Traumatic Injury Research at NIOSH Reviews of Research Programs of the National Institute for Occupational Safety and Health (2009) / Chapter Skim
Currently Skimming:
2 Assessment of Programmatic Relevance and Impact
2 Assessment of Programmatic Relevance and Impact
Pages 43-110
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From page 43... ...
Much of the evidence derives from the evidence package prepared by TI Research Program staff. While the committee had information on extramural TI research grants, the information in the evidence package was presented with a focus on the work of the staff in the Division of Safety Research (DSR)
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From page 44... ...
External factors identified by the com mittee that broadly impact NIOSH research activities, including those of the TI Research Program, include budgetary issues (such as congressional funding and earmarks) , lack of complete occupational injury surveillance data, inadequate action by regulatory agencies such as the Occupational Safety and Health Admin istration (OSHA)
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From page 45... ...
These targeted areas can be productive, but the strategic decision of where to focus funds and effort is sometimes external to NIOSH and its own strategic thinking and analysis. Incomplete Occupational Injury Surveillance Data As will be discussed in greater detail in the following section, surveillance data on occupational injuries is incomplete, particularly for nonfatal injuries, due to factors such as gaps in the scope of surveillance and poor reporting of injuries in national surveys.
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From page 46... ...
Exemptions from federal occupational safety and health regulations -- such as the exemption from the 1970 OSH Act of employers of public-sector workers, the congressional exemption for farms employing fewer than 11 people, and the fam ily farm exemption in federal child labor laws -- are also barriers to application of some of NIOSH's research findings. Sharing Research Responsibility with Other Agencies Garnering support for research where there is a shared responsibility can be complicated when the occupational component represents a relatively small pro portion of the overall societal problem.
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From page 47... ...
58) , a fact that has made it difficult for the TI Research Program to synergistically and strategically engage the broader traffic safety community and also results in the exclusion of some occupational risk factors from national policy (e.g., exclusion of ambulances from crashworthiness consideration)
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From page 48... ...
will support the strategy of crosscutting research, but previous users of matrix organi zational structures caution that the structure can also be a source of overlap and inefficient use of resources. As an example, "fall from heights," a major source of occupational injury and fatality, is a major problem across sectors (construction falls from rooftops, surface mining falls from heavy equipment, falls from towers in telecommunications, etc.)
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From page 49... ...
Although substantial strides have been made over the past 20 years in the development of a national surveillance system for fatal occupational injuries, there is widespread evidence of substantial disparities between the number of nonfatal occupational injuries that are reported and the actual number that occur. A series of studies beginning in the 1980s demonstrated that both nonfatal and fatal injuries are underreported (Azaroff et al., 2002; Stout and Bell, 1991)
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From page 50... ...
Planning and evaluation also depend on accurate surveillance of nonfatal injuries. It is widely recognized that the current major source of national surveillance data on nonfatal occupational injuries -- the Bureau of Labor Statistics (BLS)
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From page 51... ...
Since the early 1990s, NIOSH has had an interagency agreement with the Consumer Product Safety Commission to collect data on nonfatal occupational injuries through the National Surveillance of Nonfatal Occupational Injuries Using the National Electronic Injury Surveillance System (NEISS)
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From page 52... ...
Goal 1: reduce injuries and fatalities due to Motor Vehicles NIOSH and the TI Research Program's involvement in motor vehicle injury research began in the late 1990s in response to data demonstrating a lack of progress in reducing work-related crashes and fatalities. At this time, TI Research Program staff also recognized the problem of poor data capture tying crash incidents to oc cupational injuries in crash data systems.
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From page 53... ...
. Having focused motor vehicle safety research goals (rather than the broader goal of reducing injuries and fatalities due to highway motor vehicle crashes)
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From page 54... ...
. Transfer Activities The TI Research Program has engaged in proactive transfer activities for both motor vehicles subgoals.
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From page 55... ...
The NIOSH publication "Building Safer Highway Work Zones: Measures to Prevent Worker Injuries from Vehicles and Equipment" and the FACE investigation reports are available for download from the NIOSH Web site. Technical assistance in the form of diagrams of blind areas for work zone equipment is distributed externally upon request (NIOSH, 2007c, pp.
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From page 56... ...
There are other indicators of stakeholder use of the TI Research Program's work on work zone safety. The NIOSH publication "Building Safer Highways and Work Zones: Measures to Prevent Worker Injuries from Vehicles and Equipment,"11 for example, has been used by stakeholders for a variety of purposes and has resulted in workplace changes to safety training.
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From page 57... ...
Although activities for subgoal 1.1 were not particularly innovative, many important outputs resulted from this work. The approval of the ANSI Z15.1 standard and the incorporation of the NIOSH recommendation to revise the FLSA section on child labor are strong intermediate outcomes impacting safety training and regulations for workplaces.
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From page 58... ...
Improve fall-arrest harnesses 2.3. Reduce worker falls from telecommunications towers Planning and Production Inputs Quantitative inputs to the TI Research Program's work on falls from eleva tions were BLS data on the number of fatal and nonfatal occupational injuries resulting from falls from elevations as well as information on societal costs.
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From page 59... ...
Transfer Activities The TI Research Program has engaged in significant transfer activities for its research on falls. Specifically, the program has been successful at generating the interest of potential manufacturers in several technologies.
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From page 60... ...
The evidence package does not demonstrate serious attention to the spe cial problems of these stakeholders nor does it outline special efforts to disseminate the information particularly to small businesses. Outputs The major outputs of this program include four journal articles, nine confer ence presentations, one NIOSH publication, 11 FACE reports, and one provisional patent application.13 Outcomes The evidence package documents intermediate outcomes for subgoal 2.3 only, although the many transfer activities documented in a previous section suggest likely intermediate outcomes in the near future.
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From page 61... ...
Other intermediate outcomes include providing the Federal Aviation Administration (FAA) with information it found useful when retrofitting a damaged antenna in the Bahamas and providing the United Kingdom with safety information pertaining to working safely at heights (NIOSH, 2007e, p.
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From page 62... ...
. Planning and Production Inputs Quantitative inputs into the TI Research Program's work on workplace vio lence were NTOF surveillance data on numbers of fatal and nonfatal occupational injuries resulting from workplace violence, as well as the types of job settings in which workplace violence occurs.
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From page 63... ...
Activities TI Research Program activities for workplace violence included surveillance, risk factor research, intervention effectiveness research, and transfer. The committee found these activities to be relevant to the challenge of reducing injuries and fatalities due to workplace violence.
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From page 64... ...
Transfer Activities NIOSH and the TI Research Program engaged in several relevant proactive transfer activities for workplace violence. In 2002, NIOSH formed the Federal Interagency Task Force on Workplace Violence Research and Prevention.
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From page 65... ...
also build upon NIOSH's institutional knowledge base and facilitate effective cross-agency and internal-external collaborations. Outcomes The evidence package documents several intermediate outcomes, including substantially increased attention to workplace violence by researchers since the late 18 Jenkins, E
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From page 66... ...
OSHA cited the NIOSH Current Intelligence Bulletin "Violence in the Workplace: Risk Factors and Prevention Strategies"19 in its recommendations for taxi and delivery drivers as well as its guidelines for healthcare and community service workers. OSHA also cited TI Research Program surveillance and convenience store research in its recommendations for the pre vention of workplace violence in late-night retail establishments (NIOSH, 2007g, p.
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From page 67... ...
Replicating this progress for, and identifying technologies that address, other work environments; broadening the input from federal agencies; and continued transfer of research into practice, such as the work done in Los Angeles to test workplace violence interventions in convenience stores, will be vital to continued progress toward reducing the burden of workplace violence and death. Goal 4: REDUCE INJURIES AND FATALITIES DUE TO Machines The TI Research Program developed three subgoals for research aimed at reducing injuries and fatalities due to machines: 4.1.
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From page 68... ...
as a focus reflects the inad equate information in general surveillance systems identifying individual machines or types of machines associated with worker injuries. Even when injury and fatality data are available, information on the circumstances that led up to the incident, to identify risk factors and intervention options, is often missing.
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From page 69... ...
The TI Research Program also used TISF data to conduct assessments of the cost-effectiveness of retrofitting tractors with ROPS, the results of which showed that retrofitting saves lives and money. One retrofitting assessment that included the cost of nonfatal injuries found that retrofitting tractors would save almost $490,000 per averted injury (NIOSH, 2007h, pp.
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From page 70... ...
The committee supports the TI Research Program's plans to include machine-related fatalities under the FACE Program in the future. Transfer Activities Transfer activity for subgoal 4.1 involved work with an equipment manufac turer to develop new AutoROPS for the manufacturer's zero-turn commercial mower.
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From page 71... ...
Outcomes The TI Research Program reports intermediate outcomes for each of the three subgoals for machines. Each of these intermediate outcomes contributes to the desired end outcome of a reduction in machine-related injuries.
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From page 72... ...
. Distribution of safety recommendations from fatality investigations and NIOSH publications to reduce machine-related injuries likely played some role in this decline.
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From page 73... ...
The committee found the FACE Program to be the shining star of the research program for machines. In addition to ROPS and JamAlert, FACE investigations and NIOSH publications appeared to impact intermediate outcomes.
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From page 74... ...
. The committee learned from TI Research Program staff that it plans to move work on acute back injury out of its program and into the musculoskeletal program.25 The decreases in funding may be reflective of that shift.
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From page 75... ...
Findings from the work on safe patient lifting were published in the NIOSH document "Safe Lifting and Movement of Nursing Home Residents"26 and disseminated to thousands of nursing homes in the United States. The TI Research Program staff contributed to the work of a DOL-OSHA committee to synthesize evidence on safe patient lifting programs from 1998 to 2002.
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From page 76... ...
Outcomes TI Research Program work on back injuries has resulted in workplace changes through the passage of legislation. Patient handling research was used in support of the passage of safe patient handling legislation in six states from 2005 to 2006 (NIOSH, 2007i, pp.
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From page 77... ...
GOAL 6: REDUCE INJURIES AND FATALITIES AMONG WORKERS IN ALASKA The TI Research Program developed an Alaska goal area after discovering in the late 1980s that the state had a higher worker fatality rate than any other U.S. state.
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From page 78... ...
Reduce injuries and fatalities in helicopter-logging operations 6.3. Reduce injuries and fatalities in Alaska aviation Inputs One of the first efforts of the TI Research Program in Alaska was to establish a comprehensive occupational injury surveillance system.
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From page 79... ...
An impressive focused intervention effort was a 2000 project to find and disseminate solutions to fatal and nonfatal injuries that occur on fishing vessel decks. Working with the North Pacific Fishing Vessel Owners Association, the TI Research Program conducted focus groups with crab fishermen on deck safety problems and toured vessels to view problems and discuss potential modifications 30 CFIT is an accident in which an airworthy aircraft inadvertently flies into terrain, an obstacle, or water.
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From page 80... ...
A TI Research Program evaluation of the CFIVSA showed that, since passage of the act, there has been a decline in the number of fatalities among commercial fishermen but not in the number of vessels sunk. This activity resulted in recommendations to modify the CFIVSA approach to focus on the prevention of disasters rather than the use and availability of safety equipment during and after disasters and in the NIOSH document "Commercial Fishing Fatalities and Prevention Strategies in Alaska,"32 which describes risk factors and prevention strategies for commercial fishing deaths in Alaska (NIOSH, 2007j, pp.
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From page 81... ...
Subgoal 6.1 transfer activities involved technical assistance from TI Research Program staff. In 2005, the TI Research Program assisted the USCG with an evaluation of the USCG Dockside Pre-season Boarding Program.
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From page 82... ...
1998. Helicopter logging safety: Alaska interagency working group for the prevention of occupational injuries.
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From page 83... ...
. Although the committee cannot say with certainty that these declines are due to the TI Research Program's work, it agrees that outputs and intermediate outcomes of the TI Research Program and partners, particularly those related to safety for crab fishermen, likely played a role.
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From page 84... ...
However, increased awareness of aviation safety through the TI Research Program and partner consensus building, program outputs, and intermediate outcomes likely played some role. Discussion The committee found all elements of the Alaska program to be based on rel evant statistics and designed to address important risks in various Alaska work sites.
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From page 85... ...
The end outcomes -- reductions in deaths of commercial fishermen in Alaska, in crashes of helicopters flying in logging operations, and in pilot fatality rates -- generally were likely tied to program outputs and intermediate outcomes. GOAL 7: REDUCE INJURIES AND FATALITIES TO EMERGENCY RESPONDERS NIOSH developed three subgoals for research aimed at reducing injuries and fatalities to emergency responders: 7.1.
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From page 86... ...
FTEs ranged from a low of 2.5 in FY1998 to high of 18.5 in FY2003. Activities In response to the congressional appropriation for firefighter safety research, the TI Research Program initiated the Fire Fighter Fatality Investigation and Pre vention Program (FFFIPP)
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From page 87... ...
. Transfer Activities The TI Research Program investigations of firefighter fatalities (subgoal 7.1)
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From page 88... ...
technical com mittees developing standards to support firefighter safety and health.43 The TI Research Program's Personal Protective Technology Program staff also conducted physiological-ergonomic testing of a prototype personal protective equipment firefighter ensemble as part of Project HEROES (Homeland Emergency Response Operational Equipment Systems)
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From page 89... ...
Outcomes There are several intermediate outcomes for the TI Research Program's work on emergency responders that demonstrate program impact. End outcomes were not reported for any of the subgoals.
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From page 90... ...
. A major intermediate outcome for subgoal 7.2 has been the contribution of NIOSH project research and TI Research Program anthropometric data to the modification of the Star of Life Ambulance Specification.47 Among the changes called for was the need for increased head clearance above seats based on NIOSH research.
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From page 91... ...
. Intermediate outcomes for subgoal 7.3 are in relation to the NIOSH-RAND report on disaster safety management.
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From page 92... ...
The FFFIPP evaluation study finding that rec ommendations from firefighter fatality investigations are being used to update safety training programs in thousands of fire departments is important, especially considering the risk-accepting culture of firefighters. With respect to ambulance safety, the influence of NIOSH and TI Research Program research on the Star of Life Ambulance Specifications was an important intermediate outcome.
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From page 93... ...
through an interagency agreement with the TI Research Program to review the adequacy of existing child labor laws that prohibit youth from work identified as especially hazardous (NIOSH, 2007k, p.
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From page 94... ...
For subgoal 8.1, the TI Research Program has devoted substantial effort to drawing together existing research results so that they are useful to agencies or legislators considering the development of new rules or laws affecting the safety of young workers. For example, in the interagency agreement with ESA, the TI Research Program performed a review of existing child labor laws that prohibit youth from performing work identified as especially hazardous.52 The agreement also led to the development of requests for application (RFAs)
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From page 95... ...
to characterize young worker agricultural injuries, risk factors, and outcomes for young agricultural workers and to develop and evaluate interventions. Since the initiation of the youth FACE investigation program in 1999, the TI Research Program has conducted 3 investigations of young worker deaths in agriculture while the state-based program has conducted 17 such investigations.
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From page 96... ...
The program developed guidelines for the conduct of investigations of young worker deaths and provided technical assistance to states participating in state-based FACE programs. The TI Research Program played an important role in providing statistics and analyses to ESA, which is responsible for developing child labor regulations and developing and enforcing federal child labor laws.
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From page 97... ...
. Finally, as stated for subgoal 8.1, the TI Research Program provided recommendations to ESA for revisions to federal child labor laws by submitting comments to an Advanced Notice for Proposed Rulemaking.
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From page 98... ...
The TI Research Pro gram authored 11 NIOSH documents with data on young worker injuries and completed 29 FACE reports of investigations of youth fatalities, while states with cooperative agreements completed another 42 investigation reports. Findings from the investigations helped to show that work tasks not prohibited by existing child labor laws have resulted in fatal injuries.
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From page 99... ...
. A NIOSH-funded project in Massachusetts -- the Teens at Work Injury Surveillance and Prevention Project -- was instrumental in providing data that contributed to a revision of the Massachusetts child labor laws as well as changes in policy and training in vocational education schools.
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From page 100... ...
The 2002 NIOSH report that provided recommendations to ESA on changes to child labor laws has been used by others advocating for changes in child labor regulations in the agriculture industry (NIOSH, 2007k, p.
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From page 101... ...
A number of products developed and tested through the demonstration projects seem to have been well received by stakeholders, as evidenced by requests for additional copies and incorporation of products into youth occupational safety programs. Finally, the TI Research Program's goal on working youth appears to have resulted in several modest yet important intermediate outcomes.
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From page 102... ...
3 = Research is in high-priority or priority subject areas, but NIOSH is not engaged in appropriate transfer activities; or research focuses on lesser priorities but NIOSH is engaged in appropriate transfer activities. 2 = Research program is focused on lesser priorities and NIOSH is not engaged in or plan ning some appropriate transfer activities.
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From page 103... ...
These transfer activities are appropriate and related to the intermediate outcomes demonstrated for some of the program activities. Score for Relevance In summary, the committee notes impressive work, including transfer, in priority goal areas.
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From page 104... ...
4 = Research program has made some contributions to end outcomes or well-accepted intermediate outcomes. 3 = Research program activities are ongoing and outputs are produced that are likely to result in improvements in worker health and safety (with explanation of why not rated higher)
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From page 105... ...
OSHA published recommendations for workplace violence prevention programs in 1998 and guidance documents for preventing workplace violence to healthcare and community service workers in 2004. Notable intermediate outcomes in goal 4 (machines)
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From page 106... ...
Many NIOSH reports have been picked up by stakeholders and disseminated. For example, the TI Research Program-authored report "Build ing Safer Highway Work Zones: Measures to Prevent Worker Injuries from Vehicles and Equipment"62 has been distributed by OSHA offices and reproduced as part of the Laborers' Health and Safety Fund of North America 2003.
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From page 107... ...
The committee discusses important contributions to intermediate outcomes in a previous section. NIOSH reports a steady decrease in fatalities caused by machines, plant and industrial powered vehicles, and tractors since 1992.
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From page 108... ...
a lack of significant intermediate outcomes for some subgoals. The committee assigns a score of 4 for the impact of the TI Research Program.
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From page 109... ...
1996. Current Intelligence Bulletin 57, Violence in the workplace: Risk factors and prevention strategies.
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From page 110... ...
2001. Building safer highway work zones: Measures to prevent worker injuries from vehicles and equipment.
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