The Devil Is In The Details

Yesterday, I had pulled a job description that had been provided to us for a Functional Capacity Evaluation to use as a resource during a discussion with a client as they sought to understand the dynamics of a particular job position within the security field. As I reviewed the description, I remembered that despite the description’s length and detail level, the description had some significant issues when it came to the issue of lifting and carrying.

Hidden Information On What May Be Carried


One piece of information that needs to be kept in mind is a small quote embedded in description box located two pages prior to the physical demands. The box that can be easily missed states: “Personal gear per individual carried routinely is about 28 pounds and may need to climb towers as high as 60 feet with about 21 pounds of gear (rifles are normally staged for towers).” A box just below that indicates that this gear includes weapons, binoculars and/or night vision equipment, special purposed detectors, ballistic helmet, ballistic vest, ammunition, flashlight, and other small items.

One of the issues is not the fact that the two tables don’t match due to the “21-24 pounds” in the carry section versus “11-24 pounds” in the lift section. That is a typo that can be easily clarified through a quick call to the employer (note to FCE providers: never be afraid to call the case manager to ask to reach out the employer for clarification of demands – even for typos.)

There are three issues in regards to the carrying and lifting tables within the job description:

Issues With Carrying

The first issue is that the carry demand is not clearly defined. As noted above, there is a small box that denotes “personal gear individually carried routinely is about 28 pounds”. Those items in the list are not carried in the traditional sense of a bimanual or unilateral carry. The items listed in that box are items that are either worn directly on the body (ballistic helmet, ballistic vest, handgun in a holster, etc.) or items that would be carried in pouches or attached to their belt or vest (ammunition, flashlight, radio, etc.).

That knowledge helps to potentially explain the 12 hours per day of carrying 25-34 pounds in the above table but the table does not include an explanation that would indicate that this is the case. It does not help to explain any of the values greater or less than that specific range. Loaded rifles typically weight below 10 pounds (as do radios, binoculars, night vision optics, sensors, and many other items) yet the 10 pounds and under range is marked as “NA” or not applicable.

The 35-50 pound range and the 51-74 pound range have less frequent demands but it is difficult to determine whether those categories are inclusive of the 28 pounds of gear carried on the security officer or those are different items that are to be carried in some manner.

The carrying section should include more descriptive information to inform the reader as to what is being carried as well as the object’s weight and the manner in which it is carried (with two hands, with one hand, or worn/attached to the body).

Issues With Lifting

The lifting section brings its own issues – partially due to the ambiguity of the section defining the carry demands as well as ambiguity within the lifting section.

A quick look at the lifting demands indicates occasional lifting within the 11-24 pound and 25-34 pound ranges with no lifting demands above 34 pounds. There are no lifting demands above 34 pounds yet the carrying section indicates carrying loads up to 74 pounds. Typically, in order to carry an object that object must first be lifted – unless it is being directly loaded onto a person by someone else (such as lifting a backpack for another individual to don).

As with the carrying section, the lifting section does not provide any definitions, beyond weight ranges, of what the security officer actually lifts during the performance of their job role. While the section we discussed at the beginning lists some of the gear for the position, it is difficult to apply those items to the lifting table.

While we can make assumptions that items that are carried are either carried with both hands, carried with one hand, or carried by wearing, it is difficult to make assumptions from this table about how the lifting is performed. In addition, the table does not indicate the height ranges that lifts are performed from (knee height, waist height, shoulder height, overhead). This is an important issue when performing post-offer physical abilities testing or when performing a return to work or fit for duty FCE to determine whether an employee qualifies for return to work at full duty.

The lack of details in both the carrying and lifting sections also make it difficult to determine if accommodations are available for modified duty or not.

What About Pushing And Pulling?

Carrying and lifting are two of the three big strength tasks that should be included in a job description. We haven’t discussed pushing and pulling and the tables above don’t include either. Over the course of the primary five pages of the job description, the words pushing and pulling were not present while some of the simple grasping tasks listed (opening doors, gates, hatches, etc.) have frequency values but not force values listed.

However, the physical abilities battery that all candidates must complete includes a requirement of completing a specified number of push/pull cycles of “41 PSI” and a single 6 inch push that is set at “91 PSI”. There is not any documentation within the job description or the test that can be tied directly to these values.

The Climbing Section Is Good

The section that deals with climbing tasks is much better and denotes the types of climbing that may be performed. One of the positive aspects of this section of the description is that it includes stairs as a form of climbing. I have read too many job descriptions in the past that indicate that the job title does not require the ability to climb yet the employee was injured while ascending or descending a flight of stairs.

The one detail that would be helpful is a better description of ladder types. In the past, we have performed onsite ergonomic assessments for generation of customized job descriptions which included multiple types of ladders for the same site including A-frame ladders, extension ladders up to 40 feet, and fixed ladders – both angled and vertical.

Summary

While this job description provides a significant level of detail, it does not include the details that a treating physician, treating physical therapist, or a therapist providing a return to work evaluation would need to successfully prepare an injured employee for return to full duty. These professionals need to know what is being carried, how it is being carried, what is being lifted and where it is being lifted from or to, and how the security officer is outfitted while performing their daily tasks. Pushing and pulling demands need to be better defined – from opening and closing doors, gates, and hatches to other tasks that may require pushing and pulling actions.

Often, when you ask an individual (therapists and physicians included) to describe a security officer, they will respond with a description of a generic security officer that one would meet in a shopping mall or at a concert/sports event. In the case of this job description for security officer, the position is much closer to a paramilitary role and security officers in this role need to treated/rehabbed in that manner.

This job description was heavy on words and tables and would have greatly benefitted from the addition of photographs that help to visually describe and define the actions performed by those in this job title as well as the environments in which the tasks are performed.

“Average-weight objects” and Job Descriptions

Job descriptions like this that use terms such as “average-weight objects” and moderate physical activity are difficult for treating physicians and physical therapists when helping to return an injured employee to work.

Vague job descriptions impact treatment and return to work testing (a Functional Capacity Evaluation works best when there are objective minimum essential demands available for comparing the employee’s ability to push, pull, lift, carry, etc.). It is much more helpful for a physical therapist to understand the physical and postural demands when planning rehab activities and understanding goals.

But, in NJ, these vague descriptions may play out well past the end of treatment. Governor Murphy signed A2617/S-2998 which amends the Workers Compensation laws to provide a hiring “preference” to those who have reached MMI but were not returned to their job position. While the mechanics of this “preference” have not been defined, it does include language that the individual must meet the essential functions of the position:

“Following a work-related injury, an employer shall provide a hiring preference to an employee who has reached maximum medical improvement (MMI) and is unable to return to the position at which the employee was previously employed for any existing, unfilled position offered by the employer for which the employee can perform the essential functions of the position.”

Take a look at your job descriptions to see if the essential functions have been defined to include essential minimum physical and postural demands.

If you are not sure, we can help review your job descriptions. If you haven’t defined the essential physical and postural demands within your job descriptions, we can help measure those demands.

Not A Replacement

OSHA offers a great e-mail feature that provides a workplace safety tip in your e-mail on a daily basis. Today’s tip was a solid reminder that while masks can help prevent spread of COVID, they are not a substitute for physical distancing and barriers.


Personal protective equipment (PPE), whether masks for COVID or hearing protection in noisy areas, is considered the last line of defense in protection of employees. Employers should attempt to use engineering controls or administrative controls to reduce or mitigate risks before relying on PPE to protect an employee.

Engineering controls involve changes to the physical workspace that change how a task is performed. When possible, engineering controls are the preferred over administrative controls because they help to mitigate risks at the source.

  • Engineering controls for COVID include physical barriers between workstations, changes to air filtration, inclusion of decontamination stations, installing drive through windows, installing contactless payment kiosks, etc.
  • Engineering controls for non-COVID related issues may include reducing the weight of objects, the use of assistive devices to handle materials, or machine guards.

Administrative controls involve changes in policies, procedures, and practices to reduce risks. Administrative controls rely on changing workers behaviors in a task and are not as effective as engineering controls.

  • Administrative controls for COVID include encouraging sick employees to stay home, use of Zoom meetings over face to face meetings, and establishing alternating workday cohort schedules.
  • Administrative controls for non-COVID related issues may include job rotation schedules, written operating procedures for a task, warning signs and alarms, etc.

With non-COVID related issues, the first steps are to identify the hazards and risks so that a decision can be made as to what engineering controls or administrative controls can be put into place. One of the job description projects that we had performed helped to expedite the purchase of an engineering control solution for a client.

County Weights and Measures personnel are responsible for testing the accuracy of pumps at gas stations and typically have performed this task using calibrated 5 gallon tanks that are filled at the pump and then poured back into the fuel storage tanks after measurement. This can be a dangerous task as it relies on drivers noticing the cones that may be placed to show that a pump is not available for service or notice the safety vest worn by the Weights and Measures employee.

After documenting this task for the custom job description, a suggestion was noted that the specialized pickup mounted collection and measurement device would reduce this risk. The device allows Weights and Measures officials to pump directly from the gas pumps into a truck mounted collection device that can be moved from pump to pump, rather than making multiple trips carrying 5 gallon containers across busy parking lots. This engineering control allows for significant reduction in risk of injury to the employee.

You Can’t Have Good Work Conditioning Without Good Job Descriptions

Recently**, a physical therapist who I’ve known for years reached out to me for some advice. She had two patients that were being sent for “work conditioning” to her. The problem was that job descriptions weren’t provided for either of the two patients. She knew that the “I only have to do this…..I never have to do that” wasn’t the whole story. She also knew that I had been involved in writing job descriptions for those positions for some of our clients. Having performed Functional Capacity Evaluations with us in the past, she also knew that having a solid job description is key in matching up demonstrated performance to essential physical and postural demands.

Work conditioning is defined by the American Physical Therapy Association as “work related, intensive, goal-oriented treatment program specifically designed to restore an individual’s systemic, neuromusculoskeletal and cardiopulmonary functions. The objective is to restore the injured employee’s physical capacity and function for return to work.”

Without understanding what the functional demand is for a specific position, it is difficult to define the goals of a work conditioning program. One of the patients that she had inquired about was a school bus driver. He had told my friend that he “really didn’t have to do much beyond sit in the driver’s seat and drive. Maybe, open the door every so often to let the kids on in the morning or off in the afternoon.” He was returning to work from a lower extremity injury that resulted in a joint replacement. Having performed FCEs for school bus personnel before, she knew that the demands were more but was unsure of the other tasks.

School bus drivers are tasked with performing pre- and post- inspections of their vehicles. This involves checking in and around the vehicle, checking storage compartments (if the bus has one), ensuring that all emergency exits (including the roof exits) are operational, and being able to check under the seats for both children and their belongings. Also, in some districts, bus drivers may be switched to different routes based on employer needs. Switching routes may require drivers to pick up students who may be in wheelchairs. When the wheelchair lift malfunctions, drivers use a manual, hydraulic pump to elevate and lower the lift as needed. This task requires the driver to be able to squat or kneel to a level to operate the manual pump. Drivers, if an aide is not present, may have to secure wheelchairs to floor mounted devices, which requires the ability to kneel while reaching. With demands such as those listed, she needed to work with this patient on being able to step up/down to get into and out of the bus, to be able to kneel to perform tasks, and make sure that the driver demonstrated the ability to perform the overhead tasks of checking the emergency exits. The ability to perform these demands are even more important as a result of the NTSB school bus driver recommendations that I mentioned in a January blog post.

Based on the APTA definition, work conditioning covers a larger swath than when the patient was being treated solely for the injury that brought them to physical therapy. During that initial portion of the treatment, therapy focused on the needs of healing for the specific body part along with improving range of motion and strength as appropriate based on the healing process. Work conditioning helps to pick up to make sure that the other aspects of the injured worker such as their cardiovascular endurance, strength, power, and muscular endurance are not impaired when they are returned back to work. As a result, work conditioning includes activities to improve physical capacity in all of these areas. When an individual begins a work conditioning program, their initial status in these components should be documented – both as a baseline as well as for comparison to the essential postural and physical demands. This will help the therapist communicate to the patient, the case manager, the physician, and the employer as to where the patient is in regard to return to duty.

When quarantine/shelter in place orders begin to be lifted, work conditioning is going to play an important role in returning workers that had been out on workers comp prior to the pandemic to their previous roles. For many of these patients, they may have been shifted over to telerehab as clinics closed for safety issues. Telerehab and “virtual physical therapy” are great for keeping in contact with the worker and moving them along in their rehab journey as best as can be done in these circumstances. However, they may not have access to the resources or guidance to recondition themselves for work prior to returning to their job. Correcting this deconditioning is going to be vital to their success upon return to work as well as for reducing their risks for suffering another injury after return to work.

Yellow school bus. Vector illustration
Yellow school bus. Vector illustration

** – I had started writing this several weeks before all of the “shelter in place” orders started to come down from the different states and it sat in a draft folder for a while. As I revisited the draft after a little over 3 weeks in quarantine, it made me think about the fact that some injured workers currently in PT may be deconditioned if not by now, but definitely by the time the shelter in place orders are lifted. Getting these workers into a work conditioning program at the soonest appropriate time point may be the best chance for a successful return to work process.

Taking A Deeper Dive Into Your Injury Data

Recently, WorkersCompensation.com and Safety+Health Magazine ran two articles that provided interesting injury information that came from taking a deeper dive into reported injury data.

WorkersCompensation.com reported that injury rates in construction workers in Tennessee were higher for those on the job under two years. In both Tennessee and Ohio, injury rates for workers with less than 1 year of experience accounted for 47.5% and 45.6% of the total injuries, respectively. Workers with less than 6 months of experiences accounted for 37.1% and 33.6%, respectively.   The article notes two important thoughts:

  • Fingers and hand injuries were among the top 10 injured body parts – an issue that can be reduced with appropriate PPE
  • Teaming up new, inexperienced workers with mentors to learn to recognize work hazards

Safety+Health took an interesting look at the effects of shift length and inexperience on the risk of injury to those working in the mining industry. They reported on data from a study by researchers at University of Illinois at Chicago that found that miners working shifts longer than 9 hours “were 32% more likely to suffer work-related fatalities and 73% more likely to be part of an incident that caused injuries to multiple miners.” Risk factors for injury for those working more than 9 hours included workers that had less than 2 years experience in the job as well as irregular work schedules. Among the suggestions to reduce the risks were fixed schedules and a recommendation into looking deeper into the effects of longer shifts on “fatigue and nutrition”.

One of the key things that we ask on our FCE intake paperwork is the amount of time that a claimant has been working in their current position. More often than not, many of those who have been sent to us for the functional capacity evaluation have less than 1 year in the position in which they were injured. Length of employment at time of injury is a data point that all employers should be monitoring. When trends appear such as in the two studies noted, employers need to take a look at hiring practices and new hire training practices. They may find that their hiring process should include a post-offer pre-employment test of physical abilities to ensure that new hire candidates meet the essential physical and postural demands of the position.

Looking at injury data (OSHA logs, loss run data, etc.) should be a part of the process of setting up a post-offer pre-employment process in conjunction with performing on-site measurements to create a customized job description of the essential postural and physical demands. The injury data may help to pinpoint job tasks that require a deeper look to determine why employees are getting injured. Is it an ergonomic issue? Is it an issue of strength? Is it an issue of better standard operating procedures?

One of our clients asked for our assistance in reviewing the injury data after initiating a post-offer pre-employment testing process for an ambulance transport service to determine the effectiveness of the program. We looked at data from 3 years prior to initiation of the process as well as 3 years after (we encourage employers to look at this more frequently).   The initial review of the data indicated a minor drop in injuries after initiating the program (an overall drop of 6 injuries after initiating testing).

With only a small reduction in injuries, a deeper dive into the data was required. Several interesting variables were found during this deeper dive:

  • The number of neck, shoulder, and lower back injuries decreased but injuries involving the hands and exposure injuries increased
  • The number of employees decreased by 20% between the two periods
  • The number of transports increased after testing when there were less employees increasing the amount of exposure opportunities to be injured

Taking into account the reduction in the number of employees and the increase in patients transported, there is a 26.8% reduction in injuries.

Taking the deeper dive into the data allows for a greater understanding of the mechanisms that may be driving the injuries that your employees are experiencing. Make the time to look at your OSHA logs to see if there are injury trends, look at the amount of time employed at time of injury to see if there are trends with your new employees, or take a look at your loss runs to see if certain departments have either a greater number of injuries or a greater amount of lost time compared to other departments. All of these become a starting point in reducing future injuries.minied

 

 

 

The most important Super Bowl viewers

Over the last decade, the issue of concussions in professional football has been addressed in books, movies, lawsuits, and significant coverage in the news media.

While nobody is fully sure of the best way to completely address the issue and minimize the risk of concussions during play and practice, the NFL instituted an important program in 2012 to become more proactive in addressing potential concussion situations during games.  The NFL began placing certified athletic trainers (ATCs) in the stadiums to view games with the purpose of looking at both the in-game contact as well as player behavior after plays and along the sidelines.

The inclusion of these healthcare professionals was a result of a hit to Browns quarterback Colton McCoy during a late season game in  December 2011 after the institution of a video review system for injuries.  The hit that McCoy took was not noticed during the game but after the game.  The NFL realized that a set of eyes were needed to review potential issues in real time.  The ATC spotters observe both the game and video feed from the broadcast coverage in real time to identify plays that may result in concussion or injury whether it is from player to player contact or contact with the ground.  The ATCs then contact either the team medical staff or the unaffiliated neurotruama consultant to advise them of what was observed.  These calls can not be handled by bench staff from the team.  The ATCs also instruct technicians to send the video of the specific incident to the sidelines for medical staff to include in their evaluation of the athlete.  According to the NFL, approximately 10 plays per game initiate this process.  ATC spotters can also initiate a medical timeout.  These timeouts are not charged to either team.

While there are several criteria for ATCs who wish to apply to this program, I think the most interesting are:

  • At least 10 years experience – enough experience to really have an idea of what they are observing
  • Can not have been the Head Trainer for any NFL team previously
  • Can not have been employed by an NFL team in the last 20 years

I think the last two criteria that I mentioned are probably the best at showing a positive intent for this program by the NFL.  These two criteria help to minimize the impact that past relationships with teams and/or players may have on an ATC Spotters observations.

While this is a great program and the NFL appears to have done a great job in keeping the program impartial and they have empowered the ATCs with the authority to stop game play, this only addresses observational, subjective game day issues.  It still does not provide an objective and measured value to the cumulative impacts that occur during the game – or more importantly, the significant hours of practice and seasons of games that comprise a player’s career.

Helmet impact sensors like those from Shockbox may help to provide a more objective dataset to determine the amount of cumulative impacts that a player goes through during the course of games and practices.  The US military has been studying head trauma through the use of helmet sensors since 2007 and began collaborating with the NFL in 2012 to better advance the science and address the issues.

The US Army had been using helmet based sensors in Afghanistan to measure blast pressures during IED events during combat patrols.  The sensors are triggered with forces greater than 150 newtons, which is the equivalent of just under 34 pounds of force.  Not a whole lot of force when compared to the forces of between 447 pounds and 1,066 pounds in boxers when punching.  However, a drawback to the Army/DARPA program was that it was only run in combat zones and did not take into account proximity and cumulative exposure to blast pressures when firing heavy weapons. The program was ended in late 2016.

There is one five year study that was done at University of North Carolina that looked at not just game day impacts but also the hits sustained during practice sessions.  The data that they collected shows some interesting data points.  They found that some impacts that were of significant force did not cause concussions while some lesser impacts that were below “threshold” did cause concussions.  Within these below threshold concussions, they found that the area of the point of impact on the head is just as important as the amount of force.

We still have a lot to learn about the causes and effects of concussions as well as treatment post concussion (as we’ve pointed out in a Friday Five post).  But, we can take notes from the positive aspects of what the NFL has done so far with their ATC Spotter program in being more proactive in dealing with health related “workplace” issues.