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 questions
1. 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
Classification
Employee commits suicide at work but due to
work related issues
Employee commits suicide at work due to
personal home pressures
Employee falls ill at site but dies later in
hospital due to same illness
Employee has a non work related illness (e.g.
stroke, whilst resting off duty in the work camp
Employee dies at home from non work related
illness
Employee dies from on work related illness
whilst in hotel away on business
Employee dies from a fatal occupational illness
Work
fatality
NAD
related
NAD
NAD
Death in service
Death in service
Work
fatality
related
Non Accidental Death - Challenges
1.
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 preemployment 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 NADs
Challenge
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 Issue of appropriate exams.
and medical surveillance
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
Non-Accidental Death Cases 1998-2012
25
20
15
21
10
18
15
17
15
16
13
5
13
11
10
8
8
2001
2002
11
8
7
0
1998
1999
2000
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
My apologies for late response.
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
Age distribution of NADs
12
10
8
6
NADs
4
2
0
20-30
31-40
41-50
51-61
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.