Direct costs and patterns of injuries among residential carpenters, 1995-2000

Workers' compensation loss prevention representative contact and risk of lost-time injury in construction policyholders

INTRODUCTION

Insurance loss prevention (LP) representatives have access and contact with businesses and employees to provide targeted safety and health resources. Construction firms, especially those smaller in size, are a high-risk population. This research evaluated the association between LP rep contact and risk for lost-time injuries in construction policyholders.

METHODS

Workers' compensation data were utilized to track LP rep contact with policyholders and incidence of lost-time injury over time. Survival analysis with repeated events modeling calculated hazard ratios (HR) and 95% confidence intervals (CI).

RESULTS

Compared no LP contact, one contact was associated with a 27% reduction of risk (HR=0.73, CI=0.65-0.82), two with a 41% (HR=0.59, CI=0.51-0.68), and three or more contacts with a 28% reduction of risk (HR=0.72, CI=0.65-0.81).

CONCLUSIONS

LP reps appear to be a valuable partner in efforts to reduce injury burden. Their presence or contact with policyholders is consistent with reduction in overall incidence of lost-time injuries.

PRACTICAL APPLICATIONS

Reduction in lost-time injuries, resulting in reduced workers' compensation costs for policyholders and insurance companies, builds a business-case for safety and injury prevention. LP reps are often a low or no-cost benefit for insurance policyholders and may be an important injury prevention resource for small firms and/or those with lack of safety resources and staff.

Nail gun injuries treated in U.S emergency departments, 2006-2011: not just a worker safety issue

BACKGROUND

Nail guns increase productivity in residential building but with a corresponding increase in worker injuries. They are also easily accessible, at low cost, to consumers.

METHODS

Data from the occupational supplement to the National Electronic Injury Surveillance System (NEISS-Work) were used to calculate national estimates of work-related injuries from nail guns between 2006 and 2011. These were compared to estimates of consumer injuries obtained through online access to the Consumer Product Safety Commission's (CPSC) NEISS data.

RESULTS

Approximately 25,000 ED-treated work-related and consumer nail gun injuries were estimated each year. During the construction economy collapse, injuries among workers declined markedly, closely following patterns of reduced residential employment. Reduction in consumer injuries was much more modest.

CONCLUSIONS

Current nail gun injury patterns suggest marked blurring of work and home exposures. A united effort of CPSC, NIOSH, and OSHA is warranted to address these preventable injuries.

Analysis of ethnic disparities in workers' compensation claims using data linkage

OBJECTIVE

The overall goal of this research project was to assess ethnic disparities in monetary compensation among construction workers injured on the job through the linkage of medical records and workers' compensation data.

METHODS

Probabilistic linkage of medical records with workers' compensation claim data.

RESULTS

In the final multivariable robust regression model, compensation was $5824 higher (P = 0.030; 95% confidence interval: 551 to 11,097) for white non-Hispanic workers than for other ethnic groups when controlling for injury severity, affected body region, type of injury, average weekly wage, weeks of temporary total disability, percent permanent partial disability, death, or attorney use.

CONCLUSIONS

The analysis indicates that white non-Hispanic construction workers are awarded higher monetary settlements despite the observation that for specific injuries the mean temporary total disability and permanent partial disability were equivalent to or lower than those in Hispanic and black construction workers.

Injury rates, severity, and drug testing programs in small construction companies

PROBLEM

Construction work is hazardous and workers consistently rank in the top of all occupations and industries for illicit drug and heavy alcohol use.

METHODS

Drug-testing programs were classified into three categories: no program, pre-employment/post-accident, and pre-employment/post-accident/random/suspicion. We analyzed workers' compensation claims from 1,360 construction companies over a six-year period to assess the possible association of testing program with injury rate.

RESULTS

Compared to no program, results respectively were RR=0.85 (CI=0.72-1.0) and RR=0.97 (CI=0.86-1.10) for all injuries, and RR=0.78 (CI=0.60-1.03) and RR=1.01 (CI=0.86-1.19) for lost-time injuries. Variability of results was exhibited across trade and union status, among other categories.

SUMMARY

Drug-testing programs may be associated with lower, non-significant, injury rates in this population.

IMPACT ON INDUSTRY

Drug-testing programs may be associated with lower injury rates, but care should be exercised to ensure accurate injury reporting, characterize underlying safety practices of a company, and to determine quality and consistency of testing.

Buyer beware: personnel selling nail guns know little about dangerous tools

BACKGROUND

Nail gun use is ubiquitous in wood frame construction. Accessibility and decreasing costs have extended associated occupational hazards to consumers. Compelling evidence documents decreased injury risk among trained users and those with tools with sequential triggers. To prevent inadvertent discharge of nails, this safer trigger requires the nose be depressed before the trigger is pulled to fire. The sequential trigger is not required by the Consumer Product Safety Commission (CPSC) or the Occupational Safety and Health Administration (OSHA) nor are there any guidelines for training.

METHODS

We collected data from personnel at 217 points of sale/rental of framing nail guns in four areas of the country.

RESULTS

Sales personnel had little understanding of risks associated with use of framing nail guns. Individuals who had used the tool and those working in construction outlets were more likely to be knowledgeable; even so, less than half understood differences in trigger/actuation systems.

CONCLUSIONS

Consumers, including contractors purchasing for workers, cannot count on receiving accurate information from sales personnel regarding risks associated with use of these tools. The attitudes and limited knowledge of some sales personnel regarding these potentially deadly tools likely contributes to a culture accepting of injury. The findings demonstrate how influences on the culture of construction are not limited to workers, employers, or the places construction gets done.

A framework of task demand factors for residential framing

In the USA, framing contractors consistently have the highest rate of non-fatal injuries of all speciality contractors. Residential framing contractors face additional challenges, partly due to the exception of ‘residential type’ activities from fall protection regulations. This study investigated residential framing accidents with a focus on the task features that affect the task difficulty of the residential framing activities and consequently the likelihood of errors and accidents. The study analysed 654 safety incidents that occurred over a period of 5 years 6 months in a large residential framing company. Accident analysis and interviews with safety and production experts identified the high-risk tasks, the errors that lead to incidents and the task elements that increase the likelihood of errors. The study identified five task factors that increase the task difficulty of residential framing activities and consequently the likelihood of accidents: (a) support conditions; (b) body posture constraints; (c) load-handling requirements; (d) tool accuracy requirements; and (e) external forces. The combination of these factors generates high task demands that can lead to errors and accidents. Reducing the task difficulty (independent of the hazards) is an important safety strategy that can reduce the likelihood of accidents while at the same time it can increase productivity.

Low back injury risks during construction with prefabricated (panelised) walls: effects of task and design factors

New technology designed to increase productivity in residential construction may exacerbate the risk of work-related musculoskeletal disorders (WMSDs) among residential construction workers. Of interest here are panelised (prefabricated) wall systems (or panels) and facilitating an ongoing effort to provide proactive control of ergonomic exposures and risks among workers using panels. This study, which included 24 participants, estimated WMSD risks using five methods during common panel erection tasks and the influences of panel mass (sheathed vs. unsheathed) and size (wall length). WMSD risks were fairly high overall; e.g. 34% and 77% of trials exceeded the 'action limits' for spinal compressive and shear forces, respectively. Heavier (sheathed) panels significantly increased risks, although the magnitude of this effect differed with panel size and between tasks. Higher levels of risk were found in tasks originating from ground vs. knuckle height. Several practical recommendations based on the results are discussed. STATEMENT OF RELEVANCE: Panelised wall systems have the potential to increase productivity in residential construction, but may result in increased worker injury risks. Results from this study can be used to generate future panel design and construction processes that can proactively address WMSD risks.

Non-fatal contact injuries among workers in the construction industry treated in U.S. emergency departments, 1998-2005

PROBLEM

The National Occupational Research Agenda (NORA) for the construction industry calls for efforts to identify areas where guidance and regulation are needed to adequately prevent traumatic injuries resulting from a worker coming into contact with objects or equipment.

METHOD

This descriptive study of work-related contact injuries in the construction industry that were treated in emergency departments (EDs) between 1998 and 2005 utilized records of work injuries captured through a national probability-based sample of U.S. hospitals with 24-hour ED services.

RESULTS

Contact injuries accounted for 54% of all construction ED-treated injuries. Hospitalizations were most common for injuries from contact with discharged nails from pneumatic nail guns, with hand held power saws, and fixed saws. Some injuries were proportionally more serious and sometimes involved multiple workers including trenching injuries and those resulting from collapse of buildings under construction, walls, roofs, and scaffolding. DISCUSSION AND IMPACT: Given that nail gun use is limited primarily to wood frame construction, efforts are needed to control frequent serious injuries associated with these tools. Enforcement of existing trenching regulations is also needed.

Continued progress in the prevention of nail gun injuries among apprentice carpenters: what will it take to see wider spread injury reductions?

PROBLEM

Nail guns are a common source of acute, and potentially serious, injury in residential construction.

METHOD

Data on nail gun injuries, hours worked and hours of tool use were collected in 2008 from union apprentice carpenters (n=464) through classroom surveys; this completed four years of serial cross-sectional data collection from apprentices. A predictive model of injury risk was constructed using Poisson regression.

RESULTS

Injury rates declined 55% from baseline measures in 2005 with early training and increased use of tools with sequential actuation. Injury rates declined among users of tools with both actuation systems, but the rates of injury were consistently twice as high among those using tools with contact trip triggers. DISCUSSION AND IMPACT: Nail gun injuries can be reduced markedly through early training and use of tools with sequential actuation. These successful efforts need to be diffused broadly, including to the non-union sector.

Nonfatal tool- or equipment-related injuries treated in US emergency departments among workers in the construction industry, 1998-2005

BACKGROUND

Individuals in the construction industry are exposed to a variety of tools and pieces of equipment as they work.

METHODS

Data from the National Institute for Occupational Safety and Health (NIOSH) occupational supplement to the National Electronic Injury Surveillance System (NEISS-Work) were used to characterize tool- and equipment-related injuries among workers in the construction industry that were treated in US emergency departments between 1998 and 2005. Based on a national stratified probability sample of US hospitals with 24 hr emergency services, NEISS-Work allows calculation of national injury estimates.

RESULTS

Over the 8-year period between 1998 and 2005, we estimated 786,900 (95% CI 546,600-1,027,200) ED-treated tool- or equipment-related injuries identified by the primary or secondary source of injury code. These injuries accounted for a quarter of all ED-treated construction industry injuries. Although over 100 different tools or pieces of equipment were responsible for these injuries, seven were responsible for over 65% of the injury burden: ladders, nail guns, power saws, hammers, knives, power drills, and welding tools in decreasing order.

CONCLUSIONS

Current injury estimates and their severity, marked by the proportion of cases that were not released after ED treatment, indicate interventions are particularly needed to prevent injuries associated with use of ladders as well as nail guns and power saws. Attention should focus on design and guarding to more efficiently prevent these injuries rather than simply calling for the training of workers in how to safely use a dangerous tool or piece of equipment.

Identifying work related injuries: comparison of methods for interrogating text fields

Background

Work-related injuries in Australia are estimated to cost around $57.5 billion annually, however there are currently insufficient surveillance data available to support an evidence-based public health response. Emergency departments (ED) in Australia are a potential source of information on work-related injuries though most ED's do not have an 'Activity Code' to identify work-related cases with information about the presenting problem recorded in a short free text field. This study compared methods for interrogating text fields for identifying work-related injuries presenting at emergency departments to inform approaches to surveillance of work-related injury.

Methods

Three approaches were used to interrogate an injury description text field to classify cases as work-related: keyword search, index search, and content analytic text mining. Sensitivity and specificity were examined by comparing cases flagged by each approach to cases coded with an Activity code during triage. Methods to improve the sensitivity and/or specificity of each approach were explored by adjusting the classification techniques within each broad approach.

Results

The basic keyword search detected 58% of cases (Specificity 0.99), an index search detected 62% of cases (Specificity 0.87), and the content analytic text mining (using adjusted probabilities) approach detected 77% of cases (Specificity 0.95).

Conclusions

The findings of this study provide strong support for continued development of text searching methods to obtain information from routine emergency department data, to improve the capacity for comprehensive injury surveillance.

The use of narrative text for injury surveillance research: a systematic review

OBJECTIVE

To summarise the extent to which narrative text fields in administrative health data are used to gather information about the event resulting in presentation to a health care provider for treatment of an injury, and to highlight best practise approaches to conducting narrative text interrogation for injury surveillance purposes.

DESIGN

Systematic review.

DATA SOURCES

Electronic databases searched included CINAHL, Google Scholar, Medline, Proquest, PubMed and PubMed Central. Snowballing strategies were employed by searching the bibliographies of retrieved references to identify relevant associated articles.

SELECTION CRITERIA

Papers were selected if the study used a health-related database and if the study objectives were to a) use text field to identify injury cases or use text fields to extract additional information on injury circumstances not available from coded data or b) use text fields to assess accuracy of coded data fields for injury-related cases or c) describe methods/approaches for extracting injury information from text fields.

METHODS

The papers identified through the search were independently screened by two authors for inclusion, resulting in 41 papers selected for review. Due to heterogeneity between studies meta-analysis was not performed.

RESULTS

The majority of papers reviewed focused on describing injury epidemiology trends using coded data and text fields to supplement coded data (28 papers), with these studies demonstrating the value of text data for providing more specific information beyond what had been coded to enable case selection or provide circumstantial information. Caveats were expressed in terms of the consistency and completeness of recording of text information resulting in underestimates when using these data. Four coding validation papers were reviewed with these studies showing the utility of text data for validating and checking the accuracy of coded data. Seven studies (9 papers) described methods for interrogating injury text fields for systematic extraction of information, with a combination of manual and semi-automated methods used to refine and develop algorithms for extraction and classification of coded data from text. Quality assurance approaches to assessing the robustness of the methods for extracting text data was only discussed in 8 of the epidemiology papers, and 1 of the coding validation papers. All of the text interrogation methodology papers described systematic approaches to ensuring the quality of the approach.

CONCLUSIONS

Manual review and coding approaches, text search methods, and statistical tools have been utilised to extract data from narrative text and translate it into useable, detailed injury event information. These techniques can and have been applied to administrative datasets to identify specific injury types and add value to previously coded injury datasets. Only a few studies thoroughly described the methods which were used for text mining and less than half of the studies which were reviewed used/described quality assurance methods for ensuring the robustness of the approach. New techniques utilising semi-automated computerised approaches and Bayesian/clustering statistical methods offer the potential to further develop and standardise the analysis of narrative text for injury surveillance.

How much time is safety worth? A comparison of trigger configurations on pneumatic nail guns in residential framing

OBJECTIVE

Nail gun injuries are among the most common in wood frame construction. Despite evidence that the majority of injuries from unintentional firings could be prevented with a sequential trigger mechanism on the tools, the safer trigger has not been embraced in the fast-paced residential construction industry. An experiment was conducted in an attempt to realistically evaluate the magnitude of productivity concerns.

METHODS

Ten journeymen carpenters built a yard shed on two occasions, using nail guns with two different trigger configurations, alternately, under controlled conditions. Mean differences in time required, nails used, and proper placement were evaluated considering the trigger used and whether the building was the carpenter's first or second project.

RESULTS

The sequential trigger tool required a mean of 10 additional minutes of active nailing time, which represented 10% of mean nailing time (97 minutes) but only 0.77% of the total mean work time (1,298 minutes) to construct each shed. No significant differences were observed in nail count or placement. The majority of the time variability was related to who was using the tool, rather than the type of tool in the person's hand.

CONCLUSIONS

Productivity concerns should focus more on improving the skill of the carpenter rather than on the trigger mechanism. Failure to place tools with the safer trigger configuration, which requires the nose piece to be depressed before the trigger is pulled, in the hands of workers does not make sense given the frequency and potential repercussions of injuries associated with the use of these tools in wood framing.

Challenges in residential fall prevention: insight from apprentice carpenters

BACKGROUND

Falls remain a serious source of morbidity and mortality in residential construction despite considerable knowledge of risk factors and prevention strategies. While training is universally viewed as positive, we know little about its effectiveness in preventing residential falls.

METHODS

A series of focus groups were conducted with union apprentice carpenters (n = 36) at varied levels of training to elicit input on factors that might influence the effectiveness of residential fall prevention training, including hazard awareness, timing of elements of formal instruction, jobsite mentoring, and workplace norms.

RESULTS

While apprentices identified many residential fall hazards, they voiced little concern about work near unprotected vertical or horizontal openings such as stairwells, window openings or leading edges. On residential jobs, apprentices worked at heights immediately and were often exposed to hazards they had not yet been trained to handle. The quality of mentoring varied tremendously, and things they had been taught in school were often not the norm on these small worksites. Use of fall arrest equipment was uncommon. Job insecurity in this fast-paced work environment influenced behaviors even when apprentices reported knowledge of safe procedures; this was more of a problem for less experienced apprentices.

CONCLUSIONS

These data provide compelling evidence that apprentices often do not apply safety principles they have been taught in school in the actual work environment, illuminating how attempts to empower workers through training alone can fall short. The findings have policy implications and demonstrate the importance of measuring more than knowledge when evaluating effectiveness of training.

Nail gun injuries in apprentice carpenters: risk factors and control measures

BACKGROUND

Nail guns increase residential construction productivity but their use is associated with risk of injury.

METHODS

Active surveillance data from 772 apprentice carpenters were used to document the injury risk associated with the use of nail guns and the potential impact of modifiable risk factors. Using reported work hours and nail gun injuries injury rates per 200,000 hr worked in the past year were calculated. Using estimates of hours of tool use, Poisson regression was used to calculate adjusted rate ratios for injury associated with time in the trade, trigger mechanism on the tools and training prior to injury.

RESULTS

Forty-five percent of these apprentices had sustained a nail gun injury; injury rates in the past year based on hours of work were considerably higher than previously recognized. Those with less than 1 year in the trade compared to those with more than 5 years experience (RR = 2.7; 95% CI 1.2, 5.9) and those with no training in tool use (RR = 2.9; 95% CI 1.9, 4.4) were at greatest risk. After adjusting for experience and training, the rate of injury was twice as high with tools with a contact trip trigger compared to those with a sequential trigger (RR = 2.0; 95% CI 1.2, 3.3).

CONCLUSIONS

Preventive measures should include change to the safer sequential trigger that prevents unintentional firing and early training in safe tool use. Because of the high prevalence of use of tools with contact trip triggers the greatest number of injuries among these apprentices could be prevented with an engineering solution.

Construction work and risk of occupational disability: a ten year follow up of 14,474 male workers

AIMS

Most industrialised countries have public income maintenance programmes to protect workers in case of disability but studies addressing disability risk of specific professional groups are rare. The objective of this study was to establish a detailed pattern of the nature and extent of occupational disability among construction workers.

METHODS

A cohort study was set up including 14,474 male workers from the construction industry in Württemberg (Germany) aged 25-64 years who underwent occupational health exams between 1986 and 1992. The cohort was linked to the regional pension register of the manual workers' pension insurance institution to identify workers who were granted a disability pension during the 10 year follow up. All-cause and cause specific standardised incidence ratios (SIR) and 95% confidence intervals (CI) were calculated using disability rates from the general workforce and from all blue collar workers in Germany as references.

RESULTS

In total, 2247 (16%) members of the cohort were granted a disability pension. Major causes of disability were musculoskeletal (45%) and cardiovascular diseases (19%). In comparison with the general workforce, construction workers experienced a higher risk of disability from cancer (SIR = 1.26; 95% CI 1.08 to 1.47), respiratory diseases (SIR = 1.27; 95% CI 1.03 to 1.55), musculoskeletal diseases (SIR = 2.16; 95% CI 2.03 to 2.30), injuries/poisoning (SIR = 2.52; 95% CI 2.06 to 3.05), and all causes combined (SIR = 1.47; 95% CI 1.41 to 1.53). When compared with the blue collar reference group, increased risks of disability among construction workers were found for musculoskeletal diseases (SIR = 1.53; 95% CI 1.44 to 1.63), injury/poisoning (SIR = 1.83; 95% CI 1.50 to 2.21), and all causes combined (SIR = 1.11; 95% CI 1.07 to 1.16).

CONCLUSIONS

Musculoskeletal diseases and external causes are major factors limiting the work capability of construction workers and lead to an increased proportion of occupational disability.

Analysis of text from injury reports improves understanding of construction falls

OBJECTIVE

We combined payroll data, coded workers' compensation (WC) data, and text descriptions of injuries from the construction of Denver International Airport to create a more comprehensive picture of falls from height (FFH) than is typically available from WC data. Text descriptions were coded to identify circumstances surrounding falls. Slips/trips preceded one third of FFH, often involving motor vehicles or heavy equipment. Another third involved movement or collapse of work surfaces, usually ladders or scaffolds.

CONCLUSIONS

The significant contribution of motor vehicles and heavy equipment to FFH, particularly those preceded by slips/trips, was not apparent from coded data. Heavy equipment engineering modifications are called for and workers in street/roadway construction/site development need fall protection training. Text analyses allow exploration of factors not identified at the time of data collection and better understanding of the context in which injuries occur.

Disabling and fatal occupational claim rates, risks, and costs in the Oregon construction industry 1990-1997

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.

Ergonomic Pain-Part 1: Etiology, Epidemiology, and Prevention

Work-related musculoskeletal disorders (MSDs) have reached a costly epidemic proportion in recent years, producing ergonomic pain as their most frequent clinical consequence. While work-related MSDs have declined in incidence, their prevalence continues. Individuals develop symptoms as a consequence of numerous factors that include force, sustained posture, repetitive motion, and vibration. Different combinations of these factors lend to different pathomechanical and pathophysiological consequences that appear to be unique to different regions of the body and related to distinctive work environmental and task characteristics. Federal and state agencies have made considerable attempts to regulate the work environment in a preventative fashion in order to reduce the incidence of ergonomic pain and other sequelae of work-related MSDs.

Falls in residential carpentry and drywall installation: findings from active injury surveillance with union carpenters

Active injury surveillance was conducted with a large, unionized workforce of residential and drywall carpenters over a 3-year period. Injured carpenters were interviewed by trained carpenter investigators and sites were visited where falls occurred. Qualitative information was collected on exposures, risk perception, training, and mentoring. Falls accounted for 20% of injuries. Same-level falls were often related to weather, carrying objects-sometimes with an obstructed view-housekeeping, terrain of the lot, and speed of work. Falls from height occurred from a variety of work surfaces and involved ladders, scaffolding, roofs, work on other unsecured surfaces, unprotected openings, speed, and weather conditions. Recognized fall protection strategies, such as guardrails, toe boards, tying off to appropriate anchors, and guarding openings, would have prevented many of these falls; these practices were not the norm on many sites.