Occupational Injuries: Falls, Reactions, and Violence Among Workers Treated in Hospitals

2. NEISS-Work Case Identification and Coding Issues Susan Derk and Audrey Reichard Division of Safety Research

3. How the Data are Used • Publication: Nonfatal Occupational Injuries from Slips, Trips, and Falls Among Older Workers Treated in Hospital Emergency Departments, United States 1998 • Larry A. Layne, MA and Keshia M. Pollack, MPH • Health Hazard Alerts • Data Requests • NIOSH Internal Requests • Other Federal, State, City Agencies • Academic Researchers • Industry—Employers, Unions, etc • J.Q. Public • Press • Lawyers

4. Healthy People 2010--Reduce occupational injuries to young workers (20-2)

5. Occupational Injuries to WomenSelected Falls & Bodily Reactions

6. Violence—Rate per 10,000 FTE 1999 NE = 112,000

7. NEISS Case Definition • Medical • Injury or illness treated in an ED (1st visit) • Population • Civilian non-institutionalized workers • Demographics • All workers without restriction by age, type of employer or industry, or employer size • Work • Doing work for pay or other compensation • Work activities on a farm • Volunteer work for an organized group

8. Work for Pay The Grocer • When cutting open case of milk, boxcutter slipped and sliced palm. The Bartender • c/o injury to r. thumb on broken cup at work. The Warehouse Laborer • Facial lac, facial contusion-hit wall with a forklift at work. The Carpenter • Using a nailgun at work & hit another nail causing nailgun to jerk l. hand injuring his wrist. The Longshoreman • Caught hand between chain and slab holding 42,000 lbs of steel.

9. Farm Work • 8 yr— moving wagon load of corn on family farm, heavy wagon tongue came down on rt lower leg, pinning him to ground. • 15 yr— right hand stepped on by cow. Nerve injury/contusion right hand. • 68 yr— on farm bucked off horse hit head loc. Cerebral concussion. • 71 yr—missed step from grain bin fell 25’ landing on the ground upper leg pain, fx femur. • 83 yr— open tib/fib - rollover accident on farm tractor in the ditch on farm- entrapped under tractor for 8 hours before he was found by his son.

10. When is a chore work? • When mowing your lawn? • When washing your car? • When spring cleaning your home? • When it’s on a farm! • Report all farm/ranch cases when involving production activity regardless of age NO

11. Volunteers • 13 yr— facial lac-from a “cat attack” while working @ county human society as volunteer. • 29 yr— pt doing volunteer work on his church when he fell from a scaffolding about 9 feet landing on head; closed head injury. • 51 yr— rt hand lac- delivering campaign flyers from door to door-fell-hit a storm door. • 66 yr— pt at schoolvolunteering was involved in a fire drill, fell down some stairs striking head; closed head injury. • 81 yr— injured while doing volunteer work using power saw remodeling house for Habitat for Humanity.

15. Young Workers • 4 yr— lt corneal ab-@ home on the farm- fell off hayrack while pulling hay off for the animals -hit his eye on a cornstalk. • 12 yr— blunt abdomen trauma/pancreatitis; states when he wrecked bike while doing paper route, handlebar hit him & “knocked wind out of him.” • 16 yr— 16yom welding assistant sustained lac at work when grinder caught his l forearm. DX deep laceration l forearm with tissue defect.

16. Older Workers • 86 yr— pain across lower back since lifting tires at family business 1 ½ weeks ago. DX low back pain. • 89 yr— 89yom was replacing a board on a cart; board broke and struck him on the nose. Fracture of nose. (farm supplies) • 90 yr— pt tripped on a key ring on the floor and fell to floor. Fractured pubic ramis – admitted to hospital.

17. Employer’s Premises Refers to: • 27yof was running across parking lot at work when she slipped on mud and fell hitting r wrist & knee on pavement. • Pt. was horseplaying with another employee and pt. got sprayed with hot water – steam burns to his buttocks and lower back. • Pt slipped on water on floor in cafeteria tray line, cont elbow and muscle spasm. • Patient walking down hallway when door opened and hit eyelid. DX Eyelid laceration.

18. Sports at Work The Camp Counselor • Pt injured r foot playing volleyball at camp, r 1st toe contusion. Troubled-youth Advisor • Pt inj l. ankle at work when playing basketball with clients, twisted. DX l. ankle sprain. Coach • 42yof – volleyball coach, jump up for a ball, lost her balance and fell twisting her knee/knee strain. Professional • Pt. playing baseball sliding into base cut right knee on a pair of cleats laceration knee.

19. Violence • Pt. was assaulted by male psych pt who pulled her hair and threw her to the floor then kicked and punched her; DX sprain r wrist. • FX l wrist, lac l eyebrow; assaulted @ work by boyfriend; hit with a plastic lottery ticket container. • Patient assaulted by angry co-worker, picked up and thrown to the floor. DX nasal fracture, tm perforation, knee strain. • Pt was trying to stop altercation between 2 students male student tried to hit her she held him and she fell backwards hit chair & table.

20. Motor Vehicle • 18 yr— was driving a 4-wheeler across pasture, fell into 7ft ditch, 4-wheeler flipped, landed on hip and butt; DX contusion to hip and butt. • 33 yr— fire department; pt in MVC roll over while driving work vehicle now with facial/knee injuries. • 30 yr— police officer on duty, MVC restrained driver, car t-boned on pass side, heavy damage post concussion ha, c strain, cont lt knee, sinusitis. • 39 yr— at work, restrained driver of cab, in MVC, car pulled in front of him, hit phone pole, shoulder hit steering wheel. lt shoulder strain. • 61 yr— thrown from 18 wheeler that turned over into ditchbed. DX contusion neck & lower back. Possible age undetermined FX of T11.

21. Ergonomic Disorders • 25yof has developed pain in l wrist from repetitive data entry at work; DX ganglion cyst l wrist. • Back pain doing oilfield work heavy repetitive lifting; DX Mechanical back and chest wall pain. • Lumbar strain-inj lower back at work while lifting patients. c/o increasing pain in mid and lower back today. • 21yof had developed pain in r upper arm from doing repetitive work at job where she puts wraps on candy; DX strain r deltoid

22. Heart Attack, Chest Pain,and Stroke at Work • Driving instructor, had heart attack today while giving a lesson in car. • Chest pain - while at work - ”surge of pulse” mid chest- while doing heavy work on assembly line. • Pt with numbness to side of face since stepping out of truck and slipping on ice yesterday. Seen by MD, DX stroke.

23. Stress & Syncope • Patient felt warm at work, took off jacket and fainted hitting head on corner of shelf, has head abrasion. DX vasovagal syncope. • Witness co-worker crushed under wheel & killed in work accident; DX post traumatic stress • Non-English speaking patient (Peru), alarms went off at work, she became anxious, scared due to language barrier. DX anxiety reaction.

24. Respiratory Illness • Fluorescent light bulb exploded over head, possible inhalation of powder at work, sob. Chemical bronchitis, acute exacerbation of asthma. • Police officer who ran into house fire looking for kids triggered asthma attack; DX short of breath (fire dept did attend fire). • Patient with severe asthma exacerbation every time he goes to work, shovels flour at bakery. DX asthma exacerbation, occupation exposure. • Welding in enclosed area with a tractor running, c/o headache and nausea. DX carbon monoxide poisoning.

25. Allergic Reaction and Dermatitis • Pt at work spraying pesticide (demon tc) when he developed a diffuse rash allergic reaction to pesticide. • Spider bite of right elbow at work, spider was black and yellow. DX allergic reaction spider bite right elbow. • Working in MICU at hosp, exposed to latex (had problem in past with it), eyes red and inflamed. Mild hypersensitivity reaction to latex. • Pt at worksite got into some poison ivy sustained a generalized rash and itchy allergic reaction. • Allergic reaction skin rash on rt trunk-@ work-exposure to new chemical in new job.

26. Bloodborne Pathogens • Patient cleaning up after a code when splashed in eye with IV of lidocaine and blood. Poss. HIV, HEP B/C exposure. DX Blood exposure. • Patient struck on finger by bloody piece of glass at scene of MVA. Punctured through glove. DX puncture wound, thumb; blood exposure. • Pt is police officer who got in altercation with prisoner while he was guarding prisoner, worried about blood exposure, here for HIV test. • Patient exposed to blood while working with dirty spring loaded cartridge in hospital. DX corneal abrasion, poss. blood exposure, eye.

27. Infectious Disease • Handles all mail - company rec’d envelope with white powder, sent & reported to FBI; DX poss exposure to anthrax vs unknown white substance. • Pt at work exposed to tuberculosis positive ppd test; DX-occupational exposure to TB. • Bitten by a potential rabies infected cat at work. DX puncture wound, left inner wrist.

28. Exclusions--Do Not Report: • Routine drug/alcohol-screening • Second visits to the same ED • Common illnesses unrelated to work task or work environment

29. Guidelines for illnesses • Do not report common illnesses (e.g., colds, flu, kidney stone, cancer) • Do report all heart attacks and strokes that occur in the workplace • Report illnesses that are possibly related to work or work environment

30. Demographics • Age • Sex • Race & Ethnicity • Important to capture a complete picture of the patient

31. Race & Ethnicity • White • Black • Other • American Indian or Alaska Native • Asian • Native Hawaiian or other Pacific Islander • Hispanic

32. Race & Ethnicity: Nationality • When the chart lists Race as a nationality (French, Mexican, Russian, Jamaican, Honduran, etc) include in Race Other

33. Comment Fields • Who: Age, sex, job title, business • What: Body part, diagnosis • Where: Location of event • When: Injury date vs. treatment date • Why: Comments • How: Product codes

34. Comment FieldsBest Practices • Who • “17YOM” is better than “Pt” • “17YOM carpenter” is best • What • “Fracture 3rd finger” is better than “Dx: frac” • Where • “At work” better than nothing • “At fast-food restaurant” best

35. Comment FieldsBest Practices (continued) • When/Why/How • Repeat what is in the record • “Lac finger with box cutter when opening cartons” is better than “Lac finger” • “Prevention is in the details”

36. Comment Field Checklist • Who-What-Where-When-Why-How • Lac finger • 17YOM lac finger at work • 17YOM lac finger with box cutter at work • 17YOM lac finger with box cutter when opening cartons at work • 17YOM grocery stocker lac finger with box cutter when opening cartons at work

37. Keys to Success • Collect all work-related cases • Correct identification of all cases • Collect detailed injury information • Information must be in the ED record • Critical information must be transcribed to NEISS

38. NEISS-Work • Work for pay or other compensation • Work activities on a farm • Volunteer work for an organized group • Work-related injuries and illnesses

39. Work Study Variables • Victim’s job title • Kind of business • Name of employer • City and state where employed

40. Job Title--Occupation • What you do for your job overall • Primary descriptive job title • It is not incidental activities or tasks • Job titles are descriptive • Manager customer service • Supervisor housekeeper • Dowel maker • Tree surgeon • Make-up artist

41. Kind of Business • Primary activity of the employer, farm, or volunteer organization • Terms should indicate both a general and a specific function • Company names should not be used

42. Name of Employer • Provide the exact name of the employer • Minimize abbreviations • May use “self-employed” • Family farm • Uncertain-- “Trimming neighbor’s tree?”

43. Job Title & Kind of Business • Enter what is clearly stated in the ED record • Enter what is reasonable to assume based on the record and employer information • Use “NS” for not stated • Do not use “self-employed” for job title or kind of business

44. City & State of Employer • Provide the city and state where the employer is located • If in doubt, provide the city and state where the worker was injured

45. Industry Classification • Agriculture, forestry, fishing • Mining • Construction • Manufacturing • Transportation, communications, electric, gas, & sanitary services • Wholesale trade • Retail trade • Finance, insurance & real estate • Services • Public administration

46. The Big Picture • With detailed work data, we can identify areas of concern: • Industries • Occupations • Target populations • Types of injuries and illnesses • Causes of injuries and illnesses

47. Work-RISQS www2.cdc.gov/risqs/

48. NEISS—a Partnership for Prevention

49. NEISS-Work Susan Derk and Audrey Reichard Injury Surveillance Team Surveillance & Field Investigations Branch National Institute for Occupational Safety & Health 1095 Willowdale Rd, MS H1808 Morgantown, WV 26505 Phone: 304-285-5916 (main line) FAX: 304-285-5774 E-mail: SDerk@cdc.gov and AReichard@cdc.gov

50. NEISS-Work Larry L. Jackson, Ph.D. Chief, Injury Surveillance Team Surveillance & Field Investigations Branch National Institute for Occupational Safety & Health 1095 Willowdale Rd, MS H1808 Morgantown, WV 26505 Phone: 304-285-5980 FAX: 304-285-5774 Email: LLJackson@cdc.gov