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Jun J, Lee JH, Han J, Kim SH, Kim S, Cho GC, Park EJ, Lee DH, Hong JY, Kim MJ. Characteristics of fall-from-height patients: a retrospective comparison of jumpers and fallers using a multi-institutional registry. Clin Exp Emerg Med 2024; 11:79-87. [PMID: 38018072 PMCID: PMC11009701 DOI: 10.15441/ceem.23.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE Fall from height (FFH) is a major public health problem that can result in severe injury, disability, and death. This study investigated how the characteristics of jumpers and fallers differ. METHODS This was a retrospective study of FFH patients enrolled in an Emergency Department-based Injury In-depth Surveillance (EDIIS) registry between 2011 and 2018. Depending on whether the injury was intentional, FFH patients who had fallen from a height of at least 1 m were divided into two groups: jumpers and fallers. Patient characteristics, organ damage, and death were compared between the two groups, and factors that significantly affected death were identified using multivariable logistic analysis. RESULTS Among 39,419 patients, 1,982 (5.0%) were jumpers. Of the jumpers, 977 (49.3%) were male, while 30,643 (81.9%) of fallers were male. The jumper group had the highest number of individuals in their 20s, with the number decreasing as age increased. In contrast, the number of individuals in the faller group rose until reaching their 50s, after which it declined. More thoracoabdominal, spinal, and brain injuries were found in jumpers. The in-hospital mortality of jumpers and fallers was 832 (42.0%) and 1,268 (3.4%), respectively. Intentionality was a predictor of in-hospital mortality, along with sex, age, and fall height, with an odds ratio of 7.895 (95% confidence interval, 6.746-9.240). CONCLUSION Jumpers and fallers have different epidemiological characteristics, and jumpers experienced a higher degree of injury and mortality than fallers. Differentiated prevention and treatment strategies are needed for jumpers and fallers to reduce mortality in FFH patients.
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Affiliation(s)
- Jinhae Jun
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hwan Lee
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Juhee Han
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Hyu Kim
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sunpyo Kim
- Department of Emergency Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Gyu Chong Cho
- Department of Emergency Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Eun Jung Park
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Duk Hee Lee
- Department of Emergency Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ju Young Hong
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
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Kaur H, Wurzelbacher SJ, Bushnell PT, Bertke S, Meyers AR, Grosch JW, Naber SJ, Lampl M. Occupational Injuries Among Construction Workers by Age and Related Economic Loss: Findings From Ohio Workers' Compensation, USA: 2007-2017. Saf Health Work 2023; 14:406-414. [PMID: 38187211 PMCID: PMC10770107 DOI: 10.1016/j.shaw.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/18/2023] [Accepted: 10/03/2023] [Indexed: 01/09/2024] Open
Abstract
Background This study examined age-group differences in the rate, severity, and cost of injuries among construction workers to support evidence-based worker safety and health interventions in the construction industry. Methods Ohio workers' compensation claims for construction workers were used to estimate claim rates and costs by age group. We analyzed claims data auto-coded into five event/exposure categories: transportation incidents; slips, trips, and falls (STFs); exposure to harmful substances and environments; contact with objects and equipment (COB); overexertion and bodily reaction. American Community Survey data were used to determine the percentage of workers in each age group. Results From 2007-2017, among 72,416 accepted injury claims for ∼166,000 construction full-time equivalent (FTE) per year, nearly half were caused by COB, followed by STFs (20%) and overexertion (20%). Claim rates related to COB and exposure to harmful substances and environments were highest among those 18-24 years old, with claim rates of 313.5 and 25.9 per 10,000 FTE, respectively. STFs increased with age, with the highest claim rates for those 55-64 years old (94.2 claims per 10,000 FTE). Overexertion claim rates increased and then declined with age, with the highest claim rate for those 35-44 years old (87.3 per 10,000 FTE). While younger workers had higher injury rates, older workers had higher proportions of lost-time claims and higher costs per claim. The total cost per FTE was highest for those 45-54 years old ($1,122 per FTE). Conclusion The variation in rates of injury types by age suggests that age-specific prevention strategies may be useful.
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Affiliation(s)
- Harpriya Kaur
- Division of Science Integration, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Steven J. Wurzelbacher
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - P. Tim Bushnell
- Office of the Director, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Stephen Bertke
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Alysha R. Meyers
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - James W. Grosch
- Division of Science Integration, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | | | - Michael Lampl
- Ohio Bureau of Workers' Compensation, Columbus, OH, USA
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Industrial construction safety policies and practices with cost impacts in a COVID-19 pandemic environment: A Louisiana DOW case study. J Loss Prev Process Ind 2022; 76:104723. [PMID: 35002093 PMCID: PMC8719009 DOI: 10.1016/j.jlp.2021.104723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 10/21/2021] [Accepted: 12/24/2021] [Indexed: 12/21/2022]
Abstract
There are always significant challenges in improving the safety culture by changing and adding additional safety protocols. The unknown impacts of COVID-19 and how it quickly spreads led the industry to institute essential safety protocols. This paper addresses two problem statements. The first problem statement is: what are the additional safety protocols for process safety, construction & maintenance, and personal protective equipment requirements? The second problem statement is: what are the cost and schedule impacts of industrial construction projects resulting from implementing safety protocols and process safety during construction with the added PPE? While complying with added safety protocols, the industrial construction industry cannot forget that it has a distinct reputation for high incident rates and less than desirable safety performance. In 2017, the construction industry suffered 971 fatalities. This alarming number is compared to 1123 total fatalities in 2017 for the Gulf Coast States. The objective is to share the rationale and practices of social distancing, required additional PPE, and personal hygiene practices to reduce spreading and outbreaks during a pandemic within an industrial construction environment. Before any construction work, the process safety teams must clear, isolate, and tag out process lines, equipment, and instruments to be repaired or replaced. The information presented demonstrates the significant cost and schedule impacts that industrial construction companies will encounter during a pandemic like COVID-19. This paper aims to improve safety processes, cost & schedule impacts, and prescribe additional personal protective equipment in industrial construction during a pandemic such as COVID-19. The COVID-19 pandemic spread globally in a very short period. The reactions in mitigating the spread were suggestive, with little to no data on safety protective equipment and practices. The contribution this paper addresses are how to employ efficient safety practices and policies during a pandemic in an industrial construction environment.
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Chellappa V, Salve UR, Li RYM, Liias R. A knowledge-based approach for enhancing fall prevention in the construction industry. JOURNAL OF STATISTICS & MANAGEMENT SYSTEMS 2020. [DOI: 10.1080/09720510.2020.1736320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Vigneshkumar Chellappa
- Department of Design, Indian Institute of Technology Guwahati, Guwahati 781039, Assam India
| | - Urmi Ravindra Salve
- Department of Design, Indian Institute of Technology Guwahati, Guwahati 781039, Assam India
| | - Rita Yi Man Li
- HKSYU Real Estate and Economics Research Lab, Hong Kong Shue Yan University, 10 Wai Tsui Crescent North Point, Hong Kong
| | - Roode Liias
- Department of Civil Engineering and Architecture, Tallinn University of Technology, Ehitajate tee Tallinn 12616 Estonia
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van der Molen HF, Basnet P, Hoonakker PLT, Lehtola MM, Lappalainen J, Frings‐Dresen MHW, Haslam R, Verbeek JH. Interventions to prevent injuries in construction workers. Cochrane Database Syst Rev 2018; 2:CD006251. [PMID: 29400395 PMCID: PMC6491133 DOI: 10.1002/14651858.cd006251.pub4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Construction workers are frequently exposed to various types of injury-inducing hazards. There are a number of injury prevention interventions, yet their effectiveness is uncertain. OBJECTIVES To assess the effects of interventions for preventing injuries in construction workers. SEARCH METHODS We searched the Cochrane Injuries Group's specialised register, CENTRAL (issue 3), MEDLINE, Embase and PsycINFO up to April 2017. The searches were not restricted by language or publication status. We also handsearched the reference lists of relevant papers and reviews. SELECTION CRITERIA Randomised controlled trials, controlled before-after (CBA) studies and interrupted time-series (ITS) of all types of interventions for preventing fatal and non-fatal injuries among workers at construction sites. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed their risk of bias. For ITS studies, we re-analysed the studies and used an initial effect, measured as the change in injury rate in the year after the intervention, as well as a sustained effect, measured as the change in time trend before and after the intervention. MAIN RESULTS Seventeen studies (14 ITS and 3 CBA studies) met the inclusion criteria in this updated version of the review. The ITS studies evaluated the effects of: introducing or changing regulations that laid down safety and health requirements for the construction sites (nine studies), a safety campaign (two studies), a drug-free workplace programme (one study), a training programme (one study), and safety inspections (one study) on fatal and non-fatal occupational injuries. One CBA study evaluated the introduction of occupational health services such as risk assessment and health surveillance, one evaluated a training programme and one evaluated the effect of a subsidy for upgrading to safer scaffoldings. The overall risk of bias of most of the included studies was high, as it was uncertain for the ITS studies whether the intervention was independent from other changes and thus could be regarded as the main reason of change in the outcome. Therefore, we rated the quality of the evidence as very low for all comparisons.Compulsory interventionsRegulatory interventions at national or branch level may or may not have an initial effect (effect size (ES) of -0.33; 95% confidence interval (CI) -2.08 to 1.41) and may or may not have a sustained effect (ES -0.03; 95% CI -0.30 to 0.24) on fatal and non-fatal injuries (9 ITS studies) due to highly inconsistent results (I² = 98%). Inspections may or may not have an effect on non-fatal injuries (ES 0.07; 95% CI -2.83 to 2.97; 1 ITS study).Educational interventionsSafety training interventions may result in no significant reduction of non-fatal injuries (1 ITS study and 1 CBA study).Informational interventionsWe found no studies that had evaluated informational interventions alone such as campaigns for risk communication.Persuasive interventionsWe found no studies that had evaluated persuasive interventions alone such as peer feedback on workplace actions to increase acceptance of safe working methods.Facilitative interventionsMonetary subsidies to companies may lead to a greater decrease in non-fatal injuries from falls to a lower level than no subsidies (risk ratio (RR) at follow-up: 0.93; 95% CI 0.30 to 2.91 from RR 3.89 at baseline; 1 CBA study).Multifaceted interventionsA safety campaign intervention may result in an initial (ES -1.82; 95% CI -2.90 to -0.74) and sustained (ES -1.30; 95% CI -1.79 to -0.81) decrease in injuries at the company level (1 ITS study), but not at the regional level (1 ITS study). A multifaceted drug-free workplace programme at the company level may reduce non-fatal injuries in the year following implementation by -7.6 per 100 person-years (95% CI -11.2 to -4.0) and in the years thereafter by -2.0 per 100 person-years (95% CI -3.5 to -0.5) (1 ITS study). Introducing occupational health services may result in no decrease in fatal or non-fatal injuries (one CBA study). AUTHORS' CONCLUSIONS The vast majority of interventions to adopt safety measures recommended by standard texts on safety, consultants and safety courses have not been adequately evaluated. There is very low-quality evidence that introducing regulations as such may or may not result in a decrease in fatal and non-fatal injuries. There is also very low-quality evidence that regionally oriented safety campaigns, training, inspections or the introduction of occupational health services may not reduce non-fatal injuries in construction companies. There is very low-quality evidence that company-oriented safety interventions such as a multifaceted safety campaign, a multifaceted drug workplace programme and subsidies for replacement of scaffoldings may reduce non-fatal injuries among construction workers. More studies, preferably cluster-randomised controlled trials, are needed to evaluate different strategies to increase the employers' and workers' adherence to the safety measures prescribed by regulation.
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Affiliation(s)
- Henk F van der Molen
- Academic Medical CenterAcademic Medical Center, University of Amsterdam, Department: Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam Public Health research instituteP.O. Box 22700AmsterdamNetherlands1100 DE
| | - Prativa Basnet
- Finnish Institute of Occupational HealthCochrane Work Review GroupNeulaniementie 4PO Box 310KuopioFinland
| | - Peter LT Hoonakker
- University of Wisconsin, MadisonCenter for Quality and Productivity Improvement3128 Engineering Centers Building1550 Engineering DrMadisonWIUSA53706
| | - Marika M Lehtola
- Finnish Institute of Occupational HealthSolutions for SafetyNeulaniementie 4KuopioFinlandFI‐70210
| | | | - Monique HW Frings‐Dresen
- Academic Medical Center, University of AmsterdamCoronel Institute of Occupational Health and Research Center for Insurance MedicineMeibergdreef 9PO Box 22700AmsterdamNetherlands1100 DE
| | - Roger Haslam
- Loughborough UniversityLoughborough Design SchoolLeicestershireUKLE11 3TU
| | - Jos H Verbeek
- Finnish Institute of Occupational HealthCochrane Work Review GroupNeulaniementie 4PO Box 310KuopioFinland
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Dasgupta P, Sample M, Buchholz B, Brunette M. Is worker involvement an ergonomic solution for construction intervention challenges: a systematic review. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2017. [DOI: 10.1080/1463922x.2016.1274452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Priyadarshini Dasgupta
- Division of Applied Science and Technology, University of Massachusetts Lowell, Lowell, MA, USA
| | - Michael Sample
- Loss Control Advisory Services – Field Operations, Liberty Mutual Insurance Group, Weston, MA, USA
| | - Bryan Buchholz
- Department of Work Environment, University of Massachusetts Lowell, Kitson Hall, Lowell, MA, USA
| | - Maria Brunette
- Department of Work Environment, University of Massachusetts Lowell, Kitson Hall, Lowell, MA, USA
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Abstract
INTRODUCTION Falls from heights are an important cause of unintentional fatal injury. We investigated the relationship between the characteristics of fatal falls and resulting injury patterns. MATERIALS AND METHODS We reviewed prospectively collected data from the Office of Chief Medical Examiner in New York City between 2000 and 2010. Data included fall height, work or non-work related, use of safety equipment, intentionality, specific organ injuries, and death on impact. The primary outcome was organ injury based on fall height. RESULTS Higher falls were associated with hemorrhage as well as rib and various organ injuries. Organ injury pattern did not differ based on work status. The presence of equipment misuse or malfunction was associated with more deaths upon impact. Victims of falls from 200 ft or higher were 11.59 times more likely to die on impact than from lower than 25 ft. CONCLUSIONS Fall height and work-related falls were significantly associated with death on impact. This is a public health issue, as 13% of falls were work related and 4% of falls were due to improper use of safety equipment. Some work-related falls are potentially preventable with proper safety equipment use. Understanding patterns of injury may play a role in prevention and management of survivors in the acute period.
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Falls from Height in the Construction Industry: A Critical Review of the Scientific Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13070638. [PMID: 27367706 PMCID: PMC4962179 DOI: 10.3390/ijerph13070638] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 11/17/2022]
Abstract
Globally, falls from height (FFH) are a substantial public health jeopardy and are among the important leading causes of serious and fatal injuries for construction workers. A comprehensive understanding of the causal factors in FFH incidents is urgently required; however, the literature appears to lack a scientific review of FFH. In this study, 297 articles that contribute to the topic of fall incidents were reviewed. Seventy-five (75) articles met the criteria for relevance and were aggregated in a database to support a critical review. A synthesis of macro-variables approach was adopted rather than a structured meta-analysis. Such a method of analysis provides the flexibility to combine previous studies' findings. The most common factors associated with FFH are risky activities, individual characteristics, site conditions, organizational characteristics, agents (scaffolds/ladders) and weather conditions. The outcomes contributed to identifying the most significant research area for safety enhancement by improving engineering facilities, behaviour investigations and FFH prevention methods.
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Sparer EH, Okechukwu CA, Manjourides J, Herrick RF, Katz JN, Dennerlein JT. Length of time spent working on a commercial construction site and the associations with worker characteristics. Am J Ind Med 2015; 58:964-73. [PMID: 26122700 PMCID: PMC5473608 DOI: 10.1002/ajim.22461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Construction workers move frequently from jobsite to jobsite, yet little is documented about length of stay on-site and associations with worker characteristics. METHOD Using cross-sectional data, we investigated associations between worker characteristics (including trade and musculoskeletal pain) and length of stay on-site (dichotomized as < 1 month, n = 554, and ≥ 1 month, n = 435). RESULTS Approximately, 56% of workers remained on the worksite for at least 1 month. Length of stay was significantly associated with workers' race/ethnicity, union status, title, trade, and musculoskeletal pain (P-values < 0.05). Trades associated with longer length of stay included pipefitters and plumbers. Trades associated with shorter length of stay included operators and piledrivers. Workers with single-location pain had 2.21 times (95%CI: 1.52, 3.19) the odds of being short-term versus long-term, adjusting for trade, title, and race/ethnicity. CONCLUSION The length of stay and associated characteristics provide important insight into how workers come and go on construction sites and the methodological challenges associated with traditional intervention evaluations.
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Affiliation(s)
- Emily H Sparer
- Department Environmental Health, Harvard T.H. Chan School of Public Health
| | - Cassandra A Okechukwu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health
| | - Justin Manjourides
- Department of Physical Therapy, Movement, and Rehabilitation Sciences, Bouvé College of Health Sciences, Bouvé College of Health Sciences, Northeastern University
| | - Robert F Herrick
- Department Environmental Health, Harvard T.H. Chan School of Public Health
| | - Jeffrey N Katz
- Department Environmental Health, Harvard T.H. Chan School of Public Health
- Department of Epidemiology, Harvard T.H. Chan School of Public Health
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School
| | - Jack T Dennerlein
- Department Environmental Health, Harvard T.H. Chan School of Public Health
- Department of Physical Therapy, Movement, and Rehabilitation Sciences, Bouvé College of Health Sciences, Bouvé College of Health Sciences, Northeastern University
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Sparer EH, Herrick RF, Dennerlein JT. Development of a safety communication and recognition program for construction. New Solut 2015; 25:42-58. [PMID: 25815741 DOI: 10.1177/1048291115569025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Leading-indicator-based (e.g., hazard recognition) incentive programs provide an alternative to controversial lagging-indicator-based (e.g., injury rates) programs. We designed a leading-indicator-based safety communication and recognition program that incentivized safe working conditions. The program was piloted for two months on a commercial construction worksite and then redesigned using qualitative interview and focus group data from management and workers. We then ran the redesigned program for six months on the same worksite. Foremen received detailed weekly feedback from safety inspections, and posters displayed worksite and subcontractor safety scores. In the final program design, the whole site, not individual subcontractors, was the unit of analysis and recognition. This received high levels of acceptance from workers, who noted increased levels of site unity and team-building. This pilot program showed that construction workers value solidarity with others on site, demonstrating the importance of health and safety programs that engage all workers through a reliable and consistent communication infrastructure.
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Affiliation(s)
- Emily H Sparer
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | | | - Jack T Dennerlein
- Harvard T. H. Chan School of Public Health, Boston, MA, USA Northeastern University, Boston, MA, USA
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van der Molen HF, Lehtola MM, Lappalainen J, Hoonakker PLT, Hsiao H, Haslam R, Hale AR, Frings-Dresen MHW, Verbeek JH. Interventions to prevent injuries in construction workers. Cochrane Database Syst Rev 2012; 12:CD006251. [PMID: 23235627 DOI: 10.1002/14651858.cd006251.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Construction workers are frequently exposed to various types of injury-inducing hazards. A number of injury prevention interventions have been proposed, yet their effectiveness is uncertain. OBJECTIVES To assess the effects of interventions to prevent injuries in construction workers. SEARCH METHODS We searched the Cochrane Injuries Group's specialised register, CENTRAL, MEDLINE, EMBASE, PsycINFO, OSH-ROM (including NIOSHTIC and HSELINE), Scopus, Web of Science and EI Compendex to September 2011. The searches were not restricted by language or publication status. The reference lists of relevant papers and reviews were also searched. SELECTION CRITERIA Randomised controlled trials, controlled before-after (CBA) studies and interrupted time series (ITS) of all types of interventions for preventing fatal and non-fatal injuries among workers at construction sites. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted data and assessed study quality. For ITS, we re-analysed the studies and used an initial effect, measured as the change in injury-rate in the year after the intervention, as well as a sustained effect, measured as the change in time trend before and after the intervention. MAIN RESULTS Thirteen studies, 12 ITS and one CBA study met the inclusion criteria. The ITS evaluated the effects of the introduction or change of regulations (N = 7), a safety campaign (N = 2), a drug-free workplace programme (N = 1), a training programme (N = 1), and safety inspections (N = 1) on fatal and non-fatal occupational injuries. One CBA study evaluated the introduction of occupational health services such as risk assessment and health surveillance.The overall risk of bias among the included studies was high as it was uncertain for the ITS studies whether the intervention was independent from other changes and thus could be regarded as the main reason of change in the outcome.The regulatory interventions at national or branch level showed a small but significant initial and sustained increase in fatal (effect sizes of 0.79; 95% confidence interval (CI) 0.00 to 1.58) and non-fatal injuries (effect size 0.23; 95% CI 0.03 to 0.43).The safety campaign intervention resulted in a decrease in injuries at the company level but an increase at the regional level. Training interventions, inspections or the introduction of occupational health services did not result in a significant reduction of non-fatal injuries in single studies.A multifaceted drug-free workplace programme at the company level reduced non-fatal injuries in the year following implementation by -7.6 per 100 person-years (95% CI -11.2 to -4.0) and in the years thereafter by -2.0 per 100 person-years per year (95% CI -3.5 to -0.5). AUTHORS' CONCLUSIONS The vast majority of technical, human and organisational interventions that are recommended by standard texts of safety, consultants and safety courses have not been adequately evaluated. There is no evidence that introducing regulations for reducing fatal and non-fatal injuries are effective as such. There is neither evidence that regionally oriented safety campaigns, training, inspections nor the introduction of occupational health services are effective at reducing non-fatal injuries in construction companies. There is low-quality evidence that company-oriented safety interventions such as a multifaceted safety campaign and a multifaceted drug workplace programme can reduce non-fatal injuries among construction workers. Additional strategies are needed to increase the compliance of employers and workers to the safety measures that are prescribed by regulation. Continuing company-oriented interventions among management and construction workers, such as a targeted safety campaign or a drug-free workplace programme, seem to have an effect in reducing injuries in the longer term.
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12
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Abstract
OBJECTIVE This study examines recent trends and patterns in fall fatalities in the U.S. construction industry to determine whether fatal falls among older workers are different from younger workers in this industry. BACKGROUND Falls are the leading cause of fatalities in the U.S. construction industry. Given the increasingly aging workforce in construction, it is important to assess the risk of falls among older construction workers. METHODS Fatality data were obtained from the Census of Fatal Occupational Injuries for the years 1992 through 2008. Denominators for death rates were estimated from the Current Population Survey. Stratified and multivariate analyses were performed to examine whether there are differences in fatal falls between older workers (> or = 55 years) and younger workers (16-54 years). Fatal falls in nonconstruction industries were excluded from this study. RESULTS Older workers had higher rates of fatal falls than younger workers; results were significant in 11 of 14 construction occupations. Regression analysis indicated that older decedents had a higher likelihood that work-related death was caused by a fall, after controlling for major demographic and employment factors (odds ratio = 1.50, confidence interval [1.30, 1.72]). Falls from roofs accounted for one third of construction fatal falls, but falls from ladders caused a larger proportion of deadly falls in older decedents than in younger decedents. CONCLUSION Older workers have a higher likelihood of dying from a fall. Roofs and ladders are particularly risky for older construction workers. APPLICATION As the construction workforce ages, there is an urgent need to enhance fall prevention efforts, provide work accommodations, and match work capabilities to job duties.
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Affiliation(s)
- Xiuwen Sue Dong
- CPWR-The Center for Construction Research and Training, Silver Spring, Maryland 20910, USA.
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Dong XS, Fujimoto A, Ringen K, Men Y. Fatal falls among Hispanic construction workers. ACCIDENT; ANALYSIS AND PREVENTION 2009; 41:1047-1052. [PMID: 19664444 DOI: 10.1016/j.aap.2009.06.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 06/02/2009] [Accepted: 06/13/2009] [Indexed: 05/28/2023]
Abstract
This study evaluated occupational deaths resulting from fall injuries among Hispanic construction workers using data from the Census of Fatal Occupational Injuries and the Current Population Survey. The demographics and characteristics of fatal falls among Hispanic workers were examined and compared with that of their white, non-Hispanic counterparts. The results show that fatal injuries among Hispanic construction workers were more likely to be caused by a fall than their white, non-Hispanic counterparts (OR=1.48, 95% CI: 1.05-2.10) after controlling for possible confounders. The rate of fatal falls for foreign-born Hispanic construction workers was 5.5 per 100,000 FTE, which is significantly higher than 4.1 per 100,000 FTE for Hispanic workers who were born in the U.S. (OR=1.36, 95% CI: 1.08-1.67). The disparities in fatal injuries from falls were found in age groups, job tenure, occupations, and types of construction projects. This study also found that about every two of three fatal falls in construction occurred in establishments with 10 or fewer employees. More prevention, intervention, and training measures must be applied to Hispanic workers, especially those who are new immigrants. OSHA enforcements should target small construction establishments in order to lower overall fatality rates, costs, and unnecessary losses of life.
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Affiliation(s)
- Xiuwen Sue Dong
- CPWR - The Center for Construction Research and Training, Silver Spring, MD 20910, United States.
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Kaskutas V, Dale AM, Nolan J, Patterson D, Lipscomb HJ, Evanoff B. Fall hazard control observed on residential construction sites. Am J Ind Med 2009; 52:491-9. [PMID: 19363784 DOI: 10.1002/ajim.20698] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Falls are a leading cause of mortality and morbidity in the construction industry. This study measured fall hazards at residential construction sites. METHODS Trained carpenters administered the St. Louis Audit of Fall Risks and interviewed carpenters. The prevalence of fall prevention practices meeting safety criteria was counted and correlations explored. RESULTS We identified a high prevalence of fall hazards at the 197 residential sites audited. Roof sheathing met safety criteria most consistently (81%) and truss setting least consistently (28%). Use of personal fall arrest and monitoring of unguarded floor openings were rare. Safer performance on several scales was correlated. Construction sites of large-sized contractors were generally safer than smaller contractors. Apprentice carpenters were less familiar with their employers' fall prevention plan than experienced workers. CONCLUSIONS Safety could be improved with consistent use of recognized fall prevention practices at residential construction sites.
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Affiliation(s)
- Vicki Kaskutas
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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15
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Dennerlein JT, Ronk CJ, Perry MJ. Portable ladder assessment tool development and validation-quantifying best practices in the field. SAFETY SCIENCE 2009; 47:636-639. [PMID: 20161250 PMCID: PMC2710809 DOI: 10.1016/j.ssci.2008.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Many causes for falls from ladders in construction are related to the user's activities; however, the extent to which users comply with ladder use best practices is unknown and has not been well quantified before. We developed and tested an audit tool that assesses compliance with best practices guidelines for portable ladder use designed for applications in the construction industry. Implemented on a hand-held computer, the assessment tool consisted of a series of checklists categorized in four groups; ladder condition, setup, moving on a ladder, and completing tasks from a ladder. For these four observational categories, the resulting tool contained 31 and 33 questions for step and extension ladders, respectively. Three individuals trained to use the tool scored a set of photographs and videos depicting 25 ladder conditions, 20 ladder setups, 10 users moving on ladders, and 13 users completing tasks from a ladder for a total of 78 observations. The assessment tool had good agreement across and within raters. For the three raters, agreement ranged from 79% to 97% across the questions. Within one subject, kappa coefficients for the intrarater reliability ranged from 0.67 to 0.91. The tool offers a practical method to quantify best practices associated with ladder use that can ultimately inform targeted intervention efforts.
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Affiliation(s)
- Jack T Dennerlein
- Department of Environmental Health, Harvard School of Public Health, Boston, MA USA
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16
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Kaskutas VK, Dale AM, Lipscomb HJ, Evanoff BA. Development of the St. Louis audit of fall risks at residential construction sites. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2008; 14:243-249. [PMID: 19043910 PMCID: PMC9022011 DOI: 10.1179/oeh.2008.14.4.243] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
We describe the development and pilot testing of the St. Louis Assessment of Fall Risks, a worksite audit to assess fall prevention safety practices on residential construction sites. Surveillance data and feedback from carpenters and safety instructors regarding work tasks associated with falls from heights were used to develop the audit instrument. The audit focuses on the framing process, including general safety climate/housekeeping, floor joist/sub-floor installation, walking surfaces/edges, wall openings, truss setting, roof sheathing, ladders, scaffolds, and personal fall arrest equipment. The audit was tested at sixteen residential construction sites, documenting excellent inter-rater reliability (kappa = 0.93). Results suggest that the audit has good face and content validity and is a reliable instrument for measuring fall safety risks at residential construction sites. It is practical, easy, and safe to administer, making it a potentially useful instrument for field research as well as regular safety monitoring by foremen and crew.
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Affiliation(s)
- Vicki K Kaskutas
- Program in Occupational Therapy, Washington University School of Medicine, Campus Box 8505, St. Louis, MO 63108, USA.
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17
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The effectiveness of interventions for preventing injuries in the construction industry: a systematic review. Am J Prev Med 2008; 35:77-85. [PMID: 18482821 DOI: 10.1016/j.amepre.2008.03.030] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Revised: 01/23/2008] [Accepted: 03/11/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND Occupational injury rates among construction workers are the highest among the major industries. A number of injury-prevention interventions have been proposed, yet the effectiveness of these is uncertain. Thus a systematic review evaluating the effectiveness of interventions for preventing occupational injuries among construction workers was conducted. METHODS Seven databases were searched, from the earliest available dates through June 2006, for published findings of injury prevention in construction studies. Acceptable study designs included RCTs; controlled before-after studies; and interrupted time series (ITS). Effect sizes of similar interventions were pooled into a meta-analysis in January 2007. RESULTS Of 7522 titles found, four ITS studies and one controlled ITS study met the inclusion criteria. The overall methodologic quality was low. No indications of publication bias were found. Findings from a safety-campaign study and a drug-free-workplace study indicated that both interventions significantly reduced the level and the trend of injuries. Three studies that evaluated legislation did not decrease the level (ES 0.69; 95% CI=-1.70, 3.09) and made the downward trend (ES 0.28; 95% CI=0.05, 0.51) of injuries less favorable. CONCLUSIONS Limited evidence was found for the effectiveness of a multifaceted safety campaign and a multifaceted drug program, but no evidence was found that legislation is effective to prevent nonfatal or fatal injuries in the construction industry.
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van der Molen HF, Lehtola MM, Lappalainen J, Hoonakker PLT, Hsiao H, Haslam R, Hale AR, Verbeek J. Interventions for preventing injuries in the construction industry. Cochrane Database Syst Rev 2007:CD006251. [PMID: 17943901 DOI: 10.1002/14651858.cd006251.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Construction workers are frequently exposed to various types of injury-inducing hazards. A number of injury prevention interventions have been proposed, yet the effectiveness of these is uncertain. OBJECTIVES To assess the effects of interventions for preventing injuries among workers at construction sites. SEARCH STRATEGY We searched the Cochrane Injuries Group's specialised register, CENTRAL, MEDLINE, EMBASE, PsycINFO, OSH-ROM (including NIOSHTIC and HSELINE), EI Compendex. The reference lists of relevant papers, reviews and websites were also searched. The searches were not restricted by language or publication status. All databases were searched up to June 2006. SELECTION CRITERIA Randomized controlled trials, controlled before-after studies and interrupted time series of all types of interventions for preventing fatal and non-fatal injuries among workers at construction sites. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed study quality. For interrupted time series, we reanalysed the studies and used an initial effect, measured as the change in injury-rate in the year after the intervention, as well as a sustained effect, measured as the change in time trend before and after the intervention. MAIN RESULTS Five interrupted time series studies met the inclusion criteria. Three studies evaluated the effect of regulations, one evaluated a safety campaign, and one a drug-free workplace program on fatal or non-fatal injuries compared to no drug-free workplace program. The overall methodological quality was low. The regulatory interventions did not show either an initial or sustained effect on fatal or non-fatal injuries, with effect sizes of 0.69 (95% confidence interval (CI) -1.70 to 3.09) and 0.28 (95% CI 0.05 to 0.51). The safety campaign did have an initial and sustained effect, reducing non-fatal injuries with effect sizes of -1.82 (95% CI -2.90 to -0.75) and -1.30 (95% CI -1.79 to -0.80) respectively. The drug-free workplace program did have an initial and sustained effect, reducing non-fatal injuries compared to no intervention, with effect sizes of -6.74 (95% CI -10.02 to -3.54) and -1.76 (95% CI -3.11 to -0.41) respectively. AUTHORS' CONCLUSIONS The vast majority of technical, human factors and organisational interventions which are recommended by standard texts of safety, consultants and safety courses, have not been adequately evaluated. There is no evidence that regulations for reducing fatal and non-fatal injuries are effective. There is limited evidence that a multifaceted safety campaign and a multifaceted drug program can reduce non-fatal injuries in the construction industry.
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Affiliation(s)
- H F van der Molen
- Coronel Institute, Arbouw, P.O. Box 8114, Amsterdam, Netherlands, 1005.
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van der Molen HF, Lehtola MM, Lappalainen J, Hoonakker PLT, Hsiao H, Haslam R, Hale AR, Verbeek J. Interventions for preventing injuries in the construction industry. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2006. [DOI: 10.1002/14651858.cd006251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Lentz TJ, Wenzl TB. Small businesses with high fatality rates: assessment of hazards and their prevention. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2006; 3:D8-14. [PMID: 16396827 DOI: 10.1080/15459620500496715] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- T J Lentz
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Lipscomb HJ, Dement JM, Behlman R. Direct costs and patterns of injuries among residential carpenters, 1995-2000. J Occup Environ Med 2003; 45:875-80. [PMID: 12915789 DOI: 10.1097/01.jom.0000083035.56116.46] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Workers' compensation records for residential contractors were combined with hours worked provided by the union to examine injury rates and costs among union carpenters between 1995 and 2000. Brief text descriptions were reviewed to describe more costly injuries. Costs per hour worked decreased over 6 years, largely because of declines in rates and mean costs for falls from elevations. Higher costs were associated with injuries from falls, raising framed walls, setting steel I-beams, and pneumatic nail guns. Prevention priorities should include fall protection; methods to safely set steel beams, raise and brace framed walls; and steps to prevent injuries from pneumatic tools. Cost data provide an important measure that is useful in focusing prevention; combined with even limited descriptions of injuries target areas for intervention can be identified based on frequency or severity.
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Affiliation(s)
- Hester J Lipscomb
- Division of Occupational and Environmental Medicine, Duke University Medical Center, Durham, NC 27705, USA.
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Courtney TK, Matz S, Webster BS. Disabling occupational injury in the US construction industry, 1996. J Occup Environ Med 2002; 44:1161-8. [PMID: 12500458 DOI: 10.1097/00043764-200212000-00010] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In 1996 the US construction industry comprised 5.4% of the annual US employment but accounted for 7.8% of nonfatal occupational injuries and illness and 9.7% of cases involving at least a day away from work. Information in the published literature on the disability arising from construction injuries is limited. The construction claims experience (n = 35,790) of a large workers' compensation insurer with national coverage was examined. The leading types and sources of disabling occupational morbidity in 1996 in the US construction industry were identified. Disability duration was calculated from indemnity payments data using previously published methods. The average disability duration for an injured construction worker was 46 days with a median of 0 days. The most frequently occurring conditions were low back pain (14.8%), foreign body eye injuries (8.5%), and finger lacerations (4.8%). Back pain also accounted for the greatest percentage of construction claim costs (21.3%) and disability days (25.5%). However, the conditions with the longest disability durations were sudden-onset injuries, including fractures of the ankle (median = 55 days), foot (42 days), and wrist (38 days). Same-level and elevated falls were the principal exposures for fractures of the wrist and ankle, whereas elevated falls and struck by incidents accounted for the majority of foot fractures. Manual materials handling activities were most often associated with low back pain disability. The results suggest that these most disabling injuries can be addressed by increasing primary prevention resources in slips and falls and exposures related to injuries of sudden-onset as well as in reducing manual materials handling and other exposures associated with more gradual-onset injuries.
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Affiliation(s)
- Theodore K Courtney
- Liberty Mutual Research Center for Safety and Health, 71 Frankland Road, Hopkinton, MA 01748, USA.
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