Heinrich’s1 Injury Triangle asserted that minor injuries predict serious injuries, and by controlling the causes behind minor injuries, serious injuries and fatalities (SIFs) will also be controlled.

This assertion has been questioned in recent years2,3,4,5 with data from numerous sources showing minor injuries nationwide decreasing, with a corresponding trend across all industries for SIF statistics to plateau. Recent work by Mercer ORC HSE Networks (now ORCHSE) showed about 20 percent of all the injury cases examined were potential SIFs.

To determine if an incident has the potential to be an SIF, use the five-level classification system commonly used in hospital emergency departments6,7: Life-Threatening (Level 5 – Critical – uncertain survival); Life-Altering (Level 4 – Severe – probable survival); Temporary Disability (Level 3 – Serious – not life-threatening); Temporary change of job duties (Level 2 – moderate severity); and First-Aid treatment (Level 1 – mild severity). A potential SIF is normally deemed to be a “Life-Threatening” or “Life-Altering” injury, but there is also a case for including “Temporary Disability,” particularly if the disability exceeds 30 days. 

Understand the issues

Most potential SIFs relate to certain types of precursor situations, generally related to “non-routine” situations (e.g. process upsets) or in the lexicon Root Cause Analysis (RCA), influencing factors, according to Fred Manuele. But most potential SIFs arise from everyday routine situations (e.g. maintenance). For example, when requested to analyze contractor incidents in the past two years, we found 90 percent of potential SIFs related to everyday routine precursor situations, giving a one in three chance of an incident being a potential SIF. A potential SIF can arise at any moment in time, in any area of activity. Review your incidents during the past year or so to define, identify and mitigate those “Routine” and “Non-Routine” precursor situations most likely to lead to a potential SIF.

People undertake various activities within any given precursor situation. These activities identify and define specific “Exposure Categories” so those most likely to cause a potential SIF can be targeted for action. In our contractor work, we identified 21 exposure categories accounting for all the incidents recorded, suggesting that many risk control systems were missing, deficient, or were not being complied with. One practical lesson: ensure every single precursor situation and exposure category is clearly defined with concrete examples to ensure consistency when different people are identifying potential SIFs.

Conduct a finer grained analysis and get to the root causes to link any potential SIF analysis with “Underlying Cultural Contributors” (e.g. safety communications). Typical “Underlying Cultural Contributors” include people’s individual behaviors, as well as issues under management’s direct control such as leadership, job planning, job methods, sub-standard equipment, job pressures, and manpower levels. Job planning and people’s behavior was the root cause for about 75 percent of all potential SIFs identified in our analysis of contractor incidents. Corrective actions focused on job planning could eliminate about 30 percent of potential SIFs and focusing on people’s behavior could reduce another 45 percent. This is more cost-effective than focusing on a larger number of precursor situations and exposure categories to achieve the same result (this is not to argue that the latter should be ignored).

Philosophical implications

Implementing a Potential Serious Injury and Fatality (SIF) program is a proactive response with significant time and cost implications. Most companies currently use Root Cause Analysis (RCA) when an actual serious injury occurs, but tend not to allocate similar resources to lesser incidents, even if they have the potential to be much more
serious.

A genuine SIF program presupposes that any incident, regardless of actual severity, will be root cause analyzed if it has the potential to lead to a life-threatening or life-altering event. Potential consequence(s) should be the primary driver for prioritizing corrective and preventative action. This should include [a] allocation of sufficient resources to mitigate the precursor situations, exposure categories and underlying cultural contributors; [b] in-depth investigation of every potential SIF; [c] thorough root cause analysis of every potential SIF; [d] Lessons learned dissemination and execution; [e] tracking recommendations and corrective & preventative action (CAPA) completion; [f] follow-up and review of the effectiveness of corrective and preventive actions; and [g] an annual review of the SIF program.

The way forward

Potential SIFs are the outcome of organizational failings. These should have been identified and addressed8. Encouraging the reporting of close-calls and actual events presupposes [a] that there is a willingness to openly and proactively receive these reports, and [b] there is the means to easily capture and record such information9. Eighty-seven percent of all potential SIFs can be identified from safety observations using BBS processes and safety leadership “walk rounds,” according to Tom Krause. Your people need training in hazard recognition to competently identify any potential SIF. Definitions of precursor situations, exposure categories and underlying cultural contributors are useful to develop “tailored” potential SIF training programs so your people know exactly what to look for.

Databases to record and analyze the potential SIFs identified via “close calls” and safety observation processes facilitate computing and tracking a Potential SIF metric  (i.e. Number of Potential SIFs / Man-hours Worked) to be regularly reviewed.

References

1 Heinrich H.W. (1931). Industrial Accident Prevention. McGraw Hill. New York

2 Petersen D.C. (1989). Techniques of safety management. A systems approach. (3rd edition). Aloray Goshen. New York

3 Hale, A. (2002) Conditions of occurrence of major and minor Accidents: Urban myths, deviations and accident scenario's. Tijdschrift voor toegepaste Arbowetenschap. 15 (3), 34-41.

4 Manuele , F.A. (2008) Serious Injuries & Fatalities: A call for a new focus on their prevention. Professional Safety, 53 (12), 32-39.

5 Krause, T. (2012). New perspectives in fatality and serious injury prevention. Presentation at Fatality Prevention Forum 2012, Coraopolis, PA, USA.

6 Massachusetts Department of Public Health. Inpatient Hospitalizations for Work?Related Injuries and Illnesses in Massachusetts, 1996?2000. Boston: Occupational Health Surveillance, 86pp. 2005. Technical Report OHSP?0501.

7 Massachusetts Department of Public Health. Emergency Department Visits for Work?Related Injuries and Illnesses in Massachusetts, 2001?2002. Boston: Occupational Health Surveillance, 52pp. 2007. Technical Report OHSP?0701.

8 Reason, J. (1998). Managing the Risks of Organizational Accidents. Aldershot, UK:  Ashgate Publishing

9 Roe, T.H., Hollars, L., Marinan, C., et al (2011). Establishing a Lessons learned Program. Center for Army Lessons Learned, KS USA.