New Report Highlights U.S. Medical Costs of Injuries

January 29, 2004

Injuries cost the United States an estimated $117 billion in medical expenses each year suggests a report released by the Centers for Disease Control and Prevention (CDC). This estimate represents approximately ten percent of total medical spending and is similar in magnitude to the medical costs associated with other leading public health concerns such as obesity and smoking.

“The medical costs associated with injuries are staggering but it’s just the tip of the iceberg,” said CDC Director Dr. Julie Gerberding. “When we add in productivity losses, decreased quality of life and the emotional toll that injuries and disabilities have on families, the problem is enormous.”

The report, “Medical Expenditures Attributable to Injuries in the United States, 2000” published in the January 16, 2004 issue of Morbidity and Mortality Weekly Report (MMWR), revealed that approximately 16 percent of the civilian, non-institutionalized population in the United States reported treatment for at least one injury in 2000. Falls accounted for at least 33 percent of the total medical cost of injuries and motor vehicle crashes accounted for at least 18 percent.

Dr. Sue Binder, director of the CDC Injury Prevention Center, said that communities can have a dramatic impact on reducing injuries by implementing prevention programs that work. “We know that seat belts and child safety seats and smoke alarms are effective. And we can prevent falls among older adults through exercise programs that include balance training, vision correction, and reduction of medications to the fewest number and doses, and environmental changes.”

Researchers noted that the actual cost of injuries is much greater than the estimate reported above, which is solely limited to medical costs. Lost wages, caregiver costs and non-medical costs resulting from injuries are likely to exceed the medical burden of injuries. A future CDC study will examine the costs of injuries from this broader perspective.

This report can be found on CDC’s web site at

New Hours-of-Service Feedback Largely Positive, Focused on Details

An initial review shows that truckers contacting the Federal Motor Carrier Safety Administration (FMCSA) are committed to following new hours-of-service rules, but still have questions about changes made to the 60-year old regulations. The review is based on thousands of calls from commercial drivers made to the FMCSA’s 24-hour, toll-free help line established to answer questions about the new hours-of-service rule implemented Jan. 4, 2004.

Help line personnel have answered almost 5,500 calls from truckers wanting to understand the new rule. Initial call tracking reports indicate the majority of questions asked concern the sleeper-berth exemption, the 34-hour restart provision, the definition of a 14-hour workday, and procedures for recording hours in driver logbooks.

The largest number of calls, 18 percent, concern the 34-hour restart period. Another 16 percent of callers want to know more about the sleeper berth provision. Nine percent have asked about the 60/70-hour workweek change. Likewise, five percent were calling about record keeping. The remaining calls vary widely, including questions specific to unique driving scenarios, questions on the difference between drive time and duty time, and inquiries into the use of electronic on-board recorders. FMCSA personnel answering the phones say that most calls are drivers trying to comply with the new rule. Anecdotal reports show that drivers are finding the new rules are not causing the types of problems predicted by some.

The toll-free telephone line, 1-800-598-5664, is staffed around the clock to answer drivers’ questions. The line became active on Dec. 29, 2003.

It is estimated that the new hours-of-service rule will save 75 lives, prevent 1,326 fatigue-related injuries, and prevent 6,900 property damage-only crashes annually, saving the American economy $628 million a year. The rule represents the first major rewrite of the hours-of-service regulations in more than 60 years.

CSB Considers National Safety Issues as West Pharmaceutical Investigation Continues One Year after Explosion

The U.S. Chemical Safety and Hazard Investigation Board (CSB) has broadened its investigation into the root causes of the catastrophic dust explosion and fire which occurred at the West Pharmaceutical Services plant in Kinston, NC, on January 29, 2003, initiating a nationwide review of safety issues raised by accident.

The West explosion killed six workers and injured dozens more. As the CSB announced at a June 2003 public meeting in Kinston, investigators believe fine polyethylene dust particles, released during the production of rubber products, had accumulated above the tiles of a false ceiling, creating an explosion hazard at the plant. Investigators have not yet determined what ignited the dust.

In a statement, CSB Chairman Carolyn Merritt said, “The explosion at West Pharmaceuticals and a similar incident a few weeks later in Kentucky raise safety questions of national significance. Our investigators have found that both disasters resulted from accumulations of combustible dust. Workers and workplaces need to be protected from this insidious hazard. I can’t help but think that if only this hazard had been revealed to West beforehand, we would not be here on the first anniversary of this tragedy analyzing its causes.”

The explosion February 20, 2003, in Corbin, KY, killed seven workers, injured more than 30 others, and seriously damaged the CTA Acoustics fiberglass insulation manufacturing plant. A further dust explosion – on October 29, 2003, at the Hayes Lemmerz automotive parts plant in Huntington, IN – is also under investigation by the Board. In that incident, one man was killed and two were severely burned when aluminum dust was ignited.

Prompted by these events, the CSB is now examining the number and severity of dust explosions throughout the United States over the past several decades. Preliminary results of the study are expected to be available when the West investigation is complete, approximately within the next six months.

Stephen Selk, lead investigator in the West Pharmaceuticals accident, said earlier tests, including a demonstration at the June 2003 public meeting, showed the explosive potential of even small amounts of combustible dust. Mr. Selk said, “The investigation is progressing, and we are testing more theories about how the dust ignited. Laboratory tests are underway to determine whether an undisturbed layer of dust can be ignited by a hot surface or spark. We are also evaluating the causes of other fires and explosions in the rubber compounding industry to see if there is any similarity.”

Mr. Selk said the CSB is examining whether the hazards of combustible dust have been adequately controlled through codes, standards, and good operating practices, and will also review programs in place overseas. “How much dust accumulation can be tolerated before it becomes hazardous? And if it is hazardous, what are the appropriate controls? We believe all this information will be applicable to a variety of industries across the country,” Mr. Selk said.

The CSB is an independent federal agency charged with investigating industrial chemical accidents. The agency’s board members are appointed by the president and confirmed by the Senate. CSB investigations look into all aspects of such events, including physical causes such as equipment failure as well as inadequacies in safety management systems. Typically, the investigations involve extensive witness interviews, examination of physical evidence, and chemical and forensic testing. The Board does not issue citations or fines but does make safety recommendations to plants, industry organizations, labor groups, and regulatory agencies such as OSHA and EPA.

Ways to Prevent Injuries From Backhoes and Mine Rock Falls Are Described in New Series

NIOSH inaugurated a new series of publications with two new documents that offer practical ways to prevent occupational injuries and deaths from backhoes and mine rock falls.

The documents are the first in a new NIOSH “Workplace Solutions” series that offers easy-to-understand, easy-to-access, and easy-to-use recommendations that turn the results of NIOSH research into occupational safety and health practice.

“Workplace Solutions: Preventing Injuries When Working with Hydraulic Excavators and Backhoe Loaders,” DHHS (NIOSH) Publication No. 2004-107, notes that 346 workplace deaths were associated with excavators or backhoe loaders during 1992-2000. The fatalities included deaths that were caused when operators or nearby employees were struck by the machines or components of the equipment, struck by excavator buckets that unexpectedly detached, or electrocuted.

Practical steps suggested by NIOSH for preventing injuries and fatalities include these:

  • Make all workers on the site aware of the machine's established swing areas (the radius of the excavator or backhoe arm as it swings) and blind spots (areas to the sides or rear of the machine that are blocked from or beyond the operator’s range of vision) before the operator works the machine. Keep workers on foot outside these areas by marking them with rope, tape, or other barriers.
  • Keep workers outside the hydraulic excavator swing areas and clear of attachments when using the machine for hoisting materials. Do not allow workers to stand under suspended loads or suspended machine components such as the boom, arm, or bucket.
  • Install and maintain equipment attachments and their operating systems according to manufacturer's specifications.
  • Make frequent visual inspections of quick-disconnect systems (systems for attaching buckets to excavators, designed to detach the bucket quickly) especially after changing attachments.

“Workplace Solutions: Ground Fall Injuries in Underground Stone Mines,” DHHS (NIOSH) Publication No. 2004-106, notes that employees in underground stone mines have a fatality rate nearly 20 times higher than that of employees in the manufacturing sector. As many as 35 new underground stone mines are expected to open in 2005, many of which will employ new or inexperienced workers.

Three quarters of all fatalities in underground stone mines are caused by ground falls, or pieces of rock falling from the roofs or walls of mines and striking employees. Nearly half of all injuries involving ground falls were associated with scaling – the removal of loose rock from the roof or walls of a mine before mining operations resume there.

Precautions recommended by NIOSH to avoid risk of injury or death include these:

  • Safety harnesses and hard hats should be used properly during scaling.
  • Equipment baskets used in scaling should be equipped with a padded railing and a canopy or caging to absorb and deflect falling rock.
  • While loading explosives, miners should wear personal protective equipment such as a hard hat with a back rim to deflect small rock pieces from hitting the neck and back.
  • When roof bolting, employees should use mechanical bolters with a protective cab if possible.

“Workplace Solutions: Preventing Injuries When Working with Hydraulic Excavators and Backhoe Loaders” is available on the NIOSH web page at

“Workplace Solutions: Ground Fall Injuries in Underground Stone Mines” is available on the web page at

For printed copies of the documents, or for further information on NIOSH research, call the toll-free NIOSH information number, 1-800-35-NIOSH (1-800-356-4674).

High-Tech Safety in Fields and Orchards: NIOSH Advances Innovative Rollover Guard

The National Institute for Occupational Safety and Health (NIOSH) is advancing the development and commercialization of a high-tech system to protect tractor operators from serious injury or death in a tractor rollover, the leading cause of occupational fatalities in agriculture.

The system, called Auto-ROPS, consists of a sensor wired to a protective metal bar or rollover protective structure (ROPS), shaped like a squared, upside-down U and mounted behind the tractor seat. In normal circumstances, the Auto-ROPS bar sits no higher than the operator’s head. However, its arms have the ability to telescope upward on compression springs when unlatched.

When the sensor detects that a tractor is tilting on uneven terrain in a way likely to result in a turnover, the sensor signals the latches to release. This release deploys the rollover bar to a level higher than the operator’s head. Instantaneously activated, the bar prevents the operator’s head from fatally striking the ground or bearing the impact of the rollover. Rollovers account for more than 100 deaths in farming every year. Rollover fatalities can be prevented with the use of a ROPS and a seat belt.

“ROPS are fundamental protective equipment for tractors, but the two traditional versions – fixed ROPS and manually adjustable ROPS – both pose complications that Auto-ROPS is designed to overcome,” noted NIOSH Director John Howard, M.D.

“For example, farmers may find fixed ROPS, which remain elevated above the level of the operator’s head, physically impossible to use in orchards and other settings where clearance is low,” Dr. Howard said. “A manually adjustable ROPS provides some flexibility in that it can be lowered in such settings, then raised when the tractor moves onto open ground, but the farmer still needs to remember to raise it, and to take time to do so. The new Auto-ROPS prototype, which NIOSH developed in close partnership with the farming community and equipment manufacturers, represents an ingenious use of high tech to meet those challenges.”

NIOSH evaluated the prototype earlier this year in successful field tests that compared it with traditional ROPS. The tests involved simulations in which remotely controlled tractors without drivers were overturned in ways that could occur in actual operations. The tests showed that the sensors operated reliably, that the bars deployed to levels higher than those where most operators’ heads would be positioned, and that the bars met industry standards for withstanding the impact and weight of overturns.

NIOSH also asked a group of farmers to compare the Auto-ROPS with a manually adjustable ROPS system. The farmers said they believed that the Auto-ROPS was more effective than the manually adjustable version, and that it provided better protection. NIOSH and FEMCO, a McPherson, Kansas, ROPS manufacturer, are working with tractor and power equipment manufacturers to determine ways to bring the technology to commercial use through marketing in the agricultural industry. Further information on the technology is available from Tony McKenzie, Ph.D., safety research engineer, NIOSH Division of Safety Research, at tel. (304) 285-6064 or email

Visit to see a rear view test of Auto-ROPS and visit to see a side view test of Auto-ROPS.