Risk management major events

Disaster events disrupt the integrity of water containment and systems, and contamination can occur. Depending on the location of the disaster, nurses should use one or both of the WHO guidelines and the EPA standards to provide a foundation for assessment of risk and risk management for water-related infectious diseases following a disaster or major public health event. Much of this discussion addresses those parts of the world without an adequate infrastructure, whereas in the United States, nurses will most frequently encounter well water contamination from flooding. 

The objective of risk management and a safety culture should be a proactive treatment of clinical risk and therefore minimisation of adverse incidents arising from HIT. Nevertheless this should not detract from the notion that one can learn a great deal from analysing incidents or near misses. A patient safety incident is an event or circumstance which could have resulted, or did result, in unnecessary harm to a patient [22]. The ongoing study of incident reports can help identify common types of problems [23] and incident reporting has been cited as one of the major steps in improving the safety of HIT [24]. 

The majority of hazards will not be issues and will not typically benefit from routine weekly review by the project team. Hazards can, in the main, be seen as entities sitting in the background characterising the risk in the event than an incident was to occur. Their purpose is to focus and prioritise the development of controls during the CRM analysis and to demonstrate the practical measures that have been put in place to reduce the clinical risk to ALARP. In contrast, issues are problems which require active management - they need someone to take ownership and run with the task of fixing them. 

In some cases, the probability of someone being present is higher than would normally be anticipated because those people are there to work on what appears to be a relatively minor problem. For example, at a chemical facility in Texas, a tank exploded killing 17 workers. The area in which the explosion occurred was normally deserted but the workers were there to correct the conditions that led to the explosion. On another occasion, a refinery in west Texas experienced a major explosion and fire. Many major equipment items were destroyed, and the smoke from the fire was so great that an adjacent freeway had to be closed down. If a risk management team had modeled the event ahead of time they would surely have postulated multiple fatalities and serious injuries. In fact, no one was hurt. 

Such events lead to loss of life, major environmental problems, huge economic losses, very bad public relations, civil htigation, and even criminal prosecution. Senior managers do not want to be in that place— they look to the risk management program to keep them from going there. 

Major incidents usually require that an unusual, even bizarre, set of events take place because most of the predictable accident scenarios have already been considered, and corrective action taken. Given, therefore, that most incidents are complex and even strange, one of the most important roles of a risk management professional is to explain to the court just what happened in terms and language that they can understand. 

ABSTRACT The Dutch government is in the process of revising its national flood safety policy. The current Dutch Flood Defense Act lays down design standards for the Dutch flood defenses. These standards have been based on/rationahzed by economic optimizations in which investment costs are balanced against the discounted value of (potential) future losses. Loss of life is not considered separately. This paper presents the results of a research project that evaluated the potential roles of two risk metrics individual and societal risk. These metrics are already used in the in the Dutch major hazards pohcy for the evaluation of risks to the public. Individual risk concerns the annual probabihty of death of an average, unprotected person. Societal risk concerns the probability of a multi-fatality event. This paper discusses technical aspects of the use of individual and societal risk metrics in flood risk management, as well as policy implications. 

Another of James Reason s books—Managing the Risks of Organizational Accidents—is a must read for safety professionals who want an education in human error reduction. It was published in 1997 and has been reprinted five times. Reason writes about how the effects of decisions accumulate over time and become the causal factors for incidents resulting in serious injuries or damage when all the circumstances necessary for the occurrence of a major event come together. This book was referenced in Chapter 3, Serious Injury Prevention, because it stresses the need to focus on decision making above the worker level to prevent major accidents. Reason writes this ... 

Risk analysis is a live document and it should be thoroughly reviewed by the operator whenever there is any change in the system because it is the responsibility of the operator to understand all risks and control measures all the time. Also to improve the quality of risk analysis it is important to validate all hazards/major incident events, likelihood, control measures, and consequence, very rigorously. Proper communication, updating, and education/training are parts of risk management, which is an extension of risk analysis. So far helpful discussions have taken place regarding control measure, but what is control measure The next clause provides the answer. 

Finally, a critical issue in the risk management and reduction of impact after a seismic event is to assess the functionality of mainshock damaged infrastructures (e.g., major bridges, hospitals) considering the aftershock hazard (Fig. 2e). This is a challenging issue due to limited time availability (days months), the lack of adequate models for the fragility assessment of damaged structures, and the inherent uncertainties in aftershock hazard assessment. 

In the supply risk realm, major disasters are likely to color managerial perceptions of the frequency of major dismptions. Combining a misconception of how widespread major disruptions are with a tendency to focus on avoiding negative events to the exclusion of more positive events may drive actions where supply management professionals spend more on preventing rare events than is warranted, while at the same time paying less attention to comparatively common sources of risk than is appropriate. 

From a human reliability perspective, a number of interesting points arise from this example. A simple calculation shows that the frequency of a major release (3.2 x lO"" per year) is dominated by human errors. The major contribution to this frequency is the frequency of a spill during truck unloading (3 X10" per year). An examination of the fault tree for this event shows that this frequency is dominated by event B15 Insufficient volume in tank to imload truck, and B16 Failure of, or ignoring LIA-1. Of these events, B15 could be due to a prior human error, and B16 would be a combination of instrument failure and human error. (Note however, that we are not necessarily assigning the causes of the errors solely to the operator. The role of management influences on error will be discussed later.) Apart from the dominant sequence discussed above, human-caused failures are likely to occur throughout the fault tree. It is usually the case that human error dominates a risk assessment, if it is properly considered in the analysis. This is illustrated in Bellamy et al. (1986) with an example from the analysis of an offshore lifeboat system. 

Elevated homocysteine concentrations have been associated with an increased risk for cardiovascular disease in both epidemiologic and clinical studies.43 Several studies have evaluated the benefit of lowering homocysteine levels with folic acid supplementation. One study reported a reduction in major cardiac events with the combination of folic acid, vitamin B12, and vitamin B6 following PCI.44 However, a more recent study found an increased risk of instent restenosis and the need for target-vessel revascularization with folate supplementation following coronary stent placement.45 The role of folate in the management of IHD is currently unclear. 

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