A review of crane safety in the construction industry

The complex, dynamic, and continually changing nature of construction work has been recognized as an important contributor to the high rates of injuries and fatalities in the industry. Cranes are a central component of many construction operations and are associated with a large fraction of construction deaths; in fact, estimates suggest that cranes are involved in up to one-third of all construction and maintenance fatalities. Safety and health professionals serving the construction industry need adequate training and knowledge regarding available crane safety devices and procedures so that they may insure these techniques are effectively utilized during construction operations. This paper reviews available information on crane-related injuries, currently available safety devices, and commonly used crane safety procedures. Recommendations for improved crane injury prevention and future crane safety research are given.

Delays in the EMS response to and the evacuation of patients in high-rise buildings in Singapore

BACKGROUND

Singapore is a highly urbanized and cosmopolitan city situated at the crossroads of Southeast Asia. High-rise buildings and "vertical living" are common, and the city serves as a major business, financial, and industrial hub in the region. More than 80% of the population live in high-rise apartments. This poses unique problems and challenges for emergency ambulance services personnel in the access to and evacuation of patients.

OBJECTIVE

To estimate the arrival-to-patient contact delay when accessing patients in high-rise buildings and evacuating them to the hospital, compared with accessing patients in ground-level premises.

METHODS

This was a prospective study carried out from February 2 to March 1, 1998, for emergency calls from two of the busiest fire stations. The first 150 consecutive cases were enrolled into each of the two groups. Cases of road traffic accidents were excluded because these did not require the crew to get into a building. The times were clocked by one of the paramedics, using a stopwatch. A high-rise building was defined as one where the crew had to ascend at least one flight of stairs. A ground-level building did not involve any stair climbing. We set forth to determine whether the interval between the following was statistically significant when comparing high-rise vs ground-level premises: 1) time when the ambulance arrives at the scene (taken as the time when the driver turns the engine off) and time of arrival at the patient's side; 2) time of leaving the dwelling with the patient and time when the ambulance starts its journey to the hospital (taken as the time when the driver starts the engine). Data analysis was done with the use of SPSS, and the one-tailed unpaired Student's t-test was used for significance testing, with the alpha error rate set at 0.05. Results. One hundred fifty runs were analyzed for each group. The mean delay from arrival to patient contact was 2.49 +/- 0.98 minutes for the high-rise group compared with 1.02 +/- 1.41 minutes for the ground-level group (difference was statistically significant with 95% CI: 1.20, 1.74 minutes; p = 0.0106). The mean delays from the time of leaving the building with the patient to the time when the ambulance turned its engine on to start its journey to the hospital were 3.24 +/- 1.58 minutes and 1.27 +/- 0.71 minutes for the two groups, respectively (difference was statistically significant with 95% CI: 1.68, 2.04 minutes; p = 0.0098).

CONCLUSION

There were significant delays present when accessing patients in high-rise buildings and evacuating them to the hospital. Modification to buildings and increasing public awareness and education have been suggested to help minimize these delays.

Charter for disabled people using hospitals: a completed access audit cycle

This completed audit cycle assessed access for disabled people to a district general hospital, in relation to standards laid down in the Royal College of Physicians Charter for Disabled People using Hospitals. The project was effective in demonstrating problems and implementing change to overcome them. It was also useful in raising disability awareness in the young investigators, who easily recognised the shortcomings in facilities for disabled people, and is proposed as a possible model for inclusion in medical undergraduate training programmes to raise disability awareness amongst a new generation of doctors.

Behavioral analysis of computer-administered vicarious exposure in agoraphobic subjects: the effect of personality on in-session treatment process

Pretreatment measures of personality and symptom levels in agoraphobic subjects (N = 18) were correlated with their behavior on an interactive computer simulation that provided vicarious exposure to a phobia of elevators. Behavior during treatment sessions was assessed via human-computer interactions (HCIs). Automated programs analyzed these interactions to provide detailed behavioral descriptions. All subjects engaged in vicarious exposure, but the extent of this varied eightfold. Vicarious exposure increased across treatment sessions, with a qualitative shift to a high-exposure routine of staying in the simulated elevator and repeatedly traveling the maximum number of floors. The amount of activity spent on traveling in the elevator increased from 43% to 62% across three treatment sessions. Correlations were observed between vicarious exposure behaviors and a number of subject characteristics including neuroticism and conscientiousness. We conclude that HCIs provide a detailed record of behavior during computer-administered treatment. Subjects demonstrate learning of exposure strategies across treatment sessions. Interindividual differences in behavior correlate with a number of pretreatment subject personality characteristics.

North American approach to smoke management

The term smoke is used to mean the airborne products of combustion and air that is mixed with those products. A smoke control system is used to mean a system intended to manage smoke by pressurisation, and smoke management system is a broader term that includes systems that use any combination of compartmentation, dilution, air flow, pressurization or buoyancy. Smoke control systems include zoned smoke control, pressurized stairwells, and elevator smoke control. Over the past few decades there have been a number of full scale fire tests that demonstrate that pressure differences can prevent smoke migration from the low pressure side to the high pressure side of a barrier. While there are equations that can be used for smoke control design, network computer models can account for the effects of complex building leakage paths. For simplicity the term atrium was used in this paper in a generic sense to mean almost any large space (such as arcades, sports arenas, and exhibition halls). In North America most atria rely on sprinkler protection for spaces connected to the atrium and fan powered exhaust at or near the top of the atrium. Because the ability of sprinklers to suppress fires in spaces with ceilings higher than about 11m is limited, smoke exhaust is especially important for fires that start in the atrium. Equations and computer zone models can be used for the design of atrium exhaust systems. When these approaches are inappropriate, CFD modelling or physical modelling can be used.

Aging and postural control: postural perturbations caused by changing the visual anchor

OBJECTIVE

To determine the effect of modifying the stable visual anchor on the postural stability of older individuals. The visual anchor was changed by opening doors similar to those found in an elevator cage. Lighting intensities inside and outside the cage were varied to create increasing or decreasing luminosity conditions. The effect of adding a cognitive load (counting backwards) was also tested.

DESIGN

A controlled laboratory study.

SETTING

Tests performed in a balance laboratory.

MEASUREMENTS

Sensory and clinical measurements to insure the integrity of the central and peripheral nervous system. Measures of balance were derived from the recordings of the center of foot pressure. These measures included range and speed of the center of foot pressure.

PARTICIPANTS

Eight older, community-dwelling subjects and nine young subjects participated. A sensorimotor evaluation was used to insure that all older individuals were free from any pathologies affecting postural stability. All participants had a low score (indicating high balance confidence) on the Falls Efficacy Scale and no history of falls.

RESULTS

Older individuals were affected by modification of the stable visual anchor induced by the opening of doors similar to that of an elevator cage. They showed greater ranges of the center of foot pressure (COP) and speed of the COP after than before the opening of the doors. Furthermore, the increased ranges and speed were two to three times greater than that observed for the young subjects. A lighting intensity considered as comfortable for reading inside the elevator affected the overall postural stability of the older participants negatively. Counting backwards also decreased their overall stability.

CONCLUSION

Changing the stable visual anchor, as when exiting an elevator cage, could be a significant risk factor for older persons. Moreover, when combined with a cognitive load or lower lighting intensity inside the elevator cage, the negative effects on the postural stability of older persons are exacerbated.

[What do people talk about in Danish hospital elevators?]

Hospital elevators make up a part of the public space of hospitals which is used by both employees, patients, and patients' relatives. We performed an observational study to ascertain the frequency of ethically problematic conversations between employees in the elevators of three Danish hospitals. We defined a conversation as problematic if it breached confidentiality or if it could raise doubts about the professional or ethical standard of the hospital or its employees. Based on this definition we found that problematic conversations occurred in 18 out of 201 elevator-trips where more than one member of the hospital staff was present in the elevator (9%, 95% confidence limits 5-14%). The most common types of problems were breaches of confidentiality (6 cases), complaints about stressful work (4 cases), and complaints about the organisation (3 cases).

Escalator-related injuries in children

OBJECTIVE

Escalator-related trauma is uncommon but can cause significant injury. This study reviewed escalator-related injuries in children to determine risk factors, types of injuries, medical interventions, and long-term outcomes.

DESIGN AND SETTING

Retrospective clinical patient series, Municipal Hospital Pediatric Emergency Service. Participants. All children less than 18 years of age who presented to the Pediatric Emergency Service with an escalator-related injury from August 1990 through February 1995.

METHODS

We reviewed the chart and interviewed the parent of each child by telephone. We collected the following information: age, gender, child's supervision and activity while on the escalator, escalator location, direction of motion, presence of escalator defects, nature and extent of injury, medical interventions, and outcome.

RESULTS

Twenty-six children had escalator-related injuries. The average age was 6 years (range, 2-16). Thirteen children (50%) were 2 to 4 years old. There were 15 (57%) boys. Eighteen children (69%) were accompanied by an adult. All children 7 years and younger were accompanied by an adult; however, 50% were not holding the hand of their guardian. Eight children (31%) were injured while riding improperly, ie, walking, running, playing, or sitting on the escalator, and among these, all who were standing fell down before the injury. Six (23%) children were injured while stepping off the escalator. Of 9 children less than 4 years old, 7 (78%) were riding the escalator properly. Of 9 children 4 years or older, only 3 (33%) were riding properly. Circumstances of injury included falling down with subsequent blunt trauma, falling down with subsequent entrapment of an extremity, and entrapment of an extremity not related to falling down. Locations of entrapment were between two steps, between a step and the side-rail, and between the last step and the comb plate. Twenty-one (81%) injuries occurred in rail or subway stations. Eight escalators were reported to have functional or structural problems. Seventeen (65%) children sustained lower extremity injuries and 8 (31%) sustained upper extremity injuries. Injuries included lacerations, avulsions and degloving injuries of the extremities, tendon and nerve lacerations, and digit fractures and amputations. Thirteen (50%) children were admitted to the hospital for operative management; the average length of hospitalization was 13 days (range 1-29). Four children (15%) suffered significant functional loss, and 12 (46%) sustained permanent cosmetic deformities.

CONCLUSION

Children are at risk for sustaining severe injuries on escalators. Young age, inadequate adult supervision, improper activity while riding on the escalator, and escalator-related mechanical problems all increase the risk of injury. Public and parent education directed toward escalator safety issues may help to reduce escalator-related injuries in children.

Managing hospital emergency power testing programs

All hospitals must have an emergency power testing program that includes generator load testing and emergency power supply system maintenance. This document examines a management program that uses lessons learned from an emergency power testing program to improve the hospital's facilities and training.

An uplifting experience? Hospital passenger lifts and their suitability for disabled people

Hospitals should be welcoming places, and disabled people should not expect difficulties when using a hospital's facilities. For some elderly and disabled people the passenger lift may be the only means of vertical movement within a building. We visited four hospitals and inspected their passenger lifts for use by disabled and elderly people. We compared our findings with those of an "ideal lift' drawn from recommendations by disabled support groups, National Health Services Estates Department and building regulations. We found that most hospital passenger lifts are inadequate for those with mobility, visual and hearing impairments. Consequently, disabled and elderly people might have problems using hospital passenger lifts, with a subsequent loss of independence. The provision of well-designed and accessible passenger lifts is central to imaginative hospital building design.

Courier robot keeps hospital staff 'on the job'

A courier robot at Abington Memorial Hospital has allowed the hospital to maintain high standards of patient care in the face of budget constraints. The robot handles after-hours deliveries of meals and supplies efficiently and cost-effectively, thus freeing support staff to focus on other tasks.

Escalator injuries in Genevan children: a report of 6 cases

We present a retrospective survey of the mechanism and the lesions caused by escalators in Genevan children. Though these accidents are rare, they are often very serious. They occur primarily among children around the age of three and affect especially the hand. It is not economically feasible to replace or modify current escalators. It is therefore important that the current warning signs on escalators be improved. As there is a specific risk to children of catching fingers in the escalator and most parents are unaware of this type of danger, a warning sign with an explicit illustration could be of value. Also an insertion of a plastic bar just above the moving stairs on each lateral wall would block any potential extremities from being caught in the gap between the steps and the side of the staircase.

Elevator talk: observational study of inappropriate comments in a public space

OBJECTIVES

We conducted a study to determine the type and frequency of inappropriate comments made by hospital employees while riding hospital elevators.

METHODS

Four observers rode in elevators at five hospitals, listening for any comments made by hospital employees that might be deemed inappropriate. All potentially inappropriate comments were reviewed by the research team and were classified as inappropriate if they met at least one of the following criteria: violated patient confidentiality, raised concerns about the speaker's ability or desire to provide high-quality patient care, raised concerns about poor quality of care in the hospital (by persons other than the speaker), or contained derogatory remarks about patients or their families.

RESULTS

We observed 259 one-way elevator trips offering opportunity for conversation. We overheard a total of 39 inappropriate comments, which took place on 36 rides (13.9% of the trips). The most frequent comments (18) were violations of patients confidentiality. Next most frequent (10 comments) were unprofessional remarks in which clinicians talked about themselves in ways that raised questions about their ability or desire to provide high-quality patient care. Other comments included derogatory statements about the general quality of hospital care (8) and derogatory remarks about patients (5). Physicians were involved in 15 of the comments, nurses in 10, and other hospital employees in the remainder.

CONCLUSION

Inappropriate comments took place with disturbing frequency in the elevator rides we sampled. These comments did not exclusively involve violations of patient confidentiality, but encompassed a range of discussions that health care employees must be careful to avoid.

Outfitting your hospital for the new wave of robots

Automated materials handling systems have provided dramatic labor savings and efficiency benefits to healthcare facilities. A growing trend is the use of a new breed of service robots that provide automated materials handling without major modifications to the existing building. The robots navigate through hallways, go through doors and ride elevators using a computerized controller that contains a layout of each floor of the hospital; the robots do not rely on any type of physical track to guide them on their way. The robots are programmed to pick up or deliver supplies to nursing stations or other departments, and determine the best route. Purchase and rental options exist at a substantial savings over human labor.

Depth perception of interfering periodic patterns: a possible contribution to disorientation on escalators

Incongruous and illusory depth cues, arising from 'interference patterns' produced by overlapping linear grids at the edges of escalator treads, may contribute to the disorientation experienced by some escalator users, which in turn may contribute to the causes of some of the many escalator accidents which occur. The apparent depth of the interference pattern from the viewer is analysed in terms of the cues deriving from size and viewer motion. Both of these cues support the depth of the target being infinite. Preliminary observations are reported which confirm this analysis. Remedies for the problem are suggested. The possible contribution of this illusion to disorientation on escalators, due to misjudgment of depth, is compared with another recently reported factor which is due to stereoscopic miscorrespondence of periodic targets.