Industries and occupations at high risk for work-related homicide

25-Year fatal workplace suicide trends in North Carolina: 1992-2017

BACKGROUND

Suicide is a serious public health problem in the United States, but limited evidence is available investigating fatal suicides at work. There is a substantial need to characterize workplace suicides to inform suicide prevention interventions and target high-risk settings. This study aims to examine workplace suicide rates in North Carolina (NC) by worker characteristics, means of suicide used, and industry between 1992 and 2017.

METHODS

Fatal workplace suicides were identified from records of the NC Office of the Chief Medical Examiner system and the NC death certificate. Sex, age, race, ethnicity, class of worker, manner of death, and industry were abstracted. Crude and age-standardized homicide rates were calculated as the number of suicides that occurred at work divided by an estimate of worker-years (w-y). Rate ratios and 95% confidence intervals (CIs) were calculated, and trends over calendar time for fatal workplace suicides were examined overall and by industry.

RESULTS

81 suicides over 109,464,430 w-y were observed. Increased rates were observed in workers who were male, self-employed, and 65+ years old. Firearms were the most common means of death (63%) followed by hanging (16%). Gas service station workers experienced the highest fatal occupational suicide rate, 11.5 times (95% CI: 3.62-36.33) the overall fatal workplace suicide rate, followed by Justice, Public Order, and Safety workers at 3.23 times the overall rate (95% CI: 1.31-7.97).

CONCLUSION

Our findings identify industries and worker demographics that were vulnerable to workplace suicides. Targeted and tailored mitigation strategies for vulnerable industries and workers are recommended.

Twenty-five year occupational homicide mortality trends in North Carolina: 1992-2017

INTRODUCTION

Determining industry of decedents and victim-perpetrator relationships is crucial to inform and evaluate occupational homicide prevention strategies. In this study, we examine occupational homicide rates in North Carolina (NC) by victim characteristics, industry and victim-perpetrator relationship from 1992 to 2017.

METHODS

Occupational homicides were identified from records of the NC Office of the Chief Medical Examiner system and the NC death certificates. Sex, age, race, ethnicity, class of worker, manner of death, victim-perpetrator relationship and industry were abstracted. Crude and age-standardised homicide rates were calculated as the number of homicides that occurred at work divided by an estimate of worker-years (w-y). Rate ratios and 95% CIs were calculated, and trends over calendar time in occupational homicide rates were examined overall and by industry.

RESULTS

456 homicides over 111 573 049 w-y were observed. Occupational homicide rates decreased from 0.82 per 100 000 w-y for the period 1992-1995 to 0.21 per 100 000 w-y for the period 2011-2015, but increased to 0.32 per 100 000 w-y in the period 2016-2017. Fifty-five per cent (252) of homicides were perpetrated by strangers. Taxi drivers experienced an occupational homicide rate that was 110 times (95% CI 76.52 to 160.19) the overall occupational homicide rate in NC; however, this rate declined by 76.5% between 1992 and 2017. Disparities were observed among workers 65+ years old, racially and ethnically minoritised workers and self-employed workers.

CONCLUSION

Our findings identify industries and worker demographics that experienced high occupational homicide fatality rates. Targeted and tailored mitigation strategies among vulnerable industries and workers are recommended.

Work Related Assaults: The Impact on Victims

This pilot project employed a case study design consistent with that of Rice to describe the impact of violence on individuals who incurred a work related assault in 1992. Ten randomly selected subjects were interviewed from a population of 429 individuals reporting a work related assault that resulted in a wage loss claim. Half of the subjects had received permanency ratings, thought to be a measure of injury severity. The study hypothesis, stating the impact of the assault (e.g., pain and suffering, decrease in functioning) years after a work related assault was associated with the severity of the injury (i.e., permanency rating), was not supported by the data. However, individuals' health and quality of life 4 years after the assault were affected significantly and resulted in job changes, chronic pain, changes in functional status, and depression. The new hypothesis resulting from this study is employer support and mental health intervention immediately after an assault may prevent employee job changes and decrease mental health sequelae.

Convenient Victims - A Research Note

During 1993-1996, the Massachusetts Executive Office of Public Safety participated in a national study of convenience store robbery. In order to understand victim perceptions and actions during these crimes, personal semi-structured interviews were conducted during with 20 employees robbed in Boston. Most subjects were owners or managers, and tended to be entrenched in the convenience store industry. The inter view instrument contained over 80 items, and solicited a range of infor mation on the criminal event, as well as post-victimization experiences.

Harm to Those Who Serve: Effects of Direct and Vicarious Customer-Initiated Workplace Aggression

While there is a large body of research on the effects of being a direct target of workplace aggression, there is far less research on the vicarious experience of aggression at work, despite the fact that more people experience workplace aggression vicariously (i.e., observe it or hear about it) than they do directly. In this study, we develop and test a model of the effects of direct and vicarious exposure to aggression that is directed at employees by customers. Structural equation modeling provided support for the proposed model, in which direct and vicarious workplace aggression influences the perceived risk of future workplace aggression, which in turn affects organizational attachment (affective commitment and turnover intentions) and individual well-being (psychological and physical). Conceptual research and policy implications are discussed.

Area-based socioeconomic characteristics of industries at high risk for violence in the workplace

This study examined socioeconomic factors associated with the presence of workplaces belonging to industries reported to be at high risk for worker homicide. The proportion of 2004 North Carolina workplaces in high-risk industries was computed following spatial linkage of individual workplaces to 2000 United States Census Block Groups (n = 3,925). Thirty census-derived socioeconomic variables (selected a priori as potentially predictive of violence) were summarized using exploratory factor analysis into poverty/deprivation, human/economic capital, and transience/instability. Multinomial logistic regression models indicate associations between higher proportion of workplaces belonging to high-risk industries and Block Groups with more poverty/deprivation or transience/instability and less human/economic capital. The relationship between human/economic capital and Block Groups proportion of high-risk industry workplaces was modified by levels of transience/instability. Community characteristics therefore contribute to the potential for workplace violence, and future research should continue to understand the relationship between social context and workplace violence risk.

Employee and customer injury during violent crimes in retail and service businesses

OBJECTIVES

We sought to compare the frequency and risk factors for employees and customers injured during crimes in retail (convenience, grocery, and liquor stores) and service businesses (bars, restaurants, motels).

METHODS

A total of 827 retail and service businesses in Los Angeles were randomly selected. Police crime reports (n=2029) from violent crimes that occurred in these businesses from January 1996 through June 2001 were individually reviewed to determine whether a customer or an employee was injured and to collect study variables.

RESULTS

A customer injury was 31% more likely (95% confidence interval [CI]=1.11, 1.51) than an employee injury during a violent crime. Customer injury was more frequent than employee injury during violent crimes in bars, restaurants, convenience stores, and motels but less likely in grocery or liquor stores. Injury risk was increased for both employees and customers when resisting the perpetrator and when the perpetrator was suspected of using alcohol. Customers had an increased risk for injury during crimes that occurred outside (relative risk [RR]=2.01; 95% CI=1.57, 2.58) and at night (RR=1.79; 95% CI=1.40, 2.29).

CONCLUSIONS

Security programs should be designed to protect customers as well as employees.

An epidemiological study of the magnitude and consequences of work related violence: the Minnesota Nurses' Study

AIMS

To identify the magnitude of and potential risk factors for violence within a major occupational population.

METHODS

Comprehensive surveys were sent to 6300 Minnesota licensed registered (RNs) and practical (LPNs) nurses to collect data on physical and non-physical violence for the prior 12 months. Re-weighting enabled adjustment for potential biases associated with non-response, accounting for unknown eligibility.

RESULTS

From the 78% responding, combined with non-response rate information, respective adjusted rates per 100 persons per year (95% CI) for physical and non-physical violence were 13.2 (12.2 to 14.3) and 38.8 (37.4 to 40.4); assault rates were increased, respectively, for LPNs versus RNs (16.4 and 12.0) and males versus females (19.4 and 12.9). Perpetrators of physical and non-physical events were patients/clients (97% and 67%, respectively). Consequences appeared greater for non-physical than physical violence. Multivariate modelling identified increased rates for both physical and non-physical violence for working: in a nursing home/long term care facility; in intensive care, psychiatric/behavioural or emergency departments; and with geriatric patients.

CONCLUSIONS

Results show that non-fatal physical assault and non-physical forms of violence, and relevant consequences, are frequent among both RNs and LPNs; such violence is mostly perpetrated by patients or clients; and certain environmental factors appear to affect the risk of violence. This serves as the basis for further analytical studies that can enable the development of appropriate prevention and control efforts.

Compliance to a Workplace Violence Prevention Program in small businesses

BACKGROUND

Robberies are the leading motive for work-related homicide and assault. Interventions to reduce robberies and related injuries have been limited to convenience stores, and evaluations have not addressed compliance as a factor in program effectiveness.

SETTING/PARTICIPANTS

A total of 314 intervention and 96 control businesses were included in this intervention evaluation.

INTERVENTION

The Workplace Violence Prevention Program provided a customized robbery and violence prevention program to a stratified random sample of 314 small, high-risk businesses in Los Angeles City. An additional 96 comparison businesses did not receive the intervention. The intervention included individualized consultation, printed materials, training brochures, and a video. Interventions were conducted from August 1997 through August 2000.

MAIN OUTCOME MEASURES

For both intervention and comparison businesses, a comprehensive security program assessment was conducted at baseline and at 3- and 12-month follow-up visits. Crime rates in intervention and comparison businesses were examined for 12 months pre- and post-intervention with the use of police reports.

RESULTS

By the second follow-up visit, compliance to the intervention program was significant for each program component. Employee training was the most frequently implemented intervention component. Neighborhood crime level, primary language spoken by the business owner, and the number of employees were all related to compliance. Although crime rates generally increased for all businesses from the pre- to post-intervention periods, businesses with high compliance to the program experienced a decrease in overall violent crime and robbery.

CONCLUSIONS

Participating businesses were willing to voluntarily implement components of the intervention program, and greater implementation was related to reductions in robbery and violent crime.

Workplace Violence in Oregon: An Analysis Using Workers???Compensation Claims from 1990???1997

One of the most serious occupational problems in the workplace is the occurrence of violent assaults. This study examined 2028 workers' compensation claims of workplace violence from Oregon between 1990 and 1997, and used Current Population Survey data for risk analysis. The rate of workplace violence was 1.86 per 10,000 employees annually (95% confidence interval, 1.78-1.94), with females and workers under 35 years of age experiencing the most violence. The average claim resulted in approximately 40 days of indemnity and $6200 in costs. Workers on evening and night shifts had significantly higher rates of being victims of violence, as did those working on weekends. Preventative interventions should be targeted at younger workers and those with less tenure. Special measures should be focused on ensuring the safety of evening/night-shift workers and weekend employees.

Risk factors for physical assault. State-managed workers' compensation experience

BACKGROUND

The estimation of incidence and evaluation of risk factors associated with nonfatal occupational assault injuries have rarely been documented in a statewide population context. A state-managed workers' compensation system can provide estimates of incidence of such injuries and allow evaluation of risk factors.

METHODS

Using claims data from the state-managed West Virginia Workers' Compensation, the incidence rates of workplace injuries resulting from physical assault were estimated for the period 1997-1999. Data on potential risk factors were obtained from the claim-related electronic data files, and the risk associated with each factor was assessed using proportional injury ratios (PIRs).

RESULTS

During the study period, 2122 compensated injuries were associated with workplace violence. The incidence of assault injuries was 108.2 cases per 100,000 employee years. Women sustained a higher incidence than men. Healthcare workers, public safety workers, and teachers accounted for almost 75% of all assault injuries. Workers in these occupations also differed from each other with regard to seasonality and timing of assault, perpetrator-victim relationship, and types of injury. Evidence of gender-occupation interaction indicated higher risk of assault injury in men compared to women across the three leading occupations. Nighttime work shifts were associated with greater risk of assault for female healthcare workers (PIR=1.8; 95% confidence interval, 1.09-2.87).

CONCLUSIONS

The healthcare sector sustained the bulk of assault injuries in West Virginia. Although the majority of healthcare-sector employees were women, the risk of assault injuries was higher in male employees. Risk factors and injury characteristics identified in this study, particularly for three high-risk occupations, should help develop strategies for preventing workplace violence. Protecting female healthcare workers on night-shift duty, especially in nursing home settings, appears to be an important target for intervention.

Violent events and security programs in California Emergency Departments before and after the 1993 Hospital Security Act

INTRODUCTION

Health care workers have long been recognized as having a high risk of work-related assault. In response to a growing threat of violence in hospitals, California implemented the Hospital Security Act (AB508) in 1993. This study compares surveys of emergency nurses before and after implementation of AB508.

METHODS

In 1990, the CAL/ENA surveyed emergency departments in California to enumerate violent events and describe security programs. Using the CAL/ENA membership directory, hospitals were resurveyed in 2000 to identify changes from the original survey. Surveys were mailed to the ED nurse manager or equivalent. Survey responses were anonymous.

RESULTS

Most hospitals reported fewer violent episodes after the implementation of AB508. However, 32% of hospitals reported that 5 or more verbal threats occurred monthly, and 5% reported that 5 or more violent injuries occurred monthly. Overall, hospitals reported improvements in security programs. The most notable increase was in employee training, which rose from 34% to 95.6% of reporting hospitals. However, almost a quarter of hospitals reported not having general violence prevention policies, and many believed that security personnel were inadequate.

DISCUSSION

Although results reported here cannot be directly attributed to AB508, the increase in security program components suggests that hospitals are responding positively to reduce violence. The high prevalence of threats and violent events reported indicates a persistent risk of violence against health care workers.

Predictors and outcomes of workplace violence and aggression

The authors developed and assessed the psychometric properties of an instrument measuring risk for workplace violence and expanded a model linking (a) risk and experience of violence and aggression from the public and (b) experience of aggression from coworkers to emotional well-being, psychosomatic well-being, affective commitment, and turnover intentions. Using data from 254 employees representing 71 different occupations, the measure demonstrated acceptable within-occupation and 1-month test-retest reliability. The data supported the model and showed that public-initiated violence and aggression and coworker-initiated aggression were differentially associated with personal and organizational outcomes.

Alcohol use and workplace aggression: an examination of perpetration and victimization

PURPOSE

The purpose of the present investigation was to examine the relationship between victimization from and perpetration of workplace aggression between coworkers and frequency of alcohol use during the last year.

METHODS

Civilian employees (N = 300) selected from the US population were interviewed over the telephone with psychometrically sound measures of workplace aggression and alcohol use frequency during the last year. Hierarchical regression analyses were used to examine the relationship between alcohol use and workplace aggression, after controlling for sociodemographic variables.

RESULTS

Both percentage of days of any drinking and percentage of days of heavy drinking during the last year were positively related to (a) victimization from verbal and physical aggression at work and (b) perpetration of verbal and physical aggression at work.

IMPLICATIONS

Consistent with research studies spanning the sociobehavioral literature, the present investigation found alcohol use was associated with perpetration of and victimization from verbal and physical workplace aggression. Although the study established an association exists between alcohol use and workplace aggression, future investigations should attempt to understand employee alcohol use in the context of a multifaceted model that includes other likely factors that contribute to the incidence of aggressive behavior on the job.

Critical incident stress debriefing: a health promotion model for workplace violence

PURPOSE

To view the global impact of violence as a critical incident.

DATA SOURCES

Published literature, author's experience.

CONCLUSIONS

Psychiatric nurses can use the critical incident stress debriefing protocol to minimize adverse outcomes after a traumatic event. Workplace violence threatens the safety and well-being of nurses. Psychiatric nurses are more likely to encounter workplace violence than nurses in other settings and must prepare themselves using proactive health-promoting activities, for example the critical incident stress debriefing (CISD) model. This health-promotion model provides immediate emotional support and education about normal stress reactions, and may reduce the risk of chronic and disabling emotional and physical consequences.

The role of surveillance and evaluation research in the reduction of violence against workers

BACKGROUND

Violence against workers is garnering increased attention as awareness grows of the toll violent events have on workers and work environments.

METHODS

In this review, we summarize information about surveillance of violent events in the workplace and summarize evaluations of intervention programs to reduce such violence. We describe surveillance programs that nationally collect data, and we compare some data. We summarize two systematic studies of workplace violence-prevention programs: The first study examined evaluations of the Crime Prevention Through Environmental Design approach to prevention, and the second examined evaluations of behavioral and administrative interventions.

RESULTS

Reliable national data sets of worker homicides exist, but case identification and coding problems have yet to be solved. Although the number of workplace homicides has decreased since the mid-1990s, much less is known about the incidence of nonfatal events. The role that prevention programs have played in reducing workplace homicide remains largely unknown because so few evaluations have been conducted.

CONCLUSIONS

Information about effective methods to reduce violence against workers is needed. Research that evaluates existing prevention programs, especially efforts conducted in a collaborative manner, will be invaluable to shaping effective programs in the future.

Violence prevention at work. A business perspective

INTRODUCTION

The risk of workplace violence varies depending on the type and location of the business. Business managers should assess violence risk and develop a program based on the level of risk faced by their employees.

DISCUSSION

This assessment should include: (1) a review of workplace security and identification of positions with increased risk of exposure to violence, (2) risk reduction through environmental design and employee training, (3) development of a plan and identification of professional resources to respond to incidents should they occur, and (4) communication of the employer's commitment to providing a safe work environment for employees.

CONCLUSIONS

For most businesses, threat assessment and management comprise the cornerstone of a workplace violence-prevention program. Planning and preparation are key to workplace violence prevention.

Death by homicide in Italy, 1980-94: age and gender differences among victims

To investigate the role of sociodemographic factors in the risk of death by homicide in Italy, official statistics from 1980 to 1994 concerning death by homicide have been studied. Homicide rates increase from 1980 to 1994 for males and, to a much lesser extent, for females. Clear differences exist by age and gender, with rates peaking in both genders at young adult age (25-34) and men having five times higher rates than women. Mean rate in the general population is 1.98 per 100,000, one of the highest rates in the civilized world. These findings are mostly influenced by higher homicide rates for both males and females in southern regions, where cultural attitudes towards violence, linked to the greater diffusion of criminal organizations, greatly influence the risk of death by homicide. About 75% of homicides involve firearms: clearly in Italy availability of lethal weapons is a key factor in homicide. Intervention aimed at increasing community awareness of the causes and methods of prevention of violence (including the roles of substance abuse and social inequality) are needed if adequate policies are to be developed to reduce the risk of death by homicide. Differences in homicide rates across countries clearly indicate that homicide is a preventable cause of death.

Killed on the clock: a population-based study of workplace homicide, 1977-1991

BACKGROUND

This paper describes the epidemiology of workplace homicides in North Carolina, with emphasis on the circumstances.

METHODS

Workplace homicide victims were identified by and data were abstracted from the North Carolina medical examiner system.

RESULTS

Workplace homicide rates are highest for men, older and self-employed workers, minorities and specific occupations, especially taxi drivers. Robberies, mostly in retail settings, accounted for half of the cases, while 20% were known to involve disputes, the contexts of which differed by sex. Women were most likely to be killed by estranged partners.

CONCLUSIONS

Preventive strategies need to address the specific contexts in which workplace homicide occurs, such as retail and taxi robberies, and law enforcement officers interacting with suspects. A workplace response to domestic violence is also needed. Other areas for future research and intervention include environmental modifications, employee screening and training, and identifying more inclusive occupational data sources.

Violence in the workplace: new perspectives in forensic mental health services in the USA

BACKGROUND

This paper reviews current research on workplace violence in the USA and offers suggestions concerning the roles that mental health professionals with forensic expertise can play in this expanding field.

AIMS

To clarify the role of the mental health professional in evaluating issues related to workplace violence.

METHOD

Manual and computer literature searches were performed.

RESULTS

The incidence of reported workplace violence is on the rise and can be devastating beyond the immediate injury. Forensically oriented mental health professionals can assist companies by providing pre-employment screenings, fitness-for-duty evaluations and threat assessment by using the results of current research on potentially violent individuals.

CONCLUSIONS

With the growing interest in workplace violence come many opportunities for mental health professionals to assist companies in assessment, intervention and prevention.

Occupational fatalities in Israel

Occupational fatal injuries are a worldwide problem. Certain occupations pose a greater risk than others. The purpose of this study was to estimate the death rates from occupational injuries in Israel over a period of 30 months, and to examine the trends in the light of the large numbers of foreign workers who have been brought into the country in the last decade. Two-thirds of the occupational fatalities were in the construction business, mostly owing to falls from a height resulting in death from multiple trauma. About one-third of these victims were foreign workers, even though they comprise only 20% of the work force in this field. Negligible amounts of alcohol were detected in a number of cases. The construction industry is recognized worlwide as a high-risk area claiming many lives each year. The findings in this study suggest that too little attention is given to safety regulations in general, and particularly concerning foreign workers in Israel.

Comparison of fatal and severe nonfatal traumatic work-related injuries in Washington state

OBJECTIVE

To compare fatal and hospitalized nonfatal work-related traumatic injuries by occupation and cause.

METHODS

Fatal and hospitalized nonfatal injuries occurring from 1991-1995 were identified from Washington State workers' compensation claims data. Nonfatal injuries were classified as severe if they had at least one of the following criteria: a brain or spinal cord injury, an Injury Severity Score of >/=16, or were hospitalized for more than 7 days. The frequency and rate of fatal and severe nonfatal injuries were then described by industrial risk class and cause.

RESULTS

The study identified 335 fatal injuries and 4,405 hospitalized nonfatal injuries, of which 1,105 were classified as severe. Tree topping and pruning, carnival work, roofing, and metal siding and gutters risk classes had several severe nonfatal injuries, but few, if any, fatalities. Causes of fatal and severe nonfatal injuries were notably different for the roofing, restaurant, and orchard workers risk classes.

CONCLUSIONS

The inclusion of severe hospitalized injuries in occupational injury surveillance systems will provide a broader view of high-risk occupations and profile of injury causation with which to direct occupational injury prevention efforts.

Traumatic occupational fatalities in the retail industry, United States 1992-1996

BACKGROUND

Retail is a growing economic sector and employs an increasing number of the overall workforce, yet little is known about the incidence and characteristics of work-related deaths in the retail industry.

METHODS

Workplace deaths were examined using the Census of Fatal Occupational Injuries from 1992 through 1996. Occupational fatality rates were calculated by age, gender, and type of establishment, and characteristics of occupational deaths in the retail industry were compared to other industries.

RESULTS

Liquor stores had the highest work-related fatality rates in the retail industry. The two leading causes of death in the retail industry were violence (69.5%) and motor vehicle crashes (19.3%). Females, younger, minority, and foreign-born workers were more likely to be killed in retail than other industries. Deaths in the retail industry were more likely to be in small businesses, after normal business hours, and in urban settings.

DISCUSSION

Workers in the retail industry were at lower risk of most types of workplace deaths but had a markedly increased risk of violent death than workers in other industries.

Impact of traumatic events and organizational response. A study of bank robberies

This study explored how experiencing a traumatic event in the workplace affects employee physical health, mental health, personal functioning, and work performance. Post-event use of health care services and the effectiveness of critical incident stress debriefing sessions and other coping interventions were also examined. A retrospective self-report methodology and mailed survey were used with 141 employees of 42 different bank branches that had recently been robbed. The results found that most employees had multiple negative consequences from experiencing a bank robbery while at work. Psychological, physical, work, and personal areas were all affected by the robbery. Furthermore, more threatening incidents were associated with more severe consequences. Critical incident stress debriefing interventions delivered after robbery were rated as helpful by 78% of employees who attended. The implications for health care providers and organizations are discussed.

Use of national data systems for firearm-related injury surveillance

INTRODUCTION

The purpose of this paper is to provide an overview of federal data systems that report national data on fatal and nonfatal firearm-related injuries and associated risk factors and behaviors.

RESULTS

There are 13 federal data systems that provide useful information for national surveillance of firearm-related injuries in the United States. Each data system has useful features and limitations. Each provides a different methodologic approach to capture data for monitoring and characterizing firearm-related deaths or injuries, or behavioral risks associated with unintentional and violent events.

CONCLUSION

Although much progress has been made over the past decade to improve national data on firearm-related injuries, many gaps still remain. A mechanism is needed to better coordinate and integrate federal efforts to collect, analyze, and disseminate data on firearm-related injury.

Work-related physical assault

Violence in the workplace is a serious public health problem. Yet, to date, little has been documented relevant to non-fatal events associated with physical assault. The aim of the present study was to identify the magnitude of work-related physical assault in Minnesota and to identify potential risk factors; both fatal and non-fatal cases were included. Minnesota workers' compensation records, relevant to assault, were used to identify 712 cases involving more than three days of lost work time for 1992; six homicide cases were included. Assault rates were calculated by industry and occupation. Women had an assault rate twice that of men (51 versus 26 per 100,000 workers). Workers in industries of social services (340), health services (202), and transportation (914) had the highest rates of assault per 100,000 full-time employees. The fact that in addition to overall workers' compensation costs of $1.6 million, the average lost time for closed compensated cases was 54 days (median, 14 days) and time to reach maximum medical improvement for 44% of the cases reporting was 156 days (median, 83 days), indicates a major problem. The findings suggest that specific groups of workers are at risk for physical assault on the job. Further research is essential to identify specific risk factors that will enable the development of appropriate prevention strategies.

Washington State's late night retail worker crime protection regulation. Relationships with employer practices

Washington's late night retail worker crime protection regulation, enforced by the state Occupational Safety and Health Administration (OSHA) program, was intended to prevent injuries by deterring violent crimes. We investigated whether the regulation was associated with businesses' violence prevention activities. We surveyed 1,516 employers at high risk of robbery, including gas stations, groceries, hotels, restaurants, and taverns, in 1995 to determine whether they had violence prevention training programs for their employees (a requirement of the standard). Awareness of the regulation was low (4.4%). Employers covered by the regulation were more likely to have programs (Odds Ratio [OR] = 1.4), as were those aware of a regulation (OR = 3.4). State OSHA plan contact (an inspection or consultation) was also associated with having a program (OR = 1.9). Despite low awareness of the standard, results suggested that regulatory efforts to protect high-risk employees were associated with employers' robbery and crime prevention activities.

Motor vehicle fatalities in the United States construction industry

A death certificate-based surveillance system was used to identify 2144 work-related motor vehicle fatalities among civilian workers in the United States construction industry over the years 1980-92. Construction workers were twice as likely to be killed by a motor vehicle as the average worker, with an annual crude mortality rate of 2.3/100,000 workers. Injury prevention efforts in construction have had limited effect on motor vehicle-related deaths, with death rates falling by only 11% during the 13-year period, compared with 43% for falls, 54% for electrocutions and 48% for machinery. In all industries combined, motor vehicle fatality rates dropped by 47%. The largest proportion of motor vehicle deaths (40%) occurred among pedestrians, with construction accounting for more than one-fourth of all pedestrian deaths. A minimum of 54 (6%) of these pedestrian fatalities were flaggers or surveyors. Flaggers accounted for half the 34 pedestrian fatalities among women, compared with only 3% among men. Along with previous studies and recent trends in the amount and type of road construction, these results underscore the need for better traffic control management in construction work areas to reduce pedestrian fatalities. As the second leading cause of traumatic death in construction, with an annual average share of 15% of the total deaths, exceeded only by falls, prevention of work-related motor vehicle research should become a greater priority in the construction industry.

Incidence of non-fatal workplace assault injuries determined from employer's reports in California

Although fatal work-related assault assault injury rates are routinely reported in the United States, reports of non-fatal injuries are not routinely examined. Non-fatal workplace assault injuries can be reported through many agencies. One of the most common reporting mechanisms in California is the Employer's Report of Occupational Illness and Injury. Employer's Reports filed from October 1, 1994 through January 31, 1995 in the state of California were the source of workplace assault information for this study. All reports indicating an assault-related injury were identified and characterized by gender and occupation of the victim, type of assault and weapon used, and industry. Annual rates were determined based on the number of estimated annual reports and the civilian working population. The estimated annual rate of workplace assault injuries for California based on Employer's Reports is 72.9 per 100,000 workers, which is approximately 50 times the fatal rate. Rates differed by industry, with retail, hospital, transportation and police workers exhibiting the highest rates. Assaults were predominantly Type I, which involve criminal activity, and Type II, which involve an assault by a client, patient, or inmate. The rates of non-fatal work-related assault injury are much greater and have different characteristics than fatal injuries. These non-fatal injury patterns need to be considered when estimating the burden of assault injuries on businesses, and can help identify the most effective prevention strategies.

Workplace violence: preventive and interventive strategies

Violence is pervasive in the workplace. Homicides are a major cause of death among workers, but their impact and cost are considerably outweighed by the prevalence of near-misses, physical assaults, abusive behavior, and threats of violence, much of which remains unreported and unrecognized. Violence is not just a criminal justice problem nor just one involving aberrant behavior attributable to alcohol, drugs, or mental illness. It is often predictable and preventable. This article describes a plan for a coordinated effort by employers, workers, occupational health professionals, and other relevant specialists to develop and implement a coherent set of strategies for prevention and intervention.

Representativeness of trauma center registries for farm injury surveillance

Trauma center registries are the foundation for many surveillance systems that attempt to define the frequency and spectrum of various types of injuries. To assess the representativeness of trauma center-based farm injury surveillance, we evaluated data for 1986-1991 from the Marshfield Clinic/St Joseph's Hospital, a major trauma center located in Central Wisconsin. We compared the pattern of farm injuries seen in residents of the Marshfield Epidemiologic Surveillance Area (MESA), a geographically defined, population-based surveillance area, with those from outside MESA, a nonpopulation-based mix of primary care and referral patients typical of most trauma registries. The population-based and nonpopulation-based surveillance data suggested similar patterns with respect to seasonality, circumstances of injury, and source of injury. There were significant differences with respect to the body part injured, severity of injury, and selected aspects of acute medical care. While useful for many purposes, trauma center-based injury surveillance data should be interpreted cautiously.

Employee injuries and convenience store robberies in selected metropolitan areas

The number of robberies and robbery-related injuries to employees in convenience stores (C-stores) during 1992 or 1993 were estimated for selected metropolitan areas around Miami and Tampa, Florida; Atlanta, Georgia; Chicago, Illinois; Baltimore, Maryland; Boston, Massachusetts; Detroit, Michigan; Pittsburgh and Philadelphia, Pennsylvania; Charleston, Columbia, Greenville, and Spartanburg, South Carolina; and Arlington, Chesterfield, and Henrico counties, Virginia. Of the 1835 C-store robberies that occurred during 1992 or 1993 in all selected areas (excluding Atlanta and Chicago), there were 12 homicides of C-store employees; 219 nonfatal injuries of C-store employees; 1071 robberies in which there were no injuries but a weapon was used, displayed, or implied toward a C-store employee; and 132 robberies in which there was no injury and no weapon used, but an employee was struck, pushed, or shoved. Corresponding figures for the 238 robberies that occurred in Chicago during January to June 1993, and for which victim employment status was unknown (customer or employee) were three homicides, 53 nonfatal injuries, 120 attacks in which a weapon was used but there was no injury, and 57 attacks in which a person was struck, pushed, or shoved but there was no injury. The proportion of robberies that resulted in a homicide or injury to an employee varied among selected areas from .03 to .25. The proportion of homicides and injuries to an employee was. 14 or higher for target areas in Baltimore (.24), Detroit (.25), and Virginia (.14); the proportion to an employee or customer was .24 in Chicago. The conclusions from these data are that the risk of employee injury in C-store robberies was high in selected metropolitan areas. This underscores the need for effective robbery prevention programs to reduce injury. In addition, further research is needed to determine the effectiveness of prevention programs in the C-store industry and the application of these programs to other retail industries.

Occupational medicine for policing

A wide variety of medical conditions may be associated with police work. Unlike other occupations where a specific link can be traced between an exposure or an action and a specific pathology, the link between police work and disease is more problematic. The medical conditions which seem to be associated with police work are all conditions for which numerous other risk factors are identifiable. These risk factors include physical inactivity, poor nutritional practices, cigarette smoking and alcohol overuse. While it is undoubtedly desirable to minimise these risk factors in any patient population it is imperative, given the increased risks among police personnel, that aggressive attempts he undertaken to reduce cumulative risks. The physician plays an important part in this process by screening for specific conditions associated with police work, by educating the police officer about increased risks and by encouraging lifestyle choices that will reduce risk. It is also important that the physician encourages the use of personal protective equipment where appropriate. Periodic health assessment of police officers by a physician knowledgeable about police work should include education about the risks associated with the occupation and about methods to reduce risk. The physician should also enquire about exposures to violent or dangerous occurrences and should include assessment for possible emotional sequelae of such exposure. Operational procedures designed to reduce risk of violence and to improve police officer safety and survival are appropriate but are not in the normal realm of the physician. The question of whether a medical condition may be attributable to the occupation of policing is liable to produce strong emotions. When a police officer becomes ill there is an understandable desire on the part of other officers and, often, on the part of the public, to attempt to demonstrate a connection between the occupation and the illness. In line with this tendency several US states have policies in place to unquestioningly accept atherosclerotic heart disease among police officers as 'occupationally induced' for pension purposes. This leads to situations where the scientific evidence may be at odds with the political agenda of individuals and groups participating in the determination. This review will examine the evidence for a number of medical conditions. Specific occupational exposures, such as lead exposure among ballistics specialists, or chemical exposure among forensic laboratory workers are addressed elsewhere. Biohazard risks will be addressed in a later review.