Properly Designed Early Intervention: A Worker’s Compensation Speed Bump Curt DeWeese and Kevin Hollingshead Dec. 6, 2018 3-4 PM
Agenda • Introductions • Objectives • Background on MSD’s at DB Schenker • Strategies Implemented • Results • Questions
Objectives • Identify an early intervention (EI) program’s structure and components • Review OSHA allowable first aid care and what care constitutes a recordable injury • Determine an EI program’s impact and benefits
DB Schenker Background • Locations and services • Employees • Shifts • Injury History
Atlas IPS Background • Team members
Atlas IPS Approach • Philosophy – People in discomfort need to talk to people-EI – Correcting stressors is a key component- Ergo – Using either approach in a vacuum misses opportunity
Traditional Paradigm
Early Intervention Paradigm Recordable Injury Pain & Dysfunction Discomfort Root Causes
Early Intervention Paradigm Recordable Injury Pain & Dysfunction Discomfort Root Causes
Early Intervention Paradigm Recordable Injury Pain & Dysfunction Discomfor t Root Causes
Signs & Symptoms OSHA speaks to Signs & Symptoms of an Injury or Illness
Symptoms of Injury • Symptoms of an injury or illness are information transferred by the injured person to the care provider (e.g. what he or she says to the care provider). • " My knee feels unstable ." • " My wrist hurts; it is painful when I move it ." • " I have tingling in my thumb and index finger. “ • “ My arm feels tired.” • “My back is fatigued at the end of the day.” • There is an increased awareness of that body area
Signs of Injury • Signs of a musculoskeletal injury or illness are indications the provider of care can sense when attending to an injured person (e.g. the things that the provider can see, hear and/or feel). Joint pain Tenderness at a specific point Swelling or warmth Bruising Reduced range of motion Comparative weakness (right vs. left) Joint instability testing Neurologic examination Special tests associated with body part (i.e., Tinel Sign, Phalen Sign, Finkelstein Test)
The Continuum Tired Signs Fatigued Heaviness & Soreness Symptoms Ache Twinge Discomfort Throb Distress Pain
Medical Treatment vs. First Aid Per OSHA • What is the definition of medical treatment? "Medical treatment" means the management and care of a patient to combat disease or disorder. For the purposes of Part 1904, medical treatment does not include:
Medical Treatment vs. First Aid For the purposes of Part 1904, medical treatment does not include: 1904.7(b)(5)(i)(A) o Visits to a physician or other licensed health care professional solely for observation or counseling; 1904.7(b)(5)(i)(B) o The conduct of diagnostic procedures, such as x-rays and blood tests, including the administration of prescription medications used solely for diagnostic purposes ( e.g. , eye drops to dilate pupils); or 1904.7(b)(5)(i)(C) o "First Aid" as defined in paragraph (b)(5)(ii) of this section.
OSHA on First Aid "First Aid" as defined in paragraph (b)(5)(ii) of this section 1904.7(b)(5)(ii)(A) o Using a non-prescription medication at nonprescription strength (for medications available in both prescription and non-prescription form, a recommendation by a physician or other licensed health care professional to use a non-prescription medication at prescription strength is considered medical treatment for recordkeeping purposes); 1904.7(b)(5)(ii)(B) o Administering tetanus immunizations (other immunizations, such as Hepatitis B vaccine or rabies vaccine, are considered medical treatment);
OSHA on First Aid "First Aid" as defined in paragraph (b)(5)(ii) of this section 1904.7(b)(5)(ii)(C) o Cleaning, flushing or soaking wounds on the surface of the skin; 1904.7(b)(5)(ii)(D) o Using wound coverings such as bandages, Band-Aids™, gauze pads, etc.; or using butterfly bandages or Steri-Strips™ (other wound closing devices such as sutures, staples, etc., are considered medical treatment); 1904.7(b)(5)(ii)(E) o Using hot or cold therapy;
OSHA on First Aid "First Aid" as defined in paragraph (b)(5)(ii) of this section 1904.7(b)(5)(ii)(F) o Using any non-rigid means of support, such as elastic bandages, wraps, non-rigid back belts, etc. (devices with rigid stays or other systems designed to immobilize parts of the body are considered medical treatment for recordkeeping purposes); 1904.7(b)(5)(ii)(G) o Using temporary immobilization devices while transporting an accident victim ( e.g. , splints, slings, neck collars, back boards, etc.).
OSHA on First Aid "First Aid" as defined in paragraph (b)(5)(ii) of this section 1904.7(b)(5)(ii)(H) o Drilling of a fingernail or toenail to relieve pressure, or draining fluid from a blister; 1904.7(b)(5)(ii)(I) o Using eye patches; 1904.7(b)(5)(ii)(J) o Removing foreign bodies from the eye using only irrigation or a cotton swab;
OSHA on First Aid "First Aid" as defined in paragraph (b)(5)(ii) of this section 1904.7(b)(5)(ii)(K) o Removing splinters or foreign material from areas other than the eye by irrigation, tweezers, cotton swabs or other simple means; 1904.7(b)(5)(ii)(L) o Using finger guards; 1904.7(b)(5)(ii)(M) o Using massages (physical therapy or chiropractic treatment are considered medical treatment for recordkeeping
OSHA on First Aid "First Aid" as defined in paragraph (b)(5)(ii) of this section 1904.7(b)(5)(ii)(N) o Drinking fluids for relief of heat stress.
OSHA on First Aid "First Aid" as defined in paragraph (b)(5)(ii) of this section 1904.7(b)(5)(iii) • Are any other procedures included in first aid? • No, this is a complete list of all treatments considered first aid for Part 1904 purposes.
OSHA on First Aid Complete Listing of First Aid Treatments A Using a non-prescription medication at nonprescription strength B Administing tetanus immunization First Aid Treatment: 1904.7 (5)(ii)(A)-(N) C Cleaning, flushing or soaking wounds on the surface of the skin Using wound coverings; bandages, Band-Aids™, gauze pads, etc.; or using butterfly D bandages or Steri-Strips™ E Using hot or cold therapy F Any non-rigid means of support, such as elastic bandages, wraps, non-rigid back belts, etc. Temporary immobilization evices while transporting an accident victim (e.g., splints, G slings, neck collars, back boards, etc.) H Drilling a fingernail or toenail to relieve pressure, or draining fluid from a blister I Using eye patches J Removing foreign bodies from the eye using only irrigation or a cotton swab Removing splinters or foreign material from areas other than the eye by irrigation, K tweezers, cotton swabs, or other simple means L Using finger guards M Using massage N Drinking fluids for relief of heat stress
OSHA on First Aid "First Aid" as defined in paragraph (b)(5)(ii) of this section 1904.7(b)(5)(iv) o Does the professional status of the person providing the treatment have any effect on what is considered first Aid or medical treatment? o No, OSHA considers the treatments listed in § 1904.7(b)(5)(ii) of this Part to be first aid regardless of the professional status of the person providing the treatment. Even when these treatments are provided by a physician or other licensed health care professional, they are considered first aid for the purposes of Part 1904. Similarly, OSHA considers treatment beyond first aid to be medical treatment even when it is provided by someone other than a physician or other licensed health care professional.
Cause Work Relatedness
Address Employee Discomfort • Interview employee about what they are feeling (Sxs) • Ask about causative factors o Work related / Non-work related • Screen for Signs o ROM o Strength o Special Tests o Function and Job Tasks
Address Employee Discomfort • Provide Appropriate EI first aid care • Provide for non work related concerns • Work Station Assessment and Solution Development • Job Coaching • Document and Report
Ergonomics • Primary stressors Posture Force Repetition Duration
Ergonomics • Need to correct or reduce the stressors
Simple Changes • Perform task audits to identify stressors • Provide real time feedback to reinforce safe activity or correct technique • Position monitors on fork trucks to keep head and neck neutral • Instruction on proper hand placement on boxes to decrease thumb and wrist strain
Iowa Results
Iowa Results
US Results through Q3 2018 • 73 of 78 possibly work-related EI cases resolved without referral • 276 cases of non-work related discomfort seen • All cases resolved without referral • These individuals remain working, do not require time away from work • 229 contacts for safe practice, job coaching or wellness interaction • Avoidance of $2,426,082 in WC claim costs*
“There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they're falling in.” Desmond Tutu
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