What do police do

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					What do Special Constables do?

Peace officers, law enforcement officers, security officers and people in related
positions may be called to any number of work environments, and perform a variety
of tasks.

The main duties of a police officer, among others, are to:

      Respond to emergency calls such as crimes, accidents, and natural disasters
      Patrol assigned areas to maintain public safety
      Enforce laws and regulations
      Investigate crimes and accidents
      Perform first aid
      Educate the public on crime prevention and safety




What are some health and safety issues for law enforcement persons?

Law Enforcement work is among the most dangerous and requires special training.
The hazards of police work include:

      Violent attacks
      Exposure to contagious and infectious diseases from people, animals,
       needles, and other sources
      Exposure to various chemical or biological hazards
      Pain from physical overexertion, and prolonged or awkward body postures
      Exposure to extreme temperatures
      Noise
      Slips, trips and falls
      Fatigue from shift work
      Psychological stress or trauma




What are some preventive measures for peace officers?

      Have extensive safety and skills training.
      Exercise regularly to keep fit and reduce the risk of injury.
      Wash your hands frequently, to reduce the chance of infection.
      Use personal protective equipment or others barriers for the task.
      Learn safe lifting techniques.
      Always be aware of your surroundings, and on the alert for dangerous people
       or situations.
      Take breaks, as appropriate, from awkward positions or repetitive physical
       tasks.
      Follow a recommended shift work pattern and protect yourself from the
       hazards associated with shift work.
      Follow or establish safety procedures for working alone, or for avoiding
       working alone wherever possible.
      Learn about stress and post-traumatic stress, and consider a debriefing
       session or counselling after a critical or traumatic event.




What are some good general safe work practices?

Ensure that you are trained and informed on how to avoid the various health and
safety hazards of your job. Read about these:

      Chemical hazards and WHMIS
      Blood borne diseases
      The importance of hand washing
      Needlestick injuries
      Proper selection, use, maintenance and storage of personal protective
       equipment
      Safe lifting techniques
      Preventing slips, trips and falls
      Shift work
      Working alone

Always:

      Follow the established safety procedures for your profession.
      Know how to report a hazard
      Follow good housekeeping procedures

What are work-related musculoskeletal disorders (WMSDs)?

Work-related musculoskeletal disorders (WMSDs) are a group of painful disorders of
muscles, tendons, and nerves. Carpal tunnel syndrome, tendonitis, thoracic outlet
syndrome, and tension neck syndrome are examples. Work activities which are
frequent and repetitive, or activities with awkward postures cause these disorders
which may be painful during work or at rest.

Almost all work requires the use of the arms and hands. Therefore, most WMSD
affect the hands, wrists, elbows, neck, and shoulders. Work using the legs can lead
to WMSD of the legs, hips, ankles, and feet. Some back problems also result from
repetitive activities.




Are there other names for WMSDs?

WMSDs are very difficult to define within traditional disease classifications. These
disorders have received many names, such as:

      Repetitive motion injuries
      Repetitive strain injuries
      Cumulative trauma disorders
      Occupational cervicobrachial disorders
      Overuse syndrome
      Regional musculoskeletal disorders
      Soft tissue disorders

Most of the names do not accurately describe the disorders. For example, the term
"repetitive strain injuries" suggests that repetition causes these disorders, but
awkward postures also contribute. These terms are used synonymously, and in the
absence of agreement, WMSD is used in this document.




How common are WMSDs?

WMSDs are recognized as leading causes of significant human suffering, loss of
productivity, and economic burdens on society. However, we do not have reliable
estimates of the number of WMSDs in Canada. The data available are limited and
does not represent the magnitude of the problem because there is a great deal of
under-reporting of these types of injuries. For example, over 20,000 Ontario workers
received compensation in 1987 for new cases of WMSDs, accounting for about
600,000 days of lost work. In British Columbia, over half the industrial disease
claims are due to WMSDs. A survey of cashiers throughout B.C., performed by Simon
Fraser University and the United Food and Commercial Workers in 1982, indicated
that over 30% of the work force surveyed suffered a form of WMSD.




What are the risk factors for WMSDs?

WMSDs arise from ordinary arm and hand movements such as bending,
straightening, gripping, holding, twisting, clenching and reaching. These common
movements are not particularly harmful in the ordinary activities of daily life. What
makes them hazardous in work situations is the continual repetition, often in a
forceful manner, and most of all, the speed of the movements and the lack of time
for recovery between them. WMSDs are associated with work patterns that include:

      Fixed or constrained body positions
      Continual repetition of movements
      Force concentrated on small parts of the body, such as the hand or wrist
      A pace of work that does not allow sufficient recovery between movements

Generally, none of these factors acts separately to cause WMSD. WMSDs commonly
occur as a result of a combination and interaction among them.

Heat, cold and vibration also contribute to the development of WMSD.

Body Position

There are two aspects of body position (posture) that contribute to injuries in jobs
involving repetitive tasks.
The first relates to the position of the part of the body that performs the actual task,
usually the upper limb. For example, tasks that require repetitive movements to the
extreme ranges of the joint in the wrist, elbow or shoulder contribute to the
occurrence of a painful condition in those areas. Table 1 gives examples of such
movements. Poor layout of the workstation and improper selection of equipment and
tools can lead to these hazardous body movements.


                                                      Table 1

                                      Body Movement                                               Areas of Pain

repetitive, horizontal or vertical movements of the wrist to the extreme ranges (Fig. 1A)
                                                                                                wrist and palm
moving fingers while the wrist is in an extreme position (Fig. 1B,1C)

repetitive bending or straightening of the elbow from its neutral position (at a right angle)
                                                                                                elbow
twisting the wrist and forearm (Fig. 2)

reaching above shoulder level (Fig. 3B)

reaching behind the trunk (Fig. 3C)
                                                                                                neck and shoulder
reaching far out in front of the body (Fig. 3A)

twisting the arm (Fig. 3C)



The other postural aspect that contributes to WMSD is a fixed position of the neck
and the shoulders. To perform any controlled movement of an upper limb, the
worker must stabilize the shoulder-neck region. Muscles in the shoulder and the neck
contract and stay contracted to hold the position stable for as long as the task
requires. The contracted muscles squeeze the blood vessels. This restricts the flow of
blood all the way down to the working muscles of the hand where the blood, because
of the intense muscular effort, is needed the most. The result is twofold. The neck-
shoulder muscles become fatigued, even though there is no movement. This
contributes to pain in the neck area. At the same time, the reduced blood supply to
the remaining parts of the upper limb accelerates fatigue in the moving muscles,
making them more susceptible to injury.
                                     Figure 2 - Exerting force while
                                           extending forearm
   Figures 1A, 1B & 1C -
Hazardous movements of the
           hand




  Figure 3A - Hazardous reaching movements -
                reaching forward                   Figure 3B - Hazardous reaching movements -
                                                           reaching above shoulder level


Repetition

Workers performing highly repetitive tasks are at the highest risk for WMSD. This
shows that repetition of movements, although it never acts separately, is most likely
the strongest risk factor. Tasks requiring repetitive movements always involve other
risk factors for WMSD such as fixed body position and force: the worker, in order to
perform the task, has to maintain the shoulder and neck in a fixed position and to
exert some force.
                              Figure 3C - Hazardous reaching
                           movements - reaching behind the trunk


Work involving movement repeated over and over again is very tiring. This is
because the worker cannot fully recover in the short periods of time that are given
between tasks. With time, the effort to maintain the repetitive movements, even if
they involve minimal forces, steadily increases. When the work activity is continued
in spite of the developing fatigue, injuries occur.

Force

The force required to do the task also plays an important role in the onset of WMSD.
More force equals more muscular effort, and consequently, a longer time is needed
to recover between tasks. Since in repetitive work, as a rule, there is not sufficient
time for recovery, the more forceful movements develop fatigue much faster.
Exerting force in certain hand positions is particularly hazardous (Fig. 1A-4F). The
amount of force needed depends on the weight of the tools and objects that the
worker is required to operate or move, and their placement in relation to the
worker's body. More strength has to be used, the farther away from the body the
force has to be applied. The shape of the tool plays an important role, also. Tools
that do not allow the best position of the wrist, elbow and shoulder substantially
increase the force required. Worn and poorly maintained tools are very important as
well, yet often overlooked. For example, a worn screwdriver, pliers with worn jaws,
or dull scissors can increase the operating force as much as tenfold.

            Figure 4A - Pulp pinch                         Figure 4B - Lateral pinch




              Figure 4A and 4B - Exerting force in various hand positions
        Figure 4C - Palm                           Figure 4D - Finger




                                   Press



Pinch
            Figures 4C and 4D - Exerting force in various hand positions




                Figure 4E - Pulp                              Figure 4F - Finger press




grasp
                  Figures 4E and 4F - Exerting force in various hand positions


Pace of Work

Pace of work determines the amount of time available for rest and recovery of the
body between cycles of a particular task. The faster the pace, the less time is
available and the higher the risk for WMSD.

When the worker has no control over timing and speed of work because of external
factors like assembly line speed or quota systems then stress level increases. With
higher stress level comes muscle tension causing fatigue and again increased risk for
WMSD. Controlling the pace of work externally denies the worker the flexibility to
determine their own work speed. It is a human characteristic to work at varying
rates at different times of the day.

Temperature and Vibration

Temperature and humidity affect the worker performing repetitive work. When it is
too hot and too humid, the workers tire more quickly and thereby become more
susceptible to injury. On the other hand, cold temperatures decrease the flexibility of
muscles and joints, increasing the likelihood of injury of any kind.
Vibration affects tendons, muscles, joints, and nerves. Workers using vibrating tools
may experience numbness of the fingers, loss of touch and grip, and pain. For more
information on this subject, refer to OSH Answers document Raynaud's Phenomenon.




How do WMSDs occur?

WMSDs do not happen as a result of a single accident or injury. Rather, they develop
gradually as a result of repeated trauma. Excessive stretching of muscles and
tendons can cause injuries that only last a short time. But repeated episodes of
stretching causing tissue inflammation can lead to long-lasting injury or WMSDs.

WMSDs include three types of injuries:

        muscle injury
        tendon injury
        nerve injury

Muscle Injury

When muscles contract, they use chemical energy from sugars and produce by-
products such as lactic acid which are removed by the blood. A muscle contraction
that lasts a long time reduces the blood flow. Consequently, the substances
produced by the muscles are not removed fast enough, and they accumulate. The
accumulation of these substances irritates muscles and causes pain. The severity of
the pain depends on the duration of the muscle contractions and the amount of time
between activities for the muscles to get rid of those irritating substances.

Tendon Injury

Tendons consist of numerous bundles of fibres that
attach muscles to bones. Tendon disorders related to
repetitive or frequent work activities and awkward
postures occur in two major categories --tendons with
sheaths (Fig. 5), found mainly in the hand and wrist;
and tendons without sheaths (Fig. 6), generally found
around the shoulder, elbow, and forearm.


The tendons of the hand are encased in sheaths
through which the tendon slides.




                                                        Figure 5 - Finger tendons and their sheaths
The inner walls of the sheaths contain cells that produce a slippery fluid to
lubricate the tendon. With repetitive or excessive movement of the hand,
the lubrication system may malfunction. It may not produce enough fluid,
or it may produce a fluid with poor lubricating qualities. Failure of the
lubricating system creates friction between the tendon and its sheath,
causing inflammation and swelling of the tendon area. Repeated episodes
of inflammation cause fibrous tissue to form. The fibrous tissue thickens
the tendon sheath, and hinders tendon movement. Inflammation of the
tendon sheath is known as tenosynovitis.




                                                                                Figure 6 - Tendon, muscle,
                                                                                         bone unit


When inflamed, a tendon sheath may swell up with lubricating fluid and cause a
bump under the skin. This is referred to as a ganglion cyst.

Tendons without sheaths are vulnerable to repetitive motions and awkward postures.
In fact, when a tendon is repeatedly tensed, some of its fibres can tear apart. The
tendon becomes thickened and bumpy, causing inflammation. Tendonitis is the
general term indicating inflammation of the tendon. In some cases, such as in the
shoulder, tendons pass through a narrow space between bones. A sac called the
bursa filled with lubricating fluid is inserted between the tendons and the bones as
an anti-friction device. As the tendons become increasingly thickened and bumpy,
the bursa is subject to a lot of friction and becomes inflamed. Inflammation of the
bursa is known as bursitis.

Nerve Injury

Nerves carry signals from the brain to control activities of muscles. They also carry
information about temperature, pain and touch from the body to the brain, and
control bodily functions such as sweating and salivation. Nerves are surrounded by
muscles, tendons, and ligaments. With repetitive motions and awkward postures, the
tissues surrounding nerves become swollen, and squeeze or compress nerves (Fig.
7A,7B).
    Figure 7A - Wrist in natural condition       Figure 7B - Wrist showing symptoms of Carpal
                                                               Tunnel Syndrome


Compression of a nerve causes muscle weakness, sensations of "pins and needles"
and numbness. Dryness of skin, and poor circulation to the extremities, may also
occur.




What are the symptoms of WMSDs?

Pain is the most common symptom associated with WMSDs. In some cases there
may be joint stiffness, muscle tightness, redness and swelling of the affected area.
Some workers may also experience sensations of "pins and needles," numbness, skin
colour changes, and decreased sweating of the hands.

WMSDs may progress in stages from mild to severe.

Early stage: Aching and tiredness of the affected limb occur during the work shift
but disappear at night and during days off work. No reduction of work performance.

Intermediate stage: Aching and tiredness occur early in the work shift and persist
at night. Reduced capacity for repetitive work.

Late stage: Aching, fatigue, and weakness persist at rest. Inability to sleep and to
perform light duties.

Not everyone goes through these stages in the same way. In fact, it may be difficult
to say exactly when one stage ends and the next begins. The first pain is a signal
that the muscles and tendons should rest and recover. Otherwise, an injury can
become longstanding, and sometimes, irreversible. The earlier people recognize
symptoms, the quicker they should respond to them.

Table 2 outlines occupational risk factors and symptoms of the most common
disorders of the upper body associated with WMSDs.


                                                  Table 2
                       Identified disorders, occupational risk factors and symptoms

           Disorders                    Occupational risk factors                      Symptoms

Tendonitis/tenosynovitis           Repetitive wrist motions               Pain, weakness, swelling, burning
                                   Repetitive shoulder motions            sensation or dull ache over affected
                                   Sustained hyper extension of arms      area
                                   Prolonged load on shoulders

Epicondylitis (elbow tendonitis)   Repeated or forceful rotation of the   Same symptoms as tendonitis
                                   forearm and bending of the wrist at
                                   the same time

Carpal tunnel syndrome             Repetitive wrist motions               Pain, numbness, tingling, burning
                                                                          sensations, wasting of muscles at base
                                                                          of thumb, dry palm
DeQuervain's disease        Repetitive hand twisting and forceful   Pain at the base of thumb
                            gripping

Thoracic outlet syndrome    Prolonged shoulder flexion              Pain, numbness, swelling of the hands
                            Extending arms above shoulder
                            height
                            Carrying loads on the shoulder

Tension neck syndrome       Prolonged restricted posture            Pain




How are WMSDs recognized?

The evaluation of WMSDs includes identifying workplace risks. Evaluation begins with
a discussion of the person's employment and requires a detailed description of all the
processes involved in a typical workday. Consideration is given to the frequency,
intensity, duration, and regularity of each task performed at work.

Diagnosis of WMSDs is confirmed by performing laboratory and electronic tests that
determine nerve or muscle damage. One such test, electroneuromyography (ENMG),
encompasses two areas: electromyography (EMG) and nerve conduction velocity
(NCV). Magnetic resonance imaging (MRI), an alternative to x-rays, provides images
of tendons, ligaments, and muscles and improves the quality of the diagnostic
information.




How are WMSDs treated?

The treatment of WMSDs involves several approaches including the following:

        Restriction of movement
        Application of heat or cold
        Exercise
        Medication and surgery

Restriction of Movement

The first approach to treatment of WMSDs is to avoid the activities causing the
injury. This often requires work restrictions. In some cases, transfer to a different job
should be considered. A splint can also be used to restrict movements or to
immobilize the injured joint. However, the use of splints in occupational situations
requires extreme caution. If used inappropriately, splints can cause more damage
than good. Splints are usually used for two reasons: to mechanically support a joint
where an excessive load on the joint is anticipated, or to restrict the movement of
the injured joint.

In the occupational context, splints should not be used as a mechanical support for
the joint. Instead, the job should be redesigned to avoid the extreme load on the
worker's joint in the first place. To be effective, the use of splints to immobilize an
affected joint also requires that the work activity that caused the injury be stopped
or changed. If injurious work continues, then the worker is exposed to risk of injury
to other joints that have to compensate for the one that is splinted.

Application of Heat or Cold

Applying heat or cold seems to relieve pain and may accelerate the repair process.
Heat is recommended for pain relief of minor injuries. It is not recommended for
injuries with significant inflammation and swelling.

Heat increases the flow of blood and increases swelling. Ice reduces pain and
swelling.

Exercise

Stretching is beneficial because it promotes circulation and reduces muscle tension.
However, people suffering from WMSDs should consult a physical therapist before
exercising. Stretching or exercise programs can aggravate the existing condition if
not properly designed.

Medication and Surgery

Aspirin, non-steroidal anti-inflammatory drugs, and injected corticosteroid can
reduce pain and inflammation. The doctor may try more elaborate treatments or
even surgery if all other approaches fail.




How can we prevent WMSDs?

Hazards are best eliminated at the source; this is a fundamental principle of
occupational health and safety. In the case of WMSDs, the prime source of hazard is
the repetitiveness of work. Other components of work such as the applied force,
fixed body positions, and the pace of work requiring repetition of the same
movements over and over again, are also contributing factors to WMSDs. Therefore
the main effort to protect workers from WMSDs should focus on avoiding repetitive
patterns of work through job design which may include mechanization, job rotation,
job enlargement and enrichment or teamwork. Where elimination of the repetitive
patterns of work is not practical, prevention strategies involving workplace layout,
tool and equipment design, and work practices should be considered.

Job Design

Mechanization

One way to eliminate repetitive tasks is to mechanize the job. Where mechanization
is not feasible or appropriate, other alternatives are available.

Job Rotation

Job rotation is one possible approach. It requires workers to move between different
tasks, at fixed or irregular periods of time. But it must be a rotation where workers
do something completely different. Different tasks must engage different muscle
groups in order to allow recovery for those already strained.

However, job rotation alone will not be effective in reducing WNSDs if not combined
with the proper design of workstations. And it will not be effective while the high
pace of work persists.

Job Enlargement and Enrichment

Another approach is job enlargement. This increases the variety of tasks built into
the job. It breaks the monotony of the job and avoids overloading one part of the
body. Job enrichment involves more autonomy and control for the worker.

Team Work

Team work can provide greater variety and more evenly distributed muscular work.
The whole team is involved in the planning and allocation of the work. Each team
member carries out a set of operations to complete the whole product, allowing the
worker to alternate between tasks, hence, reducing the risk of WMSDs.

Workplace Design

The guiding principle in workplace design is to fit the workplace to the worker.
Evaluation of the workplace can identify the source or sources of WMSD. Proper
design of the workstation decreases the effort required of the worker to maintain a
working position. Ideally, the workstation should be fully adjustable, providing a
worker with the options to work in standing, sitting or sitting-standing positions, as
well as fitting the worker's body size and shape. Detailed information about proper
workplace design can be found in the OSH Answers documents "Working in a
Standing Position" and "Working in a Sitting Position".

Tools and Equipment Design

Proper design of tools and equipment significantly decreases the force needed to
complete the task.

Providing the worker with the proper jigs or fixtures for tasks that require holding
elements saves a lot of muscular effort in awkward positions.

Good tools, maintained carefully and where necessary frequently changed, can also
save a lot of muscle strain. More information about hand tools and preventing WMSD
resulting from their use can be found in the OSH Answers document "Hand Tool
Ergonomics".

Work Practices

A well-designed job, supported by a well-designed workplace and proper tools,
allows the worker to avoid unnecessary motion of the neck, shoulders and upper
limbs. However, the actual performance of the tasks depends on individuals.
Training should be provided for workers who are involved in jobs that include
repetitive tasks. Workers need to know how to adjust workstations to fit the tasks
and their individual needs. Training should also emphasize the importance of rest
periods and teach how to take advantage of short periods of time between tasks to
relax the muscles, and how to consciously control muscle tension throughout the
whole work shift.




Conclusion

WMSDs of muscles, tendons and nerves are a major cause of lost work in many
labour-intensive industries. Occupational risk factors include continual repetition of
movements, fixed body positions, forces concentrated on small parts of the body,
and lack of sufficient rest between tasks.

Prevention must aim at eliminating the repetitiveness of the work by proper job
design. Where this is not possible, preventive strategies such as good workplace
layout, tool and equipment design, and proper work practices should be considered.
Early recognition of these disorders is very important because medical treatments
are unlikely to be effective once these injuries become longstanding.

Preventive and control measures, in order to be truly effective, require significant
involvement on the part of the workers, their representatives, and management to
improve occupational health and safety.

What are work-related musculoskeletal disorders (WMSDs)?

Work-related musculoskeletal disorders (WMSDs) are a group of painful disorders of
muscles, tendons, and nerves. Carpal tunnel syndrome, tendonitis, thoracic outlet
syndrome, and tension neck syndrome are examples. Work activities which are
frequent and repetitive, or activities with awkward postures cause these disorders
which may be painful during work or at rest.

Almost all work requires the use of the arms and hands. Therefore, most WMSD
affect the hands, wrists, elbows, neck, and shoulders. Work using the legs can lead
to WMSD of the legs, hips, ankles, and feet. Some back problems also result from
repetitive activities.




Are there other names for WMSDs?

WMSDs are very difficult to define within traditional disease classifications. These
disorders have received many names, such as:

      Repetitive motion injuries
      Repetitive strain injuries
      Cumulative trauma disorders
      Occupational cervicobrachial disorders
      Overuse syndrome
      Regional musculoskeletal disorders
      Soft tissue disorders

Most of the names do not accurately describe the disorders. For example, the term
"repetitive strain injuries" suggests that repetition causes these disorders, but
awkward postures also contribute. These terms are used synonymously, and in the
absence of agreement, WMSD is used in this document.




How common are WMSDs?

WMSDs are recognized as leading causes of significant human suffering, loss of
productivity, and economic burdens on society. However, we do not have reliable
estimates of the number of WMSDs in Canada. The data available are limited and
does not represent the magnitude of the problem because there is a great deal of
under-reporting of these types of injuries. For example, over 20,000 Ontario workers
received compensation in 1987 for new cases of WMSDs, accounting for about
600,000 days of lost work. In British Columbia, over half the industrial disease
claims are due to WMSDs. A survey of cashiers throughout B.C., performed by Simon
Fraser University and the United Food and Commercial Workers in 1982, indicated
that over 30% of the work force surveyed suffered a form of WMSD.




What are the risk factors for WMSDs?

WMSDs arise from ordinary arm and hand movements such as bending,
straightening, gripping, holding, twisting, clenching and reaching. These common
movements are not particularly harmful in the ordinary activities of daily life. What
makes them hazardous in work situations is the continual repetition, often in a
forceful manner, and most of all, the speed of the movements and the lack of time
for recovery between them. WMSDs are associated with work patterns that include:

      Fixed or constrained body positions
      Continual repetition of movements
      Force concentrated on small parts of the body, such as the hand or wrist
      A pace of work that does not allow sufficient recovery between movements

Generally, none of these factors acts separately to cause WMSD. WMSDs commonly
occur as a result of a combination and interaction among them.

Heat, cold and vibration also contribute to the development of WMSD.

Body Position

There are two aspects of body position (posture) that contribute to injuries in jobs
involving repetitive tasks.

The first relates to the position of the part of the body that performs the actual task,
usually the upper limb. For example, tasks that require repetitive movements to the
extreme ranges of the joint in the wrist, elbow or shoulder contribute to the
occurrence of a painful condition in those areas. Table 1 gives examples of such
movements. Poor layout of the workstation and improper selection of equipment and
tools can lead to these hazardous body movements.


                                                      Table 1

                                      Body Movement                                               Areas of Pain

repetitive, horizontal or vertical movements of the wrist to the extreme ranges (Fig. 1A)
                                                                                                wrist and palm
moving fingers while the wrist is in an extreme position (Fig. 1B,1C)

repetitive bending or straightening of the elbow from its neutral position (at a right angle)
                                                                                                elbow
twisting the wrist and forearm (Fig. 2)

reaching above shoulder level (Fig. 3B)

reaching behind the trunk (Fig. 3C)
                                                                                                neck and shoulder
reaching far out in front of the body (Fig. 3A)

twisting the arm (Fig. 3C)



The other postural aspect that contributes to WMSD is a fixed position of the neck
and the shoulders. To perform any controlled movement of an upper limb, the
worker must stabilize the shoulder-neck region. Muscles in the shoulder and the neck
contract and stay contracted to hold the position stable for as long as the task
requires. The contracted muscles squeeze the blood vessels. This restricts the flow of
blood all the way down to the working muscles of the hand where the blood, because
of the intense muscular effort, is needed the most. The result is twofold. The neck-
shoulder muscles become fatigued, even though there is no movement. This
contributes to pain in the neck area. At the same time, the reduced blood supply to
the remaining parts of the upper limb accelerates fatigue in the moving muscles,
making them more susceptible to injury.
                                     Figure 2 - Exerting force while
                                           extending forearm
   Figures 1A, 1B & 1C -
Hazardous movements of the
           hand




  Figure 3A - Hazardous reaching movements -
                reaching forward                   Figure 3B - Hazardous reaching movements -
                                                           reaching above shoulder level


Repetition

Workers performing highly repetitive tasks are at the highest risk for WMSD. This
shows that repetition of movements, although it never acts separately, is most likely
the strongest risk factor. Tasks requiring repetitive movements always involve other
risk factors for WMSD such as fixed body position and force: the worker, in order to
perform the task, has to maintain the shoulder and neck in a fixed position and to
exert some force.




                                Figure 3C - Hazardous reaching
                             movements - reaching behind the trunk


Work involving movement repeated over and over again is very tiring. This is
because the worker cannot fully recover in the short periods of time that are given
between tasks. With time, the effort to maintain the repetitive movements, even if
they involve minimal forces, steadily increases. When the work activity is continued
in spite of the developing fatigue, injuries occur.

Force

The force required to do the task also plays an important role in the onset of WMSD.
More force equals more muscular effort, and consequently, a longer time is needed
to recover between tasks. Since in repetitive work, as a rule, there is not sufficient
time for recovery, the more forceful movements develop fatigue much faster.
Exerting force in certain hand positions is particularly hazardous (Fig. 1A-4F). The
amount of force needed depends on the weight of the tools and objects that the
worker is required to operate or move, and their placement in relation to the
worker's body. More strength has to be used, the farther away from the body the
force has to be applied. The shape of the tool plays an important role, also. Tools
that do not allow the best position of the wrist, elbow and shoulder substantially
increase the force required. Worn and poorly maintained tools are very important as
well, yet often overlooked. For example, a worn screwdriver, pliers with worn jaws,
or dull scissors can increase the operating force as much as tenfold.

              Figure 4A - Pulp pinch                         Figure 4B - Lateral pinch




                Figure 4A and 4B - Exerting force in various hand positions




        Figure 4C - Palm                           Figure 4D - Finger




                                  Press



Pinch
            Figures 4C and 4D - Exerting force in various hand positions
              Figure 4E - Pulp                              Figure 4F - Finger press




grasp
                Figures 4E and 4F - Exerting force in various hand positions


Pace of Work

Pace of work determines the amount of time available for rest and recovery of the
body between cycles of a particular task. The faster the pace, the less time is
available and the higher the risk for WMSD.

When the worker has no control over timing and speed of work because of external
factors like assembly line speed or quota systems then stress level increases. With
higher stress level comes muscle tension causing fatigue and again increased risk for
WMSD. Controlling the pace of work externally denies the worker the flexibility to
determine their own work speed. It is a human characteristic to work at varying
rates at different times of the day.

Temperature and Vibration

Temperature and humidity affect the worker performing repetitive work. When it is
too hot and too humid, the workers tire more quickly and thereby become more
susceptible to injury. On the other hand, cold temperatures decrease the flexibility of
muscles and joints, increasing the likelihood of injury of any kind.

Vibration affects tendons, muscles, joints, and nerves. Workers using vibrating tools
may experience numbness of the fingers, loss of touch and grip, and pain. For more
information on this subject, refer to OSH Answers document Raynaud's Phenomenon.




How do WMSDs occur?

WMSDs do not happen as a result of a single accident or injury. Rather, they develop
gradually as a result of repeated trauma. Excessive stretching of muscles and
tendons can cause injuries that only last a short time. But repeated episodes of
stretching causing tissue inflammation can lead to long-lasting injury or WMSDs.

WMSDs include three types of injuries:

       muscle injury
       tendon injury
       nerve injury
Muscle Injury

When muscles contract, they use chemical energy from sugars and produce by-
products such as lactic acid which are removed by the blood. A muscle contraction
that lasts a long time reduces the blood flow. Consequently, the substances
produced by the muscles are not removed fast enough, and they accumulate. The
accumulation of these substances irritates muscles and causes pain. The severity of
the pain depends on the duration of the muscle contractions and the amount of time
between activities for the muscles to get rid of those irritating substances.

Tendon Injury

Tendons consist of numerous bundles of fibres that
attach muscles to bones. Tendon disorders related to
repetitive or frequent work activities and awkward
postures occur in two major categories --tendons with
sheaths (Fig. 5), found mainly in the hand and wrist;
and tendons without sheaths (Fig. 6), generally found
around the shoulder, elbow, and forearm.


The tendons of the hand are encased in sheaths
through which the tendon slides.




                                                             Figure 5 - Finger tendons and their sheaths




The inner walls of the sheaths contain cells that produce a slippery fluid to
lubricate the tendon. With repetitive or excessive movement of the hand,
the lubrication system may malfunction. It may not produce enough fluid,
or it may produce a fluid with poor lubricating qualities. Failure of the
lubricating system creates friction between the tendon and its sheath,
causing inflammation and swelling of the tendon area. Repeated episodes
of inflammation cause fibrous tissue to form. The fibrous tissue thickens
the tendon sheath, and hinders tendon movement. Inflammation of the
tendon sheath is known as tenosynovitis.




                                                                                Figure 6 - Tendon, muscle,
                                                                                         bone unit


When inflamed, a tendon sheath may swell up with lubricating fluid and cause a
bump under the skin. This is referred to as a ganglion cyst.

Tendons without sheaths are vulnerable to repetitive motions and awkward postures.
In fact, when a tendon is repeatedly tensed, some of its fibres can tear apart. The
tendon becomes thickened and bumpy, causing inflammation. Tendonitis is the
general term indicating inflammation of the tendon. In some cases, such as in the
shoulder, tendons pass through a narrow space between bones. A sac called the
bursa filled with lubricating fluid is inserted between the tendons and the bones as
an anti-friction device. As the tendons become increasingly thickened and bumpy,
the bursa is subject to a lot of friction and becomes inflamed. Inflammation of the
bursa is known as bursitis.

Nerve Injury

Nerves carry signals from the brain to control activities of muscles. They also carry
information about temperature, pain and touch from the body to the brain, and
control bodily functions such as sweating and salivation. Nerves are surrounded by
muscles, tendons, and ligaments. With repetitive motions and awkward postures, the
tissues surrounding nerves become swollen, and squeeze or compress nerves (Fig.
7A,7B).




   Figure 7A - Wrist in natural condition
                                            Figure 7B - Wrist showing symptoms of Carpal
                                                          Tunnel Syndrome


Compression of a nerve causes muscle weakness, sensations of "pins and needles"
and numbness. Dryness of skin, and poor circulation to the extremities, may also
occur.




What are the symptoms of WMSDs?

Pain is the most common symptom associated with WMSDs. In some cases there
may be joint stiffness, muscle tightness, redness and swelling of the affected area.
Some workers may also experience sensations of "pins and needles," numbness, skin
colour changes, and decreased sweating of the hands.

WMSDs may progress in stages from mild to severe.

Early stage: Aching and tiredness of the affected limb occur during the work shift
but disappear at night and during days off work. No reduction of work performance.
Intermediate stage: Aching and tiredness occur early in the work shift and persist
at night. Reduced capacity for repetitive work.

Late stage: Aching, fatigue, and weakness persist at rest. Inability to sleep and to
perform light duties.

Not everyone goes through these stages in the same way. In fact, it may be difficult
to say exactly when one stage ends and the next begins. The first pain is a signal
that the muscles and tendons should rest and recover. Otherwise, an injury can
become longstanding, and sometimes, irreversible. The earlier people recognize
symptoms, the quicker they should respond to them.

Table 2 outlines occupational risk factors and symptoms of the most common
disorders of the upper body associated with WMSDs.


                                                  Table 2
                       Identified disorders, occupational risk factors and symptoms

           Disorders                   Occupational risk factors                        Symptoms

Tendonitis/tenosynovitis           Repetitive wrist motions                Pain, weakness, swelling, burning
                                   Repetitive shoulder motions             sensation or dull ache over affected
                                   Sustained hyper extension of arms       area
                                   Prolonged load on shoulders

Epicondylitis (elbow tendonitis)   Repeated or forceful rotation of the    Same symptoms as tendonitis
                                   forearm and bending of the wrist at
                                   the same time

Carpal tunnel syndrome             Repetitive wrist motions                Pain, numbness, tingling, burning
                                                                           sensations, wasting of muscles at base
                                                                           of thumb, dry palm

DeQuervain's disease               Repetitive hand twisting and forceful   Pain at the base of thumb
                                   gripping

Thoracic outlet syndrome           Prolonged shoulder flexion              Pain, numbness, swelling of the hands
                                   Extending arms above shoulder
                                   height
                                   Carrying loads on the shoulder

Tension neck syndrome              Prolonged restricted posture            Pain




How are WMSDs recognized?

The evaluation of WMSDs includes identifying workplace risks. Evaluation begins with
a discussion of the person's employment and requires a detailed description of all the
processes involved in a typical workday. Consideration is given to the frequency,
intensity, duration, and regularity of each task performed at work.

Diagnosis of WMSDs is confirmed by performing laboratory and electronic tests that
determine nerve or muscle damage. One such test, electroneuromyography (ENMG),
encompasses two areas: electromyography (EMG) and nerve conduction velocity
(NCV). Magnetic resonance imaging (MRI), an alternative to x-rays, provides images
of tendons, ligaments, and muscles and improves the quality of the diagnostic
information.
How are WMSDs treated?

The treatment of WMSDs involves several approaches including the following:

      Restriction of movement
      Application of heat or cold
      Exercise
      Medication and surgery

Restriction of Movement

The first approach to treatment of WMSDs is to avoid the activities causing the
injury. This often requires work restrictions. In some cases, transfer to a different job
should be considered. A splint can also be used to restrict movements or to
immobilize the injured joint. However, the use of splints in occupational situations
requires extreme caution. If used inappropriately, splints can cause more damage
than good. Splints are usually used for two reasons: to mechanically support a joint
where an excessive load on the joint is anticipated, or to restrict the movement of
the injured joint.

In the occupational context, splints should not be used as a mechanical support for
the joint. Instead, the job should be redesigned to avoid the extreme load on the
worker's joint in the first place. To be effective, the use of splints to immobilize an
affected joint also requires that the work activity that caused the injury be stopped
or changed. If injurious work continues, then the worker is exposed to risk of injury
to other joints that have to compensate for the one that is splinted.

Application of Heat or Cold

Applying heat or cold seems to relieve pain and may accelerate the repair process.
Heat is recommended for pain relief of minor injuries. It is not recommended for
injuries with significant inflammation and swelling.

Heat increases the flow of blood and increases swelling. Ice reduces pain and
swelling.

Exercise

Stretching is beneficial because it promotes circulation and reduces muscle tension.
However, people suffering from WMSDs should consult a physical therapist before
exercising. Stretching or exercise programs can aggravate the existing condition if
not properly designed.

Medication and Surgery

Aspirin, non-steroidal anti-inflammatory drugs, and injected corticosteroid can
reduce pain and inflammation. The doctor may try more elaborate treatments or
even surgery if all other approaches fail.
How can we prevent WMSDs?

Hazards are best eliminated at the source; this is a fundamental principle of
occupational health and safety. In the case of WMSDs, the prime source of hazard is
the repetitiveness of work. Other components of work such as the applied force,
fixed body positions, and the pace of work requiring repetition of the same
movements over and over again, are also contributing factors to WMSDs. Therefore
the main effort to protect workers from WMSDs should focus on avoiding repetitive
patterns of work through job design which may include mechanization, job rotation,
job enlargement and enrichment or teamwork. Where elimination of the repetitive
patterns of work is not practical, prevention strategies involving workplace layout,
tool and equipment design, and work practices should be considered.

Job Design

Mechanization

One way to eliminate repetitive tasks is to mechanize the job. Where mechanization
is not feasible or appropriate, other alternatives are available.

Job Rotation

Job rotation is one possible approach. It requires workers to move between different
tasks, at fixed or irregular periods of time. But it must be a rotation where workers
do something completely different. Different tasks must engage different muscle
groups in order to allow recovery for those already strained.

However, job rotation alone will not be effective in reducing WNSDs if not combined
with the proper design of workstations. And it will not be effective while the high
pace of work persists.

Job Enlargement and Enrichment

Another approach is job enlargement. This increases the variety of tasks built into
the job. It breaks the monotony of the job and avoids overloading one part of the
body. Job enrichment involves more autonomy and control for the worker.

Team Work

Team work can provide greater variety and more evenly distributed muscular work.
The whole team is involved in the planning and allocation of the work. Each team
member carries out a set of operations to complete the whole product, allowing the
worker to alternate between tasks, hence, reducing the risk of WMSDs.

Workplace Design

The guiding principle in workplace design is to fit the workplace to the worker.
Evaluation of the workplace can identify the source or sources of WMSD. Proper
design of the workstation decreases the effort required of the worker to maintain a
working position. Ideally, the workstation should be fully adjustable, providing a
worker with the options to work in standing, sitting or sitting-standing positions, as
well as fitting the worker's body size and shape. Detailed information about proper
workplace design can be found in the OSH Answers documents "Working in a
Standing Position" and "Working in a Sitting Position".

Tools and Equipment Design

Proper design of tools and equipment significantly decreases the force needed to
complete the task.

Providing the worker with the proper jigs or fixtures for tasks that require holding
elements saves a lot of muscular effort in awkward positions.

Good tools, maintained carefully and where necessary frequently changed, can also
save a lot of muscle strain. More information about hand tools and preventing WMSD
resulting from their use can be found in the OSH Answers document "Hand Tool
Ergonomics".

Work Practices

A well-designed job, supported by a well-designed workplace and proper tools,
allows the worker to avoid unnecessary motion of the neck, shoulders and upper
limbs. However, the actual performance of the tasks depends on individuals.

Training should be provided for workers who are involved in jobs that include
repetitive tasks. Workers need to know how to adjust workstations to fit the tasks
and their individual needs. Training should also emphasize the importance of rest
periods and teach how to take advantage of short periods of time between tasks to
relax the muscles, and how to consciously control muscle tension throughout the
whole work shift.




Conclusion

WMSDs of muscles, tendons and nerves are a major cause of lost work in many
labour-intensive industries. Occupational risk factors include continual repetition of
movements, fixed body positions, forces concentrated on small parts of the body,
and lack of sufficient rest between tasks.

Prevention must aim at eliminating the repetitiveness of the work by proper job
design. Where this is not possible, preventive strategies such as good workplace
layout, tool and equipment design, and proper work practices should be considered.
Early recognition of these disorders is very important because medical treatments
are unlikely to be effective once these injuries become longstanding.

Preventive and control measures, in order to be truly effective, require significant
involvement on the part of the workers, their representatives, and management to
improve occupational health and safety.
What are sound and noise?

Sound is what we hear. Noise is unwanted sound. The difference between sound and
noise depends upon the listener and the circumstances. Rock music can be
pleasurable sound to one person and an annoying noise to another. In either case, it
can be hazardous to a person's hearing if the sound is loud and if he or she is
exposed long and often enough.

Sound is produced by vibrating objects and reaches the listener's ears as waves in
the air or other media. When an object vibrates, it causes slight changes in air
pressure. These air pressure changes travel as waves through the air and produce
sound. To illustrate, imagine striking a drum surface with a stick. The drum surface
vibrates back and forth. As it moves forward, it pushes the air in contact with the
surface. This creates a positive (higher) pressure by compressing the air. When the
surface moves in the opposite direction, it creates a negative (lower) pressure by
decompressing the air. Thus, as the drum surface vibrates, it creates alternating
regions of higher and lower air pressure. These pressure variations travel through
the air as sound waves (Figure 1).




                                          Figure 1


Table 1 lists the approximate velocity of sound in air and other media. In gases, the
higher the velocity of sound, the higher the pitch will be (Remember the "Mickey
Mouse" sound when people talk after inhaling helium gas?)


                              Table 1
           Approximate Speed of Sound in Common Materials

                        Sound Velocity
  Medium                    (ft/s)                     m/s

Air, dry (0C                              1,100              330
and 0.76
mm Hg)
Wood (soft                             11,100          3400
- along the
fibre)

Water                                   4,700          1400
(15C)

Concrete                               10,200          3100

Steel                                  16,000          5000

Lead                                    3,700          1200

Glass                                  18,500          5500

Hydrogen                                4,100          1260
(0C and
0.76 m)



The hearing mechanism of the ear senses the sound waves and converts them into
information which it relays to the brain. The brain interprets the information as
sound. Even very loud sounds produce pressure fluctuations which are extremely
small (1 in 10,000) compared to ambient air pressure (i.e., atmospheric pressure).
The hearing mechanism in the ear is sensitive enough to detect even small pressure
waves. It is also very delicate: this is why loud sound may damage hearing.




Why is noise an important workplace hazard?

Noise is one of the most common occupational health hazards. In heavy industrial
and manufacturing environments, as well as in farms, cafeterias, permanent hearing
loss is the main health concern. Annoyance, stress and interference with speech
communication is the main concern in noisy offices, schools and computer rooms.

To prevent adverse outcomes of noise exposure, noise levels should be reduced to
acceptable levels. The best method of noise reduction is to use engineering
modifications to the noise source itself, or to the workplace environment. Where
technology cannot adequately control the problem, personal hearing protection (such
as ear muffs or plugs) can be used. Personal protection, however, should be
considered as an interim measure while other means of reducing workplace noise are
being explored and implemented.

As a first step in dealing with noise, workplaces need to identify areas or operations
where excessive exposure to noise occurs.




How can I tell if my workplace is too loud?

If you answer yes to any of the following questions, the workplace may have a noise
problem.

          Do people have to raise their voices?
      Do people who work in noisy environments have ringing in their ears at the
       end of a shift?
      Do they find when they return home from work that they have to increase the
       volume on their car radio higher than they did when they went to work?
      Does a person who has worked in a noisy workplace for years have problems
       understanding conversations at parties or restaurants, or in crowds where
       there are many voices and "competing" noises?

If there is a noise problem in a workplace, then a noise assessment or survey should
be undertaken to determine the sources of noise, the amount of noise, who is
exposed and for how long.




What are some properties of noise that can be measured?

The properties of noise which are important in the workplace are:

      frequency
      sound pressure
      sound power
      time distribution




What are pitch and frequency?

Frequency is the rate at which the source produces sound waves, i.e. complete
cycles of high and low pressure regions. In other words, frequency is the number of
times per second that a vibrating body completes one cycle of motion. The unit for
frequency is the hertz (Hz = 1 cycle per second: Figure 1 shows one cycle from an
air compression to a minimum pressure and back to a maximum pressure). Low
pitched or bass sounds have low frequencies. High-pitched or treble sounds have
high frequencies. A healthy, young person can hear sounds with frequencies from
roughly 20 to 20,000 Hz. The sound of human speech is mainly in the range 300 to
3,000 Hz.




What is sound pressure?

Sound pressure is the amount of air pressure fluctuation a noise source creates. We
"hear" or perceive sound pressure as loudness. If the drum in our example (Figure 1)
is hit very lightly, the surface moves only a very short distance and produces weak
pressure fluctuations and a faint sound. If the drum is hit harder, its surface moves
farther from its rest position. As a result, the pressure increase is greater. To the
listener, the sound is louder.

Sound pressure also depends on the environment in which the source is located and
the listener's distance from the source. The sound produced by the drum is louder
two metres from the drum if it is in a small bathroom, than if it is struck in the
middle of a football field. Generally, the farther one moves from the drum, the
quieter it sounds. Also if there are hard surfaces that can reflect the sound (e.g.
walls in a room), the sound will feel louder than if you heard the same sound, from
the same distance, in a wide-open field.

Sound pressure is usually expressed in units called pascals (Pa). A healthy, young
person can hear sound pressures as low as 0.00002 Pa. A normal conversation
produces a sound pressure of 0.02 Pa. A gasoline-powered lawn mower produces
about 1 Pa. The sound is painfully loud at levels around 20 Pa. Thus the common
sounds we hear have sound pressure over a wide range (0.00002 Pa - 20 Pa).

It is difficult to work with such a broad range of sound pressures. To overcome this
difficulty we use decibel (dB, or tenth (deci) of a Bel)). The decibel or dB scale is
more convenient because it compresses the scale of numbers into a manageable
range. More information about this "compressed", logarithmic scale is in Appendix A.
The decibel is named after Alexander Graham Bell, the Canadian pioneer of the
telephone who took great personal interest in the problems of deaf people.




What is a sound pressure level?

Sound pressure converted to the decibel scale is called sound pressure level (Lp).
Appendix A gives a detailed explanation of decibels and sound pressure levels. Figure
2 compares sound pressures in pascals and sound pressure levels in decibels (dB).
The zero of the decibel scale (0 dB) is the sound pressure of 0.00002 Pa. This means
that 0.00002 Pa is the reference sound pressure to which all other sound pressures
are compared on the dB scale. This is the reason the decibels of sound are often
indicated as dB re 0.00002 Pa.




                                       Figure 2
What is sound power?

The sound power is the sound energy transferred per second from the noise source
to the air. A noise source, such as a compressor or drum, has a given, constant
sound power that does not change if the source is placed in a different environment.

Power is expressed in units called watts (W). An average whisper generates a sound
power of 0.0000001 watts (0.1 W), a truck horn 0.1 W, and a turbo jet engine
100,000 W.

Like sound pressure, sound power (in W) is usually expressed as sound power levels
in dB. Appendix B provides examples of sound power level calculations.

Figure 3 relates sound power in watts to sound power level in decibels. Note that
while the sound power goes from one trillionth of a watt to one hundred thousand
watts, the equivalent sound power levels range from 0 to 170 dB.




                                       Figure 3




What is the relation between sound pressure and sound power?

Because the sound power of a noise source is constant and specific, it can be used to
calculate the expected sound pressure. The calculation requires detailed information
about the noise source's environment. Usually a noise source with a lower sound
power generates less sound pressure.
The manufacturer can often provide the sound power of equipment. A number of
international standards are available for labelling machines and equipment with their
noise emission levels. From the sound power of a compressor, one can calculate the
expected sound pressure and sound pressure level at a certain location and distance.
This information can be helpful in determining possible noise exposures and how
they compare to the noise guidelines.




What kinds of noise are there?

Noise can be continuous, variable, intermittent or impulsive depending on how it
changes over time. Continuous noise is noise which remains constant and stable over
a given time period. The noise of boilers in a power house is relatively constant and
can therefore be classified as continuous.

Most manufacturing noise is variable or intermittent. Different operations or different
noise sources cause the sound changes over time. Noise is intermittent if there is a
mix of relatively quiet periods and noisy. Impulse or impact noise is a very short
burst of loud noise which lasts for less than one second. Gun fire or the noise
produced by punch presses are examples of such noise.




What are A-weighted decibels?

The sensitivity of the human ear to sound depends on the frequency or pitch of the
sound. People hear some frequencies better than others. If a person hears two
sounds of the same sound pressure but different frequencies, one sound may appear
louder than the other. This occurs because people hear high frequency noise much
better than low frequency noise.

Noise measurement readings can be adjusted to correspond to this peculiarity of
human hearing. An A-weighting filter which is built into the instrument de-
emphasizes low frequencies or pitches. Decibels measured using this filter are A-
weighted and are called dB(A). Legislation on workplace noise normally gives
exposure limits in dB(A). Table 2 lists examples of typical noise levels.

A-weighting serves two important purposes:

1. gives a single number measure of noise level by integrating sound levels at all
frequencies

2. gives a scale for noise level as experienced or perceived by the human ear


                                Table 2
                          Typical Noise Levels

              Noise Source                       dB(A)

pneumatic chipper at 1 metre                      115
hand-held circular saw at 1 metre                         115

textile room                                              103

newspaper press                                             95

power lawn mower at 1 metre                                 92

diesel truck 50 km per hour at 20 metres                    85

passenger car 60 km per hour at 20 metres                   65

conversation at 1 metre                                     55

quiet room                                                  40




What are basic rules of working with decibel (dB) units?

The decibel [dB, and also dB(A)] is a logarithmic scale. For mathematical calculations
using dB units, we must use logarithmic mathematics (see Appendix A). However, in
our day-to-day work we do not need such calculations.

The use of dB unit makes it easy to deal with the workplace noise level data provided
we use a set of simple rules as summarized in Table 3.


                                           Table 3
                                      Decibel (dB) basics

         Change in dB                                Change in sound energy

          3 dB increase                                Sound energy doubled

          3 dB decrease                                 Sound energy halved

         10 dB increase                        Sound energy increased by factor of 10

         10 dB decrease                        Sound energy decreased by factor of 10

         20 dB increase                        Sound energy increased by factor of 100

         20 dB decrease                       Sound energy decreased by factor of 100




How are noise levels added?

Sound pressure levels in decibels (dB) or A-weighted decibels [dB(A)] are based on a
logarithmic scale (see Appendix A). They cannot be added or subtracted in the usual
arithmetical way. If one machine emits a sound level of 90 dB, and a second
identical machine is placed beside the first, the combined sound level is 93 dB, not
180 dB.

Table 4 shows a simple way to add noise levels.


                                           Table 4
                                   Addition of Decibels

  Numerical difference between two noise       Amount to be added to the higher of the two
               levels [dB(A)]                          noise levels [dB or dB(A)]

                     0                                              3.0

                 0.1 - 0.9                                          2.5

                 1.0 - 2.4                                          2.0

                 2.4 - 4.0                                          1.5

                 4.1 - 6.0                                          1.0

                  6.1 - 10                                          0.5

                    10                                              0.0

Step 1: Determine the difference between the two levels and find the corresponding row in
the left hand column.
Step 2: Find the number [dB or dB(A)] corresponding to this difference in the right hand
column of the table.
Step 3: Add this number to the higher of the two decibel levels.



For instance, using the example of two machines each emitting a noise level of 90
dB:

        Step 1: The numerical difference between the two levels is 0 dB (90-90= 0),
         using the first row.
        Step 2: The number corresponding to this difference of 0, taken from the
         right hand column, is 3.
        Step 3: Add 3 to the highest level, in this case 90. Therefore, the resulting
         noise level is 93 dB.

When the difference between two noise levels is 10 dB(A) or more, the amount to be
added to the higher noise level is zero. In such cases, no adjustment factor is
needed because adding in the contribution of the lower in the total noise level makes
no perceptible difference in what people can hear or measure. For example if your
workplace noise level is 95 dB(A) and you add another machine that produces 80
dB(A) noise, the workplace noise level will still be 95dB(A).

Appendix A - Sound Pressure Level Calculations

Sound pressure level in decibels is defined in the following way:

dB = 20 log (Sound Pressure/Reference Pressure)

The "log" or logarithm of a number is a mathematical manipulation of the number,
based on multiples of 10. It is the exponent that indicates the power to which the
number 10 is raised to produce a given number. For example, the logarithm of 10 is
1 since 10 is multiplied by itself only once to get 10. Similarly, the logarithm of 100
is 2 since 10 times 10 is 100. The logarithm of 1000 is 3 since 10 times 10 times 10
is 1000.
Therefore

log(1) = 0 Since 10 to the exponent 0 = 1,

log(10) = 1 since 10 to the exponent 1 = 10,

log(100) = 2 since 10 to the exponent 2 = 100,

log(1000) = 3 since 10 to the exponent 3 = 1000

The logarithm scale simply compresses the large span of numbers into a manageable
range. In other words, the scale from 10 to 1000 is compressed, by using the
logarithms, to a scale of 1 to 3.

The decibel scale for sound pressures uses as the reference pressure the lowest
noise that the healthy young person can hear (0.00002 Pa). It divides all other
sound pressures by this amount when calculating the decibel value. Sound pressures
converted to the decibel scale are called sound pressure levels, abbreviated Lp. So,
the sound pressure level of the quietest noise the healthy young person can hear is
calculated in this way:

Lp = 20 log ( 0.00002/ 0.00002) = 20 log (1) = 20 X 0 = 0 dB

The sound pressure level or Lp in a very quiet room, where the sound pressure is
0.002 Pa, is calculated:

Lp = 20 log (0.002/ 0.00002) = 20 log (100) = 20 X 2 = 40 dB

The sound pressure level of a typical gasoline-powered lawn mower, which has a
sound pressure of 1 Pa, is calculated

Lp = 20 log (1/0.00002) = 20 log (50 000) = 20 X 4.7 = 94 dB

Appendix B - Sound Power Level Calculations

Sound power levels or Lw are determined by the following formula:

Lw = 10 log (Sound Power Level / Reference Power Level )

The reference power is one trillionth of a watt (0.000000000001 W). Therefore

Lw = 10 log (Sound Power Level / 0.000000000001)

Thus, the sound power level associated with an average whisper, which has a sound
power of 0.0000001 W, is calculated

Lw = 10 log (0.0000001/ 0.000000000001) = 50 dB

What is the definition of "rotational shiftwork"?
The term "rotational shiftwork" covers a wide variety of work schedules and implies
that shifts rotate or change according to a set schedule. These shifts can be either
continuous, running 24 hours per day, 7 days per week, or semi-continuous, running
2 or 3 shifts per day with or without weekends. Workers take turns working on all
shifts that are part of a particular system.

The definition of rotational shiftwork in this document does not include fixed shifts
like straight nights, straight afternoons or straight days and, generally, fixed shifts
are not discussed here. However, we should remember that workers on fixed night
shifts and those on rotational shiftwork have much in common due to the constantly
changing schedules, night work and possible disruption to family and social lives.

Also, the length of a shift can vary between 8 and 12 hours. Specific concerns about
the extended workdays (10-12 hour shifts) is discussed in the Extended Workday
document.




Why study the effects of shiftwork?

Shiftwork is a reality for about 25 percent of the North American working population.
Interest in the effects of shiftwork on people has developed because many experts
have blamed rotating shifts for the "human error" connected with nuclear power
plant incidents, air crashes, and other catastrophic accidents.

Alternating day, night and afternoon shifts are common in industrial work, mines,
hospitals, as well as food, health, and transportation services. Shiftwork is also
common in workplaces where technical processes cannot be interrupted without
affecting the product and/or where expensive equipment is used more profitably
when in constant operation.

Many workers find that shiftwork disrupts their family and personal life and leads to
health problems including chronic fatigue and gastrointestinal disorders. On the other
hand, some workers prefer shiftwork because it usually allows for more free time.




Are there adverse health and safety effects to working shifts?

A shiftworker, particularly one who works nights, must function on a schedule that is
not natural. Constantly changing schedules can:

      upset one's circadian rhythm (24-hour body cycle),
      cause sleep deprivation and disorders of the gastrointestinal and
       cardiovascular systems,
      make existing disorders worse, and
      disrupt family and social life.

Scientific studies throughout the world have shown that shiftwork, by its very nature,
is a major factor in the health and safety of workers.
What are the effects on circadian rhythms?

Many human physical functions follow a daily rhythm or a 24-hour cycle. These
cycles are called circadian rhythms. The word circadian comes from the Latin "circa
dies" which means "about a day." Sleeping, waking, digestion, secretion of adrenalin,
body temperature, blood pressure, pulse and many other important aspects of body
functions and human behaviour are regulated by this 24-hour cycle. These
rhythmical processes are coordinated to allow for high activity during the day and
low activity at night.

Normally, the body uses cues from its processes and from the environment such as
clock time, social activities, the light/dark cycle, and meal times to keep the various
rhythms on track. For example, body temperature is highest during the afternoon
and early evening (6:00 p.m.) and lowest in the early morning (4:00 a.m. or just
before sunrise). However, if the person is working at night, the body temperature
does not have as much variation during a 24-hour period as it would normally. The
temperature rhythm and other body rhythms get out of sync: these rhythms also get
out of phase with the person's activity pattern. This disorientation can lead to
feelings of fatigue and disorientation. "Jet lag" is a term often used to describe these
feelings.

Some rhythms adapt in two to three days while others change only after longer
periods. People adapt to new schedules at different rates as do the different
rhythms. Total reversal of circadian rhythms may never occur because on days off
most people go back to a "normal" day schedule. Frequent changes in schedule and
disruption to circadian rhythms can lead to chronic fatigue and other health
problems.




What are the changes in sleep patterns?

Disruption of both the quality and quantity of the normal sleep is inevitable in
shiftwork particularly where night work is involved. The daytime sleep is seldom as
deep or as refreshing as sleep at night. The problem is greater if there is not a quiet,
dark, comfortable place to sleep. Even when disturbances are removed, a worker
who returns home in the morning may still find sleep impossible or less refreshing.
This difficulty occurs because the circadian rhythms are no longer synchronized.
Being constantly tired is a typical complaint of shift workers.




What are the gastrointestinal disorders associated with shiftwork?

Gastrointestinal and digestive problems such as indigestion, heartburn, stomachache
and loss of appetite are more common among rotating shiftworkers and night
workers than among day workers. It is less clear if more serious conditions such as
peptic ulcers are more common in shiftworkers. Certainly the irregular work, sleep
and eating schedules are not helpful for the proper care of ulcers.
Given the irregularity in type and timing of meals, it is not surprising that the night
worker is more likely to have a poorer diet. At night, the loss of appetite often leads
to increased snacking on "junk" food rather than eating a full, well-balanced meal.
Feelings of fatigue may encourage the consumption of beverages with caffeine
(coffee, cola) to help the worker stay awake.




What are the cardiovascular disorders associated with shiftworkers?

Shiftwork is not absolutely associated with cardiovascular disease. However, heart
rate and blood pressure have been shown to follow a circadian rhythm. Life-style can
directly affect an individual's health. Therefore, it is very important that a shiftworker
follows exercise programs to maintain an adequate level of fitness. It is also very
important not to smoke, to have good dietary habits and to participate in leisure
activities.

A study of Swedish men with a history of heart attack showed they were significantly
more likely to have been shiftworkers than those men without a history of heart
attack. Another study showed that the modification of shift rotation schedules by
changing the direction of rotation of shifts to a forward direction (for example, days -
> afternoons -> nights) can significantly decrease the levels of several coronary risk
factors, e.g., triglycerides, glucose, and urinary excretion of catecholamines
(chemicals like adrenalin that occur naturally in the body).




Can shiftwork aggravate existing conditions?

Workers who require prescription drugs to control certain disorders should be aware
that disruption of the circadian rhythm can interfere with the medical treatment of
some diseases. Check with your family physician if you take medication while
working shifts. Your pharmacist may also be able to give you some additional
information. If you get all your prescription drugs from the same pharmacy, the
pharmacists can also advise you if one drug is likely to interact with another one you
may be taking.




What are the effects on family and social life?

Compared with people who work straight days, shiftworkers report more interference
to their family lives, especially the time available to spend with spouses and children.
This fact is very important since the amount and quality of social interaction is
related to physical and mental health. Individuals who cannot establish regular
routines in their daily activities have difficulties planning for family responsibilities
and coping with physical and mental fatigue as effectively as non-shiftworkers.
Participation in clubs, sports and other organized activities is very difficult since they
are usually geared to the normal day schedule. The lack of regular social contact can
lead to feelings of loneliness and isolation. In addition, quality child care facilities
aimed at meeting the needs of shiftworkers is almost nonexistent.
What are the safety concerns associated with working shifts?

The causes of accidents are very complicated. Usually, no single factor can be
identified as having "caused" an accident. The disturbance of circadian rhythms can
affect concentration, motivation, and reaction time, particularly at night. This
combination can result in an increased risk of accident and injury.

However, there is disagreement about whether shiftworkers have a greater risk of
injury. Studies can be found to show that shiftworkers' accident rates are less, the
same, or more than day workers. Part of the difficulty with the research is that work
conditions are not always the same on different shifts. For example, the amount of
supervision, the nature of the workload, the backup systems available, and so on all
can vary from shift to shift: these factors can make comparisons inaccurate.

Nonetheless, lack of sleep heightens the decline in performance normally
experienced at certain times of the day. When deprived of sleep, a worker is not fully
aware that his or her performance has deteriorated. Research has shown that the
optimum mental performance level for workers occurs between 2 and 4 p.m. and
maximum general awareness is between 1 and 7 p.m. Performance levels are lowest
between 3:30 and 5:30 a.m.




What are some strategies for improvement?

The best solution to the problems of shiftwork would be to eliminate it but this is not
often a practical possibility. Shiftwork is likely to continue to be a reality for a large
percentage of Canadian workers.

There are two basic levels where improvements can be made:

      The organizational level - primarily through the design of shift schedules,
       education and better facilities.
      The individual level - helping workers to get better sleep, a healthier diet, and
       the reduction of stress.




What are some organizational approaches?

There are several approaches the organization can take to help reduce the effects of
shiftwork. There are also several important considerations for organizations.

Shift Schedule Design: Optimizing the design of the shift schedule is the most
effective way of reducing the health and safety problems. Satisfaction with a
particular shift system is the result of a complicated balancing act that is the best
compromise for personal, psychological, social and medical concerns.
      Consider the length of the rotation period (the number of days on any one
       shift before switching to the next shift). The optimum length of the rotation
       period has been disputed. The most common system has a rotation period of
       one week, with five to seven consecutive night shifts. However, since it
       generally takes at least seven days for adjustment of the circadian rhythms, it
       is argued that just as adjustment starts to occur, it is time to rotate to the
       next shift. Some schedule designers feel that a longer shift rotation should be
       arranged so that the worker spends from two weeks to one month on the
       same shift that would allow circadian rhythms to adjust. A problem occurs
       when the worker reverts to a "normal" day/night schedule on days off, thus,
       possibly cancelling any adaptation. Also, longer periods of social isolation may
       result.

Others suggest a rapid shift rotation where different shifts are worked every two to
three days. This system may reduce disruption to body rhythms because the
readjustment of circadian rhythms is minimized. It also provides time for some social
interaction each week.

Individual differences and preferences, in the end, play the most important role.
Based on scientific information, there is no way to determine which is the best length
of rotation period.

      Consider the direction of rotation of shifts. It is recommended that shifts
       rotate forward from day to afternoon to night because circadian rhythms
       adjust better when moving ahead than back.
      Consider the time at which a shift starts and finishes. Early morning shifts are
       associated with shorter sleep and greater fatigue. It is advisable to avoid shift
       start times as early as 5 or 6 a.m. The social customs and desires of the
       specific work force should be considered as well as the availability of public
       transportation. The safety on the streets, in terms of crime and violence, is
       another consideration.
      Provide a rest period of at least 24 hours after each set of night shifts. The
       more consecutive nights worked, the more rest time should be allowed before
       the next rotation occurs.
      Consider alternative forms of organizing work schedules. For example,
       extended work days of ten or twelve hours have been used. It has the
       advantage of fewer consecutive night shifts and longer blocks of time off.
       However, the additional fatigue from long work hours may also have adverse
       effects. The physical and mental load of the task should be considered when
       selecting the length of a workshift. Exposure to chemical or physical agents
       should also be considered when selecting a shift system.
      Provide time off at "socially advantageous" times like weekends whenever
       possible.
      Start a special shift system if production demands result in extended periods
       of overtime work.
      Inform shiftworkers of their work schedules well ahead of time so they and
       their families and friends can plan activities. Allow as much flexibility as
       possible for shift changes. Keep schedules as simple and predictable as
       possible.

Facilities: The provision of certain facilities can help the shiftworker cope better.
       Give attention to the work environment. For example, good lighting and
        ventilation are important on all shifts. Do not widely separate workstations so
        that workers at night can remain in contact with one another.
       Provide rest facilities where possible. Whenever a person must remain at
        work after a night shift to attend a meeting or a training session, providing
        rest facilities is advisable. When a night worker is "on call" and must remain
        in the building, it is advantageous for this person to be well rested rather than
        tired and bored.
       Provide good cafeteria services so a balanced diet can be maintained. The
        nutritional needs differ between day shifts and other shifts because of
        circadian rhythms.
       Consider offering facilities for social activities with the needs of the
        shiftworker in mind. Recreational opportunities are often minimal for workers
        on "non-day" shifts.
       Consider access to quality day-care for shiftworkers' children. Some strain on
        all family members would be alleviated.

Education: Educate employees on the potential health and safety effects of
rotational shiftwork and what can be done to stop these effects. In particular,
education in stress recognition and reduction techniques is helpful.




What can the individual do to cope with shiftwork?

People who work shifts face many problems that others do not recognize. The
difficulties stem from the change in eating, sleeping, and working patterns. The
following guidelines can help people cope better.

Guidelines for Diet and Eating Patterns

       Maintain regular eating patterns as much as possible. Balanced, varied meals
        are very important. Keep family meal times the same even though the work
        routine constantly changes. Family meals may need to be altered in content
        to suit the shiftworker.
       Time meals carefully. Afternoon workers should have the main meal in the
        middle of the day instead of the middle of the work shift. Night workers
        should eat lightly throughout the shift and have a moderate breakfast. This
        way they should not get too hungry while sleeping during the day and
        digestive discomfort should be minimal.
       Pay careful attention to the type of food eaten. Drink lots of water and eat the
        usual balance of vegetables, fruit, lean meat, poultry, fish, dairy products,
        grains and bread. Eat crackers and fruit instead of pop and candy bars during
        work breaks. Reduce the intake of salt, caffeine, and alcohol. Avoid greasy
        foods, particularly at night.
       Avoid excessive use of antacids, tranquilizers and sleeping pills. It is healthier
        to watch what and when you eat, and use relaxation techniques to aid sleep.
       Relax during meals and allow time for digestion.

Sleep
      Sleep on a set schedule to help establish a routine and to make sleep during
       the day easier. Some people may prefer to get a full period of rest just before
       the next work shift (as it is with "normal day" work). Try different patterns of
       work and sleep to see which is best for you.
      Make sure that family and friends are aware of and considerate of the
       worker's sleep hours and needs. Ensure that the shiftworker has a
       comfortable, dark, quiet place to sleep during the day. Air conditioning, a
       telephone answering machine, and good blinds on windows are
       recommended.
      Make time for quiet relaxation before bed to help get better sleep. Learn how
       to relax using muscle relaxation, breathing techniques and so on. Use mental
       imagery to block out unpleasant thoughts. If you still do not fall asleep after
       an hour, read a book or listen to quiet music on the radio for a while. If sleep
       still does not come, reschedule sleeping hours for later in the day. Limit
       commitments later in the day to allow for napping.

Other Important Considerations

      Pay attention to general physical fitness and good health habits.
      Find out about and understand the potential health and safety effects of
       shiftwork.
      Learn how to recognize and reduce stress through physical fitness, relaxation
       techniques and so on.
      Take leisure seriously.

Can "workplace stress" be defined?

We hear a lot about stress, but what is it? Taber's Cyclopedic Medical Dictionary
defines stress as "the result produced when a structure, system or organism is acted
upon by forces that disrupt equilibrium or produce strain". In simpler terms, stress is
the result of any emotional, physical, social, economic, or other factors that require a
response or change. It is generally believed that some stress is okay (sometimes
referred to as "challenge"or "positive stress") but when stress occurs in amounts that
you cannot handle, both mental and physical changes may occur.

"Workplace stress" then is the harmful physical and emotional responses that can
happen when there is a conflict between job demands on the employee and the
amount of control an employee has over meeting these demands. In general, the
combination of high demands in a job and a low amount of control over the situation
can lead to stress.

Stress in the workplace can have many origins or come from one single event. It can
impact on both employees and employers alike. As stated by the Canadian Mental
Health Association:

Fear of job redundancy, layoffs due to an uncertain economy, increased demands for
overtime due to staff cutbacks act as negative stressors. Employees who start to feel
the "pressure to perform" can get caught in a downward spiral of increasing effort to
meet rising expectations with no increase in job satisfaction. The relentless
requirement to work at optimum performance takes its toll in job dissatisfaction,
employee turnover, reduced efficiency, illness and even death. Absenteeism, illness,
alcoholism, "petty internal politics", bad or snap decisions, indifference and apathy,
lack of motivation or creativity are all by-products of an over stressed workplace.

(From: Canadian Mental Health Association, "Sources of Workplace Stress "
Richmond, British Columbia)




I have heard stress can be both good and bad. Is this true?

Some stress is normal. In fact, it is often what provides us with the energy and
motivation to meet our daily challenges both at home and at the workplace. Stress in
these situations is the kind that helps you "rise" to a challenge and meet your goals
such as deadlines, sales or production targets, or finding new clients. Some people
would not consider this challenge a type of stress because, having met the challenge,
we are satisfied and happy. However, as with most things, too much stress can have
negative impacts. When the feeling of satisfaction turns into exhaustion, frustration
or dissatisfaction, or when the challenges at work become too demanding, we begin
to see negative signs of stress.




What are examples of things that cause stress at the workplace?

In the workplace, stress can be the result of any number of situations. Some
examples include:


Categories of Job                                         Examples
Stressors

Factors unique to         workload (overload and underload)
the job
                          pace / variety / meaningfulness of work
                          autonomy (e.g., the ability to make your own decisions about our own job or
                           about specific tasks)
                          shiftwork / hours of work
                          physical environment (noise, air quality, etc)
                          isolation at the workplace (emotional or working alone)



Role in the               role conflict (conflicting job demands, multiple supervisors/managers)
organization
                          role ambiguity (lack of clarity about responsibilities, expectations, etc)
                          level of responsibility



Career development        under/over-promotion
                          job security (fear of redundancy either from economy, or a lack of tasks or work
                           to do)
                          career development opportunities
                          overall job satisfaction



Relationships at          supervisors
work (Interpersonal)
                          coworkers
                          subordinates
                          threat of violence, harassment, etc (threats to personal safety)



Organizational            participation (or non-participation) in decision-making
structure/climate
                          management style
                          communication patterns




(Adapted from: Murphy, L. R., Occupational Stress Management: Current Status and
Future Direction. in Trends in Organizational Behavior, 1995, Vol. 2., p. 1-14)




Can stress really cause health effects?

Yes, stress can have an impact on your overall health. Our bodies are designed, pre-
programmed if you wish, with a set of automatic responses to deal with stress. This
system is very effective for the short term "fight or flight" responses we need when
faced with an immediate danger. The problem is that our bodies deal with all types
of stress in the same way. Experiencing stress for long periods of time (such as
lower level but constant stressors at work) will activate this system, but it doesn't
get the chance to "turn off". The body's "pre-programmed" response to stress has
been called the "Generalized Stress Response" and includes:

        increased blood pressure
        increased metabolism (e.g., faster heartbeat, faster respiration)
        decrease in protein synthesis, intestinal movement (digestion), immune and
         allergic response systems
        increased cholesterol and fatty acids in blood for energy production systems
        localized inflammation (redness, swelling, heat and pain)
        faster blood clotting
        increased production of blood sugar for energy
        increased stomach acids

(From the Basic Certification Training Program: Participant's Manual, Copyright©
1999 by the Workplace Safety and Insurance Board of Ontario).

Luckily, there are usually a number of warning signs that help indicate when you are
having trouble coping with stress before any severe signs become apparent. These
signs are listed below.




How do I know if someone is (or if I am) having trouble coping with stress?

There are many different signs and symptoms that can indicate when someone is
having difficulty coping with the amount of stress they are experiencing:
Physical: headaches, grinding teeth, clenched jaws, chest pain, shortness of breath,
pounding heart, high blood pressure, muscle aches, indigestion, constipation or
diarrhea, increased perspiration, fatigue, insomnia, frequent illness

Psychosocial: anxiety, irritability, sadness, defensiveness, anger, mood swings,
hypersensitivity, apathy, depression, slowed thinking or racing thoughts; feelings of
helplessness, hopelessness, or of being trapped

Behavioural: overeating or loss of appetite, impatience, quickness to argue,
procrastination, increased use of alcohol or drugs, increased smoking, withdrawal or
isolation from others, neglect of responsibility, poor job performance, poor personal
hygiene, change in religious practices, change in close family relationships




Do all of these signs or symptoms happen all at once and what level of help
should be sought?

No, not normally. The signs and symptoms from stress tend to progress through
several phases or stages. The phases can be described as below:


              Phase                          Signs/Symptoms                                Action

Phase 1 - Warning                        feelings of vague anxiety                    talking about
                                         depression                                    feelings
Early warning signs are often            boredom                                      taking a vacation
more emotional than physical and                                                       making a change
may take a year or more before
                                         apathy
                                                                                        from regular
they are noticeable.                     emotional fatigue
                                                                                        activities
                                                                                       taking time for
                                                                                        yourself



Phase 2 - Mild Symptoms                  sleep disturbances                           more aggressive
                                         more frequent headaches/colds                 lifestyle changes
Warning signs have progressed                                                           may be needed.
                                         muscle aches
and intensified. Over a period of 6                                                    short-term
to 18 months, physical signs may
                                         intensified physical and emotional
                                                                                        counseling
                                          fatigue
also be evident.
                                         withdrawal from contact with
                                          others
                                         irritability
                                         intensified depression



Phase 3 - Entrenched                     increased use of alcohol,            The help of medical and
Cumulative Stress                         smoking, non-prescription drugs      psychological professionals is
                                                                               highly recommended.
                                         depression
This phase occurs when the               physical and emotional fatigue
above phases continue to be
ignored. Stress starts to create a
                                         loss of sex drive
deeper impact on career, family          ulcers
life and personal well-being.            marital discord
                                         crying spells
                                         intense anxiety
                                         rigid thinking
                                     withdrawal
                                     restlessness
                                     sleeplessness



Phase 4 - Severe/ Debilitating       careers end prematurely             Significant intervention from
Cumulative Stress Reaction                                                professionals.
                                     asthma
                                     heart conditions
This phase is often considered
"self-destructive" and tends to
                                     severe depression
occur after 5 to10 years of          lowered self-esteem/self-
continued stress.                     confidence
                                     inability to perform one's job
                                     inability to manage personal life
                                     withdrawal
                                     uncontrolled anger, grief, rage
                                     suicidal or homicidal thinking
                                     muscle tremors
                                     extreme chronic fatigue
                                     over-reaction to minor events
                                     agitation
                                     frequent accidents
                                     carelessness, forgetfulness
                                     paranoia




(From: Anschuetz, B.L. "The High Cost of Caring: Coping with Workplace Stress" in
Sharing: Epilepsy Ontario. Posted 29 November 1999)




What are some general tips for dealing with stress at the workplace?

Since the causes of workplace stress vary greatly, so do the strategies to reduce or
prevent it.

Where stress in the workplace is caused, for example, by a physical agent, it is best
to control it at its source. If the workplace is too loud, control measures to deal with
the noise should be implemented where ever possible. If you are experiencing pain
from repetitive strain, workstations can be re-designed to reduce repetitive and
strenuous movements. More detailed information and suggestions are located in the
many other documents in OSH Answers (such as noise, ergonomics, or violence in
the workplace, etc.) or by asking the Inquiries Service.

Job design is also an important factor. Good job design accommodates an
employee's mental and physical abilities. In general, the following job design
guidelines will help minimize or control workplace stress:

        the job should be reasonably demanding (but not based on "sheer
         endurance") and provide the employee with at least a minimum of variety in
         job tasks
        the employee should be able to learn on the job and be allowed to continue to
         learn as their career progresses
      the job should comprise some area of decision-making that the individual can
       call his or her own.
      there should be some degree of social support and recognition in the
       workplace
      the employee should feel that the job leads to some sort of desirable future




Is there anything I can do to help myself deal with the stress I am
experiencing?

In many cases, the origin of the stress is something that cannot be changed
immediately. Therefore, finding ways to help maintain good mental health is
essential. There are many ways to be proactive in dealing with stress. In the
workplace, you might try some of the following as suggested by the Canadian Mental
Health Association:

Laughing is one of the easiest and best ways to reduce stress. Share a joke with a
co-worker, watch a funny movie at home with some friends, read the comics, and try
to see the humour in the situation.
Learn to relax, take several deep breaths throughout the day, or have regular stretch
breaks. Stretching is simple enough to do anywhere and only takes a few seconds.
Take charge of your situation by taking 10 minutes at the beginning of each day to
priorize and organize your day. Be honest with your colleagues, but be constructive
and make practical suggestions. Be realistic about what you can change. (From:
Canadian Mental Health Association, "Sources of Workplace Stress" Richmond, British
Columbia)


Are there organizations that can help?*

Yes, there are many. Your family doctor can often recommend a professional for you.
Other examples include the Employee Assistance Programs (EAP) or associations
such as the Canadian Mental Health Association (CMHA) or the Canadian Centre on
Substance Abuse (CCSA) to name just a few.

      EAP programs are confidential, short term, counselling services for employees
       with problems that affect their work performance. The services of EAP
       providers are often purchased by your company. Check with your human
       resources department (or equivalent) for contact information.
      CMHA's programs are meant to ensure that people whose mental health is
       endangered will find the help needed to cope with crisis, regain confidence,
       and return to community, family and job. They can be reached on the
       Internet at http://www.cmha.ca/
      The CCSA promotes informed debate on substance abuse issues, and
       disseminates information on the nature, and assists organizations involved in
       substance abuse treatment, prevention and educational programming. They
       can be reached on the Internet at http://www.ccsa.ca/

Reliable information on mental health matters, substance use/addiction (and many
other health concerns) is available through the Canadian Health Network at
http://canadian-health-network.ca
(*We have mentioned these organizations as a means of providing a potentially
useful referral. You should contact the organization(s) directly for more information
about their services. Please note that mention of these organizations does not
represent a recommendation or endorsement by CCOHS of these organizations over
others of which you may be aware.)




What else can I do to improve my overall mental health?

Ten general tips for mental health include:


1.    build confidence          identify your abilities and weaknesses together, accept them build on them and
                                do the best with what you have

2.    eat right, keep fit       a balanced diet, exercise and rest can help you to reduce stress and enjoy life.

3.    make time for family      these relationships need to be nurtured; if taken for granted they will not be
      and friends               there to share life's joys and sorrows.

4.    give and accept support   friends and family relationships thrive when they are "put to the test"

5.    create a meaningful       financial problems cause stress. Over-spending on our "wants" instead of our
      budget                    "needs" is often the culprit.

6.    volunteer                 being involved in community gives a sense of purpose and satisfaction that paid
                                work cannot.

7.    manage stress             we all have stressors in our lives but learning how to deal with them when they
                                threaten to overwhelm us will maintain our mental health.

8.    find strength in          sharing a problem with others have had similar experiences may help you find a
      numbers                   solution and will make you feel less isolated.

9.    identify and deal with    we all need to find safe and constructive ways to express our feelings of anger,
      moods                     sadness, joy and fear.

10.   learn to be at peace      get to know who you are, what makes you really happy, and learn to balance
      with yourself             what you can and cannot change about yourself.



(From: Canadian Mental Health Association - National Office. Home Page located at:
http://www.cmha.ca/ )

Biological Hazards




Sources of biological hazards include bacteria, viruses, insects, plants, birds,
animals, and humans. These sources can cause a variety of health effects ranging
from skin irritation and allergies to infections (e.g., tuberculosis, AIDS), cancer and
so on.
If you started searching in the directory for the cause of a disease or injury, you
would probably end up in the "Biological Hazards" section first. On the other hand, if
you searched for the disease itself, the search engine would take you to the
"Diseases, Disorders and Injuries" section.

This section will include information on animal bites, since they can cause certain
infections or diseases. However, this section does not include information on the
harm or injuries caused by the physical action of animals. For example, kicks from
horses would be discussed in the "safety" section [not there yet].

chemical is any substance made up of chemical elements. This section of OSH
Answers will describe the properties as well as health and safety hazards of
workplace chemicals - individual chemicals, mixtures like petroleum solvents,
synthetic polymers (plastics), and so on. You will also find out how to find
information about chemical products (MSDSs - material safety data sheets) and how
to understand MSDSs. How to work safely with different kinds of chemicals is
covered in the section "Prevention and Control of Hazards".




In addition, the CCOHS Products & Services - Chemicals & Materials web page has
links to

      Publications,
      Fact sheets,
      Bibliographic databases on CD-ROMs and the Internet,
      Databases with ready-to-use information on CD-ROMs and the Internet,
      Full-text CD-ROM products,
      IPCS International Chemical Safety Cards (ICSCs),
      IPCS Environmental Health Criteria publications (EHCs),
      NIOSH Manual of Analytical Methods,
      NIOSH Pocket Guide to Chemical Hazards

and many other products that have information dealing with chemicals and their
hazards.

What is meant by 'working alone'?

A person is alone at work when they are on their own; when they cannot be seen or
heard by another person; and when they cannot expect a visit from another worker
or member of the public for some time.

It is important to consider all situations carefully. Working alone includes all
employees who may go for a period of time where they do not have direct contact
with a co-worker. For example, the receptionist in a large office building may be
considered a "lone" worker. Alternatively, a construction worker who is doing work in
a bathroom or other location that cannot be seen by co-workers may also be
considered a lone worker.
Is working alone a problem?

While it is not always hazardous to work alone, it can be when other circumstances
are present. Whether a situation is a high or low risk will depend on the location,
type of work, interaction with the public, or the consequences of an emergency,
accident, injury, etc. This wide variety of circumstances makes it important to assess
each situation individually.




What will be covered in this document?

This OSH Answers document will cover the administrative details needed for lone
workers in general (check-in procedures and hazard assessment). Please see related
OSH Answers documents for more specific information on:

      handling money
      off-site
      working with patients




What are examples of high and low risk activities?

In most cases, high risk activities should never be done by a lone worker. High risk
activities would include working:

      at heights,
      in confined spaces (such as tanks, grain bins or elevators, culverts, etc.),
      with electricity,
      with hazardous substances or materials,
      with hazardous equipment such as chainsaws or firearms,
      with materials at great pressure, or,
      with the public, where there is a potential for violence.

Except in hazardous locations, examples of work that may be considered low risk
include:

      maintenance functions (except on active equipment)
      security or watch functions
      janitorial or custodial duties
      desk work




What can be done to help a lone worker stay safe?

Check the regulations in your area. Some jurisdictions have specific laws concerning
working alone.

There are many steps that can be taken to help ensure the safety of the lone worker:
      Assess the hazards of your workplace.
      Talk to employees about their work. Get their input about the work they do
       and possible solutions.
      Investigate incidents at your workplace, and those from similar workplaces.
      Avoid having a lone work whenever possible, especially for jobs with a
       recognized risk.
      Take corrective action to prevent or minimize the potential risks of working
       alone.
      Provide appropriate training and education.
      Report all situations, incidents or 'near misses' where being alone increased
       the severity of the situation. Analyze this information and make changes to
       company policy where necessary.
      Establish a check-in procedure. Make sure that regular contact is kept with all
       employees. Establish ways to account for people (visually or verbally) while
       they are working.
      Schedule higher risk tasks to be done during normal business hours, or when
       another worker capable of helping in an emergency is present.




What is an example of a check-in procedure?

It is important that a check-in procedure be in place. Decide if a verbal check-in is
adequate, or if the employee must be accounted for by a visual check. Make sure
your plan is appropriate for both regular business hours as well as after main office
hours.

For most lone workers, the telephone will be the main source of contact. If you work
at a desk or station, have a telephone close by. If you are away from a main office or
work station, the use of a cellular phone is very helpful. If a cellular phone is
unreliable in your area, be sure to have alternative methods of communication
available (such as use of public telephones, site visits or satellite technology).

When travelling out of the office, the main contact person should know the following
details:

      destination,
      estimated time of arrival,
      return time or date,
      contact information if staying overnight,
      mode of travel (public transit, car, plane, etc.) and,
      alternate plans in the event of bad weather, traffic problems, etc.

An example of a check-in procedure is:

      Prepare a daily work plan so it is known where the lone employee will be and
       when.
      Identify one main person to be the contact at the office, plus a back up.
      Define under what circumstances the lone employee will check in and how
       often.
      Stick to the visual check or call-in schedule. You may wish to have a written
       log of contact.
      Have the contact person call or visit the lone employee periodically to make
       sure he or she is okay.
      Pick out a code word to be used to confirm that help is needed.
      Develop a plan to be followed if the lone employee does not check-in when he
       or she is supposed to.

(Adapted from CCOHS Violence in the Workplace Prevention Guide, 2001)




What are some factors to consider when assessing the workplace or
situations?

The following are some points to consider. Each circumstance will be different, so be
sure to adapt the questions to suit your situation.

Length of time the person will be working alone:

      What is a reasonable length of time for the person to be alone?
      Is it reasonable for the person to be alone at all?
      How long will the person be alone to finish the job?
      Is it legal for the person to be alone while doing certain activities? (For
       example: some jurisdictions may restrict working alone in a confined space,
       or during lock-out / tag-out operations).
      What time of the day will the person be alone?

Communication:

      What forms of communication are available?
      Is it necessary to "see" the person, or is voice communication adequate?
      Will emergency communication systems work properly in all situations?
      If the communication systems are located in a vehicle, do you need
       alternative arrangements to cover the person when they are away from the
       vehicle?

Location of the work:

      Is the work in a remote or isolated location? (Remember that a remote
       location does not have to be far away. Storage rooms that are rarely used can
       be considered remote or isolated.)
      Is transportation necessary to get there? What kind of transportation is
       needed?
      Is the vehicle equipped with emergency supplies such as food and drinking
       water, as well as a first aid kit?
      Will the person need to carry some or all of the emergency supplies with them
       when they leave the vehicle?
      Does the person need training to be able to use the first aid equipment?
      What are the consequences if the vehicle breaks down?
      Will the person have to leave the vehicle for long periods of time?

Type or nature of work:
        Is there adequate training and education provided for the person to be able to
         work alone safely?
        Is there adequate personal protective equipment available? Is it in good
         working order?
        What machinery, tools or equipment will be used?
        Is there a high risk activity involved?
        Is fatigue likely to be a factor?
        Are there extremes of temperature?
        Is there risk of an animal attack, insect bite (poisonous, or allergic reaction),
         etc.?
        If the person is working inside a locked building, how will emergency services
         be able to get in? (For example: a night cleaner in a secure office building)
        Does the work involve working with money or other valuables?
        Does the work involve seizing property or goods (such as repossession,
         recovering stolen property, etc)?

Characteristics required by the individual who is working alone

        Are there any pre-existing medical conditions that may increase the risk?
        Does the person have adequate levels of experience and training? (For
         example: first aid, communication systems repair, vehicle breakdowns,
         relevant administrative procedures, and/or outdoor survival?)

(questions adapted from: WorkSafe Western Australia Commission, 1999. "Working
Alone: Guidance Note")

Is it important to wash your hands?

Simply put, yes. Hand washing is the single most effective way to prevent the spread of infections. You can
spread certain "germs" (a general term for microbes like viruses and bacteria) casually by touching another
person. You can also catch germs when you touch contaminated objects or surfaces and then you touch your face
(mouth, eyes, and nose).


"Good" hand washing techniques include using an adequate amount of soap, rubbing the hands together to
create friction, and rinsing under running water. The use of gloves is not a substitute for hand washing.


There is additional information in OSH Answers about how the common cold is transmitted by contaminated
hands.


Please note: In some workplaces, universal precautions should be followed when workers are exposed to blood
and certain other body fluids. Please see the OSH Answers document Universal Precautions for more complete
information.




When should I wash my hands?

Different situations where people can pick up "germs" include:


        when hands are visibly soiled,
        after using the washroom (includes changing diapers),
        after blowing your nose or after sneezing in your hands,
        before and after eating, handling food, drinking or smoking,
        after touching raw meat, poultry, or fish,
        after handling garbage,
        visiting or caring for sick people,
        handling pets, animals or animal waste.


Ensuring that employees wash their hands properly after using the washroom is very important in reducing
disease transmission of stomach "flus" (which really is not a "flu" or influenza) and other gastrointestinal
infections. Using soap and lathering up is very important (rinsing hands in water only is not as effective). Use
comfortably warm, running water. Hands should be washed for a minimum of 10 seconds - longer if the hands
are visibly soiled. To help people (especially children) wash long enough, one option may be to sing a short song
such as "Happy Birthday". The idea of surgeons scrubbing for an operation (as on TV) is very similar.




How do I properly wash my hands?

For effective hand washing, follow these steps:


        remove any rings or other jewelry,
        use warm water and wet your hands thoroughly,
        use soap (1-3 mL) and lather very well,
        scrub your hands, between your fingers, wrists, and forearms with soap for 10 seconds,
        scrub under your nails,
        rinse thoroughly,
        turn off the taps/faucets with a paper towel,
        dry your hands with a single use towel or air dryer,
        protect your hands from touching dirty surfaces as you leave the bathroom.
Other tips include:


         Cover cuts with bandages and wear gloves for added protection (cuts are very vulnerable to infections).
         Artificial nails and chipped nail polish have been associated with an increase in the number of bacteria
          on the fingernails. Be sure to clean the nails properly.
         Keep your hands away from your eyes, nose or mouth.
         Assume that contact with any human body fluids is infectious.
         Liquid soap in disposable containers is best. If using reusable containers, they should be washed and
          dried before refilling. If using a bar of soap, be sure to set it on a rack that allows water to drain or use
          small bars that can be changed frequently.




What about antibacterial soaps and waterless hand scrubs?

While it is true that regular soap and water does not actually kill microorganisms (they create a slippery surface
that allows the organisms to "slide off"), antibacterial soaps are typically considered to be "overkill" for most
purposes. The exception may be in a hospital where special situations are present (e.g., before invasive
procedures, when caring for severely immuno-compromised patients, critical care areas, intensive care nurseries,
etc.). Antibacterial agents should be chosen carefully based on their active ingredients and characteristics, and
when persistent antimicrobial activity on the hands is desired.


When there is no soap or water available, one alternative is to use waterless hand scrubs. Some of these
products are made of ethyl alcohol mixed with emollients (skin softeners) and other agents. They are often
available as a rinse, or on wipes or towelettes. They can be used by paramedics, home care attendants, or other
mobile workers where hand washing facilities are not available. However, these agents are not effective when the
hands are heavily contaminated with dirt, blood, or other organic materials. In addition, waterless hand scrubs
may have a drying effect on the skin and may have odours which may be irritating to some users.


What are needlestick injuries?


Needlestick injuries are wounds caused by needles that accidentally puncture the skin. Needlestick injuries are a
hazard for people who work with hypodermic syringes and other needle equipment. These injuries can occur at
any time when people use, disassemble, or dispose of needles. When not disposed of properly, needles can
become concealed in linen or garbage and injure other workers who encounter them unexpectedly.


Needlestick injuries transmit infectious diseases, especially blood-borne viruses. In recent years, concern about
AIDS (Acquired Immune Deficiency Syndrome), hepatitis B, and hepatitis C has prompted research to find out
why these injuries occur and to develop measures to prevent them. Despite published guidelines and training
programs, needlestick injuries remain an ongoing problem.




What are the hazards of needlestick injuries?


Accidental punctures by contaminated needles can inject hazardous fluids into the body through the skin. There is
potential for injection of hazardous drugs, but injection of infectious fluids, especially blood, is by far the greatest
concern. Even small amounts of infectious fluid can spread certain diseases effectively.


Accidental injection of blood-borne viruses is the major hazard of needlestick injuries, especially the viruses that
cause AIDS(the HIV virus), hepatitis B, and hepatitis C.


The risk of infection after exposure to infected blood varies by bloodborne pathogen. The risk of transmission
after exposure to HIV-infected blood is about 0.3%, whereas it is estimated to be up to 100 times greater for
hepatitis B virus (30%) and could be as high as 10% for hepatitis C virus.


HIV/AIDS


The risk of needlestick transmission of HIV, the virus that causes AIDS, is considerably less than for hepatitis B
virus. Several hundred health care workers have been accidentally exposed, mostly through needlestick injuries,
to blood from patients infected with the HIV virus. As of June 1999, researchers report that needlestick injuries
transmitted HIV to 49 of these health care workers in the United States. Researchers estimate that needlestick
injuries involving blood- contaminated with HIV can spread the virus in 0.3 percent of cases. Stated another way,
99.7 percent of needlestick/cut exposures do not lead to infection.


In Canada, the Division of HIV Epidemiology Research, Bureau of HIV/AIDS and STD, Public Health Agency of
Canada, Health Canada, has reported one case of occupational transmission of HIV that can be clearly linked to a
needlestick injury. There have been two other cases of HIV infection in Canada that have been attributed to
possible occupational transmission, both involving laboratory workers.


A possible occupational transmission occurred to a 75 year old Ontario biochemist who had worked in many
laboratories with blood and blood products. There were no other risk factors reported.


Another possible occupational transmission occurred to a Quebec laboratory technician in the early 1990s. This
case is still under investigation.


Hepatitis B


The risk of transmission of HBV is reduced by immunization against hepatitis B, which is 90% to 95% effective.
The risk of transmission of HBV to susceptible HCWs via a needlestick injury varies from 1% to 40%.


Because HBV may survive on environmental surfaces for more than a week, indirect exposure to HBV can occur
via contaminated inanimate objects and appears to have been a factor in HBV outbreaks among patients and
staff of hemodialysis units.


Hepatitis C


Needlestick injuries may also transmit hepatitis C. The risk factors for hepatitis C virus transmission in
occupational settings is 1.8% (range 0% to 7%).


Needlestick injuries have transmitted many other diseases involving viruses, bacteria, fungi, and other
microorganisms to health care workers, laboratory researchers, and veterinarian staff. The diseases include :


        Blastomycosis                                   Mycoplasma caviae
        Brucellosis                                     Rocky Mountain spotted fever
        Cryptococcosis                                  Sporotrichosis
        Diphtheria                                      Staphylococcus aureus
        Cutaneous gonorrhea                             Streptococcus pyogenes
        Herpes                                          Syphilis
        Malaria                                         Toxoplasmosis
        Mycobacteriosis                                 Tuberculosis




Many of these diseases were transmitted in rare, isolated events. They still demonstrate, however, that
needlestick injuries can have serious consequences.




How common are needlestick injuries?


Needlestick injuries are far too common hazard. Some hospitals report one third of nursing and laboratory staff
suffer such injuries each year.


Available statistics probably underestimate the severity of the problem because many workers do not report their
injuries. This makes it difficult to know exactly how serious the problem is or how well prevention programs work.


The following tables, published by the Canadian National Surveillance of Occupational Exposure to the Human
Immunodeficiency Virus, Health Canada, provide information on reported needlestick injuries.
Table 1 provides data on the type of exposure by profession. There was a total of 690 reported exposures as of
December 2000. Nurses sustained the largest number of exposures (485 or 70% of the total) and needlestick
injuries were the most common exposure type (320 or 75% of total).


                                                               Table 1
                                      National Surveillance of Occupational Exposure to HIV :
                                  Exposure Types by Occupational Group (as of 31 December, 2000)

                      Nurse             Therapist/        Student/         Laboratory         Physician            Other
                                        Technician        Resident         Technician

                A      B      C     A      B     C    A     B    C     A      B       C   A      B        C   A     B      C   Total    %

Needlestick     320 75% 66%         16     4% 47%     21 5% 78%        27     6% 47%      26    6% 62%        17   4% 40%       427    62%

Surgical        19 47%        4%     1     3%    3%    3 8% 11%         6 16% 10%          4 11% 10%           7 18% 16%         40    6%
instrument
wound

Mucous          46 62% 10%           8 11% 24%         2 3%      7%     9 12% 16%          5    7% 12%         5   7% 11%        75    11%
membrane

Skin contact:

a)Intact            6 40%     1%     1     7%    3%    0 0%      0%     2 14%        3%    2 14%      5%       4 29% 10%         15    2%
b)Non-          60 67% 12%           5     6% 15%      1 1%      4%    12 13% 21%          5    6% 12%         7   8% 17%        90    13%
intact*

c)Unknown       34 79%        7%     3     7%    9%    0 0%      0%     2     5%     3%    0    0%    0%       4   9% 10%        43    6%

TOTAL           485                 34                27               58                 42                  44                690 100%**

% of total    70%                  5%                 4%               8%                 6%                  6%               100%
injuries

* Previous tables had a separate heading called 'Open Wound Contamination' which has now been combined with 'Nonintact Skin
Contact' exposures.
** Percentages in the table have been rounded.


A = number of injuries
B = % of this type of injury for this worker category compared with all workers' injuries of this type
C = % of this type of injury compared with all injuries for this category of worker


Healthcare workers (HCWs) in Canada exposed to human immunodeficiency virus (HIV) have been the subject of
surveillance since September 1985. In January 2000, an integrated project combined the existing HIV
occupational sharp exposure database with a hepatitis B virus (HBV) and hepatitis C virus (HCV) database held
by the Bloodborne Pathogens/Nosocomial and Occupational Infections Division (BBP/NOID). The goal of the new
Canadian Needle Stick Surveillance Network (CNSSN) is to monitor HCW's occupational exposures to blood or
body fluids and follow subsequent seroconversions to bloodborne viruses (HBV, HCV, HIV).


This report presents the first year of surveillance data (1 April, 2000 to 31 March, 2001) from the CNSSN.


Table 2 summarizes the frequency and rates of exposure by job title, with exposure events listed in descending
order of frequency. Nurses accounted for 52% of all exposures. However, the nurse's exposure rate per 100 FTEs
was only 4.88, a rate much lower than that observed among phlebotomists (42.78), medical residents (20.97),
nuclear medical technicians (13.59), sterilization attendants (12.14), or medical specialists (10.06).


                               Table 2
Annual exposure rates* based on the number of full-time equivalents
 (FTEs), by job title - Canadian Needle Stick Surveillance Network,
                   1 April, 2000 to 31 March, 2001

                                                                           Rate per
           Job title                     FTEs         Exposures
                                                                           100 FTEs

Registered nurse**                       15,282.87               746              4.88
MD (resident)                         515.00               108         20.97

MD (specialist)                       824.95                 83        10.06

Phlebotomist                          172.98                 74        42.78

Nursing assistant                   2,024.21                 67         3.21

Other                               5,958.75                 68         1.14

Clinical laboratory
                                    1,862.46                 51         2.74
technician

Sterilization attendant               403.79                 49        12.14

Housekeeper                         1,247.38                 53         4.25

MD (general practitioner)           1,319.80                 25         1.89

Other technician                      325.38                 23         7.09

Nursing student                       772.55                 18         2.33

Medical student                       227.00                 15         6.61

Inhalation therapist                  309.60                 13           4.2

Other attendant                       896.30                 12         1.34

Nuclear medicine technician            66.22                  9        13.59

Radiology technician                  576.90                  8         1.39

Patient attendant                     509.93                  8         1.57

Laundry worker                        240.86                  4         1.66

Unknown                               257.57                  2         0.77

Dentist                                21.20                  0             0

Dental hygienist                       18.30                  0             0

Total                             33,833.90              1,436          4.24

* Includes both percutaneous and mucocutaneous exposures.
** Includes 981 days of follow-up among community health nurses = 3.78
FTEs.


A summary of exposures due to 1,214 percutaneous injuries is presented in Table 3. Sixty-two percent of injuries
were caused by five categories of devices that included: (removed all hollow-bore) needles used for drawing
arterial/venous blood (14%) or inserting intravenous/arterial lines (7%), needles for percutaneous injection
(23%), suture needles (12%), or scapel blades (7%). Three-quarters of the injuries involved broken skin with
moderate bleeding, and 5% involved deep cuts with or without bleeding. About 43% of the 1,196 reported
injuries occurred during use of the device, 33% after its use (but, before its disposal) and 12% were related to
disposal (information was missing and unknown for 12% of the exposures).


                                  Table 3
  Summary of exposures due to percutaneous injuries - Canadian Needle Stick
                          Surveillance Network,
                      1 April, 2000 to 31 March, 2001

                                                                       Number       %
Percutaneous injury device and purpose for the use of device

Needles for blood drawing                                                       174      14

Needles for inserting intravenous/arterial line                                  87       7

Needles for injecting percutaneously                                            276      23

Needles used for manipulating an intravenous line                                32       3

Lancets or other device for taking sample from finger, heel or ear               35       2

Needles for obtaining tissue or organic fluid except blood                       15       1

Suture needles for suturing                                                     140      11

Scapel blades for surgery                                                        80       7

Other surgical instruments (razor, scissors, retractors, metal wire,
                                                                                 68       6
etc.)

Glass (vial, tube, pipette, glass object)                                        24       2

Others (other devices, other/unknown purposes)                                  264      22

Unknown devices                                                                  19       2

Total                                                                         1,214     100

Depth of injury

Superficial (scratch without bleeding)                                          184      15

Moderate (broken skin with bleeding)                                            901      74

Deep (stick or deep cut with or without bleeding)                                59       5

Missing information                                                              70       6

Total                                                                         1,214     100




How do needlestick injuries occur ?


A needlestick injury is the result of an accident with a needle. Several studies show that needles cause injuries at
every stage of their use, disassembly, or disposal. But there is disagreement as to why the accidents are so
common among health care workers or why simple solutions fail to solve the problem.


Nursing and laboratory staff usually experience 30 to 50 percent of all injuries during clinical procedures.
Equipment design, nature of the procedure, condition of work, staff experience, recapping, and disposal have all
been mentioned as factors that influence this occurrence.


Equipment Design


Safer innovative devices using protected needle devices or needle-free systems with self-sealing ports would
alleviate many of these injuries. There is accumulating evidence suggesting that syringes with safety features
reduce needlestick injuries.


Nature of Procedure


Critical situations during clinical procedures include:
          withdrawing a needle from a patient, especially if staff attend to bleeding patients while disposing of the
           needle.
          having the device jarred by a patient.
          pulling a needle out of the rubber stopper of a vacuum tube which can jab the hand in a rebound reflex.


Injuries commonly occur when workers try to do several things at the same time, especially while disassembling
or disposing of needles.


Conditions of Work


Work conditions that might contribute to an increase in the number of needlestick injuries include:


          staff reductions where nurses, laboratory personnel and students assume additional duties.
          difficult patient care situations.
          working at night with reduced lighting.


Staff Experience


New staff or students tend to have more needlestick injuries than experienced staff.


Recapping


Recapping can account for 25 to 30 percent of all needlestick injuries of nursing and laboratory staff. Often, it is
the single most common cause.


It is extremely dangerous to hold a needle in one hand and attempt to cover it with a small cap held in the other
hand. Injuries occur three different ways:


          the needle misses the cap and accidentally enters the hand holding it.
          the needle pierces the cap and enters the hand holding it.
          the poorly fitting cap slips off of a recapped needle and the needle stabs the hand.


Several agencies have recommended that workers avoid recapping needles before disassembly or disposal.
Despite this, some health care workers have continued the practice even when informed of the dangers. In some
cases, inappropriate training or force of habit may be responsible. In a recent study, however, workers gave the
following reasons for recapping despite knowing about the potential hazards:


          to protect themselves when disassembling a non-disposable needle device with an exposed
           contaminated needle.
          to protect themselves from exposed needles when several items were carried to a disposal box in a
           single trip.
          to store a syringe safely between uses if its contents were to be administered in two or more doses at
           different times.
          to protect other people in crowded conditions on the way to the disposal box.


Guidelines from the Laboratory Centre for Disease Control recommend that workers do not recap (or bend or cut)
needles but dispose of them directly into approved, puncture-proof containers.


Disposal


Needlestick injuries commonly occur when workers dispose of needles. They occur when staff use special
containers for needles and sharps. They also occur when needles are disposed of improperly in regular garbage
or lost in the workplace.


Special Containers


Up to 30 percent of needlestick injuries of nursing and laboratory staff occur when workers attempt to dispose of
needles using sharps containers. Accidents occur at every step:
        while carrying the needle to the disposal container, especially when the needle is uncapped and mixed
         with other trash.
        while placing the needle into the disposal container, especially if the container is overfilled.
        while emptying disposal containers instead of sealing them for disposal.


Improper Disposal


Virtually all needlestick injuries of domestic and portering staff are from needles that have either been lost in the
workplace or thrown into regular garbage. Janitors and garbage handlers can also experience needlestick injuries
or cuts from "sharps" when handling trash that contains needles or scalpels. Most investigators find it difficult to
understand why this situation occurs. Some attribute the problem to forgetfulness or lack of motivation or
training on the part of people who work with and dispose of needles. Others feel that inconvenient disposal
systems contribute to these incidents.


Maintenance staff have also experienced needlestick injuries when they have been cleaning ducts or other areas
with their hands and have found hidden needles and syringes. These injuries have usually happened when they
are reaching into areas where they cannot see and were not wearing leather gloves.




How can needlestick injuries be prevented?


Preventing needlestick injuries is the most effective way to protect workers from the infectious diseases that
needlestick accidents transmit. A comprehensive needlestick injury prevention program would include:


        employee training.
        recommended guidelines.
        safe recapping procedures.
        effective disposal systems.
        surveillance programs.
        improved equipment design.


Employee Training


To reduce needlestick injuries, an effective program must include employee training. Workers need to know how
to properly use, assemble, disassemble, and dispose of needles. Workers need to understand the risks associated
with needlestick injuries and know the proper means to prevent them. Specifically, the training programs should
address:


        risk of injury.
        potential hazards.
        recommended precautions for use and disposal of needles.
        procedures for reporting injuries.
        the importance of hepatitis B vaccination where appropriate.


Recommended Guidelines


The Laboratory Centre for Disease Control's Bureau of Communicable Disease Epidemiology reviews, publishes,
and updates guidelines to protect staff from exposure to all blood-borne disease-causing agents.


The following guidelines deal specifically with needle safety:


        Needles, scalpel blades and other sharp instruments--workers should consider these as potentially
         infectious and handle them with care to prevent accidental injuries.
        Disposable needles and syringes, scalpel blades, and other sharp items--workers should place these in
         puncture-resistant containers located near the area of use. They should avoid overfilling the containers
         because accidental needlestick injuries may occur.
          Recapping--Workers should not recap needles by hand or purposely bend, break, or remove them from
           disposable syringes or otherwise manipulate them by hand


Safe Recapping Procedures


In situations where recapping is considered necessary, develop safe approaches which workers can follow.
Workers should never move an exposed needle tip towards an unprotected hand.


Single-Handed Scooping


Recapping can be safe when people lay the cap on a flat surface and scoop it onto the tip of a syringe held in one
hand. They must keep the free hand away from the sheath and well behind the exposed needle.


Recapping Devices


Several devices are available for recapping needles safely. Some devices permit single-handed recapping by
parking a needle cap on a flat surface. Other devices are designed to protect the hand that holds the cap during
two-handed recapping procedures. As yet, most products have not received independent testing and the two-
handed recapping process remains a cause for concern. Recapping devices require further investigation. They
may provide a practical solution for situations where recapping is considered necessary.


Disposal


An effective system for disposing of used needles is crucial to preventing needlestick injuries. Having disposal
containers readily available can greatly reduce the concern for recapping needles.


Workers should place needles in wide-mouth, puncture-proof containers. Locate disposal containers specifically
where needles are used to make safe disposal possible without recapping. Replace the containers before they are
completely filled. Make sure they are sealed, collected, and disposed of in accordance with local regulations for
biomedical waste.


All staff should report every incident in which they find needles left at the bedside or thrown into the regular
garbage.


Surveillance


There is still a serious lack of information about the various factors that cause accidents with needles.
Surveillance programs that provide in-depth analysis of needlestick accidents are an important tool for obtaining
this information. The goals of these programs should include:


          determining the rate of needlestick injuries.
          investigating the factors that cause the injuries.
          ensuring that injured workers receive proper treatment.
          identifying areas in which the prevention program needs improvement.
          eventually providing practical strategies for dealing with the problem.


The Division of HIV Epidemiology Research, Bureau of HIV/AIDS and STD, LCDC maintains a program to monitor
occupational exposure to HIV-infected blood and body fluids among health care workers.


Continued Innovation


There is a need for further investigation and innovation to develop means for preventing needlestick injuries.
These investigations should aim:


          to identify the types and designs of needle instruments that are potentially capable of causing
           needlestick injuries.
          to understand better how needle devices are normally handled in the workplace and how they cause
           injuries.
           to find methods that eliminate the need to move hands towards the tips of contaminated needles, or to
            manually disassemble contaminated needle equipment.


What should I do if I notice a hazard?

You should report it immediately to your supervisor. You do not need to wait for an
inspection team to come by. In fact, health and safety legislation requires employees
to report hazards to their supervisor.

The immediate hazard reporting process allows employees to report hazardous
conditions or practices as they notice them. This procedure allows for prompt
reporting and subsequent corrective action without waiting for the next round of
regular inspections.

Hazards can be reported verbally or by filling a simple form available at bulletin
boards or other conspicuous places. The following is an example of such a form.

                                    Hazard Report Form - Example


Name:                                                                         Date:

Location:

Equipment:

Description of the hazard:




Suggested corrective action:




Signature:

Supervisor's remarks:




Corrective action taken:




Signature of Supervisor:                                                      Date:

Why should we pay attention to housekeeping at work?

Effective housekeeping can eliminate some workplace hazards and help get a job
done safely and properly. Poor housekeeping can frequently contribute to accidents
by hiding hazards that cause injuries. If the sight of paper, debris, clutter and spills
is accepted as normal, then other more serious health and safety hazards may be
taken for granted.

Housekeeping is not just cleanliness. It includes keeping work areas neat and
orderly; maintaining halls and floors free of slip and trip hazards; and removing of
waste materials (e.g., paper, cardboard) and other fire hazards from work areas. It
also requires paying attention to important details such as the layout of the whole
workplace, aisle marking, the adequacy of storage facilities, and maintenance. Good
housekeeping is also a basic part of accident and fire prevention.

Effective housekeeping is an ongoing operation: it is not a hit-and-miss cleanup done
occasionally. Periodic "panic" cleanups are costly and ineffective in reducing
accidents.




What is the purpose of workplace housekeeping?

Poor housekeeping can be a cause of accidents, such as:

      tripping over loose objects on floors, stairs and platforms
      being hit by falling objects
      slipping on greasy, wet or dirty surfaces
      striking against projecting, poorly stacked items or misplaced material
      cutting, puncturing, or tearing the skin of hands or other parts of the body on
       projecting nails, wire or steel strapping

To avoid these hazards, a workplace must "maintain" order throughout a workday.
Although this effort requires a great deal of management and planning, the benefits
are many.




What are some benefits of good housekeeping practices?

Effective housekeeping results in:

      reduced handling to ease the flow of materials
      fewer tripping and slipping accidents in clutter-free and spill-free work areas
      decreased fire hazards
      lower worker exposures to hazardous substances
      better control of tools and materials
      more efficient equipment cleanup and maintenance
      better hygienic conditions leading to improved health
      more effective use of space
      reduced property damage by improving preventive maintenance
      less janitorial work
      improved morale
How do I plan a good housekeeping program?

A good housekeeping program plans and manages the orderly storage and
movement of materials from point of entry to exit. It includes a material flow plan to
ensure minimal handling. The plan also ensures that work areas are not used as
storage areas by having workers move materials to and from work areas as needed.
Part of the plan could include investing in extra bins and more frequent disposal.

The costs of this investment could be offset by the elimination of repeated handling
of the same material and more effective use of the workers' time. Often, ineffective
or insufficient storage planning results in materials being handled and stored in
hazardous ways. Knowing the plant layout and the movement of materials
throughout the workplace can help plan work procedures.

Worker training is an essential part of any good housekeeping program. Workers
need to know how to work safely with the products they use. They also need to know
how to protect other workers such as by posting signs (e.g., "Wet - Slippery Floor")
and reporting any unusual conditions.

Housekeeping order is "maintained" not "achieved." This means removing the
inevitable messes that occur from time to time and not waiting until the end of the
shift to reorganize and clean up. Integrating housekeeping into jobs can help ensure
this is done. A good housekeeping program identifies and assigns responsibilities for
the following:

      clean up during the shift
      day-to-day cleanup
      waste disposal
      removal of unused materials
      inspection to ensure cleanup is complete

Do not forget out-of-the-way places such as shelves, basements, sheds, and boiler
rooms that would otherwise be overlooked. The orderly arrangement of operations,
tools, equipment and supplies is an important part of a good housekeeping program.

The final addition to any housekeeping program is inspection. It is the only way to
check for deficiencies in the program so that changes can be made. The documents
on workplace inspection checklists provide a general guide and examples of
checklists for inspecting offices and manufacturing facilities.




What are the elements of an effective housekeeping program?

Dust and Dirt Removal


In some jobs, enclosures and exhaust ventilation systems may fail to collect dust,
dirt and chips adequately. Vacuum cleaners are suitable for removing light dust and
dirt. Industrial models have special fittings for cleaning walls, ceilings, ledges,
machinery, and other hard-to-reach places where dust and dirt may accumulate.
Dampening floors or using sweeping compounds before sweeping reduces the
amount of airborne dust. The dust and grime that collect in places like shelves,
piping, conduits, light fixtures, reflectors, windows, cupboards and lockers may
require manual cleaning. Special-purpose vacuums are useful for removing
hazardous substances. For example, vacuum cleaners fitted with HEPA (high
efficiency particulate air) filters may be used to capture fine particles of asbestos or
fibreglass.

Compressed air should not be used for removing dust, dirt or chips from equipment
or work surfaces.

Employee Facilities


Employee facilities need to be adequate, clean and well maintained. Lockers are
necessary for storing employees' personal belongings. Washroom facilities require
cleaning once or more each shift. They also need to have a good supply of soap,
towels plus disinfectants, if needed.

If workers are using hazardous materials, employee facilities should provide special
precautions such as showers, washing facilities and change rooms. Some facilities
may require two locker rooms with showers between. Using such double locker
rooms allows workers to shower off workplace contaminants and prevents them from
contaminating their "street clothes" by keeping their work clothes separated from the
clothing that they wear home.

Smoking, eating or drinking in the work area should be prohibited where toxic
materials are handled. The eating area should be separate from the work area and
should be cleaned properly each shift.

Surfaces


Floors: Poor floor conditions are a leading cause of accidents so cleaning up spilled
oil and other liquids at once is important. Allowing chips, shavings and dust to
accumulate can also cause accidents. Trapping chips, shavings and dust before they
reach the floor or cleaning them up regularly can prevent their accumulation. Areas
that cannot be cleaned continuously, such as entrance ways, should have anti-slip
flooring. Keeping floors in good order also means replacing any worn, ripped, or
damaged flooring that poses a tripping hazard.

Walls: Light-coloured walls reflect light while dirty or dark-coloured walls absorb
light. Contrasting colours warn of physical hazards and mark obstructions such as
pillars. Paint can highlight railings, guards and other safety equipment, but should
never be used as a substitute for guarding. The program should outline the
regulations and standards for colours.

Maintain Light Fixtures


Dirty light fixtures reduce essential light levels. Clean light fixtures can improve
lighting efficiency significantly.

Aisles and Stairways
Aisles should be wide enough to accommodate people and vehicles comfortably and
safely. Aisle space allows for the movement of people, products and materials.
Warning signs and mirrors can improve sight-lines in blind corners. Arranging aisles
properly encourages people to use them so that they do not take shortcuts through
hazardous areas.

Keeping aisles and stairways clear is important. They should not be used for
temporary "overflow" or "bottleneck" storage. Stairways and aisles also require
adequate lighting.

Spill Control


The best way to control spills is to stop them before they happen. Regularly cleaning
and maintaining machines and equipment is one way. Another is to use drip pans
and guards where possible spills might occur. When spills do occur, it is important to
clean them up immediately. Absorbent materials are useful for wiping up greasy, oily
or other liquid spills. Used absorbents must be disposed of properly and safely.

Tools and Equipment


Tool housekeeping is very important, whether in the tool room, on the rack, in the
yard, or on the bench. Tools require suitable fixtures with marked locations to
provide orderly arrangement, both in the tool room and near the work bench.
Returning them promptly after use reduces the chance of being misplaced or lost.
Workers should regularly inspect, clean and repair all tools and take any damaged or
worn tools out of service.

Maintenance


The maintenance of buildings and equipment may be the most important element of
good housekeeping. Maintenance involves keeping buildings, equipment and
machinery in safe, efficient working order and in good repair. This includes
maintaining sanitary facilities and regularly painting and cleaning walls. Broken
windows, damaged doors, defective plumbing and broken floor surfaces can make a
workplace look neglected; these conditions can cause accidents and affect work
practices. So it is important to replace or fix broken or damaged items as quickly as
possible. A good maintenance program provides for the inspection, maintenance,
upkeep and repair of tools, equipment, machines and processes.

Waste Disposal


The regular collection, grading and sorting of scrap contribute to good housekeeping
practices. It also makes it possible to separate materials that can be recycled from
those going to waste disposal facilities.

Allowing material to build up on the floor wastes time and energy since additional
time is required for cleaning it up. Placing scrap containers near where the waste is
produced encourages orderly waste disposal and makes collection easier. All waste
receptacles should be clearly labelled (e.g., recyclable glass, plastic, scrap metal,
etc.).

Storage
Good organization of stored materials is essential for overcoming material storage
problems whether on a temporary or permanent basis. There will also be fewer strain
injuries if the amount of handling is reduced, especially if less manual materials
handling is required. The location of the stockpiles should not interfere with work but
they should still be readily available when required. Stored materials should allow at
least one metre (or about three feet) of clear space under sprinkler heads.

Stacking cartons and drums on a firm foundation and cross tying them, where
necessary, reduces the chance of their movement. Stored materials should not
obstruct aisles, stairs, exits, fire equipment, emergency eyewash fountains,
emergency showers, or first aid stations. All storage areas should be clearly marked.

Flammable, combustible, toxic and other hazardous materials should be stored in
approved containers in designated areas that are appropriate for the different
hazards that they pose. Storage of materials should meet all requirements specified
in the fire codes and the regulations of environmental and occupational health and
safety agencies in your jurisdiction.


         Police / Law Enforcement Officer
                                                                [Hazards]
                                                                [Preventive Measures]
                                                                [Specialized Information]
What is a Hazard Datasheet on Occupation?                       [List of Datasheets]


This datasheet is one of the International Datasheets on Occupations. It is intended
for those professionally concerned with health and safety at work: occupational
physicians and nurses, safety engineers, hygienists, education and Information
specialists, inspectors, employers ' representatives, workers' representatives, safety
officers and other competent persons.

This datasheet lists, in a standard format, different hazards to which police / law
enforcement officers may be exposed in the course of their normal work. This
datasheet is a source of information rather than advice. With the knowledge of what
causes injuries and diseases, is easier to design and implement suitable measures
towards prevention.

This datasheet consists of four pages:

      Page 1: Information on the most relevant hazards related to the occupation.
      Page 2: A more detailed and systematized presentation on the different
       hazards related to the job with indicators for preventive measures (marked
         and explained on the third page).
      Page 3: Suggestions for preventive measures for selected hazards.
      Page 4: Specialized information, relevant primarily to occupational safety
       and health professionals and including information such as a brief job
       description, a list of tasks, notes and references.



Who is a police / law enforcement officer?
A worker whose main job is to protect the public. This includes protection against
crime, the preservation of civil order, enforcement of traffic and other regulations,
prevention of alcohol and substance abuse, prevention of neighborhood disorders,
firearm and weapon control, law enforcement and investigations as mandated by law
and requested by the relevant national or local authority.



What is dangerous about this job?

        Police / law enforcement officers run a high risk of being attacked, wounded
         or even killed by criminals, hoodlums and other people whose behavior
         disagrees with the law and the society norms. They may also suffer from
         "friendly fire".
        Many police / law enforcement officers are involved in work-related accidents
         - vehicle crashes, falls during chase, rescue and similar operations, etc.
        Police / law enforcement officers usually live under constant apprehension of
         physical danger, work long and irregular hours, and are exposed to
         unpleasant sides of life. This often results in psychological stress, family and
         personality problems.
        Police / law enforcement officers may develop health problems as a result of
         spending much time outdoors, including under the sun or in bad weather.
        Unavoidable physical contact with people who have contagious diseases
         (especially HIV) is a serious health hazard.



                                                                                 [Top]
                                                                                 [Preventive Measures]
                                                                                 [Specialized Information]
Hazards related to this job                                                      [List of Datasheets]




Specific preventive measures can be seen by clicking on the respective   in the third column of the table.


Accident hazards                    Accidents are most likely during emergency
                                     response of the policeman/law enforcement officer
                                     and may occur especially while doing first aid work,
                                     patrol car driving and riot control
                                    Slips, trips, and falls while ascending and
                                     descending from roofs or while chasing suspects in a
                                     crime
                                    Wounds caused by knife or other object (metal rod,
                                     baseball bat, etc.), as a result of being attacked by
                                     persons contacted in the course of duty (suspects,
                                     offenders, their sympathizers, etc.)
                                    Wounds caused by random or careless shooting by
                                     others (incl. "friendly fire")


                                    Self-inflicted wounds caused during firearms
                                     cleaning, loading, etc.
                                    Car or motorcycle accidents while chasing fleeing
                         vehicles, or while fast driving in response to
                         emergency calls


Physical hazards        Exposure to ambient environmental factors (low or
                         high air temperatures, rain, wind, snow, sun)
                         resulting in acute (common cold, heat stroke,
                         dehydration, etc.) or chronic (rheumatism , etc.)
                         diseases


                        Exposure to high noise levels from the emergency
                         horn or on the firing range


Chemical hazards        Exposure to lead while directing traffic, working on
                         the firing range, or doing finger printing work [See
                         Note 1]
                        Exposure to excessive levels of carbon monoxide
                         while directing traffic


Biological hazards      Risk of contracting a contagious disease (HIV,
                         infectious hepatitis, rabies, etc.) as a result of
                         needle stick injury, human or animal bite, or close
                         contact with infected/ill people (esp. members of
                         high-risk groups)


                        Infection caused by insects or rodents while
                         entering polluted or abandoned places (esp. cellars,
                         basements, etc.) for the purpose of inspection,
                         search, observation, etc.


Ergonomic,              Long periods of time spent inside vehicles may in
psychosocial and         the course of time result in musculoskeletal
organizational           disorders (esp. low-back pains)
factors
                        Cumulative trauma disorders of lower extremities
                         (e.g., flatfoot) as a result of long-time, extensive
                         foot patrolling assignments
                        Post-traumatic stress disorder (PTSD), most likely if
                         the incident witnessed by the policeman has
                         resulted in serious injury, or death to any of those
                         involved


                        Exposure to various psychological stressors (stress -
                         related disorders may be manifested as behavioral
                         problems, marital or family problems, or sometimes
                         as alcohol or substance abuse)


                        Personal and/or family problems caused by
                         shiftwork, irregular work hours (incl. at night),
                            constant state of alertness (incl. when off duty),
                            relations with peers and superiors within an
                            hierarchical system typical of police and law-
                            enforcement forces, and similar psychosocial factors
                            [See Note 2]


                           Fear of being prosecuted afterward for actions which
                            seemed to be clearly indicated as necessary during
                            an event, but later not considered as such
                            (particularly by others) when the moments of peak
                            stress were past [See Note 3]
                           The paperwork duties, as opposed to active law
                            enforcement, are often experienced as a major
                            stressor


                                                               [Top]
                                                               [Hazards]
                                                               [Specialized Information]
Preventive measures                                            [List of Datasheets]



     When on duty, wear the personal protective equipment provided for the job at
     hand, e.g., bulletproof clothing

     Wear appropriate hearing protection on the firing range


     In rescue operations or when dealing with drug addicts, take precautions to
     avoid contact with body fluids; in particular do not expose cuts or other open
     skin wounds to body fluids, to avoid contamination with agents causing
     diseases such as AIDS, hepatitis, etc.loves

     Learn relaxation exercises and perform them during long waiting periods


     Seek psychological or vocational advice if experiencing work-related stresses or
     burnout

     Select a shiftwork schedule that would have the least harmful effect on the
     employee's health, family and personal life - consult employees and specialists
     in shift scheduling


                                                                  [Top]
                                                                  [Hazards]
                                                                  [Preventive Measures]
Specialized information                                           [List of Datasheets]



Synonyms     Policeman / woman, Law Enforcement Officer, Officer, Cop [slang]


Definitions Protects the public from attack, mugging and robbery. Takes prisoners
and/or      under control where possible and transports them to jail or other
description restraining facility. Works in traffic control and issues tickets (court
            summons) to violators of traffic laws. Disperses unruly crowds Renders
            first aid at accidents if there are no others more highly qualified
            (physicians, nurses, MDA) on scene. Serves warrants and makes
            arrests of sought persons. Examines medical and dental x-rays, finger
            prints and other information to identify bodies held in morgue. Testifies
            in court to present evidence regarding cases. Guards prisoners
            detained at police station or in detention room pending hearings.
            Searches all prisoners for weapons, contraband, drugs and other
            harmful articles. May investigate offenders and causes for arrest and
            make recommendations to magistrate concerning disposition of the
            case. In most jurisdictions, whether on or off duty, these officers are
            expected to exercise their authority whenever necessary (Based on
            DOT [Police Officer I, II, III] and Occ. Outlook Handbook [Police,
            Detectives, and Special Agents]


Related and Police Officer - Identification and Records Unit; Police Officer -
specific    Community Relations Unit; Police Officer - Traffic Unit; Police Officer -
occupations Complaint Evaluation Unit; Police Officer - Police Officer - Motorized /
            Mounted Unit; Police Officer - Investigation Unit; Police Officer -
            Homicide Unit; Police Officer - Police Academy Instructor; Police officer
            - Vice Unit; Police Officer - Internal Affairs Unit, and Police Officer -
            Fingerprint Unit [In addition, the name of Detective may be connected
            with each of the occupations above]; marshal; sheriff deputy; trooper;
            etc.


Tasks         Arresting; assisting (citizens, etc.); chasing; checking; consulting;
              directing traffic; driving; evaluating (evidence, complaints, etc.);
              examining; impounding; issuing (tickets, reports, etc.); fingerprinting;
              immobilizing a prisoner; investigating; negotiating; patrolling;
              protecting; responding (to calls, alarms, etc.); reporting; running;
              shooting; tackling; testifying; training


Primary       Communication equipment; vehicles of different types (mostly
equipment     automobiles); weapons (incl. personal firearms); personal protective
used          equipment (bulletproof vests, helmets, shields, etc.); subduing and
              riot-control equipment (incl. handcuffs, clubs, smoke grenades,
              launchers, nets, etc.);


Workplaces Administrative authorities at different levels: state, regional, municipal,
where the local, etc.: law-enforcement agencies of different types: civilian,
occupation military, or paramilitary
is common


Notes            1. Firing-range instructors must submit periodical urine/blood tests
                    for lead.

                 2. The profession of a Police / Law Enforcement Officer is rarely
                    meeting an impartial attitude on the part of the public: it may
   vary from high respect and praise to despise and hate,
   depending on the social consciousness and law-abiding
   practices of a certain person or group. This, often unpredictable,
   emotional diversity contributes to the development of anxiety
   and similar personal traits in Police / Law Enforcement Officers.

3. Such second thoughts may make actions look unnecessary
   (particularly to others and at a later time when the stress is
   lower) and the result of having acted may lead to reduction in
   rank, possible removal from the police force and even to loss of
   the pension due the officer.

4. Police / Law Enforcement Officers have a 200% greater risk of
   cardiovascular diseases, including heart attack and stroke, than
   the general population.

				
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