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E5.1 Race Modifies Other Risk Factors for Knee-related Disability Among Women in the U.S. Army-Sulsky S, Mundt K, Bigelow C, Amoroso P

Objective: To identify occupational and sociodemographic determinants of knee-related disability discharge among women enlisted in the U.S. Army.

Methods: A case-control study of 692 women (n=232 nonwhite) discharged with knee-related disability and 2,080 (n=1,053 nonwhite) density-sampled controls, nested within the cohort of active duty enlisted women, 1980-1997. We used multiple logistic regression models to identify determinants of disability discharge, and stratified analyses to explore effect modification.

Results: In multivariable analyses, non-white women had half the risk of disability compared to whites (odds ratio (OR)=0.5, 95% CI (CI): 0.41, 0.60). Age, marital status, pay grade, and job category were also predictors of disability. In stratified analyses, ORs increased monotonically from 0.68 to 2.66 with increasing quintiles of age for white women (range: 17-60 years). Among non-whites, ORs stayed at 1.1 through the third, doubled in the fourth and increased to 2.4 in the fifth relative to the first quintile of age. Risk of disability was lower for married versus non-married women of both races. For both races, women in the highest pay grades had the lowest ORs vs. women in the lower grades (OR=0.25, CI: 0.12, 0.50 for whites and OR=0.14, CI: 0.06, 0.33 for nonwhites). Relative to support/administration, most job categories showed small increases in risk. ORs for white women were lower than ORs for nonwhite women for three of eight, and higher for two of eight categories.

Conclusions: For Army enlisted women, sociodemographic characteristics were stronger determinants of knee-related disability discharge than work exposures. Interactions between race and occupation suggest certain subgroups in the Army are at higher risk of disability than others; further understanding of these patterns may suggest effective interventions. To elucidate the role, if any, of job characteristics and/or work exposures in the development of knee-related disability, future research should be restricted to specific demographic subgroups.

E5.2 Toward a Typology of Dynamic and Hazardous Work Environments-Scharf T, Vaught C, Kidd P, Steiner L, Kowalski K, Wiehagen B, Cole H

Mining, fishing, logging, farming, construction, and transport: by many measures, these are the most hazardous industries in the U.S. Is there an underlying consistency to the fatality records? Or are the causes of occupational fatalities so unique to each industry that no common features can be determined? On the one hand, we see the same jobs ranking highest on fatalities year after year - suggesting a consistent pattern. On the other hand, the causes of these fatalities are quite specific to each of the jobs, e.g. falls from heights (construction), tractor overturns (agriculture), roof collapse (mining), etc. - suggesting unrelated mechanisms of injury.

We suggest that the common feature of these jobs is that the work environments are under constant change. The central thesis of this paper is that the requirement to continually adapt and respond to a dynamic and hazardous work environment places workers in these jobs at highest risk, regardless of the specifics of the hazards. What our observations suggest is that workers react in similar ways to changing hazardous situations, even though the specific hazards may be quite different.

Translated into a research hypothesis, what are the common components of change that can be identified across different dynamic and hazardous work environments? More specifically, since the hazards are very different, are there common qualities about the dynamic nature of the hazards that can be identified? Two questions are implied: 1) what makes an environment hazardous, and 2) what makes a work environment dynamic?

These questions are examined and discussed. A preliminary typology of dynamic and hazardous work environments is proposed, and the workload pressures on the workers are considered. The long-term goal of this effort is to improve the safety and efficacy of organizational-level work practices in dynamic and hazardous work environments.

E5.3 Indicators of Lift Readiness and Lift Posture in Patients With Low Back Pain-Dionne CP, Smith SS

The purposes of this study were to (a) determine clinical indicators for initiation of lifting by patients with low back pain (LBP); (b) determine the greatest lift force exerted by patients in three lift postures, comparing lift capacities with those of healthy subjects.

From a consecutive sample of 40 patients with LBP, 35 patients (18 men [aged X = 36.7 years, SD= 7.5], 17 women [aged X = 39.3 years, SD = 7.8]) passed the screening criteria and were randomly assigned to one of four groups in which repeated movements testing (RM) was compared separately and in combination with trunk extensor muscle endurance, sitting, and all protocols. Thirty-one patients confirmed lift readiness with a self-selected lift, then tested in three lift positions (self-selected, lordotic, and kyphotic).

To compare the four sets of lift criteria, a Chi-square test for independent samples was used. To determine predictive clinical indicators of lift readiness, positive predictive values were calculated. A repeated measures MANOVA was used to determine differences in lift force between patients and healthy subjects and among lift postures in patients.

No difference was found among the four sets of lift criteria used to confirm lift readiness. All four sets lift readiness criteria were positively predictive (PPV 3 75%). Thirty of 31 patients lifted, and successfully managed their symptoms. Isometric lift force capacity differed between healthy subjects and patients, but did not differ between lordotic and self-selected lift postures among patients.

RM testing may be the only criterion necessary because RM was as predictive as the other sets of lift readiness criteria. Patients with LBP may lift in either lordotic or self-selected postures.

E5.4 Fatal and Nonfatal Injuries Among Public Sector Employees-Windau JA, Drudi D

Almost 5,000 government workers lost their lives in the line of duty between 1992-98. About half of these deaths were to workers involved in protecting the public safety, such as police officers, firefighters, and military personnel. Although government workers in general have lower fatality rates than private sector workers, public safety workers are at increased risk of suffering a fatal injury at work. Other public sector industries with relatively large numbers of fatal injuries include health, education, and social services, highway construction, and public utilities.

This presentation will summarize data from the Bureau of Labor Statistics' Census of Fatal Occupational Injuries (CFOI). Working in collaboration with State agencies, the CFOI program uses diverse data sources to identify, verify, and profile fatal work injuries. In addition to the circumstances surrounding the fatal event, the presentation will discuss the level of government (Federal, State, Local), industry, occupation, and demographic characteristics of the fatally injured worker. Data on nonfatal injuries from the 25 States that provide public sector data in the Bureau's Survey of Occupational Injuries and Illnesses will also be summarized.

E5.5 Nonfatal Occupational Injuries Among African-American Women by Industry-Chen GX, Hendricks KJ

A previous study suggested that African-American women may have a higher rate of work-related injury that requires treatment in emergency department (EDs) and a higher proportion of employment in the healthcare industry compared to white women and women of other races. This study examined this type of injury by industry among African-American women using the National Electronic Injury Surveillance System, a national surveillance system for nonfatal work-related injuries treated in EDs in the U.S. Injury rates were calculated based on employment data from the Current Population Survey. In 1996, African-American women, aged 16 or older, were treated in U.S. EDs for an estimated 141,427 nonfatal work-related injuries (2.3/100 full-time equivalents (FTEs)). Of these injuries, 38% occurred in the healthcare industry, with retail trade accounting for 14% and manufacturing accounting for 12%. The healthcare industry experienced the highest injury rate (4.5/100 FTEs), followed by construction (2.9/100 FTEs) and retail trade (2.4/100 FTEs).

Injury patterns varied by industry in terms of source and event. For example, in healthcare, the leading injury source involved interactions with patients (i.e., lifting/moving patients) and the leading injury event was bodily reactions and exertions. Whereas, the leading source of injury for retail trade involved falls to the floor and the leading injury event was struck by or against objects. This study is consistent with the previous study and demonstrates that the higher injury rate among African-American women is due, at least in part, to the higher proportion of employment in the healthcare industry, an industry with the highest injury rate. The different injury patterns by industry underscores the need for targeted research and effective prevention efforts in high-risk industries.

E5.6 Occupational Fatalities Among Emergency Medical Services (EMS) Providers in the US: A Comprehensive Review of the 1992 to 1997 Data From CFOI, FARS and the National EMS Memorial Service-Maguire BJ, Hunting KL

Introduction: Emergency medical technicians and paramedics respond to automobile collisions, shootings, medical emergencies, hazardous material incidents and large-scale disasters. These emergency medical services (EMS) personnel are exposed to a wide variety of occupational hazards including: ambulance collisions, assaults, infectious disease, hearing loss, lower back injury, hazardous materials exposure, stress, extended work hours, and exposure to temperature extremes and shift rotation.

Objective: To determine the risk of occupational fatality among EMS personnel.

Design: Analysis of data for 1992 to 1997 from the Census of Fatal Occupational Injuries, the Fatal Accident Resorting System and the National EMS Memorial Service.

Result: 143 EMS occupational fatalities were recorded. Almost three quarters of the fatalities occurred in collisions. Ten of the decedents were struck by a moving vehicle. Nineteen died while working in the patient compartment. Ten of the fatalities occurred secondary to assault. Three individuals drowned during rescue attempts.

Conclusions: Improved driver training programs, ambulance engineering changes, scene safety training and changes to personnel scheduling policies may all be needed in order to reduce the fatality rate secondary to collisions. Additional research is needed to develop and evaluate other interventions to reduce the fatality rate. A national database must be established to identify risks and track changes secondary to planned interventions.

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