Construction/Traumatic Injury Prevention (CONxTIP)

Burden

In 2016, there were over ten million workers in the U.S. construction industry, a number that has been rising since bottoming out in 2012 [CPWR 2017]. Between 2003 and 2016, there were between 267 and 448 fatal falls annually in construction. In 2015, almost six times as many fatal falls occurred in construction compared to manufacturing, the industry with the second highest number [CPWR 2017]. Examining 1,533 fatal falls in construction between 2011 and 2015, approximately 33% were falls from roofs, 24% were falls from ladders, and 15% were falls from scaffolding [CPWR 2017]. Occupations at higher risk include laborers, roofers, ironworkers, sheet metal workers, welders, and power-line installers [CPWR 2013, 2017]. Vulnerable workers at an elevated or disproportionate risk include Hispanic workers, foreign-born workers, workers in small businesses, workers with non-standard work arrangements, and older (55 and over) workers [CPWR 2013, 2017].

The burden of injuries from falls on the same level in construction is sometimes overlooked. In 2010, there were approximately 18,130 non-fatal injuries to construction workers as a result of falls. Approximately 40% of those injuries were the result of falls that occurred on the same level [CPWR 2013]. Fatal and non-fatal falls in construction result in heavy economic burdens on workers, families, employers, and society. Even when workers survive, many have traumatic brain or other injuries requiring lengthy rehabilitation, placing substantial emotional, medical, and financial burdens on their families. Falls also result in significant costs to employers, including lost productivity, loss of skilled workers, and increased workers’ compensation costs [OSHA 2012].

Need

Intervention and translation research addressing engineering and design, education and training, communication, and administrative issues is needed to address this problem and achieve meaningful results. Future research to prevent and protect from falls should consider the effects and interactions of environmental, task-related, and personal factors that can affect workers’ balance. Improvements in the work environment, in construction materials and methods, and in work procedures and practices should reduce falls. Research to reduce falls among higher risk groups is especially needed, along with research to develop, evaluate, and understand the safety, productivity, and latent hazards of emerging work methods and technologies (e.g., advanced fall prevention and protection technologies, height access devices, drones, automation, and robots). There is a need to better understand the best approaches to train and educate construction workers, employers, and safety professionals on fall protection. Many of these groups include non-English speaking learners and low-literacy audiences. Additional efforts are needed to transfer findings from this research into influential documents such as guidance and voluntary consensus standards. There is also a need to translate research findings into software products, applications and interactive webpages to make information easily accessible for construction stakeholders.

Falls on the same level or slips, trips, and falls (STFs) are common in construction (representing approximately 19% of all construction falls requiring emergency room visits from 1998–2005) and a leading cause of workers’ compensation claims [Shislov et al. 2011]. Many causes of STFs are unique to construction, easily observable, and should be addressed through research; for example, housekeeping and maintenance are often major contributing factors to falls on the same level [Lipscomb et al. 2006]. A better understanding of causal factors will address the need to develop and enhance effective interventions and technologies that can be translated into the construction work environment.

Burden

Construction workers represent 7.3% of the US workforce and 21.7% of all fatal injuries in 2020 [CPWR 2022].  Struck-by incidents are the second most common cause of fatalities among construction workers and the leading cause of nonfatal injuries in construction since 1992 [CPWR 2018]. The risk of nonfatal struck-by injuries in construction is twice that of all other industries combined [CPWR 2017]. The construction workplace is a dynamic environment with a wide variety of machinery and tools in operation. In addition, potentially distracting levels of noise are present that may increase the risk of struck-by events. Many of these fatal and nonfatal injuries are occurring to construction workers in small businesses that tend to have significantly higher injury rates than those in larger businesses [CPWR 2018]. There are two major sources of injuries to workers who experience a struck-by event: objects (e.g., tools, machines, construction materials, etc.) and motor vehicles. From 1992-2015, there were 4,648 construction worker deaths from being struck by an object or vehicle. Struck-by events are the leading cause of non-fatal construction injuries since 1992 [CPWR 2018]. There were 27.4 injuries per 10,000 workers in 2015. This hazard is estimated at $1.4 (13.2%) billion in workers’ compensation costs among construction industry workers [Liberty Mutual 2021]. The true burden of struck by injuries is likely to be underestimated. As infrastructure spending and related work ramps up across the country, injuries and fatalities in construction could unfortunately increase.

Need

There is a significant need for more surveillance and intervention research to address this persistent hazard in the construction industry. Some of this research may involve providing a better understanding of the economic costs of struck-by injuries and deaths. Intervention research for engineering and design, education and training, communication, and administrative issues is needed to address the problem and achieve meaningful results. There is a strong need for improved surveillance through linkage of existing data to improve understanding and awareness of the many factors that influence struck-by incidents and how to mitigate them. These influencing factors could include low visibility (e.g., night work, operating in reverse), proximity to machinery, and human factors (e.g., stress, fatigue, lack of awareness, distraction, lack of planning and communication, lack of teamwork, lack of resources). There is also a need to explore how emerging technologies, as well as prevention through design can be applied to reduce both major types of struck-by incidents, such as workers struck-by objects in the workplace and struck-by motor vehicles. Some new preventive technologies include sensors and proximity detectors to address blind spots, wearable technologies, and greater use of full sequential triggers on nail guns. Increasing use of robotics and anticipated use of autonomous vehicles on worksites pose new construction worker struck-by hazards. Research aimed at increasing our understanding of the potential impact of autonomous vehicles and robotics on worksites and on struck-by incidents is needed.

References

CPWR [2017]. Quarterly Data Report. Struck-by Injuries and Prevention in the Construction Industry. Second Quarter 2017. Available from: https://www.cpwr.com/wp-content/uploads/2017/08/publications_Quarter2-QDR-2017.pdf

CPWR [2018]. Fatal Injuries at Road Construction Sites among Construction Workers. 2018 Available from: https://www.cpwr.com/wp-content/uploads/publications/publications_Quarter2-QDR-2018.pdf

CPWR [2018]. Fatal and nonfatal injuries – leading causes of fatal and nonfatal injuries in construction. 2018. Available from https://www.cpwr.com/research/data-center/the-construction-chart-book/chart-book-6th-edition-fatal-and-nonfatal-injuries-leading-causes-of-fatal-and-nonfatal-injuries-in-construction/

CPWR [2018].  Fatal Injuries among Small Construction Establishments.  2018.  Available from: publications_Quarter3-QDR-2018_0.pdf (cpwr.com)

CPWR [2020]. National Stand-down to Prevent Struck-by Incidents. April 20, 2020. Available from: https://www.cpwr.com/wp-content/uploads/publications/National-Struck-by-Stand-Down-PPT-final.pdf

CPWR [2022].  Fatal and Nonfatal Injuries in the Construction Industry.  2022.  Available from: DataBulletin-May2022.pdf (cpwr.com)

Liberty Mutual Insurance [2021]. Safety Index for the Construction Industry. https://business.libertymutual.com/wp-content/uploads/2021/06/2021_WSI_1002_R2.pdfct of autonomous vehicles and robotics on worksites and on struck-by incidents is needed.

Burden

More than ten million U.S. construction workers are at high risk of traumatic injuries because of inherently hazardous tasks and dynamic conditions of construction sites. With recent advances in automation and robotics, novel construction approaches are being developed with the potential to reduce occupational injury risks. New and emerging types of robots (e.g., collaborative robots, aerial robots) are becoming more available, and beginning to be more widely used in the construction industry to assist workers in handling hazardous tasks that have been performed traditionally by human workers. Ground robots can take on heavy loads; perform dirty, dangerous, or repetitive work; work at elevation, in hard to reach places, and perform tasks requiring awkward postures at a construction site. Unmanned Aerial Vehicles (UAVs) also can be used in the construction industry for various tasks including mapping of construction sites for project planning, monitoring workflow and logistics, inspecting and assessing structures and damages, and handling and transporting materials. In particular, UAVs can prevent construction worker injuries involving falls from heights by taking on tasks at higher elevations.

Market data show that average industrial robot sales worldwide increased 16% per year from 2010–2015, and continuing increases in adoption of industrial robots are predicted [IFR 2016]. It is estimated that more than 1.4 million new industrial robots will be installed in workplaces worldwide from 2016–2019 [IFR 2016]. Rapid advances and growth of applications of UAVs are particularly significant in the construction industry. It is estimated that the UAV market will increase to $100 billion by 2020 and the construction industry is expected to be the biggest market for commercial uses that are expected to account for over $11 billion [Goldman Sacks 2016]. Predicted growth of robotics in the construction industry can create new hazards to human workers who work in close proximity to or interact with these emerging technologies. This challenge can be particularly significant because of the characteristics of most construction projects: ever-changing work environments, the need for multiple skilled craftsmen, multiple employers sharing a common worksite, and the interactions of multiple pieces of automated equipment.

Need

Basic and etiologic research are needed to expand our understanding of applications of robotics and automation technologies in the construction industry and associated injury risks. Due to the rapid growth in these technologies, safety research is needed to address the efficacy, safety, and productivity improvements related to use of collaborative robots, mobile robots, and aerial robots in construction environments. Studies are needed on the impact of personal, environmental, and task-related risk factors in reducing worker injuries associated with robotics. In addition, developing engineering and administrative controls to enhance uptake of automation and robotic solutions and minimize robot-related incidents used in construction are topics warranting further study. There is a need to better understand the best approaches to train and educate construction workers, employers, and safety professionals on construction hazards. Many of these groups include non-English speaking learners and low-literacy audiences. Additional efforts are needed to transfer findings from this research into influential documents such as guidance and voluntary consensus standards. There is also a need to translate research findings into software products, applications and interactive webpages to make information easily accessible for construction stakeholders.

There is also an urgent need to expand occupational injury surveillance capabilities to better identify, monitor, and quantify the burden of fatal and nonfatal injury incidents involving the robotics and automation technologies in the construction industry. For instance, new source or event codes for automation- and robot-related incidents need to be developed for effective surveillance.

Burden

Construction comprises residential and commercial building and heavy and civil engineering (e.g., water and sewer lines, highways, and bridges), and includes specialty trades such as roofing, plumbing, electrical, and drywall. Over 10 million workers are employed in construction in the U.S. [BLS 2017], and these workers face risks of fatal and non-fatal injuries resulting from falls from elevated surfaces, struck-by incidents, and musculoskeletal disorders (MSDs), as well as adverse health effects from noise, silica, and other exposures. Construction work is demanding and labor-intensive, involving significant manual material handling and awkward postures in challenging environments on dynamic work sites. Many of the building trades require skilled workers who are sometimes in short supply [CPWR 2018b].

Recent research demonstrates that workers and workplaces are impacted by the opioid crisis.overdose epidemic. According to the National Survey of Drug Use and Health, an estimated 4% of respondents age 18 years or older reported illicit opioid use in 2017, and an estimated 67% of these self-reported users were employed [SAMHSA 2018]. Prescription opioids may be both a personal risk factor for and a consequence of work-related injury. [Kowalski-McGraw et al. 2017].

The opioid crisis overdose epidemic impacts construction workers more than other occupational groups. Construction workers have been commonly prescribed opioids to treat pain associated with MSDs and injuries [Thumula and Liu 2018], contributing to the opioid overdose epidemic. In 2007–2012, the percentage of opioid-related overdose deaths was higher in construction than the percentage of opioid-related overdose deaths in all occupation groups combined [Harduar Morano et al. 2018]. A recent analysis of data from the Bureau of Labor Statistics’ Census of Fatal Occupational Injuries similarly found that the construction industry had high numbers and rates of drug overdose deaths at work compared to other industries [Tiesman et al. 2019]. Studies in Massachusetts and Ohio reported opioid overdose deaths among constructions workers that were 6 and 7 times higher than for other workers [Massachusetts Department of Public Health 2018; CPWR 2018a]. In another study, over half of those who died from an overdose had suffered at least one job-related injury [Cheng et al. 2013].

Misuse of illicit drugs and other substances is a public health problem that also affects the workplace. Numerous studies have documented the adverse impact of illicit drug and alcohol use (including heavy drinking) on workers [Wiebe 1995]. These negative outcomes can include absenteeism, turnover, accidents, reduced performance and productivity. This problem has had a greater impact on the construction industry and its workers than many other industry sectors. Studies of this issue have looked at prevalence of use and high-risk industries, demographic variables, the impact (including links to workplace accidents), and how employers have responded [Wickizer et al. 2004; Pidd et al. 2011; Cook et al. 2004].

Need

Surveillance is a significant part of the national response to the opioid crisis. Overdosew epidemic. Data collection and analyses related to prescription drug (incl. opioids), illicit drug, and substance use/misuse in construction are needed. A better understanding of the work-related factors and exposures that occur in construction and may increase the use of these substances would be helpful. There are many questions about the impact of substance use and misuse on construction workers and the work they do, the role of the work environment on use and misuse, and the effectiveness of employer-based interventions. Epidemiologic analyses of federal, state, and local data are needed to identify work-related factors, trends, and to evaluate prevention efforts. The following databases and data sources are promising: workers’ compensation systems, prescription drug monitoring programs, emergency medical services runs, emergency department data, medical examiner data, data from ESOOS (Enhanced State Opioid Overdose Surveillance) and SUDORS (State Unintentional Drug Overdose Report System), and employer data. Methodologic challenges include: absence of validated survey instruments and questions about occupational exposures; absence of data on work-relatedness and work context in many systems; unstructured narrative data; improving data timeliness; database linkages to maximize the quality and utility of data on work and opioids; identifying type(s) of opioids, and whether use was licit or illicit; and assessing a range of outcomes for workers and employers (e.g. injuries, absenteeism, economic costs, mental health impacts). Potential areas of research include: teasing out temporal associations between construction work factors and substance use/misuse; and assessing the effectiveness of efforts by construction employers, unions, and communities to reduce the impacts of substances on construction workers and workplaces.

Intervention research is needed to evaluate the determinants and consequences of existing and new employer-based interventions to reduce use/misuse of prescription drugs (incl. opioids), illicit drugs, and substances. Evaluation of these interventions should consider their effectiveness in reducing use of these substances and ultimately the impact on workplace safety and health including potential links to traumatic injuries. Such efforts might consider the business case for safety, owner and management commitment to safety, and novel work arrangements and their impact on leading and lagging indicators of safety and health. Translation research is needed to disseminate barriers and aids to implementation of proven effective interventions to reduce use/misuse of prescription drugs (incl. opioids), illicit drugs, and other substances and the impact on traumatic injuries. Findings from this research need to be incorporated into standards, guidance and other influential documents. There is also a need to translate research findings into software products, applications and interactive webpages, short videos, and other communication products to maximize its impact on construction stakeholders.