Return to Work!

Returning a recovering employee to work should be the focus of all workplace accident programs. Even prior to an accident occurring, you, as the employer, should be thinking of transitional light duty assignments.

When identifying light duty assignments it is important to keep in mind that the transitional job needs to be of value to your business. You want the employee to be involved with the understanding being that the goal is to return the employee to their own regular work assignment. 

The employee should also understand that he will have time made available to keep all medical appointments and treatment directives. Again, with the understanding, that he will be returning to his own regular job duties at the conclusion of treatment and that the light duty assignment is temporary.

There are always those jobs or tasks that go undone because of time or neglect. Those jobs might be perfect for the beginning of a light duty assignment. An example might be to have the employee take part in the review of your safety program. What could be done to eliminate the risk that caused the accident that occurred. They might have a great idea to reduce accidents in the future. You might also have the employee prepare and share safety training, again coming from the perspective of “pay attention, I got hurt, you can too!”

You might consider light duty tasks like checking the contents of the company first aid kits. That is listing and ordering the contents of the first aid kit that have been used, in both the office and in company vehicles. This sometimes goes undone and will help you and your employees remain prepared for accidents and emergencies.

Take the time to list out tasks like this. I think you will be surprised at how many you come up with. Involve your employees. After all, they are the ones who will be doing the light duty assignments when needed. You might find that they have a greater insight into what needs to be done on a daily basis.

Involving your employees also reminds them of how important they are in the process and to you, as members of your team. It is often said that it is difficult to find good employees and more difficult to keep them. By offering a light duty program you increase the chances of keeping a good employee.

And if you are saying, “Well, they’re not such a good employee, why should I bother?” Then you need to check your hiring practices. You cannot discriminate in your light duty program. If you are anticipating problems you will need to separate personnel issues from workers’ compensation issues. The employee is still expected to comply with all aspects of your personnel program. Just because they were involved in an accident does not give them the right to be a bad employee. As with any personnel issue, documentation is always the key.

Setting up and offering a light duty program not only assists in keeping valuable employees, but will also help you keep claim costs down. When an employee returns to a light duty assignment, the weekly maintenance allowance stops. This is the part of any workers’ compensation claim that can get out of control and can easily be the biggest portion of any claim. By offering a light duty program it becomes much easier to maintain control of that expense and reduce anticipated claim costs. 

Being a member of your self insured group assistance is available to help you better understand transitional light duty programs. Pro Group Management believes that any and all members can benefit from a light duty program.

If you have questions or are interested in setting up a transitional work program contact Craig Cozair of Pro Group Management at (800) 859-3177.

AHA Renews Call for Increasing CPR Training

A unified effort by the public, educators and policymakers is needed to reduce deaths from sudden cardiac arrest by increasing the use and effectiveness of cardiopulmonary resuscitation (CPR), according to a statement from the American Heart Association.  The statement, “Reducing barriers for implementation of bystander-initiated cardiopulmonary resuscitation,” appears online in Circulation:  Journal of the American Heart Association.

“Bystander cardiopulmonary resuscitation rates are woefully inadequate, resulting in an enormous missed opportunity to save lives for cardiac arrest,” said Benjamin S. Abella, M.D., M.Phil., clinical research director for the Center for Resuscitation Science at the University of Pennsylvania in Philadelphia, and lead author of the statement.

Studies indicate that in many communities only 15 percent to 30 percent of out-of-hospital cardiac arrest victims receive bystander CPR before emergency medical services (EMS) personnel arrive at the scene.  Considering that cardiac arrest survival falls an estimated seven percent to 10 percent for every minute without CPR, the low rate of bystander CPR has a big impact on outcomes, he explained. 

Approximately 166,200 out-of-hospital sudden cardiac arrest deaths occur annually in the United States.  Sudden cardiac arrest often results from an irregular heartbeat called ventricular fibrillation (VF) which causes the heart to quiver so that it cannot generate blood flow.  Treatment of VF requires CPR to keep blood moving through the body until the patient’s heart can be shocked to terminate the VF and allow the heart’s pacemaker cells to establish a normal rhythm, AHA officials said. 

In the last decade, automated external defibrillators (AEDs), portable defibrillation machines, have become increasingly common in public buildings such as casinos, airports and schools.  However, Abella said defibrillation is only one of the four links in the Chain of survival, a sequence of four actions that must occur quickly to help assure the best chances of survival. 

The Chain of Survival requires:

• Early recognition of the emergency and phoning 911 for EMS
• Early bystander CPR
• Early delivery of a shock via defibrillator if indicated
• Early advanced life support and post-resuscitation care delivered by healthcare providers.

Quick initiation of CPR, as well as providing high quality CPR, is crucial to survival,” Abella said.  “What’s needed is a two-pronged approach: first, substantially increase the number of bystanders trained in CPR who then provide CPR during an actual emergency and second, improve the quality of training and actual CPR performance through measures of its effectiveness.”

The statement identifies specific potential barriers to improving U.S. cardiac arrest survival rates including: fear of infectious disease, fear of litigation and fear of poor performance, all of which Abella said could be overcome with adequate education, training and public awareness. 

Rescuer Breaths Not Required, AHA Says in New Scientific Statement

Chest compressions alone (Hands-Only Cardiopulmonary Resuscitation) can help an adult who suddenly collapses if administered by rescuers who are untrained in conventional CPR or unsure of their ability to give compressions and breaths, according to an American heart Association scientific statement dated April 1 that is available by clicking here. The statement is from the association’s Emergency Cardiovascular Care Committee and was published in circulation, the AHA journal.

“Bystanders who witness the sudden collapse of an adult should immediately call 9-1-1 and start what we call Hands-Only CPR. This involves providing high-quality chest compressions by pushing hard and fast in the middle of the victim’s chest, without stopping until emergency medical services responders arrive,” Dr. Michael Sayre, chair of the statement writing committee and associate professor in the Ohio State University Department of Emergency Medicine, said in a release posted on AHA’s Website.

About 310,000 adults in the United States die each year from sudden cardiac arrest. Immediate, effective CPR from a bystander is needed or the person’s chance of surviving decreased by 7 – 10 percent per minute. AHA said on average, fewer than one-third of out-of-hospital cardiac arrest victims receive bystander CPR, which can double or triple a person’s chance of surviving cardiac arrest. “Many times, people nearby don’t help because they’re afraid that they will hurt the victim and aren’t confident in what they’re doing,” Sayre said. “We want people to know that they can help many victims just by calling 9-1-1 and doing chest compressions. Don’t be afraid to try it. We are sure many lives will be saved if the public does Hands-Only CPR for adult victims of sudden cardiac arrest.”

The new recommendation is an update to the 2005 American Heart Association Guidelines for CPR and ECC, which previously recommended that lay rescuers use compression-only CPR only if they were unable or unwilling to provide breaths. AHA says conventional CPR is still an important skill to learn, and medical professionals should perform conventional CPR in the course of their professional duties. These new recommendations apply only to bystanders who come to the aid of adult cardiac arrest victims outside a hospital setting.

Council Supports AHA’s Advisory Statement on Hands-only CPR

In the journal Circulation released this week, the American Heart Association released an advisory statement to encourage use of hands-only CPR by bystanders who are not confident they can perform conventional CPR.

The statement clarifies and elaborates upon Dallas-based AHA’s “2005 Guidelines for CPR and Emergency Cardiovascular Care,” affecting bystanders who see an adult collapse in a nonhospital setting.  It does not apply to adults whose sudden cardiac arrest is not witnessed, victims of drowning, infants and children.

The statement also notes that trained bystanders who can perform conventional CPR with minimal interruption to chest compressions may do so, or can perform hands-only CPR.  

National Safety Council First Aid, CPR and AED courses follow AHA guidelines, and the council’s current CPR materials are technically correct.  The council will continue to teach conventional CPR and incorporate hands-only techniques into adult CPR instruction for lay rescuers. 

At Home, Work, or Play, It’s Hot

Sweat or no sweat, heat or no heat, not wearing protective clothing when performing a job with a known hazard simply because of comfort is unacceptable.

High humidity and high temperature are the key ingredients for a recipe of disaster if the body is not properly prepared to handle a hot environment.  Whether exposure is a result of regular employment (such as in a foundry, steel mill, or other heated environment), fluctuating seasonal temperature changes (heat waves during the summer), or abruptly changing environments (such as vacationing or business travel), heat stress conditions can have a serious impact on one’s health and well-being. 

Exposure to excessive heat can cause illness, disability, and death.  Every year, employees become “statistics” from exposure to heat.  Even people who may think they are immune to heat stress can, over time and with the aging process, develop heat stress conditions.  Here’s how it happens…

The body attempts to maintain a 98.6 degrees F internal temperature.  When the internal temperature starts to rise (approximately at 99 degrees F), the body’s cooling mechanism reacts.  Heated blood causes the blood vessels to dilate closer to the surface of the skin, activating the sweat glands located in the dermal skin layer.  The sweat glands secrete fluids containing electrolytes (positive charged sodium, potassium, magnesium, and others) and water onto the surface of the skin, where the fluid can evaporate into the air. 

The warmer the body gets (up to 103 degrees F), the more the body sweats.  This causes a loss in body fluids within the cells, and dehydration begins.  Just through sweating, a person can lose up to three gallons of fluids each day.  If the fluids and electrolytes are not replaced and the body temperature is not controlled, heat-related signs and symptoms become noticeable. 

Body temperature rises from performing work.  When warmer/hot temperatures and increased humidity are also introduced to the body as part of the work environment, temperatures can rise faster than the body can adjust.  Because potassium and magnesium contribute to muscle performance and sodium (salt) helps maintain balanced water levels, loss of these electrolytes creates chemical imbalances, causing the body to adversely react.  A number of heat-stress conditions can develop as a result of these chemical changes.  These conditions may include heat rash, heat cramps, fainting (or syncope), transient heat fatigue, heat exhaustion, and heat stroke. 

How Heat Affects Performance

Some people are more sensitive to having a heat-related illness than others.  These include infant and children up to age four (inability to sweat), senior adults (dehydration, poor circulation), people who are overweight (increased heart stress, increased heat generation), certain types of prescription medications (increases susceptibility), those suffering from heart disease or poor circulation (increased physical signs and symptoms), and those using alcohol. 

Certain medications require a person to keep exposure to sun, as well as exposure to external heat, to a minimum.  It may require telling the employer if or when high-heat conditions will be encountered. 

Heart disease and poor circulation cause problems when blood vessels dilate in an attempt to rid the body of extra heat, leading to a heart attack or insufficient blood flow (working like the radiator in a vehicle) to circulate the increased heat in the body. 

The use of alcohol is a serious contributor to heat stress.  Alcohol is a central nervous system depressant, meaning it slows the circulation and breathing, which affects the body’s ability to remove excess or building heat.  Alcohol is also a dehydrator (why do you think you go the bathroom more often when drinking alcohol?), causing the cells to lose water, and it does not replenish the body with needed water after already losing up to three  gallons from sweating while at work.

In other words, going home for a “cold one” or two, or a six-pack, may look fun on television commercials, but a person working in a high-heat environment will compound the problem going back to work tomorrow because the alcohol just sucked out even more water from the cells and did nothing to replace what was already lost through the shift.

Preparing for Heat Stress Conditions
The human body can adjust to heat as long as enough time is given to do so.  The body can acclimatize to increased temperatures within five to seven working days but cannot do so immediately.  A person who regularly works in high-heat environments can stay acclimatized from regular exposures as long as the right fluids and foods are consumed to keep the body in balance. 

But even a person working in this type of environment all of the time can become susceptible to heat-related illnesses because of extended time away from work, such as vacations, temporary transfers to other departments, or other “absentee” schedules.  It will take another five to seven days to get back to pre-absence levels before 100 percent performance can again be achieved.

Sudden changes in ambient temperatures that fluctuate from day to day, such as seasonal transitions, can play havoc with the body’s adjustment to heat. 

Supervisors need to help employees acclimatize by providing short, frequent breaks with water

and electrolyte-replacement drinks, controlling the heavier amount of physical work during the cooler hours of the day whenever possible, and frequently checking and observing employees for physical or mental changes in performance on the job. 

To help in the adjustment, a person can slightly increase salt intake during meals, increase water intake (at least 64 ounces or more each day), and wear lighter-colored, lighter-weight clothing whenever possible.  This does not mean slacking on personal protective equipment.  Sweat or no sweat, heat or no heat, not wearing protective clothing when performing a job with a known hazard simply because of comfort is just not acceptable.  Knowing extra clothing is required to protect a person on the job must be considered and planned for to safely and properly adjust to the heat.  Removing it is not an option!

Heat Stress Conditions:  Overview
Heat rash occurs as a result of profuse sweating that is not successfully wicked away from the body for prolonged periods of time.  It occurs most often where the body retains moisture:  the neck, the upper chest, elbow creases, and groin.  To prevent and treat heat rash, use absorbing powder, stay cool whenever possible, and take a second pair of clothing  that is dry to replace sweat-soaked clothing, if possible. 

Heat cramps are muscle pain or spasms that result from loss of electrolytes during the sweating process.  They generally affect the muscles that are involved in the most strenuous activity:  abdomen, arms, legs.  Rarely life-threatening unless the spasm occurs when the person is exposed to potential hazards, treatment involves stopping the activity, cooling down for a few minutes, drinking water, and switching job assignments for a couple of hours.  If the pain or spasm is not relieved within an hour, medical attention may be needed.

Fainting and Transient Heat Fatigue (THF) can be dangerous – not from the events themselves, but from how they adversely affect a person’s performance when they occur.  Fainting can create secondary serious injuries, and THF may prevent a person from functioning with the strength or the mental judgment necessary to remain alert on the job.  Potential for these events will reduce as the body becomes more acclimatized to the heat conditions.

Heat stroke is caused when a person’s internal core temperature exceeds 104 degrees F and brain cells are affected.  The person appears flushed or red, very dry (no longer sweating), and the skin is hot to the touch, like someone with a high fever.  In advanced stages, the person may already be unconscious.  Heat stroke is truly a medical emergency.  The patient must be immediately and continually cooled in as quick and effective a means as possible.  Medical transport is required and cooling must be continued, even after arriving at the hospital. 

Senate hearing examines worker safety

Safety laws are “virtually meaningless” to many large corporations because any penalties those businesses incur are minuscule compared with their profits, Eric Frumin, Health and Safety Coordinator for Washington-based labor union Change to Win, testified this week at a Senate subcommittee hearing on workplace safety. 

The April 1 hearing examined various worker safety issues, including employer underreporting of injuries and illnesses, voluntary compliance versus enforcement, and employers who repeatedly fail to comply with OSHA rules.

Sen. Patty Murray, D-WA, chairs the Senate Health, Education, Labor and Pensions Committee’s Subcommittee on Employment and Workplace Safety.  She called the hearing in part to gather testimony in support of the stalled Protecting America’s Workers Act (S. 1244). 

Introduced in 2007 by Sen. Edward Kennedy, D-MA, the legislation would amend the Occupational Safety and Health Act of 1970 to substantially raise civil penalties for employers and would allow the federal government to bring felony charges against employers who commit willful violations. 

At the hearing, former OSHA Administrator Gerald F. Scannell chastised U.S. business executives for a lack of leadership in ensuring safe workplaces. 

Simply complying with OSHA rules will not guarantee a culture of safety and keep workers from being killed or injured on the job, Scannell said.  “It must start at the top as with everything else with a business – the CEO,” he said. 

Scannell, who also is a former President and CEO of the National Safety Council, said holding CEO’s criminally responsible for ensuring safety might be the best way to get their attention.  OSHA officials did not testify at the hearing.