First Aid Principles and Codes of Practice

Safe Work Australia, in conjunction with various States and Territories of Australia, has developed a model Code of Practice which includes information on first aid kits, procedures, facilities, and training for first aiders. This Code of Practice has been implemented in Queensland, New South Wales, Australian Capital Territory, Northern Territory and Tasmania. The remaining states have similar documents that they have developed independantly, see the below list/links:

• Victoria.

• South Australia.

• Western Australia.

According to Safe Work Australia's mode Code of Practice, people conducting a business have a duty to provide first aid services and facilities that are appropriate to their industry risk factor. For example, workers in factories, motor vehicle workshops and forestry operations are at a greater risk of injury requiring immediate medical treatment than workers in offices or libraries.

Therefore all business owners must write their Workplace, Health and Safety or First Aid Policy taking into consideration the following factors:

• The nature of the work being carried out at the workplace.

• The nature of the hazards at the workplace.

• The size and location of the workplace.

• The number and composition of the workers and other persons at the workplace.

To summarise the duty of care for employers is: 

Business managers have the responsibility to comply with the Code of Practice, or other State regulated regulations, implement a workplace risk management program, and provide first aid services and facilities.

The DRSABCD process is a method of conducting a visual and verbal assessment of a patient and a means of initiating the chain of survival in the case of a sudden cardiac arrest and/or cessation of breathing incident.

The chain of survival principles in this context is:

• Early Access - Recognising that the situation is a cardiac arrest/cessation of breathing incident and acting immediately to begin first aid treatment/resuscitation.

• Early Cardiopulmonary Resuscitation (CPR) - If commenced within four minutes of the heart-stopping oxygenation of the vital organs can be maintained.

• Early Defibrillation - Used in combination with CPR and within the 8-12 minutes of the heart-stopping, these devices can shock the heart back into action and restore correct rhythm.

• Early Advanced Life Support - Medical treatment delivered by professional paramedics, nurses and doctors. An ambulance should ALWAYS be called in the case of a sudden cardiac arrest and/or cessation of breathing incident.

Safe Work Australia have constructed a list of common hazards which may require first aid (note: this list is generic and does not apply specifically to the sport, fitness and recreation industry):

• Manual tasks [Ergonomic] - Overexertion can cause muscular strain.

• Working at height or on uneven or slippery surfaces - Slips, trips, and falls can cause fractures, bruises, lacerations, dislocations, and concussion.

• Electricity - Potential ignition source - could cause injuries from fire. Exposure to live electrical wires can cause shock, burns, and cardiac arrest.

• Machinery and equipment [Physical] - Being hit by moving vehicles, or being caught by moving parts of machinery can cause fractures, amputation, bruises, lacerations, and dislocations.

• Hazardous chemicals - Toxic or corrosive chemicals may be inhaled or swallowed or may contact skin or eyes causing poisoning, chemical burns, and irritation. Flammable chemicals could result in injuries from fire or explosion.

• Extreme temperatures - Hot surfaces and materials can cause burns. Working in extreme heat can cause heat-related illness. It can also increase risks by reducing concentration and increasing fatigue and chemical uptake into the body. Exposure to extreme cold can cause hypotermia and frostbite.

• Radiation - Welding arc flashes, ionising radiation and lasers can cause burns. Ultraviolet (UV) radiation from the sun can cause sunburn, skin cancers and eye damage.

• Violence - Behaviours including intimidation and physical assault can cause both physical and psychological injuries.

• Biological - Infection, allergic reactions.

• Animals - Bites, stings, kicks, crush injuries, scratches.

In addition to this generic list of hazards, the sport, fitness and recreation industry also has the additional hazard of health related incidents occurring as a result of clients will pre-existing medical or physical conditions overexerting themselves during fitness activities. This hazard can result in serious medical situations which require immediate first aid. Always ensure you have conducted the pre-exercise medical screening document developed by industry associations and provide adequate supervision.

When implementing a risk management program it is worth consulting this list to determine which of the hazards may be applicable to your workplace and formulating policies, procedures, and internal audit checklists accordingly.

Fitness Australia has developed a Fitness Industry Risk Management Manual which includes some first aid related risks among other generic risks that are applicable within the industry. They have identified the main areas of risk (not necessarily related to first aid) as being:

1. The competency of fitness professionals.

2. The effectiveness of pre-exercise screening and the management of de-conditioned clients.

3. Poor supervision of fitness service users and incorrect use of equipment.

4. Fitness trainers failing to remain within their scope of practice.

5. Equipment misuse (as distinct from incorrect use).

6. Poor fitness training environments.

Implementing safe work practices to minimise risk and potential hazards includes:

• Identifying hazards - Find out what could cause harm.

• Assess risks, if necessary - Understand the nature of the harm that could be caused by the hazard, how serious the harm could be and the likelihood of it happening. 

• Control risks - Implement the most effective control measure that is reasonably practicable in the circumstances and ensure it remains effective over time. This is known as the hierarchy of control, and it is discussed in more detail below.

• Review hazards and control measures - To ensure they are working as planned.

The hierarchy of control methods can be used to help mitigate risks associated with hazardous activities or equipment.

• Elimination - By completely removing a hazardous activitiy from a program or removing a dangerous piece of equipment from the facility the risk is eliminated. Although this may not be a practical solution.

• Substitution - Replacing hazardous activities or equipment with a similar but safer alternative may be more practical than eliminating the situation altogether. 

• Engineering Controls - Making adjustments (or purchasing equipment with adjustments already installed) such as the inclusion of barriers, safety switches, or weight racks to alter a hazard to make it safer may be necessary. 

• Administration Controls - Implementing policies and procedures regarding hazards and risks to inform staff and clients of the hazard and risk and provide solutions on how to undertake safe work practices can be effective. 

• PPE - Providing personal protective equipment (PPE) and ensuring it is used when applicable, although this method should only be used in conjunction with at least one other method as it is not enough to mitigate risk all by itself. 

Even with all of these safe work practices in place, first aid emergencies do still happen from time to time. Therefore managers and business owners should also be aware of the need for stress-management, counselling, and debriefing after a serious first aid incident. Staff members and bystanders, may be extremely distressed if they have had to deal with or have witnessed a traumatic event, especially a fatality.

Identifying a professional counselling organisation which might be able to visit the workplace and speak to staff is important. Debriefing can help in the following ways:

• Provides participants with ways to deal with physical or psychological symptoms associated with trauma exposure.

• Provides closure to the incident and sets in motion the rebuilding process.

• Provides an opportunity to reflect upon the incident, and can provide valuable insight into existing policies and procedures and how they might be improved to prevent a recurrence.

Remember, people will have varying degrees of distress and therefore not everyone will want to participate (although it is highly recommended). 

Infection control is an important consideration during the application of first aid to protect yourself and also the patient. M

Standard precautions that can be used to help promote infection control include:

• Hand hygiene - Washing your hands prior to attempting first aid and wearing gloves (not applicable in emergency situations where urgency is required).

• Using personal protective equipment (PPE) - Gloves, masks, eye protection, gowns and disposable face shields can all be used to prevent the transfer of body fluids.

• Handling clinical waste (sharps, dressings, padding) appropriately - Disposing of clinical waste in specific biological waste cannisters is advisable.

• Cleaning and managing spills of blood and body substances correctly - Appropriate cleaning products should be used to sanitise surfaces after a first aid incident, especially if blood and other body fluids were spilt. If necessary professional cleaning services should be contracted to correctly clean and dispose of contaminated surfaces and objects.

According to the Safe Work Australia Code of Practice the number of trained first aid officers employed in a workplace differs depending on the risk level of the business:

• Low-risk workpalces - one first aider for every 50 workers (and/or clients).

• High-risk workplaces - one first aider for every 25 workers (and/or clients).

• Remote high-risk workplaces - one first aider for every 10 workers (and/or clients).

As the sport, fitness and recreation industry is so broad, and includes provision to members of the public in varying numbers, the risk factor would likely be high-risk for larger fitness facilities such as gyms or organised sport arenas. However, small operations such as community fitness or personal training may be considered low-risk if they do not service many clients at any one time.

Consideration should always be made regarding the specfic type of physical activity being undertaken and the percentage of clients that have been asssessed as moderate to high risk.

First aid accreditation is evidenced by a Statement of Attainment issued by a Registered Training Organisation (RTO) for the nationally endorsed unit of competency HLTAID003 Provide First Aid (and possibly also HLTAID001 Provide Cardiopulmonary Resuscitation). Industry recommendation is that HLTAID003 should be renewed every three years and HLTAID001 should be renewed every 12 months. 

You must be aware of your own skills and limitations regarding first aid. If you do not feel confident in your skills and knowledge then consider the following tactics:

• Undertaking a refresher course or perhaps and advanced training program.

• Organising or participating in scenario drills at your workplace to ensure you and everyone knows how to handle first aid related incidents confidently.

• Speak to your manager (if applicable) to ensure there are other first aid officers trained and on shift so you are not the only qualified person.

• Consult workplace policies and procedures, as well as industry standards and codes of practice, for helpful strategies.

As part of establishing a first aid policy for your workplace/business due consideration must be made to protect the privacy and confidentiality of employees and clients. Things to consider include:

• Discretion when discussing any medical conditions. This should be undertaken in a private room and records kept confidential and secure.

• Consent should be obtained regarding the disclosure of any medical information to appropriate personnel (ie. ambulance officers) in the event of a first aid related emergency. This consent can be obtained verbally from the patient if they are conscious or it can be obtained in writing prior to activity ie. during the initial screening discussion / orientation.

• First aid rooms should offer privacy in the form of screening or a door.

• Where possible consent should be obtained prior to attempting first aid on a patient, if the patient is under 18 years of age then consent should be obtained from their parent or guardian. This consent may be obtained prior to undertaking an activity (especially a high-risk activity) and may be included in the membership contract wording. If the patient is unconscious then first aid consent is not required, although it may already be inferred through the prior consent process.

People who are ill or injured may be extremely distressed and require reassurance and information about their predicament, who you are, what you going to do, and how they can manage their own reactions (ie. breathing techniques). At all time respectful behaviour towards the patient is required.