Annex 3: Rules for the construction of right hand side Storybuilder
diagrams
Hans Baksteen, 12 April 2005
Introduction
Before the start of the Right-Hand-Side(RHS)-construction of a Storybuilder(SB)-diagram
for a particular bowtie there are several points of special interest:
• Mitigating related aspects
• Dose-response related aspects
Mitigating related aspects
Mitigating related aspects are aspects which determine or influence the dose which results
from the occurrence of a Center Event.
Before analysing the incident descriptions the analyst should have a clear picture of the
factors that determine the dose. If those dose determining factors (DDFs) are mentioned in
the incident description than they should be recorded in the RHS of the SB-diagram in a
DDF-block. Before the construction of the RHS of a SB-diagram for a particular bowtie
RIVM should deliver the list of DDFs for that bowtie and discuss this list with the story
builders.
Example 1: Dose determining factors for Bowtie 1 “Falling from height”
Dose determining factors Bowtie “Falling from height”
1. Falling height
2. Shape of the impacted surface
3. Hardness of the impacted surface
4. Energy dissipating barriers between starting and final point
Example 2: Dose determining factors for Bowtie 12 “Contact with electricity”
Dose determining factors Bowtie “Contact with electricity”
1. Voltage (type of current (AC/DC), low/ high)
2. Resistance (way of current through body, material of
shoes, temperature, humidity, ground, condition of skin,
contact surface)
3. Time of current flow
4. Amperage (low/medium/high)
In fig 1 the SB-diagram of the DDFs of bowtie 12 is presented.
Rules for the construction of RHS SB-diagrams, rev. 3 – RIVM, HB, 12042005
87
A
Amperage
95
R
Material of shoes
96
R
Humidity
97
R
Temperature
98
R
90
Ground
1
CE
Contact with electricity
(Bowtie 12)
R
Resistance
101
Way of current
through body
R
102
R
Condition of skin
103
R
Contact surface
66
DDF
Dose determining
factors
91
V
Voltage
100
Time
Time of current flow
105
UNK
Unknown
Fig.1 Dose determining factors of Bowtie 12 (“Contact with electricity”)
Rules for the construction of RHS SB-diagrams, rev. 3 – RIVM, HB, 12042005
The unknown-block must be used if there is no information at all about the DDFs in the
incident description. If f.e. only a part of all DDFs is known than the corresponding DDFsblocks should be filled in and the unknown-sub-blocks of the unknown DDFs.
Probably the number of DDFs can change during the construction of the SB-diagram,
because new DDFs might appear when reading all the incident descriptions.
When constructing Barrier-blocks in the SB-diagram during analysing the incident
descriptions, keep in mind that there are three general types of mitigating barriers which
influence the final dose (see Yannis’ presentation in Chester):
1. Barriers limiting the amount or the intensity of the hazard
2. Barriers shielding persons from the hazard
3. Barriers limiting the duration of the exposure
For every type of bowtie these barriers will be different. It depends upon the definition of
the Center Event whether all three types of barriers will be present.
Example: Mitigating barriers for Bowtie “Falling from height”
Mitigating barrier, type 1
Given a specific fall, the height and the ground are situation-specific
and therefore fixed. These factors will determine the dose. Only
barriers which prevent that the person hits the ground will limit the
intensity of the hazard. So a fall arrestor, a safety net, or ground
protection are barriers of mitigating barrier type 1.
Mitigating barrier, type 2
If a person is protected by a hard hat or a cap (like horse(wo)men),
this hat or cap shields the person from the hazard and is a mitigating
barrier type 2.
Mitigating barrier, type 3
If a person falls there are no barriers which can reduce the exposure
time.
Dose-response aspects
Dose-response aspects are aspects which determine or influence the final consequence of a
Center Event given a dose.
Before analysing the incident descriptions the analyst should have a clear picture of the
factors that determine the consequence given a dose.
For most of the bowties the next 4 general characteristics of the injured person (CIP) will
determine the final consequence given a dose:
1. Age of the injured person
2. Weight of the injured person
3. Sex of the injured person
4. Condition of the injured person
If those characteristics are mentioned in the incident description than they can be recorded
in the RHS of the SB-diagram in a CIP-block.
Rules for the construction of RHS SB-diagrams, rev. 3 – RIVM, HB, 12042005
In fig. 2 the SB-diagram of the 4 general characteristics of injured persons which determine
the final consequence given a dose are presented.
56
AGE
Age of victim
64
SEX
Male
65
SEX
57
SEX
Female
1
CE
Center Event
66
DDF
Dose determining
factors
78
Sex of victim
SEX
Unknown
55
COV
Characteristics of
victim
67
WEIGHT
Weight of victim
82
CONDITION
Condition of victim
104
UNK
Unknown
Fig.2 SB-diagram of the 4 general characteristics of injured persons which
determine the final consequence given a dose.
The unknown-block must be used if nothing is known about the characteristics of the
victim. If only the age is known, than the age-block should be filled in and the unknownsub-blocks of the blocks ‘sex of victim’, weight of victim’, condition of victim’.
Because information about AGE & SEX are coded in GISAI there is no need to record
this information in the storybuilderfiles (this information can easily be added to the sbfile later).
Rules for the construction of RHS SB-diagrams, rev. 3 – RIVM, HB, 12042005
Of course the involved body part will also determine the final consequence, but this
information is already covered in one of the INJP-blocks.
The information of the final consequences of an injury which is recorded in GISAI must
always be categorized in terms of non permanently injured or permanently injured.
Sometimes, e.g. when incidents from other databases (e.g. LOC-incidents in TNO-FACTS
database) are analysed, the recorded injury information might differ: x persons had a minor
injury and y persons where severely injured. This type of information can not
unambiguously be translated in the terms of (non) permanently injuries. This information
can only be preserved by introducing extra final consequence SB-blocks:
• Severe injury (FOS-block)
• Minor injury (FOM-block)
In fig.3 the SB-diagram with INJP-blocks and extra FO-blocks are presented.
10
INJP
00 Part of body
injured, not specified
11
INJP
10 Head, not further
specified
1
CE
Center Event
66
DDF
Dose determining
factors
55
COV
Characteristics of
victim
2
INJN
Number of casualties
12
INJP
20 Neck, not further
specified
47
FOD
13
INJP
30 Back, including
spine and vertebra in
the back
48
FOP
(Probably) permanently
injured
14
INJP
40 Torso and organs,
not further specified
51
Death
FOI
(Probably) Non
permanently injured
body part
9
INJP
Part of body injured
code
28
INJT
Type of injury code
43
HOSP
Hospitalisation
15
INJP
50 Upper Extremities,
not further specified
53
20
INJP
60 Lower Extremities,
not further specified
109
24
INJP
70 Whole body and
multiple sites, not
further specified
110
FO
Unknown
FOM
Minor injury
FOS
Severe injury
27
INJP
99 Other Parts of
body injured
Fig.3 SB-diagram with the INJP-blocks and extra FO-blocks
When constructing Barrier-blocks in the RHS-diagram during analysing the incident
descriptions, keep in mind that there is one general type of dose-response barrier which
influence the final consequence: the adequacy of the medical attention or first aid.
Of course there are more factors which determine this adequacy. But probably the response
time is a factor which can be found in a part of the incident descriptions.
Rules for the construction of RHS SB-diagrams, rev. 3 – RIVM, HB, 12042005