Definition
Bipolar disorder — sometimes called manic-depressive disorder — causes mood swings that range from of the lows of depression to the highs of mania. When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts in the other direction, you may feel euphoric and full of energy. Mood shifts may only occur only a few times a year, or as often as several times a day. In some cases, bipolar disorder causes symptoms of depression and mania at the same time.
Although bipolar disorder is a disruptive, long-term condition, you can keep your moods in check by following a treatment plan. In most cases, bipolar disorder can be controlled with medications and psychological counseling (psychotherapy).
Symptoms
Bipolar disorder is divided into several subtypes. Each has a different pattern of symptoms. Types of bipolar disorder include:
Bipolar I disorder. Mood swings with bipolar I cause significant difficulty in your job, school or relationships. Manic episodes can be severe and dangerous.
Bipolar II disorder. Bipolar II is less severe than bipolar I. You may have an elevated mood, irritability and some changes in your functioning, but generally you can carry on with your normal daily routine. Instead of full-blown mania, you have hypomania — a less severe form of mania.
In bipolar II, periods of depression typically last longer than periods of hypomania.
Cyclothymia. Cyclothymia is a mild form of bipolar disorder. With cyclothymia, hypomania and depression can be disruptive, but the highs and lows are not as severe as they are with other types of bipolar disorder.
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The exact symptoms of bipolar disorder vary from person to person. For some people, depression causes the most problems; for other people manic symptoms are the main concern. Symptoms of depression and symptoms of mania or hypomania may also occur together. This is known as a mixed episode.
Manic phase of bipolar disorder
Signs and symptoms of the manic or hypomanic phase of bipolar disorder can include:
Euphoria
Extreme optimism
Inflated self-esteem
Poor judgment
Rapid speech
Racing thoughts
Aggressive behavior
Agitation or irritation
Increased physical activity
Risky behavior
Spending sprees or unwise financial choices
Increased drive to perform or achieve goals
Increased sex drive
Decreased need for sleep
Inability to concentrate
Careless or dangerous use of drugs or alcohol
Frequent absences from work or school
Delusions or a break from reality (psychosis)
Poor performance at work or school
Depressive phase of bipolar disorder
Signs and symptoms of the depressive phase of bipolar disorder can include:
Sadness
Hopelessness
Suicidal thoughts or behavior
Anxiety
Guilt
Sleep problems
Low appetite or increased appetite
Fatigue
Loss of interest in daily activities
Problems concentrating
Irritability
Chronic pain without a known cause
Frequent absences from work or school
Poor performance at work or school
Other signs and symptoms bipolar disorder
Signs and symptoms of bipolar disorder can also include:
Seasonal changes in mood. As with seasonal affective disorder (SAD), some people with bipolar disorder have moods that change with the seasons. Some people become manic or hypomanic in the spring or summer and then become depressed in the fall or winter. For other people, this cycle is reversed — they become depressed in the spring or summer and manic or hypomanic in the fall or winter.
Rapid cycling bipolar disorder. Some people with bipolar disorder have rapid mood shifts. This is defined as having four or more mood swings within a single year. However, in some people moods shifts occur much more quickly, sometimes within just hours.
Psychosis. Severe episodes of either mania or depression may result in psychosis, a detachment from reality. Symptoms of psychosis may include false but strongly held beliefs (delusions) and hearing or seeing things that aren't there (hallucinations). In some people, sudden psychosis (a psychotic break) is the first sign of bipolar disorder.
Symptoms in children and adolescents
Instead of clear-cut depression and mania or hypomania, the most prominent signs of bipolar disorder in children and adolescents can include explosive temper, rapid mood shifts, reckless behavior and aggression. In some cases, these shifts occur within hours or less — for example, a child may have intense periods of giddiness and silliness, long bouts of crying and outbursts of explosive anger all in one day. Changing sleep patterns are also a common indicator of childhood bipolar disorder.
When to see a doctor
If you have any symptoms of depression or mania, see your doctor or mental health provider. Bipolar disorder doesn't get better on its own. Getting treatment from a mental health provider with experience in bipolar disorder can help you get your symptoms under control.
Many people with bipolar disorder don't get the treatment they need. Despite the mood extremes, people with bipolar disorder often don't recognize how much their emotional instability disrupts their lives and the lives of their loved ones. And if you're like some people with bipolar disorder, you may enjoy the feelings of euphoria and cycles of being more productive. However, this euphoria is always followed by an emotional crash that can leave you depressed, worn out — and perhaps in financial, legal or relationship trouble.
If you're reluctant to seek treatment, confide in a friend or loved one, a health care professional, a faith leader or someone else you trust. They can help you take the first steps to successful treatment.
If you have suicidal thoughts.
Suicidal thoughts and behavior are common among people with bipolar disorder. If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:
Contact a family member or friend.
Seek help from your doctor, a mental health provider or other health care professional.
Call a suicide hot line number — in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor.
Contact a minister, spiritual leader or someone in your faith community.
When to get emergency help.
If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, make sure someone stays with that person. Take him or her to the hospital or call for emergency help.
Causes
Several factors seem to be involved in causing and triggering bipolar episodes:
Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
Neurotransmitters. An imbalance in naturally occurring brain chemicals called neurotransmitters seems to play a significant role in bipolar disorder and other mood disorders.
Hormones. Imbalanced hormones may be involved in causing or triggering bipolar disorder.
Inherited traits. Bipolar disorder is more common in people who have a blood relative (such as a sibling or parent) with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.
Environment. Stress, abuse, significant loss or other traumatic experiences may play a role in bipolar disorder.
Risk factors
Factors that may increase the risk of developing bipolar disorder include:
Having blood relatives such as a parent or sibling with bipolar disorder
Periods of high stress
Drug or alcohol abuse
Major life changes, such as the death of a loved one
Being between the ages of 15 and 30
Conditions that commonly occur with bipolar disorder
If you have bipolar disorder, you may also have another health condition that's diagnosed before or after your diagnosis of bipolar disorder. Such conditions need to be diagnosed and treated because they may worsen existing bipolar disorder.
They include:
Anxiety disorders. Examples include post-traumatic stress disorder (PTSD), social phobia and generalized anxiety disorder.
Attention-deficit/hyperactivity disorder (ADHD). ADHD has symptoms that overlap with bipolar disorder. For this reason, bipolar disorder can be difficult to differentiate from ADHD. Sometimes one is mistaken for the other. In some cases, a person may be diagnosed with both conditions.
Addiction or substance abuse. Many people with bipolar disorder also have alcohol or drug problems. Street drugs or alcohol may seem to ease symptoms, but they can actually trigger, prolong or worsen depression or mania.
Physical health problems. People diagnosed with bipolar disorder are more likely to have certain other health problems, including heart disease, thyroid problems and obesity.
Complications
Left untreated, bipolar disorder can result in serious problems that affect every area of your life. These can include:
Problems related to substance and alcohol abuse
Legal problems
Financial problems
Relationship troubles
Isolation and loneliness
Poor work or school performance
Frequent absences from work or school
Suicide
Preparing for your appointment
You're likely to start by first seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a psychiatrist — a medical doctor who specializes in diagnosing and treating mental health conditions.
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
-Write down any symptoms you've had, including any that may seem unrelated to the reason for which you scheduled the appointment.
-Write down key personal information, including any major stresses or recent life changes.
-Make a list of all medications, as well as any vitamins or supplements that you're taking.
-Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
-Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. For problems related to bipolar disorder, some basic questions to ask your doctor include:
Is bipolar disorder likely causing my symptoms or condition?
Other than the most likely cause, what are other possible causes for my symptoms or condition?
What kinds of tests will I need?
What treatment is likely to work best for me?
What are the alternatives to the primary approach that you're suggesting?
I have these other health conditions. How can I best manage them together?
Are there any restrictions that I need to follow?
Should I see a psychiatrist or other mental health provider? What will that cost, and will my insurance cover seeing a specialist?
Is there a generic alternative to the medicine you're prescribing me?
Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor.
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
When did you or your loved ones first begin noticing your symptoms of depression, mania or hypomania?
How frequently do your moods change?
Do you ever have suicidal thoughts when you're feeling down?
How severe are your symptoms? Do they interfere with your daily life or relationships?
Do you have any blood relatives with bipolar disorder or another mood disorder?
What other mental or physical health conditions do you have?
Do you drink alcohol or use street drugs?
How much do you sleep at night? Does it change over time?
Do you go through periods when you take risks you wouldn't normally take, such as unsafe sex or unwise, spontaneous financial decisions?
What, if anything, seems to improve your symptoms?
What, if anything, appears to worsen your symptoms?
Tests and diagnosis
When doctors suspect someone has bipolar disorder, they typically do a number of tests and exams. These can help rule out other problems, pinpoint a diagnosis and also check for any related complications. These can include:
Physical exam. This may involve measuring your height and weight; checking your vital signs, such as heart rate, blood pressure and temperature; listening to your heart and lungs; and examining your abdomen.
Lab tests. These may include blood and urine tests. These tests can help identify any physical problems that could be causing your symptoms.
Psychological evaluation. A doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms and possible episodes of mania or depression.
Mood charting. To identify exactly what's going on, your doctor may have you keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment.
Diagnostic criteria for bipolar disorder.
To be diagnosed with bipolar disorder, you must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment. Diagnostic criteria for bipolar disorder are based on the specific type of bipolar disorder.
Bipolar I disorder: You've had at least one manic or one mixed episode. You may or may not have had a major depressive episode. Because bipolar I varies from person to person, there are more specific subcategories of diagnosis based on your particular signs and symptoms.
Bipolar II disorder: You've had at least one major depressive episode and at least one hypomanic episode (but not a fully manic or mixed episode). With bipolar II, symptoms cause distress or difficulty in some area of your life — such as relationships or work. Bipolar II disorder also has subcategories based on your particular signs and symptoms.
Cyclothymic disorder: You've had numerous hypomanic episodes and periods of depression — but you've never had a full manic episode, a major depressive episode or a mixed episode. For a diagnosis of cyclothymic disorder, symptoms last two years or more (one year in children and adolescents). During that time, symptoms never go away for more than two months. Symptoms cause significant distress or difficulty in some area of your life — such as in relationships or at work.
The DSM has very specific criteria for manic, hypomanic, major depressive and mixed episodes:
Criteria for a manic episode.
A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood that lasts at least one week (or less than a week if hospitalization is necessary). During the period of disturbed mood, three or more of the following symptoms must be present (four if the mood is only irritable):
Inflated self-esteem or grandiosity.
Decreased need for sleep (for example, you feel rested after only three hours of sleep)
Unusual talkativeness
Racing thoughts
Distractibility
Increased goal-directed activity (either socially, at work or school, or sexually)
Engagement in pleasurable activities that have a high potential for painful consequences — for example, unrestrained buying sprees, sexual indiscretions or foolish business investments
To be considered a manic episode:
The mood disturbance must be severe enough to cause noticeable difficulty at work, at school or in usual social activities or relationships; to require hospitalization to prevent harm to yourself or others; or to trigger a break from reality (psychosis).
Symptoms do not meet the criteria for a mixed episode (see criteria for mixed episode below).
Symptoms are not due to the direct effects of something else such as alcohol or drug use, taking a medication, or a having a medical condition such as hyperthyroidism.
Criteria for a hypomanic episode.
A hypomanic episode is a distinct period of elevated, expansive, or irritable mood that lasts at least four days, and is different from the usual nondepressed mood. During the period of disturbed mood, three or more of the following symptoms must be present (four if the mood is only irritable):
Inflated self-esteem or grandiosity
Decreased need for sleep (for example, you feel rested after only three hours of sleep)
Unusual talkativeness
Racing thoughts
Distractibility
Increased goal-directed activity (either socially, at work or school, or sexually)
Engagement in pleasurable activities that have a high potential for painful consequences — for example, unrestrained buying sprees, sexual indiscretions or foolish business investments
To be considered a hypomanic episode:
The mood disturbance must be severe enough to cause a noticeable and uncharacteristic change in functioning.
The episode isn't severe enough to cause significant difficulty at work, at school or in usual social activities or relationships; to require hospitalization; or to trigger a break from reality (psychosis).
Symptoms do not meet the criteria for a mixed episode (see criteria for mixed episode below).
Symptoms are not due to the direct effects of something else such as alcohol or drug use, taking a medication, or a having a medical condition such as hyperthyroidism.
Criteria for a major depressive episode
To be diagnosed with a major depressive episode, you must have five (or more) of the following symptoms over a two-week period. At least one of the symptoms is either depressed mood or loss of interest or pleasure. Symptoms can be based on your own feelings or on the observations of someone else. They include:
Depressed mood most of the day, nearly every day, such as feeling sad, empty or tearful (in children and adolescents, depressed mood can appear as constant irritability)
Diminished interest or feeling no pleasure in all — or almost all — activities most of the day, nearly every day
Significant weight loss when not dieting, weight gain, or decrease or increase in appetite nearly every day (in children, failure to gain weight as expected can be a sign of depression)
Insomnia or increased desire to sleep nearly every day
Either restlessness or slowed behavior that can be observed by others
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt nearly every day
Diminished ability to think or concentrate, or indecisiveness, nearly every day
Recurrent thoughts of death or suicide, or a suicide attempt
To be considered a major depressive episode:
Symptoms don't meet the criteria for a mixed episode (see criteria for mixed episode below)
Symptoms must be severe enough to cause noticeable difficulty in day-to-day activities, such as work, school, social activities or relationships with others
Symptoms are not due to the direct effects of something else, such as drug abuse, taking a medication or a having a medical condition such as hyperthyroidism
Symptoms are not caused by grieving, such as after the loss of a loved one
Criteria for mixed episode
The criteria are met both for a manic episode and for a major depressive episode nearly every day during at least a one-week period
The mood disturbance must be severe enough to cause noticeable difficulty at work, at school, or in usual social activities or relationships; to require hospitalization to prevent harm to self or others; or to cause a break from reality (psychosis)
Symptoms are not due to the direct effects of something else, such as drug abuse, taking a medication or a having a medical condition such as hyperthyroidism
Diagnosis in children
The same official criteria used to diagnose bipolar disorder in adults are used to diagnose children and adolescents. However, bipolar symptoms in children and adolescents often have different patterns than they do in adults, and may not fit neatly into the categories used for diagnosis. While adults generally tend to have distinct periods of mania and depression, children and adolescents may have erratic, rapid changes in mood, behavior and energy levels.
It's often hard to tell whether these are normal ups and downs, the results of stress or trauma, or signs of a mental health problem other than bipolar disorder. To make it even more difficult, children who have bipolar disorder are frequently also diagnosed with other mental health conditions such as attention-deficit/hyperactivity disorder (ADHD) or behavior problems such as oppositional defiant disorder (ODD).
Although bipolar disorder can occur in young children, diagnosis in children preschool age or younger is especially difficult. The current criteria used for diagnosis have not been proved in young children, and a wide range of issues other than bipolar disorder can cause mood and behavior problems at this age.
Treatments and drugs:
Bipolar disorder requires lifelong treatment, even during periods when you feel better. Treatment is usually guided by a psychiatrist skilled in treating the condition. You may have a treatment team that also includes psychologists, social workers and psychiatric nurses. The primary treatments for bipolar disorder include medications; individual, group or family psychological counseling (psychotherapy); or education and support groups.
Hospitalization may be needed if you are behaving dangerously, you feel suicidal or you become detached from reality (psychotic).
Initial treatment generally involves taking medications to balance your moods right away. Once your symptoms are under control, you'll work with your doctor to find the best long-term treatment.
Continued treatment (maintenance treatment) is used to manage bipolar disorder on a long-term basis. People who skip maintenance treatment are at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression.
Substance abuse treatment may be necessary if you have problems with alcohol or drugs. Otherwise, it can be very difficult to manage bipolar disorder.
Medications:
A number of medications are used to treat bipolar disorder. If one doesn't work well for you, there are a number of others to try. Your doctor may suggest combining medications for maximum effect. Medications for bipolar disorder include those that prevent the extreme highs and lows that can occur with bipolar disorder (mood stabilizers) and medications that help with depression or anxiety.
Medications for bipolar disorder include:
Lithium. Lithium (Lithobid, others) is effective at stabilizing mood and preventing the extreme highs and lows of certain categories of bipolar disorder and has been used for many years. Periodic blood tests are required, since lithium can cause thyroid and kidney problems. Common side effects include tremor, weight gain and digestive issues.
Anticonvulsants. These mood stabilizing medications include valproic acid (Depakene), divalproex (Depakote) and lamotrigine (Lamictal). The medication asenapine (Saphris) may be helpful in treating mixed episodes. Depending on the medication you take, side effects can vary. Common side effects include weight gain, tremor and drowsiness. Rarely, certain anticonvulsants cause more serious problems, such as skin rashes, blood disorders or liver problems.
Antidepressants. Depending on your symptoms, your doctor may or may not recommend you take an antidepressant. In some people with bipolar disorder, antidepressants can trigger manic episodes, but may be OK if taken along with a mood stabilizer. The most common antidepressant side effects include reduced sexual desire and problems reaching orgasm. Older antidepressants, which include tricyclics and MAO inhibitors, can cause a number of potentially dangerous side effects and require careful monitoring.
Antipsychotics. Certain antipsychotic medications, such as olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel), may help people who don't gain benefits from anticonvulsants. Side effects depend on the medication, but can include weight gain, sleepiness, tremors, dry mouth, blurred vision and sexual side effects. Weight gain in children is a significant concern. Antipsychotic use may also affect memory and attention and cause involuntary facial or body movements.
Symbyax. This medication combines the antidepressant fluoxetine and the antipsychotic olanzapine - it works as a depression treatment and a mood stabilizer. Side effects can include weight gain, drowsiness, dry mouth, increased appetite and fatigue. This medication may also cause sexual problems similar to those caused by antidepressants.
Benzodiazepines. These anti-anxiety medications may help with anxiety and improve sleep. Examples include clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Xanax). Benzodiazepines are generally used for relieving anxiety only on a short-term basis. Side effects can include drowsiness, reduced muscle coordination, and problems with balance and memory.
Finding the right medication:
Everyone's different, so finding the right medication or medications for you will likely take some trial and error. This requires patience, as some medications need eight weeks or longer to take full effect. Generally only one medication is changed at a time so your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. This can take months or longer, and medications may need to be adjusted as your symptoms change. Side effects improve as you find the right medications and doses that work for you, and your body adjusts to the medications.
Medications and pregnancy
A number of medications for bipolar disorder can cause birth defects.
Use effective birth control (contraception) to prevent pregnancy. Discuss birth control options with your doctor, as birth control medications may lose effectiveness when taken along with certain bipolar disorder medications.
If you plan to become pregnant, meet with your doctor to discuss your treatment options.
Discuss breast-feeding with your doctor, as some bipolar medications can pass through breast milk to your infant.
Psychotherapy
Psychotherapy is another vital part of bipolar disorder treatment. Several types of therapy may be helpful. These include:
Cognitive behavioral therapy. This is a common form of individual therapy for bipolar disorder. The focus of cognitive behavioral therapy is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. It can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
Education. Counseling to help you learn about bipolar disorder (psychoeducation) can help you and your loved ones understand bipolar disorder. Knowing what's going on can help you get the best support and treatment, and help you and your loved ones recognize warning signs of mood swings.
Family therapy. Family therapy involves seeing a psychologist or other mental health provider along with your family members. Family therapy can help identify and reduce stress within your family. It can help your family learn how to communicate better, solve problems and resolve conflicts.
Group therapy. Group therapy provides a forum to communicate with and learn from others in a similar situation. It may also help build better relationship skills.
Other therapies. Other therapies that have been studied with some evidence of success include early identification and therapy for worsening symptoms (prodrome detection) and therapy to identify and resolve problems with your daily routine and interpersonal relationships (interpersonal and social rhythm therapy). Ask your doctor if any of these options may be appropriate for you.
Electroconvulsive therapy (ECT)
Electroconvulsive therapy can be effective for people who have episodes of severe depression or feel suicidal or people who haven't seen improvements in their symptoms despite other treatment. With ECT, electrical currents are passed through your brain. Researchers don't fully understand how ECT works. But it's thought that the electric shock causes changes in brain chemistry that leads to improvements in your mood. ECT may be an option if you have mania or severe depression when you're pregnant and cannot take your regular medications.
Hospitalization
In some cases, people with bipolar disorder benefit from hospitalization. Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you're having a manic episode or a deep depression. Partial hospitalization or day treatment programs also are options to consider. These programs provide the support and counseling you need while you get symptoms under control.
Treatment in children and adolescents
Children and adolescents with bipolar disorder are prescribed the same types of medications as those used in adults. However, there's very little research on the safety and effectiveness of bipolar medications in children, so treatment decisions are based on adult research. Treatments are generally decided on a case-by-case basis, depending on exact symptoms, medication side effects and other factors. As with adults, ECT may be an option for adolescents with severe bipolar I symptoms or for whom medications don't work.
Most children diagnosed with bipolar disorder require counseling as part of initial treatment and to keep symptoms from returning. Psychotherapy — along with working with teachers and school counselors — can help children develop coping skills, address learning difficulties and resolve social problems. It can also help strengthen family bonds and communication. Psychotherapy may also be necessary to resolve substance abuse problems, common in older children with bipolar disorder.
Lifestyle and home remedies
You'll probably need to make lifestyle changes to stop cycles of behavior that worsen your bipolar disorder, and to make sure you get the support you need from people in your life. Here are some steps to take:
Quit drinking or using illicit drugs. One of the biggest concerns with bipolar disorder is the negative consequences of risk-taking behavior and drug or alcohol abuse. Get help if you have trouble quitting on your own.
Steer clear of unhealthy relationships. Surround yourself with people who are a positive influence and won't encourage unhealthy behavior or attitudes that can worsen your bipolar disorder.
Get regular exercise. Moderate, regular exercise can help steady your mood. Working out releases brain chemicals that make you feel good (endorphins), can help you sleep and has a number of other benefits.
Get plenty of sleep. Sleeping enough is an important part of managing your mood. If you have trouble sleeping, talk to your doctor or mental health provider about what you can do.
Alternative medicine
Some alternative treatments may help, but there isn't much research on them. Most of the studies that do exist are on major depression, so it isn't clear how well most of these work for bipolar disorder.
Omega-3 fatty acids. These oils may help improve brain function and depression associated with bipolar disorder. Bipolar disorder appears to be less common in areas of the world where people regularly eat fish rich in omega-3s. Omega-3s appear to have a number of health benefits, but more studies are needed to determine just how much they help with bipolar disorder.
St. John's wort. This herb may be helpful with depression. However, it can also interact with antidepressants and other medications, and has the potential to trigger mania in some people.
S-adenosyl-L-methionine (SAMe). This amino acid supplement appears to help brain function related to depression. It isn't clear yet whether it's helpful in people with bipolar disorder. As with St. John's wort, SAMe can trigger mania in some people.
Herbal combinations. Herbal remedies that combine a number of different herbs, such as those used in traditional Chinese medicine, haven't been well studied. Some appear to help, but the risks and benefits still aren't clear.
Acupuncture. This ancient Chinese practice of inserting tiny needles into the skin may relieve depression, but more studies are needed to confirm its benefits. However, it won't hurt for you to try it — acupuncture is safe and can be done along with other bipolar disorder treatments.
Yoga. Yoga may help ease depression and mood swings associated with bipolar disorder. It also has a number of other health benefits.
Massage therapy. Massage may also help relieve anxiety and stress, which can worsen bipolar symptoms.
Although some alternative medicine treatments can be a good addition to your regular treatment, take some precautions first:
Don't stop taking your prescribed medications or skip therapy sessions. Alternative medicine is not a substitute for regular medical care when it comes to treating bipolar disorder.
Be honest with your doctors and mental health providers. Tell them exactly which complementary treatments you use or would like to try.
Be aware of potential dangers. Just because it's natural doesn't mean it's safe. Before using alternative medicine, be sure you know the risks, including possible interactions with medications.
Prevention
There's no sure way to prevent bipolar disorder. However, getting treatment at the earliest sign of a mental health disorder can help prevent bipolar disorder or other mental health conditions from worsening.
If you've been diagnosed with bipolar disorder, some strategies can help prevent minor episodes from becoming full-blown episodes of mania or depression:
Pay attention to warning signs. Addressing symptoms early on can prevent episodes from getting worse. You and your caregivers may have identified a pattern to your bipolar episodes and what triggers them. Call your doctor if you feel you're falling into an episode of depression or mania. Involve family members or friends in watching for warning signs.
Avoid drugs and alcohol. Even though you may feel better, using alcohol or street drugs makes your symptoms more likely to come back.
Take your medications exactly as directed. Medications can have unwanted side effects, and you may feel unhappy about having a mental health condition that requires lifelong treatment. During periods when you feel better, you may be tempted to stop treatment. This can have immediate consequences — you may become very depressed, feel suicidal, or go into a manic or hypomanic episode. If you think you need to make a change, call your doctor.
Check first before taking other medications. Call the doctor who's treating you for bipolar disorder before you take medications prescribed by another doctor. Sometimes other medications trigger episodes of bipolar disorder or may interfere with medications you're already taking to treat bipolar disorder.
Sources: Sulaiman Muhd Kutti (OHN/MA)
Wednesday, November 30, 2011
JANGKITAN ROTAVIRUS
ASSALAMMUALAIKUM SEMUA..
Pengalaman drp seorang sahabat. Semoga ianya menjadi peringatan untuk semua.
Pengalaman untuk dikongsi bersama ;
3 hari lepas anak saya disahkan dijangkiti kuman ini dan terpaksa dimasukkan kedalam Paed Ward untuk rawatan khusus setelah pihak hospital mendapati anak saya telah masuk tahap kekeringan cecair tubuh. Sangat sedih dan bimbang apabila melihat keadaannya tak bermaya akibat perut tidak dapat menerima apa apa makanan dan minuman.
Alhamdulillah syukur patient telah berada pada tahap recovery dan telah discharge bersama sedikit ubat ubatan dan nasihat dari Pakar Kanak2.
Sulaiman MK
MA / OHN
Occupational Health Practitioner
APH Project.
JOHOR
Details of ROTAVIRUS
What is rotavirus?
Rotavirus is a virus that infects the bowels. It is the most common cause of severe diarrhea among infants and children throughout the world and causes the death of about 600,000 children worldwide annually. The name rotavirus comes from the characteristic wheel-like appearance of the virus when viewed by electron microscopy (the name rotavirus is derived from the Latin rota, meaning "wheel").
Almost all children have become infected with rotavirus by their third birthday. Repeat infections with different viral strains are possible, and most children have several episodes of rotavirus infection in the first years of life. After several infections with different strains of the virus, children acquire immunity to rotavirus. Children between the ages of 6 and 24 months are at greatest risk for developing severe disease from rotavirus infection. Adults sometimes become infected, but the resulting illness is usually mild.
What are rotavirus symptoms?
The time period from initial infection to symptoms (incubation period) for rotavirus disease is around two days. Symptoms of the disease include fever, vomiting, and watery diarrhea. Abdominal pain may also occur, and infected children may have profuse watery diarrhea up to several times per day. Symptoms generally persist for three to nine days. Immunity from repeated infection is incomplete after a rotavirus infection, but repeated infections tend to be less severe than the original infection.
Rotavirus infection can be associated with severe dehydration in infants and children. Severe dehydration can lead to death in rare cases, so it is important to recognize and treat this complication of rotavirus infection. In addition to the symptoms of rotavirus infection discussed above, parents should be aware of the symptoms of dehydration that can occur with rotavirus infection or with other serious conditions.
Symptoms of dehydration include:
• lethargy,
• dry, cool skin,
• absence of tears when crying,
• dry or sticky mouth,
• sunken eyes or sunken fontanelle (the soft spot on the head of infants), and
• extreme thirst.
How is rotavirus spread?
Rotavirus infection is highly contagious. The primary mode of transmission of rotavirus is the passage of the virus in stool to the mouth of another child. This is known as a fecal-oral route of transmission. Children can transmit the virus when they forget to wash their hands before eating or after using the toilet. Touching a surface that has been contaminated with rotavirus and then touching the mouth area can result in infection.
There also have been cases of low levels of rotavirus in respiratory-tract secretions and other body fluids. Because the virus is stable (remains infective) in the environment, transmission can occur through ingestion of contaminated water or food and contact with contaminated surfaces. Rotavirus can survive for days on hard and dry surfaces, and it can live for hours on human hands.
How is rotavirus diagnosed?
The diagnosis may be made by rapid detection of rotavirus in stool specimens. Strains of rotavirus may be further characterized by special testing with enzyme immunoassay or polymerase chain reaction, but such testing is not commonly available or necessary.
How is rotavirus treated?
There is no specific treatment for rotavirus. For people with healthy immune systems, rotavirus infection of the bowel (gastroenteritis) is a self-limited illness, lasting for only a few days. The treatment consists of increased fluid intake (oral rehydration) to prevent dehydration. About one in 40 children with rotavirus infection of the bowel requires hospitalization for intravenous fluid.
What is the outcome (prognosis) of rotavirus infection?
Rotavirus infection is a self-limited disease that resolves after three to nine days of symptoms. In rare cases, severe dehydration accompanying rotavirus infection has led to death. Recognition of the condition and proper supportive treatment (rehydration) can prevent serious complications.
How can rotavirus infection be prevented?
Because the virus is so prevalent, it is very difficult or even impossible to prevent rotavirus infection. Even places with excellent standards of hygiene and sanitation can become contaminated. Vaccination is the most effective preventive measure.
An older vaccine to prevent rotavirus was withdrawn due to adverse effects. In August 1998, the U.S. Food and Drug Administration (FDA) approved a live virus vaccine for use in children at ages 2, 4, and 6 months. However, this recommendation was withdrawn in October 1999 because the vaccine appeared to increase the risk of intussusception (the prolapse or telescoping of a portion of the intestine into the immediately adjacent portion of the intestine). The vaccine known as RotaShield was withdrawn from the market in 1999.
However, in February 2006, the FDA approved a new rotavirus vaccine. This vaccine RotaTeq™ is a live oral vaccine for use in children. The Advisory Committee on Immunization Practices (ACIP) voted to recommend a newly licensed vaccine to protect against rotavirus. Studies have shown that the vaccine prevents about 74% of all rotavirus cases, about 98% of severe rotavirus cases, and about 96% of hospitalizations due to rotavirus. Three doses of the rotavirus vaccine are recommended at 2, 4, and 6 months of age.
Rotavirus Infection At A Glance
• Rotavirus is the most common cause of severe diarrhea among infants and children throughout the world.
• Most children become infected with rotavirus by age 3.
• There are different strains of rotavirus, and multiple infections by different strains may occur.
• Rotavirus causes fever, vomiting, and watery diarrhea.
• Rotavirus infection is highly contagious.
• Rotavirus illness typically resolves on its own after three to nine days.
• A vaccine to prevent rotavirus infection is available.
________________________________________
Apa Itu Rotavirus?
Muntah dan cirit-birit adalah perkara biasa di kalangan kanak-kanak, namun ianya amat berbahaya bagi bayi. Bagi kes yang normal, muntah adalah cara badan kita mengeluarkan toksin daripada perut dan ianya bukanlah diklasifikasikan sebagai kes serius. Kebanyakan kes tersebut biasanya akan pulih dalam tempoh beberapa jam. Namun begitu, ibubapa perlu bimbang sekiranya suhu anak mula meningkat dan diikuti dengan muntah atau cirit-birit yang berpanjangan. Ini kerana kajian menunjukkan cirit- birit adalah merupakan salah satu punca utama kematian di kalangan kanak-kanak di seluruh dunia. Di Malaysia, dianggarkan 35 hingga 50 peratus daripada kes kemasukan kanak-kanak berusia bawah 5 tahun di hospital akibat cirit- birit teruk adalah berpunca daripada jangkitan Rotavirus.
Apa itu Rotavirus?
Rotavirus adalah sejenis virus yang amat mudah berjangkit dan boleh kekal selama beberapa jam di atas kulit manusia, malah mampu bertahan beberapa hari di atas permukaan objek keras dan kering. Ini bermakna virus ini mudah merebak melalui air atau makanan yang tercemar. Penyebaran virus juga boleh berlaku melalui orang dewasa yang dijangkiti atau yang menguruskan bayi yang telah dijangkiti.
Virus ini mampu hidup selama seminggu dalam najis individu yang dijangkiti. Ia dikenalpasti menjadi punca berlakunya masalah cirit- birit di kalangan bayi baru lahir khususnya di kalangan kanak-kanak yang berumur di antara 6 hingga 24 bulan. Rotavirus sangat mudah tersebar dengan cepat melalui kitaran najis ke mulut. Ia amat mudah berjangkit melalui sentuhan biasa di kalangan kanak-kanak. Virus ini boleh berada di mana-mana khususnya permukaan lantai, tombol pintu atau alat permainan kanak-kanak.
Perkataaan “Rota” yang bermaksud roda kerana bentuk virus ini seperti roda apabila dilihat dibawa elektron mikroskop. Dalam kebanyakan kes,kanak-kanak yang berusia lebih daripada 3 tahun yang mendapat penyakit ini selalunya tidak perlu dimasukkan ke dalam wad di hospital. Malangnya jangkitan Rotavirus pada kanak-kanak yang berusia di bawah 2 tahun boleh menyebabkan keadaan yang agak serius malahan boleh membawa maut.
Walaubagaimanapun, jangkitan Rotavirus di kalangan bayi berusia di bawah umur 3 bulan yang menyusu badan selalunya tidak begitu serius. Ini adalah kerana terdapatnya ‘passive immunity’ daripada ibu dan juga perlindungan daripada susu ibu. Kebanyakan kanak-kanak boleh dijangkiti Rotavirus sebelum berumur 5 tahun. Dengan jangkitan yang berulang, seorang individu akan meningkatkan tahap immunitinya terhadap jangkitan virus ini.
Punca jangkitan Rotavirus
Pada kebiasaanya, muntah dan cirit-birit kerap berlaku di kalangan kanak-kanak. Kanak-kanak yang dijangkiti Rotavirus biasanya akan mengalami demam, muntah dan diikuti pula dengan cirit-birit yang teruk dengan najis yang berair . Kanak-kanak tersebut turut mengalami dehidrasi kesan daripada muntah serta cirit birit. Malahan yang membimbangkan lagi, mereka juga biasanya berdepan dengan masalah menghadam laktosa disebabkan maslah yang berterusan. Walaupun ianya berpunca mungkin disebabkan oleh keracunan makanan, sakit perut atau meningitis, namun kebanyakan kes yang sering dialami oleh kanak-kanak dan bayi adalah disebabkan oleh jangkitan virus dan dikenali sebagai Gastroenteritis Akut.
Gastroenteritis biasanya dikaitkan dengan masalah radang perut dan usus. Walaupun selalunya ia tidak begitu serius kepada kanak-kanak, namun ia juga boleh membahayakan dan dalam sesetengah kes ianya dapat mengancam nyawa bayi. Penyebab utama gastroenteritis adalah sejenis virus yang dipanggil Rotavirus.
Virus ini menjangkiti usus manusia dan mudah merebak. Ianya dapat masuk ke dalam usus kita melalui mulut. Cara jangkitan adalah melalui “feco oral” ataupun dari najis ke mulut. Oleh kerana virus ini mudah merebak, wabak ini amat senang berlaku khususnya di pusat-pusat penjagaan kanak-kanak atau TASKA.
Justeru itu langkah pencegahan adalah amat penting dan pemantauan perlu dibuat dari masa ke semasa.
Apakah simptom jangkitan Rotavirus?
Selepas masa inkubasi selama 2 hingga 7 hari, kanak-kanak atau bayi yang mendapat jangkitan Rotavirus akan mula demam diikuti dengan muntah-muntah dan cirit-birit. Najis mereka biasanya berbentuk cecair tetapi tidak berdarah. Demam dan muntah selalunya akan pulih selepas 2 hari namun masalah cirit- birit akan berterusan.
Di kalangan kanak-kanak yang lebih muda terutamanya yang berusia di bawah 2 tahun, mereka akan mengalami ‘lactos intolerance’ iaitu oleh kerana usus mereka tercedera dan kehilangan enzim Laktase, biasanya najis mereka akan bertukar menjadi asid yang mana boleh mencederakan dan menyebabkan punggung kanak-kanak tersebut melecur. Sekiranya masalah cirit birit ini berlarutan,mereka akan mengalami masalah kekurangan air dalam badan (dehidrasi), kekurangan tenaga serta berkeadaan letih. Tanda-tanda dehidrasi di kalangan kanak-kanak adalah mulut dan bibir yang kering, mata terbenam, kurang kencing, sentiasa letih, tidak bermaya serta kelihatan pucat.
Rawatan
Pencegahan adalah lebih penting dari rawatan. Bagi pencegahan di rumah, tabiat mencuci tangan dengan sebersih-bersihnya selepas ke tandas dan sebelum makan adalah amat penting. Bagi ibu- ibu yang menjaga bayi adalah sangat penting untuk mereka mencuci tangan sebersihnya selepas membersihkan najis bayi mereka serta sentiasa memastikan puting botol atau puting payudara berkeadaan bersih sebelum memulakan penyusuan.
Kebersihan peralatan rumah seperti peralatan makanan (sudu, garpu, cawan dan pinggan mangkuk), alatan permainan, lantai serta tahap kebersihan makan yang disediakan perlulah sentiasa berkeadaan bersih. Semua langkah tersebut mampu mengelakkan jangkitan Rotavirus tersebar terutamanya kepada bayi anda.
Oleh yang demikian, langkah-langkah kebersihan adalah sangat penting dalam mencegah penyakit ini. Pesakit yang mengalami dehidrasi memerlukan rawatan di dalam wad di hospital. Dehidrasi dapat diubati dengan kemasukan cecair intravenous ke dalam badan. Rawatan untuk muntah dan cirit birit selalunya terhad dan akan berhenti selepas 2 hingga 5 hari. Jika pesakit mempunyai masalah dengan “lactos intolence” maka rawatan menerusi susu tanpa laktos perlu diberikan selama beberapa hari atau minggu (bergantung pada keadaan pesakit). Penyusuan ibu juga boleh disambung. Ubat demam akan diberikan sekiranya pesakit mengalami demam.
Sekiranya cirit-birit atau muntah tidak begitu serius, pengambilan “oral rehydration salt” (ORS) dengan kerapnya, bergantung kepada kekerapan pembuangan najis pesakit tersebut. Pengambilan antibiotik tidak diperlukan kerana ianya tidak memberi akan memberikan kesan kepada kuman Rotavirus. Satu cara yang paling berkesan dalam mencegah daripada jangkitan Rotavirus adalah melalui pengambilan suntikan vaksin untuk kanak-kanak.
Langkah berjaga-jaga yang umum
Sentiasa menjaga kebersihan., itulah satu nasihat yang perlu ditekankan di mana jua anda berada. Cuci tangan dengan bersih selepas ke tandas dan juga sebelum menyediakan makanan. Ibu-ibu yang sedang dan masih menyusu bayi atau anak mereka digalakkan untuk terus menyusu. Secara amnya didapati susu ibu dapat mengurangkan masalah cirit birit di kalangan bayi atau kanak-kanak.
Kini terdapat 2 vaksin Rotavirus yang boleh diberikan kepada bayi anda. Vaksin ini akan diberikan dalam 2 atau 3 dos bermula dari umur bayi anda di antara 6 hingga 12 minggu dan perlu di habiskan sebelum umur bayi mencecah 8 bulan. Walaupun kos vaksin ini agak tinggi, ibubapa digalakkan untuk memberi vaksin ini kepada anak-anak mereka kerana jika dibandingkan dengan kos rawatan bagi masalah cirit-birit terutamanya yang melibatkan kemasukan ke wad, kosnya sudah pasti lebih tinggi daripada kos vaksin tersebut. Justeru itu kepada ibubapa, buatlah keputusan yang bijak demi kesihatan anak anda.
Sources: En.Sulaiman Muhd Kutti (OHN/MA)
Pengalaman drp seorang sahabat. Semoga ianya menjadi peringatan untuk semua.
Pengalaman untuk dikongsi bersama ;
3 hari lepas anak saya disahkan dijangkiti kuman ini dan terpaksa dimasukkan kedalam Paed Ward untuk rawatan khusus setelah pihak hospital mendapati anak saya telah masuk tahap kekeringan cecair tubuh. Sangat sedih dan bimbang apabila melihat keadaannya tak bermaya akibat perut tidak dapat menerima apa apa makanan dan minuman.
Alhamdulillah syukur patient telah berada pada tahap recovery dan telah discharge bersama sedikit ubat ubatan dan nasihat dari Pakar Kanak2.
Sulaiman MK
MA / OHN
Occupational Health Practitioner
APH Project.
JOHOR
Details of ROTAVIRUS
What is rotavirus?
Rotavirus is a virus that infects the bowels. It is the most common cause of severe diarrhea among infants and children throughout the world and causes the death of about 600,000 children worldwide annually. The name rotavirus comes from the characteristic wheel-like appearance of the virus when viewed by electron microscopy (the name rotavirus is derived from the Latin rota, meaning "wheel").
Almost all children have become infected with rotavirus by their third birthday. Repeat infections with different viral strains are possible, and most children have several episodes of rotavirus infection in the first years of life. After several infections with different strains of the virus, children acquire immunity to rotavirus. Children between the ages of 6 and 24 months are at greatest risk for developing severe disease from rotavirus infection. Adults sometimes become infected, but the resulting illness is usually mild.
What are rotavirus symptoms?
The time period from initial infection to symptoms (incubation period) for rotavirus disease is around two days. Symptoms of the disease include fever, vomiting, and watery diarrhea. Abdominal pain may also occur, and infected children may have profuse watery diarrhea up to several times per day. Symptoms generally persist for three to nine days. Immunity from repeated infection is incomplete after a rotavirus infection, but repeated infections tend to be less severe than the original infection.
Rotavirus infection can be associated with severe dehydration in infants and children. Severe dehydration can lead to death in rare cases, so it is important to recognize and treat this complication of rotavirus infection. In addition to the symptoms of rotavirus infection discussed above, parents should be aware of the symptoms of dehydration that can occur with rotavirus infection or with other serious conditions.
Symptoms of dehydration include:
• lethargy,
• dry, cool skin,
• absence of tears when crying,
• dry or sticky mouth,
• sunken eyes or sunken fontanelle (the soft spot on the head of infants), and
• extreme thirst.
How is rotavirus spread?
Rotavirus infection is highly contagious. The primary mode of transmission of rotavirus is the passage of the virus in stool to the mouth of another child. This is known as a fecal-oral route of transmission. Children can transmit the virus when they forget to wash their hands before eating or after using the toilet. Touching a surface that has been contaminated with rotavirus and then touching the mouth area can result in infection.
There also have been cases of low levels of rotavirus in respiratory-tract secretions and other body fluids. Because the virus is stable (remains infective) in the environment, transmission can occur through ingestion of contaminated water or food and contact with contaminated surfaces. Rotavirus can survive for days on hard and dry surfaces, and it can live for hours on human hands.
How is rotavirus diagnosed?
The diagnosis may be made by rapid detection of rotavirus in stool specimens. Strains of rotavirus may be further characterized by special testing with enzyme immunoassay or polymerase chain reaction, but such testing is not commonly available or necessary.
How is rotavirus treated?
There is no specific treatment for rotavirus. For people with healthy immune systems, rotavirus infection of the bowel (gastroenteritis) is a self-limited illness, lasting for only a few days. The treatment consists of increased fluid intake (oral rehydration) to prevent dehydration. About one in 40 children with rotavirus infection of the bowel requires hospitalization for intravenous fluid.
What is the outcome (prognosis) of rotavirus infection?
Rotavirus infection is a self-limited disease that resolves after three to nine days of symptoms. In rare cases, severe dehydration accompanying rotavirus infection has led to death. Recognition of the condition and proper supportive treatment (rehydration) can prevent serious complications.
How can rotavirus infection be prevented?
Because the virus is so prevalent, it is very difficult or even impossible to prevent rotavirus infection. Even places with excellent standards of hygiene and sanitation can become contaminated. Vaccination is the most effective preventive measure.
An older vaccine to prevent rotavirus was withdrawn due to adverse effects. In August 1998, the U.S. Food and Drug Administration (FDA) approved a live virus vaccine for use in children at ages 2, 4, and 6 months. However, this recommendation was withdrawn in October 1999 because the vaccine appeared to increase the risk of intussusception (the prolapse or telescoping of a portion of the intestine into the immediately adjacent portion of the intestine). The vaccine known as RotaShield was withdrawn from the market in 1999.
However, in February 2006, the FDA approved a new rotavirus vaccine. This vaccine RotaTeq™ is a live oral vaccine for use in children. The Advisory Committee on Immunization Practices (ACIP) voted to recommend a newly licensed vaccine to protect against rotavirus. Studies have shown that the vaccine prevents about 74% of all rotavirus cases, about 98% of severe rotavirus cases, and about 96% of hospitalizations due to rotavirus. Three doses of the rotavirus vaccine are recommended at 2, 4, and 6 months of age.
Rotavirus Infection At A Glance
• Rotavirus is the most common cause of severe diarrhea among infants and children throughout the world.
• Most children become infected with rotavirus by age 3.
• There are different strains of rotavirus, and multiple infections by different strains may occur.
• Rotavirus causes fever, vomiting, and watery diarrhea.
• Rotavirus infection is highly contagious.
• Rotavirus illness typically resolves on its own after three to nine days.
• A vaccine to prevent rotavirus infection is available.
________________________________________
Apa Itu Rotavirus?
Muntah dan cirit-birit adalah perkara biasa di kalangan kanak-kanak, namun ianya amat berbahaya bagi bayi. Bagi kes yang normal, muntah adalah cara badan kita mengeluarkan toksin daripada perut dan ianya bukanlah diklasifikasikan sebagai kes serius. Kebanyakan kes tersebut biasanya akan pulih dalam tempoh beberapa jam. Namun begitu, ibubapa perlu bimbang sekiranya suhu anak mula meningkat dan diikuti dengan muntah atau cirit-birit yang berpanjangan. Ini kerana kajian menunjukkan cirit- birit adalah merupakan salah satu punca utama kematian di kalangan kanak-kanak di seluruh dunia. Di Malaysia, dianggarkan 35 hingga 50 peratus daripada kes kemasukan kanak-kanak berusia bawah 5 tahun di hospital akibat cirit- birit teruk adalah berpunca daripada jangkitan Rotavirus.
Apa itu Rotavirus?
Rotavirus adalah sejenis virus yang amat mudah berjangkit dan boleh kekal selama beberapa jam di atas kulit manusia, malah mampu bertahan beberapa hari di atas permukaan objek keras dan kering. Ini bermakna virus ini mudah merebak melalui air atau makanan yang tercemar. Penyebaran virus juga boleh berlaku melalui orang dewasa yang dijangkiti atau yang menguruskan bayi yang telah dijangkiti.
Virus ini mampu hidup selama seminggu dalam najis individu yang dijangkiti. Ia dikenalpasti menjadi punca berlakunya masalah cirit- birit di kalangan bayi baru lahir khususnya di kalangan kanak-kanak yang berumur di antara 6 hingga 24 bulan. Rotavirus sangat mudah tersebar dengan cepat melalui kitaran najis ke mulut. Ia amat mudah berjangkit melalui sentuhan biasa di kalangan kanak-kanak. Virus ini boleh berada di mana-mana khususnya permukaan lantai, tombol pintu atau alat permainan kanak-kanak.
Perkataaan “Rota” yang bermaksud roda kerana bentuk virus ini seperti roda apabila dilihat dibawa elektron mikroskop. Dalam kebanyakan kes,kanak-kanak yang berusia lebih daripada 3 tahun yang mendapat penyakit ini selalunya tidak perlu dimasukkan ke dalam wad di hospital. Malangnya jangkitan Rotavirus pada kanak-kanak yang berusia di bawah 2 tahun boleh menyebabkan keadaan yang agak serius malahan boleh membawa maut.
Walaubagaimanapun, jangkitan Rotavirus di kalangan bayi berusia di bawah umur 3 bulan yang menyusu badan selalunya tidak begitu serius. Ini adalah kerana terdapatnya ‘passive immunity’ daripada ibu dan juga perlindungan daripada susu ibu. Kebanyakan kanak-kanak boleh dijangkiti Rotavirus sebelum berumur 5 tahun. Dengan jangkitan yang berulang, seorang individu akan meningkatkan tahap immunitinya terhadap jangkitan virus ini.
Punca jangkitan Rotavirus
Pada kebiasaanya, muntah dan cirit-birit kerap berlaku di kalangan kanak-kanak. Kanak-kanak yang dijangkiti Rotavirus biasanya akan mengalami demam, muntah dan diikuti pula dengan cirit-birit yang teruk dengan najis yang berair . Kanak-kanak tersebut turut mengalami dehidrasi kesan daripada muntah serta cirit birit. Malahan yang membimbangkan lagi, mereka juga biasanya berdepan dengan masalah menghadam laktosa disebabkan maslah yang berterusan. Walaupun ianya berpunca mungkin disebabkan oleh keracunan makanan, sakit perut atau meningitis, namun kebanyakan kes yang sering dialami oleh kanak-kanak dan bayi adalah disebabkan oleh jangkitan virus dan dikenali sebagai Gastroenteritis Akut.
Gastroenteritis biasanya dikaitkan dengan masalah radang perut dan usus. Walaupun selalunya ia tidak begitu serius kepada kanak-kanak, namun ia juga boleh membahayakan dan dalam sesetengah kes ianya dapat mengancam nyawa bayi. Penyebab utama gastroenteritis adalah sejenis virus yang dipanggil Rotavirus.
Virus ini menjangkiti usus manusia dan mudah merebak. Ianya dapat masuk ke dalam usus kita melalui mulut. Cara jangkitan adalah melalui “feco oral” ataupun dari najis ke mulut. Oleh kerana virus ini mudah merebak, wabak ini amat senang berlaku khususnya di pusat-pusat penjagaan kanak-kanak atau TASKA.
Justeru itu langkah pencegahan adalah amat penting dan pemantauan perlu dibuat dari masa ke semasa.
Apakah simptom jangkitan Rotavirus?
Selepas masa inkubasi selama 2 hingga 7 hari, kanak-kanak atau bayi yang mendapat jangkitan Rotavirus akan mula demam diikuti dengan muntah-muntah dan cirit-birit. Najis mereka biasanya berbentuk cecair tetapi tidak berdarah. Demam dan muntah selalunya akan pulih selepas 2 hari namun masalah cirit- birit akan berterusan.
Di kalangan kanak-kanak yang lebih muda terutamanya yang berusia di bawah 2 tahun, mereka akan mengalami ‘lactos intolerance’ iaitu oleh kerana usus mereka tercedera dan kehilangan enzim Laktase, biasanya najis mereka akan bertukar menjadi asid yang mana boleh mencederakan dan menyebabkan punggung kanak-kanak tersebut melecur. Sekiranya masalah cirit birit ini berlarutan,mereka akan mengalami masalah kekurangan air dalam badan (dehidrasi), kekurangan tenaga serta berkeadaan letih. Tanda-tanda dehidrasi di kalangan kanak-kanak adalah mulut dan bibir yang kering, mata terbenam, kurang kencing, sentiasa letih, tidak bermaya serta kelihatan pucat.
Rawatan
Pencegahan adalah lebih penting dari rawatan. Bagi pencegahan di rumah, tabiat mencuci tangan dengan sebersih-bersihnya selepas ke tandas dan sebelum makan adalah amat penting. Bagi ibu- ibu yang menjaga bayi adalah sangat penting untuk mereka mencuci tangan sebersihnya selepas membersihkan najis bayi mereka serta sentiasa memastikan puting botol atau puting payudara berkeadaan bersih sebelum memulakan penyusuan.
Kebersihan peralatan rumah seperti peralatan makanan (sudu, garpu, cawan dan pinggan mangkuk), alatan permainan, lantai serta tahap kebersihan makan yang disediakan perlulah sentiasa berkeadaan bersih. Semua langkah tersebut mampu mengelakkan jangkitan Rotavirus tersebar terutamanya kepada bayi anda.
Oleh yang demikian, langkah-langkah kebersihan adalah sangat penting dalam mencegah penyakit ini. Pesakit yang mengalami dehidrasi memerlukan rawatan di dalam wad di hospital. Dehidrasi dapat diubati dengan kemasukan cecair intravenous ke dalam badan. Rawatan untuk muntah dan cirit birit selalunya terhad dan akan berhenti selepas 2 hingga 5 hari. Jika pesakit mempunyai masalah dengan “lactos intolence” maka rawatan menerusi susu tanpa laktos perlu diberikan selama beberapa hari atau minggu (bergantung pada keadaan pesakit). Penyusuan ibu juga boleh disambung. Ubat demam akan diberikan sekiranya pesakit mengalami demam.
Sekiranya cirit-birit atau muntah tidak begitu serius, pengambilan “oral rehydration salt” (ORS) dengan kerapnya, bergantung kepada kekerapan pembuangan najis pesakit tersebut. Pengambilan antibiotik tidak diperlukan kerana ianya tidak memberi akan memberikan kesan kepada kuman Rotavirus. Satu cara yang paling berkesan dalam mencegah daripada jangkitan Rotavirus adalah melalui pengambilan suntikan vaksin untuk kanak-kanak.
Langkah berjaga-jaga yang umum
Sentiasa menjaga kebersihan., itulah satu nasihat yang perlu ditekankan di mana jua anda berada. Cuci tangan dengan bersih selepas ke tandas dan juga sebelum menyediakan makanan. Ibu-ibu yang sedang dan masih menyusu bayi atau anak mereka digalakkan untuk terus menyusu. Secara amnya didapati susu ibu dapat mengurangkan masalah cirit birit di kalangan bayi atau kanak-kanak.
Kini terdapat 2 vaksin Rotavirus yang boleh diberikan kepada bayi anda. Vaksin ini akan diberikan dalam 2 atau 3 dos bermula dari umur bayi anda di antara 6 hingga 12 minggu dan perlu di habiskan sebelum umur bayi mencecah 8 bulan. Walaupun kos vaksin ini agak tinggi, ibubapa digalakkan untuk memberi vaksin ini kepada anak-anak mereka kerana jika dibandingkan dengan kos rawatan bagi masalah cirit-birit terutamanya yang melibatkan kemasukan ke wad, kosnya sudah pasti lebih tinggi daripada kos vaksin tersebut. Justeru itu kepada ibubapa, buatlah keputusan yang bijak demi kesihatan anak anda.
Sources: En.Sulaiman Muhd Kutti (OHN/MA)
KESELAMATAN ELEKTRIKAL
KESELAMATAN ELEKTRIKAL
Elektrik yang digunakan dengan tertib adalah bentuk tenaga yang selamat dan efisien tetapi jika digunakan sebaliknya boleh menjadi punca bahaya. Antara bahaya utama adalah renjatan, melecur, kebakaran dan letupan, dan dalam sesetengah keadaan arka mata. Walau bagaimanapun jika renjatan elektrik yang diterima oleh seseorang tidak secara sendirinya membahayakan, ia boleh mempunyai kesan yang dahsyat, seperti ketika bekerja pada ketinggian tertentu atau di atas tangga, satu renjatan yang lemah mungkin mengakibatkan kejatuhan; meskipun renjatan itu tidak menyebabkan kecederaan, kejatuhan itu mungkin boleh.
Perlu diingati bahawa tenaga elektrik digunakan berterusan di dalam semua tempat kerja bukan sahaja kilang-kilang tetapi pejabat, bank, sekolah, dsb dan penggunaannya di tempat-tempat tersebut semakin meningkat sepanjang masa apabila teknologi baru dan ‘pejabat elektronik’ menjadi satu kebiasaan. Jadi walaupun bahan di dalam bab ini akan membincangkan terutamanya mengenai kilang-kilang dan tapak binaan, pelajaran dan langkah-langkah yang perlu diambil, adalah relevan kepada mereka yang bekerja didalam pejabat dsb.
Tanggungjawab-tanggungjawab Majikan
Adalah tanggungjawab majikan untuk memastikan bahawa langkah berhati-hati yang mencukupi diambil untuk mengelakkan bahaya-bahaya ini pertama sekali dengan memuaskan hatinya bahawa semua kelengkapan elektrik direkabentuk untuk memastikan bahawa dalam operasi normal bahagian-bahagian hidup tidak boleh dimasuki, bahawa perlindungan terhadap litar pintas dengan peralatan seperti alat pembumi atau di dalam peralatan mudahalih, digunakan sistem voltej terkurang dengan semua peralatan yang ditebat atau didwi-tebat. Apabila kelengkapan elektrikal sebahagian daripada sesuatu sistem perlu diselenggarakan dsb., adalah penting bahawa satu sistem permit-untuk-bekerja berada di dalam operasi dan diselia oleh seseorang yang mempunyai latihan yang mencukupi dan kompeten untuk memastikan bahawa kelengkapan yang ingin diselenggarakan itu telah ‘mati’. Ini bermakna ia bukan sahaja perlu dimatikan tetapi keseluruhannya diasingkan dan tertutup daripada sebarang bahagian sistem yang boleh mengakibatkan, ia hidup dengan tidak sengaja. Sebelum kerja-kerja disambung kelengkapan dsb. tersebut hendaklah diuji dengan alat yang sah untuk membuktikannya ‘mati’.
Mengelakkan Renjatan Elektrik
Kelengkapan elektrikal yang direkabentuk dengan wajar dan berkeadaan baik adalah selamat. Apabila ia rosak atau diselenggarakan dengan buruk ia boleh membunuh walaupun pada 240 volt. Antara yang mudah terdedah adalah lampu tangan, dan peralatan mudah alih. Penghubung kabel yang berbulu atau rosak perlu dihantar untuk dibaiki dengan segera. Penggunaan kelengkapan voltej dikurangkan seperti sistem volt 110 dengan soket tengah dibumikan akan mengurangkan bahaya renjatan elektrik yang serius.
Jika kelengkapan voltej terkurang tidak digunakan, seperti di dalam pejabat, salah satu daripada perlindungan terbaik adalah penggunaan satu bentuk’earth leakage circuit breaker’. Tidak seperti fius, yang direkabentuk untuk melindungi kelengkapan, bukan manusia, apabila berlaku litar pintas pemutus sedemikian akan menghentikan arus dengan pantas agar tiada bahaya akibat kecederaan.
Jika kedua-dua voltej terkurang atau ‘earth leakage breaker’ tidak digunakan, apabila mungkin, pemutus litar otomatik mini perlu digunakan. Penggunaan pemegang fuis yang boleh diwayar semula perlu dielakkan seboleh mungkin kerana bahaya penggantian wayar yang tidak bersesuaian dengan saiz wayar fius.
Kemungkinan untuk renjatan elektrik boleh dikurangkan oleh seorang kompeten yang menjalankan pemeriksaan berikut:-
• sekurang-kurangnya satu ujian mingguan berkenaan keterusan konduktor bumi di antara peralatan mudahalih bersalut logam dan palam - ini akan memastikan bahawa konduktor di dalam wayar bumi kekal cukup untuk membawa cukup arus pintas untuk meletupkan fius; tambahan lagi ketahanan penebat kedua-dua alat dan plumbum fleksibel harus diperiksa;
• sekurang-kurangnya satu pemeriksaan mingguan kotak fius;
• sekurang-kurangnya satu ujian setiap tahun terhadap litar otomatik mini;
• satu pemeriksaan mingguan terhadap sarung tangan getah, alas berpenebat, kepingan dsb untuk kegunaan elektrikal;
• ujian setiap 6 bulan terhadap sarung tangan getah elektrikal;
• penggantian peralatan salut logam dengan peralatan atau kelengkapan yang berpenebat penuh bersesuaian di mana boleh dipraktikkan;
• pemeriksaan rutin terhadap pemasangan elektrikal;
• pengujian dan pemeriksaan tetap semua kelengkapan pejabat; dan
• pemeriksaan kerap terhadap semua soket dinding.
Satu kaedah mudah untuk memastikan penyelenggaraan dan pemeriksaan rutin kelengkapan elektrikal dilakukan adalah dengan melabel dan menandakan tarikh pada semua kelengkapan sewaktu ia diperiksa. Jika tarikh pada label menunjukkan kelengkapan tersebut tidak diperiksa dalam jangkawaktu yang ditentukan, kelengkapan itu tidak akan digunakan sehingga ia telah diperiksa.
Selain daripada memeriksa dan menguji kelengkapan yang perlu digunakan, perlu juga difikirkan kedudukan soket dan jumlah serta jenis kelengkapan yang dipasangkan padanya. Seringkali, khususnya di pejabat, soket-soket sama ada di dalam kedudukan yang tidak sesuai, menyebabkan wayar meleret di dalam bilik, atau terlalu banyak perkakas menggunakan terlalu sedikit soket. Dalam kes sedemikian ada risiko untuk kebakaran di samping risiko untuk renjatan.
Wayar Overhed
Terdapat satu atau dua kawasan, di mana walaupun orang tidak bekerja secara langsung dengan kuasa elektrik, mereka masih berada dalam risiko. Pertama adalah oerhed yang dijalankan menggunakan kren kuasa elektrik dengan ‘bare electric down shop’ dan ‘cross shop wires’ untuk membekalkan kuasa kepada kren overhed. Bahaya akibat renjatan boleh dielakkan dengan menggunakan kabel fleksibel pada gelendung gulung sendiri, wayar ‘down shop’ dan ‘cross shop’ tertutup di dalam logam atau pelindung berpenebat atau wayar pintal-sendiri yang tergantung pada ‘cantenary’.
Apabila pengecatan atau penyelenggaraan perlu dilakukan berhampiran dengan wayar-wayar sedemikian, adalah penting untuk memastikan langkah beringat-ingat yang sewajarnya diikuti agar kerja tersebut dapat dijalankan dengan selamat seperti dengan mengasingkan wayar-wayar tersebut sebelum dibenarkan masuk. (Lihat Bab 21 : Penyelenggaraan Selamat)
Bahaya-bahaya lain adalah kehadiran wayar overhed tidak berpenebat yang dimiliki oleh Lembaga Elektrik tetapi melintasi ruang terdedah termasuk tempat kerja. Ia akan diletakkan pada ketinggian yang selamat daripada tanah menurut ‘Overhead Lines Regulations’, tetapi ingat - tangga besi, jib kren bergerak dsb. boleh mengurangkan jarak tersebut dan mungkin bersentuh dan mengakibatkan tragedi. Pastikan majikan-majikan menandakan dengan jelas bahaya-bahaya ini. (Lihat HSE Guidance Note G S6).
Perlu juga diingat bahawa dengan punca atau wayar voltej tinggi satu litar ke bumi mungkin boleh berlaku tanpa sebarang sentuhan dilakukan.
Wayar-wayar overhed adalah bahaya khusus kepada pemandu-pemandu kren sewaktu kerja pembinaan. Sekiranya kren digunakan dlam keadaan tersebut perlu didapatkan nasihat daripada Lembaga Elektrik. Mereka yang memandu kren bergerak atau kenderaan yang hampir sama, perlu memastikan majikan mereka telah mengikuti prosedur-prosedur ini untuk keselamatan. Sekiranya boleh ‘tiang gol’ dan pita amaran perlulah didirikan.
Kabel Bawah Tanah
Satu lagi bahaya kepada pekerja binaan timbul apabila penggalian dilakukan. Kabel bawah tanah mungkin tertanam dalam laluan penggalian. Terdapat juga prosedur-prosedur untuk mengenalpasti bahaya-bahaya ini. Pastikan para majikan mengikutinya dan laluan-laluan kabel dikenalpasti oleh pihak-pihak yang berkenaan, dengan menggunakan pelan, alat pengesan kabel dsb., ditandakan dan jika perlu kabel-kabel itu dimatikan sebelum memulakan kerja. (Lihat NJUG Publication di bawah item 2 Useful Publications).
Pengimpalan Elektrik
Pengimpalan arka menggunakan kuasa elektrik sama ada ac atau dc. Dalam keadaan yang sama pengimpalan dc lebih selamat daripada ac dan merupakan pilihan di tempat terbatas dan sukar. Pada pengimpalan ac alat kerja perlu dibumikan dan ia mestilah satu-satunya pembumi kepada litar kimpalan tersebut.
Adalah disyorkan semua pemegang elektrod berpenebat terpasang kepada plumbum kimpalan dengan palam dan soket. Plumbum kembali perlu diapitkan kepada hasil kerja. Plumbum kembali itu penting untuk mengawal arah arus yang sedang kembali daripada kerja kepada transformer. Tanpanya, arus tersebut, berukuran 80 amps, mungkin mengambil laluan rawak melalui struktur keluli, garisan landasan, paip dsb., yang boleh merangkumi rintangan tinggi (misalnya, sambungan bolt yang longgar) menyebabkan penjanaan haba dan mungkin kebakaran.
Litar kimpalan perlu dibumikan sewaktu bekerja. Jika pembumi berada pada pemusing transformer dan satu retakan berlaku pada plumbum kembali laluan arus kembali akan tidak terkawal. Oleh itu adalah amat penting bahawa pembumi yang mencukupi berada di semua tempat kerja untuk kegunaan pengimpal.
Set pengimpal arus ulang-alik boleh dipasang dengan satu alat untuk mencegah voltej pada pemegang elektrod meningkat melebihi 50 volt apabila tiada arka yang dinyalakan. Tanpa alat ini voltej boleh meningkat hingga ke takat yang boleh membahayakan operator.
Rujukan yang lebih lanjut berkenaan langkah-langkah keselamatan am ada dalam bab mengenai pengimpalan.
Bilik Bateri
Dalam kerja-kerja yang menggunakan arus dc, sama ada untuk peralatan atau lampu kecemasan, kemungkinan ada bilik bateri di mana bateri-bateri dicaskan. Bateri mengeluarkan hidrogen apabila dicaskan dan ini akan membentuk satu campuran mudah letup bila bercampur dengan udara. Pengalihudaraan bilik bateri perlulah dalam keadaan di maan tiada penumpuan berlaku. Oleh kerana hidrogen lebih ringan daripada udara, lubang atau salur pengalihudara perlulah sama rata dengan siling dan langkah beringat-ingat harus diambil untuk megelakkan pengumpulan hidrogen pocket.
Pengalihudaraan secara paksa mungkin diperlukan. Walau bagaimanapun motor kipas elektrik biasa mungkin menghasilkan percikan api dan mewujudkan bahaya di dalam persekitaran yang mudah letup. Di mana perlu, nasihat pakar harus dicari sebelum pengalihudaraan sedemikian disediakan.
Aksesori elektrik dalam kawasan pencasan bateri perlulah kalis asid dan tidak dipasang pada siling tetapi pada dinding lebih kurang enam kaki atau lebih daripada lantai, untuk memastikan bahawa ia berada di bawah tahap tumpuan hidrogen walaupun pengalihudaraan adalah mencukupi.
Merokok atau menghidupkan air mestilah dilarang di dalam bilik-bilik bateri dan di mana sahaja kerja yang melibatkan puca api, ia perlulah dilakukan di bawah penyeliaan langsung seeorang yang kompeten. Perkara ini juga sama dengan lampu berpemegang dan peralatan yang mempunyai bahaya tersembunyi. Peralatan berpenebat yang bersesuaian untuk bateri hendaklah disediakan dan digunakan.
Akhir sekali, bateri jenis plumbum atau asid mengandungi asid sulfurik yang berbahaya dan langkah beringat-ingat yang paling minimum adalah pemakaian pelindung mata dan sarung tangan yang bersesuaian. Bekas pencuci mata dan bekalan air steril atau larutan garam yang bersesuaian juga perlu disediakan.
Generator Bergerak
Generator bergerak yang dijalankan oleh enjin petrol untuk membekalkan bekalan kuasa elektrik sementara sering digunakan sewaktu bekerja. Dari segi keperluan keselamatan, bekalan tersebut hendaklah dikendalikan sama seperti bekalan normal seperti wayar neutral generator tersebut dan semua bahagian logam yang terdedah yang boleh tercas hendaklah dibumikan. Secara amnya sebelum generator bergerak digunakan untuk menggantikan bekalan awam, semua konduktor daripada bekalan awam mestilah di asingkan (dihentikan keseluruhannya) dan kekal begitu sehingga generator digunakan dan dihentikan. Ini juga harus diamalkan apabila generator digunakan kerana kegagalan bekalan awam. Sekiranya sesuatu generator mengalirkan arus ke dalam sistem elektrik bekalan awam, bahayanya bukan sahaja kepada mereka yang terlibat secara langsung tetapi kepada pekerja-pekerja yang bekerja di Lembaga Elektrik. Ini tidak seharusnya dilakukan tanpa persetujuan daripada Lembaga Elektrik. Komen-komen terdahulu mengenai penyelenggaraan yang mencukupi juga boleh digunapakai untuk generator bergerak.
Pertolongan Cemas dan Penyelamatan
Katakanlah, walaupun semua langkah beringat-ingat telah diambil, (seseorang telah terkena renjatan elektrik. Adakah anda harus berdiri sahaja tanpa melakukan sesuatu? Tidak, tidak seharusnya begitu. Untuk menolong mangsa, kepantasan tanpa panik adalah amat penting. Pertama sekali arus elektrik hendaklah dihentikan atau suruh seseorang untuk melakukannya. Panggil seorang doktor atau ahli pertolongan cemas tetapi jangan menanti ketibaan mereka sahaja.
Apabila arus elektrik telah dihentikan, mulakan dengan pernafasan bantuan dengan serta-merta, dan teruskan untuk memulihkan pernafasan semulajadi sehingga ketibaan pakar dan menyuruh anda menghentikannya. Banyak nyawa telah hilang secara sia-sia kerana tidak memulakan pernafasan bantuan dengan serta-merta dan menghentikannya terlalu cepat.
Sekiranya tiada sesiapa pun yang mengetahui di mana untuk mematikan arus, tidak mustahil untuk membebaskan mangsa daripada bersentuh dengan kuasa elektrik pada voltej yang normal, iaitu 415/240, dengan menggunakan sarung tangan getah atau alas getah. Jika barangan tersebut tidak ada, gunakan gelung tali atau kot atau topi untuk menyeret dan membebaskan mangsa tersebut. Elakkan bersentuhan kulit dengan mangsa yang tercedera. Apa sahaja yang digunakan hendaklah kering dan bukan konduktor.
Jika diketahui atau disyaki bahawa si mangsa telah bersentuh dengankonduktor hidup melebihi 415v, adalah amat berbahaya untuk cuba membebaskannya, kecuali ada bahan berpenebat terhadap sistem itu atau sehingga anda pasti bahawa arus elektrik telah dihentikan. Jika sebarang bahagian daripada sesuatu sistem elektrik itu melebihi 250v, majiakn itu diwajibkan untuk mempamerkan satu poster yang memberi arahan berkenaan cara-cara untuk merawat seseorang yang terkena renjatan elektrik.
Akhir sekali, adalah dinasihatkan para pekerja perlu menerima latihan pernafasan bantuan yang kerap dan di mana perlu cara-cara untuk menghentikan bekalan elektrik perlulah ditunjukkan dengan jelas.
Senarai Semak : Kuasa Elektrik
• Adakah semua kelengkapan elektrik yang digunakan di dalam tempat kerja anda kerap kali diperiksa oleh seseorang yang kompeten?
• Adakah sebarang tanda kelengkapan elektrik yang rosak?
• Adakah kelengkapan voltej terkurang disediakan dalam keadaan lembap?
• Adakah semua kabel overhed dan bawah tanah ditandakan dengan jelas?
• Adakah semua pengimpalan arka elektrik dibumikan dengan mencukupi?
• Adakah terdapat bilik bateri di tempat kerja anda? Jika ada, sila periksa pengalihudaraan, pencegahan bunga api dan pencucuhan, larangan merokok dan bantuan kecemasan.
• Adakah semua pekerja terlatih di dalam teknik-teknik pertolongan cemas dan penyelamatan bagi renjatan elektrik?
Sources: Info drp seorang sahabat dalam bidang yang sama.
Elektrik yang digunakan dengan tertib adalah bentuk tenaga yang selamat dan efisien tetapi jika digunakan sebaliknya boleh menjadi punca bahaya. Antara bahaya utama adalah renjatan, melecur, kebakaran dan letupan, dan dalam sesetengah keadaan arka mata. Walau bagaimanapun jika renjatan elektrik yang diterima oleh seseorang tidak secara sendirinya membahayakan, ia boleh mempunyai kesan yang dahsyat, seperti ketika bekerja pada ketinggian tertentu atau di atas tangga, satu renjatan yang lemah mungkin mengakibatkan kejatuhan; meskipun renjatan itu tidak menyebabkan kecederaan, kejatuhan itu mungkin boleh.
Perlu diingati bahawa tenaga elektrik digunakan berterusan di dalam semua tempat kerja bukan sahaja kilang-kilang tetapi pejabat, bank, sekolah, dsb dan penggunaannya di tempat-tempat tersebut semakin meningkat sepanjang masa apabila teknologi baru dan ‘pejabat elektronik’ menjadi satu kebiasaan. Jadi walaupun bahan di dalam bab ini akan membincangkan terutamanya mengenai kilang-kilang dan tapak binaan, pelajaran dan langkah-langkah yang perlu diambil, adalah relevan kepada mereka yang bekerja didalam pejabat dsb.
Tanggungjawab-tanggungjawab Majikan
Adalah tanggungjawab majikan untuk memastikan bahawa langkah berhati-hati yang mencukupi diambil untuk mengelakkan bahaya-bahaya ini pertama sekali dengan memuaskan hatinya bahawa semua kelengkapan elektrik direkabentuk untuk memastikan bahawa dalam operasi normal bahagian-bahagian hidup tidak boleh dimasuki, bahawa perlindungan terhadap litar pintas dengan peralatan seperti alat pembumi atau di dalam peralatan mudahalih, digunakan sistem voltej terkurang dengan semua peralatan yang ditebat atau didwi-tebat. Apabila kelengkapan elektrikal sebahagian daripada sesuatu sistem perlu diselenggarakan dsb., adalah penting bahawa satu sistem permit-untuk-bekerja berada di dalam operasi dan diselia oleh seseorang yang mempunyai latihan yang mencukupi dan kompeten untuk memastikan bahawa kelengkapan yang ingin diselenggarakan itu telah ‘mati’. Ini bermakna ia bukan sahaja perlu dimatikan tetapi keseluruhannya diasingkan dan tertutup daripada sebarang bahagian sistem yang boleh mengakibatkan, ia hidup dengan tidak sengaja. Sebelum kerja-kerja disambung kelengkapan dsb. tersebut hendaklah diuji dengan alat yang sah untuk membuktikannya ‘mati’.
Mengelakkan Renjatan Elektrik
Kelengkapan elektrikal yang direkabentuk dengan wajar dan berkeadaan baik adalah selamat. Apabila ia rosak atau diselenggarakan dengan buruk ia boleh membunuh walaupun pada 240 volt. Antara yang mudah terdedah adalah lampu tangan, dan peralatan mudah alih. Penghubung kabel yang berbulu atau rosak perlu dihantar untuk dibaiki dengan segera. Penggunaan kelengkapan voltej dikurangkan seperti sistem volt 110 dengan soket tengah dibumikan akan mengurangkan bahaya renjatan elektrik yang serius.
Jika kelengkapan voltej terkurang tidak digunakan, seperti di dalam pejabat, salah satu daripada perlindungan terbaik adalah penggunaan satu bentuk’earth leakage circuit breaker’. Tidak seperti fius, yang direkabentuk untuk melindungi kelengkapan, bukan manusia, apabila berlaku litar pintas pemutus sedemikian akan menghentikan arus dengan pantas agar tiada bahaya akibat kecederaan.
Jika kedua-dua voltej terkurang atau ‘earth leakage breaker’ tidak digunakan, apabila mungkin, pemutus litar otomatik mini perlu digunakan. Penggunaan pemegang fuis yang boleh diwayar semula perlu dielakkan seboleh mungkin kerana bahaya penggantian wayar yang tidak bersesuaian dengan saiz wayar fius.
Kemungkinan untuk renjatan elektrik boleh dikurangkan oleh seorang kompeten yang menjalankan pemeriksaan berikut:-
• sekurang-kurangnya satu ujian mingguan berkenaan keterusan konduktor bumi di antara peralatan mudahalih bersalut logam dan palam - ini akan memastikan bahawa konduktor di dalam wayar bumi kekal cukup untuk membawa cukup arus pintas untuk meletupkan fius; tambahan lagi ketahanan penebat kedua-dua alat dan plumbum fleksibel harus diperiksa;
• sekurang-kurangnya satu pemeriksaan mingguan kotak fius;
• sekurang-kurangnya satu ujian setiap tahun terhadap litar otomatik mini;
• satu pemeriksaan mingguan terhadap sarung tangan getah, alas berpenebat, kepingan dsb untuk kegunaan elektrikal;
• ujian setiap 6 bulan terhadap sarung tangan getah elektrikal;
• penggantian peralatan salut logam dengan peralatan atau kelengkapan yang berpenebat penuh bersesuaian di mana boleh dipraktikkan;
• pemeriksaan rutin terhadap pemasangan elektrikal;
• pengujian dan pemeriksaan tetap semua kelengkapan pejabat; dan
• pemeriksaan kerap terhadap semua soket dinding.
Satu kaedah mudah untuk memastikan penyelenggaraan dan pemeriksaan rutin kelengkapan elektrikal dilakukan adalah dengan melabel dan menandakan tarikh pada semua kelengkapan sewaktu ia diperiksa. Jika tarikh pada label menunjukkan kelengkapan tersebut tidak diperiksa dalam jangkawaktu yang ditentukan, kelengkapan itu tidak akan digunakan sehingga ia telah diperiksa.
Selain daripada memeriksa dan menguji kelengkapan yang perlu digunakan, perlu juga difikirkan kedudukan soket dan jumlah serta jenis kelengkapan yang dipasangkan padanya. Seringkali, khususnya di pejabat, soket-soket sama ada di dalam kedudukan yang tidak sesuai, menyebabkan wayar meleret di dalam bilik, atau terlalu banyak perkakas menggunakan terlalu sedikit soket. Dalam kes sedemikian ada risiko untuk kebakaran di samping risiko untuk renjatan.
Wayar Overhed
Terdapat satu atau dua kawasan, di mana walaupun orang tidak bekerja secara langsung dengan kuasa elektrik, mereka masih berada dalam risiko. Pertama adalah oerhed yang dijalankan menggunakan kren kuasa elektrik dengan ‘bare electric down shop’ dan ‘cross shop wires’ untuk membekalkan kuasa kepada kren overhed. Bahaya akibat renjatan boleh dielakkan dengan menggunakan kabel fleksibel pada gelendung gulung sendiri, wayar ‘down shop’ dan ‘cross shop’ tertutup di dalam logam atau pelindung berpenebat atau wayar pintal-sendiri yang tergantung pada ‘cantenary’.
Apabila pengecatan atau penyelenggaraan perlu dilakukan berhampiran dengan wayar-wayar sedemikian, adalah penting untuk memastikan langkah beringat-ingat yang sewajarnya diikuti agar kerja tersebut dapat dijalankan dengan selamat seperti dengan mengasingkan wayar-wayar tersebut sebelum dibenarkan masuk. (Lihat Bab 21 : Penyelenggaraan Selamat)
Bahaya-bahaya lain adalah kehadiran wayar overhed tidak berpenebat yang dimiliki oleh Lembaga Elektrik tetapi melintasi ruang terdedah termasuk tempat kerja. Ia akan diletakkan pada ketinggian yang selamat daripada tanah menurut ‘Overhead Lines Regulations’, tetapi ingat - tangga besi, jib kren bergerak dsb. boleh mengurangkan jarak tersebut dan mungkin bersentuh dan mengakibatkan tragedi. Pastikan majikan-majikan menandakan dengan jelas bahaya-bahaya ini. (Lihat HSE Guidance Note G S6).
Perlu juga diingat bahawa dengan punca atau wayar voltej tinggi satu litar ke bumi mungkin boleh berlaku tanpa sebarang sentuhan dilakukan.
Wayar-wayar overhed adalah bahaya khusus kepada pemandu-pemandu kren sewaktu kerja pembinaan. Sekiranya kren digunakan dlam keadaan tersebut perlu didapatkan nasihat daripada Lembaga Elektrik. Mereka yang memandu kren bergerak atau kenderaan yang hampir sama, perlu memastikan majikan mereka telah mengikuti prosedur-prosedur ini untuk keselamatan. Sekiranya boleh ‘tiang gol’ dan pita amaran perlulah didirikan.
Kabel Bawah Tanah
Satu lagi bahaya kepada pekerja binaan timbul apabila penggalian dilakukan. Kabel bawah tanah mungkin tertanam dalam laluan penggalian. Terdapat juga prosedur-prosedur untuk mengenalpasti bahaya-bahaya ini. Pastikan para majikan mengikutinya dan laluan-laluan kabel dikenalpasti oleh pihak-pihak yang berkenaan, dengan menggunakan pelan, alat pengesan kabel dsb., ditandakan dan jika perlu kabel-kabel itu dimatikan sebelum memulakan kerja. (Lihat NJUG Publication di bawah item 2 Useful Publications).
Pengimpalan Elektrik
Pengimpalan arka menggunakan kuasa elektrik sama ada ac atau dc. Dalam keadaan yang sama pengimpalan dc lebih selamat daripada ac dan merupakan pilihan di tempat terbatas dan sukar. Pada pengimpalan ac alat kerja perlu dibumikan dan ia mestilah satu-satunya pembumi kepada litar kimpalan tersebut.
Adalah disyorkan semua pemegang elektrod berpenebat terpasang kepada plumbum kimpalan dengan palam dan soket. Plumbum kembali perlu diapitkan kepada hasil kerja. Plumbum kembali itu penting untuk mengawal arah arus yang sedang kembali daripada kerja kepada transformer. Tanpanya, arus tersebut, berukuran 80 amps, mungkin mengambil laluan rawak melalui struktur keluli, garisan landasan, paip dsb., yang boleh merangkumi rintangan tinggi (misalnya, sambungan bolt yang longgar) menyebabkan penjanaan haba dan mungkin kebakaran.
Litar kimpalan perlu dibumikan sewaktu bekerja. Jika pembumi berada pada pemusing transformer dan satu retakan berlaku pada plumbum kembali laluan arus kembali akan tidak terkawal. Oleh itu adalah amat penting bahawa pembumi yang mencukupi berada di semua tempat kerja untuk kegunaan pengimpal.
Set pengimpal arus ulang-alik boleh dipasang dengan satu alat untuk mencegah voltej pada pemegang elektrod meningkat melebihi 50 volt apabila tiada arka yang dinyalakan. Tanpa alat ini voltej boleh meningkat hingga ke takat yang boleh membahayakan operator.
Rujukan yang lebih lanjut berkenaan langkah-langkah keselamatan am ada dalam bab mengenai pengimpalan.
Bilik Bateri
Dalam kerja-kerja yang menggunakan arus dc, sama ada untuk peralatan atau lampu kecemasan, kemungkinan ada bilik bateri di mana bateri-bateri dicaskan. Bateri mengeluarkan hidrogen apabila dicaskan dan ini akan membentuk satu campuran mudah letup bila bercampur dengan udara. Pengalihudaraan bilik bateri perlulah dalam keadaan di maan tiada penumpuan berlaku. Oleh kerana hidrogen lebih ringan daripada udara, lubang atau salur pengalihudara perlulah sama rata dengan siling dan langkah beringat-ingat harus diambil untuk megelakkan pengumpulan hidrogen pocket.
Pengalihudaraan secara paksa mungkin diperlukan. Walau bagaimanapun motor kipas elektrik biasa mungkin menghasilkan percikan api dan mewujudkan bahaya di dalam persekitaran yang mudah letup. Di mana perlu, nasihat pakar harus dicari sebelum pengalihudaraan sedemikian disediakan.
Aksesori elektrik dalam kawasan pencasan bateri perlulah kalis asid dan tidak dipasang pada siling tetapi pada dinding lebih kurang enam kaki atau lebih daripada lantai, untuk memastikan bahawa ia berada di bawah tahap tumpuan hidrogen walaupun pengalihudaraan adalah mencukupi.
Merokok atau menghidupkan air mestilah dilarang di dalam bilik-bilik bateri dan di mana sahaja kerja yang melibatkan puca api, ia perlulah dilakukan di bawah penyeliaan langsung seeorang yang kompeten. Perkara ini juga sama dengan lampu berpemegang dan peralatan yang mempunyai bahaya tersembunyi. Peralatan berpenebat yang bersesuaian untuk bateri hendaklah disediakan dan digunakan.
Akhir sekali, bateri jenis plumbum atau asid mengandungi asid sulfurik yang berbahaya dan langkah beringat-ingat yang paling minimum adalah pemakaian pelindung mata dan sarung tangan yang bersesuaian. Bekas pencuci mata dan bekalan air steril atau larutan garam yang bersesuaian juga perlu disediakan.
Generator Bergerak
Generator bergerak yang dijalankan oleh enjin petrol untuk membekalkan bekalan kuasa elektrik sementara sering digunakan sewaktu bekerja. Dari segi keperluan keselamatan, bekalan tersebut hendaklah dikendalikan sama seperti bekalan normal seperti wayar neutral generator tersebut dan semua bahagian logam yang terdedah yang boleh tercas hendaklah dibumikan. Secara amnya sebelum generator bergerak digunakan untuk menggantikan bekalan awam, semua konduktor daripada bekalan awam mestilah di asingkan (dihentikan keseluruhannya) dan kekal begitu sehingga generator digunakan dan dihentikan. Ini juga harus diamalkan apabila generator digunakan kerana kegagalan bekalan awam. Sekiranya sesuatu generator mengalirkan arus ke dalam sistem elektrik bekalan awam, bahayanya bukan sahaja kepada mereka yang terlibat secara langsung tetapi kepada pekerja-pekerja yang bekerja di Lembaga Elektrik. Ini tidak seharusnya dilakukan tanpa persetujuan daripada Lembaga Elektrik. Komen-komen terdahulu mengenai penyelenggaraan yang mencukupi juga boleh digunapakai untuk generator bergerak.
Pertolongan Cemas dan Penyelamatan
Katakanlah, walaupun semua langkah beringat-ingat telah diambil, (seseorang telah terkena renjatan elektrik. Adakah anda harus berdiri sahaja tanpa melakukan sesuatu? Tidak, tidak seharusnya begitu. Untuk menolong mangsa, kepantasan tanpa panik adalah amat penting. Pertama sekali arus elektrik hendaklah dihentikan atau suruh seseorang untuk melakukannya. Panggil seorang doktor atau ahli pertolongan cemas tetapi jangan menanti ketibaan mereka sahaja.
Apabila arus elektrik telah dihentikan, mulakan dengan pernafasan bantuan dengan serta-merta, dan teruskan untuk memulihkan pernafasan semulajadi sehingga ketibaan pakar dan menyuruh anda menghentikannya. Banyak nyawa telah hilang secara sia-sia kerana tidak memulakan pernafasan bantuan dengan serta-merta dan menghentikannya terlalu cepat.
Sekiranya tiada sesiapa pun yang mengetahui di mana untuk mematikan arus, tidak mustahil untuk membebaskan mangsa daripada bersentuh dengan kuasa elektrik pada voltej yang normal, iaitu 415/240, dengan menggunakan sarung tangan getah atau alas getah. Jika barangan tersebut tidak ada, gunakan gelung tali atau kot atau topi untuk menyeret dan membebaskan mangsa tersebut. Elakkan bersentuhan kulit dengan mangsa yang tercedera. Apa sahaja yang digunakan hendaklah kering dan bukan konduktor.
Jika diketahui atau disyaki bahawa si mangsa telah bersentuh dengankonduktor hidup melebihi 415v, adalah amat berbahaya untuk cuba membebaskannya, kecuali ada bahan berpenebat terhadap sistem itu atau sehingga anda pasti bahawa arus elektrik telah dihentikan. Jika sebarang bahagian daripada sesuatu sistem elektrik itu melebihi 250v, majiakn itu diwajibkan untuk mempamerkan satu poster yang memberi arahan berkenaan cara-cara untuk merawat seseorang yang terkena renjatan elektrik.
Akhir sekali, adalah dinasihatkan para pekerja perlu menerima latihan pernafasan bantuan yang kerap dan di mana perlu cara-cara untuk menghentikan bekalan elektrik perlulah ditunjukkan dengan jelas.
Senarai Semak : Kuasa Elektrik
• Adakah semua kelengkapan elektrik yang digunakan di dalam tempat kerja anda kerap kali diperiksa oleh seseorang yang kompeten?
• Adakah sebarang tanda kelengkapan elektrik yang rosak?
• Adakah kelengkapan voltej terkurang disediakan dalam keadaan lembap?
• Adakah semua kabel overhed dan bawah tanah ditandakan dengan jelas?
• Adakah semua pengimpalan arka elektrik dibumikan dengan mencukupi?
• Adakah terdapat bilik bateri di tempat kerja anda? Jika ada, sila periksa pengalihudaraan, pencegahan bunga api dan pencucuhan, larangan merokok dan bantuan kecemasan.
• Adakah semua pekerja terlatih di dalam teknik-teknik pertolongan cemas dan penyelamatan bagi renjatan elektrik?
Sources: Info drp seorang sahabat dalam bidang yang sama.
HSE-MS Elements
HSE-MS Elements
1.0 Leadership & Commitment
This element addresses the top-down management commitment and company culture necessary for success in the systematic management of HSE.
2.0 Policy & Strategic Objectives
In this element where the organization addresses their intention, principles of action and aspirations with regard to respect the health, safety and environment and the aim of improve HSE performance.
3.0 Organization, Responsibilities, Resources, Standard and Documents
This HSE element addresses the organization of people, resources and competence required for sound HSE performance.
4.0 Hazard and Effect Management Process
This element addresses the hazard identification, risk assessment and effect management process for all activities, product and services.
5.0 Planning, Standard and Procedures
This element addresses the planning of work activities, including the risk reduction measures. This includes planning for existing operations, managing changes and developing response measure.
6.0 Implementation and Monitoring
This HSE element addresses the manner in which activities are to be performed and monitored and corrective action to be taken when necessary.
7.0 Audit
In this HSE element the audit program shall be in place to review and verify effectiveness of the management system.
8.0 Management Review
In the element it stressed the management shall review the suitability and effectiveness of the HSEMS
Sources: Info drp seorang sahabat dalam bidang yang sama.
1.0 Leadership & Commitment
This element addresses the top-down management commitment and company culture necessary for success in the systematic management of HSE.
2.0 Policy & Strategic Objectives
In this element where the organization addresses their intention, principles of action and aspirations with regard to respect the health, safety and environment and the aim of improve HSE performance.
3.0 Organization, Responsibilities, Resources, Standard and Documents
This HSE element addresses the organization of people, resources and competence required for sound HSE performance.
4.0 Hazard and Effect Management Process
This element addresses the hazard identification, risk assessment and effect management process for all activities, product and services.
5.0 Planning, Standard and Procedures
This element addresses the planning of work activities, including the risk reduction measures. This includes planning for existing operations, managing changes and developing response measure.
6.0 Implementation and Monitoring
This HSE element addresses the manner in which activities are to be performed and monitored and corrective action to be taken when necessary.
7.0 Audit
In this HSE element the audit program shall be in place to review and verify effectiveness of the management system.
8.0 Management Review
In the element it stressed the management shall review the suitability and effectiveness of the HSEMS
Sources: Info drp seorang sahabat dalam bidang yang sama.
Tuesday, November 29, 2011
Accident Investigation Procedures
Accident Investigation Procedures
Items:
-What is an accident and why should it be investigated?
-Who should do the accident investigating?
-Should the immediate supervisor be on the team?
-Why look for the "root cause"?
-What are the steps involved in investigating an accident?
-What should be looked at as the cause of an accident?
-How are the facts collected?
-What should I know when making the analysis and conclusions?
-Why should recommendations be made?
-What should be done if the investigation reveals "human error"?
-How should follow-up be handled?
What is an accident and why should it be investigated?
The term "accident" can be defined as an unplanned event that interrupts the completion of an activity, and that may (or may not) include injury or property damage.
An incident usually refers to an unexpected event that did not cause injury or damage this time but had the potential. "Near miss" or "dangerous occurrence" are also terms for an event that could have caused harm but did not.
Please note: The term incident is used in some situations and jurisdictions to cover both an "accident" and "incident". It is argued that the word "accident" implies that the event was related to fate or chance. When the root cause is determined, it is usually found that many events were predictable and could have been prevented if the right actions were taken -- making the event not one of fate or chance (thus, the word incident is used). For simplicity, we will use the term accident to mean all of the above events.
The information that follows is intended to be a general guide for supervisors or joint occupational health and safety committee members. When accidents are investigated, the emphasis should be concentrated on finding the root cause of the accident rather than the investigation procedure itself so you can prevent it from happening again. The purpose is to find facts that can lead to actions, not to find fault. Always look for deeper causes. Do not simply record the steps of the event.
Reasons to investigate a workplace accident include:
•most importantly, to find out the cause of accidents and to prevent similar accidents in the future
•to fulfill any legal requirements
•to determine the cost of an accident
•to determine compliance with applicable safety regulations
•to process workers' compensation claims
Incidents that involve no injury or property damage should still be investigated to determine the hazards that should be corrected. The same principles apply to a quick inquiry of a minor incident and to the more formal investigation of a serious event.
Who should do the accident investigating?
Ideally, an investigation would be conducted by someone experienced in accident causation, experienced in investigative techniques, fully knowledgeable of the work processes, procedures, persons, and industrial relations environment of a particular situation.
Some jurisdictions provide guidance such as requiring that it must be conducted jointly, with both management and labour represented, or that the investigators must be knowledgeable about the work processes involved.
In most cases, the supervisor should help investigate the event. Other members of the team can include:
•employees with knowledge of the work
•safety officer
•health and safety committee
•union representative, if applicable
•employees with experience in investigations
•"outside" expert
•representative from local government
Should the immediate supervisor be on the team?
The advantage is that this person is likely to know most about the work and persons involved and the current conditions. Furthermore, the supervisor can usually take immediate remedial action. The counter argument is that there may be an attempt to gloss over the supervisors shortcomings in the accident. This situation should not arise if the accident is investigated by a team of people, and if the worker representative(s) and the members review all accident investigation reports thoroughly.
Why look for the "root cause"?
An investigator who believes that accidents are caused by unsafe conditions will likely try to uncover conditions as causes. On the other hand, one who believes they are caused by unsafe acts will attempt to find the human errors that are causes. Therefore, it is necessary to examine some underlying factors in a chain of events that ends in an accident.
The important point is that even in the most seemingly straightforward accidents, seldom, if ever, is there only a single cause. For example, an "investigation" which concludes that an accident was due to worker carelessness, and goes no further, fails to seek answers to several important questions such as:
•Was the worker distracted? If yes, why was the worker distracted?
•Was a safe work procedure being followed? If not, why not?
•Were safety devices in order? If not, why not?
•Was the worker trained? If not, why not?
An inquiry that answers these and related questions will probably reveal conditions that are more open to correction than attempts to prevent "carelessness".
What are the steps involved in investigating an accident?
The accident investigation process involves the following steps:
•Report the accident occurrence to a designated person within the organization
•Provide first aid and medical care to injured person(s) and prevent further injuries or damage
•Investigate the accident
•Identify the causes
•Report the findings
•Develop a plan for corrective action
•Implement the plan
•Evaluate the effectiveness of the corrective action
•Make changes for continuous improvement
As little time as possible should be lost between the moment of an accident or near miss and the beginning of the investigation. In this way, one is most likely to be able to observe the conditions as they were at the time, prevent disturbance of evidence, and identify witnesses. The tools that members of the investigating team may need (pencil, paper, camera, film, camera flash, tape measure, etc.) should be immediately available so that no time is wasted.
What should be looked at as the cause of an accident?
Accident Causation Models
Many models of accident causation have been proposed, ranging from Heinrich's domino theory to the sophisticated Management Oversight and Risk Tree (MORT).
The simple model shown in Figure 1 attempts to illustrate that the causes of any accident can be grouped into five categories - task, material, environment, personnel, and management. When this model is used, possible causes in each category should be investigated. Each category is examined more closely below. Remember that these are sample questions only: no attempt has been made to develop a comprehensive checklist.
Figure 1: Accident Causation
Task
Here the actual work procedure being used at the time of the accident is explored. Members of the accident investigation team will look for answers to questions such as:
•Was a safe work procedure used?
•Had conditions changed to make the normal procedure unsafe?
•Were the appropriate tools and materials available?
•Were they used?
•Were safety devices working properly?
•Was lockout used when necessary?
For most of these questions, an important follow-up question is "If not, why not?"
Material
To seek out possible causes resulting from the equipment and materials used, investigators might ask:
•Was there an equipment failure?
•What caused it to fail?
•Was the machinery poorly designed?
•Were hazardous substances involved?
•Were they clearly identified?
•Was a less hazardous alternative substance possible and available?
•Was the raw material substandard in some way?
•Should personal protective equipment (PPE) have been used?
•Was the PPE used?
•Were users of PPE properly trained?
Again, each time the answer reveals an unsafe condition, the investigator must ask why this situation was allowed to exist.
Environment
The physical environments, and especially sudden changes to that environment, are factors that need to be identified. The situation at the time of the accident is what is important, not what the "usual" conditions were. For example, accident investigators may want to know:
•What were the weather conditions?
•Was poor housekeeping a problem?
•Was it too hot or too cold?
•Was noise a problem?
•Was there adequate light?
•Were toxic or hazardous gases, dusts, or fumes present?
Personnel
The physical and mental condition of those individuals directly involved in the event must be explored. The purpose for investigating the accident is not to establish blame against someone but the inquiry will not be complete unless personal characteristics are considered. Some factors will remain essentially constant while others may vary from day to day:
•Were workers experienced in the work being done?
•Had they been adequately trained?
•Can they physically do the work?
•What was the status of their health?
•Were they tired?
•Were they under stress (work or personal)?
Management
Management holds the legal responsibility for the safety of the workplace and therefore the role of supervisors and higher management and the role or presence of management systems must always be considered in an accident investigation. Failures of management systems are often found to be direct or indirect factors in accidents. Ask questions such as:
•Were safety rules communicated to and understood by all employees?
•Were written procedures and orientation available?
•Were they being enforced?
•Was there adequate supervision?
•Were workers trained to do the work?
•Had hazards been previously identified?
•Had procedures been developed to overcome them?
•Were unsafe conditions corrected?
•Was regular maintenance of equipment carried out?
•Were regular safety inspections carried out?
This model of accident investigations provides a guide for uncovering all possible causes and reduces the likelihood of looking at facts in isolation. Some investigators may prefer to place some of the sample questions in different categories; however, the categories are not important, as long as each pertinent question is asked. Obviously there is considerable overlap between categories; this reflects the situation in real life. Again it should be emphasized that the above sample questions do not make up a complete checklist, but are examples only.
How are the facts collected?
The steps in accident investigation are simple: the accident investigators gather information, analyze it, draw conclusions, and make recommendations. Although the procedures are straightforward, each step can have its pitfalls. As mentioned above, an open mind is necessary in accident investigation: preconceived notions may result in some wrong paths being followed while leaving some significant facts uncovered. All possible causes should be considered. Making notes of ideas as they occur is a good practice but conclusions should not be drawn until all the information is gathered.
Injured workers(s)
The most important immediate tasks--rescue operations, medical treatment of the injured, and prevention of further injuries--have priority and others must not interfere with these activities. When these matters are under control, the investigators can start their work.
Physical Evidence
Before attempting to gather information, examine the site for a quick overview, take steps to preserve evidence, and identify all witnesses. In some jurisdictions, an accident site must not be disturbed without prior approval from appropriate government officials such as the coroner, inspector, or police. Physical evidence is probably the most non-controversial information available. It is also subject to rapid change or obliteration; therefore, it should be the first to be recorded.
Based on your knowledge of the work process, you may want to check items such as:
•positions of injured workers
•equipment being used
•materials or chemicals being used
•safety devices in use
•position of appropriate guards
•position of controls of machinery
•damage to equipment
•housekeeping of area
•weather conditions
•lighting levels
•noise levels
•time of day
You may want to take photographs before anything is moved, both of the general area and specific items. Later careful study of these may reveal conditions or observations missed previously. Sketches of the accident scene based on measurements taken may also help in subsequent analysis and will clarify any written reports. Broken equipment, debris, and samples of materials involved may be removed for further analysis by appropriate experts. Even if photographs are taken, written notes about the location of these items at the accident scene should be prepared.
Eyewitness Accounts
Although there may be occasions when you are unable to do so, every effort should be made to interview witnesses. In some situations witnesses may be your primary source of information because you may be called upon to investigate an accident without being able to examine the scene immediately after the event. Because witnesses may be under severe emotional stress or afraid to be completely open for fear of recrimination, interviewing witnesses is probably the hardest task facing an investigator.
Witnesses should be kept apart and interviewed as soon as possible after the accident. If witnesses have an opportunity to discuss the event among themselves, individual perceptions may be lost in the normal process of accepting a consensus view where doubt exists about the facts.
Witnesses should be interviewed alone, rather than in a group. You may decide to interview a witness at the scene of the accident where it is easier to establish the positions of each person involved and to obtain a description of the events. On the other hand, it may be preferable to carry out interviews in a quiet office where there will be fewer distractions. The decision may depend in part on the nature of the accident and the mental state of the witnesses.
Interviewing
Interviewing is an art that cannot be given justice in a brief document such as this, but a few do's and don'ts can be mentioned. The purpose of the interview is to establish an understanding with the witness and to obtain his or her own words describing the event:
DO...
•put the witness, who is probably upset, at ease
•emphasize the real reason for the investigation, to determine what happened and why
•let the witness talk, listen
•confirm that you have the statement correct
•try to sense any underlying feelings of the witness
•make short notes or ask someone else on the team to take them during the interview
•ask if it is okay to record the interview, if you are doing so
•close on a positive note
DO NOT...
•intimidate the witness
•interrupt
•prompt
•ask leading questions
•show your own emotions
•jump to conclusions
Ask open-ended questions that cannot be answered by simply "yes" or "no". The actual questions you ask the witness will naturally vary with each accident, but there are some general questions that should be asked each time:
•Where were you at the time of the accident?
•What were you doing at the time?
•What did you see, hear?
•What were the environmental conditions (weather, light, noise, etc.) at the time?
•What was (were) the injured worker(s) doing at the time?
•In your opinion, what caused the accident?
•How might similar accidents be prevented in the future?
If you were not at the scene at the time, asking questions is a straightforward approach to establishing what happened. Obviously, care must be taken to assess the credibility of any statements made in the interviews. Answers to a first few questions will generally show how well the witness could actually observe what happened.
Another technique sometimes used to determine the sequence of events is to re-enact or replay them as they happened. Obviously, great care must be taken so that further injury or damage does not occur. A witness (usually the injured worker) is asked to reenact in slow motion the actions that preceded the accident.
Background Information
A third, and often an overlooked source of information, can be found in documents such as technical data sheets, health and safety committee minutes, inspection reports, company policies, maintenance reports, past accident reports, formalized safe-work procedures, and training reports. Any pertinent information should be studied to see what might have happened, and what changes might be recommended to prevent recurrence of similar accidents.
What should I know when making the analysis and conclusions?
At this stage of the investigation most of the facts about what happened and how it happened should be known. This has taken considerable effort to accomplish but it represents only the first half of the objective. Now comes the key question--why did it happen? To prevent recurrences of similar accidents, the investigators must find all possible answers to this question.
You have kept an open mind to all possibilities and looked for all pertinent facts. There may still be gaps in your understanding of the sequence of events that resulted in the accident. You may need to reinterview some witnesses to fill these gaps in your knowledge.
•When your analysis is complete, write down a step-by-step account of what happened (your conclusions) working back from the moment of the accident, listing all possible causes at each step.
This is not extra work: it is a draft for part of the final report. Each conclusion should be checked to see if:
•it is supported by evidence
•the evidence is direct (physical or documentary) or based on eyewitness accounts, or
•the evidence is based on assumption.
This list serves as a final check on discrepancies that should be explained or eliminated.
Why should recommendations be made?
The most important final step is to come up with a set of well-considered recommendations designed to prevent recurrences of similar accidents. Once you are knowledgeable about the work processes involved and the overall situation in your organization, it should not be too difficult to come up with realistic recommendations.
Recommendations should:
•be specific
•be constructive
•get at root causes
•identify contributing factors
Resist the temptation to make only general recommendations to save time and effort.
For example, you have determined that a blind corner contributed to an accident.
Rather than just recommending "eliminate blind corners" it would be better to suggest:
• install mirrors at the northwest corner of building X (specific to this accident)
• install mirrors at blind corners where required throughout the worksite (general)
Never make recommendations about disciplining a person or persons who may have been at fault. This would not only be counter to the real purpose of the investigation, but it would jeopardize the chances for a free flow of information in future accident investigations.
In the unlikely event that you have not been able to determine the causes of an accident with any certainty, you probably still have uncovered safety weaknesses in the operation. It is appropriate that recommendations be made to correct these deficiencies.
The Written Report
If your organization has a standard form that must be used, you will have little choice in the form that your written report is to be presented. Nevertheless, you should be aware of, and try to overcome, shortcomings such as:
• If a limited space is provided for an answer, the tendency will be to answer in that space despite recommendations to "use back of form if necessary."
• If a checklist of causes is included, possible causes not listed may be overlooked.
• Headings such as "unsafe condition" will usually elicit a single response even when more than one unsafe condition exists.
• Differentiating between "primary cause" and "contributing factors" can be misleading. All accident causes are important and warrant consideration for possible corrective action.
Your previously prepared draft of the sequence of events can now be used to describe what happened. Remember that readers of your report do not have the intimate knowledge of the accident that you have so include all pertinent detail. Photographs and diagrams may save many words of description. Identify clearly where evidence is based on certain facts, eyewitness accounts, or your assumptions.
If doubt exists about any particular part, say so. The reasons for your conclusions should be stated and followed by your recommendations. Weed out extra material that is not required for a full understanding of the accident and its causes such as photographs that are not relevant and parts of the investigation that led you nowhere. The measure of a good accident report is quality, not quantity.
Always communicate your findings with workers, supervisors and management. Present your information 'in context' so everyone understands how the accident occurred and the actions in place to prevent it from happening again.
What should be done if the investigation reveals "human error"?
A difficulty that has bothered many investigators is the idea that one does not want to lay blame. However, when a thorough worksite accident investigation reveals that some person or persons among management, supervisor, and the workers were apparently at fault, then this fact should be pointed out. The intention here is to remedy the situation, not to discipline an individual.
Failing to point out human failings that contributed to an accident will not only downgrade the quality of the investigation. Furthermore, it will also allow future accidents to happen from similar causes because they have not been addressed.
However never make recommendations about disciplining anyone who may be at fault. Any disciplinary steps should be done within the normal personnel procedures.
How should follow-up be handled?
Management is responsible for acting on the recommendations in the accident investigation report. The health and safety committee, if you have one, can monitor the progress of these actions.
Follow-up actions include:
• Respond to the recommendations in the report by explaining what can and cannot be done (and why or why not).
• Develop a timetable for corrective actions.
• Monitor that the scheduled actions have been completed.
• Check the condition of injured worker(s).
• Inform and train other workers at risk.
• Re-orient worker(s) on their return to work.
Sources: Kiriman info dari seorang sahabat yang berkecimpung dalam bidang yang sama.
Items:
-What is an accident and why should it be investigated?
-Who should do the accident investigating?
-Should the immediate supervisor be on the team?
-Why look for the "root cause"?
-What are the steps involved in investigating an accident?
-What should be looked at as the cause of an accident?
-How are the facts collected?
-What should I know when making the analysis and conclusions?
-Why should recommendations be made?
-What should be done if the investigation reveals "human error"?
-How should follow-up be handled?
What is an accident and why should it be investigated?
The term "accident" can be defined as an unplanned event that interrupts the completion of an activity, and that may (or may not) include injury or property damage.
An incident usually refers to an unexpected event that did not cause injury or damage this time but had the potential. "Near miss" or "dangerous occurrence" are also terms for an event that could have caused harm but did not.
Please note: The term incident is used in some situations and jurisdictions to cover both an "accident" and "incident". It is argued that the word "accident" implies that the event was related to fate or chance. When the root cause is determined, it is usually found that many events were predictable and could have been prevented if the right actions were taken -- making the event not one of fate or chance (thus, the word incident is used). For simplicity, we will use the term accident to mean all of the above events.
The information that follows is intended to be a general guide for supervisors or joint occupational health and safety committee members. When accidents are investigated, the emphasis should be concentrated on finding the root cause of the accident rather than the investigation procedure itself so you can prevent it from happening again. The purpose is to find facts that can lead to actions, not to find fault. Always look for deeper causes. Do not simply record the steps of the event.
Reasons to investigate a workplace accident include:
•most importantly, to find out the cause of accidents and to prevent similar accidents in the future
•to fulfill any legal requirements
•to determine the cost of an accident
•to determine compliance with applicable safety regulations
•to process workers' compensation claims
Incidents that involve no injury or property damage should still be investigated to determine the hazards that should be corrected. The same principles apply to a quick inquiry of a minor incident and to the more formal investigation of a serious event.
Who should do the accident investigating?
Ideally, an investigation would be conducted by someone experienced in accident causation, experienced in investigative techniques, fully knowledgeable of the work processes, procedures, persons, and industrial relations environment of a particular situation.
Some jurisdictions provide guidance such as requiring that it must be conducted jointly, with both management and labour represented, or that the investigators must be knowledgeable about the work processes involved.
In most cases, the supervisor should help investigate the event. Other members of the team can include:
•employees with knowledge of the work
•safety officer
•health and safety committee
•union representative, if applicable
•employees with experience in investigations
•"outside" expert
•representative from local government
Should the immediate supervisor be on the team?
The advantage is that this person is likely to know most about the work and persons involved and the current conditions. Furthermore, the supervisor can usually take immediate remedial action. The counter argument is that there may be an attempt to gloss over the supervisors shortcomings in the accident. This situation should not arise if the accident is investigated by a team of people, and if the worker representative(s) and the members review all accident investigation reports thoroughly.
Why look for the "root cause"?
An investigator who believes that accidents are caused by unsafe conditions will likely try to uncover conditions as causes. On the other hand, one who believes they are caused by unsafe acts will attempt to find the human errors that are causes. Therefore, it is necessary to examine some underlying factors in a chain of events that ends in an accident.
The important point is that even in the most seemingly straightforward accidents, seldom, if ever, is there only a single cause. For example, an "investigation" which concludes that an accident was due to worker carelessness, and goes no further, fails to seek answers to several important questions such as:
•Was the worker distracted? If yes, why was the worker distracted?
•Was a safe work procedure being followed? If not, why not?
•Were safety devices in order? If not, why not?
•Was the worker trained? If not, why not?
An inquiry that answers these and related questions will probably reveal conditions that are more open to correction than attempts to prevent "carelessness".
What are the steps involved in investigating an accident?
The accident investigation process involves the following steps:
•Report the accident occurrence to a designated person within the organization
•Provide first aid and medical care to injured person(s) and prevent further injuries or damage
•Investigate the accident
•Identify the causes
•Report the findings
•Develop a plan for corrective action
•Implement the plan
•Evaluate the effectiveness of the corrective action
•Make changes for continuous improvement
As little time as possible should be lost between the moment of an accident or near miss and the beginning of the investigation. In this way, one is most likely to be able to observe the conditions as they were at the time, prevent disturbance of evidence, and identify witnesses. The tools that members of the investigating team may need (pencil, paper, camera, film, camera flash, tape measure, etc.) should be immediately available so that no time is wasted.
What should be looked at as the cause of an accident?
Accident Causation Models
Many models of accident causation have been proposed, ranging from Heinrich's domino theory to the sophisticated Management Oversight and Risk Tree (MORT).
The simple model shown in Figure 1 attempts to illustrate that the causes of any accident can be grouped into five categories - task, material, environment, personnel, and management. When this model is used, possible causes in each category should be investigated. Each category is examined more closely below. Remember that these are sample questions only: no attempt has been made to develop a comprehensive checklist.
Figure 1: Accident Causation
Task
Here the actual work procedure being used at the time of the accident is explored. Members of the accident investigation team will look for answers to questions such as:
•Was a safe work procedure used?
•Had conditions changed to make the normal procedure unsafe?
•Were the appropriate tools and materials available?
•Were they used?
•Were safety devices working properly?
•Was lockout used when necessary?
For most of these questions, an important follow-up question is "If not, why not?"
Material
To seek out possible causes resulting from the equipment and materials used, investigators might ask:
•Was there an equipment failure?
•What caused it to fail?
•Was the machinery poorly designed?
•Were hazardous substances involved?
•Were they clearly identified?
•Was a less hazardous alternative substance possible and available?
•Was the raw material substandard in some way?
•Should personal protective equipment (PPE) have been used?
•Was the PPE used?
•Were users of PPE properly trained?
Again, each time the answer reveals an unsafe condition, the investigator must ask why this situation was allowed to exist.
Environment
The physical environments, and especially sudden changes to that environment, are factors that need to be identified. The situation at the time of the accident is what is important, not what the "usual" conditions were. For example, accident investigators may want to know:
•What were the weather conditions?
•Was poor housekeeping a problem?
•Was it too hot or too cold?
•Was noise a problem?
•Was there adequate light?
•Were toxic or hazardous gases, dusts, or fumes present?
Personnel
The physical and mental condition of those individuals directly involved in the event must be explored. The purpose for investigating the accident is not to establish blame against someone but the inquiry will not be complete unless personal characteristics are considered. Some factors will remain essentially constant while others may vary from day to day:
•Were workers experienced in the work being done?
•Had they been adequately trained?
•Can they physically do the work?
•What was the status of their health?
•Were they tired?
•Were they under stress (work or personal)?
Management
Management holds the legal responsibility for the safety of the workplace and therefore the role of supervisors and higher management and the role or presence of management systems must always be considered in an accident investigation. Failures of management systems are often found to be direct or indirect factors in accidents. Ask questions such as:
•Were safety rules communicated to and understood by all employees?
•Were written procedures and orientation available?
•Were they being enforced?
•Was there adequate supervision?
•Were workers trained to do the work?
•Had hazards been previously identified?
•Had procedures been developed to overcome them?
•Were unsafe conditions corrected?
•Was regular maintenance of equipment carried out?
•Were regular safety inspections carried out?
This model of accident investigations provides a guide for uncovering all possible causes and reduces the likelihood of looking at facts in isolation. Some investigators may prefer to place some of the sample questions in different categories; however, the categories are not important, as long as each pertinent question is asked. Obviously there is considerable overlap between categories; this reflects the situation in real life. Again it should be emphasized that the above sample questions do not make up a complete checklist, but are examples only.
How are the facts collected?
The steps in accident investigation are simple: the accident investigators gather information, analyze it, draw conclusions, and make recommendations. Although the procedures are straightforward, each step can have its pitfalls. As mentioned above, an open mind is necessary in accident investigation: preconceived notions may result in some wrong paths being followed while leaving some significant facts uncovered. All possible causes should be considered. Making notes of ideas as they occur is a good practice but conclusions should not be drawn until all the information is gathered.
Injured workers(s)
The most important immediate tasks--rescue operations, medical treatment of the injured, and prevention of further injuries--have priority and others must not interfere with these activities. When these matters are under control, the investigators can start their work.
Physical Evidence
Before attempting to gather information, examine the site for a quick overview, take steps to preserve evidence, and identify all witnesses. In some jurisdictions, an accident site must not be disturbed without prior approval from appropriate government officials such as the coroner, inspector, or police. Physical evidence is probably the most non-controversial information available. It is also subject to rapid change or obliteration; therefore, it should be the first to be recorded.
Based on your knowledge of the work process, you may want to check items such as:
•positions of injured workers
•equipment being used
•materials or chemicals being used
•safety devices in use
•position of appropriate guards
•position of controls of machinery
•damage to equipment
•housekeeping of area
•weather conditions
•lighting levels
•noise levels
•time of day
You may want to take photographs before anything is moved, both of the general area and specific items. Later careful study of these may reveal conditions or observations missed previously. Sketches of the accident scene based on measurements taken may also help in subsequent analysis and will clarify any written reports. Broken equipment, debris, and samples of materials involved may be removed for further analysis by appropriate experts. Even if photographs are taken, written notes about the location of these items at the accident scene should be prepared.
Eyewitness Accounts
Although there may be occasions when you are unable to do so, every effort should be made to interview witnesses. In some situations witnesses may be your primary source of information because you may be called upon to investigate an accident without being able to examine the scene immediately after the event. Because witnesses may be under severe emotional stress or afraid to be completely open for fear of recrimination, interviewing witnesses is probably the hardest task facing an investigator.
Witnesses should be kept apart and interviewed as soon as possible after the accident. If witnesses have an opportunity to discuss the event among themselves, individual perceptions may be lost in the normal process of accepting a consensus view where doubt exists about the facts.
Witnesses should be interviewed alone, rather than in a group. You may decide to interview a witness at the scene of the accident where it is easier to establish the positions of each person involved and to obtain a description of the events. On the other hand, it may be preferable to carry out interviews in a quiet office where there will be fewer distractions. The decision may depend in part on the nature of the accident and the mental state of the witnesses.
Interviewing
Interviewing is an art that cannot be given justice in a brief document such as this, but a few do's and don'ts can be mentioned. The purpose of the interview is to establish an understanding with the witness and to obtain his or her own words describing the event:
DO...
•put the witness, who is probably upset, at ease
•emphasize the real reason for the investigation, to determine what happened and why
•let the witness talk, listen
•confirm that you have the statement correct
•try to sense any underlying feelings of the witness
•make short notes or ask someone else on the team to take them during the interview
•ask if it is okay to record the interview, if you are doing so
•close on a positive note
DO NOT...
•intimidate the witness
•interrupt
•prompt
•ask leading questions
•show your own emotions
•jump to conclusions
Ask open-ended questions that cannot be answered by simply "yes" or "no". The actual questions you ask the witness will naturally vary with each accident, but there are some general questions that should be asked each time:
•Where were you at the time of the accident?
•What were you doing at the time?
•What did you see, hear?
•What were the environmental conditions (weather, light, noise, etc.) at the time?
•What was (were) the injured worker(s) doing at the time?
•In your opinion, what caused the accident?
•How might similar accidents be prevented in the future?
If you were not at the scene at the time, asking questions is a straightforward approach to establishing what happened. Obviously, care must be taken to assess the credibility of any statements made in the interviews. Answers to a first few questions will generally show how well the witness could actually observe what happened.
Another technique sometimes used to determine the sequence of events is to re-enact or replay them as they happened. Obviously, great care must be taken so that further injury or damage does not occur. A witness (usually the injured worker) is asked to reenact in slow motion the actions that preceded the accident.
Background Information
A third, and often an overlooked source of information, can be found in documents such as technical data sheets, health and safety committee minutes, inspection reports, company policies, maintenance reports, past accident reports, formalized safe-work procedures, and training reports. Any pertinent information should be studied to see what might have happened, and what changes might be recommended to prevent recurrence of similar accidents.
What should I know when making the analysis and conclusions?
At this stage of the investigation most of the facts about what happened and how it happened should be known. This has taken considerable effort to accomplish but it represents only the first half of the objective. Now comes the key question--why did it happen? To prevent recurrences of similar accidents, the investigators must find all possible answers to this question.
You have kept an open mind to all possibilities and looked for all pertinent facts. There may still be gaps in your understanding of the sequence of events that resulted in the accident. You may need to reinterview some witnesses to fill these gaps in your knowledge.
•When your analysis is complete, write down a step-by-step account of what happened (your conclusions) working back from the moment of the accident, listing all possible causes at each step.
This is not extra work: it is a draft for part of the final report. Each conclusion should be checked to see if:
•it is supported by evidence
•the evidence is direct (physical or documentary) or based on eyewitness accounts, or
•the evidence is based on assumption.
This list serves as a final check on discrepancies that should be explained or eliminated.
Why should recommendations be made?
The most important final step is to come up with a set of well-considered recommendations designed to prevent recurrences of similar accidents. Once you are knowledgeable about the work processes involved and the overall situation in your organization, it should not be too difficult to come up with realistic recommendations.
Recommendations should:
•be specific
•be constructive
•get at root causes
•identify contributing factors
Resist the temptation to make only general recommendations to save time and effort.
For example, you have determined that a blind corner contributed to an accident.
Rather than just recommending "eliminate blind corners" it would be better to suggest:
• install mirrors at the northwest corner of building X (specific to this accident)
• install mirrors at blind corners where required throughout the worksite (general)
Never make recommendations about disciplining a person or persons who may have been at fault. This would not only be counter to the real purpose of the investigation, but it would jeopardize the chances for a free flow of information in future accident investigations.
In the unlikely event that you have not been able to determine the causes of an accident with any certainty, you probably still have uncovered safety weaknesses in the operation. It is appropriate that recommendations be made to correct these deficiencies.
The Written Report
If your organization has a standard form that must be used, you will have little choice in the form that your written report is to be presented. Nevertheless, you should be aware of, and try to overcome, shortcomings such as:
• If a limited space is provided for an answer, the tendency will be to answer in that space despite recommendations to "use back of form if necessary."
• If a checklist of causes is included, possible causes not listed may be overlooked.
• Headings such as "unsafe condition" will usually elicit a single response even when more than one unsafe condition exists.
• Differentiating between "primary cause" and "contributing factors" can be misleading. All accident causes are important and warrant consideration for possible corrective action.
Your previously prepared draft of the sequence of events can now be used to describe what happened. Remember that readers of your report do not have the intimate knowledge of the accident that you have so include all pertinent detail. Photographs and diagrams may save many words of description. Identify clearly where evidence is based on certain facts, eyewitness accounts, or your assumptions.
If doubt exists about any particular part, say so. The reasons for your conclusions should be stated and followed by your recommendations. Weed out extra material that is not required for a full understanding of the accident and its causes such as photographs that are not relevant and parts of the investigation that led you nowhere. The measure of a good accident report is quality, not quantity.
Always communicate your findings with workers, supervisors and management. Present your information 'in context' so everyone understands how the accident occurred and the actions in place to prevent it from happening again.
What should be done if the investigation reveals "human error"?
A difficulty that has bothered many investigators is the idea that one does not want to lay blame. However, when a thorough worksite accident investigation reveals that some person or persons among management, supervisor, and the workers were apparently at fault, then this fact should be pointed out. The intention here is to remedy the situation, not to discipline an individual.
Failing to point out human failings that contributed to an accident will not only downgrade the quality of the investigation. Furthermore, it will also allow future accidents to happen from similar causes because they have not been addressed.
However never make recommendations about disciplining anyone who may be at fault. Any disciplinary steps should be done within the normal personnel procedures.
How should follow-up be handled?
Management is responsible for acting on the recommendations in the accident investigation report. The health and safety committee, if you have one, can monitor the progress of these actions.
Follow-up actions include:
• Respond to the recommendations in the report by explaining what can and cannot be done (and why or why not).
• Develop a timetable for corrective actions.
• Monitor that the scheduled actions have been completed.
• Check the condition of injured worker(s).
• Inform and train other workers at risk.
• Re-orient worker(s) on their return to work.
Sources: Kiriman info dari seorang sahabat yang berkecimpung dalam bidang yang sama.
Panduan Keselamatan – Panduan dan langkah keselamatan menghadapi banjir.
Panduan Keselamatan – Panduan dan langkah keselamatan menghadapi banjir.
Nampaknya hujan masih lagi tak menentu dalam dua tiga hari ni..
Memang dengan kadar taburan hujan yang macam ni tidak akan menyebabkan banjir, tapi kalau nak diikutkan dari tahun yang sebelumnya, banjir tahun ni sudah terlebih lewat dari yang sepatutunya… mungkin ini salah satu kesan dari pemanasan Global yang menyebabkan musim sudah tak menentu…
Tapi sebenarnya aku agak risau dengan keadaan ni, walaupun kampung aku terletak dalam kawasan yang agak tinggi dan boleh dikatakan terselamat dari bencana banjir tapi bencana banjir ni sedikit sebanyak akan turut sama menjejaskan orang ramai..
Dan yang paling aku tak seronok dengar ialah laporan laporan yang mengakibatkan kehilangan nyawa yang dah seakan akan rutin wajip setip kali bencana banjir ni tiba.
Panduan dan Langkah Menghadapi Banjir
PERSEDIAAN SEBELUM BANJIR
-Dapatkan maklumat tentang banjir di tempat anda.
-Pastikan sistem amaran banjir dan dengar hebahan semasa yang disampaikan melalui radio,televisyen dan agensi-agensi kerajaan yang berkenaan serta Bilik-Bilik Gerakan Banjir Negeri atau Daerah yang berhampiran.
-Periksa lubang air seperi longkang atau saluran najis. Bersihkan halangan dan pastikan ia tertutup rapat supaya air banjir tidak masuk melaluinya.
-Pastikan di mana Pusat Pemindahan dan Pusat Bantuan Bencana di tempat anda.
-Sediakan peralatan kecemasan dan bekalan makanan secukupnya.
-Pastikan seluruh keluarga anda mengetahui cara-cara bertindak semasa kecemasan di rumah.
SEBELUM BANJIR – SEMASA TANDA-TANDA DIKESAN
-Dengar melalui pengumuman radio, televisyen atau pihak-pihak tertentu.
-Pindahkan perabut atau peralatan-peralatan lain ke tempat yang selamat.
-Letakkan dokumen penting di tempat yang selamat atau bawa bersama anda dalam bekas kalis air.
-Bersedia untuk menutup suis elektrik, injap utama bekalan air dan gas.
-Beritahu jiran anda dan bersedia untuk berpindah.
SEMASA BANJIR – SEMASA PEMINDAHAN
-Apabila menerima arahan, segeralah berpindah ke pusat-pusat pemindahan yang disediakan.
-Berpindah awal sebelum banjir meningkat atau pada waktu siang kerana ianya lebih mudah dan selamat.
-Ikut laluan yang ditentukan, laluan singkat mungkin terhalang.
SEMASA BANJIR – DI DALAM KENDERAAN
-Jangan terus mengharungi kawasan banjir, hendaklah berpatah balik ke tempat yang selamat.
-Jika kenderaan anda terhenti, kunci kenderaan serta tinggalkan kenderaan tersebut dan pergilah. ke tempat yang selamat
SEMASA BANJIR – DI DALAM RUMAH
-Dengar pengumuman melalui radio, televisyen atau pihak tertentu.
-Bersedia dengan peralatan kecemasan.
-Jika diarahkan keluar dan berpindah, segera lakukan.
SEMASA BANJIR – DI LUAR RUMAH
-Pergi ke tempat tinggi dan selamat.
-Elakkan dari melalui kawasan banjir, arus deras yang boleh menghanyutkan anda.
-Jangan sengaja bersiar-siar di kawasan banjir sama ada dengan sampan mahupun berjalan kaki.
-Jangan sentuh mana-mana kabel atau wayar yang jatuh.
-Awasi kanak-kanak, jangan biarkan mereka bermain-main di longkang, sungai atau lombong.
-Jangan minum air banjir.
SELEPAS BANJIR
-Dengar pengumuman melalui radio atau tunggu arahan pihak yabg berkuasa, jangan kembali ke rumah sebelum dibenarkan atau sebelum keadaan benar-benar selamat.
-Beri bantuan kepada jiran anda atau orang kurang upaya (orang tua, kanak-kanak atau golongan istimewa).
-Periksa rumah anda, lihat tanda-tanda rekahan atau mendapan kerana ianya mengkin tidak selamat.
-Jangan terus memasukki rumah yang masih dibanjiri air, berhati-hati banyak bahaya yang tersembunyi.
SELEPAS BANJIR – SEMASA MEMASUKI BANGUNAN
-Pakai kasut.
-Periksa kerosakkan dinding, lantai, pintu dan tingkap.
-Periksa sebarang kehadiran binatang atau serangga berbisa yang merbahaya. Gunakan kayu untuk mengalihkan sebarang halangan yang bertaburan di lantai rumah anda.
-Perhatikan siling dan plaster dinding yang mungkin rekah, lerai dan jatuh.
SELEPAS BANJIR – PERIKSA ANCAMAN BAHAYA
-Periksa paip saluran gas yang mungkin pecah atau bocor.
-Periksa wayar elektrik yang terendam di dalam air.
-Periksa peralatan elektrik yang tenggelam.
-Periksa bahan-bahan yang mudah terbakar yang mungkin mengalir masuk semasa banjir (Minyak tanah, petrol, diesel dan sebagainya).
-Buang bahan-bahan makanan yang terendam yang terkena banjir termasuklah makanan dalam tin.
-Periksa kerosakan tangki septik untuk mengelakkan bahaya biologi.
-Laporkan sebarang kerosakan kemudahan-kemudahan awam kepada pihak yang berkuasa.
Sumber maklumat: Jabatan Pertahanan Awam Malaysia
Nampaknya hujan masih lagi tak menentu dalam dua tiga hari ni..
Memang dengan kadar taburan hujan yang macam ni tidak akan menyebabkan banjir, tapi kalau nak diikutkan dari tahun yang sebelumnya, banjir tahun ni sudah terlebih lewat dari yang sepatutunya… mungkin ini salah satu kesan dari pemanasan Global yang menyebabkan musim sudah tak menentu…
Tapi sebenarnya aku agak risau dengan keadaan ni, walaupun kampung aku terletak dalam kawasan yang agak tinggi dan boleh dikatakan terselamat dari bencana banjir tapi bencana banjir ni sedikit sebanyak akan turut sama menjejaskan orang ramai..
Dan yang paling aku tak seronok dengar ialah laporan laporan yang mengakibatkan kehilangan nyawa yang dah seakan akan rutin wajip setip kali bencana banjir ni tiba.
Panduan dan Langkah Menghadapi Banjir
PERSEDIAAN SEBELUM BANJIR
-Dapatkan maklumat tentang banjir di tempat anda.
-Pastikan sistem amaran banjir dan dengar hebahan semasa yang disampaikan melalui radio,televisyen dan agensi-agensi kerajaan yang berkenaan serta Bilik-Bilik Gerakan Banjir Negeri atau Daerah yang berhampiran.
-Periksa lubang air seperi longkang atau saluran najis. Bersihkan halangan dan pastikan ia tertutup rapat supaya air banjir tidak masuk melaluinya.
-Pastikan di mana Pusat Pemindahan dan Pusat Bantuan Bencana di tempat anda.
-Sediakan peralatan kecemasan dan bekalan makanan secukupnya.
-Pastikan seluruh keluarga anda mengetahui cara-cara bertindak semasa kecemasan di rumah.
SEBELUM BANJIR – SEMASA TANDA-TANDA DIKESAN
-Dengar melalui pengumuman radio, televisyen atau pihak-pihak tertentu.
-Pindahkan perabut atau peralatan-peralatan lain ke tempat yang selamat.
-Letakkan dokumen penting di tempat yang selamat atau bawa bersama anda dalam bekas kalis air.
-Bersedia untuk menutup suis elektrik, injap utama bekalan air dan gas.
-Beritahu jiran anda dan bersedia untuk berpindah.
SEMASA BANJIR – SEMASA PEMINDAHAN
-Apabila menerima arahan, segeralah berpindah ke pusat-pusat pemindahan yang disediakan.
-Berpindah awal sebelum banjir meningkat atau pada waktu siang kerana ianya lebih mudah dan selamat.
-Ikut laluan yang ditentukan, laluan singkat mungkin terhalang.
SEMASA BANJIR – DI DALAM KENDERAAN
-Jangan terus mengharungi kawasan banjir, hendaklah berpatah balik ke tempat yang selamat.
-Jika kenderaan anda terhenti, kunci kenderaan serta tinggalkan kenderaan tersebut dan pergilah. ke tempat yang selamat
SEMASA BANJIR – DI DALAM RUMAH
-Dengar pengumuman melalui radio, televisyen atau pihak tertentu.
-Bersedia dengan peralatan kecemasan.
-Jika diarahkan keluar dan berpindah, segera lakukan.
SEMASA BANJIR – DI LUAR RUMAH
-Pergi ke tempat tinggi dan selamat.
-Elakkan dari melalui kawasan banjir, arus deras yang boleh menghanyutkan anda.
-Jangan sengaja bersiar-siar di kawasan banjir sama ada dengan sampan mahupun berjalan kaki.
-Jangan sentuh mana-mana kabel atau wayar yang jatuh.
-Awasi kanak-kanak, jangan biarkan mereka bermain-main di longkang, sungai atau lombong.
-Jangan minum air banjir.
SELEPAS BANJIR
-Dengar pengumuman melalui radio atau tunggu arahan pihak yabg berkuasa, jangan kembali ke rumah sebelum dibenarkan atau sebelum keadaan benar-benar selamat.
-Beri bantuan kepada jiran anda atau orang kurang upaya (orang tua, kanak-kanak atau golongan istimewa).
-Periksa rumah anda, lihat tanda-tanda rekahan atau mendapan kerana ianya mengkin tidak selamat.
-Jangan terus memasukki rumah yang masih dibanjiri air, berhati-hati banyak bahaya yang tersembunyi.
SELEPAS BANJIR – SEMASA MEMASUKI BANGUNAN
-Pakai kasut.
-Periksa kerosakkan dinding, lantai, pintu dan tingkap.
-Periksa sebarang kehadiran binatang atau serangga berbisa yang merbahaya. Gunakan kayu untuk mengalihkan sebarang halangan yang bertaburan di lantai rumah anda.
-Perhatikan siling dan plaster dinding yang mungkin rekah, lerai dan jatuh.
SELEPAS BANJIR – PERIKSA ANCAMAN BAHAYA
-Periksa paip saluran gas yang mungkin pecah atau bocor.
-Periksa wayar elektrik yang terendam di dalam air.
-Periksa peralatan elektrik yang tenggelam.
-Periksa bahan-bahan yang mudah terbakar yang mungkin mengalir masuk semasa banjir (Minyak tanah, petrol, diesel dan sebagainya).
-Buang bahan-bahan makanan yang terendam yang terkena banjir termasuklah makanan dalam tin.
-Periksa kerosakan tangki septik untuk mengelakkan bahaya biologi.
-Laporkan sebarang kerosakan kemudahan-kemudahan awam kepada pihak yang berkuasa.
Sumber maklumat: Jabatan Pertahanan Awam Malaysia
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