“I appeal to political leaders, religious leaders, opinion makers, media personnel

and all Indian citizens to place a moratorium on all issues which are impediments

to the development for the nation, from now and pledge ourselves to make the

missions of developed India a reality.

This will be the greatest legacy that we can proudly leave behind for our next

generation. Let us sacrifice our today so that our children can have a better

tomorrow.”

-APJ Abdul Kalam.

We are deeply saddened by the loss of

Dr. Abdul Kalam, Former President of India. May his soul rest in peace.

Telangana Chapter

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Dear Readers and Friends

I am happy to announce that the exclusive web site for Telangana

Chapter is now fully functional with all relevant information on state,

chapters and sheexpress links.

The word CROWD MANAGEMENT is ideal talk for this time. After the

terrible tragedy struck on Day 1 of the Godavari Maha Pushkaralu in

Andhra Pradesh widely regarded as the Maha Kumbh of the South—

as 29 pilgrims were killed and two went missing in a stampede at

Maddhu N C

President:

ASSE Telangana Chapter

around 8.30 in the morning at the holy Pushkara Ghat in Rajahmundry . Among the dead 23

were women. Around 50 persons were also hospitalised at the Rajah mundry Area Hospital, of

which the condition of 15 is said to be critical.

Let’s see what HSE tells about the Crowd Management:

Crowd management to help those organising events to manage crowds safely including the

use of barriers.

Your duties as an event organiser

As an organiser you must as far as reasonably practicable ensure the safety of visiting crowds.

While certain aspects of crowd safety can be allocated to contractors, for example stewarding,

you will retain overall responsibility for ensuring the safety of the public.

What you should know

► Hazards presented by a crowd:

► Crushing between people.

► Crushing against fixed structures, such as barriers.

► Trampling underfoot.

► Surging, swaying or rushing.

► Aggressive behaviour.

► Dangerous behaviour, such as climbing on equipment or throwing objects.

Hazards presented by a venue:

► Slipping or tripping due to inadequately lit areas or poorly maintained floors and the build-

up of rubbish.

► Moving vehicles sharing the same route as pedestrians.

► Collapse of a structure, such as a fence or barrier, which falls onto the crowd.

► People being pushed against objects, such as unguarded, hot cooking equipment on a food

stall.

► Objects, such as stalls, that obstruct movement and cause congestion during busy periods.

► Crowd movements obstructed by people queuing at bars etc.

► Cross flows as people cut through the crowd to get to other areas, such as toilets.

► Failure of equipment, such as turnstiles.

► Sources of fire, such as cooking equipment.

► Assessing the risks and putting controls in place

Carry out an assessment of the risks arising from crowd movement and behaviour as they

arrive, leave and move around the site.

Note: Whether health and safety law will apply on routes to and from the venue will largely de-

pend on the circumstances (other legislation to do with Licensing and traffic law may take prec-

edence). If health and safety law does apply, an organiser’s legal duty regarding crowd safety

will depend on the extent of control they have, which should be judged on a case-by-case basis.

These duties are likely to be shared with others, including the local authority, landowners and

transport providers.

Barriers

Barriers at events serve several purposes, eg:

as an aid to manage and influence the behaviour of the audience; to line routes; and to prevent

the audience climbing on top of temporary structures and putting themselves at risk of falling

to relieve and prevent overcrowding and the build-up of audience pressure

to provide physical security, as in the case of a high-perimeter fence at an outdoor event

to shield hazards from people

If you decide to use barriers and fencing as a crowd management tool, then they should be risk

assessed. Depending on the complexity of the risk and barrier/s, you may need a source of

competent advice to help you.

The factors you should take into account include:

► the planned use of barriers

► layout

► ground conditions and topography

► the presence of underground services, eg water pipes, electric cables that could restrict

the use of pins to secure barriers

► weather

► load on the barrier – wind and/or crowd pressure

► audience numbers and behaviour

These and any other factors peculiar to the location will determine the type of barrier or fence

you select. It is crucial that the type of barrier and fence does not present greater risks than

those they are intended to control. In some cases, barriers have failed due to incorrect selec-

tion.

To install simple barriers like rope and posts is relatively straightforward. However, for more

complex barrier arrangements like stage barriers you may need a competent contractor to do

this for you.

Deploy barriers and fencing with proper crowd management procedures, eg use of stewards

to help achieve an all-round effective management of the risk. If appropriate, consult with a

crowd management director on the use of barriers.

Source : http://www.hse.gov.uk/event-safety/crowd-management.htm

PDF document is available for further studies : http://www.hse.gov.uk/pubns/priced/

hsg154.pdf

What do you do when the thing that is supposed to heal you could actually harm you? A 22-year-old marketing executive from Sion found herself asking this very question last week when she found that her multivitamin pill also contained a very unwanted source of protein. The medicine is manufactured by Nouveau Medicament, under the brand name MA DHA, and it was prescribed to Venkat toto help with her pre- and post-pregnancy vitamin needs Ramya Venkat happened to check the last capsule of the strip of multivitamins, marketed under the brand name MA DHA, when she was about to take it on July 2 and was shocked to find a dead insect lodged inside the translucent capsule. Venkat, who was prescribed the medication by her gynaecologist to help with her pre- and post-pregnancy vitamin needs, had been taking medication for eleven months, including the time when she was pregnant. What surprised her even more was the response of officials of the manufacturer of the medicine, Nouveau Medicament a Chennai-based service provider, manufacturer and supplier of medical equipment and products. Responding to her e-mail, which had a photograph attached, the vice-president of the company said it was “very unfortunate” that there was “some black particle” inside the capsule. Even after it was established that the “black particle” was indeed a dead insect, the company allegedly only offered an apology and a box consisting of 10 strips of the same pills for free. Beginnings, Venkat, who delivered a baby on April 15, said she had been taking the MA DHA capsules on the advice of her gynaecologist since September 2014 and had never examined any of the capsules before consuming them. The contaminated strip was bought on May 13, along with a few other medicines. On the night of July 2, when Venkat was taking the pill, she happened to notice a black spot on it. It was dark and she thought something was stuck on the capsule and tried to scratch it off. When that didn’t work, she held up the translucent capsule against the light and was shocked to see a dead insect inside.

“It was the last pill of the strip and, while watching TV, I happened to take a good look at the capsule before consuming it. I was in a state of shock after seeing the insect and kept wondering whether the entire strip had been contaminated because I had never checked any of the pills before consuming them in the past,” said Venkat. She then checked the strip and found an email address mentioned. As per the information on the foil, the pill belonged to batch no MD 1039. The manufacturing date mentioned on the foil was February 15 and the expiry date was January 2017. Here’s more On July 3, Ramya sent an email to the address mentioned on the foil. She attached a photo and said that she was aghast to see an insect stuck inside the MA DHA pill, which she found absolutely unacceptable. She also said that the incident raised questions on the quality standards followed while manufacturing the medicine. “I am going to contact my doctor to change my prescription. I wouldn’t recommend medicines from Nouveau to anyone,” she said in the mail. Responding to her mail, R Dhevarajan, vice-president of Nouveau Medicament, said he was grateful that she had opted to buy the medication and that it was “very unfortunate that there is some black particle inside the capsule”, which the organisation regretted. The organisation then sent two representatives to Ramya’s residence to confirm her claims. After confirming that the particle was a dead insect, all they allegedly did was apologise for the mistake and offer her another box of the same pills, assuring her that it was a widely prescribed medication for those in need of multivitamins. Venkat has now written to the Food and Drugs Administration and is also planning to approach the consumer court. “The medicine is widely prescribed by doctors, especially during the pre- and post-pregnancy periods. If the manufacturing process is so flawed that a dead insect is found inside the capsule, appropriate action needs to be taken,” she said. The other side “I’ve been with the company for more than 12 years and this is the first time such an incident has taken place. Though we have outsourced the manufacturing of the pills, automatic machinery is used and high standards are maintained. We manufacture millions of MA DHAs in a day and the packets are sealed before they come out of the factory, hence there is no chance of an external party being involved. We can only call it an unfortunate incident and nothing else,” said S Sukumar, Regional Sales Manager, Nouveau Medicament.

FDA speak Harshdeep Kamble, Commissioner of the state Food and Drugs Administration department, told mid-day that stringent action will be taken against the company under the Drugs and Cosmetics Act if the complainant’s claims are found to be true. “We will review the entire batch to which this particular pill belonged. If the claims are found to be true, we will take action against the organisation,” said Kamble. Help is at hand If you find that a food article or medicine is contaminated, complaints can be mailed, along with a bill of the purchased article, sample of the article and its packet to: >> Food & Drugs Administration department Survey No.341 Bandra-Kurla Complex Bandra (E) Mumbai 400 051 Tel: (022) 2659 2363-65/2659 1959 Source : http://www.msn.com/en-in/news/national/mumbai-woman-finds-insect-in-multivitamin-pills/ar-AAcK0PO?ocid=iehp

Last month, I delivered a keynote address at a Health &

Safety Congress in India to an audience of around 100

health and safety professionals. During the course of the

address, I touched upon the subject of Presenteeism and

took a snap poll of how many of them were actually

familiar with the term. Just two hands went up. Discount-

ing the presence of shy participants, it is almost certain

that a very small proportion of health and safety

professionals in that audience actually knew what this

was.

Author : Mr. JC Sekar - UL

I cannot fault them for their ignorance especially when the default setting of

Microsoft Office does not recognize that term and shows it up as a word need-

ing a spelling correction (thus the image of a screen shot from Microsoft Word

for this blog post!).

For those who may not be familiar with the term, presenteesim in a very broad

sense refers to the reduced productivity when employees come to work and

are not fully engaged or perform at lower levels as a result of ill health – wheth-

er it be physical or mental. It is the lesser known cousin of absenteeism which is

familiar to all of us. Various research studies on the topic point out to the fact

that presenteeism is actually a bigger drain on productivity than absenteeism.

Some revealing statistics:

Statistics Canada found that lost productivity from presenteeism was at

least 7.5 times greater than productivity loss from absenteeism and that it is

estimated that presenteeism costs Canadian businesses 15 to 25 billion

dollars per year.

The Centre for Mental Health calculates that presenteeism based on

psychological health problems alone costs the UK economy £15.1bn a year.

Further research in 2010 estimated the cost of presenteeism to be anywhere

between one and seven times the costs of absence.

A study by Bank One (quoted in the Oct 2004 issue of the Harvard Business

Review) estimates that presenteeism, calculated as dollars lost due to illness-

related reductions in productivity accounted for 63% of all medical costs. On

the other hand, disability and absenteeism expenses which are costs paid

when employees are away from work totaled just 12% of total medical costs.

Why is there a lack of acknowledgment for the concept of presenteeism in

corporate culture?

I arrived at a hypothesis when a wise colleague Venki blamed “our obsession

with all things quantitative” for oversights in workplace health and safety in my

previous blog. Presenteeism is one of those things for which there is no easy or

reliable method to measure. We live in a measurement obsessed corporate

world where the cliché “You cannot manage what you do not measure” reigns

supreme. This is so ingrained in our world view that we are constantly managing

(or trying to manage!) what we measure. When it comes to things that we

cannot measure, we choose to not manage them. In other words, in our quest

for measurements, we have probably lost sight of the need to manage those

things that cannot be measured but are still relevant.

What exactly do we mean by “managing” presenteeism and how do we do it?

This is an evolving topic where there is much to research and learn on the possi-

ble approaches. Let me offer a few thoughts:

I guess this goes back to Leadership 101 and requires leaders to create a work

culture that respects employees as a human being with feelings and not as a

revenue generating piece of equipment that needs to be constantly timed and

have his / her output measured. It also requires us to create a culture of mutual

trust where an employee does not hesitate to let an employer know when he /

she is truly unwell without misusing that trust. It requires leaders and employers

to be having that one on one conversation with employees to build that trust.

Leaders should also understand that rewarding employees who put in long hours

at work and looking down at employees who prefer to maintain a work-life

balance encourages a culture where “showing up” at work takes precedence – ir-

respective of their health condition. This is especially the case in a tough eco-

nomic situation where job security is at stake.

As a preventative measure, it requires employers to recognize that employee

wellbeing is not just a welfare measure for an employee but a strategic

imperative that helps an organization with productivity improvement. In this

context, providing for a safe, hygienic and ergonomic workplace should not be

seen as factors that are needed to meet a regulatory requirement but as a

means to manage presenteeism.

As many nations grapple with an ageing work force and strive for productivity

driven growth, presenteeism is a topic that needs urgent attention. Managing

presenteeism requires leaders to recognize its existence and understand the

linkages with workplace health, safety and ergonomics and put in place a work

culture that respects employees and a work environment that protects their

safety and wellbeing.

Do look forward to hearing your thoughts on this subject. Source : https://

www.linkedin.com/pulse/presenteeism-silent-productivity-killer-jc-sekar

Effective housekeeping can eliminate some workplace hazards and help get a job done safely

and properly. Poor housekeeping can frequently contribute to accidents by hiding hazards

that cause injuries. If the sight of paper, debris, clutter and spills is accepted as normal, then

other more serious health and safety hazards may be taken for granted.

Housekeeping is not just cleanliness. It includes keeping work areas neat and orderly;

maintaining halls and floors free of slip and trip hazards; and removing of waste materials

(e.g., paper, cardboard) and other fire hazards from work areas. It also requires paying

attention to important details such as the layout of the whole workplace, aisle marking, the

adequacy of storage facilities, and maintenance. Good housekeeping is also a basic part of

accident and fire prevention.

Effective housekeeping is an ongoing operation: it is not a hit-and-miss clean up done

occasionally. Periodic "panic" cleanups are costly and ineffective in reducing accidents.

What is the purpose of workplace housekeeping?

Poor housekeeping can be a cause of accidents, such as:

tripping over loose objects on floors, stairs and platforms

being hit by falling objects

slipping on greasy, wet or dirty surfaces

striking against projecting, poorly stacked items or misplaced material

cutting, puncturing, or tearing the skin of hands or other parts of the body on projecting nails,

wire or steel strapping

To avoid these hazards, a workplace must "maintain" order throughout a workday. Although

this effort requires a great deal of management and planning, the benefits are many.

Why should we pay attention to housekeeping at work?

What are some benefits of good housekeeping practices?

Effective housekeeping results in:

reduced handling to ease the flow of materials

fewer tripping and slipping accidents in clutter-free and spill-free work areas

decreased fire hazards

lower worker exposures to hazardous substances (e.g. dusts, vapours)

better control of tools and materials, including inventory and supplies

more efficient equipment clean up and maintenance

better hygienic conditions leading to improved health

more effective use of space

reduced property damage by improving preventive maintenance

less janitorial work

improved morale

improved productivity (tools and materials will be easy to find)

How do I plan a good housekeeping program?

A good housekeeping program plans and manages the orderly storage and

movement of materials from point of entry to exit. It includes a material flow plan to

ensure minimal handling. The plan also ensures that work areas are not used as

storage areas by having workers move materials to and from work areas as needed. Part

of the plan could include investing in extra bins and more frequent disposal.

The costs of this investment could be offset by the elimination of repeated handling of

the same material and more effective use of the workers' time. Often, ineffective or

insufficient storage planning results in materials being handled and stored in

hazardous ways. Knowing the plant layout and the movement of materials throughout

the workplace can help plan work procedures.

Worker training is an essential part of any good housekeeping program. Workers need to

know how to work safely with the products they use. They also need to know how to

protect other workers such as by posting signs (e.g., "Wet - Slippery Floor") and

reporting any unusual conditions.

Housekeeping order is "maintained" not "achieved." Cleaning and organization must be

done regularly, not just at the end of the shift. Integrating housekeeping into jobs can

help ensure this is done.

A good housekeeping program identifies and assigns responsibilities for the following:

clean up during the shift

day-to-day clean up

waste disposal

removal of unused materials

inspection to ensure clean up is complete

Do not forget out-of-the-way places such as shelves, basements, sheds, and boiler rooms

that would otherwise be overlooked. The orderly arrangement of operations, tools,

equipment and supplies is an important part of a good housekeeping program. The final

addition to any housekeeping program is inspection. It is the only way to check for

deficiencies in the program so that changes can be made.

The documents on workplace inspection checklists provide a general guide and examples of

checklists for inspecting offices and manufacturing facilities.

What are the elements of an effective housekeeping program?

Dust and Dirt Removal

In some jobs, enclosures and exhaust ventilation systems may fail to collect dust, dirt and

chips adequately. Vacuum cleaners are suitable for removing light dust and dirt. Industrial

models have special fittings for cleaning walls, ceilings, ledges, machinery, and other hard-to

-reach places where dust and dirt may accumulate.

Special-purpose vacuums are useful for removing hazardous substances. For example,

vacuum cleaners fitted with HEPA (high efficiency particulate air) filters may be used to

capture fine particles of asbestos or fibreglass.

Dampening (wetting) floors or using sweeping compounds before sweeping reduces the

amount of airborne dust. The dust and grime that collect in places like shelves, piping,

conduits, light fixtures, reflectors, windows, cupboards and lockers may require manual

cleaning.

Compressed air should not be used for removing dust, dirt or chips from equipment or work

surfaces.

Employee Facilities

Employee facilities need to be adequate, clean and well maintained. Lockers are

necessary for storing employees' personal belongings. Washroom facilities require

cleaning once or more each shift. They also need to have a good supply of soap, towels plus

disinfectants, if needed.

If workers are using hazardous materials, employee facilities should provide special

precautions such as showers, washing facilities and change rooms. Some facilities may

require two locker rooms with showers between. Using such double locker rooms allows

workers to shower off workplace contaminants and prevents them from contaminating their

"street clothes" by keeping their work clothes separated from the clothing that they wear

home.

Smoking, eating or drinking in the work area should be prohibited where toxic materials are

handled. The eating area should be separate from the work area and should be cleaned

properly each shift.

To be continued .. See you in next issue

Health Hazards of Paper Cups Philosopher Ivan Illich said the automobile has increased the general velocity of our lives; and

that increased velocity translates into a perpetual state of crisis. In managing that crisis-like

state, many people grab hit-and-run coffee on the way to work, or just buy paper cups

because they don't have the time or energy to wash the non-disposable kind, which some people

suggest may not be such a great idea.

Wax Build up

Some people had been afflicted with gastrointestinal distress for a long time, and couldn't

figure out what was wrong with them. Doctors also had a hard time identifying the source of the

discomfort, until they got a personal history from these patients. Patients were routinely

drinking hot drinks like coffee, tea and cocoa from paper cups. The paper cups are

impregnated with wax to make them waterproof. The hot liquid melts some of the wax, which is

ingested then builds up along the digestive tract.

Carbon Build up

Even drinking cold drinks in paper cups may affect your health, though not in such a direct way.

Paper cups are made using trees as a feedstock. Cutting trees to make paper products lowers net

carbon sequestration and oxygen production, and amplifies water pollution, which contributes to

poor air and water quality. Moreover; when paper cups are disposed of, they find their way into

landfills, where they break down into methane, another powerful greenhouse gas.

Black Mold

Paper cups stored in dark, humid environments are excellent hosts for Stachybotrys

chartarum, or black mold. Black mold articulates a mycotoxin that can cause asthma attacks,

memory loss and pulmonary hemorrhage. Black mold on paper cups may not be that easy to see

when it first finds a purchase, because the mold attaches to the places where moisture has been

wicked into the cellulose, or the seam around the bottom of the inside of the cup.

BPA

Bisphenol A is a substance that imitates some human hormones. Because human hormones exist

in such a delicate balance in the body, hormone-mimics can disrupt the endocrine

system. Thus, bisphenol A (BPA) is called a hormone disruptor. It is commonly found in plastics,

and several states are considering bans on the many plastic products that contain BPA. One of

those products is paper cups. Not all paper cups are made with plastic impregnated paper, but

some are; some cups made out of recycled paper have been found to contain BPA as well

http://www.ehow.com/info_8527801_health-hazards-paper-cups.html

HEALTH CARE PRACTICE SPECIALITIES—ASSE-T

An operating room may be designed and equipped to provide care to patients with

a range of conditions, or it may be designed and equipped to provide specialized

care to patients with specific conditions.

Description

OR environment

Operating rooms are sterile environments; all personnel wear protective clothing

called scrubs. They also wear shoe covers, masks, caps, eye shields, and other

coverings to prevent the spread of germs. The operating room is brightly lit and the

temperature is very cool; operating rooms are air-conditioned to help prevent

infection.

The patient is brought to the operating room on a wheelchair or bed with wheels

(called a gurney). The patient is transferred from the gurney to the operating table,

which is narrow and has safety straps to keep him or her positioned correctly.

The monitoring equipment and anesthesia used during surgery are usually kept at

the head of the bed. The anesthesiologist sits here to monitor the patient's

condition during surgery.

Depending on the nature of the surgery, various forms of anesthesia or sedation are

administered. The surgical site is cleansed and surrounded by a sterile drape.

The instruments used during a surgical procedure are different for external and

internal treatment; the same tools are not used on the outside and inside of the

body. Once internal surgery is started, the surgeon uses smaller, more delicate

devices.

Operating room equipment

An operating room has special equipment such as respiratory and cardiac support,

emergency resuscitative devices, patient monitors, and diagnostic tools.

Life support and emergency resuscitative equipment

Equipment for life support and emergency resuscitation includes the following:

OPERATING ROOM (OPERATION THEATRE)

Heart-lung bypass machine, also called a cardiopulmonary bypass pump—

takes over for the heart and lungs during some surgeries, especially heart or

lung procedures. The heart-lung machine removes carbon dioxide from the

blood and replaces it with oxygen. A tube is inserted into the aorta to carry

the oxygenated blood from the bypass machine to the aorta for circulation

to the body. The heart-lung machine allows the heart's beating to be stopped

during surgery.

Ventilator (also called a respirator)—assists with or controls pulmonary

ventilation. Ventilators consist of a flexible breathing circuit, gas supply,

heating/humidification mechanism, monitors, and alarms. They are

microprocessor-controlled and programmable, and regulate the volume,

pressure, and flow of respiration.

Infusion pump—device that delivers fluids intravenously or epidurally through

a catheter. Infusion pumps employ automatic, programmable pumping

mechanisms to deliver continuous anesthesia, drugs, and blood infusions to

the patient. The pump hangs from an intravenous pole that is located next to

the patient's bed.

Crash cart—also called resuscitation cart or code cart. A crash cart is a

portable cart containing emergency resuscitation equipment for patients who

are "coding" (i.e., vital signs are in a dangerous range). The emergency

equipment includes a defibrillator, airway intubation devices, resuscitation

bag/mask, and medication box. Crash carts are strategically located in the

operating room for immediate accessibility if a patient experiences

cardiorespiratory failure.

Intra-aortic balloon pump—a device that helps reduce the heart's workload

and helps blood flow to the coronary arteries for patients with unstable

angina, myocardial infarction, or those awaiting organ transplants.

Intra-aortic balloon pumps use a balloon placed in the patient's aorta. The

balloon is on the end of a catheter that is connected to the pump's console,

which displays heart rate, pressure, and electrocardiogram (ECG) readings.

The patient's ECG is used to time the inflation and deflation of the balloon.

Read more: http://www.surgeryencyclopedia.com/La-Pa/Operating-

Room.html#ixzz3gLadXAL2

Operation theatre Safety

HEALTH CARE PRACTICE SPECIALITIES—ASSE-T

Hospital staff delivered

a healthy baby, but the

woman later needed

plastic surgery for burns

sustained in fire started

by diathermic needle.

A woman suffered burns during a cesarean operation

when a fire broke out in the operating room at Sheba

Medical Center in Tel Hashomer in 2008, a report by a

Health Ministry inquiry committee reveals.

Hospital staff had washed the woman with various chemical solutions to sterilize

her before the operation and then dried her off. But when she was brought to the

operating room, the surgeon asked that the relevant areas of her body be washed

down again with an alcohol solution, just to be doubly sure.

The surgeon then cut into her with a diathermic needle. But the instrument, which

uses an electric current, emitted a spark, and when the spark touched the alcohol

on her body, it burst into flame.

After putting out the fire and bandaging her, the staff continued the operation and

delivered a healthy baby. But the woman later needed plastic surgery for the

burns, including a skin transplant in her buttocks and thighs.

Following several earlier cases in which a diathermic needle caused a fire, the

ministry had published rules aimed at preventing such fires. Among other things, it

said the device cannot be used until the patient is completely dry - a rule evidently

not followed in this case.

The inquiry committee noted that the danger of fire is particularly great during

operations, like a cesarean, performed with the legs elevated, since this causes the

alcohol solution to collect under the buttocks.

It also recommended that the ministry require the use of non flammable sheets in

operations involving diathermy. In the Sheba case, the problem was compounded

when the sheets caught fire.

Source : http://www.haaretz.com/print-edition/news/operating-theater-accident-sets-pregnant-woman-alight-1.328110

Rabies is a zoonotic disease (a disease that is transmitted to humans from

animals) that is caused by a virus. The disease affects domestic and wild animals,

and is spread to people through close contact with infectious material, usually

saliva, via bites or scratches.

Rabies is present on all continents with the exception of Antarctica, but more than

95% of human deaths occur in Asia and Africa. Once symptoms of the disease

develop, rabies is nearly always fatal.

Rabies is a neglected disease of poor and vulnerable populations whose deaths are

rarely reported. It occurs mainly in remote rural communities where measures to

prevent dog to human transmission have not been implemented. Under-reporting

of rabies also prevents mobilization of resources from the international community

for the elimination of human dog-mediated rabies.

Symptoms

The incubation period for rabies is typically 1–3 months, but may vary from

<1 week to >1 year. The initial symptoms of rabies are fever and often pain or an

unusual or unexplained tingling, pricking or burning sensation (paraesthesia) at the

wound site.

As the virus spreads through the central nervous system, progressive, fatal

inflammation of the brain and spinal cord develops.

Two forms of the disease can follow. People with furious rabies exhibit signs of

hyperactivity, excited behaviour, hydrophobia and sometimes aerophobia. After a

few days, death occurs by cardio-respiratory arrest.

Paralytic rabies accounts for about 30% of the total number of human cases.

This form of rabies runs a less dramatic and usually longer course than the

furious form. The muscles gradually become paralyzed, starting at the site of

the bite or scratch. A coma slowly develops, and eventually death occurs. The

paralytic form of rabies is often misdiagnosed, contributing to the

under-reporting of the disease.

Diagnosis

No tests are available to diagnose rabies infection in humans before the onset

of clinical disease, and unless the rabies-specific signs of hydrophobia or

aerophobia are present, the clinical diagnosis may be difficult. Human rabies

can be confirmed intra-vitam and post mortem by various diagnostic

techniques aimed at detecting whole virus, viral antigens or nucleic acids in

infected tissues (brain, skin, urine or saliva).

Transmission

People are usually infected following a deep bite or scratch by an infected

animal. Dogs are the main host and transmitter of rabies. They are the source

of infection in all human rabies deaths annually in Asia and Africa.

Bats are the source of most human rabies deaths in the Americas. Bat rabies

has also recently emerged as a public health threat in Australia and western

Europe. Human deaths following exposure to foxes, raccoons, skunks, jackals,

mongooses and other wild carnivore host species are very rare.

Transmission can also occur when infectious material – usually saliva – comes

into direct contact with human mucosa or fresh skin wounds. Human-to-human

transmission by bite is theoretically possible but has never been confirmed.

Rarely, rabies may be contracted by inhalation of virus-containing aerosol or

via transplantation of an infected organ. Ingestion of raw meat or other

tisues from animals infected with rabies is not a source of human infection.

► Post-exposure prophylaxis (PEP)

► Post-exposure prophylaxis (PEP) consists of:

► local treatment of the wound, initiated as soon as possible after exposure;

► a course of potent and effective rabies vaccine that meets WHO

recommendations; and

► the administration of rabies immunoglobulin, if indicated.

► Effective treatment soon after exposure to rabies can prevent the onset of

symptoms and death.

► Local treatment of the wound

Removing the rabies virus at the site of the infection by chemical or physical

means is an effective means of protection. Therefore, prompt local treatment

of all bite wounds and scratches that may be contaminated with rabies virus

is important. Recommended first-aid procedures include immediate and

thorough flushing and washing of the wound for a minimum of 15 minutes

with soap and water, detergent, povidone iodine or other substances that kill

the rabies virus. (http://www.who.int/mediacentre/factsheets/fs099/en/)

In India:

In a rabies endemic country like India where there is sustained dog-to-dog

transmission, every animal bite is suspected as a potentially rabid

animal bite, and treatment should be started immediately after

exposure. Bite by all warm blooded animals necessitates post-exposure

prophylaxis. As rabies is practically 100% fatal, bites by dogs and cats

in particular must be considered as a “medical emergency” and the

“life-saving” post exposure prophylaxis must be provided immediately.

Observation of biting dog/cat: The PEP should be started immediately

after the bite. The observation period of 10 days is valid for dogs and

cats only. The natural history of rabies in mammals other than dogs and

cats is not fully understood and therefore the 10-day observation period is

not applicable.

The treatment may be modified if dog or cat involved remains healthy

throughout the observation period of 10 days by converting

post-exposure prophylaxis to pre-exposure vaccination by skipping the

vaccine dose on day 14 and administering it on day 28 while using Essen

Schedule. While using ID administration complete course of vaccination

should be given irrespective of status of animal.

Download link : National Guidelines on Rabies Prophylaxis – Government of

India

10 Patient Safety Tips for Hospitals—Continuation for July issue

Limit shift durations for medical residents and other hospital staff if possible.

Evidence shows that acute and chronically fatigued medical residents are

more likely to make mistakes. Ensure that residents get ample sleep and

adhere to 80-hour workweek limits. Residents who work 30-hour shifts should

only treat patients for up to 16 hours and should have a 5-hour protected

sleep period between 10 p.m. and 8 a.m.iii Resident Duty Hours: Enhancing

Sleep, Supervision, and Safety is available at http://books.nap.edu/

openbook.php?record_id=12508&page=R1 Link to Exit Disclaimer.

Major foodborne illnesses and causes : Foodborne illnesses are usually

infectious or toxic in nature and caused by bacteria, viruses, parasites or

chemical substances entering the body through contaminated food or water.

Foodborne pathogens can cause severe diarrhoea or debilitating infections

including meningitis. Chemical contamination can lead to acute poisoning or

long-term diseases, such as cancer. Foodborne diseases may lead to

long-lasting disability and death. Examples of unsafe food include uncooked

foods of animal origin, fruits and vegetables contaminated with faeces, and

raw shellfish containing marine biotoxins.

Bacteria:

Salmonella, Campylobacter, and Enterohaemorrhagic Escherichia coli are

among the most common foodborne pathogens that affect millions of people

annually – sometimes with severe and fatal outcomes. Symptoms are fever,

headache, nausea, vomiting, abdominal pain and diarrhoea. Examples of

foods involved in outbreaks of salmonellosis are eggs, poultry and other

products of animal origin. Foodborne cases with Campylobacter are mainly

caused by raw milk, raw or undercooked poultry and drinking

water. Enterohaemorrhagic Escherichia coli is associated with unpasteurized

milk, undercooked meat and fresh fruits and vegetables.

Listeria infection leads to unplanned abortions in pregnant women or death

of newborn babies. Although disease occurrence is relatively low, listeria’s

severe and sometimes fatal health consequences, particularly among infants,

children and the elderly, count them among the most serious foodborne

infections. Listeria is found in unpasteurised dairy products and various

ready-to-eat foods and can grow at refrigeration temperatures.

HEALTH CARE PRACTICE SPECIALITIES—ASSE-T

Vibrio cholerae infects people through contaminated water or food.

Symptoms include abdominal pain, vomiting and profuse watery

diarrhoea, which may lead to severe dehydration and possibly death. Rice,

vegetables, millet gruel and various types of seafood have been implicated

in cholera outbreaks.

Antimicrobials, such as antibiotics, are essential to treat infections caused

by bacteria. However, their overuse and misuse in veterinary and human

medicine has been linked to the emergence and spread of resistant

bacteria, rendering the treatment of infectious diseases ineffective in

animals and humans. Resistant bacteria enter the food chain through the

animals (e.g. Salmonella through chickens). Antimicrobial resistance is one

of the main threats to modern medicine.

Viruses:

Norovirus infections are characterized by nausea, explosive vomiting,

watery diarrhoea and abdominal pain. Hepatitis A virus can cause

long-lasting liver disease and spreads typically through raw or

undercooked seafood or contaminated raw produce. Infected food

handlers are often the source of food contamination.

Parasites:

Some parasites, such as fish-borne trematodes, are only transmitted

through food. Others, for example Echinococcus spp, may infect people

through food or direct contact with animals. Other parasites, such

as Ascaris, Cryptosporidium, Entamoeba histolytica or Giardia, enter the

food chain via water or soil and can contaminate fresh produce.

Prions:

Prions, infectious agents composed of protein, are unique in that they are

associated with specific forms of neurodegenerative disease. Bovine

spongiform encephalopathy (BSE, or "mad cow disease") is a prion disease

in cattle, associated with the variant Creutzfeldt-Jakob Disease (vCJD) in

humans. Consuming bovine products containing specified risk material,

e.g. brain tissue, is the most likely route of transmission of the prion agent

to humans.

The Effects of Workplace Hazards on Female Reproductive Health

National Institute for Occupational Safety and Health - Document

Substances or agents that affect the reproductive health of women or men or

the ability of couples to have healthy children are called reproductive hazards.

Radiation, some chemicals, certain drugs (legal and illegal), cigarettes, some

viruses, and alcohol are examples of reproductive hazards. This pamphlet

focuses on reproductive hazards in the workplace that affect women and their

ability to have healthy children. For information about a pamphlet describing

male reproductive hazards. The harmful effects of a few agents found in the

workplace have been known for many years. For example, more than 100 years

ago, lead was discovered to cause miscarriages, stillbirths, and infertility in

female pottery workers. Rubella (German measles) was recognized as a major

cause of birth defects in the 1940s. However, the causes of most reproductive

health problems are still not known. Many of these problems infertility,

miscarriage, and low birth weight are fairly common occurrences and affect

working and nonworking women.

A reproductive hazard could cause one or more health effects, depending on

when the woman is exposed. For example, exposure to harmful substances

during the first 3 months of pregnancy might cause a birth defect or a

miscarriage. During the last 6 months of pregnancy, exposure to reproductive

hazards could slow the growth of the fetus, affect the development of its brain,

or cause premature labor. Reproductive hazards may not affect every worker or

every pregnancy.

Table 1 (download the document) lists chemical and physical reproductive

hazards for women in the workplace. The list is not complete and is constantly

being revised. Therefore, do not assume that a substance is safe if it is missing

from the list. Table 2 (download the document) lists viruses and other disease-

causing (infectious) agents that are found in some workplaces and that have

harmful reproductive effects in pregnant women.

Workers with immunity through vaccinations or earlier exposures are not

generally at risk from diseases such as hepatitis B, human parvovirus B19,

German measles, or chicken pox. But pregnant workers without prior immunity

should avoid contact with infected children or adults. Workers should also use

good hygienic practices such as frequent handwashing to prevent the spread of

infectious diseases among workers in elementary schools, nursery schools, and

day care centers. Click to download full document.

Continuity for July month issue

Segregation by occupation leads to exposure to particular occupational health

and safety hazards. The type of health risks women face are associated with

their specific working conditions. Certain health disorders are related to

occupations or industries which employ large numbers of women workers. For

example, a high proportion of back injuries of women working in the health

sector is related to the nature of the work and the concentration of women

workers in nursing. Due to the multiple roles they have in society, women

workers have special needs concerning nutrition, lifestyle and reproductive

health. Women have a dual reproductive and economic role as unpaid workers

at home and in the fields, and as paid workers outside the household. A woman

works an average of one to three hours per day longer than a man in the same

society.9 Many women suffer from excessively long hours of work and they

usually have to do the predominant share of the housework as well. Special

health problems can arise from this situation including stress, chronic fatigue,

premature aging and other psycho-social and health effects.

Ergonomic factors and human variability:

Manual handling injuries represent one of the main source of back injury and

musculoskeletal disorders for workers. In the 1960s the maximum permissible

load to be carried by a woman was suggested to be fixed between 15 and 20

kgs which was approximately half of the recommended limit for male workers.

These specifications are still used in the legislation of a number of countries.

However, it is not clear based on which scientific assumption it was decided

that the maximum permissible load for women should be half of that

established for male workers. The presumption may have been based on the

perceived weakness of women at the time. Later studies which estimated the

predicted limits for lifting and carrying in female and male working

populations, based on anthropometric data10 of white Anglo-Saxon workers,

have shown that the capacity range for both groups was very similar.

Mechanical equipment injuries account for a high proportion of all work-related

injuries in all occupations. The design of machinery and equipment has

demonstrated to be a major cause of injury when is not conceived or not used

properly, particularly in the manufacturing industry.

Read more: http://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/

---safework/documents/briefingnote/wcms_146255.pdf

Are there special occupational hazards for women workers?

Continuity for July month issue

• Driver Diverted Attention (DDA)-The diversion of attention away from

activities critical for safe driving toward a competing activity, which may

be result in insufficient or no attention to activities critical for safe driving.

This category of inattention is equivalent to the more traditional

definitions

of “driver distraction”. The authors further divide Driver Diverted Attention

into two subcategories:

DDA driving-related (DDA-DR; between driving-related tasks) is the diversion

of attention away from activities critical for safe driving toward a competing

driving-related activity. <>

Everyone Has a Personal Responsibility

With more portable technology now than ever, driver distractions have risen

to unprecedented numbers. We live in a world where people expect instant,

real time information 24 hours-a-day and those desires do not stop just

because people get behind the wheel. Drivers simply do not realize the

dangers that are posed when they take their eyes and minds off the road and

their hands off the wheel and focus on activities other than driving.

Common sense and personal responsibility are a major part of the solution.

We simply can’t legislate our way out of this problem. It’s up to each and

every person to make sure they pay attention to road. The risks are simply

too high!

Everyone has a role

We all have a stake in this problem and we are all part of the solution. We

must focus our attention on driving, be a good example to our children, our

peers, and our community, and insist that when riding with others they do the

An approach for better Road Safety Culture

Some of effect on Driver Workload / Arousal:

1. Traditional Cruise Control : Reduction: Drivers no longer required to

modulate throttle in response to changes in roadway conditions or road

slope

2. Adaptive Cruise Control ; Reduction : Drivers no longer required to

modulate throttle positions in response to changes in roadway condition,

road slope or movement of surrounded traffic

3. Radial tires: Reduction: steering input less frequent due to reduced vehicle

“wander” due to road imperfections,

4. Improved Road surface: Reduction: Less attention has to be paid to

roadway surface while driving to avoid potential loss of control due to such

hazards such as potholes, seams, or other surface irregularities.

5. Reduction in in-vehicle noise : Reduction: The effort of filtering out such

vehicle-related interferences with concentration substantially increased

overall driver workload

6. On-Dash warning lights: Reduction : Introduction of monitoring features

reduces operator effort formerly spent in monitoring gauges and comparing

current to optimal values

7. Improved Braking: Reduction: Reduced stopping distance results in reduced

area ahead that must be actively monitored by vehicle operator

8. Seat belts / Air bags: Reduction; Decreased potential likelihood of personal

injury in event of accident may result in reduced perceived critically in

avoiding them

9. Improved Steering: Reduction: Decreased “Play” in steering results in

decreased need for driving steering input <>

<> / ** Source ; SAE International, Driver Distraction: Are we Mistaking a symptom for the problem 2013-01-0439

*Source: http://morth.nic.in/index2.asp?slid=311&sublinkid=141&lang=1

► Journal of Eastern Asia Society for Transportation Studies

► http://papers.sae.org/2013-01-0439/

Farmers face many potential dangers in their line of work, from machinery

injuries to chemical exposures, but one danger they can’t see is the sun’s

ultraviolet rays. They spend many hours in the mid-day sun, which is a major risk

factor for all skin cancers, including the most serious, melanoma.

Farmers receive more ultraviolet radiation (UV) exposure than the general

public for many reasons, including:

► Long workdays spent outside in the sun, especially from May-October.

► Sweating may also contribute to UV-related skin damage because it increases

a person’s photosensitivity of the skin, leading to the risk of sunburns.

► Sunscreen comes off when you sweat. Remember to reapply!

► UV radiation reflects off water, sand, concrete, light-colored surfaces and

snow.

► Even when wearing a hat, UV radiation will reflect off the surface and can

damage the skin.

► There are more than 3.5 million new cases of skin cancer in more than 2

million people that will be diagnosed in the United States annually. One

person dies from melanoma every hour in the United States. The risk of

melanoma can be reduced by protecting the skin from the sun and its harmful

ultraviolet rays. Even on a cloudy day, up to 80% of the sun’s ultraviolet rays

can pass through the clouds.

Farmers need to be protective of their bodies when working outdoors. With a

few simple steps, you can be active and protect your skin from the sun:

► Seek shade when appropriate. Avoid the sun’s rays when they are the strong-

est between 10 a.m. and 2 p.m. If your shadow appears to be shorter than

you are, seek shade.

► Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed

hat, and sunglasses, where possible. Ask for a cloth flap that can be secured

to your cap or hardhat to protect the back of the neck.

Un-Told story : Farmers and

Skin Cancer Agriculture Branch

► Generously apply a broad-spectrum, water-resistant sunscreen with a Sun

Protection Factor (SPF) of 30 or more to all exposed skin. “Broad-spectrum”

provides protection from both ultraviolet. A (UVA) and ultraviolet B (UVB)

rays. Reapply approximately every two hours, even on cloudy days, and

after excessive sweating.

► Use extra caution near water, snow, and sand because they reflect and

intensify the damaging rays of the sun, which can increase your chanc-

es of sunburn.

► Avoid tanning beds. Ultraviolet light from the sun and tanning beds can

cause skin cancer and wrinkling. If you want to look tan, consider using a

self-tanning product or spray, but continue to use sunscreen with it.

► Know your spots and be aware of your skin and the moles you have. If you

see any mole or spot on your skin that is changing, itching, bleeding or

growing, see a dermatologist.

Source ; https://www.aad.org/File%20Library/Global%20navigation/For%20the%20public/Skin%20cancer%20prevention%

20downloads/farmers-and-skin-cancer.pdf

Most of the food we buy is packed in plastic, metal or other fabricated

materials. That makes it easy to store and transport, but how can we be sure

food packaging isn’t harmful to our health?

Substances in plastic containers make them flexible The information on

cardboard boxes is printed in typographic paint. Should we be concerned that

these chemicals are in contact with what we eat? To answer that question

scientists at the Joint Research Centre in Italy are studying how various kinds

of packaging and tableware interact with food, chemically.

“The packaging is made of lots of different materials. We have plastics, we

have tinned goods in varnished metal, so we have materials that are not food,

and there’s always a possibility that certain compounds of these materials

could migrate, transfer into the food,” said Catherine Simoneau, a food chemist

at the JRC and head of Europe’s reference laboratory for food contact

materials (EURL-FCM).

Contact with food

It’s not just packaging that’s going under the microscope. Various chemicals

could theoretically get into food from kitchenware and utensils. That is

especially the case for baking ware, such as silicone moulds, which are subjected

to high temperatures. But it is also true for the dishes we eat off.

Eddo Hoekstra, a chemical engineer at JRC, EURL-FCM demonstrated to

Futuris a typical experiment undertaken as part of the research: “While

preparing this dough, we do an experiment – because during the time that

we’re mixing there might be chemicals from this polypropylene bowl migrating

into the dough, and this we’ll find out later by analysing the dough.”

The methods and techniques developed at the JRC are used in national

laboratories across the EU, so the standards are the same across the Union.

The goal is that all European consumers should feel confident about the safety

of food and the tableware they use.

Read more : http://www.euronews.com/2015/07/20/in-touch-with-food-could-chemicals-used-in-packaging-be-harmful/

Could chemicals used in

packaging be harmful?

This is NOT the way to start the holidays. (Obvious? Yes.) Yet, every year,

hundreds of people fall from ladders while hanging decorations.

In November and December 2010, more than 13,000 people were treated in

emergency rooms nationwide from injuries related to holiday decorations. That’s

the largest number of injuries in 8 years.

So, while you might think that you already know how to use a ladder safely, now’s

a good time to review ladder do’s and don’ts.

Always select the correct ladder for the job. That’s one that extends at least 3

feet over the roofline or working surface.

Always place your ladder on level and firm ground. Use leg levelers under the

ladder to level uneven or soft ground. Leg levelers are devices that you can buy

at a hardware or home improvement store.

Make sure the ladder can support both your weight and the load you are putting

on it by checking the ladder’s maximum load rating.

Make sure your straight and adjustable ladders have both slip-resistant feet.

Set up straight, single or extension ladders at about a 75–degree angle. To test

if you have the correct angle, stand up straight with your toes touching the feet

of the ladder as it leans away from you. Extend your arms in front of you. Your

palms should touch the top of the rung that’s at shoulder level.

Don’t use a metal ladder near power lines or electrical equipment. Stick with

wood or fiberglass ladders in these situations and use extra caution. And no

ladder should ever touch a live electric wire.

Check all rung locks and spreader braces on your ladder to make sure they are

set.

Have a helper hold the bottom of the ladder.

Keep ladders away from a door that can be opened.

Only allow one person on a ladder at a time.

LADDER SAFETY

Center your body between the rails of the ladder at all times. Leaning too far

to one side while working is a no-no and can cause you to fall. If you were to

have a belt on, the buckle should never be outside of the right or left rail of

the ladder.

Do not stand on the top three rungs of a straight, single or extension ladder.

Stay off of the ladder’s top step and bucket shelf. Labels on ladders warn you

not to stand on them as well. Don’t try to climb or stand on the rear section

of a stepladder.

Only use a ladder for its intended purpose. And follow the ladder’s instruction

labels.

When you’re done with the ladder, put it away immediately. Never leave a

raised ladder unattended.

Source : http://onsafety.cpsc.gov/blog/2011/12/03/ladder-safety-101/

A 20-year-old man, Boyan Slat, has a promising plan that can help cure one of the major problems Earth is facing right now. He is so motivated to do everything he can and won’t stop until he has succeeded.

20-year old student found a way to clean World’s oceans

You might think he is some kind of a wizard mega-mind who discovered a new

way to fix the Global Crisis. But he is just really the embodiment of hard work,

commitment and preservation of resources. He shares that for him science is a

work in progress.

As you might know, a great part of the surface of the Pacific Ocean is covered

in garbage which is polluting the water and threatening the sea life. The

amount of junk is larger than the State of Texas. Most of it is scattered and

poisons our planet everywhere it floats.

Slat launched an IndieGogo Campaign to raise money for his Ocean Cleanup

Project. His TED Talk on the subject helped his idea to spread around the world

which resulted in earning over $80,000 making his campaign successful. Maybe

the world is concerned about its oceans after all.

On the locations are illustrated the zones where there is on average six times more plastic than zooplankton weight. These areas are known as “gyres”.

But that is not enough for putting the plan into action. Not long ago, Slat

raised over $2-Million and shared that with that money they can make a

“theoretical concept” come true.

Most importantly, he managed to raise the money when there we just two days

left in his campaign. This gave him new and stronger hopes for clean and safe

oceans.

With much more work to be done, Slat has successfully caught the attention of

thousands of people and has done amazing things driven by his strong

dedication and belief in his cause. He has given hope that his idea can become

true and can heal one of the major problems the world is facing right now.

Source ; http://iheartintelligence.com/2014/10/17/clean-the-oceans/

Story Contributor :N C Maulika, ASSE Student Member and proud WISE group member

Source:

https://

www.youtube.com/

watch?

t=153&v=hmPHBhYaC

R4

A China escalator accident has left a mother dead.

The accident took place on Sunday at a shopping mall in China’s Hubei province.

Surveillance footage, which was posted online, shows Xiang Liujuan, 30, riding the

up-escalator with her 2-year-old son. As she reached the top, a metal bar started

to give way, causing the woman and the toddler to stumble, according to the

Washington Post.

As the metal flooring caved in, Xiang was able to shove her son into the arms of a

shopping assistant. Another shopping assistant tried to pull Xiang to safety, but

sadly she was pulled in and swallowed by the escalator.

Witnesses at the shopping mall immediately called for help. When firefighters

arrived at the scene, they spent nearly four hours cutting open the machine to

retrieve Xiang’s body, which showed “no signs of life,” according to the Agence

France-Presse, reported via Yahoo News.

Maintenance workers had just serviced the escalator at the Anliang department

store in Jingzhou in the central province of Hubei, but forgot to screw the metal

floor into place, an unconfirmed report stated.

The footage has outraged China’s social media users, with many questioning why

the shopping mall was so negligent.

“Why didn’t the staffers stop customers at the entrance to the machine or just turn

it off?” one user wrote. “The department store is definitely responsible.”

Woman Swallowed

By Escalator After

Pushing Son To

Safety

“When I saw her fall in I felt awful – but at the same time I felt how strong a

mother’s love can be – during such a sudden event, the mother’s first reaction

was still to push the child away from the gap,” user I am a Promising Youth

said.

This is not the first time that someone has been killed on an escalator in China.

According to AFP, China frequently has safety accidents due to their lax

standards. In 2012, a 9-year-old boy was sucked into an escalator at a Beijing

department store as witnesses looked on, horrified. In 2011, a 13-year-old boy

was killed and more than 20 others were injured after an escalator changed

direction during rush hour.

The shopping mall has not released a statement regarding the accident.

Source : http://www.inquisitr.com/2288117/china-escalator-accident-woman-

swallowed-by-escalator-after-pushing-son-to-safety/