Wednesday, March 3, 2010

How serious is a 'Serious Injury'?

All work-related injuries, illnesses and diseases are serious. Period. I will go further and say that many ‘near misses’, exposures, and traumatic events that do not involve any physical harm to the worker are also very serious. If you believe this as I do, you are part of the way to understanding why it is important that such events be reported. You will also agree that the impact of certain work-related harms can be life changing or even life ending while others result in only minor interruption in work or life’s day to day activities. So how do workers’ compensation and prevention agencies decide which harms deserve the most attention?

In measuring the unacceptable, the most common way to differentiate this spectrum of harms is to focus only on those that result in time away from work. Lost-time injuries are the basis for most Injury Rate calculations. There are three major ‘threshold’ measures Injury Rate measures:

  • IR or IR0 includes all cases that result in any time lost from work beyond the day of injury
  • IR3 includes only cases that involve more than 3 days away from work
  • IR5 or IR7 based on cases that involve greater than one work week away from work
While WorkSafeBC reports the provincial injury rate as IR0, much of the world uses IR3 as the threshold. The US Bureau of Labor Statistics and OSHA have reporting systems and analysis based on this measure. The Workers’ Compensation Research Institute uses IR7 in most of its analysis.

It is important to note the source of any reports you might look at. While WorkSafeBC is both the workers’ compensation insurer and the primary prevention agency for the province, these roles are often split and the data collected can be very different. Australia reports Compensation Claims Frequency based on absences of greater than a week. This is not exactly the same as an IR7 but it is similar enough for most purposes.

Chile’s ACHS, the largest mutual workers’ compensation insurer, reports the distribution of injuries by number of days lost. Using the translated equivalents of “minor” (1-3 days), “serious” (4-10) days) and “very serious” (the balance usually displayed as separate lines 15 days to 24 days, those in the range of 25 to 50 days and those greater than 50 days).

Categorical measures are common in specific industries. The airline industry, for example, has a Serious Injury Rate (using ‘per 1,000 departures’ as the denominator) and defines Serious Injuries as follows:

Every injury that
(1) requires hospitalization for more than 48 hours, commencing within 7 days from the date the injury was received;
(2) results in a fracture of any bone (except simple fractures of fingers, toes, or nose)
(3) causes severe hemorrhages, nerve, muscle, or tendon damage;
(4) involves any internal organ; or
(5) involves second- or third-degree burns, or any burns affecting more than 5 percent of the body surface
The advantage of categorical definitions is that they can quickly focus attention for prevention.
A similar approach is used by WorkSafeBC in its Serious Injury Rate. I would classify this as a composite measure because the measure includes fatalities, long duration claims, high medical costs and other time-loss claims involving certain ICD-9 injury codes. This approach has the advantage of being clearly focused on those work-injury events that have had or could potentially have life altering or ending consequences.

Whatever the method, every system needs a basis to prioritize harms for the purpose of preventing them. Even though there is no universal standard, allocating resources in such a way as to reduce and eliminate harms is an essential element to any prevention strategy.

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