High-Reliability Safety During Emergency Operations 2017B014 C O R Y W O R D E N, M S, C S H M, C S P, C H S P, A R M, R E M, C E S C O A N D K E L L E Y L O M B A R D O, M. E D, U S A F M A S T E R I N S T R U C T O R
In accordance with the policies on disclosure of the Accreditation Council for the American Nurses Credentialing Center s Commission on Accreditation (ANCC), the American Academy of Family Physicians (AAFP), The Commission for Case Manager Certification (CCMC), all planner and presenters for this conference have been asked and are expected to identify whether they do or do not have any real or apparent conflict(s) of interest or other relationships related to the content of their presentations(s). Conflicts of Interest A conflict of interest occurs when an individual has an opportunity to affect educational content about health-care products or services of a commercial company with which he/she has a financial, professionals, or personal relationship. THE FOLLOWING INFORMATION WAS DISCLOSED Kelley Lombardo, M.Ed, USAF Master Instructor is employee that makes and sells electronic health records software specifically for school nurses. The presentation she presented is unrelated to her role at the company and she will not mention these products in her presentation. Commercial/Noncommercial Support or Sponsorship These CNE activities are not supported by an unrestricted educational grant or in-kind donation. Non-Endorsement of Products Any and all commercial products, services displayed or company advertised at the AOHP 2017 National Conference do not constitute endorsement by the Association of Occupational Health Professionals in Healthcare (AOHP). DISCLAIMER Association of Occupational Health Professionals in Healthcare (AOHP) acknowledges the operational requirements of credentialing organizations. The sponsors of continuing education activities and the presenter(s) at these activities disclose significant relationships with commercial companies whose products or services are discussed in educational presentations. Disclosure of a relationship is not intended to suggest or condone bias in any presentation, but is made to provide participants with information that might be of potential importance to their evaluation of a presentation. All presenters have completed a Faculty Disclosure Form to AOHP. Presenter(s) will deliver a disclosure statement indicating if they have any commercial affiliation to the audience. The information presented at this conference represents the views and opinions of the individual presenters, and does not constitute the opinion or endorsement of, or promotion by, the Association of Occupational Professionals in Healthcare (AOHP). Reasonable efforts have been taken intending for educational subject matter to be presented in a balanced, unbiased fashion and in compliance with accreditation/regulatory requirements. However, each program attendee must always use his/her own personal and professional judgment when considering further application of this information. Association of Occupational Health Professionals in Healthcare is an accredited provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
Overview Introduction / Precedent Workplace Safety Emergency Management Case Studies in Integration
Who are We? Cory Worden Kelley Lombardo
Setting the Precedent Disasters do not move safety from first to last
High-Reliability Theory Methodical and systemic hazard controls applied consistently to avoid catastrophic results Applies to conditions and behaviors Allows for engagement and decentralization Validity Reliability High-Reliability vs. Compliance High-Reliability vs. Normal Accident Theory
Enterprise Risk Management Risk Control Loss Prevention / Loss Control Risk Transfer Risk Acceptance Risk Avoidance
Workplace Safety
Workplace Safety Enterprise Risk Management Hierarchy of Controls Job Safety Analysis
Program Needs
Program Development
Training Context-Dependent Memory Situated Cognition Emotions and Learning Forgetting and Remembering
Memory
Forgetting Curve
Training
High-Reliability Construct
Training to Remember
Centralized, Decentralized, and Situational Learning
Training / Situational Awareness
Colonel Boyd s OODA Loop
Case Study Implementations in order: Ongoing engagement Ongoing post-accident investigations Safety Committee Hazard Analysis Hazard Controls Information Program Observations/Inspections Continual Improvement
Emergency Management
Emergency Management Emergency Management is a program to identify and manage the response to threats that have a significant impact on the community The goal of emergency management is to put order to chaos
Phases of Emergency Management Mitigation is taking steps to eliminate or minimize a disaster. Ex: Installing flood doors in a flood prone area Preparedness is taking steps to prepare for a potential disaster. Ex: Completing annual decontamination training Response occurs immediately after the event to save life, limb, and property. Ex: Activating for a mass casualty response Recovery is returning to what is now considered normal life, which is followed by a return to mitigation to apply the lessons learned to future plans. Holding an After Action Conference to identify opportunities for improvement
NIMS and ICS National Incident Command System Incident Command System A Federally developed framework for responding to disasters. Provides standards for training, structure, documentation, and process A management system to provide clear lines of planning, communication, and responsibility in a disaster. A component of NIMS
Incident Command Structure Liaison Public Information Incident Commander Safety Med/Tech Specialists Logistics Planning Finance Operations
Role of the Safety Officer To develop and recommend measures for assuring personnel safety, and to monitor and/or anticipate hazardous and unsafe situations Hazard assessment Identify appropriate personal protective equipment Monitor operational safety Terminate and report any unsafe practices Continual assessment and recommendation
Safety Officer Jurisdiction Liaison Public Information Incident Commander Safety Med/Tech Specialist s Logistics Planning Finance Operations
Responsibilities The Safety Officer is a Senior Advisor to the Incident Commander Must have the ability and authority to stop any practices that cause harm -regardless of impact to operations The assigned Safety Officer may not be a subject matter expert on the hazard or response procedures being implemented (i.e.. radiological decontamination, infection control procedures)
Case Studies in Integration
Case Studies Ebola Decontamination Natural Disaster
Safety and EM Mitigation Safety Unsafe behaviors Unsafe conditions Hazards Hazard Controls EM (Safety PLUS) Potentially larger scale incident Heightened risks Reputational damage Increased downtime Impact on public/customers
Hazards and Hazard Controls Slips/Trips/Falls Needlestick Prevention Ergonomics / Safe Patient Handling Contamination Control /Avoidance Chemical Biological Radiological
Key Objective Minimize impact to operations through a Culture of Safety Culture of Safety is not the responsibility of the ICS Safety Officer it is to be integrated into the organizational culture long before a contingency arises
Hazard Control
Employee Preparedness
The Decontamination Environment Safety Incident Commander Operations Decon Unit Leader Decon Safety Officer Decon Operations Team
Conclusion and Forewarning
Questions or Concerns? cory.worden@memorialhermann.org 832 677 9821