Use of a State Based Syndromic Surveillance System for the Classification and Capture of Non-

Fatal Occupational Injuries and Illnesses

Marija Borjan, PhD, MPH

Occupational Health Surveillance Unit

New Jersey Department of Health

Why Syndromic Surveillance for Occupational Health?� Real-time, early detection and monitoring� Enhancements to current data collection

methods◦ Help to monitor trends of work-related injuries and

illnesses over time◦ Multiple data sources can help identify populations,

occupations and industries at high risk ◦ Will help provide a broader characterization of health

risks faced by the workers population

Included Keywords Excluded KeywordsInitial Keyword ListJOB; AT WORK; @ WORK; WORK RELATED; OCCUPA ACCIDENT WORK; WORK ACC; WORK INJ; WHILE WORK; WORKERS COMP; WORKER’S COMP; WORK MANS COMP; WORKMENS COMP

WORKOUT; WORK UP; WORK NOTE; LABWORK; LAB WORK; BLOODWORK; BLOOD WORK

Final Keyword ListJOB; AT WORK; @ WORK; WORK RELATED; OCCUPA ACCIDENT WORK; WORK ACC; WORK INJ; WHILE WORK; WORKERS COMP; WORKER’S COMP; WORK MANS COMP; WORKMENS COMP; WORKPLACE; WORK COMP; WORKMANS COMP; WORK WOUND; WORKMENS COMPENSATION; WORK-RELATED

WORKOUT; WORK UP; WORK NOTE; LABWORK; LAB WORK; BLOODWORK; BLOOD WORK

ICD-9 DefinitionE000.0 Civilian activity done for income or payE000.1 Military activityE800-E807 Railway accident among railway employee (4th digit = 0)E830-E838 Water transport accident among crew, Dockers and stevedores (4th digit = 2 or 6)E840-E845 Air and space transport accidents among crew and ground crew (4th digit = 2 or 8)

E846Accidents involving powered vehicles used solely within the buildings and premises of industrial or commercial establishment

E849.1 Place of occurrence: farm building/land under cultivationE849.2 Place of occurrence: mine or quarryE849.3 Place of occurrence: industrial place and premises

Occupational Related Injuries Custom Classifier

Keywords Only E-Codes Only Total

Workers’ Compensation as Payer 956 3 959Event or Exposure

Falls slips trips 1327 352 1679Injury by other person 141 45 186Transportation incidents 135 16 151Animal and insect related incidents 79 66 145Overexertion in lifting or lowering 46 0 46Struck by object 14 1 15

Caught in object equipment material 12 2 14Nature of Injury or Illness

Cuts lacerations 582 459 1041Burns 157 98 255Sprains strains tears 175 10 185Punctures (except gunshot wounds) 25 10 35Fractures 10 4 14Bruises contusions 8 5 13Soreness pain 6 7 13Amputations 2 2 4

Number of probable non-fatal work-related injuries by case characteristic reported via EpiCenter in NJ, 2014

Keywords Only E-Codes Only TotalPart of Body Affected

Back 1067 347 1414Hand 758 428 1186Head 634 300 934Arm 480 203 683Knee 423 243 666Shoulder 311 220 531Foot 307 176 483Eye 285 158 443Ankle 269 163 432Wrist 202 132 334Neck 178 86 264Toe 47 32 79

Source of Injury IllnessBiological 170 68 238Chemical products 40 21 61Ladders 18 7 25Machinery 10 1 11Hand tools 7 1 8Forklift 5 2 7

Number of probable non-fatal work-related injuries by case characteristic reported via EpiCenter in NJ, 2014

Chemical Exposure Keywords

Include Exclude

Vapor Withdraw

\bfume Hazard

Toxic gas Hazard to

Inhaled? gas Detox

\bc chem\b Depend

Chemical Chem screen

hazard Chem panel

chlorine Blood chem

HAZMAT Perfume

HAZ MAT Chem [0-9]

HZ MAT \bon chem

Chemical Exposure Alert

Examples of Chemical Exposures� Toluene exposure at a nail polish manufacturing plant in northern NJ◦ Two plant workers (one of whom died) and four emergency responders who became ill after

being exposed to toluene vapor. OHS contacted OSHA and the employer immediately, and conducted an investigation of the incident (report pending). NJDOH Public Employee Occupational Health and Safety (PEOSH) was also contacted and responded to the EMTs who reported to the site.

� Pesticide exposure at a produce repacking facility in southern NJ ◦ Grapes imported from Brazil. Workers were treated for gastric discomfort and lab tests were

performed. Federal OSHA’s NJ area office was contacted by DOH, and the U.S. Food and Drug Administration (FDA) tested for pesticides. The investigations by OSHA and FDA are pending. OHS staff assisted the local health department and hospital emergency department staff by identifying and sharing resources for medical management of pesticide-exposed patients. OHS staff also alerted state health department food safety staff of OSHA involvement in the investigation.

� Explosion at Manufacturing Plant◦ Alerted of multiple chemical exposures due to a fire at a manufacturing plant. A plastic resin was

being melted down and a clog had formed causing the oven to overheat to over 900 degrees causing a backup and smoke to be released in the building.

Severe Weather Events -Tree Related Injuries

Include if contains Exclude if contains

sawbranchwood chipwoodchiptree chainsawchain saw

saw pmdsaw nursebranchialallergbranch avebranch ctbundledistreeextrememdpedsrespiratorysaw bloodsaw docsaw drsaw pedspotsstreettable sawtablesawtree drtree lane

Tree Related Injuries

Tree Related Injuries

Concluding thoughts – Occ. Health� Use of the EpiCenter chief complaint reporting system has

shown that it can yield real-time knowledge of incidents and local conditions for OHS to assist with and identify prevention opportunities

� EpiCenter allows staff to identify illnesses early so a rapid response can be initiated, reducing further risk of occupational injuries and illness

� OHS can expand upon its existing surveillance to help better characterize the health risks faced by the NJ worker population

� While not precise, gives a good overview of ED activity statewide

Publications� Borjan, M. and Lumia, M. Evaluation of a State Based Syndromic Surveillance System

for the Classification and Capture of Non-Fatal Occupational Injuries and Illnesses in New Jersey. American Journal of Industrial Medicine, 60(7): 621-626, 2017.

� Marshall, E.G., Lu, S., Williams, A.O., Lefkowitz, D., and Borjan, M. Tree-Related Injuries Associated with Response and Recovery from Extreme Weather Events. Public Health Reports, 133(3): 266-273, 2018.

� Morano, L., Jagger, M., Barrett, E., Berisha, V., Borjan, M., Heitzinger, K., Kumar, R., Lane, K., Lumia, M., Menager, H., Thie, L., CSTE Climate and Health Syndromic Workgroup. 2017. Syndromic Surveillance Climate and Health Guidance Document: How Jurisdictions Can Use Surveillance to Quantify and Track Climate-Related Health Impacts.

Acknowledgements

� NJDOH, Communicable Disease Service◦ Stella Tsai◦ Teresa Hamby

� HMS, Inc◦ Kristen Weiss

Questions & Comments◦ Email: Marija.Borjan@doh.nj.gov◦ Phone: 609-826-5473