First aid

Framework

Title 5 "First Aid" of book I of the Code on Well-being at Work provides a framework for the organisation of first aid in the company without going into specific details which are the subject of a brochure. This title presents benchmarks which each employer can use to achieve the optimal organisation of first aid that must suit the characteristics of his business.

The main priorities of title 5 focus on:

the distribution of personnel responsible for providing first aid and the nature of the resources required, which are determined based on the number of workers, the characteristics of the company and the results of the risk analysis;
the removal of required content from the first aid kit;
the withdrawal of approvals, replaced by a procedure which allows first aid training providers to appear on a list of organisations providing training;
the content of the basic training for first aiders, which is drawn up in terms of into objectives.

Definitions

Precise definitions are given: first aid, first aider and treatment room.

First aid (Art. I.1-4, 8°)

These are all the necessary procedures which are intended to limit the consequences of an accident or a traumatic or non-traumatic condition, and to ensure that the injuries do not worsen while waiting, if necessary, for specialised help.
The definition focuses on the following objective: the aim is to remove a victim of an accident or illness from a dangerous situation, using appropriate means, which may include immediate and temporary care. The actions that are taken are therefore relief but may also be first aid.
The concept of "emergency care" is no longer used because the FPS Public Health has the power to establish the criteria for providing emergency care. This care can now only be provided by specialised nurses.

First aider (Art. I.5-1 , 1°)

This is a worker responsible for providing first aid after having successfully completed basic and refresher training related to specific objectives. This basic training must be supplemented by specific training related to the company's activities, if there are specific risks related to these activities.

Treatment room (Art. I.5-1 , 2°)

This room is located in the workplace or in his immediate environment.
It may only contain equipment intended for first aid and only accommodate victims of an accident or illness for the purpose of giving first aid. This room may also, after consulting the Prevention Advisor/Occupational Physician (PAOP), accommodate pregnant and breastfeeding workers to enable them to rest or breastfeed, under the conditions laid down by specific regulations.

Employer's obligations

General obligation (Art. I.5-2)

The general principle is that the employer must take the necessary steps to:

be able to provide first aid to workers who have suffered an accident or become ill and, if necessary, inform the specialised services,
be able to provide transport for victims either to their homes or to a care facility, provided that the victim can be transported,
organise the necessary contacts with the services specialising in emergency medical assistance and rescue operations and health care institutions, with the aim of ensuring that victims obtain the appropriate medical assistance as quickly as possible.

In order to be able to provide external transport for victims (taxi, ambulance, etc.), and to be able to inform the specialised services, the main telephone numbers and addresses of these services must be directly accessible.

Article I.5-2, §2 requires that all these measures to be taken by the employer also apply to other persons who may be present in the workplace, such as contractors, subcontractors, students, visitors, clients, patients, etc. These persons may also be victims of an accident or illness and, in this case, the employer must be able to provide them with first aid and possibly transport them.

What are the measures to be taken (Art. I.5-3)?

The employer takes the necessary measures:

after consulting the Committee,
working with the internal or external service, depending on the size of the company and the division of tasks between the two services,
and working with the Prevention Advisor/Occupational Physician who supervises the organisation of first aid,

He takes into account:

the nature of his business activities,
the results of the risk analysis,
the number of workers and the risk group to which they may belong,

The measures to be taken are as follows:

Procedures : the employer must establish the first aid procedures set out in the internal emergency plan, since this plan must be drawn up pursuant to Article I.2-23. The employer also establishes the measures in the event of serious and immediate danger, as provided for in Articles I.2-24 to I.2-26. Procedures must be established to ensure that workers who have suffered an illness or accident can receive appropriate assistance as quickly as possible.
These procedures cover, in particular, the way in which workers are informed about the organisation of first aid, the internal communication system for contacting the persons responsible for first aid as quickly as possible, external communication with the specialised services, etc.
Equipment : the employer determines the resources necessary for the organisation of first aid. These resources are the necessary equipment, the first aid kit and the treatment room.
Organisation : the employer determines the number of workers to be assigned to provide first aid. He determines what qualifications they must possess in accordance with the criteria referred to in Article I.5-6: either first aiders, nursing staff or other designated persons.
Training : the employer must list the specific risks related to the company's activities, for which first aiders must have acquired either basic training or basic training supplemented with specific training, in accordance with Article I.5-8.

Equipment (Art. I.5-4 and I.5-5) = resources

Basic equipment and first aid kit

After consulting the Prevention Advisor/Occupational Physician and the committee, the employer determines:

which basic equipment is needed,
the contents of the first aid kit,
where this equipment is to be located,
whether additional elements are required.

The employer also regularly checks that this equipment and the first aid kit are indeed located in the place provided for this purpose.
An indicative list of the contents of the first aid kit is given in the brochure focusing on the practical aspects of first aid.
It is not recommended that medicines, even those not subject to medical prescription, are included in the first aid kit.
Indeed, occupational medicine is designed to be essentially preventive and the first aider is not authorised to administer medicines.

The treatment room

The treatment room is compulsory in Group A, B or C companies, unless the risk analysis shows that it is not necessary.

The layout of the treatment room (characteristics of the room, equipment, furniture, etc.) is also determined by the employer after consulting the Occupational Physician and the committee.
Advice on the layout of this space will also be included in the brochure.

Although this room can only be used for first aid purposes, a new provision provides that it may also be used as a rest room where pregnant workers can take a break in appropriate conditions of comfort and where breastfeeding workers can breastfeed their child.

In the provisions relating to social facilities (Art. III.1-62), it is stipulated that the employer will provide these workers with an appropriate place to rest.
Article I.5-5, § 2 simply adds the possibility that the treatment room may also be used as a rest room for these workers, after consulting the Occupational Physician.

Organisation (Art. I.5-6)

Distribution of first aid personnel

This distribution is no longer fixed as in the old regulations and is more suited to the reality of the company's activities.

In Group A, B or C companies, the employer determines the number and qualifications of the personnel responsible for providing first aid:

after consulting the Prevention Advisor/Occupational Physician and the committee,
depending on the number of workers the company employs,
depending on the characteristics of the company's activities,
depending on the results of the risk analysis,

These staff members are:

either first aiders with basic training (see training section),
or first aiders with basic training and specific knowledge and skills (if specific risks are present in the company),
or nursing staff members,
or designated workers.

In Group D companies, the employer designates one or more workers who do not need to have acquired basic first aid training, but must have received the information necessary to use the first aid kit and inform the appropriate emergency services.

When designating staff, the employer must take into account the fact that first aid must be available throughout the working hours, including at night, in the case of night work and shift work.

Keeping a register

The purpose of keeping a register of first aid interventions is essentially part of the prevention policy:

to prevent similar accidents from happening again,
to enable the organisation of first aid to be evaluated and adapted,
to allow a different schedule in the organisation of refresher courses,
as evidence in case of minor occupational accidents that the employer does not have to report to the occupational accidents’ insurer,
and to ensure, where appropriate, legal certainty if first aid is not given in good time or is given incorrectly.
In the context of the Well-being Act, the first aider is a worker and therefore cannot be criminally prosecuted under this Act, as the responsibility for taking first aid measures lies with the employer. The first aider is obviously exposed to sanctions set by the employer under their contractual relations. Moreover, in the event of gross negligence on the part of the first aider, common law (civil or criminal) would apply, as it would for any other citizen.

The register must include at least the following elements:

the victim's name,
the name of the person who provided first aid,
the location, date and time of the accident, as well as a description and circumstances of the accident, in order to dispense with the declaration of such accidents to the occupational accidents’ insurer and keep it as evidence in the event of worsening,
the date and time of the intervention,
the nature of the intervention (nature of the injury, type of treatment and resources provided, follow-up given after first aid, etc.),
the identity of any witnesses.

Competence of the Directorate General of Supervision of Well-being at Work (Contrôle du bien-être au travail - CBE)

Officials responsible for the supervision of well-being at work may consider it useful to impose on the employer a different classification of the personnel responsible for providing first aid, or a different or additional contents for the first aid kit, or the furnishing of a treatment room, in case there is no such room and the officials consider that such a room is necessary.

Training and retraining (Art. I.5-8 to I.5-13)

Basic and specific knowledge and skills (Art. I.5-8, I.5-9 and I.5-13)

Basic training for first aiders

The basic knowledge and skills must enable the first aider to achieve the objectives referred to Appendix I.5-1 in order to:

be able to recognise life-threatening conditions,
be able to apply first aid principles while awaiting the intervention of specialised services.

If the company's activities do not involve specific risks for workers, basic training is sufficient. This basic training must be known in all companies.

Specific training

If there are specific risks related to the employer's activities, the basic training must be supplemented by specific training focused on these risks, carried out under the conditions set out in Article I.5-13.
The specific risks are determined by the employer in consultation with the Prevention Advisor/Occupational Physician, the internal service and after consulting the Committee.
In the context of these specific risks, account should also be taken at the same time of the specific first aid provisions set out in:

Title I "Chemical agents" of book VI (Art. VI.1-21 to VI.1-26)
Book VII "Biological Agents" (Art. VII.1-39 to VII.1-41)
and the Royal Decree of 25 January 2001 on temporary and mobile construction sites (Art. 50 and Appendix III, A, 13).

Retraining

Retraining normally happens annually unless the employer can demonstrate that annual retraining is not necessary based on a prior risk analysis and the opinion of the Occupational Physician and the committee: in this case, retraining may be carried out every two years.

For example, if first aiders are required to provide first aid regularly, an annual refresher course is not always useful.

However, there cannot be an unlimited reduction in the frequency of retraining: it can only be reduced to a minimum of once every two years.

A first aider who, for a valid reason, is unable to attend a refresher course must attend another refresher course within 12 months of the originally scheduled refresher course; otherwise they are no longer assumed to have the knowledge and skills in first aid. In this case, the worker will have to attend a completely new training course, otherwise they are no longer supposed to act as a first aider.

The qualification or certificate remains valid as long as retraining continues.

Training content in terms of objectives

Training content is determined in terms of final objectives, which also allows workers who may have undergone first aid training abroad to meet the objectives which are:

the basic principles (role of the first aider, basic hygiene, correct analysis of the situation, comfort care prior to evacuation and his procedure);
support of vital functions (actions in case of unconsciousness, respiratory and cardiovascular problems);
first aid in case of other issues (e.g. poisoning, bleeding, injuries, burns).

Institutions that appear on the list of institutions that provide first aid training (detailed list below) may have to assess whether the content of a training course followed abroad corresponds to the basic knowledge and skills referred to in the Code.

Indeed, first aid training is translated into objectives, in a similar way to the procedures prescribed for the basic training of Prevention Advisors (see title 4 on the training and retraining of Prevention Advisors, in book II of the Code on Well-being at Work).

Conditions for organising first aid courses (Art. I.5-10)

Basic and refresher training

Institutions or employers who want to provide basic and refresher training must:

ensure that the course content is consistent with the three objectives given in the previous point (basic principles, life support and other issues),
have competent lecturers,
have appropriate premises, teaching and training equipment,
organise the courses so that they include at least 15 hours,
organise annual refresher courses of at least 4 hours,
limit the number of students to 15 per class and per lecturer,
at the end of the course, issue a certificate to students after an ongoing skills assessment. There is therefore no final test or exam at the end of the course.

Courses for specific knowledge and skills

These courses are organised by institutions, sectors, professional organisations or employers who, for the courses, use recognised individuals or organisations specialising in first aid for victims of accidents or illnesses linked to the risks inherent in the company's activities. It is logical that the Prevention Advisor/Occupational Physician should be involved in organising these courses.

List of institutions or employers providing training and retraining for first aiders (Art. I.5-11 and I.5-12)

Procedure for inclusion on the list

For the provider:

the training course provider sends an application to the Directorate General Humanisation of Work (Humanisation du travail - HUT),
this application contains:

the name, status and address of the institution
the location of the courses and location of the equipment
lecturers' qualifications: degree, experience, curriculum, how they retrain
a written declaration by which the provider agrees to comply with the conditions laid down in Article I.5-10 for organising the courses (see above)

The application can be made using the online form, available in French (Demande afin de figurer sur la liste des institutions ou employeurs qui dispensent une formation et un recyclage aux secouristes (DOCX, 73.24 KB)) and Dutch (Aanvraag om opgenomen te worden in de lijst van instellingen of werkgevers die vorming en bijscholing aan hulpverleners verstrekken (DOCX, 81.15 KB)), in the "Documentation" module.

Course of the procedure

The Directorate General HUT checks whether the application is complete.
HUT forwards the request to the Directorate General Supervision of Well-being at Work (CBE) for review, report and opinion.
if the CBE's opinion is favourable: the provider is included in the list published by HUT on the FPS’ website.
if the conditions for inclusion in the list are no longer fulfilled (for example if following a CBE survey, the course content is no longer considered satisfactory, if there are too many students per lecturer, if a lecturer does not have the necessary skills, etc.), and the provider has had the opportunity to explain himself, the provider can be removed from the list.

How to call on a first aid training provider

The providers of basic training for first aiders must meet the conditions set out by the Code on Well-being at Work, which are explained above.
When the Directorates General HUT and CBE have found that all the conditions have been met, these providers are included on a list, entitled "List of institutions or employers who provide training and retraining for first aiders".
This list can be viewed in the "Approvals" module: List of institutions or employers who provide training and retraining for first aiders.

Old certificates and approvals

Old approvals obtained by the bodies that issued first aid certificates in application of the provisions of the General Labour Protection Rules expired on 30 June 2011 if these bodies did not submit a new application to be included on the aforementioned list under the conditions set by the Code on Well-being at Work and explained above.

If they meet these conditions, they will be included on the list of institutions or employers that provide training and retraining for first aiders.

The old provisions of the General Labour Protection Rules (Art. 174 to 183b) are repealed.

Validity of first aid certificates obtained under the old regulations

First aid certificates obtained individually and issued by bodies approved under Article 177 of the General Labour Protection Rules are certificates granted personally.

These certificates therefore remain valid if the holder of such a certificate attends the annual refresher course under the conditions referred to in Article I.5-9.