“Early Intervention to Address Repetitive Motion

Discomfort and Avoid Injury”

Vince Cooke

Director of Safety

National Office Furniture

vince.cooke@nationalofficefurniture.com

PH: 812-634-3127

I

n

j

u

r

y

F

r

e

e

One of the biggest, if not

the BIGGEST, challenge we

face in Safety in

manufacturing is

Repetitive Motion Injuries!

I

n

j

u

r

y

F

r

e

e

What is a RMI?

• Repetitive motion injuries, also called repetitive stress injuries, are temporary

or permanent injuries to muscles, nerves, ligaments, and tendons caused by

doing the same motion over and over again. A common repetitive motion

injury is carpal tunnel syndrome. This disorder occurs when the median

nerve, which travels from the forearm to the hand through a "tunnel" in the

wrist, is compressed by swollen, inflamed ligaments and tendons.

• The injury can be quite painful and can also cause numbness, clumsiness,

and a loss of motion, flexibility, and strength in the area. It can worsen over

time without treatment, and can result in a complete loss of function.

I

n

j

u

r

y

F

r

e

e

According to the U.S. Department of

Labor, Occupational Safety and Health

Administration (OSHA), repetitive strain

injuries are the nation's most common

and costly occupational health problem,

affecting hundreds of thousands of

American workers, and costing more

than $20 billion a year in workers

compensation.

I

n

j

u

r

y

F

r

e

e

The costs to businesses that employ workers

at high risk to develop Carpal Tunnel

Syndrome and other Repetitive Stress

Injuries is staggering. It is estimated that RSI

"costs employers over $80 billion yearly."

According to the National Council of

Compensation Insurance, the average

compensation of a CTS victim is $33,000.

I

n

j

u

r

y

F

r

e

e

Carpal Tunnel Syndrome is the #1 reported medical

problem, accounting for about 50% of all work-related

injuries

Only 23% of all Carpal Tunnel Syndrome patients were

able to return to their previous professions following

surgery

Up to 36% of all Carpal Tunnel Syndrome patients require

unlimited medical treatment.

CTS Alone

I

n

j

u

r

y

F

r

e

e

• This session will discuss how we have used the 'early intervention' process to significantly reduce and or eliminate repetitive motion injuries within National Office Furniture.

• Early intervention is a process to raise awareness and encourage employees to 'report early' any discomforts associated with their jobs.

• Through the use of our rehabilitation partners we promptly identify ERGONOMIC improvements, body mechanics and provide stretching and strengthening exercises.

• We use a formal system that identifies each person's 'status' and take appropriate action to ensure success for each employee.

• We currently have a success rate over 98%.

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

Governor Holcomb awarded 34 Indiana companies with the Governor’s

Century and Half Century Business Awards during today’s ceremony.

Kimball International Chairman of the Board and CEO, Bob Schneider,

accepted the award on Kimball’s behalf and stated, “On behalf of our 3,000

plus employees, and especially the 2,400 who work in our Indiana

operations, we are truly honored and humbled by this recognition. Our

community service over the last 67 years was a cornerstone of the Guiding

Principles established by our founder, Arnold Habig, who in 1950, started

our company in the southern Indiana town of Jasper. We remain committed

to community service and the remainder of those principles to this day at

Kimball International.”

Kimball International Named 2016 Recipient of Indiana Governor’s Half Century Award

JASPER, Ind., March 27, 2017 (GLOBE NEWSWIRE) -- Kimball International, today, was recognized at the Indiana Statehouse by Governor Eric Holcomb as a recipient of the 2016 Governor’s Half Century Award for 67 years of operation and community

service.

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

Our Vision in Safety

We strive for an “INJURY FREE”

working environment for our

people”.

Danville receives 2017 “Kentucky Governor’s

Safety Award"

National receives “2018 Indiana Governor’s

Workplace Safety Award”

Category:

Innovation

Large

Company

Early

Intervention

National receives “2018 Kentucky Labor

Cabinet Partnership Award”

I

n

j

u

r

y

F

r

e

e

2017 was a Record Setting Year

for us

• # of Injuries

• Injury Rate

• Lost Work Day Rate

• Workers Compensation Costs

I

n

j

u

r

y

F

r

e

e

10.6

6

6.9

3.8

2.1

0.7 0.81.4 1.2 1.3 1.2 1.4 1.3

0.660

2

4

6

8

10

12

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

INJURY RATE

94% reduction

148

8

I

n

j

u

r

y

F

r

e

e

0.7

0.4

0.25

0.8

0.5 0.48

0.16

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

2011 2012 2013 2014 2015 2016 2017

National's Lost Work Day Rate

80% reduction

I

n

j

u

r

y

F

r

e

e

OSHA CERTIFICATIONS

I

n

j

u

r

y

F

r

e

e

Management

CommitmentEmployee Involvement Worksite Analysis

Hazard Prevention &

ControlTraining

Top Management Organized Safety Team Job Hazard Analysis Lead Measures New Employee Orientation

Safety is a Value Safety Suggestion System Trend Analysis Planning Matrix Documentation on Training

Safety Manager Local Emergency Response Team Audit Process Behavioral Based Safety Weekly Topics

Adequate Resources First Aid Team Injury /Incident Evaluation Emergency Planning Drills Contractors Safety

Line Accountability for Results Ergonomics Team Job Safety Procedures Ergonomics Ergonomics

Mission Statement with

Policy/CommitmentSafety Representatives Program Industrial Hygiene Monitoring Near Miss Program Employees assist in training

Goal Setting BBS Site Champions External Resources Written Safety Plans Specialized Training for Supervision

All Relative Items Receive Closure A.E.D. ProgramPersonal Protective Equipment

program

Safety Performance Feedback Housekeeping Rating System Early Intervention Program

Return to Work Program Maintenance Support

Contractors Safety ProgramOrganized filing system

SAFETY MANAGEMENT SYSTEM

I

n

j

u

r

y

F

r

e

e

Early Intervention

Program

I

n

j

u

r

y

F

r

e

e

First exposure was in 1998

What we will discuss has been an

EVOLUTION for us

I

n

j

u

r

y

F

r

e

e

Basic Principle

• Early intervention is a process to raise awareness and encourage employees to 'report early' any discomforts associated with their jobs.

Early intervention is a proactive strategy designed to discover early warning signs of MSDs and prevent the early warning signs from developing into an injury.

I

n

j

u

r

y

F

r

e

e

Video

I

n

j

u

r

y

F

r

e

e

Video

I

n

j

u

r

y

F

r

e

eVideo

I

n

j

u

r

y

F

r

e

e

How does it work?

• We ‘partner’ with local rehabilitation resources

– which come onsite weekly

• Our employees put their names on the list to be seen

• A file is started on each employee in the program

• Each employee’s condition is RATED

• The employee remains in the process until completed

I

n

j

u

r

y

F

r

e

e

Process

TRIGGER

ANALYSIS

Report

Generated

EmployeeArea

Leader

Rating

Continued

follow up

Completion

Green Yellow Red

Actions

Deep

MassageMedical

Provider

Onsite

Partner

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

Early Reporting is the Key!

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

On Site ReportsVisit Discussion:

Follow up EIP consult with employee this date. Employee

states that she is still doing well with minimal pain in her wrist.

States that she feels better just knowing what is going on but

does not think that she will want to do anything else at this time

because she is not having any issues. States that she is doing

many different tasks at work to help avoid increased pain from

repetition. Reviewed all previous discussions with employee

and instructed her to continue with all previous

recommendations. No formal follow up planned at this time.

Visit Discussion:

Follow up EIP consult this date in reference to initial consult on 4-

12-16. Employee states that her wrist is feeling somewhat better

and the wrist wrap does help with pain when lifting product up

from line. Employee reports she still does feel some pain

especially with sanding. Observed employee with this task-

instructed her to watch her gripping technique and try to achieve

power grip position instead of alternate techniques to allow for

optimal strength with neutral positions. Reviewed previous

discussion with employee about general first aid as well as

stretching.

Visit Discussion:

Follow up EIP consult this date in reference to initial consult on 4-

12-16. Employee states that he has not been following through

with recommendations because he did not remember exactly what

he was supposed to do. Reviewed previous discussion with

employee and instructed him to be stretching more regularly and

to use general first aid as needed. Will follow up with employee at

next scheduled session.

I

n

j

u

r

y

F

r

e

e

EARLY INTERVENTION

RISK MANAGEMENT LOGIC CHART

O.T/P.T. Therapist ______________________ Deep Massage Therapist ____________________

Visits Visits

Employee's Name Status or Risk Level Status or Risk Level

Ther

ap

ist m

akes

re

ferr

al t

o t

he

Dee

p M

assa

ge T

her

ap

ist

Actions triggered by Status Level

Green (low risk)Yellow (medium risk) Red (high risk)

Note entry in the binder or file Setup meeting with Area and Employee is moved temporarily to a new role

Fol low any specific actions by Production Manager reviewing report Therapist follows up within 7 days

the Therapist Job Rotation started If after 2 visits no improvement, then referral is made to Deep Massage Therapist

Requires follow up by

Therapist within 7 days

RATINGSBen Active

I

n

j

u

r

y

F

r

e

e

WHAT ARE SOME OF THE

RECOMMENDATIONS OR ACTIONS?

• Job Rotation (part of their role)

• Ergonomic improvements

• Workstation height

• Anti-vibration improvements

• Posture

• Movement

• Tools

• Process

• Stretches

• Strengthening exercises

I

n

j

u

r

y

F

r

e

e

WHAT ARE SOME OF THE

RECOMMENDATIONS OR ACTIONS?

• Ice

• Compression

• Body mechanics

• Grip

• Strike zone

• Hands neutral position

• Technique

• After hours

• Work, hobbies

• Sleeping posture (ie…hands)

• Job Re-evaluation

I

n

j

u

r

y

F

r

e

e

How do we get Early Reporting?

1). It is NOW part of our dna

2). Triggers

-requests for braces

3). Lean Job Hazard Analysis

4). Daily Safety Observations

5). Daily Safety Matters Messages

I

n

j

u

r

y

F

r

e

e

Lean Job Hazard Analysis

ASK THE EMPLOYEE IF THEY ARE EXPERIENCING DISCOMFORT

OR PAIN (WHICH WE CAN HAVE AN ERGONOMIST OR

OCCUPATIONAL THERAPIST REVIEW)

I

n

j

u

r

y

F

r

e

e

Daily Safety Observations

The employee appears to be working ergonomically correct (not in

an awkward position)

I

n

j

u

r

y

F

r

e

e

Daily Safety Matters messages

I

n

j

u

r

y

F

r

e

e

EARLY INTERVENTIONIt has been proven many times that the earlier we react to

discomfort, the easier and faster we can recover. Safety is each

and every one of us working together as a team to keep our

workplace INJURY FREE!

Have a Safe Day!!!

I

n

j

u

r

y

F

r

e

e

Deep Tissue Massage

We started complimenting our

Early Intervention program with

the use of Deep Tissue

Massage approximately 3 years

ago

I

n

j

u

r

y

F

r

e

e

Data Analysis

I

n

j

u

r

y

F

r

e

e

Injury

Condition Behavior

85% of all injuries statistically are caused by unsafe acts or behaviors

INJURY CAUSATION

I

n

j

u

r

y

F

r

e

e

Behavior, 4, 50%

Condition, 4, 50%

By Primary Cause

I

n

j

u

r

y

F

r

e

e

Contusion, 1

Puncture, 1

Sprain/Strains, 5

Cut, 1

By Nature of Injury

I

n

j

u

r

y

F

r

e

e

98.4%

I

n

j

u

r

y

F

r

e

e

EARLY INTERVENTION TRACKING

2017 Calendar Year

Early Intervention Program

# total Early Intervention # total moved into Deep Massage #sent on to Medical Provider Recordable injuries

11thJanuary-June 53 8 0 0

11th July-December 33 8 0 0

DV January-June 39 5 0 0

DV July-December 51 3 0 0

SC January-June 45 3 1 0

SC July-December 34 1 1 0

FV January-June 27 3 2 0

FV July-December 34 0 0 0

Non-Mfg January-June 38

Non-Mfg July-December 20 3 0 0

Total January-June 202 19 3 0

Total July-December 172 15 1 0

Total January-June 9% 1% 0%

Total July-December 9% 1% 0%

2017 totals 374 34 4 0

9% 1.1% 0.0%

BY JOB Upholsterer

Handsan

der Assembly

Finish

Spray Cutting

Machine

Room

Final

Inspect

Mat.

Hand. Sew

Maintena

nce Office

Sand/insp

ect U.V. Final assy. Pack

11th January-June 17 4 9 4 5 1 2 4 1 1

11th July-December 9 4 5 4 1 4 1 1

DV January-June 26 3 1 1 6 2

DV July-December 25 3 8 2 1 8 4

SC January-June 1 10 1 5 4 3 4

SC July-December 1 8 1 3 4 1

FV January-June 1 4 4 4 1 3 4

FV July-December 3 4 2 4 2 2 2

Non-Mfg January-June 38

Non-Mfg July-December 20

totals 77 17 51 19 6 19 5 10 22 1 72 6 0 0 6

I

n

j

u

r

y

F

r

e

e

How long does an employee stay in

the Early Intervention Process?

• We average about 5 visits per employee

• We (and the employee) are looking for

‘IMPROVEMENT’ while in the process

I

n

j

u

r

y

F

r

e

e

There is a cost to the program but we see

a great return on the investment

• Our last repetitive motion injury = $48,000

• Our Injury rate is .66 (8 injuries)

• Our NAICS industry average is 3.6 82% higher

• If we were ‘average’ we would have had 47 injuries

• That is 39 additional injuries

• If only 50% were repetitive motion related

• That would have been 19 additional claims at $48,000 each

• That would be a potential of an additional $912,000

I

n

j

u

r

y

F

r

e

e

Testimonies

I

n

j

u

r

y

F

r

e

e

OSHA Recordability

• You must understand what is OSHA Recordable, what is

considered first aid and what is not

• E.I. is not ‘treatment’ it is ‘prevention’

• Your ‘partners’ must understand the same

• It is your responsibility to assure compliance in regards to

recordability

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

• Simply stated, an injury or illness exists and is recordable if medical treatment

beyond first aid takes place, or if it involves a significant injury or illness diagnosed

by a physician or other licensed health care professional

• 1904.7(b)(5)(i)(C)

• o "First aid" as defined in paragraph (b)(5)(ii) of this section

• 1904.7(b)(5)(ii)(E)

• Using hot or cold therapy;

• 1904.7(b)(5)(ii)(F)

• Using any non‐rigid means of support, such as elastic bandages, wraps,

non‐rigid back belts, etc. (devices with rigid stays or other systems

designed to immobilize parts of the body are considered medical

treatment for recordkeeping purposes);

• 1904.7(b)(5)(ii)(M)

• Using massages (physical therapy or chiropractic treatment are

considered medical treatment for recordkeeping purposes);

I

n

j

u

r

y

F

r

e

e

Indiana OSHA

I

n

j

u

r

y

F

r

e

e

Evolution

Timeline of MSD Management

Post-Injury Management (Clinical Treatments)

Data Analysis

cu

rre

nt

Early Intervention & Prevention (EIP) program

1980s

1990s

1998

2000

Pre-Work Stretching Program roll out

Job Hazard Analysis/Ergo Improvements

2007

2012

-2014

Lean JHA , Social and Daily Safety Observations

Pre-Employment Job Function Testing

2016

I

n

j

u

r

y

F

r

e

e

Stretching Programs

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

New Hire Orientation

• Ergonomic Evaluations

I

n

j

u

r

y

F

r

e

e

Office Ergonomics

I

n

j

u

r

y

F

r

e

e

Office Ergonomics

I

n

j

u

r

y

F

r

e

e

Office Ergonomics

I

n

j

u

r

y

F

r

e

e

Office Ergonomics

I

n

j

u

r

y

F

r

e

e

Post Offer Job Function Testing

I

n

j

u

r

y

F

r

e

e

• 370 Ergonomic Improvements

• 501 Job Hazard Analysis

• 3,544 Safety Improvements

• 4,655 Daily Safety Observations (full

court press)

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

I

n

j

u

r

y

F

r

e

e

Ergonomic Improvements

I

n

j

u

r

y

F

r

e

e

Ergonomic Improvements

I

n

j

u

r

y

F

r

e

e

Ergonomic Improvements

I

n

j

u

r

y

F

r

e

e

Ergonomic Improvements

I

n

j

u

r

y

F

r

e

e

Ergonomic Improvements

I

n

j

u

r

y

F

r

e

e

Ergonomic Improvements

I

n

j

u

r

y

F

r

e

e

Ergonomic Improvements

I

n

j

u

r

y

F

r

e

e

Ergonomic Improvements

I

n

j

u

r

y

F

r

e

e

Ergonomic Improvements

I

n

j

u

r

y

F

r

e

e

Ergonomic Improvements

I

n

j

u

r

y

F

r

e

e