Accld. Anal. & Pm Vol. I!. pp. 185-188 0 Pergamon Press Ltd.. 1986 Printed in Great Brilain

FATAL OCCUPATIONAL ACCIDENTS IN SWEDEN

PERSONAL SAFETY EQUIPMENT AND RESCUING

TORGNY JARL

Department of Environmental Hygiene, UmeH University, S-901 87 Umeb, Sweden

(Received 26 March 1979; in waked form 19 Nowmher 1979)

Abstract-With the help of official documents 198 fatal occupational accidents that occurred in Sweden in 1973 have been analyzed. The aims of the study were to find out: (1) The optimal effect of increased use of personal safety-equipment and (2) How many lives may be saved by better rescue-preparedness and optimal medical care? The results are that in one third of the cases personal safety equipment offers significant protection against a fatal outcome. Proper action after a severe accident has taken place could reduce fatalities by about one sixth.

BACKGROUND

4ccidents at work are-as far as we know-the dominant source of risk in the working :nvironment[Jarl and Thorson, 19781. In Sweden every year about 2.50 workers are killed and about 2000 are injured in such a way that they get some kind of permanent disablement 1 National Insurance Board, 19761. From a medical, humane and also economic point of view it s urgent to prevent or at least to reduce the consequences of occupational accidents.

Prevention of accidents may principally be carried out in the same way as any other health hazard in the working environment. Preferably this means eliminating the dangers during the I)lanning of processes and work sites. A second way is to prevent contact between the harmful process and the worker, e.g. by protective screens, safety barriers etc. The third level of protection is to reduce the effect of violence by using persona1 safety equipment such as

helmets and protective clothing[National Board of Occupational Safety and Health, l%ll. The capacity of the human body to tolerate large impacts is well known[de Haven, 1942; Kazarian, 13ole, Ketchum et al., 1976; Thorson, 19751. Personal safety devices have been used by man r;ince early history[Gurdjian, 19731 and the effects of protective devices have been analyzed in order to improve and to motivate increased usage of them[Gurdjian, Roberts, Thomas, 1966; Petty, 19751. As a last level of protection rescuing and proper medical care of the injured is a way of limiting the consequences of an occupational accident [Arens, 19761.

This study deals with the two levels last mentioned above. Questions to be answered were the following: (i) To what extent can the risks of serious injuries and fatalities be reduced by increased usage of personal safety equipment? (ii) To what extent can more efficient care-taking of severely injured workers reduce the number of fatalities in occupational accidents?

MATERIAL AND METHODS

The study is based on 198 fatal occupational accidents that happened in Sweden during 1973. These cases are all that were reported to the Swedish authorities as occupational accidents. Bengtsson and Jarl[ 19791 have examined the reporting of occupational accidents in Sweden and f 3und that the drop-outs are mainly of two kinds: (1) fatal accidents to one-man companies and (:!) traffic casualties. The following materials have been used: Acts from the National Insurance b;oard, reports from the Labour Inspectorates, police investigations, autopsy protocols, case records and internal investigations from the actual workplaces.

The nature of the violence has been compared with the observed injuries, and a medical emstimation as regards relevancy of personal safety equipment has been carried out. To be classified as “relevant” the equipment must fulfil three criteria, compare Skiba[ 19761:

(I) It must be applicable to the body region in question; e.g. a helmet as protection against falling objects.

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186 T. JARL

(II) It must be sufficient; i.e. be in proportion to the force it is supposed to resist. A helmet will not be considered sufficient if a miner gets one ton of rocks on his head.

(III) It must be realistic; i.e. not hindering the work cycle and also realistic as regards risk exposure. This is, thus, mainly a question of motivation.

The personal safety equipment included in this study is: safety belts with life lines, helmets, safety belts (in cars and trucks), protective clothing, protective gloves, shoes and life vests. An evaluation of the final course of events between the accident and the actual time of death concerning rescuing, first aid and medical care has also been made.

RESULTS

Personal safety equipment

A division of the events according to activity at the time of the injury shows that a major part of these fatal occupational accidents took place in changing working environments, see Table 1:

These figures are not comparable to the official statistics, where the cases are classified according to branch of industry [National Board of Insurance, 19761.

It may be concluded that in many of these constantly changing work-places it is difficult to apply once-and-for-all solutions in dangerous sub-operations, e.g. by changes in the organiza- tional structure or by stationary guards. Thus the relative importance of personal safety equipment increases in these situations. The relevance of personal safety equipment is seen in Table 2.

In a majority of these events the magnitude and nature of the violence or other circumstances have meant that personal safety equipment has insufficient life saving capacity. High impact

Table I. 198 fatal occupational accidents according to activity at the time of the accidents

Activity Number of cases %

Transport, mainly road traffic Construction industry Service and repairs Agricultural work and forestry Production industry (processing) Warehousing, stevedoring, sailing Mining and quarrying Aviation Total

50 25.3 40 20.2 39 19.7 21 10.6 17 8.6 16 8.1 9 4.5

-6 198

3.0 -_. 100.0

Table 2. Type of violence and relevance of personal safety-equipment in 198 fatal accidents at work (Sweden 1973). Number of cases

1.

II.

III.

IV

Type of violence Personal safety equipment Total

Mechanical Energy A. B.

C.

Horizontal Vertical 1 falls of objects, slides 2 falls of persons Combined mechanical violence

Relev. Not relev. 21 41 62

7 22 29 22 12 34 4 24 28

Thermal Energy A. Explosions B. Fire, burns

Electricity

Obstruction of Vital Functions A. Suffocation

1 by compression of the thorax 2 by aspiration

- 4 4 7 - 7

6 7 13

- 8 8 6 2 8

B. Other causes of death - 5 5 Total 73(37%) 125(63%) 198

Fatal occupational accidents in Sweden 187

speed resulting in massive brain damage is one example of this, see[Hutchinson, 1975; Bartiey, 19751. In about one third of the cases personal safety equipment has been classified as relevant.

The largest group of events where this is the case is the group “falls of persons” group I B2. In half of these a life line or a helmet could have saved lives. Another important group is the workers that have been injured by horizontal violence. Increased usage of safety belts in cars and trucks could contribute to a decrease of the death figures. Protective clothing against chemical agents and burns, gloves and shoes resistant to electricity and using a life vest when working close to water are other examples of personal safety equipment that may be of importance.

In 48 of the “relevant” cases personal safety equipment was not used, in another fourteen cases it was impossible to find out whether such equipment had been used or not. However, in eleven cases relevant personal safety equipment was used. Fatai outcome in these cases was due to (I) Incorrect use (e.g. not using the chin strap on the helmet) or (2) Medical com- plications (see below, Table 3).

Table 3. Analysis of the final course of events in 198 fatal occupational accidents in Sweden in 1973

Factor of significance to the Number of outcome of the event cases Total

Working alone Complicated rescue Insufficient first aid

Fatal in spite of medical care (medical complications)

No significant factor present Total

15 - 7 - 3 -

9 34

164 164 198 198

Rescuing

The time of survival for the injured varied considerably. In nearly half of the cases the injured workers died immediately, in a fifth of the cases within five minutes. In four cases the affected workers lived for more than a month after the event. An analysis of the last level of protection, namely how the final course of events has affected the outcome of these accidents is shown in Table 3.

In fifteen cases the injured worker did not die at once, but since he was alone at his work place his situation was not observed in time to save his life. The most common cause of death n this group is suffocation (group IV Al). In seven other cases it was not possible to save the ife of the injured even though attempts at rescue started immediately. According to this investigation further investments in first aid can have only a marginal effect as regards fatalities. Thus, in three cases the first aid arrangements at the site of the event were inadequate. When :;omeone is seriously injured there is also a risk of life-threatening complications such as blood l&oning and pulmonary embolism in spite of professional medical care. Nine such cases were found in this study.

CONCLUSIONS

Altogether this investigation shows that an increased usage of personal safety equipment in risky situations at work may reduce fatal outcome of occupational accidents considerably. A bletter consideration of the special risks when working alone and a better preparation for rescue should also, but to a lesser extent, be contributive to a decreased number of fatal occupational accidents.

REFERENCES

Arbetarskyddsverket, Anvisningar 45:O. Personlig skyddsutrustning. Allmanna bestammelser. (Instructions 45:O. Personal s~ety-equipment. General instructions). Stockholm, 1961.

Arens W., Notfa~i~bandlung im Betrieb. Zbf A~~e~tsme~iz~n 26(4). 7&U, 1976. B,artley V. H., Analysis of fatal blunt trauma presenting at an areawide trauma center. 111 Med. 1. M&5), Sl l-515, 1975.

188 T. JARL

Bengtsson B. and Jar1 T., The Reporting of Occupational Accidents. Department of Environmental Hygiene, Umea. Sweden, 1979.

Gurdjian E. S., Prevention and mitigation of head injury from antiquity to the present. J. Trauma 13(1 I), 931-945. 1973. Gurdjian E. S., Roberts V. L. and Thomas L. M., Tolerance curves of acceleration and intracranial pressure and protective

index in experimental head-injury. J. Trauma 6(5), 6OB-604, 1%6. De Haven H., Mechanical analysis of survival in falls from heights of fifty to one hundred and fifty feet. War Medicine 2,

5865%. 1942. Hutchinson T. P., Factors affecting the times till death of pedestrians killed in road accidents. Injury 6(3), 201212. 1975. Jar1 T. and Thorson J., Occupational accidents in Sweden. Review of the problem and the research in this field. In. Health

and Society-f. Accidents and Violent Death. Committee for Future Oriented Research, Stockholm, 1978. Kazarian et al., High-Flyer Syndrome. Survival after 17-story fall. N.Y. State J. Med. 76(6), 982-985, 1976. Petty P. G., The influence of seat belt wearing on the incidence of severe head-injury. Med. J. (2) 768-769, Aust. 1975. Riksfiirsakringsverket (National Insurance Board), Yrkesskador (occupational iniuries) 1973. Stockholm. 1976. Skiba R., Taschenbuch Arbeitssicherheif. Bielefeldt, 1976. Thorson J., Long-term Efects of Traflc Accidents. Lund, 1975.