Ergonomic ViewpointMedical Services Fraport (Frankfurt Airport)Walter - PDF document

Ergonomic ViewpointMedical Services Fraport (Frankfurt Airport)Walter Gaber,MDBack pain dominates the illness statistics of our industrial society. Acute andchronic back problems cost the German economy 50 billion marks annually,mainly because 60 million lost workdays must be paid for each year (Grigelat,1994). Some 80 percent of the population in the West experience this type of painat some time. One in five of the patients at a general medical practice and one inthree at an orthopaedic practice seek medical advice because of back pain.Turning and/or leaning to one side when lifting loads jerkily is the mostfrequent cause of back complaint at the workplace .Costs to the EconomyA look at the statistics of Health Insurance Companies reveals that injury to the- muscular-skeletal systemresults in frequent absence from work and causes high costs to both individualbusinesses and the national economy.Depending on an employee’s level of training, his absence costs between and E 400 per day, including all incidental wage costs. In the case of acutelumbago, when an employee may be unable to work for a period of ten days,these costs can easily add up to a sum ofEuro 4,000 per employee.Considering that employees are normally not replaced during sick leave, this willinevitably lead to additional/inappropriate work-loads for the remainingemployees. Reducing the Strain by Following an Ergonomically Correct Patternof MovementOur industrial society and its consequent progress has resulted in man changinghis lifestyle and environment. Particularly in the area of movement increasinglysophisticated methods have been introduced to ”protect man against movement”.Demands on the muscular system have drastically changed from a dynamic to astatic passive type. Demands on muscles have decreased in both professional andprivate life due to the use of various aids.With company preventive care (prevention at the workplace) we can todayinduce changes in behaviour and conditions. Workplace conditions often forcepersonnel to carry out work in a non-physiological way.For a critical workplace analysis in connection with the assessment of back pain-particularly in the lumbar vertebral area - thought has to be given to- in what formpersonnel can be trained to reduce existing strain to an absolute minimum.Medical/ergonomic knowledge can be used to optimize movement by correctlyusing physical strength and technical aids.The following aspects must be considered:Reaching and movement areaRange of optimum muscle strengthRules for ”Lifting and Carrying Correctly”Reduction in monotonyAssignment of dutiesRoom climate and work atmosphere Risk FactorsFrom an industrial health care point of view, the following risk factors areresponsible for frequent incidence of back pain:Leaning sideways and torsion of the spineOver a period of years, each of the risk factors listed above can result in injury toBody size and weightLevel of fitnessThis analysis does not take into account psyche, working climate and the currentLegal Basis (Germany)If one examines the legal obligations of everyone responsible for safety systemsat work, and, particularly, those of the employers ( … ”to protect employees frominjury at the workplace” …), it must regrettably be said that little is done in thearea of prevention in many fields of industry.The Regulation for Industrial Disease (Berufskrankheitenverordnung) - oftenquoted in recent months - represents only a part of the legal obligations. Therequirement for prevention can be deduced from the following legal texts -amongst others:German Civil Code (BGB) § 618Employers’ Welfare ObligationsSafety at Work Act (ASIG - Arbeitssicherheitsgesetz) § 3Employment Protection Act (Arbeitsschutzgesetz)Health Reform Act (Gesundheitsreformgesetz) § 20”Women on Vehicles” Regulation Flughafen Frankfurt/Main AG's Concept (Fraport AG)Back injuries are a principle cause for absence from work at Fraport.The model for reducing muscular-skeletal injuries is based on clear premises:Company Spinal Training Program for Lifting and CarryingCompany Spinal Training Program for Lifting and Carrying differssignificantly from similar training programs provided by many fitness studios,health insurance companies and physiotherapists. Training programs of this kindwhich do not take into account company-internal structures, typical companywork practices, working atmosphere and specific ergonomic conditions are in myopinion doomed to failure.A spinal training program for the proper lifting and carrying of objects which isnot tailored to employee needs and local conditions is not only problematic forthe trainer, but is also of limited effect for the employees. A trainer is directlyjudged by the capability of the training program to be adapted to normal companyA company spinal training program needs a clear aim - matched to thecompany needs. Company StructuresIf a training program is to be successfully presented to company management, asurvey of internal company structures should be made beforehand. Each companyhas its own problems and ”features” which outsiders have to take into account. Inmy view the principle contact person should be the company doctor.If there is no company doctor then the trainer should contact the followingdepartments:ManagementWorks CouncilIndustrial SafetySpecialist Departments that are to be catered forHealth Insurance CompaniesEmployers' liabilitiy insurance associationsBefore lauching a company spinal training program a presentation should bemade to make the management staff concerned aware of the need for such aprogram. The following points must, however, be clarified beforehand:The aim of the trainingProgram lengthEfficiency checks/EvaluationChecks at work by so-called ”co-trainers” are particularly helpful for successCo-trainers are long-term employees with a supervisory status who are active insports and more intensively trained. The supervisor status, success control on the shop floor (close to practice) andsetting an example.Advantage should be taken of opportunities to produce photo and videodocumentation for teaching purposes, even for ”negative presentations”. Asemployees gain little from posters and trade literature, the production of small,washable MEMORY CARDS (see Eagosh) at PIRELLI (Höchst) proved to be ofvalue. The cards showed the key factors for ”Lifting and Carrying Correctly” inan easily understandable way.Full management familiarization and short training sessionTraining of supervisorsTraining of employeesTraining of new employees(before they are actually available to their work unit)Training of apprentices(Training of office workers)Rules1.There is no patent cure2.Each baggage item has its own problems3.Lift slowly4.Check the weight5.Handle loads close to the body6.Do not rotate the upper body7.Do not (or as little as possible) bend the back8.Bend the knees (use leg muscles)9.Always use both arms to lift10.Never lift jerkily11.Seek help from colleagues when in doubt12.Use technical aids13.Always seek a firm hold/gripObserving the above rules will prevent flexion of the vertebra and relieve thestrain on the intervertebral disks, back muscles, and pectoral girdle. The actuallifting is done by the leg muscles. The arms are used mainly to hold the loads.The training is supplemented by relaxation combined with loosening exercisesand muscle training. As long as there are industry workplaces where load and stress cannot be reducedby ergonomic workplace design, it is necessary to train personnel properly anduse the full potential of technical aids.In areas where heavy weights are lifted and carried the use of back belts must beconsidered individually.Due to several successful studies we believe that the use of these back belts, incombination with spinal training and ergonomically designed workplaces, ispromising.reduction in absence from workreduction in medicine needed for back painreduction i subjective complaintsExperiences in this field have been described in different publications in theLong-term studies in the U.S.A. with 36,000 employees carried out over 6 yearsyielded the same results.The aim is a:reduction in absence from work (due to conditions at work)compulsion for ”correct” body postureStudy Resultspromote correct movementmake the back flexibleserve as a preventative measureincrease intra-abdominal pressure (Krämer, Bochum)have a psychological effect which is not negligibleprovide physiological thermal protection as a secondary effectHowever, the following potential problems should be analyzed critically whenassessing studies on the subject of suspensory bandages: differences in teamsdifferences in agedifferences in weight, sizedifferences in muscular situationdifferent nationalitiesRegardless of these potential weaknesses, the positive response from employeesto testing different belts on an individual basis must be taken into account.However, the statements made by Bunch (USA; 1993) remain valid;"Back belts are not needed if employees understand and use lumbar stabilisationtechniques during material handling.Back belts will not reduce the occurrence of back injuries unless used properly."The AimsHealthy employeesHumane working conditionsFewer impaired employeesFewer absences from work due to work conditionsHow can the aims given above be represented in the interests of both thecompany and the employee?During an analysis phase the responsible trainer/coach must get to know theIn the ideal case this results in the workplace being modified in keeping withmedical/technical requirements. SummaryCompany Spinal Training must become an integral part of the industrial healthcare concept. Only expert back trainers who have experience in ergonomics willbe taken seriously by management and employees as being competent advisors.Qualified professional training is currently provided by a only a feworganizations (These include: "Forum Gesunder Rücken"[the Forum for HealthySpinal training is only a small piece in the mosaic of an overall preventionconcept which requires interdisciplinary cooperation between the responsiblemanagement of the different specialist departments.Communication and cooperation between different disciplines such as:Industrial medicinePhysiotherapyis absolutely necessary. Professional egotism is inappropriate in the interests ofour employees and patients.Dr. med. Walter GaberDirector of Medical Services,Specialist for Industrial Medicine and