Best Practices in HSI - System Safety

System safety factors consist of those system design characteristics that serve to minimize the potential for mishaps causing death or injury or threaten the survival and/or operation of the system.  Some examples of ways in which safety factors can impact system design include:

Equipment and gear may not be easily located when needed due to inadequate storage or poor organization.
Problems associated with physical setup of equipment and gear impose negative effects for personnel job satisfaction and unnecessary tasking. Ineffective supply systems can decrease response time and interrupt the mission, potentially increasing safety risks.

There may be an insufficient quantity of protective gear.
Since emergencies will occur, preplanning is necessary to prevent possible disaster. An urgent need for rapid decisions, shortage of time, and lack of resources and trained personnel can lead to chaos during an emergency. The planning process may bring to light deficiencies, such as the lack of resources (equipment, trained personnel, supplies), or items that can be rectified before an emergency occurs.

The work schedule may induce people to take performance enhancing drugs that result in behavioral or cognitive changes.
Irregular work/rest patterns frequently cause disturbed sleep and excessive sleepiness, which are associated with increased risk of error. Countermeasures against fatigue at work include improved scheduling, naps, light-induced manipulation of circadian rhythms, and performance-enhancing drugs.

High workload can lead to errors.
Human factors research has demonstrated that workload is a key factor in causing human error. Individuals experience difficulty processing the flood of information typical of high workload conditions. Failure to process all the available information or accomplish all the necessary tasks within a limited amount of time contributes to the occurrence of errors.

Personnel may be required to perform tasks that are not part of their normal responsibilities and outside of their training.
Due to the evolving nature of Coast Guard missions, personnel may be responsible for both primary and alternate duties they are not normally responsible for and have not been trained for.

Personnel may not comprehend the risk associated with a specific action.
Personnel may be ill-equipped to estimate risks associated with certain tasks and procedures, increasing the likelihood they will engage in risky behaviors with potentially harmful outcomes.

Errors may result from poor teamwork or communication.
Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Poor communication can create a chain of event errors that include a poor organizational climate, lack of team structure, poor task prioritization, lack of quality control (e.g., team members checking each other's actions), and lack of team oriented assertiveness needed within a EMF environment. Communication failures are an extremely common cause of inadvertent patient harm (Leonard, Graham, & Bonacum, 2009).

The operational environment may impact personnel performance.
The interaction between people and their surroundings can produce physiological and psychological strain on individuals. This can lead to discomfort, annoyance, subtle and direct effects on performance and productivity, health and safety. The combined effects of heat, cold, vibration, noise, and light on the health, comfort, and performance of humans must be considered.

Training may not adequately address risks present in the environment to ensure safety.
There may be a lack of training on safety and occupational health issues. Personnel may need training on hand washing, potable water, vector control, waste disposal, food sanitation, noise, asbestos, environmental contamination, radiation, and how to behave and how to treat patients in a nuclear/biological/chemical threat situation.

There may be an over-reliance on training to address safety problems.
Training should not be used as a substitute for the integration of safety features into the design of equipment and gear. The training program may not be effective and personnel may not follow the safety procedures taught during training.

Protective gear may interfere with the safe operation of equipment.
Some medical activities, such as medical evacuation, may expose medical personnel and patients to hostile fire while performing required tasks. Maintenance of the facility may require personnel to complete repairs and routine maintenance in the open while exposed to potential hostilities. In these cases, personnel may have to wear appropriate protective equipment. However, protective equipment may physically limit or prevent certain movements which are critical to performing required tasks. Protective equipment may also be so cumbersome that errors in the operation of equipment may occur due to lack of manual dexterity.

Critical gear may be inaccessible or difficult to access due to safety concerns.
Medical or standard equipment may be have accessibility issues in an EMF setting due to safety compliance issues such as aisles and work space requirements or human factors issues such as reaching and lifting strains or poor users interface designs in medical instruments.

Unsanitary conditions due to improper cleaning may lead to long term health concerns.
Routine cleaning of the medical facility and equipment is necessary due to the unstable structure of the temporary tent making the tent an inadequate shield from outside elements. However, frequent cleaning is challenging due to the fast turnover of patients and the recurring need to perform emergency invasive operations.

Protective gear may be so cumbersome that it impacts compliance.
The added weight and bulkiness of protective gear may create bodily discomfort and degrade the performance of personnel, prompting them to modify or remove protective gear.

Safety features may be too easily ignored.
Safety features intended to protect members, such as warnings and alarms, may be ignored by personnel if the feature is not reliable, the associated risks are not well understood, or the feature interferes with their ability to complete tasks.

Safety procedures may be too difficult to remember.
Characteristics of the design can influence safety outcomes if adequate training is not provided. Complex safety procedures are in place to ensure errors do not occur, but can be cumbersome for users if trying to rely solely on memory to perform the tasks. Developing safety procedures for expeditionary medical facilities and leveraging from air safety programs like crew resource management will assist in the identification of required knowledge, skills, and abilities (KSAs) to be incorporated in safety systems/procedures and training methodologies.

Errors may be induced by poor teamwork skills.
Expeditionary medical teams are deployed to remote locations and expected to take immediate and effective action as a team under stressful conditions. Without targeted team training on effective communication and teamwork, there exists an elevated risk of error and inadvertent patient harm.

Errors may not be addressed because of lack of reporting.
Many medical errors and "near misses" occur in health care settings on a daily basis, leading to injury and death and creating significant liability and liability-related costs for providers. Acknowledging and reporting medical errors constitute a necessary first step toward improving patient safety, and have the potential to reduce the number similar incidents in the future.