Confidentiality of Health Information Essay

1. Should corrections be date and time stamped? Yes, it is very important to keep track of when changes are made to an individual’s medical records. Any correction made to confidential medical information should be time and date stamped. In addition, the name of the person who makes the changes should be recorded with the time and date change. should there not be a note of who makes changes to the medical record. An example of the negative consequences of not date and time stamping medical records, electronic or otherwise, is that in a court of law, one’s medical records could be inadmissible due to this simple negligence. A medical malpractice case, in which the patient deserves compensation for being diagnosed incorrectly, or not diagnosed at all, could hinge on this incredibly important detail. Whether or not the patient’s medical records was date and time stamped, as well as signed by the individual working on the patient’s electronic medical record. 2. When should the patient be advised of the existence of computerized databases containing medical information about the patient? A patient should be advised of the existence of computerized database containing medical information about the patient , before the patient’s physician releases said information to the entity keeping the computer bases. All medical information must be shared with the patient before any treatments are performed, so that the patient may give their informed consent for the treatment or procedure to be administered. If patients were unaware of the existence of their medical information stored in computerized database, they obviously would not have the knowledge to access their own records, which is highly unprofessional and detrimental to the patient’s health care in the future. According to the American Medical Association (AMA), patients have the right to know where their records are being stored and who has access to them for safety and privacy of the individual. 3. When should the patient be notified of purging of archaic or inaccurate information? States â€Å" procedures for purging the computerized data base of archaic or inaccurate data should be established and the patient and physician should be notified before and after the data has been purged.† It is essential that the patient and physician always know what is going on with their confidential medical records. Care must be taken to make sure that the medical record are never accidently mixed with other computer based record. With technology growing faster than most of us can keep up, most of today information is on computer. Either being stored on a disk, on websites, or even online storage . The American Medical Association (AMA), has issued opinion 5.07 confidentiality for computers. 4. When should the computerized medical database be online to the computer terminal? The computerized medical database is online to the computer terminal only when authorized computer programs requiring the medical data are in use. According to the (AMA ) policy, External individuals or organizations should not have online access to these computerized database. containing identifiable data from medical records patient. Access should be controlled through security measures. Some examples of these are encryption of the file, password to gain access to the file, or other user identification. In addition, leaving a terminal online to the database when it is not necessary can make it easier for hackers to get into the system. 5. When the computer service bureau destroys or erases records, should the erasure be verified by the bureau to the physician? I believe that when the computer services bureau destroys or erases the record, the physician should be notified in writing that it has taken place. Before records can be destroyed or erased the bureau has to establish that the physician has another copy, of some form, in his possession. The patient and the physician have the right to know any little alteration on any record. This will help in knowing what information has been erased and what significance it has as far as patient’s medical process is concerned. 6. Should individuals and organizations with access to the database be identified to the patient? Yes, all individuals and organizations with some form of access to the computerized databases, and the level of access permitted should be specifically identified in advance. Full disclosure of this information to the patients is necessary in obtaining consent to treatment. patient data should be assigned a security level appropriate for the data’s degree of sensitivity, which should be used to control who has access to the information. The patient has the right to know who have an access to his/her information and why. This will for the respect of the patient’s right to privacy and confidentiality. 7. Does the AMA ethics opinion mention encryption as a technique for security? Yes, the computerized data systems have a compromising information security. The (AMA) opinion is that â€Å" there should be controlled access to the computerized database via security procedures such as encryption (encoding), passwords, and other user identification including scan able badges†. Confidentiality agreements should be made with other healthcare professional whom the office networks with encryption is recommended if the network entails public channel of communication such a radio waves, telephone wires, and microwaves. This will increase the changes of information confidentiality. 8. In regard to electronic medical record (EMR), what is the policy for disclosing authorized data requested by third parties? The patient must give consent in writing authorization for disclosing any information about his/her medical record. the individual or groups requesting the data required to obtain the expressed consent of the patient. The dissemination of confidentiality medical data should be limited to only those individuals or agencies with a bona fide use of the data. As well as the fact that, the third parties receiving the Electronic – PHI , do not have the authorization to disclose the information to additional sources. Then , the database should disclose the least amount of E-PHI possible to serve the purpose , while also limiting the period of its use. Finally, the policy for disclosing the E-PHI is clear, the database must acquire consent for the dissemination of the least amount of information possible , the database must maintain the patient’s confidentiality, and, the third parties receiving the data may not disclose the data to any other organization or individual. American Medical Association, (AMA) opinion 5.07. REFERENTS: www.ama-assn.org/ Search box type, opinion 5.07 www.ahima.org/ www.ama-assn.org/ama/category

Alternatives to Incarceration Essay

In today’s economy keeping people in prison is becoming an ugly, expensive mess. There are now so many alternatives to incarceration that we need to explore and start using. Johnny Cash wrote a song called â€Å"Folsom Prison Blues† describing the angst of inmates, permanently immortalizing them in the publics minds. However, now that prisons across the country are running out of resources and space, it is the prison officials who are feeling the blues. There are a number of alternatives that are used for offenders who have committed non-violent crimes. The options can range from probation all the way to public shaming. For those who have been convicted of drunk driving, public shaming might have the most impact. In some states, convicted offenders will be made to drive around with signs put on their cars stating that they have been convicted. No one convicted of this sort of crime runs around announcing what they have done because its embarrassing. In general most prefer to keep it a secret because it is humiliating. With signs pasted to their vehicles, there is no way to escape the public knowing what they have done. Another option used for drunk driving is the use of a breathalyzer. This device is installed into the offenders car and the car is actually programmed not to start if they are intoxicated. This could put a definite damper on party habits. Another alternative that has popped up is based out of Texas. Texas is one of the last few states that enforces the death penalty and also has one of the highest incarceration rates in the world. Ironically, a state with such an â€Å"iron fist† reputation, has started to put offenders on probation and sentence them to read as opposed to prison time. This trend has slowly started to spread across the United States. Offenders and repeat offenders are ordered to attend a specific reading group where they get into discussions over classics like â€Å"Of Mice and Men† and â€Å"To Kill A Mockingbird.† A study was done from 1997 to 2008 and it was discovered that only 6% were either sent back to jail or had their probations revoked. Another perk of this program is that it only costs taxpayers $500 a year as opposed to the $30,000 a year it takes to keep an inmate imprisoned. This programs seems to work best for those who have been convicted of crimes involving robbery or drug abuse. It gives them a chance to have a voice and even a sense of identity and confidence. Another tough crime to address as far as sentencing goes, is when a person is arrested and that individual is mentally ill. For the longest time when someone was arrested for drug possession, trespassing or any other non-violent offense, they were automatically sent to jail or probation, regardless of their mental instability. Now it seems, there is a new option of an alternative court type setting where attorneys, mental health organizations, and the judge work together to coordinate a treatment option that will ensure the offender will stay on the right path. So many people are incarcerated who have mental illnesses, yet have never had the opportunity to be officially diagnosed and continue to go untreated. Providing treatment is the right thing to do, it is humane, and is even more cost effective then incarceration. Overall the criminal justice system needs to really start to change the way certain offenders are handled and then pretty much lost in the system. It effectively helps to create more and more offenders and even encourages repeat offenders. Financially for taxpayers it makes more sense. It is cheaper to provide outpatient options and treatments then to pay to keep an offender confined in prison. Aside from all of this, the criminal justice system needs to remember these low level offenders are still human beings. We all make mistakes and deserve to do the appropriate punishments, but a lot of these mistakes might just benefit more from appropriate treatment programs and interventions. Hard prison time is not always the best answer. References: 1) The Economist, July issue, 2010 2) Nolo.com 3) American Psychological Association 4) The Guardian, July, 2010

Analysis and Interpretation of The Cove

Analysis and Interpretation of The Cove That’s what those call it around here, where traveling long distances though wooded scenery is the norm. After a dozen or so miles north of Caribou, Maine, traveling over hill and down into valleys coming around a few wide turns you have only traveled half of your journey to Van Buran Cove. Turning onto a road unpaved by industrial means, through closer knit cedar trees and mud holes that can swallow your vehicle if you are not careful. Only then do you find The Cove, a break of sun in the middle of a forest with slightly murky waters on a rocky beach. It could be a popular place If it was a little easier to get to, though the other side of the lake is dotted with cabins of which you could easily decipher which was from the higher class then others. Though that isn’t the view that really catches your eye, what can really put your mind into wonder are the 7-foot-long skeletons of whatever marine life that hides below the waters of the cove. Ducks peddle along across the top of the water with their duckling seemingly peaceful, and the sound of the waves lapping against the rough shores. You can see children paying across the lake, boat skimming across the top, but by the cove is a graveyard of the mysteries of that same lake. Hidden by the balsam fir and the white cedar, you can be the fly on the wall to the secrets of the lake, or you can take you time enjoying the sun and water in your solitude in a place where no human life treads often. Albeit the bones of the deceased monsters of the deep or rocky path that can ruin a car or truck which leads there, no one seems to come often and it is a place you can really remember.

Most authors tell us that the family changes in industrial societies Essay

Most authors tell us that the family changes in industrial societies and the nuclear family becomes particularly important. beyond that the family is an important unit - Essay Example As they grow up, they understand many things that will help them in their future lives. Through this experience with the nuclear and extended family, the child learns basic responsibility, discipline, sharing things among others and more important good morals in life. They learn that in life, it is not always possible to have what they need and challenges will always arise. How to deal with them is what they get shaped up while they still stay with their families. Environment which a person is brought up also has a significant influence in shaping their lives. People in different places have unique way of doing things. Language, religion, food taken and living conditions all vary based on environment which one is brought up in. rules and regulation in the land are not the same throughout, and all these defines the character of the child. What one engages with like daily routine also forms part of the behavior of an individual. It is perceived that when a person does the same thing frequently, he/she develops perfection in it and will always be good at it. This helps in shaping the social life of that child. In conclusion, development of a child is determined by various factors. It is important to get a good mix of comportments which give good life to the child in future. Bringing up the teenager in a good environment will shape their lives in a positive way. Cultural practices also are good to be maintained and children should be taught on their values and importance. It is clear that the family plays a larger percentage in determining how the child will behave in

Male v. Female differences in stress Essay Example | Topics and Well Written Essays - 2500 words

Male v. Female differences in stress - Essay Example While stress is an individual response, it differs across gender. This paper will examine the reasons of difference and the coping strategies in stress in male versus female at workplace. Gender has been defined as the socially learned behaviors and expectations that are associated with the two sexes (Iwasaki, Mackay, & Mactavish, 2005). Thus being a male or a female is a biological phenomenon, being a man or a woman is a cultural process. Gender segregation directs the social relations with others. Under stress the body releases a lot of hormones including cortisol and adrenaline, which raise blood pressure and cholesterol levels and suppress the immune system (Eller, 2000). This puts the stressed people under greater risk ranging from ailments like cold to heart problems. Long term exposure to stress can also lead to weight gain due to cortisol. Research suggests that initially women have the same response to men but gradually women also begin secreting oxytocin from the pituitary glands. This leads to reduction in the levels of cortisol and adrenaline, thereby reducing the damaging effects. While men also secrete oxytocin, the level is much lesser than women. Besi des, testosterone, the male hormone further reduces the impact of oxytocin in men. According to the Law of Stress, stress is the difference between pressure and adaptability of any kind (Dato, ISMA 2001). â€Å"The process of living is the process of having stress imposed on you and reacting to it†(Sarnoff, 1963). A stress produces or threatens to produce alteration in the homeostasis. Stress refers to widespread, generalized responses of the body to various environmental, physical or social situations. It is the force that effects our emotions and motives. It is called the disease of modern civilization. It effects people of all ages and can be both good and bad. Each person reacts differently to stress but we all need some stress in

Market Trend Analysis For Art Gallery Research Paper

Market Trend Analysis For Art Gallery - Research Paper Example Market trends reports show that there is a growing demand for Chinese art pieces and the million dollar auction graph for 2010 reflects 401in the US to 491 in China. Thus in keeping with the trend of buyer demand for works from artisans from China, the gallery should plan for a theme exhibition which would showcase local and foreign talent. The media mix should include advertising and promotion by newspapers, the internet and local radio shows. The art industry is forecasted to continue to revive in the coming years with more focus on private sales and smaller auctions. The use of vertical co-operative advertising would help in keeping the advertising budget at minimum. The use promotional sales by giving loyalty discounts to repeat customers, awarding bonus points for referrals, help in getting patronage and increase the volume of footfalls into the gallery. The gallery should also retain the local focus by showcasing one local talent in the week which proves germane to pulling in s upporters and providing deeper market reach.The prime competitors would be the multitudes of galleries with established clientele which abound the area around Dragon street and thus there has to consistent effort to develop and maintain a loyal customer base. The Cameron Gallery, HCG gallery and others which grace the design district of Dallas are competitors for our gallery and the primary mode of competition is divertive in nature and thus the gallery needs to focus on its USP and build a niche for itself in the competition.

Turning Away From Drug Abuse and Allowing God to Reign Over the Life Case Study - 1

Turning Away From Drug Abuse and Allowing God to Reign Over the Life - Case Study Example According to the organization’s strategy, the members are given a platform where they can hold meetings in accordance with the principles in the organization’s literature. The organization maintains no hierarchical authority structure. Meetings are held on the basis of the group’s specifications but adhering to the organization’s principles. When I joined my group, I was warmly welcomed by the other members who were more than willing to help me recover from my disease. The twelve step program aims at enabling a person to accept himself/herself as a powerless person over drug use and that his/her life had become unmanageable. The second step is concerned with helping the drug addict believe that a greater power can restore sanity back to the addict. The third step involves helping the addict turn away from drug abuse and allowing God to reign over the addict’s life. Through sharing our life experiences and how drug abuse had rendered our lives unmana geable, I realized how I had lost very many opportunities out of drug use. A self-realization process started taking control and I started keeping off from drug use at a slow pace. By the end of the program, I had fully recovered from drug abuse and can now comfortably manage my life (Milhorn, 2003). Through prayer and meditation, my conscious contact with God greatly improved and I continued taking the personal inventory of myself. When I made a mistake, I admitted the mistake and worked towards the betterment of my life. Attending the Narcotics Anonymous has truly helped me recover from the use of drug substances.

Pharmacology Essay Example | Topics and Well Written Essays - 3000 words

Pharmacology - Essay Example reaches the targeted site, while the remaining fraction of the drug interacts with other sites, with consequences of inefficient drug delivery and undesirable side effects. Insufficient aqueous solubility and protein binding characteristics of that inhibit crossing blood brain barriers are two examples of the manner in which the relevance of some drugs in clinical therapeutics gets limited. It is against this background that pro-drugs and their utility in overcoming the limitations of bioavailability and pharmacokinetics profiles has become a significant subject of study in pharmacology (Shek, 1994). A look at the history of pro-drugs shows that understanding of pro-drugs and their pharmaco-kinetics in the human body came more as a result of after the introduction of the drugs for therapeutic purposes. The introduction of phenacetin as a therapeutic agent dates back to 1887, but it took till 1949 for the realization that paracetamol was the active metabolite of phenacetin, which resulted in the gradual erosion of phenacetin as a therapeutic agent to be replaced by paracetamol, demonstrating that many of the pro-drugs result from metabolism in the human body. (Pleuvry, 2006). This understanding of the possibility of enzymatic action to create active therapeutic agents has now become the basis of overcoming the problems of potential drug candidates demonstrating poor therapeutic effects, because of poor bioavailability and pharmacokinetic profiles. Kratz et al, 2008, define pro-drugs as â€Å"derivatives of a drug that are metabolized or activated in the body to release or generate the active drug – if possible at the site of action†. Thus pro-drugs are chemically modified versions of the pharmaceutical agent that needs to undergo a transformation in vivo for the release of the active drug. This feature of pro-drugs is employed to enhance the bioavailability and pharmacokinetic properties of pharmacologically potent compounds. In a majority of the cases

Summary of reading Essay Example | Topics and Well Written Essays - 1000 words

Summary of reading - Essay Example Whereas traditional marriage gets support from majority of the people, whether other forms like Gay and Homosexual marriages deserve discrimination and should be deprived of their fundamental right to marry and beget children as per the procedure they choose? Dent, though a strong supporter of the traditional marriage acknowledges their fundamental right and freedom to choose their life-partner and above all the freedom to love the individual of their choice. If one is to summarize the article in a few sentences, this is an important observation by George Dent. He argues, â€Å"If the government treats traditional marriage as the norm, citizens are also more likely to view it that way than they would if government treats traditional marriage as but one of many equally valid choices" (p. 421). Deviation from the joint family and nuclear family has socially turned out to be disastrous all over the world, particularly in America. That the divorce rate has crossed 50% is the grim indication and the worst scenario that has engulfed the American society. At the same time, there is a section of the society and the leadership that favors gay marriages. Historically the same sex marriages have been resented and they think it is a "caricature of the real thing...an insult to a relationship that they consider to have a sacred as well as a legal dimension" (p. 425). What is the ground reality related to such marriages? Homosexual couples will not b e able to procreate, and they cannot have the marriage ceremonies performed as per cultural and traditional standards, it is at the most a social or a club event. With no emotional commitment, the agenda behind such marriages is to get some financial benefits. But the paradox is they can have the benefits through other fair alternatives. One of the prime objectives of the institution of marriage is to beget children. That is not possible for the homosexual

Place name disambiguation pages Essay Example for Free

Place name disambiguation pages Essay Have you ever heard the saying, â€Å"Don’t judge a book by its cover and wondered what it meant? Sandra Cisneros, author of the short story, Salvador Late or Early, creates a frame of mind and brings fourth a sad and sympathetic feeling within the reader towards Salvador; who is a young boy with more weight on his shoulder than any average kid his size should have to bare. Cisneros uses imagery, diction, and characterizes Salvador as solitary, troubled, and as unnoticed child. Who takes on more responsibilities as a young boy than most would imagine at a glance, that any kid would have to endure. Author Sandra Cisneros uses simplistic tone to create a sympathetic frame of mind within the reader by using an range of imagery to grab the readers attention. Cisneros describes Salvadors responsibilities, the way he looks, and where Salvador lives leaving the reader tender in thought toward Salvador. â€Å"Inside that forty-pound body of boy with its geography of scars, its history of hurt, limbs stuffed with feathers and rags†¦Ã¢â‚¬ (Cisneros) illustrate a weak, flimsy young boy with no sense of hope or direction. Cisneros then goes on to state, In that vague direction where homes are the color of bad weather†¦, painting a dark cloud over the home of Salvador inside the readers mind. Cisneros never gives the reader a specific age for Salvador but we can tell from the diction being used along with the specific details given to us by the author that Salvador is a young boy given an incredible amount of responsibility. The reader can also assume that Salvador has a head of the house type role. Also the reader immediately picks up on how poor Salvador and his family are when Cisneros writes, combs their hair with water, feeds them milk and cornflakes from a tin cup in the dim dark of the morning. This all being done by the young Salvador and by this passage the reader picks up on a depressing feeling that leaves the audience fascinated and worried at the problems this young boy is in. Cisneros labels the main character with great detail that he has a past shrouded in problem and puzzlement which in turn, leaves the reader mind with the question of what could have happened to this boy that left him with such with such a burden to carry. Salvador whose name the teacher cannot remember, is a boy who is no ones friend,†¦ (Cisneros) this statement describes Salvador as a loner and not very out spoken considering his own teacher cant remember his name. In conclusion Sandra Cisneros creates a very graphic visualization of the characteristics that help the reader build an image and a diverse amount of feelings towards the character Salvador. Leaving the reader questioning the past of the young boy, which seems to eat away at his inner emotions and will continue to do so until there is nothing left but a empty shell of pain, and agony. Burdened at a young age with the role as the head of the household young, shy, Salvador is faced each day with obstacles not many his age must overcome. Filled with a past full of secrecy, Salvador pushes forward each day braving this storm not only for himself, but for his younger siblings and a Mama, who seems to be on her own also. Described as his limbs stuffed with feathers and rags, (Cisneros) a valid argument can be made that Salvador holds more than just pain, and agony within. One can argue that any young boy who has to burden the trouble and responsibilities that Salvador carries on his shoulders each day represents, the brave and determined will to go on not for himself but for the other he loves and that quality in anyone no matter size, or age makes them an amazing person.

Emas Installation At Mangalore Airport Engineering Essay

Emas Installation At Mangalore Airport Engineering Essay YP- Eurocontrol Support any engineering device which helps to mitigate risks associated with runway overrun (Page, 2010). Every proposal that is made to ICAO will be consulted with all member states, where each member state has a role to play in consultation and coordination of any changes with Annex 14. Moreover, aerodrome panel collects decides on any amendments. DH- The main difficulty involved in installing EMAS is not the actual cost of installation, in fact is the question of who funds the actual project?(Quan, 2010). This issue is dealt differently by FAA administer the funding of installations where approved effective through Airport Improvement Programme (AIP). AIP is a program which provides grant to airport operators including private operators to improve their airports safety and efficiency (FAA, 2010b). The money is raised through taxes on airplane ticket sold to public and taxes on aviation fuel. In contrary, many European airports have a privatised nature of ownership and since there is no government funding supporting EMAS. Consequently, it will be purely a commercial business decision for airport abuthorities whether to implement an EMAS or extend their RESA (Eurocontrol, 2010). YP FAA has a legal responsibility to implement safety standards in all US airports in terms of safety regulation as it is both regulator and navigation service provider and in some cases airport operator which enables it to cover whole air traffic management. FAA is not the aircraft operator but it regulates the aircraft operators. In contrary, many airports outside US find it extremely difficult to decide whether to invest in a several million dollars structure which might be never used or instead invest in runway quality improvements and also focusing on stabilise approaches which they seem to be more effective in preventing runway overrun in the first place (Eurocontrol). Currently EMAS installation within RESA is a fragmented scenario particularly in Europe once the entire eventualities are covered (CAA, 2010b). However various aviation authorities are supportive with the idea if aresstor beds as an effective and efficient mitigator (CAA, 2010b; Eurocontrol, 2010b). Moreover EMA S should be taken into consideration in light of other preventative methods. CAA Currently CAA is assisting ICAO with study focused on the touch-down lights particularly for the aerodromes with steep approaches as well as short runways. There will be a proposal to implement a set of lights as it is currently adopted by London City Airport aiming to assist operating crew to initiate a go-around in cases where pilots fail to land within the appropriate touch-down zone (CAA, 2010b). CAA (2010b) suggest that they are contributing to enhance safety margins through a different approach which is to identify risks and accordingly implement preventative measures than investing financially into a infrastructure. However a member of CAA aerodrome safety points out that civil aviation authorities in many European countries are gradually following the footsteps of FAA with regards to promoting safety equipments and procedures. They are starting to introduce themselves not only as a regulator with regards to runway safety which conducts regular aerodromes auditing yet the y are initiating to acknowledge and encourage any safety enhancement within aerodromes. It may be true that they do not have the budget like FAA to support safety projects yet they are offering consultations on variety of options available for each airport to consider which they might be unaware of such solutions, aiming to maximise margins of error. CAA CAA has always proposed and supported the 240m should be the ICAO standard. Meanwhile the idea of EMAS has been part of the recent debate as CAA are currently putting a paper together to propose it to ICAO in October 2010 which they hope it passed through panels and eventually to the Air Navigation Council (ANC) and by the time it reaches this point, it will be mature document with all different agreements from all parties, however the gestation period for these types of processes may take up to 5 years. This is crucial to focus and study the procedures followed by ICAO before making any improvements to annexes, as they operate on the basis of consensus and it generally takes a long times to collects agreements from most if not all member states. CAA According to a runway safety advisor at CAA, who worked with many airports has identied that the concept of capital expenditure in any aerodrome being large, medium or small was revolved around balancing acts between a varieties of competing needs. Moreover, in some airports where there are deficiencies in their RESA, it is still the responsibility of board not the CAA to make the decision which in most cases is the commercial business decision. Unfortunately, there is a deficiency within the current system that suggests at some airports due to lack of financial profitability of some safety projects, the proposed safety enhancement will be compromised with economical issues. YP In case of UK CAA enforcing 240m RESA as a requirement for all UK airports regardless of their size just like FAA might be significantly effective in maximising safety margins yet the social cost of such enforcement on society would be destructive, therefore, it is apparent that it is unlikely to happen due to its unfavourable nature. YP However this is the gap where IATAs adopted policy of implementing rules could lead on ICAO towards alternative level of compliance. Moreover it is possible that in near future IATA could be setting up an implementing rule which states with regards to annex 14 RESAs, the alternative means of compliance to the current requirement is an approved arrestor bed (CAA, 2010b). YP There is currently a debate whether aerodromes should declare mapping and charting RESA or EMAS in aeronautical notification publications. This has been raised on the basis of risk compensation where extending RESA is suggested to make pilots less cautious during landing once they know that they have extra space for landing. In contrast, IFALPA (2008) states extra RESA would be effective as it would provide extra braking capacity for operating crew as excursion accidents rate has not improved for the past 20 years (Eurocontrol, 2010). CAA- Proposals for the inclusion of information about arrestor system will be considered by ICAO in October (CAA, 2010). According to CAA there are currently some airports in UK that are considering to adopt an EMAS at their RESA. EMAS Kevin KQ KQ Currently Zodiac Aerospace is working with ICAO in order to get their support, recognition and approval of EMAS as an effective product and according to Quan (2010) there will be hopefully an amendment to annex 14 by December 2010, which would state that ICAO recognise and accept the product as an option for airport to meet their RESA requirements. Once the approval is made, other countries aviation authorities will be more serious about the product particularly after the ICAO requirements has been met. KQ Cost of an EMAS will depend on location and the design aircraft type for which the arrestor bed will be installed for, however, a project in US is less expensive than other countries due to the transportation cost such as shipping. According to Quan an EMAS project in US could be between 3-10 million US dollars. KQ Even though EMAS has been funded and approved by FAA but every US airport before installation must consider other alternatives such as use of declared distance which reassigns some part of runway as a RESA. This option would certainly introduce operational limitations and also shorter runway promotes lower utility from the airfield. However the FAA requirement is 300m RESA which is only recommendation by ICAO. As there are many airports in US which are limited to meet the FAA RESA requirement, which encourages them to adopt other alternatives such as putting as much EMAS bed as possible in their RSA to enhance their safety margins (Quan, 2010). According to ESCO (2010), the smallest EMAS bed installed in US is about 50m length and 30m width. KQ As FAA essentially encourages airports to endeavour and deploy highest practical limit of safety (Heald, 2010). According to Advisory Circle 5200.9 (FAA, 2005) every airport aiming to meet the requirement must do a 20 years life cycle values to establish the cost of installing an EMAS on each end of runway and furthermore the airport is then permitted to spend up to the calculated cost value from AIP budget to improve safety. KQ In case of Madrid, the EMAS was not deployed to meet the ICAO recommended practice, as the runway had already 240m of RESA beyond the runway strip. However Madrids airport authority decided to deploy EMAS on two parallel runways due to the operational concerns involved. They two sets of parallel runways, one set are used for landing and the other is used for takeoff. KQ Additionally, the landing runway has a safety area which intercepts to safety area of another runway, in essence, there were two safety areas occupying the same space. Their concern was in case of an overrun in landing runway and the aircraft ends up in the safety area that a portion of which intersects the departure runway safety area. Consequently both runways would be closed, therefore, they decided to deploy EMAS within the safety area to prevent the overrunning aircraft from entering the other RESA. KQ Based on study conducted by ESCO (2010), the EMAS bed is most appropriate at airports with geographical and physical limitations which constrain them to meet the ICAOs requirement. For instance, a 400ft of EMAS bed is as effective as 1000ft RESA in stopping B737 travelling pass the end of runway with speed of 70knot. Considering the reduction in foot print requirement is promotes EMAS as an ideal solution for many airports worldwide. KQ -EMAS bed is based on a modular system, therefore, during an overrun only the sections that are used to sink the tyres and stop the aircraft need to be repaired. According to Quan (2010) an estimate price for each block in US market is roughly around 1200 US dollars. Moreover according to FSF (2006), repair of the arrestor bed that brought the 747 at John F. Kennedy International Airport to rest in December 2005 cost about US$2 million dollars, as it stands to the most costly repair known to ESCO. The most recent EMAS arrestment was outlined by KQ, which was a Bombardier CRJ-200 operated by a regional Jet at Charleston, West Virginia. The aircraft entered an EMAS bed that comprised of 4200 blocks and it brought the aircraft to stop safely, saving over 34 people and only consumed 170 blocks where there is a steep 446ft beyond the EMAS bed (EMAS, 2010). In case of any overrun, the operator of the aircraft is liable for the repair of the airport property as the aircraft has ended up at a point which is technically not suppose to enter. Typically the insurer of the aircraft operator pays for repair of any damage to airport property. EMAS David DH DH EMAS beds implementation in both China and Spain were conducted according to FAAs policy. However, once ICAO recognise EMAS as suitable alternative to standard recommended RESA, ICAO position will not make any reference to FAA policies. DH In essence FAA considers an EMAS capable of decelerating range of aircrafts on a runway at 70 knots, based on the study conducted by FAA that found that 90 percent of aircraft depart the end of runway at 70knot or less. Furthermore, FAA approves such systems equivalent to 305m safety area in US. According to Zodiac Aerospace (2010) every EMAS installation was funded through AIP. However the final stage for any airport upon the acceptance of an EMAS as an effective substitute to RESA that aims to meet the ICAOs requirements is based on financial calculations. The most financial feasible option for airport usually will be chosen, whether it is to install an EMAS, shift or shorten the runway to meet the requirements (Heald, 2010). DH Additionally if there is a situation where there are physical constraints that are not practical to remove such as highways, railways and any topographical features that would cause the cost to be so high as to preclude that area, an EMAS becomes an appropriate choice. According to ESCO (2008), airports also tend to deploy EMAS where there have been environmental concerns associated with expansion of RESA such as physical cost of acquisition. DH As it was pointed out by DH, China was the first country to adopt EMAS outside US, using it to maximise its runway safety margins at high-altitude airport in Jiuzhaigou (FSF, 2006). DH One of the most critical advantages of EMAS over normal RESA is that its predictable static properties as oppose to RESA which could be influenced significantly by adverse weather conditions. EMAS has been designed not to be impacted by meteorological conditions. Furthermore, the performance of an overrunning aircraft on a grassy RESA with length of 240m is unpredictable, as the grass could be wet, muddy or frozen. As the results, even a recommended RESA at poor weather condition might fail to accommodate an overrunning aircraft in case of which the properties of grounds surface have been compromised such that it will not support the weight of the aircraft. DH On May 25, 2008, a Kalitta Air B747-200 overran runway 20 of the Brussels Airport, Belgium after a Rejected Take-Off. According to the final accident report by Air Accident Investigation Unit (AAIU), the aircraft came to halt 300m after the threshold where pilot escape slide was going down to railway bed. There were no fatalities however the aircraft was completely destroyed and broken down in three parts. Although runway 20 meets the ICAO minimum requirements but it does not conform to the ICAO recommendation as the extension of RESA is extremely costly. There will be a serious cost issue since runway 20 is geographically constraint due to the presence of the railway tracks on one end and existence of motorway from the other end. DH Moreover, AAIU have recommended Brussels Airport Authorities to consider installing EMAS to maximise the braking effect. Computational analysis conducted by AAIU proves that in case of EMAS in placed within the RESA, the aircraft would have came to halt within the designated RESA and the level of severity to the B747-200 would have been significantly minimised (AAIU, 2009). DH EMAS is a new technology and even in US, it was not until 2005 after FAA released Advisory Circle 5200.9 which finally established a policy on its application. According to Zodiac Aerospace, ICAO has started studying EMAS since early 2008 and moreover ICAO revises its annex every 7 years. DH From the primary research conducted it is found that EMAS manufacturer will work voluntarily free of charge with any airport worldwide to help them develop a preliminary propose solution as well as estimating preliminary cost of installing EMAS at ends of their runways (Zodiac Aerospace, 2010). For instance it has already been done for 5 airports in India and 6 airports in Thailand free of charge. DH EMAS manufacturer states that it was not until 2006 that they felt their product is appropriate and ready for international market, as they are producing third generation of EMAS. The previous generations required high level of maintenance such that for the cases of airports in US which have deployed EMAS before 2006 require to resurface their EMAS bed every 3 to 5 years which could cost them between US $100,000 to US $300,000 (ESCO, 2010b) which is a significant drawback to ownership. Furthermore, EMAS manufacturer were not keen to enter international market prior to the introduction of the most recent generation EMASMAX where it does not have a maintenance intensive nature. EMASMAX bed eliminates large cost of ownership which encouraged Zodiac Aerospace to promote its product more confidently to international market. DH Today many airport mangers are reluctant to deploy EMAS within their RESA even though there are significant amount of evidence that supports the effectiveness of such proposal. Currently there are no acknowledgements made by ICAO to support airports which are suffering from lack of inadequate safety margins at their RESA to consider EMAS as an approved and efficient substitute. DH EMAS recommends airports with runways having inadequate RESA to benefit from EMAS as an alternative technology. In some countries transportation safety department recognise the effectiveness of such device, however regulator still remains to be reluctant and fails to acknowledge and respond to such proposal. DH In April 2008, Austrailian Civil Aviation Safety Administration (CASA) part 139 aerodrome standards were revised to permit an alternative Engineering solution to be deployed within RESA (CASA, 2009). They used engineering solution rather than EMAS since it would have appeared to be recommending a manufacturer rather than a safety concept. However, EMAS organisation is the only company approved by FAA to install EMAS beds. DH CASA has completed the project of ensuring all of it air carrier runways to meet ICAO requirements except runway 25 at Sydney Kingsford Smith International Airport (FSF, 2008). Although RESAs have been adopted for the other five runways fairly simply however runway 25 had been challenged by physical constrains to extend its RESA in order to meet ICAO requirement. Runway 25 abutted a major highway, airport perimeter road and a river which introduced heavy cost issues as the airport authorities decided to build a RESA above the obstructions. According to project manager Mr. Plummer (2010) the final cost of building the sixth and final RESA at Sydney airport was around $AU100 million which contradicts with published information on Sydney airport website that states Sydney Airports $AU100 million runway safety project is completed on the 1st of April 2010 which cover the cost of extension of all six runways. DH In addition, while the construction was being carried out, Airport authority opted to establish temporary RESA for runway 25 by reducing the take-off and landing distance on the 2529m runway by 97 meters (FSF, 2008). The criticisms still remain against Sydney airport authority as they failed to acknowledge the revised aerodrome standard made by CASA which effectively permitted airports to deploy an engineering solution to enhance their RESA safety margins. Having spent over $AU25 million just on the final sixth they still have not reaches ICAOs standard recommended practices, moreover, they could have install EMAS for another $AU6 million (EMAS, 2010). DH Having established that, from ICAOs point of view Sydney airport currently meets the standards, however, there is a little motivation for airport such as Sydney to endeavour to reach the ICAO recommended practice particularly if the airport is owned and operated by a profit driven organisation. Moreover, in case of an overrun accident Sydney airport authority will not be in a position to defend themselves if they will asked on what basis they did not try to meet the recommended practice as they failed to deploy engineering solutions according to part-139 to mitigate risks and promote higher level of safety. Certainly it is beyond financial feasibility considerations as they could have invested a few more million dollars in installing EMAS which would driven their RESA safety standard more towards recommended practice than minimum requirement. The Australian Airports Association reported to the Air Transportation Safety Board that the Association does not believe a safety case for extending RESAs beyond 90 m in length can be mounted or sustained (ATSB, 2009). DH Currently, ICAO is looking into permitting arresting systems to be installed within runway RESA. In addition, ICAO is focusing to revise runway strip specifications, as of now, only objects allowed in runway strip are navigation aids provided that they are not hazards to operating aircraft. However, once the specifications are revised the outcome might allow navigational aids as well as aircraft safety systems in the runway strip. This revision will permit EMAS to be installed 11 meter from the runway end (EMAS, 2010). As DH suggests, The safety of the flying public and the credibility of our industry depends on making the right choices, and on implementing new technologies. We must choose wisely and we must always choose safety. SMS According to Morier (2005), the traditional approach to safety management was particularly concentrated on following certain required standards and react after the accidents has taken place which blinded the authorities to look beyond the regulation. They failed to concentrate on how safety margin could be enhanced which is strongly adopted by SMS (Kikland, 2001). As SMS is adopted the mentality and the safety culture existed within the implemented aviation organisation has been significantly improved where management by oversight has been replaced by management insight (Leveson, 2004). In line with this, Kirkland (2001b) states that UK CAA has altered its safety regulation policy from enforcing rules into auditing and mitigating. Currently there are many aerodrome licensees around the world that fail adopt a SMS to minimise risks to reduce the likelihood of an overrun. A crucial driver in order to implement SMS in an aviation organisation is the general willing of the managers to improve the safety standards considering operational and economical efficiencies in case of adopting SMS (ICAO, 2006). SMS has a proactive nature which tends to solve and rectify shortfalls prior to an accident. SMS is effectively based on the accidents and incidents reports as well as other daily reports which encounter any unsafe area which could cause vulnerability to the system. once the area with certain level of risk is identified, specific mitigating measures can be adopted according to the level of severity of the risk. Consequently, SMS enables an airport to evaluate its safety standards as it is more transparent and clear to measure (ICAO, 2006). As SMS is a continuous cycle, it continues to be updated and improved once it is implemented within an organisation, therefore it gradually become a uniform process which starts with risk identification, followed by risk evaluation, implementing mitigation measures and finally monitoring their effectiveness in managing the identified risks (Mitchell, 2010). According to ICAO, SMS adopted by an airport is defined as; A system for the management of safety at aerodromes including the organisational structure, responsibilities, processes and provisions for the implementation of aerodrome safety policies by an aerodrome operator, which provides for the control of safety at, and the safe use of, the aerodrome (ICAO 2002b). SMS ha s various advantages to the tradition approach. SMS is based on collecting and analysing relevant factors to monitor and manage risks. This method as it is based on quantitative as well qualitative evidences, avoid the previous influential human judgement. Another advantage of using SMS is it allows the organisation not only to identify yet to prioritise various challenges according to their level of severity (DOT, 2006). Once the SMS is adopted, the airport automatically becomes more practical in monitoring risks and implementing robust procedures to manage safety (CAA, 2003). Unfortunately, there are still cost issues which prevent an SMS to be adopted by many aviation organisations, particularly in third world countries. This is why the later stage of this report will focus on a cost analysis of installing an engineering device within RESA of Mangalore Airport in India, in order to enhance the survivability of the passengers in a case of an overrun. Summaryof just SMS Excursion accidents are not just about an adequate RESA or EMAS, in fact they are involved precision approaches, the ability to stabilise the approach for the pilot and landing on the touchdown zone at the right end of the runway. Moreover, ability to take the most appropriate exit for pilot while having the freedom to taxi to terminal without undue pressure of having taken an exit. Overall, EMAS is a mitigator not a preventer (Eurocontrol, 2010). It must not be forgotten to invest on the ways which the overrun accident could have been prevented from happening. The very first step must be focused on tracking and identifying contributing factors and how effectively it can be managed to enhance safety margins. However, this thesis focuses on improving safety margins while minimising the severity level of damages post-overrun accident. . EMAS Financial Feasibility This part focuses to answer the final objective of this thesis which is to evaluate the financial feasibility of installing EMAS. To study this, a case study is proposed which is based on the most recent fatal overrun accident that occurred in India, Mangalore Airport, which killed 158 people onboard, on the 22nd of May 2010. Air India Express was operating B737-800 which overran the 2450m (8,033ft) runway number 06/24 (Hindustan Times, 2010). Financial calculation for installing EMAS will be structured according to FAA Order 5200.9 (FAA, 2005) however there are some assumptions and estimations in the calculation due to limited data received from Mangalore Airport. Mangalores overrun The accident report is yet to be completed by Indias accident investigation unit, however according to Hepher (2010a), the aircraft landed long and over shot the runway and consequently ended up in a steep ravine at the end of the runway. As the aircraft was overrunning the end of the runway, it damaged the Instrument Landing System (ILS) localiser antenna which is an instrument to provide precision guidance to operating crew of an aircraft which is approaching and landing on a runway. Only the damaged caused to the ILS significant delays or cancelled number of flight which took Mangalores airport authority more than a month to return to their normal/scheduled operation. The Boeing 737-800 is counted and known as one of the most reliable and competitive aircraft in the current market which is operated by many airline all over the world. It current price in the market is between 66-75 million dollars (Hepher, 2010b). According to Flight Safety Foundation (FSF) (2010) Mangalore crash is the worst accident involving 737-800 so far. In addition according to Ranganathan (2010), The Air India Express crash was waiting to happen. The current level of safety standards adopted in Indian civil aviation authority are significantly below the SARPs required by ICAO, particularly regarding the Aerodrome design. Even though there have some changes and amendments made in the regulation in order to rectify some of the issues but systematic rot is so deep (Gupta, 2010). Recent countrys robust growth promoted rapid growth and need for air travel. Indias international market for air travel has tripled between 2000 and 2008 (IATA, 2009) but its infrastructural safety margin are stretched beyond the recommended safe level by ICAO. Even though the runway 06/24 met the required RESA by ICAO and adequate runway length was provided for B737-800 to land but its adopted safety margins for its RESA did not allow any room for error in case of an overrun or veer-off. As previously mentioned, runway excursions make quarter of air transport accidents and incident (IFALPA, 2008) and yet there is still no unified standard for RESA and installation of safety areas where they are potentially needed to minimise the possibility of runway overruns. According to an anonymous Indian official involved in aviation, A disaster was waiting to happen and we have been very lucky to have had no major accidents in the past 10 years,. This is in line with Indias director of general civil aviation Mr. Gohain statement in April 2008 which reportedly said that India had just three inspectors for 10 commercial airlines and 600 planes. (worldaviationjournal, 2010). According to ICAOs safety audit, India was listed as the worst country in terms of technical personnel qualification and training(ICAO, 2006). The crash at Mangalore airport occur just about four after a similar fatal accident was prevented. The aircraft came to halt within designated safety area at Charleston Airport, (West Virginia), where the airport authority installed EMAS to enhance the level of survivability of their RESAs. Only after such disastrous event, Indian civil aviation authority decides to extend the runway 06/24 from 2450m to 2743m where as the result its RESA will extend too (Aviation Week, 2010). However, if there was an EMAS installed prior to the accident not only so many lives would have been saved but many unfavourable costs to airlines and airport would have avoided. Therefore next section will focus on cost analysis of installing an EMAS at Mangalore airport. EMAS is one of the alternative ways which airport authorities could have adopted in order maximise the safety margins. Consequently, the level of severity of the crash could have been significantly reduced if not completely avoided. DP -Believ es that if AAI had followed and adopted specific safety measures by studying the accident predictive model which was developed by Wong (2007), they could have saved so many lived but they ignored such safety implementations. DP- The cost of an overrun accident can be more many time more than the cost of mitigating the risks but unfortunately, cost minimisation has been considered more important than safety maximisation where airports decided to choose an option which offer lower margin error but it costs less. DP-Pitfield (2010) states in case where there is no adequate RESA is in place, airport authority should also consider closing the runway since there is no margin of an error unless the runway is long enough to extend the RESA without introducing operational limitations to the airport. DP- Even though the Pilots operated many time to that particular airport, Pitfield states that they are not the main people to be blamed. The most destructive factor is the some shortfalls of present airport safety area regulations which are not uniformly monitored around the world. However the existing shortfalls in the present RESA regulation are gradually improved by introduction of Safety Management System (SMS) (Pitfield, 2010). However he still believes that there would be still institutional infrastructural constraints on implementing RESA from an aerodrome perspective. EMAS Installation Cost at Mangalore Airport The financial feasibility is considered vital, since it is one the most effective alternative options for airports particularly facing geographical limitations, consequently they are constraints by terrains or obstacles to extend their RESA. There are number of ways to calculate EMAS installation cost, however the most recommended way is followed by a guideline produced by FAA Order 5200.9 and EMAS manufacturer (Zodiac Aerospace). Airport Authority of India (AAI) agreed to provide the author up-to-date information regarding runway 06/24 to estimate the cost of installing an EMAS at both ends of the runway. In order to calculate the cost certain factors specific to the airport must be considered; EMAS must be capable of safely bringing a DESIGN/CRITICAL aircraft (which is in most cases the most frequent and heaviest aircraft that uses the runway) overrunning the threshold (end of runway) with a speed of 70 knots. The accident investigation unit has not yet reported the speed which B737-800 overran the end of runway at Mangalore airp