Thesis (MScMedSc)-- Stellenbosch University, 2014. / ENGLISH ABSTRACT: Diving medical doctors frequently make use of Hyperbaric Facilities without fully realising
their legal and ethical responsibilities towards the safety of their patients and their staff. Few
have specific training in the technical or operational aspects of these facilities; this deficiency
is exacerbated when these are established in remote areas. The potential dangers are real and
the results can be devastating. Most current regulatory, manufacturing, safety and operational
guidance documents are not flexible enough to be applied universally, nor do they offer
practical guidance on the recognition and the mitigation of the unique and relevant hazards at
a given facility. The goal of integrated safety is rarely achieved.
The Risk Assessment Guide (RAG) was developed by the investigator as a tool to qualify the
actual safety status of a hyperbaric facility and to offer guidance on how to improve and
maintain it. Although the RAG has been subject to extensive peer review and field
implementation over the past 13 years, it has not been subject to scientific validation.
Therefore, the objective of this thesis was to do so by (1) retrospectively reviewing the most
common safety concerns affecting facility status as identified by the RAG; (2) using the data
derived from the analysis to produce a predictive model of likely safety status for un-assessed
facilities; and (3) consolidating the results in the form of specific recommendations to
improve and maintain safety status.
Data collected from a consistent application of the RAG over a period of 13 years, covering
105 applicable facilities, was analysed to determine the common safety concerns, particularly
those affecting safety status by means of a consolidated Risk Assessment Score (RAS). The
RAS values permitted comparisons between the facilities assessed. The various factors
associated with a higher RAS were determined by means of a multivariate regression.
Thereupon, the most significant determinant factors were built into a predictive model for the
likely safety status of an un-assessed facility. Finally, the most common safety concerns were
identified and summarised so that medical practitioners are empowered to determine,
improve and maintain the safety status of a given facility. The conclusions of this project are that: (1) the RAG is an appropriate tool to assess facilities
for risk elements relevant to their safety status while simultaneously filling the knowledge
gaps to equip medical practitioners and staff to improve and maintain safety; (2) reliable
predictions on unknown facilities can be made to provide medical practitioners with the
necessary information on whether a given facility is appropriate for patient referral; and (3)
the RAG is a suitable benchmark for determining hyperbaric facility safety; the review of its
application has provided objective data that will permit the formulation of future safety
guidelines based on empirical rather than arbitrary information. / AFRIKAANSE OPSOMMING: Duikmediese dokters maak dikwels gebruik van hiperbariese fasiliteite sonder om die wetlike
en etiese verantwoordelikhede ten opsigte van die veiligheid van hul pasiënte en personeel te
besef. Weinig het spesifieke opleiding in die tegniese of operasionele aspekte van hierdie
fasiliteite; hierdie tekort is gewoonlik erger in afgeleë gebiede. Die potensiële gevare is
wesenlik en die gevolge kan verwoestend wees. Meeste van die huidige regulatoriese-,
vervaardigings-, veiligheids en operasionele leidingsdokumente is nie buigsaam genoeg om
in die algemeen toegepas te kan word nie. Hulle bied ook nie praktiese leiding oor die
erkenning en die versagting van unieke en relevante gevare by 'n gegewe fasiliteit nie. Die
doelwit van geïntegreerde veiligheid word selde bereik.
Die “Risk Asssessment Guide” (RAG) is voorheen deur die navorser ontwikkel as 'n
instrument om die werklike veiligheidsstatus van 'n hiperbariese fasiliteit te kwantifiseer en
leiding te bied oor hoe om dit te verbeter en in stand te hou. Alhoewel die RAG onderhewig
was aan uitgebreide eweknie hersiening en praktiese uitvoering oor die afgelope 13 jaar, was
dit nie voorheen onderhewig aan wetenskaplike validasie nie. Die doelwit van hierdie tesis is
dus om hierdie te bewerkstellig deur (1) die mees algemene veiligheidskommernisse wat
fasiliteitstatus beïnvloed, soos deur die RAG geïdentifiseer, retrospektiewelik te hersien; (2)
die data wat deur die hersiening verkry is te gebruik om 'n model te ontwikkel vir
onbeoordeelde fasiliteite, wat die waarskynlike veiligheidsstatus kan voorspel, en (3) die
resultate te konsolideer in die vorm van spesifieke aanbevelings om veiligheidsstatus te
verbeter en in stand te hou.
Die data wat ingesamel is deur die konsekwente toepassing van die RAG oor 'n tydperk van
13 jaar en wat 105 fasiliteite gedek het, is ontleed om die algemene veiligheidskommernisse,
veral die wat die veiligheidsstatus beïnvloed, deur middel van 'n gekonsolideerde Risikoassesserings
waarde (RAW) te bepaal. Die duidelike en aangepaste RAW laat toe om
vergelykings tussen die fasiliteite te tref. Faktore wat verband hou met 'n hoër RAW was deur
middel van 'n meervoudige regressie bepaal. Daarna is die belangrikste determinante in 'n
voorspellende model gebou om die waarskynlike veiligheidsstatus van 'n onbeoordeelde
fasiliteit te bepaal. Ten slotte was die mees algemene veiligheidskommernisse geïdentifiseer
en opgesom om sodoende mediese praktisyns te bemagtig om die veiligheidsstatus van 'n
gegewe fasiliteit vas te stel, te verbeter en in stand te hou. Die gevolgtrekkings van hierdie projek is dat: (1) die RAG 'n geskikte instrument is om
fasiliteite te evalueer vir risiko-elemente wat relevant is tot hul eie veiligheidsstatus en
terselfdertyd die kennisgapings te vul om geneeshere en personeel toe te rus om veiligheid te
verbeter en in stand te hou; (2) redelik betroubare voorspellings oor onbekende fasiliteite kan
gemaak word om vir mediese praktisyns die nodige inligting te verskaf aangaande die
geskiktheid van 'n gegewe fasiliteit vir pasiënt-verwysing, en (3) dat die RAG 'n geskikte
maatstaf is vir die bepaling van hiperbariese fasiliteit veiligheid. Die hersiening van die
toepassing het objektiewe data voorsien wat die formulering van toekomstige
veiligheidsriglyne, geskoei op empiriese eerder as arbitrêre inligting, sal toelaat.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/86328 |
| Date | 04 1900 |
| Creators | Burman, Francois |
| Contributors | Meintjes, Willem Albertus Jacobus, Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Community Health. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | 59 p. |
| Rights | Stellenbosch University |
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