City Employee Injuries Overview

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1 INFORMATION MEMO City Employee Injuries Overview Learn about the most common and costly city employee injuries according to League Insurance Trust workers compensation coverage data. Understand how to avoid workers compensation insurance premium increases by avoiding workers compensation losses. RELEVANT LINKS: I. Workers compensation costs The LMCIT Workers Compensation program has experienced increasing loss costs over the past five years. This is primarily a result of increasing medical costs, which is consistent with trends in the industry. Medical costs are now the single largest category in work comp, comprising approximately 58 percent of total loss costs in LMCIT has experienced increases in work comp medical costs every year since 2001 and predicts these costs will continue to rise. LMCIT workers compensation rates and dividends. LMCIT has increased work comp premium rates 7 to 12 percent in each of the last five years, with the exception of Given the rise in medical costs, the only way cities can truly avoid premium increases is to avoid work comp losses altogether. With this goal in mind, LMCIT has reviewed work comp losses by job class, injury characteristics, and other criteria to help cities identify where and how to focus risk reduction and safety programs. On average, LMCIT handles approximately 4,300 work comp claims a year. Incurred work comp costs for the most recent five-year period totaled more than $70 million. Three job classes public works, police, and firefighters accounted for 70 percent, or nearly $49 million, of total incurred loss costs from 2002 to Four additional job classes worth mentioning parks and recreation, clerical office employees, electric and steam, and healthcare comprised 20 percent or approximately $14 million. Thirty-eight additional job classes were combined into the all other category. Among the job classes in this category, none of them comprised more than 3 percent of total loss costs. This material is provided as general information and is not a substitute for legal advice. Consult your attorney for advice concerning specific situations. 145 University Ave. West 2/22/2014 Saint Paul, MN (651) or (800) All Rights Reserved

2 Percent of Incurred Loss Costs by Job Class: 2002 to 2006 Healthcare 5% Electric & steam plant 5% Clerical office employees 5% Parks & Rec 5% All Other 10% Public Works 27% Firefighters 17% Police 26% In addition to looking at the proportion of total loss costs that each job class represents, it s also valuable to look at the number of claims by job class and average cost per claim. Distribution of Incurred Loss Costs by Job Class: 2002 to 2006 $4,500 $4,000 $3,500 $3,000 $2,500 $2,000 $1,500 $1,000 $500 $0 Public Works Police Firefighters Parks & Rec Clerical Electric & Healthcare office steam plant employees All Other 6,000 5,000 4,000 3,000 2,000 1,000 0 Average Cost Per Claim Number of Claims Firefighters and electric and steam plant employees have the highest average cost per claim. The high average cost per claim for the electric & steam plant job class is the result of several, quite severe injuries. In fact, from 2002 to 2006, there were eight injuries to electric and steam plant employees, with total incurred costs greater than $100,000 each. The high cost per claim for firefighters is the result of several on-the-job deaths and a few severe motor vehicle accidents. Specific information on injuries to firefighters is found. City Employee Injuries Overview Page 2

3 Public works employees and police officers also have high average claim costs. Thirty-one public works injuries each had a total incurred cost of $100,000 or greater. Among them are a few deaths and a few severe back and head injuries. Thirty-four work comp claims for police officers had total incurred costs greater than $100,000 each. Some of the high-cost claims for police were deaths. More details on injuries to police officers from our injury analysis study are described later. It s also valuable to understand other breakdowns of claim costs. Even though a majority of claims were medical-only, the largest proportion of injury costs were comprised of temporary disabilities (total and partial) and permanent partial disabilities. It s likely that at least some of these employees will never return to work. Those that do may not be able to work at full capacity. As the below chart shows, these are the injuries that end up costing the most. Distribution of Incurred Loss Costs by Type of Injury: 2002 to Temp total disability & Temp partial disability Perm partial disability Med only claims Death Impairment comp Perm total disability Incident only Economic recovery comp Percent of Claims Percent of Total Incurred A. Injuries to body parts More than 67 percent of work comp injuries occur to one of three body parts backs, upper extremities, and lower extremities. Back injuries are the single most costly injury within LMCIT. Lower and upper extremity injuries can include a variety of injuries, ranging from shoulder strains to carpal tunnel syndrome. City Employee Injuries Overview Page 3

4 These are the percentages of incurred loss costs by body part from 2002 to 2006: Back 26% Upper extremity 22% Lower extremity 19% Internal organs 4% Neck 4% Head 5% Hand 5% No physical injury 6% You might be curious about the no physical injury category, which comprised approximately 6 percent of all work comp costs during the fiveyear period. Injuries in this category include claims in which the employee was exposed to an infectious disease, experienced post-traumatic stress syndrome, or damaged eye glasses or artificial limbs. The single most common nature of injury category was sprain/strain. Sprains and strains comprised 62 of total incurred costs from 2002 to This is directly related to our findings about lifting/pushing/pulling and slips/falls. When an employee injures him/herself by falling or lifting a heavy object, the result is usually a strained muscle. These are the percentage of incurred loss costs by the nature of the injury from 2002 to 2006: Sprains, strains 62% Contusions, crushing, bruised 9% Dislocation, fracture 8% Laceration, cut, puncture, scratch 4% All other 17% B. Costs and cause of injuries Over half of the total cost of work comp injuries over the last five years is attributed to injuries caused by lifting/pushing/pulling or slips/falls. This finding suggests that a good portion of work comp injuries may be prevented with ergonomic equipment that eliminates or reduces manual handling of objects and people, and footwear, good housekeeping practices and elimination or otherwise isolating hazards on working and walking surfaces, etc. City Employee Injuries Overview Page 4

5 The percent of incurred loss costs by the cause of injury from 2002 to 2006 was: Strain or injury by lifting, pushing or pulling 41% Slip or fall injury 21% Person in the act of a crime 8% Struck or injured by 7% Motor vehicle collision 5% All other 17% II. Public works losses Public works employees comprised the greatest proportion of incurred loss costs over the past five years more than 27 percent. To date, the League has not conducted an in-depth analysis of injuries to public works employees. Anecdotally, however, we know many injuries to public works employees are musculoskeletal in nature and often caused by overexertion. Given this, we believe employee safety training and ergonomic reviews will decrease some of the injuries public works employees experience. The public works job class is made up of four distinct job functions: Street construction. Waterworks. Sewage disposal plant. City shop and yard. Among the four job functions, street construction comprised the largest proportion of costs, approximately 63 percent. Job functions as a percent of incurred los costs for public works employees from 2002 to 2006 were: Street construction 63% Waterworks 17% Sewage disposal plant 11% City shop and yard 9% An overview of the injury data for public works employees confirms their injuries follow the same trends that we see overall in work comp. Backs and upper/lower extremities are the most commonly injured body parts. In addition, a majority of injuries to public works employees are sprains/strains. City Employee Injuries Overview Page 5

6 LMC Regional Safety Groups. To address these injuries and concerns, LMCIT offers Regional Safety Group (RSG) program to cities to assist them in meeting OSHA requirements and starting safety programs, no matter the size of the city or its budget. LMCIT will continue to monitor and study injuries to public works employees in the future, with an emphasis on training programs that can help cities reduce injuries and therefore reduce work comp claim costs. III. Public safety losses Police officers and firefighters pose unique risk management issues to cities because their work is inherently dangerous. Work comp injuries to police and firefighters represent a substantial portion of LMCIT s overall work comp costs 26 and 17 percent, respectively. A. Police injuries LMCIT s police injury analysis was completed using detailed claims information from 330 lost-time claims that occurred between 2002 and The claims included in the analysis had a total incurred value of approximately $7.9 million. Police injuries were categorized according to 14 possible activities: Training. Use of force confrontations. Medical assistance. Rescue. Motorist assist. Foot pursuit. Other running. Tactical area search. Emergency response in a motor vehicle. Non-emergency motor vehicle incidents. Pursuit of a suspect. Office work. Working in traffic. Other. The top five injury categories by total incurred costs for police officers were: Chart, Police Activities as a percentage of Claims and Incurred Loss Costs: Foot pursuits 17.2% Use of force 15.6% Training 13.3% Non-emergency motor vehicle operations 7% Medical assists 6.7% City Employee Injuries Overview Page 6

7 1. Foot pursuit There were 41 foot pursuit injuries to police from 2002 to Foot pursuit injuries cost, on average, approximately $33,000. Approximately 54 percent of foot pursuit injuries were to the legs. In addition, more than 75 percent of foot pursuit injuries were sprains/strains. 2. Use of force There were 67 use-of-force injuries to police during the study period. Use of force claims comprised the second largest proportion of total incurred costs, approximately 15.6 percent. Approximately 62 percent of use-offorce injuries were sprains/strains. Similar proportions of use-of-force injuries occurred to the following body parts: legs (26.9 percent), arms (24.9 percent), and hands (20.9 percent). 3. Training There were 44 injuries during the study period which occurred during training. Training injuries comprised approximately 12 percent of costs, with the average injury costing about $22,000. A majority of training injuries were to the legs (39.5 percent) or arms (23.3 percent). 4. Non-emergency motor vehicle operations This activity had one of the highest average costs per claim more than $39,000. A large number of injuries in this category were to the neck (21.7 percent), arms (13.0 percent), and head (8.7 percent). A vast majority of claims (60.9 percent) were sprains/strains. 5. Medical assists Medical assists comprised nearly 7 percent of claims and more than 9 percent of incurred costs. Medical assists had an average cost per claim of nearly $33,000. Fifty percent of medical assist injuries were to the back. An additional 18.2 percent of injuries were to the legs. More than 96 percent of medical assist injuries were sprains/strains. B. Recommendations for police Perhaps the most viable and immediate risk management strategy for police departments is to build agency-wide awareness of the risks associated with foot pursuits. A fair question to ask is whether chasing someone is really worth the risk. Risk of injury will increase under low light conditions and especially when confronting unfamiliar terrain. City Employee Injuries Overview Page 7

8 Taking people into custody (also known as use of force confrontations ) is an inevitable aspect of a police officer s duties. Eliminating this duty because it is hazardous is not an option, but thinking about how to address the risks is extremely worthwhile. One issue to think about is the use of technology. During pilot studies, some departments reported reductions in officer injuries ranging from percent once a Taser was introduced. Reductions in citizen injuries and excessive force complaints were also reported. While these outcomes provide cause for optimism about what technology can do, some law enforcement policy makers question whether officers are becoming overly reliant on Taser devices. They express concern that officers are opting to use the device in circumstances where a simple escort hold or other lowerlevel force options might be sufficient to gain the subject s compliance. These are complex issues that balance officer safety considerations against community expectations. Resolving them requires substantial thought and deliberation. There s no easy solution. Police departments do not have control over where foot pursuits, use of force events, or medical assistance activities take place. They do, however, have control over where and how training takes place. Indeed, training is the one activity for which departments have extensive control over the work environment and the activities being conducted. They also have the opportunity to put controls in place to safeguard their employees. The challenge is figuring out what the controls ought to be. Some theorize that injuries stem from officers failing to maintain a sufficiently warm body temperature to keep their muscles pliable and resistant to injury. Others theorize that the soft, gripping surface of training mats allow officers to get too much traction during various drills, and puts knees and other joints at risk of excessive extension or twisting. While there are theories about the causes of training injuries, there are no scientifically validated information as of yet. LMCIT studies don t validate or provide answers in this regard. Designing interventions for these types of injuries is going to require collaborative efforts among various industry experts, such as training officers/police managers and doctors/physical therapists. City Employee Injuries Overview Page 8

9 It s not surprising that non-emergency driving accidents cause a lot of injuries to police officers they spend a great deal of time in the car. Defensive driving courses are available on the commercial market and might prove useful in avoiding vehicle accidents. In addition, creating a culture that places an emphasis on safe driving may also be helpful. A formal process for reviewing each motor vehicle mishap can provide agencies with insights into causal factors and can also send a cultural message that avoidable accidents are not accepted as normal incidents of police work. The large number and cost of injuries to police officers during medical assists was greater than expected. Departments should provide safe patient handling equipment as feasible and insist that First Responder and other EMS training include components on safe patient handling. C. Firefighter injuries Firefighter work comp losses are the third largest incurred in LMCIT s work comp program. These data include injuries from paid full-time, paidon-call, and volunteer firefighters. Previous LMCIT analyses have shown there isn t a significant difference in injury statistics by type of firefighter. The findings below include data from 290 lost-time firefighter work comp claims from injuries which occurred between 2002 and 2006, excluding high-cost claims exceeding $50,000. (There are so few of these claims and the dollar amount is so great, including them would have skewed the findings.) Claims included in this analysis had a total incurred value of approximately $10.1 million. Fire injuries were classified into 13 possible injury categories: Fire scenes. EMS. Training. Fire station and maintenance. Occupational disease. Repetitive stress. Emergency driving. Non-emergency driving. Physical fitness. Inspection. Office work. HazMat. Other. The top four injury-producing activities for firefighters as a proportion of incurred loss costs from 2002 to 2006 were: City Employee Injuries Overview Page 9

10 Fire scene 41% EMS 17% Fire station and maintenance 14% Training 8% All other 20% Eighty percent of all lost-time injury costs can be classified into one of these four operational areas: Fire scenes. EMS operations. Fire station and maintenance. Training. The percent of loss costs by cause of injury for firefighters from 2002 to 2006 was: Strain/injury by lifting, pushing, pulling 41% Slip or fall injury 26% Struck or injured by 17% All other causes of injury 16% 1. Lifting, pushing, pulling and slip and fall injuries Injuries from lifting/pushing/pulling and slips/falls are the most common among firefighters, comprising more than 65 percent of all loss costs. More than 47 percent of costs for injuries occurring at a fire scene were caused by a slip/fall. Among these, ice was a contributing factor in more than half of the injuries. Approximately 36 percent of injuries occurring at the fire scene were caused by lifting/pushing/pulling an object. Lifting/pushing/pulling activities also accounted for more than 74 percent of all injury costs attributable to EMS scenes. Fourteen percent of injury costs for injuries to firefighters were the result of injuries which took place at the fire station or happened during maintenance activities. Injuries occurring at the fire station and during the course of routine maintenance were most often caused by lifting/pushing/pulling (43 percent of costs) and slips/falls (36 percent of costs). 2. Training Eight percent of injury costs during the period of study were due to injuries that took place during training. Among training injuries, 43 percent of injury costs were the result of lifting/pushing/pulling. Nearly 20 percent of training injury costs were attributable to slips/falls. City Employee Injuries Overview Page 10

11 3. Non-emergency driving Non-emergency driving wasn t among the top injury producing activities for firefighters; however, it merits attention Non-emergency driving had the highest average cost per claim for firefighters more than $20, Other factors In addition to classifying firefighter injuries by activity and cause of injury, LMCIT identified several other factors leading to firefighter injuries. These factors might be considered aggravating or contributing factors to firefighter injuries. The most commonly identified contributing factors to a firefighter injury were: ice, hose-handling, and traffic hazards. Ice was a contributing factor in at least 13.7 percent of all claims. Hose-handling was a factor in at least 10.5 percent of claims, and traffic hazards were a factor in at least 6.5 percent of claims. One of these factors was mentioned in at least 31 percent of all claims. D. Recommendations for firefighters A firefighter on the scene of a fire during December in Minnesota faces a unique set of job hazards. Not only does s/he have to carry around 50 to 60 pounds worth of gear, but s/he also has to walk on the ice that s been created by water used to put out the fire. One can easily see how a slip/fall injury can be aggravated when a firefighter falls to the ground with the weight of his/her own body plus the weight of equipment needed to do the job. There is no simple fix to this issue. Budgets in small cities are already strained and buying special boots to avoid these injuries would not be cheap. For cities that can t afford ice-gripping boots, we recommend regular boot inspections. If there isn t a sufficient amount of tread, it s time to replace the boots. 1. Physical fitness This is an important component in the overall effort to decrease injuries to firefighters. There is a great deal of research demonstrating that employees who are physically fit are less likely to have a work-related injury, including sprains/strains and injuries from lifting/pushing/pulling an object. In addition, a physically-fit employee is likely to be less severely injured than an employee who is not physically fit. City Employee Injuries Overview Page 11

12 Many firefighters are injured handling patients while providing EMS services. LMCIT has a great deal of knowledge about patient-handling injuries. We know that patient extraction and patient transportation are some of the most injury-producing activities an employee can do. The traditional lifting techniques do not prevent patient handling injuries. In addition, lifting injuries can be compounded by one of two factors either EMS runs are numerous and employees are lifting repetitively throughout the day, or patient extraction is handled infrequently enough that lifting techniques are easily forgotten between events. Contact your loss control consultant for information on purchasing ergonomic equipment. 2. Ergo equipment Ergonomic equipment is designed to assist in safe patient handling has been proven to decrease the number of patient handling injuries in hospitals and nursing homes. Similar but more portable equipment is also available for public safety personnel who provide EMS services. Safe patient handling equipment could effectively reduce a significant number of injuries for police and fire due to EMS activities. LMCIT is willing and able to advise police and fire departments who are considering the purchase of ergonomic equipment for patient handling. A municipal fire station isn t all that different from a city workshop. Many of the same risk factors exist in both environments. Some of the common musculoskeletal risk factors that firefighters face include: Awkward postures. Prolonged postures. Repetition. Temperature extremes. Vibration. Excessive force/weight. Common maintenance or fire station job duties include hose rolling, carrying heavy equipment, and physical exertion. We assume that many of the lifting/pushing/pulling injuries firefighters experience are the result of one or all of these musculoskeletal risk factors. A solution to these injuries might involve job hazard evaluation and ergonomic guidelines. The purpose of ergonomics is to design the job to fit the worker not to make the worker fit the job. LMCIT already has a great deal of experience in job hazard analysis and workshop ergonomics and can help departments interested in this type of evaluation. 3. Training City Employee Injuries Overview Page 12

13 Similar to the findings for police, training injuries to firefighters can be severe and quite costly. Training needs to take place in a controlled environment and injuries during training activities should be completely amenable to loss control. Traffic hazards are also an area of concern for firefighters. There have been five firefighter deaths among LMCIT member cities over the past decade. All of these deaths have been the result of an auto accident or a firefighter being struck by a vehicle while on the side of a roadway. Driver training and roadway safety policies might help your department prevent firefighter injuries and deaths. LMCIT has made some important outreach to key agencies such as MSFCA (Minnesota State Fire Chiefs Association), MSFDA (Minnesota State Fire Department Association), MPFF (Minnesota Professional Firefighters), and IAFF (International Association of Firefighters) to help us design solutions that will be well-received by both city administration and fire departments. E. Other job classes 1. Parks and recreation Analysis of claims data shows that parks and recreation employees comprised more than 5 percent of incurred loss costs over the past six years. Job hazards for parks and recreation employees are often quite similar to those faced by public works employees. In fact, we anticipate skills presented in the OSHA/Safety Assistance program for public works employees are also directly applicable to many of the job hazards faced by parks and recreation employees. 2. Clerical Clerical employees in cities also comprise a similar proportion of WC injury loss costs. Over the six-year period of 2000 to 2006, injuries to clerical employees accounted for approximately 5 percent of incurred loss costs. Many of these injuries are cumulative and/or repetitive strains and often are the result of office ergonomic issues. 3. Healthcare LMCIT provides work comp coverage for several dozen municipal hospitals and nursing homes. Injuries to employees in municipal healthcare facilities comprised approximately 5 percent of injury costs over the past five years. Patient handling is one of the riskiest job tasks an employee can engage in, similar to industrial job tasks such as construction and mining. City Employee Injuries Overview Page 13

14 LMC no-lift demonstration project. A key way to prevent injury to healthcare employees is to use safe patient handling equipment. LMCIT has provided a safety grant in the form of a forgivable loan to the Fieldcrest Healthcare Center (FCC) in Hayfield. The Healthcare Center has now been converted to a no-lift facility. Ceiling lifts and alternative handling devices have been implemented so staff does not manually lift patients. LMCIT is carefully monitoring the changes taking place at FCC. We hope we will be able to demonstrate the costbenefit relationship of no-lift equipment to other healthcare facilities across the state. IV. Future activities Cities have an active interest in the health and well-being of their employees. LMCIT will continue to engage in research and education activities in the arena of employee safety. As we learn more about how city employees are injured, LMCIT will share information on how to increase employee safety and reduce injuries. Because we expect continued increases in the cost of healthcare over the next several years, the value in avoiding the avoidable injury will become even more apparent. Rachel Carlson, Loss Control Manager V. Further assistance If your city would like to learn more about employee safety and how to prevent on-the-job injuries, please contact League staff. Chris White, Loss Control Program Coordinator City Employee Injuries Overview Page 14

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