Decisions made by emergency services personnel about whether or not to take risks in fraught situations have been the subject of much negative media attention recently, so Bill Gough outlines the issues facing ‘first responders’ and suggests ways in which their managers can help them do the right thing – for themselves and those who need their help.
The civil emergency rescue services meet the challenges of safety in the workplace in much the same ways as any responsible employer. They respond to and observe legislation and regulation as all employers should, ensuring all the components of successful health and safety management are in place, regularly scrutinised, and reviewed at responsible intervals. In fact, it is fair to say that the emergency rescue services expose their risk management arrangements to external and peer review more so than many other employing organisations.
However, as responsible employers they also face a unique challenge – managing risk at the many chaotic, rapidly-changing, often life-threatening incidents they attend, which are, essentially, their normal places of work. Such environments are not exempt from the need to conduct a “suitable and sufficient” risk assessment, and the emergency rescue services satisfy this requirement through the application of dynamic risk assessment (DRA).1
It was the circumstances surrounding the tragic death of 10-year-old Jordan Lyon in Bolton last year that served to raise the profile of DRA. This was the case where two Police Community Support Officers (PCSOs) were publicly castigated for not attempting a rescue, having been ordered not to by managers via their personal radios. This incident clearly demonstrated the dilemma faced by a particular section of the emergency rescue services – those that are first on the scene, when chaos is at its height and information on which to react to the circumstances is often based on observation, sometimes enhanced by confusing communication from onlookers at the scene.
These are the first responders of the emergency rescue services (1ERS), the group who, in the case of the Fire and Rescue Service, may be several in number, or, in the case of the Ambulance Service, Police, Coastguard, and similar rescue organisations, may, on some occasions, be alone or accompanied by only one other.
The public outcry and media furore that followed the Bolton case resulted in a wealth of negative publicity for health and safety in the media. The managers involved defended both the PCSOs and the rule-based, risk-management doctrine on which the policy was based.
This was also the response of coastguard managers, who admonished a member of a cliff-rescue team for breaching health and safety regulations in the rescue of a 13-year-old girl from a crumbling cliff face in East Cleveland last year.2 The outcome for the highly-trained, competent, and commended cliff-rescue specialist was resignation after 13 years as an emergency rescue volunteer.
Clear and present danger
No doubt there have been many more such incidents where 1ERS have found themselves dealing with incident dynamics, in which immediate threat to life often calls for decisions between risk-taking and potential benefit to be taken in the blink of an eye. This is the environment of DRA where rapid assessment of hazard is required in order for the competent rescuer to decide on appropriate risk-control measures and any associated risk-taking behaviour.
The public expectation that 1ERS should put the safety of the victim before their own was graphically demonstrated by the media-fuelled public reaction to the Jordan Lyon tragedy. Indeed, the shadow home secretary, David Davis, was widely quoted as saying that a Conservative government would sweep away dozens of health and safety rules, and would rebalance the system to ensure that protecting the public would take precedence over risk to members of the emergency rescue services.
However, it is also clear that the expectation of 1ERS’ managers – who are responsible for creating the systems of work that will always have a dynamic dimension, particularly when life is at risk – is that 1ERS will observe the rules and risk-averse rules, often carefully blended with the influence of the litigator. This leaves 1ERS stuck between the proverbial rock and a hard place when facing ‘eye-blink’ risk and benefit decisions – they are damned if they do and damned if they don’t.
In reality, the expectation of the public, politicians, the media, and employers should be that, when faced with having to make risk and benefit decisions in a life-threatening situation, 1ERS will act appropriately in the best interests of victim safety. This means that outside of the normal training and development of competence and understanding of systems of work, managers must recognise the risk-taking paradox and acknowledge that it is 1ERS who face the moral dilemma at the scene, where family members expect action, but rules – and their associated blame and fear – at worst, prevent or, at best, delay intervention.
This means that managers must develop a doctrine that accepts that on (fortunately) rare occasions, 1ERS will find themselves in a high-risk but high-benefit situation, without the luxury of time to put into effect all the control measures required by an ideal safe system of work. By adopting such a doctrine, 1ERS will be better prepared for safe risk-taking.
The risk paradox
In its report Reducing Risk, Protecting People,3 the HSE explored the concept of a Tolerability of Risk Framework (TOR), making it clear that there can be an unacceptable level of risk, whatever the levels of benefit associated with risk-taking activity – circumstances where the activity would be too hazardous unless it could be modified to reduce the degree of risk to a more tolerable level. This reflects the process of DRA, where control measures should be sought to reduce the level of risk to an acceptable level.
However, the HSE recognised the risk paradox faced by 1ERS by also stating that TOR should be used with flexibility and common sense, and acknowledging that “certain activities are undertaken, which would fall into the intolerable region for a short period of time, e.g. when the emergency services are engaged in saving life”.
In his discussion on the predictability of risk when undertaking DRA, Duncan Spencer argued that even the situations faced by 1ERS have an element of predictability and are less dynamic than believed.4 Holding the view that “on those occasions when an employee does recognise that the existing risk-control strategy is inadequate they need to know how to adapt the working method, or add to the existing risk controls there and then, to reduce the risks back down to a tolerable level”.
Indeed, it is probably true to say that, in many of the situations encountered by 1ERS, risk is not dynamic. A still-water rescue is generic, as are many aspects of cliff rescue; the real dynamics lie in the situation of the victims, which results in dynamic time constraints. Spencer fails to recognise that society will not accept the doctrine that: “If neither is an option, they should know to stop the job if the risk is too great.”
Flexibility and common sense
Managers of 1ERS must recognise that a time will come when their staff will face the need to take risk safely, and so must prepare them to do so with decision-making options built on makeshift minimum levels of control. And, if regulators can accept ‘flexibility and common sense’, so should the litigator.
As managers sit at their desks and write rule-based procedures for 1ERS, they try to capture as many ‘what if?’ scenarios as possible, and so produce extensive, bullet-pointed lists designed to influence behaviour in circumstances where, at best, only one or two points can be recalled in the decision-making split second.
It has long been recognised that 1ERS use recognition of previous experiences to drive these responsive decisions. Known as Recognition Primed Decision-making (RPD),5 it is this that should be in the mind of the rule-writers, if Spencer’s view that “risk prediction is not an exact science” is accepted.
Instead of writing a 20-page list of rules, which, if it is not followed, results in admonishment, they should be providing two or three ‘priming statements’, which, along with developing their repertoire of skills, knowledge and competence, can be impressed on 1ERS and recalled when they encounter a life at immediate risk.
This is not to say that managers should accept ‘gung-ho’ behaviour; rather, they should adopt a doctrine that prepares 1ERS for safer risk-taking in those circumstances that their managers and the rule-writers don’t encounter.
This can only be achieved by enabling 1ERS themselves to be part of the rule-writing process. They should be called upon to analyse worst-case encounters from their specific discipline – those incidents and situations where, owing to the immediate threat to life, intervention called for solutions outside the formal procedure. Taking the form of Critical Decision Exercises (CDEs) based on case study, 1ERS should begin to understand minimum levels of control relating to the risk/benefit decisions involved, and acknowledge how responses can be ‘primed’ in the mind of those facing similar situations.
Ultimately, this would simply be a smarter way of using the lessons of debrief and post-event review. If both successful and unsuccessful interventions are analysed in this way, 1ERS could build a repertoire of priming statements, which, as in the now-accepted cognitive process of RPD, would influence action or reaction in life-threatening circumstances.
Although such a risk-taking doctrine calls for a significant cultural shift for the rule-based emergency rescue services, it nevertheless recognises that 1ERS – and only 1ERS – face the risk-taking paradox of the dynamic situations they encounter and, when tempted to claim the moral high ground, their managers should recognise that, when faced with the need to “do something”, society clearly expects that 1ERS will, and prepare them to do so while remaining as safe as possible.
References
1 Home Office (1998): Dynamic Management of Risk at Operational Incidents – A Fire Service Guide, (pamphlet), HMSO, London
2 To read SHP’s original story, visit www.shponline.co.uk/article.asp?pagename=
archive&article_id=7084
3 HSE (2001): Reducing Risk, Protecting People, HSE Books
4 Spencer, D (2005): ‘Expect the unexpected’, in SHP Sept 2005, Vol.23 No.9, pp43-44
5 Klein, G, Klinger, D (1991): ‘Naturalistic Decision-Making, Human Systems’, in IAC Gateway, Vol.XI,No.3, pp16-19
Bill Gough is one of the longest-serving operational officers in the British Fire and Rescue Service
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