First aid course for work in Spain free, with a certificate

• The employer must analyse possible emergencies and adopt first-aid, firefighting and evacuation measures, taking into account its size, its activity and whether outsiders are present (Law 31/1995, Article 20).
• It must designate the staff who carry them out. Those staff must have the necessary training, be sufficient in number and have the right equipment.
• And it must organise contact with outside services (emergency medical care, rescue) so help arrives quickly.

What INSST recommends (NTP 458)

• The first aider is a volunteer, trained according to the company's risks and with regular refresher training.
• As a guide, in low-risk work such as an office, one first aider per 50 workers per shift, with substitutes. Elsewhere, that figure is the minimum.
• Someone must always be available: shifts, holidays and the distance to the medical centre are taken into account.
• All workers must be told how it works, with posters, talks or leaflets, and new staff must know what to do as witnesses.

The NTP is a good-practice guide: it is not compulsory unless a regulation says so.

Source: Ley 31/1995, de Prevención de Riesgos Laborales (Law on the Prevention of Occupational Risks; consolidated text, in Spanish), Article 20 · INSST, NTP 458: Primeros auxilios en la empresa: organización (first aid organisation at work, in Spanish), sections on legal framework, first aider and organisation

1. Protect. Before you approach, make sure there is no danger to the casualty or to you: traffic, electric current, gas, smoke, a running machine. A second casualty helps nobody.
2. Alert. Call 112, or the emergency number your employer has given you.
3. Help. Look after the casualty where they are until medical help arrives.

What to tell 112

NTP 1062 lists what you need to know when you call:

• The exact location of the accident.
• How many casualties there are and their condition: whether they are conscious and whether they are breathing.
• What has happened and what care they are getting.
• Who is calling and a contact number.

If possible, someone should wait at the door to guide the ambulance (NTP 1062).

The chain of help

Witness, phone operator and first aider inside the company; ambulance, emergency team and hospital outside. Everyone must know who comes before and who after (NTP 458). Keeping calm and raising the alarm properly is already helping.

Source: INSST, NTP 458: Primeros auxilios en la empresa: organización (first aid organisation at work, in Spanish), principles and chain of help · INSST, NTP 1062: Primeros auxilios: soporte vital básico en el adulto (adult basic life support, in Spanish), PAS sequence

1. Are they conscious?

Talk to them loudly. If they do not respond, use gentle stimulation, such as tapping their shoulders. No pinching or shaking (NTP 1062).

2. Open the airway

If they do not respond, open the airway with the head tilt-chin lift (one hand on the forehead and the other on the chin). An in-person course teaches it on a manikin.

3. Are they breathing normally?

Check with look, listen and feel: watch whether the chest moves, listen and feel for air. It takes no less than 5 seconds and no more than 10.

• If they do not respond and are not breathing normally, suspect cardiac arrest: call 112 and start CPR (module 4).
• If they do not respond but are breathing, put them in the recovery position, call 112 and check they keep breathing. The recovery position keeps the airway open and stops them choking if they vomit (112 SOS Deiak poster).

The recovery position, like CPR, is learned by practising: an in-person course teaches you to turn the person without hurting them.

Source: INSST, NTP 1062: Primeros auxilios: soporte vital básico en el adulto (adult basic life support, in Spanish), checking consciousness and breathing · Gobierno Vasco, Osakidetza and 112 SOS Deiak: «Primeros auxilios» poster (in Spanish), recovery position

If the person does not respond and is not breathing normally, call 112, ask for a defibrillator and start cardiopulmonary resuscitation (CPR) straight away.

Chest compressions (NTP 1062)

• The casualty on their back on a firm surface.
• Heel of one hand in the centre of the chest and the other on top, arms straight.
• A rate of at least 100 compressions a minute.
• A depth of about 5 cm, no more than 6 cm.
• Let the chest come back up between compressions, without lifting your hands.

Compressions and rescue breaths

• 30 compressions and 2 rescue breaths, each lasting about 1 second.
• If you do not feel able to give rescue breaths or it is not advisable (there is blood or something in the mouth), the NTP says they can be left out: do compressions only, without stopping.
• Every 2 minutes, check again whether they are breathing.

The defibrillator (AED)

1. Switch it on and stick the pads on the chest as its pictures show.
2. Follow its voice instructions. Nobody touches the casualty while it analyses.
3. If it advises a shock, make sure nobody is touching them and press the button. Then carry on with CPR.
4. If it does not advise a shock, carry on with CPR for 2 minutes.

The NTP notes that the chance of successful resuscitation drops by 10% for every minute without defibrillation.

When to stop

When medical help arrives, when the casualty starts breathing normally, or when the rescuer is exhausted (NTP 1062).

Source: INSST, NTP 1062: Primeros auxilios: soporte vital básico en el adulto (adult basic life support, in Spanish), CPR and AED use · Gobierno Vasco, Osakidetza and 112 SOS Deiak: «Primeros auxilios» poster (in Spanish), CPR

Choking

• If they can breathe and cough, encourage them to cough.
• If they cannot breathe, give 5 back blows. If that does not work, do the Heimlich manoeuvre: your fist below the lower end of the breastbone, under the ribs, held with your other hand, and pull in hard and repeatedly until the object comes out or they lose consciousness.
• If they become unconscious, CPR. And call 112.

Heart attack

Pressure in the centre of the chest that may spread to the left arm, stomach or neck, with paleness and sweating. No exertion, rest in the most comfortable position, and call 112.

Stroke

The mouth droops, they lose strength in an arm or leg, they struggle to speak or walk. Stay with them and call 112.

Seizures

Sudden, repeated movements, with no awareness of what is going on around them. Move objects away so they do not hurt themselves and never put anything in their mouth. They usually last less than 1 minute. When they stop, recovery position until help arrives. Call 112.

Severe allergic reaction and low blood sugar

• A severe allergy (anaphylaxis) can cause difficulty breathing, dizziness and loss of consciousness: call 112 and follow their instructions; if they become unconscious, recovery position.
• A person with diabetes who has hypoglycaemia may be pale, sweaty or behave strangely. If they are conscious and can swallow, give them juice, fruit or a biscuit. If unconscious: 112 and recovery position.

Source: Gobierno Vasco, Osakidetza and 112 SOS Deiak: «Primeros auxilios» poster (in Spanish), choking, heart attack, stroke, seizure, allergic reaction and hypoglycaemia

Put on gloves from the first-aid kit before touching blood: INSST includes avoiding contact with biological agents in basic first-aid training (NTP 458).

Wounds and bleeding

• Wash the wound with soap and water and cover it with gauze or a clean cloth. If it is on an arm or leg, raise it.
• Do not use creams, cotton wool or paper tissues.
• If it is bleeding, press on the wound with gauze or a clean cloth.
• Nosebleed: head forward (not back) and pinch the nose for 10 minutes. If it does not stop, see a doctor.

Burns

• Move the person away from the heat without putting yourself in danger and cool the area with cold water.
• Do not pull off clothing stuck to the skin, do not burst blisters and do not apply creams unless a doctor says so.

Fractures and sprains

• Fracture (pain, cannot move the area, deformity): comfortable position, immobilise the limb and apply cold. If there is an open wound, cover it and press with gauze.
• Sprain: support the limb, apply cold and avoid tight bandaging.

Eyes

• An object stuck in the eye: never remove it. Cover it and see a doctor.

Source: Gobierno Vasco, Osakidetza and 112 SOS Deiak: «Primeros auxilios» poster (in Spanish), wounds, nosebleeds, burns, fractures, sprains and eye injuries · INSST, NTP 458: Primeros auxilios en la empresa: organización (first aid organisation at work, in Spanish), basic and additional training

Here the first rule of PAS, protect, is the one that saves most lives. Rescue in a toxic atmosphere is specific training for teams prepared for it (NTP 458): if you are not one of them, do not go in.

Electrocution

• Switch off the power first.
• If you have to separate the person, always use an insulating object or clothing, never your hands.
• If they are unconscious and breathing, recovery position. If not breathing, CPR.

Gases

• There may or may not be a smell. It causes dizziness, confusion and nausea, and can lead to loss of consciousness.
• Open windows, turn off the gas valve and switch off the power. No sparks.
• Get the person out only if you can do so safely. Do not stay in an unsafe area.

Chemicals

• In the eye: rinse with plenty of water, cover it and see a doctor, taking a sample of the product. They must never rub the eye.
• Swallowed (for example, petroleum products): move the person away from the source and remove soaked clothing. Do not give food or drink and never make them vomit. If unconscious, recovery position.

Heat

With headache, strange behaviour, a fast pulse and hot skin: into the shade, lying down, cold cloths and water if conscious.

Source: Gobierno Vasco, Osakidetza and 112 SOS Deiak: «Primeros auxilios» poster (in Spanish), electrocution, poisoning, chemical eye injuries and heatstroke · INSST, NTP 458: Primeros auxilios en la empresa: organización (first aid organisation at work, in Spanish), protect and specific training

What Royal Decree 486/1997 requires (Annex VI)

• Every workplace must have first-aid equipment suited to the number of workers, the risks and how far away the medical centre is.
• At least a portable first-aid kit with approved disinfectants and antiseptics, sterile gauze, cotton wool, bandage, adhesive tape, plasters, scissors, tweezers and disposable gloves.
• It is checked regularly and restocked as soon as something expires or is used.
• Workplaces with more than 50 workers must have a first-aid room; so must those with more than 25 if the labour authority so decides because of the danger or the distance to medical help. The room has, at least, a first-aid kit, a stretcher and drinking water.
• Equipment and rooms must be signposted.

What INSST recommends (NTP 458)

• In the kit, only first-aid material, tidy, with expiry dates checked and suited to the training of whoever will use it.
• Add, among other things, a thermal blanket, a resuscitation mask, eye pads, sealed saline solution if there is no eyewash, and bags for used material.
• For work away from the premises, a travel first-aid kit.

Source: Real Decreto 486/1997, sobre lugares de trabajo (workplaces; consolidated text, in Spanish), Annex VI · INSST, NTP 458: Primeros auxilios en la empresa: organización (first aid organisation at work, in Spanish), first-aid kit