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Learning Lessons from the Santika Nightclub Fire

For many years SafetyAtWorkBlog and its forerunner Safety At Work magazine reported on various tragic fires in crowded nightclubs around the world. Several in recent memory include the 2003 Rhode Island fire that killed 100 patrons and for which, according to an Associated Press report from the time,

Superior Court Judge Francis Darigan Jr sentenced 29-year-old Daniel

Biechele to 15 years, but suspended 11 years of that sentence, and

also ordered three years of probation.

“Superior Court Judge Francis Darigan Jr sentenced 29-year-old Daniel Biechele to 15 years, but suspended 11 years of that sentence, and also ordered three years of probation.”

A brief report on the Rhode Island fire is in the OSHA media archives.

In March 2006, Safety At Work included an AFP report saying

“The municipal council has impeached Buenos Aires Mayor Anibal Ibarra after finding him guilty of dereliction of duty following a December 30, 2004 nightclub fire that killed 194 people.”

An earlier report on the mayor’s response is include at the CrowdSafe website.

Engineering and design company ARUP have provided SafetyAtWorkBlog with an article that analyses recurring elements of nightclub fires using the Santika fire in Bangkok from 1 January 2009 as a most recent incident. Below is the introduction to the article which can be found in full in the pages listed above.

Our thanks to ARUP for the terrific article.

Kevin Jones

LEARNING LESSONS FROM THE SANTIKA NIGHTCLUB FIRE

by Dr Marianne Foley and Travis Stirling, Arup Fire, Sydney

In the early hours of New Years Day 2009, fire engulfed Bangkok’s Santika nightclub, killing 64 people and injuring more than 200. Our knowledge of the events of that night is based on media reports and publicly available information, and the precise cause of the fire is still unclear. However, we do know that there are strong correlations between this and many similar tragedies at entertainment venues dating back as far as the first half of the twentieth century. While we wait for the results of the official investigation and coronial enquiries, it’s timely to ask questions about these fires. Why do they happen over and over again? Why do so many people lose their lives? What lessons can be learnt? And what practical measures can be implemented to stop them happening?

RECURRING MISTAKES

Arup’s analysis of case studies has revealed six themes that commonly contribute to the severity of high-fatality nightclub fires: insufficient exits, the presence of highly flammable materials, a lack of good fire safety systems, confusing environments, pyrotechnics and open flames, and buildings used inappropriately and maintained poorly. By addressing each of these themes, we aim to provide design solutions that could mitigate the risk of future nightclub disasters.

[The themes in the full article are

Insufficient exits

Highly flammable materials

Fire safety systems

Confusing environments

Pyrotechnics and open flames

Buildings used inappropriately or maintained poorly]

Vehicles are workplaces too

Radical Concept 1 – A vehicle can be workplace

Today the Australasian New Car Assessment Program (ANCAP) urged fleet managers to consider OHS obligations in their choice 0f work vehicles. ANCAP said

“Our understanding of the OH&S principles is that there is an obligation on companies and fleet managers to ensure a safe workplace.

“Vans certainly constitute a workplace under the legal definition. We would urge fleet purchasers to examine the legislation and then factor safety into their fleet purchasing policies.”

But in practice this creates enormous challenges for the fleet manager who may only have chosen vehicles in the past that were fit-for-purpose without considering the needs of the driver.

Only recently have steps been added to trucks to allow for easier access to goods on the rear trays. When technology became affordable tilt-down hydraulic ramps were installed, although these have their own work hazards. In both of these examples the changes occurred outside the cabin and related to accessing the transportable products. Looking after the physical and psychological needs of the driver as a worker is different.

For instance, emergency fire appliances in Australia have had substantially improved design over the last ten years. Many of the features are for the benefit of drivers and passengers, such as flip-out steps for when the vehicle is stationary or special seating to allow for personal protective clothing. But the cost of each of these new “safer” vehicles is such that the introduction is phased in and most likely as replacement vehicles. This process could take years. How can a workplace justify allowing only some workers to use “safer” workplaces? The churn of vehicles could establish an inequitable safety standard ion the workplace.

ANCAP’s argument seem to be that a fleet manager who chooses a vehicle that does not have the highest level of safety available are not providing a safe workplace. We could be back to determining what is reasonably practicable.

Radical Concept 2 – A road can be considered a workplace.

Some bus drivers consider their regular route to be a workplace. To some extent this is supported by the road traffic authorities who only allow certain speed control mechanisms on the roads that have bus traffic, such as speed islands rather than speed humps. Although this may be due to the needs of not knocking the passengers around as well.

Regardless of the whether it is passenger safety, pedestrian safety or public liability insurance that creates these design decisions, bus drivers take some “ownership” of their routes.

Important Consideration 1 – Vehicles have drivers

A lot of attention has been given to driver distraction and how drivers drive. Not only are there distractions from within the cabins from passengers, radios, phones, cigarette smoking and a range of driving activities, the relationship between external signage and driver response has also been high.

The complexity of the distraction issue can perhaps be summarized by a couple of recent links. In July 2009 a roadside memorial to a fatality itself is identified as having contributed to a fatality. Research in the United States has begun on the impact of roadside memorials but at the moment the jury is out.

“Our results showed that the number of red light violations was reduced by 16.7% in the 6 weeks after the installation of the mock memorials compared to the 6 weeks before whereas the number of violations at two comparison sites experienced an increase of 16.8%.”

Managers, fleet and OHS, also need to assess the suitability of their workers for driving and consider the following matters.

Companies have an obligation to induct new workers. Do companies induct new drivers on their vehicles or is a valid driver’s licence deemed sufficient?
Is a driving licence a certificate of competence?
Is a worker’s driving record considered when employing them? Would one employ a driver whose record shows a propensity for speeding?
Are driving applicants asked whether there is a history of road rage?
How many demerit points are left on their licence when employed?
For car driving the same licence is used for personal vehicle use and driving work vehicles. What would happen if the worker has their driver’s licence suspended thereby ending their capacity to drive for work?
It would be necessary to clarify in what circumstance transport accident insurance applies and when injuries relate to workers’ compensation?
Who should investigate a traffic incident involving work vehicles – the OHS regulator, police or some other authority?
Are traffic incident statistics collected for work-related vehicles?

Perhaps ANCAP could begin looking not only at the design of vehicles and additional safety features but also how these matters affect a driver’s perception of their own safety. Does the elevation of the driver compared to other vehicles change the way the driver drives? Could the safety features encourage the driver to drive recklessly? Is technology deadening the driver’s instincts?

Similar questions have been posed in the occupational field for decades in relation to the operation of plant, the safe design of workplaces and the types and locations of safety signage. Now these concepts must be considered for the mobile workplace. Many will find this process challenging with some thinking that it is just another grab by the OHS “fascists”.

The issues do need considerable discussion in workplaces. The recent WorkSafe Victoria “Guide to safe work related driving” is a good starting point but for the development of appropriate policies and, more importantly, to affect cultural change on the matter, companies require an elaboration by traffic authorities and from groups like ANCAP.

Kevin Jones

Do health professionals make the best OHS leaders?

David Michaels has been nominated by President Obama as the new Assistant Secretary for the Occupational Safety and Health Administration in the Department of Labor. (A brief profile of Michaels is available HERE.) A posting at a US Workers’ Compensation website links through to a discussion on the potential impacts of the Michaels’ appointment.

There are several telling quotes in the podcast. Sidney Shapiro, a law professor at Wake Forest University, says that OHS achieves more when run by someone with a health professional background.

“…I think it’s important that we know that David Michaels is a health professional. And I think OSHA’s done best when it’s had administrators from the public health community. It is, after all, a public health agency. More times than many of us would wish, it’s been headed by someone who’s been an adamant critic of OSHA and has come from industry or been an industry lawyer.”

Whether this position can be applied to regulators in other jurisdictions is an interesting question.

The Chair of the UK HSE Board, Judith Hackett, has a background in petrochemicals. The CEO of the HSE, Geoffrey Podger, has a background in the civil service, health and food safety. The chair of the Safe Work Australia Council, Tom Phillips was the former CEO of car manufacturer, Mitsubishi, and has served on a range of industrial company boards in South Australia. The Chair of WorkSafe BC board, Roslyn Kunin, harks from human resources and the labour market. Greg Tweedly CEO of WorkSafe Victoria has a background in insurance and compensation. Nina Lyhne of WorkSafe WA comes from road safety and compensation.

This unrepresentative sample shows a mix of experience and not all from health promotion. If the list was comprehensive, it would be interesting to see if Shapiro’s comments stack up and to see how many trade union officials have moved to “the top” or will simply remain “on the board”.

The Living on Earth podcast includes the following quote from Michaels from some time ago:

“What polluters have seen is that the strategy that the tobacco industry came up with, which essentially is questioning the science, find the controversy and magnify that controversy, is very successful in slowing down public health protections. And so the scientists who used to work for the tobacco industry are now working for most major chemical companies. They don’t have to show a chemical exposure is safe. All they have to do is show that the other studies are in question somehow. And by raising that level of uncertainty, they throw essentially a monkey wrench into the system.”

This statement could generate optimism for OSHA’s future but there are many examples of the views of environmentalists changing once they move into the corporate world. Politicians like Australia’s Minister for the Environment, Peter Garrett, is an obvious recent Australian example. Harry Butler in the 1970s was roundly criticised for “selling out” to the petrochemical industry.

However, the appointment of David Michaels pans out, it will be an interesting one to watch, particularly if the US Democrats can stay in power for more than Obama’s two terms.

Kevin Jones

Leadership, stress and performance reviews – interview

Graham Winter is an Australian psychologist who was the chief psychologist for the Australian Olympic team and is now an author and business adviser. In August 2009 he has a book released entitled “The Man Who Cured the Performance Review”.

SafetyAtWorkBlog managed to interview Graham last week about the book, stress and safety leadership. The SafetyAtWorkBlog podcast is available for download.

SafetyAtWorkBlog Graham Winter Interview

Kevin Jones

New OHS research on the limits of management based regulation

The National Research Centre for Occupational Health and Safety Regulation at the Australian National University is one of the few Australian research centres who provide free access to their data. The number is growing but is still way behind institutions overseas.

The latest research report they have released concerns management-based regulations as opposed to prescriptive regulations. Australia and many other countries have moved away from prescriptive OHS rules but this research by Neil Gunningham and Darren Sinclair has some good points on establishing workplace safety cultures by looking at a couple of case studies.

The abstract says

“The paper argues that notwithstanding the heavy emphasis currently being placed on both internal (company driven) and external (government driven) management-based regulation, a commitment at corporate level does not necessarily percolate down to individual facilities where ritualistic responses or resistant sub-cultures may thwart effective change. The findings have important implications for the effectiveness of management based regulation and meta-regulation more broadly.” (my emphasis)

The researchers go on to discuss the spread of shared values and shared meaning, how individuals and small units can thwart the good management intentions by a lack of organisational trust, through a literature review as well as the case studies and empirical data

For anyone who is the least bit interested in establishing a workplace safety culture, the following quote should get them downloading this report.

“Management based regulation does not ignore the challenges of engaging with group behavior. Indeed, its proponents assert that the capacity to achieve cultural change is one of its attributes (Welford 1997). But whether, to what extent, or in what circumstances this is the case remains a matter of conjecture. Certainly changing cultures is no easy matter and it may well be far more difficult for senior management to manipulate than many organizational theorists assume (Morgan 1986:139). Yet without cultural commitment on the part of those who are expected to implement the system, then edicts from regulators or (in the case of internal regulation) from senior management, may be met with creative compliance (McBarnet & Whelan 1999), resistance, “ritualism” (Merton 1968; Braithwaite 2008a:140-56) or various other forms of tokenism.”

Kevin Jones

New Work/Life Research

There seems to be new institutes and academic schools popping up regularly over research into the issue of work/life balance. Recently one of the oldest and most prominent of the institutes, the Centre for Work + Life at the University of South Australia, released new research data.

The latest Australian Work and Life Index (AWALI) was released in late July 2009. The executive summary identifies several important issues relevant to OHS:

“Three years of data about work-life interference in Australia tell us that many employees experience frequent interference from work in their personal, home and community lives, many feel overloaded at work and feelings of time pressure are also common and growing.”

“Work hours are central to work-life interference….. Many Australians are a long way from their preferred working hours and the 2008/09 economic downturn has not made any difference to the incidence of this mismatch.”

The work by Barbara Pocock and others at the Centre is characterised by recommendations for improvements rather than simply describing a situation. In this data the researchers say

“Our AWALI reports over the past three years suggest that employers and public policy makers can help workers deal with work-life pressures. This involves improving the quality of supervision and workplace culture, controlling workloads, designing ‘do-able’ jobs, reducing long working hours and work-related commuting, increasing employee-centered flexibility and options for permanent part-time work, improving the fit between actual and preferred hours and increasing care supports.”

It is obvious from these comments that OHS professionals need to work hard on these matters to create, or maintain, their workplace safety cultures.

Kevin Jones

New old US research into driving and talking

The New York Times has revealed research on the hazards of driving and using mobile phones that was withheld since 2003. The newspaper understandably focuses on the intrigue that prevented the report from being released but the content of the report has the potential to substantially change how companies “manage” the hazard of their staff using mobile phones whilst driving.

The report, obtained through Freedom of Information and made available on the newspaper’s website, was a substantial project for the National Highway Traffic Safety Administration and, according to NYTimes:

“The research mirrors other studies about the dangers of multitasking behind the wheel. Research shows that motorists talking on a phone are four times as likely to crash as other drivers, and are as likely to cause an accident as someone with a .08 blood alcohol content.”

The full report is available by clicking on the image in this post.

Kevin Jones

Tag: research

Learning Lessons from the Santika Nightclub Fire

LEARNING LESSONS FROM THE SANTIKA NIGHTCLUB FIRE

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Vehicles are workplaces too

Radical Concept 1 – A vehicle can be workplace

Radical Concept 2 – A road can be considered a workplace.

Important Consideration 1 – Vehicles have drivers

Like this:

Do health professionals make the best OHS leaders?

Like this:

Leadership, stress and performance reviews – interview

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New OHS research on the limits of management based regulation

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New Work/Life Research

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New old US research into driving and talking

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LEARNING LESSONS FROM THE SANTIKA NIGHTCLUB FIRE

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Radical Concept 1 – A vehicle can be workplace

Radical Concept 2 – A road can be considered a workplace.

Important Consideration 1 – Vehicles have drivers

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