WC ISSUES & INJURY PREVENTION PRESENTED TO RADISSON PAPER VALLEY HOTEL APPLETON, WI 9/12/08 FITZGERALD CLAYTON JAME

1. WC ISSUES & INJURY PREVENTION PRESENTED TO RADISSON PAPER VALLEY HOTEL APPLETON, WI 9/12/08 FITZGERALD CLAYTON JAMES & KASTEN JEFF THIEL, CPCU – EXECUTIVE VICE PRESIDENT DARREN CHEREK - LOSS PREVENTION CONSULTANT

2. AGENDA • INTRODUCTIONS • HOW IS YOUR RATE DETERMINED • HOW IS YOUR EXPERIENCE MOD DETERMINED • INJURY TRENDS • SAFETY COMMITTEE • IDENTIFYING LOSS TRENDS • FLEET • MAINTENANCE • DRIVER • REVIEW LOSS RUNS • IDENTIFY REPEATERS • CONDUCT INJURY REVIEWS • QUESTIONS & ANSWERS

3. CREATION OF CODE 7705 • The following amendments to the Wisconsin Basic Manual have been approved effective October 1, 2007, applicable to new and renewal business: • 1. Ambulance and Emergency Medical Services • Wisconsin background: Wisconsin currently classifies for-profit ambulance service providers under code 7380 and volunteer ambulance service providers under code 7710. Thus, Wisconsin already is an exception to NCCI’s classification of ambulances under code 7370. • Approved action: Adopt code 7705 for paid, for-profit ambulance providers while retaining code 7710 for volunteer ambulance services. The rate for code 7705 will be the same as code 7380 until such time that the class develops sufficient experience to determine its own rate. NCCI’s description of code 7705 will also be adopted with the exception of striking any language indicating that volunteers are to be included under the code. Finally, in time, if the rates for codes 7705 and 7710 do not indicate large differentials, consideration will be given to combining the two ambulance codes, paid for-profit and volunteer, just as NCCI proposes in this filing. Wisconsin Compensation Rating Bureau

4. 7705 for paid, for-profit ambulance providers • Code 7380 • 10/1/2008 $5.20 • 10/1/2007  $5.26 • 10/1/2006 $6.05 • 10/1/2005 $6.33 • 10/1/2004 $6.14 • 10/1/2003 $6.63 • 07/1/2002 $6.33 • Code 7705 • 10/1/2008 $5.20 • 10/1/2007 $5.26 Wisconsin Compensation Rating Bureau

5. 7710 for volunteer ambulance services • Code 7710 • 10/1/2008 $11.15 • 10/1/2007  $9.13 • 10/1/2006 $7.47 • 10/1/2005 $5.86 • 10/1/2004 $4.69 • 10/1/2003 $4.16 • 07/1/2002 $4.02 Description: CIVIL DEFENSE WORKERS AND VOLUNTEER RESCUE SQUADS - INCLUDING MEMBERS SERVING AS AUXILIARY POLICE OFFICERS AT EMERGENCIES (Actual payroll shall be taken, but in no event less than $1,560 per individual per annum in calculating premium.) Wisconsin Compensation Rating Bureau

6. WHAT IS AN EXPERIENCE MODIFICATION FACTOR? THE EXPERIENCE MOD IS AN INDICATOR OF HOW SAFELY OR UNSAFELY THE BUSINESS HAS OPERATED. THE STATE OBTAINS INFORMATION ON THE NUMBER OF ACCIDENTS, AND THE COSTS OF THE ACCIDENTS, FOR EACH OCCUPATION, STATEWIDE. THE STATE THEN CALCULATES WHAT THE AVERAGE NUMBER OF ACCIDENTS AND THE AVERAGE COST OF THOSE ACCIDENTS FOR EACH OCCUPATION. THIS IS CALLED AN“EXPECTED LOSS RATE” THESE AVERAGES ARE BASED ON THREE (3) YEARS OF LOSSES.

7. EXPERIENCE MODIFICATION EXPLANATION FITZGERALD CLAYTON JAMES & KASTEN

8. WHAT IS AN EXPERIENCE MODIFICATION FACTOR? THE EXPERIENCE MOD IS AN INDICATOR OF HOW SAFELY OR UNSAFELY THE BUSINESS HAS OPERATED. THE STATE OBTAINS INFORMATION ON THE NUMBER OF ACCIDENTS, AND THE COSTS OF THE ACCIDENTS, FOR EACH OCCUPATION, STATEWIDE. THE STATE THEN CALCULATES WHAT THE AVERAGE NUMBER OF ACCIDENTS AND THE AVERAGE COST OF THOSE ACCIDENTS FOR EACH OCCUPATION. THIS IS CALLED AN“EXPECTED LOSS RATE” THESE AVERAGES ARE BASED ON THREE (3) YEARS OF LOSSES.

9. HOW IS AN EXPERIENCE MODIFICATION FACTOR CALCULATED? 3 YEARS OF LOSSES, 3 YEARS OF PAYROLL INFORMATION ARE USED FROM THE LAST 4 YEARS, EXCLUDING THE MOST RECENT. EXAMPLE: 10/1/08 - 09 MOD – 4/30 UNIT STAT DATE – CLAIMS SHOULD BE REVIEWED PRIOR TO 4/30 FOR MOST ACCURATE MOD 10/1/07 – 08 10/1/06 – 07 10/1/05 – 06 10/1/04 – 05 PAYROLL PAYROLL PAYROLL PAYROLL LOSSES LOSSES LOSSES LOSSES YOUR PAYROLL IS MULTIPLIED BY AN EXPECTED LOSS RATE FACTOR THAT IS DETERMINED BY THE WORKERS’ COMPENSATION BUREAU. THIS DETERMINES THE AMOUNT OF LOSSES EXPECTED FOR THE AMOUNT OF PAYROLL YOU HAVE IN THE CLASS CODES USED BY YOUR BUSINESS.

10. HOW IS AN EXPERIENCE MODIFICATION FACTOR CALCULATED? LOSSES ARE VALUED 18 MONTHS AFTER THE INCEPTION DATE OF THE POLICY, AND YEARLY THEREAFTER FOR A TOTAL OF 3 TIMES. THEREFORE, LOSSES AFFECT THE MOD FOR 3 YEARS. THE ACTUAL LOSSES ARE COMPARED TO THE EXPECTED LOSSES TO DETERMINE THE EXPERIENCE MOD FACTOR. IF THE ACTUAL LOSSES ARE HIGHER THAN EXPECTED LOSSES A DEBIT MOD RESULTS. > 1.00 (COSTS ABOVE EXPECTED) IF THE ACTUAL LOSSES ARE LOWER THAN EXPECTED A CREDIT MOD RESULTS. < 1.00 (COSTS BELOW EXPECTED)

11. HOW IS AN EXPERIENCE MODIFICATION FACTOR CALCULATED? LOSSES ARE IN 3 CATEGORIES: MEDICAL ONLY - NO WAGES WERE PAID BY THE INSURANCE CARRIER. (MEDICAL ONLY CLAIMS GO IN AT 30% OF THEIR VALUE. I.E. A $100 CLAIM WILL ONLY COST YOU $30 ON THE MOD CALCULATION.) FREQUENCY (INDEMNITY CLAIMS UNDER $5,000) - WAGES WERE PAID TO THE INJURED WORKER BY THE INSURANCE CARRIER. SEVERITY (INDEMNITY CLAIMS OVER $5,000) - WAGES WERE PAID TO THE INJURED WORKER BY THE INSURANCE CARRIER.

12. WHAT IS YOUR CURRENT MOD? 1.29

13. # Claim Type Comparison on Mod

14. $ Claim Type Comparison on Mod

15. 2008 MOD BREAKDOWN BETWEENFREQUENCY, MEDICAL ONLY AND SEVERITY CLAIMS 2008 mod = 1.29

16. COST EFFECTS OF MOD $24,493 SAVINGS $16,892 SAVINGS

18. CLAIM AMOUNT: $40,641 MOD POINTS: 5.68 COST FOR 3 YEARS ON PREMIUM: $48,529 INDIRECT COSTS OF A CLAIM TIME TO INVESTIGATE, REPORT, LOSS IN PRODUCTIVITY, DECREASE IN QUALITY, PROPERTY DAMAGE, ETC. 4 TO 10 TIMES THE VALUE OF THE CLAIM $48,529 x 4 = $194,115 SALES PROFITS VS INDIRECT COSTS $194,115 / 5% = $3,882,298 LOSS / PROFIT MARGIN = UNINSURABLE COST

19. Where do we go from here? Lower Payrolls? Lower Rates? Lower Losses?

21. MANAGER’S ROLE • RETURN TO WORK PROGRAM • PRE-IDENTIFIED TASKS • DO NOT SEND PEOPLE HOME • ACCIDENT INVESTIGATION • 1ST DAY REPORTING • IDENTIFY ROOT CAUSE • I.D. CORRECTIVE ACTION • ADVERTISE POSITIVE CHANGES TO STAFF

22. MANAGER’S ROLE • UP HOLD SAFETY POLICIES OF YOUR DEPARTMENT / ORGANIZATION • FOLLOW YOUR PROGRESSIVE DISCIPLINARY PROGRAM • MAKE SAFETY PART OF EACH EMPLOYEE MEETING • FORUM TO DISCUSS CONCERNS • SAFETY TOPIC OF THE MONTH

23. POINTS TO PONDER Statistical Data: Ambulance crashes account for the bulk of EMS workplace mortality. According to the National Institute for Occupational Safety and Health, EMS workers have an estimated fatality rate of 12.7 per 100,000. For non-EMS workers, the estimated fatality rate is 5.0 per 100,000. Getting struck by another vehicle at the scene is the second most prevalent event that kills EMS personnel. Isn’t it ironic that those whose primary purpose is to save lives have a risk of work-related death more than twice that of the general population? How can one apply Risk Management Principles to guarantee that all Medical Transportation personnel “Arrive Alive and Do No Harm”? VITALS A Weekly Safety Newsletter for Medical Transport Professionals

24. POINTS TO PONDER In the May, 2003, issue of JEMS, Les R. Becker, Ph.D., NREMT-P, used two large national databases to show that between 1988 and 1997 there were 305 fatal ambulance crashes, 71 ambulance occupant fatalities and 9,465 injuries. Similar numbers were observed between 1991 and 2000.At the time of the publication of the JEMS article, Dr. Becker had another publication in press which showed a detailed statistical analysis that indicated the following: The fatality risk for restrained ambulance occupants involved in a crash was nearly four times lower than for unrestrained ambulance occupants. The risk of suffering an incapacitating injury for restrained ambulance occupants involved in a crash was nearly 6.5 times lower than for unrestrained occupants. The risk of fatality vs. no injury for rear occupants of an ambulance involved in a crash was more than five times greater than for front-seat occupants. VITALS A Weekly Safety Newsletter for Medical Transport Professionals

25. POINTS TO PONDER Ambulance occupants traveling non-emergency were nearly 2.7 times more likely to be killed than occupants traveling emergency if involved in a crash. Ambulance occupants traveling non-emergency were nearly 1.7 times more likely to suffer an incapacitating injury than occupants traveling emergency if involved in a crash.52% of ambulance fatalities occurred among “unrestrained occupants riding in positions other than the front seat” and restrained occupants riding in the back accounted for another 20% of fatalities VITALS A Weekly Safety Newsletter for Medical Transport Professionals

26. POINTS TO PONDER Key Concepts: 1) Risk Identification 2) Risk Evaluation 3) Prioritize Risk 4) Determine and Implement Controls 5) Evaluate and Revise. Dr. Becker clearly identified the risk, evaluated it, and showed that the reduction of risk is indeed a priority. Everybody and everything in the vehicle needs to be secured. There has been a recent spate of claims regarding patients who were not “tied down” properly. Remember that even if immobilization is not required for potential spinal or orthopedic injuries, patients must be safely secured at all times. Also, passengers who are not essential for patient care should be avoided. Evaluations which lead to the development of safer ambulance interiors and personal protective equipment specific to in transit needs also provides a scientific basis for the revision of transport standards. It is also estimated that emergency units cause 60,000 “wake effect” crashes annually. VITALS A Weekly Safety Newsletter for Medical Transport Professionals

27. what did you say? Exposures > 85 dB may cause hearing loss 85 dB Possible solution – move siren to front grill vs top of ambulance. NIOSH Sound Meter www.cdc.gov/niosh/topics/noise

28. DAYS AWAY FROM WORK FOR AMBULANCE COMPANY PERSONNEL 2006 DATA USA BY AGE BLS DAYS AWAY FROM WORK 2006 OSHA REPORTABLE INCIDENTS 4,730 DAYS

29. DAYS AWAY FROM WORK FOR AMBULANCE COMPANY PERSONNEL 2006 DATA USA BY LENGTH OF SERVICE BLS DAYS AWAY FROM WORK 2006 OSHA REPORTABLE INCIDENTS 4,730 DAYS

30. DAYS AWAY FROM WORK FOR AMBULANCE COMPANY PERSONNEL 2006 DATA USA DAYS AWAY FROM WORK (MEDIAN 5) PER BLS BLS DAYS AWAY FROM WORK 2006 OSHA REPORTABLE INCIDENTS 4,730 DAYS

31. DAYS AWAY FROM WORK FOR AMBULANCE COMPANY PERSONNEL 2006 DATA USA NATURE OF INJURY BLS DAYS AWAY FROM WORK 2006 OSHA REPORTABLE INCIDENTS 4,730 DAYS

32. DAYS AWAY FROM WORK FOR AMBULANCE COMPANY PERSONNEL 2006 DATA USA SOURCE OF INJURY BLS DAYS AWAY FROM WORK 2006 OSHA REPORTABLE INCIDENTS 4,730 DAYS

33. DAYS AWAY FROM WORK FOR AMBULANCE COMPANY PERSONNEL 2006 DATA USA EVENT OR EXPOSURE BLS DAYS AWAY FROM WORK 2006 OSHA REPORTABLE INCIDENTS 4,730 DAYS

34. DAYS AWAY FROM WORK FOR AMBULANCE COMPANY PERSONNEL 2006 DATA USA DAY OF WEEK BLS DAYS AWAY FROM WORK 2006 OSHA REPORTABLE INCIDENTS 4,730 DAYS

35. DAYS AWAY FROM WORK FOR AMBULANCE COMPANY PERSONNEL 2006 DATA USA TIME OF DAY BLS DAYS AWAY FROM WORK 2006 OSHA REPORTABLE INCIDENTS 4,730 DAYS

36. DAYS AWAY FROM WORK FOR AMBULANCE COMPANY PERSONNEL 2006 DATA USA HOURS WORKED BLS DAYS AWAY FROM WORK 2006 OSHA REPORTABLE INCIDENTS 4,730 DAYS

37. DAYS AWAY FROM WORK FOR AMBULANCE COMPANY PERSONNEL 2006 DATA USA WHAT ALL OF THIS MEANS….. WHO IS MOST LIKELY TO BE INJURED? SOMEONE WHO IS 25 TO 34 YEARS OLD AND HAS BEEN WORKING WITH YOU FOR 1 TO 5 YEARS. WHEN ARE THEY MOST LIKELY TO BE INJURED? ON A FRIDAY BETWEEN 8:01 AM & 12:00 PM. WHAT WILL THEY BE DOING? LIFTING A PERSON IN NEED OF TRANSPORT WHAT WILL BE THE RESULT? A STRAINED BACK RESULTING IN 3 – 5 DAYS AWAY FROM WORK.

38. DAYS AWAY FROM WORK FOR AMBULANCE COMPANY PERSONNEL 2006 DATA USA SOLUTION…… GIVE THESE PEOPLE FRIDAY MORNINGS OFF?

39. AMBULANCES AROUND THE WORLD CANADA SOURCE: THE INTERNET

40. AMBULANCES AROUND THE WORLD INDIA SOURCE: THE INTERNET

41. AMBULANCES AROUND THE WORLD RUSSIA SOURCE: THE INTERNET

42. AMBULANCES AROUND THE WORLD FRANCE SOURCE: THE INTERNET

43. AMBULANCES AROUND THE WORLD BULGARIA SOURCE: THE INTERNET