OSHA requirements are set by statute, standards and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at https://www.osha.gov.

July 17, 1991

Mr. John Pompei
Oregon Occupational Safety and Health Division
Department of Insurance and Finance
21 Labor and Industries Building
Salem, Oregon 97310

Dear Mr. Pompei:

This is an update to our response to your inquiry to Mr. James Lake concerning the intent of "advance first-aid" mentioned in section 29 CFR 1910.120(q)(3)(vi) of the Hazardous Waste Operations and Emergency Response standard. Please accept my apology for the long delay in this reply.

The referenced standard is as follows: "...Advance first-aid support personnel, as a minimum, shall also stand by with medical equipment and transportation capability." Both of the training levels addressed in your letter meet the intent of the standard. They do, however, go further than our requirements.

Advanced First Aid Per 29 CFR 1910.120
    | State of     | Advance Life   |    >110  hours |     YES      |
    | Oregon       | Support        |                |              |
    |              |   (EMT-3)      |                |              |
    | Emergency    | Basic Life     |     110        |     YES      |
    | Responders   |Su pport        |                |              |
    |              |   (EMT-1)      |                |              |
    | OSHA         | Advance First  |  No Specified  |      NO      |
    |              | Aid            |                |              |

*"Advance first aid" means advance first aid as evaluated by a competent professional. Training must be tailored to the specific needs of the workplace conditions. Individuals trained to this level should be capable of providing basic first aid involving maintenance of the airway, control of bleeding, immobilization of fractures, CPR and similar duties which do not require the use of the medical equipment carried on ambulances. An example of a course which meets the intent includes the U.S. Department of Transportation's Emergency Medical Services: First Responder Training Course.

To further assist you, we have enclosed a copy of OSHA Instruction CPL 2-2.53, Guidelines for First Aid Training Programs.

We hope this information is helpful. Again, we apologize for the delay in this response.


Patricia K. Clark, Director
Directorate of Compliance Programs


February 14, 1990

James W Lake Regional Administrator Occupational Safety and Health Administration 909 First Ave Seattle WA 98174

Subject: Request for Rule Interpretation Hazardous Waste and Emergency Response

Dear Mr. Lake:

In developing our question and answers manual for the hazardous waste and emergency response rules, our Technical Services Section received the following question:

What is meant by the statement, "Advance first-aid support personnel, as a minimum, shall also stand by with medical equipment and transportation capability."? 29 CFR 1910.120(q)(3)(vi)

We formulated the following response:

"Advance first-aid" means Advanced Life Support (ALS) certification level (ALS certified equals (1) EMT-3 or higher). "Medical equipment" and "transportation capability" means those specifically required as outlined by ALS. Private ambulance providers are required to have ALS certification training. Law enforcement personnel are not required to have ALS training; however, ALS must be made available. Public highway workers or municipal waste treatment workers who discover a release are not required to have ALS certification. However, incident commanders at emergency responses must require an ALS provider to stand by at the scene.

However, emergency responders have requested that we revise our response:

"Advance first-aid" means advanced first-aid as certified by the American Red Cross. The rules require these personnel to be standing by with medical equipment and transportation capability at hazardous materials incidents. This means that a Basic Life Support (BLS) ambulance is required; and, it must be staffed by a minimum of two personnel who are certified at EMT-1 or higher.

The responders argue that the revised interpretation is achievable in Oregon and that our initial interpretation is not. Does this revision meet the intent of the OSHA rules? If not, what would meet the intent of the rules? Page 9309 of the March 6, 1989, Federal Register is vague in defining what advance first-aid is for emergency response operations.

Additionally, it has come to our attention that federal OSHA will be issuing formal clarifications on the large quantity generator exemption and other issues. Your timely response on the advance first aid question and the impending clarifications would be greatly appreciated.

John A. Pompei Administrator Oregon Occupational Safety & Health Division (503) 378-3272