Top of page Skip navigation


First Aid Training: Retention of Skills and Knowledge

Date: 11 Oct 2004

Proof that 3 years is too long for a First Aid at Work certificate!

By Dr Mark Woods PhD, from the Medical Sciences Unit, Health and Safety Executive


The Health and Safety (First-Aid) Regulations 1981 place a legal duty on employers to provide suitable equipment, facilities and personnel for the first aid treatment of employees who are injured or become ill at work. The regulations specify that a person who provides first aid is not suitable unless they have undergone:

  1. such training and has such qualifications as the Health and Safety Executive may approve for the time being in respect of that case or class of case, and
  2. such additional training, if any, as may be appropriate in the circumstances of that case.

The main purpose of first aid is to preserve life and minimise the consequences of injury and illness until expert help is available. Currently, HSE requires first aiders in the workplace to successfully complete a 4 day first aid at work course and undertake 2 day refresher training every 3 years. Training providers offering these courses must be approved by HSE for this purpose.

There is no legal obligation to provide first aiders with formal training during the intervening 3 year periods. However, in HSE's guidance to the first aid regulations, employers are encouraged to allow first aiders time for ‘self directed revision' in order to maintain their first aid skills. In reality, this may not always be a practical proposition for the employer and first aiders may lack the motivation to develop their own programmes for refreshing skills (Pettifer, 1996).

Lack of practice in skills such as performing cardiopulmonary resuscitation (CPR), is compounded further where first aiders deal with very few, if any, serious incidents in the workplace (Rivett, 1988). An anonymous questionnaire completed by 33 of 35 first aiders in a food processing plant indicated that the commonest problems dealt with were cuts, bruises and burns (Foulis et al, 1991). Another study in the food and drink manufacturing industry, based on a postal questionnaire completed by 36 of 54 companies, showed that 93% of first aid treatment provided was of a minor nature (Ferriday, 1995). First aiders in these studies only rarely used their skills for the management of serious medical emergencies. This would suggest it is unwise for first aiders and employers to rely on first aid skills being maintained solely through dealing with incidents which arise in the workplace.

Retention of first aid skills and knowledge has been the subject of numerous papers published in scientific and medical journals (see ‘Results' section). HSE has also been involved in research in this area (Ruddick-Bracken et al, 1987; Cullen, 1992). Evaluation of the Health and Safety (First-Aid) Regulations 1981 has provided an opportunity to take a systematic look at retention of first aid skills and knowledge. It is a key issue in helping to inform a decision on whether any changes should be made to the current training regime for first aiders in the workplace.


  • To summarise relevant studies in the scientific and medical literature which have evaluated retention of skills/knowledge following training in adult basic life support (BLS)/first aid
  • To consider the implications of the literature summary in the context of the current training regime for first aiders in the workplace


This document is based primarily on a review of relevant abstracts and therefore does not represent a ‘critical appraisal' of the available literature. In certain cases this has limited interpretation of the data, particularly where conflicting findings in different studies have been identified. Despite this, the methodological approach used has been sufficiently robust to allow some key themes to emerge:

  • Some individuals cannot adequately perform BLS within 2 months of training and after 3 years results are generally very poor.
  • The ability to perform BLS/first aid may be influenced by a number of factors including the competence of instructors, training methods used, criteria applied to assess performance and motivation of study subjects.
  • It should not be assumed that dealing with actual first aid incidents will keep all skills fresh.
  • The medical/ scientific literature strongly suggests that first aiders in the workplace should undertake refresher training more frequently than every 3 years.

This report has been summarised. For a full copy contact 1st aid at work training services.