1. NH Department of Health & Human Services 1 Tyler Brandow, BS, MPH Intern, NH Occupational Health Surveillance Program Division of Public Health Services NH Department of Health and Human Services tyler.b.brandow@dhhs.state.nh.us

2. NH Department of Health & Human Services NIOSH: National Institutes for Occupational Safety and Health 1 -Facilitates surveillance and prevention activities among State partners; funds the NH OHSP NH OHSP (Occupational Health Surveillance Program) 2 -Collects, analyzes and interprets surveillance data -Addresses the limitations of existing databases and develops new data sources -Identifies priority occupational health and safety conditions in NH -Disseminates data on the magnitude of occupational injuries and illnesses 2 1.Centers for Disease Control and Prevention, Workplace safety and health topics, Surveillance, December 28, 2011. Accessed 2/6/13. Available online: http://www.cdc.gov/niosh/topics/surveillance/ http://www.cdc.gov/niosh/topics/surveillance/ 2.Armenti, K. New Hampshire Occupational Health Surveillance Program: Fundamental Program Grant # 1U60OH009853-02, Annual Report of Major Outputs and Outcomes (2011 to 2012), July 2012. Accessed 5/1/13. Available online: http://www.dhhs.nh.gov/dphs/hsdm/ohs/documents/nhapr2011-2012.pdf http://www.dhhs.nh.gov/dphs/hsdm/ohs/documents/nhapr2011-2012.pdf

3. NH Department of Health & Human Services US Work-Related Injuries, 2010 3 -139.1 million US workers -4.1 million non-fatal injuries (3.9 cases per 100 FTE 4 ) -3.3 million non-fatal, private sector injuries (3.6 cases per 100 FTE) NH Work-Related Injuries -740,000 NH workers (US DOL-Bureau of Labor Statistics) -40,000 NH Workers’ Compensation claims (2011) -Average award was about $350 -Under-reporting is significant 3 3. Centers for Disease Control and Prevention, Workplace safety and health topics, Traumatic Occupational Injuries, May 9, 2013. Accessed 2/6/13. Available online: http://www.cdc.gov/niosh/injury http://www.cdc.gov/niosh/injury 4. US Census, Table 660. Nonfatal Occupational Injuries and Illnesses by industry: 2009, 2012. Accessed 5/1/13. Available online: http://www.census.gov/comendia/statab/2012/tables/12s0660.pdf http://www.census.gov/comendia/statab/2012/tables/12s0660.pdf

4. NH Department of Health & Human Services NH TEMSIS 5 -Receives data from 81% of NH EMS agencies -Responders are mandated to report work-related injuries -95% of private sector incidents are injuries 6 -Data Fields: relative frequency averages Location: where workers are injured Primary Impression: type of injury sustained Mechanism: how the injury occurred Gender: burden of injury among males and females Age: burden of injury in specific age groups 4 5NHTEMSIS, About Us, 2011. Accessed 2/6/13. Available online: http://www.nhtemsis.org/default.cfm?page=about http://www.nhtemsis.org/default.cfm?page=about 6Bureau of Labor Statistics, News Release, Workplace Injuries and Illnesses- 2011, October 25, 2012. Accessed 2/6/13. Available online: http://www.bls.gov/news.release/pdf/osh.pdf http://www.bls.gov/news.release/pdf/osh.pdf

5. NH Department of Health & Human Services Inclusion Criteria -Must affirm work-relatedness -No duplicate Incident ID numbers -Eligible cases must contain data in all fields -Cases must be of working age, between 16-65 Primary Analysis -Baseline proportions of primary injury characteristics -All data fields, all response options Demographic Analysis -Work-related injuries by Gender -Age-Stratified: 5 Groups 16-25 26-35 36-45 46-55 56-65 Comparative Analysis -Identify TEMSIS subpopulations with increased risk of work-related injury 5

6. NH Department of Health & Human Services Total Incidents, 2009-2011 N= 7733 Eligible Work-Related Incidents, 2009-2011 N= 2168 Baseline Primary Injury Characteristics and Proportions Data FieldMost Frequent ResponseProportion (%) GenderMale72.1% Age Group46-5525.5% LocationIndustrial25.2% Primary ImpressionTraumatic Injury48.6% MechanismFalls25.4% 6

7. NH Department of Health & Human Services Gender Age-Stratified Cases Relative Frequency Age Groups Gender%# Male72.1%1564 Female27.9%604 Total100.0%2168 7

8. NH Department of Health & Human Services Location%# Industrial25.2%547 Service/Trade21.3%462 Highway14.2%308 Residence13.8%299 Public Building11.2%243 HC Facility5.4%117 All Other Categories5.0%109 Recreation3.8%83 Total100.0%2168 8

9. NH Department of Health & Human Services Primary Impression%# Traumatic Injury48.6%1053 Pain21.6%469 All Other Categories12.6%273 Cardiac/ Chest Pain4.8%104 Syncope/Fainting2.6%57 Back Pain2.4%51 Headache2.3%50 Heat Stroke/Dehydration2.2%47 Allergic Reaction1.6%35 Electrocution1.3%29 Total100.0%2168 9

10. NH Department of Health & Human Services Mechanism%# Other, Not Available, Not Known, Not Recorded33.8%733 Falls25.4%550 Motor Vehicle Accident9.6%209 Struck Against or by Blunt Object7.5%162 Stab/Cut/Pierce7.0%151 All Other Categories6.6%144 Machinery Accident4.9%106 Caught In2.5%54 Electrocution1.4%30 Foreign Body1.3%29 Total100.0%2168 10

11. NH Department of Health & Human Services Data Fields:GenderAge GroupLocation Primary ImpressionMechanism Primary Injury Characteristics:Males46-55IndustrialTraumatic InjuryFalls Entire Study Population Baseline Proportions N=216872.1%25.5%25.2%48.6%25.4% Males n=1564-24.7%29.3%53.9%23.5% 46-55 n=55270.1%-24.3%47.6%31.0% Industrial n=54783.7%24.5%-63.8%17.4% Traumatic Injury n=105380.1%25.0%33.1%-30.9% Falls n=55066.9%31.5%17.3%59.1%- Columns: compare the baseline primary injury characteristic proportion to the proportions of that characteristic in each subpopulation. Ex. Industrial Locations: Compared to the baseline, the proportion of industrial injuries was significantly greater for males; there were significantly more traumatic injuries at industrial locations; and there were significantly fewer fall injuries at industrial locations. Rows: show the primary injury characteristic proportions of each subpopulation and highlight significant differences from the baseline. Ex. Male Subpopulation: Compared to the baseline proportions, males have significantly more industrial injuries and traumatic injuries. 11

12. NH Department of Health & Human Services Gender CategoryMaleFemale Baseline N=216872.1%27.9% Industrial n=54783.7%16.3% Traumatic Injury n=105380.1%19.9% Falls n=55066.9%33.1% Age 46-55 n=55270.1%29.9% -Males suffered more industrial work-related Injuries -Males suffered more traumatic work-related Injuries -Females suffered more work-related falls than was expected by their baseline injury proportion; most falls occurred at service/trade locations like bars and restaurants. 12

13. NH Department of Health & Human Services -Workers aged 26-35 suffered more industrial work-related injuries. -Workers aged 46-55 suffered more work-related falls. -Workers aged 56-65 suffered more work-related falls. Age Group16 - 2525 - 3536 - 4546 - 5556 - 65 Baseline N=216819.7%20.9%20.2%25.5%13.8% Industrial n=54716.6%25.0%21.4%24.5%12.4% TI n=105318.8%21.6%19.8%25.0%14.8% Falls n=55013.8%14.5%19.8%31.5%20.4% Age Groups Proportions (%) 13

14. NH Department of Health & Human Services Baseline Proportions: All work-related injuries N=2168 -Males suffer more work-related injuries than females (72.1%) -Workers aged 46-55 are most likely to be injured (25.5%) -Industrial occupational settings have the greatest prevalence of work related injuries (25.2%) -Traumatic injury is the most common primary impression-type (48.6%) -Falls cause the majority of work-related injuries (25.4%) Location: Industrial workplace Injuries n=547 Compared to baseline proportions, industrial workplaces had: -Significantly more injuries in males (+11.6%) -Significantly more injuries among workers aged 26-35 (+4.1%) -Significantly more traumatic injuries (+15.2%) -Significantly fewer fall injuries (-8%) 14

15. NH Department of Health & Human Services Primary Impression: Traumatic work-related injuries n=1053 Compared to baseline proportions, traumatic injuries were: -Significantly higher among males (+8%) -Significantly more prevalent in industrial workplaces (+7.9%) -Significantly higher among workers who suffered a fall injury (+5.5%) Mechanism : Work-related falls n=550 Compared to baseline proportions, work-related falls were: -Significantly lower among males (-5.2%) -Significantly higher among workers aged 46-55 (+6%) and 56-65 (+6.6%) -Significantly more prevalent at service locations than industrial locations (+10.9%) -Caused a significantly greater proportion of traumatic injuries (+10.5%) 15

16. NH Department of Health & Human Services -Males aged 26-35 working in Industrial locations could benefit from traumatic Injury prevention -Males and females, age 46-55, working in Industrial locations could benefit from falls prevention -Males and females, age 46-55 in Service locations like restaurants and bars could benefit from falls prevention. 16

17. NH Department of Health & Human Services -TEMSIS population is a subset of the study population: it is not representative of the total population suffering work- related injuries; only 81% of EMS agencies reported to TEMSIS; some are captured by Emergency Departments. -Data quality: interpretation and documentation may depend on level of training/experience of EMS personnel. -Event-based reporting: individuals may have more than one incident during the study period. -Recall bias: EMS personnel enter the data retrospectively. 17

18. NH Department of Health & Human Services -TEMSIS is a beneficial new data source for Occupational Health Surveillance. -Provides a broad scope of work-related injuries. -What we learn can help us target prevention efforts. -In order to be useful in other states, it is important to require that “work-relatedness” is captured in the data entry process. 18

19. NH Department of Health & Human Services Dr. Karla Armenti: Principal Investigator, NH OHSP, NH Division of Public Health Services Dr. Lida Anderson: Chronic Disease Epidemiologist, NH Division of Public Health Services Chip Cooper: Bureau of Emergency Medical Services MaryGaye Grizwin: University of New Hampshire The NH OHSP is supported by the National Institute for Occupational Safety and Health (NIOSH) and the Council of State and Territorial Epidemiologists (CSTE). This project is supported by Grant # 5U60OH009853-02 from CDC-NIOSH. Its contents are solely the responsibility of the authors and do not represent the official views of NIOSH 19

20. NH Department of Health & Human Services 1.Centers for Disease Control and Prevention, Workplace safety and health topics, Surveillance, December 28, 2011. Accessed 2/6/13. Available online: http://www.cdc.gov/niosh/topics/surveillance/ http://www.cdc.gov/niosh/topics/surveillance/ 2.Armenti, K. New Hampshire Occupational Health Surveillance Program: Fundamental Program Grant # 1U60OH009853-02, Annual Report of Major Outputs and Outcomes (2011 to 2012), July 2012. Accessed 5/1/13. Available online: http://www.dhhs.nh.gov/dphs/hsdm/ohs/documents/nhapr2011-2012.pdf http://www.dhhs.nh.gov/dphs/hsdm/ohs/documents/nhapr2011-2012.pdf 3.Centers for Disease Control and Prevention, Workplace safety and health topics, Traumatic Occupational Injuries, May 9, 2013. Accessed 2/6/13. Available online: http://www.cdc.gov/niosh/injury http://www.cdc.gov/niosh/injury 4.US Census, Table 660. Nonfatal Occupational Injuries and Illnesses by industry: 2009, 2012. Accessed 5/1/13. Available online: http://www.census.gov/comendia/statab/2012/tables/12s0660.pdf http://www.census.gov/comendia/statab/2012/tables/12s0660.pdf 5.NHTEMSIS, About Us, 2011. Accessed 2/6/13. Available online: http://www.nhtemsis.org/default.cfm?page=about http://www.nhtemsis.org/default.cfm?page=about 6.Bureau of Labor Statistics, News Release, Workplace Injuries and Illnesses- 2011, October 25, 2012. Accessed 2/6/13. Available online: http://www.bls.gov/news.release/pdf/osh.pdfhttp://www.bls.gov/news.release/pdf/osh.pdf 20

21. NH Department of Health & Human Services 21