Document gbd2wJaRynrJ3p5d6R6xzVazV

FILE NAME: Caterpillar (CAT) DATE: 1962 DOC#: CAT017 DOCUMENT DESCRIPTION: Published Article from 50th National Safety Congress - Metals Section 50th NATIONAL SAFETY CONGRESS Papers delivered in the METALS SECTION CONTENTS Back Injuries -- Problems, Costs and S olu tio n s D en t II D. M cCost/e 3 The Cost o f U nsafely S afety A ttitu d e s : Pad, Fact, or Fancy Dr. John B. Nicosia 4 Me L* Walkor 7 G eorge . Flaccus, Jr. 9 G. . W eaver 12 O fficers o f the M etals Section 1962-63 17 O th e r Volum es in 1962 N a tio n a l S a fe ty Congress Transactions Back Cover BACK INJURIES---PROBLEMS. COSTS AND SOLUTIONS By DARRELL D. M cCASTLE Forem an, P lant E ngineering, Caterpillar T ractor Co.. Peoria, XU. W e a t C aterpillar believe th a t in using " m ad e f o r th e job** liftin g devices, w e have reduced the num ber of back injuries. In our P eoria plant, using overhead and boom crane, electric and air hoht* on jib cranes an d m onorails, in an averace day w e m ake between 600 and 650 mechanical lift every 60 seconds. In a live year period, averaging 250 w ork days per year, we m ake 250 to .t00 million mechanical lifts. O u r lost tim e reco rd fo r th e p ast five yar* show s 25 l>'<t tim e cases due to han d lin g m a te ria l wit)) lif tin g devices. 1 was in fo rm e d th a t 21 o f these w ere caused by m isusing the device or using the w rong device for the job. This leave only fo u r lost tim e cases out o f 500 m illion mechanical lifts. l*m n o t try in g to tell you th a t w e h ave a w ay r.f liftin g m aterial in o u r plant th a t will elim inate back injuries, but we have de veloped a system which we have found very su ccessfu l, n o t o n ly in red u cin g th e ntimler of la c k injuries, h ut oth er Injuries as well. W e have a special section which de-ign-. forges, repairs and inspects all lifting de vices. W e have eleven men in th e section, w ish a com bined to ta l m` 226 y ea rs o f ex* j*cricncc. T h is represents a lot o f experience in designing lifting devices. B ecause these m en a r e h eld solely responsible fr>r this u u rk . it stops every Tom . Dick and H a rry fro m taking a bent piece of iron an d trying to lift m aterial or repairing broken and w orn devices. Consequently, it helps to re duce all kinds of injuries due to lifting and m oving m aterial. A t C ate rp illa r, w e Have tw o slogans. B y adhering to these tw o slo g an s we have im proved our safety record and continue to m anufacture quality products. O u r first logan needs n o explanation. A t C aterpillar, "safety is alw ays our num ber one business/* T h e second slogan is *T. T A B , W O D I*'--* " is there a better w ay o f doing it? " T hat 1 a slo g an th a t w ill w o rk in a n y situation, especially those concerning safety. W e keep a record i.t each liftin g device. W e h a v e clo>e to 5/1.000 o n file. T h e in f o r m ation is compiled o n o rd in ary cards and includes the rated safety load an d service, the departm ent and location, the date made and condition. T he rem arks a re used fo r in-pcctton and repair inform ation. T h e rec ord is kept until th e device is scrapped. W e keep a co n tin u o u s tn*t<cction o f all liftin g chains and device*. H ow ever, it is also itnortant that each operator inspect his own equipment. 1 believe >ou mu*t follow th e following methods in designing an y liftin g derice, if you're going to pick up a huge tra c to r o r a -mall casting. (T h a t is, if you can g et over the center of gravity, and th e hoist hook m u st alw a y s l*e o v e r th e c e n te r o f g ra v ity .) 1. A slin g load o r tw o o r fo u r ey e bo tts --w e u*e ?hi w h en ev er y o u ca n get to th e l\vl on th e i fn r <ide*-- h o o k o v e r c e n te r o f sravity. 2. W henever >ou can get under th e load, but can't get to the fo u r sides. Kick and end a rc blocked. 5. W h e n e'e r you can get directly over the center o f gravity, you can use tongs, o r an eye bolt or any device that w ilt go over the center of grarit> . 4. W hen all o th er w ays are blocked, but the lift section a m co off center, pry down with a tail and m o\e the eye over the center (.1 gravity. 5. T h e only o th e r w ay, if jo u ca n 't get over the center of gravity w ith the hoist hook, as in these fo u r m eth o d s. Is to go to a fulcrum o r lever. Rem em ber, when you use the lever m ethod, th a t it creates a haz ard. The application of these m ethods to our many different liftin g device* has certainly helped to reduce back injuries in our opera tions. 7P(j _? f C a t i i f i d S a f e t y C & n g rcss By DR. JOHN B. NICOSIA Medical Director Bast Chicago Works. Blaw-Knox Co.. East Chicago. Ind. Low back pain is a symptom and not a disease. It can and docs occur at any age. I t is f a i r to s a y th a t backache is a freq u en t sv-mptoTr., causes m uch loss o f m an hour labor, is difficult to diagnose to r cause, and s*. in m a n y instance, difficult to relieve. I t is w ell recognized that backache is asso ciated w ith such diseases as arthritis and cancer and commonly follows injuries in industry*; in a larg e segm ent o th e popu lation, it also occurs unassociated w ith dis ease or injury. A physician w ill occasionally be called so >ee a case o f bac k ach e o acute th a t the p a tie n t is u n ab le to v is it th e doctor's office f o r ex a m in atio n . T h is m a y lc a first a t ta c k o r or.c m a re c u rre n t series. In any case, th e essential duty of the doctor is to relieve pain. A quick history will disclose the occurrence o f the attacks, an exam ina tion w ill determ ine w hether the symptom s a re refen-able to acute backache alone by elim inating all other probable conditions. If th e person can m ove both legs and feet, has good sensation, no fever, no blood pres sure change, n o pulse rise o r signs o f an acute abdomen, it would seem fairly sate to proceed w ith the treatm ent of the acute backache. M ost acute attacks of mechanical origin w ill be sufficiently im proved in 4S to 72 h o u rs to allow a detailed examination. P ersistcnce o f acute symptoms beyond 72 hours is highly indicative os some serious under lying problem other than ordinary m echan ical derangem ent, and hospitalization should be strongly considered in order to arrive a t th e proper diagnosis. A ny cause o f chronic recurring low back pain can also produce an acute attack. T here fore, to continue the search fo r the cause o f acute backache, consideration m ust be given to all causes o f chronic low back pain. A quick rundown makes it apparent th a t an X -ray survey o f the back will yield findings that include o r exclude most other causes. T h e iollow ing outline lists tlic most likely causes th a t w ill be encountered. T he causes a re listed w ith o u t reg ard to incidence o r frequency*: they are arranged to facilitate differential diagnosis classification. 4 1. In fectio n a- Non-specific--Staphylococcus, strept, etc. b. S pecific-T uberculosis, etc. 2. Diseases a Rheum atoid arthritis b. H ypertrophic arthritis c Ostoporosis 3. Tum ors--Benign a Osteomas b. F ibrom as c. H em angiom a 4. M alignant & inelastic tum ors a. M ultiple myeloma b. C arcinom a o f P ro state c. C arcinom a o f th e th y ro id w ith m e tastasis d. Carcinom a o f the breast 5. M echanical a. Acute sprains b. C hronic sprains c. D eg en eratio n o f d isc (1 ) w ith ru p tu re o f disc (2 ) w ith instability d. Congenital anom alies (1 ) Spondylolisthesis 6. M alingering A lthough usually considered lightly, in fection. both specific and non-specific, still occurs in the spine, as elsew here in the body, a t any age. M ost infections of the spine are subtle an d do not show th e ex pected constitutional sym ptom s until well established. T o keep them in m ind is the quickest w ay to establish a diagnosis. One m ust also keep in m ind th a t the X -ray signs m ay be slow to develop--up to tw o o r three m onths a fter the onset o f sym ptom s. Bed rest, im mobilization of the spine an d the proper anti-bacterial ag en t is th e tre a tm e n t Non-specific infections w ill ordinarily re spond prom ptly and heal w ith overgrow th o f bone a t the m argins o f th e involved interspace. T uberculosis w ill b e slow er to respond and ultim ate surgery m ay be neces sary (fusion) to ensure and m aintain a r rest o f the disease. M etals industries A s fo r diseases rheum atoid arth ritis in volving th e spine -usually begins in th e low back and sacro-iliac joints and eventually in v o k e - m o st o t th e -pine, ending in th e so called poker spine o r bam boo spine. T h e onset is slow w ith vague aches across the Ion* b a c k ; a s th e d isea se p rogresses, th e re can b e rad iatin g pains in th e leg o r legs resem bling th e pain o f a ru p tu red disc. T h e tendency to use and abuse the term "hy pertrophic arth ritis" o r osteo-arthritis is ever w ith us. T h is is understandable since bony overgrow ths at the vertebral body m argins can and do occur frequently. T he m ere presence of spurs, however, docs not indi cate the existence of the disease, namely hypertrophic arth ritis. In ju ry to one level in the spine frequently results in bony spur ring a t th a t level, yet to labei this hypertrr.phic a rth ritis w ould be inaccurate. W e should attem pt then to la$e a diag nosis on th e m a tin g agent, rath er than the af'erm a th . Such reasoning will allow us to reserve th e term hypertrophic arthritis to - the recognized entity fo r which it wa* intended. W hen the entire spine becomes involved in a degenerating process w ith pro gressive pain a n d restriction o f spine m o tion, certainly th e diagnosis o t hypertrophic ftr ir itis can be applied. T his is and m u: be a progressive disease, jut a it if in the knee, hips and hands which arc fre q u en tly asso cia ted w ith it. T h e r e is tut treatm ent to arrest the process end allei^otion o f sym p to m s is difficult. I n o r d e r to u n d e rs ta n d b ack pain, it i n ec essary to s a y so m eth in g cm th e m e ch an ics ox th e spine. T h e spinal colum n can best be described as a flexible role- It provides us w ith the means o f rem aining in the upright position. If it w ere a rigid straig h t pole, it w ould be m ore difficult to resist forces th a t tend to tip the body; so nature has provided curves in the spinal column th a t can resist bending forces. These curves are developed in orderly and regu la r sequence. T h e first curvature encountered is that w hich allow s the head to be held upw ard form ing a convexity forw ard (C er vical L o rd o sis). T h e n e x t is a curve in the lum bar area, w hich perm its a sitting position (L u m b ar L ordosis). A s standing is attem pted, the pelvis in clines fo rw a rd fo r balan ce; this affects all the existing curves, and tends to flatten an d broaden them . Kor the spinal colum n to rem ain upright, it m ust be held over the line ox g ra v ity . T h e m uscles o f th e spine and abdomen constantly adjust w here needed, to serve as the active lalnnccrs to move the flexible spinal column over th e line of gravity. These are th e factors w hich give the spine its w ide range o f stability. O f all the soft tissues o f the spine, the inter vertebral disc carries the g reatest re sponsibility fo r the preservation o f the func tion o f the spinal column. T he d k c is located between the s e p a r a te v e r t e b r a e . S pe cial em phasis is given to the disc liecause norm al deterioration, so common to this structure, leads to mechanical derangem ents which produce backache. A lso, thU is one o f the m any bug-a-boos in industrial m edi cine. It is not m eant to exclude th e o th er structures of th e pine capable o f causing back pain, but rather to point out the com m onest condition: the so called "R uptured D isc." A norm al disc reaches its greatest develop m ent a t the end of the second decade o f life. T he aging process begins a fte r the econd d ecad e a n d is a com plex, little u n d e r stood process. D isc disease is found w ith th e g reatest frequency in the io u rth an d fifth lum bar area. A dise protrusion o r ru p tu re ts caused by a break through the ligam ent th a t h old th e dise in its n o rm a l position I-etw een th e v erteb rae. N a r r o w in g o f th e disc space between the vertebrae, w ith asso ciated sym ptom s o f backache, a n d fiber in the disc itself w hich arc painful under pressure are pretty much indicative of rup tured disc disease A m yelogram confirm s the diagnosis. T he second ot the industrial m edical prob lem s is the ac u te back sp rain . A sp rain , by definition, is a te ar o f the supporting stru c tures in the spine--nam ely th e ligam ents, capsules and fascial planes. T e ars can occur only when movements have exceeded the norm al range. T w o common causes a re : f l ) T h e sudden forw ard flexion as m ight occur in a fall w hen a person slips on ice or a greasy area. (2 ) A sudden increased load w hile liftin g in a stooped position, as m ight occur when holding one end o f a beam that is dropped. O ften th is is re ferre d to a a sprung back. E xam ination w ithin 4S h ours w ill rev eal protective m u de spaem. painful pressure point and m otions o f the spine lim ited in all }Ci2 X c t m a l S a f e t y C ongress directions, particularly th a t m otion which occurred during: th e in ju ry . X -ra y films w ill be negative unless th e force o f in ju ry was to caue fracture o r dislocation, in which case the diagnosis is conclusive. M ost sprains will heal in th ree w eeks if protected against vvce*sive motion an d ex trem e p o s iti o n T h e prognosis is pood to r retu rn to previous occupation. A s fo r chronic recurrent low back sprain, the causes vary fretn occupational 10 poor posture. The history o f th e patient is help ful in that the straining incident m ay be suspected by him . T h e disco m fo rt is slow in onset. prccTC'five, a g g ra v a te d by fatigue, and m ore or less relieved by re st, heat and masace. Spina] m ovem ents o rdinarily re main normal, except w hen the strained area is placed under fu rth e r tension, then the pain is reproduced a n d th e strain is localized. X -ray examination m ay show calcifications at the insertion o r o rig in o f th e particu lar ligam ents strained. T h e tre atm en t os this group of baekachcs is th e elim ination o f the strain producing act. C ontracted muscles and ligaments should b e stretched ar.d a support applied to the w eak area. T o summarize. degeneration of th e disc Is physiological, begins rig h t a f t e r the age of twenty, shows increased incidence am ong heavy workers. U associated w ith injury, aggravated by dam pness, d rafts and infec tion It can be extensive w ithout back pain, hut tnoM o ite n it is a s s o c ia te d w ith back pain w hich l'corns c h ro n ic a n d continuous. Leg pain and fo r sciatica is frequently an added ymptom in th is g roup an d the h istory of back and leg trouble often extends for months to tears. S ince degeneration i* lik e ly to l>e p ro sre-siv e once it h a s s ta rte d , it is u n d ertandable that the clinical p ic tu re can change from tim e to time. F u rth erm o re, w e know from experience that sym ptom s ran be re lieved at any stage, eith er spontaneously or by treatm ent. It is assum ed th a t natu re will repair the abnorm al tissues by scarring, but th e length o f tim e n e c e ss a ry f o r healin g unknown. W e m ust accept that w e do not know* th e n atu ral co u rse o f re g e n e ra tio n and therefore cannot give accurate prognosis. It is for this reason th a t varied opinion will be given in the sam e e a se : each ex am in er m ust base an opinion on h is ow n experience. W hile the onset o f back pain in early 6 degeneration m ay be variable, m inor strains will start the first attack. T he pain across th e low* b ac k com es o n a f t e r a su d d en stoop, sustained stoop, lifting. long autom obile trip, sudden tw ist o r slip, o r m ay follow a fall. Characteristically th e pain begins some hours a fte r these incidents, w hich tends to rule out ligam entous strain. T h e pain th e n builds in intensity fo r several days and slowly sub sides in tw o to th re e w eeks. Such attacks oeeur once o r twice a year, occasionally re quire bed re ft and seldom lead to medical consultation. Each succeeding year the a t tacks occur m ore frequently, are of greater intensity and last longer: th e patient be come concerned and seeks medical aid. Exam ination a t this time U often of little help, except to localize tenderness in the low back, X -rays will show, at the most, narrow ing o f th e disc space, but w in be helpful to rule out diseases involving the bone. T reatm ent a t this time is of real value. Tt is th e tim e to sh o w th e p atien t how to u se the* b ac k p ro p e rly a n d avoid m e chanical results. Support m ay be helpful to Safeguard against strains, at least until ex er cises have established stronger than norma! active support. M anipulations a re to be avoided an d no know n d ru g th e ra p y will hasten or assure the nrre*t of the degenera tive disease. O peration fo r the relief o : pain^ in a ruptured disc has a definite place in the treatm ent of backache. T he indications arc c le a r: ( 1 ) I f d em anded by th e p atien t t* r th e relief ox pain, o r ( 2 ) W h e n n eu ro lo g ic signs arc severe o r progressive. T he opera tion is done by either an orthopedic surgeon or a neurosurgeon, depending m ainly on w hich is av ailab le an an y g iv en co m m u n ity Before concluding, a few suggestions re garding m alingering m ay be in o rd er since it 1 encountered in in d u strial m e d ical p ractice. Inconsistency o f findings, w idespread tender ness. lack o f fit between objective and sub jective signs and symptoms and so on. should certainly put one on guard. T he benefit of the doubt, how ever, should dem and a re peated exam ination and additional corrohntive evidence. V ariations in straight leg raising from one body position lo another, changes in signs b y d istractin g the atten tion o f the patient, and duplication o f tests in reverse ord er will help pinpoint presence o r absence o f definite signs. O In some cafes m alingering is difficult to detect because some persons a re quite a p prehensive and likely to exaggerate. I know of no rules to apply to detect the M etals Industries m alingerer except for the aforem entioned tests. A definite diagnosis should be m ade on the presence o f the objective and sub jectiv e symptoms. By M. L. WALKER District Manager, Pennsylvania Manufacturers* Association Casualty Insurance Co., Pittsburgh, Pa. T he title o f this could well be-- "O h. m y aching b ack!" Sacks aid u* to sit dow n, stan d up. He dow n and in o u r w a lk in g an d everyday activities. T hey are one o f the intricate mechanisms of our body. T h eir c a re is m ost im p o rtan t to us a n d 'ur e m ployers. In th e hum an back arc centered m ost of the nerves and muscles and one o f the most complicated bone structures in the lodv. Hack injuries are the to rtu re o f the innocent.^ the w eakness o f race, an d th e refu g e of the m alingerer. Hack injuricc fall into several categories: traum a, strain, falls and aggravation. T hose caused by traum a usually m anifest them selves by bruises, discoloration, cuts o r fracture. S train accidents are usually caused by im proper lifting or overtaxing of an individt&ars firengeth. a n d re su lt in d a m ag e o r injuries to the muscle or nerve structure. T h e ir casual effects are h ard to m easure, an d it is in this a re a th a t m a lin g e rin g i most prevalent. W e have all seen the dem on stration of the safety engineer w ho lift a brick by m eant of a fragile string. A sudden je rk o r jvmk w ill b reak the strin g and not m en raise the brick. On the other hand, a slrrw even pull w ill raise th e b ric k a n d leave the string intact. Legislation mi rules governing back in ju ries and lifting a re observed only by tw o states, and in those states the law s touch ftn only lifting b y fem ales. O ne state p ro hibits objects over 25 pounds being lifted by fem ales, the other, objects over 35 pound. K xtrn help or m echanical devices m ust be given. T h ere are no know n law* covering m ale employees. In many industrial injuries, there are scheduled benefits given by various states which involve a certain num ber o f weeks* com pensation fo r each type o f loss o f m em b er. o r p ercen tag e th e re o f. T h e re a r e n, rhcdules of benefits fo r back injuries. T h e w orkm en's com pensation ra te tim es the num ber of weeks disability, plus medical care, determine, the cost of each case. Hack injuries arc uu:dly rated on either a tem p orary total disability or a perm anent total disability. In rare instances, w hen an em ployee is ju d g e d able to d o som e w o rk , a p artial di-ability involving a p ercentage o f th e w eekly rate is aerccd upon. M ost baek injuries usually result in short disabilities. T h is ty p e r>i case develops f r o m a m ild hack sprain o f th e mucle*. In Pennsylvania, for instance, in the y ea r o f 1900. 6.653 back cases w ere aw arded an average o f $420 per case in com pensa tion. M ost of these w ere tem porary to tal in ju ries with an average aw ard of $325. F o r the same year. Illinois reported a total o f 5,476 back in ju ries w ith an average aw ard on tem /c*rary to tal / $ 4 6 0 ; N e w J e r s e y ?bow ed $501 and N ew Y o rk $714. I 'fcase l*e.tr in m ind th a t th e se costs a r e o n ly f o r th e eom f^nsatton benefits and do not take into account the national safety council av er age o f indirect costs-- from fo u r to seven time* that am ount paid out by the insurance com pany, in dam age to equipm ent, training of new em ployees and many o ther expenses. M any o f tlicr-c ca*cs Involve a g r e a t n u n jl-cr of trips to the doctor fo r strapping, d ia therm y and massage. In cases w here no tim e is involved, tim e spent during th e w orking day iu trip s to the doctor's office and em ployee inefficiency on returns to w ork, in volve the em ployer in a g reat deal o f exjen-c. T h e rru rc seriou s b a c k cases a re breath-taking in their costs. A young mar. liccumcs a perm anent total dL abiltty ease fo r his life expectancy. T he costs can well run into m any thousands of dollars. T h e rep o rt ing states show that, in Pennsylvania, 35 w ere perm anent total disabilities w ith an av erag e aw a rd o f $12,165 and 20 w e re fatals w ith an av erag e aw ard o f $11,285. Illinois does n o t show* se p a ra te a w a rd s f o r b ack in ju ries o f different severity, but it doe* 7