Working Together as a Team

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Occupational Health Wellness
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Health, Safety Wellness

• Personal Health Wellness
• On-Site Medical Clinic (FCHC)
• Health Safety
• Policies, Procedures, Programs, Training
• Management Systems/Programs
• Occupational Wellness
• Occupational Exposure Protection
• Occupational Hazards
• Pyrotechnic Safety
• Risk management Loss Prevention
• Operation Performance Indicators
• Incident Rate
• Severity Rate
• W.C. Cost/Hour
• BBS Safe
• Perception Surveys
• Celebrate Success
• GSB Excellence in Safety
• Sr. Safety Council

• Pre-Employment
• SOS Post Offer Employment Testing (POET) Core
  Strength
• Autoliv Post Offer Employment Testing (POET)
  SOS Pool
• Pre-Employment Physical
• Work Fit/Work Hardening
• Occupational Health Wellness
• On-Site Medical Providers
• Early Intervention Program (EIP)
• Return Work Program (RTW)
• Work Fit/Work Hardening
• Medical Case Management
• Ergonomics
• Employee Physical Capacity
• Machine/Task Demand
• Physical Capacity Task Demand
• Warm-ups/Stretches
• Machine Build Standards
• U of U Ergonomics Research

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RHSE Timeline CY2000 CY2008
2000 . HS Auditing Program/Database . SER/SAR
Program/Database . Process Safety Management (PSM)
2003 . On-Site Occupational Healthcare .
Workers Compensation Program . Early
Intervention Program . Machine Design
Specifications
2005 . Yokoten Program/Database . IH
Occupational Exposure Database . BBS Observation
Program . Risk Reduction Program
2007 . FCHC - On-Site Medical Clinic . Personal
Health Care Focus
2008 . Standard Machine Safety Specs. .
Standardized Ergonomics
2006 . Global Risk Management Program . RMLP
Database . Electrical Safety Council . OSC
Position Statements
2004 . Workfit/Work Hardening . RTW Program .
POET Program . Task Demand Physical Capacity .
Garg-Moore Strain Index
2001 . Commonsense Ergonomics Program . RULA
Analysis . NIOSH Lifting Index . Strain Index .
External Ergo Analysis . GSB Excellence In
Safety Program
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W.C. Claim CountU.S. Facilities
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Days AwayU.S. Facilities
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Days RestrictedU.S. Facilities
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W.C. Preventative TrendingU.S. Facilities
Medical cost continue to out-pace inflation
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Introduction to Autolivs Onsite Healthcare
Clinics
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FirstChoice Healthcare? (FCHC)

• FCHC is a partnership between Autoliv and
  third-party caregivers established to provide
  onsite healthcare for Autoliv employees and
  families.
• FCHC is an independent provider of basic health
  and wellness services, so your health history
  remains completely private.

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Introduction to FirstChoice Healthcare

• Why did we do it?
• Medical costs continue to increase 7-10 per year
• Help to secure business future through containing
  cost
• Additional options
• Affordable, high-quality health care
• Reduce cost
• Employee co-pays, lab fees, diagnostics, physical
  therapy
• Convenience
• Efficient utilization of services

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Services

• Basic Care
• Annual Exams, Infectious Diseases, Lab Tests,
  Diabetes/Cholesterol/Blood Pressure management
• Vaccinations and Immunizations
• Pediatric (Measles, Mumps, Rubella, Polio,
  Meningitis)
• Adolescent
• Adult
• Urgent Care
• Fractures, Sprains/Strains, Lacerations, Asthma,
  Sports Injuries, Overuse Injuries, etc.
• Screening Exams
• Physical Therapy
• Pharmaceutical

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Who is Staffing theFirst Choice Healthcare
Clinics?

• Board-certified Physician of Family Medicine
• Nurse Practitioner
• Registered Nurse
• Medical Assistants
• Physical Therapist
• Laboratory Technician
• Receptionist

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Virtual Tour
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Virtual Tour
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Virtual Tour
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First Choice Healthcare(Members Potential
Visits)
_at_ 80
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First Choice HealthcareAnticipated Visits/Month
_at_ 30
_at_ 35
_at_ 50
_at_ 70
_at_ 80
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First Choice HealthcareTotal Visits/Month
_at_ 80
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First Choice HealthcareOperating Cost/Visit
_at_ 80
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First Choice HealthcarePMPM Cost
_at_ 80
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First Choice HealthcareTotal Customer
Satisfaction
_at_ 80
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First Choice HealthcareGain Sharing Rollup
Measurable
Score
Goals

WT
Goal Actual
Cost Plus Co-Pays Number of Visits
Cost/Visit
79.00 84.83
93.07
20
18.61
Actual Goal
Monthly Visits Defined Capacity
Utilization
1,336 1,284
100
20
20.00
Customer Satisfaction
Actual Goal
Actual Possible
96 95
100
20
20.00
Actual Possible
Goal Actual
PMPM Cost
156.78 170.55
91.92
40
36.76
TOTAL
95.37
CY2007 CY2008
CY2009 CY2010 TOTAL 174.19 156.78 152.08
149.04
Critical Cost PMPM
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WORK RELATED INJURYRisk Assessment and
Intervention Strategies

• Mont Didericksen, MPT
• total rehab, inc.

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Challenge Prevent WRIs

• Accurately identify employees most at risk for
  sustaining a musculoskeletal injury
• Implement appropriate intervention methods to
  reduce risk

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Intervention Methods

• Proactive - Injury prevention
• Reactive - Injury management

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Injury Prevention

• Education and training
• Warm-up exercises and stretches
• Ergonomic task analysis
• Physical assessment
• Risk analysis
• WorkFit program

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Education and Training

• Education
• Principles of ergonomics
• Musculoskeletal disorder (MSD) signs/symptoms
• Work postures
• Training
• Warm-up exercises
• Preventative stretching
• Proper lifting techniques / body mechanics

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Warm-up Exercises and Stretches

• Warm-up exercises
• performed 1-2 times per shift
• facilitates joint lubrication and blood flow
• Stretches
• customized stretching routine
• performed 2-3 times per shift
• provides natural mini-break for employees
• helps to counteract stresses associated with
  repetitive movements

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Ergonomic Task Analysis

• Quantifies job demand by body part
• Helps identify where physical stresses occur
• Adds science to rotation schemes
• Appropriate return-to-work placement or modified
  duty
• A physical demand profile (PDP) is generated for
  each task/workstation
• Essential component of the risk profile

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Physical Assessment

• Quantifies physical capacity by body part
• Used in conjunction with the task analysis
• Essential component of the risk profile
• Identifies employees most at risk for
  sustaining a musculoskeletal injury
• Appropriate job placement of new hires

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Physical Assessment (cont.)

• Assesses each individuals strength, posture,
  range of motion, flexibility, and work techniques
  (when applicable)
• A physical capacity profile (PCP) is generated
  for each employee

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Risk Analysis

• Risk physical demand/physical capacity
• Compare PCP of each individual with PDP of each
  task/workstation
• Produces a risk profile for each employee by body
  part for each task/workstation

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WorkFit

• An injury prevention program
• Twelve (12) week training program for at risk
  employees
• Implementation of focused intervention methods to
  increase individual work capacity
• Employees share responsibility in injury
  prevention
• Employees recognize management's commitment to
  their health and safety

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Research on Low Back Pain

• Matthew Thiese, PhD, MSPH
• Rocky Mountain Center for Occupational and
  Environmental Health
• University of Utah
• Matt.thiese_at_hsc.utah.edu
• 801 587-3322

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Road MapWhere are we headed this afternoon?

• Low Back Pain Cohort Study
• Distal Upper Extremity Study

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Methodology (similar for the 2 studies)

• Selected workers who had been with the company
  for at least a year
• Enrolled at baseline
• Questionnaire
• Exams
• Additional data (height, weight, blood, NCS)
• Followed up monthly
• Measured Job Physical factors

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Methods cont.

• Each participant underwent two standardized
  examinations. The first by an occupational
  medicine resident or a hand therapist, the second
  by a board certified occupational medicine
  attending physician

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Baseline Measures

• 4. 1st Physical Exam (HT or OM resident.)
  (standardized examination with all maneuvers
  performed on all subjects as part of an
  inventory, 497 items)
• 5. 2nd Physical Exam (BC-OM attending)
• (focused on diagnostic categorization. Confirm
  positive findings and assess pertinent negatives)

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Methods cont.

• Each participant underwent a nerve conduction
  study (NCS) by a certified electrodiagnostic
  physician (PMR).

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NCS Criteria

• Normals
• Transcarpal delta
• Motor latency
• Sensory latency

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Methods cont.

• Case definition for CTS

Numbness/tingling in any 2 median served digit(s)
Abnormal Nerve Conduction Velocity

Median Nerve - Yellow
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Low Back Pain Quantifying Risks

• Primary Investigator Arun Garg, PhD, PE,
• Sub-Primary Investigators Kurt T. Hegmann (UT),
  MD, MPH, J. Steven Moore, MD (TX)
• Texas
• Raghava Nagaraj, MD, MPH, Bharath Gururaj, MD,
  MPH, Marie-Madeline Ekani, M.D., M.P.H, Purvi
  Patel, M.D., MPH, Surinder Tank, M.D., MPH
  John-Paul Stephens, PhD, Gordon Vos, PhD, Yoon Ho
  Bai, BS, Wonjun Hwang, BS, and Clint Young, MS
• Utah
• Edward Holmes, MD, MPH Eric Wood, MD, MPH
  Bonnie Held, OTR, CHT Hannah Edwards, MD, MPH,
  Ryan Derby, MD, MPH, Jessica Simmons, MS, Lisa
  Hollien, BS, Megan Fox, RN, Megan Call, BS,
  Melanie Tanner, BS, August Mayai, BS, Craig
  Schuman, BS, Chris White, BS, Debra Passey, Debra
  Robertson, BS, Jennifer Dowdy, BS, Jolene Barker,
  Harrison Pham, Trevis Jensen, Rosemary Russo, BS,
  Sandra Eaton, MPH, Christina Vokt, MD, MPH,
  Susanne Thobe, MD, MPH, Steven Ross, MD, MPH,
  Steve Angerbauer, MD, JD, Anne Donahue, MD, Bin
  Yang, MD, MPH, Carla Olsen, MD, MPH, Christiane
  Latagne, MD, MPH, Christine Tabatzky, MD, MPH,
  David Hazra, MD, MPH, Kathy Chang, MD, MPH, Laura
  Kaufman, MD, MPH. Don Bloswick, PhD, P.E.,
  C.P.E., Richard Sesek, PhD, CSP, MPH, Andrew
  Merryweather, MS, Byungju (Robert) Yoo, Jungmin
  (Ryan) Choi, Tyson Skinner, Robert Poulsen, and
  Bryan Adams. Matthew S. Thiese, MSPH, PhD,
  Xiaoming Sheng, PhD, Richard Holubkov, PhD,
  Steven J. Oostema, MS, Ulrike Ott, MS, and
  Sivithee Srisukhumbowornchai, MS
• Wisconsin
• David L. Drury, MD, MPH, James C. Foster, MD.
  MPH, Gail Groth, MS, OTR CHT, Margaret Schuller,
  PT, Suzanne Marchant, OTR, CHT, John Beaty, MS
  PT, Keith Hatch, OCS, CSCS, and Bob Seeds PhD,
  PT, Jay Kapellusch, MS, Parag Bhoyar, M.Des.,
  Sruthi Boda, MSBE, Gwen Deckow-Schaefer, MS OTR,
  Suzanne Milholland, MS OTR, Jessica Gin, MS,
  Abigail DSouza, MS OTR, Joan Korpi, MS OTR and
  Mary Fitzpatrick, MS OTR

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LBP Cohort Study

• Enrolled 817 Participants from 32 different
  plants in Utah, Texas, Wisconsin.
• Mostly Manufacturing or Manual Materials Handling
• Production
• Warehouse
• Questionnaire, medical history, physical exam at
  baseline.
• Monthly follow-up questionnaires and exams since
  2003 (Ongoing)
• All aspects of job measured

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Health Outcome Measures

• Pain of any intensity
• In at least 1 of 5 body areas
• Symptom free 90 days become eligible to
  incident case.
• Measure to 1st incidence
• Only Job Related LBP

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Results (Preliminary)

• Psychosocial
• Depression (HR2.8)
• Perceived Job Stress (HR 3.1)
• Anxiety (RR 2.1)
• History of LBP
• Light Duty (HR 2.1)
• Increasing duration of longest LBP (HR 1.8)
• Increasing duration of most recent LBP (HR 1.5)
• Ever taken medication for LBP (HR 2.0)
• Ever seen a health care practitioner for LBP (HR
  2.1)
• of episodes of Lost Time because of LBP (HR2.5)

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Results (Preliminary) cont.

• Job Factors
• Lifting from below 5 inches (HR 2.1)
• Lifting from above 52 inches (HR 2.7)
• Very Low or High Cumulative Lifting Index (HR
  4.4)
• 25 lifts per minute (HR 2.7)
• 75 of time with back bent (HR 2.1)

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Discussion

• There appear to be many factors related to LBP in
  this population
• Personal
• Psychosocial
• Past History of LBP
• Job
• Difficult lifts
• Many Lifts
• Poor work postures

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Distal Upper Extremity Study

• Primary Investigator Arun Garg, PhD, PE,
• Sub-Primary Investigators Kurt T. Hegmann (UT),
  MD, MPH
• Utah
• Edward Holmes, MD, MPH Eric Wood, MD, MPH
  Bonnie Held, OTR, CHT Hannah Edwards, MD, MPH,
  Ryan Derby, MD, MPH, Jessica Simmons, MS, Lisa
  Hollien, BS, Megan Fox, RN, Megan Call, BS,
  Melanie Tanner, BS, August Mayai, BS, Craig
  Schuman, BS, Chris White, BS, Debra Passey, Debra
  Robertson, BS, Jennifer Dowdy, BS, Jolene Barker,
  Harrison Pham, Trevis Jensen, Rosemary Russo, BS,
  Sandra Eaton, MPH, Christina Vokt, MD, MPH,
  Susanne Thobe, MD, MPH, Steven Ross, MD, MPH,
  Steve Angerbauer, MD, JD, Anne Donahue, MD, Bin
  Yang, MD, MPH, Carla Olsen, MD, MPH, Christiane
  Latagne, MD, MPH, Christine Tabatzky, MD, MPH,
  David Hazra, MD, MPH, Kathy Chang, MD, MPH, Laura
  Kaufman, MD, MPH. Don Bloswick, PhD, P.E.,
  C.P.E., Richard Sesek, PhD, CSP, MPH, Andrew
  Merryweather, MS, Byungju (Robert) Yoo, Jungmin
  (Ryan) Choi, Tyson Skinner, Robert Poulsen, and
  Bryan Adams. Matthew S. Thiese, MSPH, PhD,
  Xiaoming Sheng, PhD, Richard Holubkov, PhD,
  Steven J. Oostema, MS, Ulrike Ott, MS, and
  Sivithee Srisukhumbowornchai, MS
• Wisconsin
• David L. Drury, MD, MPH, James C. Foster, MD.
  MPH, Gail Groth, MS, OTR CHT, Margaret Schuller,
  PT, Suzanne Marchant, OTR, CHT, John Beaty, MS
  PT, Keith Hatch, OCS, CSCS, and Bob Seeds PhD,
  PT, Jay Kapellusch, MS, Parag Bhoyar, M.Des.,
  Sruthi Boda, MSBE, Gwen Deckow-Schaefer, MS OTR,
  Suzanne Milholland, MS OTR, Jessica Gin, MS,
  Abigail DSouza, MS OTR, Joan Korpi, MS OTR and
  Mary Fitzpatrick, MS OTR

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Prospective Cohort Study

• n920
• Wisconsin, Utah companies (n15)
• Electric motor manufacturing, assembly, apparel
  manufacturing, meat processing, electric light
  manufacturing, small motor manufacturing,
  generator manufacturing, light office work, etc
• All examined at baseline (Questionnaire,
  Structured Interview, Standardized Physical
  Exams, NCS)
• Monthly follow-up for changes in symptoms and job
  changes
• Nerve Conduction Study done on random people and
  potential cases every 6 months

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Basic Descriptive Variables

• n 920
• Age 41.5 11.2 years
• Male 31.7 Female 67.3
• BMI 29.5 6.92 kg/m2
• Tobacco
• Current smoking 28.4
• Ex-smokers 22.7
• Lifelong non 48.9
• Handedness
• Left 9.3
• Right 85.5
• Ambidextrous 5.2
• Diabetes 5.2
• High Blood Pressure 16.1
• High Cholesterol 15.3
• Thyroid Disease 6.7

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Baseline Analyses

• Right CTS by Age and Gender

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Baseline Analyses

• Right CTS by BMI

Underweight- 66 current smokers, 83 male,
21-45, 66 High SI
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Take Away Points

• Many Factors Influence LBP
• Psychosocial
• History of LBP
• Tobacco?
• Physical Activity (beneficial)
• Job Factors
• Others?
• Not all factors have a dose response relationship
• Many of these are modifiable

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Questions?