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

2. Introduction and Program Objectives Overview of program objectives Overview of program objectives Overview of workplace injury issues Overview of workplace injury issues Presentation of some injury data over past 10 years Presentation of some injury data over past 10 years

3. Introduction and Program Objectives Review key concepts in injury prevention for highest or emerging injury trends Review key concepts in injury prevention for highest or emerging injury trends Review key concepts for treatment of the highest or emerging injury trends Review key concepts for treatment of the highest or emerging injury trends Review audience perceptions of key injury trends, prevention and treatment Review audience perceptions of key injury trends, prevention and treatment Questions and Answers Questions and Answers

4. Overview 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

5. Overview of Problem Treatment approaches and transitional work options can also be tailored to best fit the work injury trendsTreatment approaches and transitional work options can also be tailored to best fit the work injury trends Employers can use this information to better know what to expect and how to approach injury prevention and transitional workEmployers can use this information to better know what to expect and how to approach injury prevention and transitional work

7. A Different Perspective As expressed on a local law firm’s web site: As expressed on a local law firm’s web site: “Ohio workers’ compensation attorneys expect this number to be much higher. Many programs are in place to discourage workers from reporting injuries or making a worker’s compensation claim, and as a result, underreporting is a growing problem for our nation’s workers.”“Ohio workers’ compensation attorneys expect this number to be much higher. Many programs are in place to discourage workers from reporting injuries or making a worker’s compensation claim, and as a result, underreporting is a growing problem for our nation’s workers.” Source Elk and Elk website

21. 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

22. Categories of Workplace Injury Causes 1. Overexertion (over lifting, pushing, pulling) 2. Falls on the same level (Slip and Falls) 3. Fall to lower level (off ladders etc.) 4. Bodily reaction (Slips/trips/grabs w/o fall) 5. Struck by object (such as a tool falling) 6. Struck against object (walking into door) 7. Highway incidents 8. Caught in/ compressed by (equipment) 9. Repetitive motion (repeated stress and strain) 10. Assaults/Violent acts (from co-workers/customers) Source is U.S. Bureau of Labor Statistics & Workers’ Compensation

23. Costs by Workplace Injury Causes 1. Overexertion – 25.7% of injuries and = 12.4 billion 2. Falls on the same level – 13.3% of injuries = 6.4 billion 3. Fall to lower level – 10.8% = 5.3 billion 4. Bodily reaction – 10% = 4.8 billion 5. Struck by object – 8.9% = 4.3 billion 6. Struck against object – 6.1% = 2.5 billion 7. Highway incidents – 4.9% = 4.9 billion 8. Caught in/ compressed by – 4.4% = 2.1 billion 9. Repetitive motion – 4.0% = 2.0 billion 10. Assaults/Violent acts – 0.9% = 0.4 billion Source is U.S. Bureau of Labor Statistics & Workers’ Compensation

24. A Different Perspective on “Common” Workplace Injury Causes 1. Defective or Hazardous Equipment 2. Hazardous Materials 3. Repetitive Motion 4. Motor Vehicle Mishaps 5. Insufficient Safety Guidelines 6. Insufficient Training 7. Reckless Co-worker Conduct Source is lawyershop.com

25. Basic Safety Measures by Cause Overexertion Overexertion Train employees to use correct lifting techniquesTrain employees to use correct lifting techniques Have mechanical lifting aids available for use when neededHave mechanical lifting aids available for use when needed 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 any need to “lift and twist”Check the areas where lifting is necessary and minimize any need to “lift and twist” Train supervisors to encourage teamwork with respect to lifting such that asking for help is acceptable behaviorTrain supervisors to encourage teamwork with respect to lifting such that asking for help is acceptable behavior Design tasks such that there is minimal need to overreach or bend when liftingDesign tasks such that there is minimal need to overreach or bend when lifting

26. Basic Safety Measures by Cause 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 solesHave workers wear shoes/boots with slip-resistant soles Make sure workers can see over the loads they are carryingMake sure workers can see over the loads they are carrying Use handrails when walking on stairsUse handrails when walking on stairs

27. Basic Safety Measures by Cause Falls from height (falls different level) Falls from height (falls different level) Routinely check equipment that is used to climb or work from heightRoutinely check equipment that is used to climb or work from 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 minimize workers who move faster than it is safeEncourage steady and deliberate work from height to minimize 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

28. Basic Safety Measures by Cause Struck by an object or striking an object Struck 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 themHelp workers to be aware of their bodies and the space around them Workers should have adequate clearance to get jobs done in confined spaceWorkers should have adequate clearance to get jobs done in confined space Make sure all machinery operators are fully trained and aware of their surroundingsMake sure all machinery operators are fully trained and aware of their surroundings Use all equipment as specified by the manufacturer and have all guards and safety features operationalUse all equipment as specified by the manufacturer and have all guards and safety features operational

29. Emerging Trends for Injury Prevention Be proactive and not reactive Be proactive and not reactive Prescreening for musculoskeletal adequacy post-offer along with any other screening you require such as a physical or drug testPrescreening for musculoskeletal adequacy post-offer along with any other screening you require such as a physical or drug test Serves the purpose of screening out a few potential employees that are clearly unable to perform the required duties of their job Serves the purpose of screening out a few potential employees that are clearly unable to perform the required duties of their job Initiates education about lifting and body mechanics from a neutral source and reinforces the importance the employer places on workplace safety Initiates education about lifting and body mechanics from a neutral source and reinforces the importance the employer places on workplace safety Relatively inexpensive addition to a post-offer physical examination Relatively inexpensive addition to a post-offer physical examination

30. Emerging Trends for Injury Prevention Be proactive and not reactive Be proactive and not reactive Have a physical therapist or occupational health nurse visit your plant periodically to review ways to prevent musculoskeletal injuries with your employees or supervisorsHave a physical therapist or occupational health nurse visit your plant periodically to review ways to prevent musculoskeletal injuries with your employees or supervisors Preventive stretching and simple exercises can often be helpful if presented in a positive and fun atmosphere Preventive stretching and simple exercises can often be helpful if presented in a positive and fun atmosphere Allow employees enough time to do a simple warm-up routine before starting production Allow employees enough time to do a simple warm-up routine before starting production

31. Emerging Trends for Injury Prevention Be proactive and not reactive Be proactive and not reactive Try to give employees adequate break times during the day to minimize fatigue near the end of shiftsTry to give employees adequate break times during the day to minimize fatigue near the end of shifts Many injuries occur near the end of shifts when workers are most tired Many injuries occur near the end of shifts when workers are most tired Make sure adequate fluids are available in hot work areas and during the warmer summer months Make sure adequate fluids are available in hot work areas and during the warmer summer months It is proven that rested workers are more productive and make up for rest time with fewer injuries and better products It is proven that rested workers are more productive and make up for rest time with fewer injuries and better products

32. At Mercy OHC – Injuries Top 12 Injuries by percentage of total injuries for 2000 (account for 55%)Top 12 Injuries by percentage of total injuries for 2000 (account for 55%) Lumbar Sprain/Strain10.9% 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%

33. At Mercy OHC – Injuries Top 12 Injuries by percentage of total injuries for 2011 (account for 52.7%)Top 12 Injuries by percentage of total injuries for 2011 (account for 52.7%) Lumbar Sprain/Strain 9.8% dec. Open Wound of the Finger 8.5% Shoulder Sprain/Strain 5.8% Knee Sprain/Strain 4.3% inc. Eye abrasion/foreign body 4.0% dec. Neck Sprain/Strain 4.0% inc. Wrist Sprain/Strain 3.8% Ankle Sprain/Strain 3.1% Thoracic Sprain/Strain 2.8% Knee Contusion 2.4% Open Wound of Hand 2.1% Finger Contusion 2.1% dec.

34. At Mercy OHC – Injuries Top 12 Injuries by percentage of total injuries for 2000 through 2011 (account for 57.8%)Top 12 Injuries by percentage of total injuries for 2000 through 2011 (account for 57.8%) Lumbar Sprain/Strain 11.7% Open Wound of the Finger 9.7% Shoulder Sprain/Strain 6.7% Eye abrasion/foreign body 5.7% Knee Sprain/Strain 3.8% Ankle Sprain/Strain 3.6% Thoracic Sprain/Strain 3.5% Wrist Sprain/Strain 3.3% Neck Sprain/Strain 3.2% Open Wound of Hand 2.5% Knee Contusion 2.1% Finger Contusion 2.0%

35. At Mercy OHC – Body Areas Injured 2000 - 2011 Top 12 areas injured and their percentage of total injuries within the top 12Top 12 areas injured and their percentage of total injuries within the top 12 Thumb/Hand/Finger30.0% Lumbar Spine15.4% 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%

36. At Mercy OHC – Injuries Expensive Ones !! (even without surgery included in costs)Expensive Ones !! (even without surgery 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

37. Emerging Trends for Injury Management Get the diagnosis right and allow that to evolve properly Get the diagnosis right and allow that to evolve properly Initial diagnosis, especially through ER, is often incomplete or an initial estimateInitial diagnosis, especially through ER, is often incomplete or an initial estimate Most diagnoses are made over time where treatment intervention can be assessed and more specific diagnoses become clearMost diagnoses are made over time where treatment intervention can be assessed and more specific diagnoses become clear Diagnostic tests might be necessary to define the more specific diagnosis, but may still not be necessaryDiagnostic tests might be necessary to define the more specific diagnosis, but may still not be necessary 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 “static” magnetic images interpreted by a radiologistMRI’s are not photorealistic images of all structures within an area and do not show the area “dynamically”. An MRI is a series of “static” magnetic images interpreted by a radiologist Most MCOs and TPAs do not allow ANY diagnosis to be added without Industrial Commission review thus delaying needed treatment, adding costs, and frustrating employers by “losing” so many cases at the IC level.Most MCOs and TPAs do not allow ANY diagnosis to be added without Industrial Commission review thus delaying needed treatment, adding costs, and frustrating employers by “losing” so many cases at the IC level.

39. Emerging Trends for Injury Management Once a diagnosis can be properly defined, be aggressive with treatment and return-to- work Once a diagnosis can be properly defined, be aggressive with treatment and return-to- work Appropriate and rapid treatment and early return-to- work have been shown to improve outcomes and shorten claims/costsAppropriate and rapid treatment and early return-to- work have been shown to improve outcomes and shorten claims/costs Direct costs might be more, but indirect costs can be much less depending on type of injuryDirect costs might be more, but indirect costs can be much less depending on type of injury Direct costs might not be more if the rapid treatment shortens the duration of injury symptomsDirect costs might not be more if the rapid treatment shortens the duration of injury symptoms

40. Emerging Trends for Injury Management 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 and wrist after packing boxes with small parts.A 42 y/o worker complained of severe pain in the forearm and wrist after packing boxes with small parts. The worker has been doing this type of work for only 2 months.The worker has been doing this type of work for only 2 months. The worker was sent to the ER at 7 PM when the symptoms became unbearable and production was affectedThe worker was sent to the ER at 7 PM when the symptoms became unbearable and production was affected The ER diagnosed a “sprain/strain” of the wrist and referred the worker to Occupational Health the next morningThe ER diagnosed a “sprain/strain” of the wrist and referred the worker to Occupational Health the next morning The worker really cannot describe any specific accident at work except that the quota for parts had been increasing due to a large customer orderThe worker really cannot describe any specific accident at work except that the quota for parts had been increasing due to a large customer order

41. Emerging Trends for Injury Management Physician review and management Physician review and management The worker presented to Occupational Health with a large area of swelling from the wrist and into the forearm. The swelling was on the thumb side of the forearm.The worker presented to Occupational Health with a large area of swelling from the wrist and into the forearm. The swelling was on the thumb side of the forearm. The exam demonstrated marked crepitation (a crunchy sound and feeling) in the area of swelling when the thumb and wrist is movedThe exam demonstrated marked crepitation (a crunchy sound and feeling) in the area of swelling when the thumb and 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 worker was given a cortisone injection under the large swollen tendon sheath. Ice and movement restrictions were recommended.The diagnosis of acute tendonitis was made and the worker was given a cortisone injection under the large swollen tendon sheath. Ice and movement restrictions were recommended. Follow-up scheduled in 1 weekFollow-up scheduled in 1 week

42. Emerging Trends for Injury Management Physician review and management Physician review and management The worker returns in one week and the area of swelling is virtually goneThe worker returns in one week and the area of swelling is virtually gone The crepitation noted was also mostly gone but not completelyThe crepitation noted was also mostly gone but not completely The worker reported that work restrictions were followed and they were happy that they could still help in the production areaThe worker reported that work restrictions were followed and they were happy that they could still help in the production area The worker reported that pain was reduced significantlyThe worker reported that pain was reduced significantly

43. Emerging Trends for Injury Management Physician review and management Physician review and management The worker is placed on a noncortisone antiinflammatory and continued work restrictionsThe worker is placed on a noncortisone antiinflammatory and continued work restrictions Occupational Therapy (hand/wrist) therapy was ordered and started within 2 days. 5-10 treatments were ordered and custom splint if neededOccupational Therapy (hand/wrist) therapy was ordered and started within 2 days. 5-10 treatments were ordered and custom splint if needed A two week follow-up is scheduledA two week follow-up is scheduled

44. Emerging Trends for Injury Management Physician review and management Physician review and management The worker returns in 2 weeks and all swelling and crepitation is goneThe worker returns in 2 weeks and all swelling and crepitation is gone The medication is controlling the pain and restricted duty work is going wellThe medication is controlling the pain and restricted duty work is going well The worker is returned to full duty and Occupational Therapy is recommended to conclude after 6 treatmentsThe worker is returned to full duty and Occupational Therapy is recommended to conclude after 6 treatments The Occupational Therapist reviews proper wrist/hand mechanics and assists the worker in methods of doing their job with less stress on the tendons and musclesThe Occupational Therapist reviews proper wrist/hand mechanics and assists the worker in methods of doing their job with less stress on the tendons and muscles The worker is scheduled in 3 weeks for a final visit after having been returned to full duty to assure recoveryThe worker is scheduled in 3 weeks for a final visit after having been returned to full duty to assure recovery No reoccurrence is noted after one yearNo reoccurrence is noted after one year

47. 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

48. At Mercy OHC – Injuries Expensive Ones !! (even without surgery included in costs)Expensive Ones !! (even without surgery 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

49. Emerging Trends for Workplace Injuries Safety Experts Opinions and Commentary

50. Emerging Trends in Workplace Injuries QUESTIONS & ANSWERS Lorain County Safety Council Elyria, Ohio James Anthony, MD Medical director Mercy Occupational Health Center Lorain, Ohio

51. Mercy Occupational Health Center Thank you for your kind attention and information!