University experiment safety error almost costs two students their lives

We work for a number of education establishments and the risks within them are diverse, its a challenge for a person or a small team to manage each of them.

This example represents a situation which could arise in any number of similar organisations when risk isn’t adequately controlled, the consequences here could have been very serious, all the way to a very possible dual fatality.

University makes near fatal error

The experiment involved the study of the effects of caffeine, a substance which we typically experience in tea and to a larger extent coffee.  Caffeine is a stimulant which affects the central nervous system and is a good example of a chemical which we sometimes given less respect to than it deserves (largely due to our continued use of it within society, suffice to say that too much can have serious effects on your health.

Caffeine has uses within sports science and it was within that department that the exposure took place.  The two students were intended to be part of an experiment which studied the effects of the substance, in terms of sports performance, on two volunteers.

Each cup of coffee contains, on average, 0.1mg of caffeine and the intention was to administer 0.3mg of caffeine through a drink.  However, we understand that two issues lead to a near fatal mistake.

  1. The method required the use of caffeine in tablet form and none being available a powdered alternative was found;
  2. The staff did not posses the necessary competence to follow the method, were inexperienced in similar work and had received no instruction on the method from others;
  3. An error was made in the calculation which meant that the dose was measured as 30mg, 100X the intended amount of 0.3mg which is equivalent to 3 cups of coffee

To put this in perspective, a death had previously been reported after ingestion of 18mg of pure caffeine and the effects on the two students were almost immediate including;

  • dizziness
  • blurred vision
  • vomiting
  • shaking
  • rapid heartbeat.

They were rushed to hospital where their conditions were considered life threatening, dialysis was required to rid their bodies of the excessive levels of caffeine.

One student was kept in hospital for six days, reported short-term memory loss and lost 26.5lb (12kg) in weight, the second student treated for two days in intensive care and losing 22lb (10kg) in weight.

The key issue here was a failure to see the real risk.  An error of this type could easily result in death, given that this, the highest of risks was a real possibility the University should have put far more controls in place.  in truth, the two students were likely only saved by their youth and physical fitness.

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