510 EM 385-1-1 Chapters 1-8

3-8. General Requirements.

General Responsibilities

Contractors and USACE must arrange medical facilities and personnel for injured employees before work begins, inform them about job-related injuries, and may require formal agreements for high-risk tasks.
Provide all employees with effective, tested communication means for emergencies and transport for injured workers.
Post emergency contact numbers and a map to the nearest medical facility prominently at the workplace.

First Aid and CPR Availability

Ensure at least two employees can administer first aid and CPR per shift, with special provisions for employees working alone or in remote areas.
For sites with over 100 employees, maintain and provide a list of certified individuals to site security personnel.

First Aid Kits

First aid kits must comply with ANSI Z308.1, with one kit for every 25 employees (or fewer), and additional contents based on work environment hazards.
Mark and distribute kits clearly throughout the site, protect them from weather, and inspect them regularly.
All employees in proximity to a first aid kit must receive training as per paragraph 3-3.

Automatic External Defibrillators (AED)

AED placement is optional but recommended. Justify their placement based on EMS proximity and maintain uniformity in manufacturer and model.

First Aid and Medical Facility Requirements

Provide first aid kits, establish first aid stations for 100-299 employees, and equip health clinics for high-risk operations or those with 300+ employees.
Equip health clinics with essential facilities, maintain them strictly for emergencies, and staff them with qualified medical personnel.
Identify the location of first aid stations and health clinics with markers and provide emergency lighting.

Drenching and Flushing Facilities

Provide facilities for immediate use in areas with potential exposure to toxic or corrosive materials.

Bloodborne Pathogens (BBP)

Equip and train employees for BBP protection, establish a site-specific Exposure Control Plan, and ensure maintenance of personal protective equipment (PPE).

Biologic and Environmental Diseases

Before work starts, inform employees about diseases in the area, provide comprehensive disease prevention information, and consult relevant health authorities.

3-9. Figures and Tables.

See Figures/Tables Checklists/Forms

3-10. Checklists and Forms.

Not Applicable.

Knowledge Check Choose the best answer for the question.

3-5. A single first aid kit must be provided for every _____ employees in a workplace?

10 or fewer

25 or fewer

50 or fewer

100 or fewer

You forgot to answer the question!

EM 385-1-1 Paragraph 3-8.

3-8. General Requirements.

a.  General. Contractors and all USACE locations must arrange for medical facilities and personnel to provide prompt attention to injured employees before starting work.  Inform the medical facilities and personnel expected to treat injured employees of the nature of the work to be performed and the injuries and illnesses prevalent on such jobsites. Depending on the scope and size of the job, the USACE supervisor/KO or COR may require a formal written agreement.  For work or tasks with a high or
extremely high residual RAC, confirm in writing the arrangements with the medical facility.  See chapter 1 or 2, as applicable.  (3-8.a)

(1)  Provide all employees with an effective means of communication that is readily available (for example, hard-wired, cellular telephone, or two-way radio) to dial 911 or other emergency response access.  Test the communication devices in the area of use to assure functionality.

(2)  Provide an effective means of transportation for immediate care of injured workers.

(3)  Post the telephone numbers of physicians, hospitals, or ambulances on the safety bulletin board, near the onsite project office telephones, and at other conspicuous locations.

(4)  Prepare a highly visible map delineating the best route to the nearest medical facility and post it on the safety bulletin board (see chapter 1 or 2).

b.  First Aid and CPR Availability.  (3-8.b)

(1)  For shifts with more than one (1) employee, provide at least two employees that are certified to administer first aid and CPR (see para 3-3).

(2)  When employees work alone, they must be certified in first aid and be provided an effective means of communication to call for assistance in the event of an emergency.
    (3)  When an employee(s) work in remote areas, or in areas where it is not reasonably accessible by time or distance for first aid, they too will be certified in first aid and be provided an effective means of communication to call for assistance in the event of an emergency.

(4)  For jobsites with more than 100 employees on one shift, maintain a list of certified individuals in the site office and provide to site security personnel, as applicable.

c.  First Aid Kits.  (3-8.c)

(1)  First aid kits must meet ANSI Z308.1 and contain the minimum fill requirements in table 3-1.

(2)  Provide at least one first aid kit for every 25 (or fewer) employees.

(3)  In addition to the basic fill requirements of the first aid kit, the contractor or local USACE SOHO, in consultation with a health care professional, must evaluate the hazards found in the work environment to determine the necessity of additional fill contents.

(4)  Base the performance requirements for the first aid kits on the location where they will be stored according to ANSI Z308.1.

(a)  Type I kits are intended for use in stationary, indoor settings where the potential for damage of kit supplies due to environmental factors and rough handling is minimal.

(b)  Type II kits are for portable indoor settings where the potential for damage of kit supplies due to environmental factors and rough handling is minimal.

(c)  Type III kits are for portable use in mobile, indoor and/or outdoor settings where the potential for damage of kit supplies due to environmental factors is not probable (for example, general indoor, sheltered outdoor use).

(d)  Type IV kits are intended for portable use in mobile industries (that is, utilities, construction, transportation, armed forces) and/or outdoor settings where the potential for damage of kit supplies due to environmental factors and rough handling is significant.

(5)  Clearly mark and distribute first aid kits through the site so that they are easily accessible to all workers and protected from the weather.  The individual contents of the first aid kits must be kept sterile.

(6)  Inspect first aid kits according to paragraph 3-5.

(7)  All employees who work where there is a first aid kit must be trained according to paragraph 3-3.

d.  Automatic External Defibrillators (AED).  The placement of AEDs is optional, (except for health clinics) but highly recommended.  Perform an assessment of the time and distance to EMS and provide a justification for the AEDs before placing them on the work site. When AEDs are present in the workplace for employee use, an AED Program must be developed (see para 3-7.b).  For the ease of use and program maintenance, all AEDs in a location and/or Command must be the same manufacturer and model. For guidance, USACE facilities should refer to “Guidelines for Public Access Defibrillation Programs in Federal Facilities.”  (3-8.d)

e.  First Aid and Medical Facility Requirements.  (3-8.e)

(1)  Provide a first aid kit(s) according to paragraph 3-8.c for all projects, activities, or contracts (USACE or contractor operated) where:

(a)  Less than 100 persons are employed (greatest total number of employees on a shift) and a first aid station nor a health clinic is available, or

(b)  The site is not in near proximity from a hospital, medical clinic, or doctors’
    office which has coordinated to provide emergency medical support.

(2)  First Aid Stations.

(a)  Establish and equip a first aid station at all projects, activities, or contracts (USACE or contractor operated) where between 100 and 299 persons are employed (greatest total number of employees on a shift) at the site of the work.  In non-rural locations where at least two employees per shift are CPR certified (see para 3-3.a) and a first aid kit is available (see para 3-8.c), a first aid station is not required.  In this case, emergency medical support must be provided by a medical clinic, hospital, or doctor’s office that is in near proximity of the work location, and that is capable of and has coordinated to provide emergency medical support.

(b)  Where tunnels are being excavated, provide a first aid station and transportation so that treatment is readily available and in near proximity.

(c)  A certified first aid attendant must be on duty in the first aid stations at all hours when work is in progress (except when on emergency calls) (see para 3-3.a).

(3)  Health Clinics.

(a)  All medium, high, or extremely high-risk operations, projects, activities, or contracts (USACE or contractor operated) for which 300 or more persons are employed at work (greatest total number of employees on a shift), must establish and equip, as directed by a Health Care Provider, a health clinic.
        (b)  Health Clinics must provide privacy, adequate lighting, climate control, adequate toilet facilities, hot and cold water, drainage, and electrical outlets.  Walls and ceilings must be finished with the equivalent of two coats of white paint, windows and doors must be screened, and floors must be constructed with impervious materials.

(c)  In remote locations where a health clinic is required, but where medical care is not available in near proximity, provide a properly equipped emergency vehicle, helicopter, or mobile first aid unit during work.  The emergency vehicles may not be used for any other purpose, except in the case of a helicopter, which may be used for shift crew changes.

(d)  An RN, a certified Emergency Medical Technician, Intermediate/Paramedic, or an LPN, with Health Care Provider oversight when allowed and required by state law, must be assigned on a full-time basis to each installation requiring a health clinic.

(e)  Health clinics must be equipped with an AED.

(4)  For activities requiring a first aid station or a health clinic, determine the type of facilities and equipment that will be provided after considering the proximity and quality of available medical services.  The layout and operation of the facilities and equipment must follow the recommendations of a Health Care Provider.  Alternative facilities that provide the quantity and quality of services outlined in this chapter may be used if recommended by the consulting Health Care Provider.

(5)  Denote the location of first aid stations and health clinics with identification and directional markers.

(6)  Provide emergency lighting for all first aid stations and health clinics.

(7)  All locations where the work efforts are primarily administrative, such as a district or regulatory office, must have either an accessible, staffed infirmary in the building or a medical clinic, hospital, or doctors’ office that is accessible within 15 minutes and that is capable of and has coordinated to provide emergency medical support.  If an outside emergency medical clinic, hospital, or doctor’s office is used, the facility must be equipped with a first aid kit(s) that meets ANSI Z308.1 and have a minimum of two employees on each shift certified to administer first aid and CPR.  (See paras 3-3.a and 3-8.c)

f.  Drenching and Flushing Facilities.  When work activities present potential exposure (of any part of the body) to toxic or corrosive materials, provide drenching and/or flushing facilities in the work area for immediate emergency use.  (See chapter 6) (3-8.f)

g.  Bloodborne Pathogens (BBP).  This paragraph applies when employees may be exposed to blood or other potentially infectious materials through the performance of their job duties.  This includes but is not limited to employees designated as responsible
for rendering first aid or medical assistance.  In addition to the below, also follow 29
CFR 1910.1030. (3-8.g)

(1)  Provide employees with and ensure use and maintenance of PPE (for example, breathing barrier, latex-free gloves, gowns, masks, eye protectors, and/or resuscitation equipment) when appropriate for rendering first aid or other medical assistance to prevent contact with blood or other potentially infectious materials.

(2)  Establish a site-specific Exposure Control Plan according to paragraph 3-7. (3)  Train the necessary employees according to paragraph 3-3.

h.  Biologic and Environmental Diseases.  Prior to the start of work outside the employee’s normal geographical area, inform employees of parasitic, bacterial, viral, and environmental diseases endemic to the geographical work location (for example, Lyme Disease, West Nile Virus, Hantavirus, Histoplasmosis, Rocky-Mountain Spotted Fever, Dengue Fever, Malaria).  (3-8.h)

(1)  Seek guidance on the potential biological and environmental diseases in the work location.  Consult the CDC Traveler’s Health webpage, Defense Centers for Public Health – Aberdeen, and the local health department.

(2)  Provide the following information to the employee traveling in areas where such diseases are endemic:

(a)  Modes of disease transmission.

(b)  Specific health risks associated with the disease.

(d)  Appropriate work practices to prevent contact with infected agents (for example, bird or rodent droppings), such as watering down areas prior to dust- generating activities.

(e)  Vaccine information, to include information on the effectiveness, risk, and availability.

(f)  Safe removal of the source, where applicable.

(g)  Symptom recognition and medical referral.

510 EM 385-1-1 Chapters 1 - 8

3-8. General Requirements.

General Responsibilities

First Aid and CPR Availability

First Aid Kits

Automatic External Defibrillators (AED)

First Aid and Medical Facility Requirements

Drenching and Flushing Facilities

Bloodborne Pathogens (BBP)

Biologic and Environmental Diseases

3-9. Figures and Tables.

3-10. Checklists and Forms.

Knowledge Check Choose the best answer for the question.

3-8. General Requirements.