A retrospective review of the most common safety concerns encountered at a range of international recompression facilities when applying the Risk Assessment Guide for Recompression Chambers over a period of 13 years

Burman, Francois (2014-04)

Thesis (MScMedSc)-- Stellenbosch University, 2014.

Thesis

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.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/86328
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