The association between safety climate and noncombat injury events among United States Air Force workers.

INTRODUCTION: Work-related injuries are a common lagging safety indicator whereas safety climate assessments can help identify constructs serving as leading indicators. The National Institute for Occupational Safety and Health (NIOSH) partnered with the U.S. Department of the Air Force (DAF) Safety Center to examine the association between perceptions of safety climate survey constructs and the number of injury events within the DAF workforce. METHODS: The DAF administers voluntary, anonymous, occupation-specific safety climate surveys to DAF workers using the internal Air Force Combined Mishap Reduction System (AFCMRS). Survey responses from 2014 to 2018 provided by DAF workers and injury events in maintenance, support, and operations occupations were shared with NIOSH. Exploratory Factor Analysis revealed five constructs: Leadership and Communication; Organizational Safety Priority; Error Management; Resource Adequacy; and Deployment/Official Travel Impact. Squadron-level analysis included bivariate correlations and estimated Rate Ratios (RRs). RESULTS: 1,547 squadrons administered the survey, averaging 144 workers and 15.8 reportable injuries per squadron. Higher (more favorable) squadron-level construct scores were consistently correlated with fewer reported injuries (p < 0.001). Controlling for the number of workers, RRs revealed significant reductions in injury rates with each one-unit increase in responses: Leadership and Communication RR = 0.40 (95%CI: 0.32-0.48); Organizational Safety Priority RR = 0.50 (95%CI: 0.40-0.64); Error Management RR = 0.37 (95%CI: 0.30-0.47); Deployment/Official Travel Impact RR = 0.36 (95%CI: 0.29-0.45). Resource Adequacy revealed a non-significant lower injury rate RR = 0.87 (95%CI: 0.73-1.04). CONCLUSIONS: This unique study quantified safety climate and the association with injuries across a multi-year period. While safety climate measurements may be limited by frequent turnover and the self-reported, voluntary, anonymous nature of AFCMRS, the strength of this study is in the census of injuries. PRACTICAL APPLICATIONS: Future research should include longitudinal analyses to examine the impact on injuries when squadron leaders are provided feedback on safety climate survey results.

Using safety data to describe common injury-producing events examples from the U.S. Air force.

BACKGROUND: The U.S. military leadership has recently increased its efforts to reduce the number of lost-workday injuries for both the active duty and civilian employee components of the total force. The detailed causes and circumstances of those nonfatal injuries-information needed for injury prevention-has largely been unexplored. The purpose of this project was to determine the utility of Air Force safety data for nonfatal injury prevention. METHODS: In 2004, events associated with injury-producing mishaps reported through the U.S. Air Force (USAF) Ground Safety Automated System from 1993-2002 (n = 32,812 injuries) were reconstructed. Essential data elements necessary to reconstruct event causes and circumstances were identified in both coded data and in free-text mishap narratives. Activities and mechanisms were coded in a format similar to that of the ICD-10. A taxonomy was then developed to identify hazard scenarios associated with injury-producing activities or mechanisms. RESULTS: Coded data provided only four data elements (activity, injury event/exposure, nature of injury/body part, and outcome) that were sufficiently descriptive for prevention purposes. Therefore, narrative information was coded and analyzed to obtain additional information. The assembled data enabled identification and description of hazard scenarios associated with the most common injury-producing activities and mechanisms. CONCLUSIONS: Safety reports from the USAF provide detailed mishap descriptions for lost-workday injuries that could support in-depth analysis and more effective preventive efforts. However, some of the most valuable information is found in the pre-text narratives that require coding and classification, such as was conducted for this report in order to be optimally useful for injury epidemiology and prevention.

Mechanisms of slow-pitch softball injuries reported to the HQ Air Force Safety Center a 10-year descriptive study, 1993-2002.

BACKGROUND: Softball is a popular sport in civilian and military populations and results in a large number of lost-workday injuries. The purpose of this study is to describe the mechanisms associated with softball injuries occurring among active duty U.S. Air Force (USAF) personnel to better identify potentially effective countermeasures. METHODS: Data derived from safety reports were obtained from the USAF Ground Safety Automated System in 2003. Softball injuries for the years 1993-2002 that resulted in at least one lost workday were included in the study. Narrative data were systematically reviewed and coded in order to categorize and summarize mechanisms associated with these injuries. RESULTS: This report documents a total of 1181 softball-related mishap reports, involving 1171 active duty USAF members who sustained one lost-workday injury while playing softball. Eight independent mechanisms were identified. Three specific scenarios (sliding, being hit by a ball, and colliding with a player) accounted for 60% of reported softball injuries. CONCLUSIONS: Mechanisms of injury for activities such as playing softball, necessary for prevention planning, can be identified using the detailed information found in safety reports. This information should also be used to develop better sports injury coding systems. Within the USAF and U.S. softball community, interventions to reduce injuries related to the most common mechanisms (sliding, being hit by a ball, and colliding with a player) should be developed, implemented, and evaluated.

Mechanisms of basketball injuries reported to the HQ Air Force Safety Center a 10-year descriptive study, 1993-2002.

BACKGROUND: Basketball is the most popular sport among the U.S. Air Force (USAF) active duty population and causes a large number of lost-workday injuries. The purpose of this study is to describe how basketball injuries occur to allow development of effective countermeasures. METHODS: This study used data derived from safety reports obtained from the USAF Ground Safety Automated System. Basketball injuries for the years 1993-2002 that resulted in at least one lost workday were included in the study conducted in 2003. Narrative data from 32,818 safety reports were systematically reviewed and coded in order to categorize and summarize mechanisms associated with these injuries. RESULTS: A total of 2204 mishap reports involving active duty USAF members playing basketball were documented by the study. This study identified seven mechanisms causing basketball injury. Two similar causes involving jumping (landing awkwardly and landing on someone's foot) accounted for 43% of basketball injuries followed by collisions with other players (10%). CONCLUSIONS: This study shows that mechanisms of basketball-related injury can be identified using the detailed information found in USAF safety reports. Knowledge of leading hazards or mechanisms for basketball injuries can be used to prioritize and develop prevention strategies.

Mechanisms of flag-football injuries reported to the HQ Air Force Safety Center a 10-year descriptive study, 1993-2002.

BACKGROUND: Flag (touch or intramural) football is a popular sport among the U.S. Air Force (USAF) active duty population and causes a substantial number of lost-workday injuries. The purpose of this study is to describe the mechanisms of flag-football injuries to better identify effective countermeasures. METHODS: The data were derived from safety reports obtained from the USAF Ground Safety Automated System. Flag-football injuries for the years 1993-2002 that resulted in at least one lost workday were included in the study conducted in 2003. Narrative data were systematically reviewed for 32,812 USAF mishap reports; these were then coded in order to categorize and summarize mechanisms associated with flag football and other sports and occupational injuries. RESULTS: Nine hundred and forty-four mishap reports involving active duty USAF members playing flag football met the criteria for inclusion into this study. Eight mechanisms of injury were identified. The eight mechanisms accounted for 90% of all flag-football injuries. One scenario (contact with another player) accounted for 42% of all flag-football injuries. CONCLUSIONS: The most common mechanisms of injury caused by playing flag football can be identified using the detailed information found in safety reports. These scenarios are essential to developing evidence-based countermeasures. Results for flag football suggest that interventions that prevent player contact injuries deserve further research and evaluation. The broader implications of this study are that military safety data can be used to identify potentially modifiable mechanisms of injury for specific activities such as flag football.

Injuries to air force personnel associated with lifting, handling, and carrying objects.

BACKGROUND: The U.S. Air Force (USAF) active duty and civilian populations experience a substantial number of lost-workday injuries while lifting, handling, and carrying objects. Back injuries are most frequently reported. PURPOSE: The purpose of this study is to describe the hazard scenarios of lift-handle-carry injuries to better identify effective countermeasures. METHODS: The data were derived from safety reports obtained from the USAF Ground Safety Automated System. Lift-handle-carry injuries for the years 1993-2002 that resulted in at least one lost workday were included in the study. A total of 4085 lost-workday injuries resulting in 24,940 lost workdays for USAF military and civilian members met the criteria for inclusion. Objects associated with these injuries were identified and aggregated to determine the most common causes of lift-handle-carry injuries. RESULTS: Twelve distinct objects or type of objects were identified as the most common source of lift-handle-carry injuries. Among the most common sources of injury were lifting aircraft components, boxes, and furniture. Most importantly, lifting one group of objects, aircraft components, was associated with 33% of all lift-handle-carry injuries. CONCLUSIONS: Safety report data can be used to identify the most common object or object types causing lift-handle-carry injuries. The information included in this report suggests countermeasures that should be considered for implementation and evaluation studies. Countermeasures to address the most common lift-handle-carry injuries, such as lifting aircraft components among aircraft maintenance workers, are warranted.

A process to identify military injury prevention priorities based on injury type and limited duty days.

BACKGROUND: Injuries, one of the leading public health problems in an otherwise healthy military population, affect operational readiness, increase healthcare costs, and result in disabilities and fatalities. This paper describes a systematic, data-driven, injury prevention-decision making process to rank potential injury prevention targets. METHODS: Medical surveillance and safety report data on injuries for 2004 were reviewed. Nonfatal injury diagnoses (ICD-9-CM codes) obtained from the Defense Medical Surveillance System were ranked according to incident visit frequency and estimated limited duty days. Data on the top five injury types resulting in the greatest estimated limited duty days were matched with hospitalization and Service Safety Centers' accident investigation data to identify leading causes. Experts scored and ranked the causes using predetermined criteria that considered the importance of the problem, preventability, feasibility, timeliness of intervention establishment/results, and ability to evaluate. Department of Defense (DoD) and Service-specific injury prevention priorities were identified. RESULTS: Unintentional injuries lead all other medical conditions for number of medical encounters, individuals affected, and hospital bed days. The top ten injuries resulted in an estimated 25 million days of limited duty. Injury-related musculoskeletal conditions were a leading contributor to days of limited duty. Sports and physical training were the leading cause, followed by falls. CONCLUSIONS: A systematic approach to injury prevention-decision making supports the DoD's goal of ensuring a healthy, fit force. The methodology described here advances this capability. Immediate follow-up efforts should employ both medical and safety data sets to identify and monitor injury prevention priorities.

Positive predictive value of a health history questionnaire.

The U.S. Air Force Academy (USAFA) is one of the nation's military universities, with the mission to educate and motivate cadets to be career Air Force officers. This diverse population arrives at the USAFA with varying immunization records and disease histories. Analyses of costs and benefits regarding immunization strategies rely on accurate data and assumptions used in their calculation. Health history questionnaires are a low-cost way of evaluating immunization and disease history. However, this requires a good estimate of the questionnaire's positive predictive value, which may vary among populations. This study attempts to provide a more accurate estimate of the positive predictive value of health history questionnaires regarding varicella and rubella disease and vaccination strategies for the population of fourth degree (freshman) cadets at the USAFA. We found positive predictive values of 99% for rubella and 86% for varicella. These data emphasize the importance of analyzing the specific population for which a program is intended rather than broadly applying recommendations that were developed in other populations.