Prevention of occupational head injuries starts by following the hierarchy of controls.

Preventing Occupational and Non-Occupational Head Injuries

Preventing occupational head injuries starts by following the hierarchy of controls.

Thousands of Americans suffer a traumatic brain injury each year: about 1.7 million did from 2002 to 2006, Merck & Co. Inc.'s Merck Manual reported a few years ago, and CDC reported 2.5 million traumatic brain injuries occurred nationwide, either as an isolated injury or along with other injuries, in 2010 alone. Most TBIs are not workplace injuries, but between 4 and 7 percent of all traumatic head and brain injuries are occupational injuries, the Washington State Department of Labor & Industries has reported.

An average of 53,014 deaths per year among U.S. residents during 1997-2007 were associated with TBIs, Dr. Victor G. Coronado of the Division of Injury Response in CDC's National Center for Injury Prevention and Control and colleagues reported1 in May 2011 in MMWR. They found that although the death rate declined by 8.2 percent during the period, TBIs remained a significant U.S. public health problem, with about 580,000 people with TBI diagnoses dying during that decade.

Key Mandatory and Consensus Standards
OSHA’s 29 CFR 1910 Subpart I, Personal Protective Equipment, contains sections specific to eye and face protection (1910.133) and head protection (1910.135). The first of these requires employers to:

  • Ensure that each affected employee wears eye or face protection PPE when he or she is exposed to eye or face hazards from flying particles, molten metal, liquid chemicals, acids or caustic liquids, chemical gases or vapors, or potentially injurious light radiation.
  • Ensure that each affected employee uses eye protection that provides side protection when there is a hazard from flying objects.
  • Ensure that each affected employee who wears prescription lenses while engaged in operations that involve eye hazards wears eye protection that incorporates the prescription in its design or wears eye protection that can be worn over the prescription lenses without disturbing the proper position of the prescription lenses or the protective lenses.
  • Ensure that each affected employee uses equipment with filter lenses that have a shade number appropriate for the work being performed for protection from injurious light radiation.

It requires that eye and face PPE comply with ANSI/ISEA Z87.1-2003, American National Standard Practice for Occupational and Educational Eye and Face Protection, or the 1989 edition of that consensus standard, which are incorporated by reference. In fact, the current edition is ANSI/ISEA Z87.1-2010, approved by ANSI in in April 2010. A significant change in the 2010 edition was its focus on the hazard—impact from flying fragments or particles, chemical or molten metal splash, hot sparks, dust, optical radiation, fine dust particles—rather than the type of protector.

ISEA announced Jan. 27, 2015, that it is accepting comments from stakeholders and the public on a proposed update to Z87.1-2010. According to ISEA's news release, specific proposals include testing of protectors commonly referred to as readers and magnifiers; testing changes for prescription safety lenses; angle of dependence criteria for welding devices; updated product markings, and updated use and selection guidance. The deadline for submitting comments is March 9, 2015. For a copy of the draft standard and a comment form, or for more information, contact Cristine Fargo, ISEA's director of member and technical services, at [email protected].

The head protection section requires employers to:

  • Ensure that each affected employee wears a protective helmet when working in areas where there is a potential for injury to the head from falling objects.
  • Ensure that a protective helmet designed to reduce electrical shock hazard is worn by each such affected employee when near exposed electrical conductors which could contact the head.
  • Ensure that the head protection PPE being used complies with ANSI/ASSE Z89.1-2009, American National Standard for Industrial Head Protection, or the 2003 or 1997 editions of that consensus standard, which, again, are incorporated by reference. This standard establishes requirements for industrial head protection relating to impact protection, penetration protection, and electrical insulation protection.

Head Injury Prevention
Preventing occupational head injuries starts by following the hierarchy of controls. "There is no one hierarchy of controls that all health and safety professionals agree upon, but most are similar to the hierarchy found in the American National Standards Institute's (ANSI) and American Industrial Hygiene Association's ANSI/AIHA Z10-2012 Occupational Health and Safety Management Systems standard, which has six levels, starting with elimination, substitution, and engineering controls in the higher levels and ending with warning systems, administrative controls, and personal protective equipment (PPE) in the lower levels," Matthew O'Connell, Ph.D., co-founder and executive vice president of Select International, Inc., and Ron Gantt, CSP, ARM, vice president of operations for Safety Compliance Management, pointed out in their article "Moving Selection to the Top of the Hierarchy," published in our July 2013 issue.

This article is worth revisiting: They wrote that Select International had conducted several studies that looked at applying an assessment of safety risk in the hiring process of a number of industries. What these found is that fewer than 10 percent of employees accounted for a disproportionate percentage of work-related injuries. "As part of a systematic approach to safety management and risk reduction, it's clear that the identification and removal by selection of high-risk individuals in a scientifically valid and legally defensible way before they step onto the work site might be one of the most cost-effective solutions available," O'Connell and Gantt wrote.

Select International reviewed research in this area and came up with these four primary risk factors, as described in their article:

(1) Stays in Control. This relates to personal and emotional control. This is an important factor that typically only comes into play under stressful situations. In other words, some people may perform well on the other three factors under normal situations, but when an emergency happens, they have difficulty maintaining composure and are likely to do something that puts them or others into harm’s way.

(2) Aware of Surroundings. The second factor focuses on the individual's awareness of his or her environment. Incidents often occur not because of overt actions such as taking shortcuts, not wearing proper protective equipment, or behaving in an unsafe manner, but because the individual was not sufficiently aware of the dangers around him.

(3) Follows Rules. This factor focuses on diligence, following rules, working hard, and taking responsibility. Simply put, some individuals are more rule-bound than others. Those who are not are more likely to increase their level of exposure by not following safety rules that they feel do not apply to them or are not important.

(4) Exhibits Caution. The fourth and final factor focuses on the individual's proclivity toward risk-taking behavior, as well as his impulsivity. Impulsive individuals tend to be more volatile and unpredictable. Individuals high in risk taking are often described as "thrill seeking" or "sensation seeking." Combining volatility and thrill seeking greatly increases the likelihood of increased exposure.

If the approaches in the higher levels of the hierarchy cannot fully eliminate the hazard, complying with the standards above is the answer for. To prevent non-occupational head injuries, CDC and others recommend wearing a seat belt whenever you drive or ride in a motor vehicle; never driving while under the influence of alcohol or drugs; wearing a helmet when playing contact sports, skiing or snowboarding, or riding a bicycle or motorcycle; and taking several steps to prevent falls at home, such as using non-slip mats in bathtubs and showers, installing grab bars, and removing tripping hazards.


This article originally appeared in the March 2015 issue of Occupational Health & Safety.

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