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