Law and first aid Promoting and protecting life-saving action
Jeffrey Pellegrino
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Abstract
First aid is a proven, cost-effective measure to save lives. Widespread training and education in first aid can improve the chances that someone is close at hand who is able and willing to provide the necessary intervention in the first moments after an injury or other sudden health crisis, avoiding “death by delay” pending the arrival of more highly trained health professionals. Nevertheless, lawmakers have traditionally paid relatively little attention to first aid provided by laypeople. From country to country, there is enormous variety as to whether and how first aid training and delivery is promoted and regulated by law, with important gaps in many countries. This report highlights three areas in which stronger legislation related to first aid may contribute to saving more lives. It draws on an extensive review of current medical and grey literature, several surveys of first aid experts from National Red Cross and Red Crescent Societies around the world, and a study of the laws of 37 sample countries. First, it is recommended that first aid training be made mandatory in certain circumstances. One of these is in schools. It goes without saying that parents everywhere expect schools to do their best to ensure the safety of their children. However, many countries do not require teachers or school personnel to have first aid training. Perhaps more important, studies have shown that children themselves, even at quite a young age, are capable of learning and applying aspects of first aid. Moreover, they are well placed to learn and to receive training and in particular refresher sessions to cement their knowledge. Yet, only a minority of the countries examined required first aid training for students. Another opportunity relates to driver’s license applicants. Countries that have instituted mandatory first aid training requirements for applicants have seen dramatically higher permeation of first aid knowledge in their populations compared to those that have not. Moreover, road traffic accidents make up the largest proportion of unintentional injury deaths in the world and other drivers are often those closest at hand when they occur. Countries in Europe have gone farthest in this respect, though even there about a fourth of countries have no mandatory requirements. The most common type of first aid training requirement around the world is related to occupational safety and health rules. Evidence has shown that workplace first aid training not only saves lives in situations of crisis but also enhances participants’ motivation to avoid occupational injuries and illnesses in the first place and improves their risk control behaviour. Even here, however, the picture is mixed. Some countries do not impose first aid training as part of their occupational and health approach, and some that do have such rules lack the institutional infrastructure for enforcement. A second issue raised by this report goes to the quality of first aid education. As may be expected, studies confirm that correctly performed first aid is much more likely to save lives than clumsier attempts. Yet, very few states examined for this report had any official guidelines or standards for the minimum quality of content of first aid courses. Finally, the report points to the issue of liability of lay first aiders. Studies in the literature and the surveys of Red Cross and Red Crescent first aid experts have shown that bystanders are frequently very reluctant to provide assistance in situations of crisis, and one of the reasons is a fear of legal entanglement. In some countries, this fear is clearly justified in light of a substantial number of cases where victims or the state have brought action against persons who tried unsuccessfully to intervene. While some countries provide explicit protections against liability for those who try to help in such situations, this is not the case everywhere else. Moreover, even in some countries where protections do exist, they are not well known (or believed) in the population. Of course, mistakes can and do happen, but society is much better served by encouraging people to help than increasing a personal sense of risk among those who might be in a position to save a life. Accordingly, the report recommends that states expressly provide for protection against liability for the good faith efforts of lay first aiders.
