Safety Program Development and Management LEARNING OBJECTIVES Upon completion of this chapter, you should be able to: • List the essential elements of a safety and health program. • Describe the process required for the development of goals and objectives. • Develop an action plan based on goals and objectives. • Perform a cost-benefit analysis. • Describe the relationship of training to the safety and health program. • Describe the process for developing standard operating procedures.
On March 17, 2017, at 10:20 hours, a 54-year-old male career firefighter responded to a structure fire in a two-and-a-half-story single-family home. The firefighter coordinated interior attack operations, gave an in-person report to the incident commander, changed his air bottle, and returned to the interior to assist with overhaul. At 10:41 hours, he collapsed Fellow firefighters immediately removed him from the fire room, transported him outside, and lifted him onto a stretcher that was brought to the front of the house. Firefighters initiated cardiopulmonary resuscitation (CPR as the stretcher was wheeled to the ambulance. Paramedics provided advanced life support (ALS) protocols en route to the hospital, including administering cardiac medication and multiple defibrillations. The ambulance arrived at the hospital emergency department (ED) at 10:58 hours. Hospital ED personnel continued resuscitation efforts unsuccessfully for approximately 30 minutes. The firefighter was pronounced dead on March 17, 2017, at 11:26 hours. The medical examiner's report and death certificate listed "carbon monoxide toxicity in a person with hypertensive and atherosclerotic cardiovascular dis-ease" as the immediate cause of death. The National Institute for Occupational Safety and Health (NIOSH) concluded that the physical exertion associated with firefighting and the elevated levels of carbon monoxide (CO) in the presence of severe underlying cardiovascular disease likely triggered an arrhythmia in this firefighter. After analyzing the incident, investigators published several key recommendations, including the following: • Ensure that all firefighters receive an annual medical evaluation consistent with National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments. Ensure that firefighters are cleared for duty by a physician knowledgeable about the physical demands of firefighting, the personal protective equipment (PPE) used by firefighters, and the various components of NFPA 1582. Phase in a mandatory comprehensive wellness and fitness program for firefighters. • Perform annual physical performance (physical ability) evaluations of firefighters. • Provide annual medical clearance for self-contained breathing apparatus (SCBA) use. • Ensure that firefighters wear SCBA when working in a potentially hazardous atmosphere.
Introduction As the text goes on, the requirements for a comprehensive safety and health program will be presented as a tool for the safety and health program manager. First, however, the reader must gain an understanding of the steps needed to develop a successful program, including determining essential elements, setting goals and objectives, planning necessary actions, weighing costs versus benefits, conducting safety training, and developing standard operating procedures (SOPs). Although the steps are presented in this order for the purposes of this chapter, the actual order of the process may differ depending on the organization.
Determining Essential Elements The first step in the process of developing the safety and health program is to determine what essential elements are needed. These elements, which vary by department type and size and by the nature of responses, include the following (the specific roles and responsibilities will be discussed in Chapter 11, Personnel Roles and Responsibilities): • Top management's commitment to the program, as evidenced by an official written occupational safety and health statement
A safety and health program manager -note that in a fire department, this position must meet the requirements of the health and safety Introduction As the text goes on, the requirements for a comprehensive safety and health program will be presented as a tool for the safety and health program manager. First, however, the reader must gain an understanding of the steps needed to develop a successful program, including determining essential elements, setting goals and objectives, planning necessary actions, weighing costs versus benefits, conducting safety training, and developing standard operating procedures (SOPs). Although the steps are presented in this order for the purposes of this chapter, the actual order of the process may differ depending on the organization. officer (HSO) as described in NEPA 1521, Standard for Fire Department Safety Officer Professional Qualifications
There is no specific number of objectives needed to reach a goal; the number depends on the complexity of the goal and the number of interrelated activities needed to reach it. to research options for relocating the storage of heavy equipment on the apparatus to a lower level, and then submit a written report with recommendations to fire department management. Objective 1.3: Before Xx/Xx/20xx, consult with the department physician to develop a fitness TIP An objective must deal with one specific activity and must be obtainable within the given time frame. Do not create too many objectives in an unrealistic time frame, as this can lead to failure. routine designed to strengthen back muscles. Objective 1.4: Before Xx/Xx/20xx, research the use of back support belts in emergency services applications, including organizational results, and file a written report with the safety com-mittee, including recommendations based on a The following is an example of a poorly written objective for the goal "Develop a comprehensive back-injury reduction program": Objective 1.1: A training program will be developed and presented to all employees, and each employee will be issued a back support belt before the next budget is passed. Analysis of this objective reveals a few flaws. First, the objective describes more than one solution (i.e., training and support belts). Second, the time frame is ambiguous. Instead, the following objectives more consistently comply with the suggested guidelines for SMART objectives: Objective 1.1: Before xxxx/20xx, develop an SOP that requires an employee to request assistance when performing nonemergency lifting of equipment over 50 pounds. cost-benefit analysis. These four objectives are all clear and to the point. They are measurable, include reasonable time frames, can be achieved, are relevant to the goal, and can be easily evaluated at the end of the specified time frames for completion. FIGURE 4-2 provides a summary of the goal and objectives for the example program. The goal and objective process is dynamic and ever-changing: Because goals and objectives need to be developed for each problem area, they may change over time as new problems are identified. Addition-ally, each goal and objective should be reevaluated during the implementation process to see whether they are being met; if they are not being met, an objective may need to be changed to better ensure goal accomplishment. Problem: The average annual frequency of back injuries in the fire department is higher than that in comparable departments. Goal 1: Develop a comprehensive back-injury reduction program. Objective 1.1: Before Xx/Xx/20xx, develop an SOP that requires an employee to request assistance when performing nonemergency lifting of equipment over 50 pounds. Objective 1.2: Before Xx/Xx/20xx, form a team to research options for relocating heavy equipment on the apparatus to lower levels, and then submit a written report with recommendations to fire department management. Objective 1.3: Before XxXx/20xx, consult with the department physician to develop a fitness routine designed to strengthen back muscles. Objective 1.4: Before Xx/Xx/20xx, research the use of back support belts in emergency services applications, including organizational results, and file a written report with the safety committee including recommendations based on a cost-benefit analysis. FIGURE 4-2 The goal and SMART objectives for a back-injury reduction program.
Action Planning As described in the previous section, the goal statements are the road map for the safety and health pro-gram, and the objectives are the road map to the goal. What, then, is the road map to the objectives? The answer is the action plan, a step-by-step written guide to meeting an objective (FIGURE 4-3). Each objective needs its own action plan. The action plan, which should be developed by the team that has been assigned the objective, should list the goal and objective that it is designed for. The plan should also contain the team members' names and very specific steps for completing the objective, often presented in tabular form. For each step, the plan should include a specific action, the benchmark completion date, the person or persons responsible, resources needed, anticipated support or roadblocks, and the actual completion date (FIGURE 4-4). There may be cases in which the support and roadblock information is left out of the action plan; however, for the most part, it should be identified so the team can anticipate issues that may occur during the implementation process. As exemplified in Figure 4-4, the action plan covers all of the necessary steps to fully implement the objective, and further progress can easily be measured against the completed benchmarks. Cost-Benefit Analysis A cost-benefit analysis is often used to show that the initial outlay for the program will save money in the future via risk reduction. It is often necessary to support a position set forth in the action plan, particularly if the objective involves any financial outlay. For exam-ple, the purchase of new firefighting PPE should result in the reduction of burn injury costs, and the cost of an extensive driver training program should result in an associated reduction in vehicle accidents, and therefore possibly a reduction in insurance premiums. When using a cost-benefit analysis, assumptions often must be made. Sometimes the data are based on estimations of improvement rather than actual results because it is almost impossible to determine the exact outcome of a program prior to its implementation. • Goals • Objectives the ces Its, m- 1 a ) the time , and ified des a mple and d to ange ion-ated ther ob- goal CHAPTER 4 Safety Program Development and Management • Risk identification 61 • Action plan FIGURE 4-3 The relationship between goals, objectives, and the action plan. However, by using information from similar agencies that have done similar projects, an estimation of expected outcomes can be formed. Similarly, by analyzing historical injury data, it can be determined which injuries would likely have been prevented if the program in question had been in effect. A cost-benefit analysis typically allows the safety and health program manager to evaluate the cost-effectiveness of a program. The analysis examines the current cost of the risk and compares those costs to the cost of program implementation, considering both direct and indirect losses and costs. Recall from Chapter 3, Risk Management, that the cost of a risk is measurable and can be both direct and indirect. Direct costs might include the costs of medical treatment, the overtime paid to cover a vacancy on a crew, or the cost of replacing equipment. Indirect costs might include loss of productivity, the loss of using the equipment, stress-related concerns of coworkers, and possibly the cost of replacing employees. A price cannot always be put on some of the losses that are incurred by the emergency services. For example, if a program would prevent loss of life, it would need to be undertaken, regardless of the result of the cost-benefit analysis. Direct and indirect costs may also be applied as program costs. The first step in the cost-benefit analysis is to de-scribe, in numerical terms, the current cost of the risk without intervention. The next step is to determine the cost of the risk after the intervention has been im-plemented. After this step, the safety and health program manager can determine whether the measure in question would be effective from a pure cost stand-point. Finally, the cost of program implementation must be calculated. Once these three steps are com-pleted, an informed decision can be made. Remember that a program that saves only $1000 per year and costs $5000 to implement may still be beneficial to the organization in the long run.
FIGURE 4-5 demonstrates what a spreadsheet would look like for a cost-benefit analysis in the example of the back-injury reduction program. The analysis reveals that the organization would save $24,960 the first year. Aside from some ongoing training and replacement back supports, the cost of the program in future years would be greatly decreased. Therefore, the savings over time would be higher and could be calculated using the same format. Training There is a direct and close relationship between training and safety (FIGURE 4-6). In fact, in some organi-zations, the training officer or division assumes the functions of the safety and health program. In addition, many training programs are based on the notion of operating safely, and the safety initiatives that a department undertakes are often disseminated through the Cost-Benefit Analysis Goal: Development of Back Injury Prevention Program-First Year Current Situation and Costs 25 back injuries per year, with the resultant hospital/doctor visit average cost $1000 per visit and an average 1.5 (36 hours) days of work lost Direct Costs Medical expenses Indirect Costs Overtime (OT) to cover vacancies on shift, average hourly rate $20 36 Hours x 25 Injuries X 1.5 OT X $20 Average Hourly Rate Total Costs Future Estimation of Situation 13 back injuries per year, with resultant hospital/doctor visit average cost $1000 per visit and an average 1.5 (36 hours) days of work lost Direct Costs Medical expenses Indirect Costs OT to cover vacancies on shift, average hourly rate $20 36 Hours X 13 Injuries x 1.5 OT x $20 Average Hourly Rate Total Costs First Year Savings (Estimation based on research) Program Costs Direct Costs Physician's time Back supports Indirect Costs Training time Apparatus compartmentation change Total Program Costs First Year Savings Minus Program Implementation Costs FIGURE 4-5 A sample cost-benefit analysis of a back-injury prevention program. $25,000 $27,000 $52,000 $13,000 $14,040 $27,040 $24,960 $5,000 $3,000 $1,500 $1,500 $11,000 $13,960
department's training programs. Training programs must be designed to provide training and education to ensure that the responders have the knowledge, skills, and abilities commensurate with the duties and functions that they are expected to perform. The training program must also have entry qualifications and a process monitor responder proficiency. An active and aggressive training program is needed in order to prepare the responder for all operations, particularly operations at low-frequency but high-risk events. A number of standards and regulations dictate how an emergency services organization operates, as discussed in Chapter 2, Review of Safety-Related Regulations and Standards. Within these standards and regulations are requirements for certain levels of training. For example, OSHA 1910.120, the hazardous materials incident operations regulation, bases training requirements on five levels of response. Many states require a minimum level of training for firefighters or paramed-ics; these training requirements always contain some consideration related to safety, whether it be the use of self-contained breathing apparatus (SCBA), infection control, or any number of other considerations. TIP Training mandates are designed in hopes of ensuring that an appropriate level of training is provided to responders so that they can safely handle the incident and recognize dangers. Standard Number Title NFPA 1401 Recommended Practice for Fire Service Training Reports and Records NFPA 1402 Standard on Facilities for Fire Training and Associated Props NFPA 1403 Standard on Live Fire Training Evolutions NFPA 1404 Standard for Fire Service Respiratory Protection Training NFPA 1407 Standard for Training Fire Service Rapid Intervention Crews NFPA 1408 Standard for Training Fire Service Personnel in the Operation, Care, Use, and Maintenance of Thermal Imagers NFPA 1410 Standard on Training for Emergency Scene Operations NFPA 1451 Standard for a Fire and Emergency Service Vehicle Operations Training Program NFPA 1452 Guide for Training Fire Service Personnel to Conduct Community Risk Reduction for Residential Occupancies Training is important as the organization's safety and health program develops. A training program can be a vehicle for introducing and testing new procedures. Remember that an accountability system that looks great on paper but does not work during training evolutions will probably not work at a real-life incident. Training may also be developed to help deal! with existing injury problems, such as lifting injuries or thermal burns. The training staff should be integrated into the safety and health program (in both development and implementation) more than any other function within the emergency services organization. Vast resources are available for the organizations training program, including fire and emergency medical services (EMS) professional organizations; the U.S. Fire Association (USFA), including the Training Resources and Data Exchange (TRADE), a regionally based network managed by the USFA designed to foster the exchange of fire, rescue, and EMS-related training information and resources; state fire/EMS training cen-ters; local colleges and universities; the fire academy; textbooks; and the National Fire Protection Association (NFPA) (TABLE 4-1). The Internet can be used to research training information, ideas, and experiences from other emergency services departments (described in more detail in Chapter 13, Information Management). Developing Standard Operating Procedures and Safety Policies Developing safety procedures and policies is necessary to meet some of the goals and objectives defined in the safety and health program. After development, approval, and implementation, these policies must be reviewed for effectiveness and updated as necessary. The USFA publication titled Guide to Developing Effective Standard Operating Procedures for Fire and EMS Departments is an excellent resource for the development of SOPs. This guide describes a four-step development process:
Wrap Up CHAPTER SUMMARY • The safety and health program has several essential elements, including: • Top management's commitment to the program • A safety and health program manager • ISOS