| Think Prevention

A Safety Manager’s Guide to

EARLY INTERVENTION

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Table of Contents:

1. Early Intervention 101

2. How an Early Intervention Consultation Works

3. Two Early Intervention Case Studies from the Real World

4. Frequently Asked Questions About Early Intervention

5. Five Reasons Why You Should Get Started With Early Intervention Today

6. About Ergonomics Plus

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Early Intervention 101

Imagine for a second that you have a
crystal ball in your office.

Through it, you can see the next three

years of recordable injuries at your facility.

Sue, carpal tunnel.

Joe, back strain.

Tom, thoracic outlet compression.

And the list goes on and on.

Here’s the thing. You don’t need a crystal ball to uncover the next three years of
MSDs at your facility. What you need is early intervention.

Discover Early Warning Signs, Prevent MSDs

We know that MSDs develop over the course of time as the result of exposure to
risk factors.

Carpal tunnel doesn’t happen overnight.

Tendonitis doesn’t develop in a day.

This means the early warning signs of these injuries are present long before an
MSD develops to the point of lost function and pain requiring medical treatment.

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Armed with this knowledge, we can implement a proactive strategy to discover the
early warning signs of MSDs and fix the underlying causes. This is exactly what early
intervention does.

Early intervention is a proactive strategy designed to discover early warning signs of

MSDs and prevent the early warning signs from developing into an injury.

The early warning signs of the next 2-3 years’ worth of MSDs are present in your
workforce today. The question is, what are you going to do about it?

Assuming you don’t have a crystal ball handy, getting started with early intervention
should be on the top of your to-do list.

There are five steps to the early intervention process.

Step 1 – Awareness and Education

Workers need to understand the early warning signs of MSDs so they can recognize
them when they appear. It’s important that they understand the fundamental
principles of prevention as well as the self-care regimen that is recommended for
all employees.

Step 2 – Encourage Early Reporting

Employees should be highly encouraged to report early warning signs of MSDs to
supervisors, team leads or directly to the on-site injury prevention specialist.
Creating a culture that encourages early reporting is critical to this process.

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Step 3 – React Positively and Respond Quickly

Supervisors and team leads should be trained to react positively and respond
quickly to early reports of fatigue and discomfort. We often mention being “over the
top” positive to these early reports. The injury prevention specialist should be
notified immediately and quickly respond to the report.

Over the top and on the hop! Sounds cheesy, but it’s extremely effective in practice.

Step 4 – Conduct the Early Intervention

Consultation
When an early report is received, the injury prevention specialist conducts a one-
on-one consultation with the employee.

This consultation has three parts:

1. Listen to the employee and understand the problems they are having.
2. Review the self-care program for the employee and make them aware of the
prevention tools available to them.
3. Evaluate the job and remove any causative risk factors present through the
ergonomics improvement process and implementing the necessary
ergonomic controls.

Step 5 – Follow up & Report

The injury prevention specialist should follow up with the employee on a weekly
basis until the early signs are resolved and the employee is returned to peak health.

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Each of these interactions should be recorded. Results of all early intervention

consultations should be compiled and reported on a monthly basis. These reports
should be used to identify overall trends and workplace improvement
opportunities.

Bonus Tip
You might be thinking that an early intervention process sounds great, but
wondering who is qualified to do the early intervention consultations and how you
are going to find time for this.

We’ve written before about how a workplace Athletic Trainer deserves to be on

your OHS team, and early intervention is where they really shine.

Athletic trainers are allied healthcare professionals specifically trained in injury

prevention and human performance. We’re a little biased because we use the
Workplace Athletic Trainer model of injury prevention for our clients, but you might
consider adding an athletic trainer to your roster! You’ll be glad you did.

Conclusion
Musculoskeletal Disorders develop over the course of time, and the early warning
signs of future injuries are present in your workforce today.

What are you going to do about it?

Early intervention will not only allow you to find the next three years of injuries, but
help you take proactive steps to prevent them from happening.

Think prevention!

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How an Early Intervention

Consultation Works

“An ounce of prevention is worth a pound of

cure.” – Benjamin Franklin
It’s clear that prevention is better than
treatment. If given the choice, nobody
would ever choose to have a painful
musculoskeletal disorder that requires
surgery or prescription medications with
potentially disastrous side effects.

Preventing the injury makes much more

sense. It’s better for the person and
better for the company.

Having an ergonomics improvement process and robust education and training for
everyone at your facility goes a long way to remove MSD risk factors and prevent
MSDs. It’s necessary to have these parts of your MSD prevention process in place.

However, whenever workers use their bodies to perform a job, they are inherently
at risk for developing an MSD. Their bodies experience daily fatigue, and if this
fatigue outpaces their body’s recovery system it causes a muscular imbalance,
eventually leading to an MSD.

Because MSDs develop over the course of time, the early warning signs (fatigue and
discomfort) of future injuries are present in your workforce today.

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So what makes the difference between early warning signs developing into an MSD
verses the worker returning to peak health?

The Critical Difference – One-on-One Early

Intervention Consultations
A one-on-one consultation with an injury prevention specialist is a powerful way to
prevent injuries. Early intervention is a strategy designed to discover early warning
signs of MSDs and prevent the early warning signs from developing into an injury.

An early intervention consultation has three parts:

1. Listen to the employee and understand the problems they are having.
2. Review the self-care program for the employee and make them aware of the
prevention tools available to them.
3. Evaluate the job and remove any causative risk factors present through the
ergonomics improvement process and implementing ergonomic controls.

Let’s take these on one at a time to understand why early intervention can be the
difference between an MSD and a healthy, productive worker.

1. Listen to the employee and understand the

problems they are having.
When the injury prevention specialist is notified of an early report of fatigue and
discomfort, they should respond quickly and positively. The first step is to listen to
the employee and understand their specific situation. It is also helpful in many
cases to watch the worker performing their job.

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The initial consultation should answer two basic questions about what risk factors
are contributing to this worker’s fatigue and discomfort.

 Are there any individual risk factors present? (Using poor work practices, has
a poor health profile, physical fitness, nutrition habits, etc.)
 Are there any ergonomic risk factors present in the employee’s workstation?
(Force, repetition, awkward postures.)

Understanding the root cause of the issue will inform the prevention process and
plan of action to remove risk factors.

2. Review self-care program and injury prevention

tools.
Once the injury prevention specialist has a grasp on the causative risk factors
contributing to fatigue and discomfort, they will review the self-care program with
the employee. This one-on-one time spent training the employee reinforces group
education sessions and empowers the employee to take care of their body.

Prevention tools and techniques available to all employees:

 Preventive warm-up exercises

 Proper lifting techniques
 Proper body mechanics
 Identification of ergonomics improvement opportunities
 Preventive counteractive stretching exercises
 Proper resting/sleeping posture
 Strengthening exercises
 Fatigue recovery and sleep
 Proper nutrition and hydration
 Good health habits

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 Personal fitness and wellness

3. Evaluate the job for causative ergonomic risk

factors.
An objective ergonomic assessment of the workstation should be conducted to
determine if ergonomic risk factors are present.

If it is determined that there are ergonomic risk factors, ergonomic controls

(engineering and/or administrative controls) should be implemented to remove the
incompatibilities between the work and the worker.

Rinse and Repeat – Follow up on a weekly basis

The injury prevention specialist should follow up with the employee on a weekly
basis to evaluate the progress of the employee’s situation and continue to reduce
causative risk factors.

These follow up visits should be conducted until the worker returns to peak health.

Conclusion
A one-on-one consultation with an injury prevention specialist is a powerful way to
prevent injuries. Also, by providing employees with an injury prevention specialist
(workplace athletic trainer) to conduct these consultations, you are putting a last
line of defense in place to prevent injuries.

This is good for your business and great for your people. Think prevention!

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Two Early Intervention Case Studies

from the Real World
There is a story behind everything.

How a company proactively prevented

an injury.

How a worker’s health slowly

deteriorated to the point of a disability.

How a person remained healthy and

productive at work.

The lessons behind these stories are invaluable learning tools. We can learn from
both the successes and the failures of people who have gone before us.

Following are two very different stories. One of failure, the other of success.
Hopefully you find a practical application in these stories that benefits your
situation.

Early Intervention Case Study - Ed

Meet Ed.

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Ed’s story provides a lesson in what not to do. Sadly, Ed suffered a painful injury
that ended in a disability that affected him for the rest of his life.

The Problem:

Ed was exposed to a variety of risk factors. Some of these risk factors were the
responsibility of the company and some were Ed’s responsibility.

Company

 Poor health and safety culture

 No leadership commitment
 Reactive, treatment-focused approach

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 No ergonomics improvement process

 No early intervention process
 Production trumped health and safety

Ed

 Poor health habits

 Poor body mechanics
 Did not recognize early warning signs
 Did not report increased fatigue/discomfort until functional capacity was
compromised

The Solution:

Unfortunately, the reactive approach taken by the company Ed worked for provided
no solution to minimize Ed’s exposure to risk factors or provide Ed with a way to
report fatigue and discomfort before it progressed into an injury.

Without a proactive prevention strategy in place, the results shouldn’t surprise you.

The Results:

The outcome of this story was bad for the company and even worse for Ed.

 This system failure resulted in heavy costs.

 Direct and indirect costs to the company (over six figures)
 Human costs to Ed and his family – multiple surgeries and disability.

Unfortunately, this story plays out across the country every day. This is what
happens when you take a reactive approach to ergonomics, injury prevention and
wellness.

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Early Intervention Case Study – Kay

Meet Kay.

Kay’s story provides a lesson in what can be accomplished with a world-class

prevention process. It’s a story of a company and an employee both taking
responsibility for their role in the prevention process (with the help of an on-site
injury prevention specialist). It won’t shock you to learn that the outcomes of this
story are much, much improved compared to the previous story.

The Problem:

Similar to Ed, Kay was exposed to a number of risk factors. These included both
ergonomics risk factors (force, repetition, posture) and individual risk factors (poor
work practices, poor health habits, etc).

The Solution:

Fortunately for Kay, the company she worked for had a proactive prevention
process that included early intervention.

Here is how the story unfolded:

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One morning, Kay’s supervisor (Steve) noticed that something was missing – her
smile. Her body language seemed different as well, so he asked her if there was a
problem. “Not really, it’s nothing really.” But Steve didn’t let it go, and again he
asked, “Are you sure something’s not bothering you?”

Kay then told him that she was experiencing some discomfort in her right arm.
Steve responded, “I’m glad you told me, thank you. I’ll have Mark (the onsite injury
prevention specialist) come talk to you about this and we’ll see if we can get you the
help that you need to resolve this.”

The Early Intervention Consultation

When the injury prevention specialist was notified of the early report, he quickly
responded by conducting an early intervention consultation. The consultation
consisted of three parts.

1. The specialist listened to Kay to fully understand her issue.

2. He reviewed the self-care program and injury prevention tools available to
Kay.
3. He conducted an objective ergonomic assessment of the workstation to
determine if any ergonomic risk factors were contributing to Kay’s
discomfort.

Several prevention measures were put in place as the result of this consultation.

 It was determined that there were ergonomic risk factors contributing to

Kay’s discomfort. Engineering controls were put in place to reduce these risk
factors.
 Kay was compliant in maintaining the recommended self-care program and
utilizing the injury prevention tools available to her.
 The specialist visited with Kay on a weekly basis to track her progress and
help her return to peak health.

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The Results:

The discomfort in Kay’s right arm faded away and she returned to peak health. Due
to the proactive prevention process and solutions that were put in place, an injury
was avoided and Kay remained a healthy and productive worker. This was a big win
for the company and an even bigger win for Kay.

Key Takeaways
The different outcomes of these stories provide a number of takeaways. Clearly, we
want to follow the example of Kay’s story. Here is what Kay and the company she
worked for got right:

1. The company took responsibility for Kay’s safety and health. They had a
prevention process in place that included early intervention and contracted
with an injury prevention specialist to make weekly, on-site visits. This early
reporting mechanism and weekly dedication by the prevention specialist
provided a channel for Kay to report her problem and get the help she
needed.
2. Kay took responsibility for her own safety and health. She reported the
discomfort in her right arm due to her well-trained and alert supervisor. She
was compliant and followed the recommended self-care program and
utilized the injury prevention tools available to her.

Conclusion
The early warning signs of future injuries are present in your workforce today. Early
intervention is a powerful prevention tool because it identifies these early warning
signs and puts control measures in place to make sure they don’t progress into
injuries. Think prevention!

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Frequently Asked Questions About

Early Intervention
If you’re a proactive safety or human
resource manager and you’re looking to
achieve health and safety excellence,
you might be wondering whether or not
you should implement early
intervention as part of your OHS
process.

Perhaps you’ve heard that early

intervention has proven to be successful for many other companies. Naturally, you
have some questions about how it might work for you.

Sound familiar? Here are the most frequently asked questions we get from
prospective clients, answered.

Let’s start at the beginning …

What is early intervention?

The early warning signs of future injuries are present in your workforce today. Early
intervention is a proactive strategy designed to discover early warning signs of
MSDs and prevent the early warning signs from developing into an injury.

This process has five parts:

1. Awareness and Education

2. Encourage Early Reporting

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3. React Positively and Respond Quickly

4. Conduct the Early Intervention Consultation
5. Follow Up and Report

(For more, read A Safety Manager’s Guide to Early Intervention.)

What happens during an early intervention

consultation?
The goal of the early intervention consultation is to identify the contributing risk
factors to the worker’s fatigue and discomfort and remove them.

This consultation has three parts:

1. Listen to the employee and understand the problems they are having.
2. Review the self-care program for the employee and make them aware of the
prevention tools available to them.
3. Evaluate the job and remove any causative risk factors present through the
ergonomics improvement process and implementing ergonomic controls.

Once the injury prevention specialist has identified risk factors, they remove them
by implementing controls. Ergonomic controls reduce ergonomic risk factors.
Individual controls such as reviewing good work practices, good health habits and
injury prevention tools reduce individual risk factors.

(For more, read Early Intervention – The Critical Difference Between an MSD and a
Healthy, Productive Worker.)

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On average, how often does an early report result

in an injury? In other words, what is the success
rate of early intervention consultations?
By identifying risk factors and putting controls in place, most early intervention
consultations successfully resolve and the worker is returned to peak health.

For example, so far in 2013 96% of early reports have been resolved without a
medical injury through early intervention consultations with an Ergonomics Plus
injury prevention specialist.

If employees are encouraged to report fatigue

and discomfort, won’t they take advantage of
that?
Before getting the early intervention process off the ground, some of our clients
and prospects are concerned about allowing early reporting of fatigue and
discomfort.

They were worried that employees would take advantage of early reporting and
over report fatigue and discomfort. They thought this would create an avalanche of
reports that would eventually become injuries.

These would have become more significant and severe injuries down the road if not
reported early. Right now is always the best time to seek help for combating
discomfort that can lead to an injury. Risk factors can be identified and (workplace
and individual) controls can be implemented to prevent the need for the employee
to seek medical evaluation and treatment.

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Will employees really utilize the self-care

program?
A recommended self-care program and injury prevention tools should be available
to all employees.

These tools include:

 Preventive warm-up exercises

 Proper lifting techniques
 Proper body mechanics
 Identification of ergonomics improvement opportunities
 Preventive counteractive stretching exercises
 Proper resting/sleeping posture
 Strengthening exercises
 Fatigue recovery and sleep
 Proper nutrition and hydration
 Good health habits
 Personal fitness and wellness

Some people are skeptical that employees will be compliant with their self-care
program and utilize these tools. After all, things like good health habits, proper
hydration and counteractive stretching aren’t mandatory and accountability is
difficult.

Here’s the thing. When employees recognize the early warning signs of an MSD,
they become very motivated. An abnormal amount of fatigue and discomfort is not
an enjoyable experience. They know if their issue progresses into an injury it will be
very painful. Employees understand that they need to take responsibility for their
part in the prevention process.

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After doing thousands of early intervention consultations, I can confidently state

that most employees are compliant and do a great job implementing a self-care
program. Of course, every once in a while there is an outlier who isn’t compliant.

But is that going to stop you from helping the ones that are?

Who should perform early intervention

consultations?
Early intervention consultations should be conducted by an experienced injury
prevention specialist. At Ergonomics Plus, we use Certified Athletic Trainers. They’re
specifically trained in injury prevention and human performance, and make the
perfect partner for your OHS process.

(For more, read Five Reasons Why an Athletic Trainer Deserves a Spot on Your OHS
Team.)

Is an early intervention consultation a recordable

injury?
In 2011, OSHA published an interpretation relating to exercise that has caused
some confusion and concern among safety and human resource managers.

Specifically, the interpretation request asked if “exercise is considered medical

treatment” as defined in OSHA’s recordkeeping regulations. OSHA’s response was,
“If a physician or licensed health care professional
recommends therapeutic exercise in response to a work-related injury or illness,
the case is considered to involve medical treatment and the case is recordable.”

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Note that although the question posed to OSHA asked if “exercise is considered
medical treatment”, OSHA’s response specifies “therapeutic exercise in response
to a work-related injury or illness.” OSHA states in its response that it considers
“therapeutic exercise” a form of physical therapy, and that physical therapy is
considered medical treatment for recordkeeping purposes.

The early intervention strategy employed by the Injury Prevention Specialists at

Ergonomics Plus is about prevention, not treatment.

Preventive consultations are available to each and every employee. The self-help
techniques recommended are not therapeutic in nature, and serve as a means to
help employees counteract daily fatigue.

Employees are encouraged to seek self-help advice to prevent injury and illness.
When an employee requests self-help advice for any concern (related to work
activities or not) and does not desire or request a medical evaluation, our injury
prevention specialists will consult with the employee to review and encourage a
variety of prevention tools and techniques. These techniques are advocated and
reviewed in our injury prevention training program and in handouts or publications
that are available to all employees.

(For more, read Exercise – Is it a Recordable or Not?)

Why should I consider adding early intervention

to our OHS process?
These are just a few of the benefits of adding early intervention to your OHS
process:

1. Early intervention identifies and removes MSD risk factors.

2. Early intervention prevents injuries.

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3. Early intervention is the right thing to do for your people.

4. Early intervention is a cost-effective prevention strategy for your business.
5. Early intervention can help you build the safety culture you’ve always wanted.

(For more, read Five Reasons Why You Need to Get Started With Early Intervention
Today.)

Did we miss anything?

Do you have a question about early intervention that we missed?

Get in touch with us today and we’d be happy to help you out.

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Five Reasons Why You Should Get

Started With Early Intervention
Today
Have you had any musculoskeletal
disorders (MSDs) at your facility in the
past year?

Do you think you’ll have any this year?

If you’re like many industrial

companies, you have recordable MSDs
every year and it’s costing your
company and employees.

According to the Liberty Mutual Workplace Safety Index, overexertion injuries alone
accounted for more than $50 billion in direct workers compensation costs in 2011.
With indirect costs being three to twenty times the amount of direct costs,
overexertion injuries account for a significant portion of the injury burden in the
United States.

Because overexertion is being directly correlated to these injuries, it’s necessary for
companies to develop a prevention strategy specifically focused on addressing
fatigue and discomfort before it becomes a recordable injury.

Proactively Address Fatigue and Discomfort

Proactively address fatigue and discomfort with early intervention. This is a five-
step process.

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1. Educate employees to recognize early signs of musculoskeletal disorders.

2. Provide a way for employees to report early signs to supervisors, team
leaders or directly to the injury prevention specialist.
3. When an early report is received, be over the top positive and notify
the injury prevention specialist.
4. The injury prevention specialist should conduct a one-on-one early
intervention consultation. During the consultation, the injury prevention
specialist should evaluate the job for risk factors present and consult with
the employee on a self-care program to return them back to peak health.
5. The injury prevention specialist should follow up with the employee on a
weekly basis until the early signs are resolved and the employee has
returned to peak health.

5 Reasons Why You Need to Get Started With

Early Intervention Today
We know that MSDs develop over the course of time as the result of exposure to
risk factors. The earlier you address the early signs of an MSD, the greater your
chances are of preventing the injury in the first place.

Consider this: The next two to three years of MSDs at your facility are in
development right now. The question is what are you going to do about it? Get
started today!

Here are five reasons why you should get started with early intervention today.

1. Identify and remove risk.

A fundamental concept in prevention is identifying and removing risk. By

encouraging early reporting of fatigue and discomfort, you can identify the risk
factors at fault and work to remove them.

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2. Prevent injuries.

Removing risk factors and establishing a self-care program for the employee will
improve your injury rate. Most early reports are resolved without a recordable
injury!

3. It’s the right thing to do for your people.

Addressing the fatigue and discomfort of your employees is simply the right thing
to do. Musculoskeletal injuries and disorders are physically and emotionally
devastating and can have a major impact on the rest of the employee’s life.
Prevention is always better than treatment.

4. It’s the right thing to do for your business.

Prevention is good for business. Not only can you avoid costly injuries, but you have
an opportunity to turn human performance into a competitive advantage for your
business.

5. Build the safety culture you’ve always wanted.

Providing a workplace athletic trainer (injury prevention specialist) to work side-by-

side with your employees out on the shop floor has a dramatically positive effect on
company safety culture. It shows the company’s dedication to the safety and health
of every employee and that you actually care for their well-being.

Implement Early Intervention as Part of a

Comprehensive Process
Early intervention is partially reactive. While it seeks to proactively address fatigue
and discomfort that is present in the workplace, it does not prevent fatigue and
discomfort from happening in the first place.

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For this reason, it’s important to include early intervention as part of a

comprehensive prevention strategy that includes a workplace ergonomics process
and ongoing education and training.

 An ergonomics improvement process systematically identifies and removes

ergonomic risk factors. This process will remove incompatibilities between
the work and the worker, making the workstation more efficient and
productive while also reducing injury risk.
 An educated and trained workforce is necessary to ensure all employees
understand their role in the prevention process and have the tools and
training to meet their responsibilities.

Over to you …
Do you have MSDs at your facility every year? Do you think an early intervention
process would benefit you?

Get in touch with us any time and we’ll be happy to assist you.

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About Ergonomics Plus

At Ergonomics Plus, we believe that prevention is better than treatment and

one injury at work is too many.

Our experience has shown that a focus on prevention today improves returns
tomorrow. Proactive companies that build a culture of safety and wellness achieve
levels of human performance that is a competitive advantage for their business. We
can help with that

Industrial companies hire Ergonomics Plus for a hands-on, practical and cost-
effective approach to injury prevention and human performance. We make weekly
visits to our client's facilities to implement our ergonomics and injury prevention
methodology; a proven methodology that has been developed over two decades of
providing services and thousands of hours on the shop-floor.

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Are you ready to take your OHS

process to the next level?
Take advantage of over two decades of experience conducting early
intervention consultations and request a free consultation today.

Request a Free Consultation

Interested in more?
Contact Mark Middlesworth, Ergonomics Plus founder and president, to discover
how your company can implement an early intervention process.

[email protected]

Office: 765.384.4499

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