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Downs JW, Wills BK, Cumpston KL, Rose SR. Descriptive epidemiology of clinically significant occupational poisonings, United States, 2008-2018. Clin Toxicol (Phila) 2021; 59:1259-1263. [PMID: 33703981 DOI: 10.1080/15563650.2021.1892717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION References listing common occupational poisons often include agents that were observed decades prior to the introduction of worker protective laws and regulations. Current causes of work-related acute poisonings have not been characterized. This study's primary objective was to describe the most common poisons and routes of exposure responsible for clinically significant occupational poisonings. A secondary objective was to determine the crude rate of clinically significant occupational poisonings and occupational poisoning-related deaths over the study period. METHODS This was a retrospective cohort study using electronic data from the American Association of Poison Control Centers' (AAPCC) National Poison Data System (NPDS), and open source data from the United States Bureau of Labor Statistics (BLS). The NPDS was queried for all cases with exposure reason coded as "Unintentional-Occupational" for the period 1 January 2008 to 31 December 2018. A case of clinically significant occupational poisoning (CSOP) was defined as a case with moderate or severe clinical effects reported, to include fatal cases. A descriptive analysis was conducted using unadjusted odds ratios to assess the strength of association between main variables of interest and CSOP. RESULTS 329,437 exposure cases were available for analysis. Of these, 54,254 were considered CSOP and included 196 deaths. The top five poisons responsible for occupational fatalities were hydrogen sulfide, ammonia, carbon monoxide, simple asphyxiants, and chlorines. Fatalities were 3.7 times (OR: 3.7; 95% CI: 2.2-6.4) more likely to be men and 5.7 times (OR: 5.7; 95% CI: 4.0-8.1) more likely to have had an inhalational exposure, compared to those workers with CSOP without fatality. The crude rate of occupational fatal poisoning reported to US poison centers was 11.3 deaths per 100,000,000 worker-years during the study period. The crude rate of clinically significant occupational poisoning was 3.1 per 100,000 worker-years. These rates remained generally stable over the study period. CONCLUSION Occupational poisonings continue to be a significant cause of morbidity and mortality in the workplace despite significant improvements in workplace chemical safety over the last four decades. Workplace education and proper preventive measures devoted to inhalational toxicants and respiratory protection are opportunities for improvement.
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Affiliation(s)
- John W Downs
- Division of Clinical Toxicology, Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Brandon K Wills
- Division of Clinical Toxicology, Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Kirk L Cumpston
- Division of Clinical Toxicology, Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - S Rutherfoord Rose
- Division of Clinical Toxicology, Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA, USA
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Frame MH, Schandl CA. A case example of asphyxia due to occupational exposure to airborne chemicals and review of workplace fatalities. J Forensic Sci 2014; 60:521-4. [PMID: 25537023 DOI: 10.1111/1556-4029.12695] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 03/21/2014] [Accepted: 04/02/2014] [Indexed: 11/28/2022]
Abstract
Although worker injury and fatalities have decreased since adoption of the Occupational Safety and Health Act in 1970, it remains an important safety issue. This article describes a 27-year-old white male who died from occupational exposure to airborne chemicals. Several trends in the last several decades, both in the types of injuries and the occupations associated with fatalities, are noted. Additionally, individual risk factors such as age, gender, chronic disease, smoking, and alcohol and drug use are implicated in worker health and safety. The role of the forensic pathologist in the investigation of workplace deaths is highlighted, in addition to the future of occupational safety and current improvements brought about by such incidents.
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Burlet-Vienney D, Chinniah Y, Bahloul A. The need for a comprehensive approach to managing confined space entry: summary of the literature and recommendations for next steps. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2014; 11:485-498. [PMID: 24467798 DOI: 10.1080/15459624.2013.877589] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Despite all the regulatory and standard-setting efforts that have been made in North America, judging from the most recent statistics many fatal incidents related to work in confined spaces still occur. In Canada, fatal incidents in the province of Quebec reveal failures in and absence of the identification and preparation of work situations in confined spaces and in risk management. In this study, we performed a literature review consisting of 77 documents on existing hazards and risk assessment for confined spaces. Moreover, we formulated proposals regarding the design of specific and improved tools for assessing such risks. We found that atmospheric hazards monopolized attention in the literature on confined spaces, while risk estimation specific to confined space interventions received little practical coverage overall, apart from atmospheric hazards. The parameters used to establish classes or groupings of confined spaces in existing tools were imprecise. The development of a risk analysis process that is (i) more systematic and based on the concepts recognized in risk management standards, (ii) multidisciplinary, and (iii) adapted to the specific characteristics of confined spaces is therefore needed. Such a process will better support managers and occupational health and safety (OH&S) personnel in their efforts to prioritize and reduce risks. Suggestions on such a risk analysis tool and categorization of interventions in confined spaces are proposed in this article. Lastly, risk analysis tools adapted to confined space interventions are needed to ensure the inherently safe design of these spaces.
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Affiliation(s)
- Damien Burlet-Vienney
- a Institut de recherche Robert-Sauvé en santé et en sécurité du travail , Montreal , Canada
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Henn SA, Bell JL, Sussell AL, Konda S. Occupational carbon monoxide fatalities in the US from unintentional non-fire related exposures, 1992-2008. Am J Ind Med 2013; 56:1280-9. [PMID: 23868822 DOI: 10.1002/ajim.22226] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2013] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To analyze characteristics of, and trends in, work-related carbon monoxide (CO) fatalities in the US. METHODS Records of unintentional, non-fire related fatalities from CO exposure were extracted from the Bureau of Labor Statistics' Census of Fatal Occupational Injuries and the Occupational Safety and Health Administration's Integrated Management Information System for years 1992-2008 and analyzed separately. RESULTS The average number of annual CO fatalities was 22 (standard deviation=8). Fatality rates were highest among workers aged≥65, males, Hispanics, winter months, the Midwest, and the Fishing, Hunting, and Trapping industry subsector. Self-employed workers accounted for 28% of all fatalities. Motor vehicles were the most frequent source of fatal CO exposure, followed by heating systems and generators. CONCLUSIONS CO has been the most frequent cause of occupational fatality due to acute inhalation, and has shown no significant decreasing trend since 1992. The high number of fatalities from motor vehicles warrants further investigation.
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Affiliation(s)
- Scott A. Henn
- Division of Surveillance, Hazard Evaluations, and Field Studies; National Institute for Occupational Safety and Health; Cincinnati; Ohio
| | - Jennifer L. Bell
- Division of Safety Research; National Institute for Occupational Safety and Health; Morgantown; West Virginia
| | - Aaron L. Sussell
- Division of Surveillance, Hazard Evaluations, and Field Studies; National Institute for Occupational Safety and Health; Cincinnati; Ohio
| | - Srinivas Konda
- Division of Safety Research; National Institute for Occupational Safety and Health; Morgantown; West Virginia
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Hallam DM, Liao J, Choi K. Manure pit injuries: Rare, deadly, and preventable. J Emerg Trauma Shock 2012; 5:253-6. [PMID: 22988406 PMCID: PMC3440894 DOI: 10.4103/0974-2700.99702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 08/01/2011] [Indexed: 11/23/2022] Open
Abstract
A male worker entered an underground manure pit and lost consciousness. His coworker tried to rescue him and also lost consciousness in the pit. Emergency service arrived in minutes and removed both of them from the pit. Both men suffered anoxic brain injury and died in the hospital. Cases from Iowa Fatality Assessment and Control Evaluation Program Data Base program were reviewed. Occupational mortality rate was found to be 7.4 per 10,000 per year for occupational deaths related to agriculture compared to 3.1 per 10,000 per year for deaths not related to agriculture. In most of the cases associated with sewage or livestock waste handling, victims died of asphyxiation. While manure pit injury is rare, it has an extremely high fatality rate. The most effective strategy to decrease mortality is active prevention.
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Affiliation(s)
- Daniel M Hallam
- Department of Surgery, University of Iowa Hospital and Clinics, Iowa City, IA, USA
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Martínez MA, Ballesteros S, Alcaraz R. Reporting a sudden death due to accidental gasoline inhalation. Forensic Sci Int 2012; 215:114-20. [PMID: 21354726 DOI: 10.1016/j.forsciint.2011.01.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 11/06/2010] [Accepted: 01/30/2011] [Indexed: 11/30/2022]
Abstract
The investigation of uncertain fatalities requires accurate determination of the cause of death, with assessment of all factors that may have contributed to it. Gasoline is a complex and highly variable mixture of aliphatic and aromatic hydrocarbons that can lead to cardiac arrhythmias due to sensitization of the myocardium to catecholamines or acts as a simple asphyxiant if the vapors displace sufficient oxygen from the breathing atmosphere. This work describes a sudden occupational fatality involving gasoline. The importance of this petroleum distillate detection and its quantitative toxicological significance is discussed using a validated analytical method. A 51 year-old Caucasian healthy man without significant medical history was supervising the repairs of the telephone lines in a manhole near to a gas station. He died suddenly after inhaling gasoline vapors from an accidental leak. Extensive blistering and peeling of skin were observed on the skin of the face, neck, anterior chest, upper and lower extremities, and back. The internal examination showed a strong odor of gasoline, specially detected in the respiratory tract. The toxicological screening and quantitation of gasoline was performed by means of gas chromatography with flame ionization detector and confirmation was performed using gas chromatography-mass spectrometry. Disposition of gasoline in different tissues was as follows: heart blood, 35.7 mg/L; urine, not detected; vitreous humor, 1.9 mg/L; liver, 194.7 mg/kg; lung, 147.6 mg/kg; and gastric content, 116,6 mg/L (2.7 mg total). Based upon the toxicological data along with the autopsy findings, the cause of death was determined to be gasoline poisoning and the manner of death was accidental. We would like to alert on the importance of testing for gasoline, and in general for volatile hydrocarbons, in work-related sudden deaths involving inhalation of hydrocarbon vapors and/or exhaust fumes.
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Affiliation(s)
- María Antonia Martínez
- Instituto Nacional de Toxicologia y C. Forenses, Ministerio de Justicia, C/José Echegaray, 4, 28232 Las Rozas de Madrid, Madrid, Spain.
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Wilson MP, Madison HN, Healy SB. Confined space emergency response: assessing employer and fire department practices. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2012; 9:120-128. [PMID: 22300305 DOI: 10.1080/15459624.2011.646644] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
An emergency response plan for industrial permit-required confined space entry is essential for employee safety and is legally required. Maintaining a trained confined space rescue team, however, is costly and technically challenging. Some employers turn to public fire departments to meet their emergency response requirements. The confined space emergency response practices of employers and fire departments have not been previously assessed. We present (1) federal data on the U.S. occurrence between 1992 and 2005 of confined space fatal incidents involving toxic and/or oxygen-deficient atmospheres; (2) survey data from 21 large companies on permit-required confined space emergency response practices; (3) data on fire department arrival times; and (4) estimates by 10 senior fire officers of fire department rescue times for confined space incidents. Between 1992 and 2005, 431 confined space incidents that met the case definition claimed 530 lives, or about 0.63% of the 84,446 all-cause U.S. occupational fatal injuries that occurred during this period. Eighty-seven (20%) incidents resulted in multiple fatalities. Twelve (57%) of 21 surveyed companies reported that they relied on the fire department for permit-required confined space emergency response. Median fire department arrival times were about 5 min for engines and 7 min for technical rescue units. Fire department confined space rescue time estimates ranged from 48 to 123 min and increased to 70 and 173 min when hazardous materials were present. The study illustrates that (1) confined space incidents represent a small but continuing source of fatal occupational injuries in the United States; (2) a sizeable portion of employers may be relying on public fire departments for permit-required confined space emergency response; and (3) in the event of a life-threatening emergency, fire departments usually are not able to effect a confined space rescue in a timely manner. We propose that the appropriate role for the fire department is to support a properly trained and equipped on-site rescue team and to provide advanced life support intervention following extrication and during ambulance transportation.
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Affiliation(s)
- Michael P Wilson
- Labor Occupational Health Program, School of Public Health, 3334 Fulton St. 4th Floor, University of California, Berkeley, Berkeley, CA 94720-5120, USA.
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Abstract
Intoxications resulting from asphyxiate gases, such as nitrogen can cause hypoxia and even death. We present a case of a patient with nitrogen intoxication due to inadvertent industrial exposure. In this case, the patient survived and the outcome was different from those reported in the literature. For patients presenting to the emergency department from a workplace with a history of loss of consciousness after using of self-contained breathing apparatus, possibility of nitrogen or other simple asphyxiate gas intoxication should be considered seriously.
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Tourigny PD, Hall C. Diagnosis and management of environmental thoracic emergencies. Emerg Med Clin North Am 2011; 30:501-28, x. [PMID: 22487116 DOI: 10.1016/j.emc.2011.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Physiologic sequelae from increasing ambient pressure in underwater activities, decreasing ambient pressure while at altitude, or the consequences of drowning present a unique set of challenges to emergency physicians. In addition, several environmental toxins cause significant respiratory morbidity, whether they be pulmonary irritants, simple asphyxiants, or systemic toxins. It is important for emergency physicians to understand the pathophysiology of these illnesses as well as to apply this knowledge to the clinical arena either in the prehospital setting or in the emergency department. Current treatment paradigms and controversies within these regimens are discussed.
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Affiliation(s)
- Paul D Tourigny
- Division of Emergency Medicine, Foothills Medical Centre, University of Calgary, 1403-29 Street Northwest, Calgary, Alberta, Canada.
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Horwitz IB, McCall BP. Disabling and fatal occupational claim rates, risks, and costs in the Oregon construction industry 1990-1997. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2004; 1:688-698. [PMID: 15631060 DOI: 10.1080/15459620490508787] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This study estimated injury and illness rates, risk factors, and costs associated with construction work in Oregon from 1990-1997 using all accepted workers' compensation claims by Oregon construction employees (N = 20,680). Claim rates and risk estimates were estimated using a baseline calculated from Current Population Survey data of the Oregon workforce. The average annual rate of lost-time claims was 3.5 per 100 workers. More than 50% of claims were by workers under 35 years and with less than 1 year of tenure. The majority of claimants (96.1%) were male. There were 52 total fatalities reported over the period examined, representing an average annual death rate of 8.5 per 100,000 construction workers. Average claim cost was $10,084 and mean indemnity time was 57.3 days. Structural metal workers had the highest average days of indemnity of all workers (72. 1), highest average costs per claim ($16,472), and highest odds ratio of injury of all occupations examined. Sprains were the most frequently reported injury type, constituting 46.4% of all claims. The greatest accident risk occurred during the third hour of work. Training interventions should be extensively utilized for inexperienced workers, and prework exercises could potentially reduce injury frequency and severity.
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Affiliation(s)
- Irwin B Horwitz
- University of Texas School of Public Health at Houston, Houston, Texas 77030, USA.
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