Properly Designed Early Intervention: A Workers Compensation Speed - - PowerPoint PPT Presentation

Curt DeWeese and Kevin Hollingshead

• Dec. 6, 2018

3-4 PM

Properly Designed Early Intervention: A Worker’s Compensation Speed Bump

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

• pportunity

Traditional Paradigm

Early Intervention Paradigm

Root Causes Discomfort Pain & Dysfunction Recordable Injury

Early Intervention Paradigm

Root Causes Discomfort Pain & Dysfunction Recordable Injury

Early Intervention Paradigm

Root Causes Discomfort Pain & Dysfunction Recordable Injury

Signs & Symptoms

OSHA speaks to Signs & Symptoms of an Injury

• r 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)

Twinge Fatigued Heaviness Soreness Ache Tired Discomfort Throb Distress Pain

Signs & Symptoms

The Continuum

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)

• Visits to a physician or other licensed health care professional solely for
• bservation or counseling;

1904.7(b)(5)(i)(B)

• 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)

• "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)

• 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)

• 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)

• Cleaning, flushing or soaking wounds on the surface of the skin;

1904.7(b)(5)(ii)(D)

• 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)

• 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)

• 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)

• 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)

• Drilling of a fingernail or toenail to relieve pressure, or draining fluid from

a blister; 1904.7(b)(5)(ii)(I)

• Using eye patches;

1904.7(b)(5)(ii)(J)

• 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)

• 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)

• Using finger guards;

1904.7(b)(5)(ii)(M)

• 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)

• 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.

A Using a non-prescription medication at nonprescription strength B Administing tetanus immunization C Cleaning, flushing or soaking wounds on the surface of the skin D Using wound coverings; bandages, Band-Aids™, gauze pads, etc.; or using butterfly 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. G Temporary immobilization evices while transporting an accident victim (e.g., splints, 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 K Removing splinters or foreign material from areas other than the eye by irrigation, tweezers, cotton swabs, or other simple means L Using finger guards M Using massage N Drinking fluids for relief of heat stress

Complete Listing of First Aid Treatments First Aid Treatment: 1904.7 (5)(ii)(A)-(N)

OSHA on First Aid

OSHA on First Aid

"First Aid" as defined in paragraph (b)(5)(ii) of this section 1904.7(b)(5)(iv)

• Does the professional status of the person providing the treatment

have any effect on what is considered first Aid or medical treatment?

• 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
• Work related / Non-work related
• Screen for Signs
• ROM
• Strength
• Special Tests
• 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

• ut why they're falling in.”

Desmond Tutu

Key Takeaways

• Early intervention for employee discomfort resolves most issues
• There are many things that can be done in first aid that don’t trigger

OSHA recordability

• It is critical for Employers to work with a provider who understands

these limits

• Providers must understand individual needs of the employer

– Not a one size fits all approach

• Results include reduced MSD claims, decreased costs and lost time

Questions

• Curt DeWeese, PT

– cdeweese@atlas-ips.com – 616-607-6868

• Kevin Hollingshead

– kevin.hollingshead@dbschenker.com – 740-601-6494