Katherine L. Hunting

Occupational Injuries among Emergency Medical Services Personnel

Background. Emergency medical services (EMS) personnel treat 22 million patients a year in the United States, yet little is known of their injury risks. Objectives. To describe the epidemiology of occupational injuries among EMS personnel, calculate injury rates, andcompare the findings with those for other occupational groups. Methods. This was a retrospective review of injury records kept by two urban agencies. The agencies submitted all 617 case reports for three periods between January 1, 1998, andJuly 15, 2002. The agency personnel worked an estimated 2,829,906 hours during the study periods. Cases were coded according to U.S. Department of Labor (DOL) criteria. Results. Four hundred eighty-nine cases met the DOL inclusion criteria. The overall injury rate was 34.6 per 100 full-time (FT) workers per year (95% confidence interval [CI] 31.5–37.6). “Sprains, strains, andtears” was the leading category of injury; the back was the body part most often injured. Of the 489 cases, 277 (57%) resulted in lost workdays, resulting in a rate of 19.6 (95% CI 17.3–21.9) per 100 FT workers; in comparison, the relative risks for EMS workers were 1.5 (95% CI 1.35–1.72) compared with firefighters, 5.8 (95% CI 5.12–6.49) compared with health services personnel, and7.0 (95% CI 6.22–7.87) compared with the national average. Conclusions. The injury rates for EMS workers are higher than rates reported by DOL for any industry in 2000. Funding andadditional research are critical to further defining the high risks to EMS workers anddeveloping interventions to mitigate this serious problem.

Surveillance of construction worker injuries through an urban emergency department

To learn more about the causes of nonfatal construction worker injuries, and to identify injury cases for further work-site investigations or prevention programs, an emergency department-based surveillance program was established. Construction workers with work-related injuries or illnesses were identified by reviewing the medical records of all patients treated at the George Washington University Emergency Department between November 1, 1990 and November 31, 1992. Information regarding the worker, the injury, and the injury circumstances were abstracted from medical records. Information was obtained on 592 injured construction workers from numerous trades. Lacerations were the most commonly treated injuries among these workers, followed by strains and sprains, contusions, and eye injuries. Injuries were most commonly caused by sharp objects (n = 155, 26%), falls (n = 106, 18%), and falling objects (n = 70, 12%). Thirty-five percent of injuries were to the hands, wrists, or fingers. Among the twenty-eight injuries severe enough to require hospital admission, eighteen (64%) were caused by falls. Laborers and Hispanic workers were overrepresented among these severe cases. Emergency Department records were a useful surveillance tool for the initial identification and description of work-related injuries. Although E codes were not that useful for formulating prevention strategies, detailed review of injury circumstances from Emergency Department records was valuable and has helped to establish priorities for prevention activities.

The epidemiology of occupational heat exposure in the United States: a review of the literature and assessment of research needs in a changing climate.

In recent years, the United States has experienced record-breaking summer heat. Climate change models forecast increasing US temperatures and more frequent heat wave events in the coming years. Exposure to environmental heat is a significant, but overlooked, workplace hazard that has not been well-characterized or studied. The working population is diverse; job function, age, fitness level, and risk factors to heat-related illnesses vary. Yet few studies have examined or characterized the incidence of occupational heat-related morbidity and mortality. There are no federal regulatory standards to protect workers from environmental heat exposure. With climate change as a driver for adaptation and prevention of heat disorders, crafting policy to characterize and prevent occupational heat stress for both indoor and outdoor workers is increasingly sensible, practical, and imperative.

Haematopoietic cancer mortality among vehicle mechanics.

OBJECTIVE AND METHODS--This historical cohort study investigated causes of death among car and mobile equipment mechanics in the District of Columbias Department of Public Works. Men who were employed for at least one year between 1977 and 1989 were eligible for inclusion in the cohort; follow up was up to the end of 1991. Three cases of leukaemia (index cases) had been reported among these workers before the inception of this study. This research was undertaken to estimate the relative risk of haematological cancer among mechanics working for the District of Columbia. RESULTS--Among the 335 male fleet maintenance workers, the all cause standardised mortality ratio (SMR) was 0.50 (33 observed deaths, 95% confidence interval (95% CI) 0.35-0.70), and the all cancer SMR was 0.55 (nine deaths, 95% CI 0.25-1.05). Three deaths from lymphatic and haematopoietic cancer were observed; the SMR was 3.63 (95% CI 0.75-10.63). In the subgroup with highest potential for exposure to fuels and solvents, the SMR for leukaemia and aleukaemia was 9.26 (two deaths, 95% CI 1.12-33.43), and the SMR for other lymphatic and haematopoietic neoplasms was 2.57 (one death from malignant lymphoma, 95% CI 0.06-14.27). All three lymphatic and haematopoietic cancer deaths were among car and mobile equipment mechanics (one was an index case). The two additional index cases were a fourth mechanic who died of leukaemia in 1992, after mortality follow up ended, and a fifth mechanic who was diagnosed with leukaemia in 1988 and is still alive. CONCLUSION--Many garage mechanics in this cohort regularly used petrol to clean parts and to wash their hands; some workers would occasionally siphon petrol by mouth. Benzene, a recognised cause of haematological cancer, is a component of petrol. Previous research indicates that garage mechanics may be at risk of leukaemia and other haematological cancers, presumably due to exposure to petrol; this study supports those findings.

Impact of musculoskeletal and medical conditions on disability retirement-a longitudinal study among construction roofers.

BACKGROUND To assess the intersection of work demands, chronic medical and musculoskeletal conditions, aging, and disability, we initiated a longitudinal study of construction roofers who were current union members between the ages of 40 and 59. METHODS Participants were asked about the presence of medical conditions and musculoskeletal disorders; the Work Limitations Questionnaire, the SF-12, and other validated assessments of social and economic impact of injury were included. RESULTS Factors at baseline that predicted leaving for a health-related reason were older age, lower physical functioning, work limitations, and having missed work. Those who left roofing for a health-related reason were much more likely to have a lower economic score at the 1 year interview. CONCLUSIONS Medical and musculoskeletal conditions are strongly associated with work limitation, missed work, and reduced physical functioning; these factors are also associated with premature departure from the workforce.

Characterizing occupational heat-related mortality in the United States, 2000-2010: an analysis using the Census of Fatal Occupational Injuries database.

BACKGROUND Occupational heat-related mortality is not well studied and risk factors remain largely unknown. This paper describes the epidemiological characteristics of heat-related deaths among workers in the US 2000-2010. METHODS Fatality data were obtained at the Bureau of Labor Statistics from the confidential on-site Census of Fatal Occupational Injuries database. Fatality rates and risk ratios with 95% confidence intervals were calculated by year, sex, age group, ethnicity, race, state, and industry. RESULTS Between 2000 and 2010, 359 occupational heat-related deaths were identified in the U.S., for a yearly average fatality rate of 0.22 per 1 million workers. Highest rates were found among Hispanics, men, the agriculture and construction industries, the state of Mississippi, and very small establishments. CONCLUSIONS This study provides the first comprehensive national profile of heat-related deaths in the U.S. workplace. Prevention efforts should be directed at small businesses and at industries and individuals with the highest risk.

Occupational exposure to dust and lung disease among sheet metal workers

A previous large medical survey of active and retired sheet metal workers with 20 or more years in the trade indicated an unexpectedly high prevalence of obstructive pulmonary disease among both smokers and non-smokers. This study utilised interviews with a cross section of the previously surveyed group to explore occupational risk factors for lung disease. Four hundred and seven workers were selected from the previously surveyed group on the basis of their potential for exposure to fibreglass and asbestos. Selection was independent of health state, and excluded welders. A detailed history of occupational exposure was obtained by telephone interview for 333 of these workers. Exposure data were analysed in relation to previously collected data on chronic bronchitis, obstructive lung disease, and personal characteristics. Assessment of the effects of exposure to fibreglass as distinct from the effects of exposure to asbestos has been difficult in previous studies of construction workers. The experienced workers studied here have performed a diversity of jobs involving exposure to many different types of materials, and this enabled exposure to each dust to be evaluated separately. The risk of chronic bronchitis increased sharply by pack-years of cigarettes smoked; current smokers had a double risk compared with those who had never smoked or had stopped smoking. The occurrence of chronic bronchitis also increased with increasing duration of exposure to asbestos. Workers with a history of high intensity exposure to fibreglass had a more than doubled risk of chronic bronchitis. Obstructive lung disease, defined by results of pulmonary function tests at the medical survey, was also related to both smoking and occupational risk factors. Number of pack years smoked was the strongest predictor of obstructive lung disease. Duration of direct and indirect exposure to welding fume was also a positive predictor of obstructive lung disease. Duration of exposure to asbestos was significantly associated with obstructive lung disease but the dose-response relation was inconsistent, especially for those with higher pack-years of smoking exposure. Exposure to fibreglass was not a risk factor for obstructive lung disease.

Fatalities in the landscape and horticultural services industry, 1992–2001

BACKGROUND Although landscape and horticultural services workers have high injury and illness rates, little is known about fatalities in this industry. METHODS Census of Fatal Occupational Injuries and Current Population Survey data were analyzed to determine fatality rates and causes of landscaping deaths from 1992 to 2001. RESULTS There were 1,101 fatalities during the 10-year period and the average fatality rate was 13.50 deaths per 100,000 full-time employees. In 2001, the landscaping fatality rate was 3.33 (95% CI 2.84-3.91) times the all industry rate. The leading causes of death were transportation incidents (27%), contact with objects or equipment (27%), falls (24%), exposure to harmful substances and environments (18%), and assaults and violent acts (4%). The fatality rate for African American landscapers was 1.51 (95% CI 1.25-1.83) times the rate for white workers. Fatalities were also common among self-employed, small business, and young landscapers. CONCLUSIONS Landscaping workers are at increased risk of fatal injury. Further research is needed to characterize industry hazards.

Surveillance of Construction Worker Injuries: The Utility of Trade-Specific Analysis

Construction is a dangerous industry, with high rates of both fatal and nonfatal injuries. To learn more about the causes of nonfatal construction worker injuries, and to identify injury cases for further work site-based investigations or prevention programs, we established an emergency department-based surveillance program in November 1990. This article describes circumstances of injury, diagnoses, and demographic characteristics of injured construction workers for 2,791 cases identified through mid-August, 1997. Lacerations and strains and sprains were the most frequent diagnoses; cutting and piercing objects were the leading causes of injury among all construction workers, followed by falls and overexertion. Because of the variety of work performed in this industry, more detailed injury descriptions, by trade, are most useful for thinking about injury prevention. To illustrate this, we profile injury patterns among workers from four specific trades: carpenters, electricians, plumbers, and ironworkers. Areas of concern highlighted by the trade-specific analyses include eye injuries among plumbers; falls from ladders among electricians and plumbers; slips, trips, and falls on the same level among ironworkers; electrical exposure among electricians; and, amputations among carpenters.

Occupational sunlight exposure and risk of renal cell carcinoma.

Recent findings indicate that vitamin D obtained from ultraviolet (UV) exposure may reduce the risk of several different cancers. Vitamin D is metabolized to its active form within the kidney, which is the major organ for vitamin D metabolism and activity. Because both the incidence of renal cell carcinoma (RCC) and the prevalence of vitamin D deficiency have increased over the past few decades, in the current study, the authors explored whether occupational UV exposure was associated with RCC risk.