January 17, 2024
Jeremy W. Woolward, NHSA, CTSP
Fleet Safety Manager, Chariot Express Ltd.
In industry, we often talk about slips, trips, and falls being some of the most common injuries experienced in the workplace. Hazards, such as water, equipment, and uneven surfaces, can lead to unforeseen and unfortunate outcomes. These are outcomes that you can visually see, and these visual outcomes are easy to manage. However, it is the unknown outcomes and those you cannot see that can cause the most trouble. A secondary injury that can occur because of a slip, trip, or fall is a head injury. A direct blow to the head, while painful, is manageable. It’s what’s happening inside the body that can lead to severe, and possibly fatal, outcomes. The most common occurrence people receive with head injuries is a concussion.
Commonly associated with contact and combat sports, concussions are brain injuries that occur because of a hit to the head, neck & face, or body. While protected by the skull, the human brain can move inside the body, and it is that movement that causes the concussion. Concussions do not show up on CT Scans, MRI’s, or X-Rays. Concussions are diagnosed by observing a person and taking note of what they are experiencing. The problem is that many people leave concussions undiagnosed because they treat the outward signs and symptoms without addressing the root cause of them. Concussions can disrupt sleep patterns, emotional outlooks, physical attributes, as well as cognitive awareness. Because each person is different, concussion symptoms vary from individual to individual, which makes identifying concussions harder. It is recommended, however, that if you do have a direct blow to the head, neck/face, and/or body, you should watch for the following:
- Neck pain
- Double vision
- Loss of consciousness
- Seizure or convulsion
- Continuous and repetitive vomiting
- Severe headaches or amplification of an existing headache
- Weak, burning, or tingling sensations in your extremities
If any of these symptoms begin to manifest, immediately stop what you are doing and seek medical attention. If you witness another worker experiencing any of these or making remarks that they’re experiencing any of these sensations, have them immediately stop what they are doing, and assist them in getting medical aid. Never leave yourself or another worker alone as the situation can worsen without any warning. If you come across an unconscious worker, apply the same rationale you would for first aid and do not move them or remove anything from them. Assume there’s a spinal injury in play and respond accordingly.
If an approved medical professional has confirmed a positive diagnosis of a concussion, they will work with you in establishing a return to activity program. Approved medical professionals able to diagnose concussions are doctors and nurse practitioners using the appropriate assessment tool. Once this return to activity program is established, it is imperative you do not deviate from it as the program allows the body to properly heal from the injury. Symptoms typically last from one to four weeks. Adults tend to recover from concussions faster than children because of physical development, but that does not mean that you can just take a day or two off work and then return to your regular duties. Doing so runs the risk of the concussion reoccurring, and those reoccurring concussions can lead to permanent disability or death. If, at any point along the way in your return to activity program, you notice a bit of a relapse, start the return to activity program over from the beginning in consultation with your doctor. Sometimes, concussion recovery is a one step forward, two steps back process.
A way to incorporate concussion awareness in the workplace is for employers to review their formal hazard assessments (FHA) and when identifying slipping hazards, tripping hazards, or falling hazards, they incorporate brain injuries into the FHA. And, following the rationale set out in COR and SECOR, the company’s Emergency Response Plan (ERP) should be updated to include what to do in case of a suspected brain injury / concussion. (Remember that you, unless you’re a medical doctor or nurse practitioner, cannot diagnose or confirm a concussion in Canada) When drafting the ERP for suspected brain injuries, follow the same steps you would for any other emergency response. (If unsure, you can reference questions 8.1 as well as 8.2 in the AMTA COR Audit that outlines what should be in your ERP) Also be sure to drill this scenario with your team at some point in the year. Awareness and understanding go a long way in promoting long-term and complete recovery.
When we begin to consider what’s possible outside of a regular status quo, we have the potential to shift our thinking and broaden our approach to whatever it is we are doing. Hazard Management works in a very similar manner. When you begin to ask yourself what is present in the workplace that can harm me, consider asking what are some secondary or tertiary outcomes that ought to be considered, and manage those outcomes with the same vigor as you would the primary ones. The goal of any holistic health and safety management system is ensuring that you do all that you can that is reasonably practicable to keep people safe. Managing suspected brain injuries and/or concussions is just an extension of that. It is not just a sports thing. It is an everyday thing. We all must do our part.
Views expressed in columns do not necessarily reflect those of the association