Volume 10 Number 10 February 2013
From the Director’s Desk
John Howard, M.D.
We often speak of “working under pressure” in a metaphoric sense. For workers employed in digging highway or rail tunnels underground, it can be a literal description. In projects where workers are enclosed in caissons or other protective structures, compressed air is used to increase the atmospheric pressure inside the structure to prevent water seepage or to stabilize the surrounding soil.
Working in high pressure exposes tunnel workers to the risks of decompression sickness, which can take the form of “the bends” and other painful and potentially fatal disorders unless the body properly decompresses in returning to normal outside pressure. Similar risks face deep-sea divers who return too quickly to the surface. The main occupational safety and health tool for preventing decompression sickness is the use of tables that set specific schedules for gradually decreasing pressure at varying time intervals. The first such tables were developed in 1908.
I am indebted to one of NIOSH’s partners, Anita Johnson with Sound Transit Inc., in Seattle, Washington, for raising the issue of tunnel worker safety in a conversation not long ago at the Washington State Governor’s Safety and Health Conference. Large tunneling projects are on the increase worldwide, given the availability of new tunnel boring machine technologies. In Seattle, for example, the expansion of the city’s light rail system involves a tunneling project.
The conversation with Anita prompted NIOSH to do a little digging of its own into the question of whether current decompression tables are sufficiently protective.
Large Tunnel Boring Machine (photo courtesy of Port of Miami)
NIOSH formed a workgroup to review the state of the science. It found that NIOSH had supported research by scientists Eric Kindwall and Peter Edel in the late 1970s and early 1980s to develop and test revised decompression tables. The revised tables were developed in response to research findings showing that the decompression tables used in Occupational Safety and Health Administration’s underground construction standard (1926 Subpart S) were not sufficiently protective. For example, research at the time found that seven of twenty one workers in a Milwaukee tunnel project had developed dysbaric osteonecrosis, a decompression illness resulting in the destruction of bone tissue.
The NIOSH-supported effort resulted in four new tables released in 1981. At that time, NIOSH transmitted the tables to OSHA. However, for general review, the tables have been available only on microfilm in the NIOSH archives.
Based on discussions with OSHA and others, NIOSH has decided to make these “Edel-Kindwall” tables more accessible. We created a new topic page called “Decompression Illness and Tunnel Workers” http://www.cdc.gov/niosh/topics/decompression/ which describes the interesting history of this hazard and which provides the safety and health community and underground construction industry with direct access to the tables.
In addition, NIOSH also published a Federal Register notice in December 2012 inviting comments on decompression tables used for protecting tunneling (caisson) workers from developing decompression illnesses. See https://www.federalregister.gov/articles/2012/12/13/2012-30080/
While we know that the Edel-Kindwall tables are more protective, we also know that they do not address pressures greater than 50 pounds per square inch, and that some modern projects involve such greater pressures. Consequently, there is a need for up-to-date decompression tables. NIOSH thus requests information on:
- Types of projects where the Edel-Kindwall Tables have been used,
- Published and unpublished reports and findings relating to the use of the Edel-Kindwall Tables, including information on possible health effects or lack of observed health effects in tunnel/caisson workers who were decompressed with data from the Edel-Kindwall Tables,
- Information on related control measures (e.g., engineering controls, work practices, personal protective equipment) in use in workplaces where decompression is required, and
- Information on alternative tables and approaches being used to protect tunneling workers from pressures greater than 50 psi.
In addition, NIOSH has submitted official comments in response to OSHA’s request for information on our partner agency’s Standards Improvement Project – Phase IV. In our comments, we recommended that OSHA replace the outdated decompression tables in 29 CFR part 1926 subpart S with the Edel-Kindwall tables.
NIOSH’s review has presented an interesting case of legacy hazard meeting emerging issue. It also touches on the value of research, the importance of making research accessible to our stakeholders and other interested parties, and the long timelines sometimes needed to make a difference. The docket is open until March 29, 2013 –please share any comments you have.
Total Worker Health™ In Action Available Now
The quarterly issue of the NIOSH Total Worker Health™ newsletter, TWH™ in Action!, is now available. Hear from our TWH™ managers, updates from the NIOSH Centers of Excellence to Promote a Healthier Workforce and more! www.cdc.gov/niosh/twh/newsletter/TWHnewsV2N1.html
Updated Occupational Injury and Illness Classification System Resource
NIOSH, in collaboration with the U.S. Bureau of Labor Statistics (BLS), has posted an updated resource for the Occupational Injury and Illness Classification System (OIICS). The enhanced web site provides graphical interfaces to the BLS-redesigned OIICS Code Trees and prior versions, along with downloadable software applications. The web site is a resource for anyone who may need to use the OIICS for characterizing occupational injuries and illnesses or for a better understanding of the national occupational injury and illness data released by BLS and NIOSH.
New Funding Opportunity for Development and Demonstration of Mine Safety and Health Technology
The NIOSH Office of Mine Safety and Health Research has announced a new funding opportunity. NIOSH considers the following five topics, which are listed in no special order, to be areas of elevated interest: Technology for Detection of Hazardous Conditions, Battery Technology, Technology to Reduce Float Dust, Through-the-Earth Communication, and Rapid Drilling for Mine Rescue. As described in this solicitation, other topics are also appropriate for consideration. Deadline for responses: March 21 at 4:30 PM ET. http://www.cdc.gov/niosh/mining/omshr4u/fundingseekers.html
NIOSH congratulates Ron Hall, industrial hygienist, on passing the Certified Safety Professional Comprehensive Exam. A recipient of the CSP certification is recognized as having met the professional challenge of illustrating competency through education, experience, and examination.
Entrapment in an Intermodal Cargo-Container Spreader Kills Worker at Seaport Terminal
The failure in intermodal cargo-container spreaders not being designed so lubrication tasks could be done without reaching into moving parts of the spreader, the lack of standard operating procedures and training specific to maintenance, intermodal container-cargo spreaders not having panic buttons or interrupt switches, the lack of communication systems, the lack of visual or sensing devices on mobile equipment, and not doing a job hazard analysis for work activities were some of the contributing factors that led to the death of the worker.
Hispanic Construction Worker Wearing Fall Protection Dies after Falling 40 Feet from Roof
An improper anchor plate used for the type of decking being installed, the wrong type of screws used to fasten the anchor plate, the anchor plate being mounted on an unsecured edge, having the anchor of the fall protection system affixed to an unsecured leading edge, and the lack of a safety and health plan based on a job hazard analysis for the assigned tasks were some of the contributing factors that led to the death of the construction worker.
52-Year-Old Dies After Being Crushed between Dumpster and Rails of Roll-Off Truck
A truck not being the unit that was usually operated, slippery and muddy conditions, failure in ensuring the power take-off (PTO) was disengaged, the truck door having a broken hinge, and not conducting a job hazard analysis were some of the contributing factors that led to the death of the public worker.
Special-Needs Sanitation Route Helper Caught in Tailgate of Waste Collection Truck
Failure in keeping a safe distance from moving trucks and unloading activities, not having designated trained spotters, the lack of driver training, not wearing high-visibility apparel, unsecured tailgate latches and the operation of tailgate mechanisms, not following protocols for removing lodged materials, and the lack of training programs were some of the contributing factors that led to the death of the sanitation route helper.
Fatal Burn Injury While Bulldozing and Burning Brush
Failure in supervising a brush fire, operating machinery near open flames, not having a fully charged fire extinguisher, the lack of a burning permit, failure in contacting the fire department to advise them of burning plans, the lack of planning for accessing emergency services, working alone in isolated areas, not maintaining machinery in good condition, and the lack of machinery inspections prior to use were some of the contributing factors that led to the death of the construction worker.
Construction Laborer Fell From Ladder
Failure in not using a hoist or pulley to raise or lower objects, improper ladder setup, not securing the ladder, lack of training, improper ladder size, and not following the ladder manufacturer’s rated capacity were some of the contributing factors that led to the death of the laborer.
New Fire Fighter Fatality Investigation and Prevention Program Reports Available
Fire Fighter Suffers Fatal Heart Attack While Performing Driver/Operator Duties at a Motor Vehicle Crash—South Carolina
A 63-year-old male volunteer fire fighter was dispatched to a crash involving three motor vehicles with possible entrapment. At the scene, the fire fighter operated the pumper. A short while later the Chief found the fire fighter collapsed on the elevated pump platform. The fire fighter was transported to the local hospital’s emergency department where cardiac resuscitation efforts continued until the fire fighter was pronounced dead. Given the fire fighter’s history of underlying coronary heart disease, NIOSH investigators concluded that the physical stress of responding to the call and performing driver/operator duties triggered his heart attack and subsequent sudden cardiac death. http://www.cdc.gov/niosh/fire/reports/face201220.html
Lieutenant Suffers Fatal Heart Attack During a Fire in a Commercial Structure—New York
A 47-year-old male career lieutenant responded with his crew to a commercial fire. After operating on scene for about an hour, a chief officer noticed that the lieutenant was not looking well and summoned the Rapid Intervention Team to remove him from the building. Once outside, the lieutenant’s care was transferred to on-scene Emergency Medical Service personnel. Despite pulmonary resuscitation and advanced life support, the lieutenant died. NIOSH investigators concluded that the physical exertion associated with his work at the fire triggered the heart attack and sudden cardiac death. http://www.cdc.gov/niosh/fire/reports/face201216.html
Fire Fighter Suffers Sudden Cardiac Death During Ladder Training—Texas
A 69-year-old male volunteer fire fighter was participating in ladder training when he became ill. While climbing up a 24-foot extension ladder, the fire fighter became dizzy and climbed back down to the ground where he became unresponsive and pulseless; crew members began CPR. The on-site paramedic unit and an ambulance unit provided advanced life support on scene and en route to the local hospital. After 11 minutes of resuscitation inside the hospital, the fire fighter was declared dead. NIOSH investigators concluded that the physical stress of ladder training triggered a heart attack or an arrhythmia, which resulted in his sudden cardiac death.
News from Our Partners
Iowa Dept of Public Health Partnering with Public Health
Rural health and safety are a big focus of public health programming in Iowa, especially for the Iowa Department of Public Health (IDPH) Occupational Health & Safety Surveillance Program (OHSSP). The IDPH OHSSP utilized the 2012 Farm Progress Show to reach a potential audience of over 150,000 farmers in a three day period. While serving as the coordinators of the Health & Safety Tent Area for this event, we utilized our state-based surveillance data and resources throughout the planning and implementation stages to synergistically increase our impact in the area of occupational health and safety. You can view a PDF highlighting this and other projects at www.idph.state.ia.us/eh/common/pdf/lead_poisoning_prevention/ph_campaigns.pdf.
Colorado Surveys Certified Pesticide Applicators
With funding support from the NIOSH High Plains Intermountain Center for Agricultural Health and Safety, the Colorado Department of Public Health and Environment (CDPHE) partnered with the Colorado Department of Agriculture and researchers at Colorado State University to conduct a public health survey with 2,000 of the state’s certified pesticide applicators. Preliminary findings suggest that pesticide illness and injury surveillance using poison center data alone is likely an under-estimation of the true incidence among this group of workers, researchers said. Results also suggest that other common data sources for occupational health surveillance in Colorado, such as hospital discharge data, may not be effective at filling this data gap, the survey also found. A final report will be published by CDPHE’s Occupational Health and Safety Surveillance Program (http://www.colorado.gov/cs/Satellite/CDPHE-DCEED/CBON/1251607754915). For more information or to request a direct notice of publication, please contact Meredith.Towle@state.co.us.
OSHA Webpage for Clinicians
OSHA recently released a new web page that provides information, resources, and links to help clinicians navigate OSHA’s web site and to aid clinicians in caring for workers. The web page is designed to serve clinicians new to occupational health and to serve occupational health providers. For more information, go to www.osha.gov/dts/oom/clinicians/index.html.
Health Hazard Evaluation (HHE) Program Update
Evaluation of Radon Levels at a U.S. Government Facility
HHE program investigators evaluated employee exposures to naturally occurring radon inside a government building. Investigators found that radon concentrations outdoors and in the occupied work area were below the Occupational Safety and Health Administration and Environmental Protection Agency exposure limits. Radon concentrations in the building’s basement, which is typically unoccupied, were higher than in the work area or outdoors. Investigators recommended that the employer:
- Minimize the amount of time employees spend in the basement.
- Consider installing a ventilation system in the basement to remove radon if the space is ever used as an occupied work area.
A link to this report can be found at http://www.cdc.gov/niosh/hhe/whats_new.html.
Posters on Cleaning Chemicals
Members of the NORA Services Sector Council worked with staff at OSHA and NIOSH to produce posters Protect Yourself: Cleaning Chemicals and Your Health to inform workers and employers about occupational hazards and interventions during the use of cleaning chemicals. The posters (11 in X 17in, DHHS (NIOSH) Publication No. 2012-125) are now available in English, Spanish, Tagalog, and Chinese. The posters can be downloaded from http://www.cdc.gov/niosh/docs/2012-125/ and hard copies can be ordered from http://wwwn.cdc.gov/pubs/niosh.aspx. The companion OSHA/NIOSH information sheet can be downloaded at http://www.cdc.gov/niosh/docs/2012-126/pdfs/2012-126.pdf. For further information, contact Scott Henn at SHenn@cdc.gov
Foundation Calls for Mining Safety and Health Research Concepts
The National Mining Sector Council (http://www.cdc.gov/niosh/nora/councils/mining/) developed the National Mining Agenda (http://www.cdc.gov/niosh/docket/review/docket246/). Its goals overlap many of the priorities in the first Call for Proposals of the Alpha Foundation for the Improvement of Mine Safety and Health, Inc. Researchers seeking Foundation funding should submit a concept paper by March 15. See http://www.alpha-foundation.org/ for more information.
New NIOSH Partnership with The Center for Health Design©
Recently, NIOSH and the Center for Health Design© (CHD) signed a new partnership agreement. NIOSH and CHD will collaborate in the development of guidance documents and other materials that incorporate safety and health considerations of both patients and workers during the design and construction of healthcare facilities. For more information contact Eileen Storey at (304) 285-6382 or EStorey@cdc.gov
What's New on the NIOSH Science Blog? Join the Discussion Today!
Federal Register Notices of Public Meetings and Public Comment
Evaluation of Scientific Data on Silver Nanoparticles (AgNPs)
Deadline to submit comment is February 19.
Proposed Data Collections Spectrum of Flavoring Chemical-Related Lung Disease
Published November 16, 2012. Written comments should be received within 60 days.
Request For Information: Update Of NIOSH Nanotechnology Strategic Plan For Research And Guidance
The deadline to submit comments is March 19.
Request for Information on Edel-Kindwall Caisson Tables for Preventing Decompression Illness in Construction Workers
The deadline to submit comments is March 29. https://federalregister.gov/a/2012-30080
For a full listing of NIOSH official publications for rules, proposed rules, and notices, go to http://www.cdc.gov/niosh/fedreg.html.
New NIOSH Communication Products
Criteria for a Recommended Standard: Occupational Exposure to Hexavalent Chromium
NIOSH has released a series of fact sheets and posters for correctional facilities on preventing the spread of MRSA.
- Handle Laundry Safely (Correctional Facilities)
- If You have a MRSA Infection (Correctional Staff)
- Managers: Protect Correctional Staff from MRSA
- Managers' Checklist for Protecting Correctional Staff from MRSA
- MRSA Can Live on High-Touch Surfaces (Correctional Facilities)
- Sharing Personal Items Can Spread MRSA (Correctional Staff)
- Use Hand Sanitizer, Bottle (Correctional Staff)
- Use Hand Sanitizer, Wall-Mounted Dispenser (Correctional Staff)
- Use Personal Protective Equipment (Correctional Staff)
- Washing Your Hands Stops MRSA (Inmates)
- Washing Your Hands Stops MRSA (Correctional Staff)
- What is MRSA? (Correctional Officers)
- What is MRSA? (Inmates)
- What is MRSA? (Correctional Staff)
Call for Abstracts, Proposals, and Presentations
23rd Annual Art and Science of Health Promotion Conference
March 18–22, Hilton Head Island, SC
Call for peer presentations. Deadline for submission is February 15
61st Annual International Association of Emergency Managers
October 25–30, Reno, NV
Call for speakers. Deadline for submissions is February 20.
Institute for Healthcare Advancement
May 8-10, Irvine CA.
Call for posters. Deadline for submission is March 1.
Upcoming Conferences and Workshops
Pennsylvania Governors Occupational Safety and Health Conference
February 19–20, Hershey, PA
Digital Health Communication Extravaganza 2013 (DHCX)
February 20–22, Orlando, FL
Association of Perioperative Nurses—Look for us, booth 1740!
March 2–7, San Diego, CA
Fire Industry Equipment Research Organization Fire PPE Symposium
March 4–6, Raleigh, NC
23rd Annual Art and Science of Health Promotion Conference
March 18–22, Hilton Head, SC
IAFC Wildland Urban Interface 2013
March 19–21, Reno, NV
2013 National Safety Council Texas Safety Conference & Expo
April 7–9, Galveston, TX
American Association of Occupational Health Nurses
April 15–18, Las Vegas, NV
Fire Department Instructors Conference
April 22–27, Indianapolis, IN
American College of Occupational and Environmental Medicine
April 28–May 1, Orlando, FL
IAFC Fire-Rescue Med
May 3–7, Las Vegas, NV
Institute for Healthcare Advancement (IHA), 12th Annual Health Literacy Conference
May 8–10, Irvine, CA
APA Work, Stress, and Health 2013: Protecting and Promoting Total Worker Health™
May 16–19, Los Angeles, CA
AIHCE 2013—The Art and Science of Professional Judgment
May 18–23, Montreal, Canada
6th Occupational and Environmental Exposures of Skin to Chemicals Conference
June 2–5, Amsterdam (Netherlands)
Association for Professionals in Infection Control, 40th Annual Conference
June 7–10, Ft. Lauderdale, FL
New England Fire/Rescue/EMS 2013
June 19–23, Springfield, MA
American Society of Safety Engineers (ASSE), Safety 2013 Conference
June 24–27, Las Vegas, NV
8th International Conference on Prevention of Work-related Musculoskeletal Disorders
July 8–11, Busan, Korea
IAFC Missouri Valley Annual Conference
July 10–12, Colorado Springs, CO
Fraternal Order of Police—Look for us, booth 112!
August 10–13, Cincinnati, OH
International Association of Firefighters Redmond Symposium
August 21–25, Denver, CO
29th Annual National VPPPA Conference
August 26–29, Nashville, TN
Association of Occupational Health Professionals in Healthcare
September 11–14, Orlando, FL
National Tactical Officers Association, Kansas City, MO—Look for us, booth 421!
September 22–27, Kansas City, MO
ICOH SC Joint Conference
September 23–26, São Paulo, Brazil
2013 NSC Congress & Expo
September 28–October 4, Chicago, IL
International Association of Chiefs of Police
October 19–23, Philadelphia, PA
61st Annual International Association of Emergency Managers
October 25–30, Reno, NV
A comprehensive list of upcoming conferences can be found at www.cdc.gov/niosh/exhibits.html.
Did You Know?
Did you know that that NIOSH now has a Spanish twitter site? Follow us today @NIOSHespanol.
Please send your comments and suggestions to us by visiting http://www.cdc.gov/niosh/contact/.
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