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Missouri follows the federal OSHA rule (29 CFR 1910.151(b)): no fixed ratio, but where no infirmary, clinic or hospital is in near proximity, the employer must ensure at least one adequately trained first-aider is available, on a performance-based program matched to the workplace's foreseeable hazards.

Missouri's child care licensing rules (5 CSR 25-500), administered by the Department of Elementary and Secondary Education's Office of Childhood, require pediatric (adult, child, infant) CPR and first aid including AED, with at least one certified caregiver for every 20 children in licensed capacity. Staff generally certify within 90 days of hire and renew every two years, and online courses are accepted.

Missouri's Good Samaritan law (Mo. Rev. Stat. § 537.037) shields anyone who in good faith voluntarily and gratuitously provides emergency care from liability, except for gross negligence (professionals) or willful and wanton misconduct (laypersons). Mo. Rev. Stat. § 190.092 (Public Access to AED Act) extends immunity to gratuitous, good-faith AED rescue.

Standard RN and LPN renewal in Missouri, overseen by the Missouri State Board of Nursing, requires no continuing-education hours, but nurses must maintain competence to act in an emergency under the Missouri Nursing Practice Act. BLS is in practice an employer and hospital requirement, and recognized, up-to-date CPR/AED, ACLS or PALS training meets that expectation.

Under Missouri long-term care regulations, assisted living and residential care facilities must have staff trained in first aid and CPR available to residents so a trained responder is on hand in a medical emergency. A recognized, up-to-date first-aid and CPR certificate meets this standard, in addition to the worker's occupational training, and is renewed periodically.

In Missouri, foster parent applicants must become certified in CPR and first aid as a pre-service requirement, and each adult with parenting responsibilities must complete competency-based training approved by the Children's Division under 13 CSR 35-60. Traditional licensure requires additional in-service training every two years and keeping certification current.

Online CPR and first aid training is recognized in Missouri, as neither OSHA nor Missouri law mandates a validity period or bans online training for workplace first-aiders. Online theory is accepted with a hands-on skills component recommended for CPR, and certification is valid for 3 years.