Things That Hurt People Are Not the Same as the Things That Kill People: Key Differences in the Proximal Causes of Low-and High-Severity Construction Injuries

This study explored the differences between SIFs and non-SIF events from utility, oil & gas, commercial, pipeline and specialised construction trades.

Providing background:

·       They talk briefly about Heinrich’s work, noting that while Heinrich “did not suggest that the safety pyramid was causal, his work was cited to support the pervasive belief that preventing low-severity injuries leads to a corresponding reduction in high-severity injuries”

·       A range of work has debated the validity of ratios in the safety pyramid, some finding a correlation between minor and major over a long period, whereas others disputing these links

·       It’s said that if the ratios of low to high severity injuries were fixed, then long-term injury rates would move in parallel. American data suggests that the rate of lower-severity injuries have declined over the last decade, while the rate of fatalities has plateaued

·       Some data on proximal factors contributing to different severity levels found that working without supervision was more often related to fatalities than less serious injuries; another study found that younger workers were more vulnerable to SIFs than older workers; another study found differences in proportions of common underlying factors of fatal vs serious nonfatal accidents, but this difference disappeared when controlling for the same type of hazard scenario

·       Hence in that last study, “they examined 36 Dutch safety barrier failures that led to serious accidents and found that all identified causes of fatal accidents were also present in nonfatal injuries”

·       Another angle is proximal causes and precursors; a precursor is a “detectable event, condition, or action that serves as a warning sign to a fatal or disabling injury.”

·       SIFs are “paradoxical. Although it is fortunate that SIF events are rare, the low rate of occurrence hampers our ability to trend and learn”

The study employed the following research questions:

1.       What are the differences, if any, in the proximal causes of serious injuries and fatalities (SIFs) and low-severity injuries (LSIs)?

2.       What are the differences, if any, in the proximal causes of serious injuries and fatalities (SIFs) and potential serious injuries and fatalities (PSIFs)?

 Results

Overall the study found:

·       There were no differences between SIF and potential SIF cases (PSIF)

·       Two factors differentiated between low severity incidents (LSI) and PSIF/SIF: 1) absent direct controls, and 2) absent or not followed work plan

·       “the odds that a SIF involves a missing direct control is about two orders of magnitude higher than an LSI”

·       No “human factors” were significant, implying that “safety practices focused on human behavior might be important for injury prevention broadly, but not for targeting the concerning plateau on SIFs directly”

·       Results indicate that “the control of high-energy hazards through effective work planning, discipline, and execution is vital for targeting SIFs, supporting the theory that a differentiated approach is needed to avoid the concerning plateau in the rate of construction fatal injuries”

·       They suggest the need for “a differentiated approach … to prevent serious injuries and fatalities (SIFs) in construction, and the key is the control of high-energy hazards (i.e., hazards involving 1,500 J or more) through proper planning, discipline, and execution”

·       “Within the safety profession, the idea that the things that hurt people are not the same as the things that kill people has begun to replace the antiquated view that SIFs will be prevented by addressing LSIs

·       Moreover, “unavailable resources is an issue for safety broadly, but not a concern unique to SIFs”

Some of the specific findings unpacked:

Finding 1: Absent or not followed work plan is a key differentiator of SIFs

Issues with work planning, discipline and execution have been repeatedly identified as contributing factors to SIFs, but this study identified these factors “as being possibly unique to SIFs”.

The implication, they argue, is that “proper work planning and execution is needed to specifically address the control of high-energy hazards, which may be a cornerstone of a program that targets SIFs”.

Finding 2: Absent direct controls is a key differentiator

It’s said that “a missing or insufficient direct control almost always precedes a SIF but is almost never involved in an LSI”. Hence, LSIs occur in situations where no specific identifiable control was missing.

They also found that ‘absent direct controls’ and ‘absent or not followed work plan’ were found to be involved in almost all of the same SIF cases.

For practical takeaways then, “organizations should focus on ensuring the presence of direct controls against high-energy hazards through effective work planning and execution”, and supports that “safety should be measured by the extent to which life-threatening hazards are observed to be controlled”.

Finding 3: The human factors studied were not differentiators

An unexpected finding was that a range of factors related to people were not significantly related to SIFs (task unfamiliarity, risk normalisation, poor hazard recognition and more); and that they were equally present in SIFs and LSIs.

They argue that this suggests “although human factors are prevalent causal factors of injuries, they are not differentiators of SIF”. Hence, “generalized safety practices that focus on human behavior might be important for injury prevention broadly, but that they may not help to target SIFs directly”.

Finding 4: PSIFs and SIFs happen for the same reasons

No differentiators were found between SIFs and PSIFs, suggesting similar contributing factors; and supporting a focus on potential events to expand learning and improvement.

In conclusion, they state that “As companies focus their safety programs, the results suggest that the control of high-energy hazards through effective work planning, discipline, and execution should be a primary focus.”

Link in comments.

Authors: Bayona, A., Hallowell, M. R., & Bhandari, S. (2024). The Things That Hurt People Are Not the Same as the Things That Kill People: Key Differences in the Proximal Causes of Low-and High-Severity Construction Injuries. Journal of Construction Engineering and Management, 150(8), 04024089.

Study link: https://ascelibrary.org/doi/pdf/10.1061/JCEMD4.COENG-14545

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