Safety Standards for First Aid at Metal and Nonmetal Mines

DEPARTMENT OF LABOR

Mine Safety and Health Administration

30 CFR Parts 56 and 57

RIN 1219-AA97

Safety Standards for First Aid at Metal and Nonmetal Mines

AGENCY: Mine Safety and Health Administration, Labor.

ACTION: Final rule.

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SUMMARY: This final rule revises existing standards at metal and

nonmetal mines, requiring first aid capability to be available in the

event a miner is injured. The final rule provides operators more

flexibility and clarifies requirements for persons trained in first

aid.

EFFECTIVE DATE: December 26, 1996.

FOR FURTHER INFORMATION CONTACT: Patricia W. Silvey, Director; Office

of Standards, Regulations, and Variances, MSHA; 703-235-1910 (voice),

703-235-5551 (facsimile), [email protected] (Internet e-mail).

SUPPLEMENTARY INFORMATION:

I. Rulemaking Background

Sections 56/57.18010, requiring first aid training, were originally

promulgated as advisory standards on July 31, 1969, and made mandatory

on August 29, 1973. MSHA issued Program Policy Letter (PPL) No. P94-IV-

2 on October 3, 1994, to underscore the first aid requirements. MSHA

withdrew the PPL by notice in the Federal Register (60 FR 9986) on

February 22, 1995, and began a new procedure for formulating certain

policies with increased participation by the mining community. MSHA

asked the mining community to comment on the issues and to help with

development of a policy for the first aid standard.

By letter of August 25, 1995, the National Mining Association (NMA)

petitioned the Secretary of Labor requesting that MSHA institute

rulemaking, rather than develop policy on the first aid issue, and

suggested language for a new standard. The NMA recommended that MSHA

develop a new rule to require that an individual capable of providing

first aid be available on all shifts and that first aid training be

made available to all interested miners. The recommendation from NMA

addressed mutual concerns of MSHA and the mining industry.

In lieu of finalizing a first aid policy, MSHA used NMA's

recommendation as the basis for a proposed first aid rule published in

the Federal Register (60 FR 55150) on October 27, 1995. MSHA received

comments from organized labor, industry associations, mining

contractors, and medical personnel first aid trainers, all of which

were considered in developing the final rule. MSHA also reviewed and

considered written comments previously submitted to the Agency on its

draft policy letter. One request for a public hearing was received, but

it was subsequently withdrawn.

II. Discussion and Summary of the Final Rule

A. General Discussion

Mining has historically experienced one of the highest rates of

severe injuries among its employees of any major industry group in

America. Despite significant long-term improvements in safety and

health, in the three-year period from 1993 through 1995, mine operators

and independent contractors reported 226 amputations among the

approximately 225,000 miners in the metal and nonmetal industry. During

the same period, over 500 burns; 1500 fractures; and 1200 cuts,

lacerations, or punctures resulted in time lost from work. The

frequency and severity of injuries in the mining industry and the

remoteness of many operations and working places require a skilled

first aid response, the first level of care for many injured miners.

First aid is basic emergency treatment rendered on-site as soon as

possible

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after an injury occurs and is intended to help a victim until medical

care arrives. In severe instances, first aid typically precedes two

subsequent care levels: a secondary level often performed by

paraprofessionals, such as emergency medical technicians (EMT's), and

full medical care performed by professionals, such as physicians and

nurses.

Existing MSHA standards at Secs. 56/57.18010 provide that:

``Selected supervisors shall be trained in first aid. First aid

training shall be made available to all interested employees.'' The

primary purpose of these standards is to assure that a responsible

person, trained to provide first aid, is available to render assistance

in the event a miner is injured. An additional purpose is to encourage

first aid education among miners so that they are able to help an

injured co-worker or even provide self-treatment.

The existing standards identify supervisors as the persons required

to receive first aid training. Supervisors are typically more mobile

than other workers. Companies often provide transportation to

supervisors so they can quickly access areas of the mine in the

performance of their duties. Traditionally, supervisors are present

where work is performed and injuries are most likely to occur.

Since the existing standards were first promulgated, however, there

has been significant progress in emergency response care and conditions

in the mining industry. At a number of mines, medical paraprofessionals

or professionals are members of mine workforces and able to render

skilled help at mine properties. This rulemaking takes into account

these developments.

B. Discussion of Final Rule

Final Secs. 56/57.18010 require that an individual capable of

providing first aid be available on all shifts. This individual must be

currently trained and have the skills to perform patient assessment and

artificial respiration; control bleeding; and treat shock, wounds,

burns, and musculoskeletal injuries. Operators must make first aid

training available to all interested miners.

The final rule adopts the proposal with two changes: it expressly

requires that the individual be currently trained and it deletes the

requirement for transportation and handling skills. MSHA received

comments that addressed many aspects of the proposal as discussed

below.

Individual With First Aid Skills

The final rule requires that operators have an individual capable

of providing first aid. Some commenters suggested that operators should

be allowed to use any medical personnel and paraprofessionals, such as

nurses or EMT's, to satisfy the first aid standard whether or not that

person is a supervisor. Another commenter said that the term

``individual'' should be interpreted to refer to any miner, even if the

miner is not a professional medical service provider. One commenter

asked whether a security guard could fulfill the requirements of the

proposal.

A primary reason for this rulemaking is to broaden the scope of the

rule to permit any person, regardless of title, to provide first aid.

Under the final rule, operators will have the flexibility to use anyone

who meets the requirements.

One commenter raised a concern that a miner could become an agent

of the company when the miner is available to provide first aid. The

final rule requires that operators have a capable individual available

who can perform first aid. The operator has the responsibility to

arrange for this first aid coverage. An individual's assignment for

purposes of this coverage does not make that person an ``agent'' in the

sense of being empowered to act as a representative of the operator.

Capability

One commenter was concerned that the proposed requirement for an

individual ``capable'' of performing first aid would be open to

subjective interpretation. This commenter asked how MSHA would

interpret such a requirement. Commenters generally pointed to training

as the means to establish capability and raised the issue of what type

of training was contemplated. While the existing rule requires that

supervisors ``be trained,'' the proposal contained no expressed

training requirement other than that first aid training be made

available to interested miners.

The final rule expressly provides that the individual must be

``currently trained'' and have certain specified first aid skills. The

individual who is so trained and skilled is ``capable.'' To be

``currently trained'' means that the individual must have received in-

depth first aid training which covers the specific skills in the final

regulation and that such training be up-to-date. Persons, such as

EMT's, nurses, and physicians, with current licenses or certifications

to practice, are considered ``currently trained'' under the final rule.

One commenter suggested that first aid training be provided

annually. Organizations with histories of successfully training

individuals in first aid skills differ in the frequency, breadth, and

depth of the retraining required to maintain competence. Some, such as

the American Red Cross, use a different interval from annual retraining

to maintain certification of competence. The American Red Cross's

current standard course is initially an 8-hour program to receive

certification. It requires retraining every three years to maintain a

current certification. Training offered by similar organizations, such

as local fire departments, also has varying retraining components.

Rather than exclude or constrain programs that have effectively

prepared individuals for rendering first aid, the final rule does not

incorporate an annual retraining requirement. MSHA will accept the

retraining requirements prescribed by the organization providing the

initial training.

One commenter said that first aid training taken to meet the

existing requirements of 30 CFR part 48 should qualify individuals as

``capable''. The commenter stated that part 48 training allows ample

time for adequate first aid training.

Part 48 training, however, may not automatically qualify an

individual as capable since part 48 is a different type of training

provision from the final rule. Part 48 requires basic first aid

training for all miners. The final rule for Secs. 56/57.18010 requires

that certain persons, trained and skilled in first aid, be available

and that the more in-depth first aid training to acquire those skills

be made available to interested miners.

Part 48 was promulgated in 1978. It implements Section 115 of the

Federal Mine Safety and Health Act of 1977 (Mine Act) 30 U.S.C. 825

which was intended by Congress to prevent miners from being put to work

before having received some safety and health training, including basic

first aid.

Part 48 requires training in many health and safety subjects. The

24-hour training required of new surface miners must cover at least

eleven other subjects besides first aid. The 8-hour annual refresher

training must cover at least ten other subjects. Operators have sought

flexibility to adjust the time spent on any one subject, particularly

during annual refresher training, according to the accident experience

and safety and health needs of the mine and the miners. An operator

with a high number of back injuries, for example, may determine that

miners need more training on proper lifting. To allocate

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more time to lifting, first aid training might be curtailed. Under

these circumstances, a brief review of first aid would not adequately

train persons to maintain skills as required by Secs. 56/57.18010.

MSHA will accept part 48 training for compliance with the final

rule if it is sufficiently in-depth to develop the capability to

perform the necessary first aid skills. In all instances, training that

complies with this rule would satisfy the new miner training

requirements for first aid under part 48 and annual refresher training

requirements for the year in which it was received.

Availability

Commenters asked that MSHA clarify the meaning of the terms

``available'' and ``on all shifts.'' The concept of availability is

critical to the purpose of the final rule and is intended to have its

ordinary meaning--present and ready for use or at hand.

The final rule requires that, if an injury occurs, a person skilled

in first aid must be present at the site and must be able to be at the

scene quickly. Individuals on-site are able to respond sooner because

they are closer to the scene of an accident and know the mine. The

likelihood of survival for a seriously injured miner would be greatly

diminished if first aid treatment were not administered before off-site

medical personnel could provide it. Operators also will have to plan to

assure that this on-site coverage is provided during absences and

vacations.

One commenter questioned whether the person capable of providing

first aid would be required underground and, if so, must the person be

trained to go underground. The final rule revises current Sec. 57.18010

and expressly applies to underground mines where first aid availability

is a critical element of injury response planning. To be available, the

first aid person must be prepared to provide first aid to injured

miners promptly. An individual capable of first aid and located on the

surface at an underground mine would not be available for miners

underground in many cases because the time required to reach the

injured person would be too long. For example, reaching some areas of

an old underground mine may require traveling through a mile or more of

old workings and could take an hour or more, depending on the

availability of transportation. In those few cases where a first aid

person on the surface is available to miners injured underground, such

as some small adit mines, that person would have to be trained to go

underground to the extent required by other MSHA standards.

Similarly, to ensure availability under conditions of difficult

access and remote work areas, an underground mine operator may be

required to have more than one first aid person underground. This

concept of availability also applies to surface mines where miners may

be working in remote areas.

One commenter suggested that the term ``readily'' be inserted in

the standard before ``available'' to ensure a prompt response.

``Available'' is commonly defined to mean present and ready for use or

at hand. Adding the term ``readily'' would not increase miner

protection and, therefore, this suggestion is not adopted in the final

rule.

Another commenter suggested that availability be established either

by having the person present on-shift or reachable through radio

contact. While such factors as communication, transportation, and

presence on-shift help determine availability, they do not make a

person available to provide first aid. For example, radio communication

without the ability to reach an accident scene quickly would not meet

the requirements of the final rule.

The final rule provides that an individual skilled in first aid be

available ``on all shifts.'' Commenters questioned which shifts need to

be covered. One commenter said that only ``production'' shifts should

be covered. Another commenter stated that the standard should apply

``to all shifts where two or more miners are engaged in production,

extraction, or maintenance activities.''

Under the Mine Act, mining includes activities beyond those

suggested by the comments. Production (excavation, extraction, and

milling), development, stripping, construction, dismantling,

maintenance, and abandonment comprise mining activities according to

the Mine Act. All of these activities involve exposure to hazards that

may require the application of first aid skills. The final rule retains

the ``on all shifts'' wording to convey the breadth of these activities

while keeping the language as simple as possible. The final rule does

not apply, however, in the few instances when no mining activities

occur, for example, when only security, sales, or office work is

performed.

Independent Contractors

One commenter suggested that independent contractors should be

solely responsible for compliance with the rule for their own

employees. Another commenter said that the rule's requirements should

not apply when independent contractors are performing explosives-

related work, such as shot service, which can involve a single

employee.

Under the final rule, independent contractors will be treated the

same as under other MSHA safety and health standards. Independent

contractors working on mine property are responsible for compliance

with MSHA regulations. In some instances, the mine operator and

independent contractor are isolated from one another and a single

individual capable of first aid could not be available for both. In

those situations, each would be responsible for their own coverage. In

other instances, the mine operator and independent contractor work in

such close proximity that one can choose to provide first aid coverage

for the other. In those situations, it is the mine operator's and

independent contractor's responsibility to agree on the coverage and to

coordinate and communicate its implementation. Consistent with MSHA's

enforcement of the existing standard, mine operators and independent

contractors have the flexibility to use anyone at the mine with the

necessary skills and availability, regardless of employer.

Mining activity can present hazards to an employee whether the

employee is working alone or with another person. If an employee is

alone and becomes injured, the ability to provide self-treatment could

be critical to survival. The final rule, therefore, does not include an

exception for miners or contractor employees working alone.

First Aid Skills

Several commenters addressed the proposed first aid skills needed

to establish capability. One commenter suggested that the required

skills for those other than EMT's be limited to ``basic first aid such

as for breathing, bleeding, and shock.'' This recommendation would

exclude patient assessment and treatment of wounds, burns, breaks,

sprains, and strains. MSHA's experience is that the injuries that occur

in mines require assessment and treatment skills; the final rule,

therefore, retains the proposed skill requirements, except as discussed

below.

This commenter also said that a good procedure for obtaining

``outside medical assistance'' should be emphasized. Separate existing

standards, however, already require operators to have suitable

emergency communications and arrangements for obtaining medical

assistance (Secs. 56/57.18012, 18014).

One commenter suggested that cardiopulmonary resuscitation (CPR) be

[[Page 50435]]

added to the list of required skills. The commenter suggested that

firefighting, extrication, and evacuation also be included. The ability

to perform CPR competently can require additional patient assessment

skills, physical dexterity, and endurance. Traditionally, CPR training

has been a supplement to first aid training and is not always offered

with first aid.

The final rule does not require that first aid skills include CPR.

Mine operators are encouraged, however, to add skills which are

considered appropriate to their workforce and environment. Likewise,

the final rule does not include the suggestion that persons be

specially trained in firefighting, extrication, or evacuation. This

suggestion exceeds the scope of first aid. In addition, existing

standards require operators to train miners in these areas.

One commenter recommended that the individuals capable of providing

first aid be able to treat injuries from hazardous liquids and gases.

The final rule requires skills for treatment of injuries from any

source or cause. Skills in patient assessment and artificial

respiration and treatment of shock and burns would have direct

application to injuries from hazardous liquids and gases.

The proposed rule would have required an individual to have the

skills to handle and transport injured persons. One commenter stated

that transportation is no longer taught in the American Red Cross's

basic first aid course. The commenter pointed out that when

transporting an injured person, particularly one with a neck or spinal

injury, there is the potential to cause greater harm and possible

paralysis. The commenter suggested that the handling and transportation

of injured persons be deleted from the required skills under the final

rule.

MSHA agrees that mishandling and improper transportation of a

victim with a serious neck or spinal injury presents a high potential

to exacerbate the injury. The American Red Cross does not currently

include separate instruction on transportation and handling of the

injured in its standard first aid course, although it furnishes

guidance about these subjects in an informational section of its

textbook. The American Red Cross teaches that one of the most dangerous

threats to any seriously injured victim is unnecessary movement.

Further, the National Safety Council's course emphasizes that injured

persons should be moved only if they are in immediate danger from their

environment.

Special training, experience, dexterity, and strength are often

required to successfully handle or transport a victim with an injured

spine. Emergency medical personnel have the skills to successfully

handle and transport victims in these cases. Improvements in

transportation and communications, and the widespread availability of

emergency service present an alternative that MSHA believes is more

protective of miner safety. Under current regulations at Secs. 56/

57.18014, operators must make advance arrangements for obtaining

transportation for injured persons and emergency medical assistance

beyond first aid. The final rule, therefore, does not include the skill

requirements for transportation and handling of injured persons

contained in the proposal.

Interested Miners

The second sentence of the existing standard is revised in the

final rule to require that training be available to all interested

``miners'' rather than all interested ``employees.'' This is not a

substantive change and merely conforms the rule's terminology with

other MSHA standards. To comply with the rule, operators must inform

miners of the training in advance, so the miners can plan to attend.

One commenter questioned whether the operator must pay for first

aid training. Consistent with the existing standard, the final rule

requires the operator to make the training available to all interested

miners. Therefore, to encourage the miners' attendance at the course,

the operator must pay ordinary course expenses. The final rule, like

the existing rule, does not address the issue of compensation for the

miner's time.

III. Executive Order 12866 and the Regulatory Flexibility Act

Executive Order 12866 requires that regulatory agencies assess both

the costs and benefits of intended regulations. MSHA has determined

that this rulemaking is not a significant regulatory action

representing additional costs in excess of $100 million to a segment of

the economy and, therefore, has not prepared a separate analysis of

costs and benefits. The Regulatory Flexibility Act requires regulatory

agencies to consider a rule's impact on small entities. For the purpose

of the Regulatory Flexibility Act, MSHA policy defines a small entity

as an operation employing fewer than 20 employees. This final rule

would not have a significant economic impact on a substantial number of

small entities. The analysis contained in this preamble meets MSHA's

responsibilities under Executive Order 12866 and the Regulatory

Flexibility Act.

A few commenters were concerned that the rule would expand training

and personnel requirements beyond part 48 and existing Secs. 56/

57.18010. One commenter stated that MSHA should prepare a regulatory

analysis before proceeding further with the rulemaking.

Operators are currently required to provide supervisors trained in

first aid who, by virtue of their position, work with and are available

to the workforce. There may be some operators, however, who have not

provided this first aid coverage for the miners on all shifts under the

existing rule. These operators may incur some additional costs to

comply with the final rule. These costs, however, would be minimal and

offset by the flexibility provided in the final rule.

The final rule incorporates the National Mining Association's

petition for rulemaking and broadens the scope of persons who can

provide the first aid capability required by the standard. A mine

operator can rely on existing, non- supervisory personnel who possess

these special skills. Accordingly, MSHA has determined that this rule

will not result in any significant costs to the mining industry.

IV. Paperwork Reduction Act

This final rule contains no information collection or paperwork

requirements subject to the Paperwork Reduction Act of 1995. The

compiling and maintaining of records or other documentation of a

miner's first aid training is incurred by mine operators in the normal

course of their business activities. The burden associated with such

usual and customary business records are excluded from the information

collection burden under 5 CFR 1320.3(b)(2) (60 FR 44985).

One commenter maintained that the rule would represent a

significant burden by virtue of increased paperwork. It was suggested

that MSHA accept a certification by the mine operator as sufficient

evidence of the training. Currently, MSHA determines compliance with

the existing requirements by reviewing documentation already kept by

the mine operator, particularly course records. MSHA accepts available

documentation, such as course completion certificates, diplomas,

letters from a qualified instructor, or similar evidence. Under the

final rule, MSHA would continue this practice.

V. Unfunded Mandates Reform Act

Title II of the Unfunded Mandates Reform Act of 1995, Pub. L. 104-

4,

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requires each Federal agency to assess the effects of Federal

regulatory actions on state, local, and tribal governments and the

private sector, other than to the extent such actions merely

incorporate requirements specifically set forth in a statute, and to

determine if the rule might significantly or uniquely affect small

governments. MSHA has concluded that small governmental entities are

not significantly or uniquely impacted by this regulation. The final

rule will impact about 10,800 metal and nonmetal mining operations of

which about 400 sand and gravel or crushed stone operations are run by

state, local, or tribal governments for the construction and repair of

highways and roads. These entities may incur some additional costs to

comply with the final rule. These costs, however, would be minimal and

offset by the flexibility provided in the final rule. Notwithstanding

this conclusion, MSHA will mail a copy of the final rule to these 400

entities.

List of Subjects in 30 CFR Parts 56 and 57

Emergency medical services, Metal and nonmetal mines, Mine safety

and health.

Dated: September 18, 1996.

J. Davitt McAteer,

Assistant Secretary for Mine Safety and Health.

Parts 56 and 57, subchapter N, chapter I, title 30 of the Code of

Federal Regulations are amended as follows:

PART 56--[AMENDED]

1. The authority citation for part 56 continues to read as follows:

Authority: 30 U.S.C. 811.

2. Section 56.18010 is revised to read as follows:

Sec. 56.18010 First aid.

An individual capable of providing first aid shall be available on

all shifts. The individual shall be currently trained and have the

skills to perform patient assessment and artificial respiration;

control bleeding; and treat shock, wounds, burns, and musculoskeletal

injuries. First aid training shall be made available to all interested

miners.

PART 57--[AMENDED]

3. The authority citation for part 57 continues to read as follows:

Authority: 30 U.S.C. 811.

4. Section 57.18010 is revised to read as follows:

Sec. 57.18010 First aid.

An individual capable of providing first aid shall be available on

all shifts. The individual shall be currently trained and have the

skills to perform patient assessment and artificial respiration;

control bleeding; and treat shock, wounds, burns, and musculoskeletal

injuries. First aid training shall be made available to all interested

miners.

[FR Doc. 96-24720 Filed 9-25-96; 8:45 am]

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