May 4, 2009

Introduction

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When people make lists of dangerous careers, they often focus on jobs in logging or law enforcement. While these are risky professions, it is a fact that all occupations have their risks. One profession with a unique set of injury potential is veterinary medicine. Being an animal doctor is more than treating kittens and vaccinating dogs. On a daily basis vets are at risk of physical trauma, chemical hazards and biological threats that can harm their health, reduce their productivity and even shorten their career if not properly dealt with.

Paper and Website written by Kelly Smeltzer.

This website was created as an accompaniment to a written project for PubH 6120: Injury Prevention in the Workplace, Community and Home.

May 1, 2009

Physical Trauma

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Veterinarians are assigned to treating uncooperative, often large, patients on a daily basis. As a result, physical injuries are commonplace and costly.

Studies have shown
· 65% of Vets suffered a major animal related injury in last 12 months (Landercasper et al., 1988)
· 93% of MN & WI vets estimated to be victims of dog & cat bites (Drobatz and Smith, 2003)
· Professionals lose 8.5 work days during career (Landercasper et al., 1988)
· More than 30% work in improper postures (Reijula et al., 2003)
--- Creating back strain and injury
--- 67% of vets say they need improvements in work environment/ergonomics

As you can imagine, these injuries are the result of many factors. For the most part physical injury can be put into two categories: animal attack and non-attack type situations.

Mechanisms of Injury: Animal Attack Related
· Animal Kick
· Bite
· Crushed by Animal
· Scratch
· Other (includes goring, head-butting, running over)

Mechanisms of Injury: Non-attack
· Lifting large and heavy animals
· Restraining animals
· Awkward postures while performing procedures
· Needle sticks

Of course, injuries vary in severity, but studies have shown the following to be among the most common medical assistance required:

Treatment Required
· 17% of injuries estimated to require outside medical attention (Landercasper et al., 1988)
· Sutures
· Repair of fractures & dislocation
· Dental Work
· Physical Therapy

Chemical Hazards

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Modern veterinary medicine exposes professionals to a variety of chemicals necessary to safe and sanitary practice. Many of these agents can be toxic in the wrong dose. (Jeyaretnam & Jones, 2000)

Common Culprits
· Disinfectants
· Analgesics
· Anesthetic gases
· Therapeutic agents
· Hormones
· X-rays

Concerns
· Injected drugs often in doses beyond levels approved in humans
· NIOSH reports that levels of anesthetic gases exceeds maximum recommended exposure level
· Use of x-ray & surgical procedures up in younger vets
Quicker, faster diagnosis & treatment
More exposure to gases, drugs and radiation

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Biological Factors

Being a vet can be dangerous, and the hazards go beyond the everyday scratches and bites! While allergens and zoonotic diseases are concerning, the stress of caring for patients and running a business often results in more danger to a veternarian that anything.

Common Exposures
· Allergens: dander, latex and dermatitis
· Zoonotic Infections
· 30% of vets will contract an animal disease during career (Jeyaretnam & Jones, 2000)

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Mental & Physical Stress
· 73% of Finnish veterinarians report being “rather stressed” (Reijula et al., 2003)
· Studies of average week: 44 to 56 hours at work
· Highly dedicated professionals – motivated by work
· On-call, emergency cases
· 3 out of 4 veterinarians are employed in a solo or group private practice (BLS, 2008)


Often times veterinarians work in these conditions with limited safety training in veterinary school. Increasing fatigue results in carelessness, especially in young doctors without a great deal of on-the-job safety experience.

April 28, 2009

Missing Work: A Costly Problem

The Bureau of Labor Statistics notes:
· 3 out of 4 Vets are employed in solo or group practice
· Mean hourly wage in U.S. = $40.43

Self-employed veterinarians are often not covered by workers' compensation insurance.
· No reimbursement for lost wages
· Occupational injuries are often excluded from reimbursement
· Solo practices suffer from lost patient time (nobody to cover)

Injuries = Expensive
· Typical worker compensation claim for a vet back injury: $22,000 (AVMA, 2008)
· AVMA group life & health insurance program paid out $4 million to injured members in 2006

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April 27, 2009

Underreporting: A Persistent Problem

Many financial incentives exist to discourage injury reporting in veterinary medicine. For this reason, it has been documented that many veterinarians will avoid seeking medical care for more mild injuries. (Jeyaretnam & Jones, 2000)

As we noted before, vets are often self-employed and the result is:
· Little or no worker’s compensation coverage
· Self-employment often means poor health insurance

Veterinarians are medical professionals, with knowledge of medical procedures
· 77% of respondents to one study report self-treatment of injuries
sutures, antibiotics the most common (Landercasper et al., 1988)

April 26, 2009

Who's at greatest risk?

New Veterinarians:
· More time in practice = less injury
(Gabel and Gerberich, 2002)

Large Animal Veterinarians:
· Cows and horses rank as top injury offenders
· Heavier animals
· Performing surgery on large animals often requires awkward postures
· “House Calls” – lots of work done on site, without restraining and lifting devices
(Gabel and Gerberich, 2002; Jeyaretnam and Jones, 2000; Fritschi et al., 2006)

Workaholics
· Working more than 60 hrs correlates with higher injury rate
· Fatigue leads to loss of caution
(Gabel and Gerberich, 2002; Reijula et al., 2003)

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April 25, 2009

Current Safety Measures

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There are factors that have limited injury in veterinary practice; however, there use often varies with different professionals (Gabel and Gerberich, 2002)

· Hydraulic lifts: helps to lift heavy and awkward animals
· Restraining devices: drugs, physical restraints, muzzles
· Sharps boxes for needle disposal
· Increasing safety education in Veterinary colleges
· Assistants on staff

For instance, many rural and large animal veterinarians make "house calls" to farms where many of the safety advantages of a Vet office are not available.

April 23, 2009

Addressing the Problem with Epidemiology

While it would be ideal to prevent all injuries before they occur, the real world shows us that this cannot always happen.

By approaching occupational injuries with an epidemiological approach, we are able to evaluate the problem in terms of:
· Host
· Agent
· Environment

William Haddon created the idea of looking at injury problems in terms of a matrix (Robertson, 2007). The Haddon’s Matrix illustrates how the factors of host, agent and environment can be adjusted to limit injury problems during every phase of an injury. The phases of injury and prevention are as follows:
· Pre-injury (Primary Prevention)
· Injury (Secondary Prevention)
· Post-injury (Tertiary Prevention)


Haddon’s method of analysis is great for occupational injuries in veterinary medicine. For an example, I will use his matrix to evaluate injuries problems that occur from lifting heavy and dangerous animals.

Haddon's Matrix

Injury from physical threats: lifting large & dangerous animals

factors

Phases

Human (Vet)

Vehicle (Animal)

Environment

Pre-Injury

Training in animal handling, Good physical fitness

Proper restraint and sedation

Use of animal lifting devices

Injury

Learn to anticipate dangerous animals and tasks

Muzzle and tranquilize dangerous animals to limit unsafe postures & handling

Assistance from coworkers in lifting & animal control

Post-Injury

Encourage and seek medical care early in career to manage muscle strain & stress

Quarantine dangerous animals

Train in proper lifting and animal control techniques, seek advice from experienced Vets

From a primary prevention angle:
-- More emphasis can be put on basic animal handling skills and safety training in vet school. Veterinary colleges are noting that more students are coming from urban backgrounds and lack some of the skills that previous generations might have learned in farm work.

-- To reduce the threat from animals, vets could focus more energy on properly sedating animals before procedures and utilizing environmental controls such as hydraulic lifting tables to reduce the amount of lifting burden on the person.

Secondary prevention includes:
-- Learning how to anticipate dangerous animals and regain control when something goes wrong.

-- Knowing how to properly tranquilize animals to help regain proper postures and avoid further injury.

-- Asking for assistance and relying on the environment around you.

Finally, after an injury, vets can focus on tertiary prevention measures
-- Learn to evaluate the situation and environment after an issue to develop ways to prevent future incidents

-- Seek medical care to prevent further injury and limit symptoms


Utilizing a combination of primary, secondary and tertiary preventions will help veterinary professionals modify their behavior and environment to encourage safety.

Haddon's Strategies

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Haddon identified 10 distinct strategies for injury control during his career, a number of which are very applicable to the issues in veterinary injuries:

“Prevent the release of the hazard that already exists.”

The hazards from large and injured animals are an unavoidable aspect of the job. However, if a vet can introduce something that can prevent the hazard from causing injury, they are going to prevent a lot of trouble and pain. For instance, properly restraining and sedating an injured and scared dog might prevent a dog bite from occurring. Using a safety device such as a load-lifting table might improve ergonomics and reduce back injury. Proper education in animal handling can do a lot in preventing the release of a hazard that will always be there.

“Separation of the hazard and that which is to be protected by interposition of a material barrier.”

The use of safety equipment is one of the most important lines of defense between the veterinarian and dangerous animals and working situations. For instance, using proper gloves and protective gear can protect an animal care worker from zoonotic diseases and common allergens. Utilizing waste gas scavengers during surgical procedures can help prevent exposure to anesthetic drugs (Fritschi et al., 2008). Muzzles and cages that keep animals contained and not kicking are yet another example.

“Making what is to be protected more resistant to damage.”

This involves self-care techniques like strength training exercises to help prevent back injury and keeping ones weight down to maintain an ideal physical condition. Since so many veterinarians report being under heavy stress, efforts to reduce work related pressure and anxiety should be employed to preserve emotional well being. By focusing on good work practices and self-care, a vet might be able to focus and anticipate dangerous situations before they become injurious.

"Stabilize, repair and rehabilitate the object of the damage.”

This idea encompasses two injury strategies presented above. First is seeking medical care when it is necessary. It is easy to self-treat an injury and neglect the cause. Also, this strategy involves evaluating causes of injury and instituting training programs to prevent further injury. The American Veterinary Medical Association has promoted this idea through the distribution of ergonomic guideline posters (AVMA, 2009). These encourage veterinary staff to evaluate their workplace and identify areas that could potentially injure. By labeling these “Caution Zone Tasks,” the clinic can bring attention to the procedure and institute proper training, lifting and engineering protections to ensure a safer workplace.

April 22, 2009

How can research help?

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Veterinary injury can only be helped by further knowledge, surveillance and prevention techniques. Some ideas for further research include:

-- What role does avoiding medical treatment have on the length and quality of a veterinarian's career?

-- How can surveillance systems be improved to detect more non-fatal injuries? We know that most vet injuries are non-fatal and are not reported to any type of agency.

-- In what ways can the veterinary business model be improved to reduce injuries?

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April 21, 2009

Related Links

The American Veterinary Medical Association

The Bureau of Labor Statistics

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Works Cited

American Veterinary Medical Association. (2007). Dealing with back injuries. JAVMA News. Published October 15, 2007. Retrieved from: http://www.avma.org/onlnews/javma/oct07/071015g.asp

American Veterinary Medical Association. (2008). Introduction for ergonomics guidelines for veterinary practice. AVMA Policy, approved May 2003 and reaffirmed April 2008. Retrieved from: http://www.avma.org/issues/policy/ergonomics.asp

Bureau of Labor Statistics, U.S. Department of Labor. (2007). Occupational Employment and Wages, [May 2007], Bulletin [29-1131]. U.S. Government Printing Office, Washington, DC. Retrieved from: http://www.bls.gov/oes/2007/may/oes291131.htm

Bureau of Labor Statistics, U.S. Department of Labor. (2008). Occupational Outlook Handbook 2008-2009. Bulletin [O*NET 29-1131.00]. U.S. Government Printing Office, Washington, DC. Retrieved from: http://www.bls.gov/oco/pdf/ocos076.pdf

Chapman, H., Taylor, E., Buddle, J., & Murphy, D. (2007). Student Training in Large Animal Handling at the School of Veterinary and Biomedical Sciences, Murdoch University, Australia. Journal of Veterinary Medical Education. 34 (5): 576-82.

Drobatz, K. & Smith, G. (2003). Evaluation of risk factors for bite wounds inflicted on caregivers by dogs and cats in a veterinary teaching hospital. Journal of the American Veterinary Medical Association. 223 (3): 312-316.

Fritschi, L., Day, L. Shirangi, A., Robertson, I., Lucas, M., & Vizard, A. (2006). Injury in Australian veterinarians. Occupational Medicine. 56:199-203.

Fritschi, L., Shirangi, A., Robertson, I., & Day, L. (2008). Trends in exposure of veterinarians to physical and chemical hazards and use of protection practices. International Archives of Occupational Environmental Health. 81:371-378.

Gabel, C. & Gerberich, S. (2002). Risk Factors for Injury among Veterinarians. Epidemiology. 13 (1): 80-86.

Hill, D., Langley, R., & Morrow, W. (1998). Occupational injuries and illnesses reported by zoo veterinarians in the United States. Journal of Zoo and Wildlife Medicine. 29 (4): 371-385.

Jeyaretnam, J. & Jones, H. (2000). Physical, chemical and biological hazards in veterinary practice. Australian Veterinary Journal. 78 (11): 751-758.

Landercasper, J., Cogbill, T., Strutt, P., & Landercasper, B. (1988). Trauma and the Veterinarian. The Journal of Trauma. 28 (8): 1255-1259.

McGreevy, P. (2007). Firm but gentle: learning to handle with care. Journal of Veterinary Medical Education. 34 (5): 539-41.

Meggs, WJ. (1999). Chemical hazards faced by animal handlers. Occupational Medicine. 14 (2): 213-224.

Reijula, K., Rasanen, K., Hamalainen, M., Juntunen, K., Lindbohm, M., Taskinen, H., Bergbom, B., & Rinta-Jouppi, M. (2003). Work environment and occupational health of Finnish veterinarians. American Journal of Industrial Medicine. 44:46-57.

Robertson, L. (2007). Injury Epidemiology: Research and Control Strategies. New York: Oxford University Press.