Traumatic Injury Prevention Program

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Burden, Need and Impact

NIOSH strives to maximize its impact in occupational safety and health. The Traumatic Injury Prevention Program identifies priorities to guide investments, and bases those priorities on the evidence of burden, need and impact. Below are the priority areas for the Traumatic Injury Prevention Program.

Burden: Falls in the workplace can occur during the simple act of tripping over a cord or from a complex series of events such as a construction worker using equipment to perform a job 50 feet above the ground. Regardless of how falls occur, they remain a common cause of injury and death for workers across the United States, as reflected by the most recent data below.

  • In 2017, 26% of the 882,730 nonfatal work injuries resulting in one or more days away from work were related to falls, slips, and trips1
  • In 2017, 17% of the 5,147 deaths were related to falls, slips, and trips2
  • In 2016, $17.5 billion in direct costs to businesses was linked to falls, slips, and trips3

Need: NIOSH is the only U.S. federal entity responsible for conducting research and making recommendations for the prevention of work-related injuries and deaths from falls . Falls remain a persistent and costly problem, which warrants the need for additional fall prevention research efforts. Such efforts should focus on common precursors to fall events as well as the evaluation and implementation of engineering and administrative solutions in high risk industries, such as construction, agriculture, services, and wholesale and retail trade.

Impact: Our research collaborations with partners have contributed to innovations like: the NIOSH Ladder Safety App; research that provides evidence for the effectiveness of a no-cost-to-workers, slip-resistant footwear program for reducing slip-related injuries in food services workers; and the National Stand Down to Prevent Falls in Construction campaignexternal icon.  We continue our efforts in this area by leveraging Institute strengths in partnership to: develop effective and practical strategies to design out fall risk, craft engineering solutions, and implement organizational interventions to reduce fall incidents and prevent fall injuries.


  1. BLS [2019]. Resource Table R4. Number of nonfatal occupational injuries and illnesses involving days away from work by industry and selected events or exposures leading to injury or illness, private industry, 2017. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshcdnew2017.htmexternal icon
  2. BLS [2018]. All charts, Census of Fatal Occupational Injuries. Fatal occupational injuries by major event, 2017. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshwc/cfoi/cfch0016.pdfpdf iconexternal icon
  3. Liberty Mutual Insurance [2019]. 2019 Liberty Mutual Workplace Safety Index, https://viewpoint.libertymutualgroup.com/article/top-10-causes-disabling-injuries-at-work-2019/?extcmp=NI_PR_VP_Content_WCexternal icon

Burden: Millions of workers drive or ride in a motor vehicle as part of their jobs. Work-related motor vehicle crashes affect workers in all industries and occupations, whether they drive heavy or light vehicles on the job, and whether driving is a main or incidental job duty. As recent data show, on-the-job crashes take a heavy toll on workers and their families, communities, and employers:

  • In 2017, vehicle crashes made up 36% of all work-related injury deaths in the United States, and were the first or second leading cause of death in every major industry group1
  • 45% of the crash-related deaths in 2016 involved workers employed as motor vehicle operators, with the remaining 55% employed in a range of other occupations2
  • In 2013 alone, motor vehicle crashes at work cost U.S. employers $25 billion – $65,000 per nonfatal injury and $671,000 per death3

Need: NIOSH is the only U.S. federal entity responsible for conducting research and making recommendations for the prevention of work-related motor vehicle crashes and resulting injuries for all worker populations. Guided by data that show the injury and cost burden, our research and outreach focuses on truck drivers and workers in other high-risk jobs, such as emergency responders, oil and gas workers, and taxi drivers. We also consider the general population of workers who drive, including those who drive light vehicles and for whom driving may not be the primary job duty. Our research program emphasizes development and evaluation of safety interventions that are both effective and practical in preventing work-related motor vehicle crashes, including technology-based interventions such as in-vehicle monitoring systems (IVMS) and fatigue detection systems.4

Impact: Through partnerships with industry, labor, professional and trade associations, government agencies, and academia, NIOSH has developed a strong understanding of the safety risks, work settings, and barriers to progress associated with on-the-job driving. To move our research results into the workplace, we contribute to consensus standards that are widely used by employers and industry to guide vehicle design and testing and motor vehicle safety management. We also communicate crash-prevention information directly to workers and employers through user-friendly webpages, social media (e.g., @NIOSH_MVSafety), animated images (GIFs), the e-newsletter Behind the Wheel at Work, and many other publications. While we have made significant progress to keep those who drive for work safe, the opportunity still exists to continue to build our evidence base for solutions to prevent on-the-job crashes.


  1. BLS [2019]. Table A-2. Fatal occupational injuries resulting from transportation incidents and homicides, all United States, 2017. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://stats.bls.gov/iif/oshwc/cfoi/cftb0314.xlsxexcel iconexternal icon
  2. BLS [2019]. Table A-6. Fatal occupational injuries resulting from transportation incidents and homicides by occupation, all United States, 2016. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://stats.bls.gov/iif/oshwc/cfoi/cftb0318.xlsxexcel iconexternal icon
  3. NETS (Network of Employers for Traffic Safety) [2016]. Cost of motor vehicle crashes to employers – 2015. Vienna, VA: Network of Employers for Traffic Safety, http://trafficsafety.org/wp-content/uploads/2016/03/NETS-CostOfCrashes-Report-2015.pdfpdf iconexternal icon
  4. Bell JL, Taylor MA, Chen GX, Kirk RD, Leatherman ER [2017]. Evaluation of an in-vehicle monitoring system (IVMS) to reduce risky driving behaviors in commercial drivers: Comparison of in-cab warning lights and supervisory coaching with videos of driving behavior. J Saf Res 60:125-136

Burden: Workplace violence is the act or threat of violence, ranging from verbal abuse to physical assaults, and the impact can range from psychological issues to physical injury, or even death. Violence can occur in any workplace. The 2016 statistics provided below for the United States describe part of the problem, but it is important to note that many cases of violence go unreported.

  • In 2017, 18,400 intentional injuries by other persons resulted in one or more days away from work1
  • In 2017, about 9% of reported fatal workplace injuries were the result of a workplace homicide2
  • Recent publications highlighted differences in work-related homicides by age, sex, race, ethnicity, region, and birth country3-5

Need: NIOSH is the only U.S. federal entity responsible for conducting research and making recommendations for the prevention of workplace violence. Rates of workplace violence vary dramatically by industry and occupation. Our research demonstrates the need for industry and occupation-specific interventions. Products that highlight common causes of workplace violence and effective intervention strategies are needed for all workers, especially those in high-risk industries like public safety, healthcare and social services. Adoption of known best practices to prevent workplace violence for occupations at increased risk remains a high priority need. Additionally, health economic research demonstrating cost control and return on investment is crucial for adoption by industry stakeholders in preventing injuries.

Impact: To date, NIOSH and stakeholders’ workplace violence prevention efforts have focused on healthcare workers,6-8 taxi drivers, convenience store workers, education staff, and law enforcement personnel. Examples of impact include thousands of healthcare workers taking NIOSH’s free online violence prevention course, and cities and taxi companies requiring the use of security cameras that NIOSH research demonstrated are associated with reduced homicides. While we have made progress to educate and keep workers safe on the job, wide-spread adoption of targeted workplace violence prevention strategies and interventions that benefit all workers is needed to reduce on-the-job violence-related injuries and deaths.


  1. BLS [2019]. Resource Table R4. Number of nonfatal occupational injuries and illnesses involving days away from work by industry and selected events or exposures leading to injury or illness, private industry, 2017. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshwc/osh/case/cd_r4_2017.htmexternal icon
  2. BLS [2019]. Table A-2. Fatal occupational injuries resulting from transportation incidents and homicides, all United States, 2017. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshwc/cfoi/cftb0314.htmexternal icon
  3. Steege AL, Baron SL, Marsh SM, Menéndez CC, Myers JR [2014]. Examining occupational health and safety disparities using national data: a cause for continuing concern. Am J Ind Med 57(5):527-538
  4. Menéndez CC, Konda S, Hendricks S, Amandus H [2013]. Disparities in work-related homicide rates in selected retail industries in the United States, 2003-2008. J Saf Res 4:25-29
  5. Chaumont Menéndez CK, Socias-Morales C, Daus MW [2017]. Work-related violent deaths in the U.S. taxi and limousine industry 2003-2013: disparities within a high-risk working population. J Occ Environ Med 59:768-774
  6. Glass N, Hanson GC, Anger WK, Laharnar N, Campbell JC, Weinstein M, Perrin N [2017]. Computer-based training (CBT) intervention reduces workplace violence and harassment for homecare workers. Am J Ind Med 60(7):635-643
  7. Hamblin LE, Essenmacher L, Luborsky M, Russell J, Janisse J, Upfal MJ, Arnets JE [2017]. Worksite walkthrough intervention: data-driven prevention of workplace violence on hospital units. J Occup Environ Med 59(9):875-884
  8. Brann M, Hartley D [2017]. Nursing student evaluation of NIOSH workplace violence prevention for nurses online course. J Saf Res 60:85-91

Burden: From augers that drill holes in the ground to forklifts used for moving materials around a worksite, machinery and industrial vehicles are vital in performing a variety of work tasks in agriculture, construction, manufacturing, mining, transportation, warehousing and utilities industries. Machinery and industrial vehicles are involved in many work-related injuries and deaths, which are reflected in the most recent data below. In addition, recent advances in robotics (e.g., collaborative robots, aerial robots, fixed robots, exoskeletons) are beginning to be used to assist workers with hazardous tasks traditionally performed by human workers. However, these technologies can also create new hazards to human workers who work in close proximity to or interact with these emerging technologies.

  • In 2017, 229,170 injuries due to contact with objects and equipment were so severe they resulted in one or more days away from work, accounting for 26% of 882,730 nonfatal work injuries1
  • In 2017, about 14% of deaths were due to contact with objects and equipment2
  • In 2016, $8.3 billion in direct costs to businesses were due to deaths and injuries from contact with objects and equipment3
  • In 2018, worldwide annual sales of robots reached 422,271 units. For the eighth year in a row, sales peaked in the United States, with an estimated 40,373 robots sold 4

Need: NIOSH is the only U.S. federal entity responsible for conducting research and making recommendations for the prevention of work-related injury and death from machinery and industrial vehicles. The emerging use of robotics and other automated technologies calls for basic and etiologic research to understand these technologies in situ and their associated risks, injury surveillance, and interventions. Prevention through Design (PtD) research efforts are ideally suited for designing out safety hazards from machinery and industrial vehicles. There is a need for outreach to equipment manufacturers with important safety information that supports design improvements and cost-effective controls. Additionally, strengthening partnerships with industry is needed to disseminate injury prevention information and strategies.

Impact: In support of PtD, NIOSH and partners developed cost-effective roll over protective structures for tractors and aerial lift safety education tools. Additional PtD efforts as well as outreach to manufacturers and employers may help to influence national standards as well as the machinery and industrial vehicles purchased for workplace use.


    1.  BLS [2019]. Resource Table R4. Number of nonfatal occupational injuries and illnesses involving days away from work by industry and selected events or exposures leading to injury or illness, private industry, 2017. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshcdnew2016.htmexternal icon
    2. BLS [2018]. All charts, Census of Fatal Occupational Injuries. Fatal occupational injuries by major event, 2017. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshwc/cfoi/cfch0016.pdfpdf iconexternal icon
    3. Liberty Mutual Insurance [2019]. 2019 Liberty Mutual Workplace Safety Index, https://viewpoint.libertymutualgroup.com/article/top-10-causes-disabling-injuries-at-work-2019/?extcmp=NI_PR_VP_Content_WCexternal icon
    4. IFR [2018]. Executive summary world robotics 2019 industrial robots. Frankfurt, Germany: International Federation of Robotics, https://ifr.org/downloads/press2018/Executive%20Summary%20WR%202019%20Industrial%20Robots.pdfpdf iconexternal icon

Burden: High-risk jobs, such as those in transportation, construction, agriculture, public safety and healthcare have substantially higher rates of injury as a result of the type of work they perform, and vulnerable workers are part of a group susceptible to injury risks in different ways. Vulnerable workers can include those with non-standard work arrangements, such as contingent work and precarious employment. While we recognize that many health risks are associated with specific jobs or industries, one group should not bear the brunt of injuries over another or accept that injuries are ‘just part of the job,’ yet that is not the case based on recent data.

  • From 1994 to 2017, an annual average of 43 youth less than 18 years old died due to an injury at work1
  • From 2003 to 2017, an annual average of 38 deaths occurred in the commercial fishing industry2
  • Between 2003 and 2017, most work-related deaths to Hispanic workers were to those born outside of the U.S.3
  • In 2017, homicides were the second leading cause of work-related death for women4

Need: NIOSH is the only U.S. federal entity whose mission encompasses prevention of work-related injury and death for all workers. Vulnerable workers span all industries and occupations. Focused dissemination efforts are needed to reach the breadth of these workers who may not have labor agreements or membership in business associations that provide access to safety efforts. Engineering research that fits the work to the worker and makes equipment easier to use safely is crucial, especially among high-risk jobs.

Impact: Our efforts have reached a variety of high-risk jobs and vulnerable worker groups. For example, a recent NIOSH Workplace Solutions reached a large fire service audience to raise awareness of the dangers of fighting basement fires. In addition, NIOSH released recommendations on how to protect emergency medical services workers. NIOSH and partners developed Youth@Work: Talking Safety, a curriculum to teach high school students how to stay safe at work.

In addition to these products, our surveillance work was integral in identifying hazards and tailoring prevention efforts, which contributed to a decline in the number of deaths among the highest-risk industries in Alaska. Specifically, there was a 75% decline in the number of commercial fishing deaths and 88% decrease in the number of pilot deaths. Likewise, our work identified higher rates of drug overdose deaths at work for the transportation and warehousing, construction, and healthcare and social assistance industries.

All types of workers and their employers benefit from injury prevention guidance and safer equipment and workspaces. For this reason, additional surveillance, research, and materials focused on high-risk jobs and vulnerable workers are valuable in reducing injuries and disparities.


  1. Fatal injury totals were generated by NIOSH researchers with restricted access to the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI) microdata; additional information at bls.gov/iif/oshcfoi1.htmexternal icon.  The views expressed here do not necessarily reflect the views of BLS.
  2. BLS [2018]. Injuries, illnesses, and fatalities. In: All worker profile, 2003-2017. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshcfoi1.htm#chartsexternal icon
  3. BLS [2018]. Static charts, Census of Fatal Occupational Injuries. Chart 11. Fatal work injuries involving Hispanic or Latino workers, 2003-2017. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshwc/cfoi/cfoi-chart-data-2017.htmexternal icon
  4. BLS [2018]. Static charts, Census of Fatal Occupational Injuries. Chart 9. Distribution of fatal injury events by gender of worker, 2017. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshwc/cfoi/cfoi-chart-data-2017.htmexternal icon

Page last reviewed: November 5, 2019