July 2013

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Development and Application of an Occupational Injury and Illness Classification System

Systems of workplace injury and illness surveillance constitute a critical resource for management and reduction of occupational injuries and illnesses. They provide essential data which can be used to identify workplace problems, develop corrective strategies and thus prevent future injuries and illnesses.

To accomplish these goals effectively,surveillance systems must be constructed which capture the characteristics of workplace injuries in considerable detail.

To be of maximum value, such a system should be able to provide answers to such questions as which workplaces are the most hazardous, which injuries produce the most time lost from work and even what part of the body is injured most frequently.

This article describes the development of an exhaustive classification system by the Bureau of Labor Statistics of the United States Department of Labor (BLS). The system was developed to meet the needs of a variety of constituencies: state and federal policy analysts, safety and health researchers, employers, employee organizations, safety professionals, the insurance industry and others involved in promoting safety and health in the workplace.

The Classification System

Several criteria were established governing the individual code structures. The system must have a hierarchical arrangement to allow maximum flexibility for varied users of occupational injury and illness data. The system should be, to the extent possible, compatible with the International Classification of Diseases, of the WHO. The system should meet the needs of other government agencies involved in the safety and health arena. Finally, the system must be responsive to the differing traits of nonfatal and fatal cases.

The final version of the classification system consists of five case characteristic code structures, an occupational code structure and an industry code structure. The Standard Industrial Classification Manual is used to classify industry (OMB ), and the Bureau of the Census Alphabetical Index of Occupations for coding occupation (Bureau of the Census 1). The BLS Occupational Injury and Illness Classification System is used to code the following five characteristics:

• nature of injury or illness
• part of body affected
• event or exposure
• source of injury or illness
• secondary source of injury or illness.

Besides numerical codes that represent specific conditions or circumstances, each code structure includes aids to assist in identification and selection of the proper code. These aids include: definitions, rules of selection, descriptive paragraphs, alphabetical listings and edit criteria for each of the structures.

Nature of injury or illness codes

The nature of injury or illness code structure describes the principal physical characteristic of the worker’s injury or illness. This code serves as the basis for all other case classifications. Once the nature of injury or illness has been identified, the remaining four classifications represent the circumstances associated with that particular outcome. The classification structure for nature of injury of illness contains seven divisions:

• traumatic injuries and disorders
• systemic diseases or disorders
• infectious and parasitic diseases
• neoplasms, tumours and cancer
• symptoms, signs and ill-defined conditions
• other conditions or disorders
• multiple diseases, conditions or disorders.

Several situations required careful consideration when establishing rules to select codes in this division. Review of fatality cases revealed difficulties in coding certain types of fatal injuries. For example, fatal fractures usually involve direct or indirect mortal damage to a vital organ, such as the brain or spinal column. Specific coding categories and instructions were required to note the mortal damage associated with these types of injuries.

Part of body affected

The part of body affected classification structure specifies the part of the body which was directly affected by the injury or illness. When linked with the nature of injury or illness code, it provides a more complete picture of the damage incurred: amputated finger, lung cancer, fractured jaw. This structure consists of eight divisions:

• head
• neck, including throat
• trunk
• upper extremities
• lower extremities
• body systems
• multiple body parts
• other body parts.

Three issues surfaced during evaluation of redesign options for this theoretically simple and straightforward piece of the classification system. The first was the merit of coding external location (arm, trunk, leg) of the injury or illness versus the affected internal site (heart, lungs, brain).

Event or exposure

The event or exposure code structure describes the manner in which the injury or illness was inflicted or produced. The following eight divisions were created to identify the primary method of injury or exposure to a harmful substance or situation:

• contact with objects and equipment
• falls
• bodily reaction and exertion
• exposure to harmful substances or environments
• transportation accidents
• fires and explosions
• assaults and violent acts
• other events or exposures.

Injury-producing incidents are frequently composed of a series of events. To illustrate, consider what occurs in a traffic accident: A car hits a guard-rail, crosses the median strip and collides with a truck. The driver has several injuries from striking parts of the car and being struck by broken glass. If the micro-events—such as hitting the windshield or being struck by flying glass—were coded, the overall fact that the person was in a traffic accident could be missed.

In these multiple event instances, the BLS designated several occurrences to be considered primary events and to take precedence over other micro-events associated with them. These primary events included:

• assaults and violent acts
• transportation accidents
• fires
• explosions.

Source of injury or illness

The source of injury or illness classification code identifies the object, substance, bodily motion or exposure which directly produced or inflicted the injury or illness. If a worker is cut on the head by a falling brick, the brick is the source of injury. There is a direct relationship between the source and the nature of the injury or illness. If a worker slips on oil and falls to the floor, breaking an elbow, the fracture is produced by hitting the floor, so the floor is source of injury. This code system contains ten divisions:

• chemicals and chemical products
• containers
• furniture and fixtures
• machinery
• parts and materials
• persons, plants, animals and minerals
• structures and surfaces
• tools, instruments and equipment
• vehicles
• other sources.

Secondary source of injury or illness

The BLS and other data users recognized that the occupational injury and illness source classification structure captures the object that produced the injury or illness but sometimes fails to identify other important contributors to the event. In the previous system, for example, if a worker was struck by a piece of wood that flew off a jammed saw, the wood was the source of injury; the fact that a power saw was involved was lost. If a worker was burned by fire, the flame was selected as the source of injury; one could not also identify the source of the fire.

To make up for this potential loss of information, the BLS developed a secondary source of injury or illness which “identifies the object, substance, or person that generated the source or injury or illness or that contributed to the event or exposure”. Within the specific rules of selection for this code, the emphasis is on identifying the machines, tools, equipment or other energy-generating substances (such as flammable liquids) that are not identified through source classification. In the first example noted above, the power saw would be the secondary source, since it threw out the piece of wood. In the latter example, the substance that ignited (grease, gasoline and so on) would be named as the secondary source.

Source: ILO Encyclopaedia of Occupational Health & Safety

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Prevent lower back pain can continue with a productive and healthy life

Swivelling a sedentary lifestyle with a daily walk of 15 minutes, keeping a healthy weight, avoid staying long periods seated and inadequately loaded objects are just some of the recommendations that the Mexican Social Security Institute (IMSS) for those entitled to prevent the low back pain (LBP).

This discomfort in the lower back is the first cause of work disability of people, because it restricts their activities

It orthopaedist and traumatologist at Hospital of Traumatology and Orthopedics Lomas Verdes, Jorge Luis Campa Arellano, warned that LBP affects not only men and women in productive stage, but also at any stage in life is common to have some episode of pain.

However, he said that in some cases you need a surgical procedure to the possibility that it could be a tumor that produces pain or degenerative changes as in the elderly.

Arellano Campa explained that elderly people back pain is due to the narrowing of the spinal canal in the lower spine. This narrowing puts pressure on the spinal cord and affects the lower extremities which decreases strength and sensation in the legs.

Through family medical courses, Social Security provides ongoing training to detect it in a timely manner and other conditions in the primary care level and thus prevent the patient reaches the High Specialty Medical Units.

The orthopedist said that to make an accurate diagnosis of low back pain is necessary to resort to physical examination, as well as X-ray studies and, in some cases MRI to determine the source of pain and provide appropriate treatment.

At least 80 of every 100 adults in Mexico suffer from back pain or back pain at some point in their lives, and 30 of them suffers from a chronic, ongoing or recurrent orthopedic specialists say the Mexican Social Security Institute (IMSS) .

The Joshua Solano Rogelio Perez, head of Department of Orthopedics Joint of High Specialty Medical Unit (UMAE), Orthopaedic Hospital "Dr. Victorio de la Fuente Narváez" IMSS, explained that in our country it is estimated that half of the working population suffer some clinical picture of low back pain, of which 30% required for that cause disability, with an average of 12 days per case.

For column complications such as slippage of one vertebra on another (spondylolisthesis), which require surgery for placement of a prosthesis, Institute materials are used high technology design, made with titanium, corrosion element, as light as resistant, and is not rejected by the body, he said.

He said the surgery takes three to five hours and requires personal attention in the intensive care unit, where doctors and specialized nurses monitor breathing, heart and overall condition.

According to data from the World Health Organization (WHO), low back pain or pain that occurs in the lower back region, suffers from at some point in their life, 80% of the world population.

Source: IMSS

Para mas información relacionada o acerca de nuestra herramienta para mejorar los procesos administrativos hacia el Seguro Social vista nuestra pagina: sistemasheuristicos.com

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