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Occupational injuries among police workers: Patterns and contributing factors in an Australian jurisdiction
Safety Science 122 (2020) 104525
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Occupational injuries among police workers: Patterns and contributing factors in an Australian jurisdiction
T
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Carlyn Muira, , Khic-Houy Prangb, Dianne Shepparda, Sharon Newnama a b
Monash University Accident Research Centre, Monash University, Australia Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Australia
A B S T R A C T
Police are regularly exposed to potentially traumatic events, which puts them at risk of physical and psychological injury. International evidence suggests that police have high injury rates relative to other occupations, however most research either focuses on specific situations (e.g., use of force); specific injury causes (e.g., weapons); or specific injury types (e.g. Post-traumatic Stress Disorder). Few studies have focused on understanding injury patterns across the workforce. Thus, the primary objective of this paper was to describe the rate, mechanisms, type and costs of occupational injuries experienced by police in one Australian jurisdiction. Using administrative workers’ compensation claims data, claims records of police were examined for the period 2003/04–2011/12. Descriptive analyses were conducted to characterise the distribution of first and subsequent claims, stratified by claim type (minor, medical and time loss). Rates were calculated using labour force statistics (per 1000 full-time equivalent workers). This study described a number of factors associated with the incidence of injury among police. Over the study period, there was a decrease in first claim rates and an increase in subsequent claim rates across all claim types. Key findings to inform prevention strategies included that younger males (in the 35–44 year age groups) made the most claims, and the greatest proportion of injuries for medical and time loss claims were caused by body stressing (e.g., lifting, carrying). Future research linking corporate statistics to operational/incident information would be beneficial to understand the specific incident factors that are important in outcomes.
1. Introduction Police are regularly exposed to potentially traumatic events, which puts them at risk of physical injury and may impact their mental health (Beyond Blue, 2016). Police work is also subject to a combination of stressors, including: shift work; long working hours; repeated exposure to death, trauma and/or violence; difficult interactions with members of the public; high expectations of the profession; high levels of governance; strong cultural pressures; and stigmatizing attitudes towards mental health and suicide (Beyond Blue, 2016). International evidence suggests that police have high injury rates relative to other occupations; in the US, police have highest occupational injury rates of all emergency responders, and high risk of fatal occupational injury (Volanti et al., 2012; Bauerle et al., 2016). The rate of serious injuries among police is more than three times the national average for occupational injuries (42.7 serious injuries per 1000 workers for police, compared to 13.0 serious injuries per 1000 workers overall, 2008–2009 (Safe Work Australia, 2017). In fact, the rate of serious injuries among police is one of the highest rates observed across all occupational groups (Gray and Collie, 2017). Despite evidence that policing involves high-risk work, there has been limited research that has considered the incidence or impact of different types of occupational injuries among police. ⁎
The risks associated with policing vary according to the specific tasks being undertaken, for example desk duties versus arrest and restrain (Mayhew, 2001). However, most research that has been conducted either focuses on specific situations (e.g., use of force); specific injury causes (e.g., weapons); or specific injury types (e.g. Post-Traumatic Stress Disorder (PTSD)). Few studies, particularly in Australia, have focused on understanding injury patterns across the workforce. In the few studies conducted, the most frequently observed injury types among police include musculoskeletal disorders (MSDs) (particularly low back pain from work-related driving and manual handling), and sprains and strains (Gyi and Porter, 1998). Other frequently reported injuries include contusions, abrasions and lacerations during arrest and restrain (Reichard and Jackson, 2010). International research reported sprains and strains as the leading injury type among all emergency service personnel, including police, firefighters and emergency medical occupations (Reichard and Jackson, 2010). A growing incidence of back pain has been associated with extended hours spent in the sedentary position in patrol cars (Gyi and Porter, 1998), contributing significantly to absenteeism and workers compensation claims (Nabeel et al., 2007). Research has indicated that policing is amongst the most stressful of all occupations (e.g., (Burke et al., 1993; Hart et al., 2003), and given the unpredictable and stressful nature of the job, the prevalence of
Corresponding author at: 21 Alliance Lane, Clayton Campus, Monash University, VIC 3800, Australia. E-mail address: [email protected] (C. Muir).
https://doi.org/10.1016/j.ssci.2019.104525 Received 12 November 2018; Received in revised form 26 August 2019; Accepted 21 October 2019 Available online 09 November 2019 0925-7535/ © 2019 Elsevier Ltd. All rights reserved.
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schemes across Australia (Gray and Collie, 2017). Benefits, including income replacement while on sick leave and medical and rehabilitation expenses, are provided where reasonably required for both acute musculoskeletal injuries and other physical pain-related conditions with a more gradual onset. ‘Psychological injuries’ can also receive compensation where work was a major contributor to an individual’s mental health status (Gray and Collie, 2017). The current study focused on one state of Australia, with a single state-based police agency with approximately 18,000 employees.
PTSD is estimated to be six to seven times that of the wider community (Asmundson and Stapleton, 2008). The impact on mental health can be significant, and a recent study identified an increase in suicide and homicide among police (Klinoff et al., 2015). The high-stress nature of jobs such as policing have identified this as an emerging public health issue that needs to be addressed (Gershon et al., 2002). A number of factors have been identified that contribute to policing injuries. First, continued exposure to stress and traumatic experiences has been associated with secondary health related issues such as alcoholism, substance abuse and in more severe cases, spousal abuse (AlHumaid et al., 2007; Anshel et al., 1997; Brown et al., 1996). Second, an increase in police workload as well as the effects of shift work increase fatigue levels and contribute to workplace injury (Volanti et al., 2012, 2013). Sleep disruption has also been associated with the development of chronic diseases, such as cardiovascular diseases and hypertension (McCanlies et al., 2012; Ramey et al., 2012). In addition, organizational management practices and gender issues have been identified as barriers to addressing mental health in police (Huddleston et al., 2007; Stergiou-Kita et al., 2015). The psychological safety culture unique to policing is thought to discourage the acknowledgement of work-related emotional issues and contribute to the potential for psychological injury (Huddleston et al., 2007; Davey et al., 2001). In order to effectively address workplace injury among police, it is important to first quantify the incidence, nature and consequences of injuries experienced in the workplace. Thus, the primary objective of this paper is to describe the rate, mechanisms, type and costs of occupational injuries experienced by police in one Australian jurisdiction. A better understanding of the patterns and contributing factors will assist in the development of more effective prevention policies, practices and education programs, leading to mitigation in the rate and severity of incidents and injuries as well as reduction in cost of compensation claims. This research will contribute to existing evidence by providing a more detailed analysis of trends and contributing factors over time.
2.3. Data sources Analyses in this study were based on workers’ compensation claims. Compensation insurance is provided for most employers (~85%) by the state-based Regulator. Those not covered by this scheme include federal government employees, self-insuring agencies and sole traders. All claims that exceed the financial threshold for health care expenses or those requiring more than 10 days off work are required under state law to register with the Regulator; and these cases are subsequently managed by private sector insurers contracted for this purpose. To receive workers’ compensation benefits, workers must have their illness or injury certified by an approved medical practitioner. The Regulator provides a range of compensation and services to injured workers, including: income replacement, medical and allied health treatments, ambulance transport, hospital treatment, personal and household help, impairment lump sums, and common law damages (when specific criteria are met). The Compensation Research Database (CRD) is an administrative database held by the Institute for Safety Compensation and Recovery Research (ISCRR) at Monash University to support research into compensation health. The CRD includes de-identified data for work-related claims covered by the state-based Regulator from 1986. The dataset includes more than 20 years of compensable transport and workplace injury claims (both accepted and denied), which are collected in accordance with relevant legislation and privacy policies. The information collected includes: demographics (e.g. age, gender, index of relative social advantage and disadvantage), injury types and mechanisms, occupation and industry groups, workplace size, income payment and health services treatments (Prang et al., 2016).
2. Methods 2.1. Study design We conducted a retrospective analysis of administrative compensation claims data in one jurisdiction in Australia, focusing on occupational injury among police. The study was approved by Monash University Human Research Ethics Committee.
2.4. Inclusion criteria 2.2. Study context Data were extracted for claims that met the criteria for minor, medical and time loss claims. Minor claims are defined as those claims that do not have any associated costs (i.e., the worker has been absent for less than 10 days and/or they do not reach the medical expenses threshold set by the Regulator (AUD$495 in 2003/2004)). These claims are usually covered by the employer and are recorded in the CRD for tracking purposes only. Medical claims are defined as occupational disease claims that reach the threshold for medical claims but do not incur any time loss; claimants would receive medical treatments but not weekly compensation. Time loss claims are defined as claims where the threshold level of medical expenses is reached, and/or when a worker has been absent from work for 10 or more days; these workers would receive both medical treatments and weekly compensation. Claims were extracted for police employed full-time (identified using the Australian and New Zealand Standard Classification of Occupation code ‘4413’) (ABS, 2013) where the affliction date was between the fiscal year 2003/2004 and 2011/2012. Where more than one claim related to the same employee, both original claims and any subsequent claims were included. Cases were excluded if the claim was terminated by the insurer (e.g., failed to provide medical certificates or information on injury, fraudulent claims, claims opened in error).
Australia is a federated country that is made up of eight major states and territories (six states and two territories). Government in the Commonwealth of Australia is exercised on three levels: federal; state/ territory; and local. Each state has its own constitution, with its own legislature (parliament), judiciary and executive. Specific areas of legislative power are held by the federal government, including taxation, defence, foreign affairs and postal and telecommunications services. The states retain legislative power over all other matters that occur within their borders, including police, hospitals, education and public transport. Workers’ compensation is a compulsory statutory form of insurance for all employers in every state and territory in Australia, and provides protection to workers if they suffer a work-related injury or disease. Each state and territory has its own workers’ compensation scheme and the Commonwealth has three that cover seafarers, military personnel and Commonwealth employees and authorities licensed to self-insure under the Safety, Rehabilitation and Compensation Act 1988 (Commonwealth). There are some differences in the provision of entitlements for workers’ compensation across the states and territories in Australia. For example, the rate and duration of income replacement varies between 2
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2.5. Data analysis
then decreased in 2011/12 (Fig. 2).
Descriptive analyses were performed for minor claims and conducted separately from medical and time loss claims (as these claims were recorded for tracking purposes only). First and subsequent claims were identified by the affliction date and a unique claimant identifier, and stratified into medical or time loss claims. Rates of first and subsequent claims for minor, medical and time loss claims per 1000 full-time equivalent (FTE) workers were calculated using publicly available workforce statistics. Descriptive statistics were used to characterise the distribution of first and subsequent claims by gender, age group, injury type, and mechanism of injury, stratified by medical and time loss claims. The total number and mean costs of healthcare services (i.e., medical doctor, allied health providers and hospital) for first and subsequent claims for the 2003/2004 and 2011/ 2012 period, stratified by medical and time loss claims were reported. Costs were indexed to Consumer Price Index 2012 (ABS, 2017). Analyses were conducted using IBM SPSS v23.
3.3. Minor claims
3. Results
In total, 4242 claimants lodged an initial claim, of which 1217 were medical claims and 3025 were time loss claims. The majority of medical and time loss claims were made by males and in the 35–44 years age group. The top three most frequent types of reported injuries for medical and time loss claims included: traumatic joint/ligament and muscle/tendon injury; wounds, lacerations, amputations & organ damage; musculoskeletal and connective tissue diseases. The greatest proportion of injuries for medical and time loss claims were caused by body stressing (e.g., lifting, carrying), being hit by moving objects and slips, trips and falls. Table 2 presents the characteristics of first claims stratified by medical and time loss claims.
Overall, 4034 claimants lodged a minor claim and 1169 claimants lodged more than one minor claim (n = 1669 claims). The majority of first and subsequent minor claims were made by males and in the 30–39 years age group. The top three most frequent categories of reported injuries (for both first and subsequent claims) included: traumatic joint/ligament and muscle/tendon injury; wounds, lacerations, amputations & organ damage; and musculoskeletal and connective tissue diseases. The greatest proportion of injuries for first and subsequent claims were caused by body stressing (e.g., lifting, carrying), being hit by moving objects and falls, trips and slips. Table 1 describes the characteristics of minor claims stratified by first and subsequent claims. 3.4. First claims
3.1. First claim rates The rates of single claims in the minor, time loss and medical categories decreased over the study period (per 1000 FTE). The rate of minor claims substantially decreased from 2003/04 to 2007/08 and then steadily decreased until 2011/12, with a slight increase from 2007/08 to 2008/09. A similar pattern was observed for time loss claims until 2007/08 with a slight increase until 2009/10, followed by a decrease in the rate. A steady decrease was observed for medical claims from 2003/04 to 2011/12, with slight increases in 2005/06 and 2008/09 (Fig. 1).
3.5. Subsequent claims
3.2. Subsequent claim rates
Overall, 419 claimants lodged more than one medical claim (n = 475 total claims) and 991 claimants lodged more than one time loss claim (n = 1300 total claims). The majority of medical and time loss claims were made by males and in the 40–44 years age group. The top three most frequent categories of reported injuries for medical and time loss claims included: traumatic joint/ligament and muscle/tendon injury; wounds, lacerations, amputations & organ damage; and
In contrast, when considering subsequent injury claims, claim rates generally increased (per 1000 FTE). A steady increase was observed for time loss and medical claims from 2003/04 to 2011/12, with a large increase in time loss claims from 2008/09 to 2009/10. The rate of minor claims increased substantially from 2003/04 to 2006/07 and
Fig. 1. Rate for first claims per 1000 FTE. 3
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Fig. 2. Rate for subsequent claims per 1000 FTE. Table 1 Characteristics of minor claims stratified by first and subsequent claims.
Sex Male Female Age 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60+ Injury type Traumatic joint/ligament and muscle/ tendon injury Wounds, lacerations, amputations & organ damage Musculoskeletal and connective tissue diseases Other Injuries Fractures Other diseases Mental diseases Skin and subcutaneous tissue disease Nervous system and sense organ diseases Respiratory system diseases Mechanism of injury Body stressing Being hit by moving objects Falls, trips and slips Hitting objects with a part of the body Chemicals and other substances Vehicle incidents and other Biological factors Sound & pressure Mental stress Heat/electricity/other environmental factors
Table 2 Characteristics of first claims stratified by medical and time loss claims.
First claim
Subsequent claims*
Medical claims
Time loss claims
N
%
N
%
N
%
N
%
3247 787
80.5 19.5
984 185
84.2 15.8
986 231
81 19
2391 634
79 21
219 618 801 876 684 439 276 106 15
5.4 15.3 19.9 21.7 17.0 10.9 6.8 2.6 0.4
75 189 261 255 187 117 68 15 2
6.4 16.2 22.3 21.8 16.0 10.0 5.8 1.3 0.2
54 161 208 264 216 159 110 40 5
4.5 13.2 17.1 21.7 17.7 13.1 9.0 3.3 0.4
92 304 485 627 609 470 304 115 19
3.0 10.0 16.0 20.7 20.1 15.5 10.0 3.8 0.6
1262
31.6
521
31.7
441
36.7
28.8
28.3
1239
31.0
472
28.7
391
32.6
25.3
24.8
929
23.3
464
28.2
183
15.2
25.0
24.5
352 105 44 28 13 13 8
8.8 2.6 1.1 0.7 0.3 0.3 0.2
109 38 4 16 8 10 2
6.6 2.3 0.2 1.0 0.5 0.6 0.1
49 44 44 3 38
4.1 3.7 3.7 0.2 3.2
10.0 8.2 1.0 0.7 0.5
9.8 8.0 1.0 0.7 0.5
5 3
0.4 0.2
0.2 0.3
0.2 0.3
1354 1109 652 306 215 160 123 62 42 11
33.6 27.5 16.2 7.6 5.3 4.0 3.0 1.5 1.0 0.3
645 445 272 111 65 63 30 11 15 12
38.6 26.7 16.3 6.7 3.9 3.8 1.8 0.7 0.9 0.7
562 198 179 109 51 27 43 36 8 4
46.2 16.3 14.7 9.0 4.2 2.2 3.5 3.0 0.7 0.3
979 795 456 338 309 103 29 8 7 1
32.36 26.28 15.07 11.17 10.21 3.40 0.96 0.26 0.23 0.03
Sex Male Female Age 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60+ Injury type Traumatic joint/ligament and muscle/ tendon injury Musculoskeletal and connective tissue diseases Wounds, lacerations, amputations & organ damage Fractures Other Injuries Mental diseases Other diseases Nervous system and sense organ diseases Respiratory system diseases Skin and subcutaneous tissue disease Mechanism of injury Body stressing Falls, trips and slips Being hit by moving objects Vehicle incidents and other Hitting objects with a part of the body Chemicals and other substances Mental stress Sound & pressure Biological factors Heat/electricity/other environmental factors
* Age and gender of claimants at their first subsequent claim; injury type and mechanism of injury for all subsequent claims.
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4. Discussion
Table 3 Characteristics of subsequent claims stratified by medical and time loss claims.
Sex* Male Female Age* 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60+ Injury type^ Traumatic joint/ligament and muscle/ tendon injury Musculoskeletal and connective tissue diseases Wounds, lacerations, amputations & organ damage Fractures Other Injuries Mental diseases Other diseases Nervous system and sense organ diseases Respiratory system diseases Skin and subcutaneous tissue disease Mechanism of injury^ Body stressing Falls, trips and slips Being hit by moving objects Vehicle incidents and other Hitting objects with a part of the body Chemicals and other substances Mental stress Sound & pressure Biological factors Heat/electricity/other environmental factors
Medical claims
Time loss claims
N
%
N
%
349 70
83.3 16.7
815 176
82.2 17.8
6 33 66 84 87 69 43 27 4
1.4 7.9 15.8 20.0 20.8 16.5 10.3 6.4 1.0
12 53 133 225 208 180 125 51 4
1.2 5.3 13.4 22.7 21.0 18.2 12.6 5.1 0.4
58
15.8
326
25.5
208
56.5
312
24.4
49
13.3
421
32.9
11 9 19 1 12
3.0 2.4 5.2 0.3 3.3
113 85 9 4 5
8.8 6.6 0.7 0.3 0.4
1 –
0.3 –
2 3
0.2 0.2
268 72 52 28 18 6 18 11 – 2
56.4 15.2 10.9 5.9 3.8 1.3 3.8 2.3 – 0.4
533 296 178 126 121 35 8 – 3 –
41.0 22.8 13.7 9.7 9.3 2.7 0.6 – 0.2 –
The nature of police work, and the work environment, has the potential to increase the risk of occupational injury. Most research on police injury to date has focused on specific injury types or specific occupational hazards (such as stress, or use of force), and thus there is limited information describing the broader patterns of injuries (and associated costs) experienced by police workers across an entire workforce. This broader understanding is important given that longterm health morbidity and mortality rates in police exceed other occupations and the general population (Mumford et al., 2014). It is also known that emergency service workers face a wide range of hazards in relation to the nature of their work, and thus a clear understanding of the nature and characteristics of injuries is important to assist in the development of targeted prevention approaches. Therefore, the aim of the current research was to describe the rate, mechanisms, type and costs of occupational injuries experienced by police in one Australian jurisdiction. 4.1. Decline in compensable injuries A key finding in the current study was an overall decline in the number of compensable injuries recorded among police in the Australian jurisdiction studied. Over the period from 2003 to 2012, substantial decreases in first claim injury rates and time loss claims were observed. This trend is consistent with international research that has found decreases in police injuries over time. A U.S. study suggested declining injury rates likely reflect changes in work practices, enhanced training and a lower reliance on weapons (Brandl and Stroshine, 2012). Further, the use of personal protective equipment (PPE) is more common among police, including integrated operational equipment vests which help to provide protection from firearms and edged weapons (Brandl and Stroshine, 2012). For example, some studies suggest that removing equipment from belts to the vest can reduce the number of injuries to the lower back and hip areas, and potentially provide some protection from vehicle crashes or incidents (Brandl and Stroshine, 2012). 4.2. Subsequent claims
* Age and gender of claimants at their first subsequent claim. ^ Injury type and mechanism of injury for all subsequent claims.
While the overall rate for first claims declined over time; increases in subsequent claims were observed for minor, medical and time loss claims. There is evidence in other occupational populations that prior injuries represent an independent risk factor for sustaining subsequent injuries in the workplace (Jones et al., 1993; Ryden et al., 1989). One study in Australia identified that a substantial proportion of injured workers experience a second occupational injury or disease; these workers pose a greater economic burden than those with single claims, and experience a substantially greater cumulative period of work disability (Ruseckaite and Collie, 2011). The authors reported that there is potential to reduce the social, health and economic burden of workplace injury by enacting prevention programs targeted at these workers (Ruseckaite and Collie, 2011). The increasing trend for multiple claims in police is consistent with a 2016 study that focused on injuries in a single Australian specialist policing unit. In this research, 138 specialist operational police reported being injured at work over a 4 year period (Larsen et al., 2016). Among this group, 58 were injured more than once (with an average 2.6 times), which represents 65.1% of the total injuries observed. The authors suggested that this finding invites speculation as to whether the recovery time and/or rehabilitation processes in this unit were adequate in allowing full recovery from sustained injuries (Larsen et al., 2016). It is possible that the police in the study were returning to duty before they were fully rehabilitated—a factor that may increase their risk of sustaining additional injuries. Further, recovery from physical injury is complex and multifactorial, and psychosocial factors are known to
musculoskeletal and connective tissue diseases. The greatest proportion of injuries for medical and time loss claims were caused by body stressing (e.g., lifting, carrying). Table 3 shows the characteristics of subsequent claims stratified by medical and time loss claims.
3.6. Cost of healthcare services Considering first claims only, claims involving a medical doctor were ten times higher for time loss claims compared to medical claims, four times higher for allied health providers and twelve times higher for hospital admissions. The highest numbers of allied health services accessed by claimants were psychological, osteopathy, physiotherapy and chiropractic services, with psychological services showing the highest average cost for both time loss and medical only claims. Similarly, for subsequent claims, the highest numbers of allied health services accessed were for psychological, osteopathy, physiotherapy and chiropractic services, with psychological services showing the highest average cost for both time loss and medical only claims. Table 4 summarizes the number and costs of healthcare services for first claims and subsequent claims stratified by time loss and medical claims.
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Table 4 Number and costs of healthcare services for first and subsequent claims stratified by medical and time loss claims. Medical claims
Time loss claims
N services
Mean Cost ($)
Std Dev cost ($)
N services
Mean Cost ($)
Std Dev cost ($)
First claim Medical doctor Allied health Psychologist Osteopath Physiotherapist Chiropractor Others* Hospital^ Public Private
3945 14,291 94 1403 6239 3064 3491 889 17 243
156.60 58.95 139.12 59.50 46.09 42.11 94.32 256.12 1394.57 647.99
241.15 129.49 16.80 8.41 12.14 6.23 257.59 671.44 1212.83 893.32
41,619 70,351 7559 2382 26,842 4336 29,232 10,819 4083 6736
158.02 59.31 138.35 59.34 47.29 42.43 52.41 439.76 3110.67 836.32
271.21 100.09 25.04 7.37 12.59 7.79 148.16 1416.55 5239.81 1528.64
Subsequent claims Medical doctor Allied health Psychologist Osteopath Physiotherapist Chiropractor Others* Hospital^ Public Private
1298 4981 46 475 1937 1411 1112 123 3 101
169.33 56.88 139.04 57.76 46.82 41.52 90.13 492.49 1572.04 539.17
271.55 106.54 25.48 6.38 12.94 5.00 220.56 475.42 1124.71 424.02
16,295 29,259 3106 799 11,170 1868 12,316 3519 64 1498
164.89 56.43 139.49 58.31 47.65 42.87 45.39 523.11 2748.61 812.95
282.58 87.76 21.05 8.32 13.33 7.76 126.69 1095.27 2718.04 1189.85
Std Dev = standard deviation. * Others includes all other allied services with low numbers of claims, for example services relating to ambulance services, nursing service, dental, acupuncture, chiropodist/podiatrist, remedial massage, naturopaths, dietitian, occupational therapist, optometrist, remedial exercise, social worker, hydrotherapy, exercise physiology services, benefits & support services assessment, and counselling. ^ Hospital includes inpatient and outpatient services.
et al., 1996). Similarly, continued exposure to wearing body armor was found to contribute to persistent lower back pain symptoms and associated work time loss (Burton et al., 1996). More recent research found that PPE among police increases metabolic demands, and (among a small sample), the researchers observed increases in perceived effort, exertion and discomfort using PPE (DiVincenzo et al., 2014). In contrast, other studies suggest that removing equipment from belts and changing to vests/body armor can reduce the number of injuries to the lower back and hip areas, and potentially provide some protection from vehicle crashes or incidents (Brandl and Stroshine, 2012). Some of the body stressing injuries reported in the current study may relate to repeated vehicle use. The effect of occupational driving on the prevalence and incidence of low back pain and other musculoskeletal problems has been a topic of interest for some time, and prolonged exposure to driving has consistently been observed as a risk factor for the development of low back pain (Gyi and Porter, 1998). While epidemiological studies examining the relationship between driving and back pain are challenging due to multiple interacting factors, driving is a task that can directly lead to musculoskeletal injury due to prolonged sitting, a fixed posture and vibration. A study in the UK examined the effect of driving on injury prevalence and work time loss for musculoskeletal problems among police who routinely drove as part of their role. They found that police drivers are at high risk of injury for a number of reasons: they are predominantly tall males and wear bulky clothing and thus seat adjustment may be insufficient to obtain a good posture; they drive fleet cars where the seat and suspension are exposed to excessive wear and tear; they often have to drive in rapid response situations where they are exposed to fast acceleration and deceleration; driving is often followed by strenuous physical activity such as lifting and running; they spend most of the eight-hour shift driving or sitting in their vehicle; and they often have to take backseat passengers which makes seat adjustment challenging (Gyi and Porter, 1998).
impact injury outcomes and lost time. For example, a review of experiences of workers with on-the-job injuries and the effects of psychosocial factors on their abilities to return to work identified four common themes: frustration, depression, discrimination, and obstacles in understanding how the workers’ compensation system works and in obtaining care (Eggert, 2010). Thus, approaches for the management of injured workers, and appropriate rehabilitation and return to work plans, are very important in preventing future injury. 4.3. Types of injury The most frequently reported categories of injuries for both first and subsequent medical and time loss claims were: traumatic joint/ligament and muscle/tendon injuries; wounds, lacerations, amputations and organ damage; and musculoskeletal and connective tissue diseases. The greatest proportion of injuries for medical and time loss claims for both first and subsequent claims related to body stressing (e.g., lifting, carrying). This is consistent with international research which found sprains and strains to be the leading injury type among all emergency services personnel (including police, firefighter and emergency medical occupations) (Reichard and Jackson, 2010). National occupational injury surveillance data from the U.S indicated that 33–41% of all injuries to emergency service workers were sprains and strains, and are most commonly reported by police and career firefighters (Reichard and Jackson, 2010). In the present study, the most common mechanism of injury for all claims was body stressing. Body stressing injuries include muscle strains, back conditions, and tendonitis/tenosynovitis, and it can be difficult to attribute a specific cause to these types of injuries as work may only be one factor. However, international evidence suggests that occupational exposure to PPE used by police (such as belts and heavy body armor) can contribute to body stressing injuries. For example, a series of studies in the UK found exposure to heavy body armor to be a risk indicator for first-time onset of low back injury and a significantly higher prevalence of low back issues among those exposed (Burton 6
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make comparisons over time difficult, although source code mapping is applied to ensure consistent coding over time and minimize these issues. The analysis excluded police engaged in part-time work who made a claim. Part-time police encompassed only approximately 2% of all claims. There is likely to be a slight underestimation of claims in 2011/ 12 as it is not a complete year (administrative system lag for the last couple of months). Underestimation of prevalence is possible where the injured person did not file a claim (in particular minor claims as they must be submitted to the regulator via agents, and most never reach the threshold levels), or if the claim was rejected and services can be missed if the healthcare providers did not report it for billing purposes. Similarly, services not covered by the state-based insurer and those accessed outside the compensation system (e.g. via the public healthcare system or private insurance) would not be reflected in the data.
4.4. Age of claimants In the current study, the highest rates of first claims were made by males in the 35–44 years age group, and for subsequent claims, in the 40–44 years age group. The observation of high injury rates among younger staff members could reflect the likely work roles in this group. While we did not have any information on rank/role in the present study, the results may reflect that the younger groups may have more exposure to situations such as arrest and restrain. This is supported by research in the U.S, where they found that younger age was associated with a range of injuries, such as injuries sustained during arrest and restrain, and exposure injuries (particularly needlestick) (Lorentz et al., 2000). A key finding in this study (involving a survey of 1738 active duty law enforcement officers) was that a large proportion of respondents (n = 803) had received at least one needlestick injury (30%), and a significant proportion of those who had received one needlestick injury went on to receive more (28%). The risk factors for a needlestick injury included male gender, less experience, evening shifts, pat-down searches, and patrol duties. This suggests that a combination of task types and inexperience can be important factors in sustaining workplace injuries among police. Another U.S. study noted that it would be useful to examine variations in the frequencies by which individual staff members are injured in the line of duty, as it could be reasonably expected that some police sustain more injuries than others relating to the way in which they do their work (Brandl and Stroshine, 2012). They proposed that different working styles and activity levels may translate into different injury rates, for example, younger police who are generally more active, or those that make a lot of arrests may find themselves in situations which have higher potential to sustain an injury (Brandl and Stroshine, 2012). These factors are also related to the individual perception of danger in conducting work activities and to the shaping of police culture (e.g., (Dorn and Brown, 2003). Similarly, research has found that the occurrence of injury-related leave is higher for those on night shifts; and night shift work has been significantly associated with long-term injury among police after adjusting for age and gender (Violanti et al., 2012, 2013). It is thought that this relationship is mediated in part by fatiguerelated impairments due to circadian disruption, which can in turn affect performance and decision making capacity. Therefore, it would be of interest to examine the circumstances in which the injuries occur in more detail in future research.
4.7. Conclusions, implications & further research The primary objective of this paper was to describe occupational injuries for one state-based police agency in Australia. Key findings to inform prevention strategies included that younger males (in the 35–44 year age groups) made the most claims, and the greatest proportion of injuries for medical and time loss claims were caused by body stressing (e.g., lifting, carrying). Further, while there was an overall decrease in compensation claims over time, there was a steady increase in subsequent claims over time. It is possible police were returning to duty before they were fully rehabilitated—a factor that may increase their risk of sustaining additional injuries. It would therefore be worth investigating whether the current rehabilitation, injury management and return to work processes are sufficient to prevent future injury. While this study described a number of factors associated with the incidence of injury among police, it would be beneficial to link more detailed organizational information to injuries; including shift work, patterns of work, practices around injury management, return to work, and injury severity. Linkage to corporate statistics on operational/incident information would also be useful to understand what specific factors relating to the incident are important. Further, it would be valuable to replicate the analyses with data from other Australian jurisdictions to determine whether the results are consistent. This would also act to validate interpretation of these findings. References
4.5. Mental health and stress claims
ABS, 2013. ANZCO - Australian and New Zealand Standard Classification of Occupations V1.2. ABS, 2017. 6401.0 - Consumer Price Index, Australia. Al-Humaid, Hussein, el-Guebaly, Nady, Lussier, Debra, 2007. Substance use and the police: an international workplace experience. Addictive Disord. Their Treat. 6 (3), 107–115. https://doi.org/10.1097/01.adt.0000210728.38509.3d. Anshel, M.H., Robertson, M., Caputi, P., 1997. Sources of acute stress and their appraisals and reappraisals among Australian police as a function of previous experience. J. Occup. Org. Psychol. 70 (4), 337–356. Asmundson, G.J., Stapleton, J.A., 2008. Associations between dimensions of anxiety sensitivity and PTSD symptom clusters in active-duty police officers. Cogn. Behav. Therapy 37 (2), 66–75. Australia, S.W., 2017. Safe Work Australia statistics. Available from: https://www. safeworkaustralia.gov.au/statistics-and-research/statistics/statistics. Bauerle, T., McGonagle, A., Magley, V., 2016. Mere overrepresentation? Using cross-occupational injury and job analysis data to explain men’s risk for workplace fatalities. Saf. Sci. 83, 102–113. Beyond Blue, 2016. Good practice framework for mental health and wellbeing in first responder organisations, 2016. Melbourne, Australia. Beyond Blue, 2018. Answering the Call, in National Mental Health and Wellbeing Study of Police and Emergency Services. Melboure, Australia. Brandl, S., Stroshine, S., 2012. The physical hazards of police work revisited. Police Quart. 15 (3), 262–282. Brown, J., Cooper, C., Kirkcaldy, B., 1996. Occupational stress among senior police officers. Brit. J. Psychol. 87 (Pt 1), 31–41. Burke, M., Brief, A., George, J., 1993. The role of negative affectivity in understanding relations between self-reports of stressors and strains: a comment on the applied psychology literature. J. Appl. Psychol. 78, 402–412. Burton, K., et al., 1996. Occupational risk factors for the first-onset and subsequent course of low back trouble: a study of serving police officers. Spine 21–22, 2612–2620. Davey, J.D., Obst, P.L., Sheehan, M.C., 2001. It goes with the Job: officers' insights into
In the current study, the number of mental health claims (including stress claims) was proportionally very small, accounting for one percent of initial claims and less than one percent of subsequent claims. Research has found that stigma associated with mental disorder claims may deter people from making such claims; potentially leading to an underestimation of the problem when considering claim rates alone (Dollard et al., 2003). This was confirmed in a recent Australian study exploring mental health among first responders (Blue, 2018). They found that while most emergency service personnel did not hold stigmatizing attitudes to their colleagues, they found very high rates of selfstigma; and 61% of survey respondents reported avoiding telling others about their mental health condition. Thus, the small number of mental health claims in the current study is unlikely to be an accurate reflection of the problem. 4.6. Limitations The information collected in the CRD is restricted to data required for administrative purposes, and therefore key information of interest cannot be extracted from this database (including, for example, rank, tenure, time of day and other organizational factors). Further, changes to administrative procedures can potentially change definitions and 7
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force. Am. J. Preventive Med. 18 (2), 146–150. Mayhew, C., 2001. Occupational Health and Safety Risks faced by Police Officers. Australian Institute of Criminology: Trends and Issues. McCanlies, E.C., et al., 2012. Metabolic syndrome and sleep duration in police officers. Work 43 (2), 133–139. Mumford, E., Taylor, B., Kubu, B., 2014. Law enforcement officer safety and wellness. Police Quart. 18 (2), 111–133. Nabeel, I., et al., 2007. Correlation between physical activity, fitness, and musculoskeletal injuries in police officers. Minn. Med. 90 (9), 40–43. Prang, K., Hassani-Mahmooei, B., Collie, A., 2016. Compensation research database: population-based injury data for surveillance, linkage and mining. BMC Res. Notes 9, 456–467. Ramey, S.L., et al., 2012. The effect of work shift and sleep duration on various aspects of police officers' health. Workplace Health Saf. 60 (5), 215–222. Reichard, A., Jackson, L., 2010. Occupational injuries among emergency responders. Am. J. Ind. Med. 53 (1), 1–11. Ruseckaite, R., Collie, A., 2011. Repeat workers’ compensation claims: risk factors, costs and work disability. BMC Public Health 11, 492–500. Ryden, L., et al., 1989. Occupational low-back injury in a hospital employee population: an epidemiologic analysis of multiple risk factors of a high-risk occupational group. Spine 14, 315–320. Stergiou-Kita, M., et al., 2015. Danger zone: men, masculinity and occupational safety in high risk occupations. Saf. Sci. 80, 213–220. Violanti, J.M., et al., 2012. Shift work and the incidence of injury among police officers. Am. J. Ind. Med. 55 (3), 217–227. Violanti, J.M., et al., 2013. Shift work and long-term injury among police officers. Scand. J. Work Environ. Health 39 (4), 361–368. Volanti, J., et al., 2012. Shift work and the incidence of injury among police officers. Am. J. Indus. Med. 55, 217–222. Volanti, J., et al., 2013. Shift work and long-term injury among police officers. Scand. J. Work, Environ. Health 39 (4), 361–368.
the impact of stress and culture on alcohol consumption within the policing occupation. Drugs: Educ., Prevent. Policy 8 (2), 141–149. DiVincenzo, H., et al., 2014. Metabolic demands of law enforcement personal protective equipment during exercise tasks. Ergonomics 57 (11), 1760–1765. Dollard, M., et al., 2003. Unique aspects of stressing human services work. Australian Psychol. 38, 84–91. Dorn, L., Brown, B., 2003. Making sense of invulnerability at work - a qualitative study of police drivers. Saf. Sci. 41, 837–859. Eggert, S., 2010. Psychosocial factors affecting employees’ abilities to return to work. AAOHN J. 58 (2), 51–56. Gershon, R., Lin, S., Li, X., 2002. Works stress in aging police officers. J. Occup. Environ. Med. 44 (2), 160–167. Gray, S., Collie, A., 2017. The nature and burden of occupational injury among first responder occupations: a retrospective cohort study in Australian workers. Injury 48 (11), 2470–2477. Gyi, D., Porter, J., 1998. Musculoskeletal problems and driving in police officers. Occup. Med. 48 (3), 153–160. Hart, Peter, Cotton, Peter, 2003. Conventional wisdom is often misleading: police stress within an organisational health framework. In: Dollard, Maureen, Winefield, Anthony, Winefield, Helen (Eds.), Occupational Stress in the Service Professions. CRC Press, pp. 103–141. https://doi.org/10.1201/9780203422809.ch4. Huddleston, L., Stephens, C., Paton, D., 2007. An evaluation of traumatic and organizational experiences on the psychological health of New Zealand police recruits. Work 28 (3), 199–207. Jones, B., et al., 1993. Epidemiology of injuries associated with physical training among young men in the army. Med. Sci. Sports Exerc. 25, 197–203. Klinoff, Vera A., Van Hasselt, Vincent B., Black, Ryan A., 2015. Homicide-suicide in police families: an analysis of cases from 2007-2014. J. Forensic Pract. 17 (2), 101–116. https://doi.org/10.1108/JFP-07-2014-0019. Larsen, B., Aisbett, B., Silk, A., 2016. The injury profile of an australian specialist policing unit. Int. J. Res. Public Health 13 (4), 370. Lorentz, Hill, Samimi, 2000. Occupational needlestick injuries in a metropolitan police
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Contents lists available at ScienceDirect
Safety Science journal homepage: www.elsevier.com/locate/safety
Occupational injuries among police workers: Patterns and contributing factors in an Australian jurisdiction
T
⁎
Carlyn Muira, , Khic-Houy Prangb, Dianne Shepparda, Sharon Newnama a b
Monash University Accident Research Centre, Monash University, Australia Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Australia
A B S T R A C T
Police are regularly exposed to potentially traumatic events, which puts them at risk of physical and psychological injury. International evidence suggests that police have high injury rates relative to other occupations, however most research either focuses on specific situations (e.g., use of force); specific injury causes (e.g., weapons); or specific injury types (e.g. Post-traumatic Stress Disorder). Few studies have focused on understanding injury patterns across the workforce. Thus, the primary objective of this paper was to describe the rate, mechanisms, type and costs of occupational injuries experienced by police in one Australian jurisdiction. Using administrative workers’ compensation claims data, claims records of police were examined for the period 2003/04–2011/12. Descriptive analyses were conducted to characterise the distribution of first and subsequent claims, stratified by claim type (minor, medical and time loss). Rates were calculated using labour force statistics (per 1000 full-time equivalent workers). This study described a number of factors associated with the incidence of injury among police. Over the study period, there was a decrease in first claim rates and an increase in subsequent claim rates across all claim types. Key findings to inform prevention strategies included that younger males (in the 35–44 year age groups) made the most claims, and the greatest proportion of injuries for medical and time loss claims were caused by body stressing (e.g., lifting, carrying). Future research linking corporate statistics to operational/incident information would be beneficial to understand the specific incident factors that are important in outcomes.
1. Introduction Police are regularly exposed to potentially traumatic events, which puts them at risk of physical injury and may impact their mental health (Beyond Blue, 2016). Police work is also subject to a combination of stressors, including: shift work; long working hours; repeated exposure to death, trauma and/or violence; difficult interactions with members of the public; high expectations of the profession; high levels of governance; strong cultural pressures; and stigmatizing attitudes towards mental health and suicide (Beyond Blue, 2016). International evidence suggests that police have high injury rates relative to other occupations; in the US, police have highest occupational injury rates of all emergency responders, and high risk of fatal occupational injury (Volanti et al., 2012; Bauerle et al., 2016). The rate of serious injuries among police is more than three times the national average for occupational injuries (42.7 serious injuries per 1000 workers for police, compared to 13.0 serious injuries per 1000 workers overall, 2008–2009 (Safe Work Australia, 2017). In fact, the rate of serious injuries among police is one of the highest rates observed across all occupational groups (Gray and Collie, 2017). Despite evidence that policing involves high-risk work, there has been limited research that has considered the incidence or impact of different types of occupational injuries among police. ⁎
The risks associated with policing vary according to the specific tasks being undertaken, for example desk duties versus arrest and restrain (Mayhew, 2001). However, most research that has been conducted either focuses on specific situations (e.g., use of force); specific injury causes (e.g., weapons); or specific injury types (e.g. Post-Traumatic Stress Disorder (PTSD)). Few studies, particularly in Australia, have focused on understanding injury patterns across the workforce. In the few studies conducted, the most frequently observed injury types among police include musculoskeletal disorders (MSDs) (particularly low back pain from work-related driving and manual handling), and sprains and strains (Gyi and Porter, 1998). Other frequently reported injuries include contusions, abrasions and lacerations during arrest and restrain (Reichard and Jackson, 2010). International research reported sprains and strains as the leading injury type among all emergency service personnel, including police, firefighters and emergency medical occupations (Reichard and Jackson, 2010). A growing incidence of back pain has been associated with extended hours spent in the sedentary position in patrol cars (Gyi and Porter, 1998), contributing significantly to absenteeism and workers compensation claims (Nabeel et al., 2007). Research has indicated that policing is amongst the most stressful of all occupations (e.g., (Burke et al., 1993; Hart et al., 2003), and given the unpredictable and stressful nature of the job, the prevalence of
Corresponding author at: 21 Alliance Lane, Clayton Campus, Monash University, VIC 3800, Australia. E-mail address: [email protected] (C. Muir).
https://doi.org/10.1016/j.ssci.2019.104525 Received 12 November 2018; Received in revised form 26 August 2019; Accepted 21 October 2019 Available online 09 November 2019 0925-7535/ © 2019 Elsevier Ltd. All rights reserved.
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schemes across Australia (Gray and Collie, 2017). Benefits, including income replacement while on sick leave and medical and rehabilitation expenses, are provided where reasonably required for both acute musculoskeletal injuries and other physical pain-related conditions with a more gradual onset. ‘Psychological injuries’ can also receive compensation where work was a major contributor to an individual’s mental health status (Gray and Collie, 2017). The current study focused on one state of Australia, with a single state-based police agency with approximately 18,000 employees.
PTSD is estimated to be six to seven times that of the wider community (Asmundson and Stapleton, 2008). The impact on mental health can be significant, and a recent study identified an increase in suicide and homicide among police (Klinoff et al., 2015). The high-stress nature of jobs such as policing have identified this as an emerging public health issue that needs to be addressed (Gershon et al., 2002). A number of factors have been identified that contribute to policing injuries. First, continued exposure to stress and traumatic experiences has been associated with secondary health related issues such as alcoholism, substance abuse and in more severe cases, spousal abuse (AlHumaid et al., 2007; Anshel et al., 1997; Brown et al., 1996). Second, an increase in police workload as well as the effects of shift work increase fatigue levels and contribute to workplace injury (Volanti et al., 2012, 2013). Sleep disruption has also been associated with the development of chronic diseases, such as cardiovascular diseases and hypertension (McCanlies et al., 2012; Ramey et al., 2012). In addition, organizational management practices and gender issues have been identified as barriers to addressing mental health in police (Huddleston et al., 2007; Stergiou-Kita et al., 2015). The psychological safety culture unique to policing is thought to discourage the acknowledgement of work-related emotional issues and contribute to the potential for psychological injury (Huddleston et al., 2007; Davey et al., 2001). In order to effectively address workplace injury among police, it is important to first quantify the incidence, nature and consequences of injuries experienced in the workplace. Thus, the primary objective of this paper is to describe the rate, mechanisms, type and costs of occupational injuries experienced by police in one Australian jurisdiction. A better understanding of the patterns and contributing factors will assist in the development of more effective prevention policies, practices and education programs, leading to mitigation in the rate and severity of incidents and injuries as well as reduction in cost of compensation claims. This research will contribute to existing evidence by providing a more detailed analysis of trends and contributing factors over time.
2.3. Data sources Analyses in this study were based on workers’ compensation claims. Compensation insurance is provided for most employers (~85%) by the state-based Regulator. Those not covered by this scheme include federal government employees, self-insuring agencies and sole traders. All claims that exceed the financial threshold for health care expenses or those requiring more than 10 days off work are required under state law to register with the Regulator; and these cases are subsequently managed by private sector insurers contracted for this purpose. To receive workers’ compensation benefits, workers must have their illness or injury certified by an approved medical practitioner. The Regulator provides a range of compensation and services to injured workers, including: income replacement, medical and allied health treatments, ambulance transport, hospital treatment, personal and household help, impairment lump sums, and common law damages (when specific criteria are met). The Compensation Research Database (CRD) is an administrative database held by the Institute for Safety Compensation and Recovery Research (ISCRR) at Monash University to support research into compensation health. The CRD includes de-identified data for work-related claims covered by the state-based Regulator from 1986. The dataset includes more than 20 years of compensable transport and workplace injury claims (both accepted and denied), which are collected in accordance with relevant legislation and privacy policies. The information collected includes: demographics (e.g. age, gender, index of relative social advantage and disadvantage), injury types and mechanisms, occupation and industry groups, workplace size, income payment and health services treatments (Prang et al., 2016).
2. Methods 2.1. Study design We conducted a retrospective analysis of administrative compensation claims data in one jurisdiction in Australia, focusing on occupational injury among police. The study was approved by Monash University Human Research Ethics Committee.
2.4. Inclusion criteria 2.2. Study context Data were extracted for claims that met the criteria for minor, medical and time loss claims. Minor claims are defined as those claims that do not have any associated costs (i.e., the worker has been absent for less than 10 days and/or they do not reach the medical expenses threshold set by the Regulator (AUD$495 in 2003/2004)). These claims are usually covered by the employer and are recorded in the CRD for tracking purposes only. Medical claims are defined as occupational disease claims that reach the threshold for medical claims but do not incur any time loss; claimants would receive medical treatments but not weekly compensation. Time loss claims are defined as claims where the threshold level of medical expenses is reached, and/or when a worker has been absent from work for 10 or more days; these workers would receive both medical treatments and weekly compensation. Claims were extracted for police employed full-time (identified using the Australian and New Zealand Standard Classification of Occupation code ‘4413’) (ABS, 2013) where the affliction date was between the fiscal year 2003/2004 and 2011/2012. Where more than one claim related to the same employee, both original claims and any subsequent claims were included. Cases were excluded if the claim was terminated by the insurer (e.g., failed to provide medical certificates or information on injury, fraudulent claims, claims opened in error).
Australia is a federated country that is made up of eight major states and territories (six states and two territories). Government in the Commonwealth of Australia is exercised on three levels: federal; state/ territory; and local. Each state has its own constitution, with its own legislature (parliament), judiciary and executive. Specific areas of legislative power are held by the federal government, including taxation, defence, foreign affairs and postal and telecommunications services. The states retain legislative power over all other matters that occur within their borders, including police, hospitals, education and public transport. Workers’ compensation is a compulsory statutory form of insurance for all employers in every state and territory in Australia, and provides protection to workers if they suffer a work-related injury or disease. Each state and territory has its own workers’ compensation scheme and the Commonwealth has three that cover seafarers, military personnel and Commonwealth employees and authorities licensed to self-insure under the Safety, Rehabilitation and Compensation Act 1988 (Commonwealth). There are some differences in the provision of entitlements for workers’ compensation across the states and territories in Australia. For example, the rate and duration of income replacement varies between 2
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2.5. Data analysis
then decreased in 2011/12 (Fig. 2).
Descriptive analyses were performed for minor claims and conducted separately from medical and time loss claims (as these claims were recorded for tracking purposes only). First and subsequent claims were identified by the affliction date and a unique claimant identifier, and stratified into medical or time loss claims. Rates of first and subsequent claims for minor, medical and time loss claims per 1000 full-time equivalent (FTE) workers were calculated using publicly available workforce statistics. Descriptive statistics were used to characterise the distribution of first and subsequent claims by gender, age group, injury type, and mechanism of injury, stratified by medical and time loss claims. The total number and mean costs of healthcare services (i.e., medical doctor, allied health providers and hospital) for first and subsequent claims for the 2003/2004 and 2011/ 2012 period, stratified by medical and time loss claims were reported. Costs were indexed to Consumer Price Index 2012 (ABS, 2017). Analyses were conducted using IBM SPSS v23.
3.3. Minor claims
3. Results
In total, 4242 claimants lodged an initial claim, of which 1217 were medical claims and 3025 were time loss claims. The majority of medical and time loss claims were made by males and in the 35–44 years age group. The top three most frequent types of reported injuries for medical and time loss claims included: traumatic joint/ligament and muscle/tendon injury; wounds, lacerations, amputations & organ damage; musculoskeletal and connective tissue diseases. The greatest proportion of injuries for medical and time loss claims were caused by body stressing (e.g., lifting, carrying), being hit by moving objects and slips, trips and falls. Table 2 presents the characteristics of first claims stratified by medical and time loss claims.
Overall, 4034 claimants lodged a minor claim and 1169 claimants lodged more than one minor claim (n = 1669 claims). The majority of first and subsequent minor claims were made by males and in the 30–39 years age group. The top three most frequent categories of reported injuries (for both first and subsequent claims) included: traumatic joint/ligament and muscle/tendon injury; wounds, lacerations, amputations & organ damage; and musculoskeletal and connective tissue diseases. The greatest proportion of injuries for first and subsequent claims were caused by body stressing (e.g., lifting, carrying), being hit by moving objects and falls, trips and slips. Table 1 describes the characteristics of minor claims stratified by first and subsequent claims. 3.4. First claims
3.1. First claim rates The rates of single claims in the minor, time loss and medical categories decreased over the study period (per 1000 FTE). The rate of minor claims substantially decreased from 2003/04 to 2007/08 and then steadily decreased until 2011/12, with a slight increase from 2007/08 to 2008/09. A similar pattern was observed for time loss claims until 2007/08 with a slight increase until 2009/10, followed by a decrease in the rate. A steady decrease was observed for medical claims from 2003/04 to 2011/12, with slight increases in 2005/06 and 2008/09 (Fig. 1).
3.5. Subsequent claims
3.2. Subsequent claim rates
Overall, 419 claimants lodged more than one medical claim (n = 475 total claims) and 991 claimants lodged more than one time loss claim (n = 1300 total claims). The majority of medical and time loss claims were made by males and in the 40–44 years age group. The top three most frequent categories of reported injuries for medical and time loss claims included: traumatic joint/ligament and muscle/tendon injury; wounds, lacerations, amputations & organ damage; and
In contrast, when considering subsequent injury claims, claim rates generally increased (per 1000 FTE). A steady increase was observed for time loss and medical claims from 2003/04 to 2011/12, with a large increase in time loss claims from 2008/09 to 2009/10. The rate of minor claims increased substantially from 2003/04 to 2006/07 and
Fig. 1. Rate for first claims per 1000 FTE. 3
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Fig. 2. Rate for subsequent claims per 1000 FTE. Table 1 Characteristics of minor claims stratified by first and subsequent claims.
Sex Male Female Age 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60+ Injury type Traumatic joint/ligament and muscle/ tendon injury Wounds, lacerations, amputations & organ damage Musculoskeletal and connective tissue diseases Other Injuries Fractures Other diseases Mental diseases Skin and subcutaneous tissue disease Nervous system and sense organ diseases Respiratory system diseases Mechanism of injury Body stressing Being hit by moving objects Falls, trips and slips Hitting objects with a part of the body Chemicals and other substances Vehicle incidents and other Biological factors Sound & pressure Mental stress Heat/electricity/other environmental factors
Table 2 Characteristics of first claims stratified by medical and time loss claims.
First claim
Subsequent claims*
Medical claims
Time loss claims
N
%
N
%
N
%
N
%
3247 787
80.5 19.5
984 185
84.2 15.8
986 231
81 19
2391 634
79 21
219 618 801 876 684 439 276 106 15
5.4 15.3 19.9 21.7 17.0 10.9 6.8 2.6 0.4
75 189 261 255 187 117 68 15 2
6.4 16.2 22.3 21.8 16.0 10.0 5.8 1.3 0.2
54 161 208 264 216 159 110 40 5
4.5 13.2 17.1 21.7 17.7 13.1 9.0 3.3 0.4
92 304 485 627 609 470 304 115 19
3.0 10.0 16.0 20.7 20.1 15.5 10.0 3.8 0.6
1262
31.6
521
31.7
441
36.7
28.8
28.3
1239
31.0
472
28.7
391
32.6
25.3
24.8
929
23.3
464
28.2
183
15.2
25.0
24.5
352 105 44 28 13 13 8
8.8 2.6 1.1 0.7 0.3 0.3 0.2
109 38 4 16 8 10 2
6.6 2.3 0.2 1.0 0.5 0.6 0.1
49 44 44 3 38
4.1 3.7 3.7 0.2 3.2
10.0 8.2 1.0 0.7 0.5
9.8 8.0 1.0 0.7 0.5
5 3
0.4 0.2
0.2 0.3
0.2 0.3
1354 1109 652 306 215 160 123 62 42 11
33.6 27.5 16.2 7.6 5.3 4.0 3.0 1.5 1.0 0.3
645 445 272 111 65 63 30 11 15 12
38.6 26.7 16.3 6.7 3.9 3.8 1.8 0.7 0.9 0.7
562 198 179 109 51 27 43 36 8 4
46.2 16.3 14.7 9.0 4.2 2.2 3.5 3.0 0.7 0.3
979 795 456 338 309 103 29 8 7 1
32.36 26.28 15.07 11.17 10.21 3.40 0.96 0.26 0.23 0.03
Sex Male Female Age 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60+ Injury type Traumatic joint/ligament and muscle/ tendon injury Musculoskeletal and connective tissue diseases Wounds, lacerations, amputations & organ damage Fractures Other Injuries Mental diseases Other diseases Nervous system and sense organ diseases Respiratory system diseases Skin and subcutaneous tissue disease Mechanism of injury Body stressing Falls, trips and slips Being hit by moving objects Vehicle incidents and other Hitting objects with a part of the body Chemicals and other substances Mental stress Sound & pressure Biological factors Heat/electricity/other environmental factors
* Age and gender of claimants at their first subsequent claim; injury type and mechanism of injury for all subsequent claims.
4
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4. Discussion
Table 3 Characteristics of subsequent claims stratified by medical and time loss claims.
Sex* Male Female Age* 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60+ Injury type^ Traumatic joint/ligament and muscle/ tendon injury Musculoskeletal and connective tissue diseases Wounds, lacerations, amputations & organ damage Fractures Other Injuries Mental diseases Other diseases Nervous system and sense organ diseases Respiratory system diseases Skin and subcutaneous tissue disease Mechanism of injury^ Body stressing Falls, trips and slips Being hit by moving objects Vehicle incidents and other Hitting objects with a part of the body Chemicals and other substances Mental stress Sound & pressure Biological factors Heat/electricity/other environmental factors
Medical claims
Time loss claims
N
%
N
%
349 70
83.3 16.7
815 176
82.2 17.8
6 33 66 84 87 69 43 27 4
1.4 7.9 15.8 20.0 20.8 16.5 10.3 6.4 1.0
12 53 133 225 208 180 125 51 4
1.2 5.3 13.4 22.7 21.0 18.2 12.6 5.1 0.4
58
15.8
326
25.5
208
56.5
312
24.4
49
13.3
421
32.9
11 9 19 1 12
3.0 2.4 5.2 0.3 3.3
113 85 9 4 5
8.8 6.6 0.7 0.3 0.4
1 –
0.3 –
2 3
0.2 0.2
268 72 52 28 18 6 18 11 – 2
56.4 15.2 10.9 5.9 3.8 1.3 3.8 2.3 – 0.4
533 296 178 126 121 35 8 – 3 –
41.0 22.8 13.7 9.7 9.3 2.7 0.6 – 0.2 –
The nature of police work, and the work environment, has the potential to increase the risk of occupational injury. Most research on police injury to date has focused on specific injury types or specific occupational hazards (such as stress, or use of force), and thus there is limited information describing the broader patterns of injuries (and associated costs) experienced by police workers across an entire workforce. This broader understanding is important given that longterm health morbidity and mortality rates in police exceed other occupations and the general population (Mumford et al., 2014). It is also known that emergency service workers face a wide range of hazards in relation to the nature of their work, and thus a clear understanding of the nature and characteristics of injuries is important to assist in the development of targeted prevention approaches. Therefore, the aim of the current research was to describe the rate, mechanisms, type and costs of occupational injuries experienced by police in one Australian jurisdiction. 4.1. Decline in compensable injuries A key finding in the current study was an overall decline in the number of compensable injuries recorded among police in the Australian jurisdiction studied. Over the period from 2003 to 2012, substantial decreases in first claim injury rates and time loss claims were observed. This trend is consistent with international research that has found decreases in police injuries over time. A U.S. study suggested declining injury rates likely reflect changes in work practices, enhanced training and a lower reliance on weapons (Brandl and Stroshine, 2012). Further, the use of personal protective equipment (PPE) is more common among police, including integrated operational equipment vests which help to provide protection from firearms and edged weapons (Brandl and Stroshine, 2012). For example, some studies suggest that removing equipment from belts to the vest can reduce the number of injuries to the lower back and hip areas, and potentially provide some protection from vehicle crashes or incidents (Brandl and Stroshine, 2012). 4.2. Subsequent claims
* Age and gender of claimants at their first subsequent claim. ^ Injury type and mechanism of injury for all subsequent claims.
While the overall rate for first claims declined over time; increases in subsequent claims were observed for minor, medical and time loss claims. There is evidence in other occupational populations that prior injuries represent an independent risk factor for sustaining subsequent injuries in the workplace (Jones et al., 1993; Ryden et al., 1989). One study in Australia identified that a substantial proportion of injured workers experience a second occupational injury or disease; these workers pose a greater economic burden than those with single claims, and experience a substantially greater cumulative period of work disability (Ruseckaite and Collie, 2011). The authors reported that there is potential to reduce the social, health and economic burden of workplace injury by enacting prevention programs targeted at these workers (Ruseckaite and Collie, 2011). The increasing trend for multiple claims in police is consistent with a 2016 study that focused on injuries in a single Australian specialist policing unit. In this research, 138 specialist operational police reported being injured at work over a 4 year period (Larsen et al., 2016). Among this group, 58 were injured more than once (with an average 2.6 times), which represents 65.1% of the total injuries observed. The authors suggested that this finding invites speculation as to whether the recovery time and/or rehabilitation processes in this unit were adequate in allowing full recovery from sustained injuries (Larsen et al., 2016). It is possible that the police in the study were returning to duty before they were fully rehabilitated—a factor that may increase their risk of sustaining additional injuries. Further, recovery from physical injury is complex and multifactorial, and psychosocial factors are known to
musculoskeletal and connective tissue diseases. The greatest proportion of injuries for medical and time loss claims were caused by body stressing (e.g., lifting, carrying). Table 3 shows the characteristics of subsequent claims stratified by medical and time loss claims.
3.6. Cost of healthcare services Considering first claims only, claims involving a medical doctor were ten times higher for time loss claims compared to medical claims, four times higher for allied health providers and twelve times higher for hospital admissions. The highest numbers of allied health services accessed by claimants were psychological, osteopathy, physiotherapy and chiropractic services, with psychological services showing the highest average cost for both time loss and medical only claims. Similarly, for subsequent claims, the highest numbers of allied health services accessed were for psychological, osteopathy, physiotherapy and chiropractic services, with psychological services showing the highest average cost for both time loss and medical only claims. Table 4 summarizes the number and costs of healthcare services for first claims and subsequent claims stratified by time loss and medical claims.
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Table 4 Number and costs of healthcare services for first and subsequent claims stratified by medical and time loss claims. Medical claims
Time loss claims
N services
Mean Cost ($)
Std Dev cost ($)
N services
Mean Cost ($)
Std Dev cost ($)
First claim Medical doctor Allied health Psychologist Osteopath Physiotherapist Chiropractor Others* Hospital^ Public Private
3945 14,291 94 1403 6239 3064 3491 889 17 243
156.60 58.95 139.12 59.50 46.09 42.11 94.32 256.12 1394.57 647.99
241.15 129.49 16.80 8.41 12.14 6.23 257.59 671.44 1212.83 893.32
41,619 70,351 7559 2382 26,842 4336 29,232 10,819 4083 6736
158.02 59.31 138.35 59.34 47.29 42.43 52.41 439.76 3110.67 836.32
271.21 100.09 25.04 7.37 12.59 7.79 148.16 1416.55 5239.81 1528.64
Subsequent claims Medical doctor Allied health Psychologist Osteopath Physiotherapist Chiropractor Others* Hospital^ Public Private
1298 4981 46 475 1937 1411 1112 123 3 101
169.33 56.88 139.04 57.76 46.82 41.52 90.13 492.49 1572.04 539.17
271.55 106.54 25.48 6.38 12.94 5.00 220.56 475.42 1124.71 424.02
16,295 29,259 3106 799 11,170 1868 12,316 3519 64 1498
164.89 56.43 139.49 58.31 47.65 42.87 45.39 523.11 2748.61 812.95
282.58 87.76 21.05 8.32 13.33 7.76 126.69 1095.27 2718.04 1189.85
Std Dev = standard deviation. * Others includes all other allied services with low numbers of claims, for example services relating to ambulance services, nursing service, dental, acupuncture, chiropodist/podiatrist, remedial massage, naturopaths, dietitian, occupational therapist, optometrist, remedial exercise, social worker, hydrotherapy, exercise physiology services, benefits & support services assessment, and counselling. ^ Hospital includes inpatient and outpatient services.
et al., 1996). Similarly, continued exposure to wearing body armor was found to contribute to persistent lower back pain symptoms and associated work time loss (Burton et al., 1996). More recent research found that PPE among police increases metabolic demands, and (among a small sample), the researchers observed increases in perceived effort, exertion and discomfort using PPE (DiVincenzo et al., 2014). In contrast, other studies suggest that removing equipment from belts and changing to vests/body armor can reduce the number of injuries to the lower back and hip areas, and potentially provide some protection from vehicle crashes or incidents (Brandl and Stroshine, 2012). Some of the body stressing injuries reported in the current study may relate to repeated vehicle use. The effect of occupational driving on the prevalence and incidence of low back pain and other musculoskeletal problems has been a topic of interest for some time, and prolonged exposure to driving has consistently been observed as a risk factor for the development of low back pain (Gyi and Porter, 1998). While epidemiological studies examining the relationship between driving and back pain are challenging due to multiple interacting factors, driving is a task that can directly lead to musculoskeletal injury due to prolonged sitting, a fixed posture and vibration. A study in the UK examined the effect of driving on injury prevalence and work time loss for musculoskeletal problems among police who routinely drove as part of their role. They found that police drivers are at high risk of injury for a number of reasons: they are predominantly tall males and wear bulky clothing and thus seat adjustment may be insufficient to obtain a good posture; they drive fleet cars where the seat and suspension are exposed to excessive wear and tear; they often have to drive in rapid response situations where they are exposed to fast acceleration and deceleration; driving is often followed by strenuous physical activity such as lifting and running; they spend most of the eight-hour shift driving or sitting in their vehicle; and they often have to take backseat passengers which makes seat adjustment challenging (Gyi and Porter, 1998).
impact injury outcomes and lost time. For example, a review of experiences of workers with on-the-job injuries and the effects of psychosocial factors on their abilities to return to work identified four common themes: frustration, depression, discrimination, and obstacles in understanding how the workers’ compensation system works and in obtaining care (Eggert, 2010). Thus, approaches for the management of injured workers, and appropriate rehabilitation and return to work plans, are very important in preventing future injury. 4.3. Types of injury The most frequently reported categories of injuries for both first and subsequent medical and time loss claims were: traumatic joint/ligament and muscle/tendon injuries; wounds, lacerations, amputations and organ damage; and musculoskeletal and connective tissue diseases. The greatest proportion of injuries for medical and time loss claims for both first and subsequent claims related to body stressing (e.g., lifting, carrying). This is consistent with international research which found sprains and strains to be the leading injury type among all emergency services personnel (including police, firefighter and emergency medical occupations) (Reichard and Jackson, 2010). National occupational injury surveillance data from the U.S indicated that 33–41% of all injuries to emergency service workers were sprains and strains, and are most commonly reported by police and career firefighters (Reichard and Jackson, 2010). In the present study, the most common mechanism of injury for all claims was body stressing. Body stressing injuries include muscle strains, back conditions, and tendonitis/tenosynovitis, and it can be difficult to attribute a specific cause to these types of injuries as work may only be one factor. However, international evidence suggests that occupational exposure to PPE used by police (such as belts and heavy body armor) can contribute to body stressing injuries. For example, a series of studies in the UK found exposure to heavy body armor to be a risk indicator for first-time onset of low back injury and a significantly higher prevalence of low back issues among those exposed (Burton 6
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make comparisons over time difficult, although source code mapping is applied to ensure consistent coding over time and minimize these issues. The analysis excluded police engaged in part-time work who made a claim. Part-time police encompassed only approximately 2% of all claims. There is likely to be a slight underestimation of claims in 2011/ 12 as it is not a complete year (administrative system lag for the last couple of months). Underestimation of prevalence is possible where the injured person did not file a claim (in particular minor claims as they must be submitted to the regulator via agents, and most never reach the threshold levels), or if the claim was rejected and services can be missed if the healthcare providers did not report it for billing purposes. Similarly, services not covered by the state-based insurer and those accessed outside the compensation system (e.g. via the public healthcare system or private insurance) would not be reflected in the data.
4.4. Age of claimants In the current study, the highest rates of first claims were made by males in the 35–44 years age group, and for subsequent claims, in the 40–44 years age group. The observation of high injury rates among younger staff members could reflect the likely work roles in this group. While we did not have any information on rank/role in the present study, the results may reflect that the younger groups may have more exposure to situations such as arrest and restrain. This is supported by research in the U.S, where they found that younger age was associated with a range of injuries, such as injuries sustained during arrest and restrain, and exposure injuries (particularly needlestick) (Lorentz et al., 2000). A key finding in this study (involving a survey of 1738 active duty law enforcement officers) was that a large proportion of respondents (n = 803) had received at least one needlestick injury (30%), and a significant proportion of those who had received one needlestick injury went on to receive more (28%). The risk factors for a needlestick injury included male gender, less experience, evening shifts, pat-down searches, and patrol duties. This suggests that a combination of task types and inexperience can be important factors in sustaining workplace injuries among police. Another U.S. study noted that it would be useful to examine variations in the frequencies by which individual staff members are injured in the line of duty, as it could be reasonably expected that some police sustain more injuries than others relating to the way in which they do their work (Brandl and Stroshine, 2012). They proposed that different working styles and activity levels may translate into different injury rates, for example, younger police who are generally more active, or those that make a lot of arrests may find themselves in situations which have higher potential to sustain an injury (Brandl and Stroshine, 2012). These factors are also related to the individual perception of danger in conducting work activities and to the shaping of police culture (e.g., (Dorn and Brown, 2003). Similarly, research has found that the occurrence of injury-related leave is higher for those on night shifts; and night shift work has been significantly associated with long-term injury among police after adjusting for age and gender (Violanti et al., 2012, 2013). It is thought that this relationship is mediated in part by fatiguerelated impairments due to circadian disruption, which can in turn affect performance and decision making capacity. Therefore, it would be of interest to examine the circumstances in which the injuries occur in more detail in future research.
4.7. Conclusions, implications & further research The primary objective of this paper was to describe occupational injuries for one state-based police agency in Australia. Key findings to inform prevention strategies included that younger males (in the 35–44 year age groups) made the most claims, and the greatest proportion of injuries for medical and time loss claims were caused by body stressing (e.g., lifting, carrying). Further, while there was an overall decrease in compensation claims over time, there was a steady increase in subsequent claims over time. It is possible police were returning to duty before they were fully rehabilitated—a factor that may increase their risk of sustaining additional injuries. It would therefore be worth investigating whether the current rehabilitation, injury management and return to work processes are sufficient to prevent future injury. While this study described a number of factors associated with the incidence of injury among police, it would be beneficial to link more detailed organizational information to injuries; including shift work, patterns of work, practices around injury management, return to work, and injury severity. Linkage to corporate statistics on operational/incident information would also be useful to understand what specific factors relating to the incident are important. Further, it would be valuable to replicate the analyses with data from other Australian jurisdictions to determine whether the results are consistent. This would also act to validate interpretation of these findings. References
4.5. Mental health and stress claims
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