Health and Safety ReportVolume 14, Issue 10

It’s in the news. It’s recognized in legislation, and high-profile individuals from generals to journalists have stepped forward to tell their story about Post-Traumatic Stress Disorder (PTSD).

It’s always been around, but more than ever PTSD is getting increased attention as a work-related health issue. As the understanding of this illness increases, its definition continues to expand and evolve to include new risk factors and occupations most at risk for exposure to trauma. PTSD can disrupt your whole life: job, relationships, health, and enjoyment of everyday activities. While we may not be able to prevent trauma, there is help for those who develop significant mental health issues following the experience.

People can have very different reactions to traumatic situations. They may feel anxious, have difficulty sleeping, or replay details of the event in their mind. These are typical reactions and, with time, most people are able to get back to their daily lives. For others, these effects last much longer and getting back to one’s regular daily life is not a simple matter. PTSD is not fully understood. There is no explanation why some people who experience the same event develop PTSD while others don’t.

Disorder or Injury?

Is it Post-Traumatic Stress Disorder or Post-Traumatic Stress Injury? This discussion around language and labels has attracted considerable attention. Those who support dropping the “D” in PTSD believe that doing so will reduce any perceived stigma associated with the word “disorder”. This perceived stigma might deter those in need from seeking help. Supporters of switching “injury” for “disorder” hope using “injury” will lead to a greater acceptance of those who experience post-traumatic stress. Greater acceptance will allow those affected to heal without prejudgment. For now the terminology is interchangeable and the discussion on this important issue continues.

What is Post-Traumatic Stress?

Post-traumatic stress is an extreme reaction to exposure to a traumatic event. It may develop following either direct or indirect exposure to actual or threatened death, serious injury, or sexual violence. Direct exposure may occur through experiencing one or more traumatic events or through witnessing such an event happen to others. Indirect exposure can occur when learning about a traumatic event or when exposed to details about an event.

PTSD can occur at any age, and can last months or years.  Symptoms often begin within one to three months following the traumatic event, and may include the affected person becoming estranged from others or oddly unaffected because they are generally in shock. Later, they may experience recurrent images or thoughts of the traumatic event, nightmares, or flashbacks.

Not every person who experiences a traumatic event will experience PTSD. With time, support, and good self-care, most people recover.  A person may have PTSD if the symptoms get worse or last for months or even years and interfere with daily life.

Soldiers exposed to warfare were among the first to be identified as being at risk for PTSD. First responders who are exposed to traumatic events on a regular basis, such as police officers, paramedics, firefighters, nurses, emergency dispatchers, correctional workers, and First Nations emergency response teams are also recognized as being at risk. These occupations are now identified in the workers compensation legislation of a number of provinces, resulting in the formal recognition of certain cases of PTSD as being work-related.

Causes

The cause of PTSD is often obvious: it is a psychologically traumatic event that triggers feelings of terror and causes flashbacks. Factors that affect the likelihood of developing post-traumatic stress include the severity, duration, and proximity of the person's exposure to that traumatic event. The risk is generally highest among those who thought they would be killed or seriously injured during the event.

Violent personal assault, rape, mugging, car or plane accidents, military combat, industrial accidents, and natural disasters are the types of triggering events which have caused people to experience PTSD. In some cases, seeing another person harmed or killed, or learning that a close friend or family member was in serious danger has caused the stress.

Symptoms

The symptoms of PTSD usually begin within 3 months of the traumatic event; however, they may also take years to appear.  The duration of PTSD and the strength of the symptoms vary.

According to the PTSD Association of Canada, people who experience PTSD may have a variety of symptoms.  Responses can include a deep sense of helplessness, abnormal fear, feelings of devastation, flashbacks from the event, a feeling of emotional numbness, aversion to social contact, and avoidance of situations that might trigger memories of the event. Additional responses can include depression, anxiety, sleep disturbances, panic attacks, irritability, anger outbursts, difficulty with concentration or memory, feelings of vulnerability, fear of normal everyday activities, or feeling overwhelmed by the smallest of tasks.

Treatment

According to Statistics Canada about half of the people with PTSD fully recover within three to six months of symptoms developing, but others can experience symptoms for years.

Treatments for PTSD, which include medications and psychotherapy, can improve symptoms.  Cognitive-behavioural therapy can also be effective. Through this therapy, individuals learn how to change their thought patterns to overcome anxiety. Support groups can also help as a place to share thoughts and feelings of the traumatic event, and gain confidence in coping. In some cases, treatment may be required for many years to prevent relapse.

When left untreated, PTSD symptoms can become worse, and result in:

• drug or alcohol addiction,
• chronic pain, hypertension, and other physical problems,
• employment problems,
• relationship  problems and divorce, and
• self-injury.

Why only some?

While most people experience trauma at some point in their life, not all traumatic experiences lead to PTSD. First responders are repeatedly exposed to traumatic events, but not all will develop PTSD. It’s not known why trauma causes PTSD in some people and not others, but it’s likely linked to many different factors. These factors include the length of time the trauma lasted, the number of other traumatic experiences in a person’s life, their reaction to the event, and the kind of support they received after the event.

Reducing the risk of PTSD

To reduce the risk of PTSD, employers in vulnerable professions can offer programs aimed at preventing, mitigating, and managing the effects of stress.  These programs can help increase overall awareness of mental health issues, decrease the stigma of PTSD, and build the resilience of workers exposed to traumatic situations. For example, first responders can learn how to use stress management techniques during and after stressful events.  Training on topics such as anger and stress management, creating a healthy home life, suicide intervention, and addictions awareness can also help minimize the effects of PTSD.

Early intervention after a traumatic event is critical.  Employers should plan ahead to ensure that affected workers receive appropriate information and support, and early access to treatment.

PTSD is treatable

You may know them as morning check-ins, tailgate meetings, safety briefings, or toolbox talks. You may have had one this morning. Though the names may be different, they are all brief, safety-focussed discussions among managers or supervisors and workers. Toolbox talks can be an effective means for promoting a strong safety culture by keeping workers and supervisors up-to-date and informed about safety concerns, relevant procedures and topics.

Why do we call them toolbox talks?

The name toolbox talks likely comes from the original location of many workplace safety talks, which was around the toolbox to talk about workplace hazards and safety.  Though these discussions can go by a variety of names, they share the goal of identifying hazards in the workplace and communicating to workers what is done to mitigate those hazards.

Who should lead the toolbox talk?

Supervisors commonly lead toolbox talks but any subject matter experts available at the worksite can lead such a discussion. Any qualified management representative can give direction to employees (Site Supervisors, Foremen, General Manager, etc.). Other workers at the site can share their knowledge, skills and experience. You may wish to look to experts in your group i.e. a safety officer or safety advisor. These individuals may have interesting and relevant examples from their daily inspections or routines to share. Involving all workers helps to ensure that all hazards are identified so that workers can perform their tasks safely.

How often should they be held?

Holding a daily talk is a good idea. High risk industries like mining tend to have a safety meeting every morning before the shift starts on a different topic or piece of safety information.

Industries and workplaces with a high employee turnover or changing work environments should schedule more frequent meetings to account for this change.

How long should these talks be?

A toolbox talk needs to be long enough to clearly identify the hazards, the risks, and how you’re going to control those hazards. There should be an opportunity for some discussion, questions from workers and responses from the employer representatives.  Remember, a toolbox talk is not a substitute for training. Employers must ensure that workers receive training for the jobs they’re performing to work safely.

Where and when should these discussions take place?

Meetings are best held in a comfortable location at the beginning of a shift, after lunch or a break, or incorporated into another operational meeting. Be aware that noise levels or other factors nearby don’t create distractions for the participants.

Tips for effective talks:

• Prepare in advance
• Allocate a sufficient amount of time – remember to allow for time to answer questions!
• Ensure all workers are involved in the talk
• The topic must be relevant to workplace safety
• Focus on identifying hazards and risks
• Include controls that can be put into place to mitigate hazards and risks
• Use subject matter experts
• Lead by example
• Keep the participants focussed on safety – be careful not to become distracted by other unrelated topics/issues/complaints

Does everyone need to attend?

Yes, everyone should be required to attend the talk. That way, everybody involved knows what the risks and hazards are in the work that is about to be done and they have the ability to do the job safely. Tracking attendance at the talk ensures that you know that the person you’re sending off to do the task has the information they need to work safely.

7 Guidelines for Preparing Toolbox Safety Talks

1. For each discussion or talk, focus on one idea (hazard or job-related task).
2. Select a key topic to discuss (i.e. a hazard workers need to understand and can relate to):
   • Consider your own experiences, observations, and beliefs
   • Think of your area of control, repeated problems, recent accomplishments, and areas for improvements
   • Think of the workers, what they want and need, opinions, accomplishments, and areas for improvements
   • Keep notes of day-to-day occurrences so you can address them in timely safety talks
   • Read safety-related material, bookmark occupational health and safety websites, research and save news articles
3. Summarize your talk in point form
   • Know what you’re going to say
   • Write down key points, facts, and examples
4. Practice your talk
   • Run through your material before your present it to your workers. Over time this will get easier.
5. Make toolbox talks a scheduled and regular part of the work day and if needed, before starting a particular task.
6. You should:
   • Have the immediate supervisor conduct the meeting
   • Make them short and to the point
   • Focus on one topic but cover it in as much detail as necessary to convey the safety information
   • Have an agenda to keep the talks on track
   • Document the talk and maintain a record in your business files
7. Toolbox safety talks, like all safety meetings, are critical to the employer’s health and safety program and establishing due diligence. Using a log book is the best way to document that you conduct safety talks, what topics are covered and who attended.

Resources:

• Toolbox Talks, Workers’ Safety and Compensation Commission (WSCC)
• Toolbox Talks, BC Construction Safety Alliance

Are you looking for engineering controls for crystalline silica dust when grinding concrete or information on how to control the ergonomic hazards in the dry cleaning industry?

The National Institute for Occupational Safety and Health (NIOSH) has a new Engineering Controls Database that provides information on effective engineering controls that can protect workers by eliminating or reducing hazardous conditions. Well-designed engineering controls can be highly effective in protecting workers and can lead to safer systems, where the risk of illness or injury has been substantially reduced. 

Search the database by occupation or work process to find a solution that may work to control the exposure in your workplace.

Searching words like welding, painting, or dry cleaning or chemical names like acetone will deliver summaries and diagrams of the controls and details about their effectiveness.

The NIOSH Engineering Control Database contains only previously published material authored by NIOSH researchers.

Links:

• Engineering Controls Database, The National Institute for Occupational Safety and Health (NIOSH)

This month’s Health and Safety To Go! features the new podcast episode Health and Safety Solutions for the Aging Workforce and an encore of the podcast Radiation in the Workplace: The Basics.

Feature Podcast: Health and Safety Solutions for the Aging Workforce

How do the physical and mental changes that come with aging affect people and the jobs they do? Jan Chappel, Senior Technical Specialist at CCOHS, sheds some light on what workplaces can do to ensure the aging population is healthy and safe at work.

The podcast runs 7:58 minutes. 

Listen to the podcast now.

Encore Podcast: Radiation in the Workplace: The Basics

This month's edition features Claire Cohalan, of the Radiation Safety Institute of Canada in the first of this special two-part mini-series on radiation in the workplace. This episode focuses on radiation basics such as what radiation is, where it can be found and the health effects to workers.

The podcast runs 9:26 minutes.

Listen to the podcast now.

CCOHS produces free monthly podcasts on a wide variety of topics designed to keep you current with information, tips, and insights into the health, safety, and well-being of working Canadians. You can download the audio segment to your computer or MP3 player and listen to it at your own convenience... or on the go!

See the complete list of podcast topics. Better yet, subscribe to the series on iTunes and don't miss a single episode.

What are the signs of heat stroke? How should I set up my workstation so I don’t hurt myself? How do chemicals enter the body? When does my crew need to wear fall protection? It’s good to know that when you have questions related to workplace health and safety, there are answers available online for free. Better yet – there’s an app for that!

The OSH Answers fact sheet collection from the Canadian Centre for Occupational Health and Safety (CCOHS) is now available as an app for iPhone, iPad and android devices. Delivered in an easy to read question and answer format, OSH Answers covers an extensive range of topic areas in workplace health and safety, from hazards to diseases to ergonomics to workplace promotion. These topics are based on questions that the Inquiries Service at the Canadian Centre for Occupational Health and Safety has received from workers, their families, health and safety committee members, employers, occupational hygienists, safety professionals, doctors, nurses and other health care professionals, government officials, lawyers, the media, and the general public over the years. The number of fact sheets continues to grow as inquirers raise new questions and topics.

This app contains the entire OSH Answers database, including full text and images, in English and French. Once it’s downloaded to your device, there is no need for a wireless connection in order to run the app. It can be used offline, in remote areas and manufacturing shop floors where wireless connectivity is absent or unreliable. 

Download the app and browse or search by keywords and topics to easily access health and safety information. http://www.ccohs.ca/products/oshanswers_app/

The app is available for free download on iOS and Android devices.

Google Play: https://play.google.com/store/apps/details?id=ca.ccohs.oshanswers&hl=en 

iTunes: https://itunes.apple.com/ca/app/osh-answers/id1031111932?mt=8

Search the OSH Answers fact sheets from the CCOHS web site: http://www.ccohs.ca/oshanswers/

Still need answers? Contact our confidential, person to person Inquiries Service.

On November 2nd more than 250,000 grade nine students across Canada will head off to work with their parents, relatives, or friends for Take Our Kids to Work™. This annual, national program from The Learning Partnership gives young people a chance to job shadow their parent or another adult at work for a day, to get an up close glimpse of work life. In addition, the entire community of parents, teachers and employers has an opportunity to get involved in the career development of young Canadians.

Teachers and Parents: Preparing the kids for the workplace

It's important that young people receive information about health and safety prior to their workplace visit. They need to know and understand their rights and responsibilities for jobs they may hold now and in the future. Parents need this same information and to be aware of the work that their children are doing. They should ask questions about the health and safety concerns and how they are being addressed in the workplace.

Teachers should encourage all participants in the Take Our Kids to Work program to commit themselves to a safe day. On forms, include a section demonstrating that students have read and discussed materials on health and workplace safety before participating.

Employers: Preparing the workplace to keep the kids safe

In preparation for Take Our Kids to Work, workplaces should conduct an inspection prior to the day with a view to youth workplace safety. One of the first things employers should do on Take Our Kids to Work day is hold workplace orientations with the students that focus on health and safety issues relevant to that environment. Students should be supervised all day while they are at the workplace site and should only be allowed to undertake tasks and experiences for which they have been properly oriented. In the work environment, students should be encouraged to speak up about health and safety concerns, ask questions, and comment on situations they observed during the day.

More information

Visit The Learning Partnership website to register your participation, download resources and posters, and learn more about the Take Our Kids to Work program.

Young Workers Zone from CCOHS offers resources for young workers, parents, employers and teachers to help young people be healthy and safe at work.

Learn about the free Teaching Tools.