Wednesday, November 08, 2006

Genuine errors that kill

Good post on NHS Blog Doctor. Discusses how we should deal with errors that have catastrophic consequences when someone does something quite normal. In this case the example is loosing control because of sneezing when either driving a car or a surgeon operating. The trouble is if someone dies because of someone else's error, the general public expect someone to be punished. Where someone is negligent or reckless (i.e. driving or operating drunk) this is quite clear-cut. But punishing someone for sneezing does not seem right.

A news article on a similar theme was on BBC website 7 November 2006 nurse gives baby morphine overdose.

In this case the nurse gave morphine meant for another baby when she thought she was giving human albumin solution. She was an experienced nurse and there seems to be no explanation for why she made the error. However, she was sacked and has now been found guilty of misconduct.

Tuesday, November 07, 2006

European power outage

Parts of Germany, France, Belgium, Spain, Portugal, Croatia and Italy were blacked out on 5 November 2006 when German power controllers switched off a cable that left some areas lacking power and others overloaded.

Good article about it on BBC website

It is interesting that inter-connecting national grids intends to secure supply. However, it adds complexity which can contribute to failures. This seems to be the result of new technology. The likelihood of failures are reduced but there consequences when they happen are often much greater.

Andy Brazier

Fire risks

There is a phenomenal amount of information available regarding fire at the following website.

I think it refers to the old regulations (i.e. before 1 October 2006) hence is in archive, but most will still be useful guidance.

Andy Brazier

Fatigue & alertness testing

A company in US (Bowles Langley Technology) has developed online tools that people can use to test their alertness. Aim is to allow people to test themselves to check if they are safe to work or drive home. You can try a demo on their website

Andy Brazier

Monday, November 06, 2006

Chronic fatigue after long working hours

October 2002 Mark Fiebig was killed when he fell asleep at the wheel of his car driving home from work. His employer has recently been found guilty of breaching health and safety laws and fined £30k + £24k costs as it was felt they had failed to monitor work hours closely enough.

This is interesting because the accident happened outside work hours. Admittedly the hours being worked were way in excess of what most would do, with it being reported that he had worked 17 hour shifts for four consecutive days. But it is a point I have raised with clients in the past, especially following night shifts. I have tried to encourage them to consider what they would do if someone said they felt really tired. Would they drive the employee home to make sure he got there safely?

The case is reported in a number of places including

Norwich Union

Cambridge evening news