J. Soc. Occup. Med. (1991) 41, 73-76
Accidents in the Workplace C. HARKER Department of Environmental & Occupational Medicine, University of Aberdeen Medical School, UK A. B. MATHESON Accident & Emergency Department, Aberdeen Royal Infirmary, UK J. A. S. ROSS and A. SEATON Department of Environmental & Occupational Medicine, University of Aberdeen Medical School, UK
Introduction National statistics on workplace accidents depend upon information obtained through the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1985 which were introduced in 1986 and which place on the employer an obligation to report to the Health and Safety Executive, inter alia, deaths and a specified range of serious accidents1. Figures on fatal accidents tend to be well documented, but data on major injuries not resulting in death tend to be under reported 2 . Moreover such a system means that less severe injuries, leading to fewer than three days' incapacity to work, go unreported. Nevertheless, such minor injuries may impose a considerable burden on both employer and the accident and emergency services of the National Health Service, and represent an area where preventive action could prove cost-effective. The overall size of the problem of workplace accidents in Britain is not known, though many individual firms keep their own records. Aberdeen and its surrounding area provides an unusual opportunity to investigate this, since accident services are largely concentrated on one hospital site and the workforce is divided among a range of industries representing service (65 per cent), manufacturing (16 per cent), construction (7 per cent), fishing, forestry and farming (2 per cent), and energy production (mainly related to the offshore oil industry - 10 per cent) 3 . Approximately 300000 people live in and around Aberdeen and about 200000 in the surrounding rural areas. In planning this survey it was our intention not only to document the size of the problem of work-related accidents, but also to identify industries where risks were relatively
© 1991 Butterworth-Heinemann for SOM 0301-0023/91/020073-04
high in order to determine targets for future preventive action action.
Patients and Methods We studied all patients attending the Accident and Emergency Department of Aberdeen Royal Infirmary from 16 January 89 to 11 February 89 inclusive, together with all patients attending the emergency clinic of the adjacent Eye Outpatient Department between 28 March 89 and 7 April 89 inclusive. On the assumption that the study period rates remained constant throughout the year, projected annual attendance rates were calculated. All patients were asked by a clerk if their accident occurred at work, this including such activities as housework and travelling in the course of work. In addition, accidents as a result of housework were included, although these are not reportable under RIDDOR. All those who answered positively were entered into the study and completed a questionnaire. If the injury prevented this, the questionnaire was administered and completed by a receptionist. Information was sought on occupation and employer, and on location, date and time of the accident. In addition, the nature of the job, the circumstances of the accident and the type of injury were recorded. The casualty records of patients entering the study were stamped with an identifying mark and retrieved after the course of treatment had been completed, when further details of the injury and its management were recorded. In order to check for incomplete identification by the clerks of work-related accidents, all the casualty cards completed on two randomly chosen days during the study were examined. On both days all patients attending had been assessed by receptionists for inclusion, four (1.6 per cent) with probable work-related injuries being inadvertantly excluded from further study. The daily attendance rates, for new patients, in the two departments over the study periods were compared with rates throughout the year 1989, and were close to the annual average in both (130 vs. 139 in Accident and Emergency, 27 vs. 22 in Eye Casualty). The occupations of individuals were coded to group and unit level according to the classification of the Office of Population Censuses and Surveys, while industry was classified by the Standard Industrial Classification 19804. Where necessary, further information on type of industry was obtained from the local business directory or by telephoning the company involved. External causes of
Downloaded from http://occmed.oxfordjournals.org/ at Carleton University on July 19, 2015
Summary A prospective survey of patients attending the central Accident and Emergency Department and Eye Casualty Department in Aberdeen was made to determine the contribution of accidents at work to the workload of the departments and to estimate risks of injury in different industrial sectors. Work-related injuries accounted for 16.5 per cent of new patients attending the general accident department and 21.7 per cent of those attending eye casualty. Analysis by industrial sector led to estimates that almost one in 10 workers employed in manufacturing industries and in agriculture/forestry/fishing will attend casualty in the course of a year for a work-related injury. The relatively low-risk service sector, because of the large numbers of people employed, contributed the greatest number of individuals with work-related injuries. Two industries had very high rates of specific and preventable injuries - food and fish processing with an estimated 17 knife lacerations per 1000 per annum and mechanical engineering with 60 eye injuries per 1000 per annum. We give reasons for believing that our estimates of risk in the different industrial sectors are conservative.
74
OCCUPATIONAL MEDICINE ( 1 9 9 1 ) VOL. 4 1 / N O . 2
Results
Over the study period exactly 3500 patients attended the accident department, of whom 578 (16.5 per cent) admitted to a work-related accident. Of these, 472 (82 per cent) were male. Over the 11-day period of the Eye Hospital survey, 244 patients attended with eye injuries, of which 53 (22 per cent) had occurred while at work. Again, the majority of patients (51, 96 per cent) were male. Table I summarizes the numbers of subjects attending the accident and emergency department with different types of injury from the major industrial sectors, the numbers at risk being derived from the 1987 census. Using these figures, and assuming constant rates through the rest of the year, Table II describes the accident rates per 1000 people at risk in the different industrial sectors. Thesefiguresshow very similar annual rates in construction, manufacturing and agriculture, forestry and fishing, at an estimated 73, 73 and 69 per 1000 respectively. Types of injury differed between the industrial sectors, a
Table I. Injuries occurring in different industry sectors, and attending at the Accident and Emergency Department Industry sector (approx number at risk)
Internal Fractures Dislocations Concussion injury
Poisoning Soft and tissue Sprains/ Superficial Foreign Multiple Lacerations injuries Burns gassings injuries bodies injuries Unknown Total strains
Agriculture/ forestry/ fishing (5270)
10
0
0
0
7
8
0
0
2
0
0
0
0
27
Energy and water supply industries (20511)
10
0
1
0
15
25
2
1
7
0
4
0
0
65
15
0
0
0
73
44
2
0
21
6
19
0
4
184
10
0
0
1
17
23
1
0
17
1
4
0
1
75
Manufacturing (34136) Construction (13 805) Public service industries, entertainment (137295)
17
1
1
1
49
70
13
1
43
7
9
2
0
214
0
0
0
0
3
6
0
0
3
0
1
0
0
13
62
1
2
2
164
176
18
2
93
14
37
2
5
578
Missing* Total
* Information not available from questionnaire Table II. Accident rates in 5 industrial sectors per 1000 employees during the study period at the Accident and Emergency Department Accidents
Agriculture forestry, fishing Energy and water supply industries Total manufacturing Construction Service industries
Total number of employees*
Period rate 11000 employees
Projected annual rale/1000 employees**
27
5270
5.1
69
65 184 75 227
20511 34136 13 805 137295
3.2 5.4 5.4 1.7
43
'derived from 1987 census. ** assuming period rate remains constant throughout the year.
73 73 23
Downloaded from http://occmed.oxfordjournals.org/ at Carleton University on July 19, 2015
disproportionate number of fractures having occurred in agriculture, forestry and fishing, and large numbers of lacerations in manufacturing. Public service and entertainment, the major sources of employment, had an accident rate of 23 per 1000, mostly accounted for by soft tissue injuries and lacerations. The energy industry (almost exclusively accidents on offshore oil installations and supply vessels) fell between service and the other industrial groups in terms of risk. Eight per cent of patients presenting to the main accident unit with work-related injuries had injured themselves whilst travelling in connection with work; only a small proportion (4 per cent) had injured themselves whilst undertaking housework. Eye injuries, which were recorded over a shorter period, were predominantly caused by foreign bodies, and mostly occurred in the manufacturing and agriculture, forestry and fishing sectors (Table III). Adding the separate annual rates from the two departments gives figures of 91 per 1000 in agriculture/forestry/fishing, 46 in energy, 95 in manufacturing, 81 in construction and 27 in services. Table IV shows the main causes of accidents in the different industrial sectors. In order of frequency, falling objects, handling and lifting, slips and trips, cutting and falls from height were most important, each accounting for more than 50 accidents over the four week period. The use of cutting, instruments stands out in the manufacturing sector, in particular in food and fish
accidents were coded as in section E of the International Classification of Diseases, volume 8, as adopted by the Health and Safety Executive (form 2508)5. Injuries were coded by nature and site. The numbers of people at risk in the major industrial sectors were derived from 1987 census returns and are necessarily approximate3.
ACCIDENTS IN THE WORKPLACE
Table III. Injuries occurring in different industrial sectors, attending the Eye Casualty Department
Agriculture, farming, forestry Energy and water supply industries Total manufacturing Construction Service industries Total
Burns
Foreign bodies
Projected annual rate/1000 employees
-
4
22
4 1 1 6
2 22 3 16 47
3 22 8 4
Discussion National statistics on accidents record deaths, major bone and eye injuries, and episodes resulting in more than three days' incapacity to work5. Such statistics point to industries where risks are relatively high, such as construction, agriculture and fishing. Our aim was to obtain a more complete picture and to estimate overall rates of industrial accidents, which we believed might make a significant contribution to the work of the NHS emergency services. In doing so, we also hoped to identify local industries to which preventive efforts might be of most benefit. The information we have obtained is necessarily approximate. Possible sources of error include incomplete recording of details from injured subjects, treatment of some injuries by general practitioners, first aiders and offshore paramedics, occupational health nurses and physicians, and victims themselves, or one of the smaller casualty departments in the region. All these factors will have contributed to reducing our estimates of accident rates below the true rate based on the numbers employed.
Our estimates of the denominator may also be inaccurate since we used data from the 1987 census and the survey took place in 1989, over which period unemployment in the Region had fallen from 8 to 6 per cent; however the total numbers employed did not increase significantly. Finally, our study was a brief one and we have assumed, for the purpose of calculating annual rates, that the period rates we have observed remain constant throughout the year. In fact, attendances in the accident department are generally rather lower in winter, when the study took place, than in the summer, again suggesting a possible under-estimation. In spite of these potential sources of error, the accident rates we found reflect in general the published relative rates for serious injuries in the different industrial sectors (HSC Annual Report 1987/88 General health and safety statistics8). However the relatively high accident rate for the offshore oil and gas industry in published figures was not reflected in our own study, as about half of all accident cases from offshore installations are managed by services outside the accident department6. The numbers of industrial accidents expressed as a proportion of all accidents, at 16.5 per cent in the main department and 21.7 per cent in the eye hospital, are similar to those recorded in a comprehensive study carried out in Sweden7. In that study, which investigated all accidents occurring over a year in a community, 18.2 per cent were workrelated. Our findings were disappointing in view of the efforts made by the Health and Safety Executive to promote safety in industry. It is clear that there is plenty of scope for preventive action for industries in which almost one worker in ten will require treatment in a casualty department every year. Moreover, the importance of slips, lifting injuries and objects falling (mainly onto hands and feet) in contributing to demand for treatment in the relatively low risk service industries is apparent: indeed, because of the large numbers employed in this sector, it is the major consumer of accident services with an estimated 3707 attendances at the two departments in a year. Accident prevention is the responsibility of line management, and is normally overseen by workplace safety committees, set up under the Health and Safety at
Table IV. Causes of accidents in different industrial sectors attending at the Accident and Emergency Department
Industry sector Agriculture/ forestry/ fishing
Falling Stationary object object
5
Handling or lifting
2
Collapsing Hot or overturning Foreign Cutting object bodies instrument substance
Slip, trip or fall on same level
Fall from height
3
2
3
0
Energy and water supply industries
13
7
7
12
8
5
2
Manufacturing
30
14
28
13
14
3
17
Construction
17
2
16
6
12
1
3
Public service industries, entertainment
25
17
33
44
17
10
7
Missing data Total
Moving Moving vehicles machinery Other Total
1
7
1
1
5
65
1
17
9
184
0
2
6
5
75
11
7
4
22
214
0
0
3
1
38
0
5
17
3
27
1
0
3
2
3
0
1
2
0
0
0
1
13
91
42
88
80
56
22
30
68
12
11
29
49
578
Downloaded from http://occmed.oxfordjournals.org/ at Carleton University on July 19, 2015
processing which accounted for 16 injuries in a population of approximately 12000, giving an estimated annual rate of 17 lacerations per 1000 employees. Eye injuries from foreign bodies were seen in both accident departments, the metal goods and mechanical engineering sector accounting for a total of 28, giving an approximate annual rate of 60 per 1000 employees.
75
76
OCCUPATIONAL MEDICINE ( 1 9 9 1 ) VOL. 4 1 / N O . 2
accidental injury in the workplace that affords ample scope for preventive action, both generally and by local initiatives. Acknowledgements Our thanks to Ms Diane Christison of the Accident and Emergency Department, Aberdeen Royal Infirmary, for help in obtaining records, to the clerks employed there, and to Mrs L. Alexander for typing this manuscript. REFERENCES 1. Health and Safety Commission. Reporting of Injuries, Diseases, and Dangerous Occurrences Regulations 1985 (R1DDOR). HMSO: London, 1986. 2. Aw TC, Harrington JM. Industrial accidents underreported and not improving. Br Med J 1989; 298: 68-9. 3. September 1987 Census of Employment, Grampian Region. Department of Employment 1989. 4. Office of Population Censuses and Surveys. Economic activity Great Britain. Census 1981. HMSO: London, 1984. 5. Health and Safety Executive. A Guide to the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1985 (RIDDOR). HMSO: London, 1986. 6. Norman JN, Ballantine BN, Brebner JA, et al. Medical evacuations from offshore structures. Br J lnd Med 1988; 45: 619-23. 7. Schelp L, Svanstrom L. One year incidence of occupational accidents in a rural Swedish municipality. Scand J Soc Med 1986; 14:197-204. 8. Health and Safety Commission and Health and Safety Executive. Annual Report 1987/88. London: HMSO, 1988.
Requests for reprints should be addressed to: Dr C. Harker, Environmental and Occupational Medicine, University Medical School, Foresterhill, Aberdeen AB9 2ZD, UK.
Downloaded from http://occmed.oxfordjournals.org/ at Carleton University on July 19, 2015
Work Etc Act 1974, on which managers and workers' safety representatives serve. The effectiveness of these committees must be dependent upon a realistic perception of risk by members of the committees, and it is not possible to use our figures in such a way as to influence this effectiveness. In addition, accidents are intrinsically more likely to occur in certain industries as a consequence of more hazardous associated conditions. While many such industries, such as farming and fishing, can be detected by surveillance of statistics for serious accidents, others may only be picked up by more detailed studies such as ours. Thus we have picked out two sectors, food andfishprocessing and mechanical engineering and metal manufacturing, with exceptionally high rates of particular and troublesome injuries. The 17 lacerations per 1000 employees per annum in fish and food processors might well be prevented by consideration of working practices that involve the use of knives, while the 60 eye injuries per 1000 per annum in mechanical engineering and metal manufacturing could largely be prevented by the use of safety glasses and goggles. Disappointingly, national statistics on serious workplace accidents and on work-related fatalities have shown no significant improvement since the 1974 Health and Safety at Work Act. The effectiveness of this Act requires investigation and, if necessary, steps require to be taken to enhance its efficacy. Our study has shown a rate of
Accidents in the Workplace C. HARKER Department of Environmental & Occupational Medicine, University of Aberdeen Medical School, UK A. B. MATHESON Accident & Emergency Department, Aberdeen Royal Infirmary, UK J. A. S. ROSS and A. SEATON Department of Environmental & Occupational Medicine, University of Aberdeen Medical School, UK
Introduction National statistics on workplace accidents depend upon information obtained through the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 1985 which were introduced in 1986 and which place on the employer an obligation to report to the Health and Safety Executive, inter alia, deaths and a specified range of serious accidents1. Figures on fatal accidents tend to be well documented, but data on major injuries not resulting in death tend to be under reported 2 . Moreover such a system means that less severe injuries, leading to fewer than three days' incapacity to work, go unreported. Nevertheless, such minor injuries may impose a considerable burden on both employer and the accident and emergency services of the National Health Service, and represent an area where preventive action could prove cost-effective. The overall size of the problem of workplace accidents in Britain is not known, though many individual firms keep their own records. Aberdeen and its surrounding area provides an unusual opportunity to investigate this, since accident services are largely concentrated on one hospital site and the workforce is divided among a range of industries representing service (65 per cent), manufacturing (16 per cent), construction (7 per cent), fishing, forestry and farming (2 per cent), and energy production (mainly related to the offshore oil industry - 10 per cent) 3 . Approximately 300000 people live in and around Aberdeen and about 200000 in the surrounding rural areas. In planning this survey it was our intention not only to document the size of the problem of work-related accidents, but also to identify industries where risks were relatively
© 1991 Butterworth-Heinemann for SOM 0301-0023/91/020073-04
high in order to determine targets for future preventive action action.
Patients and Methods We studied all patients attending the Accident and Emergency Department of Aberdeen Royal Infirmary from 16 January 89 to 11 February 89 inclusive, together with all patients attending the emergency clinic of the adjacent Eye Outpatient Department between 28 March 89 and 7 April 89 inclusive. On the assumption that the study period rates remained constant throughout the year, projected annual attendance rates were calculated. All patients were asked by a clerk if their accident occurred at work, this including such activities as housework and travelling in the course of work. In addition, accidents as a result of housework were included, although these are not reportable under RIDDOR. All those who answered positively were entered into the study and completed a questionnaire. If the injury prevented this, the questionnaire was administered and completed by a receptionist. Information was sought on occupation and employer, and on location, date and time of the accident. In addition, the nature of the job, the circumstances of the accident and the type of injury were recorded. The casualty records of patients entering the study were stamped with an identifying mark and retrieved after the course of treatment had been completed, when further details of the injury and its management were recorded. In order to check for incomplete identification by the clerks of work-related accidents, all the casualty cards completed on two randomly chosen days during the study were examined. On both days all patients attending had been assessed by receptionists for inclusion, four (1.6 per cent) with probable work-related injuries being inadvertantly excluded from further study. The daily attendance rates, for new patients, in the two departments over the study periods were compared with rates throughout the year 1989, and were close to the annual average in both (130 vs. 139 in Accident and Emergency, 27 vs. 22 in Eye Casualty). The occupations of individuals were coded to group and unit level according to the classification of the Office of Population Censuses and Surveys, while industry was classified by the Standard Industrial Classification 19804. Where necessary, further information on type of industry was obtained from the local business directory or by telephoning the company involved. External causes of
Downloaded from http://occmed.oxfordjournals.org/ at Carleton University on July 19, 2015
Summary A prospective survey of patients attending the central Accident and Emergency Department and Eye Casualty Department in Aberdeen was made to determine the contribution of accidents at work to the workload of the departments and to estimate risks of injury in different industrial sectors. Work-related injuries accounted for 16.5 per cent of new patients attending the general accident department and 21.7 per cent of those attending eye casualty. Analysis by industrial sector led to estimates that almost one in 10 workers employed in manufacturing industries and in agriculture/forestry/fishing will attend casualty in the course of a year for a work-related injury. The relatively low-risk service sector, because of the large numbers of people employed, contributed the greatest number of individuals with work-related injuries. Two industries had very high rates of specific and preventable injuries - food and fish processing with an estimated 17 knife lacerations per 1000 per annum and mechanical engineering with 60 eye injuries per 1000 per annum. We give reasons for believing that our estimates of risk in the different industrial sectors are conservative.
74
OCCUPATIONAL MEDICINE ( 1 9 9 1 ) VOL. 4 1 / N O . 2
Results
Over the study period exactly 3500 patients attended the accident department, of whom 578 (16.5 per cent) admitted to a work-related accident. Of these, 472 (82 per cent) were male. Over the 11-day period of the Eye Hospital survey, 244 patients attended with eye injuries, of which 53 (22 per cent) had occurred while at work. Again, the majority of patients (51, 96 per cent) were male. Table I summarizes the numbers of subjects attending the accident and emergency department with different types of injury from the major industrial sectors, the numbers at risk being derived from the 1987 census. Using these figures, and assuming constant rates through the rest of the year, Table II describes the accident rates per 1000 people at risk in the different industrial sectors. Thesefiguresshow very similar annual rates in construction, manufacturing and agriculture, forestry and fishing, at an estimated 73, 73 and 69 per 1000 respectively. Types of injury differed between the industrial sectors, a
Table I. Injuries occurring in different industry sectors, and attending at the Accident and Emergency Department Industry sector (approx number at risk)
Internal Fractures Dislocations Concussion injury
Poisoning Soft and tissue Sprains/ Superficial Foreign Multiple Lacerations injuries Burns gassings injuries bodies injuries Unknown Total strains
Agriculture/ forestry/ fishing (5270)
10
0
0
0
7
8
0
0
2
0
0
0
0
27
Energy and water supply industries (20511)
10
0
1
0
15
25
2
1
7
0
4
0
0
65
15
0
0
0
73
44
2
0
21
6
19
0
4
184
10
0
0
1
17
23
1
0
17
1
4
0
1
75
Manufacturing (34136) Construction (13 805) Public service industries, entertainment (137295)
17
1
1
1
49
70
13
1
43
7
9
2
0
214
0
0
0
0
3
6
0
0
3
0
1
0
0
13
62
1
2
2
164
176
18
2
93
14
37
2
5
578
Missing* Total
* Information not available from questionnaire Table II. Accident rates in 5 industrial sectors per 1000 employees during the study period at the Accident and Emergency Department Accidents
Agriculture forestry, fishing Energy and water supply industries Total manufacturing Construction Service industries
Total number of employees*
Period rate 11000 employees
Projected annual rale/1000 employees**
27
5270
5.1
69
65 184 75 227
20511 34136 13 805 137295
3.2 5.4 5.4 1.7
43
'derived from 1987 census. ** assuming period rate remains constant throughout the year.
73 73 23
Downloaded from http://occmed.oxfordjournals.org/ at Carleton University on July 19, 2015
disproportionate number of fractures having occurred in agriculture, forestry and fishing, and large numbers of lacerations in manufacturing. Public service and entertainment, the major sources of employment, had an accident rate of 23 per 1000, mostly accounted for by soft tissue injuries and lacerations. The energy industry (almost exclusively accidents on offshore oil installations and supply vessels) fell between service and the other industrial groups in terms of risk. Eight per cent of patients presenting to the main accident unit with work-related injuries had injured themselves whilst travelling in connection with work; only a small proportion (4 per cent) had injured themselves whilst undertaking housework. Eye injuries, which were recorded over a shorter period, were predominantly caused by foreign bodies, and mostly occurred in the manufacturing and agriculture, forestry and fishing sectors (Table III). Adding the separate annual rates from the two departments gives figures of 91 per 1000 in agriculture/forestry/fishing, 46 in energy, 95 in manufacturing, 81 in construction and 27 in services. Table IV shows the main causes of accidents in the different industrial sectors. In order of frequency, falling objects, handling and lifting, slips and trips, cutting and falls from height were most important, each accounting for more than 50 accidents over the four week period. The use of cutting, instruments stands out in the manufacturing sector, in particular in food and fish
accidents were coded as in section E of the International Classification of Diseases, volume 8, as adopted by the Health and Safety Executive (form 2508)5. Injuries were coded by nature and site. The numbers of people at risk in the major industrial sectors were derived from 1987 census returns and are necessarily approximate3.
ACCIDENTS IN THE WORKPLACE
Table III. Injuries occurring in different industrial sectors, attending the Eye Casualty Department
Agriculture, farming, forestry Energy and water supply industries Total manufacturing Construction Service industries Total
Burns
Foreign bodies
Projected annual rate/1000 employees
-
4
22
4 1 1 6
2 22 3 16 47
3 22 8 4
Discussion National statistics on accidents record deaths, major bone and eye injuries, and episodes resulting in more than three days' incapacity to work5. Such statistics point to industries where risks are relatively high, such as construction, agriculture and fishing. Our aim was to obtain a more complete picture and to estimate overall rates of industrial accidents, which we believed might make a significant contribution to the work of the NHS emergency services. In doing so, we also hoped to identify local industries to which preventive efforts might be of most benefit. The information we have obtained is necessarily approximate. Possible sources of error include incomplete recording of details from injured subjects, treatment of some injuries by general practitioners, first aiders and offshore paramedics, occupational health nurses and physicians, and victims themselves, or one of the smaller casualty departments in the region. All these factors will have contributed to reducing our estimates of accident rates below the true rate based on the numbers employed.
Our estimates of the denominator may also be inaccurate since we used data from the 1987 census and the survey took place in 1989, over which period unemployment in the Region had fallen from 8 to 6 per cent; however the total numbers employed did not increase significantly. Finally, our study was a brief one and we have assumed, for the purpose of calculating annual rates, that the period rates we have observed remain constant throughout the year. In fact, attendances in the accident department are generally rather lower in winter, when the study took place, than in the summer, again suggesting a possible under-estimation. In spite of these potential sources of error, the accident rates we found reflect in general the published relative rates for serious injuries in the different industrial sectors (HSC Annual Report 1987/88 General health and safety statistics8). However the relatively high accident rate for the offshore oil and gas industry in published figures was not reflected in our own study, as about half of all accident cases from offshore installations are managed by services outside the accident department6. The numbers of industrial accidents expressed as a proportion of all accidents, at 16.5 per cent in the main department and 21.7 per cent in the eye hospital, are similar to those recorded in a comprehensive study carried out in Sweden7. In that study, which investigated all accidents occurring over a year in a community, 18.2 per cent were workrelated. Our findings were disappointing in view of the efforts made by the Health and Safety Executive to promote safety in industry. It is clear that there is plenty of scope for preventive action for industries in which almost one worker in ten will require treatment in a casualty department every year. Moreover, the importance of slips, lifting injuries and objects falling (mainly onto hands and feet) in contributing to demand for treatment in the relatively low risk service industries is apparent: indeed, because of the large numbers employed in this sector, it is the major consumer of accident services with an estimated 3707 attendances at the two departments in a year. Accident prevention is the responsibility of line management, and is normally overseen by workplace safety committees, set up under the Health and Safety at
Table IV. Causes of accidents in different industrial sectors attending at the Accident and Emergency Department
Industry sector Agriculture/ forestry/ fishing
Falling Stationary object object
5
Handling or lifting
2
Collapsing Hot or overturning Foreign Cutting object bodies instrument substance
Slip, trip or fall on same level
Fall from height
3
2
3
0
Energy and water supply industries
13
7
7
12
8
5
2
Manufacturing
30
14
28
13
14
3
17
Construction
17
2
16
6
12
1
3
Public service industries, entertainment
25
17
33
44
17
10
7
Missing data Total
Moving Moving vehicles machinery Other Total
1
7
1
1
5
65
1
17
9
184
0
2
6
5
75
11
7
4
22
214
0
0
3
1
38
0
5
17
3
27
1
0
3
2
3
0
1
2
0
0
0
1
13
91
42
88
80
56
22
30
68
12
11
29
49
578
Downloaded from http://occmed.oxfordjournals.org/ at Carleton University on July 19, 2015
processing which accounted for 16 injuries in a population of approximately 12000, giving an estimated annual rate of 17 lacerations per 1000 employees. Eye injuries from foreign bodies were seen in both accident departments, the metal goods and mechanical engineering sector accounting for a total of 28, giving an approximate annual rate of 60 per 1000 employees.
75
76
OCCUPATIONAL MEDICINE ( 1 9 9 1 ) VOL. 4 1 / N O . 2
accidental injury in the workplace that affords ample scope for preventive action, both generally and by local initiatives. Acknowledgements Our thanks to Ms Diane Christison of the Accident and Emergency Department, Aberdeen Royal Infirmary, for help in obtaining records, to the clerks employed there, and to Mrs L. Alexander for typing this manuscript. REFERENCES 1. Health and Safety Commission. Reporting of Injuries, Diseases, and Dangerous Occurrences Regulations 1985 (R1DDOR). HMSO: London, 1986. 2. Aw TC, Harrington JM. Industrial accidents underreported and not improving. Br Med J 1989; 298: 68-9. 3. September 1987 Census of Employment, Grampian Region. Department of Employment 1989. 4. Office of Population Censuses and Surveys. Economic activity Great Britain. Census 1981. HMSO: London, 1984. 5. Health and Safety Executive. A Guide to the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1985 (RIDDOR). HMSO: London, 1986. 6. Norman JN, Ballantine BN, Brebner JA, et al. Medical evacuations from offshore structures. Br J lnd Med 1988; 45: 619-23. 7. Schelp L, Svanstrom L. One year incidence of occupational accidents in a rural Swedish municipality. Scand J Soc Med 1986; 14:197-204. 8. Health and Safety Commission and Health and Safety Executive. Annual Report 1987/88. London: HMSO, 1988.
Requests for reprints should be addressed to: Dr C. Harker, Environmental and Occupational Medicine, University Medical School, Foresterhill, Aberdeen AB9 2ZD, UK.
Downloaded from http://occmed.oxfordjournals.org/ at Carleton University on July 19, 2015
Work Etc Act 1974, on which managers and workers' safety representatives serve. The effectiveness of these committees must be dependent upon a realistic perception of risk by members of the committees, and it is not possible to use our figures in such a way as to influence this effectiveness. In addition, accidents are intrinsically more likely to occur in certain industries as a consequence of more hazardous associated conditions. While many such industries, such as farming and fishing, can be detected by surveillance of statistics for serious accidents, others may only be picked up by more detailed studies such as ours. Thus we have picked out two sectors, food andfishprocessing and mechanical engineering and metal manufacturing, with exceptionally high rates of particular and troublesome injuries. The 17 lacerations per 1000 employees per annum in fish and food processors might well be prevented by consideration of working practices that involve the use of knives, while the 60 eye injuries per 1000 per annum in mechanical engineering and metal manufacturing could largely be prevented by the use of safety glasses and goggles. Disappointingly, national statistics on serious workplace accidents and on work-related fatalities have shown no significant improvement since the 1974 Health and Safety at Work Act. The effectiveness of this Act requires investigation and, if necessary, steps require to be taken to enhance its efficacy. Our study has shown a rate of
