More than 400,000 hand and arm injuries take place in the United States every year. Serious injuries cutting, crushing, lacerations and amputations have severe, life-changing consequences for workers and companies.

In the cases described below, the workers faced all the problems that go along with such severe injuries, such as getting appropriate medical care and healing from the physical injury, not to mention loss of work and workers' compensation issues.

For employers, injuries result in other costs and consequences: the shock of responding to a medical emergency, loss of a trained employee, uncertainty about the worker's return, paperwork and forms to fill out, notification to OSHA, possible OSHA inspections and citations, increase in workers' compensation premiums, and loss of morale in the work force because a co-worker is seriously injured.

It is in everyone's interest to reduce or eliminate hand and arm injuries. A look at these cases can help guide you on steps to take in your workplace. (Note: The following cases are based on actual injuries. Names and some details have been changed to protect privacy.)

Finger Amputations

Louise received serious injuries to her left hand when she reached across the path of a 15-inch saw blade. She was cleaning the work area, removing some material that was stuck in the saw blade, and inadvertently stepped on the foot pedal that activated the hydraulically controlled radial arm that moves the saw blade across the wood.

Louise lost two fingers and suffered severe lacerations. She was out of work for a couple of weeks and was unable to return to her previous job.

Louise had received no instruction in the operation of the saw. She had been operating the machine for about 10 hours before she was injured.

What went wrong? The immediate, obvious problems are clear. Louise had not been trained on the saw. Although a mechanical guard was available to prevent the foot pedal from being activated, she had not been told about the guard or shown how to use it.

Many factors go into why an accident occurs. Environmental factors include lighting, noise and time of day, all of which affect alertness. Working surfaces, placement of equipment and vibration are ergonomic factors that affect how easily a task can be performed.

In Louise's case, the investigation found that the position of the foot pedal made it inconvenient to use during normal operations, but easy to step on accidentally during maintenance operations from a different position along the saw table.

Louise was also doing a maintenance task. According to the lockout/tagout standard, power should have been off while she performed this task. She had not been trained in lockout/tagout; in fact, the company did not have a lockout/tagout program in place at the time of her accident.

Solutions. It's a well-known fact in the health and safety world that new employees are at much greater risk for injury. Training and information even a supervised on-the-job training period could have prevented this injury.

Personal protective equipment (PPE) in this case, steel-mesh gloves and heavy leather gloves might not have prevented an injury from a table saw, but the injury certainly would have been less severe, and Louise might not have lost her fingers. In all maintenance and repair tasks involving blades and sharp edges, PPE can be crucial in preventing or reducing injury. OSHA's PPE standards require a job hazard assessment to identify risks and provide appropriate PPE.

Smashed Hand

Ralph was wheeling a hand truck with several large, heavy boxes on it down a ramp leading to a narrow doorway. As he wheeled the hand truck backward down the ramp, the truck went out of control. As Ralph struggled to control the truck, his hand moved from the handle down along the side of the truck. His hand was smashed in the doorway, and several bones in his hand were broken.

Ralph was out of work for several weeks and has permanent damage to his hand. Alternate work had to be found for him.

What went wrong? The hand truck had too much weight on it for one person to manage, especially as it accelerated down a ramp. With the position of the doorway, right at the foot of the ramp, Ralph's injury was almost inevitable.

In this accident investigation, a number of underlying factors were revealed. Although hand trucks were used daily at this company and there had been a number of previous injuries involving hand trucks, employers were not trained, nor had the company developed any health and safety policy on hand trucks. Here, the company violated the OSHA general-duty clause as well as the material handling standard, as its citation reflected.

Solutions. Training on hand trucks should include:

  • Appropriate weight for the truck;
  • Effects of acceleration from ramps or drops;
  • When to ask for help;
  • When to let the truck go if it's getting out of control; and
  • Appropriate gloves or PPE.

The company policy could designate areas where hand trucks should not be used, a maintenance and repair plan and, through investigating accidents and near misses, company-specific procedures to reduce injuries.

Wrist Puncture

Joe was working on dry wall in a new office construction. A nail fired through the wall by another worker using a power-actuated hammer punctured Joe's wrist.

Joe was given first aid, taken to the emergency room and needed surgery to repair bones in his wrist. He was out of work for more than a month.

What went wrong? Obviously, a lack of communication between the two workers was key to Joe's injury. Following OSHA rules, power-actuated tools should only be used with warning signs and with procedures to clear the work area before using these tools.

On construction sites, with many different subcontractors working on different aspects and phases of the construction, health and safety can be difficult to manage. Financial incentives for contractors to finish work early increase efficiency, but also can tend to push health and safety concerns to the back.

In Joe's case, there were 23 subcontractors on the project, financial incentives for early completion were present, and there was no comprehensive health and safety program from the general contractor. Safety briefings did not address the overall project and included irrelevant topics (heat stress was discussed in February).

Solutions. On a large construction site, general contractors can designate a health and safety officer (HSO) who works with all the subcontractors. The HSO will ensure that no other subs are working in an area of powder-actuated tools, proper warning tape and signs are used, and it is clear to subcontractors what is expected of them. A subcontractor should make sure any walk areas, aisles or work areas that could be impacted by the power-actuated tools are blocked or taped off, and the sub's employees should actively warn other workers outside the area.

The general contractor is responsible for setting the tone on health and safety issues and for implementing policies that can lead to fewer injuries. The general contractor can require subs to provide copies of their written health and safety programs, and to show records of employee training. Many general contractors implement a no-injury policy, where financial incentives are tied to a zero-injury rate, rather than early completion.

Carpal Tunnel Syndrome

Renee has been doing piecework in a garment shop for years. She has been feeling numbness and tingling in her thumb and fingers for some time, accompanied by pain she tried to ignore. One day, a terrible weakness set in to her hand, and she could not do her job.

Renee was referred to a doctor and had wrist surgery for carpal tunnel syndrome. She was out of work for six weeks. Renee is happy that her hand works again, but she, her doctor and her employer are having a hard time finding alternate work for her that will not bring back her condition.

What went wrong? When Renee's illness was brought to her employer's attention, it was handled well. She was referred to a physician specializing in occupational health and familiar with repetitive strain injuries. She was diagnosed and treated correctly.

Unfortunately, Renee did not know the warning signs of carpal tunnel syndrome (CTS), a repetitive strain injury common in her line of work. In CTS, repeated stressful wrist motions cause inflammation to the tendons and ligaments in the wrist.

The carpal tunnel, a small opening in wrist bones that lets the nerve pass through, cannot expand to make space for the inflammation. The nerve ends up pinched against the wrist bones. Symptoms, like Renee's, include pain, tingling, numbness and eventually loss of muscular control in parts of the hand.

Solutions. The new OSHA ergonomics standard helps provide employers with guidelines for identifying musculoskeletal disorders (MSDs). The standard includes requirements for employee training.

Many MSDs have early warning signs that workers and employers can watch for. In most cases, steps can be taken to prevent the illness from progressing.

Handling Emergencies

In each of the cases described above, the medical emergency was handled as well as possible, given the fact that the workplace isn't a first-aid station or an emergency room. All these facilities had:

  • Well-stocked first aid kits;
  • Staff members trained and available to respond to medical emergencies; and
  • Arrangements with nearby hospitals or care facilities.

These accidents were handled quickly and properly. In many workplaces, where there is limited first aid and medical preparedness does not exist, such injuries will result in greater disruption, greater injury and risk to the worker, and greater loss of morale.

Conclusion

As we looked at these cases in depth, we note violations of several OSHA standards: lockout/tagout, manual material handling, machine guarding and power-actuated tools, to name a few. Compliance with these standards, as well as PPE standard 29 CFR 1910.132 and new ergonomics standard 29 CFR 1910.900, would have prevented these and many other injuries.

OSHA compliance vastly increases your ability to prevent these hand and arm injuries. OSHA statistics bear this out, as we see injury rates drop as companies come into compliance with new OSHA standards. OSHA compliance helps reduce injuries and avoids devastating costs to workers and companies.

Jennifer M. Shriver, CHMM, with WorkLife Consulting Inc. in Boulder, Colo., has been working in the occupational health and safety field for 15 years, specializing in accident investigation, determining correct PPE and ergonomic assessments. WorkLife can be reached by e-mail at worklife@indra.com or by telephone at (303) 247-1688.