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Addendum - Emergency First Aid at Work

Addendum

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Emergency First Aid at Work

Alignment with 2025 Resuscitation Council (UK) Guidelines

This addendum applies to Emergency First Aid at Work books published prior to the 2025 Resuscitation Council (UK) Guidelines (3rd edition and below) and should be read alongside the existing content.

Introduction

First aid and resuscitation guidance is regularly reviewed and updated by expert panels to ensure it reflects the latest evidence, research, and best practice.

The guidance contained in earlier editions of this Emergency First Aid at Work book was correct and appropriate at the time of publication. Ongoing assessment of outcomes and real-world experience has since identified opportunities to refine and improve the early response to life-threatening emergencies.

The 2025 Resuscitation Council (UK) Guidelines introduce updates that:

  • Encourage earlier activation of emergency services
  • Emphasise the early control of catastrophic bleeding
  • Reinforce rapid recognition and escalation in critical situations

These updates do not indicate that previous guidance was wrong or unsafe. Instead, they build upon existing good practice to help first aiders act more quickly and effectively.

This addendum has been produced to align earlier publications with current guidance.

Useful videos

Short refreshers that support the updates in this addendum.

Amputation

Immediate care and how to preserve an amputated part.

Update to the Primary Survey: DR C ABCDE

Earlier editions of this book refer to the primary survey using DR ABC.

In line with the 2025 Resuscitation Council (UK) Guidelines, the primary survey is now conducted using:

DR C ABCDE

A key change is that emergency services should be contacted as soon as a casualty is found to be unresponsive, before checking for normal breathing.

Updated primary survey sequence

D – Danger
Ensure the area is safe for the casualty, the first aider, and others.
R – Response
Check whether the casualty is responsive using the AVPU scale.
If the casualty is unresponsive, call 999/112 immediately or instruct a bystander to do so.
If available, place the phone on speaker to receive guidance while continuing first aid.
C – Catastrophic (life-threatening) bleeding
Identify and control any severe bleeding immediately using direct pressure or a tourniquet if trained to do so.
A – Airway
Open and maintain the airway.
B – Breathing
Check for normal breathing for no more than 10 seconds. Begin CPR for a non-breathing casualty.
C – Circulation
Look for signs of shock or ongoing bleeding and treat appropriately.
D – Disability

Check the casualty’s level of response and look for signs of neurological impairment or changes in brain function, such as:

  • Confusion or altered behaviour
  • Unequal or unreactive pupils
  • Slurred speech
  • Weakness, numbness, or paralysis (especially on one side)
  • Seizures
  • Signs of stroke or head injury
E – Exposure

You should look for any other injuries or conditions that haven’t already been identified, while also preventing heat loss.

  • Hidden injuries
  • Bleeding you may have missed
  • Burns, rashes, or swelling
  • Medical alert jewellery or devices
  • Preventing hypothermia by covering them up to keep them warm once checks are complete
Affects:
  • Primary Survey – Section 6 (Pages 13–14)
  • Action in an Emergency – Section 5 (Page 12)
  • Adult Basic Life Support overview – Section 11 (Page 38)

Early 999 Call

Emergency services should now be contacted as soon as a casualty is found unresponsive, before breathing is assessed.

Breathing checks should be carried out while on the phone.

Affects:
  • Primary Survey – Section 6 (Pages 13–14)
  • Contacting the Emergency Services – Section 4 (Page 10)
  • Resuscitation and AED – Section 9 (Pages 21–24)

Use of 999 Call Handler Support

First aiders are encouraged to:

  • Place phones on speaker
  • Follow call handler instructions while care begins
Affects:
  • Contacting the Emergency Services – Section 4 (Page 10)
  • Resuscitation and AED – Section 9 (Pages 21–24)

Life-Threatening Bleeding – Priority Update

Life-threatening bleeding is now prioritised before airway and breathing on arrival at a scene, in line with updated UK Resuscitation Council guidance.

For Emergency First Aid at Work (EFAW), first aiders are trained to:

  • Recognise life-threatening bleeding
  • Apply direct pressure to control bleeding
  • Call 999 at the earliest opportunity
  • Follow 999 call handler guidance while care is ongoing

More advanced bleeding control techniques (wound packing and use of tourniquets) are not included within the EFAW syllabus unless delivered as additional training.

Affects:
  • Primary Survey – Section 6 (Pages 13–14)
  • Wounds and Bleeding – Section 13 (Pages 42–48)

Agonal Breathing

Greater emphasis that:

  • Gasping or agonal breathing is not normal breathing
  • CPR must not be delayed
Affects:
  • Breathing Assessment – Section 6 (Page 14)
  • Resuscitation and AED – Section 9 (Pages 21–24)

Updated Chain of Survival

The 2025 European Resuscitation Council (ERC) Guidelines place increased emphasis on the Chain of Survival, which describes the sequence of actions that give a casualty the best chance of survival following cardiac arrest.

The Chain of Survival

Early recognition and call for help
Prompt recognition of collapse, unresponsiveness, or abnormal breathing, and immediate activation of emergency services (999/112).

Early CPR and defibrillation
Immediate CPR if the casualty is unresponsive and not breathing normally, and early use of an AED if available.

Advanced life support and post-resuscitation care
Advanced care provided by emergency services and hospital teams.

Survival and recovery
Ongoing treatment, rehabilitation, and recovery following the emergency.

Affects:
  • Chain of Survival – Section 9 (Page 25)

CPR on Soft Surfaces

First aiders are no longer expected to move casualties from beds or soft surfaces.

Increase compression depth where possible

Affects:
  • Resuscitation and AED – Section 9 (Pages 22–24)

Paediatric CPR

Paediatric CPR is not routinely included within the Emergency First Aid at Work (EFAW) syllabus unless it is delivered as additional training.

Paediatric casualties are defined as ages 0–18 years, with CPR techniques adjusted by age:

  • Infant: under 1 year
  • Child: 1–12 years
  • Adolescent: 13–18 years

The UK Resuscitation Council (RCUK) clarifies that:

  • If the rescuer is trained and competent in paediatric basic life support, the recommended compression-to-breath ratio: 15:2
  • If the rescuer is not trained in paediatric CPR, they should perform: 30:2

This approach prioritises simplicity, early action, and consistency, reducing hesitation in an emergency.

Where paediatric CPR training is provided in addition to EFAW, this may also include:

  • 5 initial rescue breaths
  • The two-thumb encircling chest compression technique for infants
Affects (where paediatric content is included as additional training):
  • Paediatric Resuscitation – Section 9 (Pages 30–32)

AED Pad Placement & Clothing

  • Correct pad placement
  • Removing or repositioning bras where required
  • Life-saving actions taking priority over modesty
Affects:
  • Defibrillation – Section 9 (Pages 26–29)

Amputations

  • Wrap amputated part in a clean, damp cloth (water or saline)
  • Place in a waterproof bag
  • Then place the bag in ice
Affects:
  • Wounds and Bleeding – Section 13 (Pages 42–48)

Drowning & Rescuer Safety – Additional Training Only

Drowning recognition, rescue, and in-water response are not normally covered within the standard Emergency First Aid at Work (EFAW) syllabus.

Where drowning awareness or rescue content is delivered in addition to EFAW, updated guidance places increased emphasis on:

  • Rescuer safety as the absolute priority
  • Avoiding unnecessary personal risk
  • Using flotation or buoyancy aids wherever possible
  • Avoiding entering the water unless it is safe and unavoidable

First aiders should be reminded that:

  • Entering the water to attempt a rescue can place them at serious risk
  • Emergency services should be contacted at the earliest opportunity
  • Use reach / throw principles rather than go, where possible
Affects (only where drowning content is included as additional training):
  • Drowning – Section 9 (Page 33)
  • Action in an Emergency – Section 5 (Page 12)

Post-Incident Self-Care

Guidance on supporting first aider wellbeing after an incident.

Recognising emotional and psychological responses.

Encouragement to access support where needed.

Affects:
  • Responsibilities of a First Aider – Section 4 (Pages 8–11)
  • Clearing Up Process – Section 4 (Page 11)

This addendum updates earlier editions of the Emergency First Aid at Work book to align with current Resuscitation Council (UK). All other guidance within the original publication remains valid when read alongside this update.