Building shared situational awareness in surgery through distributed dialogue

Background Failure to convey time-critical information to team members during surgery diminishes members’ perception of the dynamic information relevant to their task, and compromises shared situational awareness. This research reports the dialog around clinical decisions made by team members in the time-pressured and high-risk context of surgery, and the impact of these communications on shared situational awareness. Methods Fieldwork methods were used to capture the dynamic integration of individual and situational elements in surgery that provided the backdrop for clinical decisions. Nineteen semi structured interviews were performed with 24 participants from anaesthesia, surgery, and nursing in the operating rooms of a large metropolitan hospital in Queensland, Australia. Thematic analysis was used. Results: The domain “coordinating decisions in surgery” was generated from textual data. Within this domain, three themes illustrated the dialog of clinical decisions, i.e., synchronizing and strategizing actions, sharing local knowledge, and planning contingency decisions based on priority. Conclusion Strategies used to convey decisions that enhanced shared situational awareness included the use of “self-talk”, closed-loop communications, and “overhearing” conversations that occurred at the operating table. Behaviours’ that compromised a team’s shared situational awareness included tunnelling and fixating on one aspect of the situation.

Towards a structured understanding of caregivers’ safety behaviour in the domestic and driveway setting

Slow speed run-overs represent a major cause of injury and death among Australian children, with higher rates of incidents being reported in Queensland than in the remaining Australian states. Yet, little attention has been given to how caregivers develop their safety behaviour in and around the driveway setting. To address this gap, the current study aimed to develop a conceptual model of driveway child safety behaviours among caregivers of children aged five years or younger. Semi-structured interviews were conducted with 26 caregivers (25 females/1 male, mean age, 33.24 year) from rural and metropolitan Queensland. To enable a comparison and validation of findings from the driveway, the study analysed both driveway and domestic safety behaviours. Domestic safety behaviours were categorised and validated against driveway safety behaviours, uncovering a process of risk appraisal and safety behaviour that was applicable in both settings (the Safety System Model). However, noteworthy differences between the domestic and driveway setting were uncovered. Unlike in the domestic setting, driveway risks were perceived as shifting according the presence of moving vehicles, which resulted in inconsistent safety behaviours. While the findings require further validation, they have implications for the design and implementation of driveway run-over interventions.

A safe system-based approach to selection of clear zones, safety barriers and other roadside treatments

On average, 560 fatal run-off-road crashes occur annually in Australia and 135 in New Zealand. In addition, there are more than 14,000 run-off-road crashes causing injuries each year across both countries. In rural areas, run-off-road casualty crashes constitute 50-60% of all casualty crashes. Their severity is particularly high with more than half of those involved sustaining fatal or serious injuries. This paper reviews the existing approach to roadside hazard risk assessment, selection of clear zones and hazard treatments. It proposes a modified approach to roadside safety evaluation and management. It is a methodology based on statistical modelling of run-off-road casualty crashes, and application of locally developed crash modification factors and severity indices. Clear zones, safety barriers and other roadside design/treatment options are evaluated with a view to minimise fatal and serious injuries – the key Safe System objective. The paper concludes with a practical demonstration of the proposed approach. The paper is based on findings from a four-year Austroads research project into improving roadside safety in the Safe System context.

Effect of depithing on the safety and environmental aspects of bagasse stockpiling

Large scale sugarcane bagasse storage in uncovered stockpiles has the potential to result in adverse impacts on the environment and surrounding communities through hazards associated with nuisance dust, groundwater seepage, spontaneous combustion and generation of contaminated leachates. Managing these hazards will assist in improved health and safety outcomes for factory staff and reduced potential environmental impacts on surrounding communities. Removal of the smaller fibres (pith) from bagasse prior to stockpiling reduced the dust number of bagasse by 50% and modelling suggests peak ground level PM10 dust emissions would reduce by 70%. Depithed bagasse has much lower water holding capacity (~43%) than whole bagasse. This experimental and modelling study investigated the physical properties of depithed and whole bagasse. Dust dispersion modelling was undertaken to determine the likely effects associated with storage of whole and depithed sugarcane bagasse.

Team communications in surgery - creating a culture of safety

As a key department within a healthcare organisation, the operating room is a hazardous environment, where the consequences of errors are high, despite the relatively low rates of occurrence. Team performance in surgery is increasingly being considered crucial for a culture of safety. The aim of this study was to describe team communication and the ways it fostered or threatened safety culture in surgery. Ethnography was used, and involved a 6-month fieldwork period of observation and 19 interviews with 24 informants from nursing, anaesthesia and surgery. Data were collected during 2009 in the operating rooms of a tertiary care facility in Queensland, Australia. Through analysis of the textual data, three themes that exemplified teamwork culture in surgery were generated: ‘‘building shared understandings through open communication’’; ‘‘managing contextual stressors in a hierarchical environment’’ and ‘‘intermittent membership influences team performance’’. In creating a safety culture in a healthcare organisation, a team’s optimal performance relies on the open discussion of teamwork and team expectation, and significantly depends on how the organisational culture promotes such discussions.

How safe is safe enough? : a socio-technical view of low-cost level crossing safety

Low-cost level crossings are often criticized as being unsafe. Does a SIL (safety integrity level) rating make the railway crossing any safer? This paper discusses how a supporting argument might be made for low-cost level crossing warning devices with lower levels of safety integrity and issues such as risk tolerability and derivation of tolerable hazard rates for system-level hazards. As part of the design of such systems according to fail-safe principles, the paper considers the assumptions around the pre-defined safe states of existing warning devices and how human factors issues around such states can give rise to additional hazards.

An innovative information gathering and data analysis platform for railway level crossing safety data

This paper describes an innovative platform that facilitates the collection of objective safety data around occurrences at railway level crossings using data sources including forward-facing video, telemetry from trains and geo-referenced asset and survey data. This platform is being developed with support by the Australian rail industry and the Cooperative Research Centre for Rail Innovation. The paper provides a description of the underlying accident causation model, the development methodology and refinement process as well as a description of the data collection platform. The paper concludes with a brief discussion of benefits this project is expected to provide the Australian rail industry.

Problems and awareness of support services among University students

Although Australian universities have allocated significant resources toward the development of student support services, administrators have little systematic information about the problems undergraduate university students experience or students' knowledge about available support services. The author surveyed 441 students in an urban, nonresidential university to examine the prevalence of difficulties associated with learning, sexual harassment, discrimination, emotional distress, health problems, course and career concerns, financial difficulties, and difficulties with lecturers; he also assessed students' knowledge of support services in each of these areas. Course concerns were the most common problem, followed by emotional distress, worry about career choices, financial difficulties, and problems with lecturers. More than half of the students were unaware of the support services available to them to address a range of concerns from sexual harassment and discrimination to emotional distress. Approximately 20% of the students reported having used university counseling or career services. Implications for targeting specific areas for outreach programs are discussed.

Compendium of best practices on motorcycle and scooter safety

Throughout the Asia Pacific Economic Cooperation (APEC) and across the world, riders and passengers of motorcycles and scooters are among the most vulnerable road users. Such vulnerability is especially pertinent for nations that more often use motorcycles and scooters as a method of transportation. In developing effective countermeasures to reduce motorcycle and scooter death and injury across multiple regions, consideration is required of various situational and socio-cultural factors that vary across APEC economies. This compendium aims to facilitate implementation of best practice countermeasures to improve motorcycle safety in APEC member economies.

Survey of motorcycle and scooter safety for Project : Compendium of Best Practices on Motorcycle and Scooter Safety

Throughout the Asia Pacific Economic Cooperation (APEC) and across the world, riders and passengers of motorcycles and scooters are among the most vulnerable road users. There is considerably greater likelihood of death or injury from use of these vehicles compared with other motor vehicles. Such vulnerability is especially pertinent for economies that more often use motorcycles and scooters as a method of transportation. In developing effective countermeasures to reduce motorcycle and scooter death and injury across multiple regions consideration is required of various situational and socio-cultural factors that vary across APEC economies. The study presented here sought to understand important motorcycle and scooter safety issues across APEC economies and any current barriers that might exist in implementing potentially effective countermeasures. This is the first stage of a wider project which also includes a literature review and ultimately the production of a compendium to facilitate implementation of best practice countermeasures.

A Review of potential countermeasures for motorcycle and scooter safety practices across APEC for project : Compendium of Best Practices on Motorcycle and Scooter Safety

Motorcyclists and scooter riders are among the most vulnerable road users, across APEC. This report assesses the potential road safety measures that can be used to address these issues and selects measures that could feasibly and effectively be implemented across the Asia Pacific Economic Communities (APEC). The scope of the report is confined to on-road motorcycle riding. While the numbers of injuries resulting from off-road riding (including as part of farm work) are likely to be substantial based on data from other states, many of the issues and measures to reduce trauma in off-road riding would be quite different. A previous report described important motorcycle and scooter safety issues across APEC economies and any current barriers that might exist in implementing potentially effective countermeasures.

Reducing alcohol-related driving on China's roads : Traffic police officers' perceptions and practice

Alcohol-related driving is a longstanding, serious problem in China (Li, Xie, Nie, & Zhang, 2012). On 1st May, 2011 a national law was introduced to criminalize drunk driving, and imposed serious penalties including jail for driving with a blood alcohol level of above 80mg/100ml. This pilot study, undertaken a year after introduction of the law, sought traffic police officers’ perceptions of drink driving and the practice of breath alcohol testing (BAT) in a large city in Guangdong Province, southern China. A questionnaire survey and semi-structured interviews were used to gain an in-depth understanding of issues relevant to alcohol-related driving. Fifty-five traffic police officers were recruited for the survey and six traffic police officers with a variety of working experience including roadside alcohol breath testing, traffic crash investigation and police resourcing were interviewed individually. The officers were recruited by the first author with the assistance of the staff from Guangdong Institute of Public Health, Centre for Disease Control and Prevention (CDC). Interview participants reported three primary reasons why people drink and drive: 1) being prepared to take the chance of not being apprehended by police; 2) the strong traditional Chinese drinking culture; and 3) insufficient public awareness about the harmfulness of drink driving. Problems associated with the process of breath alcohol testing (BAT) were described and fit broadly into two categories: resourcing and avoiding detection. It was reported that there were insufficient traffic police officers to conduct routine traffic policing, including alcohol testing. Police BAT equipment was considered sufficient for routine traffic situations but not highway traffic operations. Local media and posters are used by the Public Security Bureau which is responsible for education about safe driving but participants thought that the education campaigns are limited in scope. Participants also described detection avoidance strategies used by drivers including: changing route; ignoring a police instruction to stop; staying inside the vehicle with windows and doors locked to avoid being tested; intentionally not performing breath tests correctly; and arguing with officers. This pilot study provided important insights from traffic police in one Chinese city which suggest there may be potential unintended effects of introducing more severe penalties including a range of strategies reportedly used by drivers to avoid detection. Recommendations for future research include a larger study to confirm these findings and examine the training and education of drivers; the focus and reach of publicity; and possible resource needs to support police enforcement.

Second Skin 2012 Workshop

The Second Skin 2012 Workshop Program consisted of a full-day intensive design immersion workshop run on Saturday 14 July 2012, at the QUT Faculty of Creative Industries Fashion Studios at Kelvin Grove Brisbane, Australia, for 30? self-selected high-achieving junior and middle school (year 5-9) students, as part of the Queensland Academies ‘Young Scholars’ Program. Inspired by a scientist researching the impact of sun on skin, and mentored by tertiary fashion design and interior design educators, and six tertiary fashion design and interior design students, the workshop explored science and design-inspired prototype solutions for sun-safety. This action research study aimed to facilitate an acute awareness in young people of the sun safety message (alternative to a scare campaign), the role of design in society and the value of design thinking skills in solving complex challenges, and to inspire the generation of strategies to address a systemic health issue. It also aimed to investigate the value of collaboration between junior and middle school students, tertiary design educators and students and industry professionals in targeting youth sun safety, and inspiring post-secondary pathways and idea generation for education. During the workshop, students developed sketching, making, communication, presentation and collaboration skills to improve their design process, while considering social, cultural and environmental opportunities. Through a series of hands-on collaborative design experiments, participants explored in teams of five, ways in which a ‘second skin’ can mirror elements of our skin – the ability to protect, divide, enclose, stretch, scar, pattern, peel and reveal – inspiring both functional and aesthetic design solutions. Underpinned by the State Library of Queensland Design Minds Website ‘inquire, ideate and implement’ model of design thinking, the experiments culminated in the development of a detailed client brief, the design and fabrication of a fashionable sun safe clothing range and then a team presentation and modelling of prototypes in a fashion parade, viewed also by parents. The final collections were judged by three prominent judges: Louise Baldwin - Executive Manager Public Health QLD Cancer Council, Shane Thompson - Architect and 2012 Queensland Smart Design Fellow, and Leigh Buchanan – Fashion designer and Project Runway Australia finalist. The workshop was filmed for Queensland television program ‘Totally Wild’ for dissemination of the value of design, the Design Minds model and the sun safety message to a wider target youth audience.

Comparing child product safety concerns with injury incidents : does the evidence support the response?

Background Efficient effective child product safety (PS) responses require data on hazards, injury severity and injury probability. PS responses in Australia largely rely on reports from manufacturers/retailers, other jurisdictions/regulators, or consumers. The extent to which reactive responses reflect actual child injury priorities is unknown. Aims/Objectives/Purpose This research compared PS issues for children identified using data compiled from PS regulatory data and data compiled from health data sources in Queensland, Australia. Methods PS regulatory documents describing issues affecting children in Queensland in 2008–2009 were compiled and analysed to identify frequent products and hazards. Three health data sources (ED, injury surveillance and hospital data) were analysed to identify frequent products and hazards. Results/Outcomes Projectile toys/squeeze toys were the priority products for PS regulators with these toys having the potential to release small parts presenting choking hazards. However, across all health datasets, falls were the most common mechanism of injury, and several of the products identified were not subject to a PS system response. While some incidents may not require a response, a manual review of injury description text identified child poisonings and burns as common mechanisms of injuries in the health data where there was substantial documentation of product-involvement, yet only 10% of PS system responses focused on these two mechanisms combined. Significance/contribution to the field Regulatory data focused on products that fail compliance checks with ‘potential’ to cause harm, and health data identified actual harm, resulting in different prioritisation of products/mechanisms. Work is needed to better integrate health data into PS responses in Australia.