Health and Safety Have the Same Problem

Dr Otis Webb Brawley, Chief Medical Officer of the American Cancer Society, has written a new book called  "How We Do Harm:A Doctor Breaks Rank About Being Sick in America."

A CNN article about the book has recounted the story of a woman, Helen, who was diagnosed with early stage breast cancer.  As was fairly common in the early 1990′s – surgery was followed by high doses of chemotherapy – and a bone marrow transplant.  Quoting Dr. Brawley:

“The therapy Helen received was expensive and commonly given to women with breast cancer in the early 1990s. During this time, numerous women sued insurance companies who did not want to pay for the therapy and nearly a dozen states passed laws saying insurance companies had to pay for it.”

“There was one really good reason why the health insurers did not want to pay for high dose chemotherapy and bone marrow transplant for breast cancer:  No study had ever been done to prove it beneficial.“

“Even without evidence, some patients and their doctors had faith that it worked. The procedure was common because some doctors taught that the transplant was beneficial to patients. Truth be told, it was very beneficial to the doctors and hospitals offering it.”

I have not read the book but have read a number of excerpts. We all know that increases in the cost of medical care are not sustainable. We all know that with third party payers, people will seek medical care, and the medical profession will  provide it. While much medical care that is sought is unnecessary no one can fault a doctor for doing whatever examination and testing is needed. Therein lies the problem. Dr. Brawley says it best:


       ”The cold hard reality is America does not need to reform health care,we need to  transform health care.”

I have seen the same problem with safety of all kinds. There are plenty of studies showing safety problems but few reliable studies showing that the suggested remedies are the solution. Often there are ridiculous claims. One recent news article quote claimed that a certain teen driving program given over a period of years to a few hundred teen drivers in one county was the cause of a reduction in teen fatalities over the same period in this multi-million population state. A basic fallacy of the safety industry is that correlation equals causation. 

For many years CPR was taught as a combination of reduce breaths and chest compression. Studies of results showed a low survival rate and the trade varied dramatically from city to city. One city with a low survival rate sends out EMT's in a fire truck with every emergency call. Other studies showed that doctors did CPR poorly. The current protocol is no rescue breaths except for drowning and drug overdose. Chest compressions are all that is done. 

Reread the quotes about breast cancer treatment. With no evidence patients and doctors believed that a certain treatment was beneficial. In safety we see this all the time. Often OSHA requires certain measures and of course that becomes the only valid reason to do something. 

A safety officer at one company asked me if one AED would be enough at his company. For any effect an AED must be used within four minutes of someone going down. This man's company has two three-story buildings. To answer his question requires knowing how long it would take to get an AED to the site. They might need three in each building, one on each floor. When AEDs are mandated by law who knows how many might be required. 

The problem with safety is that many solutions are marketed and sold that will not provide any reduction of risk. The ads generally run "The National Safety Council says that there are X number of injuries every year from Y. The ad jumps to the conclusion. "Therefore buy our product."

Today I saw a simple safety statement in an interview. It was a definition of cowboy safety. I liked it because cowboy safety is not a product brand. Cowboy safety is a process. "My job is to protect bull riders from bulls" was the answer. 

The success of "My job is to protect bull riders from bulls" is measured by how many bull riders are hurt or killed. There are stats in all of safety but an OSHA inspection is going to measure a whole lot of other things that may or may not have an impact. Every OSHA recommendation always seems to recommend more training. 

What we need in safety is a transformation. We need to understand that there achievement of safety goals is not strictly material in nature. The creative process is viewed as mental and spiritual. Safety is the same. 

David Sneed

Commitment Demands Action

If we take the four gospels and look at them from the standpoint of what it takes to be a follower of Jesus, and believe that Jesus meant what he said, there might not be many Christians.

Look just at Matthew 8:18-22. (18) Now when Jesus saw great multitudes about him, he gave commandment to depart unto the other side. (19) And a certain scribe came, and said unto him, Master, I will follow thee withersoever thou goest. (20) And Jesus saith unto him, The foxes have holes, and the birds of the air have nests; but the Son of man hath not where to lay his head. (21) And another of his disciples said unto him, Lord, suffer me first to go and bury my father. (22) But Jesus said unto him, Follow me; and let the dead bury their dead.

There are a number of things to note in this passage and in context with other passages. Jesus was not interested in having large numbers of people around him.

So many "pastors" today spend millions of dollars to keep building bigger and bigger edifices to accommodate all of those who want to be around them. That alone makes me doubt I want to hear anything these men have to say about spiritual matters. If the scribe mentioned in verse 19 was alive today he might be a megachurch pastor. He told Jesus that he would follow him "withersoever thou goest." The answer that Jesus gave him was that there would be physical hardships. Perhaps Jesus knew that the scribe thought that following Jesus would be a good career move for him. There is no record of how he responded or what he did after that.

The second man is noted as "another of his disciples." He was not just starting out. He asked Jesus if he could "first" do something else. Before getting in the boat to go to the other side he wanted to stop being a follower of Jesus for a while so that he could tend to his father's needs. I don't think the father had just died. I do think that the commandment of Jesus to depart unto the other side in verse 18 was more than just for a short time. It may well have been clear to this second man that they would not be coming back anytime soon. His father may have been near the end or quite possibly have been in reasonably good health but elderly. His leave of absence may have been for an unspecified length of time until the father died, there was a funeral, and then an estate distribution. Jesus certainly is not saying that people who are physically dead could bury another dead person. Jesus meant that there were others in the family, not followers of Jesus, who could do all that was needed to care for the needs of the father while he was still alive and after death. The man wanted to "first" not follow Jesus. Jesus said that following Him would have to come first. Here too we do not know what the man decided to do.

Commitment is more than just making a statement in church. It is action. James said "Faith without works is dead."

Jesus did not promise a life of luxury. Nor did he promise a life of misery. He did say that we were to be prepared for whatever might come our way. He did promise that by faith we could do what he said without fear of the consequences. What is incredible is that so many so-called followers of Christ have no discernment of what actions constitute following Christ. Whether giving sacrificially or out of excess they fund "pastors" with ocean-front homes, Bentleys, airplanes, and other luxuries. In their business they will service their markets on a schedule yet provide favoritism to those who can do the most for them. They will ignore the needs of the lesser customers and will not go out of their way for them. Their store is set to open at 10:00AM. It will not open one minute sooner even if there is a blizzard and a mother is standing outside the door waiting to get food for her children.

The apostle Paul worked night and day so as not to be a charge to the people at Thessalonika. He wanted to be an example to them that even though the Lord might return at any moment that they should not leave their jobs.

Let us not forget Ecclesiastes 9:10 where we are told "Whatsoever thy hand findeth to do do it with all thy might." Our heart may be looking for something else. We might not have time on this earth to do those things. We should do whatever service opportunity is in front of us.

David Sneed

Cell Phone Ban Causes Loss of Productivity

The Atlantic has an article about the new law banning use of cell phones by commercial drivers.

http://www.theatlantic.com/sponsored/zurich-risk/archive/2012/01/will-driving-and-talking-kill-your-business/252019/

The article mentions a National Safety Council survey that shows 99% of those surveyed found no decrease in productivity and some showed a productivity increase.

I am somewhat skeptical about the 99%. Yet I would like to be able to go further with the remaining 1%.

1. The employees must be observing the no cell phone use rule for their company if they have noticed a productivity decrease.

2. What is the productivity decrease when 99% say otherwise? I would really like to know what is going on with them. I could write a book about the possibilities I see here.

I remember one of the old GE factories in Bridgeport CT. They made light bulbs at that factory. The building had been built before the use of electric lighting and the roof was designed with triangular segments designed to maximize natural light in their latitude. There was a city wide power failure. A friend of mine who worked at that GE factory told me of the irony of how they were able to do some work just with the natural light.

The Cowboy Safety approach would not be to ban cell phones. It might be to design operations so that cell phones would not be a necessity. Maybe employee training should be in time management that would include having scheduled personal calls at a time when they are not driving.

Does your company ban shining shoes while driving? Why not? Such a ban sounds silly but maybe your employees wear shoes that do not need shining, their environment does not require shoe shine perfection or they have adapted their shoe shining to take place elsewhere.

David Sneed

Over the Counter Medications Limits

Here is a great summary of common over the counter medications that shows side effects and limits of dosage.

http://www.healthnetworkfoundation.org/clientuploads/Dr.%20Locke%20articles/OTCMedicationsNOV2011.pdf

Did you know that the most common calls to Poison Control involve acetaminophen overdoses?

I am not much for medications. One time I was off on a trip and had a cold. My wife bought me several items. In reading the labels I noted that all were acetaminophen in various forms. All the labels said do not take any other product with acetaminophen while taking this. I ended up taking non of them.

David Sneed

Amateur Video from Sinking Costa Concordia

The link below is to an amateur video from the sinking Costa Concordia. The video has been made private for some reason. I am leaving the link in case the owner makes it public again.

The video shows water coming down the carpeted stairway in some lobby area. A lot of water but only an inch or so deep. The ship is listing. People are running around in all directions and screaming. There seems to be no crew member present though this location would seem to warrant one. People are reacting to abnormalities rather than calmly looking for a way out. Ultimately the record shows that most did get out so the conditions there did not result in lack of egress.

I can identify with that photographer taking the time to make a video. Once I was at a birthday party for one of my youngest son's friends. It was at a lake and was a cook-out camp-out. The birthday boy had a large gash in his leg. His leg was cut to the bone but there was no bleeding. The child was screaming to be left alone to die. There was panic. There was no plan. When some calm set in I told the father how to get to the nearby hospital. I had a first aid kit yet elected to not clean and dress the wound in this case. All worked out well.

There was a recent 28 second security camera video of a mugging at a store entrance. A woman comes out of the store with her bags and was talking on a cell phone. A man comes up at high speed, pushes her, and knocks her down. There is some resistance and she holds on to her purse. The man does get her cell phone. Rapidly he is gone. She was lucky. She could have been knifed or shot. The distraction of the cell phone could have cost her life.

Does your safety plan, business or personal, formal or informal, anticipate the conditions that could occur in an emergency?

Most formal plans are laughable and most informal plans do not exist. If someone can get to the locked filing cabinet on the third floor how will they read it if the power is out and there is no nearby flashlight?

Are you secure knowing that you have a cell phone in your car for an emergency? If your car rolls a few times, is upside down in a creek, and you are having from your seat belt will your cell phone be available? Or is your cell phone location where it is most accessible for expected calls during normal driving?

In a cartoon one time, I believe it was Doonesbury, there was discussion of a government safety plan. Federal employees were to report to the nearest post office. A hand was raised. "What if the post offices are all gone?" I thought of 9/11 when the New York City emergency response center was located in the World Trade Center.

The Cowboy Safety solution is to ask What would Clint Eastwood do in his western movies? Forget about the hotel exit plans that would have you crawl down a hallway when your room is on the first floor and has a sliding glass door to the outside. The hotel cannot tell you about doing that or the law would make them build a sidewalk and have a wheelchair ramp. It is better for them that you be found dead of smoke inhalation in the hallway.

Don't get me started.

David Sneed

Explosion on Italian Ship

Rescuers in Italy have blasted four holes into the cruise ship that went aground and capsized on February 13. Divers have had increasing problems with safe access while searching the ship for survivors and the dead. This video shows the blasting of one hole. It is still unknown what will happen with the ship. The fuel will be removed from 17 tanks over the next two to four weeks. A computer model will be made to see if the ship would break in two if it was righted. The worst case scenario would be to have to cut it apart.

David Sneed

Here is a brief amateur video from Reuters of the chaos at the time of the evacuation from the Italian cruise ship Costa Concordia on January 13, 2012 after not hit a rock.

One thing it shows is that everyone should plan their own evacuation from a ship, hotel or whatever. Do not depend on the existence of practical safety plans.

Many of the passengers have lost their passports and other id, credit cards, and airline tickets home. For them the disaster is not over.

Somewhat related Reuters is a good source for information  about events all over the world.



David Sneed

As Safe As Necessary

Some good advice has been given by Peter Cornall of the UK based Royal Society for the Prevention of Accidents. He distinguishes as "safe as possible" from as "safe as necessary."

In the context of ice skating we can expect to fall and we can expect to be bumped by others. Other activities, both leisure and occupational, have different contexts of application.

Because ice skating is an infrequent event for most people there are possibilities of over-estimating ability and of not being in shape for the sport. Both issues can be the cause of serious incidents. One recommendation is to jog to warm up and to avoid the mulled wine.

David Sneed

Two Drink Free Days Per Week

There have been a number of ideas for how to control drinking.

One that has been around since 1987 is that men should consume no more than 21 drinks per week and women no more than 14. There is a little problem in defining the size of a drink but these counts are a good rough guide.

There was a later revision to no more than three to four drinks per day for men and no more than two to three per day for women.

A new one from England is the idea of having two drink free days per week. The idea is that the body needs 48 hours to recover after heavy drinking.

This idea fits with the ancient concept of fasting twice a week.

An idea that is not so good is the one that shows gender, body weight and the correlation with blood alcohol levels. These charts show at what point one is above .08, the presumptive level for DUI convictions. Anyone who has been drinking anything should not be driving.

I like the definition I heard once that an alcoholic is someone who drinks more than his doctor.

David Sneed

Au Pair Care

Au Pair Care is an example of a business that is concerned about safety and makes it a critical part of their business. Au Pair Care provides affordable live-in child care services. They found that safety is the moist important concern of their customers.

Au Pair Care has created a mission critical product called "Safety Care" and has trademarked the name. There is a four day training program for au pairs upon arrival in the United States.

The au pairs receive American Heart Association First Aid and CPR training. There are many first aid programs. American Heart Association and Red Cross are especially good because they have so many trainers around the country that consistent refresher programs and first time programs are available just about anywhere in a classroom setting at a reasonable price.

The au pairs receive driver training and household safety training.

Au Pair Care is a member of the National Safety Council. Members of the National Safety Council have access to plenty of material on a variety of safety topics.

What I have liked most about the National Safety Council is their library. I have spent plenty of time in the library in Itasca researching various subjects and have duplicated many of their publications in my library.

David Sneed

The Real Future of Safety - Think 7 Billion

We are often treated to surveys and articles about the future of safety. Mostly they show statistics from the National Safety Council, talk about how bad the problem is, and through the concept of "Correlation equals Causation" urge us to buy a certain product or service, donate to a certain cause, or urge our governments to pass new laws. And nothing gets done!

The following is a video from National Geographic. The descendants of people who, according to Thomas Malthus 1798 who should have starved or died of disease due to overpopulation are driving BMWs and Audis. The cities are the place to be for quality of life.  Unemployment? Wait until new protocols are universally known. In the United States the Census Bureau shows that there are 28 million non-employer businesses, most home-based, and the number is growing by a million a year.

Watch this video. Try to count the opportunities that you see. You may as well try to count the stars.

David Sneed

Woman Shoots and Kills Intruder

There are several points of note in this incident in the following video.

1. She had weapons for protection and knew how to use them.
2. She was aware of a possible stalker.
3. She called 911 for help with the specific situation.
4. She took action in a pre-emptive way.

There could be debate about alternatives. Could she have shouted through the door and told him to go away? He might have ignored her and been better prepared for when he came in the door. If he had left he could have planned a way to catch her off guard in the future. We do not know his plan but we do know that he was coming into the house without permission. Her only real choice to protect herself and her child was to shoot to kill.

Some might say that he was not equally equipped as he had only a knife. An intruder with a knife can often overcome someone with a gun. It is a matter of timing. There are certain steps needed with a gun that are not needed with a knife. This woman did not wait for him to actually come after her. That took place when he came through the door. She acted defensively. 

For home defense advance preparation is needed along with an understanding of different weapons. Handguns are not the best choice. For one they can fire through walls of houses and kill or injure an innocent person several houses away. This woman used a 12 gauge shotgun. A 20 gauge might be better for home use. Firing even a 20 gauge down a hall way is not likely to miss. Six shots from a handgun might result in no hits.

It is truly amazing that in the name of safety there are bans on weapons with no plans of what to do if someone comes in with a gun or other weapon with intent to do harm.

I am not a gun nut but do know realities.

David Sneed

On January 3, 2012 Massachusetts police cited their Lt Governor for speeding 108 MPH in a 65 MPH zone and for not wearing a seat belt.




Several years ago the head of the Massachusetts State Police was stopped for speed in excess of 100 mph on the Mass Pike west of Boston shortly after midnight. No action was taken until the next day when the newspapers asked questions. The Governor finally ordered the state policemen who stopped him to issue a citation for whatever he thought was appropriate and the Governor suspended him for two weeks.  Colonel Henderson had been at a retirement party and said he only had two beers all evening.

In other incidents a state official was doing over 100 in a 55. Another one was stopped and when  he got out of his car, fell and was too drunk to get up. Another was drug k and driving the wrong way on a divided highway.

Maybe Massachusetts could do two things.
1. Stop giving officials Crown Victorias with Police Interceptor engines. Political power mixed with engine power and maybe with some alcohol does not make a good recipe.
2. Make a work rule that state officials not drive drunk. It is great that they are saving on the cost of chauffeurs but that should not be at the risk of death for us lowly taxpayers.

Progressive Safety

Much of what we see in all areas of safety is a reaction to incidents. Until we can get over that mindset we are never going to make any real progress.

I do not wish to disparage any organization but do question many initiatives.

A few weeks ago, quoting the Missouri incident where a young man was texting when he caused a crash with two fatalities, the National Transportation Safety Board (NTSB) created publicity asking that all states ban not just texting but all cell phone use with the exception of the embedded system in General Motors vehicles. The last I heard the same government that owns NTSB owns at least a big chunk of General Motors. But let's go beyond that disconnect. Missouri already has a law that prohibits what that young man was doing.  So how will new laws around the country solve the problem? The answer is they won't. There are simple engineering solutions that may never be implemented because of the adverse effect on business and consumer preference.

In Cheyenne Wyoming there is today a proposed ordinance that would include prohibition of parking trailers on the street. There are 15,736 registered trailers in the county. According to the news story trailers that are not attached to a vehicle could roll and cause some damage. This proposed ordinance is not reactive because there are no known incidents. It has a number of exceptions all of which could result, and may be more likely to result, in the imagined hazards. A requirement to use wheel blocks would certainly suffice.

And then we go up to Dodd-Frank. Nothing but more expense.

Individuals and small business needs to function in a progressive way. That means not reacting to incidents. Instead look to potential hazards involving all resources of all types and make plans to deal with all of them in a methodical way. Creating form is one way of describing what must be done. Creating form can reduce expense and simplify processes. Residential fires started by candles are quite common. Instead of a compromise with the candle dealers that government and safety councils tend to do just don't have candles in your house.

Chew on that for a while as you are working on your New Years' resolutions.

David Sneed