Capping Severe Injuries

Of all non-fatal workplace injuries, head injuries are among the most serious. In this article, Mariaan Smit addresses the causes of workplace injuries and how to protect against them.

Seventh February 2018 started as a normal workday for Mr Ackerman, who is employed at a heavy engineering company as a rigger. After attending the 15-minute toolbox talk, he went out of the training office and whilst walking in the demarcated walkway, slipped on the grease stained floor, lost his balance and fell. A co-worker witnessing him falling noticed that he did not get up from the ground, and rushed over to find out what was going on. When arriving at the scene he noticed that Mr Ackerman was vomiting and bleeding from the left side of his head, between his left eye and left ear. He immediately called for help and Mr Ackerman was transported to hospital by ambulance. He was unconscious by the time that the paramedics arrived on the scene and passed away in hospital the following morning, following a temporal lobe skull fracture. He was wearing the correct head protection on the day of the incident. The incident analysis revealed that the causative factor of the fatal incident was bad housekeeping as it was slipping on the grease stained floor that caused him to hit his head against a work bench, resulting in the skull fracture that lead to his death.

Non-fatal head injuries are among the most serious types of non-fatal injuries in the workplace as they have the potential to result in a permanent disability case, or for such an employee to accept that he cannot return to his old occupation and need to make some serious adjustments in his life after the injury. Permanent complications following a head injury that may prevent an employee to return to his normal work after recovery may be: difficulty in concentration and communication problems, seizures, behaviour changes, depression, sleep disturbances, and dizziness, to name but a few.

There are different causes of workplace related head injuries and the use of head protection will not always protect an employee from sustaining a serious head injury. Examples of potential causative head injury factors may be a motor vehicle accident; slips, trips or falls; explosions where the initial blast wave throws a person or even flying debris can cause injury; impact injuries, i.e. a crane operator not controlling the load and the load smashing into someone; objects falling from above, etc. Falls are one of the leading causes of traumatic brain injuries and a common cause of head injuries in general. In case of severe head injury, the injured person may present with signs of brain injury immediately, like loss of consciousness and vomiting. However, most people will not immediately realise that they sustained a head injury and the signs and symptoms may only become visible after a few hours or even days. It is therefore best practice to always consult a doctor immediately after sustaining a head injury even if the person does not complain. Such a person should be admitted to hospital for at least 24 hours following the head injury for monitoring.

First aiders should be trained in identifying the signs and symptoms of traumatic brain injuries. Some symptoms include:

• Consistent headaches that may become more severe as time passes
• Nausea and vomiting
• Convulsions or seizures
• Loss of consciousness for a few seconds or minutes
• Fatigue or drowsiness
• Sleeping more than usual
• Loss of balance
• Tingling sensation of the muscles and / or extremities
• Difficulty concentrating, for example following instructions, concentrating on a task, remembering things, and so on
• Changes in vision
• Mood changes or mood swings
• Clear fluid draining from the nose or ears
• Dilation of one or both pupils of the eyes
• Profound confusion
• Agitation or other unusual behaviour

Some signs or symptoms may appear immediately following the trauma, others may appear hours, days or even weeks later. It is therefore good practice to take any person who sustained a head injury for a check-up by a physician and to issue a family member of such a person with a list of signs and symptoms to watch out for. Should the family member notice any such signs or symptoms, the person must be taken to a doctor for a check-up without delay.

The hierarchy of control

The American National Standards Institute (ANSI) and the American Industrial Hygiene Association ANSI/AIHA Z10- 2012 Occupational Health and Safety Management Systems Standard, has six levels of control other than the five levels of control normally found in safety training manuals. These six levels are:

• Elimination
• Substitution
• Engineering controls
• Warning systems
• Administrative controls, and last resort:
• Personal Protective Equipment

One can, however, have all the control mechanisms in place, and a work accident can still take place. One of the reasons for this is the human involvement in the workplace and the interaction of human factors within the work area. Every individual employee should firstly take responsibility for his or her own health and safety, and then the health and safety of all co-workers – be your brother’s keeper. Three human factors need to be taken into consideration when trying to prevent head injuries in the workplace: people, the workplace and management. Under these factors are a list of elements that have the potential to contribute to workplace accidents and each element needs to be evaluated during the risk assessment to eliminate or reduce the risk of a head injury.

The elements are listed under each of the following three factors: people, workplace, and management.

People factor

Individual elements:

• Knowledge
• Induction training
• Frame of reference
• Psychological factors
• Expectations
• Conscientiousness
• Awareness of the surroundings – how aware is the individual of the surroundings
• Attention
• Goals
• Behaving in a safe manner
• Committed to following the rules
• Health
• Fatigue
• Age
• Culture
• Body size
• Strength
• Impulsivity and risk-taking behaviour
• Stress
• Using the correct protective gear in the correct manner

Workplace factor

Workplace design elements:

• Facility layout
• Workstation configuration
• Accessibility

Equipment design elements:

• Displays
• Controls
• Interface
• Warning systems
• Ease of use

Work environment elements:

• Noise
• Vibration
• Lighting
• Temperature
• Chemical exposure

Management factor

Systems organisations management elements:

• Organisations of work
• Policies
• Management decisions

Job design elements:

• Work schedule
• Task design
• Work load
• Job requirements

Information transfer elements:

• Written or verbal communication
• Work instructions
• Labels and signs
• Training

Selecting correct protection

The focus of any head protection should firstly be on the hazard, rather than on the type of head protection: chemical or molten metal splash, welding and grinding sparks, impact from flying fragments or particles, etc. Therefore, the risk assessment should always first be carried out, prior to the selection of the personal protective equipment. Things to consider during the risk assessment are the following:

1. What is the probability that something can fall from above?
2. If an object falls from above, what could the consequence be?
3. Is there an electrical shock hazard / is the employee expected to work close to exposed electrical conductors which can contact the head?
4. What standard is required in your specific country when selecting the head protection for your specific hazard(s) relating to impact protection / penetration protection / electrical insulation protection / burn protection?
5. What kind of force can be generated by an object falling from a height? Calculations can be done around the physics of gravity. For example, a twopound hammer that drops one metre onto a hard hat will not cause the same damage as the same twopound hammer that is dropped from 20 metres above.
6. Also, consider the shape of the object to determine the severity of the outcome. Take the same two-pound hammer that is used in the example above. If the hammer drops three metres onto a hard hat, it will not cause the same damage as a two-pound sleever bar that also drops three metres, as the spike like shape of the sleever bar would punch through the hard hat and penetrate the skull.

Types of hard hats and accessories

The primary function of a hard hat is to protect workers from sustaining a head injury where there is a risk of falling or projectile objects. It is designed to protect the head and brain by absorbing the force of impact when an object hits a person’s head. It can also provide protection against electrical shock and burns depending on the hazards in the workplace.

Hard hats are divided into two types and three industrial classes:

• Type 1 hard hat – Intended to reduce the force of impact resulting from a blow only to the top of the head, for example, an object falling from above onto a person’s head
• Type 2 hard hat – Intended to reduce the force of lateral impact resulting from a blow which may be received from the side or to the top of the head, for example, a person bumping his head against a sharp corner or beam
• Class G hard hat – For general use and offers protection against low-voltage electrical conductors of up to 2, 200 volts (phase to ground)
• Class E hard hat – Offers protection for electrical work and against exposure to high-voltage electrical conductors up to 20, 000 volts (phase to ground)
• Class C hard hat – Do not offer any electrical protection and may even be electrically conductive

What is important to bear in mind when purchasing a hard hat, is that the hard hat should bear a label inside the shell that stipulates the following:

• The name of the manufacturer
• The class of the hat
• The international standard to which the hard hat conforms

Bump caps do not offer protection against falling or flying objects, like in the instance of hard hats, but they do provide protection against accidental impact with fixed objects, for example a beam. Bump caps can only be worn where there are low overhead hazards. The advantage of bump caps is that they can be used when head protection is preferred but not required, since they are made from lightweight plastic and only protect the head from minor bumps and abrasions. Bump caps are not ANSI compliant and should the work hazards indicate fall protection, the employer should revert to hard hats.

Faceshields and headgear are not classified under head protection, but still form an important part of the risk assessment and selection of personal protective equipment in protecting the head and face. They should be used when there is a risk of flying debris, electrical sparks, or chemical or biohazardous splashes. It is important to remember that when a faceshield is required, the employee should also use appropriate safety goggles with it to protect the eyes.

Hard hat accessories are available as the parts of the hard hat can wear out or become damaged over time. Examples are sweatbands, brow pads, hat suspensions, slots for ear muffs and safety glasses. Employees should ensure that their hard hats, bump caps or other head protection equipment are always in optimal working condition and that they inspect it daily before using it. Should any parts be defective, is should be reported to the supervisor on shift and replaced immediately. Other accessories to add to the hard hat include peel-off visor covers, lamp attachments, dielectric brackets and so on.

Hard hat suspensions come in four, six or eight points and the wearer should ensure that all the points fit securely into the slots. The more points the suspension has, the better the force deflection. Suspensions should be replaced at least once a year. The shock-absorbing lining that incorporates a head band and straps with the hard hat should suspend the shell from 2.54 cm to 3.18 cm (or 1 to 1.25 inches) away from the head.

Hard hat shades can be used to protect the neck from working in the sun. Examples of hard hat accessories to prevent the head from sweating are sweat bandanas, knit cap liners and thermos-cooling skull doo-rags.

Firefighters’ helmets are specifically designed to be multifunctional and protect the wearer from falling debris and extremely hot temperatures. The helmet is made of thermoset resin composites or thermoplastics, providing greater impact and penetration resistance compared to fibreglass, and they will hold up through repeated thermal exposures.

Multifunctional rescue helmets are designed for firefighting, traffic accidents, rescue from heights, water rescue and other technical rescue assistance.

Welding helmets do not reside under the category of head protection, but rather face and eye protection, as they are designed to protect the eyes against radiant energy produced during the welding process. It can also be used for protection against sparks caused by grinding, cutting and other hot work.

Care and storage of hard hats

The care and storage of employees’ hard hats should form part of the tool box talks and general safety communication with employees. The communication should at least contain the following information:

• The hard hat shell, suspension system and all other accessories should be inspected daily for holes, cracks, tears or any other visible damage to the hard hat, as this can compromise the protective value of the hat
• A proper fit is imperative and should allow sufficient clearance between the shell and the suspension for both ventilation and distribution of impact
• Paints, paint thinners and some cleaning agents may weaken the electrical resistance and the shell of the hard hat
• Do not store the hard hat in direct sunlight, for example, such as the rear window shelf of your vehicle, as extreme heat and ultraviolet rays can cause damage to the hard hat
• Do not paint the hard hat, drill holes into it or apply any stickers to the hat as it may reduce the protective integrity of the head gear
• The hard hat must be replaced if it sustains an impact, irrespective of whether any damage to the hat is visible or not
• Suspension systems should be replaced when there is visible damage noticed or when excessive wear is noticed
• If loss of surface gloss, chalking or flaking of the brim or shell of the hat is visible, replace the hat
• The hat should be cleaned regularly with non-damaging chemicals
• The hat must not bind or irritate the skin or slip from the head
• All hard hats must be replaced five years after date of manufacturing

Promoting a safe working environment

It should always be top priority of employers to promote a safe working environment. One should alert employees that safety starts with the individual: if they think safely, they can work safely. This attitude leads to a proactive rather than a reactive approach towards safety in the workplace.

Safety training should focus on at least six fundamental elements to promote an exceptionally good attitude towards safer work habits:

1. Awareness – Stay alert and pay attention to the working environment, be cautious of possible work place hazards.
2. Focus – Increased concentration levels could decrease the hazards of distractions, fatigue and boredom and therefor the employer should strive to put systems in place to keep employees alert.
3. Strength – Have the inner strength to do the right thing and do not take shortcuts.
4. Patience – Take the time to do the work correctly every time as there is no shortcuts to safety.
5. Responsibility – Responsibility starts with the individual. Therefore, every individual should take responsibility for his or her own safe environment and those of everyone working with them.
6. Thought – Stop and think before you act, should be the number one thought before taking any action.

Managing head safety and fitness to work starts with:

• The employee him/herself
• Then your peers – I am my brother’s keeper
• Then your supervisor
• Then the clinic
• Wellness programmes
• Training