Peter Metropoulos, DO, MPH, FACOEM

1
The Practical Approach to Ergonomics MAOHN
2009 0920am to 1010am

• Peter Metropoulos, DO, MPH, FACOEM

BENCHMARK HEALTH Epidemiology Internal Medicine
Occupational Environmental Medicine Certified
Independent Medical Examiner Certified Medical
Review Officer Board Certified Certified
Advanced Hazmat Life Support
2
Content of Discussion

• Job evaluation
• General Topics
• Basic Ergonomic Principles
• Roles of Clinical Team

3
Discussion Format

• Open Discussion
• Ask questions at any time
• We all learn from the
• questions others ask

4
Goal of All Health Safety Professionals
Prevent All Work Injuries
HELP!
5
General Concepts

• Ergonomics application of engineering knowledge
  and skills to tools, workstations, and work
  method designs so they better fit the
  capabilities of the people doing the work. It is
  making the job fit the worker rather than trying
  to fit the worker to the job.
• Cumulative Trauma Disorders (CTDs) injury that
  happens when the tissue of the body is exposed to
  physical and biomechanical stress and loads
  continuously over time leading to the breakdown
  of those tissues.

6
Cumulative Trauma Disorders
Carpal Tunnel Syndrome Cubital Tunnel
Syndrome Epicondylitis Medial
Lateral DeQuervains Intersection Syndrome
7
Job Evaluation Key Elements

• Repeated or Sustained Exertions
• Force
• Contact Stress
• Posture
• Temperature
• (low high)
• Vibration
• Psychophysical Stress

8
Exposure vs. Response

• Response
• Pain
• Fatigue,
• Myalgia,
• Tendonitis,
• etc.
• Exposure
• (Sustained exertion, Force, Contact Stress,
  Posture)

9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
VIBRATION TLVs
13
Heat Stress and Air Velocity
Deriving Effective Temperatures
Air Velocity
Dry Bulb Temperature (C degrees)
At this point, ambient temperature exceeds body
core temperature, thus increase of air velocity
has a convection effect rather than cooling.
Wet Bulb Temperature (C degrees)
14
(No Transcript)
15
Recommended Weight Limit (RWL) for Manual Lifting
He has got to be kidding! What can I do with
this?!
RWL LC x HM x VM x DM x AM x FM x CM
If you are thinking, this is all Greek to me,
You are not alone
16
Recommended Weight Limit (RWL) for Manual Lifting
Hes got to be kidding! What can I do with this?!

• RWL LC x HM x VM x DM x AM x FM x CM

17
Recommended Weight Limit (RWL) for Manual Lifting

• Based on three areas of study
• Physiology (fatigue, energy-demand, aerobic
  capacity)
• 2. Biomechanics (spinal compression of lt3.4kN)
• 3. Psychophysics (strength/perception acceptable
  to 75 of females)

18
Role of Perception
19
Posture
20
(No Transcript)
21
(No Transcript)
22
We are not all the same, but we try to make jobs
fit the 95th percent of workers.
23
Factors That Effect the Job

• LC load constant (kg or lb weight of object)
• HM horizontal multiplier (distance of bodys
  central
• point to where hands are at mid-point
  of object)
• VM vertical multiplier (height of hands above
  the floor)
• DM distance multiplier (how far does the item
  has to
• travel?)
• AM asymmetric multiplier (angle difference from
  the
• mid-plane of body from start to end of
  lift)
• FM frequency multiplier (average number of
  lifts over
• time)
• CM coupling multiplier (how easily is it held?
  Handles?
• Slippery surface?)

24
Factors That Effect the Job

• Lifting Index (LI) Load Weight / RWL
• (Reminder RWL Recommended Weight Limit)
• If LI gt 1.0, then the job needs to be redesigned.
  Not necessarily the weight of the object or
  part, but
• modify one or more factors in the
• formula. For instance, add handles
• for better gripping or use tactile
• gloves to increase friction for
• easier pick up.

25

• Even in space, ergonomics plays a role

Ah Houston, we have a problem!
OSHA Galaxy Division
26
Think About the Job
27
Sketch Out the Distances and Steps for Doing the
Work
28
Adjustable Work Stations Work Best to Accommodate
Various Heights and Physical Differences
29
Is there an ideal level to work and lift?
30
HM horizontal multiplier (distance of
body mid-point to hands at mid-point of
object) DM distance multiplier (how far
does the item have to travel from the
initial location to the lifted
level?)
HM
DM
31
HM horizontal multiplier (distance of bodys
central point to where hands are at mid-point of
object) VM vertical multiplier (height of
hands above the floor at start of lift)
VM
HM
32
(No Transcript)
33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
AM asymmetric multiplier (angle difference
from the mid-plane of body from start to end of
lift or motion)
Start
End-point
AM
37
Lift Tables
38
(No Transcript)
39
(No Transcript)
40
Other Thoughts Even Though Not Directly in the
Formula
41
Coupling

• CM coupling multiplier
• how easily is it held?
• Handles?
• Slippery surface?

42
Silverstein reference
Coupling, pinching, grasping
43
Example of Methods to Decrease the Coupling
Multiplier
44
(No Transcript)
45
Components of an Ergonomics Program
46
Important to Remember!
Feedback Loop

• Dont forget to go back and see if the measure
  worked
• If YES Continue and take across all
  applicable work sites
• If NO, Reanalyze

47
TEAMWORK

• Communication between the medical provider with
  the operator, supervisor, safety, ergonomics, and
  engineering helps identify potential problems and
  allows us to move forward on timely solutions

48
Role of Primary Care Provider Clinical Team

• Investigate non-occupational etiologies for
  symptoms (hand numbness Raynauds)
• Provide specific and accurate restrictions, if
  required, for a limited time period followed by
  frequent reassessment and determination of need
  for continued restrictions.

49
Work StatusWork today without RestrictionsWork
today with the following restriction until next
recheck No / Limit pulling or pushing No /
Limit bending, stooping, or twistingNo lifting
over _____ poundsSit/Stand at will No / Limit
repetitive or forceful graspingGround level
work only, no climbingLimit use of
_____hand_____arm_____legNo use of
_____hand_____arm_____legNo at or above shoulder
workKeep wound clean and dryMust wear splint
while workingOff Balance of ShiftOff Until
____________ (or) next visitWork
status to be determined by specialist
50
Example Work Note with Restrictions

• Name John Doe, III
• Date October 17, 2009
• Diagnosis Low Back Pain with L4-5 Disc
  Herniation
• Restrictions No lifting over 10 with both
  hands. Limit bending to 25 of shift.
  Restrictions expire in 5 days.

51
What NOT to do

• Name John Doe, III
• Date October 17, 2009
• Diagnosis Low Back Pain
• Restrictions Light Duty

52
(No Transcript)
53
(No Transcript)
54
An ounce of prevention is equal to a pound of
cure
55
Target Injury Rate
ZERO
56
(No Transcript)
57
ANY QUESTIONS?