Posted By Robert Harrison,
Thursday, September 3, 2015
Updated: Thursday, September 3, 2015
On August 13, 2015, another worker was suffocated by palm fronds in California (see news report). This is at least the fourth similar fatality since the California Fatality Assessment and Control Evaluation (FACE) program (CA/FACE) program issued a report and video on this hazard in February 2014. The drought in the Western U.S. may have intensified the problem as lack of water has led to palm trees heavy with fronds, creating the potential to crush workers who are trimming the trees from underneath the palm fronds.
When a tree trimmer cuts or pulls on dead fronds, adjacent fronds or an entire ring of fronds may collapse and encase the worker. The weight of the fronds causes pressure on the worker’s chest and can lead to suffocation. In the cases identified through CA/FACE, the workers climbed up the tree and trimmed the fronds from the bottom up, placing themselves directly beneath the fronds. Neither the workers nor the supervisors were certified tree workers. They did not follow proper safety procedures or use the correct equipment. The workers were pinned by thick layers of dead fronds and suffocated to death.
Only workers certified by organizations such as the Tree Care Industry Association (TCIA) or the International Society of Arboriculture (ISA) should perform or supervise palm tree trimming.
Proper work procedures and correct equipment should be used. Fronds should be removed by workers using an aerial device and wearing fall protection. Alternatively, workers should use climbing procedures that place them above the fronds.
Homeowners should hire tree trimming companies that have a current tree service contractor’s license (California State Contractors Licensing Board D49). Under certain circumstances, homeowners may be liable for worker injuries or deaths that occur on their property if they hire unlicensed tree trimmers.
We would appreciate your help in getting the word out about this hazard to those working in landscaping or tree-trimming businesses.
Robert Harrison, MD is a Professor of Medicine at UC San Francisco and Chief of the Occupational Health Surveillance and Evaluation Program at the California Department of Public Health. Today’s article has been reprinted with permission from the National Institute for Occupational Safety and Health (NIOSH) Science Blog. The California FACE program is funded by NIOSH and is one of nine funded FACE states. Investigations conducted through the FACE program allow the identification of factors that contribute to these fatal injuries. This information is used to develop comprehensive recommendations for preventing similar deaths.
Posted By Douglas Sackett,
Friday, October 24, 2014
What began with strong surveillance and epidemiologic data supporting a CSTE position statement has spurred a national, multidisciplinary model pool code development process, a multi-thousand-person public dialogue, and the creation of a new non-profit organization to ensure the model code remains up to date. Learn how you can improve health and safety at public pools while saving staff time and resources by adopting this exciting, new model health code in your state or local health department.
In 2004, CSTE issued a position statement, citing the increasing trend in reporting of waterborne outbreaks at swimming pools across the country. It called for Centers for Disease Control and Prevention (CDC) to lead a national workshop to develop a unified strategy to reduce future occurrence of waterborne outbreaks at public swimming venues. The following year, over 100 individuals from public health, academia, and the aquatics industry met to develop this strategy; the major recommendation was an open-access, national model code that would help local and state agencies incorporate science-based practices without having to reinvent the wheel each time they create or revise pool codes.
What our subsequent efforts produced became the Model Aquatic Health Code (MAHC), 1st Edition, released by CDC in August 2014. The scope of the MAHC reflects its multidisciplinary approach. We expanded the prevention guidance beyond just infectious disease prevention to make the MAHC an all-inclusive guidance document covering prevention of infectious diseases, drowning, and injuries through a data and best practices-driven approach to design and construction, operation and maintenance as well as policies and management.
The steering committee set to work in 2007 with a development working plan followed by the recruitment of technical committee volunteers. As an all-volunteer effort, we took time to discuss and incorporate the multifaceted perspectives and evidence from both public health and industry participants. We opened the MAHC to two rounds of public comment. After receiving more than 4400 comments, we incorporated 72 percent of comments—over 3,000 citizen suggestions made a substantive impact. The depth, quality, and practicability of the MAHC stem from our recognition of the importance of partnerships, data-driven change, incorporation of input from all sides of aquatics, and implementable changes.
The culmination of our efforts, the MAHC 1st Edition, is now available to assist health departments in working on their pool codes through voluntary adoption. In targeting aquatic design, operation, and management, the code reflects modern epidemiological practice. The code's foundation is built on strong surveillance and investigation data from key national surveillance systems, such as National Electronic Injury Surveillance System, the National Outbreak Reporting System, and the Waterborne Disease and Outbreak Surveillance System. The annex that accompanies the MAHC lays out the rationale for code-specific requirements with scientific data and references to explain the why behind the what. The MAHC also recommends decision making informed by incorporating routine pool inspections as surveillance data.
Finally, CDC is setting up sentinel surveillance to track the impact of key MAHC elements on aquatic venue operation. We will have the opportunity to analyze these data, evaluate the model code's impact, and update the code based on findings. This will occur every two years as part of a meeting convened by the new non-profit organization, the Conference for the Model Aquatic Health Code, which is tasked with collecting national input and advising CDC on necessary updates.
If you work with or for a state or local health department, please consider taking the next step for improving health and safety at aquatic facilities: familiarize yourself with the Model Aquatic Health Code.
Your community can benefit from the MAHC's guidance for the prevention of chlorine-tolerant diseases such as cryptosporidiosis, improved training requirements, enhanced design features to reduce chemical injuries, and improved drowning and injury prevention. As the MAHC is fresh out of the box, you can also get involved with our conference to help drive future improvements. What CSTE members precipitated 10 years ago, based on sound epidemiologic practice and strong surveillance data, has now come to fruition.
We need CSTE to take a fresh look at the data and the MAHC and renew its commitment to health and safety improvement. CSTE members can bring the best of epidemiology to bear by raising awareness about the MAHC, driving discussion about potential adoption, and participating in future MAHC update discussions. With this renewed commitment, CSTE can continue drive data-based improvements in public health and safety at our nation's aquatic facilities.
Douglas Sackett is Executive Director for the Conference for the Model Aquatic Health Code. To learn more, look at CDC's easy-to-read infographic, outlining the problem, process, and product.
Are you a member with an important message to tell the CSTE community? Tell us about it! Do you use social media? Stay tuned to CSTE on Facebook and Twitter for daily updates!
Posted By Robert Harrison and Laura Styles,
Thursday, July 31, 2014
As epidemiologists, we view and interpret a lot of data. It's our responsibility to take action on the surveillance we conduct. Public health professionals understand that each case, each dot on a map, each block on an epi curve represents an ill patient, a person who has died, or a worker who has been injured. To us, charts and tables and summary reports tell an important story, but for others, we have to make it more personal to make an impact.
The Fatality Assessment and Control Evaluation (FACE) program is a case-based investigation program for the prevention of work-related injuries and illnesses. When workplace fatalities for landscape services increased in California and nationally from 2010 to 2012, we wanted to look closer. Data from the Census of Fatal Occupational Injuries (CFOI) confirmed that tree trimmers' fatality rate is twice the national average for worker fatalities. There is also a high incidence of workplace injury in this industry, although not all workers report these injuries or receive medical treatment.
At the California Department of Public Health, Occupational Health Branch, we have created videos about worker safety and health issues in addition to fact sheets, fatality alerts and investigation reports. These videos are a new strategy in the California FACE program’s prevention effort – written findings and prevention recommendations are brought to life with video re-creations, photos from the investigation, interviews with co-workers and family members, and clear explanations of how these tragedies can be prevented.
One such video, "Preventing Palm Tree Trimmer Fatalities," tells the story of Roberto, a 35-year-old tree trimmer, who died of suffocation when the palm fronds he was cutting fell on him. The video also explains proper equipment and climbing techniques that prevent this type of hazard. We see these workers every day around our neighborhoods, and they perform one of the most dangerous jobs in the U.S. They often don't have adequate training, and several deaths due to falls, suffocation, and other causes have occurred in California and elsewhere.
Click here to view the video,
Preventing Palm Tree Trimmer Fatalities.
The California FACE video uses digital storytelling techniques to create a different kind of narrative to communicate public health data and messages. The key messages for the video are conveyed through real people and a real story; the video shows the devastating impact of not using proper palm trimming equipment or climbing techniques on the job. We listened to those affected by this issue so we could tell their story respectfully. This approach makes occupational health personal and local for viewers and the public, in order to encourage safety and prevent deaths.
A lot of planning went in to creating the video itself. We created a storyboard as a roadmap for the video with planned narration, video, and photos. Production partners included the Los Angeles County Fire Department, and tree climbing and safety professionals. We sought to balance the emotional and the factual, the problem and the solution, and to create a compelling video that could be used in trainings and would tell Roberto’s story.
We have found this and our other workplace safety videos on YouTube to be an effective medium to reach our target audiences and make our surveillance data come alive for maximum public health impact. We hope you can use our experience to weave together data and narrative to tell an important story for your program.
Laura Styles is the California FACE Program Manager, and Robert Harrison is the Chief of the Occupational Health Surveillance and Evaluation Program at the California Department of Public Health, Occupational Health Branch.