Emerging Trends in Workplace Injuries Lorain County Safety Council January 18, 2012 James Anthony, MD Medical director Mercy Occupational Health Center

Emerging Trends in Workplace Emerging Trends in Workplace InjuriesInjuries

Lorain County Safety CouncilLorain County Safety Council

January 18, 2012January 18, 2012

James Anthony, MDJames Anthony, MD

Medical directorMedical director

Mercy Occupational Health CenterMercy Occupational Health Center

Lorain/Elyria, Ohio Lorain/Elyria, Ohio

Introduction and Program ObjectivesIntroduction and Program Objectives

• Overview of program objectivesOverview of program objectives• Overview of workplace injury issuesOverview of workplace injury issues• Presentation of some injury data over Presentation of some injury data over

past 10 yearspast 10 years

Introduction and Program ObjectivesIntroduction and Program Objectives

• Review key concepts in injury prevention for Review key concepts in injury prevention for highest or emerging injury trendshighest or emerging injury trends

• Review key concepts for treatment of the Review key concepts for treatment of the highest or emerging injury trendshighest or emerging injury trends

• Review audience perceptions of key injury Review audience perceptions of key injury trends, prevention and treatmenttrends, prevention and treatment

• Questions and AnswersQuestions and Answers

Overview of ProblemOverview of Problem

• On average, rates of workplace injuries have declined

• Depending on your point of view, there are varying theories as to why work injury rates have declined

• Certain injury types and causes lead to far more days away from work than others

• Preventive measures can be focused based on this information

Overview of ProblemOverview of Problem

• Treatment approaches and transitional Treatment approaches and transitional work options can also be tailored to best work options can also be tailored to best fit the work injury trendsfit the work injury trends

• Employers can use this information to Employers can use this information to better know what to expect and how to better know what to expect and how to approach injury prevention and approach injury prevention and transitional worktransitional work

A Different PerspectiveA Different Perspective

• As expressed on a local law firm’s web As expressed on a local law firm’s web site:site:• ““Ohio workers’ compensation attorneys Ohio workers’ compensation attorneys

expect this number to be much higher. Many expect this number to be much higher. Many programs are in place to discourage workers programs are in place to discourage workers from reporting injuries or making a worker’s from reporting injuries or making a worker’s compensation claim, and as a result, compensation claim, and as a result, underreporting is a growing problem for our underreporting is a growing problem for our nation’s workers.”nation’s workers.”

Source Elk and Elk website

These growth trends refer to inflation adjusted direct costs for these types of injury causes.

These statistics come from the Liberty Mutual Research Institute for Safety

Categories of Workplace Injury CausesCategories of Workplace Injury Causes

1.1. Overexertion (over lifting, pushing, pulling)Overexertion (over lifting, pushing, pulling)2.2. Falls on the same level (Slip and Falls)Falls on the same level (Slip and Falls)3.3. Fall to lower level (off ladders etc.)Fall to lower level (off ladders etc.)4.4. Bodily reaction (Slips/trips/grabs w/o fall)Bodily reaction (Slips/trips/grabs w/o fall)5.5. Struck by object (such as a tool falling)Struck by object (such as a tool falling)6.6. Struck against object (walking into door)Struck against object (walking into door)7.7. Highway incidentsHighway incidents8.8. Caught in/ compressed by (equipment)Caught in/ compressed by (equipment)9.9. Repetitive motion (repeated stress and strain)Repetitive motion (repeated stress and strain)10.10. Assaults/Violent acts (from co-workers/customers)Assaults/Violent acts (from co-workers/customers)

Source is U.S. Bureau of Labor Statistics & Workers’ Compensation

Costs by Workplace Injury CausesCosts by Workplace Injury Causes

1.1. Overexertion – 25.7% of injuries and = 12.4 billionOverexertion – 25.7% of injuries and = 12.4 billion2.2. Falls on the same level – 13.3% of injuries = 6.4 billionFalls on the same level – 13.3% of injuries = 6.4 billion3.3. Fall to lower level – 10.8% = 5.3 billionFall to lower level – 10.8% = 5.3 billion4.4. Bodily reaction – 10% = 4.8 billionBodily reaction – 10% = 4.8 billion5.5. Struck by object – 8.9% = 4.3 billionStruck by object – 8.9% = 4.3 billion6.6. Struck against object – 6.1% = 2.5 billionStruck against object – 6.1% = 2.5 billion7.7. Highway incidents – 4.9% = Highway incidents – 4.9% = 4.9 billion4.9 billion8.8. Caught in/ compressed by – 4.4% = 2.1 billionCaught in/ compressed by – 4.4% = 2.1 billion9.9. Repetitive motion – 4.0% = 2.0 billionRepetitive motion – 4.0% = 2.0 billion10.10. Assaults/Violent acts – 0.9% = 0.4 billionAssaults/Violent acts – 0.9% = 0.4 billion

Source is U.S. Bureau of Labor Statistics & Workers’ Compensation

A Different Perspective onA Different Perspective on“Common” Workplace Injury Causes“Common” Workplace Injury Causes

1.1. Defective or Hazardous EquipmentDefective or Hazardous Equipment2.2. Hazardous MaterialsHazardous Materials3.3. Repetitive MotionRepetitive Motion4.4. Motor Vehicle MishapsMotor Vehicle Mishaps5.5. Insufficient Safety GuidelinesInsufficient Safety Guidelines6.6. Insufficient TrainingInsufficient Training7.7. Reckless Co-worker ConductReckless Co-worker Conduct

Source is lawyershop.com

Basic Safety Measures by CauseBasic Safety Measures by Cause

• OverexertionOverexertion• Train employees to use correct lifting techniquesTrain employees to use correct lifting techniques• Have mechanical lifting aids available for use when Have mechanical lifting aids available for use when

neededneeded• Train employees to ask for help if something is too heavyTrain employees to ask for help if something is too heavy• Check the areas where lifting is necessary and minimize Check the areas where lifting is necessary and minimize

any need to “lift and twist”any need to “lift and twist”• Train supervisors to encourage teamwork with respect to Train supervisors to encourage teamwork with respect to

lifting such that asking for help is acceptable behaviorlifting such that asking for help is acceptable behavior• Design tasks such that there is minimal need to overreach Design tasks such that there is minimal need to overreach

or bend when liftingor bend when lifting


• Falls from standing (falls same level)Falls from standing (falls same level)• Free work area surfaces of holes and tripping hazardsFree work area surfaces of holes and tripping hazards• Clean up any wet or oily spots in the work area promptlyClean up any wet or oily spots in the work area promptly• Improve lighting conditions in the work areasImprove lighting conditions in the work areas• Have workers wear shoes/boots with slip-resistant soles Have workers wear shoes/boots with slip-resistant soles • Make sure workers can see over the loads they are Make sure workers can see over the loads they are

carryingcarrying• Use handrails when walking on stairsUse handrails when walking on stairs


• Falls from height (falls different level)Falls from height (falls different level)• Routinely check equipment that is used to climb or work Routinely check equipment that is used to climb or work

from heightfrom height• Use slip resistant treads and handrailsUse slip resistant treads and handrails• Have appropriate lighting in the work areasHave appropriate lighting in the work areas• Encourage steady and deliberate work from height to Encourage steady and deliberate work from height to

minimize workers who move faster than it is safeminimize workers who move faster than it is safe• Encourage your workers to watch where they are steppingEncourage your workers to watch where they are stepping


• Struck by an object or striking an objectStruck by an object or striking an object• Make sure workers are alert to potential hazards in their areasMake sure workers are alert to potential hazards in their areas• Make sure appropriate PPE is used (Hard Hats etc.)Make sure appropriate PPE is used (Hard Hats etc.)• Help workers to be aware of their bodies and the space around Help workers to be aware of their bodies and the space around

themthem• Workers should have adequate clearance to get jobs done in Workers should have adequate clearance to get jobs done in

confined spaceconfined space• Make sure all machinery operators are fully trained and aware of Make sure all machinery operators are fully trained and aware of

their surroundingstheir surroundings• Use all equipment as specified by the manufacturer and have all Use all equipment as specified by the manufacturer and have all

guards and safety features operationalguards and safety features operational

Emerging Trends for Injury PreventionEmerging Trends for Injury Prevention

• Be proactive and not reactiveBe proactive and not reactive• Prescreening for musculoskeletal adequacy post-offer Prescreening for musculoskeletal adequacy post-offer

along with any other screening you require such as a along with any other screening you require such as a physical or drug testphysical or drug test

• Serves the purpose of screening out a few potential employees Serves the purpose of screening out a few potential employees that are clearly unable to perform the required duties of their jobthat are clearly unable to perform the required duties of their job

• Initiates education about lifting and body mechanics from a Initiates education about lifting and body mechanics from a neutral source and reinforces the importance the employer neutral source and reinforces the importance the employer places on workplace safetyplaces on workplace safety

• Relatively inexpensive addition to a post-offer physical Relatively inexpensive addition to a post-offer physical examinationexamination


• Be proactive and not reactiveBe proactive and not reactive• Have a physical therapist or occupational health Have a physical therapist or occupational health

nurse visit your plant periodically to review ways nurse visit your plant periodically to review ways to prevent musculoskeletal injuries with your to prevent musculoskeletal injuries with your employees or supervisorsemployees or supervisors• Preventive stretching and simple exercises can often be Preventive stretching and simple exercises can often be

helpful if presented in a positive and fun atmospherehelpful if presented in a positive and fun atmosphere• Allow employees enough time to do a simple warm-up Allow employees enough time to do a simple warm-up

routine before starting production routine before starting production


• Be proactive and not reactiveBe proactive and not reactive• Try to give employees adequate break times Try to give employees adequate break times

during the day to minimize fatigue near the end during the day to minimize fatigue near the end of shiftsof shifts • Many injuries occur near the end of shifts when workers Many injuries occur near the end of shifts when workers

are most tiredare most tired• Make sure adequate fluids are available in hot work areas Make sure adequate fluids are available in hot work areas

and during the warmer summer monthsand during the warmer summer months• It is proven that rested workers are more productive and It is proven that rested workers are more productive and

make up for rest time with fewer injuries and better make up for rest time with fewer injuries and better productsproducts

At Mercy OHC – InjuriesAt Mercy OHC – Injuries

• Top 12 Injuries by percentage of total Top 12 Injuries by percentage of total injuries for 2000 (account for 55%)injuries for 2000 (account for 55%)

Lumbar Sprain/Strain 10.9%

Open Wound of the Finger 8.5%

Shoulder Sprain/Strain 6.2%

Eye abrasion/foreign body 6.0%

Wrist Sprain/Strain 4.0%

Ankle Sprain/Strain 3.6%

Thoracic Sprain/Strain 3.2%

Finger Contusion 2.9%

Knee Sprain/Strain 2.8%

Open Wound of Hand 2.7%

Knee Contusion 2.3%

Neck Sprain/Strain 1.9%


• Top 12 Injuries by percentage of total Top 12 Injuries by percentage of total injuries for 2011 (account for 52.7%)injuries for 2011 (account for 52.7%)

Lumbar Sprain/Strain 9.8% dec.



Knee Sprain/Strain 4.3% inc.

Eye abrasion/foreign body 4.0% dec.

Neck Sprain/Strain 4.0% inc.




Knee Contusion 2.4%


Finger Contusion 2.1% dec.


• Top 12 Injuries by percentage of total Top 12 Injuries by percentage of total injuries for 2000 through 2011 (account injuries for 2000 through 2011 (account for 57.8%)for 57.8%)

Lumbar Sprain/Strain 11.7%



Eye abrasion/foreign body 5.7%

Knee Sprain/Strain 3.8%




Neck Sprain/Strain 3.2%


Knee Contusion 2.1%

Finger Contusion 2.0%

At Mercy OHC – Body At Mercy OHC – Body Areas Injured 2000 - 2011Areas Injured 2000 - 2011

• Top 12 areas injured and their percentage Top 12 areas injured and their percentage of total injuries within the top 12of total injuries within the top 12

Thumb/Hand/Finger 30.0%

Lumbar Spine 15.4%

Eyes 9.4%

Elbow/Forearm 6.7%

Wrist 6.1%

Knee 5.6%

Shoulder/Arm 5.2%

Head (not eyes) 5.2%

Foot/Toes 4.7%

Thoracic (mid) spine 4.7%

Neck 4.2%

Ankle 2.9%


• Expensive Ones !! (even without surgery Expensive Ones !! (even without surgery included in costs)included in costs)

1. Any fracture

2. Any injury that often leads to surgery

3. Head injuries

4. Spinal disc injuries or spinal arthritis

5. Bursitis/Tendonitis anywhere

6. Any shoulder injury

Emerging Trends for Injury ManagementEmerging Trends for Injury Management

• Get the diagnosis right and allow that to evolve Get the diagnosis right and allow that to evolve properlyproperly• Initial diagnosis, especially through ER, is often incomplete or an Initial diagnosis, especially through ER, is often incomplete or an

initial estimateinitial estimate• Most diagnoses are made over time where treatment intervention Most diagnoses are made over time where treatment intervention

can be assessed and more specific diagnoses become clearcan be assessed and more specific diagnoses become clear• Diagnostic tests might be necessary to define the more specific Diagnostic tests might be necessary to define the more specific

diagnosis, but may still not be necessarydiagnosis, but may still not be necessary• MRI’s are not photorealistic images of all structures within an area MRI’s are not photorealistic images of all structures within an area

and do not show the area “dynamically”. An MRI is a series of and do not show the area “dynamically”. An MRI is a series of “static” magnetic images interpreted by a radiologist“static” magnetic images interpreted by a radiologist

• Most MCOs and TPAs do not allow ANY diagnosis to be added Most MCOs and TPAs do not allow ANY diagnosis to be added without Industrial Commission review thus delaying needed without Industrial Commission review thus delaying needed treatment, adding costs, and frustrating employers by “losing” so treatment, adding costs, and frustrating employers by “losing” so many cases at the IC level.many cases at the IC level.


• Once a diagnosis can be properly defined, be Once a diagnosis can be properly defined, be aggressive with treatment and return-to-aggressive with treatment and return-to-workwork• Appropriate and rapid treatment and early return-to-Appropriate and rapid treatment and early return-to-

work have been shown to improve outcomes and work have been shown to improve outcomes and shorten claims/costsshorten claims/costs

• Direct costs might be more, but indirect costs can be Direct costs might be more, but indirect costs can be much less depending on type of injurymuch less depending on type of injury

• Direct costs might not be more if the rapid treatment Direct costs might not be more if the rapid treatment shortens the duration of injury symptomsshortens the duration of injury symptoms


• An example of how this all comes together:An example of how this all comes together:• A 42 y/o worker complained of severe pain in the forearm A 42 y/o worker complained of severe pain in the forearm

and wrist after packing boxes with small parts. and wrist after packing boxes with small parts. • The worker has been doing this type of work for only 2 The worker has been doing this type of work for only 2

months. months. • The worker was sent to the ER at 7 PM when the The worker was sent to the ER at 7 PM when the

symptoms became unbearable and production was affectedsymptoms became unbearable and production was affected• The ER diagnosed a “sprain/strain” of the wrist and The ER diagnosed a “sprain/strain” of the wrist and

referred the worker to Occupational Health the next referred the worker to Occupational Health the next morningmorning

• The worker really cannot describe any specific accident at The worker really cannot describe any specific accident at work except that the quota for parts had been increasing work except that the quota for parts had been increasing due to a large customer orderdue to a large customer order


• Physician review and managementPhysician review and management• The worker presented to Occupational Health with a large The worker presented to Occupational Health with a large

area of swelling from the wrist and into the forearm. The area of swelling from the wrist and into the forearm. The swelling was on the thumb side of the forearm.swelling was on the thumb side of the forearm.

• The exam demonstrated marked crepitation (a crunchy The exam demonstrated marked crepitation (a crunchy sound and feeling) in the area of swelling when the thumb sound and feeling) in the area of swelling when the thumb and wrist is movedand wrist is moved

• The exam was painful with active movementThe exam was painful with active movement• The diagnosis of acute tendonitis was made and the The diagnosis of acute tendonitis was made and the

worker was given a cortisone injection under the large worker was given a cortisone injection under the large swollen tendon sheath. Ice and movement restrictions were swollen tendon sheath. Ice and movement restrictions were recommended.recommended.

• Follow-up scheduled in 1 weekFollow-up scheduled in 1 week


• Physician review and managementPhysician review and management• The worker returns in one week and the area of The worker returns in one week and the area of

swelling is virtually goneswelling is virtually gone• The crepitation noted was also mostly gone but The crepitation noted was also mostly gone but

not completelynot completely• The worker reported that work restrictions The worker reported that work restrictions

were followed and they were happy that they were followed and they were happy that they could still help in the production areacould still help in the production area

• The worker reported that pain was reduced The worker reported that pain was reduced significantlysignificantly


• Physician review and managementPhysician review and management• The worker is placed on a noncortisone The worker is placed on a noncortisone

antiinflammatory and continued work antiinflammatory and continued work restrictionsrestrictions

• Occupational Therapy (hand/wrist) therapy Occupational Therapy (hand/wrist) therapy was ordered and started within 2 days. 5-10 was ordered and started within 2 days. 5-10 treatments were ordered and custom splint if treatments were ordered and custom splint if neededneeded

• A two week follow-up is scheduledA two week follow-up is scheduled


• Physician review and managementPhysician review and management• The worker returns in 2 weeks and all swelling and The worker returns in 2 weeks and all swelling and

crepitation is gonecrepitation is gone• The medication is controlling the pain and restricted duty The medication is controlling the pain and restricted duty

work is going wellwork is going well• The worker is returned to full duty and Occupational The worker is returned to full duty and Occupational

Therapy is recommended to conclude after 6 treatmentsTherapy is recommended to conclude after 6 treatments• The Occupational Therapist reviews proper wrist/hand The Occupational Therapist reviews proper wrist/hand

mechanics and assists the worker in methods of doing their mechanics and assists the worker in methods of doing their job with less stress on the tendons and musclesjob with less stress on the tendons and muscles

• The worker is scheduled in 3 weeks for a final visit after The worker is scheduled in 3 weeks for a final visit after having been returned to full duty to assure recoveryhaving been returned to full duty to assure recovery

• No reoccurrence is noted after one yearNo reoccurrence is noted after one year

These growth trends refer to inflation adjusted direct costs for these types of injury causes.

These statistics come from the Liberty Mutual Research Institute for Safety


• Expensive Ones !! (even without surgery Expensive Ones !! (even without surgery included in costs)included in costs)

1. Any fracture

2. Any injury that often leads to surgery

3. Head injuries

4. Spinal disc injuries or spinal arthritis

5. Bursitis/Tendonitis anywhere

6. Any shoulder injury

Emerging Trends for Workplace InjuriesEmerging Trends for Workplace Injuries

Safety Experts Opinions and Safety Experts Opinions and CommentaryCommentary

Emerging Trends in Workplace Emerging Trends in Workplace InjuriesInjuries

QUESTIONS & ANSWERS

Lorain County Safety Council

Elyria, Ohio

James Anthony, MD

Medical director

Mercy Occupational Health Center

Lorain, Ohio

Mercy Occupational Health Center

Thank you for your kind attention and information!

Documents

Emerging Trends in Workplace Injuries Lorain County Safety Council January 18, 2012 James Anthony, MD Medical director Mercy Occupational Health Center