OSH1/2 Module 2

Module 2 Overview: Why OSH?

Introduction to why the OSH program exists

This module describes the impact that injuries and occupational diseases have on paramedics and their families. It presents recent statistics that may be quite an eye-opener for many people. It also explains BCAS’s legal responsibility to provide Occupational Safety and Health (OSH) training to its employees under the Workers Compensation Act and Occupational Health and Safety (OH&S) Regulation, as well as paramedics’ responsibility to comply with safety procedures. Finally, we will look at the BCAS OSH Program and the goals it is striving to achieve.

Module 2 Topics

The following topics are covered in this module:

Impact of workplace injuries and occupational diseases Workers Compensation Act OH&S Regulation Partners in workplace safety The purpose and goals of the BCAS OSH Program Occupational Safety and Health terms The impact that injuries and occupational diseases have on BCAS paramedics Duties of employers for assuring workplace health and safety as given in the Workers

Compensation Act, Part 3, Division 3 Responsibilities of BCAS as an employer as outlined in the Workers Compensation Act, Part 3,

Division 3 Roles and responsibilities of supervisors and workers as outlined in the Workers Compensation

Act, Part 3, Division 3 Location of current safe work procedures in the OH&S Regulation Risk factors that can result in musculoskeletal injuries (MSI)

Module 2 Resources

The resources for this module are: 1. Download a copy of the content of the module (Activities are not included) HERE 2. A copy of Part 3 of the Workers' Compensation Act: Click here to open document 3. Selections from WorkSafeBC's Occupational Health and Safety Regulations: Click here to open document 4. BCAS Exposure Control Plan You may also have access to the complete versions of the WCA and the OH&S Regulation at your station.

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Click NEXT arrow above to continue with Module 2 Navigation.

Module 2 Finding Your Way

Module Outline

The module is divided into the following sections: 1. Impact of Workplace Injuries and Occupational Diseases

a. What are the hazards? b. Who is getting hurt?

2. Workers' Compensation Act 3. OH&S Regulation 4. Ergonomics (MSI) Requirements 5. Module 2 Self-Assessment

Module Navigation

If you want to exit a page, you will always be given the choice to return to the Module 2 Overview that will bring you out of the scenario. Sometimes when you are within the module, you will not be able to use the navigation arrows in the upper right hand corner. Instead, you will be given choices at the bottom of the page. These choices will let you decide where you want to go next. The links below will take you either to the start of the first three different sections of the module, or you can exit the module and go to the Course Overview. Start with the Impact of Workplace Injuries Impact of Workplace Injuries and Occupational Diseases You work in a high-risk occupation. The consequences of occupational injuries and diseases can have a significant impact on your career and personal life. Just ask Heather Maddigan, an EMA II, pictured to the right, who suffered a serious back injury when she was lifting a heavy patient. The maincot broke, pulling her forward and down. As a result of the injury, she had been disabled from car, x-ray car and fleet duties. She has not had a pain-free day in over ten years and has never worked as a paramedic again. Heather has left the ambulance service, yet to this day experiences problems associated with that incident. BCAS employees, primarily paramedics, experience over 1000 incidents annually, including injuries and exposures to hazards. Approximately 14,000 working days are lost each year and significant pain, suffering or career-ending disabilities occur. Unfortunately, the trend is towards an increase in the number of incidents that cause these problems. Continue to find out what are the hazards and how the numbers of incidents are increasing.

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What hazards are causing these incidents? The following illustration shows that while the number of incidents over the last seven years has fluctuated, it has at no time decreased.

What hazards are causing these incidents? It is not surprising that lifting or transferring patients causes the majority of injuries in BCAS. However, other types of hazards such as exposures and motor vehicle incidents are also becoming a concern. The following illustration shows a breakdown of incidents by accident type from 2001-2007.

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Another way of looking at these statistics is to consider the percentage of each accident type as it relates to the total number of incidents during this period. Musculoskeletal incidents caused by kneeling, carrying, patient transfer to or from a bed or stretcher, pushing or pulling, lifting, climbing and repetitive motion account for over 35% of the total number of incidents and over 60% of the costs of all WorkSafeBC claims. These types of incidents are causing injuries primarily to backs, hands and wrists, legs and knees, shoulders and arms, as you can see in the illustration below.

But what is of greatest concern is that the trend for workplace injuries and occupational diseases in BCAS

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shows a steady increase over the past several years. What is causing such an increase and what is the impact on paramedics and their families? Continue with Who is getting hurt? Who is Getting Hurt? Many factors can contribute to injuries and occupational diseases. Some of these factors include the type of work that paramedics perform such as lifting and carrying heavy loads; level of training and experience on the job; age and level of fitness. So it is difficult to isolate single factors and point to them as the primary cause. However, our statistics point to some significant trends that we should consider. For instance, the average age for paramedics to start their careers with BCAS is at 20-25 years in part-time positions. Younger workers tend to be involved in different types of incidents than other age groups. For example, the following graph shows that paramedics in the 25 years age or less group are involved in exposures more frequently than paramedics in other age groups, but are injured less frequently by overexertion or slip/trip/fall incidents than others.

After 10-15 years of service, paramedics 30-40 years of age have the experience, training and seniority to become eligible for full-time jobs. In many cases, full-time employment with BCAS means working in stations with high call volumes. Do full-time employees sustain more injuries and run the risk of contracting more occupational diseases than part-time people? The answer is yes, full-time paramedics account for 56% of all reported injuries and 63% of all claims. There seems to be a relationship between high call volumes and the number of incidents that occur. It results in more injuries to paramedics in the 40-45 and 45-50 age groups. But in older age groups the injuries decline, possibly because of a trend for people with more seniority (10 years of full-time work) to bid for low call volume positions.

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Another trend is that paramedics are continuing in their careers with BCAS longer. Presently, about 35% of our workforce is less than 40 years old and approximately 65% is 40 years of age and older. Our statistics show that your risk of getting hurt and the severity of injuries increase as you age. The following illustration compares the percentage of paramedics in various age groups and the percentage of total injuries each group sustains.

As you can see, paramedics in the 40-45 and 45-50 age groups each suffer over 20% of the total reported incidents, but each represent only about 15-17% of the workforce. Paramedics in the 25-30 age group account for approximately 13% of the workforce, but experience about 6% of the reported incidents. When injuries occur to paramedics later in their careers, they frequently take longer to recover from them. Several factors may account for this trend such as age, fitness and repeated injuries to the same parts of the body. Unfortunately, the outcome for paramedics is a greater loss of wages for these injuries. This trend is illustrated in the following graphs, which compare the number of incidents for various age groups, the medical costs and wage losses that result from the injuries for two different reporting periods.

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But work-related injuries and diseases do not just happen to paramedics who are 35-49. They can occur throughout your career. And they do not just have an impact on your wages. There are many other costs as well. Let’s take a look at some of these costs.

High Cost of Injuries and Occupational Diseases

Occupational injuries and diseases can restrict your career and lifestyle. They can also place stress on your families, friends and colleagues. Heather Maddigan’s family had to make a lot of changes because of her injury. She can’t contribute in the same way at home financially or in caring for her family and maintaining her home. The recreational activities she and her family enjoyed prior to her injury have had to be modified for her. Some of these activities they now do without her. What do you think about these trends and the cost of being injured or becoming ill? We think these costs

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are too high a price to pay for a career as a paramedic. And we want the trends to change. It’s important to BCAS that the majority of paramedics are injury-free and enjoy good health throughout their careers. A healthy workforce is good for our individual paramedics and good for our patients.

The purpose of the OSH program is to change these statistics by helping you reduce your risks of injury and exposure. Some incidents are unavoidable. But you can reduce the risk of being injured by applying safe work practices and working with others in your station to identify hazards. A safe workplace is everyone’s responsibility.

Continue with activites about the Impact of Workplace Injuries

Workers' Compensation Act Workplace health and safety in British Columbia is regulated under the Workers' Compensation Act (WCA), which became effective in 1998. The purpose of Part 3 of the WCA is to benefit all citizens of British Columbia by promoting occupational health and safety and protecting workers and other persons present at workplaces from work related risks to their health and safety. The specific purposes of Part 3 of the WCA are to:

Promote a culture of commitment on the part of employers and workers to a high standard of occupational health and safety

Prevent work-related accidents, injuries and illnesses Encourage the education of employers, workers and others regarding occupational health

and safety Ensure an occupational environment that provides for the health and safety of workers

and others Ensure that employers, workers and others who are in a position to affect the

occupational health and safety of workers share that responsibility to the extent of each party’s authority and ability to do so

Foster cooperative and consultative relationships between employers, workers and others regarding occupational health and safety, and to promote worker participation in occupational health and safety programs and occupational health and safety processes, and

Minimize the social and economic costs of work-related accidents, injuries and illnesses, in order to enhance the quality of life for British Columbians and the competitiveness of British Columbia in the Canadian and world economies.

The Act impacts all employers and workers in BC because it changes their roles and responsibilities for health and safety, amends the review and appeal process and institutes new penalty provisions for failure to comply with the Act or the OH&S Regulation.

WorkSafeBC (formerly Workers’ Compensation Board)

In accordance with the purposes of Part 3 of the WCA, WorkSafeBC (formerly the Workers’ Compensation Board (WCB)) has the mandate to be concerned with occupational health and safety generally, and with the maintenance of reasonable standards for the protection of the health and safety of workers in British Columbia and the occupational environment in which they work.

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In carrying out its mandate, WorkSafeBC has the following functions, duties and powers:

To exercise its authority to make regulations to establish standards and requirements for the protection of the health and safety of workers and the occupational environment in which they work

To undertake inspections, investigations, and inquiries on matters of occupational health and safety and occupational environment

To provide servicesto assist joint committees, worker health and safety representatives, employers and workers in maintaining reasonable standards for occupational health and safety and occupational environment;

to ensure that persons concerned with the purposes of this Part are provided with information and advice relating to its administration and to occupational health and safety and occupational environment generally;

to encourage, develop and conduct or participate in conducting programs for promoting occupational health and safety and for improving the qualifications of persons concerned with occupational health and safety and occupational environment;

to promote public awareness of matters related to occupational health and safety and occupational environment;

to prepare and maintain statistics relating to occupational health and safety and occupational environment, either by itself or in conjunction with any other agency;

to undertake or support research and the publication of research on matters relating to its responsibilities under this Act;

to establish programs of grants and awards in relation to its responsibilities under this Act; to provide assistance to persons concerned with occupational health and safety and occupational

environment; to cooperate and enter into arrangements and agreements with governments and other agencies

and persons on matters relating to its responsibilities under this Part; to make recommendations to the minister respecting amendments to this Act, the regulations

under this Part or Part 1 of this Act, or other legislation that affects occupational health and safety or occupational environment;

to inquire into and report to the minister on any matter referred to it by the minister, within the time specified by the minister;

to fulfill its mandate under this Part in a financially responsible manner; to do other things in relation to occupational health and safety or occupational environment that

the minister or Lieutenant Governor in Council may direct.

Employers in industries covered by the Workers Compensation Act fund the WCB. Most employers in BC, including BCAS, are covered under the Act.

What Is Your Responsibility?

Several parts of the Workers Compensation Act contain requirements that paramedics should become knowledgeable about because they define your responsibilities and safe work practices. These parts include, but are not limited to the following: (You may have already downloaded this from Module 2 Overview Resources section. Or you can download it here: Click here to open document

Part 3, Division 3, General Duties of Employers, Workers and Others

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Part 3, Division 10, Accident Reporting and Investigation

Part 3, Division 3. defines the general responsibilities of people in the workplace. The provisions that are most important to you are:

Section115, General duties of employers Section116, General duties of workers Section117, General duties of supervisors

Part 3, Division 10 describes the employer’s responsibility to report accidents. You should become familiar with this provision:

Section 172, Immediate notice of certain accidents

Excerpts covering these provisions from the WCA are provided in Book 1, Core Requirements, of the new OH&S Regulation. The Workers Compensation Act makes health and safety in the workplace everyone’s responsibility.

We all benefit when the high cost of workplace injuries, accidents and diseases is reduced. Continue with activities on WCA

Occupational Health & Safety Regulation The regulations governing workplace health and safety were updated and expanded at the same time that the WCA was introduced. The Occupational Health and Safety (OH&S) Regulation, commonly called the WCB Regs, is a set of practices that govern the workplace activities of most employers and workers in British Columbia. The practices are contained in three books:

Book 1 Core Requirements (Parts 1-4) Book 2 General Hazard Requirements (Parts 5-19) Book 3 Industry/Activity Specific Requirements (Parts 20-33)

These books are useful because they specify hazards that are particular to your workplace. The Index and User Guide – a separate book that accompanies Books 1-3 of the Regulation – will help you locate information in the Regulation.

We looked at recognizing and assessing risks in module 1. We categorized risks as High (imminent), Medium (urgent) and Low (non-urgent) and discussed the corresponding corrective action needed. And we wrote that In the dynamic environment of an ambulance call, all risks posed by hazards you recognize must be managed immediately

Your workplace is not just the station but is also the wide-ranging environments that your calls take you to. Because of the wide variety of environments and types of risks those environments may pose to you, many sections of the OH&S applies to BCAS paramedics.

Provisions Requiring Risk Assessments

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There are 17 sections of the OH&S Regulation that require risk assessments to be performed by the employer. These sections define BCAS’s responsibilities as an employer as well as the safe work practices with which you must comply. The list below are the sections of the OH&S that apply to you. You may have already downloaded a copy from the Module 2 Overview Resources section. If not, you can download a copy here: Click here to open document

Additionally, you may following the links below to the original OH&S sections on the WorkSafeBC website. The activities that follow will draw upon what you discovered in your reading of the OH&S. These sections are:

Part 4, General Conditions

Emergency Preparedness and Response : Section 4.13, Risk assessment

Working Alone or in Isoloation: Section 4.21 Violence in the Workplace: Section 4.28, Risk assessment

Ergonomics (MSI) Requirements: Sections 4.47-4.49, Risk identification, Risk assessment, Risk factors

Part 5, Chemical and Biological Substances

Controlling Exposure: Sections 5.48 -5.54

Emergency Washing Facilities: Sections 5.85-5.96 (all sections of Emergency Washing Facilities)

Emergency Procedures: Section 5.99, Risk assessment

Part 6, Substance Specific Requirements Asbestos: Section 6.6, Assessment and classification

Biohazardous Materials: Section 6.35, Risk identification

Cytotoxic Drugs: Section 6.43, Exposure control plan

Lead: Section 6.60, Exposure control plan

Toxic Process Gases: Section 6.118, Risk assessment

Part 7, Noise, Vibration, Radiation and Temperature

Noise Exposure: Sections 7.1 - 7.5 Ionizing and Non-ionizing Radiation: Section 7.20, Exposure control plan

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Heat Stress: Section 7.29, Heat stress assessment

Cold Stress: Section 7.34, Cold stress assessment

Part 9, Confined Spaces: Sections 9.2 – 9.19

In addition to the OH&S Regulations regarding Confined Spaces, read this bulletin written specfically for BCAS: Click here to open document Part 12, Tools, Machinery and Equipment Abrasive Blasting and High Pressure Washing: Section 12.98, Risk assessment We cover many of these hazards throughout the OSH Education Program. In this module, you should review the OH&S Regulation requirements that apply to them and become familiar with your rights and responsibilities. Be smart, keep healthy and work safely. Continue with Activities on OH&S

Ergonomics (MSI) Requirements The provisions in Sections 4.46-4.53 of the OH&S Regulation are designed to eliminate, or if that is not practicable, minimize the risk of musculoskeletal injuries (MSI) to workers. (You can read these sections in the copy of the OH&S you downloaded, or you can download it here: Click here to open document

A musculoskeletal injury is an injury or disorder of the muscles, tendons, ligaments, joints, nerves, blood vessels or related soft tissue including a sprain, strain and inflammation that may be caused or aggravated by work. MSIs are the most common injuries sustained by paramedics in the course of their work. They occur while paramedics are engaged in a variety of tasks, particularly ones that involve lifting and transferring patients.

Over the course of a paramedic’s career, multiple injuries may occur to some part of the body such as the back or shoulder. Although these injuries by themselves may not be severe, they can frequently cause ongoing pain and discomfort. In addition, the cumulative effect of repeated injury to the same body area, especially those poorly treated or healed, can weaken muscle and connective tissue. The result is an increasing risk of much more serious injury. These cumulative-effect injuries restrict activity, impact careers and ultimately lead to permanent disability.

Ergonomics is the methodical study of how people interact physically with their working environment. Everyone in BCAS needs to identify the risk factors in their work so that measures can be taken to minimize the risk of MSI.

Risk Factors for MSI

Section 4.49 of the OH&S Regulation lists the “risk factors” for MSI – in other words, the things that may cause or contribute to an MSI. You need to be able to identify and consider these risks prior to carrying out tasks. Most tasks you perform will have multiple risk factors, which increase the risk of injury. This table shows how risk factors for MSI apply to the paramedic workplace.

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OH&S Regulation Risk Factors Section 4.49

HOW THE RISK FACTOR APPLIES TO THE PARAMEDIC WORKPLACE

(a) The physical demands of work activities (The physical demands of a task are the main risk factors for MSI)

(i) Force Required

The effort you have to exert to complete your task: e.g., lift a patient, push a stretcher or grip the handles of a jumpkit or

defibrillator.

(ii) Repetition The number of times you use the same muscles without having the

chance to rest and recover: e.g., ventilating a patient using a BVM or doing chest compressions during CPR.

(iii) Duration

The length of time you're exposed to the risk factor when doing a task: e.g., how long you're holding a stretcher you just lifted or how

long you remain sitting on the squad bench. The longer you're exposed to a risk factor, the greater the chance of injury.

(iv) Work Postures

The position of parts of your body when doing a task: e.g., the position of your back (bent forward no more than 30 degrees is desirable) while lifting or carrying a patient or while treating a

patient who is lying on the floor.

(v) Local Contact Stresses

The stress that occurs when a hard or sharp object comes in contact with your skin: e.g., kneeling on a hard, irregular

surface while giving treatment. (b) Aspects of the layout and condition of the workplace or workstation (These can

affect the physical demands of the tasks paramedics perform)

(i) Working Reaches

How far you have to extend your arm or body to complete a task (no more than 45 degrees away from the body is

desirable): e.g., retrieving equipment using the side door of the ambulance or getting medical supplies from storage bins while

seated on the squad bench.

(ii) Working Heights

Height of a working surface on which you are completing a task, relative to your body position: e.g., treating a patient on the floor vs on a bed; the height of the back of the ambulance for a short person loading a stretcher vs a taller person doing

the same task.

(iii) Seating

Seating position relative to the work surface where you are completing a task: e.g., bench seating in the back of the

ambulance is now adjusted so it’s closer to the stretcher. The risk of injury due to too long a “working reach” and poor “work

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posture” is minimized.

(iv) Floor Surfaces

The surface on which you walk, stand, kneel, etc., to complete a task: e.g., station, hospital and ambulance floors; paths,

sidewalks, driveways. The surface can consist of loose gravel, wet grass, black ice and snow, or the cluttered floor of a

patient’s home. (C) The characteristics of objects handled (these can affect the physical demands of

the tasks paramedics perform)

(i) Size and Shape

Patients and equipment come in all shapes and sizes. This can impact your ability to lift and carry, for example.

(ii) Load Condition and

Weight Distribution

An unstable load or unevenly distributed weight of the load: e.g., a patient who suddenly tries to sit up while you are

attempting a lift; carrying a heavy piece of equipment in one hand and a light load in the other.

(iii) Container, Tool and

Equipment Handles

Jumpkit handles, stretcher handles, other lifting devices are examples.

(D) The environmental conditions, including cold temperatures (These can affect the physical demands of the tasks paramedics perform)

Cold decreases blood flow to muscles and increases the force required to grip the gatch, for example. Another example of an environmental condition that affects the physical demands of

tasks is lighting: e.g., low light or glaring light may cause a worker to stoop or bend to do a task.

(E) The following characteristics of the organization of work (These can affect the physical demands of the tasks paramedics perform)

(i) Work-recovery Cycles

and (II) Task

Variablity

These two risk factors mainly apply to an industrial work setting, where a worker would be performing the same

movement, using the same muscles, over and over. The variety of tasks paramedics typically perform means these

factors do not usually pose a risk.

(iii) Work Rate The number of times a load is handled during a specific period of time: e.g., a high call volume where the paramedic is moving

rapidly from one call to the other.

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Make sure you are familiar with these risk factors. Use them to assess hazards that you may encounter in your work. OSH 3 of the OSH Education Program is entirely devoted to ergonomics, MSI and specific procedures for eliminating or minimizing the risk for MSI.

Signs and Symptoms of MSI

Paramedics also need to be aware of and be able to recognize the early signs and symptoms of MSI so that they can take preventative measures before a significant injury occurs.

Examples of preventative measures include:

Improving your strength and flexibility so you are able to manage risk Effectively treating the affected area by elevating it, applying cold to it and resting it Changing how you do your work, for example by using your unaffected hand to carry

equipment

In addition, you can:

Document on the HLTH 1130A form a hazard that might cause an MSI (Documentation of hazards is covered in Module 2 of this course)

Talk with your supervisor or safety committee member

Early Signs and Symptoms of MSI:

Early Signs (Things you can see)

Early Symptoms (Things that you can feel)

Redness Swelling

Movement is difficult Skin colour changes

Pain Joint stiffness Tight muscles

Feeling pins and needles Numbness

Continue with Activities on Ergonomic Requirements Module 2 Conclusion

Partners in Workplace Safety

The emphasis on workplace safety in the OH&S Regulation has required BCAS to examine its operations and the ways in which it can make the workplace safer. Employees and employers throughout BC, including BCAS, have realized that putting a priority on health and safety is in the best interest of individuals and organizations.

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These factors drive the OSH Program and the strategies we have adopted to reach the ultimate goal of safety in the workplace. These strategies include:

Educating workers through flexible, timely course delivery, accessible at home or in the station Helping paramedics to implement safe work practices through a performance support program Initiating change through those who are respected by their peers and open to health and safety

education and practices Integrating health and safety education and practice in all levels of training Providing avenues for communication of health and safety concerns and remedies in the

workplace Reinforcing health and safety measures on the job through mentoring and by example Communicating the OSH message through those best able to communicate it: workers who have

been injured and workers who have managed to avoid injury through safe practices Recognition from peers and safety committees of those who have contributed to occupational

safety by example and by mentoring others Emphasizing occupational safety as a component of continuing medical education (CME)

The OSH Program approaches change realistically: we know it’s not going to happen all at once. We also know that it requires BCAS and its employees to work together. Working together, we can make a difference.

Have you now completed all modules? Once your completion has been recorded by the BCAS Learning Centre, you will be eligible to take the OSH1/2 Exam. If you have visited every page and completed each activity of this module, congratulations! If you have not yet had the chance to do so and are just surfing around to get a better feel for the course, that is great too; however, you will need to eventually visit each page in order for the BCAS Learning Centre to recognize your course completion. Start Module 3 Applying the Risk Management Process

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