knowing and understanding your boundariesfiles.constantcontact.com › 88e43688001 ›...

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Onsite Services... The Game is Changing

Knowing and Understanding Your Boundaries

PPS Annual Conference

Las Vegas, NV

Friday, October 21, 2016

Disclosure

• None of the speakers have any relevant financial relationship impacting this presentation.

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Agenda…

• Introductions

• Early Intervention Paradigm

• Medical Treatment vs. First Aide

• OSHA’s First Aide Perspective

• Standards of Interpretation

• Early Intervention Strategies

• Employee Triage

Gang of Four…

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Traditional Paradigm…

Root Causes

Discomfort

Pain &Dysfunction

RecordableInjury

Early Intervention Paradigm…

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Tug of War…

OSHA Safety Managers

What is a Recordable Injury??

Tipping Point…

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Tipping Point…

Tipping Point…

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Tipping Point…

Gary Orr, Ergonomist US Dept. of Labor - OSHA

Michael Hodgson, Medical DirectorUS Dept. of Labor - OSHA

Dave Schmidt, Office of Statistical Analysis US Dept. of Labor - OSHA

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Signs & Symptoms…

OSHA speaks to Signs & Symptoms

of an Injury or Illness

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• Signs of a musculoskeletal injury or illness are indications the provider of care can sense when attending to an injured person (e.g. the things that the provider can see, hear and/or feel).

– Joint pain

– Tenderness at a specific point

– Swelling or warmth

– Bruising

– Reduced range of motion

– Comparative weakness (right vs. left)

– Joint instability testing

– Neurologic examination

– Special tests associated with body part (i.e., Tinel Sign, Phalen Sign, Finkelstein Test)

Signs of an Injury…

• Symptoms of an injuries or illnesses is information transferred by the injured person to the care provider (e.g. what he or she says to the care provider).

– "My knee feels unstable."

– "My wrist hurts; it is painful when I move it."

– "I have tingling in my thumb and index finger.“

– “My arm feels tired.”

– “ My back is fatigued at the end of the day.”

– “ My knee is sore.”

Symptoms of an Injury…

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Twinge

Fatigued

Heaviness

Soreness

Ache

Tired

Discomfort

Throb

Distress

Pain

Signs &

Symptoms

The Continuum…

Know when to call a duck a duck...

Medical Treatment vs. First Aide…

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Employee presents w/ musculoskeletal

concern

Screening Assessment

Work StationEvaluation

Mild Symptoms w/ noPositive Physical Findings

Moderate / Severe SymptomsOr

Symptoms w/ Positive Findings

Not a Recordable CasePlausible Injury

Proceed under the guise ofFirst Aide

Proceed with intervention. Always being cognizant of Signs & Symptoms and the

relationship to work.

Proceed under the guise of

Medical Treatment

RecordableInjury

Work Relatedness…

Work Relatedness

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Per OSHA

• What is the definition of medical treatment?"Medical treatment" means the management and care of a patient to combat disease or disorder. For the purposes of Part 1904, medical treatment does not include:


For the purposes of Part 1904, medical treatment does not include:• 1904.7(b)(5)(i)(A)

– Visits to a physician or other licensed health care professional solely for observation or counseling;

• 1904.7(b)(5)(i)(B)

– The conduct of diagnostic procedures, such as x‐rays and blood tests, including the administration of prescription medications used solely for diagnostic purposes (e.g., eye drops to dilate pupils); or

• 1904.7(b)(5)(i)(C)

– "First aid" as defined in paragraph (b)(5)(ii) of this section.

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OSHA on First Aide…

"First aid" as defined in paragraph (b)(5)(ii) of this section1904.7(b)(5)(ii)(A)

– Using a non‐prescription medication at nonprescription strength (for medications available in both prescription and non‐prescription form, a recommendation by a physician or other licensed health care professional to use a non‐prescription medication at prescription strength is considered medical treatment for recordkeeping purposes);

1904.7(b)(5)(ii)(B)

– Administering tetanus immunizations (other immunizations, such as Hepatitis B vaccine or rabies vaccine, are considered medical treatment);


"First aid" as defined in paragraph (b)(5)(ii) of this section1904.7(b)(5)(ii)(C)

– Cleaning, flushing or soaking wounds on the surface of the skin;1904.7(b)(5)(ii)(D)

– Using wound coverings such as bandages, Band‐Aids™, gauze pads, etc.; or using butterfly bandages or Steri‐Strips™ (other wound closing devices such as sutures, staples, etc., are considered medical treatment);

1904.7(b)(5)(ii)(E)

– Using hot or cold therapy;

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"First aid" as defined in paragraph (b)(5)(ii) of this section1904.7(b)(5)(ii)(F)

– Using any non‐rigid means of support, such as elastic bandages, wraps, non‐rigid back belts, etc. (devices with rigid stays or other systems designed to immobilize parts of the body are considered medical treatment for recordkeeping purposes);

1904.7(b)(5)(ii)(G)

– Using temporary immobilization devices while transporting an accident victim (e.g., splints, slings, neck collars, back boards, etc.).


"First aid" as defined in paragraph (b)(5)(ii) of this section1904.7(b)(5)(ii)(H)

– Drilling of a fingernail or toenail to relieve pressure, or draining fluid from a blister;

1904.7(b)(5)(ii)(I)

– Using eye patches;1904.7(b)(5)(ii)(J)

– Removing foreign bodies from the eye using only irrigation or a cotton swab;

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"First aid" as defined in paragraph (b)(5)(ii) of this section1904.7(b)(5)(ii)(K)

– Removing splinters or foreign material from areas other than the eye by irrigation, tweezers, cotton swabs or other simple means;

1904.7(b)(5)(ii)(L)

– Using finger guards;1904.7(b)(5)(ii)(M)

– Using massages (physical therapy or chiropractic treatment are considered medical treatment for recordkeeping


"First aid" as defined in paragraph (b)(5)(ii) of this section1904.7(b)(5)(iii)

• Are any other procedures included in first aid?

• No, this is a complete list of all treatments considered first aid for Part 1904 purposes.

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"First aid" as defined in paragraph (b)(5)(ii) of this section1904.7(b)(5)(iv)

– Does the professional status of the person providing the treatment have any effect on what is considered first aid or medical treatment?

– No, OSHA considers the treatments listed in § 1904.7(b)(5)(ii) of this Part to be first aid regardless of the professional status of the person providing the treatment. Even when these treatments are provided by a physician or other licensed health care professional, they are considered first aid for the purposes of Part 1904. Similarly, OSHA considers treatment beyond first aid to be medical treatment even when it is provided by someone other than a physician or other licensed health care professional.

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Standard of Interpretation…

May 20, 2011

Mr. Paul Bragenzer1415 Rothbury Dr.Grand Rapids, MI 49505

Dear Mr. Bragenzer:

Thank you for your February 2011 letter to the Occupational Safety and Health Administration (OSHA) regarding the recordkeeping regulation contained in 29 CFR Part 1904 ‐ Recording and Reporting Occupational Injuries and Illnesses. In an effort to provide the public with prompt and accurate responses, we developed and continue to refine a set of Frequently Asked Questions (FAQ), in addition to maintaining a log of Letters of Interpretation (LOI) on the OSHA Recordkeeping web site.

Your letter asks OSHA to clarify whether an exercise regime directed by a Certified Athletic Trainer (ATC) would constitute "first aid" or "medical treatment" for OSHA injury and illness recordkeeping purposes.


Continued…

OSHA discussed the issue of therapeutic exercise in the preamble to the final rule revising OSHA's injury and illness recordkeeping regulation. See, 66 FR 5992, January 19, 2001. OSHA stated that it considers therapeutic exercise as a form of physical therapy and intentionally did not include it on the list of first aid treatments in Section 1904.7(b)(5)(ii). Section 1904.7(b)(5)(ii)(M) states that physical therapy or chiropractic treatment are considered medical treatment for OSHA recordkeeping purposes and are not considered first aid.

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Continued…

Please be aware that if a treatment is administered as a purely precautionary measure to an employee who does not exhibit any signs or symptoms of an injury or illness, the case is not recordable. For a case to be recordable, an injury or illness must exist. For example, if, as part of an employee wellness program, an ATC recommends exercise to employees that do not exhibit signs or symptoms of an abnormal condition, there is no case to record. Furthermore, if an employee has an injury or illness that is not work‐related, (e.g., the employee is experiencing muscle pain from home improvement work) the administration of exercise does not make the case recordable either.


Continued…

Your letter also requested specific guidance on several questions concerning the administration of exercise. For purposes of this response, we presume that all of the questions relate to the administration of exercise as a treatment for work‐related injuries.

• Would the providing of an employee with a written home exercise program (including sets/reps and resistance) constitute first aid or medical treatment?

– This constitutes medical treatment.

• If the ATC utilizes stretching to relieve their symptoms, does this service constitute medical treatment or first aid?

– This constitutes medical treatment.

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• Supervised Exercise – Clearly Medical Treatment

• Unsupervised Exercise– Should not be deemed

Medical Treatment

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Tipping Point…

Tipping Point…

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Tipping Point…

Tipping Point…

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Workplace Restrictions…

??


Frequently Asked Questions:• Question 7‐19. Does the employer have to record a work‐related

injury and illness if an employee experiences minor musculoskeletal discomfort, the health care professional determines that the employee is fully able to perform all of his or her routine job functions, but the employer assigns a work restriction to the injured employee?

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• As set out in Chapter 2, I., F. of the Recordkeeping Policies and Procedures Manual (CPL 2‐00.135) a case would not be recordedunder section 1904.7(b)(4) if (1) the employee experiences minor musculoskeletal discomfort, and (2) a health care professional determines that the employee is fully able to perform all of his or her routine job functions, and (3) the employer assigns a work restriction to that employee for the purpose of preventing a more serious condition from developing. If a case is or becomes recordable under any other general recording criteria contained in section 1904.7, such as medical treatment beyond first aid, a case involving minor musculoskeletal discomfort would be recordable.


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1. Soft Tissue Mobilization

2. Myofascial Release

3. Graston Technique

4. ASTYM Technique

5. Transverse Friction Massage

6. Cross Friction Massage

7. Trigger Point Release

8. Dorn

9. Rolfing

10. Cranio‐Sacral Therapy

11. Travell and Simons: advocate the use of trigger point techniques

12. Cyriax (Cyriax, 1977) advocate the use of trigger point techniques

13. S.A.S.T.M.

Like Interventions…

Go Forward…

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Early Intervention Strategies…

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Gang of Four…

Drew Bossen, PT, MBA

Atlas Injury Prevention Solutions

E: dbossen@atlas‐ips.com

C: 319‐430‐3382

Curt DeWeese, PT, COO

DSI Work Solutions

E: [email protected]

O: 270‐245‐1000 ext. 103

Scott Ege, PT, MS

Ege Work Smart Solutions


C: 815‐988‐7588

Debbie Reed, PT, MS

Advanced Rehabilitation, Inc.


C: 812‐457‐1392

+ 1

Questions…

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