2023-05-02_EFAR_V5

Safety training

Enhanced First Aid Refresher Training

Publication date: 28 April 2023

Safety training

Enhanced First Aid Refresher Training / V5 2023-05-02

CONTENTS

1. LIST OF ABBREVIATIONS ................................................................................................................................. 4 2. TERMS AND DEFINITIONS............................................................................................................................... 4 3. CHANGE LOG................................................................................................................................................... 5 4. SCOPE ............................................................................................................................................................... 7 5. GENERAL REQUIREMENTS FOR THE GWO ENHANCED FIRST AID REFRESHER........................................7 5.1 Target Group 7 5.2 Aims and Objectives 7 5.3 Duration 8 5.4 Validity Period 8 5.5 Course Codes 9 5.6 Participant Prerequisites 9 5.7 EFA Refresher Training Maintenance 9 6. GENERAL RESOURCES REQUIRED TO DELIVER ENHANCED FIRST AID MODULE.....................................9 6.1 Instructors 10 6.2 Training Equipment 10 7. USING THIS STANDARD TO DEVELOP TRAINING .......................................................................................11 8. MODULE: ENHANCED FIRST AID REFRESHER (EFA-R)................................................................................13 8.1 Aims and objectives for the EFA-R Module 13 8.2 Duration 13 8.3 EFA-R Module Participant Ratio 13 8.4 Equipment for the EFA-R Module 14 8.5 EFA-R Module Timetable 14 8.6 Detailed Description of the EFA-R Module 16 Introduction to the training .............................................................................................................. 16 Risks/Hazards/Legislation ................................................................................................................. 21 Anatomy and Physiology .................................................................................................................. 23 Incident Management, Emergency Response & Teleconsultation ...................................................25 Lifesaving & Enhanced First Aid using primary & secondary survey.................................................28 Pain management and further possible medication .........................................................................47 Enhanced first aid refresher exercises (scenario-based training) ......................................................49 Training review ................................................................................................................................. 53 ANNEX 1 - EQUIPMENT LIST ...................................................................................................................................... 55

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ANNEX 2 - EFA GUIDELINE: RECOMMENDATIONS .................................................................................................57 ANNEX 3 - VERSION HISTORY .................................................................................................................................... 64

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1. LIST OF ABBREVIATIONS AED Automatic External Defibrillator AHA American Heart Association AS/NZS Australia and New Zealand Standard BST Basic Safety Training BSTR Basic Safety Training Refresher CO2 Carbon Dioxide CPR Cardiopulmonary Resuscitation CSA Canadian Standards Association EFA Enhanced First Aid EFAR Enhanced First Aid Refresher EN European Standards ERC European Resuscitation Council GWO Global Wind Organisation WGT Wind Turbine Generator

2. TERMS AND DEFINITIONS Term Definition Human factors

Human factors refer to an established science that uses many disciplines (like anatomy, physiology, physics, and biomechanics) to understand how people perform under different circumstances and environments

Feedback Instructor’s feedback should focus on what the participant must adjust to perform correctly. Feedback may involve dialogue, where the participant reflects on their understanding or performance. Group discussion Learning activity involving all participants. Group discussions may be conducted in smaller groups. The instructor should step back and only interfere to facilitate the experience exchange between participants. Optimal group size is 4 participants.

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Function

Purpose. What is it doing? What can it be used for?

Hazard

A hazard is any source of potential damage, harm or adverse health effect on something or someone.

Practice

The participants apply what they are learning

Risk

A risk is the chance or probability that a person will be harmed or experience an adverse health effect if exposed to a hazard

3. CHANGE LOG

Amendment date

Version

Approved by & date

2 May 2023

GWO 2023

Description of changes

Changes throughout:

New layout

•

• GWO Requirements for Training – title updated

• Numbering has been adjusted, meaning lesson and element numbers have changed when compared to the previous version of this standard Section 4: Scope

• Text revised and updated Section 5: General Requirements for the GOW Enhanced First Aid Training 5.3 Duration

• Text updated to clarify instructions 5.6 Participant prerequisites for the EFA-R

• Replaced text to: All personnel participating must meet the participant prerequisites described in the GWO Requirements for Training. 5.8 Physical demands

• Section deleted. Section 7 Understanding the GWO taxonomy

• The section Understanding the GWO taxonomy has been replaced with a referral to the GWO Requirements for Training.

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Enhanced First Aid Refresher Module Section 8.2 Duration of the EFA-R Module

Text updated to clarify instructions

•

Section 8.4 EFA-R Timetable

Text updated to clarify instructions

•

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4. SCOPE Global Wind Organisation is a non-profit body founded by the wind turbine manufacturers and owners. Our members strive for an injury free work environment in the wind turbine industry, setting common international standards for safety training and emergency procedures. This standard describes the requirements for enhanced first aid training that are recommended by the members of GWO. The standard comprises of one module. GWO recognises trained persons as competent within EFA in the wind industry. GWO accepts the trained person as possessing the required knowledge, skills, and abilities to provide ongoing care to a sick or injured casualty over a short period of time while waiting for professional emergency rescue teams to arrive. This standard has been developed in response to the demand for recognisable Enhanced First Aid refresher (EFA-R) training in the industry and has been prepared in co-operation between the members of GWO based on risk assessments, in-depth descriptions of job roles and tasks relevant to Enhanced First Aid in the wind industry as well as factual incident and accident statistics from G+ and the wind industry. Training is verified through GWO’s WINDA database. General feedback on this document can be sent to info@globalwindsafety.org. See globalwindsafety.org on how to raise a complaint about a training provider or report a safety incident occurring during training. 5. GENERAL REQUIREMENTS FOR THE GWO ENHANCED FIRST AID REFRESHER 5.1 Target Group Personnel who will be working in the wind industry or related fields and will have their duties in a wind turbine environment, usually in physical contact with a wind turbine or an offshore wind structure make up the target group. Personnel that are selected by their employer to perform Enhanced First Aid onshore or offshore, where training according to the GWO Enhanced First Aid training may enable them to react to incidents and thus mitigate the results of casualties deriving from the identified risks. The Annex 2 - EFA Guideline: Recommendations has been developed to assist employers in determining who and how many should take the training. 5.2 Aims and Objectives The EFA-R training shall enable participants to support and care for others working in the industry by possessing the knowledge, skills, and ability of enhanced first aid. Upon completion of the GWO EFA-R training, participants will be able to administer safe, effective, and immediate lifesaving and enhanced first aid measures to save life and give assistance in remote areas using advanced emergency equipment and medical teleconsultation.

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5.3 Duration The total contact time for completing the stand-alone modules in the EFA refresher training standard is 14 hours and 0 minutes. This is based on the times given in the module timetables and summarised in table 5.3.1 below. The training provider must not exceed the time per day given in table 5.3.2 below.

Modules

Duration

Enhanced First Aid Refresher

14 hours 0 minutes

Table 5.3.1 – Duration of the GWO Enhanced First Aid Refresher Module

Maximum Duration Per Day

Contact time

8 hours

Total training day

10 hours

Table 5.3.2 – Maximum duration for training days

Contact time includes delivery of course lesson content, practical exercises and activities directly related to these. The total training day includes contact time, meals and breaks and travel between training sites (where applicable).

Note

Within the module timetables, approximate duration of each of the lessons are given. The training provider may choose to deliver elements of the training according to other timetables, as long as the total duration is not reduced, and practical elements are not reduced in length. Theoretical elements may be delivered during the practical exercises when feasible. 5.4 Validity Period The EFA-R training is valid for the period of 24 months as stated in the table below. Certificates and training records shall be renewed before the end of a given validity period. A certificate or training record can be renewed up to two months prior to expiry and maintain the original certification date by uploading the previous certificates valid until date in WINDA. If a certificate or training record is renewed outside of two months of expiry, it must carry the new date of certification. A participant is only allowed to attend a refresher course in the specific EFA-R training prior to the date of expiry on the current certificate or training records.

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If a certificate or training record is expired, the participant must attend the full Enhanced First Aid training to obtain new training records in ‘basic’, BST First Aid Module (GWO course code, FA) and Enhanced First Aid Standard(GWO course code, EFA). The validity period is automatically calculated by WINDA by entering the course completion date.

Course/module

Certificate Validity (Months)

EFA-R

24 Months

Table 5.4.1 – Validity period of GWO EFA-R certificate

5.5 Course Codes

Module

Course Code

Enhanced First Aid Refresher

EFA-R

First Aid Refresher

FAR

Table 5.5.1 – GWO EFA-R Module course code

GWO Enhanced First Aid Refresher Standard training is an extension of the GWO FAR training. Therefore, on completion of the GWO EFA-R standard, the participant will be eligible to receive both the GWO FAR certificate and the GWO EFA-R certificate. 5.6 Participant Prerequisites All personnel participating must meet the participant prerequisites described in the GWO Requirements for Training. 5.7 EFA Refresher Training Maintenance The GWO EFA refresher training is to be maintained with at least two training days supported by relevant drills and exercises within 24 months of completing the EFA ref. Annex 2: EFA Guideline: Recommendations. ref. Annex 2: EFA Guideline: Recommendations. 6. GENERAL RESOURCES REQUIRED TO DELIVER ENHANCED FIRST AID MODULE The training provider shall ensure that instructors, facilities, and equipment are in place to support the training of participants.

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6.1 Instructors The instructor shall possess appropriate qualifications and experience to ensure that all training and supportive activities are carried out in accordance with current legislation and/or local guidelines and current version of GWO’s Requirements for Training offering GWO training. Instructors must be: 1. trained in instructional/lecture techniques and/or have documented instructional/ teaching experience 2. to be able to provide documented evidence of continual professional development (in accordance with national guidelines/professional requirements) 3. included in an ongoing familiarisation programme consisting of either: a. visits to on-shore and/or off-shore WTGs (tower, nacelle, hub) prior to instructing Enhanced First Aid training, to enable them to maintain and update skills related to the GWO courses they instruct, or b. alternative ways of ensuring familiarisation with the wind turbine working environment and updated skills related to Enhanced First Aid 4. able to demonstrate competencies in enhanced first aid/pre-hospital emergency care through experience or internal staff development 5. competently trained in the use of airway adjuncts, pain relief and advanced first aid equipment 6. knowledge of medical teleconsultation 7. all instructors shall possess the appropriate competencies to conduct/assist the elements of training they have been assigned to. 6.2 Training Equipment The required equipment for training is shown in Annex 1 and shall be available and shall fulfil national legal requirements in the country where the training is taking place. When teaching about equipment, a generic approach to shall be applied aiming to avoid additional potential product specific formal training after completion of this training. However, national or regional legislation, company gap analysis and location specific risk assessments may require additional product specific familiarisation which is the responsibility of the duty holder. The equipment shall be maintained, inspected, and tested in accordance with current national legislation and manufacturers’ recommendations. Risk assessments shall be conducted and documented for all training equipment. The training provider shall hold the required permits to operate relevant equipment.

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7. USING THIS STANDARD TO DEVELOP TRAINING The training in this standard is designed around the GWO taxonomy described in the GWO Requirements for Training. Theoretical and practical activities must be delivered according to the defined taxonomic level in order to reach the described learning objectives. In addition to this, all training based on this standard including all related resources shall, as a minimum, meet the requirements described in the GWO Requirements for Training.

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Enhanced First Aid Refresher Module

EFA-R

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8. MODULE: ENHANCED FIRST AID REFRESHER (EFA-R) 8.1 Aims and objectives for the EFA-R Module

The aim of the EFA-R Module is to review and build on previously gained knowledge and skills from BST First Aid or to refresh current EFA skills through theoretical and practical training so that participants can administer safe and effective enhanced first aid in the wind industry. After having successfully complete this EFA-R module, the participants will have the ability to: 1. take responsibility for administering safe, effective, and immediate lifesaving and enhanced first aid measures in an emergency situation in a wind turbine generator (WTG) environment (Ability, intermediate level) 2. act independently in giving assistance in remote areas using advanced emergency equipment and medical teleconsultation while having particular regard for personal protection (Ability, intermediate level) 8.2 Duration The total contact time for completing this module is 14 hours and 0 minutes. This is based on the times given in the module timetable. The training provider must not exceed the times per day given in table 8-2.1 below.

Maximum Duration Per Day

Contact time

8 hours

Total training day

10 hours

Table 8.2.1 – Maximum durations for training days

Note

8.3 EFA-R Module Participant Ratio The ratio shown for theory sessions indicates the maximum number of participants per instructor attending the course. Practical ratios indicate the maximum number of participants to be supervised by an instructor during each activity.

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Module

Session Theory Practical

Instructor to Participant Ratio

1:12

EFA-R

1:6

Table 8.3.1 – GWO EFA-R Module instructor to participant ratio

8.4 Equipment for the EFA-R Module The equipment required for training as listed in Annex 1 must be available and must fulfil national legal requirements. 8.5 EFA-R Module Timetable The delivery of this module must comply with the requirements described in the GWO Requirements for Training .

Lesson

Element

Duration

Safety instructions and emergency procedures

1.1 1.2 1.3 1.4 1.5

1. Introduction to the training

Facilities

Introduction

Scope and main learning objectives

Ongoing assessments (participant assessment form)

Motivation

1.6 1.7

Human factors TOTAL

15 min.

Risks and hazards First aid guidelines TOTAL

2.1 2.2

2. Risks/Hazards/Legislation

10 min.

The human body’s life conditions, structures, functions and signs TOTAL Safety awareness and personal protection equipment in an emergency situation

3.1

3. Anatomy and Physiology

20 min.

4.1

4. Incident management emergency response & teleconsultation

Management of an incident

4.2 4.3

Emergency rescue teams, emergency calls and medical teleconsultation TOTAL

30 min.

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The “C” – A – B – C – D – E – principle

5.1

5. Lifesaving and Enhanced First Aid using Primary and Secondary Survey

Primary survey

5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9

“C” Catastrophic bleeding

A: Airway

B: Breathing – cardiopulmonary resuscitation (CPR)

C: Circulation D: Disability

E: Environment / exposure

Secondary survey 5.10 Damage and poisoning through contact with chemical/biological substances 5.11 Eye injury 5.12 Broken bones and injuries to joints/muscles 5.13 Burns

5.14 Bites and stings 5.15 Significant injuries 5.16 Significant illness 5.17 Psychological first aid TOTAL

465 min.

Application algorithm of pain management

6.1

6. Pain management and

further possible medication

Further possible medication TOTAL Practice first aid techniques

6.2

40 min

7.1

7. Enhanced first aid refresher exercises (scenario-based training)

Debriefing TOTAL

7.2

245 min.

Training review

8.1 8.2

8. Training review

Debriefing TOTAL

15 min. 840 min.

GRAND TOTAL

Table 8.5.1 – GWO EFA-R Module timetable

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8.6 Detailed Description of the EFA-R Module Note

The administrative part of the registration should be carried out before the course commences

INTRODUCTION TO THE TRAINING

15 min. The aim of this lesson is for the participants to be motivated and to engage in the training safely at a training facility, while recognising what is expected of them during the training. After having successfully completed lesson 1 of Enhanced First Aid Refresher Module, the participant can: 1) Recognise what is expected of them throughout the module (Knowledge, basic level) 2) Name and point out local emergency procedures and facilities (Knowledge, basic level) 3) Discuss the relevant human factors and explain their implications (Knowledge, intermediate level)

ELEMENT 1.1 - SAFETY INSTRUCTIONS AND EMERGENCY PROCEDURES

Learning objective: 4) The participants show interest or curiosity in the safety and emergency procedures at the training facility (Ability, basic level)

The instructor shall: Explain and ask involving questions aiming at: a. safety instructions according to internal procedures b. emergency procedures and emergency exits in the areas where the participants can be expected to be located during the course

The participants shall: Engage in answering questions on local safety and emergency procedures

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ELEMENT 1.2 - FACILITES

Learning objective: 5) The participants can recognise the location of facilities at the training location (Knowledge, basic level)

The instructor shall: Present a general description of the facilities at the training location (administration, dining area, restrooms, toilets, etc.) Alternative activity: lead a tour and point out facilities

The participants shall: Note relevant facilities and ask questions when in doubt

ELEMENT 1.3 - INTRODUCTION

Learning objective: 6) The participants show interest in fellow participants and the course content and design (Ability, basic level)

The instructor shall: Explain and ask involving questions aiming at the programme of the Enhanced First Aid Refresher Module training, including breaks and mealtimes Give a short introduction to themselves, including their backgrounds as instructors Ask for participants’ expectations of the training and their learning or development

The participants shall: Give a short introduction to themselves, including job function and expected primary geographic work location and share expectations on the training

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ELEMENT 1.4 - SCOPE AND MAIN LEARNING OBJECTIVES

Learning objective: 7) The participants can recognise the scope and main objectives of the Enhanced First Aid Refresher Module training (Knowledge, basic level)

The instructor shall: Present the scope and main learning objectives of the Enhanced First Aid Refresher Module training Involve participants with questions on understanding and individual experiences on Enhanced First Aid Refresher Module The participants shall: Engage in answering questions and share experiences on Enhanced First Aid Refresher Module ELEMENT 1.5 - ONGOING ASSESSMENTS (PARTICIPANT ASSESSMENT FORM) Learning objective: 8) The participants can recognise the assessment procedure and the aim of the ongoing assessment (Knowledge, basic level)

The instructor shall: Explain the reasons for the ongoing assessment Explain the layout of the GWO participant assessment form and how it will be used

The participants shall: Engage in discussions and ask questions when in doubt in relation to the assessment procedure

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ELEMENT 1.6 - MOTIVATION

Learning objective: 9) The participants show interest and willingness to engage in the learning activities (Ability, basic level)

The instructor shall: Explain and lead a discussion on: a. the importance of personal involvement in the course b. the definition of and the need for Enhanced First Aid Refresher Module understandings and abilities Positive motivation is the driving force for commitment, and the instructor should make a focused effort to support growth of the necessary ability and motivation in the participant

Note

The participants shall: Engage in discussions and share experiences on Enhanced First Aid Refresher Module

When the participants succeed by trying out on their own, bring their relevant experience into play and apply learning points from the instructor’s feedback, the participants develops a positive ability and responsibility towards the subject and the performance in the work situation

Note

ELEMENT 1.7 - HUMAN FACTORS The aim of the element is to draw the participant’s attention on how human performance and taking responsibility influences a safe work environment, and to prepare for the continued focus on human factors during practical training and exercises. Learning objectives: 10) The participants can describe the relevant human factors, and their implications (Knowledge, basic level)

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11) The participants show interest and willingness to focus on human factors during the following practical exercises (Ability, basic level)

The instructor shall: Present how human factors influence accidents in the wind industry (relevant statistics may be applied) Lead a discussion about the role of the individual in improving human behaviours and how this can improve the safety of offshore operations Ensure that constructive feedback on the participant’s performance involve human factors criteria when these are defined in the learning objective such as the ability to take responsibility or to act independently Facts and Human Factors Criteria: The consequences of human factors in accidents in the WTG environment are influenced by the following terms and conditions: a. attention and perception b. group behaviour and peer pressure c. weather conditions d. weather delays e. noise levels f. site layout and housekeeping g. fitness and health h. domestic and work-related stress i. workload (both overload and underload) j. fatigue k. time pressure and deadlines l. alcohol, medication, and substance abuse

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The participants shall: Engage in discussions and share experiences on how human factors influence accidents in the wind industry, engage in, and reflect on, received feedback and take responsibility on their own performance and development during the training

RISKS/HAZARDS/LEGISLATION

10 min. The aim of this lesson is to is to enable the participants to mitigate risks and hazards in remote areas with dangerous locations/tasks by refreshing and increasing participants previously acquired knowledge of the relevant risks/hazards/legislation and demands of first aid. Additionally, this lesson will enable participants to comply with national/local-specific and company-specific aspects relating to administering enhanced first aid and improve their awareness of the roles, responsibilities and rules that apply to first aid in a wind turbine environment. After having successfully completed this lesson, the participants can: 12) Show interest in risks and hazards relating to first aid in remote areas with dangerous locations/tasks and applicable legislation relating to enhanced first aid (Ability, basic level) 13) Show interest in the importance of carrying out basic and enhanced first aid in a safe and sound manner, in accordance with the legislative requirements of their geographic location and international first aid guidelines (Ability, basic level)

ELEMENT 2.1 - RISK AND HAZARDS

Learning objective: 14) The participants can explain risks and hazards relating to (enhanced) first aid in a WTG environment as well as relating to remote areas with dangerous locations/tasks (Knowledge, intermediate level)

The instructor shall: Lead a group discussion about risks and hazards involved in an incident relevant for job functions within the wind industry for example, difficulties in management of accidents /emergencies / survival in remote areas

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Reference to current G+ incident and national statistics as applicable Lead a group discussion about dependencies on site organisation, types of activity, work location and personnel

Note

a. onshore b. offshore c.

remote areas in general Give constructive feedback to the participants’ group discussions

The participants shall: Engage in the group discussions and share understandings about risks and hazards relating to (enhanced) first aid in a WTG environment as well as relating to remote areas with dangerous locations/tasks Receive and reflect on the instructor’s feedback ELEMENT 2.2 - FIRST AID GUIDELINES Learning objective: 15) The participants can explain various first aid guidelines – (e.g., ILCOR, ERC and AHA) in the context of (enhanced) first aid in a WTG environment (Knowledge, intermediate level)

The instructor shall: Present recent changes/updates to guidelines from e.g., ILCOR, ERC and AHA Ask the participants involving questions about the various first aid guidelines Present an overview of relevant national legislation where applicable

The participants shall: Ask questions and share understandings about the various first aid guidelines and applicable legislation.

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ANATOMY AND PHYSIOLOGY

20 min. The aim of this lesson is to enable the participants to identify and explain normal bodily function, signs, symptoms and functions of major and minor injuries and illness related to the human body by refreshing and increasing participants’ previously acquired knowledge and skills regarding the human body. After having successfully completed this lesson, the participants can: 16) Show interest in identifying normal function, normal vital signs and signs, functions, and symptoms of injuries and illness related to the human body (Ability, basic level)

ELEMENT 3.1 - THE HUMAN BODY’S LIFE CONDITIONS, STRUCTURES, FUNCTIONS AND SIGNS

Learning objectives: 17) The participants can explain understanding of the human body’s life conditions, structures, functions, and signs (Knowledge, intermediate level) 18) The participants can explain how to detect abnormal signs, symptoms, and functions of serious and minor injuries (Knowledge, intermediate level) 19) The participants can act independently in detecting abnormal signs, symptoms and functions of serious and minor illness related to the human body (Ability, intermediate level) 20) The participants can explain understanding of anatomy and First Aid in emergency situations (Knowledge, intermediate level)

The participants shall: Explain normal life conditions for the human body: a. human cells and life conditions b. cells and oxygen (O 2 ) c. role of carbon dioxide (CO 2 ) on cells

d. vital organs and their requirements Explain vital systems of the human body:

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a. nervous system b. respiratory system c. circulatory system d. other systems and organs Explain the nervous system: a. anatomy of the nervous system b. structure, functions, and normal signs c. threats to the nervous system Explain the respiratory system: a. anatomy of the respiratory system b. structure, functions, and normal signs c. threats to the respiratory system Explain the circulatory system:

a. anatomy of the circulatory system b. structure, functions, and normal signs c. threats to the circulatory system Explain other systems and vital organs of the human body:

a. anatomy of vital organs b. structure and functions c. threats to vital organs Practise and discuss how to recognise abnormal signs and symptoms and distinguish between serious and minor injuries in first aid situations The instructor shall: Give constructive feedback on the participants explanations and practice If participants do not cover all points during their review, the instructor shall ensure that following topics are covered by explaining and demonstrating:

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a. life conditions, structure, function, and signs of the human body b. serious and minor injuries - signs, symptoms, and function c. serious and minor illness - signs symptoms and function d. use of anatomy and first aid in emergency situations

INCIDENT MANAGEMENT, EMERGENCY RESPONSE & TELECONSULTATION 30 min. The aim of this lesson is to enable the participants to safely manage emergencies (accident/illness) in remote areas in a wind turbine environment. After having successfully completed this lesson, the participants can: 21) Take responsibility for the management of emergencies (accident/illness) in remote areas (Ability, intermediate level) 22) Act independently in requesting immediate medical/rescue assistance providing a concise and relevant report of the casualty’s condition (Ability, intermediate level) 23) Take responsibility for requesting telemedical consultation and medical/rescue assistance providing a concise and relevant report of the casualty’s condition and obtaining medical advice to further stabilise the casualty by using telemedical consultation according to local emergency response plans (Ability, intermediate level)

ELEMENT 4.1 - SAFETY AWARENESS AND PERSONAL PROTECTION EQUIPMENT IN AN EMERGENCY SITUATION

Learning objectives: 24) The participants can discuss personal hazards to rescue personnel and victim associated with emergency situations and apply knowledge and skills for safety awareness (Knowledge, intermediate level) 25) The participants can perform skills to take first aid measures with regard for personal protection (Skills, intermediate level) 26) The participants can discuss core aspects of psychological care in first aid situations (Knowledge, intermediate level)

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The instructor shall: Lead group discussions on: a. appropriate safety behaviour and awareness as an enhanced first aider in a WTG b. how to spot and manage hazardous rescue situations c. safety and personal protection for all persons involved in an accident including universal precautions (e.g. personal protective equipment) against infections; protection and use of barriers in emergency situations d. the fundamentals of psychological care in first aid situations (e.g. colleagues, loneliness, unusual emergency situations) The participants shall: Engage in the discussions and share their understanding on the topics approached ELEMENT 4.2 - MANAGEMENT OF AN INCIDENT Learning objectives: 27) The participants show interest in approaching and managing different emergency situations (Ability, basic level) 28) The participants can explore the principles of the ACT method (Assess, Communicate, Triage) and recognise the importance of raising the alarm before starting first aid (Knowledge, advanced level) 29) The participants can act independently to ensure the rescue of injured persons and their removal from the immediate hazard area to the nearest safe location (Ability, intermediate level)

The instructor shall: Explain and demonstrate how to manage an incident: a. how to follow an efficient and approved first aid structure b. assessment and management of an incident c. different emergency situations in the wind industry

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d. methods on calling for help both onshore and offshore

The participants shall: Explain and practise managing an incident: a. how to follow an efficient and approved first aid structure b. assessment and management of an incident c. different emergency situations in the wind industry ELEMENT 4.3 - METHODS ON CALLING FOR HELP BOTH ONSHORE AND OFFSHORE EMERGENCY RESCUE TEAMS AND MEDICAL TELECONSULTATION Learning objective: 30) The participants can explain functions and possible support from emergency rescue teams in WTG environments (Knowledge, intermediate level)

The instructor shall: Explain emergency rescue teams:

a. functions of emergency rescue teams (internal onsite or external as part of the chain of survival) b. external professional emergency rescue teams, the skills required, and the challenges associated Outline the importance of providing ongoing care and assessment while waiting for professional help to arrive Facilitate a group discussion on how to obtain telemedical advice and challenges associated e.g., poor communication skills, lack of signal, language barrier Explain the means and use of medical teleconsultation focusing on the current and future applicability and technical infrastructure

Explain the administering of first aid measures via medical teleconsultation Give constructive feedback on the participants explanations and practice

The participants shall:

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Explain, practise and demonstrate: a. functions of emergency rescue teams (internal onsite or external as part of the chain of survival), external professional emergency rescue teams, the skills required, and the challenges associated b. providing ongoing care and assessment while waiting for professional help to arrive c. the use of medical teleconsultation and communication media d. how to obtain telemedical advice and challenges associated e.g. poor communication skills, lack of signal, language barrier LIFESAVING & ENHANCED FIRST AID USING PRIMARY & SECONDARY SURVEY 465 min. The aim of this lesson is to enable the participants to follow a methodical sequence to identify and treat life threatening time critical injuries and illness in a wind industry environment. After having successfully completed this lesson, the participants can: 31) Take responsibility for the management of emergencies (accident/illness) in remote areas supported by teleconsultation (Ability, intermediate level) 32) Take responsibility for delivering immediate enhanced first aid to stabilise the casualty, to include but not limited to: using standardised methodologies, specifically the primary and secondary survey - based on the "C" A-B-C-D-E principle (Ability, intermediate level) a. stopping life-threatening bleeding b. establishing and maintaining an airway c. resuscitation and the use of automated external defibrillator (AED) according to the indications d. using basic and advanced first aid equipment in a first aid scenario 33) Take responsibility for assessing the casualty, for injury or acute illness, to determine if external medical advice and support is required; to include but not limited to: (Ability, intermediate level) a. life threatening bleeding, circulatory disorder b. impaired consciousness c. compromised airway, breathing, too slow or too fast

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Enhanced First Aid Refresher Training / V5 2023-05-02

d. immediate life threatening illness and other health problems especially with severe pain

ELEMENT 5.2 - THE "C"- A-B-C-D-E- PRINCIPLE

Learning objectives: 34) The participants can explain the principles of primary and secondary survey (Knowledge, intermediate level) 35) The participants can assess a casualty using the primary and secondary survey (Knowledge, advanced level)

The instructor shall: Explain and demonstrate: a. the "C"- A-B-C-D-E- principle in detail b. procedure of primary and secondary survey using the "C"- A-B-C-D-E- principle Ask the participants involving questions on their understanding of the procedures of primary and secondary surveys The participants shall: Engage in answering questions and share experiences on the “C” A-B-C-D-E principle and procedures of primary and secondary surveys ELEMENT 5.3 - PRIMARY SURVEY Learning objective: 36) The participants can perform a safe approach and initial assessment of the casualty (Skills, intermediate level)

The instructor shall: Explain and demonstrate:

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a. conditions and procedure of primary survey comprising assessment of risks and threats for first aider and victim, safety awareness, rescue measures, emergency call b. first approach using the “C” A-B-C-D-E-principle to identify and treat life threatening time critical injuries and illness c. check for response to find out: alert - voice/pain responsive – unresponsive “AVPU” Facilitate an exercise on life saving first aid using the "C" A-B-C-D-E principle during primary survey supported by teleconsultation Give constructive feedback to the participants on their performance

The participants shall: Practise delivering safe approach and initial assessment of the casualty

ELEMENT 5.4 - "C" CATASTROPHIC BLEEDING

Learning objective: 37) The participants can perform treatment of catastrophic external bleeding "C" catastrophic bleeding (Skills, intermediate level)

The instructor shall: Explain how to recognise catastrophic bleeding Explain and demonstrate a stepwise approach to control the catastrophic external bleeding e.g. direct pressure, tourniquets, haemostatic agents/wound packing Explain and demonstrate control of catastrophic external bleeding Ask the participants involving questions about the recognition and control of catastrophic external bleeding Facilitate an exercise on the correct treatment of a casualty with catastrophic external bleeding including the use of available first aid equipment a. direct pressure b. pressure dressings c. tourniquets

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d. haemostatic agents/wound packing Give constructive feedback to the participants on their treatment of a casualty with catastrophic external bleeding including the use of available first aid equipment

The participants shall: Engage in discussions about haemostasis of catastrophic external haemorrhage, threat and detection of catastrophic bleeding, and haemostasis using algorithm-oriented procedure Participate in the exercise and practise the treatment of a casualty with catastrophic external bleeding including the use of available first aid equipment ELEMENT 5.5 - “A”: AIRWAY Learning objective: 38) The participants can act independently in delivering correct first aid for obstruction of airways - establish and maintain an airway (Ability, intermediate level) The instructor shall: Explain and demonstrate: a. obstruction of airways, e.g. tongue, vomit, foreign object, choking, etc. first aid to an unresponsive, breathing casualty: a.i head tilt/chin lift and jaw thrust techniques- placing of a casualty in the recovery position Facilitate exercises for the participants in:

a. checking and opening airways (head tilt/chin lift and jaw thrust techniques) b. airway obstruction (removal of foreign objects and choking procedure) c. recovery position (one or more first aiders)

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Enhanced First Aid Refresher Training / V5 2023-05-02

d.iv use of a nasopharyngeal airway (NPA) d.v use of a supraglottic airway device e.g. I-gel, laryngeal tube

The participants shall: Engage in the exercises and practise:

d. correct treatment of a casualty with an obstructed airway following a step wise approach according to national/regional guidelines and best practice (as permitted by company/national regulations) d.i manual airway opening (head tilt/ chin lift, jaw thrust) d.ii use of manual suction d.iii use of an oropharyngeal airway (OPA, Guedel) d.iv use of a nasopharyngeal airway (NPA) d.v use of a supraglottic airway device e.g. I-gel, laryngeal tube ELEMENT 5.6 - “B”: BREATHING - CARDIOPULMONARY RESUSCITATION (CPR) Learning objectives: 39) The participants can perform correct first aid to an unresponsive and breathing/not breathing casualty (Skills, intermediate level) 40) The participants can perform cardiopulmonary resuscitation (CPR) including the safe use of an AED (Skills, intermediate level) 41) The participants can recognise how the use of an AED with enhanced functionality can be used in a medical teleconsultation – this learning objective can be covered in Element 4.3 Medical teleconsultation (Knowledge, basic level) 42) The participants can recognise the benefits of airway management devices during resuscitation (bag valve mask (BVM) with or without oxygen e.g., pocket mask, airway devices) (Knowledge, basic level)

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Enhanced First Aid Refresher Training / V5 2023-05-02

43) The participants can recognise the benefits and risks of oxygen therapy in significant illness and injury (according to company guidelines and national legislation)

The instructor shall: Explain and demonstrate (while seeking the participants’ understanding throughout) a. how to perform a breathing assessment b. casualties not breathing c. reasons for being unresponsive and not breathing d. cardiopulmonary resuscitation (CPR) through the use of training CPR mannequins Present the capabilities and the technical specifications of AEDs Explain and demonstrate the safe use of AED Facilitate exercises on: a. performing CPR - single first aider including correct use of AED and ventilatory equipment b. performing CPR - two first aiders correct use of AED and ventilatory equipment c. correct treatment of a casualty who requires ventilatory support including: c.i use of a pocket face mask c.ii use of a bag valve mask (two-person technique for bag-mask ventilation is recommended according to national/regional guidelines) c.iii airway devices d. demonstrate a full resuscitation sequence using all available equipment simulated external telemedical support Explain and demonstrate (while seeking the participants’ understanding throughout) a. oxygen therapy equipment including different types of masks and delivery devices b. oxygen safety c. indication for oxygen therapy according to national guidelines

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