1、Lessons Learned Entry: 1721Lesson Info:a71 Lesson Number: 1721a71 Lesson Date: 2006-03-14a71 Submitting Organization: JSCa71 Submitted by: Ron MontagueSubject: Emergency Pre-planning System Abstract: A system of pre-start tasks ane emergency plannning ameliorated the effects of an arc blast to an em
2、ployee.Description of Driving Event: An electrician suffered burns from an electrical arc/blast when a pre-existing condition in a power distribution panel ultimately led to a ground fault in a 3-phase 480-volt power supply. The pre-existing condition was believed to be an access panel fastener that
3、 had penetrated conductor insulation. The response of local emergency resources to the mishap was exemplary, but would have been delayed if the injured worker had not just done his own safety task analysis just before the mishap. The safety task analysis included among other things locating fire ala
4、rm pull boxes and extinguishers; who to call in case of an emergency; what hazards were in place in the work area; etc. This safety task analysis is routinely performed before each task to ensure that risks are minimized prior to start of work. Because the worker pulled the alarm box within ten seco
5、nds after being injured, emergency response teams responded and were at the scene within 3 minutes of the event. Response was initiated before detectors triggered alarms at the Emergency Operations Center and the fire station. The employee was already showing signs of shock upon arrival of fire prot
6、ection specialists who administered first aid until the paramedics arrived a couple minutes later. The patient was transported to a downtown hospital?s burn unit and arrived within 40 minutes of the emergency. At the same time first aid was being administered, additional fire protection specialists
7、began to fight Provided by IHSNot for ResaleNo reproduction or networking permitted without license from IHS-,-,-the small fire in the building. The fire was extinguished immediately with a dry chemical extinguisher and before the fire suppression system was triggered. Damage/loss of mission-critica
8、l equipment and facilities was averted. The reported community standard for emergency response is for resources to arrive at the scene within 30 minutes of notification. Without a working fire suppression system in place, total building involvement would have occurred. The presence of onsite resourc
9、es plus the pre-established response by the employee reduced response time to 3 minutes. Because everything was in place ? employee response, systems in place, and resources ready - the injured employee was stabilized rapidly and the damage incurred was restricted to the failed equipment.Lesson(s) L
10、earned: Conducting pre-start job safety analyses and job hazard assessments ensures success in emergency situationsRecommendation(s): 1. Consider benchmarking the distribution of emergency response resources at JSC as a ?best practice? for all NASA centers.Evidence of Recurrence Control Effectivenes
11、s: N/ADocuments Related to Lesson: N/AMission Directorate(s): N/AAdditional Key Phrase(s): a71 Additional Categories.a71 Additional Categories.Emergency Preparednessa71 Additional Categories.Facilitiesa71 Additional Categories.Human Factorsa71 Additional Categories.Human Resources & Educationa71 Add
12、itional Categories.Industrial OperationsProvided by IHSNot for ResaleNo reproduction or networking permitted without license from IHS-,-,-a71 Additional Categories.Personal Protective Equipmenta71 Additional Categories.Policy & Planninga71 Additional Categories.Risk Management/Assessmenta71 Additional Categories.Safety & Mission AssuranceAdditional Info: a71 Project: N/AApproval Info: a71 Approval Date: 2006-06-30a71 Approval Name: tmasona71 Approval Organization: HQProvided by IHSNot for ResaleNo reproduction or networking permitted without license from IHS-,-,-
