Guidance

First aid in schools, early years and further education

Updated 14 February 2022

Applies to England

About this guidance

This is non-statutory guidance for employers in early years, schools and colleges. Employers in these settings should have regard to it when carrying out duties relating to first aid issues on their premises and off-site.

This guidance is for:

• employers in early years providers, schools and colleges
• governing bodies, management committees and trustees of early years providers, schools and colleges
• senior management teams in early years providers, schools and colleges

Unless otherwise specified:

• references to ‘early years provider’ mean all early years providers in England including:
  • maintained schools
  • non-maintained schools
  • independent schools (including free schools and academies)
  • all providers on the early years register
  • all providers registered with an early years childminder agency (CMA)
• references to ‘school’ mean:
  • all schools whether maintained, non-maintained or independent schools (including academies, free schools and alternative provision academies)
  • maintained nursery schools
  • pupil referral units
• references to ‘college’ mean:
  • further education colleges and sixth-form colleges as established under the Further and Higher Education Act 1992
  • institutions designated as being within the further education sector and providers of post-16 education as set out in the Education and Training (Welfare of Children) Act 2021 including 16 to 19 academies, special post-16 institutions and independent training providers

During times of crisis, the Health and Safety Executive (HSE) may produce additional advice to employers relating to first aid, for example during the COVID-19 pandemic, which should be read in conjunction with this guidance.

This guidance makes reference to first aid in early years settings which includes reception classes and nurseries. Specific advice on paediatric first aid in early years settings can be found in the early years foundation stage statutory framework (EYFS).

Legislation this guidance refers to

The guidance refers to the:

• Health and Safety (First Aid) Regulations 1981
• Health and Safety at Work etc. Act 1974 and associated regulations
• School Premises (England) Regulations 2012
• Education (Independent School Standards) Regulations 2014

Schools and colleges

Introduction

Under the Health and Safety (First Aid) Regulations 1981, employers are responsible for providing adequate and appropriate equipment, facilities and personnel to ensure their employees receive immediate attention if they are injured or taken ill at work. HSE has published detailed first aid guidance to help employers comply with the regulations and offers practical advice on what they need to do.

While the regulations do not require employers to provide first aid for anyone other than their own employees, it is strongly recommended that all schools and colleges consider the needs of non-employees such as pupils, students and visitors when making provision for first aid.

In practice, most day-to-day functions in respect of health and safety and first aid are delegated to the headteacher or the principal. Employers should provide any relevant information to help them in drawing up the arrangements for their school or college.

First aid provision must be available while people are on school or college premises. It must also be available when staff, pupils and students are working elsewhere on school or college activities including any off-site activity such as educational visits. The regulations require employers to provide adequate and appropriate equipment, facilities and personnel based on a first aid needs assessment. This does not apply to work placements as work experience students are employed by the placement provider.

The minimum first aid provision for schools and colleges is:

• a suitable first aid container stocked in accordance with the findings of the first aid needs assessment and holding at least the minimum requirements suggested by HSE

• an appointed person or designated first aider(s) to take charge of first aid arrangements

• information for employees detailing the location of equipment, facilities and personnel

Where an employer’s assessment of first aid needs identifies that a designated first aider is not required, the minimum requirement is for an employer to appoint a person to take charge of the first aid arrangements, including looking after the equipment and facilities, and calling the emergency services when required. Arrangements should be made for the appointed person to be available to undertake these duties at all times when people are at work. HSE First aid at work guidance is available.

Any member of school or college staff may be asked to undertake first aid tasks, but they cannot be required to do so. Teachers and other staff working with pupils and students are expected to use their best endeavours at all times, particularly in emergencies, to secure the welfare of the pupils and students in education in the same way that parents might be expected to act towards their children. In general, the consequences of taking no action are likely to be more serious than those of trying to assist in an emergency.

All state-funded schools in England have, since September 2020, been required to teach Health Education. The statutory guidance, to which schools must have regard, sets out that this should include basic first aid for primary school children, for example dealing with common injuries. Pupils in secondary schools should be taught further first aid, for example how to administer CPR and the purpose of defibrillators.

First aid needs assessments

In addition to the legal requirement to have a health and safety policy, employers should ensure that schools and colleges have a first aid policy and carry out a first aid needs assessment to help inform that policy.

It is strongly recommended that a record is kept of all incidents dealt with by a first aider or appointed person to help inform the development of the policy and any subsequent first aid needs assessments. Information from health and safety risk assessments can also inform these first aid needs assessments. Identifying the likely causes of accidents or injuries will help headteachers to work out the type, quantity, and location of first aid equipment needed, and the facilities and personnel required. The needs of pupils, students and visitors should be considered alongside the needs of employees when making such assessments and when putting in place appropriate first aid provision.

Provision should be enough to ensure that first aid can be administered without delay should the occasion arise, and be available at all times. This means that arrangements should take account of absences of a first aider or appointed person and reflect alternative work practices. Further details of what factors to consider when making needs assessments and appointing emergency cover for first aiders can be found in HSE’s first aid guidance.

Employers should review their first aid needs after any major changes such as changes to staff or premises, to make sure provision remains appropriate.

Headteachers and principals should ensure that staff, pupils, students and parents and carers are aware of their first aid arrangements.

First aiders

To qualify as a first aider an individual should undergo appropriate training delivered by a competent training provider and hold a valid first aid certificate.

We would expect, in the vast majority of cases, that the first aid needs assessment would identify that at least one first aider is required to provide first aid to meet the needs of employees, pupils, students and visitors. There is no rule on the number of first aiders required as this will be identified as part of the first aid needs assessment and will be based on the circumstances of each individual school or college.

In selecting a first aider, the following factors should be considered:

• reliability and communication skills

• aptitude and ability to absorb new knowledge and learn new skills

• ability to cope with stressful and physically demanding emergency procedures

• availability to respond to an emergency immediately

First aiders will be expected to:

• give immediate help to casualties with common injuries or illnesses and those arising from specific hazards at the school or college or on educational visits

• when appropriate, ensure that an ambulance or other professional medical help is called

Appointed persons

Where an employer’s assessment of first aid needs identifies that a designated first aider is not required, an employer must appoint a person to take charge of the first aid arrangements. Arrangements should always be made for the appointed person to be available to undertake these duties when people are at work.

Appointed persons do not need to have a first aid qualification although they may benefit from training such as completing at least an emergency first aid at work course. Their role is to:

• take charge when someone is injured or becomes ill

• look after the first aid equipment

• ensure that an ambulance or other professional medical help is summoned when appropriate

First aid training

It is the responsibility of employers to ensure that their first aid staff have received the appropriate first aid training delivered by a competent first aid training provider.

Where first aid provision is intended to cover non-employees, which we strongly recommend, first aiders may need additional training above the minimum requirement, for example additional training in paediatric first aid (standard first aid at work training courses do not include resuscitation procedures for children). The school or college should discuss any specific needs with the training provider in advance as they will often tailor courses specifically to the needs of the school or college.

First aid certificates are usually valid for 3 years. Employers should arrange retraining before certificates expire. Once a certificate expires, the individual would have to undertake another full course to be reinstated as a first aider. It is strongly recommended that first aiders undertake annual refresher training to maintain their basic skills and keep up to date with any changes in procedures.

HSE provides guidance for employers to assist in the selection of a competent first aid training provider, including information on first aid course content. HSE does not recommend training providers. Selection of a provider is the responsibility of the school, college or employer.

Recording and reporting

It is strongly recommended that schools and colleges keep a record of all incidents involving staff, pupils, students and visitors, which require first aid staff to be in attendance. This will help identify trends in accidents and areas for improvement as well as when to review first aid needs assessments.

The record should be readily accessible, and details recorded should include:

• date, time and place of incident

• name of injured or ill person

• details of the injury or illness

• details of what first aid was given

• what happened immediately after the incident (for example, went home, went back to class, went to hospital)

• name and signature of first aider or person dealing with the incident

This record is not the same as the statutory accident book although schools and colleges can choose to combine them. HSE publishes an accident book (BL510) that employers may purchase and use to record all incidents including those required under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR). All reportable incidents should be notified by a specified responsible person.

Employers have specific statutory responsibilities in respect of recording and reporting incidents involving their employees under RIDDOR.

HSE should be notified of fatal and major injuries, and dangerous occurrences without delay. See the HSE RIDDOR advice for more details.

Injuries to anyone who has been involved in an accident at the school or college, or on an activity organised by the school or college, are only reportable under RIDDOR if the accident results in:

• the death of the person, and arose out of or in connection with a work activity, or

• an injury that arose out of or in connection with a work activity and the person is taken directly from the scene of the accident to hospital for treatment (examinations and diagnostic tests do not constitute treatment)

The responsible person should consider whether the incident was caused by:

• a failure in the way a work activity was organised (for example inadequate supervision of a field trip)
• the way equipment or substances were used (for example lifts, machinery, experiments)
• the condition of the premises (for example poorly maintained or slippery floors)

If there is any doubt as to whether or not to report an incident schools and colleges can consult the HSE general RIDDOR guidance.

Information for staff

Employers should inform employees, pupils, students and others of their first aid arrangements, including the first aid policy and location of:

• equipment
• facilities
• first aiders or appointed person

They should know how to contact a first aider or appointed person urgently should the need arise. They should be made aware of the procedures for monitoring and reviewing the school or college first aid needs. The information should be clear and easy to understand and shared with employees, pupils, students, contractors and visitors to the school or college as appropriate.

A simple method of keeping employees informed is to display first aid notices. At least one notice in a prominent position at each site is recommended by HSE. Schools and colleges could also develop procedures for informing staff in consultation with employees or safety representatives. The inclusion of first aid information during induction training will help make sure new employees are made aware of first aid arrangements.

Further information can be found at the HSE’s guidance on regulations.

Insurance

Where first aid provision is intended to cover both employees and non-employees, employers should check they have adequate insurance or that their risk protection arrangement (RPA) membership as an alternative to commercial insurance covers all the activities of first aiders.

Employers should determine and ensure that the appropriate level of insurance and risk cover is in place.

Material, equipment and facilities

Employers should provide sufficient materials and equipment to meet the needs identified in the first aid needs assessment. These should be made available and be easily accessible. Equipment should be suitably labelled.

First aid containers

The number and contents of first aid containers required will be identified as part of the first aid needs assessment. As a minimum, employers should provide at least one fully stocked first aid container for each site. Additional first aid containers may be needed for large or split-level sites, distant sports fields or playgrounds, any other high-risk areas and any offsite activities. All first aid containers should be marked with a white cross on a green background.

There is no mandatory list of items to be included in a first aid container. The school or college first aid needs assessment will help determine what should be provided.

HSE recommends that where there is no special risk identified, a minimum provision of first aid items could be:

• a leaflet giving general advice on first aid – HSE information is available

• 20 individually wrapped sterile adhesive dressings (assorted sizes)

• 2 sterile eye pads

• 2 individually wrapped triangular bandages (preferably sterile)

• 6 safety pins

• 6 medium sized individually wrapped sterile unmedicated wound dressings

• 2 large sterile individually wrapped unmedicated wound dressings

• 3 pairs of disposable gloves

This is only a guide as each first aid kit will be based on the school or college first aid needs assessment.

Careful consideration should be given to the siting of first aid containers and, where possible, they should be kept near to hand washing facilities.

A school or college’s first aid procedures should identify the first aider or appointed person responsible for examining the contents of first aid containers. The first aid kits should be checked frequently and restocked as soon as possible after use. Items should be discarded safely after the expiry date has passed.

Travelling first aid containers

Before undertaking any off-site activities or educational visits, the visit leader should assess what level of first aid provision is needed and identify any additional items that may be necessary for specialised activities. The Outdoor Education Advisers’ Panel (OEAP) provides advice on outdoor learning and off-site visits, including the assessment of first aid requirements.

HSE recommends that the minimum travelling first aid kit should be:

• a leaflet giving general advice on first aid – HSE information is available

• 6 individually wrapped sterile adhesive dressings

• 1 large sterile unmedicated dressing

• 2 triangular bandages individually wrapped and preferably sterile

• 2 safety pins

• individually wrapped moist cleansing wipes

• 2 pairs of disposable gloves

The Road Vehicles (Construction and Use) Regulations 1986 (for minibuses) and/or the Public Service Vehicles (Conditions of Fitness, Equipment, Use and Certification) Regulations 1981 (for larger vehicles) advise that a suitable, clearly marked first aid box should be readily available and in good condition. Further information, including advice on what the kit should contain, is available.

The following items must be kept in the first aid box:

• 10 antiseptic wipes, foil packed
• 1 conforming disposable bandage (not less than 7.5 cm wide)
• 2 triangular bandages
• 1 packet of 24 assorted adhesive dressings
• 3 large sterile unmedicated ambulance dressings (not less than 15.0 cm × 20.0 cm)
• 2 sterile eye pads, with attachments
• 12 assorted safety pins
• 1 pair of rustless blunt-ended scissors

Automated external defibrillators

Schools and colleges are encouraged to purchase an automated external defibrillator (AED) as part of their first aid equipment. To help them do this, DfE has made arrangements for schools to purchase AEDs at a reduced cost. Further details are provided in the AED guide for schools.

More information on the provision and use of automated external defibrillators (AED) in the workplace is available at provision and Use of Work Equipment Regulations 1998 (PUWER) - work equipment and machinery.

Accommodation

Employers should provide a suitable first aid room or rooms in accordance with the findings of their first aid needs assessment. Where possible, the room should be reserved exclusively for the provision of first aid.

School employers are already required under the School Premises (England) Regulations 2012 and the Education (Independent School Standards) (England) Regulations 2014 to have suitable accommodation that can be used for medical examination and treatment of pupils and for the short term care of sick or injured pupils which includes a washbasin and is near to a toilet. It need not be used exclusively for medical purposes (though it must not be used for teaching), but it should be appropriate for that purpose and readily available for use when needed. Schools and colleges may wish to consider using such a room for first aid.

Where a school or college caters for pupils and/or students with complex needs, additional medical accommodation should be provided which caters for those needs.

Further detail on the requirements for a first aid room can be found in the HSE’s guidance on regulations.

Medicines administration in schools

First aid at work does not include giving tablets or medicines. The only exception is when aspirin is used as first aid to a casualty with a suspected heart attack for those over 16. Never give aspirin to a child younger than 16, unless it has been prescribed by a doctor.

Medication should not be kept in a first aid container.

Whilst some pupils will have long-term and complex medical conditions or carry their own medication (for example, an inhaler for asthma or adrenaline for intramuscular use in anaphylaxis) the only role for a first aider is generally, limited (where appropriate) to helping pupils who need to take their own medication to do so.

Some pupils may need to have access to life saving prescription drugs in an emergency, the details will be recorded in the pupil’s individual healthcare plan and identified staff members will be aware of what to do.

The administration of prescription only medication specified in Schedule 19 of the Human Medicines Regulations 2012 should only be given by those trained to do so. However, where a first aid needs assessment identifies that Schedule 19 medication may be required to be administered in an emergency, the employer may want to consider providing first aiders with additional training so that they can be aware of the symptoms and condition and administer lifesaving medication in an emergency situation.

Any member of school staff may be asked to provide support to pupils with administering of medicines, but they cannot be required to do so.

Read the statutory guidance on supporting pupils at schools with medical conditions for more information.

Mental health

Schools and colleges are encouraged to identify a senior mental health lead. This role should include having strategic oversight of the whole school or college approach to mental health and wellbeing. They will support their school or college to make the best use of existing resources and effort to help improve the wellbeing and mental health of pupils, students and staff.

DfE has published guidance to help schools identify whether a child or young person’s behaviour may be related to an underlying mental health problem, and how to support them in these circumstances. Further details can be found in the Mental health and behaviour in schools guidance.

Following an employer’s first aid needs assessment, a school or college might decide that it will be beneficial to have personnel trained to identify and understand symptoms and be able to support pupils, students and staff who might be experiencing a mental health issue. Education staff are well placed to observe children day-to-day and identify those whose behaviour suggests that they may be experiencing a mental health problem or be at risk of developing one but only appropriately trained professionals should attempt to make a diagnosis of a mental health condition.

Consideration should be given to ways to manage mental ill health in the workplace. This could include providing information or training for managers and employees, employing occupational health professionals, appointing mental health trained first aiders and implementing support programmes.

First aid training courses covering mental health can teach staff how to recognise warning signs of mental ill health and help them to develop the skills and confidence to approach and support someone, while keeping themselves safe.

There is a wide range of training providers offering mental health awareness or first aid training and details of available training that best meets the needs of your organisation can be found by conducting a simple internet search.

HSE also provides further information on mental health conditions, work and the workplace. The Education Support charity provides free 24 hours a day telephone counselling to all serving and retired education staff in need on mental health support.

School and college staff are not mental health professionals. Where pupils and students experience more serious mental health problems, schools and colleges should expect them and their families to be able to access support from sources which include professionals working in specialist Children and Young People’s Mental Health Services (CYPMHS), voluntary organisations and local GP practices.

Early years

Introduction

Early years education providers, including schools, must meet the paediatric first aid requirements set out in the statutory framework for the early years foundation stage (EYFS). This includes arrangements for off-site activities involving young children such as educational visits.

The EYFS requires that at least one person who has a current paediatric first aid (PFA) certificate should be on the premises and available at all times when children are present and should accompany children on outings. The certificate must be for a full course consistent with the criteria set out in annex A in the EYFS.

All staff who obtained a level 2 or level 3 qualification on or after 30 June 2016 must also have either a full PFA or an emergency PFA certificate within 3 months of starting work in order to be included in the required staff to child ratios at level 2 or level 3 in an early years setting.

Childminders, and any assistant who might be in sole charge of the children for any period, should hold a current paediatric first aid certificate.

Paediatric first aid training must be renewed every 3 years and should be relevant for workers caring for young children and where relevant, babies. Employers should take into account, via their first aid needs assessment, the number of children, staff and layout of premises to ensure that a paediatric first aider is able to respond to emergencies quickly.

Training

Employers are responsible for identifying and selecting a competent training provider to deliver their PFA training.

Training is available from a wide range of providers including:

• those who offer regulated qualifications
• voluntary aid societies (St John Ambulance, the British Red Cross and St Andrew’s First Aid, who together are acknowledged by HSE as one of the standard-setters for currently accepted first aid practice for first aid at work training courses)
• those who operate under voluntary accreditation schemes
• one that is a member of a trade body with an approval and monitoring scheme
• those who operate independently of any such accreditation scheme

The register of regulated qualifications may help providers to identify paediatric first aid providers. It may also be helpful to refer to HSE’s guidance about choosing a first aid training provider.

Equipment

Providers should ensure there is always a first aid box accessible with appropriate content for use with children.

Recording and reporting

In addition to any statutory reporting requirements employers should keep a written record of accidents or injuries and first aid treatment. Employers should inform parents or carers of any accident or injury sustained by the child on the same day, or as soon as reasonably practicable, of any first aid treatment given.

Registered providers should notify Ofsted or the childminder agency with which they are registered of any serious accident, illness or injury to, or death of, any child while in their care, and of the action taken. Notification should be made as soon as is reasonably practicable, but in any event within 14 days of the incident occurring. A registered provider, who, without reasonable excuse, fails to comply with this requirement, commits an offence.

Employers should notify local child protection agencies of any serious accident or injury to, or the death of, any child while in their care, and should act on any advice from those agencies.

Further help

Resources provided by HSE

School and college safety advice provided by Royal Society for the Prevention of Accidents (RoSPA)

A teaching guide developed by the British Red Cross

St John Ambulance first aid advice including guidance on how to deal with various illnesses such as allergic reactions

Resuscitation Council UK information on CPR in schools

HSE advice on first aid requirements for swimming pools

Outdoor Education Advisers’ Panel (OEAP) guidance for outdoor learning and off-site visits, including about first aid provision, and medication