This is a question supervisors, bosses, and Human Resource specialists ask themselves constantly, albeit quietly.
Everyone wants zero injuries and companies have been known to insist on watchful waiting before committing to medical care and a reportable injury.
This is a risky game! But as a doctor with U.S. HealthWorks, one of the country’s largest operators of occupational healthcare centers, I offer some guidelines during Occupational Therapy Month that should help you avoid some of the deepest pitfalls.
Does this “injury” need medical care?
I will start with the disclaimer that the safest thing to do is have any injury evaluated. The injured employee will do better and you and your company will stay out of trouble. But if I were a supervisor, I would want some help in trying to sort the serious from the nonsense.
In looking at a possible injury, the first thing an employer naturally considers is who the employee is. They are thinking of his HR file: attitude, reliability, productivity, attendance.
Essentially, are they a great employee, or a marginal one? That approach may guide you in determining whether the employee will be here next year or will get a promotion. But it’s the wrong place to start for work-related injuries because it has nothing to do with the outcome from a specific event.
So put down the HR file and start somewhere else.
A good place to start is with the “mechanism of injury.” That is a term for “what happened” – the employee got hit with a hammer, fell down, or lifted something heavy. Would you expect a serious injury from this particular circumstance? How much force is involved?
For example: If someone falls off the loading dock onto concrete, and doesn’t land gracefully on their feet, a fracture is more than possible, even expected.
The opposite circumstance is someone hitting an elbow against a doorframe while walking through an opening. That would not be expected to produce a major elbow injury. So consider the force put upon the body at the time of injury.
Rule 1: Big force causes big injuries. That tells you to be very concerned about even an apparently minor injury if there was major force involved. An employee falls off the roof – have them checked out, even if that person attempts to brush it off.
Injuries come from outside forces acting on the outside of the body. Since the body is conveniently covered with flesh and blood, there is often physical evidence of this injury.
Especially in an extremity, there will often be swelling, a black-and-blue skin coloring, tenderness and sometimes “it just doesn’t look right” – because there is a minor deformity. If it doesn’t look right, that’s a definite sign, so beware.
Rule 2: All of these suggest more injury rather than less. So the second rule is if it looks injured, get it checked out sooner.
Rule 3: Minimize the downside risk. In medicine, downside risk is a tragically bad outcome, disability, death, medical complications – all very bad stuff.
Doctors are trained to instantly think the worst, and go about proving to ourselves it isn’t that bad. That approach avoids missing something important that will cause great grief if missed.
In essence, you ask yourself: “What is the chance of this becoming a big problem if it doesn’t get treatment quickly?” That is, admittedly, difficult to do without a lot of medical background, but we can suggest a few scenarios.
A head injury with even a brief loss of consciousness or appearing dazed is concerning. This is a brain injury. Brain injuries are always serious, because they can quickly turn out very badly. This employee needs to be evaluated even if they claim to be fine. The downside risk is too great not to aggressively look for trouble.
Broken bones can have really lousy outcomes if not addressed. Quite often the injured employee can tell you they have a broken bone. They hear or feel the bone break. Believe them and get them checked out promptly.
Foreign bodies in eyes are a very common industrial injury. The employee will tell you they have something in their eye. They are almost always right. If a foreign body is not removed it will become harder and harder to remove and put your eye and vision at risk.
It’s always worth trying to wash the eye out at work, and if that solves the problem, no worries. But don’t waste more than 10 minutes trying to wash it out. If you can’t get it out right away, it needs to be removed by a doctor.
All employers attempt to separate the truly injured from the minor stuff. A little common sense when combined with some thought about mechanism of injury, signs of injury, and downside risk will go a long way toward helping you make safe decisions.
Of course, the safest course of action is to have a medical provider evaluate the injury right away, which is our recommendation.
Remember that medical advice is a phone call away if you need specific and immediate advice.
Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.
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