control issue of the labor-intensive work environment. These work environments include public safety, nursing, utilities, industry, construction, warehousing, currency banking - any work arena that cannot be readily re-engineered to significantly lessen the degree of effort.
xxx You have considered various progressive measures to mitigate injury and disability, including re-engineering work stations and environments; giving physicals; implementing return-to-work, light-duty or other safety awareness programs; and focusing on job-specific professional development.
xxx For the employee in a high-risk or labor-intensive job, there are pitfalls to relying fully on any or all of the first three approaches to loss prevention. In constantly changing work arenas the capacity to do the job doesn't necessarily relate to the ability to perform the work safely. Awareness of safer body position and improved ergonomic tools and work stations, where applicable, can reduce incidence and severity. But the reality is if the back or wrist is absorbing a constant and large percentage of load stress, it will invariably fail just as severely as with a single extreme incident.
xxx Re-engineering a constantly changing work environment is obviously difficult, particularly in emergency management, fire prevention, law enforcement and public works. Relying primarily on re-engineering equipment or fitness and other forms of training to help workers perform in the orthopedically correct manner is fraught with variable. There are psychological and physical aspects to consider.
The High-risk Environment
xxx For example, in the high-risk arena of law enforcement, how do you pre-empt officers from injuring their backs in an arrestee struggle? The officer's primary goal in this work arena is not back safety but survival. Your job is to determine how back injury can be prevented without losing sight of this primary performance need.
xxx In firefighting and emergency medical services, it's extremely difficult to protect the back/spine of an emergency medical technician carrying a cardiac patient on a gurney or litter down a narrow flight of stairs. If the patient shifts, causing the bottom-side EMT to momentarily lose footing, the load gets away from the person at the head and it precludes quick, large foot movement to retrieve the load. This unanticipated response causes the back to do more work than it's capable of in that instant.
xxx Similarly, extricating even a frail, light cardiac patient from the narrow space between a wall and a commode requires quickly reaching for the patient over a obstruction that can't be quickly moved out of the way, and where space constraints allow only one responder to initiate the lift.
xxx These scenarios need occur only a couple of times in a career to prompt the need for disability retirement due to a back-related problem. The issue is not just whether or not the officer is physically fit or whether or not the EMS provider is aware of preemptive actions to prevent back injury. The real issue, or the primary work-behavior demand, is critical time response.
xxx In the labor-intensive environment of public works and utilities, fitness training becomes even less of a priority because, by definition, the nature of the work requires strength. Certainly awareness programs for flexibility and guidelines on permissible weight loading can improve statistics. But the bottom line issue becomes fatigue. When physical fatigue sets in, so does mental fatigue. The performance need is productivity and /or completing the task. To reduce the cumulative buildup of disability in the labor-intensive employee, you must prevent back injury without ignoring the performance need.
If the work experience doesn't make them stronger, it will break them down.
Modifying Employee Behavior
xxx Modifying risk in the high-risk work arena means modifying behavior, not re-engineering environment or attempting to premeditate all incorrect actions and excise them. Physical behavior is a product of physical and psychological response patterns to the demands of a particular job; the police officer who struggles with an assailant risks losing the fight, indeed survival; an EMS responder who doesn't react quickly risks further trauma to the patient; the utility worker who doesn't complete the task or job on time risks leaving a city without power. Changing behavior requires understanding the core stresses of the work, then imprinting safe work behavior in the employee's memory as a professional approach to work experience based on the prevailing job-specific issue. This is work safety at its most professional level, and is a most cost-effective investment.
xxx These levels of professional development need not be disproportionate, costly investments, so long as the focus for preventing physical disability injury remains relevant to the primary issues and performance needs. You must address the employees' entire work behavior in a manner that the employee believes and experiences as relevant.
Learning to Work-strengthen
xxx The behavioral modification or enhancement must parallel the employee's perceived performance needs. It requires a "whole" approach to understanding the employee, with study and insight into the work-specific nature of the employee's perceptions. This process varies by entity, department and employee.
xxx Law enforcement personnel in high-crime areas perceive risk-loss issues differently than their counterparts in less stressful districts. Yet, back injury statistics don't appear to be significantly different. Most police officers see attention to survival, not worker's compensation injury, as the routine work issue. They're not perceiving work the way they perceive recreation or exercise and therefore don't respond in the same way. However, they need to believe, kinesthetically experience and intellectually know that job labor can be both a work and strengthening exercise - the job brings about the same benefits as the gym. Only the brain makes a distinction between the two.
xxx These officers need to integrate the routine experience of working correctly into a work-strenghthening experience that ultimately relies on the same physical and psychological tools in an emergency. They need to experience optimizing physical and psychological control in all circumstances of professional activity. Whether driving or exiting a vehicle, bending, lifting, containing an arrestee or pursuing a suspect, they must know how to harness and integrate their bodies into the realities of their professional performance needs.
xxx Similarly, most EMS personnel see their work as saving life and property. Responding to the circumstances of the situation with critical time response takes priority over correctly anticipating the physical effort. They need to apply the same techniques in responding to medical incidents requiring varying ergonomic complexity as they would to routine equipment maintenance.
xxx As for public works and utilities employees, most see their work as completing the project assignment. When fatigue sets in, they'll be inclined to respond to preventing back injury only when the back starts hurting. Their motivation is the pain that follows the error in work effort. The performance need in this labor-intensive environment is productivity and/or completing the task and the workday, which might mean shoveling gravel from a truck for three hours, or pulling/fighting a stuck jackhammer out of the asphalt for the tenth time in an hour.
xxx All these workers need to know how to optimize physical and psychological control, not only for back safety on the job, but for every action - routine to extreme. If the work experience doesn't make them stronger, it will break them down. Safe work behavior must be autonomic reflex behavior 24 hours a day. The back does not know the difference between a heavy, awkward flower pot on a slippery surface in the garden on the officer's day off, and a rainy night with a limp arrestee who's under the influence of alcohol or drugs. The torque arrives at the same place on the spine. The pain is the same level of intensity. And there are no points for valor that will reduce the cost in suffering and dollars to all concerned.
Results You Can See
xxx Job-specific professional development as opposed to awareness education is critical in the high-risk and/or labor-intensive work arena. This development is called Professional Safeguard Response(r).
xxx In public safety, it's accepted practice to have specialized professional development protocols early in the career, at the academy level. This practice must extend to specialized physical work-behavior practices. These need to include all elements of physical and psychological behavior as they relate to work-strengthening, and interventions in the workplace specific to the actual demands and current status of the employee with the acquired experiences, injuries and practices.
xxx The U.S. Department of Energy and the University of California at Lawrence Livermore National Laboratories terms this Professional Safeguard Response system "performance-based safety imprinting" and has statistically proven results over a decade.
xxx Cities such as San Jose, California, which use job-specific professional development, have saved $1 million in reduced worker's compensations costs. Pasadena and Sunnyvale, California, have seen startling reductions in fire and police injury incidence and severity.
xxx Pasadena reduced its fire department injury-loss days from several hundred a year to 20 in the year following job-specific performance-based training. Sunnyvale, termed a "model managed city" by the Clinton-Gore administration, reduced its police department's back injuries by 80 percent in the subsequent year and the imprinting process has sustained itself for three years without external reeducation.When asked how it's visible beyond the ongoing positive statistics, the city safety manager replies, "You just have to watch them exit their patrol vehicles to see that is has all stuck." It remains imprinted and has become self-reinforcing.
BY JACK S. KANNER
Jack S. Kanner CEO, is director of
engineering work behavior modification and career
loss control for the PSR. Corp. , a nationally recognized public-sector
oriented training agency based in
Corte Madera, California