Thesis (M.A.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The use of emergency lights and sirens as warning devices by ambulances is a hotly debated topic within the Emergency Medical Services. For the last few decades, research has shown that lights and sirens have only a minimal effect on time required to transport patients to the hospital, and essentially no positive effect on patient outcome. Meanwhile, thousands of ambulance crashes occur every year (usually during the operation of lights and sirens), and its possible that's tens of thousands of crashes are occurring as a result of a passing ambulance, though not directly involving the ambulance itself. This paper is meant to provide a thorough review of the science behind the use of lights and sirens, the risks they pose to EMS providers, patients, and the public, and strategies to help curb the cost they pose both in dollars and lives. The available literature on this subject all points to the use of lights and sirens being out dated, ineffective, and dangerous, and yet almost nothing has been done to solve the problems they cause. Continued research and development is needed to help make ambulances safer for their occupants, more effective driver training programs need to be offered to EMS providers, and protocols need to be adopted to limit the unnecessary use of L&S. / 2999-01-01

In the U.S., construction accidents remain a significant economic and social problem. Despite recent improvement, the Construction industry, generally, has lagged behind other industries in implementing safety as a total management process for achieving zero accidents and developing a high-performance safety culture. One aspect of this total approach to safety that has frustrated the construction industry the most has been “measurement”, which involves identifying and quantifying the factors that critically influence safe work behaviors. The basic problem attributed is the difficulty in assessing what to measure and how to measure it – particularly the intangible aspects of safety. Without measurement, the notion of continuous improvement is hard to follow. This research was undertaken to develop a strategic framework for the measurement and continuous improvement of total safety in order to achieve and sustain the goal of zero accidents, while improving the quality, productivity and the competitiveness of the construction industry as it moves forward. The research based itself on an integral model of total safety that allowed decomposition of safety into interior and exterior characteristics using a multiattribute analysis technique. Statistical relationships between total safety dimensions and safety performance (measured by safe work behavior) were revealed through a series of latent variables (factors) that describe the total safety environment of a construction organization. A structural equation model (SEM) was estimated for the latent variables to quantify relationships among them and between these total safety determinants and safety performance of a construction organization. The developed SEM constituted a strategic framework for identifying, measuring, and continuously improving safety as a total concern for achieving and sustaining the goal of zero accidents.

Despite the facts that vehicle incidents continue to be the most common mechanism for Australian compensated fatalities and that employers have statutory obligations to provide safe workplaces, very few organisations are proactively and comprehensively managing their work-related road risks. Unfortunately, limited guidance is provided in the existing literature to assist practitioners in managing work-related road risks. The current research addresses this gap in the literature. To explore how work-related road safety can be enhanced, three studies were conducted. Study one explored the effectiveness of a range of risk management initiatives and whether comprehensive risk management practices were associated with safety outcomes. Study two explored barriers to, and facilitators for, accepting risk management initiatives. Study three explored the influence of organisational factors on road safety outcomes to identify optimal work environments for managing road risks. To maximise the research sample and increase generalisability, the studies were designed to allow data collection to be conducted simultaneously drawing upon the same sample obtained from four Australian organisations. Data was collected via four methods. A structured document review of published articles was conducted to identify what outcomes have been observed in previously investigated work-related road safety initiatives. The documents reviewed collectively assessed the effectiveness of 19 work-related road safety initiatives. Audits of organisational practices and process operating within the four researched organisations were conducted to identify whether organisations with comprehensive work-related road risk management practices and processes have better safety outcomes than organisations with limited risk management practices and processes. Interviews were conducted with a sample of 24 participants, comprising 16 employees and eight managers. The interviews were conducted to identify what barriers and facilitators within organisations are involved in implementing work-related road safety initiatives and whether differences in fleet safety climate, stage of change and safety ownership relate to work-related road safety outcomes. Finally, questionnaires were administered to a sample of 679 participants. The questionnaires were conducted to identify which initiatives are perceived by employees to be effective in managing work-related road risks and whether differences in fleet safety climate, stage of change and safety ownership relate to work-related road safety outcomes. Seven research questions were addressed in the current research project. The key findings with respect to each of the research questions are presented below. Research question one: What outcomes have been observed in previously investigated work-related road safety initiatives? The structured document review indicated that initiatives found to be positively associated with occupational road safety both during and after the intervention period included: a pay rise; driver training; group discussions; enlisting employees as community road safety change agents; safety reminders; and group and individual rewards. Research question two: Which initiatives are perceived by employees to be effective in managing work-related road risks? Questionnaire findings revealed that employees believed occupational road risks could best be managed through making vehicle safety features standard, providing practical driver skills training and through investigating serious vehicle incidents. In comparison, employees believed initiatives including signing a promise card commitment to drive safely, advertising the organisation’s phone number on vehicles and consideration of driving competency in staff selection process would have limited effectiveness in managing occupational road safety. Research question three: Do organisations with comprehensive work-related road risk management practices and processes have better safety outcomes than organisations with limited risk management practices and processes? The audit identified a difference among the organisations in their management of work-related road risks. Comprehensive risk management practices were associated with employees engaging in overall safer driving behaviours, committing less driving errors, and experiencing less fatigue and distraction issues when driving. Given that only four organisations participated in this research, these findings should only be considered as preliminary. Further research should be conducted to explore the relationship between comprehensiveness of risk management practices and road safety outcomes with a larger sample of organisations. Research question four: What barriers and facilitators within organisations are involved in implementing work-related road safety initiatives? The interviews identified that employees perceived six organisational characteristics as potential barriers to implementing work-related road safety initiatives. These included: prioritisation of production over safety; complacency towards work-related road risks; insufficient resources; diversity; limited employee input in safety decisions; and a perception that road safety initiatives were an unnecessary burden. In comparison, employees perceived three organisational characteristics as potential facilitators to implementing work-related road safety initiatives. These included: management commitment; the presence of existing systems that could support the implementation of initiatives; and supportive relationships. Research question five: Do differences in fleet safety climate relate to work-related road safety outcomes? The interviews and questionnaires identified that organisational climates with high management commitment, support for managing work demands, appropriate safety rules and safety communication were associated with employees who engaged in safer driving behaviours. Regression analyses indicated that as participants’ perceptions of safety climate increased, the corresponding likelihood of them engaging in safer driving behaviours increased. Fleet safety climate was perceived to influence road safety outcomes through several avenues. Some of these included: the allocation of sufficient resources to manage occupational road risks; fostering a supportive environment of mutual responsibility; resolving safety issues openly and fairly; clearly communicating to employees that safety is the top priority; and developing appropriate work-related road safety policies and procedures. Research question six: Do differences in stage of change relate to work-related road safety outcomes? The interviews and questionnaires identified that participants’ perceptions of initiative effectiveness were found to vary with respect to their individual stage of readiness, with stage-matched initiatives being perceived most effective. In regards to safety outcomes, regression analyses identified that as participants’ progress through the stages of change, the corresponding likelihood of them being involved in vehicle crashes decreases. Research question seven: Do differences in safety ownership relate to work-related road safety outcomes? The interviews and questionnaires revealed that management of road risks is often given less attention than other areas of health and safety management in organisations. In regards to safety outcomes, regression analyses identified that perceived authority and perceived shared ownership both emerged as significant independent predictors of self-reported driving behaviours pertaining to fatigue and distractions. The regression models indicated that as participants’ perceptions of the authority of the person managing road risks increases, and perceptions of shared ownership of safety tasks increases, the corresponding likelihood of them engaging in driving while fatigued or multitasking while driving decreases. Based on the findings from the current research, the author makes several recommendations to assist practitioners in developing proactive and comprehensive approaches to managing occupational road risks. The author also suggests several avenues for future research in the area of work-related road safety.

published_or_final_version / Urban Studies / Master / Master of Social Sciences

The safety literature describes senior managers as crucially influencing organisational safety. Yet, it is not fully understood, what contributes to their influence. This thesis investigated senior managers’ characteristics in relation to their impact on safety in air traffic management organisations. A review of the safety literature indicated research in this area would benefit from the introduction of a research model as a theoretical basis. The skills-based leadership model by Mumford and colleagues was proposed as a suitable model for senior managers’ influence on organisational safety. A safety–specific version of the model was devised, consisting of traits (Big Fives, regulatory focus), skills (problem solving, social competence) and safety knowledge as antecedents of safety commitment and organisational safety outcomes. Study 1 explored the relevance of these characteristics for senior managers’ work on safety using semi-structured interviews with senior managers (N = 9). Responses were coded into the characteristics with sufficient reliability using qualitative content analysis. The characteristics were found to be relevant for senior managers’ influence on safety and their content was refined based on the findings. Safety knowledge and social competence were frequently indicated. Interpersonal leadership emerged as additionally relevant. Study 2 investigated the characteristics’ relevance for safety managers’ and CEOs’ influence on safety with questionnaires consisting of open questions (N = 49). Responses were coded using qualitative content analysis with acceptable reliability. The results re-confirmed the relevance of the characteristics. As in the previous study, interpersonal leadership emerged. Furthermore, problem-solving, leadership and safety knowledge were found more frequently for CEOs than for safety managers, whereas personality was more frequently indicated for safety managers than for CEOs. Finally, Study 3 tested the characteristics’ influence on safety commitment, which was conceptualised as indicated through behaviours that reflect a positive attitude towards safety. Interview questions, scenarios and questionnaires were used to measure characteristics and safety commitment in a sample of senior managers (N = 60). Interview and scenario responses were quantified with acceptable reliability. The results indicated that not all characteristics that were previously found to be relevant for senior managers’ influence on organisational safety were also related to safety commitment. Mainly, problem solving was shown to influence safety commitment, with the ability to understand problems, to identify useful information-sources and to generate ideas that relate to changes in the organisation’s culture as most influential. The findings can inform guidance and training for senior managers. Future research in this area could benefit from a focus on the conceptualisation of safety commitment, the role of interpersonal leadership style, as well as safety knowledge and the skills included in the research model.

Objective: Medicine administration is the last process of the medication cycle. However, errors can happen during this process. Children are at an increased risk from these errors. This has been extensively investigated but evidence is lacking on effective interventions. Therefore, the aim of this research is to propose safety measures to reduce medication administration errors (MAE) in the Paediatric Intensive Care Unit (PICU). Method: The research was carried out over five studies; 1) systematic literature review, 2) national survey of PICU medication error interventions, 3) retrospective analysis of medication error incidents, 4) prospective observation of the administration practice, and 5) survey of PICU healthcare professionals' opinions on MAE contributory factors and safety measures. Results: Hospital MAE in children found in literature accounted for a mean of 50% of all reported medication error reports (n= 12552). It was also identified in a mean of 29% of doses observed (n= 8894). This study found MAE retrospectively in 43% of all medication incidents (n= 412). Additionally, a total of 269 MAEs were observed (32% per dose observation). The characteristics of the interventions used to reduce MAE are diverse but it illustrated that a single approach is not enough. Also for an intervention to be a success it is fundamental to build a safety culture. This is achieved by developing a culture of collaborative learning from errors without assigning blame. Furthermore, MAE contributing factors were found to include; interruptions, inadequate resources, working conditions and no pre-prepared infusions. The following safety measures were proposed to reduce MAE; 1) dose banding, 2) improved lighting conditions, 3) decision support tool with calculation aid, 4) use of pre-prepared infusions, 5) enhance the double-checking process, 6) medicine administration checklist, and 7) an intolerant culture to interruption. Conclusion: This is one of the first comprehensive study of to explore MAE in PICU from different perspectives. The aim and objectives of the research were fulfilled. Future research includes the need to implement the proposed safety measures and evaluate them in practice.

The huge financial and societal cost associated with traffic crashes and the fact that more than half of them occur at junctions, revealed the need for further research in the field of junction safety. This research aims to investigate the quantitative impact of junctions in relation to other selected parameters, on the frequency of road crashes in urban areas in the State of Florida. Mathematical models were developed with the use of loglinear analysis method for different traffic volumes in and out of junction. In addition, sensitivity analysis was performed in order to better understand the impact of selected parameters to the total number of crashes. The analysis has led to several conclusions such as that angle and left turn collisions have much higher probability of occurrence at junctions and that crashes which occur at junctions are much more probable for low and medium volumes compared to no-junctions. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

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