Reasearch paper due 16 Oct 13 @ 1700

Research Paper: Students are required to submit for grading a

Research Paper

in Unit VIII. Specific information and instructions regarding this assignment are provided below. A grading rubric is included with this assignment. Specific information for accessing this rubric is included below.

 Research Paper

Accidents from falling are one of the leading causes of death and injuries in the construction industry. Find and review several articles in professional publications on construction-related fall accidents. Also, find and review several sample fall protection programs for construction companies, as well as visit ww.osha.gov for relevant fall protection requirements. Choose at least one accident you would like to research further and construct a paper that includes the following:

 A brief introduction of the problem with fall-related accidents in the construction industry.

 A review and analysis of the fall accident chosen for further research.

 A detailed discussion on the causative factors associated with the fall accident.

 A sample fall protection program developed to suit only the type of work being performed in the accident that is being reviewed. Be specific and include the factors related to the accident. (Do not include portions of a program not directly related to the work in the researched accident.)

 A summary of the student’s conclusions on fall hazards in the construction industry, and opinions on the necessity for a fall protection plan.

 

Your research paper analysis should be at least five pages of text in 12-point double-spaced Times Roman font. Please include an APA style reference for the in-text citations and references that you use.

 

APA Guidelines

CSU requires that students use the APA style for papers and projects. Therefore, the APA rules for formatting, quoting, paraphrasing, citing, and listing of sources are to be followed. A document titled “APA Guidelines Summary” is available for you to download from the APA Guide Link, found in the Learning Resources area of the myCSU Student Portal. It may also be accessed from the Student Resources link on the Course Menu. This document provides links to several internet sites that provide comprehensive information on APA formatting, including examples and sample papers.

 

UNIT VI Paper Outline

Brandon Mitchell

Student ID#: 226893

1. Residential construction falls

a. Falls from heights among residential construction workers are accounting for a large majority of fatalities associated with residential building as well as those associated with framing workers. These are accidents in many cases that could have been prevented with the proper wear of fall protection.

i. Personal Protective Equipment

1. Fall protection

2. OSHA requirements

ii. Analysis of incident investigation report

iii. Cause analysis of the accident

iv. Sample of fall protection programs

1. OSHA fall protection requirements

v.

Summary

1. Conclusion on residential construction fall hazards

2. Why fall protection plans are necessary

doi: 10.1136/ip.7.suppl_1.i3
2001 7: i3-i10Inj Prev

G S Smith

injury prevention: do they work?
Public health approaches to occupational

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Public health approaches to occupational injury
prevention: do they work?

G S Smith

Occupational injuries represent a considerable
part of the injury burden to society, aVecting
people in the most productive years of their
lives. Globally, almost 1000 workers are killed
by injuries every day, and about six of every
1000 workers will be fatally injured at work
during a 40 year work life span.1 Non-fatal
injuries are an even more pervasive problem. In
the United States alone, recent studies estimate
that almost 16 000 workers daily are hurt on
the job, approximately six million occupational
injury cases annually.2 The field of public
health has made significant contributions to
worker safety in the United States in the past
century. In fact, one review3 concluded that two
of the top 10 leading public health achieve-
ments were the decline of workplace injury
fatalities from 37 to four fatalities per 100 00

0

workers between 1933 and 1997,4 and the
reduction in motor vehicle fatalities (many of
which are work related) from 18 per

100

million vehicle miles traveled in 1925 to 1.7 in
1997.5 While the above achievements demon-
strate considerable progress, the wide varia-
tions in reported occupational injury fatality
rates between industrialized countries and even
within industries in the same country1 2 suggest
that much more can be done.

This special issue of Injury Prevention, and
the recent National Occupational Injury Re-
search Symposium (NOIRS) from which it
derives, represent milestones in the public
health approach to occupational injury re-
search and to occupational injury control. The
articles contained herein and my discussion in
this commentary, demonstrate the new focus
on the comprehensive, multidisciplinary meth-
ods of reducing work injuries that we believe
will define the field of occupational public
health in the new millennium.

Milestones
The occupational injury focus of this special
issue is significant for several reasons. First, it is
gratifying to see occupational injury research
being published in Injury Prevention. This
broadened focus by the journal was initiated
earlier this year with a commentary and several
articles on work related injuries and the conse-
quences of work exposures.6–9 All too often
studies of occupational injuries have been con-
sidered separate from other injury problems,
relegated largely to occupational health and
safety publications. The fragmentation of inju-
ries into artificial categories such as “inten-
tional”, “unintentional”, and “occupational”
has resulted in an ineYcient and sometimes
unequal use of the limited resources available
to combat the causes and the consequences of
this important aspect of health care. This

problem is compounded by the fact that in
many countries there are separate organiza-
tional entities for workplace injury control pro-
grams and those devoted to general community
injury control. For example, while the United
States National Center for Injury Prevention
and Control considers itself to be the federal
focus for injury prevention, their mandate
includes everything except injuries occurring in
the workplace.10 Similarly, an analysis of the
content of the World Health Organization
(WHO) Violence and Injury Control Program
web site found not a single mention of occupa-
tional injuries.11 The subdivision of work and
non-work injuries is becoming increasingly
artificial and ignores the reality that there is
often little diVerence between the mechanisms
of injuries occurring on and oV the job. Both
work and non-work injuries can and should be
subject to the public health approach outlined
in the article by Nancy Stout found in this
issue.12

This supplement also celebrates another
milestone—namely, the second NOIRS confer-
ence that brought together the occupational
health and injury prevention communities.13

Participants at this and the earlier meeting in
199714 included representatives from many dif-
ferent backgrounds, and camaraderie has
rapidly developed across disciplines and even
nations. Many new friendships and collabora-
tions were fostered. An important realization
from these meetings was the breadth of
occupational injury research being conducted,
ranging from laboratory studies of working at
elevation, to an evaluation of school based
education to improve farm safety in teenagers.
Another insight gained from the NOIRS meet-
ings was the great learning opportunities
aVorded not just across disciplines but also
across nationalities. Many occupational injury
problems are similar between countries, yet
diVerences in some injury rates suggest there is
much we can learn from each other. Towards
this end, NOIRS has become an international
conference, drawing participants from at least
14 diVerent countries. We have tried to reflect
the diversity of interests and disciplines in this
issue.

Public health approach to injury
prevention
Beginning in the early 1950s, public health has
emphasized a broader approach to injury con-
trol, moving beyond educational methods to
“accident prevention”.15 The public health
approach views prevention from the standpoint
of population based risk. It identifies and
targets workers in high risk occupations, those
underserved by traditional occupational safety

Injury Prevention 2001;7(Suppl I):i3–10 i3

The Johns Hopkins
Center for Injury
Research and Policy,
Johns Hopkins School
of Hygiene and Public
Health, Baltimore,
Maryland

Correspondence and reprint
requests to: Gordon S Smith,
The Johns Hopkins Center
for Injury Research and
Policy, 624 N Broadway,
Room 545, Baltimore, MD
21205, USA
gsmith@jhsph.edu

www.injuryprevention.com

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programs, and areas where wide gaps exist in
injury rates and hazards in those doing similar
tasks. At the end of the 1990s the National
Occupational Research Agenda (NORA) of-
fered a broad strategy for traumatic occupa-
tional injury research based on the public
health model.16 The subsequent sections of this
commentary discuss how NORA and the arti-
cles in this issue fit into the traditional public
health approaches to prevention, namely:
x Surveillance—problem identification and

prioritization.
x Risk factor identification—analytic injury

research.
x Intervention development and evaluation—

identification/development of prevention/
control strategies.

x Implementation—methods to put into prac-
tice and evaluate prevention and control
programs.

Surveillance
IMPROVING DATA SYSTEMS

Key to the public health approach to injury
prevention is the development of good data
systems needed to identify problem areas,
prioritize the issues, and evaluate the eVective-
ness of prevention strategies. The earliest con-
tinuously reported data for the United States
are from the National Safety Council, who
began regular reporting of estimated numbers
and rates of work related fatalities nationwide
in 1933.17 However, the great variability in
occupational fatality data resulted in little
understanding of the true magnitude of the
nation’s occupational injury burden. For exam-
ple, in 1990 oYcial estimates of work related
fatal injury ranged from 2900 to 10 100.17 18

Data systems improved dramatically in the
early 1990s, starting with the National Trau-
matic Occupational Fatality (NTOF) system
built on uncoded death certificate information
from 1980.19 20 Subsequently, the more com-
prehensive Census of Fatal Occupational Inju-
ries (CFOI) was developed that provided
extensive case level data on all workplace
fatalities beginning with 1992 data.19 The eVect
of moving to individual case based counting
from estimating procedures based on ICD
codes resulted in National Safety Council esti-
mates falling from 9800 fatalities in 1991 to
4968 in 1992 (6026 in 1998), the year they
started using CFOI.17 The improved data from
NTOF and CFOI have lead to many changes
in public attitudes and policy such as the atten-
tion given to workplace violence prevention in
the United States.21 22 Occupational homicides
have declined 34% from 1994 to 1998,23 com-
pared to only a 25% decline in community
homicide rates.24 Similar advances in improv-
ing and using workplace fatality data have been
made in other countries.7 Several papers in this
issue demonstrate the next generation in occu-
pational injury surveillance technology that
should result in even greater accuracy and spe-
cificity of work related morbidity and mor-
tality.25 26

IMPROVING THE USE OF DATA THROUGH FREE

TEXT ANALYSIS

It is important to make full use of all available
data. One area of information mining that is
gaining increasing attention is the use of free
text data.20 26–29 The available text data on death
certificates in the United States, although lim-
ited, can provide invaluable information on
injury circumstances and location by allowing
searches for specific words.20 30 In other coun-
tries, such as New Zealand, free text has been
entered on the vital statistics file for many years
and has proven an invaluable source of data for
injury research.31 The addition of free text data
to any injury database can greatly improve the
value of the original data source as a case find-
ing tool.

Williamson et al takes free text analysis
beyond its use as a case finding tool and
explores how text information can be computer
coded to overcome incompatibility in injury
mechanism coding between countries.26 One of
the major limitations of doing international
comparisons of work related injuries is compa-
rability of data coding and definitions.7 The
free text data available in the records from
Australia, New Zealand and the United States,
however, allowed computer coding of cause of
injury information across national classifi-
cation systems, making comparison of occupa-
tional injury statistics feasible. While William-
son’s paper demonstrates the feasibility of
coding by computer, the diYculty of achieving
exact coding of complex cases using free text
data makes it doubtful that machine coding
could completely replace manual coding.
Despite these caveats, if specificity was set high
such that few cases were incorrectly coded and
the remaining cases were hand coded, we
believe that the savings from machine coding in
terms of cost and manpower would be
substantial and may even result in more
consistent coding.

An important barrier to more widespread
use of free text data is the lack of standardiza-
tion regarding how information is recorded.
Some descriptions may be very informative
while others may be very limited. Interactive
computer prompts with branching questions
provide an opportunity to record more detailed
and systematic information on injury causes,
such as is being used in the new United States
National Health Interview Survey.32 These
prompts also allow a more structured approach
to the collection of free text and the potential to
incorporate software to recognize certain
words that prompt for more detail. The
benefits of this approach will include decreased
abstraction time and improved machine coding
of narrative text. Other new developments in
free text mining include advanced software that
uses multiple word combinations and recog-
nizes the context in which a word is used. Such
software has already been used by national
security agencies and has been adapted for the
analysis of aviation mishaps (Dodd R, personal
communication, 1 June 2001).

i4 Smith

www.injuryprevention.com

IDENTIFICATION OF WORK RELATEDNESS

The complete and accurate estimation of non-
fatal occupational injuries is frequently ham-
pered by the limitations of currently available
surveillance systems, which separate data for
work related injuries from information about
all injuries in the population. Neither system is
complete because the latter seldom includes
indications of work relatedness and the former
often excludes certain sectors of the workforce
and/or suVers from underreporting of occupa-
tional injuries.33 34 For example, the proportion
of injury hospitalizations related to work is
unknown in the United States (and most
countries) because external cause codes do not
separately identify “injuries at work”. Workers’
compensation as the expected source of
payment on hospital discharge data may be
useful to identify some, but not all “at work”
injuries.35 Just as “cause of injury” coding is
now mandated on many statewide hospital
databases, so should “injury at work: yes/no” be
a required field included on all hospital
discharge and other databases containing
injury data.

The identification of non-hospitalized occu-
pational injuries has improved considerably in
recent years, as demonstrated by Jackson’s
paper which discusses eVorts to improve the
detection of occupational injuries presenting to
emergency departments through the National
Electronic Injury Surveillance System
(NEISS).25 Originally developed to track only
injuries related to consumer products, NEISS
was first used to gather information on selected
occupational injuries in 1981, and since 1996
they have collected data on all occupational
injuries. NEISS has recently expanded to
include all injuries (work and non-work) in two
thirds of the sample hospitals, but because of
limited resources specific E codes are not
assigned.36 Most National Center for Health
Statistics surveys also now include details on
injury causes and work relatedness.25 32 37

Emergency department data are important
but may not be representative of all medically
treated injuries. Attendance may vary by injury
severity, insurance status, local referral prac-
tices (especially after hours) and the existence
of other clinics, particularly those in the work-
place.38 NEISS and other record based surveys
also rely on the accurate reporting of work
relatedness in the original medical record. The
addition of specific questions on “injury at
work” in the recent redesign of the National
Health Interview Survey is a major advance in
achieving a more complete population based
estimate of all non-fatal occupational injuries.32

The development of integrated company-wide
surveillance activities such as that imple-
mented by Ford Motor Company,29 by the
Army,39 or through linkage of insurance claims
with outcome data,40 represents the future of
improved surveillance and provides invaluable
information to develop, and evaluate preven-
tion programs. An important aspect of these
systems is the ability to link data from diVerent
sources for more in-depth studies.

USE OF CASE BASED SURVEILLANCE

INVESTIGATIONS FOR PREVENTION

Not all injury problems require detailed popu-
lation based surveillance data or etiological
studies of risk factors to develop prevention
programs. Often a single, well done case inves-
tigation (an important component of tra-
ditional safety investigations) can lead to
important prevention strategies. The Fatality
Assessment and Control Evaluation (FACE)
Program described by Higgins et al is an exam-
ple of a systematic public health approach to
case investigations.41 FACE uses the classic
model of agent, host, and environment to
examine factors that present during the pre-
event, event, and post-event phases of injury
occurrence.42 Preventive action was taken
based on a single case investigation of an elec-
trocution from a faulty water pump in a public
swimming pool. It is gratifying to see that 73%
of respondents who received the initial hazard
alert had their pools inspected, especially since
37% of those reported finding electrical
problems. The more lasting eVects of this work,
however, was its translation into state legisla-
tion mandating regular inspection and certifi-
cation of electrical equipment in public pools.

The identification of a newly emerging
hazard created by the construction of cell
phone towers is another example of the value of
case investigations, and how they can inform
prevention practitioners at other agencies.41

Case reports from FACE are available on the
internet and encompass both topic and state
specific investigations, allowing for early identi-
fication of new occupational injury risks by
making all the isolated reports accessible in a
single location. For example, a review of FACE
investigations from Minnesota covers reports
ranging from attacks by a bull, or being
engulfed by corn in a grain bin, to being struck
by a falling 400lb zoo cage.43 The widespread
dissemination of study findings and prevention
recommendations from FACE has been an
important component of its success.

The report of serious burns from portable
oxygen systems (see in issue) also provides very
compelling evidence for the utility of specific
cause investigations for identifying and rectify-
ing specific hazards, namely the fire risk when
portable oxygen cylinders are tested.44 The
strength of this study is that it also proposed
practical solutions to observed hazards, such as
using brass regulators rather than those made
from the more combustible aluminum. The
study also illustrates the way such investiga-
tions can inform the standards setting process,
in this case the development of a national
standard and testing system for oxygen regula-
tors.

Risk factor identification
A wide variety of factors contribute to
workplace injury risk, including hazardous
environmental conditions, individual worker
characteristics, economic issues, social, and
other workplace organizational factors.16 45 46

Well designed scientific studies are needed to
identify, quantify, and prioritize modifiable risk

Public health approaches to occupational injury prevention i5

www.injuryprevention.com

factors that can be used to develop occupa-
tional injury prevention strategies. The multi-
factorial nature of occupational injuries neces-
sitates research incorporating the skills and
methods from a variety of disciplines. This is
the reason that, perhaps more than any other
field, injury science as a whole is multidiscipli-
nary, embodying diverse fields such as epide-
miology, biomechanics, physics, ergonomics,
mechanical engineering, law, and the political,
behavioral and medical sciences.15 47 The field
of occupational injury science is no diVerent.
The articles in this issue represent some of the
methodological skills needed to find solutions
to the dangers encountered in the workplace.

EPIDEMIOLOGIC STUDY DESIGNS: CASE-
CROSSOVER STUDIES

Many epidemiological study designs have been
used to study occupational injuries including
hybrid study designs, which can include using
alternative control groups such as examining
characteristics of sites with and without
injuries.48–50 The case-crossover paper by So-
rock et al (see this issue) describes one area
where new epidemiological methods are being
developed to study injuries at work.51 This
paper represents the collective wisdom of
participants in a workshop on this topic at
NOIRS. The case-crossover method is a novel
approach to overcoming some of the problems
in conducting case-control studies in the work-
place. This innovative method addresses the
question “what is diVerent about the time
period just before a person had their injury
compared to other times when the person was
not injured on the job?”. Subjects are both
cases and controls: they are controls when they
are not injured; becoming cases at the time the
injury occurs. The approach is attractive for a
number of reasons, particularly as it obviates
the expense and difficulty involved in selecting
and interviewing control subjects. Even more
important, this design eliminates between sub-
jects confounding as a source of bias. Some
aspects of the case-crossover methodology
however need further investigation, especially
the impact of diVerential recall of factors at the
time of the injury compared to other times.
Additionally, risk estimates derived from case-
crossover studies may vary from those derived
from traditional case-control designs, as the
designs often answer slightly diVerent ques-
tions.51

EXPERIMENTAL LABORATORY STUDIES

Experimental laboratory studies often provide
important information to guide the develop-
ment of intervention strategies. The study on
balance control by Simeonov is an example of
issues that are diYcult to study at the worksite
due to ethical or practical concerns but can be
done safely in the laboratory setting, without
loss of generalizability to the actual work-
place.52 Ergonomic and biomechanical studies
utilizing new investigative methods to simulate
the circumstances of injury, such as the studies
presented at the special sessions at NOIRS
related to slips, trips and falls, and on the use of

virtual reality to simulate hazardous environ-
ments,13 can provide valuable insights into
injury etiology and prevention of injuries.
While Simeonov et al’s study does not directly
prove that increasing the presence of solid
visual reference points for example will reduce
the risk of falls, this research and others like it
can provide the evidence needed to implement
eVective prevention programs, especially since
randomized controlled trials of injury preven-
tion interventions (often considered the gold
standard),49 are diYcult if not impossible to
conduct under such situations.

Intervention development and evaluation
Strategies to prevent workplace injuries vary
widely and include engineering controls, pro-
tective equipment, education/training, and
regulatory and management practices (includ-
ing those that encourage safe behavior and
practices). We have come a long way from rely-
ing on safety posters and brochures to educate
workers, as illustrated by the spectrum of
interventions discussed in this issue. However,
as noted in the special feature by Barry Pless,53

the relative paucity of studies evaluating inter-
ventions, both in the literature and at NOIRS,
is a reflection in part of the relative “newness”
of the field compared to many other areas. The
design and implementation of interventions
should be based upon a solid understanding of
eVective prevention methods. However, in
many areas this is not the case. To address this
issue, good etiological research, both epide-
miological and experimental, is needed to
identify and addresses modifiable risk factors.
Without good science to back up interventions,
prevention eVorts may fail or even do harm.
Many workplace interventions are being pro-
moted (including training programs)54 that
have not been scientifically evaluated, or, as in
the recent case of back belts, are ineVective.55

DESIGN OF ENGINEERING SOLUTIONS

Redesign of the job or engineering solutions to
make it safer are still two of the most eVective
prevention strategies available. The paper by
Powers et al on the performance of the
automated rollover protective structure (Auto-
ROPS) is an example of an eVective engineer-
ing solution to reduce tractor injuries, and is a
fitting tribute to the memory of the late Dr Karl
Snyder who championed this work at NI-
OSH.56 One of the major diYculties in
implementing ROPS has been the use of
permanent structures in low clearance areas
such as barns and fruit orchards. The practical
solution outlined in this paper goes a long way
to overcome these barriers.

PERSONAL PROTECTIVE EQUIPMENT

Many hazards in the workplace are diYcult to
completely eliminate. However, much can be
done to reduce risk such as the use of
protective clothing or by improving chances of
survival once injured. The study by Prezant et
al is an excellent example of how improved
protective clothing can provide a major reduc-
tion in burn injury risk to firefighters.57 Burns

i6 Smith

www.injuryprevention.com

to the head from serious fires were reduced by
46%, and burns to the upper extremities by
86%. The second part of the study is also
interesting in that it demonstrates that a more
comfortable uniform under the improved outer
layer does not reduce its protection eVective-
ness.

EDUCATIONAL INTERVENTIONS

Farming is a particularly hazardous occupation
and represents a group of workers diYcult to
reach by traditional safety programs or legisla-
tion. The study by Reed et al is a good example
of an educationally based intervention to
reduce injuries to children and teens on
farms.58 The study is well grounded in modern
behavioral change theory, and while not exam-
ining a direct eVect on reducing injuries;
significant improvements were made in safety
attitudes and readiness to change. The real test
in educational evaluations is to demonstrate
the relationship of attitude change to reduc-
tions in injury rates. Such studies are however
diYcult to conduct and often very expensive.59

Long term follow up of farming injury
incidence rates within this population are war-
ranted.

Other issues in developing workplace
injury prevention interventions
While the papers in this issue treat a variety of
important topics in the area of occupational
injury prevention, several important issues are
not represented. It is hoped that future volumes
of this journal will include reports on other
approaches such as community based interven-
tions, international comparisons that docu-
ment diVerences in prevention strategies, and
injury prevention methods directed at all
phases of injury occurrence or mitigation.47

COMMUNITY INJURY PREVENTION IN THE

WORKPLACE

Traditional occupational injury prevention has
focused on individual workplaces that employ
many workers, and tended to ignore small
workplaces, despite the fact they often have
some of the highest injury rates.60 In many
environments, both in market economies and
in developing countries, there is also little
separation of activities between home and
work.47 Many of these non-traditional work-
places are excluded from health and safety
regulations. A potential solution to this prob-
lem is to focus on community-wide eVorts at
prevention.61

There is much that occupational injury
practitioners can learn from the rest of the
injury field with regard to serving community
groups, such as in the expanded community
based eVorts to reduce injuries to farm
children.62 Pless’s call to establish contacts
between researchers and consumers may help
ensure that research will be of use to those who
it was designed to help.53 Some non-
occupational health funding agencies now
included consumers (such as breast cancer
survivors) as peer reviewers for their grants
programs.63 64

Pless also noted that there are some
important diVerences between workplace and
other injuries, especially with regard to the
implementation of prevention strategies.53

These diVerences may actually present some
unique opportunities to the non-occupational
injury prevention community to develop,
implement, and evaluate prevention eVorts.
Many injuries have similar causes no matter
where they occur. The workplace can be a
valuable laboratory to implement and evaluate
community prevention eVorts directed at both
on-the-job and oV-the-job injuries, as demon-
strated by the many workplace programs
designed to increase seat belt use.65 66 Often
there are regulations or laws in the workplace
that may make it easier to enact or enforce rules
than in the outside community. The worksite
also provides a captive population to deliver
prevention programs, including those directed
at lifestyle choices. Finally, some companies,
especially those that self insure their employ-
ees, have good data systems for capturing
information not just on work related injuries,
but also about all worker health problems.29 As
the trend toward company self insurance
continues to grow, the opportunities to moni-
tor and improve total worker health within the
organizational setting will also grow. These can
facilitate intervention evaluation and provide
opportunities to evaluate the costs and benefits
of the intervention.

INTERNATIONAL COMPARATIVE STUDIES

The wide variation in injury rates between
countries1 7 47 suggests that there may actually
be natural experiments of intervention imple-
mentation already in place, if we can recognize
them. Higher fatality rates have been identified
in fishermen in New Zealand compared to
Australia and the United States. Similarly,
electrocution fatality rates were higher in Aus-
tralia compared to New Zealand, a country
with the same voltage (240 volts).7 Whether
this is due to diVerent exposures or safety prac-
tices between countries has yet to be deter-
mined, but more in-depth analyses of causes
such as begun by Williamson et al 26 or of work-
place policies (such as use of ground fault cir-
cuit interrupters)67 may reveal diVerences that
could lead to important reductions in fatalities.
The recent addition of occupational injuries to
the studies included under the International
Collaborative EVort of Injury Statistics is an
important step in this direction.68

DECREASING INJURY SEVERITY AND POST-EVENT
INTERVENTIONS

The early pioneers in injury control realized
the need for a broader approach to injury pre-
vention at a time “when educational ap-
proaches to ‘accident prevention’ were the
most popular”.15 Many workplace programs
still continue to emphasize only the pre-event
phase. Some of the more eVective general
injury prevention strategies have been directed
at reducing both the severity and likelihood of
an injury during an event, or improving recov-
ery from an injury. The eVorts to increase

Public health approaches to occupational injury prevention i7

www.injuryprevention.com

automobile safety through better vehicle crash-
worthiness and highway barriers are examples
of eVective interventions directed at the event
phase.47 Similarly, the dramatic reduction in
fishing fatalities seen in a study in Alaska were
primarily due to increasing survival in the
post-event phase and had little eVect on reduc-
ing boating mishaps.69 70 Rather than thinking
of minor injuries or near misses as indicators of
the potential for more serious injuries, it may
be more productive—and accurate—to view
such incidents as indications of what was done
right rather than as failures in prevention.
Rehabilitation programs that speed recovery
and return to work are also an important part
of any comprehensive injury prevention pro-
gram,49 but are beyond the scope of this paper.
In developing new intervention strategies, it is
essential to consider the whole spectrum of
approaches to reduce the burden of injuries
and not just consider strategies directed at the
pre-event phase.

Implementation and dissemination of
existing knowledge
While more needs to be done to develop and
evaluate new intervention strategies, there is
also much we already know that works. An
important area of investigation is how to elimi-
nate those injuries that could be prevented if we
applied what we already know. While eVective
communication of knowledge and transfer of
technology to those who can use it are
important, other barriers still exist.

MANAGEMENT AND ORGANIZATIONAL ISSUES

The paper by Becker et al provides one example
of how to overcome institutional barriers to
implementation and get proven interventions
out to diverse and diYcult to reach worksites,
such as construction.71 Management attitudes
to safety and organizational factors are impor-
tant determinants of injury risk,46 and Becker et
al’s study provides an organizational frame-
work to facilitate management commitment to
fall safety programs. A key program ingredient
was accountability and labor management
involvement. While the study found that safety
practices improved, there is also a need to
demonstrate if these result in actual injury
reductions. Control contractors without the
intervention also improved in their safety prac-
tices, which illustrates the importance of
including control populations when evaluating
interventions.59 The “Maine 200” initiative,
conducted as part of eVorts to “reinvent worker
safety and health” at the Occupational Safety
and Health Administration, is an example of
applying targeted management approaches
towards prevention activities by government.72

COST

Another implementation barrier is cost. Many
of the intervention strategies discussed in this
volume, and in a recent review of eVective
workplace injury interventions73 are expensive.
However, the direct costs are often less or no
greater than those used to fix the problem once
it has occurred, and the indirect costs in the

prevention of worker pain and suVering, lost
income and lost opportunities probably render
may of these technologies even more cost
eVective. For example, the major barrier to
ROPS use has been the high cost of retro fitting
existing tractors, estimated to be at $937 per
tractor in 1993 or $825 000 per life saved.56

While this may seem high, it is about the
median cost of lifesaving interventions cur-
rently being implemented in society (assuming
that about 20 life years are saved per case by
ROPS).74 Cost eVectiveness analyses have
found that for the range of interventions stud-
ied, injury prevention interventions have very
favorable cost: benefit ratios. In addition, when
the cost per life year saved is compared, those
directed at issues such as cancer reduction are
usually much more expensive than those for
injuries.74 75 There is a need to include more
cost eVectiveness studies when conducting
injury intervention studies.

IMPLEMENTING THE PUBLIC HEALTH MODEL

A major challenge to public health is how to
implement the public health approach to occu-
pational injury prevention in the field. The
suggestion by Pless that health departments get
more involved in occupational injury preven-
tion is an important part of implementing this
approach.53 Health departments are in a
unique position to reach the groups not well
served by traditional occupational health and
safety agencies, and to coordinate eVorts across
diVerent jurisdictions. One successful imple-
mentation of the public health model at the
state level is Alaska’s occupational injury
prevention program. Surveillance data identi-
fied Alaska as the state with the highest
occupational fatality rate in the United States,
almost five times the United States average and
about 10 times that of Norway with a similar
industrial make-up.69 A multiagency collabora-
tive prevention eVort was then developed based
on the public health approach of (A) establish-
ing surveillance; (B) building multiagency col-
laborations; (C) prioritizing prevention eVorts
based on surveillance data; and (D) planning
appropriate prevention strategies tailored to
local conditions. From 1991 to 1998, overall
occupational injury fatalities decreased 46%
(49% from 1990–99, see updated data in fig 1)
with the largest improvements occurring in
fishing and logging (particularly helicopter log-
ging), two areas identified as priority areas for
intervention. An important part of this process
was the application of prevention strategies at
multiple phases of the Haddon matrix. For
example, in logging the biggest improvements
came from pre-event strategies, while in fishing
the survival rate of each incident improved
dramatically, due in part to requiring new
safety equipment such as immersion suits, life
rafts, and radio beacons to increase the chances
of finding vessels.

While not all localities have the benefit of
collaboration with a local oYce of NIOSH, the
Alaska example provides an important lesion
for what can be achieved at a state level. How-
ever, the capacity of state (and local) health

i8 Smith

www.injuryprevention.com

departments to address occupational health
problems (including injuries) varies widely and
has been identified as an important area for
development.76 New Jersey is one state with a
well-developed program.77 Given the often well
established state based activities in non-
occupational injury prevention,78 it would
make sense to coordinate their activities with
any expansion of occupational injury preven-
tion eVorts.

Conclusions
The articles in this issue, and other reviews of
occupational injury interventions, demonstrate
that we have made considerable advances in
our understanding of injury causes and the
means of reducing injuries. To achieve signifi-
cant injury reductions will require a much
more focused eVort of many diVerent groups,
and a societal commitment that any occupa-
tional injury is unacceptable. It will also require
the development of a skilled scientific work-
force to conduct the necessary injury research
and train investigators and practitioners alike.
Unlike other areas of science, funding for
occupational injury research training has not
kept up with needs, and a recent report by the
National Academy of Sciences Institute of
Medicine identified a critical shortage of
doctoral level graduates in occupational injury
prevention.79 Many of the new advances in
injury prevention will also come about through
the integration of laboratory/experimental
studies with other public health disciplines.
Often experimental articles, such as the studies
in this issue, tend to be rather technical in
nature and less comprehensive in relating their
findings to prior epidemiologic studies. Simi-
larly, the more traditional public health studies
in this journal make little reference to experi-
mental laboratory studies or use experimental
data to guide their research. There needs to be
more dialogue across disciplines in order to
overcome some of the institutional barriers to
increasing multidisciplinary work, and access-
ing each other’s literature.

80

While much is already known regarding
eVective prevention strategies, there is often a

large gap between what we know works and
what is implemented. More research is needed
to define the barriers to intervention imple-
mentation and technology transfer from the
laboratory to the workplace. Hopefully, this
supplement will stimulate further interest in
occupational injuries within the broader injury
prevention community.

Support for this work was provided by a variety of sources and
reflects my own eVorts to examine both work and non-work
injuries. The sources include grants from: the National Institute
of Occupational Safety and Health (1 R01 OH03703–01A1),
the National Institute of Alcohol Abuse and Alcoholism
(R29AA07700), the Centers for Disease Control and Preven-
tion to the Johns Hopkins Center for Injury Research and Policy
(R49/CC R 302486), and the Congressionally Directed
Medical Research Programs (DAMD17–95–1–5066). I also
wish to acknowledge the contribution of George Conway and
Jennifer Lincoln from NIOSH’s Alaska oYce who kindly
provided figure 1, and the International Collaborative EVort
(ICE) on Injury Statistics for its contributions to developing
some of the ideas behind this paper. The ICE is sponsored by
the National Center for Health Statistics, US Centers for
Disease Control and Prevention with funding from the National
Institute of Child Health and Development, National Institutes
of Health. I would also like to thank the following for helpful
comments and suggestions: Janet Johnston, Andrew Lincoln,
Nancy Stout, Ted Courtney, Gary Sorock, and Katy Benjamin.

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100

90

70

80

60

40

50

30

20

0

10

Year

Occupation
Fishermen

N
o

o
f

fa
ta

li
ti

e
s

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Civilian pilots Military

Loggers Other maritime All other

Figure 1 Decline in
occupational injury
fatalities in Alaska by
occupational group and
year, 1990–1999 (n=648).
Source: Alaska
Occupational Injury
Surveillance System,
updated data from Conway
et al, 1999.69 Trend line
show total fatality decline.

Public health approaches to occupational injury prevention i9

www.injuryprevention.com

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i10 Smith

www.injuryprevention.com

Prevention

36 ProfessionalSafety JULY 2013 www.asse.org

Fall Prevention
on Residential Construction Sites

By Vicki Kaskutas, Bradley Evanoff and Harry Miller

F
alls from height remain the most common
cause of workplace fatalities among residen-
tial construction workers, accounting for 64%

of the fatalities in residential building and 100% of
the fatalities among framing contractors in 2010
(BLS, 2011). Despite a recent decrease in fall inci-
dence rates (BLS, 2011), 164 of the 1,025 carpenter
apprentices surveyed (16%) reported a fall from
height in the past year, and 512 of these carpen-
ters (50%) knew someone who had recently fallen
(Kaskutas, Dale, Lipscomb, et al., 2010).

Work site fall safety audits at 197 residential sites
demonstrated an average compliance of 59% with
fall protection and/or prevention measures, rang-
ing from 28% for roof truss installation to 80% for

roof sheathing (Kaskutas, Dale, No-
lan, et al., 2009). As a result, residential
construction workers frequently work
at heights without fall protection.
For example, workers installing roof
trusses may stand on the top of walls
(Photo 1) or in the roof truss without
fall arrest or protection (Photo 2).

OSHA (2010) now requires use of
conventional fall protection at resi-
dential construction sites when work-
ers are more than 6 ft from a lower
level; this includes safety nets, guard-
rails and/or personal fall arrest sys-
tems (OSHA, 2006). OSHA’s (2011)
Guidance Document for Residential
Construction outlines technologies to

provide conventional fall protection during home
construction. It is critical to identify and evaluate
these technologies and to diffuse these technolo-

gies to construction professionals. This pilot study
identified fall protection technologies, measured a
small sample of carpentry professionals’ percep-
tions of these technologies, and pilot tested two
devices with several residential contractors in St.
Louis, MO.

Study Methods
Device Rating

Commercially available fall protection devices
appropriate for residential construction were iden-
tified by an Internet search and discussion with
carpentry experts, safety professionals and equip-
ment representatives. After reviewing manufactur-
ers’ instructions for technologies identified, a brief
presentation was developed to describe and dem-
onstrate the technologies, including purpose, cost
and potential uses.

A written survey was designed to measure work-
ers’ perception of ease of use, cost, durability, effect
on productivity and overall effectiveness on a 10-
cm visual analogue scale. A sample of 36 carpentry
professionals in the St. Louis, MO, metropolitan
area participated in this study. Participants were
shown the presentation describing each fall pro-
tection technology in a group or individual setting.
Discussion about each device was facilitated and
participants’ questions were answered to the best
of the researchers’ abilities. Each participant com-
pleted the written survey and chose the best device
in three categories: 1) protection of floor openings;
2) provision of temporary walking surfaces; and
3) personal fall arrest anchorage.

A group of apprenticeship instructors (n = 9) at
the St. Louis Carpenters’ Joint Apprenticeship Pro-
gram rated all devices identified to streamline rating
sessions with subsequent groups, including appren-
tice carpenters, journeymen carpenters, safety pro-
fessionals and contractor owners/operators.

One instructor recruited residential apprentice
carpenters attending regularly scheduled school-
based training to participate in a lunchtime focus
group with the researchers. Sixteen apprentices
representing all 4 years of the apprenticeship par-
ticipated in two focus groups. Two journeymen car-
penters attending training at the school were asked
to participate in a separate group. Three safety pro-
fessionals employed by a safety consulting firm that
provides safety oversight to contractor participants
in OSHA’s St. Louis area residential on-site safety

IN BRIEF
•Many types of fall protec-
tion technologies are avail-
able for residential building.
•Many workers believe
these technologies will
prevent falls, but decrease
productivity.
•Two fall protection devices
were pilot tested with resi-
dential builders

in this study.

•Conventional fall protection
devices are slow to diffuse
into residential construction.

Vicki Kaskutas, M.H.S., OTD, OT/L, is an assistant professor of occupational
therapy and medicine at Washington University School of Medicine. She holds a
B.S. in Occupational Therapy from University of Illinois, an M.H.S. in Health Care
Services from Washington University and a doctorate in occupational therapy
from Washington University School of Medicine.

Bradley Evanoff, M.D., M.P.H., is a professor of medicine at Washington
University School of Medicine. He holds a B.A. in Biology/History from Cornell
University, an M.P.H. from University of Washington and an M.D. from Washing-
ton University School of Medicine.

Harry Miller, M.S., CSP, was the safety director for the Carpenters’ District
Council of Greater St. Louis and Vicinity. He holds a B.A. in Human Resource
Management and an M.S. in Business from Lindenwood University. He is a pro-
fessional member of ASSE’s St. Louis Chapter.

Construction Safety
Peer-Reviewed

www.asse.org JULY 2013 ProfessionalSafety 37

initiative participated in a focus group at their of-
fice. Residential contractors who employ carpen-
ter members of the Carpenters’ District Council of
Greater St. Louis and Vicinity were also recruited to
participate in individual presentations (n = 6).

Comments from the apprentice focus group
were recorded and transcribed; detailed notes from
the other sessions were written and transcribed.
Mean ratings were computed for use, durability,
cost, and effect on productivity and safety on a
100-point scale for each category of carpentry pro-
fessionals. Analysis of variance compared ratings
between apprentices, journeymen, safety directors
and contractors to explore differences in percep-
tions. The devices rated as the best for each of the
three categories were tallied.

Pilot Testing
Two of the top-rated devices were purchased for

pilot testing with residential carpentry crews. Car-
penter trainers with safety expertise and research-
ers developed training methods and materials for
these devices. Residential contractors who employ
union carpenters were recruited for pilot testing
(n = 4). Participating work crews were trained to
install and use the device by a carpenter trainer;
crews were allowed to use the device while build-
ing one to three new homes.

A carpenter research assistant visited the work
site midbuild to assess device installation and use;
this was achieved using a brief checklist developed
for this project. After the build, this assistant inter-
viewed each crew member to measure perceptions
of the fall protection technology on a 10-point scale
(0 = strongly disagree, 10 = strongly agree) for
1) ease of installation, use and removal; 2) time to
install, use and remove the device; 3) device dura-
bility; 4) device maintenance; 5) improved safety;
and 6) ability to prevent worker falls.

Descriptive statistics and central tendencies for
the work site checklist and worker ratings were cal-
culated. At several work sites, the St. Louis Audit
of Fall Risks (SAFR) (Kaskutas, Dale, Lipscomb, et
al., 2008) was also administered. This 52-item au-
dit measures fall prevention safety practices during
the home framing process (see PS Extra at www
.asse.org/psextras). The audit’s nine domains are
general safety/housekeeping; floor joist/subfloor
installation; walking surfaces/edges; wall openings;
truss setting; roof sheathing; ladders; scaffolds; and
personal fall arrest equipment. The SAFR has ex-
cellent inter-rater reliability (κ = 0.93) and is con-
tent valid (Kaskutas, et al., 2008). The Electronic
Library of Construction Occupational Safety and
Health has posted the audit (http://goo.gl/IApA3)
and SAFR administrator’s manual/protocol (http://
goo.gl/kJjUu).

Results
Device Ratings

The Internet search and discussions identified
43 different technologies, all of which were pre-
sented to the apprenticeship trainers’ group. The
13 devices that received the highest ratings by the

trainers (Table 1,
p. 38) were pre-
sented to the 16
apprentice carpen-
ters, 2 journeymen
carpenters, 3 safety
consultants and 6
contractor partici-
pants. The mean
overall ratings for
these 13 devices
among the 27 individuals were highest for ability
to prevent falls, followed by durability and ease of
use, and lowest for the effect on productivity and
cost. Device ratings varied between the different
categories of carpentry professionals, although the
differences were statistically significant for only the
ladder jack railing (Table 1, p. 38).

The apprentice carpenters had the highest mean
ratings for the devices overall, while the journey-
men had the lowest. The devices identified as hav-
ing the most potential for residential construction
were not always the devices that received the high-
est mean ratings as the research team performed
both quantitative ratings and qualitative rankings.

The top device identified for protecting floor
openings at residential sites was a plastic hous-
ing that supports guardrails at floor openings and
stairways (Safety Boot manufactured by Safety
Maker Inc.) (Photo 3 p. 39). This device keeps the
guardrail in place until the permanent railing is in-
stalled, thus protecting framers, drywall installers/
finishers and painters.

The device selected as the best for providing tem-
porary walking surfaces was the pump jack scaf-
fold, followed closely by a hanging scaffold system
(Photos 4 and 5, p. 39). Since pump jack scaffolds
were already widely used for siding installation by
the sample population, the hanging scaffold sys-
tem (WallWalker manufactured by WallWalker
LLC) was chosen for the pilot study. This system
provides an adjustable-height elevated work sur-
face that hangs over the top of an interior or exte-
rior wall of the home. It can be used to install floor
joists, roof trusses and windows, and can serve as a
guardrail during roof sheathing and shingling.

The top-rated anchor for personal fall arrest an-
chorage was a reusable webbing strap (Photo 6,
p. 40), which is secured around truss members

(From top):
Photos 1 and
2 show unpro-
tected workers
during roof truss
installation.

38 ProfessionalSafety JULY 2013 www.asse.org

or floor joists, or on top of a wall during installa-
tion of trusses and sheathing, or other operations.
Since slide guards were commonly used during roof
sheathing and shingling as they were allowed by
OSHA’s residential guidelines at the time of this re-
search, anchors that could be used for other phases
of construction besides roofing were a priority.

The carpentry professionals identified many bar-
riers to using the various technologies, most of-
ten concerning use of personal fall arrest systems.
These included safety of the worker installing and
removing the anchor; concerns about whether a
coworker had installed the anchor securely; abil-
ity of the device to stop a fall before the worker hit
the lower surface due to lanyard length; contractor
liability; roof aesthetics if anchor is permanently in-
stalled; and lack of a secure construction member
to which the anchor is fastened (especially during
roof truss installation). The safety testing data for
the anchors included in this study demonstrated
that the anchors could withstand the forces ap-
plied during a fall and stay affixed to the structure
if installed according to manufacturer’s directions;
however, the structure to which the anchor is af-
fixed must also withstand these forces.

Laboratory testing has shown that unless appro-
priately braced, roof trusses often collapse when
exposed to forces similar to those generated dur-
ing a worker fall (Fiorini & Garritano, 2008; SBCA
& Truss Plate Institute, 2011). Since contractors in
the St. Louis region do not use the amount of tem-
porary truss restraint/bracing recommended by the
truss manufacturers (SBCA), personal fall arrest
anchorage was not tested in this study.

Hanging Scaffold System Pilot Testing Results
Two small contractors and one large contractor

pilot tested the hanging scaffold system at 15 con-
struction sites. The carpenter trainer visited each
work crew and instructed them in installation, use
and maintenance. Most crews used the device to
construct one home, two crews used it for two
homes and one crew used it to build three homes.

During follow-up work site visits, the
carpenter research assistant adminis-
tered the brief hanging scaffold checklist
and brief worker interview developed for
this project. Five of the eight items on the
checklist were performed correctly 100%
of the time; the overall compliance with
all items was 92%. The SAFR was also
administered at five of the 15 sites; com-
pliance with the truss setting domain of
the SAFR was 100%. No workers were
observed standing on top of walls (which
are only 3.5-in. wide) during any phase
of truss installation, whereas this was ob-
served at 85% of work sites not using the
hanging scaffold during audits performed
in a prior study of this same working pop-
ulation (Kaskutas, et al., 2009).

The 41 carpenters interviewed after pi-
lot testing the system had an average of
12 years in the construction trade (range 3

to 30 years). The mean level of agreement rating for
the item “the device is durable” was 8.5 (range of
5 to 10); “the device improves safety” was 7.6 (range
2 to 10); and “using the device prevents worker
falls” was 7.3 (range of 3 to 10). Ratings were much
lower for “time to install, use and remove device is
reasonable” (5.7) and “the device is easy to install,
use and remove” (6.6), with a wide range of scores
for these two items noted (0 to 10). Ninety percent
(n = 36) of carpenters who used the hanging scaf-
fold perceived that it decreased productivity, four
noted it increased productivity and one said pro-
ductivity was not affected. One journeyman who
described increased productivity had used the
system on three home builds. When asked if they
would like to use the hanging scaffold on future
builds, 22 answered “yes” (54%), 18 answered
“no” (44%) and one said “maybe.”

When asked about the benefits of using the
hanging scaffold, worker responses fell primar-
ily into these four categories: 1) improve safety;
2) prevent falls; 3) provide a stable work surface;
and 4) decrease time spent on walls and ladders.
Crew members identified many barriers to device
use, including excessive setup and use time; know-
ing the height to set the scaffold so that it is in the
correct position for a guardrail that accommodates
different height workers; pinch points caused by
the device; moving around the device without hit-
ting one’s head; obstructing the crane operator’s
view of hand signals when a worker is on scaffold
(and takes too long to exit the scaffold to get in po-
sition for the operator to see); and difficulty setting
the 16-ft-long walk boards used in this testing.

Guardrail Housing Pilot Testing Results
Only one small contractor field tested the guard-

rail housing as most contractors contacted had al-
ready used this device. The guardrail housing was
observed in use at three sites and five carpenters
were interviewed; mean age was 33 years and av-
erage time in the trade was 15 years.

When researchers visited the work sites to admin-

Table 1

Device Ratings by
Carpentry Professionals

 

Safety
 
professional
 
(n
 =
 3)
 

Contractors
 
(n
 =
 6)
 

Journeymen
 
(n
 =
 2)
 

Apprentices
 
(n
 =
 16)
 

Reusable
 strap
  89.6
  75.5
  66.6
  82.6
 
Disposable
 strap
  65.4
  65.3
  50.3
  61.6
 
Truss
 peak
 anchor
  68.8
  74.9
  43.8
  60.7
 
Truss
 anchor
  58.3
  70.6
  56.9
  58.8
 
Double
 roof
 anchor
  91.0
  82.3
  67.8
  76.0
 
Single
 roof
 anchor
  70.5
  74.5
  44.4
  76.5
 
Hanging
 scaffold
  47.5
  55.6
  66.9
  74.4
 
Pump
 jack
 scaffold
  85.4
  72.2
  82.8
  76.1
 
Power
 scaffold
  55.8
  52.6
  67.8
  71.3
 
Roof
 guardrail
  50.0
  43.2
  -­‐-­‐
  48.6
 
Ladder
 jack
 railing
  47.5
  66.0
  36.9
  91.1
 
Guardrail
 housing
  92.1
  71.8
  83.4
  71.8
 
Hole
 cover
  81.0
  74.7
  75.9
  85.5
 
Mean
 rating
  69.5
  67.6
  62.0
  71.9
 

 

www.asse.org JULY 2013 ProfessionalSafety 39

ister the device checklist, the devices were always in-
stalled and used correctly. All carpenters interviewed
stated that the housing did not affect productivity
and that they would prefer to use it on future builds.
Ratings for ease of use, durability, maintenance and
improving safety were similar to the hanging scaf-
fold system; however, time to use (7.6) and ability to
prevent falls (9.2) were much higher.

Discussion
This study identified commercially available fall

protection technologies to protect residential con-
struction workers at floor openings, to provide
temporary walking surfaces and to anchor person-
al fall arrest systems. The research team identified
many commercially available technologies, and the
preferred devices were a hanging scaffold system,
a guardrail housing device, and a webbing chok-
er strap with a ring on one end to strap around a
building component.

Among participants, a trend was noted that ex-
perienced workers tended to rate fall protection
technologies less favorably than inexperienced
workers; this may be due to greater expertise or
hesitancy to accept new work practices. Residential
builders and carpentry professionals were willing
to pilot test devices that they believed would pro-
tect them from falls; however, one primary concern
was the effect of device use on productivity.

After brief field training, construction crews
quickly learned to install and use the hanging scaf-
folding and guardrail housing according to manu-
facturers’ instructions. Use of the scaffold system
during truss setting improved compliance with the
truss setting domain of SAFR to 100%, in compari-
son to only 28% compliance in previous research
at sites that did not use the system. Crew mem-
bers perceived that these devices prevented falls,
but they were hesitant to adopt the technology
on a long-term basis. Repetitive use of the device
may be the key to long-term adoption, as this al-
lows workers the opportunity to determine how to
use the device in their work contexts and to change
their beliefs and habits.

Since OSHA’s interim residential guidelines
were rescinded, contractors in most states must en-
sure that conventional fall protection is used when
employees work on surfaces 6 ft or more above
the lower level. OSHA has indicated that Subpart
M is being enforced at residential sites; however,
contractors must identify fall protection devices
and methods to protect the workforce while con-
structing residential structures. This can be difficult
for small- or medium-sized contractors that likely
do not have the time, knowledge and financial re-
sources to investigate all available options.

The research team continues to loan the pilot-
tested fall protection equipment and other fall pro-
tection devices to contractors to allow them to test
out the technology and attempt to integrate it into
their work processes before they purchase it. Since
equipment may be needed for only a short dura-
tion during the construction process, increased
availability for equipment rental may be an effec-

tive way to improve the dissemination of new fall
protection technologies. Rental companies may
also be able to help contractors identify and locate
the best equipment for their situation.

This pilot study suggests that more research is
needed to understand the role of personal fall ar-
rest systems during roof truss installation. While
personal fall arrest harnesses are widely available,
a safe and feasible point to anchor the harness may
not be available during some stages of home con-
struction. Also, temporary bracing methods that
render the truss assembly capable of withstanding
the tensile and compressive forces applied during
a fall must be explored to identify viable solutions.

For example, Fiorini and Garritano (2008) found
that stabilizing truss toes with two common nails

From top:
Photo 3 shows
the guardrail
device in place
at a construc-
tion site, while
Photos 4 and
5 show the
hanging scaf-
folding system
in use (hanging
exterior and
interior to the
structure).

40 ProfessionalSafety JULY 2013 www.asse.org

adjacent to each
side of the toe on
the wall, install-
ing metal strapping
over the braces se-
cured into the truss
chords, and using
an anchor choker at
the truss joints rath-
er than midchord
positions achieved
the amount of sta-
bilization needed.
Temporary meth-
ods of bracing have
been documented
by SBCA and Truss

Plate Industry (2011); however, the time to install
the bracing is extensive.

Thus, designers and manufactures of roof
trusses and truss anchorage systems need to col-
laborate with construction professionals, safety
professionals and safety researchers to develop,
design and test roof truss and anchorage systems
and to describe specific installation and use direc-
tions so that trusses can be safely used for personal
fall arrest anchorage. Until this occurs, residential
contractors face a difficult dilemma. There is insuf-
ficient scientific evidence to prove when and how
personal fall arrest anchorage can be used during
roof truss installation, but contractors must comply
with OSHA standards that require conventional
fall protection. This is an arduous position for con-
tractors struggling to recover from a huge decline
in residential construction.

This study is a first step toward increasing the
use of fall prevention technologies during resi-
dential framing. This pilot study provides feed-
back from a small group of carpentry professionals
in different roles; however, the sample size was
small. In addition, this research occurred in a re-
gion of the country where residential construction
is unionized, which is not the norm across the U.S.
Also, this study occurred before OSHA rescinded
the residential guidelines and home construction
declined due to the economic recession; therefore,
it may not represent workers’ current perceptions
about fall protection technologies.

Furthermore, since the devices were loaned to
contractors and construction times were not for-
mally measured, the actual financial impact of fall
protection device use remains unknown. Future
research should allow for a longer period of device
use to allow workers to become competent and
competitive, possibly through a short-term loan
program. As contractors adopt these technologies,
training and monitoring systems must be in place
to ensure that devices are installed and used cor-
rectly over time.

Conclusion
Alternatives to unsafe work practices at height

must be identified and tested to ensure the safety
of residential construction workers. Fall protection

device manufacturers and the building components
industry should partner to test anchorage for per-
sonal fall arrest; this will help generate definitive
evidence about the safety of personal fall arrest sys-
tems in various applications. Researchers and safety
professionals must diffuse results from research and
share best practices with contractors, unions and the
construction workforce. It is especially challenging
to reach the small, nonunionized contractor who
performs home building or remodeling and has no
formal means to receive such information.

The national Campaign to Prevent Falls in Con-
struction aims to provide fall protection resources
to a wide range of construction workers through a
unified approach among several government and
private agencies (http://stopconstructionfalls
.com). A multitude of methods must be used in
order to ensure that the residential construction
industry embraces fall protection and that workers
are protected while working at heights. PS

References

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(CFOI): Current and revised data. Retrieved from http://
bls.gov/iif/oshcfoi1.htm

Fiorini, D. & Garritano, E. (2008). Viability of tying
off to residential roof trusses for fall protection during
truss erection. Presentation at National Occupational
Injury Research Symposium, Pittsburgh, PA.

Kaskutas, V., Dale, A., Lipscomb, H., et al. (2008).
Development of the St. Louis Audit of Fall Risks at
residential construction sites. International Journal of Oc-
cupational and Environmental Health, 14, 243-249.

Kaskutas, V., Dale, A., Lipscomb, H., et al. (2010).
Fall prevention in apprentice carpenters. Scandinavian
Journal of Work, Environment and Health, 36(3), 258-265.

Kaskutas, V., Dale, A., Nolan, J., et al. (2009). Fall
hazard control observed on residential construction
sites. American Journal of Industrial Medicine, 52(6), 491-
499.

OSHA. (2006). OSHA construction standards. 29
CFR Part 1926.

OSHA. (2010, Dec. 22). Compliance directive for fall
protection in residential construction. Retrieved from
www.osha.gov/pls/oshaweb/owadisp.show
_document?p_table=FEDERAL_REGISTER
&p_id=21875

OSHA. (2011). Residential guidance document. Re-
trieved from www.osha.gov/doc/guidance.html

Structural Building Components Association
(SBCA) and Truss Plate Institute. (2011). Fall protec-
tion and trusses. Retrieved from www.sbcindustry
.com/images/publication_images/b11

Photo 6 depicts
a reusable web

strap in use. This
personal fall

arrest anchorage
was not tested

in this study.

Acknowledgments
This study was supported by a research grant
from the University of Iowa Heartland Center
for Occupational Health and Safety (Grant
No. 5T42OH008491) and the Center for Con-
struction Research and Training (Grant No.
U60OH009762), both through CDC/NIOSH.