Things Went Awry

“Just the facts”

~Detective Sgt. Joe Friday

The headline on the story reads, “Workplace Accident Leaves One Dead, Another Seriously Injured.” A tragic story, but a headline that’s hardly out of the ordinary: there are more than a dozen stories like this every single day.
And that’s just in the States. 
But to set the record straight, there are not a lot of stories like this one. Starting with who: usually the ones getting hurt work on the front line of the business, but these two were in management. The one fatally injured was providing technical direction for the work. The one seriously injured was literally looking over her shoulder: he was in charge of safety.
See what I mean about different. 
Before you write this one off as a random event, the product of an unfortunate and unlikely set of circumstances never to be repeated again, so many things had already gone awry that a better headline might have been, “On This Project Nobody Was Safe.”
In charge of finding out the rest of the story – i.e., who, what, how and why – is the Sheriff and the FBI: this was a shooting. As to where, it took place on a movie set. A bullet fired from a prop gun struck and killed the cinematographer and seriously injured the assistant director. Surely you heard the story; it reads like a movie script. But this was real life. Just not life as portrayed in the movies. 
During rehearsal, the star fired the pistol straight at the camera. He was told the gun wasn’t loaded. Was it an accident? Could it have been a crime? Like some whodunnit, law enforcement officials will figure that out. For obvious reasons, their job will not be easy.
That’s their problem. For us, it’s an opportunity to be reminded of several important lessons to apply when things go awry.

Life Imitates Art?
What happens in the movies may bear little resemblance to real life; the same cannot be said about making movies. Long hours, tough working conditions, makeshift equipment, pressure of budget and schedule, stress, and poor morale are every bit as common on the set as they are on a real job like the one you manage. It’s hardly a fairytale existence.
Rust was no exception. After the shooting, the news was laced with reports about problems. Hours before the incident, the camera crew walked off the set to protest working conditions. Concerns had been raised about gun safety. Safety procedures were not being followed. People were complacent about guns. Staff in key roles were inexperienced, undertrained, and overwhelmed by the workload. All the while, it was hurry up, hurry up, hurry up.
Sounds like a classic case of a terrible safety culture, doesn’t it? Probably a lot of near-misses, too.
Exactly. The movie was a Western and, shockingly, it appears there had been three accidental discharges of guns. But no investigations, no safety stand downs, not even a safety meeting on the subject. Not a thing done to address the problem, at least in the opinion of those doing the work.
But not in management’s view. Stop me if you’ve heard this one before: “The safety of our cast and crew is the top priority of Rust Productions. …we were not made aware of any official complaints concerning weapon or prop safety on set…” 
Maybe those near-misses went unreported. 
Now, all this comes from the press reports, and you do know their track record on the facts. So, let’s just stick with the one fact we know for sure: tragedy struck. If you worked on the set, owned the production company, or were family and friends of the victims, you’d insist on knowing the facts. All the facts.
No different than on your job.
Regarding “Accidents”
There will be some reading this edition of the NEWS who will not be able to get past the opening headline. “A Workplace Accident? There is no such thing as an accident!” You might know the type. I do. I appreciate their passion to get to the truth about how injuries happen; what they fail to appreciate is the definition of an accident: an event that happens unintentionally. 
Do you know anyone who shows up for work wanting to go home hurt?  No. Do you want to waste your time debating what to name unfortunate events like this? No. Do you want to know how it happened, and why it happened? Of course.
The Rust shooting could have been the product of a series of unintended actions. If so, law enforcement will determine it to be an accident. It could have been the product of deliberate action to inflict harm. If so, law enforcement will determine it to be a crime. 
In either case, their conclusion will be based on the facts. It is that simple.
Regarding “Close Calls”
As to those close calls, by any of their popular names, consider them a message: something went wrong, and someone needs to find out how and why.
Every leader knows they should, but not every leader does what they should.  First, because those close calls are often unwitnessed and, therefore go unreported. “That? Never happened.” No story.  In cases where the leader knows, it’s easy to blow off a close call simply because there was no harm. “Everybody ok? Great! No need to look into that.” End of story.
Truth is, in both cases, there was a story. They had a happy ending but it might have been otherwise. As to the difference that makes the difference between a hit and a miss, it’s found in effect, not cause. Case in point: had the star of Rust fired his pistol and missed the human targets, a bullet would have harmlessly landed somewhere in the Sonoran Desert. 
End of story. 
The story is that something like that had already happened on the set – three times! Apparently nobody took them seriously enough to look into the facts. Had they, this story probably would have a happy ending.
That’s one part of this story that should be getting your attention. 
Lawyering Up
Facts explain how something goes awry. Unless it was an Act of God, human fingerprints will be found on those facts. Everyone knows that, and everyone knows what can happen to those whose fingerprints are found on those facts. They don’t want it to be their fingerprints.
Knowing that to be the case, and wanting to maintain harmonious relations on the job, it’s common to cite inanimate objects and unnamed parties as the ones responsible. You are no doubt familiar with the usual suspects: poor design, lax enforcement of the rules, common practice, complacency, management system failure, poor safety culture. In manned spaceflight, it was “normalization of deviation.”  It’s not that they might not be true, it’s just that for those causes, nobody gets called out by name. How convenient is that?
On the other hand, there can be a search for a scapegoat. In Biblical times, that was the poor goat who was saddled with everybody’s sins, and sent off to the wilderness, never to be seen again. In modern investigation, that’s where all the blame is heaped on one person. How convenient.
Truth is, there are always a set of facts that explain what went wrong. But getting to an understanding of the truth requires the combination of wisdom and courage, two commodities in short supply these days. Far easier to run with the herd. 
As to lawyering up, times being what they are, and the Rust shooting being as serious as it is, who can blame anyone for having an attorney representing their interest. But lawyering up makes law enforcement’s job of finding out the truth even more difficult.
Likely that would not have been the case in an investigation into one of those accidental firings.  One more darn good reason to look into those near-misses.
Following the Rules
Finally, no matter what the facts prove to be, this tragedy would not have happened if one golden rule of gun safety had been followed: treat every gun like it’s loaded.
My longtime neighbor and avid hunter, Bill, sat on a jury in a trial where the prosecuting attorney was waiving around a gun used to commit a serious crime. Bill was a manager in the manned spaceflight operation at NASA, and he knew how the judicial process works: in the courtroom jurors are to be seen, not heard. 
That did not stop Bill from interrupting. Turning to the Judge, in a loud voice he intervened: “Your honor: please tell that attorney to stop pointing that pistol at anyone in this courtroom.” 
Bill was not held in contempt of court or sent packing off to jail.
If nothing else, the Rust shooting serves as a stark reminder of the value in following the golden safety rules – and making sure others do, too.
Paul Balmert
November 2021

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