Investigations have concluded that all of these were at least in part attributable to fatigue and human error. ![]() The incidents involving the Bhopal Union Carbide tragedy and the Exxon Valdez, as well as the Estonia ferry incident, all occurred in the early morning hours. This same commission also cited early morning shift work error in a previous near-catastrophic launch of the shuttle Columbia on January 6, 1986. The Presidential Commission on the space shuttle Challenger accident cited the contribution of human error and poor judgment related to sleep loss and shift work during the early morning hours. 1ģ0% increase in human error incidents on night shift relative to morning shift Even the nuclear plant catastrophe at Chernobyl is officially acknowledged to have begun at 1:23 am as the result of human error. When the Racho Seco nuclear reactor near Sacramento, Calif, automatically tripped after DC power to the integrated control system was lost at 4:14 am on December 26, 1985, human errors of omission and commission caused time delays in regaining control of the plant. ![]() The incident reached more critical proportions when an operator in those early morning night shift hours pushed the wrong 2 buttons in the control room, defeating the safety function of the auxiliary feed-water system. Similarly, on June 9, 1985, the Davis–Besse reactor in Oak Harbor, Ohio, went into automatic shutdown followed by a total loss on the main feed water at 1:35 am. The incident at the Three Mile Island nuclear facility in Pennsylvania on March 28, 1979, occurred because night shift workers failed to recognize the loss of core coolant water resulting from a stuck valve between 4:00 am and 6:00 am. The health and safety of the public demands a thoughtful, evidence-based approach to scheduling.Ī look at the time of occurrence of industrial and engineering disasters provides insight into a possible association between human error and circadian rhythm as it relates to shift work (see the box on this page). The unique physiological demands of rotating shift work and night shift work have the potential to negatively impact decision-making ability. In an emergency, public health and emergency management workers may be called on to make judgments and decisions that could significantly impact the health and safety of the public. The Director’s Emergency Operations Center at 8the Centers for Disease Control and Prevention, for instance, may activate a 24-hour response readiness unit that requires a designated lead group, of which the members typically work during usual business hours, to provide 24-hour staffing for the Director’s Emergency Operations Center on a short-term basis. Since September 11, 2001, and the consequent restructuring of the nation’s preparedness and response activities, public health workers are increasingly called on to “gear up” preparedness and response activities by activating a round-the-clock staffing schedule. For example, when a natural disaster strikes, emergency management officials mount an emergency response that requires 24-hours-a-day service rather than business as usual. ![]() WHEN EMERGENCIES ARISE, some organizations for which the work responsibilities are generally during business hours need to provide surveillance, advice, and consultation 24 hours a day.
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