first-aid supplies.

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NEW SECTION

WAC 296-24-06120 What are the requirements for a first-aid response plan? (1) The employer must develop and maintain a written first-aid response plan. The plan must ensure that trained first-aid personnel are available for employees who are injured or who become acutely ill on the job.

(2) The plan must be tailored to the work location, type of work and environmental conditions. It must be effective in practice.

(3) The plan must:

(a) Identify available emergency medical services;

(b) Tell where the emergency medical services access number is posted;

(c) Tell how employees are trained in first aid;

(d) Tell how injured or ill employees will have access to first-aid-trained employees;

(e) Give the location(s) of first-aid supplies and/or first-aid stations;

(f) Identify the contents of first-aid kits; and

(g) Tell how first-aid supplies or kits will be inspected and maintained.

Note: The first-aid response plan can be part of the written accident prevention program. See Appendix 1 for further guidance on a first-aid response plan.

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NEW SECTION

WAC 296-24-06125 How many employees must be trained in first aid? The employer must determine how many employees to train in first aid based on the following factors:

Degree of occupational hazards;

Remoteness of the work place;

Complexity of the work place;

Nature of work performed;

History of past medical emergencies; and

Time and distance to emergency medical services.

Note: If the employer requires an employee to give first aid, the bloodborne pathogen standard, WAC 296-62-080 applies and requires additional training. For guidance regarding voluntary provisions of first aid by an employee please see RCW 4.24.300.

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NEW SECTION

WAC 296-24-06130 What must first-aid training cover? First-aid training must include these core elements:

(1) Role and responsibilities of the first-aid provider;

(2) Assessing a scene;

(3) Performing an initial and ongoing assessment of an injured or ill person;

(4) Ensuring scene safety and body substance isolation;

(5) Performing an emergency move;

(6) Placing an ill person in the recovery position;

(7) Opening and maintaining an airway;

(8) Providing rescue breathing;

(9) Managing an obstructed airway;

(10) Performing adult one rescuer CPR;

(11) Recognizing the warning signs and symptoms of medical problems;

(12) Recognizing and caring for an injured or ill person with decreased levels of responsiveness;

(13) Controlling external bleeding and recognizing internal bleeding;

(14) Recognizing and caring for victims of shock;

(15) Recognizing and stabilizing spinal injury;

(16) Recognizing and manually stabilizing suspected skeletal injuries; and

(17) Knowledge of voluntary provisions of first aid, consent and confidentiality.

Note: Occupational risk or extended time and distance from emergency medical services may indicate a need for training beyond the items listed above. Each work environment should be surveyed to determine the appropriate level of training that employees should receive.

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NEW SECTION

WAC 296-24-06135 How often must employees complete first-aid training? Every two years, employees must successfully complete first-aid training by demonstrating skill and knowledge in the core elements outlined in WAC 296-24-06130.

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NEW SECTION

WAC 296-24-06140 How must an employer document first-aid training? Documentation of first-aid training must be maintained by the employer. Training rosters, certificates or successful completion cards are considered documentation.

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NEW SECTION

WAC 296-24-06145 How must an employer store first-aid supplies? (1) First-aid supplies must be readily available to all employees.

(2) First-aid supplies must be stored in containers adequate to protect the contents from damage, deterioration, or contamination. The containers must be clearly marked and not locked, but may be sealed.

(3) First-aid supplies must be able to be moved to the location of the injured or acutely ill worker.

(4) The first-aid supplies must be appropriate to the occupational setting and the response time of emergency medical services.

Note: See Appendix 2 for recommended contents of first-aid kits.

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NEW SECTION

WAC 296-24-06150 Which employers must have first-aid stations? (1) Employers with fifty or more employees per shift at one location must establish a first-aid station.

(2) The first-aid station must be:

Well marked;

Available to employees during all working hours;

Equipped with first-aid supplies (type and amount depends on the number of employees, occupational setting and conditions).

(3) The first-aid station must have at least one portable first-aid kit.

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NEW SECTION

WAC 296-24-06155 APPENDIX 1 Evaluation worksheet for the first-aid response plan. This is a nonmandatory appendix. The first-aid standard (WAC 296-24-061) requires employers to prepare a first-aid response plan. The plan must address the availability of first-aid trained personnel at each place of employment. Since work sites are highly variable, the first-aid needs will also vary, depending on the number of employees, the type of work, the job hazards, and the availability of emergency medical services.

This questionnaire is designed to be used as a tool to assess the need for first-aid trained employees. Since some employers may have more than one location or type of work, this questionnaire can be used to assess each site. The plan should be reviewed annually or whenever conditions change at the work site.

1. What site or location does this plan cover?

2. Who is responsible for managing this plan?

3. How is this plan communicated to employees?

4. When was the plan written or last reviewed?

5. How many employees at the work site? (If work is seasonal, consider how many per season and shifts worked.)

6. How many work shifts at the work site? (Indicate shifts and employees per shift.)

Number of Employees Shifts

Day Swing Graveyard

less than 10 ___ ___ ___

11-49 ___ ___ ___

50-99 ___ ___ ___

100 or more ___ ___ ___

7. What are the sources of potential injuries or illnesses at the work site?

8. What types of injuries or illnesses have occurred in the past at the work site? (This information may be found in such sources as OSHA 200 forms, worker compensation claims, or safety committee minutes.)

9. What is the response time of the available emergency medical services to the work site (estimated time in minutes)?

10. How accessible are the first-aid trained personnel in the case of an accident?

11. What factors did I consider in deciding how many employees to train in first aid (specify)?

> Injury/illness history.

> Possible hazardous exposures (chemicals, flammable liquids, temperature extremes, moving machinery or machinery parts, powered tools, work at elevations, high voltage electricity, confined spaces. If seasonal work, list for each season).

> Number of separate work sites (can be either separate locations, buildings, or types of work such as offices, warehouses, production areas, etc.).

> Number of employees at this work site? (If seasonal work, list for each season.)

> Number of employees in each shift?

> Emergency medical service response time?

> First-aid response time?

12. Does the first-aid training provided to my employees include all the core elements required in the standard?

13. Based on my assessment of work site hazards, is additional training required beyond the core elements? (Examples include burns, eye injuries, poisoning, heat stress, frostbite.)

14. What factors did I consider in determining the contents of my first-aid supplies/kits (specify)?

> Injury/illness history.

> Type of hazards at work site (physical, chemical, biological).

> Number of employees and shifts.

> Recommendations of first-aid training providers, local emergency response providers, physicians or clinics, trade organizations, knowledgeable employees or first-aid kit vendors.

15. What factors did I consider in determining the number and location of my first-aid supplies/kit(s) (specify)?

> Location of employees.

> Areas of greatest hazards.

> Ease of accessibility of kit.

16. Who is responsible for maintaining first-aid supplies/kit(s)?

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NEW SECTION

WAC 296-24-06160 APPENDIX 2 Recommended contents of first-aid kits. This is a nonmandatory appendix.

Derived from October, 1996, Draft ANSI Z308.1

Minimum Requirement for Work Place First-aid Kits

Basic First-aid kit - Minimum contents

1. 1 absorbent compress, 4x8 inches

2. 16 adhesive bandages, 1x3 inches

3. 1 adhesive tape, 5 yards long

4. 10 antiseptic single-use packages, 0.5 g. application

5. 6 burn treatment single-use packages, 0.5 g. application

6. 1 eye covering (for two eyes)

7. 1 eye wash, 1 fluid ounce

8. 4 sterile pads, 3x3 inches

9. 2 pair of medical exam gloves

10. 1 triangular bandage, 39x39x55 inches

Optional First-aid kit contents

1. Bandage compresses, 2x2 inches, 3x3 inches and 5x5 inches

2. Self-activating cold packs, 4x5 inches

3. Roller bandages, 6 yards long

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REPEALER

The following sections of the Washington Administrative Code are repealed:

WAC 296-24-060 First-aid training and certification.

WAC 296-24-065 First-aid kit.

WAC 296-24-067 First-aid station.