Guidance covering the content of first-aid boxes has recently changed and is applicable from the beginning of 2012. What is the latest guidance and what do employers have to do to comply? Martin Hodgson explains.

All adult social care service providers must comply fully with the Health and Safety (First-aid) Regulations 1981, which include requirements for employers to provide facilities enabling first aid to be given to employees if they are injured or become ill at work. Effective first aid is a vital consideration in any setting but is especially important in adult social care where service users may also need to be covered by first-aid provision as well as staff. In the majority of cases this means providing trained and qualified first aiders to administer first aid, appointed persons to support them and supplying a number of first-aid boxes containing essential emergency medical supplies and equipment.

The requirement for a first-aid box

Every year many workers in the UK are injured in workplace accidents. The first few minutes after an accident are critical, and well-trained first aiders are, in many cases, able to minimise the effect of an injury if appropriate first-aid equipment is readily available. The Health and Safety (First-aid) Regulations 1981 require first-aid equipment to be provided and state that it should be easily accessible. The usual method is to provide a first-aid box, clearly marked and containing essential first-aid equipment.

A new standard for workplace first-aid kits

The Health and Safety (First-aid) Regulations 1981 originally included guidelines about the content of first-aid boxes in its Approved Code of Practice. However, the requirements for the contents of workplace first-aid kits were recently reviewed to accommodate changes in first-aid practice, new product innovations and the need for better infection control.

The British Standards Institute (BSI) has subsequently introduced a new national standard for workplace first-aid kits following extensive co-operation with the British Healthcare Trades Association (BHTA) and the Health and Safety Executive (HSE).

Based on the new standard, kits should now include increased quantities of products identified as insufficient in the old guidelines, including:

  • plasters and wipes

  • scissors or shears

  • burns dressings

  • foil survival blankets

  • a resuscitation face shield

  • nitrile gloves

  • adhesive tape.

Quantities of other items have been reduced to keep the overall size of kits broadly similar to the existing ones. A new BSI standard, BS 8599: Workplace First Aid Kits, has also been introduced describing the changes which was introduced with a six-month transition from 1 July 2011.

The accessibility of first-aid equipment

The First Aid Regulations require that the first-aid box be clearly marked and made freely available to staff. This is usually accomplished by placing the box in a convenient location where staff and first aiders can easily access it. Wall mounting kits are common as long as kits can easily be detached so as to be portable and taken to a patient if required. Locations such as locked offices are usually best avoided.

The number of first-aid kits should be decided after completing a first-aid risk assessment and taking into account such factors as the size of the workplace and how many staff work there. A potential complication of having a freely available first-aid box is that it might be abused, eg by being emptied or vandalised. An alternative is to issue a first-aid kit to each first aider for him or her to keep safe and ready for use. However, this might mean that it is not available for anyone other than the first aider to use at a particular time.

Further complications of a freely available first-aid kit are the possibility that a person self-treating will not be able to render the best treatment, that the kit may become depleted and the likelihood that the relevant records will not be completed.

First-aid box contents

BSI standard-compliant first-aid kits are now considered the safest and best way for an employer to meet their first aid obligations and have replaced the BHTA-HSE kits that conformed to the old guidelines contained in the L74 ACOP from the HSE.

With the introduction of BS8599, the following changes were made to the old HSE guidance. Boxes should now include:

  • an increased quantity of gloves — these should be Nitrile gloves to avoid possible latex sensitisation and allergic reactions

  • a more appropriate number of plasters

  • a higher quantity of wipes, which must be sterile in order to meet European CE marking rules

  • a reduced number of medium and large dressings

  • fewer triangular bandages in line with first-aid protocols which no longer suggest their need for immobilising lower limbs

  • a smaller finger dressing which is more suitable for small injuries

  • burns gel dressings — as the majority of workplaces will have a risk from burns, especially kitchens and catering settings, the dressing should also include a conforming bandage to secure it

  • adhesive tape in order to secure dressings — safety pins are still available so that first aiders can choose depending on their preference

  • a foil emergency blanket allowing a casualty to keep warm in order to reduce the potentially fatal effects of clinical shock

  • a mouth-to-mouth resuscitation device comprising a one-way valve

  • eyewash in travel kits only

  • an updated first-aid guidance leaflet.

Four sizes of kit have been introduced as follows: workplace small, medium, large and a travel kit. In order for employers to select the correct first-aid kit for their particular workplace, a risk assessment is crucial to determine the hazard levels and number of employees within the area.

BSI has outlined a guide to help employers select the most suitable kit for their requirements.

  • Low-hazard workplace (eg shops, offices, etc):

    • fewer than 25 employees — small kit

    • 25–100 employees — medium-sized kit

    • over 100 employees — 1 large kit per 100 employees.

  • High-hazard workplace (eg extensive work with machinery, food processing, warehousing, etc):

    • fewer than 25 employees — small kit

    • 5–25 employees — medium-size kit

    • over 25 employees — 1 large kit per 25 employees.

The full contents list is as follows.

Small

Medium

Large

Travel

Guidance card

1

1

1

1

Contents list

1

1

1

1

Medium dressing

4

6

8

1

Large dressing

1

2

2

1

Triangular ban

2

3

4

1

Safety pins

6

12

24

2

Sterile eyepad

2

3

4

Sterile dressings

40

60

100

10

Alcohol-free wipes

20

30

40

4

Adhesive tape

1

1

1

1

Nitrile gloves

6

9

12

1

Sterile finger dressing

2

3

4

Resuscitation faceshield

1

1

2

1

Foil blanket

1

2

3

1

Burn dressing

1

2

2

1

Shears

1

1

1

1

Conforming bandage

1

2

2

1

Eyewash 250ml

1

In kits sold specifically for catering settings, such as care home kitchens, the plasters should be washproof and the plasters, bandages, dressings and wipes are usually coloured blue. In the case of plasters this is to ensure that they are visually obvious in food preparation areas and to decrease the chance of contaminating food.

The recommended minimum contents of a first-aid kit is not exclusive and can be added to with items that are useful to first aid, except medicines and tablets, which need to be kept away from the kit. If a special need for equipment or first-aid materials arises from the assessment of need, then it should be supplied in all first-aid kits on the site.

Boxes and cases

Whatever the content of the kit, the box or case must be immediately identifiable as a first-aid kit. There is no requirement that the case be made of a particular material or even be of rigid construction but in most kitchen settings a rigid case is preferable to protect against damage, grease, dirt and water penetration.

There are some instances, notably for portable or so called “fast response” kits, where a soft padded case, possibly with shoulder straps, would be of more use.

Most first-aid boxes are coloured green with a white cross. However, blue boxes are commonly used in catering settings, along with blue plasters and other blue-coloured equipment such as gloves.

The first-aid needs of employees who are working away from the organisation's premises can be met by the provision of a suitable travelling first-aid kit, some instruction on its use and (where necessary) a means of communication.

Checking content

First-aid kits are useless if they are empty or contain out-of-date items. The contents must be regularly checked and restocked.

If any equipment is used at any time the box should be replenished as soon as possible after use. It is important to check not only the content of the kits, but also that items with a shelf-life are still in date. For most of the items, with the exception of eyewash, the shelf life is usually lengthy so this is not a serious problem.

Sufficient supplies should be held in a backup stock on site. However, it is not recommended that large quantities of first-aid materials are kept unless there is some evidence that they will be used. The benefits of bulk buying can often be outweighed by having to dispose of unused out-of-date items.

First-aid box contents should be checked by a qualified first aider or delegated to an appointed person.

Eyewash

Irrigating the eye will be necessary if there is a foreign body in the eye (but not if it is embedded or sticking out of the eye) or if a hazardous substance is splashed into the eye, for which the manufacturer's safety datasheet first-aid section recommends irrigation with water. Standard advice in first-aid manuals is to use clean tap water, the quantity of water used depending on whether a foreign body is being removed or a harmful substance is being flushed away. However, where mains-fed tap water is not available proprietary eyewash solution can replace it.

The problem with eyewash solution is that it is expensive and once opened the remainder must be disposed of. The solution usually has quite a short shelf-life — sometimes only six months — which means it also routinely needs restocking.

Most first-aid kit providers also stock what are often called “eyewash stations” which can be placed alongside first-aid boxes if indicated by a risk assessment.

Eyewash is only incorporated into the BS8599 travel kit since eyewash stations are unlikely to be available for mobile workers.

Where bottles of solution are the only means of providing this facility, it is important that they are kept clean and secure. They should be checked regularly to ensure that they are in-date and disposed of and promptly replaced when used.

Information for employees

First-aid arrangements operate efficiently in an emergency only where they are known, understood and accepted by all in the workplace. Procedures for informing staff of first-aid box locations and contents should therefore be set up in consultation with safety representatives.

A simple method of keeping employees informed is by using first-aid notices. The information needs to be clear and easily understood by all employees. Notices must be designed and worded carefully to ensure information is effectively communicated to employees. At least one notice in a prominent position at each site, including the base for travelling employees, should give enough opportunity for employees to see the information.

The inclusion of first-aid information in induction training will help ensure that new employees are made aware of first-aid arrangements.

Further information

Further information on the new BSI kits can be found on the HSE website.

Last reviewed 1 February 2012