Preventing illness and disease in tunnel construction workers

Preventing illness and disease in tunnel construction workers


(upbeat music) – So I was fortunate enough to receive a Churchill Fellowship in 2016. My Churchill Fellowship was on
investigating best practice, to prevent illness and disease, in tunnel construction workers. I’m going to go through a very
high level presentation, of some of the gold I found
as part of that journey. To kick it off, I thought
I’d set the context. I want you to think about
how much energy, effort, systems and resources we all put into preventing one fatality due to a safety incident at
work, each and every year. It’s money well spent, it’s systems and resources well spent, but how much energy, effort,
systems and resources do we put into preventing fatality due to illness and disease? Because this is how many
men and women by comparison, will actually succumb
to fatality due to that. The ratio is one to eight. So have a think about within
your own organisations, how much focus do you put on
health, in addition to safety? They’re both incredibly important, however sometimes I think
the balance is skewed. To put it into context
in the tunnel industry, we’ll plan to tunnel further
in the next seven years, than we have in more than
the past two decades. Almost two thirds of all the tunnelling, in Australia occurs in Sydney, and all tunnelling will encounter shale and Hawkesbury sandstone. That sandstone, and to
a smaller extent shale, mainly consists of quartz, and tunnelling through any
quartz containing rock generates a carcinogenic dust, known as respirable crystalline silica. Over exposure to silica dust is known to cause an incurable
disease called silicosis, as well as lung cancer, and the risk of developing silicosis from
exposure to silica dust, at our current legal limit,
over a worker’s working life, is estimated to be anywhere
from 12% to 77% of workers. However, silica from
freshly fractured rock is more toxic than any
other type of silica dust, and during tunnel construction, crystalline silica
exposures have been measured to be more than 20 times that legal limit. The common last line of defense supplied to protect the health
of our tunnel workers can tend to be the P2 dust mask. But to put that into perspective, I thought I’d use this picture from Work Health and Safety
Queensland of a five cent coin, to try to show just how
much that legal limit, or that workplace exposure
standard is for silica dust. Now, this small amount of dust represents the workplace exposure
standard, like the daily exposure, for silica dust at the
moment in Australia. Now I want you to cast your mind back, to every single construction project
that you’ve ever driven by, and think about how much
dust you actually saw coming out of that basement
excavation, for example. It’s probably a little bit more, than what is shown on the screen. This is a snapshot of
Australian tunnelling, in terms of kilometres to be tunnelled over time, from 1995 to 2021. We’re obviously in the peak
of an infrastructure boom, but it presents an opportune
time at this point, to not only look outwards internationally, but also learn from our past. It was at this point that a thought, what a great opportunity to actually go and try to get a Churchill Fellowship, so that we can actually go and have a look at international best practice and see what we can be doing better
in Australian tunnelling. As part of the Churchill
Fellowship I visited quite a number of major tunnel projects, including the Thames Tideway in the UK, Crossrail High Speed Rail 2, Belchen Renovation
Tunnel, AlpTransit Gotthard and a number of projects in the US, including the SR-99 Alaskan
Way Viaduct, which was amazing. I also visited some research institutions, and some major conferences, such as the World Tunnel
Congress in Norway. But before I went I spent a lot
of time actually looking at existing best practice
frameworks for health and safety, to establish eight
elements for investigation. The first and the most
important was leadership. Because I wanted to understand
what impact leadership had, on actually driving better health outcomes for tunnel workers at
the tunnel face per se. I wanted to look at the impacts of and the importance for health in design. How well international organisations were at engagement and collaboration. I wanted to look at standards, both contractual and legal standards. I wanted to look at targeted management, or things that would specifically reduce silica dust exposure,
versus program management, which is the systematic way that a health and safety system is applied. I wanted to look at training
and awareness campaigns, and what could we be doing better. And lastly, and also most
importantly, sustainability. How can we make sure that any initiative that we do in Australia is sustainable, and actually is retained
no matter who is in charge, or who is delivering that tunnel project. So I’ll start with leadership. I found that visible and
effective leadership, actually starting with
the client organisation, was found to be an
essential part of preventing illness and disease by the
time work has started on site. How many of you put
that level of leadership and importance on health in
the way that you do business? Because internationally,
it’s very very strong. Leadership at that client
level was demonstrated to create more stakeholders
that also began to drive health within
their own organisations. And focusing on occupational health, started way at the beginning,
in the design stage, before tenders were awarded, and they continued to
be promoted and outlined through contractual
requirements and tender evaluation. Therefore, the clients made
it very clear from the outset, to all contractors what
the standard would be, there was no surprises. Internationally, I found
some great examples in the UK on engagement and collaboration. I saw that groups such as the
BOHS, Breathe Freely Campaign. Some initiatives through the
transforming tunnel safety groups, allowed multiple projects, to actually come together
and share knowledge, so that good practices were adopted, earlier than they may have been otherwise. These industry groups
both raised awareness, but also drove best practice approach beyond mere compliance, and engagement with research partners enabled
a greater understanding of the magnitude of the issues, leading to better control
measures being implemented. In Norway for example,
they have a really good collaboration with local
research institutions, and Thames Tideway have
a really good partnership with Loughborough University. So it’s great at Sydney Metro that we have that type of relationship
with RMIT as well. Internationally I found
some great examples of training and awareness campaigns. For those that haven’t seen this, this is from Crossrails’
Health and Safety Impact series, it’s called Jenny’s Story. It’s a very short video that helps raise awareness of silica dust exposure, and things like this highlighted, that we need to be doing
more than a simple poster in a crib shed sort of campaign. Not to say that they’re not useful, but internationally they’re doing more. I also found some great
initiatives in the US. The use of helmet-cam, or a lapel camera, linked to a real-time dust monitor, which was able to help workers
and occupational hygienists, and health and safety professionals, actually look at where
peak sources of exposure were happening in the
underground environment. A really good example might be, that you find peaks of exposure when heavy plant operator’s might sit down in a fabric seat for example, but you wouldn’t actually see that dust, when you’re doing your
day to day activity. Construction and tunnelling
projects internationally, have mandated targeted
contractual requirements, or refer to legal standards
that are more stringent, than what we have in Australia. Some countries have fantastic and very high grade legal requirements, and where they’re not there
then they’re countered by very detailed contractual requirements, by the client to close that gap. I found internationally that ongoing, independent verification
of exposure controls, or things that should be in place, by some authority able to stop the work, has demonstrated to drive compliance and further improvements and therefore, lower risk of disease development. Really good examples of that would be, the UK, Switzerland and the USA. When it came to health in design, I saw that addressing health, way at the beginning in the design stage, resulted in many more
higher order controls being able to be applied
prior to construction, so not leaving it to
the construction teams. If health risks weren’t
able to be eliminated, which is pretty rare for them to be able to be in construction, then there was a requirement
to demonstrate internationally how those health risks could be managed, all the way through
the project life cycle, through to O&M. So program risk management
was really interesting, as part of the Fellowship. I found that occupational
hygiene as a discipline, was managed together
with occupational health and well being as a holistic approach. Appreciating that for example, it’s great to have a well being program, but what are we actually
doing about preventing exposures to things that actually
cause illness and disease? And what are we doing about that worker’s health from a
clinical perspective? So I found it managed
really well internationally. A great example is in the UK. I found that initial health risk assessments were used to drive decisions on controls, monitoring and health surveillance, as is the case at Sydney Metro. Health surveillance through
occupational physicians, complemented by competent
health clinical services, and a standardised approach, for what is deemed fit for duty, and a centralised collection
of data was observed, and by doing that it enables
people to look at trends, which then informs future
interventions and policy. At the moment in Australia this
area is incredibly lacking, because we don’t have a centralised health surveillance system, so we’re not able to
have that sort of data. There were many control measures that were observed internationally
to specifically control exposures to silica dust, and I’ll say that many of
these are not new to Australia. I’ve worked on many tunnelling projects, where I’ve seen these
implemented incredibly well. But what tends to fail us
on some of these projects, is that they’re not always
implemented each and every time, and they’re not consistently applied. That really goes back to leadership, and the requirement to have it
in place in the first place. Internationally, every
tunnelling project in the UK has or is in the process of developing, some form of legacy learning website. Things like that ensures
that good information is captured while fantastic
team members are on the project, and you don’t lose that good information, when they go to the next tunnelling project that inevitably pops up. Also the use of benchmarking tools, like the Occupational
Health Maturity Matrix, which is one to six scale, which is used to rank contractors in terms of their maturity
in their systems, in terms of managing occupational
health were observed to really drive best practice, and perhaps some healthy competition. So in summary what is best practice? Well I found that best practice involves leadership driven by the client, but working in collaboration with a very competent contractor, and complemented by a strong regulator. I found that it involves major projects engaging and collaborating
throughout the supply chain, also with research institutions, and with other major projects. I found that health medical
surveillance and wellbeing, being managed holistically
is best practice. And contractual requirements
and tender evaluation, occurring for health aspects, in addition to safety is very important. There were many tools
available to assess and control risks to health, but
best practice involves them being implemented
each and every time. And the use of performance metrics, that really push best practice, has resulted in healthy competition, and a better control of health risks. Knowledge sharing is commonplace, across legacy websites and
industry forums such as today. So the Churchill Fellowship demonstrated some key areas for improvement
for us in Australia. The first is leadership and the importance of such leadership across all operating client organisations in the importance of health in addition to safety. The second was to improve the way, and the amount of collaboration
and engagement we have, across all our major tunnelling projects. The third was to strengthen our standards as an industry both legal and contractual, and to increase training and
awareness around silica dust, and lastly to improve our
processes of health surveillance. The Churchill Fellowship
report was published on the Churchill Trust
website in July of last year, so a lot has happened since that time. A lot of work has been done by our health and safety regulator,
SafeWork NSW. A lot of work has been
done by many clients, and fantastic tunnelling contractors, many of whom are in this room, and through the Australasian
Tunnelling Society, and the formation of an
Air Quality Working Group. A lot has been done at Sydney Metro, to even further improve the systems
that we’re working on. In short, the Churchill
Fellowship demonstrated some key areas for improvement, and the industry has received
an overwhelming response, at how quick everyone has
been at actually taking up some of the items that
have been identified, and really working to close them out, and making some improvements. So I’d like to thank
the Churchill Trust for sponsoring such a Churchill Fellowship, because this is an
important issue that effects the health of thousands
of Australian workers each and every year, and it’s great to finally shine a light on health, in addition to safety in
this industry. Thank you.


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