EFA Standard Version 1.0 PDF

ENHANCED FIRST AID
(EFA)
ONSHORE/OFFSHORE
Version 1.0
01 October 2018
GWO | ENHANCED FIRST AID
CONTENTS
LIST OF ABBREVIATIONS ............................................................................................4
CHANGE LOG .............................................................................................................5
SCOPE ......................................................................................................................6
GENERAL REQUIREMENT TO GWO ENHANCED FIRST AID .................................................7

Target group ................................................................................................................... 7
Aims and strategic objectives ............................................................................................ 8
Conformity with other Training .......................................................................................... 8
Legal requirements .......................................................................................................... 8
Duration and organisation of EFA Module ............................................................................ 8
Validity period ................................................................................................................. 9
Delegate prerequisites for the EFA ..................................................................................... 9
EFA Refresher Training ..................................................................................................... 9
Physical demands ............................................................................................................ 9
GENERAL RESOURCES REQUIRED TO DELIVER EFA MODULE .......................................... 11

Instructors .................................................................................................................... 11
Facilities and Equipment ................................................................................................. 11
Theory training facilities.................................................................................................. 11
Practical training facilities................................................................................................ 11
Training Equipment ........................................................................................................ 12
UNDERSTAND GWO LEARNING OBJECTIVES ................................................................. 13

Taxonomy ..................................................................................................................... 13
ADMINISTRATION AND CERTIFICATION OF EFA MODULES ............................................. 16

Administrative arrangements ........................................................................................... 16
Delegate performance assessment ................................................................................... 16
Requirement to upload training record in WINDA ............................................................... 16
Training Providers own Records and Certificates issue ........................................................ 17
MODULE - ENHANCED FIRST AID ................................................................................ 18

1.1 Aims and objectives of the EFA Module ....................................................................... 18
1.2 Duration of the EFA module ....................................................................................... 19
1.3 EFA Trainer/Delegate Ratio ........................................................................................ 19
1.4 Equipment for the EFA module ................................................................................... 20
1.5 EFA Time Table ........................................................................................................ 21
1.6 Detailed description of the EFA Module ........................................................................ 23
Lesson 1 - Introduction ................................................................................................... 24
Lesson 2 - Risks/Hazards/Legislation ................................................................................ 25
Lesson 3 - Anatomy ....................................................................................................... 27
Lesson 4 - Management of an incident - Emergency Response - Medical Teleconsultation ....... 29
Lesson 5 - Lifesaving and Enhanced First Aid using primary and secondary survey ................. 32
Lesson 6 - Pain management and further possible medication ............................................. 41
Lesson 7 - Scenario-Based training .................................................................................. 43
Lesson 8 - Evaluation ..................................................................................................... 45
1.7 Delegate Performance Assessment ............................................................................. 46
ANNEX 1 - DELEGATE ASSESSMENT FORM (TEMPLATE) ................................................. 47
GLOBAL WIND ORGANISATION

www.globalwindsafety.org
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ANNEX 2 - MEDICAL SELF-ASSESSMENT FORM (TEMPLATE) ........................................... 49
ANNEX 3 - EFA GUIDELINE: RECOMMENDATIONS ......................................................... 50

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LIST OF ABBREVIATIONS
AED Automatic External Defibrillator
AHA American Heart Association
ANSI American National Standards Institute
AS/NZS Australia and New Zealand Standard
BEFAR Basic Safety and Enhanced First Aid Training Refresher
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
WTG Wind Turbine Generator

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CHANGE LOG
Table 1 - Change Log

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SCOPE
The Global Wind Organisation (GWO) is an association of Wind Turbine owners and
manufacturers with the aim of supporting an injury-free work environment in the wind
industry. An objective of GWO is to develop common industry training and best practice
Standards for health and safety as a vital and necessary way forward to reduce risks for
personnel in the wind industry working on site and to reduce environmental risks across
Europe and the globe.
This Standard has been developed in response to the demand for recognizable Enhanced
First aid (EFA) training in the industry and has been prepared in co-operation between
the members of GWO based on risk assessments and factual incident and accident
statistics pertaining to the installation, service, and maintenance of wind turbine
generators and wind power plants.
This Standard describes the requirements for Enhanced First aid training that are
recommended by the members of GWO. The members of the Global Wind Organisation
(GWO) recognize trained persons as competent within EFA in the wind industry. GWO
accepts the trained person as possessing the required knowledge, skills and attitude to
provide ongoing care to an ill or injured casualty over a short period of time while
waiting for professional emergency rescue teams to arrive.
Training is verified through the GWO database WINDA
Where national legislation sets higher requirements for the specific training, the Training
Provider shall incorporate these requirements into the training program.
Additional training may be required for company or country specific reasons.
This standard has been developed by the GWO Training Committee. Disputes and
potential non-conformities should be brought to the attention of the GWO Audit and
Compliance Committee.
The standard has been approved by the GWO Steering Committee.

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GENERAL REQUIREMENT TO GWO ENHANCED FIRST

AID
The Enhanced First Aid offers two options to attend the training - see below figure 1.
New technicians can enter via the main EFA training which consists of Basic First Aid
(FA) and EFA elements and two certificates FA and EFA will be issued.
If you already have a GWO Basic First Aid (or refresher) FA (or FAR) certificate, you
have the option of taking the Refresher First Aid (FAR) combined with EFA training
elements and you will also receive two certificates EFAR and EFA after successful
completion of the training.
Figure 1 - Chart of EFA training process
• Delegates can join the main EFA training without prior basic FA training
• The Enhanced training EFA or EFAR includes all elements of the FA(R) training
module
• At the end of the training the Delegates receive both a FA(R) and EFA(R)
certificate
Target group
Personnel who will be working in the wind industry or related fields, and who will have
duties to fulfil in a wind turbine environment, as well as usually being in physical contact
with a wind farm environment or an offshore wind structure.
Personnel that is selected by their employer to perform Enhanced First Aid onshore or
offshore, where training according to the GWO Enhanced First Aid training may enable

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them to react to incidents and thus mitigate the results of casualties deriving from the
identified risks.
The Annex 3 - EFA Guideline: Recommendations has been developed to assist employers
in determining who and how many should take the training.
Aims and strategic objectives

The EFA Training shall enable Delegates to support and care for others working in the
industry by possessing the knowledge, skills and attitude of Enhanced First Aid. Upon
completion of the GWO EFA training Delegates 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.
Conformity with other Training

The GWO EFA standard sets out minimum requirements.
The modules, learning objectives, lessons and elements may be delivered in the order
that fits best for the specific training situation.
Provided the minimum requirements of the EFA are met the Training Provider may
choose to incorporate delivery of other similar certified training or cancel particular
elements.
Legal requirements
The Training Provider shall identify whether national legislation sets additional
requirements for Enhanced First aid, or prohibits delivery of certain elements.
If so, the Training Provider shall incorporate these identified requirements in the
training.
Duration and organisation of EFA Module

Table 2 - Duration of Modules
Modules Duration (hours)
EFA 24 hours
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.

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Validity period
The EFA 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 certificate’s 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 Delegate is only allowed to attend a refresher course in the EFA Training prior to the
date of expiry on the current certificate or training records.
If a certificate or training record is expired, the Delegate must attend the full Enhanced
First Aid training to obtain new training records in Basic and Enhanced First Aid.
The validity period is automatically calculated in WINDA by entering the course

completion date.
Table 3 - Certificate Validity of Course/Modules
Course/Modules Certificate Validity (Months)
Enhanced First Aid 24 months
Delegate prerequisites for the EFA

All personnel participating in the Enhanced First aid shall be medically fit and capable of
fully participating.
Training providers shall have a procedure that requires Delegates to sign a statement
stating that they are medically fit to participate in the training and that they do not
suffer from any medical illness or are under influence of any narcotic substance or
alcohol. The Annex 2: Medical Self-Assessment Form shall be used if no other equivalent
procedure is in place.
Delegates’ signatures testifying to their medical fitness shall be collected prior to the
start of the Enhanced First aid course.
Furthermore, Delegates shall have created a personal Delegate profile in WINDA and
provide their own WINDA ID prior to completing the EFA training.
EFA Refresher Training

The GWO EFA training is to be refreshed continuously and regularly within 24 months in
a total duration of 2 days supported by relevant drills and exercises ref. Annex 3: EFA
Guideline: Recommendations.
Physical demands
EFA Modules may potentially be physically demanding.

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If there is any doubt regarding the medical fitness of any Delegate, the Training Provider
shall stop training the Delegate and seek a physician’s advice.
Note: Practical exercises shall be designed and delivered solely to meet this Standard
and shall not place any physical or mental demands on the Delegates other than those
required to meet this Standard.

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GENERAL RESOURCES REQUIRED TO DELIVER EFA

MODULE
The Training Provider shall ensure that Staff, facilities and equipment are in place to
support the training of Delegates.
Instructors
Instructors shall:
• Be trained in instructional/lecture techniques and/or have documented instructional/

teaching experience.
• Be continually trained medically and educationally in adequate time intervals
• Be included in an on-going training program, which includes visits to onshore and/or

offshore wind turbine generators (WTG) (tower, nacelle, hub) prior to instructing
Enhanced First Aid training, to enable them to maintain and update skills related to
the courses they instruct. Instructors shall physically visit the tower, nacelle and hub
of WTGs
• Have practical knowledge and demonstrable competence in pre-hospital emergency

care with evidence of practice e.g. a valid certificate for practicing a pre-hospital
functions as medical technician or similar
• Have knowledge of teleconsultation
All Staff shall possess the appropriate competencies to conduct/assist the elements of
training they have been assigned to.
Facilities and Equipment

The full range of facilities and equipment relevant to the modules delivered shall be
available during the training. The following facilities criteria shall be adhered to.
Theory training facilities

Facilities shall be designed to enable each Delegate to see, hear and fully participate in
the taught subject matter.
Practical training facilities

All facilities shall be maintained and where appropriate, inspected and tested in
accordance with current national legislation and manufacturers’ recommendations.
Risk assessments shall be conducted and documented for all training facilities. The
Training Provider shall hold the required permits to operate the facilities.
The learning process during "scenario-based training" is facilitated by identical or

comparable elements comparing the training environment and the delegates’ working
environment. Identical or comparable elements enhances the application of what is
learned.

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The practical training facilities and a training environment are expected to incorporate as
many identical or comparable elements to a real wind turbine working environment as
possible.
The objective is that the practical training facility should enable each Delegate to
individually and/or as part of a team, see, hear and practice the taught subject matter in
such a way, that it resembles the working practices in a real wind turbine environment.
The facilities shall enable training to be executed by doing relevant work tasks end-to-
end under realistic simulated working procedures, and/or realistic simulated emergency
situations (fire, first aid, evacuation or casualty rescue) end-to-end scenarios in a real or
simulated wind turbine environment.
Training Equipment
The required equipment for training shall be available and shall fulfil national legal
requirements.
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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UNDERSTAND GWO LEARNING OBJECTIVES
The described learning objectives (expected learning outcome) are the foundation of the
course contents and what the delegate performance assessment must be based upon.
Traditionally learning objectives are prepared within three different domains of learning
– knowledge, skills and attitude. A learning objective describes the expected learning
outcome on completion of a module or a course, within one or more learning domains.
If a learning objective is related to more than one domain of learning, e.g. to knowledge
and skills, one learning objective per learning domain is often prepared – to enable a
better understanding of the learning objective.
The GWO Training Provider may apply teaching methods (didactics) that are appropriate
to the course participants prior training, education and cultural backgrounds, but should
always aim to provide course participants ample possibility to perform hands-on
demonstrations and learning reflection.
Taxonomy
To formulate a measurable learning objective, taxonomy is used to describe the level of
expected learning outcome within a learning domain.
As an example belonging to the learning domain of knowledge, to have a delegate name

or recognize something, as oppose to have him explain it in his own words, or even
apply or demonstrate what he has learned – describes different performance levels, i.e.
different taxonomy levels.
Different taxonomies are associated with different learning domains, for instance:
Knowledge: such as Bloom’s “cognitive taxonomy”

• Intellectual knowledge, mental skills and procedures
Skills: such as Simpson’s “psychomotor taxonomy”

• Physical skills, cognitive controlled and observable
Attitude: such as Krathwohl’s “affective taxonomy”

• Attitude and feelings to the learning
Selecting a suitable taxonomy level, an action verb expresses the expected behavior of
the delegate, thus describing the taxonomy level of a learning objective.
Action verbs are usually highlighted in bold in this standard. The table below presents
the three learning domains with taxonomy level 1-3, provided with associated action
verbs applicable in the learning objective wording, defining the taxonomy level. In the
Enhanced First aid standard, the learning objectives are in general described as level 2
or 3.

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Table 4 - Learning domains with taxonomy level 1-3.
Knowledge Skills Attitude
3 Application / Applying Guided response Value
To use in a new situation. Follows instructions to build a Demonstrates belief in the

model. company described
Solving problems by applying process.
acquired knowledge, facts, Using a tool after observing
techniques and rules in a an expert demonstrate Shows the ability to solve
different way. how to use it. problems.
Applying a procedure to a Be able to demonstrate an Informs management on

familiar or unfamiliar task. activity to other learners. matters that one feels
strongly about.
Using a manual to calculate Can complete the steps
and operate. involved in the procedure as Decide worth and relevance
directed. of ideas and tasks.
Action verbs
Apply, Change, Choose, Action verbs Action verbs
Compute, Modify, Operate, Accomplish, Achieve, Argue, Challenge, Confront,
Practice, Prepare, Schedule, Calibrate, Complete, Control, Complete, Debate, Criticize,
Solve, Write. Demonstrate, Perform, Justify, Join, Propose.
Refine, Show.
2 Comprehension / Set Respond

Understanding
Awareness or knowledge of Completing work
Construct a meaning from the ability needed assignments with highly
instructional messages, to use the skill. respect
including oral, written and to the agreement.
graphic communication. Carry out tasks from verbal
or written instructions. Participating in team problem
Demonstrating basic solving activities.
understanding of facts and Showing eagerness to
ideas. assemble components to Questions new ideas and
complete a task. concepts in order to fully
Explain in your own words understand them.
the steps of performing a Knows and acts upon a
complex task. sequence of steps in a Participate actively and
process. respectful in discussions.
Showing enthusiasm.
Action verbs Action verbs
Action verbs
Classify, Distinguish, Assist, Contribute, Discuss,
Estimate, Explain, Express, Access, Build, Complete,
Conduct, Execute, Present, Question, Report,
Give, Illustrate, Indicate, Respond, Tell, Write.
Locate, Predict, Summarize, Implement, Operate,
Translate. Perform, Recreate.
1 Knowledge / Perception Receive

Remembering
Watch instructor and repeat Listening to discussions of
Memory of facts, action, process controversial issues
terminology, rules, or activity. with an open mind.
sequences, procedures, etc.
Respecting the rights of
Locating knowledge in long- others.
term memory and retrieving

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relevant knowledge from Recognizing sounds or Listen to others and

long-term memory. pictures that indicate certain remember their
functionalities. opinions.
Action verbs
Arrange, Define, Describe, Estimate the event of a Be positive and creative to
Find, Identify, List, Name, certain function and be what is being taught.
Outline, Recognize, Relate, prepared for it.
Action verbs
Recall, Retrieve.
Action verbs Ask, Be open to,
Attempt, Copy, Duplicate, Concentrate, Discuss, Focus,
Follow, Organize, Repeat, Follow, Listen, Reply, Take
Sketch, Replicate, part.
Reproduce.
Note: Higher taxonomy levels exist.

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ADMINISTRATION AND CERTIFICATION OF EFA

MODULES
Administrative arrangements
Appropriate for the enrolment and certification of Delegates and all aspects of the
delivery of training shall be in accordance with this Standard.
Delegate performance assessment

Delegates will be assessed by means of direct observation and supplementary oral
questions where appropriate (formative evaluation).
Throughout the entire course the instructor will enforce the Delegate Assessment Form
(see annex 1) and adhere to it, accordingly, with a high focus on evaluating the
Delegate’s practical skills.
The Trainer keeps a Delegate Assessment Form (or adaptation) for each Delegate until
the completion / evaluation of the EFA Module.
The Delegate Assessment Form (or adaption) is a final evaluation tool for the instructors
to assess Delegates during practical elements. It allows measurement of the number of
violations in regard to safety, competency, or attitude.
It shall be used as a progressive evaluation tool to discuss the performance of a

Delegate in guiding them to success and it also serves as supporting documentation if a
Delegate passes or fails the Module. If a Delegate fails to meet the demands of the EFA
module, they shall attend a new EFA Module.
Training Provider may adapt the Delegate Assessment Form to other media. Training
Providers shall have a documented procedure in place for dealing with Delegates not
meeting the stated learning outcomes.
Requirement to upload training record in WINDA

Training Providers are responsible for uploading a record of training to WINDA, the GWO
online database of training records. This must be done as soon as possible and no later
than 10 working days after completion of the training program.
Each record shall contain the following:
1) Delegate’s WINDA ID
2) Course code
3) Course completion date
Course codes:
Enhanced First Aid: EFA

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Training Providers own Records and Certificates issue

The Training Provider shall in accordance with the criteria for Training Provider maintain
own records of Delegates.
Upon request from GWO or any of the members of GWO, the Training Provider shall be
able to verify the training and competence records of any specific personnel either
attending a course and/or performing training of a course by name and nationality.
Training providers may issue other additional proof of training, e.g. as paper certificate
or plastic cards. If the training provider chooses to do so, it is recommended (not a
requirement) to include the delegate WINDA id.

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MODULE - ENHANCED FIRST AID
1.1 Aims and objectives of the EFA Module
The aim of the module is to enable the Delegates to support and care for others working
in the industry by possessing the knowledge, skills and attitude of Enhanced First Aid.
Upon completion of the GWO EFA Delegates 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.
The EFA Module shall ensure that the following objectives are covered:
• Local legislation/risks/hazards and demands to ensure knowledge of the roles,

responsibilities and rules that apply to Enhanced First Aid in Remote Areas
• 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 according to European Resuscitation Council (ERC) and American Heart
Association (AHA) guidelines
• Identifying and explaining normal function, normal signs and symptoms of serious
and minor injuries and illness related to the human body
• Demonstrating understanding and correct order of management in an emergency

situation in a Wind Turbine Generator (WTG) environment
• Delivering immediate enhanced first aid to stabilise the casualty, to include but not
limited to:
• Stopping life-threatening bleeding

• Establishing and maintaining an airway
• Knowing the indications for and the use of Automated External Defibrillator (AED)
• Using basic and advanced First Aid equipment in a First Aid scenario
• Resuscitation
• Using standardised methodologies, specifically
the Primary and Secondary Survey - based on the "C"-A-B-C-D-E principle
• Assessing the casualty, for injury or acute illness, to determine if medical advice and
external-to-incident support is required; to include but not limited to:
• Life-threatening bleeding, circulatory disorder

• Impaired consciousness
• Compromised airway, breathing, too slow or too fast
• Immediate life-threatening illnesses and other health problems especially with
severe pain
• 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 through National resources (e.g. Coastguard)

• Telemedical consultation through private contractor (where established)

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• Requesting immediate medical/rescue assistance providing a concise and relevant

report of the casualty’s condition
• Preparing the casualty for transfer to nominated evacuation/rescue point, including:
• Immobilisation where required or other non-medical mitigation e.g. cooling gels

• Understanding the complexity and restrictions of medical pain relief and the role
of clinical governance in the control of medication
• Accompanying the casualty, if required, to suitable medical facility and formally
hand over the casualty
• Escorting the casualty to the nominated evacuation/rescue point providing
continued enhanced first aid
• Acting as a leader in first aid situations
• Administering 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, while having particular regard
for personal-protection
1.2 Duration of the EFA module

The optimal total time for completing this EFA Module is estimated to be 24 hours,
including meals and breaks.
This EFA training shall focus on the access and egress conditions encountered in wind
turbine environments. The practical skills shall be trained and demonstrated in a
restricted area of movement and all elements of the course shall be covered by
demonstration and practical exercises, where possible.
If this training is part of a program of longer duration, the total contact time per day
shall not exceed 8 hours and the total training day shall not exceed 10 hours.
The total training day includes contact time, refreshment and meal breaks and travel
between training sites, where applicable.
It shall be ensured that everyone is given the opportunity to share their opinions and
experiences, where possible. Delegates with prior experience shall be able to share their
experiences related to First Aid in a way that is constructive for the entire class.
1.3 EFA Trainer/Delegate Ratio

• The ratio shown for theory sessions indicates the maximum number of Delegates
that can attend the course.
• The ratio shown for practical sessions indicates the maximum number of Delegates
to be supervised by one instructor during each activity.

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Module Session Trainer –

Delegate Ratio
Theory 1:12
EFA module
Practical 1:6
1.4 Equipment for the EFA module

The following equipment is required during the entire duration of the training to meet
the needs of the EFA module:
1) Torso anatomy dummy
2) Airway model
3) Resuscitation dummies - adult and child (e.g. for ventilation, laryngeal tubes, AED
use, immobilization)
4) First Aid equipment
5) First Aid bag
6) Make - up kit for First Aid scenarios
7) AED (Automated External Defibrillator) according to national best practise
8) Bag valve mask incl. accessories, national best practise airway devices e.g. laryngeal
tubes (sizes. 4/5), supraglottic airway device, oropharyngeal tube, manual suction
device
9) Pulse oximeter for heart rate monitoring
10) Trauma pressure dressing, haemostatic agents/dressings, tourniquet
11) Eyewash fluid
12) Medications e.g. analgesic, cooling gel (exercise samples without active ingredients)
13) Splint material, basic immobilisation, pelvic sling, chest seals
14) Cervical immobilizer according to national best practice
15) Blankets and/or chemical active warming blanket
16) Equipment for medical teleconsultation
17) Suitable media (e.g. videos)
18) Stretcher/spineboard
The equipment supplied and used by Staff and Delegates shall follow and comply with
national legislation and the appropriate guideline standards, e. g.:

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Europe - EN UK - BS
USA - ANSI Canada - CSA
Australia and New Zealand - AS/NZS Asia - ANSI / EN
Note: All equipment shall be maintained and where appropriate, inspected and tested in accordance with
current national standards/legislation and manufacturers’ recommendations.
1.5 EFA Time Table

The order in which the elements of this EFA training Module are delivered may vary.
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.
Lesson Element Approximate

Duration (min.)
1 Introduction 1.1 Safety instructions and emergency

procedures
1.2 Facilities
1.3 Introduction
1.4 Scope and main learning objectives
1.5 On-going assessment (Delegate

Assessment Form)
1.6 Motivation
TOTAL 15 min.
2 Risks/Hazards/Legislation 2.1 Risks and hazards
2.2 First Aid guidelines and emergency

plans
2.3 National legislation
2.4 Global legislation
TOTAL 25 min.

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3 Anatomy 3.1 Life conditions for the human body
3.2 Structure, functions and signs - the

human body
3.3 Serious and minor illness - signs,

symptoms, and function
3.4 Understanding of personal hygiene
TOTAL 50 min.
4 Management of an 4.1 Safety awareness in an emergency

incident - National situation
Emergency Response -
Medical Teleconsultation
4.2 Management of an incident
4.3 Emergency Rescue Teams,

Emergency Calls and Medical
Teleconsultation
TOTAL 100 min.
5 Lifesaving and Enhanced 5.1 "C" – A – B – C – D – E – Principle

First Aid using
Primary and Secondary
Survey
5.2 Primary Survey
5.3 “C”: Critical bleeding
5.4 A: Airway
5.5 B: Breathing
5.6 C: Circulation
5.7 Secondary Survey
5.8 D: Disability
5.9 E: Environment/Exposure
5.10 Psychological First Aid

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TOTAL 450 min
6 Pain management and 6.1 Application algorithm

further possible
medication
6.2 Further possible medication
TOTAL 45 min.
7 Scenario-based training 7.1 Practise First Aid techniques
TOTAL 450 min.
8 Evaluation 8.1 Summary
8.2 Evaluation
8.3 Training records
TOTAL 15 min.
GRAND TOTAL 1180 min
1.6 Detailed description of the EFA Module

The learning outcomes specified for EFA are:
Note: The administrative part of the registration should be carried out before the course commences.

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LESSON 1 - INTRODUCTION
15 min.
The aim of this lesson is to give the Delegates the needed awareness of the of the
course content and the facilities involved in order to ensure that all Delegates are aware
of what to expect and what is expected of them during the course.
After this lesson, Delegates will be aware of the following:
• Safety instructions and emergency procedures
• Facilities
• Introduction
• Scope and main learning objectives
• On-going assessment ( Delegate Assessment Form)
• Motivation
ELEMENT 1.1 - SAFETY INSTRUCTIONS AND EMERGENCY PROCEDURES

The Instructor shall explain:
Safety instructions according to internal procedures
Emergency procedures and emergency exits in the localities the Delegates can
be expected to be located during the course
ELEMENT 1.2 - FACILITIES

General description of the facilities on the location (Administration, dining

area, restrooms, toilets, etc.)
ELEMENT 1.3 - INTRODUCTION

The Instructor shall give:
A short introduction, including their backgrounds as instructors
Delegates shall give:
A short introduction, including job function and expected primary geographic

work location
The programme of the EFA Module, including breaks and meal times

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ELEMENT 1.4 - SCOPE AND MAIN LEARNING OBJECTIVES

Scope and main objectives of this EFA Module
ELEMENT 1.5 - ON-GOING ASSESSMENTS (DELEGATE ASSESSMENT FORM)

1.5.1 The reasons for the on-going assessment
1.5.2 GWO Delegate Assessment and their use
ELEMENT 1.6 - MOTIVATION

The importance of personal involvement in the course
The definition and need for correct basic and enhanced First Aid
Chain of Survival
LESSON 2 - RISKS/HAZARDS/LEGISLATION
25 min.
The aim of this lesson is to give the Delegates the needed awareness and to inform them
of the relevant risks/hazards/legislation and demands in order to ensure their
responsibilities and rules that apply to EFA.
To successfully complete this lesson, Delegates shall be able to:
• Distinguish and explain risks and hazards relating to remote areas with dangerous
locations/tasks
• Explain various First Aid guidelines (e. g. ERC and AHA) in the context of (Enhanced)
First Aid in a WTG environment and emergency plans
• Summarize national legislation relevant to (Enhanced) First Aid
• Recognize global legislation relevant to (Enhanced) First Aid
ELEMENT 2.1 - RISKS AND HAZARDS
The Instructor shall lead the group discussion on:
Risks and hazards involved in an incident relevant for job functions within the
wind industry: Difficulties in Management of accidents /emergencies / survival
in remote areas

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Dependency on site organisation, types of activity, work location and

personnel
Onshore
Offshore
Remote areas in general
ELEMENT 2.2 - FIRST AID GUIDELINES AND EMERGENCY PLANS
Basic Life Support guidelines such as from ERC and AHA
Various emergency plans of companies, depending on national regulations
ELEMENT 2.3 - NATIONAL LEGISLATION
The Instructor shall explain (dependent on planned activities/ operation areas of the
delegates):
Applicable legislation
Legislative requirements
Legal responsibilities
Role of Enhanced First Aid in the industry
ELEMENT 2.4 - GLOBAL LEGISLATION
Differences in national regulations between countries
Applicable legislation
Legal responsibilities
The responsibility of entrepreneur and employee for rescue and first aid
The relevance of legislative and normative regulations

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LESSON 3 - ANATOMY
50 min.
The aim of this lesson is to give the Delegates knowledge and skills regarding the human
body. Delegates will be able to identify and explain normal signs and symptoms of
major and minor injuries and illness related to the human body.
To successfully complete this lesson, Delegates will have the knowledge in the following
areas and be able to:
• Understand the life conditions for the human body
• Understand the structure, functions and signs of the human body
• Apply knowledge and skills to detect abnormal signs, symptoms and functions of
serious and minor injuries
• Apply knowledge and skills to detect abnormal signs and symptoms of serious and
minor illness related to the human body
• Recognize the importance of personal hygiene
ELEMENT 3.1 - LIFE CONDITIONS FOR THE HUMAN BODY

Normal life conditions for the human body
3.1.1.1. Human cells and life conditions
3.1.1.2. Cells and Oxygen (O2)
3.1.1.3. Role of carbon dioxide (CO2) on cells
3.1.1.4. Vital organs and their requirements
ELEMENT 3.2 - STRUCTURE, FUNCTIONS AND SIGNS - THE HUMAN BODY

The Instructor shall explain and demonstrate:
Vital systems of the human body
3.2.1.1. Nervous system
3.2.1.2. Respiratory system
3.2.1.3. Circulatory system
3.2.1.4. Other systems

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Nervous system
3.2.2.1. Anatomy of the nervous system
3.2.2.2. Structure, functions and normal signs
3.2.2.3. Threats to the nervous system
Respiratory system
3.2.3.1. Anatomy of the respiratory system
3.2.3.3. Threats to the respiratory system
Circulatory system
3.2.4.1. Anatomy of the circulatory system
3.2.4.3. Threats to the circulatory system
Other systems and vital organs of the human body
3.2.5.1. Anatomy of the vital organs
3.2.5.2. Structure and functions
3.2.5.3. Threats to the vital organs
ELEMENT 3.3 - SERIOUS AND MINOR INJURIES - SIGNS, SYMPTOMS, AND

FUNCTION
Serious injuries
3.3.1.4. Other systems and organs
Minor injuries
3.3.2.4. Other systems

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ELEMENT 3.4 - UNDERSTANDING OF PERSONAL HYGIENE

Personal Hygiene
3.4.1.1. As a first Aider
3.4.1.2. Protection and use of barriers (e.g. masks, gloves) in

emergency situation
LESSON 4 - MANAGEMENT OF AN INCIDENT - EMERGENCY

RESPONSE - MEDICAL TELECONSULTATION
100 min.
The aim of this lesson is to give the Delegates the knowledge, skills and attitude to
demonstrate understanding and correct order of management of emergencies
(accident/illness) in remote areas.
• Understand personal hazards to rescue personnel and victim associated with

emergency situations and apply knowledge and skills for safety awareness
• Perform skills to take FA-measures with regard for personal protection
• Show knowledge about core aspects of psychological care in first aid situations
• Demonstrate understanding and skills to approach and manage different emergency

situations
• Demonstrate understanding of the principles of the ACT Method (Assess,

Communicate, Triage) and recognize the importance of raising the alarm before
starting first aid
• Demonstrate skills on how to ensure the rescue of injured persons and their removal
from the immediate hazard area to the nearest safe location
• Conduct proper emergency calls in a remote situation
• Distinguish and use of the adequate measures given by the chain of survival
• Transfer understanding of functions and support from Emergency Rescue Teams in

WTG environments
• Use clear communication in a team setting
• Administer Enhanced First Aid via medical teleconsultation

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ELEMENT 4.1 - SAFETY AWARENESS IN AN EMERGENCY SITUATION

The instructor shall lead a discussion on:
Appropriate safety behavior and awareness as an Enhanced First Aider in a

WTG
The risks and hazards of working in the wind industry with special focus on
remote locations and the chain of survival
How to spot and stop hazardous emergency situations
Safety and personal protection for all persons involved in an accident
The core aspects of psychological care in first aid situations (e.g. colleagues,
loneliness, unusual emergency situations)
ELEMENT 4.2 - MANAGEMENT OF AN INCIDENT

How to follow an efficient and correct First Aid structure
Analysis and management of an incident
Different emergency situations in the wind industry
Call for help - challenges onshore
Call for help - challenges offshore
Moving or not moving a casualty in different emergency situations (risks of

e.g. fire, water versus deteriorating injuries)
How to move and place a casualty (depending on injuries)
How to move and place a casualty in the recovery position
Delegates shall explain and demonstrate:
How to follow an efficient and correct First Aid structure
Analysis and management of an incident
Different emergency situations in the wind industry
Call for help - challenges onshore
Call for help - challenges offshore
Moving a casualty with two First Aiders
Moving a casualty alone

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ELEMENT 4.3 - EMERGENCY RESCUE TEAMS, EMERGENCY CALLS AND MEDICAL

TELECONSULTATION
Functions of Emergency Rescue Teams (internal onsite or

external as part of the chain of survival)
Cooperation with external professional Emergency Rescue Teams and using

clear communication in a team setting
Challenges for Emergency Rescue Team on site
Skills for supporting professional emergency services
The means of “bridging the time” while waiting for professional help to arrive
The ACT-method: Assess, Communicate, Triage, requiring an emergency call

for assistance before the commencement of first aid and to immediately
recognize when an incident may be a threat to life, or beyond the capability of
those present
The principles of emergency calls in accordance with emergency response

plans
The means and use of medical teleconsultation focusing on the current and
future applicability and technical infrastructure
The administering of First Aid measures via medical teleconsultation
Delegates shall practice and demonstrate:
A proper emergency call in a remote situation
The use of medical teleconsultation and communication media
Performance of First Aid measures in representative work setting comparable

to specific remote locations including the use of medical teleconsultation

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LESSON 5 - LIFESAVING AND ENHANCED FIRST AID USING

PRIMARY AND SECONDARY SURVEY
450 min.
The aim of this lesson is to give the Delegates knowledge, skills and steps to follow a
methodical sequence to identify and treat life threatening time critical injuries and
illnesses. Delegates shall be able to demonstrate correct use of Lifesaving and Enhanced
First Aid using the "C"-A-B-C-D-E principle during primary and secondary survey
supported by teleconsultation. Further aim of this lesson is to give the Delegates
confidence and skills to be able to deliver immediate enhanced first aid to stabilize the
casualty and to perform basic life support with the help of additional FA equipment, such
as supplemental respiratory aids and the use of an Automatic External Defibrillator
(AED). Delegates shall receive the knowledge and skills to be able to assess, assist and
provide the necessary First Aid to special incidents frequently occurring after
injuries/accidents or during illnesses.
• Understand the principles of Primary and Secondary survey
• Assess a casualty using the Primary and Secondary Survey
• Immediate First Aid actions using Primary and Secondary Survey and the "C"-A-B-C-
D-E- principle
• Treatment of Catastrophic external haemorrhage "C" critical bleeding
• Deliver correct First Aid for obstruction of airways - establish and maintain an airway
• Implement the required recovery position, dependent on the status
• Correct First Aid to an unresponsive and breathing/not breathing casualty
• Perform Cardiopulmonary Resuscitation (CPR)
• Understand the capabilities, the different technical specifications and safe use of
AEDs
• Understand the enhanced use of AED through help of medical teleconsultation
• Provide knowledge of the benefits of airway management devices during

resuscitation (resuscitation bag incl. accessories, pocket mask, laryngeal tube)
• Apply techniques to assess circulation (e.g. pulse oximeter for heart rate monitoring)
• Deliver correct First Aid for external and internal bleeding
• Deliver correct First Aid for shock
• Identify signs and symptoms of serious and minor injuries and illnesses
• Deliver Enhanced First Aid for acute illnesses of deteriorated disorders/diseases

which are critical in terms of time
• Understand psychological First Aid

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ELEMENT 5.1 - THE "C"- A-B-C-D-E- PRINCIPLE

Meaning of the "C"- A-B-C-D-E- principle
Procedure of Primary and Secondary Survey
ELEMENT 5.2 - PRIMARY SURVEY

Conditions and procedure of Primary survey comprising assessment of risks

and threats for First Aider and victim, safety awareness, rescue measures,
emergency call
First approach using the “C”-A-B-C-D-E-principle as steps to follow a

methodical sequence to identify and treat life threatening time critical injuries
and illnesses
Check for response ("look, listen, feel") to find out: alert - voice/pain
responsive - unresponsive
The Delegates shall practice and demonstrate:
Delivering Enhanced Life Saving First Aid using the "C"-A-B-C-D-E principle
during primary survey supported by teleconsultation.
ELEMENT 5.3 - "C" CRITICAL BLEADING

The Instructor shall explain and demonstrate
Haemostasis of Critical/Catastrophic external hemorrhage:
Threat and detection of catastrophic bleeding
Haemostasis using algorithm-oriented procedures
Correct treatment of a casualty with catastrophic external hemorrhage

including the use of normal and enhanced first aid equipment:
o Direct pressure
o Pressure dressings
o Haemostatic agents/dressings
o Tourniquets

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ELEMENT 5.4 - A: AIRWAY

Obstruction of airways, respiratory disorders
Reasons for obstruction of airways, breathing - not breathing
Threats
First Aid to an unresponsive, breathing casualty
Adults and children
Placing of a casualty in the recovery position (lying) and use of the rescue
blanket
The Delegates shall practise and demonstrate:
Checking airways
Response and slowdown of casualties
Removal of occluding objects
Recovery position - single First Aider
Recovery position - two First Aiders
ELEMENT 5.5 - B: BREATHING - CARDIOPULMONARY RESUSCITATION (CPR)

The Instructor shall explain and demonstrate facilitation of breathing:
Casualty position needed to facilitate breathing
Casualties not breathing, unresponsive
Cardiopulmonary Resuscitation (CPR) through the use of training dummies:
Reasons for being unresponsive and not breathing
Threats
Performing CPR on adults - single First Aider

correct use of AED and ventilatory equipment
Performing CPR on adults - two First Aiders

correct use of AED and ventilatory equipment
The capabilities and the different technical specifications of AEDs
AED safety procedures including environment conditions (wet, metallic)
Correct treatment of a casualty who requires ventilatory support including:

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o Use of a pocket face mask

o Use of a bag valve mask
o Use of suction
Correct treatment of a casualty with an obstructed airway using the following

national best practice airway management devices (according to
country/company regulations):
o Oropharyngeal tube (Guedel) and/or

o Supraglottic airway and/or
o Laryngeal tubes (sizes 4/5)
o Bag valve mask resuscitation
o Mouth-mask resuscitation (pocket face mask)
o Placing the laryngeal tube and/or supraglottic airway
Performing CPR on adults - single First Aider correct use of AED and
ventilatory equipment
Performing CPR on adults - two First Aiders correct use of AED and ventilatory
equipment
Treatment of a casualty who requires ventilatory support using advanced First

Aid equipment/airway management devices:
o Bag valve mask resuscitation

o Mouth-mask resuscitation (pocket face mask)
o Laryngeal tube and/or supraglottic airway
Reanimation with correct use of resuscitation equipment and help of medical

teleconsultation, enhanced using an AED as well as inserting supraglottic
airway and/or the laryngeal tube (2 care-giver method)
Note: Resuscitation According to the European Resuscitation Council Guidelines for

Resuscitation
ELEMENT 5.6 - C: CIRCULATION
Instructor shall explain and demonstrate:
Circulation - Assessment techniques
Skin colour
Capillary refilling time
Pulse

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Correct functioning and informative value of a pulse oximeter for heart rate
monitoring
Bleeding, external
Reasons for external bleeding
Threats
Use of advanced First Aid equipment
First Aid when a casualty is bleeding externally
Bandaging
Bleeding, internal
Reasons for internal bleeding
Threats
Use of medical teleconsultation
First Aid when a casualty is bleeding internally
Recurring surveys
Identify and treat shock (see 5.5.6)
Shock
Reasons for shock
Types of shock
Threats
Recurring surveys

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First Aid to shock
First aid treatment of shock
The Instructor shall explain and give examples on:
Acute illnesses of deteriorated disorders/diseases
Heart attacks, strokes, seizure disorders, suspension syncope and other

casualties out of general or internal medicine, which are critical in terms of
time
The reasons, frequency and risks of these diseases
Minor incident in an escalating to a serious incident
FAST-schema (Face, Arms, Speech, Time) as assessment for

stroke
Necessity of support by medical teleconsultation
Discuss the difficulties of EFA
The Instructor shall show the procedure and value of:
Taking care of the casualty / psychological FA-techniques
Contacting professional rescue personnel nearby
Using medical teleconsultation services for advice on pain management and

medication (ref. lesson 6)
The Delegates shall explain and practise:
Assessment of stroke following FAST schema (see 5.6.7.4)
Continuous monitoring of casualty in cases of deteriorated disorders
Early use of medical teleconsultation services

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ELEMENT 5.7 - SECONDARY SURVEY
The general conditions of secondary survey using the A-B-C-D-E - principle

without "C"
The A - B – C - D – E- principle in the context of the secondary survey
The differences between/indications for sitting, lying and shock position

(conscious/unconscious) and the importance of keeping up body temperature
ELEMENT 5.8 - D: DISABILITY
Consciousness
The Instructor shall explain and demonstrate 3 stages of consciousness:
Conscious with adequate reactions to questions and situations, alert
Inappropriate behavior and reactions, but awake (e. g. after stroke, drugs
etc.)
Unconscious without any reactions, unresponsive
The Delegates shall be able to:
Distinguish the 3 stadiums of Consciousness
Perform adequate FA measures
Damages and poisoning through contact with chemical / biological agents
The Instructor shall explain and demonstrate toxic / allergic symptoms of the body:
Assessment of different reactions of the body
Immediate first aid measures
The need of medical teleconsultation for further treatment
The Instructor shall explain and demonstrate superficial chemical burn of skin / eye
injury:
Align with emergency / company physician because of removal/antidote

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Application of bandages and the use of an eyewash bottle
The Delegates shall perform:
Washing/removal procedure and sterile dressing
Application of bandages and the use of an eyewash bottle
Bone fractures and injuries to joints/muscles
The instructor shall explain and demonstrate:
Body check: Examination of the casualty from head to toe (skull, thorax,
upper extremities, abdomen, spinal column, hips, lower extremities)
How to take measures to immobilize and perform proper axial, pain-relieving

positioning
Rest - Ice - Compression - Elevation (R - I -C - E) method
Serious chest injuries and their management, including the use of chest seals
The Delegates shall recognize and assist:
The use of splints, spineboard and other immobilization/stabilization materials

(e.g. pelvic sling)
Positioning with head injuries
ELEMENT 5.9 - E: ENVIRONMENT/EXPOSURE
Hypothermia/Hyperthermia and Heat Stroke
The stages of hypothermia and hyperthermia and the appropriate measures
The difference between heat exhaustion/heat stroke
The use of active warming blankets
Cooling measures for heat exhaustion/heat stroke

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The Delegates shall explain and recognize:
The dangers of hypothermia and how to take appropriate measures
The difference between heat exhaustion and heat stroke
The use of active warming blankets
Drowning and water immersion
Stages and threats of water immersion:
o Cold shock
o Physical incapacitation
o Hypothermia
o Collapse: just before, during, or just after rescue
First aid depending on the symptoms of the casualty:

Continuous monitoring of the causality with the support of teleconsultation
because of possible deteriorating stages
The Delegates shall explain and describe:
Correct actions for those recovered from water immersion
Threats and necessity of medical teleconsultation support
Burn
Cooling measures
Application of a burn dressing
The Delegates shall perform:
Application of a burn dressing

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Bite Wounds
Severe, possible secondary infected bite wounds, e. g. by dogs
Bites for example of bats or raccoons possibly transmitting viral diseases like
rabies
Snake bites with toxins
The Delegates shall be able to:
Distinguish different forms / threats of bites
Know importance of companies OHS strategy depending on assessment on site
Use advice of medical teleconsultation services
ELEMENT 5.10 - PSYCHOLOGICAL FIRST AID

The Instructor shall explain aspects of Psychological First Aid:
Reactions to an unusual situation/ extreme event, and how to mitigate

abnormal reactions
Behaviour to a casualty
To the surroundings and next of kin
LESSON 6 - PAIN MANAGEMENT AND FURTHER POSSIBLE

MEDICATION
45 min.
The overall aim of this lesson is to give the Delegates an understanding of the
complexity and restrictions of medical pain relief and the role of clinical governance in
the control of medication. Depending on enhanced FA-Equipment (especially drugs for
medication on site after release through the emergency-call-physician) EFA can apply
knowledge of legal medication in casualties and administering appropriate medication to
the victims.
Note: Practical content of equipment for EFA should be supplemented at the request of
the company physician, especially application of other medication according to national
regulations.

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To successfully complete this lesson of the EFA Module, Delegates shall be able to:
• Master the application algorithm for pain management
• Administer safe and correct further possible medication via medical teleconsultation
ELEMENT 6.1 - APPLICATION ALGORITHM OF PAIN MANAGEMENT

The instructor shall explain and demonstrate:
Numerical rating scale for pain
Non-medicinal treatment according to the step-scheme of pain relief
Clarification of prerequisites for the application of medicinal pain relief through

the emergency-call physician
Delegates shall be able to demonstrate:
Correct management of a casualty in pain including:
• Assessment of pain using numerical rating scale for pain
• Performance of non-medicinal treatment according to the step-scheme of

pain relief
• Clarification of prerequisites for the application of medicinal pain relief

through the emergency-call physician
• Correctly perform the administering of appropriate analgesia via medical

teleconsultation (integrated in a WTG-related scenario by using a
telecommunication system)
ELEMENT 6.2 - FURTHER POSSIBLE MEDICATION

The general requirements for application of medications in casualties
The knowledge of the action and side-effects of medication, as far as available

for EFA, e.g. analgesia, and if necessary as well as legal, further possible
medications via medical teleconsultation
Clarification of prerequisites for the application of medication after release

through the emergency-call physician (according to national legislation)
Delegates shall be able to demonstrate:
Correct management of medication administering through the use of medical

teleconsultation

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LESSON 7 - SCENARIO-BASED TRAINING

450 min.
The aim of this lesson is to give the Delegates the knowledge and skills to be able to
assess, assist and provide the correct Enhanced First Aid in an incident.
To successfully complete this lesson, Delegates shall, through different scenarios, be

able to demonstrate:
• Managing incidents - approach and assessments
• Correctly assessing, assisting and providing the necessary First Aid in an incident
• Correct use of First Aid equipment
• Act as a leader in first aid situations
• 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, while having particular regard for personal-
protection
ELEMENT 7.1 - PRACTISE FIRST AID TECHNIQUES

Safety procedures in the training area
Safe life - saving First Aid techniques through relevant scenarios according to
the Delegate Assessment Form
The Instructor shall ensure that the following topics are covered during scenario-based
training:
Managing incidents using medical teleconsultation
Providing necessary life-saving First Aid
Correct use of First Aid and advanced emergency equipment
Knowledge of and skills for AED safety procedures
Correct use of an AED and airway management devices
This scenario-based training shall be conducted as group work with one or more
Delegates as Enhanced First Aiders, while the other Delegates act as Casualty /
Casualties or Observer / s. Each Delegate shall, as a minimum, act as Enhanced First
Aider at least one time. Relevant normal and advanced First Aid equipment shall be
available and used at all times during scenario-based training.

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To ensure all of the above-mentioned points are covered during scenario-based training,
Training Providers shall combine several of the following First Aid situations mentioned
below.
At least one scenario must be based on an electrical incident:
• First Aid situations
• Dropped object - serious head injury, unresponsive, breathing
• Fall from heights - external bleeding, unresponsive, breathing
• Serious internal bleeding
• Serious external bleeding
• Unresponsive with normal breathing
• Unresponsive, not breathing
• CPR using an AED
• Seizures
• Asthma
• Stroke (circulatory, respiratory, central nervous system, includes heat stroke)
• Serious burn
• Hypothermia
• Hyperthermia
• Crush injury
• Eye injury
• Electrical accidents minor/serious
• Amputation
• Minor incident escalating to a serious incident
ELEMENT 7.2 - DEBRIEFING
The Instructor shall facilitate debriefing - First Aid situations:
Review positive actions observed during exercise
Suggest points for improvement
The Instructor shall facilitate debriefing - complex incidents with several (2-5)
casualties in wind turbine working environments
Review positive actions observed during exercise
Suggest points for improvement

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LESSON 8 - EVALUATION
15 min.
The aim of this lesson is to enable the Delegates to reflect on and process their learning
outcome and key takeaways from the module, aiming to achieve a high learning transfer
from the module to his/her way of work. Additionally, the aim is to give the Delegates
the opportunity to conduct an open-minded written and oral formative evaluation of the
training.
To successfully complete this EFA Module, Delegates must:
• Show commitment to avoid incidents requiring a rescue operation/First Aid

assistance
• Show commitment to act out this value by demonstrating a pro-active approach and
role model behaviour
• Participate in the formative evaluation of the module in a constructive manner
ELEMENT 8.1 - REFLECTION SESSION

The Instructor shall:
Give the Delegates final feedback on the formal Delegate performance

assessment and inform them whether they have passed (failed Delegates
must be informed individually prior to the reflection session)
Help the Delegate to do a summative self-evaluation, i.e. mentally overview

and assort what is learned, identify key takeaways and bridge the gap
between what is learned during the module and applying it in his/her way of
work. This can be achieved e.g. by an individual reflection session, question
session and/or class discussion
Re-present the overall aims and objectives of the course for the Delegates'
comparison on their learning outcome and meeting of their previously stated
expectations of the course
Give an overall feedback and feed forward on the Delegates' learning outcome
Motivate the Delegates to avoid incidents requiring rescue/first aid efforts

during daily work and demonstrating a pro-active approach and role model
behavior
Delegates shall:
Conduct an online or written formative evaluation of the module, as a

minimum.
Respond on relevant elements of any oral feedback from the Delegates.

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ELEMENT 8.2 - TRAINING RECORDS

Ensure that all Delegates are registered with a personal Delegate profile in
WINDA and have provided their WINDA ID to the Training Provider prior to
completing the training course.
1.7 Delegate Performance Assessment

Assessment of learning outcomes:
Delegates will be assessed according to the learning outcomes stated in the detailed
module description by means of direct observation and supplementary oral questions,
where appropriate.
The assessment shall be conducted by practical scenarios based on the WTG

environment. Each Delegate shall demonstrate the ability to deal with a casualty that is:
1) Unconscious
2) Requires CPR
3) A scenario as detailed in Lesson 8
The formal evaluation of knowledge of above scenarios shall be in accordance with the
Delegate Assessment Form (template provided as Annex 1). The Trainer keeps the
Delegate Assessments Forms until the completion/ evaluation of the EFA Module.
Training Providers shall have a documented procedure in place for dealing with persons
not meeting the stated learning outcomes. If a Delegate fails to meet the demands, they
shall attend a new Enhanced First Aid Module.

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ANNEX 1 - DELEGATE ASSESSMENT FORM (TEMPLATE)
Delegate full name as in passport:
Delegate WINDA ID:
Course module:
Date of completion:
Topics Violation of 0-2 Instructor Remarks

Assessment passed
Measures /3
failed
Scenario Organisation
Aware of personal and

group safety at all times
Organises and utilises

correct equipment for
given scenario
Organises individuals
and groups as required
Scenario
Management
Establishes and
maintains control of the
exercise scenario at all
times
Fully participates in the

exercise scenario
Follows instructions
when required
Demonstrates correct
and safe First Aid
exercise scenario

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Knowledge, skills and

understanding
Applies subject
knowledge correctly in
given scenario
Demonstrates
understanding of
subject
Delivers appropriate
first aid measures
Total Marks 0-9 Pass PASS: ☐ FAIL: ☐

10-27 Fail
Instructor Name (in CAPITAL letters)
Instructor Signature
Training provider

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ANNEX 2 - MEDICAL SELF-ASSESSMENT FORM

(TEMPLATE)
YOUR PERSONAL HEALTH IS YOUR OWN RESPONSIBILITY. YOUR TRAINING PROVIDER

SHALL NOT BE HELD RESPONSIBLE FOR ANY ILLNESS WHATSOEVER DURING OR AFTER
THE TRAINING.
I hereby confirm that I have read and understood the listed risks and potentially life-
threatening medical conditions and that I am physically and medically fit to participate in
GWO Training.
I hereby confirm that there is no factor that will inhibit or affect my participation in GWO
Training. I agree to follow all instructions from the appointed Instructor for the duration
of the GWO Training. Should there be any doubt regarding my medical fitness, the
training provider will stop the training and seek a physician’s advice.
Name as in passport
Delegate WINDA ID
Course module
Signature and date
The following conditions could pose a risk, when you participate in GWO training
• Asthma or other respiratory disorders

• Epilepsy, blackouts or other fits
• Angina or other heart complaints
• Vertigo or inner ear problems (difficulty with balance)
• Claustrophobia/Acrophobia (fear of enclosed area/height)
• Blood pressure disorder
• Diabetes
• Pacemaker or implanted defibrillator
• Arthritis, osteoarthritis or other muscular/ skeletal disorders affecting mobility
• Known allergies (E.g. bee, wasps or spider stings / bites)
• Recent surgery
• Any other medical condition or medication dependency that could affect climbing or
physical impact of climbing

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ANNEX 3 - EFA GUIDELINE: RECOMMENDATIONS
Introduction
Wind turbines are placed in increasingly remote areas, away from established medical
facilities – both offshore and onshore. This can increase the time interval between the
placing of an emergency/distress call and the arrival of professional emergency
responders. The GWO Enhanced First Aid (EFA) Standard has been devised so that wind
turbine technicians have an additional level of first aid training focused on stabilising and
keeping a casualty alive until they are rescued.
Purpose
This training standard provides the foundation for the development of the enhanced first
aid competencies. This document serves as a guideline for when and how GWO members
should implement EFA-training and what special equipment wind technicians should be
trained to use. The decision to employ enhanced first aiders should be the outcome of a
medical risk assessment.
To implement GWO Enhanced First Aid, the employer will need to have the following:
• EFA training
• EFA equipment
• Access to medical teleconsultation services
When to implement EFA training
GWO recommends that implementation of EFA training is based on a risk assessment

(see table 1 below).
In general, all First Aid (FA) requirements for a wind farm will be dependent on the
specific activity being undertaken and an estimation of the likely time interval for either
medical support to reach the site or for the casualty to receive medical support.
Emergency calls and medical teleconsultation support system as a basic

principle
The company/employer emergency plan is a central component of the rescue chain,

especially offshore.
The employer must ensure that in the event of an emergency, it has established lines of
communication between itself and any external emergency control centre or external
facilities such as First Aid, emergency medical care, emergency rescue services and
firefighting.
All personnel must always be able to place an emergency call, from every workstation.
In an emergency, rescue and first aid workers (employed or externally contracted) must
be able to quickly respond to and access the scene of the emergency.

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The employer is also obligated to ensure appropriate transport which may include public
resources in specific cases. Onshore public emergency service facilities are usually
available to provide qualified transportation; however, this may not the case with
offshore.
Delivering EFA must be supported by company/national arrangements ensuring a system

for medical teleconsultation: It is a recommendation that the employer has a robust
telecommunication system - enabling medical teleconsultation support for EFA.
The term 'Teleconsultation' in the context of administering basic and enhanced First Aid
should be seen primarily as guidance, support and assistance provided by an
emergency-call physician to all first aiders and medical assisters in emergencies (Fig. 2).
The goals of teleconsultation are to achieve a qualitative improvement in First Aid and,
in the context of enhanced first aiders, to extend the range of potential measures. As
such, Teleconsultation should be understood as representing an additional structural
element within the existing company rescue service capabilities, aimed at realizing a
qualitatively high degree of patient care.
EFA trained personnel provide a valuable component to meet this requirement. However,
an enhanced first aider is not a medical professional and may have had limited real-life
experience in providing medical intervention. Therefore, he/she will require medical
teleconsultation and in severe cases support from professional medical responders.
Figure 2 - Teleconsultation - support of (enhanced) first aid with respect to

qualifications and approval of medication
Teleconsultation can essentially be grouped into the following components:
• Supporting first and enhanced first aiders in carrying out First Aid measures
• Diagnosing and determining the indication status of the medical measures taken
• Monitoring and supervising the measures taken
• Providing individual as well as psychological support of the (enhanced) first aider
• Ensuring documentation and evaluation

51 / 55
An essential prerequisite for teleconsultation is the availability of adequate information

and communications technology (ICT). The reliability and durability of the ICT deployed
must be assured along with the technical and organisational guarantee of data
protection and data security. The availability of bi-directional and reliable audio
transmissions (e.g. radio, satellite or IP telephony or mobile phones) is not always
sufficient. The possibility for transmitting photos to the consulting physician and the
availability of reliable, at least unidirectional, real-time video transmissions should be the
standard.
So the consulting physician will be able to oversee a patient examination while remaining
informed about the events transpiring on location. The integration of medical-technical
equipment for transmitting and monitoring vital data establishes an essential foundation
for the emergency physician in making decisions about necessary actions. Employers
should provide documented instruction as to the use and deployment of information and
ICT.
Risk Assessment
This chapter provides guidance about reasonable numbers of personnel to be EFA

trained.
In renewable energy installations there are Normally Unmanned Installations (NUI) such
as wind turbines; Manned Installations (MI) like Offshore Support Platforms (OSPs) and
fixed building structures, which will require different FA measures.
The following factors need to be considered 1:
• The nature of work activities performed at the site

• Number of people on site
• Project duration
• Transportation options and availability
• Transportation infrastructure
• Geography
• Climate
• Security
• Characteristics of the working population (e.g. age profile, gender mix, migrant
status, etc.)
In general, in a high-risk situation, basic and enhanced FA as well as paramedic support

may need to be immediately available. In a medium risk situation, basic FA should be
immediately available with Enhanced FA available within a defined time, which is to be
determined by the employer. In a low risk situation, time to provide Enhanced FA may
be prolonged. However, health related considerations alone, may be the driver for
maintaining a heightened Enhanced FA readiness.
In order to decide on the appropriate degree of FA-measures based on the risk
1
IRHC Institute for Remote Healthcare for Energy and associated Maritime activities

52 / 55
assessment it is imperative to take company-work-specific characteristics into account.

The duty of care ultimately lies with company management.
Employers can in justified cases and where appropriate deviate from the measures
recommended in this document, whenever an equally effective alternate measure has
been implemented.
Non-permanent manned installation
In general, each location and activity should be subject to its own medical risk
assessment. The following table shows an example of the output of a medical risk
assessment and the recommended ratio of personnel with EFA-training according to the
level of risk depending on type of activity and work location.
Level of risk Number or ratio of personnel with EFA-training

depending on type of
activity and work
location
High 2 EFA 2:10 ratio 2:10 ratio

EFA
• (De)commissi EFA
oning work
• Large
component
replacement
• New
installation
work
• Replacing
rotors
• Working with
cranes
• Working
under stress
Medium 1 EFA 2 EFA 2:10 ratio

EFA
• Scheduled
work
• Maintenance
work
• Minor
installation
work
Low 0 EFA 1 EFA 2 EFA

53 / 55
• Normal
inspection
work
• Operation
monitoring
<4 4-10 >10
Number of persons on a non-permanently manned

offshore/onshore renewable energy installation
Figure 3 - Table 1 (Example of) Risk Assessment with recommended ratio of EFA-
personnel for a non-permanent manned renewable energy installation
Manned installation
Manned installations, e.g. supply ships, transformer and residence platforms, normally
offer various additional FA-equipment or facilities and special rescue personnel, e.g.
paramedic support.
If, in principle, an increased level of risk exists (see preceding table 1) or at the locations
above, many workers are present for prolonged periods more highly qualified
professional emergency responders and fixed equipment should be allocated.
The emergency capabilities of co-located assets should be considered e.g. other manned
platforms, oil and gas platforms.
Organisational Measures
It is the employer’s duty to ensure, according to the specific national regulations,

coordination between all parties and participants, especially between the company
physician, safety responsible FA-personnel, onsite rescuer personnel and employee
representatives.
This also includes First Aid rendered through external sources, such as public rescue
services, emergency control centres and medical teleconsultation, as commissioned by
the employer.
EFA-Equipment - Personal rescue bag for EFA
This standard recommends work-team-related special EFA-bags are issued containing

the following items:
• Automated External Defibrillator (AED) according to national best practice

• Bag valve mask incl. accessories, national best practice airway devices e.g.
laryngeal tubes (sizes. 4/5), supraglottic airway device, oropharyngeal tube,
manual suction device
• Equipment for medical teleconsultation

54 / 55
• Pulse oximeter for heart rate monitoring

• Trauma pressure dressing, haemostatic agents/dressings, Tourniquet
• Eyewash fluid
• Medications e.g. analgesic, cooling gel
The equipment supplied and used by the instructors and delegates shall follow and
comply with relevant national legislation and the appropriate guideline standards.
The following additional EFA equipment will also be recommended on site:
• Splint material
• Cervical immobilizer and stretcher
• Blanket and/or chemical active warming blanket
For drills and exercises e.g. during mandatory breaks or planned tutorials (see section
‘Drills and Exercises’ in this annex):
• Training dummy (e.g. for ventilation, laryngeal tubes, AED use, immobilization)
• Suitable media for support (e.g. videos)
Drills and Exercises
Frequent practice of EFA competencies will ensure delegates’ capabilities are maintained.
All refresher EFA training is recommended to be combined with further training and
drills.
Employers are encouraged to focus on practice-oriented training, while addressing

offshore/onshore renewable energy installations and specific scenarios therein. For
example, drills and exercises should where possible, be carried out at the workplace e.g.
WTG nacelle.
To supplement the training, local monthly small-scale exercises are recommended with
content and participants altering regularly to ensure all personnel and scenarios are
covered during a defined calendar period, nominally 12 months.
Table top and live exercises with external emergency services should be conducted
regularly. The timing will be determined by the emergency services. As a guide, a table
top every 6 months with a live exercise every 12 months is recommended.

55 / 55

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ENHANCED FIRST AID

LIST OF ABBREVIATIONS ............................................................................................4

CHANGE LOG .............................................................................................................5

GENERAL REQUIREMENT TO GWO ENHANCED FIRST AID .................................................7

GENERAL RESOURCES REQUIRED TO DELIVER EFA MODULE .......................................... 11

UNDERSTAND GWO LEARNING OBJECTIVES ................................................................. 13

ADMINISTRATION AND CERTIFICATION OF EFA MODULES ............................................. 16

MODULE - ENHANCED FIRST AID ................................................................................ 18

ANNEX 1 - DELEGATE ASSESSMENT FORM (TEMPLATE) ................................................. 47

GLOBAL WIND ORGANISATION

ANNEX 2 - MEDICAL SELF-ASSESSMENT FORM (TEMPLATE) ........................................... 49

ANNEX 3 - EFA GUIDELINE: RECOMMENDATIONS ......................................................... 50

GLOBAL WIND ORGANISATION

AED Automatic External Defibrillator

AHA American Heart Association

ANSI American National Standards Institute

AS/NZS Australia and New Zealand Standard

BEFAR Basic Safety and Enhanced First Aid Training Refresher

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

ERC European Resuscitation Council

GWO Global Wind Organisation

WTG Wind Turbine Generator

GLOBAL WIND ORGANISATION

Table 1 - Change Log

GLOBAL WIND ORGANISATION

Training is verified through the GWO database WINDA

Additional training may be required for company or country specific reasons.

The standard has been approved by the GWO Steering Committee.

GLOBAL WIND ORGANISATION

GENERAL REQUIREMENT TO GWO ENHANCED FIRST

Figure 1 - Chart of EFA training process

GLOBAL WIND ORGANISATION

Aims and strategic objectives

Conformity with other Training

Duration and organisation of EFA Module

Modules Duration (hours)

GLOBAL WIND ORGANISATION

If a certificate or training record is renewed outside of two months of expiry, it must

The validity period is automatically calculated in WINDA by entering the course

Table 3 - Certificate Validity of Course/Modules

Course/Modules Certificate Validity (Months)

Enhanced First Aid 24 months

Delegate prerequisites for the EFA

EFA Refresher Training

GLOBAL WIND ORGANISATION

GLOBAL WIND ORGANISATION

GENERAL RESOURCES REQUIRED TO DELIVER EFA

• Be trained in instructional/lecture techniques and/or have documented instructional/

• Be continually trained medically and educationally in adequate time intervals

• Be included in an on-going training program, which includes visits to onshore and/or

• Have practical knowledge and demonstrable competence in pre-hospital emergency

• Have knowledge of teleconsultation

Facilities and Equipment

Theory training facilities

Practical training facilities

The learning process during "scenario-based training" is facilitated by identical or

GLOBAL WIND ORGANISATION