Injuries and exposures among ocean safety providers: A review of workplace injuries and exposures from 2007-2012.

Research on workplace injuries and exposures in ocean safety personnel remains limited. Despite increasing beach attendance and reliance on lifeguards for protection, the most common types of injuries, equipment resulting in injuries, and environmental exposures remains unknown. This study reviewed OSHA 300 logs summarizing workers' compensation claims from 2007-2012 to identify common body parts injured, action at time of injury, equipment causing injury, and environmental exposures. A secondary phase consisted of a cross-sectional anonymous survey to determine demographics, body part injured, equipment causing injury, sun and environmental exposures, action at time of injury, and proportion of injuries reported to the department. During the 6-year period, 304 claims from the OSHA logs were reviewed, finding the lower extremity was most commonly injured with 2921 (31.9%) cumulative lost work days (104 reported injured, 34.2%) followed by the back with 1679 (18.4%) lost work days (39 reported injuries, 12.8%). Of the 304 occupational injury claims from OSHA logs, 108 incidents (35.5%) occurred during rescues, 87 (28.6%) during normal duties, and 31 (10.2%) during training. Of survey participants, 22/52 sustained an injury, with 14 filling a worker's compensation claim. The rescueboard resulted in 7/22 injuries (31.8%) while 17 (32.7%) of respondents sought care for a sun related concern with a mean of 9.3 days lost. Occupational injuries in ocean safety personnel are largely unknown. In this study, lower extremity and back injuries were the most common musculoskeletal injuries providers encountered. Rescues and moving equipment were common actions at the time of injury. With this preliminary information, jurisdictions may develop training directed at rescue techniques and safer options for moving heavy equipment.

EMS providers' perceptions of safety climate and adherence to safe work practices.

BACKGROUND: Occupational injuries are an important source of morbidity for emergency medical services (EMS) providers. Previous work has shown that employee perceptions of an organization's commitment to safety (i.e., safety climate) correlate with adherence to safe practices. OBJECTIVE: To assess the association between perceived safety climate and compliance with safety procedures in an urban EMS system with >100,000 calls/year. METHODS: EMS providers were issued a self-administered survey that included questions on demographics, years of experience, perceived safety climate, and adherence to safety procedures. Safety climate was assessed with a 20-item validated instrument. Adherence to safety procedures was assessed with a nine-item list of safety behaviors. Strict adherence to safety procedures was defined as endorsing "agree" or "strongly agree" on 80% of items. The effect of safety climate on compliance with safe practices was estimated using multiple logistic regression. RESULTS: One hundred ninety-six of 221 providers (89%) completed surveys; 74% were male; the median age was 36-40 years; and the median amount of experience was 8 years. One hundred twenty-seven of 196 respondents (65%) reported strict adherence to safe work practice. Factor analysis confirmed the original six-factor grouping of questions; frequent safety-related feedback/training was significantly associated with safe practices (odds ratio [OR] = 2.14, 95% confidence interval [CI] = 1.01-4.51). CONCLUSION: EMS workers perceiving a high degree of perceived safety climate was associated with twofold greater odds of self-reported level of strict adherence to safe work practices. Frequent safety-related feedback/training was the one dimension of safety climate that had the strongest association with adherence to safe workplace behaviors.

Response to hepatitis A epidemic: emergency department collaboration with public health commission.

In 2004, a hepatitis A outbreak occurred in Boston, Massachusetts with an incident rate of 14.8 per 100,000, compared to 4.2 in 2003. The majority of cases had risk factors of homelessness, injection drug use, or incarceration. In September 2004, the Boston Public Health Commission began an immunization campaign partnering with health centers, detoxification centers, homeless shelters, and our Emergency Department (ED) to increase the number of hepatitis A vaccinations and stem the epidemic. The ED rapidly developed (within days) a vaccination protocol. Hepatitis A vaccinations were offered to patients over age 21 years who were homeless, substance users, or incarcerated. From October 2004 through January 2005, the ED vaccinated 122 patients notable for 64% male, 61% homeless, 28% substance users, and 11% incarcerated. No reported vaccination reactions occurred. There was a 51% decrease in the number of cases of Hepatitis A in Boston in the first 4 months of 2005. As a partner, the ED helped stem the epidemic by rapidly providing vaccinations to those most vulnerable. This project provides a model for future collaborations between EDs and local, state, and federal organizations to address epidemics.

Self-reported provider safety in an urban emergency medical system.

INTRODUCTION: Emergency Medical Service (EMS) personnel often respond to dangerous scenes and encounter hostile individuals without police support. No recent data describes the frequency of physical or verbal assaults or which providers have increased fear for their safety. This information may help to guide interventions to improve safety. Our objective was to describe self-reported abuse and perceptions of safety and to determine if there are differences between gender, shift, and years of experience in a busy two-tiered, third service urban EMS system. METHODS: This was a secondary analysis of an anonymous, cross-sectional work safety survey of EMS providers. This survey included demographics, years of experience, history of verbal and physical assault, safety behavior following an assault and perceptions of safety. Descriptive statistics were generated. RESULTS: Eighty-nine percent (196/221) of EMS providers completed the survey. Most were male (72%) and between the ages of 25 and 50 years (66%). The majority of providers had worked in this service for more than five years (54%), and many for more than ten years (37%). Verbal assaults were reported by 88% (172/196, 95% CI [82.4%-91.6%]). Although 80% (156/196, 95% CI [73.4%-84.6%]) reported physical assaults, only 40% (62/156, 95% CI [32.4%-47.6%]) sought medical care and 49% (76/156, 95% CI [41%-56.6%]) reported the assault to police. The proportion of those who sought medical care and reported the assault to the police was not the same across years of experience (p<0.0001). Fear for personal safety was reported by 68% (134/196, 95% CI [61.6%-74.5%]). There was no statistical difference in assault by gender; however, females feared more for their safety compared to men (38/50, 76% v 96/142, 68%, p=0.02). The proportion of those who have ever been physically assaulted was not the same across shift worked (p=0.01). CONCLUSION: The majority of EMS providers surveyed reported an assault and certain groups had a higher rate of assault. Most assaults were not reported to the police and medical care was infrequently sought following an event. The majority of providers reported feeling fear for their personal safety. Further research into enhancing safety mechanisms is needed.

Effects of presentation and electrocardiogram on time to treatment of hyperkalemia.

OBJECTIVES: To assess the time to treatment for emergency department (ED) patients with critical hyperkalemia and to determine whether the timing of treatment was associated with clinical characteristics or electrocardiographic abnormalities. METHODS: The authors performed a retrospective chart review of ED patients with the laboratory diagnosis of hyperkalemia (potassium level > 6.0 mmol/L). Patients presenting in cardiac arrest or who were referred for hyperkalemia or dialysis were excluded. Patient charts were reviewed to find whether patients received specific treatment for hyperkalemia and, if so, what clinical attributes were associated with the time to initiation of treatment. RESULTS: Of 175 ED visits that occurred over a 1-year time period, 168 (96%) received specific treatment for hyperkalemia. The median time from triage to initiation of treatment was 117 minutes (interquartile range [IQR] = 59 to 196 minutes). The 7 cases in which hyperkalemia was not treated include 4 cases in which the patient was discharged home, with a missed diagnosis of hyperkalemia. Despite initiation of specific therapy for hyperkalemia in 168 cases, 2 patients died of cardiac arrhythmias. Among the patients who received treatment, 15% had a documented systolic blood pressure (sBP) < 90 mmHg, and 30% of treated patients were admitted to intensive care units. The median potassium value was 6.5 mmol/L (IQR = 6.3 to 7.1 mmol/L). The predominant complaints were dyspnea (20%) and weakness (19%). Thirty-six percent of patients were taking angiotensin-converting enzyme (ACE) inhibitors. Initial electrocardiograms (ECGs) were abnormal in 83% of patient visits, including 24% of ECGs with nonspecific ST abnormalities. Findings of peaked T-wave morphology (34%), first-degree atrioventricular block (17%), and interventricular conduction delay (12%) did not lead to early treatment. Vital sign abnormalities, including hypotension (sBP < 90 mmHg), were not associated with early treatment. The chief complaint of "unresponsive" was most likely to lead to early treatment; treatment delays occurred in patients not transported by ambulance, those with a chief complaint of syncope and those with a history of hypertension. CONCLUSIONS: Recognition of patients with severe hyperkalemia is challenging, and the initiation of appropriate therapy for this disorder is frequently delayed.