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Slide 1
WELCOME
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Jack Tiffany, PA-C Industrial Medical Associates 515-560-8660
[email protected] 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
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
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