BACKDISORDERSANDINJURIES(oshatechnicalmanual)背部伤害(

SECTIONVII:CHAPTER1BACKDISORDERSANDINJURIESContents:I.IntroductionII.BackDisordersIII.ReportsofBackInjuriesIV.InvestigationGuidelinesV.PreventionandControlVI.BibliographyAppendixVII:1-1.In-DepthAnalysisAppendixVII:1-2.EvaluationofLiftingTasks:NIOSHWorkPracticeGuideforManualLiftingAppendixVII:1-3.VideotapeGuidelinesandAnalysisAppendixVII:1-4.SupplementalFactorsForErgonomicTapeEvaluationAppendixVII:1-5.NIOSHLiftingAnalysisWorksheetI.INTRODUCTION.A.GENERAL.Backdisorderscandevelopgraduallyasaresultofmicrotraumabroughtaboutbyrepetitiveactivityovertimeorcanbetheproductofasingletraumaticevent.Becauseoftheslowandprogressiveonsetofthisinternalinjury,theconditionisoftenignoreduntilthesymptomsbecomeacute,oftenresultingindisablinginjury.Acutebackinjuriescanbetheimmediateresultofimproperliftingtechniquesand/orliftingloadsthataretooheavyforthebacktosupport.Whiletheacuteinjurymayseemtobecausedbyasinglewell-definedincident,therealcauseisoftenacombinedinteractionoftheobservedstressorcoupledwithyearsofweakeningofthemusculoskeletalsupportmechanismbyrepetitivemicro-trauma.Injuriescanariseinmuscle,ligament,vertebrae,anddiscs,eithersinglyorincombination.B.INCIDENCE.Althoughbackinjuriesaccountfornowork-relateddeaths,theydoaccountforasignificantamountofhumansuffering,lossofproductivity,andeconomicburdenoncompensationsystems.Backdisordersareoneoftheleadingcausesofdisabilityforpeopleintheirworkingyearsandafflictover600,000employeeseachyearwithacostofabout$50billionannuallyin1991accordingtoNIOSH.Thefrequencyandeconomicimpactofbackinjuriesanddisordersontheworkforceareexpectedtoincreaseoverthenextseveraldecadesastheaverageageoftheworkforceincreasesandmedicalcostsgoup.II.BACKDISORDERS.A.FACTORSASSOCIATEDWITHBACKDISORDERS.Backdisordersresultfromexceedingthecapabilityofthemuscles,tendons,discs,orthecumulativeeffectofseveralcontributors:Reachingwhilelifting.Poorposture--howonesitsorstands.Stressfullivingandworkingactivities--stayinginonepositionfortoolong.Badbodymechanics--howonelifts,pushes,pulls,orcarriesobjects.Poorphysicalcondition-losingthestrengthandendurancetoperformphysicaltaskswithoutstrain.Poordesignofjoborworkstation.Repetitiveliftingofawkwarditems,equipment,or(inhealth-carefacilities)patients.Twistingwhilelifting.Bendingwhilelifting.Maintainingbentpostures.Heavylifting.Fatigue.Poorfootingsuchasslipperyfloors,orconstrainedposture.Liftingwithforcefulmovement.Vibration,suchaswithlifttruckdrivers,deliverydrivers,etc.B.SIGNSANDSYMPTOMS.Signsandsymptomsincludepainwhenattemptingtoassumenormalposture,decreasedmobility,andpainwhenstandingorrisingfromaseatedposition.III.REPORTSOFBACKINJURIES.A.CONTRIBUTINGFACTORS.Thesefactorsusuallyaccountforveryfewwork-relatedbackinjuries.Congenitaldefectsofthespine.Increaseinstaticstandingorsittingtasks.Anagingworkforce.Decreasesinphysicalconditioningandexercise.Increasedawarenessofworkplacehazards.Jobdissatisfaction.B.MANUALMATERIALSHANDLING.ManualmaterialshandlingistheprincipalsourceofcompensableinjuriesintheAmericanworkforce,andfouroutoffiveoftheseinjurieswillaffectthelowerback.IV.INVESTIGATIONGUIDELINES.A.RECORDSREVIEW:OSHA200LOG.1.NotewhenbackorothermusculoskeletaldisordersappearexcessivefromLostWorkDayInjuryandIllness(LWDII)ratecalculations.Understandthatexcessivenessisrelative,sincethereisnofirmfigureestablishedthatdelineatessafefromunsafe.Abettermeasureistolookfortrendsofescalatingnumberofinjuriesorofincreasingseverityofinjuries.ComparingyourtargetpopulationwithBLSdata,othercompanyrates,otherlines,departments,wings,oroccupationaltitlescanyieldameaningfulmeasuringpointtogaugeexcessiveness.BackinjuriesshouldbetreatedasaninjuryontheOSHA200logregardlessofwhethertheinjurywastheresultofanacuteorchronicexposure.2.Todetermineiftrendsexist,atleastseveralyearsoftheOSHA200logwillbeneededforreview.3.Recordorcopyinformation,includingoccupationaltitles,departments,datesofinjuryorillness,fromtheOSHA200logandpertinentOSHA101(orequivalent).ThisinformationcanbeusedtocalculatetheLWDIIandSeverityrates(seeAppendixVII:1-1).4.Ifyoudeterminethatthereisaneedforamorein-depthanalysisoftheextentandmagnitudeofthebackdisorders,seeAppendixVII:1-1.B.EMPLOYER,EMPLOYEEINTERVIEWS.0.Walkaround.a.Askemployeesabouttheiropiniononthedifficultyofthetaskaswellaspersonalexperiencesofbackpain.b.Observeworkerposturesandlifting.c.Determineweightofobjectslifted.d.Determinethefrequencyanddurationofliftingtasks.e.Measurethedimensionsoftheworkplaceandlift.1.Evaluation.a.Videotapesshouldbetakenoftheworktaskforlaterreviewandforevidenceofrecognizedmusculoskeletalhazards(seeAppendixVII:1-3).b.Manuallifting:Repetitivematerialhandlingincreasesthelikelihoodofadisorder.Principalvariablesinevaluatingmanualliftingtaskstodeterminehowheavyaloadcanbeliftedare:thehorizontaldistancefromtheloadtotheemployee'sspine,theverticaldistancethroughwhichtheloadishandled,theamountoftrunktwistingtheemployeeutilizedduringthelifting,theabilityofthehandtograsptheload,andthefrequencywithwhichtheloadishandled.Additionalvariablesincludefloorandshoetrac