Non Accidental Death

• Non-accidental death is the death of a company or contractor employee due to suicide or a non-work related illness occurring in the work environment i.e death in company or contractor premises.

• NAD has to be reported to the relevant supervisor, medical personnel and HSE department as soon as possible within 24 hours.

• NAD shall be investigated and line has to initiate the investigation and submit NAD report within one month. Line manger or director is the incident owner.

When you conduct NAD investigate ask yourself 5 questions1. Have all possible work related exposures that could have

contributed to the cause of death been excluded?2. Was the fitness to work requirements met?3. Was the MER requirements met?4. Were all other relevant requirements of HSE control framework to

protect the individuals’ health from cause of death in place?5. Was a PDO doctor part of the investigation team?

Non Accidental Death - Examples

Case ClassificationEmployee commits suicide at work but due to work related issues

Work related fatality

Employee commits suicide at work due to personal home pressures

NAD

Employee falls ill at site but dies later in hospital due to same illness

NAD

Employee has a non work related illness (e.g. stroke, whilst resting off duty in the work camp

NAD

Employee dies at home from non work related illness

Death in service

Employee dies from on work related illness whilst in hotel away on business

Death in service

Employee dies from a fatal occupational illness Work related fatality

Non Accidental Death - Challenges1. Remain a challenge in PDO concession area, mostly among

contracting community

2. No known prior medical condition(s) in 1/2 of the NADs.

3. Most appeared to have valid FtW certificates.

4. No significant findings during routine 2 yearly medical.

5. No appropriate follow up chronic medical conditions and health risk factors in Many of the employee.

6. Life style issues, employees denial of medical problems and ignorance of medical advice

7. The common risk factors include smoking, HTN, high cholesterol and diabetes

8. Issues with return to work following significant illnesses.

NAD – Challenges cont.

9. Lack of Proactive leadership by contract holders on OH inadequate in verifying compliance with OH specifications by the contractors (e.g pre-employment medicals, medical facilities, HRAs, camps standards etc).

10. Recent observed incidents of suicides.

11. Inappropriate medical facilities in some locations or rigs e.g.

12. Investigations often not solid conclusive with difficulties in conducting autopsy in many cases.

13. MER issues including competence of Contractors’ doctors and nurses, shortage of drugs and MER equipments.

14. Increased size of workforce - Over 55,000 workforce as oppose to the supervisors/contract holder’s ratio.

The main factors to NADsChallenge Causes

1 Pre-existing conditions HTN, Diabetes, High cholesterol level

2 Individual behaviors and life style issues

Lack of exercise, Heavy smoking, Over eating, obesity, etc.

3 Attitude, culture and beliefs issues Bad beliefs, Fears, Ignorance of medical advice and denial.

4 Non-compliance with FTW Standards and medical surveillance

Issue of appropriate exams.

5 Issues with return to work medicals Ignorance v/s fear of losing job

6 Occasional no follow up of cases with chronic medical problems.

Inappropriate follow up and care of chronic medical conditions

7 Lack of health awareness Language diversity

NAD -Epidemiology

Over 80% are due to massive heart attack or other cardiovascular disease. 11% unknown 1% suicide

PDO and contractors’ death rate of 0.49 is well below the national rate of 3.1.

PDO and contractors’ death rate from cardiovascular diseases in 2008 was 0.35 per 1000 population.

The national death rate from cardiovascular diseases was 4.09 per 1000 population for Oman and 4.28 per 1000 population for India according to WHO data base.

Percentage distribution of the workforce (PDO and Contractors

%Omanis %Expatriates Total Population

PDO 77% 23% 6500

Contractors 49% 51% >50000

NAD according to company

PDO - 14%

Contractor - 86%- 30% Oman- 65% India/Pakistan/Bangladesh- 3% Philippines- 2% Other countries

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

5

10

15

20

25

1513

108 8

11

8

11

18

15

21

17 16

13

7

Non-Accidental Death Cases 1998-2012

NADs Total manhours (mln.) rate/mln hours

1998 15 59.31 0.253

1999 13 52.81 0.256

2000 10 51.62 0.194

2001 8 48.47 0.165

2002 8 53.39 0.150

2003 11 60.87 0.181

2004 8 67.21 0.119

2005 11 64.26 0.171

2006 18 78.84 0.228

2007 15 99.62 0.151

2008 21 127.06 0.165

2009 17 147.07 0.116

2010 16 147.93 0.108

2011 13 141.24 0.092

2012 7 149.15 0.047

2013 9 158.49 0.057

My apologies for late response.

20-30 31-40 41-50 51-610

2

4

6

8

10

12

NADs

Age distribution of NADs

NADs assessment against some demography and MHMS standards (Dr. Sawai review - 2008)

No. of NADs Percentages

Omanis / Non-Omanis 7 / 14 33.4% /66.6%

PDO / Contractors 3 / 18 14.3% / 85.7%

No HRA performed 9 45%

Pre-existing medical problems 11 55%

Non-compliance to fitness to work (FtW) 10 47%

Cases with significant life style issues 9 45%

Failure to properly follow up chronic medical problems

6 28.5%

Medical emergency response (MER) 5 25%

NAD - PDO Efforts Over the years PDO has made much efforts in order to improve the

well being of its workforce and to address health and lifestyle issues.

These efforts continues today and include: The appointment of full time Head of OH in 2008 and the recent

merger of OH and Medical Dept. as one Health Team – Nov. 2011 which ensures the implementation of Minimal health management STD.

The appointment of full time Public Health Advisor and full time Dietician /nutritionist in 2012

Improved working and living Conditions(permanent accommodation for contractors, PACs)

Annual 1 month OH Road Shows to educate workers on various health topics including life style

NAD reporting and investigations- All NAD are now being discussed at MDIRC

NAD - PDO Efforts cont. OH plan Conducted OH workshop for all HSE managers, Contract holders and

PDO/Contractor medical professionals to increase OH awareness, within PDO concession area.

Training of doctors who provide FtW medical for contracting workforce and emphasize on the importance of compliance with FTW standards, the medical conditions which affect fitness to work and the follow up of high risk cases.

Just completed 5 days OH course by UAE/Irish University for 30 doctors.

Annual wellness walk and OH road shows in all interior locations.

Continue to play a leading role in OH in Oman. Provide advice, support and training to MoH, SQUH graduates.

NAD - PDO Efforts cont. Dietitian / Nutritional services and wellness program.

The appointment of full time Dietitian to look after dietary aspect of welfare of the workforce by working with catering services to improve healthy diets. The goal is to reduce the increasing trends in lifestyle related medical conditions

Stepped up workplace wellness programs in order to improve the well being of the workforce and to address health and lifestyle issues through health promotion and health education presentation. Over 670 employees received dietetic consultations in 2013.

Introduced in-house exercise facility (GYM) to encourage employee to participate in regular exercise.

PDO Efforts - continue

Public Health and Employees’ Welfare

The appointment of full time Public Health Advisor, and Welfare (Employee assistance program) Officer to support Public Health activities and the welfare of contracting community /workforce.

Improvement of the workforce welfare- PAC accommodation and supervision of camp services and hygiene including catering services.

Review of the work-leave schedule for the contractors’ workforce. (Need enforcement)

Discussion underway to look into providing Employee Assistance Program (EAP) with focus on welfare of contracting community/workforce impacting on health

NAD - PDO Efforts cont.

Medical Emergency Response (MER)

All PDO health professionals are fully versed in MER, trained in ACLS, ATLS, and Exposure to other emergency response experiences.

Procedure in place to ensure all contractors’ nurses and

doctors are well versed in MER and have valid ACLS/ ATLS.

Increased number of Designated First Aiders and introduction of the new AHA accredited First Aid course.

New fleet of ambulance is in place and 6 new paramedics have been trained to replace ambulance drivers.

Regular drills (Needs improvements)

2014 planned activities. Centralization of contractor medical services

The phasing out of small clinics manned by single nurse and provide centralized facilities manned by doctors who will be able to follow up chronic medical conditions which increased risk of heart attack and other causes of sudden death.

Stepped up workplace wellness programs with the goal to reduce the increasing trends in lifestyle related medical conditions. This includes the smoking cessation clinic.

Enhanced implementation of smoking, Drug & alcohol policy.

Enhanced implementation evaluation of pre-employment and fitness to work medical evaluation in PDO and contractor workforce.