The HSE Quarterly 32

Health, Safety and Environment

ISSUE 32

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According to the World Health Organisation (WHO), each year, almost 400,000 young people under 25 years old are killed in a road traffic crashes about 1049 youngsters every day. Most of these tragic deaths occur in low and middle-income countries like those in the Caribbean; particularly among pedestrians, cyclists, motorcyclists and those using public transport. Young road users are at risk for road traffic injuries for a number of reasons including physical and developmental characteristics such as the small stature of young children; risk taking behaviour and peer pressure particularly among adolescents; and other risk factors such as speeding, drunk-driving, not using helmets or not wearing seat-belts. In our region on any given day we see children being transported in the trays of pickups and on bicycles or as pedestrians on sidewalk-less roads.

The global organization Youth For Road Safety (YOURS) which acts to make the world’s roads safe for youth, said that the statistics are clear and there is no doubt that the crisis facing young people is very real. Road traffic injuries are the leading cause of death among 15-29 year olds, causing more deaths than HIV/AIDS or Tuberculosis. This means that road crashes are a serious threat to youth no matter where they are.

The HSE Quarterly from the very first issue which was dedicated to road safety has maintained its commitment to making Caribbean roads safer by keeping the issue alive in the pages of our magazine. To date several countries have seen significant decreases in road fatalities while some have been increasing.

In this issue we again place the spotlight on road safety this time with a focus on our youth. Fittingly our Feature article is titled Youth and Road Safety by Isaiah Stewart. In this article the author looks at the alarming statistics and plausible causes for this vehicular carnage involving youth on our roadways.

Another interesting article written by William Kennedy examines the success of the Designated Driver – the Harvard Alcohol Project – its setbacks and the applicability of the program in the Caribbean.

Our featured HSE Professional is Bernard De Freitas, the Head of the Occupational Safety, Health and Environment Department at the Cipriani College of Labour and Cooperative Studies.

I want to again thank you all for your continued support over the past twelve months. Like all sectors of the economy the magazine has been affected by the current economic realities faced by our advertisers and subscribers. We however reaffirm our commitment to continue the publication. We have been forced to make some changes, but you can be assured of the same quality that you have become accustomed to. With your continued support we will weather the economic storm and the publication would keep growing from strength to strength.

Thank you.

Janice Smith Editor-in-Chief 4

Unit 3, Aunt Jobe Building, Arnos Vale, P.O Box 1427

5

P.6 October 2016

Contents 6. Youth and Road Safety

12. Baby on Board: Ensuring Child Passenger Safety

P. 44

24. Rheumatic Fever 28. Road Safety and the Vulnerability of Young Drivers

38. Fatigue and the Designation Driver a Lethal Combination

P. 31

ISSUE 32

44. Conversations on Energy 46. Crisis and Emergency Management in the Workplace

PUBLISHER Jaric Environment, Safety and Health Services Limited.

EDITOR IN CHIEF Janice Smith EDITOR Appleloniah Kipps EDITORIAL BOARD Dr. Anthony J. Joseph Kandiss Edwards Eric Kipps Devitra Maharaj-Dash Magdalene Robin

P. 24 Health Corner

WRITERS Shazard Bansraj William Kennedy Eric Kipps Jayandran Mohan Cherma St. Clair Isaiah Stewart CREATIVE DIRECTOR Kenneth Henry GRAPHIC DESIGNER Stefan Francis PHOTOGRAPHY Graphicstock Fotolia Flickr BUSINESS ADDRESS The HSE Quarterly Lot 5B Trincity Industrial Estate, Trinicity Email: thehsequarterly@jaricesh.com Website: www.jaricesh.com The opinions expressed in the HSE Quarterly do not necessarily reflect those of the editor, publishers or their agents.

Introduction Throughout the world, governmental and non-profit organizations have meticulously devoted time to address the prevalent issue of young adults and their driving practices. On an international scale a recent publication by the Colorado Department of Transportation (2013) has unearthed that in the first year of driving, young persons, whose ages range from 18-25, are almost four times more likely to be involved in a serious or fatal vehicular accident than more experienced or older drivers. Within the context of Trinidad and Tobago, the Central Statistical Office has made public the 2015 vehicular accident statistics, which vividly shows a total of twenty-four young persons between the ages of 15-24 succumbing to injuries associated with a vehicular crash. In this article we will examine these alarming statistics and plausible causes for this vehicular carnage on the respective roadways.

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Accident Causation Factors Hartos et al. (2006) posited that lack of experience by young persons has a strong correlation with vehicle accidents mainly due to the many errors that are committed. While this is established, Curry (2013) has suggested that the main difference between young inexperienced drivers and more experienced drivers is the ability to detect roadway and/or pedestrian hazards.

Furthermore, it requires the driver to be able to discover, recognize and react against all potentially life threatening and dangerous situations as advised by Hartos et al. (2006).

Fortunately, this aspect can somewhat be addressed through recommended measures further in this article.

While not much solid accident statistics relating to deliberate risk taking behaviors have been identified in Trinidad and Tobago, internationally, the American

9

Automobile Association (2013) indicates that risk taking behaviors such as texting while driving which 50% of teenagers have admitted to doing playing with the radio controls, speeding, reckless driving and disregard for roadway signage have all contributed to the inevitable vehicular mishaps, with speeding and texting while driving accounting for the vast majority of identified causes.

Another deliberate aspect that accounts for a vast number of fatal and serious vehicular accidents among young persons is alcohol use while behind the steering wheel (Colorado Department of Transportation, 2013). With alcoholic beverages easily accessible by all, including young persons, Trinidad and Tobago is faced with a major challenge in this regard. For the year 2015, according to the nongovernmental vehicle safety agency Arrive Alive, based in Trinidad, there were a total of 2728 police arrests associated driving under the influence (DUI) of alcohol. With such alarming figures, it paints a clear picture of

the level of potential complication and danger that is faced by all citizens of Trinidad and Tobago, both drivers and pedestrians alike.

Consequently, effective January 30th, 2015, the Motor Vehicle Road Traffic Act, Chapter 48:5 was amended so that fines related to driving under the influence of alcohol and speeding have been increased (Gonzales 2015). This proactive initiative clearly indicated that the authorities have focused an admirable amount of effort to the reduction of vehicular accidents.

The National Highway Traffic Safety Administration (2015) confirmed that in the year 2014, the United States experienced one of its worst alcohol impaired driving periods; with 9,967 persons being killed in alcohol impaired driving crashes, with 24% of these deaths being young persons. Thus it is safe to conclude that the subject of alcohol

abuse is not limited to just Trinidad and Tobago, but it is however, a worldwide issue that is constantly grasping the attention of the respective authorities.

young persons, and experienced a noticeably drastic decrease in fatal or severe vehicular accidents over a two year period since implementing similar motor vehicle laws.

Recommendations

Simultaneously, the transportation laws within CDT also clearly state that for the first six months of teenage driving, only passengers twenty-one and over are allowed in the vehicle. This restriction was specifically geared towards minimizing distractions while driving on the designated roadways due to National Highway Traffic Safety Administration’s (2015) proclamation that distracted driving is indeed a high contributor to vehicular and pedestrian accidents.

The Colorado Department of Transportation (CDT) (2013) has experienced great success with comparatively lower vehicular accident figures as pertains to young drivers by implementing certain driving restrictions. Further research has unearthed that once successfully awarded a driving license, for the first year of driving, a teenage driver must abide by a curfew, which would restrict driving between midnight and 5:00 am unless accompanied by a parent or legal guardian. Similarly, Miami Dade County (2013) also basked in the success of reduced vehicle accident statistics relating to 10

While the previous two recommended vehicle laws were of an international standard, within Trinidad and Tobago, Gonzales (2015) has expressed that a more forceful

approach to treating with the national concern of teenage driving safety should be adopted.This would holistically entail decreasing the current legal limit of 35 micrograms of alcohol per 100 milligrams of breath for all legal adults to an astounding 0 micrograms for young drivers from the age group 17 to 21. With all the previous research and negative findings relating to alcohol usage, it is expected that should this amendment to the law occur, the probability of a decrease in road deaths and serious injury to young drivers can be expected.

forcefully emulate the stringent measures other global leaders have implemented with regards to youth and driving.

References American Automobile Association .2013. Teen Driving Statistics. http://www.encyclopedia.com/ topic/American_Automobile_ Association.asp (accessed June 17, 2016).

Conclusion All things considered, while many pieces of legislation and regulations relating to young persons and driving are implemented and enforced on an international level, locally, Braxton (2014) puts forward the fact that more emphasis needs to be placed on reinforcing and amending the current road traffic laws. With Trinidad and Tobago embracing a diverse culture of carnival festivities and vibrant nightlife, which can indeed contribute to teenage alcohol usage while driving – which is a leading contributor to roadway carnage – the respective authorities should 11

Arrive Alive .2015. Statistics. http://arrivealivett.com/statistics/ (accessed June 17, 2016).

Braxton, Nikita.2014. Penalties increased for drunk driving, street racing. Trinidad and Tobago Express Newspapers. http:// www.trinidadexpress.com/news/ Biggers-fines-for-drunk-driversstreet-racers-291075441.html (accessed June 18, 2016).

Central Statistical Office .2015. Vehicle Statistics. http:// cso.gov.tt/latest-indicators/ (accessed June 17, 2016).

Curry, Allison. 2013. Accident Analysis and Prevention.

Prevalence of teen driver errors leading to serious motor vehicle crashes. 43 (4).p. 1280-1287.http:// w w w. s c i e n c e d i r e c t . c o m / s c i e n c e / a r t i c l e / p i i / S0001457510002988 (accessed June 18, 2016).

National Highway Traffic Safety Administration .2015.

Teen Drivers - Graduated Driver Licensing. http://www. nhtsa.gov/Driving+Safety/Teen+Drivers (accessed June 18, 2016).

Colorado Department of Transportation .2013.

Teen Driving Restrictions. https://www.codot.gov/ safety/colorado-teen-drivers/parent/teen-drivingrestrictions.html (accessed June 17, 2016).

Gonzales, Gyasi.2015. Drunk driving serious cause for concern. Trinidad and Tobago Express Newspapers. http://www.trinidadexpress.com/20151118/news/ drunk-driving-serious-cause-for-concern (accessed June 18, 2016).

Hartos et al. 2006. Accident Analysis and Prevention.

The effect on teen driving outcomes of the Checkpoints Program in a state-wide trial. 38 (5) 112130.http://www.sciencedirect.com/science/article/pii/ S0001457506000388 (accessed June 18, 2016).

Miami Dade County .2013. Florida Teen Driving Enforcements. http://www.floridahealth.gov/ newsroom/2016/01/010716-teen-driving-habits.html (accessed June 17, 2016).

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BABY ON BOARD:

Ensuring Child

Passenger

SAFETY

By Eric Kipps Road Safety Consultant

Introduction The alarming number of deaths and injuries as a result of road crashes in Trinidad and Tobago continues to be a growing public concern. Instances where infants are placed on the rear seat of the car unrestrained, where toddlers are allowed to ride in the front passenger seat of the vehicle or where children are allowed to stand between front seats while the vehicle is in motion are unfortunately, common practices in Trinidad and Tobago. Like seat belts, child safety seats and booster seats reduce the likelihood of a child being hurt or killed in a motor vehicle crash. This article discusses the need for restraints, the importance of age-appropriate restraints, the various types of restraints and the correct use of child restraints.

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The Need for Restraints In September 2009, Ivan Ramjit is quoted as saying “As parents we must do the correct thing for our children” (Trinidad Newsday 2009) after losing both his wife and his daughter to a vehicular accident. Nevi Vionna was seated on her mother’s lap in the front passenger seat of the vehicle her father was driving. The impact of the crash pitched the baby out of the car. She died on the spot from severe chest injuries.

The horror of this death came less than three months after two-year-old Kierra Jackie died, when she too, was pitched through the windscreen of the panel van in which she was a passenger. One cannot stress enough the importance of child restraints.

According to the World Bank, the Latin American and Caribbean regions hold the highest per capita fatality rate from road crashes with 26 per 100,000 people - six times higher than in the developed world. Even worse, this rate is likely to jump to 30 per 100,000 people by 2020 when road accidents will become the main cause of disability and death around the world (World Bank 2009).

In the United States, motor vehicle crashes continue to be the leading cause of death of children after their first birthday (Staunton et. al. 2005).

Every year more than 1000 motor vehicle passengers who are 0-12 years of age are killed in crashes (Staunton et. al. 2005). For each death, there are well over 100 injuries. Most of the child passengers killed in 1999-2000 were unrestrained (52%), incorrectly restrained (18%) and/or riding in the front seat (35%) (Staunton et. al. 2005).

There are three principal ways of being killed or injured in a car crash; you hit something, something hits you, or you

are ejected from the car. Besides the obvious risk to themselves, an unrestrained passenger of any age could also kill or seriously injure you as the crash forces increase their body weight by more than 30 times (The Automobile Association Limited 2009). In a head-on crash, your vehicle’s front-end crashes, absorbing crash energy. Properly restrained children come to a more gradual stop along with the vehicle. However, if your child is either unrestrained or loosely restrained, he will continue to move forward at the same speed until he hits the car’s interior. Kids who are secured by seat belts will come to a more gradual stop along with the vehicle and are less likely to be injured (The Children’s Hospital of Philadelphia [CHOP 2009]).

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Age-Appropriate Restraints Selecting a child safety seat for your child is important because the correct seat can protect your child if you are in a crash. Children are safest when travelling in a child safety seat appropriate for their height, age and weight. When selecting a child safety seat you want to choose one that is appropriate for your child according to height and weight, one that fits properly when installed in your vehicle, and one that is easy to use. Remember, a seat that works in one car may not work in another.

According to the American Academy of Pediatrics (AAP) and the National Highway Traffic Safety Administration (NHTSA) the definition for age-appropriate restraint includes four components.

First, infants should ride in their rear facing seats until they are at least 1 year of age and at least 20 pounds. Second, children who have out grown their rear-facing seats should be placed in forward-facing seats with internal harnesses until they are 40 pounds. Most children reach 40 pounds at 4 or 5 years of age. Third, children who weigh more than 40 pounds should ride in belt positioning booster seats until they fit well in the car seat belts alone. Children generally do not fit well into car seat belts until they are approximately 9 years of age. Last, all children who are 12 years of age and younger should ride in the back seat (Staunton et. al. 2005).

Infant Car Seat A baby riding in the front seat can be fatally injured by a passenger side airbag. Seats designed for newborns and very small babies have some

unique features that make them improper for use by older children.

Infants are at greater risk of injury in crashes. This is because their heads are fragile, their neck bones are soft and the ligaments that assist in supporting the neck are stretchy.

A rear-facing seat supports your infant’s upper body, protecting the head, neck and spine and spreads crash forces across the back. If an infant is facing the front of the car during a crash, there is nothing supporting the head and neck and the force of a crash can severely injure the infant’s head and neck.

According to the National Highway Traffic Safety Administration, properly installed child safety seats reduce the risk of death by 71 % for infants involved in crashes (CHOP 2009). Your infant should be in a rear-facing seat from birth until he is at least 1 and weighs at least 20 pounds or reaches the top weight limit for the seat. The baby’s spine 16

is better protected in a head-on collision and in a side impact when he is facing the rear of the car (Vercelletto 2001,2002).

If born prematurely, or very small, your infant may need to ride lying flat in a car bed if he has any problems breathing or any other problems when sitting semi-reclined. Ask your baby’s doctor if the baby needs to be tested for breathing problems or other medical problems before he is discharged from the hospital. The AAP recommends that premature infants less than 37 weeks’ gestation have a period of observation in a car safety seat before hospital discharge (Merchant et al. 2001).

Center Rear Vs Outboard Seating Babies must be in a rear-facing infant car-seat that is securely installed at a 45° angle in the

backseat, preferably in the middle of the back seat (Sloviter 2009). This recommendation has been supported by Evans and Frick who found an overall 16% decrease in fatality risks for all age occupants when seated in the center as compared with outboard seats. For restrained children, Braver et al. found that those seated in the center rear experienced a reduction of 24% when compared with those rear facing outboard seating positions (Kallan et. al. 2007).

Types of Restraints There are three types of child safety restraints for infants: 1. The car bed - this allows the baby to lie down while travelling. It is suitable for premature or small babies as they are prone to respiratory stability when placed in the upright positions (Merchant et al.

2001). Be sure to position his head toward the middle of the car and away from the door.

2. The infant car seat – this is rear facing and most often designed for babies up to 20-22 pounds.

Most infant seats are usually accompanied by a detachable base which allows you to remove the baby from the car without

disturbing him. Remember to check it regularly to ensure that it is tightly installed.

3. The toddler seat - The rear-facing convertible seats can be used in both rear-facing and forwardfacing positions from birth to 40 pounds eliminating the need for an infant seat.

It is strongly recommended however, that a separate infant seat be purchased as they fit small babies best (Vercelletto 2001, 2002).

Babies whose weight or height exceeds the limits of the child safety seat before they reach age 1 should be moved to a convertible seat with a higher rear facing weight and height limit.

When your toddler (at least 1 year old and at least 20 pounds) reaches the highest weight limit allowed by your rearfacing seat, you need to switch to a child safety seat designed to be used forward facing until they reach the upper weight or height limit of a particular seat.

Securing the Baby in the Seat: Some Basic Points to Remember Harness straps hold your baby in the safety seat.

The most common type of harness is the 5-point. This has two straps that secure the shoulders and two more straps that secure the hips. It buckles between the legs. Be sure that the 17

harness fits snugly against your child. It is snug enough when you cannot pinch a fold in the harness material after buckling your child. A chest clip holds the harness strap on your baby’s shoulders (CHOP 2009). Here are tips for keeping the harness straps in position: • Tighten the harness straps so that you cannot get more than two fingers between the harness and the child’s collarbone • Always thread the straps through the slots or below the infant’s shoulder • Ensure that the straps lie flat in a straight line without sagging or twisting • Ensure that the harness retainer remains at the level of baby’s armpit • As stated above, the seat should be maintained at a reclined 45° angle. If your infant’s head is flopping forward, the seat may not be reclined enough

Boost Them Until they are Big Enough While using any restraint is better than none, the premature graduation to adult safety belts can result in your child being badly injured in a crash. Safety belts

are not designed for children. Beginning at around age 4, many children are too large for toddler seats but too small for adult safety belts. Correct seat belt fit is usually not achieved until a child is at least 4’9’ tall and 80 pounds, often around 9 years of age (Medscape 2000). The booster seat could be considered the final stage of the child car safety experience.

As the name suggests, a booster seat raises your child up so that the safety belt fits right and can better protect your child. The shoulder belt should cross the child’s chest and rest snugly on the shoulder, and the lap belt should be low around the pelvis or hip area, never across the stomach area (NHTSA 2005). Without the booster seat, an adult seat belt can actually cause injury in the event of a crash rather than preventing it.

Researchers at the CHOP have found that young children who are placed in adult seat belts rather than car seats or booster seats are 4 times more likely to suffer head, brain and other devastating injuries. In addition, children in seat belts suffered the only reported cases of abdominal injuries, including intestinal, liver and spleen injuries (Medscape 2000). Nonetheless, most parents still do not know that seat belts do not offer optimal protection for booster-aged kids. While the benefits of booster seats are clear, their use remains marginal at best.

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Barriers to the Use Types of Booster of Booster Seats Seats So why are children 40-80 pounds not secured by boosters? The most common reason is misinformation.

Parents believed that that their child was large enough to safely use the adult restraint system (Ramsey et. al. 2000). Many parents accredited child resistance and discomfort as another reason for the premature transition from booster seats to car seats (Ebel et. al. 2003). Parents have also identified situational factors which makes it impossible for the use of booster seats. Some cited situational factors such as the extra passengers and the duration of the trip - “short trips�. Other common barriers included the costs associated with acquiring these seats, incompatibility of motor vehicle designs and the lack of knowledge of booster seats. Many had not heard of booster seats (Ebel et. al. 2003).

There are two different types of booster seats currently in the market, each with a fundamentally different mechanism for restraining the child : the shield booster seats (SBSs) and the belt positioning booster seats. SBSs have padded shields that lock across the front of the device to secure the child in the seat and to decelerate the child in the event of a crash while preventing contact with the passenger compartment. Conversely, the beltpositioning booster seats elevate a child in the event of a crash while preventing contact with the passenger compartment.

Based on the results of several isolated crash investigations involving children in SBSs, the American Academy of Pediatrics (AAP) discourages the use of SBSs, 19

stating that they do not provide the best protection to children who are involved in motor collisions (Edgerton et. al. 2004).This was later supported by Edgerton et al. who found that there was increased risk of head, chest and abdominal injury to children who were restrained by SBSs (Edgerton et. al. 2004).

When purchasing a booster seat, consideration should also be given to the type of seats you have in your car. If your rear seat is low back, you are better off with head and neck support in a rear collision. If your rear seats are high enough to support the child’s head and neck but are deeply contoured, a backless model will sit more snugly on the seat and be less likely to tip over than a highback model (Haiken 2007).

Is Your Child Ready for Adult Seat Belts?

Most adult safety belt systems in a car do not fit a child unless he is at least 80 pounds and 4 feet 9 inches tall. In order to judge whether your child is ready to ride with a seat belt alone child Passenger Safety Specialist, Stephanie Tombrello advises the following be considered: 1. Does he sit all the way back against the car seat?

2. Do his knees bend comfortably at the edge of the seat?

3. Does the lap belt naturally rest below his belly, touching the top of his thighs?

4. Is the shoulder belt centered across his shoulder and chest?

5. Can he stay seated like this for the whole trip?

If your answer to any of these questions is no, then your child still needs to use a booster seat. If your child is ready for seat belts however, Tombrello advises against the purchase of belt-positioning devices as these tend to lower the efficacy of seat belts (Tombrello 2009).

Conclusion Without the use of appropriate restraints, infants and small children riding as passengers in motor vehicles continue to be susceptible to death, disability, and disfigurement, even in minor accidents and non-crash incidents, such as sudden stops. As a remedy, this article suggests that efforts aimed towards increasing proper restraint use should involve a palette of strategies and messages specifically geared to Trinidad and Tobago’s reality. This palette should include the incorporation of strong enforcement laws, severe penalties for failure to comply, public education. The influence of child safety laws and their influence on the practice of optimal restraint are evident in developed countries. But even as this article addresses the importance of child restraints, consideration should be given to the peculiarities of the islands’ public transportation system which includes buses, maxi taxis, hired taxis and the PH driver context.

This raises questions as to how can we make positive steps towards a reduction in the carnage on the roads of the Caribbean given our outdated traffic laws.

REFERENCES Arneson, S., Triplett, J.. Hahnemann, B., and Merington, E. 1985. Factors Affecting Parental Use of Child Automobile Restraints Use. Children’s Health Care 13, iss: 4 (Spring 1985) . http://web.ebscohost.com/ehost/pdf?vid=2&hid=106&sid=710c4fc3-d9ea-4d20-ad8f768059729084%40sessionmgr110 (accessed February 6, 2010).

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Asson, Cecily. 2009. Parents Protect Your Children. The Trinidad Newsday, September 9,. http://www.newsday.co.tt/news/0,106447.html. (accessed February 4, 2010).

The Automobile Association Limited. 2010. Child Safety: Choosing and Using In-Car Restraints. http://www.theaa.com/motoring_advice/child_safety/carseats.html (accessed February 7, 2010).

Biagioli, Frances. 2006. What Child Safety Seat Should My Child Use? Pediatrics for Parents 22, iss: 9 (September 2006) http://proquest.umi.com/pqdweb?index=56&did=1159781881&sid=1&Fmt =3&clientld=45987&RQT=309&VName=PQD (accessed February 4, 2010).

Bull, M. and Durbin, D. 2008. Rear-Facing Car Safety Seats: Getting the Message Right. Pediatrics 121, no. 3 (March 2008) http://pediatrics.org/cgi/doi/10.1542/peds.2007-3637 (accessed February 3, 2010)

use-a-booster-seat_65758.bc?showAll=true (accessed February 05, 2010).

Kallan, M., Durbin, D., Arbogast, K. 2008. Seating Patterns and Corresponding Risk of Injury Among 0-to 3-Year-Old Children in Child Safety Seats. Pediatrics 121, no.5 (May 2008). http://pediatrics.org/cgi/doi/10.1542/peds.2007-1512 (accessed February 2, 2010).

Medscape Medical News. 2010. Adult Seat Belts Don’t Keep Children Safe. http://www.medscape.com/veiwarticle/411894 (accessed February 5, 2010).

Merchant, J. et al. 2001. Respiratory Inability of Term and Near-Term Healthy Newborn Infants in Car Safety Seats. Pediatrics 108, no. 3 (September 2001). http://pediatrics.capublication.org (accessed February 2, 2010).

The Children’s Hospital of Philadelphia. 2010. Keeping Kids Safe During Crashes. http://www.research.chop.edu/programs/carseat/older_child.php (accessed February 2, 2010).

National Highway Traffic Safety Administration. 2010. Travelling Safely with Infants, Toddlers and Preschoolers. http://www.nhtsa/dot.gov/people/injury/childps/newshipsimages/PDFS/ CPSsafetyTips2.pdf (accessed February 2, 2010).

Ebel, B. et al. 2003. Too Small for a Seat Belt: Predictors of Booster Seat Use

by Child Passengers. Pediatrics 111, no. 4 (April 2003) http://www.pediatrics.org/cgi/content/full/111/4/e323 (accessed February 5, 2010).

National Highway Traffic Safety Administration. 2010. A Parent’s Guide to Buying and Using Booster Seats. http://www.nhtsa.dot.gov (accessed February 3, 2010).

Edgerton, E.A., Orzechowski, K.M., Eicelberger, M.R. 2004. Not All Child Safety Seats Are Created Equal: The Potential Dangers of Sheilds Booster Seats. Pediatrics 113, no. 3 (March 2004).

National Highway Traffic Safety Administration. 2010. Premature Graduation of Children Safety Belt. http://www.nhtsa.gov/people/outreach/traftech/TT253.htm (accessed February 5, 2010).

http://pediatrics.org/cgi/full/113/3/e153 (accessed February 5, 2010).

Haiken, M. 2010. Booster Safety: How to Choose and Use a Booster Seat. http://www.babycenter.com/0_booster-seat-safety-how-to-choose-and-

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Net Guides Publishing Inc. 2010. The History of Car Seats – The Ride That Saves Lives. http://www.thehistoryof.net/history-of-car-seats-html (accessed February 4, 2010).

car-seat-to-a-booster-sea_69823.bc (accessed February 5, 2010).

Vercelletto, C. 2010. Car-Seat Safety. http://proquest.umi.com (accessed February 5,2010).

Ramsey, A., Simpson, E., and Rivara, F.P. 2000. Booster Seats Use and Reasons for Nonuse. Pediatrics 106, no.2 (August 2000) http://www.pediatrics.org/cgi/content/full/106/2/e2.0 (accessed February 5, 2010).

Simpson, E. et al. 2002. Barriers to Booster Seat Use and Strategies to Increase Their Use. Pediatrics 110, no.4 (October 2002) http://pediatric.org/cgi/content/full/110/4/729 (accessed February 6, 2010).

Sloviter, V. 2009. Car Safety Revisited. Pediatrics for Parents 25, no. 5/6 (May/June 2009) http://web.ebscohost.com/ehost/pdf?vid=2&hid=9&sid=6bd7a2d3-42f54e31-a95e-efd1ae62c66b%40sessionmgr13 (accessed February 4, 2010).

Staunton, C. et al. 2005. Critical Gaps in Child Passenger Safety Practices, Surveillance and Legislation: Georgia, 2001. Pediatrics 115, no.2 (February 2005) http://www.pediatrics.org/cgi/content/full/115/2/372 (accessed February 2, 2010).

Thompson, Marci. 2009. Is Your Child? Combat Edge 18, iss:3 (Sep/Oct 2009) http://proquest.umi.com/pqdweb?did=187325816&sid=1&Fmt=3&clientld= 45987&RQT=309&VName=PQD (accessed February 2, 2010).

Tombrello, S. 2010. When Can My Child Switch From Booster to Seats to Seat Belts Alone. http://www.babycenter.com/404_when-should-my-child-switch-from-a-

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HSE Quotes In a split second you could ruin your future, injure or kill others, and tear a hole in the heart of hearts who loves you. ~ Sharon Heit We need to develop a traffic safety culture that does not condone driving while distracted much like we have done with drunk driving. ~ Vernon F. Betkey, Jr. Drive now. Text later. ~ Author Unknown Recklessness is a species of crime and should be so regarded on our streets and highways. ~ Marlen E. Pew The best way to keep children at home is to make the home atmosphere pleasant, and let the air out of the tyres. ~ Dorothy Parker Better a thousand times careful than once dead. ~ Author Unknown

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Context

Rheumatic Fever

By Cherma St Clair - MSc, PGCE, BA (Hons), V300, DipMid, RN Lead Nurse Practice Development, London, England Rheumatic Fever is an acute febrile illness, that may develop as a complication to untreated or sub-optimal treatment of streptococcus bacterial infection of the throat (Scarlet Fever) caused by streptococcus pyogenes or group A beta-hemolytic streptococcus. Children between the age of 5 to 15 are the majority affected with adults making up 20% of cases. Rheumatic Fever is a rare condition; only a fraction of (less than 0.3 %) persons who have had infection as a consequence of strep bacteria will go on to develop Rheumatic Fever.

The symptoms of Rheumatic Fever usually present two to four weeks post strep infection. In some cases, the infection may even be too mild to have been recognised.

Therefore a mild sore throat that persist for more than three days or a severe sore throat in the absence of flu or cold accompanied by high fever must be monitored and medical advice sought, especially in children.

For this reason, it is believed that other factors such as a weakened immune system must be involved in the development of the condition. Additional risk factors can be genetic, as those with a family history of Rheumatic Fever have a higher risk of having the condition, as well as environmental factors such as overcrowding, poor sanitation and poor access to health care, which is critical for swift treatment of strep infection.

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The body’s defence against the streptococcus bacterial infection is an inflammatory reaction in response, whereby antibodies are produced to fight the bacteria. Instead of fighting the bacteria, the antibodies produced attack the body’s own tissues, as if they were toxins or infectious agents. The antibodies begin with the joints and moves to the heart, Central Nervous System (CNS) and skin (see below) with associated symptoms. In addition, patients may have high fever and headache. Rheumatic Fever can therefore be classified as an autoimmune inflammatory disorder and the patient may present with:

There is no cure for Rheumatic Fever so treatment focuses on eradicating any streptococcal bacterial infection with antibiotics; relieving symptoms using non-steroidal anti-inflammatories and analgesia; and preventing long-term damage to the heart, probably with steroids (prednisolone). If inflammation to the heart is severe, surgery may be necessary to repair damage to the heart valves to prevent heart failure. If symptoms of Chorea are problematic, neuroleptic medicine (anticonvulsant such as carbamazepine) will be used to block the nerve signals. Children who had had rheumatic fever would need prophylactic antibiotic treatment until adulthood.

In conclusion, Rheumatic Fever is an inflammatory condition developed as a complication of bacterial infection mainly of the throat and affects mostly children. It is critical that children with sore throat and monitored and treated timely and effectively as to prevent the cardiac complication of the condition.

References NHS Choices .2015. Rheumatic Fever. http:// www.nhs.uk/conditions/rheumatic-fever/Pages/ Introduction.aspx; (accessed August 13, 2014).

Nordqvist, C. 2014. What is Rheumatic Fever. www. medicalnewstoday.com/articles. (accessed August 13, 2014).

Weil-Olivier, C. 2004. Rheumatic Fever. https://www.orpha. net/data/patho/GB/uk-RF.pdf (accessed August 13, 2014).

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Locations: Piarco Plaza, Cor. Churchill Trinidad Phone: 755-8863 Shirvan Plaza, Shirvan Road Tobago Phone: 639-9643

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existence of an individual human being or A 2) The animal.

C 4) A main road, especially one connecting major R towns or cities.

O 9) A wide way leading from one place to another, one with a specially prepared surface S especially that vehicles can use.

S 10) The control and operation of a motor vehicle.

11) The way in which a person or group lives.

13) Take or carry (people or goods) from one place to another by means of a vehicle, aircraft, or ship.

16) A road vehicle, typically with four wheels, and powered by an internal combustion engine.

17) A thing that prevents someone from giving full attention to something else.

18) Move quickly over the limit allowed.

19) A vehicle composed of two wheels held in a frame one behind the other, propelled by pedals and steered with handlebars attached to the front wheel.

D O W N

1) Vehicles moving on a road or public highway.

3) An instance of being injured.

5) A device for slowing or stopping a moving vehicle, typically by applying pressure to the wheels.

6) A person walking along a road or in a developed area.

7) A thing providing protection against a possible eventuality.

8) Grant a license to (someone or something) to permit the use of something or to allow an activity to take place.

12) Practical contact with and observation of facts or events.

14) An unfortunate incident that happens unexpectedly and unintentionally, typically resulting in damage or injury.

15) Collide violently with an obstacle or another vehicle.

20) The action or fact of dying or being killed; the end of the life of a person or organism.

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Road Safety and the

Vulnerability of

Young Drivers

By Jayandran Mohan HSE Consultant & NEBOSH IGC Tutor Chennai, India

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Introduction Road traffic injuries threaten public health, sustainable development and social equity. Around the world, road traffic injuries cause 1.3 million deaths and 20-50 million injuries each year. Some of these injuries lead to lifelong disability including brain and spinal cord injury. Road traffic injuries are the leading cause of death among young people aged 15–29. Unless serious action is taken, road traffic deaths are expected to increase by 67% by the year 2020 and will become the fifth leading cause of death by 2030. If this happens, road traffic crashes will cause an estimated 1.9 million fatalities each year by 2020 and 2.4 million fatalities each year by 2030. More than 90% of road traffic deaths occur in low and middle-income counties (LMICs). The global monetary cost of road traffic injuries is more than US$500 billion each year or 1-3% of each country’s Gross National Product (GNP). This reflects costs of medical treatment, rehabilitation and loss of productivity (fewer days at work), legal costs, and much more. In youth, vulnerability to road crash deaths increases with age, being highest among people 20–24 years old (Fig. 1). In this article we will explore the correlation between young drivers and road safety.

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risk-taking and sensation seeking behavior. Due to curiosity in young people without proper training to drive, they are unable to perceive hazards, control the vehicle, or make decisions. Children have a limited ability to handle complex road traffic environments designed for adults because of their cognitive and physical development. This lack of capacity to make correct judgments about traffic speeds and distances, and to negotiate the road with other users, leaves them as vulnerable as pedestrians and cyclists. To compound the problem, their short stature makes them less visible, and in the case of a crash, their vital body parts are more likely than those of adults to be damaged by a colliding vehicle.

Road systems and motor vehicles could therefore be better designed to account for their vulnerability.

Youth and Road Traffic Incidents

Adolescence and young adulthood is a time for exploration, and testing the limits of interaction with the environment may involve taking risks. Further, this is a period of life when peer pressure is important, and sensation-seeking may be gratifying. If this is expressed as risky driving, young people may be in hazardous situations but without adequate experience in handling them. This applies particularly to men, who also drive cars and motorcycles more than women, and are more likely to have serious and fatal crashes.

Road traffic injuries are the leading cause of death among 15-29 year olds. Over 30% of those killed and injured in road traffic crashes are less than 25 years old. Among drivers, young males under the age of 25 years are almost three times as likely to be killed as females of this age. Most young people killed by road traffic injuries are vulnerable road users – pedestrians, cyclists, motorcyclists, and users of public transport. The socioeconomic condition of a family affects the likelihood of a child or young adult being killed or injured in a road traffic crash. Those from economically poor backgrounds, in both richer and poorer countries, are at greatest risk.

Three main factors come together to put youth at more risk of road traffic crashes worldwide – age, inexperience, and gender. Young people are less able to assess risk and test their boundaries. They overestimate their abilities and have high levels of sensation-seeking behavior which can be influenced by their peers. The male gender is more inclined to 32

Bernard De Freitas B.Sc., M.Sc., GradIOSH head of the OSHE department Cipriani College of Labour and Cooperative Studies

“A life devoted to service brings with it one’s struggles to improve the wellbeing of others.”

It was this personal motto that inspired Bernard De Freitas to embark on his journey into the field of Occupational Safety, Health and the Environment. This journey began after he suffered a work-related injury that resulted in him having to make a change in my career path. Experience is the greatest teacher and using that experience and merging several years of study he went on to acquire a Diploma in Occupational Safety and Health, a B.Sc. in Occupational Safety and Health and an M.Sc. in Occupational Hygiene. He is also a Graduate Member of IOSH and focuses on continually developing his practice in the profession.

Mr. De Freitas has worked over the past fifteen years as a HSE Lecturer/Practitioner contributing to the development of hundreds of students through education and training – many of whom are making their own significant contributions in service to the country’s growing need for improvement in field. He now serves as the Head of the Occupational Safety, Health and Environment Department at the Cipriani College of Labour and Cooperative Studies. In 2012 he received the highly prestigious Excellence in Teaching award from the Cipriani College of Labour and Cooperative Studies. Bernard believes that the sacred bond that must exist between teacher and student is the central reason for him devoting his life to this vocation.

Mr. De Freitas has also worked as an advisor to many companies both in the public and private sector ensuring that their management systems for safety and health are closely aligned to those which exist in the UK, the British Commonwealth and even the European Union.

His future goals include introducing occupational safety, health and environmental studies throughout the education sphere; from primary school level and especially at the secondary school level.

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Among children younger than 15 years, the leading causes of road traffic deaths are as pedestrians (48%), followed by car occupants (32%) and bicycle riders and passengers (8%). At 15–24 years, this changes considerably, and the leading causes become car drivers or occupants (59%), riders and passengers of motorized two-wheelers (19%) and as pedestrians (17%) (Fig. 2). These differences reflect greater exposure to risk as pedestrians and cyclists among children and as car drivers or occupants and riders and passengers of motorized two-wheelers among those 15– 24 years old. This information is essential for planning and targeting prevention to those most at risk.

Factors for Road Traffic Incidents The road traffic system consists of three parts – the road and wider environment, the vehicle, and the individual (road user). The characteristics of these components and the interaction between them affect road traffic crashes and the resulting injuries. For example, a person who is driving on a road that is unlit, in a car that has bad brakes, or without wearing a seatbelt is more likely to be seriously injured than someone who is driving on a well-lit road, in a car that is in good condition, and is buckled up.

Human errors are responsible for most traffic crashes, and human errors cannot be completely eliminated. Humans will make mistakes.

The other parts of the road traffic system – the vehicle, the road and the environment – need to be designed and managed in a way that minimizes the risk of injury and death if a crash occurs. For example, crashes that happen on a road where appropriate speed limits are set and enforced are less likely to result in serious injuries. It also helps to look at road traffic injuries using a timeframe lens: before (pre-crash), during, and after a

crash (post-crash). For example, in the before-the-crash phase we might think about a person who has fastened a seatbelt or worn a helmet, a vehicle that is in good condition, and roads that follow safety standards. In the during-thecrash phase, the crash-protective design of the vehicle might prevent serious injuries or death. After the crash, the availability of quality emergency medical services might save a person’s life. If we combine the timeline with the parts of the road traffic system, we get the Haddon Matrix below in Fig. 3.

The Matrix is a basic way to understand the factors that contribute to the number and outcome of road traffic crashes and we can use it to think about how fatalities and injuries can be reduced. For example, in addition to telling a child not to run across the road on the way to school (addressing human behavior in the pre-crash phase), we can work to slow traffic down so much around schools (addressing road environment in the pre-crash phase) so if a child does get hit, the injuries will be less serious.

By analyzing the Haddon matrix, it is evident that Human Behaviors contribute significantly to road accidents.

Fig. 3 - Haddon Matrix 34

Youth and Risk Factors There are several risk factors that contribute to road traffic injuries among youth and the key risk factors are non-use of helmets; speeding; non-use of seat belts; drinking alcohol and using drugs; distracted driving; fatigue; and not being visible enough on the roads.

Non-use of Helmets Young people are not wearing helmets as some of them believe they are just hats. But unlike hats, helmets have four major components that work together to protect the head from injuries: a rigid outer shell; an impact absorbing liner; a comfort padding; and a retention system to buckle up. Only impact-tested and approved helmets that pass certain government standards for safety should be used. Secondly, young persons think that helmets block their ability to see. In reality helmets give you full ability to see what is happening in your surroundings. It was believed that helmets prevent hearing dangers but helmets only lower noises not eliminate them.

In fact they actually protect ears from wind sounds and from ear drum damage that can occur at speeds of more than 100 km/ hr.

Speeding Young people more often than not, are willing to ride fast and most of the road crashes are happening due to speeding.

Accidents as a result of speeding cause more severe injuries than those which occur at lower speeds. When motorized traffic mixes with pedestrians and cyclists, the speed limit should be under 30km/hr. The chances of avoiding a collision become smaller as the speed increases. The greater the speed, the more distance is covered while having to make decisions and take action to avoid a collision. Also, a speeding vehicle takes extra time to stop when the brakes are applied.

Non-use of Seat Belts Some youngsters think that wearing a seat belt is uncomfortable and restraining.

They believe that if there is an air bag there is no need to wear a seat belt. Seatbelts can be uncomfortable to start with, but you get used to them. As for restraining, that’s what they are supposed to do.

A seatbelt restrains you in your seat in the event of a crash so that you don’t shoot out of the windscreen. Airbags are not designed to work alone but to supplement the work of seatbelts. An air bag will not prevent you from being thrown out of the car – as a seatbelt will – it might actually cause severe injuries in high impact crashes.

Seatbelts are by far the most important protection you can have in a crash. Seatbelts are meant to restrain you in your seat and prevent you from being smashed into the steering wheel or back of the front seat, or thrown out of the car. Three quarters of people who are thrown from the car in a crash are killed. Seatbelts rarely cause any injuries and if they do they are usually surface bruises.

Drunk Driving Young people have the habit of driving after consuming alcohol due to peer pressure, over confidence or for fun.

Alcohol and drug consumption will have effects such as: • Poor coordination; • Difficulty steering; • Reacting slowly when something unexpected happens (a car approaching you from the side, people crossing the street); • Poor judgment (trouble judging your and other people’s behavior [including speed, distances, movement] and estimating risks; • Reduction in concentration, memory, vision and hearing – focusing only on the road ahead; • Losing track of what is taking place in your peripheral vision area; • Missing out on things you see and hear; and • A false sense of confidence and 35

overestimation of abilities (feeling more confident and taking risks that you would not usually take).

Distracted Driving Some young persons talk on mobile phones, text and browse while driving, believing these activities will exhibit their multi- tasking abilities. It is difficult to multi-task while driving, which is considered a ‘cognitively demanding’ task. Doing something else while you are driving, puts extra demands on the driver, which may reduce his or her driving capabilities.

For example, it may cause the driver to become less observant or to make poor decisions about how to control the vehicle safely. This lower standard of driving means that a driver is more likely to fail to anticipate hazards, and means accidents can occur due to the distraction. The result is that drivers using a phone to talk, text, or browse the internet are less able to stay in the appropriate lane, detect any changes around them and respond in time.

Solution

Drivers talking on the phone are also more likely to exceed the speed limit and not maintain a consistent speed. When texting, people often drive at lower speeds, but their delayed reaction time and inability to maintain appropriate lane positions and assess traffic conditions still makes texting while driving extremely dangerous. The World Health Organization (WHO) statistics say that a car accident is six times more likely while holding the phone and 24 times more likely while texting.

Prevention Strategies Despite limited knowledge, what we do know about young drivers and their collision involvement provides a basis for improving existing prevention programs, including regulatory (i.e., driver licensing), education programs, and for developing new programs that have potential for success. The prevention strategies are explained below.

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Graduated Driver Licensing System

• Ensuring high levels of enforcement of current drunk driving legislation; • Promoting high-visibility random breath testing; • Considering adopting blood alcohol concentration limits of 0.05 g/dl or lower and of zero for novice and professional drivers; • Encouraging the provision of alternative transport for drivers who have consumed alcohol; and • Implementing mandatory driver education and treatment programs for habitual offenders.

The purpose of this is to gradually expose young people to risks as they attain the competencies to manage those risks. A variable range of restrictions may be imposed in the intermediate stage: reducing the permissible blood alcohol concentration among drivers to zero, restricting teenage passengers in the car, restricting night driving with any passengers or imposing night curfews.

Speed Control Setting and enforcing speed limits, regulating traffic and making the overall speed more consistent have been shown to work. Local knowledge and action are needed to calm traffic and reduce traffic volume around schools and residential areas, especially in low-income neighborhoods.

Conducting Awareness Campaigns Educational interventions, whether direct or indirect, through teachers and parents, are effective in improving road safety knowledge, attitudes and to a more variable extent, behavior.

Such education programs are more likely to be more effective if the messages are repeated at regular intervals. Whereas it is desirable to equip children with the necessary skills to “behave correctly” as pedestrians, such educational initiatives should also be accompanied by other changes in the traffic and road environments to make these inherently safer. In this context, education of children and other road users can bring additional value to a comprehensive prevention effort, which includes interventions to reduce exposure such as traffic-calming measures and pedestrian walkways.

Helmet Wearing Many countries legally mandate wearing a helmet when riding motorcycles, but the proportion of wearing helmets only increases if the law is enforced. Wearing of helmets can be increased further if laws are supplemented by educational campaigns. Helmet distribution programs to subsidize the cost for children in lower-income households have been shown to increase uptake and reach those that are difficult to reach. Cycle helmet use has been promoted by both non-legislative and legislative approaches. Among non-legislative approaches, community-based approaches including the provision of helmets free of charge with an educational component are somewhat more effective than school-based education and subsidized helmets for schoolchildren. Legislation, especially in conjunction with information campaigns, has been shown to be effective in increasing helmet wearing.

Improving Road Design The road must be maintained well by: • Removal of roadside obstacles • Upgrading marked pedestrian crossings • Installing guard rails along the roadside and median guard rails • Area wide speed and traffic management • Signing of hazardous curves • Pedestrian bridges or underpasses • Simple road markings • Providing proper street lighting

Control of Alcohol Influence High visibility random breath testing as part of enforcement is highly cost-effective in discouraging drunk driving. There are other strategies such as: 37

Conclusion Road traffic injuries are a leading cause of death and disability among young people and forgetting that these injuries are largely avoidable is easy. Children and young adults need special consideration as vulnerable and inexperienced road users. Failure to safeguard the roads compromises their fundamental right to safety. Substantial disparities in road traffic deaths exist both between countries and within countries, with important differences in exposure to risk.

Such inequity is an important area of social justice that needs to be addressed. Many cost-effective and equitable interventions could reduce this issue. Action is now needed to make society more reasonable and the environment more sustainable. Policy-makers, practitioners and advocates from all sectors need to work together to respond to the call for action to protect young people globally.

Harvard Medical School. 2005. Preventing Driving Accidents.

Massachusetts: Harvard Health Publications.

International Union for Health Promotion and Education. nd.

Youth for Road Safety.

Sethi, Dinesh and Francesca Racioppi. 2007. Youth and Road Safety. Geneva: WHO. Simpson, H.M. 1987.Youth and Traffic Accidents: Causes and Prevention.

World Health Organization (WHO). 2015. Road Traffic Injuries.

Geneva: WHO.

References European Commission.2013.Practical Guide to Road Safety Awareness Raising and Education in Europe. Luxembourg: EU Publications Office.

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HSE Tips For New Drivers

1. Always wear your seat belt, and refuse to move the car until all your passengers have buckled up.

2. Slow Down and Give yourself enough time. Speeding is the number 1 cause of accidents among teen drivers.

3. Don’t follow to Close. It takes a significant distance to stop a car from 50 km/h. In fact it takes 14 meters to stop from that speed.

4. Adjust your driving speed for weather conditions.

5. Thumbs are for driving, not for texting. Anything that takes a driver’s attention from the road is a distraction, and distractions can be dangerous.

6. Adjust all accessories before you pull out into traffic. This includes the mirrors, seat, and stereo.

7. Don’t drive if you are sleepy. You put the car, yourself and any passengers at risk.

8. Don’t drive at night until you have enough experience and confidence to deal with all the extra challenges that driving in the dark present.

9. Reverse Park – Roughly 25% of all accidents happen while moving in reverse. If at all possible try to park your car so that the first motion you make is in a forward direction.

10. Look out for you first…..Then look out for everyone else. We need to watch out for those that don’t or won’t look out for themselves.

Source: Safety Services Nova Scotia (http://www.safetyservicesns.ca/)

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A Lethal Combination

By William Kennedy Road Safety Consultant

The term “designated driver” is widely used today in many countries. But you may be surprised to learn that this is not a new concept. In fact the idea of the designated driver actually originated in Scandinavia in the 1920s. In 1986 the concept was introduced in Canada as “The Canadian Club Designated Driver Program” by Hiram Walker and Sons. The program was accepted readily and supported by the police, Mothers Against Drunk Driving, the hospitality industry and the public.

However, it was at the Harvard University School of Public Health, Center for Health Communication in 1988 that brought the concept to life and laid the groundwork for what has become so widely acceptable today as the “designated driver”. That year, the Harvard Alcohol Project was launched to show how the concept of the designated driver could challenge popular social conventions of drinking and driving. The Project partnered with major Hollywood studios and television broadcast networks ABC, NBC and CBS to release a series of public service announcements aimed at drunk driving prevention. The Project received national praise and attention since road accidents was in the 1980s, the leading cause of death for Americans aged 15 to 24.

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This article will look at the success of the program internationally the setbacks and the applicability of the program in the Caribbean. It will also look at what I believe is a major flaw in the concept.

The terms “designated driver” and “designated driving” refers to the selection of a person who remains sober as the responsible driver of a vehicle whilst others have been allowed to drink alcoholic beverages. Another definition for the term is “the individual whom transports intoxicated people to and from the bar safely, and is responsible for them”.

Based on the definitions and for the purpose of this article we will say that a designated driver is a person who abstains from alcohol on a social occasion in order to drive his or her companions’ home safely.

by one. Among frequent drinkers who consumed five or more drinks in the past seven days, 62% had served as a designated driver and/or been driven home by one.

The campaign has been viewed by many as one of the contributing factors in the decline of the annual alcoholrelated traffic fatalities in the US which was stood at around 23,626 in late 1988. By 1994, fatalities had declined by 30%. Though there were many factors that contributed to the decline the designated driver campaign created a fundamental shift in social norms relating to driving-afterdrinking and that shift was essential for curbing alcoholrelated traffic fatalities.

Other countries have also been successful in implementing designated driver campaigns. In the UK Coca-Cola Great

Is the concept working?

In May 2011 recognition was given to the 21st year of the United States Designated Driver Campaign, which was created by the Harvard School of Public Health. The “designated driver” became a household phrase in the United States (U.S.) to such an extent that the term appeared in the 1991 Random House Webster’s College Dictionary. There was wide acceptance and strong popularity of the designated driver concept. According to the Roper Poll, the proportion of Americans serving as a designated driver reached 37% in 1991. Among Americans under the age of 30, 52% had actually been a designated driver. Among frequent drinkers, 54% had been driven home by a designated driver. By 1998, according to the Roper Poll, a majority of adults who drink had served as a designated driver and/or been driven home

Britain supports a nationwide designated driver campaign by rewarding drivers who choose not to drink alcohol with a ‘buy one, get one free’ offer on Coca-Cola, Diet Coke and Coke Zero. The program is now in its 5th year. Another example is in India where they are now implementing a designated driver program. On July 26th 2016 in an article titled “Designated Driver to check Drunk Driving” which was published in The Tribune the largest selling daily in North India said that the police in the Indian cities of Hyderabad and Cyberabad made a decision to introduce the designated driver concept in response to concerns over the increasing number of accidents involving drunken drivers. The Cyberabad East Police Commissioner Mahesh Bhagwat said “This (designated driver) will be very helpful in preventing accidents and thus savings lives.”

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Based on the above it may be concluded that the Designated Driver campaign is successful. However notwithstanding the success to date, some 13,000 people will lose their lives this year in an alcohol-related crash in the United States. While there is no comprehensive data in the Caribbean we can be sure that a large percentage of our road fatalities also involve drivers who were under the influence.

designated driver just as dangerous as a driver under the influence of alcohol. The major factor is fatigue. When we look at all the definitions of the designated driver they all speak to a sober driver or a driver who has not consumed as much as the others in the car. There is however no mention of the tired or fatigued driver which we will now explore.

Drowsy or Fatigued Driving

Many people worldwide have varying views on the concept of the designated driver. Some think a designated driver shouldn’t drink at all. Others say it’s fine if the driver has a drink or two. In speaking to a number of people the latter turns out to be the more popular view. Most people found it difficult to give up their drinks or at least some of it.

In a study conducted by NBC News, they surveyed 165 persons who identified themselves as designated drivers when they were exiting bars in Florida. They asked them what they’d had to drink, if anything, and gave them a Breathalyzer test.

The results showed that around 40% of designated drivers drink alcohol and almost 20% do so to the point that their own ability to drive may be impaired.

The Designated Driver - The Killer While there has been much documented success about the designated driver there are factors that can make the

Drowsy driving is the dangerous combination of driving and sleepiness or fatigue. This usually happens when a driver has not slept enough, but it can also happen due to untreated sleep disorders, medications, drinking alcohol, or shift work. Drowsy driving is a form of impaired driving that negatively affects a person’s ability to drive safely.

While most people associate impaired driving with alcohol or drugs, in this situation, sleepiness is the primary cause.

Drowsy driving is not just falling asleep at the wheel. Driver alertness, attention, reaction time, judgment and decisionmaking are all compromised leading to a greater chance of crashing. According to a National Highway Traffic Safety Administration (NHTSA) National Motor Vehicle Crash Causation Study, drowsy drivers involved in a crash are twice as likely to make performance errors as compared to drivers who are not fatigued. In extreme cases, a drowsy driver may fall asleep at the wheel.

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Being fatigued significantly increases the risk of a crash. It makes us less aware of what is happening on the road and impairs our ability to respond quickly and safely if a dangerous situation arises. Driver fatigue is believed to contribute to more than 30% of road crashes. Because fatigue impairs mental processing and decision making abilities, drivers can lapse into a “micro-sleep” without realizing. This may only last a few seconds, but if it coincides with the need to perform some critical driving task (e.g. turning the wheel or responding to a stop signal), the risk of crashing is greatly increased. Nobody is immune to the effects of driver fatigue, however some groups of people are more at risk than others.

Young drivers and the combination of inexperience and night driving is always a deadly combination.

A number of factors influence the likelihood that a driver will become fatigued, these include: • How long you have been awake (particularly beyond about 17 hours) • Time of day: your body and brain have a biological clock (circadian rhythm) that influences how alert or drowsy we are at certain times of the day • The quantity and quality of your last period of sleep • Your level of physical or mental activity at the time (eg long boring stretches of road make it difficult to maintain alertness and vigilance) • Sedative drugs Profile of the Friday Night Caribbean Limer

There are two main causes of driver fatigue lack of quality/ quantity of sleep and driving at times of the day when you would normally be sleeping. The end result is not getting enough sleep, which can lead to a build-up of a “sleep debt” – this is essentially the sleep that you ‘owe’ yourself. The only way to repay this debt is by sleeping. Until you can catch up on lost sleep you will have a greater risk of having a fatiguerelated accident.

A Lime can be defined as “of Caribbean origin; often heard from a Trinidadian or Trini”. Closest American translation is “hanging out,” but it can be used to describe a party, a planned or unplanned social gathering, or just some people sitting around, killing time together. It’s a Trini’s favorite pastime. In the Caribbean Friday nights are for many people the day when we release the stress associated with the work week, it’s when we lime and in most cases like true Caribbean people we drink. In fact for the most part, a lime is considered successful if it includes lots of drinks. Unfortunately however after the lime many of us drive home.

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An article written in the Barbados free Press titled “Welcome to Barbados where drinking and driving is legal. Don’t ask about the fatal accident statistics”. The writer said “It’s Crop Over: people die because of the drinking and partying”. She continued, “our culture embraces drinking and driving and, in the absence of an accident, a drinking driver is more likely to be viewed with humor rather than with concern”.

That is the reality of our Caribbean culture.

The Friday night lime is usually referred to as an after work lime because most people would go to their favorite spot right after work. What is interesting is that the great majority of those people would have been up from as early as 5am been at work all day and then go directly into the after work lime which in some cases can go up to midnight.

According to the preceding definition of fatigued driving one of the main determining factors associated with fatigued driving is how long you have been awake (particularly beyond about 17 hours). So then if a driver woke up at 5am on a Friday morning and he/she is driving home after 11pm that driver would have been up for 18 hours. If we add alcohol consumption to that mix the result can be sometimes fatal.

In reviewing the concept of the Designated Driver the question can now be asked, is it safe to assume that the only requirement of the designated driver is that the driver does not consume alcohol? If the designated driver has been awake, at work and then present at the lime then what you may have on the way home is 3 friends who were drinking and have fallen asleep and one friend (the designated driver) who did not consume any alcohol but is fatigued and becomes drowsy.

In some cases the designated driver became a killer!

In part two of this article we will explore the concept of the Designated Driver in the Caribbean context.

References Barbados Free Press. 2010. “Welcome to Barbados where drinking and driving is legal.

Don’t ask about the fatal accident statistics”. https://barbadosfreepress.wordpress.com (accessed September 9, 2016).

National Highway Traffic Safety Administration. 2014. “Fatality Analysis Reporting System (FARS) Database”. (accessed September 5, 2016).

National Highway Traffic Safety Administration. nd. Research on Drowsy Driving. www.nhtsa.gov/ Driving+Safety/Drowsy+Driving/ ci.Research+on+Drowsy+ Driving (accessed September 9, 2016).

Urban Dictionary. 2016. http:// www.urbandictionary.com/ define.php?term=liming.

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Crisis and Emergency Management in the Workplace

By Shazard Bansraj HSEQ Consultant

�God is a Trini� is a phrase commonly echoed throughout the population of Trinidad and Tobago. It makes reference to the fact that Trinidad and Tobago has not been ravaged by a natural disaster in recent history. However, this mentality creates a false sense of security.

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The Office of Disaster Preparedness and Management (ODPM), attempts to prepare the population for a wide range of disasters. Our coping capacity and resilience have never been fully tested but there are measures in place to prepare for and respond to disasters.

What about crises and emergencies in the workplace?

According to our local legislation; the Occupational Safety and Health Act No. 1 of 2004 (amended 2006), for organizations where there are more than twenty persons in the building, ten persons above the ground floor or where explosive or flammable materials are stored, safety provisions must be made for fires. However, many workplaces do not even make this minimum requirement.

So how can your organization prepare for the worst?

The first step is conducting a Risk Assessment to determine the most likely and most dangerous threats, who will be affected, and what measures can be put in place to prepare for and respond to these potential emergencies. From the Emergency Risk Assessment, a documented Emergency Response Plan (ERP) can be developed, which serves to instruct personnel on the actions to be taken before, during and after an emergency. This Plan usually forms part of a company’s HSSE Manual. Ideally, every organization should have an ERP and HSSE Manual, with the amount of details depending on the level of HSSE risk.

What should be part of your ERP?

The Trinidad and Tobago energy sector companies and subcontractors usually have a high standard for Health, Safety, Security and the Environment (HSSE), due especially to the high risk nature of their operations. The minimum safety requirement is set in some cases by the Safe TO Work (STOW) Guidelines. Element 10 of these guidelines (Crisis and Emergency Management) requires preparation for multiple scenarios including fire, medical, security, environmental and natural disasters.

1. An Emergency Risk Assessment – this assesses all of the risks and lists ways to mitigate and respond to hazards. The ERP is built upon this Risk Assessment.

2. A documented ERP Procedure – this is the main body of the Emergency Response Plan.

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It should contain: a. A list of likely emergency scenarios and the steps to be taken should any such event occur. The response steps can sometimes be represented diagrammatically, making it easier to understand. b. A list of the emergency response personnel and their roles. Some important roles include the Incident Commander, First Aider and Fire Warden. c. Training requirements. d. A list of emergency response equipment such as fire extinguishers, first aid kits and alarm devices.

3. An ERP drawing – this is a site plan of all facilities, which identifies the locations of emergency equipment and exit routes. Copies of such drawings should be prominently displayed in the workplace.

4. A drill schedule – your ERP means little if it isn’t communicated with staff and practically executed, periodically.

This means conducting scheduled emergency drills which simulate all emergency scenarios identified in the ERP. Drills can be fun for staff since it engages personnel, breaking the monotony of the regular work cycle and demonstrates the value management has on its workforce.

The Emergency Response Plan should cover all emergencies an organization is likely to face and must include disasters such as floods, earthquakes and explosions. The procedure can also explain collaboration with local government and national agencies such as the ODPM, the Trinidad and Tobago Fire Service and medical institutions.

It is the responsibility of every citizen to prepare for disaster. It is also the responsible of employers to provide a safe workplace for all employees. That way, we can all be safe at work and at home.

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For more information contact us at: Trinidad: 221-4100 or 223 -1198 Email: info@jaricesh.com

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The HSE Quarterly magazine specialises in interactive, illuminating advertising. Our ad designs and magazine layouts increases brand awareness, ad recall along with purchase intent from customers. We combine leading research and technology to create an intelligent design.

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Email: thehsequarterly@jaricesh.com Website: www.jaricesh.com

Writing

for Change

“Being a writer is a very peculiar sort of a job: it's always you versus a blank sheet of paper (or a blank screen) and quite often the blank piece of paper wins.” ~ Neil Gaiman

Submission Guidelines

Your original articles in basic and applied research, case studies, critical reviews and essays can be articles published in the HSE Quarterly.

The publication is keen to convey to the Caribbean, and beyond, the knowledge and experience that you possess in order to foster a deeper understanding and present a uniquely accurate view of health, safety and the environment.

Below are the terms set to ensure that the magazine continues to set an excellent standard of written work that conforms to the practice of ethics, fairness and quality of content: • There is no limit on the number of articles that can be submitted.

• The articles should be word processed or type written, and of good quality English.

• It is recommended that entries should be proof-read.

• The accuracy of information presented (i.e. of case studies, tables, charts etc.), formatting style and presentation should be maintained.

• Articles entered may be submitted with or without visual aids (e.g. diagrams or photographs). Please ensure that these visual aids are in a jpeg format.

• The text word limit should not exceed 1500-2500 words. Illustrative materials will not be included in the word count.

• The materials (both text and images) offered should be properly referenced: including the author’s and/or illustrator’s full name and any copyright details. Material should be titled and dated. All information containing any factual data should be referenced.

• When referencing, the Chicago 15th edition citation style should be used.

• Plagiarism will not be tolerated. Where necessary, information used should be cited and referenced.

• Articles will be edited. In such instances we will ensure that the integrity of your work is preserved.

• Aspiring writers and interested persons can submit documents via e-mail, C.D., or post

E-mail address: thehsequarterly@jaricesh.com Postal address: Jaric Environment, Safety and Health Services Limited Lot 5B Trincity Industrial Estate Trinicity Trinidad and Tobago West Indies Tel: 868-221-4100 Fax: 868-222-2147 • With every submission please include your full name, e-mail address and telephone numbers, occupational or academic status/position and vocational or academic institutions of which you are a part.

• You will be sent a declaration statement which you will be required to complete. Please note that Jaric ESH does not intend to claim your intellectual property as our own.

Issue No. 33 (January 2017) is “Drug Use in the Workplace” The deadline for all entries is October 17th, 2016

Issue No. 34 (April 2017) is “Depleting Natural Resources” The deadline for all entries is January 9th, 2017 54