NOTE: This document is provided for historical purposes only.
Category: Adolescent Injury
Evaluation of Occupational Diseases and Injuries Among Teen-age Workers in West Virginia—Simoyi P, Islam S, Haque A, Ducatman A
Work related injuries and diseases among teenage workers were evaluated using claim databases from West Virginia Workers Compensation Bureau. All young workers who were injured between July 1, 1995 to June 30, 1996 and submitted a claim, were included in this. Data abstracted from various tables of the compensation databases included demographic variables such as age, gender, occupation, industry of employment and county of the accident. The injury information included cause of accidents, the nature of accidents, and the body parts injured. In addition, data on claim status, number of days paid for lost time and total amounts paid for lost time were also obtained. There were 2869 claims submitted by the young workers of which 776 (27%) occurred during the months of July and August indicating peak incidents during summer period. Most of the teenagers (41%) were employed in non-classifiable establishments followed by food service industry (27%). Thirty-one percent of the young workers were classified as laborers, 8.5% as food services workers, 6.3% as cooks, and 4.8% as nurse aids. Most frequently reported types of injuries were sprains (28%) and lacerations (26%). Twenty seven percent of the teenage workers cited contact with unclassified surfaces, 5% cited the use of hand tools and another 5% cited animal bites as the cause of injury or the contact material/ equipment in use when the accident occurred. Twenty percent of all accidents involved injuries to the fingers and 14% involved injury to the back. Forty percent (1146) of the claimants received payments for lost time and the overall mean cost was $3983 (SD=$7264). Of those who received compensation for lost time, temporary total disability (TTD) accounted for 81% and permanent partial disability (PPD) accounted for 15% of the awards. Permanent disability is a clear issue in this juvenile workforce. Data will be further analyzed to identify specific job categories at greater risk and geographic patterns of injury distribution among the young workers. In addition, comparisons will be made with adult workers to identify specific risk factors for injuries in teenage workers.
Comparing Adolescent Occupational Injuries to Adult Occupational Injuries: Four Years' Experience of Emergency Department Visits—Marshall SW, Dufort VM, Kotch JB, Waller AE, Langley JD
Objective. This study compares occupational injuries among adolescents (ages 15-19) to occupational injuries among adults (20 years and older), presenting at a hospital emergency department, for 1990-93 inclusive.
Method. A new patient management database was used to identify work-related injuries, as well as information such as injury cause and type, injury site, age, and sex.
Results. There were 1,361 work-related injuries among adolescents and 11,002 work-related injuries among adults treated at the emergency department over the four years of the study. The injury rate per 200,000 hours worked (100 full-time equivalents) among adolescents (13.8/200,000 hours) was more than double the rate among adults (6.3/200,000 hours). Adolescent males had a rate of 20.6 injuries, and females 5.8 injuries, per 200,000 hours. Adult males had an injury rate of 8.5 injuries, and females 2.6. Comparing injury rates between adolescents and adults, adolescents had remarkably higher injury rates for upper extremities (7.8 vs 2.7 per 200,000 hours), head injuries (3.2 vs 1.7 per 200,000 hours) and lower extremity injuries (2.2 vs 1.2 per 200,000 hours). Upper trunk injuries and systemic and special injuries are similar between the two groups. While overall injuries occur more frequently among males than females in both age groups, the disparity is slightly less among adult workers.
Conclusion. These findings point to the different risks and needs for prevention and treatment of occupational injury among adolescents compared to adults. This study also demonstrates how a well-planned data collection system can overcome some of the previously described difficulties of getting prevention-oriented information from emergency departments.
Adolescent Work-Related Fatalities—Kentucky 1994-1995—Moon E, Scheerer A, Struttmann T
Adolescents constitute a special population of the work force. Four adolescent fatality cases extracted from data collected by the Occupational Injury Prevention Program of the Kentucky Injury Prevention and Research Center will be presented as case studies of adolescent work-related fatalities. For inclusion, cases must meet the following criteria: (1) Victims were less than 18 years of age; (2) incidents occurred in Kentucky; (3) victims were residents of Kentucky; (4) incidents occurred in 1994 or 1995; and (5) incidents occurred during the performance of productive work, either volunteer or for remuneration. Cases to be presented are: (1) A 15-year-old boy working in a tobacco field, killed when his tractor turned over; (2) a 16-year-old boy delivering newspapers, who died of head injuries received in a motor vehicle crash; (3) a 14-year-old boy who was assisting a logger, crushed by a falling tree; and (4) a 17-year-old boy installing exhaust fans in a church, who was electrocuted.
Risk factors identified include lack of experience; lack of training for task as well as occupational safety and health training; lack of supervision; inappropriate size/strength for performing task; adolescent maturity/judgment level; fatigue; and time constraints. Recommendations for prevention are suggested, including task restriction; equipment modification; required use of personal protective equipment or systems; job training; and supervision.
Category: Agriculture
Fatal Injuries in Iowa Related to Loading Equipment—Johnston W, Rautiainen R
A significant portion (14 out of 156, or 9%) of Iowa FACE fatalities during 1995-1997 have been related to loading equipment: front-end loaders on tractors, skid-steer loaders, or front forks on these machines. Causes of injury include loader buckets falling on persons working under them, workers getting crushed between a stationary object and the loader, materials falling from the loader, and loaders overturning due to a high center of gravity while lifting or moving loads. Construction and agricultural loading safety needs specific attention due to the large number of serious injuries. The Iowa FACE program has produced materials to address these hazards and continues efforts to reduce loading injuries. Following are brief summaries of four representative case investigations:
A 37-year-old farmer was trying to clean the operating pedals of a skid-steer loader, which were frozen with manure, snow, and ice. He was working in a cold, small garage with a low ceiling, which prevented using the machine's lift arm locks. The bucket was stuck in the 3/4-raised position. The victim had disabled the seatbelt safety interlock and the bucket came down on him when he loosened the pedals and hydraulic linkages with a crowbar.
Victim was a 75-year-old farmer working alone loading manure with an older narrow-front tractor equipped with a front-end loader. Working in a sloped barn yard, he was moving in a reverse turn with the bucket raised, and full of manure. The tractor was tilted to the side and to the front, increasing its instability, and it tipped over during while turning. It rolled completely over crushing and killing the farmer.
A 61-year-old farmer and retired maintenance worker was in process of cutting trees and moving logs. Victim was using a backhoe with front-end loader to position a cut tree onto a wood pile, using the bucket to pick up a large tree with many limbs intact. The tree rolled off the bucket and a branch hit the farmer in the face and neck. He was found pinned in the tractor seat. CPR was ineffective.
A 51-year-old farmer's wife was helping her husband and son construct a new house on their farm. She and her son were standing between the tractor loader bucket and the house foundation holding down drainage tiling while the son filled in with gravel from the bucket. When the husband raised the front-end bucket to dump the load, they became pinned to the foundation. The farmer suspects brake failure, however our investigation shows other significant factors in loader geometry. The farmwife died of a ruptured aorta.
The 14 cases involve several recurring hazards which we will discuss: changes in center of gravity with loader position, type of machine, and nature of work; dangers of moving or working under hydraulically controlled buckets or forks; improper use of skid-steer loaders; front-end loader use in tight spaces; and dangers from lifting loads over-capacity.
ATV Injuries and Fatalities in Agriculture in Nebraska—Hetzler B
Problem Statement. In Nebraska we had five agriculture related All Terrain Vehicle (ATV) fatalities in 1996. Four of these were on-the-job (all adults) and one was recreational (nine-year-old). With four (8%) of the 48 occupational fatalities in Nebraska in 1996 being ATV fatalities, this was cause for concern.
Method. I have collected data on the fatalities and received accident reports on all ATV accidents reported to the Department of Roads for 1996 (28 reports). An ATV survey has been prepared to send to different groups throughout the state. The director of the 4-H Program for Nebraska is distributing a sample of 2,500 surveys to 4-H clubs throughout the state. The survey will also be completed by youths attending approximately 25 summer agriculture camps sponsored by the Nebraska Department of Health. Surveys will also be available at booths at County Fairs and special agriculture events such as tractor training for youths. The Nebraska Cattleman's Association has also agreed to publish the survey in their magazine (circulation 9,500). A 1-800 number is included with the magazine version of the survey.
This survey covers how ATV's are used; age and gender of operator; size of ATV; type of ATV (3-wheel, 4-wheel or other) protective gear worn; operating environment (paved/unpaved surface); and accident experience (to include if accident resulted in: restricted work activity, medical attention required or loss of consciousness). Also information about a free ATV Rider Course, provided nationwide, is being included with the survey.
Results and conclusions will be formulated when surveys are reviewed. After this review we will determine the best avenue to pursue to reduce ATV injuries and fatalities in agriculture. We began distributing surveys in late May, 1997, and will continue through the summer of 1997.
Also available at the poster will be copies of the ATV Survey and safety flyers we developed and disseminated on ATV fatalities and other agriculture fatalities.
Occupational Injury in Migrant Hispanic Farm-Worker Families— McCurdy SA, Beaumont JJ, Wilson BW, Henderson J, Samuels SJ, Schenker MB, Morrin L, Carroll D
Background. Injury represents an important health and economic problem in the agricultural industry. Although an important body of research has accumulated for injury among farmers and agricultural workers in other areas of the U.S., few data are available for migrant farm workers. There are approximately 3 million migrant and seasonal farm workers and dependents in the U.S., and estimates of the population in California range from 600,000 to 1.2 million. Farm workers tend to belong to ethnic and linguistic minorities. The predominant ethnic group is Hispanic, and in California this group constitutes approximately 90% of migrant and seasonal farm workers.
Farm workers may be at increased risk for injury because they are most immediately involved in production tasks. Hazards include animals, machinery, chemicals, and dangerous environmental conditions. Contributing factors in this population include low educational status, poor English and literacy skills, and inadequate understanding of existing reporting and support structures such as Workers' Compensation. Finally, agriculture is unusual among industries in that law and custom allow family labor, putting children at risk for farm-related injuries.
Methods. We are conducting a prospective cohort study of occupational injury among 500 Northern California migrant Hispanic farm worker families comprising approximately 1000 adults and 700 children. The study addresses specific hypotheses regarding remediable risk factors for injury. These include organophosphate pesticide exposure, piece-work vs. hourly pay, language appropriate safety training, and the role of multiple employment. Subjects live in local government-supported migrant housing centers. The population is overwhelmingly Hispanic and Spanish-speaking. Participants complete an interviewer-administered work-and-health questionnaire at the beginning of the harvest season (April-May 1997) and a baseline acetylcholinesterase test. Subjects are contacted approximately every 4-6 weeks through the remaining harvest season to determine work exposures and injury experience. In September and October 1997, a final interview is conducted, and subjects provide an end-of-season acetylcholinesterase test.
Results. At this writing, we have completed initial interviews on 717 adults, yielding a participation rate over 85%. Of these, 52 (7.3%) reported qualifying injuries within the preceding year. Among 575 children, 19 (3.3%) reported a qualifying injury within the preceding year. Further information will be available and presented at the symposium.
The Populations of Those Injured on Family Farms in Central Wisconsin—Stueland DT, Lee B, Gunderson P, Wittman L, Layde PM, Nordstrom DL
Farming is one of the most hazardous of all occupations. Few studies have been able to evaluate the incidence and risk factors for farm residents.
The Marshfield Epidemiologic Study Area (MESA) offers an unique opportunity to do a population-based case-control study of agricultural injuries. MESA contains a population of 49,186 of whom 4,828 are farm residents. Active agricultural surveillance continues in this population. During a two year period, cases were identified for a case-control study.
Overall, there were 472 injuries of which 183 (38.8%) occurred to nonfarm MESA residents. For farm residents, numbers of injuries and injury rates per 1,000 person years, with 95% confidence limits, were calculated. There were 207 injuries to adults, age 18 to 64, with a rate of 37.6 (32.8, 43.1). Children, age less than 18, suffered 58 injuries with a rate of 17.7 (13.6, 22.8) while elderly, age 65 and over, had 27 injuries for a rate of 31.1 (21.3, 45.4). Adult males (N=191) had a rate of 55.7 (48.1, 64.2). The injured included 28 persons with previously identified learning disorders of whom 14 (50%) were farm residents.
Residents of dairy farms had an injury rate of 35.2 (30.4, 40.8) while residents of nondairy farms had an injury rate of 14.1 (9.1, 22.0).
There was a wide spectrum of severity of injuries. During the period of observation there were two deaths, both of which occurred to nonfarm residents. Among farm residents, 8% of those injured were admitted for further treatment.
The major agent of injury was animals although injuries were also seen due to falls and machines. The most significant single risk factor for injury was hours of work which increased the risk of injury 3% per hour worked.
Family agricultural production involves not only adult males and females but also children and elderly. Interventions to reduce the rate of injuries to farm residents need to address the populations at risk and the diverse agents of injury.
National Estimates of Eye Injuries Based on the Traumatic Injury Surveillance of Farmers Survey—Walker F, Myers J, Geidenberger C
Little information regarding the incidence and risk factors for agricultural eye injuries in the U.S. is available. Data from the Traumatic Injury Surveillance of Farmers (TISF) were used to generate weighted national estimates of the incidence of eye injuries occurring on U.S. farms and ranches as well as to characterize those at highest risk. The TISF survey examined self-reported work-related injuries from a random sample of agricultural operations during the period of 1993-1995. The mail-based survey obtained information on injuries that either caused the injured person to seek medical attention or restricted activity for one-half day or more. It was designed to sample all 50 states by the end of the 3-year period.
Preliminary data from the 1993 TISF survey of 20 states indicated that eye injuries represented 6.7% of all agricultural injuries reported in the survey. From the 33 reported eye injuries, it was estimated that a total of 13,512 eye injuries occurred on U.S. farms and ranches in 1993.
For all lost-time injuries in the TISF, males accounted for 90.3% of estimated cases, and for eye injuries males represented even a larger percentage (98.3%). The greatest distribution (46.8%) of the eye injuries occurred in workers 20-29 years of age, but no eye injuries were reported for those under 20 years. The majority of the injured were non-Hispanic whites (66.6%) or Hispanics (29.7%). In the TISF survey, 63% of all lost-time injuries occurred to family workers (operators, partners and their families) compared to 37% for hired workers. However, 60.7% of eye injuries were reported for hired workers. Sixty-five percent of eye injuries occurred during the summer months (May-August). All of the reported eye injuries required medical attention but none resulted in permanent disability.
The distribution of total eye injuries by the activity when the injury occurred was as follows: farm maintenance (17.8%), machine maintenance (16.7%), handling livestock (14.5%), handling or storing crops (11.1%), or field work (10.0%). The object that caused the eye injury was a power tool (21.9%), hand tool (15.2%), livestock (14.0%), plants or trees (13.6%), truck/auto (3.3%), working surface (2.5%), or other source (27.6%). Pesticides or chemicals accounted for only 2.0% of the eye injuries. The proportion of eye injuries to all types of agricultural injuries differed according to the type of operation. For example, 32% of injuries in nursery operations were eye injuries, compared to 3.6% for field crop, 4.4% for vegetable, fruit or nut, 5.3% for beef, hog or sheep, and 7.0% for dairy operations. No eye injuries were reported in this limited sample for poultry or other farming operations.
Since eye injuries are largely preventable, these data may give direction for identifying certain agricultural tasks and specific agricultural operations to target for more intensive surveillance efforts and intervention research.
Category: Construction
Effects of a “Back Care” Program in Construction—Marks N
A population of 48 construction workers with prior history of disabling low-back pain were involved in an education and exercise program aimed at reducing recurrence of disability. They were followed for 4 years post-training and their injury experience and pain ratings were reviewed.
Although limited by the sample size, the findings showed that there appears to be a positive effect on the workers' ability to manage their pain better and to prepare themselves for strenuous activity by using the exercises taught during the program.
Construction Safety Association of Ontario Occupational Injury Database—Hardy F, Eng P, McVittie D
CSAO has been compiling injury data drawn from WCB records for many years. The Injury Database ( INJ) records have several fields which are not normally resident in most insurance or WCB datasets in other jurisdictions.
In addition to the common "name, rank and serial number"-type of data, CSAO's system captures data on project-type, construction activity type, specific worker occupations including apprentice or supervisor/foreperson status, worker activity, working surface, condition of working surface, major and minor codes for part of body, type of accident event, type of injury, distance and weight. In addition, 3 fields are available to record the materials, tools or equipment involved in the accident event using fields " Acted on"," Acted with" and "Other Involvement". A 3 line full text description is available as well as compensation, medical aid and pension costs.
This data is used to conduct injury analyses for different occupational groups or for different sectors of construction. The most comprehensive use of the data system has been the production of the Injury Atlas, which examine the injury experience of over 20 specific occupations in construction. Sample sets of data from the Atlas would be presented and discussed.
Hand Protection for Drywall Installers and carpet layers—Hardy F, Eng P
Research into serious cuts in the drywall sector of construction showed that the most serious injuries were the result of cuts affecting the tendons and the palm of the hand. Testing showed that weight lifters gloves could provide adequate protection of these areas and still permit an adequate level of dexterity for picking up screws, nails and other small items. Work with apprentices in this sector showed that early exposure to this solution is important in getting acceptance of this change in work practices.
Issues relating to GFCI usage with portable generators—Hardy F, Eng P
Questions regarding the grounding of portable generators and the issue of Ground Fault Circuit Interruptor performance led CSAO to carry out testing during April '97. There are concerns that without grounding the use of GFCI's is ineffective. Grounding the generator without using the GFCI would present a risk of electric shock since the user of the tool would have a voltage potential difference with earth. If the generator is not grounded to earth, however, there are some people who suggest that this is safer than grounding since the user would not have a voltage potential difference with earth and therefore would be safer.
In order for an electric shock to be experienced by the user of an ungrounded generator, a phase to phase fault would have to occur. This is much less likely than a phase to ground fault.
Leakage currents necessary to trip GFCIs were created and measured with different grounding configurations on the generator(s). Data on configurations and leakage currents would be presented.
SAFE-TRACK--Uniform Injury Tracking Process—Martin J
SAFE-TRACK is a computer-based system that records injury incidents in the construction, industrial and commercial industry sectors. The resulting data is then interpreted utilizing focus groups of workers along with safety professionals and used to recommend specific targeted actions to provide for increased worksite safety. Followup SAFE-TRACK data is then reviewed to evaluate the effect of the targeted worksite changes.
In addition to tracking injuries to establish industry or company baselines, SAFE-TRACK data has been used successfully in more than 25 projects to improve safety concerns at construction worksites, often during the progression of the work.
SAFE-TRACK's tightly targeted injury information has proven to be a valuable tool in assisting construction companies, as well as their health and safety focus groups, in designing and implementing continuous safety improvement programs which result in measurable decreases in OSHA recordables and lost-time accidents.
SAFE-TRACK is a system that provides focused safety trend analysis for users of construction services, contractors, as well as the crafts. The injury information, easily collected on a simple form, is indexed by OSHA injury severity classifications and reports can be produced by project, by craft worker, by type of injury, by shift, or by time of day; as well as other user requested formats.
The use of SAFE-TRACK provides a uniform reporting source, from job to job, from year to year, that establishes a statistical tracking system supporting planning issues that can include:
Falls Profile of Construction Laborers—Akladios M
This poster summarizes major causes and circumstances for fatal falls among construction laborers. The primary information in this profile was generated by data from the Bureau of labor Statistics Census of Fatal Occupational Injuries.
Additional information is generated from NIOSH Fatal Accident Circumstance & Epidemiology Analysis. FACE reports are detailed reports performed by NIOSH. While FACE summaries do not provide solid statistical explanations, they help explain factors that may be overlooked by comprehensive statistical data bases such as CFOI.
Ratios were calculated by comparing data generated by the CFOI database to full-time employee totals generated by the Center to Protect Workers' Rights (CPWR). The analysis covered deaths that occurred in the labor industry during 1992-1994.
The analysis showed that in the Laborers' profile, CFOI code 879, the number of fatalities was found to be 156.
Results from CFOI and FACE showed that most fatalities occurred to males within the age range of 25-44, and that all laborers lost their lives within four days of falling. Most of them hit concrete surfaces, head first.
From FACE summaries, the most common violations were 29 CFR 1926.104, 105, and 451.
Recommendations included: 100% tie off, covered/marked man-holes, skylights, and other roof openings, the utilization of nets, and extensive employee training.
Questionnaire-based Ergonomic Hazard Assessment of Construction Workers with Musculoskeletal Injuries—Anderson J
Since 1990, we have conducted surveillance of construction worker injuries treated in George Washington University's Emergency Department. Musculoskeletal injuries were the second-most prevalent type of injury, accounting for 21% of these emergency department cases. Since June 1996, we have telephoned workers to collect details on the injury circumstances as well as return-to-work programs, ongoing musculoskeletal symptoms, and subsequent or recurrent injuries. By interviewing workers from a number of construction trades, we hope to characterize both the short- and long-term effects of these WMD injuries on physical health, emotional health, and livelihood.
One of the questions in the telephone interview addresses day-to-day trade-specific tasks. The nature and frequency of the most common tasks were identified for each worker. From initial interviews to date, we generated a preliminary listing of the tasks reported by two trades — carpenters and plumbers. From this list, we standardized and coded the tasks for the two trades. For each standardized task, we used available data (trade-specific ergonomic analyses, checklists, expert opinion, etc.) to produce a trade-specific ergonomic hazard rating that addresses posture, force, and repetition. Once an ergonomic hazard rating was developed for each task, the ratings were weighted by frequency and summed across the identified tasks for each worker.
This paper will focus on the methods for developing individual ergonomic hazard ratings from questionnaire-based data on tasks. We plan to develop similar trade-specific task-based ergonomic hazard ratings for all workers in our followup study.
These task-specific hazard ratings will enable us to compare the ergonomic hazard in the WMD-injured population to that of an age- and trade-matched comparison population who were asked the same question about their daily tasks. When the analyses are complete, we hope to have determined: (1) whether the level of ergonomic hazard influences the occurrence of ongoing musculoskeletal symptoms and subsequent or recurrent injuries; and (2) whether any specific tasks or ergonomic factors appear to put workers at risk for ongoing symptoms or recurrent WMD injuries.
Construction Injuries in Alaska—Husberg B, Conway G Introduction: Construction takes place year `round in Alaska, and the harsh arctic environment introduces factors that can interfere with worker safety. This study uses injury surveillance data from the Alaska Trauma Registry (ATR) to examine injuries in the construction industry.
Methods. Data from the ATR for the years 1991 - 1995 was used to characterize the causes of injury in the construction industry in Alaska. The ATR is a statewide, population-based data base that tracks moderate to severe injuries that occur in Alaska. Data is collected retrospectively from hospital medical records at each hospital in Alaska, then sent to the Alaska Department of Health and Social Services, Division of Public Health, Section of Community Health and Emergency Medical Services to be compiled into the ATR. Occupational injury surveillance data goes through additional data cleaning and coding by personnel at the National Institute for Occupational Safety and Health, Division of Safety Research, Alaska Field Station. The ATR only includes those moderate to serious injuries which require hospitalization. The only fatalities that meet the case definition for inclusion into the ATR are those who have been seen and treated in a hospital prior to death.
Results. The total number of hospitalized injuries in the construction industry ranked second (n=371) in number only to commercial fishing (n=396). Six (1.6%) of the construction injuries resulted in fatalities. There was a mean of 74 injuries each year in the construction industry ranging from 66-88. Falls lead all other causes of injury, accounting for 198 of the cases. The most common falls are from or out of a structure (67), while using a ladder (52), while using scaffolding (36), from one level to another (18), and slipping or tripping (10). The upper extremities are the most common body region injured followed by the head. The most common injury is a musculoskeletal injury--usually a broken bone. There is no pattern suggesting a seasonal variation to falls. It is not possible to reliably ascertain from ATR abstracts if the fall was directly caused by ice or snow.
Conclusions. Previous studies have ranked occupational fatalities in the Alaskan construction industry in the bottom third. However, construction injuries rank second in number of all industries recorded in the ATR. Even though construction continues year round in Alaska, our data show no consistent pattern suggesting an increase of falls when arctic conditions are present. From these data, further research into fall prevention and protection in the Alaskan construction industry is currently underway by a interagency working group in Alaska.
Trade-Specific Injury Patterns among Construction Workers Nessel-Stevens L, Hunting K, Welch L
In order to learn more about the causes of non-fatal construction worker injuries, we established an emergency department-based surveillance program. Between November 1990 and June 1996, we reviewed the medical records of 2,280 construction workers who have been treated in the GWU Emergency Department for work-related injuries and illnesses. These injured workers were overwhelmingly (98%) male, and most (66%) were between the ages of 25 and 44. Laborers, carpenters, and electricians led the list of occupations, though workers from over twenty construction trades were represented. The most common injuries treated were lacerations (38%) and strains and sprains (21%). Four percent of the workers had injuries serious enough to require hospital admission. Contact with sharp objects (28%), falls (16%), and overexertion (11%) were the most frequently noted injury circumstances.
While the overall demographic characteristics, diagnoses, and injury circumstances are interesting, it is the more detailed injury descriptions, by trade, that are more useful for thinking about injury prevention. To illustrate this, we will present data on injury patterns among workers from four specific trades: carpenters; electricians; ironworkers; and plumbers and pipefitters. Together, these trades represent 43% of the injured construction workers in our case series. Highlights of the results follow:
Lacerations were the most frequent injury for each of the trades except for ironworkers, and for all trades combined. For ironworkers, sprains, strains, and muscle pain was the most frequent injury category, especially to the back and ankle or foot.
Among carpenters and plumbers, lacerations were most often caused by pieces of metal or unspecified metal objects. Power saws, drills, nail guns, and screw guns were also frequently associated with carpenters' lacerations. In contrast, electricians most often sustained lacerations while fixing or changing light fixtures, while ironworkers were most frequently cut by tie wire.
Ironworkers experienced a higher proportion of falls than any other trade examined in this study. Slips/trips (many while walking on rebar) were the most frequent type of fall sustained by ironworkers. In contrast, among plumbers, electricians, and all trades combined, falls from ladders represented the most significant fall hazards.
These and other differences in injury patterns allow us to discern specific risk factors for construction work injuries, and to suggest prevention measures that might be implemented on a trade-specific and task-specific basis.
A Tool for Planning and Monitoring Construction Site Safety Gambatese JA, Hinze JW
Ensuring safety on the construction site involves careful planning and implementation of safe practices and procedures. Project safety planning involves anticipating safety hazards and applying effective safety measures to the job at hand in order to minimize or eliminate the hazards. Effective safety planning relies on one's knowledge of construction processes and procedures and the applicable safety regulations. Safety planning is enhanced when assistance is provided in determining the safety regulations applicable to each construction process and procedure. Following the safety planning effort, successful implementation of safety measures requires periodic inspections of the jobsite to ensure the safety plan is in place and safety regulations are met. While safety inspections are a valuable means of maintaining a safe jobsite, the complexity associated with many construction projects can cause some hazards to be overlooked. Many construction firms utilize safety checklists to assist in performing safety inspections.
A computer program has been developed to assist in planning and monitoring construction site safety practices and conditions. The program includes a database of construction safety checklists that address various general requirements, work phases, temporary structures, and construction materials. Instead of creating generic check-lists, the program allows the checklists to be modified to match the specific jobsite characteristics. The checklists related to specific work phases can be useful in planning and scheduling safety measures before construction begins. During construction, the check-lists can prove useful for jobsite inspections by safety personnel, safety committees, and others involved in monitoring safety conditions on a jobsite. In addition, the checklists also provide valuable information that is useful in safety training.
Mortality Patterns Among the International Brotherhood of Electrical Workers, 1982-87—Robinson CF, Petersen M, Palu S
This study evaluated the mortality of 31,068 members of the U.S. Electrical Workers' Union who worked in the construction industry and died 1982-1987. Age-adjusted proportionate mortality ratios (PMRs) and proportionate cancer mortality ratios (PCMRs) were computed using the U.S. age-, gender-, and race-specific proportional mortality for the years of the study. For white male electrical workers, significantly raised mortality was observed for lung cancer (PMR=117), mesothelioma (PMR=356), melanoma skin cancer (PMR=123), cancer of prostate (PMR=107) leukemia (PMR=115, tumors of eye, brain and central nervous system (PMR=136), diseases of the blood forming organs (PMR=141), asbestosis (PMR=248), electrocutions (PMR=1145), and all fatal injuries (PMR=116). When proportionate cancer mortality analysis was used, the risks for these cancers remained elevated, although the significance became borderline for leukemia and melanoma PMRs. Among 114 white women electrical workers, mortality due to leukemia (PMR=195) and breast cancer (PMR=124) was elevated, but not significantly. More than 82% of all electrical workers studied had greater than 30 years membership in the union. The data show that electrical workers have elevated proportionate mortality for the diseases caused by asbestos (lung cancer, asbestosis, and malignant mesothelioma) and from traumatic injuries, particularly electrocutions and other fatalities that may be related to the workplace. The findings of prostate cancer, tumors of eye, brain and central nervous system, and diseases of the blood forming organs were unexpected. Elevated mortality from leukemia and melanoma skin cancer may be related to electrical work and suggests further evaluation of possible risk factors is needed. These data suggest that construction electrical work is a very hazardous trade.
Motor Vehicle Fatalities in the United States Construction Industry— Fosbroke DE, Ore T, Hixon P
A death certificate-based surveillance system was used to identify 2,144 work-related motor vehicle fatalities among civilian workers in the United States construction industry over the years 1980-92. Construction workers were twice as likely to be killed by a motor vehicle as the average worker, with an annual crude mortality rate of 2.3/100,00 workers. Injury prevention efforts in construction have had limited effect on motor vehicle-related deaths, with death rates falling by only 11% during the 13-year period, compared with 43% for falls, 54% for electrocutions, and 48% for machinery. In all industries combined, motor vehicle fatality rates dropped by 47%. The largest proportion of motor vehicle deaths (40%) occurred among pedestrians, with construction accounting for more than one-fourth of all pedestrian deaths. A minimum of 54 (6%) of these pedestrian fatalities were flaggers or surveyors. Flaggers accounted for half the 34 pedestrian fatalities among women, compared with only 3% among men. Along with previous studies and recent trends in the amount and type of road construction, these results underscore the need for better traffic control management in construction work areas to reduce pedestrian fatalities. As the second leading cause of traumatic death in construction, with an annual average share of 15% of the total deaths, exceeded only by falls, prevention of work-related motor vehicle research should become a greater priority in the construction industry.
Category: Engineering and Protective Technology
Near Fatal Events—Momentary Lapses in Reason?—Stobbe TJ, Cormier W, Monteressi C
Every day people die in the workplace. Many of the deaths occur when highly experienced people who knew better, select actions that put them at high risk of serious injury or death. The question is WHY? Are they careless? Ignorant? Risk takers? Indifferent? This paper discusses the why by summarizing the results of 134 structured interviews of workers who had been involved in incidents that could have been fatal for them.
The purpose of the project was to understand why these incidents occurred so that intervention strategies could be developed. The interviewees were experienced coal miners at underground and surface coal mines. One or more of the authors conducted the interviews, and they lasted one to one and one-half hours. The interviews were conducted at the worksite. The focus of the interviews was to understand both what happened during the incidents, and the interviewee's role in the incident. Once these were understood, the interviews focus shifted to trying to understand WHY what happened happened—both in the global incident, and in the actual actions of the interviewee. We were particularly interested in the interviewee's actions and the judgements that led to the actions and outcomes.
The results show that the data fell into six categories. The categorie were: following orders, conscious choice, making assumptions about the state of the world, did not know the risk, were “unconscious” at the time of the incident, and deliberate risk taking. Each of these categories suggests a different combination of intervention strategies. For example, when a worker is following a supervisor's orders when they make unsafe behavior choices, it is primarily a management problem which may be addressable through supervisor training—or it may take a complete change in corporate philosophy about the comparative importance of safety and production. In comparison, a worker who does not know about a risk may need to be educated about the hazards and risks that exist in his/her workplace with classic cognitive training methods.
The paper discusses each of the six behavior categories, gives examples of each, and discusses ways in which the “safety” problems associated with each category may be addressed. It also discusses an intervention project that is being developed to address some of the categories.
An Ergonomic Audit of a Mississippi River Revetment Process— Chervak SG
An ergonomics team from the U.S. Army Center for Health Promotion and Preventive Medicine performed an assessment of a Mississippi River revetment operation.
Revetment is the process used to reinforce riverbanks with concrete plates to combat erosion. The task is unique, but the ergonomic risk factors involved are fairly typical.
The ergonomics team identified specific ergonomic hazards that can contribute to cumulative trauma disorders, resulting in decreased productivity, increased errors, lost work time, and increased costs. Tasks at the revetment operation included facilitating the removal of concrete slabs from a storage barge, aligning the slabs onto the roller barge, straightening the slabs as needed, and tying together the concrete slabs using a pneumatic tying tool. The risk factors identified included awkward postures, forceful exertions, mechanical stresses, and repetitive motions. Recommendations to reduce the risk of suffering a cumulative trauma disorder injury included modifying the tying tool to minimize poor back postures and to eliminate the amount of repetition, reducing force required to operate the tool, and eliminating mechanical stresses. The ergonomics team also recommended that the operation be examined to determine if certain jobs in the process can be eliminated and that employees be educated in the proper use of the tying tool.
Development of a Data Collection System for a Pen-based Computer— Ching CR
To facilitate the recording of survey information, an ergonomics team from the U.S. Army Center for Health Promotion and Preventive Medicine developed a data collection system for use with a pen-based computer.
The team had to evaluate video display terminal workstations at U.S. Army installations in Belgium and determine compliance with Belgian Royal Decree. In addition to the Decree, the team used International Standards Organization and European Community standards to research evaluation criteria. The survey involved three pen-based computers, each running the same software program. The team wrote a data collection program with the interface designed to take advantage of pen-based computer features. Five evaluators received training in the use of the pen-based computers. Evaluators entered information, such as features of the individual workstation and environment, and recorded potentially damaging postures. The multilingual system gave immediate feedback and “quick-fix” recommendations for each workstation. The team evaluated 340 workstations within a 15-day period with each survey lasting approximately 10 minutes. The team downloaded survey results from each pen-based computer to create one large data base for analysis. The data collection system was efficient and easy to use. The team will modify or customize the program for other applications.
Hazards Associated with Roof Drilling and Bolt Installation in Underground Coal Mines—Unger RL, Cornelius KM, Turin FC
Roof drilling and bolt installation in underground coal mines is labor intensive, repetitive, and exposes operators to many hazards which can result in accidents, both acute and cumulative in nature. One concern of mine safety officials is the number accidents occurring where the roof bolter operator is crushed by the powerful hydraulic drill boom. Another concern is the rising number of injuries due to cumulative trauma. A NIOSH team of researchers examined these problems with several goals in mind. The first was to identify the root causes of the acute trauma accidents and develop effective solutions that could be implemented promptly. The second goal was to examine the cumulative trauma exposure of roof bolter operators and develop recommendations aimed at reducing the risk of developing injuries. Finally, the team developed materials to educate the mining industry on human factors engineering principles with the intention of improving the design of roof bolting machines.
The following steps were taken to investigate traumatic crushing injuries: interviewed roof bolter operators, analyzed video tapes of roof bolting operations, discussed issues with roof bolter manufacturers, analyzed mine accident data, and reviewed past research on roof bolter safety. The team determined that the goal of any intervention should focus on reducing the probability of a control being accidentally activated and reducing the chances of roof bolter operators placing themselves in hazardous positions around the machine. To achieve that goal, the team developed a list of solutions based on their analysis of the information collected. Some of the recommended solutions include the use of an operator-in-position interlock device, fixed barriers at pinch points, improved control guarding, and reduction in speed of the fast feed. Many of these ideas have already been implemented.
In response to cumulative trauma exposure concerns, members of the project team conducted a study at an underground coal mine to examine roof bolter tasks that performed over time could put the operator at risk. For this study, three primary forms of data were collected and analyzed. Researchers analyzed 43 lost time incident descriptions, conducted a series of interviews with roof bolter operators, and observed operators performing roof bolting tasks. Common roof bolting activities were examined and issues identified as putting operators at risk of injury were discussed. Recommendations were developed which address the three elements which define a system: human, equipment, and environment. The recommendations can be used to increase worker awareness of risk factors, modify job procedures, improve existing equipment, and provide guidelines for future equipment design.
Efforts to educate the mining industry have included the development of seminars on human factors design geared toward design engineers and mine safety personnel, the construction of mockups that demonstrate human factors principles, and the publication of a world-wide-web page devoted to human factors design issues associated with mobile underground mining equipment.
Safety Considerations for Transport of Ore and Waste in Underground Ore Passes—Stewart BM, Beus MJ, Iverson SR, Moreland MW
Researchers at the Spokane Research Center of the National Institute for Occupational Safety and Health are investigating methods to improve safety during transport of ore in underground mines and to prevent injuries and fatalities to miners around ore passes. Five fatalities in the last three years were directly related to ore hang-ups resulting in ore pass structural failure and ore chute blow-out. Mine Safety and Health Administration (MSHA) accident statistics have identified ore pass hazards. Mine accident data has shown that injuries and fatalities have resulted during ore pass chute and gate operations. Nearly 75% of the accidents related to pulling or freeing ore pass chutes are caused by the use of hand tools and falls of broken rock. Recent ore pass failures have underlined the need for improved designs, standards, structural monitoring methods, and improved hang up prevention/removal techniques. A fault tree analysis identified five leading causes of ore pass failure. Ore pass transport practices and problems at past and present operating mines are discussed.
Design criteria and hang up prevention and remediation strategies include effects of static and dynamic ore and waste rock loads on chutes, walls, gates, and support structures. Particle flow analysis methods were used to simulate the response of various ore pass designs to a wide range of ore loading conditions. A full-scale and 1/3 scale mock-up of ore pass and chute assemblies currently installed were duplicated and tested for load response. Data from the particle flow code, and the mock-ups are compared. Instrumentation and load measurements of an active ore pass will be conducted after the mock-up tests are completed. Development of safer ore pass design and ore handling proceedures are the goals of the project.
Graphical Analysis of Energy Expenditure—Belard J-L, Dotson B, Wassell JT, Long D, Wojciechowski W
Waste abatement workers, due to the nature of their job, require a high level of protection and must therefore commonly wear personal protective equipment such as a self-contained breathing apparatus (SCBA) and encapsulating suits. Wearing this type of personal protective equipment while working adds a weight burden, impedes heat exchange and can lead to physiological strain and increased energy expenditure. This strain and increased energy expenditure can in turn lead to exhaustion in a period of time much shorter than would be experienced without this equipment. The goal of this study was to analyze the energy expenditure of hazardous waste abatement workers while performing tasks common to their jobs.
Nine asbestos workers aged 27 to 40 performed six typical hazardous waste abatement tasks in a laboratory setting. Subjects carried an SCBA and wore a Mine Safety Appliances Company (MSA) BlueMaxTM totally encapsulating suit. This level of protection is designated “Level A” and is utilized by workers who require the ultimate possible protection during waste site cleaning operations. Although all subjects were in a safe laboratory environment, they were required to wear this complete protection in order to approximate work site energy expenditures. However, since no activity in a toxic environment was involved, subjects were allowed to keep the garment open and the SCBA disconnected. All tests were conducted in a neutral environment (20ºCentigrade, 60% relative humidity). Heart rate, respiratory frequency, and oxygen consumption were measured every 30 seconds during the performance of the various activities.
Six different tasks were selected for simulation through an agreement with hazardous waste abatement union experts. The activities simulated typical tasks performed daily on hazardous waste sites. These typical tasks included: walking from one place to another, carrying equipment, decontamination of soiled surfaces, shoveling toxic dirt into drums, digging to uncover barrels, and crawling in confined spaces. These tasks were simulated with the following activities: walking on a treadmill at 1.5 miles an hour, carrying a 20-pound bucket at the same speed, mopping the floor at 60 strokes per minute, shoveling sand from ground level into a drum, digging at ten shovels per minute, and crawling on the treadmill at 0.3 miles an hour. In all, each tested activity lasted ten minutes, including a five minute warm-up that allowed each subjects' heart rate to reach a plateau. Oxygen uptake data obtained during the last five minutes of each test are used to measure the energy expenditure. The data collected is being analyzed in graphical form.
The risk of impending heat stress increases not only with the ambient temperature, but also with a work load. Results of this study will be useful in determining the workers' average energy expenditure when they perform a given task, and thus to assist with decision-making whether an appropriate micro cooling system is required.
Category: Surveillance
National Estimates of Occupational Injury from the National Health Interview Survey—Geidenberger CA, Jackson LL
The 1988 National Health Interview Survey Occupational Health Supplement is part of a continuing effort by the National Institute for Occupational Safety and Health to improve surveillance of occupational injury and disease. Data from this survey were used to generate national estimates of work-related injury incidence among civilian workers. Eye injuries were a particular focus of the analysis since, in general, such injuries may easily be prevented in the work place at relatively low cost. The overall incidence of occupational injury was 8.6 episodes per 100 workers or 7.2 injured persons per 100 workers. Incidence of injury episode varied by occupation and industry of employment, with injuries occurring most frequently among operator/fabricator/laborer occupations and those employed in the construction industry. Incidence also varied according to body part injured and nature of the injury, with back injury episodes and fractures/dislocations/sprains, respectively, the most common. Risk of injury declined with age for both sexes and was higher for males in every age category. Eye injuries occurred most frequently among those employed in the construction industry and in production/craft/repair occupations. Risk of eye injury was lower than risk of injury to the extremities or back within every occupation and injury category. In addition, those with eye injuries reported fewer days of missed work than did workers with trunk, extremity, or back injuries. Nevertheless, the estimated number of work-related eye injury episodes during the study period (625,745) was substantial, representing 5.9 percent of the estimated total. These results are generally consistent with findings of other injury surveillance systems, and provide further guidance for future intervention efforts.
Traumatic Occupational Fatalities Due to Falls From Elevations —Cause and Prevention—Braddee R, Pratt S
Purpose. To identify and describe trends in traumatic occupational fatalities due to falls from elevations, review recommended prevention strategies, and describe the approach of the National Institute for Occupational Safety and Health (NIOSH) to traumatic occupational fatality investigation and prevention.
Method. This study uses data from the National Traumatic Occupational Fatalities (NTOF), and Fatality Assessment and Control Evaluation (FACE) databases to describe trends and rates of fatalities of workers due to falls from elevations, over a 12-year period. The FACE program, which utilizes the traditional epidemiologic agent-host-environment model to accurately describe the pre-event, event, and post-event phases of fatal occupational injuries, is conducted in the areas of falls from elevations, logging, and machinery-related fatalities. Through surveillance and epidemiologic investigations, potential risk factors are identified and injury prevention strategies developed.
Results. During the period 1980 through 1991, approximately 72,500 U.S. civilian workers died from traumatic injuries suffered in the workplace according to data from NTOF. Over this 12-year period, an estimated 6,721 of these deaths occurred due to falls from elevations. Although the trend of falls from elevations declined from .68 per 100,000 workers in 1980 to .38 in 1991, falls from elevations remain the 4th leading cause of death Nationwide. Between October 1982 and present, the NIOSH FACE program has investigated 79 fatal incidents that involved workers who died as a result of falling from an elevation. Recommended injury-prevention strategies include working in compliance with national safety standards, establishing and implementing written safe work procedures, using proper personal protective equipment and providing appropriate worker training.
Conclusion. Approximately 560 workers die each year from falls from elevations in the course of everyday work situations, and falls remain the 4th leading cause of occupational injury fatalities Nationwide. In order to reduce these numbers, surveillance, dissemination of prevention strategies, and additional research need to be continued. The FACE model has been demonstrated as an effective tool for identifying and describing fatal occupational injuries and developing prevention strategies. The FACE data has been used to produce targeted dissemination of prevention strategies, and to provide input into the promulgation of national safety standards.
Worker Deaths by Electrocution--A Summary of NIOSH Surveillance and Investigative Findings—Casini VJ, Kisner S
Purpose. To identify and describe trends in traumatic occupational fatalities due to contact with electrical energy, review recommended prevention strategies, and describe the approach of the National Institute for Occupational Safety and Health (NIOSH) to traumatic occupational fatality investigation and prevention.
Research Hypothesis. Through surveillance and on-site fatality investigations of occupational electrocutions, risk factors can be identified and intervention strategies developed, disseminated, and implemented to reduce fatal occupational injuries.
Research Data. Data from the National Traumatic Occupational Fatalities (NTOF) surveillance system, which is based on death certificates from all 50 States and the District of Columbia meeting the following criteria: age 16 years and older; external injury cause of death; and the certifier noted that the injury occurred at work was used. Data are also included from the Fatality Assessment and Control evaluation (FACE) program gathered during field investigations using the traditional epidemiologic model.
Method. This study uses data from the NTOF surveillance system and the FACE database to describe trends and rates of fatalities of workers during to electrocution over a 12-year period. Through surveillance and epidemiologic investigations, potential risk factors are identified and injury prevention strategies are developed.
Results. According to NTOF data, a total of 5,338 workers were electrocuted in 5,170 incidents from 1980-1992. An average of 411 workers were electrocuted each year, with an average annual rate of 0.4 workers per 100,000 workers. Although the number of electrocution deaths have decreased by more than 50% from 1980-1992, electrocutions accounted for 5% of all worker deaths in 1994 in the U.S. From November 1982 to December 1994, the NIOSH FACE program investigated 224 electrocution incidents resulting in 244 occupational fatalities. Recommended prevention strategies include compliance with national safety codes, proper use of personal protective equipment, appropriate worker training, and developing and implementing comprehensive written safety programs.
Conclusion. Approximately 411 workers die each year from electrocution-related incidents in the work environment, and electrocutions account for 5% of all occupational fatalities in the U.S. To reduce these numbers, prevention strategies need to be developed and disseminated to targeted audiences. The FACE model has been demonstrated as an effective tool for describing fatal occupational injuries, developing prevention strategies, and disseminating these prevention strategies to targeted audiences.
A Profile of Occupational Eye Injuries from the West Virginia Workers' Compensation Program—Jackson LL, Islam S, Bowers C
Eye injuries are a preventable occupational injury, yet the U.S. Bureau of Labor Statistics estimates that eye injuries account for about 4% of lost work time accidents. Analysis of workers' compensation data provides an opportunity to determine the nature of eye injury in the workplace and to target intervention efforts to higher risk industries and occupations and eventually to individual employers with high incidence rates.
West Virginia is one of only a few states that has an exclusive state-managed workers' compensation insurance fund and does not allow private third-party compensation insurance coverage, although it does allow some companies to self-insure (less than 1% of all companies). We examined 4422 compensable eye injury claims from the West Virginia Workers' Compensation Program for July 1995 through June 1996. The eye injury claims accounted for about 7.6% of the total number of injury claims (58325) during the one-year period. Eighty-seven percent of the claimants are male. The average age of claimants was 35 years, ranging from 14 to 74 years of age, with 85% of the workers in the age range of 20 to 49 years.
Sixty percent of the injuries were caused by various particulate type materials and 23% were caused by chemicals, gases, fumes, or liquids. The major types of accident events were “rubbed or abraded” (60%), “struck by” (20%), “bodily reaction” (7%), and “contact with radiations, caustics, and toxic substances” (6%). The nature of the injury was mostly foreign bodies in the eye (70%) with a fewer number of cuts, punctures, and abrasions (13%) and chemical and radiation burns (7%). Less than 1% of the total number of injuries were caused by imbedded splinters or chips or punctures.
In 82% of the claims the injury involved only one eye, whereas in 10% of the claims both eyes were injured (8% were not specifically identified). For those claims in which both eyes were injured, the proportion doubled for accidents caused by chemicals, gases, fumes, and liquids (47%) and tripled for accidents caused by contact with radiations, caustics, and toxic substances (21%). Contact with temperature and pressure extremes increased to 8% in comparison to only 2% for all eye injuries. There was also a dramatic increase in burn injuries from 7% for all eye injuries to 34% of injuries involving both eyes.
In summary, the West Virginia Workers' Compensation data provide an excellent opportunity to profile minor as well as serious eye injuries in the workplace.
An Epidemiologist's Trek through Several Industries Injury/Incident Data—Thomas RJ
Analyses of personal-computer-based records of injury data with company historic demographic and job history data presents a different perspective of case definitions and the populations-at-risk than the traditional `safety' injury/incident counts to `full-time equivalent' persons.
Data from several different industries of varying size, in scattered geographic locations, and of different types (a utility, an electrical product manufacturer, and a multi-site chemical producer) illustrate the presence of confounding in both the numerator and denominator of traditionally calculated industry rates.
One client's data on current employees, which includes work and injury data back to 1952, leads to a historic view of employee's injuries. There are three employee populations (besides the classic sub-groups of male/female, recent hires/long term employees, et cetera):
Helicopter External Load Traumatic Injuries — Epidemiology and Prevention—Manwaring JC, Conway GA, Garrett LD
Helicopter external lift load operations are gaining wide acceptance as an alternative to conventional surface heavy lift and transportation. Such operations, however, are not without their hazards. Helicopter external load operations, such as helicopter logging, can be demanding on helicopters and the pilots who fly them. The potential for machine failure and human error has lead to tragic results. Helicopter external load operations have been associated with a large number of helicopter crashes resulting in serious traumatic injuries. There were 230 helicopter external load accidents in the United States investigated by the National Transportation Safety Board (NTSB) from 1980 to 1995. These accidents resulted in 57 fatalities and 74 serious non-fatal injuries. Of the 230 accidents, 44 (19%) resulted in one or more fatalities. There was a mean of 0.25 fatalities per accident, and a mean accident pilot fatality rate of 14% (40 pilot fatalities out of 276 pilots involved in 230 accidents). Of the 230 accident reports, 190 (83%) noted a flight purpose. Of these 190 events, 65 (34%) occurred during heli-logging operations. These 65 events resulted in 26 (46%) of all fatalities, and 30 (41%) of the 74 serious non-fatal injuries. Construction-related external load accidents accounted for 42 (22%) of the 190 accidents. These accidents resulted in 10 (18%) of the fatalities, and 16 (22%) of the serious non-fatal injuries. The rest of the accidents (83 in number or 44%) involved miscellaneous cargo operations (19%), power line operations (8%), christmas tree operations (6%), seismic operations (6%), fire control operations (3%), and agricultural operations (2%). These 83 accidents (44%) accounted for 21 (37%) of all fatalities, and 28 (38%) of the 74 serious non-fatal injuries. According to the NTSB who assigned “primary probable cause” to all 230 accidents, pilot error accounted for 44% (n=102), mechanical failures accounted for 38% (n=88), and maintenance accounted for 10% (n=23) of the accidents. A vast difference in primary probable cause was noted between heli-logging and non-heli-logging accidents. For heli-logging, the primary probable causes were mechanical failure (63%), pilot error (29%), undetermined (5%), and maintenance (3%). For non-heli-logging operations, the primary probable causes were pilot error (50%), mechanical error (28%), maintenance (13%), and undetermined (8%). The risks associated with these probable causes can be minimized by adherence to existing regulations and manufacturer recommendations, improved training, and more frequent and intensive helicopter maintenance. Recent experience in Alaska has shown that following these recommendations can make helicopter external load operations safer, thereby dramatically reducing the number of crashes and injuries.
Category: Miscellaneous
Characteristics of Success Following A Comprehensive Pain Control and Functional Restoration Program—Chen W
Chronic pain is a complex multidimensional problem and a multidisciplinary approach is a preferred model of management in patients with chronic pain. Functional restoration and activity based programs have documented successes in decreasing the disabling effects of chronic pain. The purpose of this study was to describe program and subject characteristics of a multidisciplinary pain program and to identify significant factors that can predict treatment outcomes of such a program. The database of a pain control and functional restoration program was reviewed. Two hundred and ninety-two subjects returned the six-month follow-up questionnaire. These subjects were assigned to either a successful or not-successful outcome group based on clinical judgment of the following criteria: return-to-work (or active retirement), off third-party-support, off narcotics, reduction in pain, and improvement in function. Characteristics of successful and not-successful outcome groups at the time they entered the program were analyzed retrospectively. Discriminant function analysis was utilized to identify significant factors that classified the two outcome groups. Initial working status, ethnicity, the schizophrenic scale of MMPI, education, and trunk flexion strength were the best predictors that correctly classified approximately 69% of the subjects into their actual outcome groups. This study may provide insight as to some of the factors that may predict treatment outcome.
Use of Narcotic and Non-narcotic Analgesic Medications in Occupational Injuries: Analyses of Reimbursed Prescriptions in a State Run Workers' Compensation Dtabase—Islam SS
Occupational injuries, such as back and shoulder injuries, muscle sprains, etc., often require treatment with analgesics and muscle relaxants. The pattern of such drug uses has not been well documented in work related injuries. In this study, using the West Virginia Workers' Compensation database, we have evaluated the pattern of reimbursed prescribed medications with an emphasis on narcotic and non-narcotic analgesics by specific body parts injured. In addition, costs associated with analgesics, muscle relaxants and anti-arthritics are also presented. Among those who were injured between July 1, 1995 and June 30, 1996, 5557 claims were reimbursed for prescription drugs at the time of data collection. Of the 200 most prescribed drugs, analgesics were the most commonly used drugs (4,724 prescriptions) followed by muscle relaxants (3,359 prescriptions) and anti-arthritics (3,131 prescriptions). However, anti-arthritic medications were the most expensive, accounting for an average of $50 per prescription compared to $26 and $25 per prescription for analgesics and muscle relaxants. Ultram 50 mg tablets were the most prescribed analgesics for all body parts injured except for eye and toe injuries. The most commonly used narcotic analgesics was Propoxy-N (Darvocet), followed by Hydrocodone and Butalbital. Among the non-steroidal anti-inflammatory schedule drugs Cataflam was the most commonly used drug followed by Toradol. Cataflam was also the most expensive schedule drug, costing $50 per prescription. Reimbursement for the cost of medication per day varied widely. For example, reimbursement for a day's supply of Ultram tablets ranged between 17 cents and $14.30 with a mean of $3.70. Such variation could result from the variation of actual units prescribed per day and whether or not generic or non-generic brands were dispensed. Further analyses are carried out to understand injury, occupation and industry specific narcotic and non-narcotic analgesics, anti-arthritics and muscle relaxants prescriptions and pharmacoeconomic aspects of cost variation for such medications.
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