What’s Wrong With OSHA Injury Reporting: Exhibit A

A new interpretation from OSHA further confuses where first aid stops and injury management starts in the workplace.  It also offers more proof that the current approach to reporting injuries and illnesses may have drifted far from the intended purpose.   

Before we go any further, let me state that this is not legal advice and each company needs to apply the regulations to its own operations.   Let me also be clear that this is not OSHA’s fault.  The analysts who write these interpretive letters wind up playing semantics games because the regulations have not kept pace with technology and trends.  

Now that that is out of the way, in late December OSHA issued a new interpretation letter to guide industry on how to comply with regulations on injury and illness recordkeeping.   This one dealt with whether OSHA classifies the use of a cold compression therapy device as medical treatment.  In other words, if a worker twists his knee or strains his arm and the company uses a cold compression device, is it a recordable injury?

OSHA’s response was “when cold compression therapy devices are used to treat a work-related injury or illness, such devices constitute medical treatment beyond first aid.”

Why?  OSHA says that the devices are generally used as part of physical therapy, are not simple to operate, require specialized training and are used by licensed professionals.

Why this is a problem:   That is bad news for companies that want to use newer technology and still keep their injury rates low.

The regulations include definitions of  medical treatment and first aid, including a very straightforward list of what is considered first aid:

  • Hot and cold therapy
  • Elastic bandages and wraps
  • Massages, including compression pressure, as long as they are not physical therapy or medical treatment.

Taken together, it is OK to put ice on the injury and wrap it with an ace bandage and OK to put pressure on it.

What if we could do all three at once by slipping a cuff over someone’s leg or arm, applying pressure and run cold water through it to keep a constant cold, but not icy temperature?

From Walmart Website

A few years ago, manufacturers did just that and, as OSHA states, the machines were first sold to physical therapists and orthopedists.  But technology advances and now you can buy a knee cold compression device at Walmart for a little more than $200.

It could have a lot of application in a workplace first-aid station. But now the OSHA interpretation may discourage employers from embracing this technology.

What it says about the current injury reporting regulations – Once again, we have lost sight of the main objective, the immediate care of an employee who has had an incident.   Remember what we are trying to do with a muscle injury:

  • Reduce pain
  • Reduce swelling
  • Flush lactic acid from the body

Those objectives apply whether first aid helps heal a sore muscle in a couple of day or whether it is an interim step to actual medical care.

The fact that OSHA is even having to make those determinations is more evidence that the injury reporting rules are broken.  Companies are under pressure to avoid having reportable injuries and that pressure will increase if injury stats are made public under the new electronic recordkeeping rules.

However, there is no evidence that all the sprains and sore muscles in the world are related to the kinds of major accidents that kill and maim workers.   A high total recordable injury rate (TRIR) does not predict a disaster.  However, safety experts have more than a sneaking suspicion that an obsession with keeping TRIRs low does distract companies from really addressing their risks and hazards.


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