Sacramento Safety & Health SummitOct. 2, 2018

Crowne Plaza Sacramento Northeast, Sacramento, CA

Presented by Peter P. Greaney, M.D.President, CEO and Medical Director, WorkCare, Inc.

Controlling the Uncontrollable: Managing Employee Exposures

and Injuries in the Field

Introduction

Peter P. Greaney, M.D.Board-certified in occupational medicine

Established WorkCare in 1984 as an occupational health consulting practice

Employee health management services in many types of industries

Protecting and Promoting Employee Health – from hire to retire

Session Overview

▪ Non-serious incidents can be safely managed in the field

▪ Specialized first aid kits improve health outcomes

▪ Educating employees raises satisfaction scores, cuts costs, lowers workers’ comp claim and OSHA-recordable rates

▪ First-aid guidance provided by clinician using mobile technology relieves anxiety and supports a rapid and safe return to work

Note: Always follow emergency response protocols in the event of an exposure or injury that could be serious or life-threatening

Commonly Occurring Injuries in the Field

Strains and sprainsCuts, scrapes and puncture wounds

Eye injuriesBites and stings

Poisonous plantsBurns

Reactions to extreme temperatures

Work in confined spaces and possible exposure to chemical byproducts also a concern

Field Management Challenges

1. Minor injuries can quickly become costly when not managed well from the beginning

2. Exposure/injury assessment is typically not within a supervisor’s skill set

3. Employees may not immediately report work-related injuries, aches or pains

4. Delayed assessment and care can result in a more serious injury and possible work loss

Field Management Solutions

Supply advanced first aid kits in the field

Train employees to recognize symptoms and respond to exposures and injuries

Encourage reporting at commencement of work-related injury or complaint of physical discomfort

Access to 24/7 telehealth for care guidance

First Aid Examples

• Cleaning minor cuts, scrapes, or scratches

• Treating a minor burn

• Use of non-prescription medicine

• Removing foreign objects from eyes

• Applying bandages and dressings

• Applying ice or heat

• Drinking fluids to relieve heat stress

• Draining blisters

• Massage

First Aid vs Medical Treatment

First Aid Medical Treatment

Health care encounter Observation, diagnostic testing, counseling, first-aid procedures Any treatment not on the first-aid list

MedicationsNon-prescription medications at non-prescription strength: ointment, cream, pill, liquid, spray, etc.

Prescription medication, whether or not it is filled or taken; non-prescription medication at prescription strength

Cuts, punctures, abrasionsBandages: Band-Aids, gauze pads, butterfly, Steri-Strips, liquid; cleaning, flushing or soaking skin wounds; non-prescription antiseptic

Sutures, staples, surgical glue, prescription-strength antiseptic; surgical debridement

Inoculations Tetanus immunizationHep B, rabies vaccine, other vaccinations necessary for worker to perform duties

Strains, sprains, dislocationsHeat or ice, non-rigid support, finger guards, temporary immobilization devices for transport (splints, slings, neck collars), preventive exercise guidance, preventive massage

Casts, rigid braces, chiropractic manipulation, physical therapy, exercise regime recommendedby a health care professional

Burns, skin rashes, blisters Soaking, hot or cold therapy Any treatment beyond first aid

Bruises, contusions Soaking, hot or cold therapy Draining bruises by needle

Foreign bodies and splintersEye irrigation or swab for foreign bodies in eye; irrigation, tweezers or other small tools for splinters

Foreign bodies/splinters requiring more than simple means to remove because of location, depth, size or shape

Advanced First Aid Kit

Contents specifically selected for work environment

Store in water-proof container

Periodic schedule for restocking and expirations

Easily accessible to anyone in field

First Aid - Reminders

If using ice or gel pack, provide a place to rest/elevate, if necessary

Have OTC medications available

If you have medication available, hand the employee the bottle or packet, DO NOT pour medicine into hand

This is considered dispensing medication

SPICE Model

We help prevent routine injuries from becoming complex, costly claims.

We understand that staying at work

promotes good health and healing.

We promote early intervention – optimally

during the "golden hour” – for best results.

We collaborate with all parties to effectively manage every case.

We provide reassurance and establish reasonable expectations for recovery.

The SPICE model provides the foundation for WorkCare’s approach to injury assessment and care guidance.The concept originated with the medical management of WWI soldiers suffering from post-traumatic stress disorders.

11

Telehealth

Contact with occupational clinicianvia 24/7contact center and smartphone app

Field triage

Initial evaluation

Referral decision

Follow-up during recovery

Telehealth Applications

Using telecommunications technology to provide remote medical support and

education to patients

Examples:▪Telephonic or smartphone app*▪Remote, video visit* ▪Sharing protect health information with another provider*

*Requires secure connection and HIPAA compliance

Case Study:8 Utility Industry Clients, 2017

*Benchmark across all client types, 75%

Total Cases Managed 7,135

Cases Self-Care (vs. clinic visit) 77%*

Cases Managed within 1 Day of Report 71%

Clinic visit cases with successful

peer-to-peer engagement91%

Percent Self-Care: Utilities

82%

79%78%

75%74%

73%

70%

UtilitiesCompany A

UtilitiesCompany B

UtilitiesCompany C

WorkCareBenchmark

UtilitiesCompany D

UtilitiesCompany E

UtilitiesCompany G

WorkCare Benchmark and Utility ClientsPercent Self-Care

U.S. Workplace Injuries & Illnesses

Category All Industries

Total recordable cases 2.9

DART cases 1.6

Days away from work cases 0.9

Job transfer or restriction cases 0.7

Per 100 FTEs:

Source: U.S. Bureau of Labor Statistics, 2016 data based on nearly 29 million nonfatal workplace injuries and illnesses

More than two-thirds of reported injuries/illnesses are “not of a serious nature” and do not result in lost time

Vulnerable Body Parts

Leading Culprit: Back Pain

▪ By far…most commonlyoccurring and most expensivein social and financial terms

▪ “Part of human experience”

▪ Expectations for recovery

First Aid: Non-specific Aches & Pains

Ice

OTC pain reliever

OTC nonsteroidal anti-inflammatory medications (NSAIDs)

Return to full or temporarily modified work

First Aid: Back Pain ACOEM Guidelines

Try simple treatments first

Set expectations

Strong reassurance

Keep active

Shoulder

First Aid: ShoulderACOEM Guidelines

OTC NSAIDs, acetaminophen, cold/heat

Nocturnal pain (RC)

Don’t baby too much

“Gentle range of motion”

Referral if red flags

Knee

First Aid: KneeACOEM Guidelines

OTC NSAIDsAcetaminophen Cold/heatFlexible knee brace

Medical Evaluation:• X-rays• MRI only if internal

derangement

Elbow

First Aid: ElbowACOEM Guidelines

OTC NSAIDs, acetaminophen, cold/heat

Hand/Wrist

First Aid: Hand/WristACOEM Guidelines

OTC NSAIDs, acetaminophen, cold/heat

Semi-flexible thumb SPICE vs. rigid

Up to 6 weeks trial first aid in most cases

Scott Specialties Thumb SPICA at Moore Medical

Ankle/Foot

Ankle

Plantar fasciitis

Calf strains

First Aid: Ankle/FootACOEM Guidelines

OTC NSAIDs, acetaminophen, cold/heat

Ankle: ACE wrap if minor

Plantar fasciitis: High-arched,stiff-soled shoe

Calf: Cam walker boot,with evaluation

Minor Eye Complaints

Foreign body sensation

Foreign body

Minor UV keratitis

First Aid: EyeACOEM Guidelines

Conservative management 48-72 hours(typical minor complaints)

Medical Evaluation: EyeFlash Burn

If indicated, refer to physician:

▪ Inspect eye for foreign body

▪ Apply ice compresses

▪ Check visual acuity (may do hand-held testing)

▪ Advise person on correct eye protective equipment

Rashes

Poisonous Plants

▪ Many types of plants can cause allergic reaction ▪ Sap oil released when plant parts are bruised,

damaged or burned ▪ Most common exposures are to poison ivy,

poison oak and poison sumac▪ Fluid in rash blisters not contagious

Most plant rashes heal within5 to 12 days

First Aid: Poisonous Plants

▪ Clean skin with Zanfel®, rubbing alcohol, skin cleanser, or soap and cold water

▪ Scrub under fingernails with brush

▪ Apply wet compress, calamine lotion, OTC hydrocortisone cream,

▪ OTC, non-drowsy antihistamine for itching

Note: Immediate care for swelling and rash on face or genitals, difficulty breathing and serious prior reactions

First Aid: Heat Rash

Symptoms:

Red clusters of pimples or blisters

Typically in groin, under breast, in elbow creases

Self-care:

Work outdoors when it’s cooler, less humid, as feasible

Keep affected area clean and dry

Wear loose-fitting, cotton clothing

Skin irritation from sweating

First Aid: Hand Rash

OTC medications OK (most cases)

If hives, OTC antihistamines

Referral if infection occursor symptoms worsen

If a “poison-ivy” delayed-onsettype of rash, then steroids may be recommended

First Aid: Insect Bites and Stings

Wash area with soap and water, wipe with rubbing alcohol or first-aid antiseptic.

For inflammation, apply wrapped ice pack for no more than 15 to 20 minutes an hour for first 6 hours

When not using ice, keep a cool, wet cloth on bite or sting for up to six hours

After 6 hours, if swelling is not present, warmth may be applied to the site for comfort

First Aid: Insect Bites and Stings

To help relieve pain and itching, OTC antihistamine, local anesthetic spray, hydrocortisone cream (1%) or

calamine lotion

If unsure about medication effects, ask a prescribing clinician or pharmacist

If a bite becomes irritated, apply OTC antibiotic ointment and cover with bandage

Medical Evaluation: Bites and Stings

Signs of infection requiring evaluation include:

▪ Increased pain

▪ Swelling

▪ Redness

▪ Warmth around bite or sting

▪ Red streaks leading from the area

▪ Draining or pus

▪ Fever

First Aid: Dog Bite

Wash the bite area with soap and water

If skin is broken:▪Apply sterile bandage to the wound

▪Apply OTC antibiotic ointment

For deeper wounds, get a medical evaluation

Burns

A burn is tissue damage that results from scalding, overexposure to the sun or other radiation, contact with

flames, chemicals or electricity

Medical Evaluation: Electrical Burn

Appearance of a burn is not anindicator of how serious it is

First aid treatment of the burned area is usually of secondary importance in comparison to possible serious heart damage

First Aid: Minor Burns

Hold the burned area under cool (not cold)running water or apply a cool, wet compress

On hands, gently removerings before swelling occurs

Do not break blisters

Apply topical OTC antiseptic

Cover mild burn withloosely wrapped sterile gauze

OTC medicationfor pain and swelling

First Aid: 1st Degree Burn

A burn marked by pain and reddening of skin Without blistering or charring of tissue

First aid may include but not be limited to:

▪ Immerse in cool water▪ Apply OTC burn gel until burning

sensation does not reoccuron exposure to air

▪ Wash gently with soap and tap water ▪ No dressings necessary

First Aid/Medical Eval:2nd Degree Burn

▪ Immerse in cool water or apply burn gel immediately until burning sensation does not reoccur on exposure to air

▪ Wash gently with soap and water

▪ Leave blisters intact

▪ Keep affected part elevated to reduce edema

A burn that causes blistering on the skin but does not damage deeper layers or require grafting

Medical Evaluation: Electrical Burn

Caused by contact with chargedelectric wire or electrical source

Vary in type; someare diffuse and shallow; others

are localized and deep

Temperature Extremes

High outdoor heat index

Heat in confined spaces

Exposure tocold temperatures

Water immersion

Temperature Extremes

Temperature Extremes

Classification Heat

Index Effect on the body

Caution 80°F -

90°F

Fatigue possible with prolonged exposure

and/or physical activity

Extreme

Caution

90°F -

103°F

Heat stroke, heat cramps, or heat exhaustion

possible with prolonged exposure and/or

physical activity

Danger 103°F -

124°F

Heat cramps or heat exhaustion likely, and

heat stroke possible with prolonged exposure

and/or physical activity

Extreme

Danger

125°F or

higher Heat stroke highly likely

First Aid: Heat Cramps

Self-care:

Stop activity and sit in a cool place

Drink juice or sports drink

Don’t return to strenuous work

until cramps subside

Seek medical intervention if:

Cramps do not subside in an hour

Worker has any heart problems

Usually affects workers who sweat a lot with strenuous activity

Sweating depletes the body of sodium and body fluid

Symptoms:Muscle spasms usually in the abdomen, arms or legs

First Aid: Heat Exhaustion

Body’s response to

loss of water and salt

from heavy sweating

Symptoms:

Cool, moist skinHeavy sweatingHeadacheThirstWeakness

IrritabilityFast heart rateDizzinessNauseaVomiting

Self-Care:

• Have worker sit or liedown in cool, shady area

• Give plenty of water orother cool beverages (avoid caffeine)

• Cool with cold compress or ice packs

Seek medical intervention if:

• EE does not respondto treatment in 1 hour

First Aid: Reactions to Cold

For shivering, re-warm by wrapping in blankets, going indoors and using radiant heat source

Move around to generate body heat and drink sweetened, warm, non-alcoholic beverage

For frostnip, place the affected area in warm, not hot, water until tissue softens

Mildly frozen tissue may be rewarmed and insulated until medical attention is received as long as there is no danger of refreezing

If you suspect frostbite or hypothermia, get medical care

Chemical Exposures

Chemical Inhalation

Lungs/pulmonary route: • Lungs quickest way for toxin

to enter the body

Toxin or simple asphyxiant?

If toxin: Water soluble?

If toxin: Irritant, sensitizeror metabolic asphyxiant?

Chemical Asphyxiants:“Mitochondrial Constipation”

Carbon monoxide (CO)

Hydrogen cyanide (AC)

Hydrogen sulfide (HS2)

Hydrogen fluoride (HF)

Medical Evaluation: Chemical Exposure

No ACOEM Guidelines

If minor and no red flags,close follow-up for a day or so

Bronchodilators or steroids may be needed

Follow-up testing (blood, urine, PFT)

Questions & DiscussionThank you for your attention!

Dr. Peter P. Greaney

Peter.Greaney@workcare.com