Health conditions among male workers in mining and other industries reliant on manual labor occupations: National Health Interview Survey, 2007-2018.

INTRODUCTION: Mining is an industry with diverse, demanding occupational exposures. Understanding the prevalence of chronic health conditions in working miners is an area of active research. Of particular interest is how the health of miners compares to that of workers in other industry sectors with a high proportion of manual labor occupations. By comparing similar industries, we can learn what health conditions may be associated with manual labor and with individual industries. This study analyzes the prevalence of health conditions in miners compared to workers employed in other manual-labor-reliant industries. METHODS: National Health Interview Survey public data were analyzed for the years 2007-2018. Mining and five other industry groups with a high proportion of manual labor occupations were identified. Female workers were excluded because of small sample sizes. The prevalence of chronic health outcomes was calculated for each industry group and compared to that of nonmanual labor industries. RESULTS: Currently-working male miners showed increased prevalence of hypertension (in those age <55 years), hearing loss, lower back pain, leg pain progressing from lower back pain, and joint pain, compared to nonmanual labor industries workers. Construction workers also demonstrated a high prevalence of pain. CONCLUSION: Miners demonstrated increased prevalence of several health conditions, even when compared to other manual labor industries. Given previous research on chronic pain and opioid misuse, the high pain prevalence found among miners suggests mining employers should reduce work factors that cause injury while also providing an environment where workers can address pain management and substance use.

Occupational exposure to respirable crystalline silica among US metal and nonmetal miners, 2000-2019.

BACKGROUND: In metal and nonmetal (M/NM) mines in the United States, respirable crystalline silica (RCS) exposures are a recognized health hazard and a leading indicator of respiratory disease. This study describes hazardous exposures that exceed occupational exposure limits and examines patterns of hazardous RCS exposure over time among M/NM miners to better inform the need for interventions. METHODS: Data for this study were obtained from the Mine Safety and Health Administration (MSHA) Open Government Initiative Portal for the years 2000-2019, examining respirable dust samples with MSHA-measured quartz concentration >1%. Descriptive statistics for RCS were analyzed for M/NM miners by year, mine type, sector, commodity, occupation, and location in a mine. RESULTS: This study found the overall geometric mean (GM) for personal exposures to RCS was 28.9 µg/m3 (geometric standard deviation: 2.5). Exposures varied significantly by year, mine type, sector, commodity, occupation, and location in a mine. Overall, the percentages of exposures above the MSHA permissible exposure limit (PEL for respirable dust with >1% quartz, approximately 100 µg/m3 RCS) and the National Institute for Occupational Safety and Health RCS recommended exposure limit (REL, 50 µg/m3 ) were 11.8% and 27.3%, respectively. GM exposures to RCS in 2018 (45.9 µg/m3 ) and 2019 (52.9 µg/m3 ) were significantly higher than the GM for all years prior. The overall 95th percentile of RCS exposures from 2000 to 2019 was 148.9 µg/m3 , suggesting a substantial risk of hazardous exposures above the PEL and REL during the entire period analyzed. CONCLUSIONS: The prevalence of high exposures to RCS among M/NM miners continues in the past 20 years and may be increasing in certain settings and occupations. Further research and intervention of the highest exposures are needed to minimize the risks of acquiring silica-induced respiratory diseases.

NIOSH Risk-Based Model to Resume Field Research and Public Health Service in 2020 During the COVID-19 Pandemic.

In the early months of the COVID-19 pandemic, field research and public health service work conducted by the National Institute for Occupational Safety and Health (NIOSH) was put on hold. During this time, NIOSH developed a risk-based model to resume fieldwork, balancing the public health benefit of such fieldwork with the risks of severe acute respiratory syndrome coronavirus 2 exposure and transmission. We describe our experiences with this model, along with the broader public health significance of the methods used to inform risk management decisions. (Am J Public Health. 2022;112(8):1138-1141. https://doi.org/10.2105/AJPH.2022.306882).

Effects of heat strain on cognitive function among a sample of miners.

Heat stress is associated with workplace injuries, likely through a combination of fatigue, reduced cognitive function, and thermal discomfort. The purpose of this study was to evaluate four cognitive tasks for sensitivity to heat stress. Eight participants performed treadmill exercise followed by assessments of serial reaction time (RT), Stroop effect, verbal delayed memory, and continuous performance working memory in an environmental chamber. A control (21.1 °C) trial, and "Hot 1" and "Hot 2" (both 37.8 °C) trials were run sequentially on two separate days to evaluate the four cognitive tasks. Heat strain (comparing Hot 1 and Hot 2 with the control trial) resulted in impairments in the serial RT test response and Stroop accuracy. Delayed memory was impacted only in the Hot 2 trial compared with the control trial. Given the demonstrated impact of heat on cognitive processes relevant to workers' real-world functioning in the workplace, understanding how to assess and monitor vigilant attention in the workplace is essential.

Health conditions in retired manual labor miners and oil and gas extraction workers: National Health Interview Survey, 2007-2017.

BACKGROUND: Within the mining industrial sector, workers in the mining and oil and gas extraction (OGE) industries have demonstrated disparities in chronic health status compared with the general working population. However, we know much less about miner and OGE worker health once retired. This study separately compares chronic illnesses in retired miners and OGE workers with all other retirees. METHODS: National Health Interview Survey (NHIS) public data were analyzed for the years 2007-2017 to estimate weighted unadjusted and adjusted prevalence of selected health conditions (cancer, cardiovascular disease, high cholesterol, diabetes, hypertension, respiratory conditions, health status, and hearing loss) in retirees. Three retired worker groups (miners, OGE, and other retirees) were defined using the respondents' longest-held industry and occupation. RESULTS: Higher prevalence of a number of adverse health conditions was noted in miners and OGE workers when compared with all other retirees. A significantly higher adjusted prevalence of hypertension, hearing loss, functionally limiting lung problems, and fair or poor health was seen in miners over other retirees. Retired OGE workers demonstrated a significantly higher adjusted prevalence of both hearing loss and poor health status. CONCLUSIONS: Miners and OGE workers have higher morbidity during their working years, and this study demonstrates that poorer health appears to continue into retirement. These results suggest the need to expand occupational health and safety programs in the mining sector to improve the health of workers into retirement. Future studies that include more robust information on workplace exposures are needed to evaluate the long-term health of retired workers.

Characterization of fatal injuries in oil and gas industry-related helicopter accidents in the Gulf of Mexico, 2004-2014.

BACKGROUND: Transportation events are the most common cause of offshore fatalities in the oil and gas industry, of which helicopter accidents comprise the majority. Little is known about injury distributions in civilian helicopter crashes, and knowledge of injury distributions could focus research and recommendations for enhanced injury prevention and post-crash survival. This study describes the distribution of injuries among fatalities in Gulf of Mexico oil and gas industry-related helicopter accidents, provides a detailed injury classification to identify potential areas of enhanced safety design, and describes relevant safety features for mitigation of common injuries. METHODS: Decedents of accidents during 2004-2014 were identified, and autopsy reports were requested from responsible jurisdictions. Documented injuries were coded using the Abbreviated Injury Scale (AIS), and frequency and proportion of injuries by AIS body region and severity were calculated. Injuries were categorized into detailed body regions to target areas for prevention. RESULTS: A total of 35 autopsies were coded, with 568 injuries documented. Of these, 23.4% were lower extremity, 22.0% were thorax, 13.6% were upper extremity, and 13.4% were face injuries. Minor injuries were most prevalent in the face, neck, upper and lower extremities, and abdomen. Serious or worse injuries were most prevalent in the thorax (53.6%), spine (50.0%), head (41.7%), and external/other regions (75.0%). The most frequent injuries by detailed body regions were thoracic organ (23.0%), thoracic skeletal (13.3%), abdominal organ (9.6%), and leg injuries (7.4%). Drowning occurred in 13 (37.1%) of victims, and drowning victims had a higher proportion of moderate brain injuries (7.8%) and lower number of documented injuries (3.8) compared with non-drowning victims (2.9 and 9.4%, respectively). CONCLUSIONS: Knowledge of injury distributions focuses and prioritizes the need for additional safety features not routinely used in helicopters. The most frequent injuries occurred in the thorax and lower extremity regions. Future research requires improved and expanded data, including collection of detailed data to allow characterization of both injury mechanism and distribution. Improved safety systems including airbags and helmets should be implemented and evaluated for their impact on injuries and fatalities.

Monte carlo method for estimating whole-body injury metrics from pedestrian impact simulation results.

The goal of the current study was to develop a method to estimate whole-body injury metrics (WBIMs), which measure the overall impact of injuries, using stochastic injury prediction results from a computational human surrogate. First, hospitalized pedestrian data was queried to identify injuries sustained by pedestrians and their frequencies. Second, with consideration for an understanding of injury mechanisms and the capability of the computational human surrogate, the whole-body was divided into 17 body regions. Then, an injury pattern database was constructed for each body region for various maximum abbreviated injury scale (MAIS) levels. Third, a two-step Monte Carlo sampling process was employed to generate N virtual pedestrians with an assigned list of injuries in AIS codes. Then, the expected values of WBIMs such as injury severity score (ISS), probability of death, whole-body functional capacity index (WBFCI), and lost years of life (LYL), were estimated. Lastly, the proposed method was verified using injury information from the inpatient pedestrian database. Also, the proposed method was applied to pedestrian impact simulations with various impact speeds to estimate the probability of death with respect to the impact speed. The probability of death from the proposed method was compared with those from epidemiological studies. The proposed method accurately estimated WBIMs such as ISS and WBFCI using either for a given distribution of injury risk or MAIS levels. The predicted probability of death with respect to the impact speed showed a good correlation with those from the epidemiological study. These results imply that if we have a human surrogate that can predict the risk of injury accurately, we can accurately estimate WBIMs using the proposed method. The proposed method can simplify a vehicle design optimization process by transforming the multi-objective optimization problem into the single-objective one. Lastly, the proposed method can be applied to other human surrogates such as occupant models.

Health Risk Factors Among Miners, Oil and Gas Extraction Workers, Other Manual Labor Workers, and Nonmanual Labor Workers, BRFSS 2013-2017, 32 States.

Background: Analyzing health risk factors among current workers by industry and occupation (IO) provides information on disparities between worker groups, especially when comparing workers within manual labor occupations. Mining and oil and gas extraction (OGE) are unique industries with different work environments that could affect health risk factors. The study objective was to compare the prevalence of health risk factors of miners, OGE, other manual labor, and nonmanual labor workers. Methods: The Behavioral Risk Factor Surveillance System's IO module was analyzed for years 2013-2017 to compare prevalences of excessive alcohol use, smoking, smokeless tobacco use, seat belt use, inadequate sleep, and obesity among four worker groups. National Health Interview Survey IO codes were used to categorize miners, OGE, other manual labor, and nonmanual labor workers. Findings: Miners and OGE workers had higher prevalence estimates than both nonmanual and manual labor workers for all health risk factors except current smoking. Both miners and OGE workers were significantly more likely than other manual labor workers to report smokeless tobacco use and not always wearing seatbelts. Compared with other manual labor workers, OGE workers were significantly more likely to report obesity, and miners were significantly more likely to report inadequate sleep. Conclusion/Application to Practice: Prevalence of most health risk factors differed among miners, OGE, other manual labor, and nonmanual labor workers. These differences could lead to disparities in health outcomes. Occupational health professionals in mining and OGE can use this information to inform and target integrated wellness and health and safety programs.

Automobile injury trends in the contemporary fleet: Belted occupants in frontal collisions.

Objective: As vehicle safety technologies and evaluation procedures advance, it is pertinent to periodically evaluate injury trends to identify continuing and emerging priorities for intervention. This study examined detailed injury distributions and injury risk trends in belted occupants in frontal automobile collisions (10 o'clock to 2 o'clock) using NASS-CDS (1998-2015). Methods: Injury distributions were examined by occupant age and vehicle model year (stratified at pre- and post-2009). Logistic regression models were developed to examine the effects of various factors on injury risk (by body region), controlling for delta-V, sex, age, height, body mass index (BMI), vehicle model year (again stratified at 2009). Results: Among other observations, these analyses indicate that newer model year vehicles (model year [MY] 2009 and later) carry less risk of Abbreviated Injury Scale (AIS) 2+ and AIS 3+ injury compared to older model year vehicles, with odds ratios of 0.69 (AIS 2+) and 0.45 (AIS 3+). The largest reductions in risk between newer model year vehicles and older model year vehicles occur in the lower extremities and in the risk of skull fracture. There is no statistically significant change in risk of AIS 3+ rib fracture or sternum injury between model year categories. Females are at greater risk of AIS 2+ and AIS 3+ injury compared to males, with increased risk across most injury types. Conclusions: For belted occupants in frontal collisions, substantial reductions in injury risk have been realized in many body regions in recent years. Risk reduction in the thorax has lagged other body regions, resulting in increasing prevalence among skeletal injuries in newer model year vehicles (especially in the elderly). Injuries also remain common in the arm and hand/wrist for all age ranges studied. These results provide insight into where advances in the field have made gains in occupant protection and what injury types remain to be addressed.

Patterns of Heat Strain Among a Sample of US Underground Miners.

OBJECTIVE: This study characterizes physiological measures of heat exposure among US underground miners. METHODS: Core body temperature measured by using ingestible sensors during subjects' normal work shifts was categorized into four temperature zones: less than 37.5 °C, 37.5 °C to less than 38 °C, 38 °C to less than 38.5 °C, and more than or equal to 38.5 °C. RESULTS: On average, subjects changed temperature zones 13.8 times per shift. Temperatures increased above the recommended limit of 38 °C nearly 5 times per shift for an average of 26 minutes each episode. CONCLUSIONS: Unlike previous heat stress research that reported only maximum and mean temperature measurements, this analysis demonstrates a dynamic pattern of physiologic heat strain, with core body temperatures changing frequently and exceeding the 38 °C limit multiple times per shift. Further research is needed on the impact of multiple short-term, intermittent heat exposures on miners.

Efficacy of a proactive health and safety risk management system in the fire service.

BACKGROUND: This study evaluated the efficacy of a fire department proactive risk management program aimed at reducing firefighter injuries and their associated costs. METHODS: Injury data were collected for the intervention fire department and a contemporary control department. Workers' compensation claim frequency and costs were analyzed for the intervention fire department only. Total, exercise, patient transport, and fireground operations injury rates were calculated for both fire departments. RESULTS: There was a post-intervention average annual reduction in injuries (13%), workers' compensation injury claims (30%) and claims costs (21%). Median monthly injury rates comparing the post-intervention to the pre-intervention period did not show statistically significant changes in either the intervention or control fire department. CONCLUSIONS: Reduced workers' compensation claims and costs were observed following the risk management intervention, but changes in injury rates were not statistically significant.

Crash safety concerns for out-of-position occupant postures: A look toward safety in highly automated vehicles.

OBJECTIVE: Highly automated vehicle occupants will all be passengers and may be free to ride while in postures for which existing occupant safety systems such as seat belts and airbags were not originally designed. These occupants could therefore face increased risk of injury when a crash occurs. Given that current vehicles are capable of supporting a variety of occupant postures outside of the normal design position, such as reclined or turned passengers, an evaluation of current field data was performed to better understand the risks of being out of position. METHODS: We investigated the frequency, demographics, and injury outcomes for out-of-position occupants using NASS-CDS. A matched analysis was performed to compare injury outcomes for out-of-position passengers with in-position drivers involved in similar crashes. Finally, case studies for out-of-position occupants were examined in the Crash Injury Research (CIREN) database. RESULTS: Only 0.5% of occupants in NASS-CDS with a coded posture were out of position at the time of crash. Of the out-of-position occupants, being turned or seated sideways was almost as likely as being reclined. Out-of-position occupants were younger and less likely to be belted than their in-position counterparts. Analysis of the injury data indicated a trend that being out of position was associated with an elevated risk for serious injury. However, the number of out-of-position occupants was too small to provide a definitive or statistically significant conclusion on injury outcome. CONCLUSION: Though highly automated vehicles may eventually reduce the number of crashes and traffic fatalities in the future, there will be a transition period when these vehicles remain at risk from collisions with human-driven vehicles. These crashes could cause higher than anticipated rates of injury if occupants are less likely to be belted or tend to be in positions for which restraints are not optimized. This study highlights the need for future research on occupant response and countermeasure design for out-of-position occupants.

Development of thoracic injury risk functions for the THOR ATD.

The Test Device for Human Occupant Restraint (THOR) 50th percentile male anthropomorphic test device (ATD) aims to improve the ability to predict the risk of chest injury to restrained automobile occupants by measuring dynamic chest deflection at multiple locations. This research aimed to describe the methods for developing a thoracic injury risk function (IRF) using the multi-point chest deflection metrics from the 50th percentile male THOR Metric ATD with the SD-3 shoulder and associating to post-mortem human subjects (PMHS) outcomes that were matched on identical frontal and frontal-oblique impact sled testing conditions. Several deflection metrics were assessed as potential predictor variables for AIS 3+ injury risk, including a combined metric, called PC Score, which was generated from a principal component analysis. A parametric survival analysis (specifically, accelerated failure time (AFT) with Weibull distribution) was assessed in the development of the IRF. Model fit was assessed using various modeling diagnostics, including the area under the receiver operating characteristic curve (AUC). Models based on resultant deflection consistently exhibited improved fit compared to models based on x-axis deflection or chord deflection. Risk functions for the THOR PC Score and Cmax (maximum resultant deflection) were qualitatively equivalent, producing AUCs of 0.857 and 0.861, respectively. Adjusting for the potential confounding effects of age, AFT survival models with Cmax or PC Score as the primary deflection metric resulted in the THOR injury risk models with the best combination of biomechanical appropriateness, potential utility and model fit, and may be recommended as injury predictors.

Implementing risk management to reduce injuries in the U.S. Fire Service.

INTRODUCTION: Risk management, a proactive process to identify and mitigate potential injury risks and implement control strategies, was used to reduce the risk of occupational injury in a fire department. The objective of this research was to study the implementation of the risk management process for future replication. A second objective was to document changes in fire personnel's knowledge, attitudes, and behaviors related to the selected control strategies that were implemented as part of the risk management process. METHOD: A number of control strategies identified through the risk management process were implemented over a 2-year period beginning in January 2011. Approximately 450 fire personnel completed each of the three cross-sectional surveys that were administered throughout the implementation periods. Fire personnel were asked about their awareness, knowledge, and use of the control strategies. RESULTS: Fire personnel were generally aware of the control strategies that were implemented. Visual reminders (e.g., signage) were noted as effective by fire personnel who noticed them. Barriers to use of specific control strategies such as new procedures on the fireground or new lifting equipment for patient transfer included lack of knowledge of the new protocols, lack of awareness/access to/availability of the new equipment, and limited training on its use. Implementation challenges were noted, which limited self-reported adherence to the control strategies. CONCLUSIONS: Fire personnel generally recognized the potential for various control strategies to manage risk and improve their health and safety; however, implementation challenges limited the effectiveness of certain control strategies. The study findings support the importance of effective implementation to achieve the desired impacts of control strategies for improving health and safety. PRACTICAL APPLICATIONS: Employees must be aware of, have knowledge about, and receive training in safety and health interventions in order to adopt desired behaviors.

Functional recovery patterns in seriously injured automotive crash victims.

OBJECTIVE: The functional capacity index (FCI) is designed to predict functional loss 12 months post-injury for each injury in the 2008 Abbreviated Injury Scale (AIS) manual on a scale from 0 (death) to 100 (full recovery), but FCI has never been validated. This study compared FCI predicted loss with patient-reported 12-month outcomes as measured through the Short Form 36 (SF-36) health assessment survey. METHODS: Using follow-up data collected on 2,858 adult car crash occupants in the Crash Injury Research and Engineering Network (CIREN) database, we compared FCI predicted outcomes to occupants' Physical Component Summary (PCS) scores, which are weighted averages of the SF-36 items addressing physical function. Our analyses included descriptive statistics, plots of typical recovery patterns, and a mixed effects regression model that describes PCS as a function of FCI, demographics, comorbidities, and injury pattern while also adjusting for the occupants' pre-crash physical capabilities. We further examined injuries in patients who report a significant drop in PCS 12 months post-crash despite being predicted to fully recover. RESULTS: At baseline, the CIREN population exhibited PCS scores similar to the overall population (mean = 51.1, SD = 10.3). Twelve months post-crash, occupants with predicted impairment (FCI < 100) report a substantial decrease in physical function, and those who were predicted to fully recover still report some, albeit less, impairment. In the multivariate mixed-effects regression model, FCI is a strongly significant (P-value <.0001) predictor of PCS, with each 1-point drop in FCI predicting a 0.27-point drop in PCS. Maximum AIS severities in the head, spine, and lower extremity body regions were also significantly associated with PCS (P-values <.05). Among occupants who were expected to fully recover but who report a significant drop in PCS at 12 months, spinal fractures without cord involvement account for 5 of the 10 most common AIS 2+ injuries. CONCLUSIONS: FCI was associated with 12-month outcomes but may not adequately describe the recovery from some head, spine, and lower extremity injuries. Some occupants who were expected to recover still report functional loss 12 months post-injury.

Fire fit: assessing comprehensive fitness and injury risk in the fire service.

PURPOSE: This study sought to develop a comprehensive measure of fitness that is predictive of injury risk and can be used in the fire service to assess individual-level health and fit-for-duty status. METHODS: A retrospective occupational cohort of 799 career fire service employees was observed over the years 2005-2009. An equally weighted score for comprehensive fitness was calculated based on cardiovascular fitness, muscular strength, endurance, flexibility, and body composition. Repeated measures survival analyses were used to estimate the risk of any injury, sprain or strain, and exercise-related injuries in relation to comprehensive fitness. RESULTS: A well-distributed comprehensive fitness score was developed to distinguish three tiers of overall fitness status. Intraclass correlations identified flexibility, total grip strength, percent body fat, and resting heart rate as the most reliable fitness metrics, while push-ups, sit-ups, and aerobic capacity demonstrated poor reliability. In general, individuals with a lower comprehensive fitness status had an increased injury risk of injury as compared to the most fit individuals. The risk of any injury was 1.82 (95% CI 1.06-3.11) times as likely for the least fit individuals, as compared to individuals in the top fire fitness category, increasing to 2.90 (95% CI 1.48-5.66) when restricted to sprains and strains. CONCLUSIONS: This 5-year analysis of clinical occupational health assessments enabled the development of a relevant metric for relating comprehensive fitness with the risk of injury. Results were consistent with previous studies focused on cardiorespiratory fitness, but also less susceptible to inter-individual variability of discrete measurements.

Implications of Functional Capacity Loss and Fatality for Vehicle Safety Prioritization.

OBJECTIVE: We investigate the use of the Functional Capacity Index (FCI) as a tool for establishing vehicle safety priorities by comparing the life year burden of injuries to the burden of fatality in frontal and side automotive crashes. We demonstrate FCI's utility by investigating in detail the resulting disabling injuries and their life year costs. METHODS: We selected occupants in the 2000-2013 NASS-CDS database involved in frontal and side crashes, merged their injuries with FCI, and then used the merged data to estimate each occupant's overall functional loss. Lifetime functional loss was assessed by combining this measure of impairment with the occupants' expected future life spans, estimated from the Social Security Administration's Actuarial Life Table. RESULTS: Frontal crashes produce a large number of disabling injuries, particularly to the lower extremities. In our population, these crashes are estimated to account for approximately 400,000 life years lost to disability in comparison with 500,000 life years lost to fatality. Victims of side crashes experienced a higher rate of fatality but a significantly lower rate of disabling injury (0.3 vs. 1.0%), resulting in approximately 370,000 life years lost to fatality versus 50,000 life years lost to disability. CONCLUSIONS: The burden of disabling injuries to car crash survivors should be considered when setting vehicle safety design priorities. In frontal crashes this burden in life years is similar to the burden attributable to fatality.

Survival Model for Foot and Leg High Rate Axial Impact Injury Data.

OBJECTIVES: Understanding how lower extremity injuries from automotive intrusion and underbody blast (UBB) differ is of key importance when determining whether automotive injury criteria can be applied to blast rate scenarios. This article provides a review of existing injury risk analyses and outlines an approach to improve injury prediction for an expanded range of loading rates. This analysis will address issues with existing injury risk functions including inaccuracies due to inertial and potential viscous resistance at higher loading rates. METHODS: This survival analysis attempts to minimize these errors by considering injury location statistics and a predictor variable selection process dependent upon failure mechanisms of bone. Distribution of foot/ankle/leg injuries induced by axial impact loading at rates characteristic of UBB as well as automotive intrusion was studied and calcaneus injuries were found to be the most common injury; thus, footplate force was chosen as the main predictor variable because of its proximity to injury location to prevent inaccuracies associated with inertial differences due to loading rate. A survival analysis was then performed with age, sex, dorsiflexion angle, and mass as covariates. This statistical analysis uses data from previous axial postmortem human surrogate (PMHS) component leg tests to provide perspectives on how proximal boundary conditions and loading rate affect injury probability in the foot/ankle/leg (n = 82). RESULTS: Tibia force-at-fracture proved to be up to 20% inaccurate in previous analyses because of viscous resistance and inertial effects within the data set used, suggesting that previous injury criteria are accurate only for specific rates of loading and boundary conditions. The statistical model presented in this article predicts 50% probability of injury for a plantar force of 10.2 kN for a 50th percentile male with a neutral ankle position. Force rate was found to be an insignificant covariate because of the limited range of loading rate differences within the data set; however, compensation for inertial effects caused by measuring the force-at-fracture in a location closer to expected injury location improved the model's predictive capabilities for the entire data set. CONCLUSIONS: This study provides better injury prediction capabilities for both automotive and blast rates because of reduced sensitivity to inertial effects and tibia-fibula load sharing. Further, a framework is provided for future injury criteria generation for high rate loading scenarios. This analysis also suggests key improvements to be made to existing anthropomorphic test device (ATD) lower extremities to provide accurate injury prediction for high rate applications such as UBB.