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WELCOME

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Jack Tiffany, PA-C Industrial Medical Associates 515-560-8660 jacktiffany@verizon.net Jack Tiffany 2006

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Review of Work-Related Injuries & Their Prevention Review of Work-Related Injuries & Their Prevention

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TEST

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What do you see?

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From OSHA Publication Forms for Recording Work-Related Injuries & Illnesses An injury is any wound or damage to the body resulting from an event in the work environment. Sprain and strain injuries to muscles, joints, and connective tissues* are classified as injuries when they result from a slip, trip, fall or other similar accidents. *tendons, ligaments, & intervertebral disks

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Butwhat about

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Musculoskeletal Disorders (MSDs)? Also called injuries Also involve muscles, joints, & connective tissue Whats the difference?

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Terms Condition: a state at a particular time Disorder: a condition in which there is a disturbance of normal function Macro: large-scale Micro: small-scale

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Load & Load Tolerance The term load describes physical stresses acting on anatomical structures of the body. These stresses include kinetic (motion), kinematic (force), oscillatory (vibration), and thermal (temperature) energy sources. The term tolerance describes the physical and physiological capacity of tissues of those structures to respond to loading. The term load describes physical stresses acting on anatomical structures of the body. These stresses include kinetic (motion), kinematic (force), oscillatory (vibration), and thermal (temperature) energy sources. The term tolerance describes the physical and physiological capacity of tissues of those structures to respond to loading.

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Injury Models

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Macro Injury Arises from a single identifiable event Occurs when an external load exceeds the internal tolerance of tissues of an anatomical structure for physical stress Event: sudden, forceful stretching of a rotator cuff tendon Response: tissue damage, e.g., a rotator cuff tendon tear causes abrupt onset of pain & loss of function (person unable to move upper extremity)

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Micro Injury Arises from a complex interaction of events that may accumulate over time Results from the accumulated effect of transient external loads that may, in isolation, be insufficient to exceed internal tolerances of tissues. It is when this loading accumulates by repeated exposures, or exposures of sufficiently long duration, that the internal tolerances of tissues are eventually exceeded Events: frequent use of hands & elbows above shoulder level Early response: inflammation of a rotator cuff tendon, stimulated by impingement, causes gradual onset of pain which can become severe enough to disturb normal function (person able to move upper extremity but reluctant to because of pain) Later response: with continued awkward shoulder movement, inflammation can advance to tissue damage, i.e., tendon tear & loss of function

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Transient external loads Inflammation Accumulated external loading Tissue damage Micro trauma MSD Cycle

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Extreme Workplace The Battle of Zama by Giulio Romano

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Work-Related Physical & Psychosocial Risk Factors for MSDs

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http://darwin.nap.edu/books/0309072840/html/R1.ht ml

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Low Back Disorders Manual material handling Awkward positions Frequent bending & twisting Heavy physical work Whole body vibration per 8 hr. day (0.5m/s action value; 1.15m/s limit value)* *Control of Vibration at Work Regulations 2005 (UK) Rapid work pace Monotonous work Low job satisfaction Low decision latitude Job stress

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Upper Extremity Disorders RepetitionDuration Awkward shoulder positions Static shoulder loads Awkward wrist positions Grip force Whole body vibration Hand vibration per 8 hr. day (2.5m/s action value; 5.0m/s limit value)* *Control of Vibration at Work Regulations 2005 (UK) High job demands High job stress

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Individual Physical & Psychosocial Risk Factors Increasing age Body Mass Index Smoking Prior low back injury, especially within last yr. Underlying medical conditions, in particular diabetes & arthritis DepressionAnxiety Psychological distress, e.g., worry, tension

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MSDs occur when the demands of the job exceed the capacity of the worker to meet those demands

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None of the common musculoskeletal disorders is uniquely caused by work exposures. They are what the World Health Organization calls work-related conditions because they can be caused by work exposures as well as non-work factors. From Executive Summary, Musculoskeletal Disorders and the Workplace, 2001

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Arthritis is the number one cause of workplace disability. According to Arthritis Foundation

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National Safety Council research shows nearly two-thirds of disabling injuries to workers each year occur off the job. From National Safety Council Injury Facts, 2005-2006 Edition

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Sowhat do employers do to prevent MSDs?

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In the workplace?

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Well

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Or Employers can intervene ergonomically to eliminate or reduce worker exposure to work-related risk factors & to modify or moderate individual risk factors (find it & fix it) Employers can intervene ergonomically to eliminate or reduce worker exposure to work-related risk factors & to modify or moderate individual risk factors (find it & fix it)

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Andwhy do employers want to do this?

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General Duty Clause (a) Each employer -- (1) shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees; (2) shall comply with occupational safety and health standards promulgated under this Act. (b) Each employee shall comply with occupational safety and health standards and all rules, regulations, and orders issued pursuant to this Act which are applicable to his own actions and conduct (a) Each employer -- (1) shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees; (2) shall comply with occupational safety and health standards promulgated under this Act. (b) Each employee shall comply with occupational safety and health standards and all rules, regulations, and orders issued pursuant to this Act which are applicable to his own actions and conduct SEC. 5. Duties - OSH Act of 1970

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Investment in well being of employees & company Cost is justified by positive return on investment

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ROI The Blue Cross/Blue Shield Rhode Island Ergonomics Program reported that it decreased its organizations lost workdays from 345 in 1999 to 104 in 2000 (70% decrease) and lowered its workers compensation costs 89% from $227, 620 to $26,010. CTD (Cumulative Trauma Disorders) News, May 2001. Between 1992 and 1996, the New York Times reported that it reduced its workers compensation claims by 84%, reduced lost work time by 75% and decreased lost workdays by 91%, as a result of its ergonomics program. Michael Gauf, Ergonomics That Work. 1998. Intracorp reported that a public service company with 330 employees realized a return of $7.35 for every $1.00 invested in its ergonomics program. CTD News, December 1999. Northwest Aerospace Company realized a 10-15 percent increase in productivity (a benefit of greater than $200,000) following implementation of an ergonomics program. Washington State Dept. of Labor and Industries, Fitting The Job to The Worker, 1994. Jerome Foods Inc. reported saving $3 for every $1 invested in an ergonomics program. Washington State Dept. of Labor and Industries, Fitting The Job to The Worker, 1994. From Investment Benefits of an Ergonomics Program, Federal Occupational Health, undated

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Ergonomics (or Human Factors) Is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance. Promotes a holistic approach in which considerations of physical, cognitive, social, organizational, environmental, and other relevant factors are taken into account. Derived from the Greek ergon (work) and nomos (laws). From International Ergonomics Association (IEA)

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Fitting the job to the worker

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Ergonomics in 12 pages http://www.osha.gov/Publications/osha3125.pdf

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Elements of an effective Ergonomic Program Management commitment (from top down) & employee participation (including union members); recognition by managers & supervisors that integrating ergonomic measures into daily operations is a best practice Trained core group + auxiliary members (optometrist, carpenter); train the trainer, cell manufacturing Risk factor identification (primary, secondary, & tertiary prevention) Risk factor control (engineering & work practice changes; administrative policies: post hire exams to determine fitness & to guide job placement, early reporting, limited OT; PPE) Early first aid or Occupational Medical management Program evaluation. Was it effective by program evaluation standards?

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Vitruvian Man Drawing with accompanying notes by Leonardo DaVinci, circa 1490

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Also called Canons of Proportions

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Proportion In all perfectly beautiful objects there is found the opposition of one part to another and a reciprocal balance John Ruskin Balance among the parts of something From hyperdictionary From hyperdictionary

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Equilibrium The state of a body or physical system at rest or in unaccelerated motion in which the resultant of all forces acting on it is zero and the sum of all torques about any axis is zero. The state of a body or physical system at rest or in unaccelerated motion in which the resultant of all forces acting on it is zero and the sum of all torques about any axis is zero. From American Heritage Dictionary From American Heritage Dictionary

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So what does this all mean???

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No physical stresses acting on body

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http://www.uhs.berkeley.edu/facstaff/pdf/designguidelines.pdf In the office

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Alternative Sitting Postures? http://www.osha.gov/SLTC/etools/computerworkstations/positions.html

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On the floor? This is the place where fitting the job to the worker is the most challenging This is the place where fitting the job to the worker is the most challenging

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Ideally http://www.osha.gov/SLTC/etools/computerworkstations/positions.html

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Realistically? Workers should move their low backs & upper extremities within safe anatomical limits & workstations should be designed or changed so workers can do that

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From Ergonomics Tech Guide 220 DOD Ergonomics Working Group

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What do employers do about individual risk factors?

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Opinion The ROI Of Wellness Tony Zook 04.24.06, 6:00 AM ET New York - It should come as no surprise that healthy employees boost a companys bottom line. They experience less sick time, take fewer disability days and suffer lesser risk of premature deaths. According to the Centers for Disease Control, more than 75% of employers' health care costs and productivity losses are related to employee lifestyle choices. And a $1 investment in wellness programs saves $3 in health care costs, according to the Wellness Council of America. It is good business for companies to help provide employees with the information and tools that will empower them to adopt healthy behaviors. However, according to a 2006 study published in the American Journal of Health Promotion, less than 20% of U.S. employers offer lifestyle modification services. Even more surprisingly, just four percent offer tobacco cessation services. http://www.forbes.com/2006/04/21/wellness-programs-gold-standards-cx_tz_0424wellness_print.html

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Possibilities Host a yearly on-site Health Fair by inviting organizations like American Heart, Lung, & Diabetes Associations, to perform BP, cholesterol, & blood sugar screenings & to promote awareness of illnesses which we are concerned about; include Arthritis Foundation & EAP Implement workplace stretching program Hold on-site smoking cessation & weight loss classes Offer flu vaccinations in Fall Imagine all the possibilities Tom Chapin

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"The significant problems we face cannot be solved at the same level of thinking we were at when we created them." Albert Einstein

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Discussion