Schools conduct a lot of sport for their students. This includes timetabled curriculum sport such as PE classes as well as a very wide range of sport programs which may take place after school, on weekends, during evenings, and includes overnight sports trips or even overseas sports tours. All students of every age are involved in school sport in some way and the variety of sports is large. School sport is often watched by parents and carers and, in some cases, a large number of additional spectators. School sports venues include non-school owned facilities and grounds and can take place in locations that may be remote and not easily accessible. In all of these circumstances and situations, schools have a legal duty to provide first aid.

The Purpose of First Aid

Providing first aid saves lives. It also improves non-fatal injury outcomes by providing immediate assessment and treatment resulting in less long term disablement, less time off school or work, shorter recovery and hospital times and can stop a bad situation getting worse by stabilising the patient, treating symptoms of shock and reducing the pain experienced by the patient.

A 2010 UK study reported in the UK Guardian newspaper found that a lack of first aid skills meant that up to 150,000 people in the United Kingdom each year may be dying unnecessarily due to a lack of first aid trained people available to assist. The article suggested that suffocations from blocked airways and heart attacks were the main areas where first aid training could be of great assistance in saving lives.

According to the Australian Red Cross, Australia has the lowest rates of first aid training in the world, with only roughly 5 per cent of the population trained in first aid and able to deal with an emergency situation.

Sports Injury Statistics

In 2018, Macquarie University reported around 13,000 children are hospitalised each year in Australia for sport injuries. The Australian Government’s AIHW 2019/20 report also stated that, of the children who were hospitalised as result of a sports injury, 43 per cent related to team ball sports. 73 per cent of hospitalisations were boys and 63 per cent hospitalisations were for fractures. The report also stated that one in 10 sports injuries (for all age groups) are life threatening.

Legal Obligations – Duty of Care and Health and Safety Laws

There are two clear legal duties in relation to the provision of first aid. The first is the duty of care principles that schools are very familiar with. The second is the duty to provide first aid under health and safety laws.

Workplace health and safety laws in all states and territories require schools to take all reasonably practicable measures to eliminate or minimise the risk of harm to workers and to others exposed to foreseeable hazards that arise from the school’s activities and operations. This is expanded on in the WHS Regulations in all of the harmonised jurisdictions (ACT, NSW, NT, Queensland, SA, Tasmania and WA) that explicitly require a PCBU/employer to have in place:

• first aid equipment in the workplace, which all workers must be able to access
• accessible facilities for the provision of first aid
• an adequate number of workers/other persons who are trained to provide first aid in the workplace.

The duty to provide first aid, as part of the more general duty to eliminate or minimise the risk of harm, applies to any location where a business is undertaking activities or operations. For school sport, this means wherever the sport is being played whether at the school’s premises or at, for example, another school’s sports fields. The duty extends to “other persons” as well as workers, which means students, visitors, volunteers and contractors and anyone else on the premises or viewing the sporting activity at the location where it is taking place.

The First Aid Codes of Practice

Further guidance on an employer’s first aid obligations is provided in the first aid Codes of Practice in each jurisdiction. While compliance with a Code is not mandatory, if a school complies with the relevant Code, it is considered to comply with the relevant duties or obligations in the WHS Act and Regulations.

Safe Work Australia’s “First Aid in the Workplace Code of Practice” dated July 2019 is the basis for the first aid Codes of Practice in each of the states and territories except Victoria. The Code provides guidance for schools as they plan and implement the provision of first aid for school sport.

In Victoria, the Occupational Health and Safety Act 2004 (Vic) and Occupational Health and Safety Regulations 2017 (Vic) do not specifically refer to the provision of first aid. However, this requirement is inferred from the duty of an employer to provide adequate facilities for the welfare of its employees in the workplace. The WorkSafe Victoria Compliance Code: First Aid in the Workplace November 2021 (Victorian Code) provides the elements for compliance with the OHS Act in relation to first aid, although compliance with the Victorian Code itself is not mandatory.

A Risk Management Approach

Both the Safe Work Australia Code and the Victorian Code outline the risk management approach that businesses should undertake for determining the first aid requirements at a workplace (which, as stated above, is wherever the school sport is being played). A risk management approach is applied because each workplace is different, with different hazards, locations and personnel. The four risk management steps in both Codes are:

 1. Identifying the hazards that could result in work-related injury or illness.

The hazards will vary substantially from sport to sport. Schools should also (in addition to hazards that may affect the students and staff) consider hazards that are relevant for spectators or volunteers assisting with the sport and for contractors being used by the school for sports coaching or other aspects of the sport.

 2. Assessing the type, severity and likelihood of injuries and illness.

This will vary from sport to sport. Data is widely available on the common types of injuries and the mechanisms of injury for specific sports. Likely injuries should also include likely injuries to spectators, volunteers and contractors.

 3. Managing the risk of injury by providing the appropriate first aid equipment, facilities and training.

Once step 2 has been completed, it is possible to determine the appropriate first aid equipment, facilities and personnel that will be required.

 4. Reviewing the first aid requirements on a regular basis or as circumstances change.

Schools should capture data on sports injuries to enable a proper assessment of the role and impact of the first aid provided, the nature and severity of the injuries that were suffered, and what might be done to improve safety, reduce injuries and provide better and more appropriate first aid.

Four Relevant Considerations

The Codes then list four relevant considerations to guide the decision-making as to the first aid required at a workplace:

 1. The nature of the work being carried out

A wide range of sports from non-contact to heavy contact is usually being undertaken by children and young people at a school or through their sports program. It is well known that certain sports have a greater risk of injury than others due to the nature of that sport. Refereeing, coaching and spectating are also activities to be considered in scoping the nature of the “work”.

2. The nature of the hazards

Hazards in the sport context include the equipment and facilities being used, the weather conditions, terrain, and the specific hazards associated with specific sports.

 3. The size and location of the workplace

There may be a substantial distance between where the sport is being played and medical facilities. This needs to be considered in determining the content of first aid kits and the requisite training for any first aiders. There may be sports being played in a wide variety of locations outside of the school grounds, for example, at other schools, on Council-owned facilities, in National Parks (for example, orienteering/bushwalking/snow sports) and even interstate and overseas.

Some of the issues here include:

• first aid availability during transport of students to and from venues
• additional more advanced first aid may be required for remote or isolated areas
• locations that may become isolated due to weather conditions or where poor roads make access more difficult or even dangerous. In some of these cases, the Safe Work Australia Code notes that consideration should be given to aerial evacuation systems
• a safe system of work includes considerations such as travel time and access for emergency services, and effective emergency communications.

 4. The number and composition of the workers and other persons at the workplace

Both Codes specifically reference schools here as an example of situations where the size of the workforce and “other persons” includes the students, the parents, the volunteers and visitors who may be on site and need first aid. This applies to both the school grounds and other locations where large numbers of people may attend a school sport event such as spectators.

“Composition” also refers to the particular medical conditions and requirements of the students and staff, for example, asthma and allergies. It should also be a relevant consideration for the provision of automated external defibrillators and the total number and location of staff qualified in first aid and first aid kits.

In addition to the risk management approach to compliance with first aid requirements as set out above, the Victorian Code gives employers the choice to apply a more formulaic method: the “prescribed approach”. If an employer elects to use the “prescribed approach” they must comply with all of the specific requirements relating to numbers of first aiders, first aid kits, and first aid facilities, as they relate to either a “high risk” or “ low risk” workplace.     

The Contents of First Aid Kits

The Codes state that all workers and others (note again this incudes students, visitors, volunteers and contractors as well as staff) must be able to access a first aid kit that contains equipment for administering first aid for:

• cuts, scratches, punctures, grazes and splinters
• muscular sprains and strains
• minor burns
• amputations and/or major bleeding wounds
• broken bones
• eye injuries
• shock.

The contents of the first aid kit should be based on a risk assessment and take into account the nature of the possible injuries, the location, the composition of the workforce for example students, spectators, volunteers etc and their medical conditions and the age of the students. A recommended composition of first aid kits is provided in both Codes.

While neither Code refers specifically to first aid for concussion injuries, this is obviously a hazard that must be considered in a number of sports. The Concussion Recognition Tool, the Concussion Management Flow Chart – on field (downloadable as a pdf from Concussion in Sport Australia) together with neck protection should be included in first aid kits for those sports with a higher risk of concussion.

Schools will also differ from the more standard workplaces in the additional overlay of their student duty of care obligations, which requires a more individual approach to foreseeable hazards. Therefore a school’s planning for first aid will need to take into account participating students who have been identified as having allergies, asthma, diabetes, epilepsy, and so forth. Following a risk assessment, extra epipens and asthma puffers potentially should be included in a first aid kit.

Access and Location of First Aid Kits

Both Codes address the location of first aid kits and note that quick access to the kit may be vital in the event of serious injury or illness. First aid kits should be prominent and accessible and located close to areas where there is a higher risk of injury or illness (the Safe Work Australia Code gives the example of school science labs) but this could equally be applied to school sport. Portable first aid kits may be required for mobile workers (or in this case students who are travelling to sports events) and at locations where activities or operations are taking place. All school vehicles must contain a first aid kit.

First Aiders

Both Codes list different levels of accredited training for first aiders depending on the number of workers and others, remoteness from medical facilities, and the types of hazard likely to be encountered. This is particularly critical where the activity is conducted in remote areas, or where there are students who have any issues that may increase the risk to their health and safety. Additional training in concussion identification and management would be appropriate for first aiders who are likely to attend sports such as the football codes.

The number of trained first aiders at a particular sporting event should also be planned. Unlike a static workplace, this will need to be determined as part of planning for each sporting event or fixture. Once again this should take into account the distance to the nearest medical facility, the number of people attending the event, and the number and likelihood of hazards – for example, going on a bushwalk where the only first aider receives a poisonous snake bite.

Joint Responsibility for First Aid – Consult, Coordinate and Cooperate

In the harmonised WHS system, primary responsibility for workers can be shared to the extent of the PCBU/employers influence and control over premises or activities. In the context of school sporting activities, a school may coordinate with another PCBU /school/ manager of the sporting premises to ensure that appropriate first aid is available. However, a school cannot completely contract out of its obligations, as it may hold knowledge of particular issues relating to its staff or students which increases the risk of harm, for example a student’s allergies, epilepsy, diabetes, or behavioural risks.

Conclusion

The appropriate provision of first aid for school sports is more complex than it seems and requires planning, risk assessments and knowledge of the requirements in the Codes. Schools should document their policies and procedures, risk assessments and decision-making regarding the provision of sports first aid at their school. Schools should make sure that they undertake regular reviews of their first aid provisions (for example, when and how many first aid qualified staff, level of training, and how many and what equipment and medication (for example, epipens) are included in first aid kits) based on foreseeable hazards, injuries or incidents that have occurred, research and other available sports injury data.