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Reprinted from Public Risk - October 2001 Issue

In January of 1997 an article with a similar title appeared in PRIMA's Public Risk Magazine. The essence of the article described a unique process of imprinted body mechanics; work behavior safety training for high-risk work sectors such as Fire and Police in order to prevent the re-occurring incidence of disability injury and related retirements. High risk is here defined as a work arena where the employee's primary work focus and performance demand must prevail, often at the expense of injury loss and chronic dysfunction leading to disability ratings and related retirements.

Now, four years after the above titled article appeared in Public Risk and 18 years after inception, PSR®; is not only continuing to expand its work with a documented track record of significantly reducing the frequency and severity of injury for the high risk work arena but the specialized loss control system also continues to produce positive results in the areas of risk financing. It becomes apparent that with a proven track record of measurable cost reduction, this type of sophisticated loss intervention program addressing difficult loss containment work arenas, can be readily merged with those standardized programs of Worker's Compensation Insurers, Self-insured, Risk managers and Finance Directors. The shared goals would be to better manage the direct and indirect cost of losses, premium costs, and ultimately reduce the overall unfunded liabilities of the entity - public or private. Managed well, this could indeed have a positive effect on Bond Ratings in the public entity.

This current article brings forward the original's (Public Risk Jan 1997) insights into the higher risk loss work arenas, in particular public safety agencies, and concludes with progressive suggestions and value propositions for merging the efforts of parallel partners in cost control. All of these partners including managers of: Finance, Insurance, Re-insurance, Risk, Human Resources, Worker's Comp., and Safety, will find most productive the areas of common interest.

THE CONTINUING CHALLENGE OF THE NEW MILLENIUM - ECONOMICS

Additionally, the effects of the economy on public and private sector management in meeting the challenges of tighter fiscal budgets - i.e. a greater return on investments in employee loss control - particularly in Public Safety and labor intensive repetitive motion industries - is requiring accountability and tangible results for performance based scorecards. Achieving productivity in both the public and private sectors is on a "back to basics" strategy vs the push to integrate the internet and technology as growth producers. The emphasis is on productivity and at the hands of the "organization's" most valued assets - the workers. As with all challenges come progressive opportunities for long-term interventions and thus benefits through integrating specialized programs that have measurable far reaching outcomes. These lead to both greater safety in high-risk loss work arenas and greater returns on investments in the professional development of the critical human resources infrastructure.

STANDARDIZED LOSS CONTROL PROGRAMS FALL SHORT FOR PUBLIC SAFETY AND LABOR INTENSIVE REPETITIVE MOTION INDUSTRIES

The professional focus of a public safety employee together with the ever changing, uncontrolled work environment being responded to often precludes achieving results with the standard safety options of redesigning the work arena or training the employee in correct body position to prevent disability injury loss. The same holds true for the petroleum refinery, skilled care nursing facility, freight beverage package distribution industry, and multiple other special emphasis areas which have both limitations to redesign, and in which employees cannot assume standardized positions to do the work without higher risk potential and occurrence of injury.

SCENARIOS: Fire-EMT & Law Enforcement
PERFORMANCE DEMAND-FOCUS:

The performance demand of a Firefighter EMT is primarily time incident mitigation and/or life saving, and the performance demand of a Police Officer is primarily survival while upholding the law. This is their professional and prevailing work focus.

Following are examples of the specific nature of the performance needs together with the work circumstances in which their body performance responses are challenged.

FIRE EMT SCENARIO-CARDIAC ARREST PATIENT TRANSPORT:

The firefighter at the high end of a medical transport with an agitated cardiac patient going down the stairway at 4 a.m. in the morning is focused on holding back the backboard or gurney, thus keeping it from descending too quickly for the backward moving responder (there may well be a 3rd responder behind and 'spotting' the backward moving firefighter). The agitated cardiac patient shifts at the same moment as the backing responder falters and the backboard simultaneously moves a foot or two away from the upper responder who reflexively retrieves it with their back and injures the spine. They were unable to quickly move the legs on the stairs. The spine is seriously overloaded, a disc is injured (bulged or herniated) and the cumulative injury leading to disability retirement thus begins. At the "moment of truth" it is too late to position correctly by 'bending the knees, keeping the back flat, bringing the weight close in. The above is a standard scenario in the professional world of emergency medical response. The performance demand is time, life saving, incident mitigation. This is the prevailing professional focus.

LAW ENFORCEMENT SCENARIO-ARRESTEE UNDER INFLUENCE STRUGGLE:

The Law Enforcement officer in a routine arrest of a seemingly diminutive arrestee of 150 lbs., abruptly discovers they are in a struggle with a person under the influence of alcohol and/or drugs such as PCP, which has given the arrestee tremendous strength to resist. It is too late for the officer to position their body correctly. If they hold on they do so with their hands and they then first overload the arms, shoulders, then the back, then lose their balance, perhaps their weapon in the ensuing struggle, then potentially their lives are at risk. If they let go in the early stages, the arrestee gets away. The performance demand is survival. This is the prevailing professional focus.

LABOR INTENSIVE, REPETITIVE MOTION SCENARIO - SPRING WATER AND BEVERAGE DELIVERY:

The route driver delivers 200 bottles in the course of the day. 1/3 of the 42 lb. Weight is overhead on the truck. Standardized positioning which relies on bending the knees, using the legs, bringing the weight close in, will not functionally apply in the overhead reaches accounting for 1.5 tons of the 4 tons of weight moved daily. The performance demand is productivity with the challenge of time, traffic and fatigue. This is the prevailing professional focus.

SKILLED CARE NURSING SCENARIO - PATIENT TRANSFER

A nurse or nurse's aid who was not hired for her reach. If 5ft 2in tall, reaching across a bed for a limp patient, she cannot bend her knees, use her legs, and bring the weight close to her. It is in trying to do the correct action (bring the patient to her albeit in a caring manner) that she is injured, again and again. The performance demand is patient care and transfer. This is the prevailing professional focus.

THE REALITIES -YOU ARE WHAT YOU DO ALL THE TIME

The reality is that if a boxer or wrestler focuses on the position of their body, they are not boxing or wrestling. If they have the time to think about the position of their back, they are probably lying flat on it with a referee counting. They are no longer achieving their performance need and demands. To succeed at the basic definition of boxing or wrestling the athlete must know what the experience of a unified stable body - still able to move - feels like and how the experience feels when applied in any circumstance all the time.

The public safety responder must react to a greater degree reflexively. This reflexive response is a product of both their physical experiences, and ongoing routine body behavior. You are what you do all the time. If you exit a vehicle by pulling on the doorpost or steering wheel with your arms, then in a struggle with a weighted backboard or resistant human, the same will occur. A person ultimately functions in extremes and emergency with the same personal body behaviors as in routine, although likely with exaggerated movement emphasis.

If routinely they get up out of a chair by leaning forward and (while holding their breath) first pushing with the arms on the legs (which causes their back to do the bulk of the work - as most persons do) they will respond in an emergency with the arms and upper body much more intensely than with the legs and hips (still holding their breath). In an extreme condition or indeed an emergency, reflexive intensity is multiplied and the probability of injury is significantly elevated. This is attested to by the musculoskeletal injury statistics in the emergency services.

COMPARTMENTALIZED STRENGTHENING & BODY POSITIONING SAFETY PROGRAMS DO NOT WORK IN THE EMERGENCY RESPONSE ARENA

Strengthening and wellness programs stress compartmentalized body fitness as in strengthening the arms, legs, abdomen, etc. through exercise. The body is taught to experience effort as separate compartments. However the reality is that in order to respond correctly without injury in the above described extremes and emergencies, the body response must be triggered as a whole unit from the center hips and legs first and lastly from the arms and upper body, in complete control of intra truncal pressure. This is the way a runner starts a race, a wrestler wrestles, a boxer boxes and a singer sings. Since the efforts carried out in routine daily life are focused on the hands and arms, the likelihood of excessive upper body use is likely and often spontaneous. As the legs stay attached to the ground, the back and shoulders take the major stresses. This is an example of why the extremely high spinal injury rates in the emergency responder and even the labor intensive repetitive motion employee. In the emergency responder, other ongoing work patterns are even influenced by the uniforms such as the necessarily cumbersome turnouts and boots of the Firefighter and the thick, heavily laden duty belts of the Law Enforcement officer - both of which do less than encourage correct center body motion without special training, and have significant limitations to their redesign possibilities.

IMPRINTING CORRECT BODY RESPONSE AS CAREER SAFETY TRAINING

The key to correct response lies in the ongoing experience of how the body correctly performs in routine and how the experience feels as an 'imprinted ' function. Any athlete while performing adequately is adjusting their experience to how it feels to perform the function, automatically, with optimum strength and stability. This is a true work hardening experience. An emergency responder rarely completely develops this correct work experience. How does the work feel when it is making them stronger spontaneously in all circumstances? This concept of "imprinted safety" in the "critical body response" psychological mechanisms of performance demand - routine through emergency is known as "professional safeguard response". The system was developed for public safety personnel by a specialized California agency - PSR® Corporation - in the early 1980's and has proven successful over the last 18 years with upwards of 100 public safety (Fire & Police) agencies across the United States. It has been adapted and successfully applied to a spectrum of other special emphasis work arenas mentioned above. PSR® is distinguished as authentic career specific performance based safety training for Public Safety personnel. The loss control program relies on the responder's own body skills correctly modified and redirected to become job specific career work hardening, self reinforcing and maturing, and does not rely on positioning the body as in standardized workplace safety training to prevent injury. Correct whole unit body effort is imprinted into the ongoing job performance demands and becomes reflexive behavioral pattern, which matures with the ongoing work experience (as it does with a professional athlete, performer or singer) and requires minimal reinforcement for the career of the employee.

MEETING THE CHALLENGE - MEASUREMENTS

AGRIP the Association for Government Risk Insurance Pools - has asked for the loss statistics of certain Cities and departments mentioned in the Public Risk magazine article of 1997. After completing the initial PSR® work behavior training, the surveyed long-term results over subsequent years proved to be excellent. In several sample cities the long-term statistical results (over 3-5 years) display a drop of significant proportions in loss injury incidents, loss time, and dollar losses.

City of Sunnyvale, California (termed a model managed city by the Clinton Gore Administration). Dept of Public safety (dual role Fire and Police) - 1 year later group trained had 82% decrease in injuries while group not trained sustained 35% increase in injuries. The successful statistics held for 3 years without reinforcement. Another targeted test group of chronically back-injured public works (parks) employees - sustained only 1 injury in 3 years. Other programs were tried with other test groups with - in every case - an increase in injuries over the 3 years.

City of Pasadena, California - In the year after the initial PSR® training Fire Department loss days dropped from averages well into the hundreds (700-1200) to 20. These positive statistics remained for several years without any reinforcement.

City of San Jose, California - In the first year after the PSR® training, Worker's Comp. Dollar losses were reduced by $1,000,000. Over 3 years by $4 ,000,000.

U.S. Dept of Energy Fire Services and US Air Force Fire command - has stated at various times that this "imprinted safety" for firefighters is the most impressive program available and at the forefront of preventative measures for preventing occupational injury in the Fire service.

AON Risk services, Johnson & Higgins and the new management of Marsh McLennan Public entities Division states, "...this time tested system targets the root causes of musculoskeletal injuries that occur in the uncontrolled environment of the public safety professional. Results are impressive. PSR® produces dramatic savings in employee injury costs. There is no other program of its kind.

PARTNERS WITH NEW TOOLS FOR RISK FINANCING

Executives along with the managers of Finance, Insurance, Risk, Safety, and Worker's Compensation each and all know that the challenge of stabilizing fiscal resources is open ended. In a political environment this challenge becomes a ' moving target ' as memoranda of understanding evolve, insurance policy premiums cycle through, new loss control programs arrive, and new tools and staff are applied to their individual sectors, often at the expense other areas of their budgets.

In response to increasing demand from entities, pools, and insurers, PSR® Corporation is - for the first time in its 18 year history - making its specialized training systems available as a licensed product which will permit the training of specialists certified in the PSR® work behavior modification system by the licensee for use within its own workforce or client workforce. This will, for instance, allow public safety training officers to represent City Fire and Police agencies to become certified in the PSR® fire and law enforcement career specific loss control training systems. Similarly, performance demand specific programs will be available for industries from skilled care nursing and petro chemical to freight distribution. This licensing of entities, allowing certification of trainers, has direct application within large organizations for contact and training intervention of large numbers of employees or throughout large geographical or insurer market areas. The completion of PSR® Certified training has gained the attention of both insurers and CEO's of large agency pools, as it provides uniform quality control and accountability with a proven product.

With the record of predictable loss outcomes in unpredictable risk environments, discussions are underway to link service providers with long term financial planners to define strategic long-term financial benefits for all parties to the process. Simply stated: all partners responsible for the total cost of risk - FROM BROKERS AND INSURERS TO ENTITIES THEMSELVES - can be brought back to the finance table to reduce costs. If career specific work behavior training significantly reduces frequency and severity as displayed and detailed above, if annual expenditures and estimated future liabilities are reduced and stabilized in a significantly more predictable manner, then insurers and reinsurers will be able to further adjust premiums and deductibles with rate credits, experience modification and loss cost expense reductions and dividend options parallel to the performance of the agency. The incentives are self-fulfilling.

The article appearing on this page appeared in Public Risk and was written by
J. M. Ingenthron - Risk Manager, (29 yrs) City of Oakland California
J.S.Osio - Mercer alum., U.S. risk value specialist (25 years)
D. Billings - Worker's Compensation Insurance executive (20 yrs)
J. S. Kanner - CEO, PSR® Corporation

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PRIMA -imprinted body mechanics -work behavior safety training -high risk work sectors - injury loss - disability - los intervention - workers compensation - human resources - human capital - human resources - safety - loss control - patient transfer - arrestee struggle - water delivery -strengthening - spinal injury - imprinting - correct body response - safety training - work behavior modification - unpredictable work environments -Public Risk