Institut universitaire romandde Santé au Travail

IST, rue du Bugnon 19, CH-1005 Lausanne http://www.iurst.ch

Education of Occupational Health professionals in risk evaluation, analyses and prevention

Brigitta Danuser, Angela Ensslin, David Vernez

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Identifying key factors

Company: Risk assessment and management

Society

OH have do deal with a potential open circle of persons!

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Identifying key factors: Modes of collaborative work

Multidisciplinary:…..bringing a number of different disciplines together to work discretly on different aspects of a problem

Interdisciplinary:……bringing disciplines together to work on the same problem

Transdisciplinary:…..cutting across disciplines through use of a common conceptual framework to adress a particular problem, blending together concepts and theories (Rosenfield 2003)

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Identifying key factors

Education in risk evaluation and management is basically formation in interdisciplinary work!

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Identifying key factors

Intellectual and institutional factors characterizing disciplines:

Symbolic generalizations Models Exemplars

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Identifying key factors

Establishing an interdisciplinary approach means foremost:

establishing a common language second establishing common models and requires

social competencies

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Identifying key factors

Interdisciplinary education has to balance:

Integration of symbolic disciplinary systems

Interdisciplinary model

Translation of symbols

Proper disciplinary models

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Identifying key factors

Interdisciplinary work has to have a common goal:

FIOH: We promote health and safety at work as part of a good full life!

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Identifying key factors: Risk assessment and risk management

S E V E R i T Y

P R OB A B I L I T Y

Non acceptable

Acceptable

ALARP

Classical approach:

Risk = f(probability and severity)

Maximal Threshold: there exists an upper limit above which the risks are not acceptable

Mininmal threshold: there exists a lower limit under which no measures have to be taken

ALARP = As low as reasonably possible!

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Identifying key factors: Risk assessment and risk management

Measurements of fatality risks (Slovic 2001): Deaths per million people in the population Deaths per million people within x miles of the

source of exposure Deaths per unit of concentration Deaths per facility Deaths per ton of air toxic released Deaths per ton of air toxic absorbed by people Deaths per ton of chemical produced Deaths per million dollars of product produced Loss of life expectancy associated with the

exposure to the hazard

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Non Acceptable Threshold

G R A V I T E

P R OB A B I L I T E

Inacceptables

Acceptables

UncertaintiesPrincipally set for adultes in good healthHealthy worker effectNew technologies – no experienceTLV for 600 substances but 60’000 in useNo reliable strategy for mixtures / interactions

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Non Acceptable Threshold

Adultes in good health: but in 2025: females and ageing workers !

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Acceptable – Non Acceptable

1,0E-03

1,0E-02

1,0E-01

1,0E+00

1,0E+01

1,0E+02

1,0E+03

1,0E+04

0,1 1 10 100 1000

f [Hz]

B [

mT

]

ENV (travailleurs) ENV (public)ÖNORM (public) ICNIRP (public)ICNIRP (travailleurs)

Public health threshold: lower than professional threshold: principle of precaution

Electromag-netic fields

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Acceptable – Non Acceptable

500 µT

1 µT

Electromagnetic fields of 50 HZ

• Professionnel exposure

• The source is part of the working process

• Based on scientific data

• Public exposure

• Precaution limit (Swiss)

• New installations

“grey zone”

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The grey zone

The acceptable risk limit is decreasing!

According to the Swiss regulations of major hazards: risks in the grey zone are considered acceptable or not acceptable according to the protection required by the population concerned and the environment as well as by public interests!

The grey zone is a zone of negotioation!

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Influences on perception and acceptance of risks

Risk category Individual involvement severity

Risk measurement Relative; absolute «psycho - political»

Communication repulsion; attraction authority; experts

Context Other risks Cost-benefice

Equity Risk distribution Social groups

Politics-society Cultural values Law

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Influence of individual choice / control

 

Individual freedom of choice /control

Example Individual acceptable risks

total High risk sports 10-2 – 10-3

partial work 10-3 – 10-4

low Collective transportation

10-4 – 10-5

zero Atmospheric pollution

10-5 – 10-6

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OH risk matrix

GRAVITE V IV III II I

A

B

C

D

E

PR

O

B

A

B

I

L

I

T

E

Catégorie Critères Qantitatifs

Très élevé A 1/mois

Elevé B 1/an à < 1/mois

Modéré C 1/5 ans à < 1/an

Négligeable D 1/20 ans à < 1/5 ans

Quasi-impossible

E 1/100 ans à < 1/20 ans

Catégorie Critères Qantitatifs

Très grave I décès

Grave I I Invalidité grave

Moyenne I I I Invalidité légère

Faible IV Blessure ave arrêt de travail

Très faible V Blessure sans arrêt de travail

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Risk assessment GRAVITE

V IV III II I

A 0.1.2, 1.3.2, 3.1.3, 3.4.4, 5.1.1, 5.5.1

0.1.4, 1.1.1, 1.3.1, 3.2.3,

B 0.1.5, 0.1.7, 1.2.1, 2.1.2, 3.1.5, 3.2.11, 3.4.1

0.1.1, 0.1.6, 1.2.2, 1.4.2, 1.4.3, 1.4.4, 1.5.1, 2.2.3, 2.2.4, 2.3.2, 2.3.3, 2.4.1, 2.4.2, 2.4.3, 2.4.4, 3.1.1, 3.1.2, 3.1.4, 3.4.2, 3.4.3, 5.3.7, 0.1.8

3.2.1 a, 3.2.5, 3.3.3, 5.3.3,

C 3.2.13, 5.4.1 0.1.3, 2.1.1, 3.1.4, , 3.2.9, 3.2.15, 5.3.2, 5.3.5, 5.3.6

1.1.2, 1.4.1, 1.4.5 a, 2.2.1 a, 2.2.2, 2.3.1, 3.2.2 a, 3.2.4 a, 3.2.7, 3.3.2 a, 5.5.3

3.2.1 b, 5.3.1,

D 5.2.1, 5.2.2, 5.3.2 3.2.6, 5.3.8, 5.4.2, 3.2.14

1.4.5 b, 2.2.1 b, 3.2.2 b, 3.2.4 b, 3.2.10, 3.3.2 b, 5.3.4,

E 3.2.8 3.2.12 3.3.1,

PR

O

B

A

B

I

L

I

T

E

A

BC

Risk analyses in an emergency departement

A: chronic annoyances: stress, fatigue

B: mecanic accidents, agressions

C: sever accidents, virus contagion

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Individual – collectiv risks

Estimatedindividual risk

HIV conversion

Hepatitis conversion

PC screen work

Mecanic accidents

Organisational risks

Noise

Client relationship

Estimated collective risks

HIV conversion

PC screen work

Mecanic accidents

Noise

Client relationship

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How to deal with the grey zone

1. reducing the individual risk above the non acceptable threshold!

2. Applying cost-benefice criteria for the collective – collective wheigted risks, ev. Cost-benefit of measures

3. Participative approach to set priorities

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Identifying key factors

To elucidate the subjective nature of risk assessment, OH specialists have to be conscious about their system of values.

To communicate risks and to discuss values

To include our clients and partners (participative approach)

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FIOH strategy 2006-2010

We promote health and safety at work as a part of a good full life

- we create solutions for improving occupational health, safety and well being together with our clients and partners

- By applying our solutions, our clients can learn new things, improve their operatons, and succeed in the changing environment

- We learn from our clients about their needs in work life.

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Interdisciplinary Approach in the MAS W+H

Interdisciplinary features in the MAS Work + Health:

-         Large common education of Occupational physicians, Occupational Hygienists and Ergonomics Professionals

-         Block II dedicated to communication, social competencies, negotiation and company environment

-         Large proportion of project oriented learning -         Interdisciplinary group work in a company (2

weeks duration) -         Topic oriented learning

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Structure of the MAS W+H

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Block I

Block I Professional basics

Basics necessary for the understanding of the three disciplines

Law and legal issues

to find a common language!

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Block II

Block II Management and company environment

Managerial aspects of OH

Communication, understanding

Social competencies

Client orientation

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Block III

Block III training in the three disciplines

Separately for:

Occupational physicians

Ergonomics

Occupational Hygienists

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Block IV

Block IV Corporate Health

Sociology, epidemiology, public health, economics, corporate organisation

2 weeks project work in an interdisciplinary group

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Ongoing evaluation

Over the last 10 years due to an ongoing evaluation process we have:

Trippled the workplace visits Doubled the interdisciplinary group

work Added training in mangerial and

economic competencies

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New: Topic oriented learning

Goals: Integration and overview of

knowledge Building of knowledge maps Identification of missing teaching

links

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Topic orientied learning

Group work Each group has one theme (Chemistry

workplaces, hospital personnel) At the end of the modules the groupes

work one hour on: Which are the relevant aspect for our workplaces learned during the modul? What do they mean, how do the new facts interact with previous learned one’s?

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From an occupational physiology point of view:

This presentation was much too long!

Thank you for your attention!