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Worker Compensation in Commercial Drivers Injury Prevention and Case Management Brian Harrison, M.D. April 2014

Worker Compensation in Commercial Drivers Injury Prevention and Case Management Brian Harrison, M.D. April 2014. Worker Comp (WC) in Commercial Drivers (CD)- Concepts. DOT Regulations reduce major WC Cases BUT: DOT Regulations may increase Lost Workdays in both major and minor cases

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Worker Compensation in Commercial Drivers Injury Prevention and Case Management Brian Harrison, M.D. April 2014

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  1. Worker Compensation in Commercial Drivers Injury Prevention and Case Management Brian Harrison, M.D. April 2014

  2. Worker Comp (WC) in Commercial Drivers (CD)- Concepts • DOT Regulations reduce major WC Cases BUT: • DOT Regulations may increase Lost Workdays in both major and minor cases • Employers can improve primary prevention of CD WC Cases through • Safe work practices while performing non-driving duty • Truck driver wellness • Safe use of all medications (Rx and OTC) • Case managers and adjusters should attend to all potential barriers to RTW in WC Cases • Use Worker Rehab Program more liberally

  3. Commercial Driving – Big Vehicles, Big Costs, Big Regulations Active Interstate Truck and Bus Companies (2004) 662,392 Between 2000 and 2010: truck and bus miles increased 20%; more carriers. Total Number of CDLs Issued 6-7 million FMCSA certification examinations for commercial motor vehicle drivers: 3-4 million exams annually Source: Motor Carrier Safety Progress Report (September, 2004) 3

  4. Professionals Drive More Safely Than We Do Vehicles Involved in non-Fatal injury per 100 Million Vehicle Miles Traveled by Vehicle Type

  5. They Live inRegulation Nation! • 1939 – First Regs: Interstate Commerce Commission “Good physical & mental health, no addiction to narcotics, no excessive use of alcohol.” • 1954 - Exams first required • 1970 – DOT created • 1999 - Ill bus driver liable for 22-death crash • 2000 – FMCSA created • 2005 – SAFE TEA – LU: Chief Medical Officer, Medical Review Board, Medical Expert Panels; National Registry of Certified Medical Examiners proposed • 2006 – Sleep Apnea: Joint Task Force Guidelines • 2014 – National Registry of Certified Medical Examiners • Trained, Tested, Certified

  6. Medical Standards (Regulations)of the FMCSA 13 standards directly related to medical requirements 4 standards are specific Medical examiner cannot interpret or alter Vision, Hearing, Epilepsy, Insulin use 9 standards are general (“likely to, which interferes,” or satisfied by Skill Performance Evaluation or OK’ed by MD) Medical examiner decides if medical condition affects driver’s ability to safely operate a CMV 6

  7. Joint Task Force Guidelines

  8. Joint Task Force Guidelines Two or more of the following: 1. Body mass index >35 kg/m2 2. Neck circumference in men >17” and in women 16” 3. Hypertension (new, uncontrolled, or unable to control with fewer than two medications)

  9. An Observational Study ofCommercial Drivers at risk of OSA And kept it off For 1 year!!! 49 (100%) Remained at BMI < 35 40% did, Average of 33# ! When given option to lose weight: 49 (56%) Seen for re-cert (10.6 mo average f/u) 613 (67%) No unaddressed OSA risk 915 Index Exams 87 (40%) At BMI < 35 in 3-9 months 219 (92%) To weight loss option 302 (33%) At risk for OSA, BMI ≥ 35 239 (79%) Available for f/u at 3-9 mo. 132 (60%) BMI still ≥ 35 at 3-9 months 1 (0.5%) To bariatric surgery 132 (100%) Proceeded to PSG and treatment (if indicated) 63 (21%) Lost to f/u 19 (7.5%) Out of service PSG (all positive)

  10. 22nd Anniversary of DOT Drug Tests The Omnibus Transportation Employee Testing Act became law on Oct. 28, 1991 Seems like a long time ago: Packers went 4-12 in 1991 with Coach Infante and QB Mike Tomczak Illegal drug use among transportation workers has since dropped 50% Fatal accidents from alcohol use by truck and bus drivers has since dropped 23%

  11. Large Truck Crash Causation StudyFMCSA 2007 Crashology - The science of Driving Safely

  12. Top 10 “Critical Reasons” (CR) for Truck Crashes(2 mechanical, 8 operator) Over loaded Making illegal maneuver Inadequate surveillance Traveling too fast for conditions Inattention Following too close Misjudgment of gap or other’s speed Stop required before crash External distraction Brake problems

  13. Top 10 “Associated Factors” (associated with CR)- Ranked By Frequency – And, 5th most important by Preventable Fraction • Brake problems • Traffic flow interruption (congestion, previous crash) • Prescription drug use • Traveling too fast for conditions • Unfamiliarity with roadway • Roadway problems • Required to stop before crash (traffic control device, crosswalk) 8. Over-the-counter drug use 9. Inadequate surveillance 10. Fatigue

  14. Trucking Cost Conundrum • Trucking Industry has improved safety, cut illegal drug use and alcohol misuse, and followed the rules • Costs should have gone down, but haven’t, in: • Health plan • Worker comp • Turnover • Compliance costs • Accident Liability

  15. Worker Comp Conundrum • Trucking companies pay higher worker comp premiums every year, even as large truck crash rates continue to drop. • Non-life threatening injuries suffered during non-driving duties make costs climb, despite fewer major injuries from crashes

  16. Transportation: Highest rates of Lost Time(258, up from 251 in 2011) 258, up from 251 in 2011

  17. Worker Comp Medical $ Climb

  18. As Has the Cost of All Benefits

  19. Worker’s Comp Conundrum – Root Causes Ill health and health-risking behavior underlie this conundrum, not a lack of driving safety Individuals with multiple health risks are more likely to submit claims Workers Comp medical care and wage indemnity costs are higher in high risk claimants Organizations with higher prevalence of health risks have higher Workers Comp costs And – Drivers must WORK more safely, not just DRIVE more safely!

  20. The burden of chronic illness in an aging workforce is a culprit you can seize!

  21. Low Risk will Mean Low CostHigh Risk Will Mean High Cost Overall Score: LowRisk(any 2 or fewer) Medium Risk(any 3 or 4) HighRisk(any 5 or more)

  22. Low Risk Will Mean Low Cost

  23. Obesity and All Medical Costs 77% higher average medical costs (obese vs. ideal) Treatment of obesity-related diseases accounted for 27% of the rise in inflation-adjusted per capita medical spending between 1987-2001 Thorp et al, “The impact of obesity on rising medical spending” Health Affairs 2004 supplement

  24. Personalized Care Drive Down Trucker Trauma byReducing Injuries Away From the Wheel

  25. Commercial Drivers Drive Safely, But Might Not Work Safely • Commercial driver safety improvements have cut large truck crashes to half of what they were 10 years ago, per million miles driven. • High rates of strains, sprains, bruises, and other conditions classified as musculoskeletal disorders (MSDS). • While lumping freight, climbing in and out of the cab, and managing the trailer.

  26. Get In And Out Safely! • Classic “3 points of contact” method. • When a 220 pound trucker jumps from the height of the cab to the ground, they drive 1,637 pounds of force throughout their body. • From the lowest step, a mere 16 inches from the ground, more than 300 pounds of force drives upward into the body. • Mechanical lifts such as powered lift gates pay for themselves. • Never climb onto cab tires to clear snow from windshields. • Flashlights to inspect the ground outside their cab door.

  27. Get Ergonomic Equipment • Cranking landing gear of the trailer pulling the fifth-wheel “kingpin”. • Air-ride seats and lumbar support. • Correctly use multi-position seats • Position the steering wheel directly in front of the driver’s seat.

  28. Motor Carriers Should Also Help Drivers to Handle Freight Safely • Drainage holes in the floors of refrigerated trailers. • Install handles at the rear of trailers that retract into the floor. • Position folding steps at the back of the trailer. • Retrofit power lift gates if needed. • Straps to dangle from the bottom of rollup trailer doors. • Help to handle unexpectedly heavy deliveries.

  29. Combat the Sitting Disease! • Weight goes up and fitness goes down • Diabetes and heart disease • Injuries happen more commonly • Prolonged sitting punctuated by short bursts of strenuous activity

  30. Off your seat & on your feet! • Get drivers to walk whenever they can • Take laps around the truck plaza after fueling • Walking 36 laps around a big rig equals 1 mile. • Walking 10 minutes 3 times a day briskly will help fitness just as much as walking once for 30 minutes does.

  31. Stop The Shake, Rattle, And Roll! Age-related degenerative lumbar disk disease develops simply as a part of life. It makes some less able to tolerate the whole body vibration they absorb from work vehicles. Get Vibration-Canceling Equipment.

  32. Prolonged Driving is Associated with Common Backache and Cervicalgia: But studies specific to Disc Degeneration (LSP and CSP DDD) do not show this correlation

  33. LSP DDD Has Not Shown Association With Driving In More Recent Studies • Twin study which used MRI (Videman, Lancet 2002 Nov 2; 360(9343):1369-74) found no effect of prolonged driving or occupational driving histories upon LSP DDD. • Some association was found with non-specific LBP, but not with LSP DDD. “Although driving may exacerbate symptoms of back problems, it does not damage the disc. Our inability to identify structural damage should be encouraging to those employed in occupations involving motorized vehicles and operation of heavy equipment.” • Earlier, the same author showed that MRI findings in professional racecar drivers are no different from controls (Videman, Clin Biomec 2000 Feb;15(2):83-6)

  34. Case Manager BOTLO: • Claimant says “I can't work d/t WC injury” (but then renews Fed Med card anyway!) • Wants to RTW but has non-WR obstacle that disqualifies Fed Med; hides in WC instead of treating own health (or retiring)! • Always ask to see Fed Med card; who signed it? • Resolve all RTW obstacles early in WC case, even if non-WR disqualifiers • Untreated OSA plus benzos or opiates can kill! • Employer might not realize the trucker can't drive if any restrictions (let them ride-along as trainer, or send to Worker Rehab Program)

  35. Worker RehabProgram

  36. Traumatic MSK Injuries Common to Commercial Drivers • Superior Labrum Ant-Post Tear (slipping and hanging from cab or trailer door) • Crushed hand - wind slamming trailer door • Contused lower leg - stepping between trailer threshold and dock plate

  37. Common to CD • Vertebral compression fx – stepping backward off trailer, hitting ground in sitting position (then concussion from hitting back of the head) • Trimalleolar ankle fx, tibial plateau fx – jumping off flatbed trailer • RC Tear – landing gear crank kicks back

  38. Non-Work Related Look Alikes • Wrist pain when steering – DJD, old scapholunate dissociation. • Carpal tunnel syndrome risk is NOT increased by the frequency of vibration which comes from the steering wheel • Neck pain while riding – age related spondylosis • Back pain with prolonged sitting – lumbar degenerative disc disease

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