Occupational Injuries Among
Audrey A. Reichard and Larry L. Jackson
Background Emergency responders frequently incur injuries
while providing medical, fire, and law enforcement services. National surveillance
systems provide fragmented perspectives on responder injuries because they omit
specific classes of workers (e.g., government or volunteers); they report only selected
injuries; and employment information is incomplete.
Methods We characterized injuries among emergency medical
services (EMS), firefighting, and police occupations by using data from the National
Electronic Injury Surveillance System—Occupational Supplement (NEISS-Work) for injuries
treated in U.S. hospital emergency departments in 2000–2001.
Results Sprains and strains were the leading injury
(33–41%) among EMS, firefighter, and police occupations. Police officers and career
firefighters had the highest injury rates (8.5 and 7.4 injuries per 100 full-time
equivalent workers, respectively).
Conclusions The physical demands of emergency response
are a leading cause of injuries that may benefit from similar interventions across
the occupations. To assess risk, improved exposure data need to be acquired, particularly
Am. J. Ind. Med. 53:1–11, 2010.
Nonfatal Work-Related Motor Vehicle Injuries
Treated in Emergency Departments in the
United States, 1998–2002.
Guang X. Chen
Background Current data on nonfatal work-related motor
vehicle injuries are limited and fragmented, often excluding government workers,
self-employed workers, and workers on small farms. This study seeks to bridge the
present data gap by providing a national profile of nonfatal work-related motor
vehicle injuries across all industries and occupations.
Methods Study subjects were people who suffered nonfatal
work-related motor vehicle injuries and were treated in a hospital emergency department
in the United States. Subjects were identified from a stratified probability sample
of emergency departments. National estimates and rates were computed.
Results From 1998 to 2002, the average annual rate
of nonfatal work-related motor vehicle injuries was 7 injuries per 10,000 full-time
equivalents. The rate was three times higher in men than in women. The rates were
higher in workers 15–19 years of age and in workers 70 years or older. Justice,
public order, and safety workers had the largest number of injuries, and taxicab
service employees had the highest injury rate of all industries. Truck drivers had
the largest number of injuries, and police and detectives, public service employees
had the highest injury rate of all occupations.
Conclusions Future efforts need to develop and enhance
the use of surveillance information at the federal and state level for work-related
nonfatal motor vehicle injuries. Prevention efforts need to address occupational
motor vehicle safety for both commercial truck/bus drivers and workers who are not
commercial drivers but who drive light motor vehicles on the job.
Am. J. Ind. Med. 52:698–706, 2009
Potential Work-Related Bloodborne Pathogen Exposures by Industry and Occupation
in the United States Part II: A Telephone Interview Study.
Guang-Xiang Chen and E. Lynn Jenkins
Background The companion surveillance portion of this
study [Chen and Jenkins, 2007] reported the frequency and rate of potential work-related
exposures to bloodborne pathogens (BBP) treated in emergency departments (EDs) by
industry and occupation, but it lacks details on the circumstances of the exposure
and other relevant issues such as BBP safety training, use of personal protective
equipment (PPE) or safety needles, or reasons for seeking treatment in a hospital
Methods Telephone interviews were conducted with workers
who had been treated in EDs for potential work-related exposures to BBP in 2000–2002.
Respondents were drawn from the National Electronic Injury Surveillance System.
Results Of the 593 interviews, 382 were from hospitals,
51 were from emergency medical service/firefighting (EMS/FF), 86 were from non-hospital
healthcare settings (e.g., nursing homes, doctors’ offices, home healthcare providers,
etc.), 22 were from law enforcement (including police and correctional facilities),
and 52 were from other non-healthcare settings (i.e., schools, hotels, and restaurants).
Needlestick/sharps injuries were the primary source of exposure in hospitals and
non-hospital healthcare settings. Skin and mucous membrane was the primary route
of exposure in EMS/FF. Human bites accounted for a significant portion of the exposures
in law enforcement and other non-healthcare settings. In general, workers from non-hospital
settings were less likely to use PPE, to have BBP safety training, to be aware of
the BBP standards and exposure treatment procedures, and to report or seek treatment
for a work-related exposure compared to hospital workers.
Conclusions This study suggests that each industry
group has unique needs that should be addressed.
Am. J. Ind. Med. 50:285–292, 2007.
Potential Work-Related Bloodborne Pathogen Exposures by Industry and Occupation
in the United States Part I: An Emergency Department-Based Surveillance Study.
Guang-Xiang Chen and E. Lynn Jenkins
Background Since the early 1990s, researchers have
attempted to assess the magnitude of potential work-related bloodborne pathogen
(BBP) exposures in the U.S. The only data derived estimate of 385,000 needlestick
and other sharps injuries per year was reported in 2004. The estimate was derived
from a convenience sample and did not include exposures outside of hospitals. This
study seeks to understand the magnitude and distribution of the exposures across
all industries and occupations.
Methods Data were from the 1998 to 2000 National Electronic
Injury Surveillance System (NEISS), a stratified probability-based sample of U.S.
hospital emergency departments (EDs). NEISS covers all industries and occupations.
National estimates of exposures and exposure rates (the number of exposures/1,000
full-time equivalents (FTE)) were computed.
Results An estimated 78,100 potential work-related
exposures to BBP were treated in hospital EDs annually in the U.S. While hospitals
accounted for 75% of all these exposures, 11 other industries had a substantial
number of exposures. While registered nurses accounted for 36% of all exposures,
13 other occupations had a substantial number of exposures. Hospitals had the highest
exposure rate of 11.3/1,000 FTE, followed by nursing homes (2.8), and residential
care facilities without nursing (1.9). Registered nurses had the highest exposure
rate of 15.3/1,000 FTE, followed by clinical laboratory technologists and technicians
(13.9), and physicians (7.1).
Conclusions While this study begins to more completely
describe the problem of potential BBP exposure in the workplace, it is but a first
step in further understanding the complex issues surrounding workplace BBP exposures.
Am. J. Ind. Med. 50:183–190, 2007.
Nonfatal occupational injuries from slips, trips, and falls among older workers
treated in hospital emergency departments, United States 1998
Larry A. Layne and Keshia M. Pollack
Background Falls are a leading cause of injury among
older adults. As the workforce demographics shift to an older population, the dearth
of information on occupational falls among older adults must be addressed.
Methods A national probability sample of hospital emergency
departments (EDs) (National Electronic Injury Surveillance System) was utilized
to characterize falls at work.
Results Older workers were found not to be at increased
risk of a fall injury, but were more likely than younger workers to be hospitalized
post-injury. Same-level falls were the most common type of incident among older
workers. Falls from height were more prevalent among men than women. The narrative
case descriptions for same-level falls to the floor primarily implicated floor contamination
and tripping hazards.
Conclusions Fall prevention programs targeted to older
workers must examine extrinsic sources of falls, particularly surface traction,
contaminant control, and footwear.
Am. J. Ind. Med. 46:32–41, 2004
Nonfatal injuries to young workers in the retail trades and services industries
Anne L. Mardis and Stephanie G. Pratt
We estimate the incidence and describe patterns of work-related injuries during
1998 to youth in retail trades and services industries. Data from the National Electronic
Injury Surveillance System and the Current Population Survey were analyzed. The
highest number of work-related injuries to youth younger than 18 years occurred
in eating and drinking establishments and food stores. Injuries occurring in these
industries accounted for 44% of all young worker injuries. Injury rates were similar
during summer and school months. Youth continue to experience high numbers and rates
of injuries in retail trades and services. Improvements in safety training and injury
prevention in these industries, particularly eating and drinking establishments,
food stores, and health services, need to be addressed for youth.
J. Occ. Environ. Med. 45(3):316-323, 2003.
Non-fatal occupational injuries and illnesses treated in hospital emergency departments
in the United States
Larry L. Jackson
Objectives To estimate the number and rate of occupational injuries and illnesses
treated in hospital emergency departments and to characterize the nature, event,
and source of injury and illness.
Setting Twenty-four hour emergency departments in U.S. hospitals.
Methods Surveillance for occupational injuries and illnesses was conducted
in a national probability-based sample of hospital emergency departments through
the National Electronic Injury Surveillance System (NEISS). Worker demographics,
nature of injury and disposition, and incident circumstances were Abstracted
from emergency department medical records, typically within 24-72 hrs of treatment.
Results Approximately 3.6 million occupational injuries and illnesses were
treated in emergency departments in 1998. Younger workers, particularly males, continue
to have the highest rates of work-related injuries. Together, lacerations, punctures,
amputations, and avulsions represented one fourth of the emergency department (ED)
-treated injuries, mostly to hand and fingers. Sprains and strains, largely to the
trunk, also accounted for one fourth of the injuries. The three leading injury events
were contact with objects, bodily reactions and exertions, and falls.
Conclusions Despite apparent decreases in rates, youth continue to have a
high burden of injury in the workplace. However, three-fourths of all ED-treated
injuries occur to workers 20-44 years of age. ED surveillance is particularly amenable
to capture of young worker injuries and provides a wealth of injury details to guide
prevention effortsefforts that will likely reduce occupational injuries as
these workers age. ED surveillance also provides injury estimates with few demographic
or employer constraints, other than the medical venue used.
Injury Prevention 7(Suppl I): i21-26, 2001.
Nonfatal occupational injuries among African American women by industrial group
Guang-Xiang Chen and Kitty J. Hendricks
Objective: This study examined characteristics of nonfatal work-related injuries
treated in emergency departments (EDs) among African American women by industry
in the U.S. in 1996.
Method: Injury data were from the National Electronic Injury Surveillance
System (NEISS). Employment data were from the Current Population Survey (CPS).
Results: In 1996, African American women, age 16 or older, were treated in
EDs for an estimated 158,335 nonfatal work-related injuries (2.6/100 full-time equivalents,
FTEs). Of these injuries, 39% occurred in healthcare, 14% in retail trade, and 12%
in manufacturing. Healthcare experienced the highest injury rate of 5.1/100 FTEs,
followed by a rate of 2.6/100 FTEs in retail trade.
Summary: This study is the first report on work-related injuries treated
in EDs among African American women by industry on a national level. Injury patterns
varied by industry in terms of source, event, diagnoses, and body part. For example,
in healthcare the leading source involved interactions with patients and the leading
event was physical exertion; whereas in retail trade the leading source was structures
and surfaces, and the leading event was contact with objects.
Impact on Industry: These findings demonstrate that nonfatal work-related
injuries are often concentrated in certain high-risk industries, such as healthcare,
manufacturing, and retail trade. To improve occupational safety and health for
African American women, future research activities and prevention strategies should
address the high-risk industries identified in this analysis.
J. Safety Research 32:75-84, 2001.
Nonfatal work-related inhalations: surveillance data from hospital emergency departments,
Paul K. Henneberger, Catherine Metayer, Larry A. Layne, and Rochelle Althouse
Background Data from a stratified sample of hospital emergency rooms in the
USA were used to describe nonfatal work-related inhalation injuries and illnesses
during July 1995 to July 1996.
Methods Information was Abstracted from emergency room
records by the Consumer Product Safety Commission (CPSC) as part of the National
Electronic Injury Surveillance System (NEISS) for all work-related injuries and
illnesses regardless of product involvement.
Results There were an estimated 44,423 occupational inhalation cases nationwide,
with an annual rate of 3.6 cases/104 workers/year. The rate for men (4.4 cases/104)
was greater than that observed for women (2.6 cases/104), and the rates tended to
decline with increasing age. An estimated 4.6% of the cases were hospitalized for
further treatment. The highest rate by industry was 16.4 cases/104 for public administration
(which included fire and police departments). Among non-firefighters, there were
an estimated 6,470 cases nationwide in which respiratory symptoms or conditions
were noted, which yielded an annual rate of 0.5 cases/104 (95% CI 0.3, 0.7). Chlorine
compounds were a common agent for the cases with adverse respiratory outcomes.
Conclusions The NEISS data provide an efficient method to learn about the
national frequency of work-related inhalation injuries and illnesses. The National
Institute for Occupational Safety and Health (NIOSH) is exploring two ways to use
these data: first, to routinely review the reports to conduct surveillance for work-related
inhalation cases; and second, to consider working with CPSC to conduct follow-back
interviews of selected cases in order to learn more about the circumstances of the
exposure, prior training of the case, and outcome of the exposure.
Am. J. Ind. Med. 38:140-148, 2000.
Adolescent occupational injuries in fast food restaurants: an examination of the
problem from a national perspective
Kitty J. Hendricks and Larry A. Layne
Work injuries to adolescents are most prevalent in the retail trades industry, with
a large portion occurring in eating and drinking establishments (E&DEs). Data
from the National Electronic Injury Surveillance System were examined for nonfatal
injuries to adolescents, ages 14 through 17, injured while working in fast food
restaurants (a subcategory of E&DEs) from July 1, 1992, to June 30, 1994. There
were an estimated 44,765 adolescent injuries in E&DEs, with an estimated 27,997
in fast food restaurants, during this period. The injury rate for E&DEs in the
15 through 17 age group was higher than for all other industries combined (rate
ratio [RR] = 1.7), with little disparity in rates between the sexes. This study
identifies the fast food industry as the source of a large proportion of occupational
injuries to adolescents, and indicates that task-specific risk factors seem to be
strongly related to sex.
J. Occ. Environ. Med. 41:1146-1153, 1999.
Where African-American women work and the nonfatal work-related injuries they experienced
in the U.S. in 1996, compared to women of other races
Guang X. Chen and Larry A. Layne
Background Occupational safety and health problems of women in general, and
African-American women in particular, have historically not been adequately addressed.
In fact, concern on racial disparity, and difficulties in obtaining scientific data
for the studies of minority public health led to the disadvantaged Minority Health
Improvement Act of 1990 (Public Law 101-527). This study was conducted to identify
where African-American women work and the nonfatal injuries they experienced on
the job in the United States in 1996, and to compare these patterns to women of
Methods Occupational nonfatal injury data for 1996 were obtained from the
National Electronic Injury Surveillance System (NEISS), a national probability sample
of hospital emergency departments (EDs) in the United States. Employment data were
derived from the Current Population Survey (CPS), monthly public use micro data
files. Injury rates were presented as the number of injuries per 100 full time equivalent
workers (FTEs), which were derived from actual hours worked.
Results In 1996, a higher proportion of African-American women worked in
service occupations when compared to whites and women of other races (25.4% compared
to 16.4% and 17.4%, respectively), and a higher proportion worked in the medical
services and hospital industries (19.2% compared to 14.5% and 12.2%, respectively).
African-American women were more likely to report family incomes of less than $20,000
(30.2% compared to 15.2% and 16.7%, respectively), and be single or without a spouse
present (65.4% compared to 42.2% for all other women). It is estimated that about
141,479 African-American women aged 16 years or older were treated for an occupational
injury in a hospital ED in the U.S. in 1996, resulting in an injury rate of 2.4/100
FTEs (95% CI = 1.4 ± 3.3). The injury incident rate ratio of African-American women
to white women was 1.4, although not statistically significant. African-American
women had higher injury rates than white women in all age groups. The body parts
most frequently injured among African-American women were the trunk, back, and groin
(26%), while the most frequently injured body parts among all other women were hands
and fingers (28%). Sprains and strains accounted for 40% of all injuries to African-American
women, compared to 33% and 32% for whites and all other races, respectively.
Conclusions and Recommendations African-American women had higher rates of
nonfatal occupational injuries presented to a hospital ED for medical treatment,
than white women, in all age groups. Differences in employment status by racial
group may suggest potential explanations for the higher risk among African-American
women. For example, the higher proportion of African- American women working in
the health care sector (where patient lifting and moving are often required) may
be associated with the high risk of sprains and strains. More information on occupation,
industry, and workplace exposure of the injured worker should be collected and examined
to study these associations. Differences in demographic characteristics by racial
group should also be considered in future design of research involving occupational
injuries among African-American women. Based on the fact that the medical service
and hospital industries covered one-fifth of all employed African-American women
in the U.S., we suggest that the services industries in general, and the health
care sector in particular, should be a priority for research and prevention of nonfatal
occupational injuries among African-American women.
Am. J. Ind. Med. Suppl 1:657-660, 1999.
A descriptive analysis of nonfatal occupational injuries to older workers, using
a national probability sample of hospital emergency departments
Larry A. Layne and Deborah D. Landen
An estimated 136,985 nonfatal, work-related injuries to workers 55 years of age
and older were presented for treatment in hospital emergency departments across
the United States during 1993. Men accounted for 63.7% of the injuries and had an
injury rate of 1.06 per 100 workers, compared with a rate of 0.76 among women. Among
the oldest workers (65+ years), injuries were more likely to be fractures or dislocations,
to result from falls on the same level, or to involve hospitalization. The services
industry had the largest number of injuries (31.9%), whereas the highest injury
rate occurred in the agriculture/forestry/fishing industry (1.50 per 100 workers).
The types of injuries most frequently requiring hospitalization were fractures or
dislocations that resulted from a fall. Because older workers' employment demographics
and injury patterns differ from the remainder of the labor force, interventions
need to be developed which are specific to the workplace for this older working
J. Occ. Environ. Med. 39:855-865, 1997.
Follow-back study of oldest workers with emergency department-treated injuries
Dawn Castillo and Rosa Rodriguez
The aging of the U.S. workforce highlights the need to address issues affecting
older workers specifically. Telephone surveys were conducted with injured workers
identified through a surveillance system based in a sample of emergency departments
in the United States. The 176 interviewed cases correspond to a national estimate
of 8.263 (s.e. = 1,258) injuries to workers aged 63 years and older during May 15-September
30, 1993. Five percent reported limitations in the types or amount of work they
could perform prior to the injury. Ninety-four percent reported familiarity with
the task resulting in injury. Fifty-one percent returned to work without missing
any workdays, however, 69% required return visits to a health care provider. Thirty-four
percent reported receiving training in injury prevention. Twenty percent of the
injured workers were self-employed and 43% worked for small businesses. Data from
this study provide insight into routinely collected statistics and have implications
for future research and intervention efforts.
Am. J. Ind. Med. 31:609-618, 1997.
Adolescent occupational injuries requiring hospital emergency department treatment:
a nationally representative sample
Larry A. Layne, Dawn N. Castillo, Nancy Stout, and Patricia Cutlip
Data from a nationally representative sample of emergency departments for the 6-month
period July through December 1992 were used to examine nonfatal occupational injuries
sustained by adolescents aged 14 through 17 years. There were 679 occupational injuries,
corresponding to an estimated 37,405 injuries nationwide. Males constituted 65.8%
of the injury victims. The injury rate for males was 7.0 per 100 full-time employees,
compared with 4.4 for females. Lacerations to the hand or finger accounted for 25.6%
of all injuries. The majority of injuries occurred in retail trades (53.7%), which
also had the highest rate (6.3 per 100 full-time employees). Seventy-one percent
of the injuries in retail trade occurred in eating and drinking establishments.
Am. J. Public Health; 84(4):657-660, 1994.
A detailed analysis of work-related injury among youth treated in emergency departments
Elizabeth B. Knight, Dawn N. Castillo, and Larry A. Layne
Telephone interviews were conducted with 146 14- to 16-year-olds who incurred an
occupational injury treated in an emergency department during the period July through
September 1992. Thirty-two percent of the injuries occurred as the result of using
equipment. Over half the workers reported not having received prior training on
how to avoid injury. The injury limited normal activities for at least 1 day for
68% of the youth and for more than a week for 25%, corresponding to an estimated
6,208 (95% CI: 4,277, 8,139) and 2,639 (95% CI: 1,580, 3,699) youths nationwide,
respectively. Employment in retail trades, equipment use, lack of training, and
burn injuries were associated with increased limitation of normal activities. Nineteen
percent of the youths appear to have been injured in jobs declared to be hazardous,
or typically prohibited for their age (14- and 15-year-olds) under federal child
labor laws. The prohibited job directly contributed to the injury in 64% of these
Am. J. Ind. Med. 27:793-805, 1995.