Workplace injuries happen.  Some such accidents involve debilitating injuries that include amputation of a hand, arm, finger, foot, leg or toe.  In fact, according to the United States Bureau of Labor Statistics, as many as 10,000 American workers are victims of amputation injury at work.  These workers represent 6.5 percent of all US amputations in a given year.

Some of these injuries may be due to equipment malfunctions or malfunction or bypass of safety features.  Others result from inattention.  Regardless of the cause, amputation injury is life changing.  The more catastrophic the injury the more expensive to treat and usually the more life changing it becomes.

As a nurse life care planner and case manager, I often work with individuals who have undergone some type of amputation secondary to injury or accident.  Their needs vary greatly depending on the level of the amputation, whether it is an upper limb or lower limb, how much family or social support they have, their pre-morbid health, etc.  In order to truly determine the impact of the amputation, it is imperative to enlist the services of a certified nurse life care planner.

A nurse is a diagnostician.  He or she is responsible for determining the human response to the injury or illness.  We must diagnose the impact.  For example, does the patient suffer from insomnia since the accident?  Does he or she have problems with a child who is unable to accept the parent with the missing limb?  Are there difficulties with activities of daily living?  Then there are the obvious issues to address as well such as pain, mobility, and depression to name a few.

Don’t attempt to determine what an amputee needs simply by asking how many prostheses he or she might need over their lifetime.  It is much bigger than that!

Related articles by Zemanta

• Electrical Amputation after 7,200 Volts (vp-medical.com)
• Catastrophic-extremely harmful; bringing physical or financial ruin (vp-medical.com)

A Virginia man has filed a $1 million lawsuit against a local PetSmart, claiming he slipped and fell on a pile of feces in the store. Robert Holloway accuses the manager and store employees of failing to create a safe environment for customers in the store. He claims in his lawsuit that the fall injured his back and head and knocked out four of his teeth.  Staff Report, The Washington Post 04/01/2010 Read Article: The Washington Post

I am not sure how one falls onto their back and knocks out four teeth at the same time, but it makes for an interesting headline!

Related articles by Zemanta

• Family of Amputee Files Lawsuit (vp-medical.com)

The word “catastrophic” congers up images of motor vehicle accidents, falls from great heights, building collapse with resulting injuries such as spinal cord injuries, severe burns, amputations, loss of eyesight or neurological injuries. While these are common types of catastrophic injuries, any injury requiring extensive medical treatment and/or has a lasting impact on one’s life is classified as a catastrophic injury.
Thankfully, catastrophic injuries make up only a small fraction of the total number of workers’ compensation claims. However, the significant medical care required by these type cases accounts for a heavy financial burden. The proper management of these high dollar claims makes a significant difference in the cost of the workers’ compensation program.

As soon as the work comp adjuster receives a case that involved a major injury or hospitalization, it is imperative for the adjuster to act immediately. The adjuster needs to drop everything and concentrate on the catastrophic injury claim. The first recommendation is to contact all parties involved (worker, family members, supervisor, witnesses, Human Resources, hospital, physician, etc.) and also assign a nurse case manager.  The goal is to obtain as much information as possible in order to get a comprehensive understanding of what occurred.  Time is of the essence and it is important to obtain the information while it is fresh on everyone’s mind.

The case manager should also make arrangements to personally meet with the employee and/or his/her family member(s) at the hospital, preferably same day the injury occurred. Contact by the adjuster and the nurse case manager the same day as the accident is reported is critical to the outcome of the claim.
The injured workers’ primary concern is simply to survive the injury. The second thought is, “What do I do now?  How will this affect me and my family?  Will I be able to return to work?”

Most injured workers are contacted by a local attorney who has staff that regularly scours public records for new cases. If the injured worker is confident that he/she will receive the appropriate medical care, and that indemnity benefits will be paid, the probability of the employee hiring legal representation is greatly diminished.  In many cases attorney representation increases the employee’s recovery time and also increases medical costs secondary to defensive medicine practiced by the physicians involved.   Establishing rapport with the employee and/or family members is imperative.

Medical Management:

The intensive involvement of the work comp adjuster in the initial stages of the catastrophic injury claim is of paramount importance. Early medical management is essential to achieve the best possible medical outcome. The highly trained nurse case manager should handle the day to day medical management of the claim.

The nurse case manager is responsible for insuring the employee receives proper medical care throughout the life of the claim. This continuity of the medical care is critical to the best possible outcome for the employee. It also prevents the medical care from drifting to non-covered issues and prevents the claim from growing larger than necessary.

The nurse case manager works with the employee to guide the injured worker through the significant life changes that follow a catastrophic injury and help make sense of the treatment recommendations. As the employee goes through hospitalization, rehabilitation, and a return to home and community activities, the nurse case manager recommends the necessary work accommodations and treatment needed to succeed with a return to the work environment.

Along the way to recovery, or maximum medical improvement, the nurse case manager will continue to work with the treating physicians, specialists, therapists, rehabilitation providers, if the employee is unable to return to work. For those employees who are permanent and totally disabled and not able to return to work, the continuing involvement of the nurse case manager is necessary. The expertise of the nurse case manager in managing the medical aspects of disability and in determining the appropriate home-based care will impact the overall cost of the catastrophic work comp claim.

In summary, catastrophic claims which are not appropriately managed by the adjuster and assigned to a nurse case manager can quickly spiral out of control thereby drastically increasing the overall cost of the claim.  Immediate attention to the medical needs, establishing rapport and controlling costs of the medical care, has a positive impact on the overall cost of the workers compensation claim.

When you are a small company, without the resources of an HR manager, safety supervisor, insurance clerk, you may find you are the single key to managing workers compensation costs.  If so, there are some things you can do to control costs without spending a great deal of money.  These tips focus on prevention as well as what to do post accident.

As a small business owner, you may be the one to train the new employees.  If so, be sure to train the employee on how to perform the job duties in a safe and effective manner. Be sure to emphasis safety issues to include proper use of safety gear, lifting techniques, proper use of the machinery and where to get help.  After training it is important to check the employee often for any bad habits which may be a safety risk.  If you note issues, correct them immediately and instruct them on the proper protocols.

If an injury does occur, make sure your employee reports the incident as soon as it happens, even if it is on the weekend or night shift.  Immediately complete a First report of Injury.  Get photos of the area, interview any witnesses and have them sign statements on what they observed, and check out any equipment that might have been involved.    Consider sending the employee for a drug/alcohol screen.

Contact your claims agent and consider assigning the case to a nurse case manager, particularly if the employee is going to require surgery or ongoing treatment.  Make sure to let your claims adjuster and case manager know that you are able to accommodate light duty and what that duty might consist of.  The quicker you can return an injured worker back to some form of work, the faster your claim will close and the less likely costs will skyrocket with litigation expenses and unnecessary return to work maneuvers.  Plan ahead for a return to limited duty by making arrangements for lifting restrictions, obtain a chair or stool for limited standing, or create temporary positions in another work area which would allow for restrictions.

The number one thing you can do is communicate with the injured worker.  Contact them weekly to check on them and let them know you are thinking of them.  Communicate your plans to return them to limited duty whenever possible.  Send flowers or a card for hospitalization.

Lastly, don’t try to be the only safety supervisor in your company.  Build a culture where all employees know and understand the importance of safety and make sure they all know their responsibility.  Share information about how workers compensation insurance premiums are affected by injuries and focus on prevention.

What tips do you have to share on ways to minimize the effects of injuries on your bottom line?  What is your most effective light duty accomodation?

Related articles by Zemanta

• How to Ease Implementation of Work Comp Cost Reduction Techniques (vp-medical.com)
• Worker’s Compensation-Claims are More Than Just Physical in Nature (vp-medical.com)
• What’s in your safety toolbox? (iowabiz.com)

A lawsuit has been filed on behalf of a Cape Cora, Fla., police officer after he suffered severe head injuries during a car accident on June 2. The Fort Myers News-Press reported that Officer Damien Garcia was on duty when he was struck by a sport utility vehicle. The driver and passenger in the vehicle are named as defendants in the lawsuit. Damages in the case could exceed $50 million, Garcia’s attorney said. Denes Husty III, Fort Meyers News-Press

This officer was on motorcycle at the time of the accident.  The original filing listed damages of $15,000 which was the amount necessary to file in circuit court.  The calculations of damages in a case like this typically requires the expertise of a life care planner.  In my role as nurse life care planner, I have written life care plans for several individuals who has suffered head injuries.  The recovery is long, slow, and life altering.  Not only is the individual affected by the injury, but also the family, friends, and co-workers.  Memory deficits, gait changes, absence or changed taste, decreased motor function; these are just a few of the changes which can result from a head injury.

The next time you represent a head injured individual, consider a Nurse Life Care Planner to assist in determining the cost of future medical care.

Related articles by Zemanta

• The Role of the Nurse Life Care Planner (vp-medical.com)
• Nurse Life Care Planning (slideshare.net)

Another lawsuit has been filed against Toyota Motors Inc., this time in Houston after a woman was killed in an accident when her car sped through a stop sign and smashed into a cement wall. The accident occurred on Dec. 18, a few weeks before the recall that would have included Trina Renee Harris’ 2009 Toyota Corolla. The Houston Chronicle reported that Harris told her husband that she felt the accelerator moved on its own at times, but didn’t think anything of it. Harris’ husband is seeking $200 million in damages for “gross negligence.” This is the third wrongful death lawsuit filed against Toyota in relation to the recalled vehicles.  Mary Flood, Houston Chronicle

At this point we all know what a heart breaking disaster the whole gas pedal problem has been.  I listened to the statements made by Mr. Toyoda and while I feel he is being sincere, the fact that they aren’t sure what is causing their cars to unexpectedly accelerate is not helping the millions of Toyota owners.  The stories from some of these individuals is heart wrenching.  The company will continue to replace floor mats and accelerators, but word has it that “it may be in the electronics.”  That is a direct quote from Toyota.

For any Toyota owners reading this blog, if you notice anything amiss, please, park your car until Toyota gets a game plan for a real fix.

Related articles by Zemanta

• Toyota’s Legal Woes Deepen (blogs.wsj.com)
• Rick Horowitz: Those Toyotas: You’ve Been Taken for a Ride! (huffingtonpost.com)
• U.S. officials review Toyota Corolla complaints (msnbc.msn.com)

Recalled!

Dorel Juvenile Group Inc. announced a voluntary recalled last week of over 200,000 baby playpens due to the threat of “suffocation or positional asphyxiation.” The company said that the floors of the Safety 1st Disney Care Center Play Yards and Eddie Bauer Complete Care Play Yards could become uneven when jostled, posing unnecessary risks to children. The toys were sold from January 2007 to October 2009 at Babies “R” Us, Kmart, Sears, Target and Walmart. No deaths have been reported involving the playpens.  *

As a grandmother with two new grandchildren on the way I am especially concerned with all of the recalls on baby gear lately.  I have also been doing a lot of shopping for the new babies and I have become addicted to reading product reviews.  I am continually amazed at some of the things that children can do to topple over, get stuck in between, unlatch, and otherwise outwit safety devices.  I don’t know if we will ever find a true baby proof product.

If you own one of these care centers, please stop using it immediately and contact the manufacturer for a repair kit.

Dorel’s Recall Hotline: (888) 233-4903 between 8 a.m. and 5 p.m. ET Monday through Thursday, 8 a.m. and 4:30 p.m. ET Friday

Dorel’s Web site: www.djgusa.com

CPSC Recall Hotline: (800) 638-2772

*Article from Chicago Tribune

Related articles by Zemanta

• Target Sold Children’s Toy That Had Illegal Levels of Lead (manolith.com)
• Strollers recalled due to amputation hazard (blisstree.com)

The National Electronic Injury Surveillance System All Injury Program, supported by the Centers for Disease Control, tracks data from a representative sample of hospital emergency departments (EDs).  This dataset was recently analyzed¹ to reveal the circumstances of injurious falls and the assistive devices that were involved, yielding estimates that:

• Each year in the US there are 47,312 nonfatal fall injury ED visits associated with the use of canes and walkers by people 65+ years of age;  60% of these happen at home.

• The injuries sustained in these falls are serious with one-third of patients requiring hospital admission for fractures, contusions, abrasions & internal injury.  Men are more likely to sustain head and neck injuries while women more commonly injure the lower trunk.

Canes are generally prescribed for a moderate level of gait instability, whereas walkers are recommended for more generalized weakness, limited weight bearing ability or poor balance.  Women are more likely to use walkers than men.  Even though there are twice as many older adult cane-users as walker-users, this analysis found that:

• Walkers are associated with 7 times as many ED fall injury visits as canes.
• Women are 2 ½ times more likely to report to the ED for these walker-fall injuries.
• Those 85+ years of age on a walker are at particularly high risk.

Clinical implications:  Assistive device use is associated with injurious falls that require medical care.  It is essential that older adults receive instruction from qualified therapists who can intervene to reduce intrinsic risk factors (poor balance) as well as maximize the likelihood of  proper fit and safe use of assistive devices.  Particular attention should be given to those helping those aged 85+ master the physical and cognitive skills required for safe walker use.

1.  Stevens JA, PhD, Thomas K, The L, ABJ, and Greenspan AI. (2009). Unintentional fall injuries associated with walkers and canes in older adults treated in US emergency departments.  JAGS 57:1464–1469.

Related articles by Zemanta

• Assistive Technology (slideshare.net)
• Eye Stick For the Blind (neatorama.com)

The Agency for Healthcare Research and Quality (AHRQ) reports results from analyses of the Healthcare Cost and Utilization Project-Nationwide Emergency Department Sample regarding ED visits among elderly adults who were coded as sustaining both a fall and an injury.  Starting from the vantage point of the ED these analyses highlight the importance of our efforts to reduce falls and illuminate how injurious falls contribute to human suffering, ED overcrowding, hospital costs, admission to long term care facilities as well as private and government health care spending.  Having sustained a fall injury requiring a trip to the ED could trigger efforts to identify, track, assess and intervene with these high risk individuals in order to reduce the risk of sustaining another fall. Having fallen is one of the strongest predictors that one will fall again.

In the United States in calendar year 2006:

Injurious falls accounted for 10.5% of all ED visits among adults aged 65+, totaling over 2.1 million visits.

• The rate was 57.4 ED visits for injurious fall injury per 1000 people 65+ years of age.

• Females accounted for 70.2% of the ED visits.  Those aged 75-84 had the highest number of visits (40.3%), followed by those 85+ (32.4%) and finally those 65-74 (27.3%).  Nearly 1 in 7 women and 1 in 10 men aged 85+ had an ED visit for an injurious fall.

• The most common injuries resulting in an ED visit were fractures (41%); superficial contusions (22.6%); open wounds (21.4%), sprains and strains (10%); internal organ injuries (4.6%) and dislocations (1.5%).

• Hip fractures accounted for about 1 in 8 ED visits among adults aged 65+.

• Nearly 30% of the injurious falls treated in the ED resulted in hospital admissions and these admissions (while not longer) had a higher average cost ($10,800) relative to older adults admitted from the ED for other reasons ($9,900).

• The aggregate national cost of hospital care for older adults who came in through the ED for an injurious fall was $6.8 billion.

• The elderly who were treated in the ED for an injurious fall and then hospitalized were more likely to be discharged to long term care (65.7%) than elderly ED patients hospitalized for other reasons (28.4%). Fractures or internal injuries were most likely to require hospital discharge to a long term care facility.

Owens PL, Russo CA, Spector W and Mutter R. Emergency department visits for injurious falls among the elderly, 2006.

HCUP Statistical Brief #80.  October 2009.  Agency for Healthcare Research and Quality, Rockville, Maryland.

http://www.hcup-us.ahrq.gov/reports/statbriefs/sb80.pdf

Related articles by Zemanta

• How to Make an Emergency Department Visit a Safe One (ahrq.gov)
• Hip Fracture Rates Drop; Reasons Are Unclear (nytimes.com)

Computer use is seeing an increasing number people in doctors’ offices or in the emergency room, according to a study published in the July issue of the American Journal of Preventative Medicine. In the study, researchers found that emergency room visits for computer-related injuries rose from 1,267 to 9,279 from 1994 to 2006. The highest rate of injuries occurred among children under 5, the study’s author said.

As an ergonomic assessment specialist, my job is to identify the risk of injury from cumulative use and to eliminate the risk.  Common problems seen with overuse of the computer and related workspace include carpal tunnel syndrome, back strain, and neck strain.

Injuries from moving computer peripherals is also becoming more common.  Fractures, cuts and bruises can occur when climbing under and around the desks in an attempt to connect or disconnect computer components.  Small children are injured when they pull computer parts down on themself.

Read more in the New York Times

Related articles by Zemanta

• Preventing Carpal Tunnel Syndrome (fitsugar.com)
• Beware ‘Cellphone Elbow’ (blogs.wsj.com)
• Fight Carpal Tunnel with Simple Desk Exercises [Exercise] (lifehacker.com)