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Company XYZ has experienced a higher than industry average injury rate due to the limited height in the cargo bins and the restricted posture lifting. Awkward postures and high repetition are the major 3 causes for musculoskeletal disorders.
Company XYZ has experienced a higher than industry average injury rate due to the limited height in the cargo bins and the restricted posture lifting. Awkward postures and high repetition are the major 3 causes for musculoskeletal disorders.
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Company XYZ has experienced a higher than industry average injury rate due to the limited height in the cargo bins and the restricted posture lifting. Awkward postures and high repetition are the major 3 causes for musculoskeletal disorders.
Droits d'auteur :
Attribution Non-Commercial (BY-NC)
Formats disponibles
Téléchargez comme PDF, TXT ou lisez en ligne sur Scribd
An Ergonomic Analysis of the Current Lifting Techniques
in Height Restricted Cargo Bins
at Company XYZ by Scott Rud A Research Paper Submitted in Partial Fulfillment of the Requirements for the Master of Science Degree III Risk Control Approved: 2 Semester Credits ale t -'- If /1// l :vV Dr. Elbeli Sorrell The Graduate School University of Wisconsin-Stout April, 2011 1 2
The Graduate School University of Wisconsin-Stout Menomonie, WI
Author: Rud, Scott A. Title: An Ergonomic Analysis of Current Lifting Techniques in Height Restricted Cargo Bins at Company XYZ Graduate Degree/ Major: MS Risk Control Research Adviser: Dr. Elbert Sorrell Month/Year: April, 2011 Number of Pages: 61 Style Manual Used: American Psychological Association, 6 th edition
Abstract The aviation industry has one of the highest rates for back strains, shoulder strains and long term MSDs. Company XYZ has experienced a higher than industry average injury rate due to the limited height in the cargo bins and the restricted posture lifting. The continued presence of higher than industry average back and shoulder strains and sprains in the height restricted cargo bins at Company XYZ is placing the organization at risk of incurring continued employee injury and other workers compensation related forms of loss. The four years of OSHA recordable injuries, the results of the ergonomic-based risk factor assessment methods of the Rapid Upper Limb Assessment (RULA) and Rapid Entire Body Assessment (REBA), and the NIOSH lifting equation were compared to recognition and remediation measures for musculoskeletal disorders (MSDs) that have been identified in professional literature on the topic. The research results indicate that awkward postures and high repetition are the major 3
causes for musculoskeletal disorders, back and shoulder sprains and strains and flexion of the neck and spine. The conclusions of this research are that a selection of administrative controls and personal protective equipment are used to educate the workers and reduce the risk factors from lifting in the height restricted cargo bin. Since the elimination of these risk factors is not feasible, reduction through proper training, implementation and employee cooperation is the goal.
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Table of Contents Page
Abstract ...................................................................................................................................... 2 List of Tables ............................................................................................................................. 6 List of Figures ............................................................................................................................. 7 Chapter I: Introduction ............................................................................................................... 8 Statement of the Problem ............................................................................................... 10 Purpose of the Study ....................................................................................................... 10 Goals of This Study ........................................................................................................ 10 Limitations of the Survey ............................................................................................... 10 Assumptions of the Survey ............................................................................................ 11 Definition of Terms ....................................................................................................... 11 Chapter II: Literature Review ................................................................................................... 13 Benchmarking Ergonomic Losses .................................................................................. 13 Ergonomic Risk Factors.................................................................................................. 17 Ergonomic-Related Injuries/Illnesses .............................................................................. 18 Task Analysis ................................................................................................................. 20 Ergonomic Job Analysis ................................................................................................. 20 Ergonomic Controls ........................................................................................................ 25 Engineering Controls ...................................................................................................... 26 Administrative Controls .................................................................................................. 27 Personal Protective Equipment (PPE) ............................................................................. 28 Summary ....................................................................................................................... 28 5
Chapter III: Methodology ......................................................................................................... 30 Subject Selection and Description .................................................................................. 30 Instrumentation .............................................................................................................. 32 Data Collection Procedures ............................................................................................ 33 Data Analysis ................................................................................................................ 36 Limitations .................................................................................................................... 38 Summary ....................................................................................................................... 38 Chapter IV: Results .................................................................................................................. 39 Objective One ................................................................................................................ 39 Objective Two ............................................................................................................... 40 Objective Three .............................................................................................................. 43 Discussion ..................................................................................................................... 50 Chapter V: Summary, Conclusions and Recommendations........................................................ 52 Methods and Procedures ................................................................................................. 52 Major Findings ............................................................................................................... 53 Conclusions .................................................................................................................... 55 Recommendations .......................................................................................................... 56 Engineering Controls ...................................................................................................... 57 Administrative Controls .................................................................................................. 57 Personal Protective Equipment ....................................................................................... 58 Recommendations for Further Study ............................................................................... 59 References ............................................................................................................................... 60 6
Page Figure 1: Rapid upper limb assessment worksheet ................................................................. 22 Figure 2: Rapid entire body assessment worksheet ................................................................ 24 Figure 3: Top view of cargo bins one and two ....................................................................... 31 Figure 4: Side view of cargo bins one and two ....................................................................... 32
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Chapter I: Introduction
Ergonomics is the science of fitting workplace conditions and job demands to the capabilities of the working population (Occupational Safety and Health Administration, Ergonomics, 2010). Ergonomic hazards exist in a multitude of industries and according to the 2008 OSHA incident rates the aviation industry ranks as one of the top industries for total non- fatal occupational injuries (OSHA, 2008). There are a variety of ergonomic risk factors that contribute to injuries in the luggage handling process of the airline ground handling industry. These risk factors would include, restricted posture lifting, repetitive lifting, forceful lifting, overexertion, pulling and pushing, and frequent heavy lifting. Working inside the height restricted cargo bins have multiple risk factors which can lead to a higher than average probability of causing long term Musculoskeletal Disorders (MSDs). Incident rates of lost time MSDs such as shoulder and back strains in the airline ground handling industry are some of the highest in all the private industry. The overall incident rate is 3.5 times the rate for private industry as a whole; rates of back and shoulder injuries are four and five times the respective rates for private industry as a whole (Korkmaz et al 2005). These MSDs evolve over an extended period of time due to the repetitive nature, frequent heavy lifting and the posture restricted duties performed. Loading the height restricted cargo bins is an extremely demanding job that possesses several ergonomic hazards. Long term risk exposure to restricted posture lifting in time sensitive conditions are of great concern to the ground handling industry. Company XYZ is a ground handling company that performs the luggage handling procedures for major airlines. They operate in over 100 different locations, employ over 5,000 ground handling employees and perform these duties in all types of weather conditions. 9
Theoretically the process of performing the job is the same in each location as stated in Company XYZs standard operating procedures manual. Realistically the challenges are many; those challenges include different training styles, management styles, work ethics, and culture. There are many unique challenges to this type of work, even with a standardized process the only real constant factor is the limited height restrictions inside the cargo bin. Company XYZ has demonstrated a strong commitment to their employee group, their share holders and the communities with safety being their top core value. Commitments include but are not limited to, training proper lifting techniques, pre and post stretching activities, and engineering controls with self-propelled belt loaders. Self-propelled belt loaders are motorized pieces of equipment that assist in moving luggage from the ground level to the cargo bins by the use of conveyor belts. This piece of equipment reduces the employees risk exposure to repetitive lifting and lifting above their shoulders, though all loading activities inside the cargo bins are manually performed by the employees. The maximum center height of the cylinder shape cargo bins in this study is 64 (54) with the front loading area measuring 58 (48). The problem exists of how to properly lift when your space is limited if the mean height of a man a 1999-2002 was approximately 69 and for woman was approximately 64 (Center for Disease Control and Prevention, CDC 2004). Some employees may fall in the range where proper lifting techniques can be performed, though hiring individuals that meet height requirements to properly lift in these spaces are not feasible. The commitment of Company XYZ of continuous improvement shows a high emphasis to the safety, health and well-being of their employees. However, back strains, shoulder strains, and long term MSDs are still occurring above the industry average and alternate means of performing these job functions in a safer manor are needed. 10
Statement of the Problem The aviation industry has one of the highest rates for back strains, shoulder strains and long term MSDs. Company XYZ has experienced a higher than industry average injury rate due to the limited height in the cargo bins and the restricted posture lifting. Purpose of the Study The purpose of this analysis is to determine the root causes of back injuries sustained during the loading process inside the height restricted cargo bins. From this root cause analysis an ergonomic solution can be derived to help reduce the severity of back injuries or ultimately eliminate them. Goals of This Study 1. Conduct an analysis of safety metrics of Company XYZ to better understand their safety related performance and historical trends. 2. Conduct a review of national aviation accidents statistics to use as a basis for comparison to Company XYZ. 3. Conduct task analysis of manual material handling activities performed by employees in height restricted cargo bins at Company XYZ. Limitations of the Study 1. This study is limited to only the lifting techniques inside the cargo bins of a commercial aircraft. 2. No considerations will be made for lifting techniques outside the defined research area. 3. This study is only for the purpose of identifying alternate lifting techniques to be used in the height restricted spaces of a commercial aircraft cargo bin. 11
4. These techniques will offer alternate methods of properly lifting to reduce the risk exposures, lower the back and shoulder strains and to provide guidance for training exercises. Assumptions of the Study 1. The employees willingness to participate with this study may alter the results. 2. The employees willingness to perform their job functions in the same manor as they would during a non observed day. 3. The employees will not alter there normal work practice or habit to adhere to the current study. 4. The process analyzed, conclusions, and recommendations for this study pertain only to the proper lifting techniques inside the aircraft cargo bin. Definition of Terms Engineering Controls. Physical changes to work stations, equipment, materials, production facilities, or any other relevant aspect of the work environment that reduce or prevent exposure to risk factors. Ergonomics. Ergonomics is the science of fitting workplace conditions and job demands to the capabilities of the working populations. Ground Handling Company. Ground handling addresses the many service requirements of a passenger aircraft between the time it arrives at a terminal gate and the time it departs on it next flight. Speed, efficiency and accuracy are important in ground handling services in order to minimize the turnaround time (the time during which the aircraft must remain parked at the gate). 12
Musculoskeletal Disorders (MSD). Disorders of the muscles, tendons, ligaments, joints, cartilage, nerves, blood vessels, or spinal discs. Some examples are muscle strains, ligament sprains, joint and tendon inflammation, pinched nerves, and spinal disc degeneration (Chengular, et al., 2004). 13
Chapter II: Literature Review The purpose of this study was to conduct an ergonomic analysis of the current lifting techniques in the height restricted space of a commercial airline cargo bin at Company XYZ. The current lifting techniques can potentially expose the employees of Company XYZ to long term musculoskeletal disorders, back and shoulder sprains and strains, flexion of the neck and spine, abduction of arms, unilateral foot coupling and ulnar deviation of the wrists. The review of literature, details current employee injury rates related to the luggage handlers in the aviation industry, the ergonomic risk factors associated with musculoskeletal disorders, the tools used to analyze the current lifting techniques, and the tools or controls which are used to implement the best form of correction. Through the recognition of improper ergonomic lifting techniques, body positioning and the implementation of correct techniques it may be possible to decrease the current injury rates. Benchmarking Ergonomic Losses Benchmarking is the process of identifying standards to use in comparison of practices, activities or standards (Teachnology, 2010). Creating a benchmark standard can help a company compare if the losses of a company have increased or decreased. Benchmarking of loss is divided into two main categories, reactive loss or lagging indicators and proactive loss or leading indicators. Reactive loss response occurs after an injury or illness and usually has the purpose of minimizing the costs associated with the injury or illness (OSHA, 2010). Whereas proactive loss response takes place before an accident has occurred. It anticipates and tries to prevent accidents. Reactive Loss . Reactive loss or lagging indicators are after-the-fact measurements that gauge past performance, such as OSHA incidence rates and injury and incident costs (Morrison, 14
2010). This reactive approach provides better administration and temporary relief, but the effort and investment must continue indefinitely because the root causes of the injuries are never addressed (EHS Today, 2010). There are multiple reactive measures that a company can utilize to compare past injury rates to the current incident rates. Incident rates take on more meaning for an employer when the injury and illness experiences of their firm is compared with that of other employers doing similar work with workforces of similar size (Bureau of Labor and statistics, 2010). This type of measurement is dependent on incidents to drive their safety activities and may reflect no more than random fluctuations and is not a valid indicator of safety improvement (Dial, 1992). One of these reactive methods of measurement is the OSHA recordable incident rate. This incident rate only takes into consideration recordable incidents and is computed using an OSHA standard formula. The number of injuries and illnesses x 200,000 divided by the total employee hours worked will give you the incident rate. The 200,000 represents 100 employees working 40 hours per week and 50 weeks per year. An OSHA recordable incident includes all work related deaths, illnesses and injuries which result in a loss of consciousness, restriction of work or motion, permanent transfer to another job within the company or that require some type of medical treatment or first aid (OSHA, 2010). Another reactive measurement tool is using the Days Away, Restrictions and Transfers (DART). The DART rate looks at the amount of time an injured employee is away from his or her regular job. To compute the DART rate, multiply the number of DART incidents times 200,000, and divide again by your companys total labor hours (Gokey, 2010). This reactive measure is base only on those injuries and illnesses severe enough to warrant Days Away, Restrictions or Transfers. Lost time case rate (TCR) is another reactive measuring tool. The TCR considers only incidents in which workdays were lost. Here again you multiply your 15
number of lost time cases by 200,000, and divide the result by the total number of hours worked by your employees. And, once again, the result tells you how many employees lost time per 100 employees on your payroll (Gokey, 2010). Severity rate is another reactive measuring tool, this looks at incidents in terms of the actual number of days that were lost on average. To calculate the Severity Rate, you simply divide the number of lost workdays by the number of recordable incidents (Gokey, 2010). Lastly, one of the most important reactive measuring tools is the claims made and the monetary amount paid out for workers compensation. Workers compensation is a state law mandated by the federal government that provides compensation medical care for employees who are injured in the course of performing work functions (Wikipedia, 2010). Using workers compensation as a reactive tool can help evaluate the probability and severity of future workers compensation claims by utilizing historical claims data. Evaluating the nature, severity and frequency of those claims has potential to identify areas that have a higher probability for reoccurrence. A rise in workers compensation premiums can be directly related to direct costs such as medical and compensation expenses, but in indirect costs as well. Losses of production, time, employee morale and client goodwill are all indirect costs that are hard to calculate (Yager, 2008). For many companies, using reactive incident rates remain their primary method of tracking company safety performance. Even when statistically valid, incidence rates are still less desirable than a proactive approach that can predict incidents before they occur. The knowledge that incidents are significantly increasing, even if founded on sound evidence, provides no information as to the causes or means to correct them (Dial, 1992). The reasoning behind this is due to the simplicity of calculating the injury rate, the ease of comparison between companies that provide the same service and product, and are used by OSHA and industry. 16
Proactive Loss. Proactive loss or leading indicators are a measure of future performance, management commitment or systems to drive performance change (Morrison, 2010). The proactive approach to controlling loss is where companies begin to take a risk management approach to managing work related musculoskeletal disorders (EHS Today, 2010). It is the prevention of injuries and illnesses in the workplace before they occur. There are methods used in the proactive approach to loss response, these methods would include, job safety analysis, routine task and job hazard analysis, employee interviews, initial, recurrent and specialized training, surveys, and questionnaires. Reported benefits of such interventions include lowering the numbers and costs of injuries, reducing discomfort and fatigue, and improving productivity (Marras, et al., 2000). Along with these reported benefits, leading indicators give a more accurate picture of any company and can provide positive reinforcement for a job being done correctly (Morrison, 2010). Interviews, surveys and questionnaires are an informative method used to gather employee input on the job processes they are performing. These informative methods can gather information electronically (computer based questionnaire) or paper based. A questionnaire can be extremely reliable if it elicits the same response under the same conditions and proctored by the same individual. Reliability is essentially about repeatability of results either by another observer or the same observer at different times or under different circumstances (Annett, 2002). These questionnaires are developed to extract attitudes and perceptions of employees toward their work environment, job duties, and can be used in the recording of information to be used for future changes or training sessions. A paralleling proactive active approach is the completion and performance of work place assessments, audits and inspections. Audits are designed to rate an organizations total safety and health program, identify its strengths and weaknesses, show were improvements are needed, 17
and obtain commitment and target dates for correcting problems (The Hartford, 2002). In other words, a proactive approach is a process orientated approach that emphasizes employee contributions to the development and implementation of various controls that are directed at the reduction of overall loss (National Safety Council, 2010). Safety training. A proactive approach and critical factor to any companys safety management program is training. Most training interventions lead to positive effects on safety knowledge, adoption of safe work behaviors and practices and safety and health outcomes (Burke, et al., 2006). The purpose of proper training and education is to provide all levels of employees with the correct information so they take ownership in their roles to reduce work place injuries. Most organizations follow a strong vertical accountability. This type of accountability tends to ensure compliance rather than commitment and goal focus (Ray, et al., 2007). Ensuring that employees take ownership in their wellbeing is an important element to the success of a proper training program. Training all levels in horizontal accountability instead of vertical accountability will provide the necessary support within the same levels of the organization. Horizontal accountability is the degree to which people communicate across the organization, problem solve with all employees and teams, and build accountability for superior outcomes (Ray, et al., 2007). Training and education at all levels of an organization in the signs and symptoms related to MSDs, ergonomic issues and efficient early reporting will help this company be proactive in taking proper action to reduce the severity of injuries. Ergonomic Risk Factors There are four major ergonomic risk factors that are associated to the contribution of long term musculoskeletal injuries (MSIs). Those four work related factors are high pace of work, excessive forces, fixed or constrained postures, and high repetition (Canadian Centre for 18
Occupational Health and Safety, 2010). It is very important to know that MSIs and specifically repetitive motion injuries (RMIs) rarely originate from one event or a particular factor. With repeated or sustained muscle activity and in jobs in which the same motor units are used extensively and repeatedly with small variations in working conditions, muscle fatigue is likely to develop (Faucett, et al., 2002). Continuous muscle fatigue with the same repetitive motion is the predecessor for RMIs. For this study restricted postures for spinal loading are the main concern though high repetition and excessive forces are both contributing factors. Given that forces from the active trunk muscles are the primary determinant of spinal load, increased muscle loading associated with restricted postures impose increased spinal loading (Splittstoeser, et al., 2007). Fixed or constrained postures is a body position that overloads muscles and tendons or loads joints in an uneven or asymmetrical manner, typically from the deviation of the neutral positions of the different body parts. Fixed or constrained postures typically include reaching above, behind, twisting, forward or backward bending, pinching, squatting and kneeling. Ergonomic-Related Injuries/Illnesses According to the Bureau of Labor and Statistics (2001) baggage handlers and airlines had the highest total recordable injury rate of all industries. With an injury rate exceeding 13 injuries per 100 employees in 2001, working at the airline is more hazardous than basic steel production, lumberjacking, heavy construction, and more than double the average of all industries in the private sector combined (BLS, 2001). That number has decreased to 8.5 injuries per 100 employees in 2009 according to the BLS, though still amongst the highest in the industry. Ergonomic risk factors associated with the lifting techniques in the aviation industry cover all aspects of employee injury; however, for this study the injuries most concerning are 19
shoulder and lower back musculoskeletal disorders. Musculoskeletal disorders (MSDs), often referred to as ergonomic injuries, are injuries or illnesses affecting the connective tissues of the body such as muscles, nerves, tendons, joints, cartilage, or spinal disks (Bureau of Labor and Statistics, 2007). It is well accepted that the manual handling of work is probably associated with work-related lower back disorders (Yeung, et al., 2003). Among the physical risk factors, scientific evidence indicates manual lifting as a strong predictor of the development of low back complaints at work (Hoozemans, et al., 2008). Hand and wrist, neck, and elbow (Epicondylitis) disorders are contributing factors and should not be overlooked however the majority of lifting injuries are to the shoulders and back. There is evidence for a positive association between highly repetitive work and shoulder MSDs (National Institute for Occupational Health and Safety, 1997). The National Institute for Occupational Health and Safety stated that prior to 1997 there had only been three studies that specifically addressed shoulder tendinitis. These studies involve combined exposure to repetition with awkward shoulder postures or static shoulder loads (NIOSH, 1997). Repetitive motion is a persistent and continual movement that can cause localized musculoskeletal injuries or illness. This type of motion is a large part of the luggage handlers duty during the loading process of the cargo bins. Awkward shoulder and back postures are a result of the height restrictions these employees face while performing lifting techniques inside the cargo bins. Since the shoulder is the most mobile joint in the human body, the cost of such versatility is an increase risk of injury (Quillen, et al., 2004). Although low back pain is the most common disabling musculoskeletal symptom, there is little understanding regarding the risk factors (Frymoyer, 1983). A lower back strain occurs when the muscle fibers are abnormally stretched. Lower back sprains occur when the ligaments 20
are torn from their attachments. These two conditions can occur from flexion of the back during improper lifting techniques, awkward trunk posture, improper lifting techniques, unilateral foot coupling and lifting heavy objects away from the body. Awkward trunk posture is the most prevalent of these five distinct movements and positions all of which are typical to the loading processes of luggage inside cargo bins. Awkward trunk postures, such as flexion, lateral bending, and twisting, increase the likelihood of back injuries, particularly during lifting (Keyserling, et al., 1991). Task Analysis Methods of collecting, classifying and interpreting data on human performance in work situations lie at the very root of ergonomics. Task analysis, as these methods are collectively known, reflects both our current understanding of human performance and the design of systems that best serve the needs of human users (Annette & Stanton, 1998). The job task analysis is a process by which a task is broken down into its component parts and produces three important tools, task lists, job breakdowns and job performance standards (Andrea, 2009). Task analysis is the big picture, by breaking a task down into smaller components you can begin to determine root causes. For this study a smaller component of a task analysis, an ergonomic job analysis, will be studied. Ergonomic Job Analysis Ergonomic job analysis is an open-ended process that involves detailed inspection, description, and evaluation of the workplace, equipment, tools, and work methods (Keyserling, et al., 1991). There are multiple tools available for a job analysis in assessing the lifting techniques, body positions and forces needed to perform the required functions inside the cargo bins. All assessment tools are used to determine the extent of the present symptoms. These tools 21
include the rapid upper limb assessment (RULA), the rapid entire body assessment (REBA), the national institute for occupational safety and health equation (NIOSH), digital inclinometer, and the hydraulic push-pull dynamometer. These ergonomic job analysis methods measure the body positioning and movement performance required during normal luggage loading procedures. Rapid Upper Limb Assessment (RULA). The RULA method has been developed by Dr. Lynn McAtamney and Professor E. Nigel Corlett, ergonomist from the University of Nottingham in England (see Figure 1). Rapid Upper Limb Assessment is a survey method developed for use in ergonomic investigations of workplaces where work related upper limb disorders are reported (McAtamney, 1993). A RULA assessment gives a quick and systematic assessment of the postural risk to a worker (Cornell University Ergonomics Web, 2010). Since the RULA method needs no specialized tools, minimal training can be provided to employees to perform the ergonomic based assessments. The RULA method is a quick method for determining upper body posture risks to employees which uses diagrams of body postures and scoring tables to evaluate risk exposure factors. Completing a RULA on a job task prior to making changes will give you a risk factor for comparison. Once changes to the job task have been implemented a post RULA should be performed to determine if the changes made have lowered the risk factor. Risk factors addressed on this form are: Force Abduction and Adduction Pronation and Supination Flexion and Extension Static Muscle Work 22
Figure 1. Rapid Upper Limb Assessment Worksheet
Rapid Entire Body Assessment (REBA). The REBA was developed by Dr. Sue Hignett and Dr. Lynn McAtamney in 1993 to associate the risk of musculoskeletal injury with the recorded postures (see Figure 2). Rapid Entire Body Assessment has been developed to fill a perceived need for a practitioners field tool, specifically designed to be sensitive to the type of unpredictable working postures found in health care and other service industries (Hignett & McAtamney, 2000). According to Hignett and McAtamney the development of REBA was aimed to: Develop a postural analysis system sensitive to musculoskeletal risks in a variety of tasks. 23
Divide the body into segments to be coded individually, with reference to movement planes. Provide a scoring system for muscle activity caused by static, dynamic, rapid changing, or unstable postures. Reflect that coupling is important in the handling of loads but may not always be via the hands. Give an action level with an indication of urgency. Require minimal equipment pen and paper method (Hignett & McAtamney, 2000). The REBA is a worksheet used to assess entire body movements during specific tasks. The worksheet is a good tool when looking at movements such as the neck, trunk, legs, upper arms, lower arms, and wrists. There is only minimal input needed which tends to be a weakness when looking at risk factors. The number system used to rank the severity of hazards works well with this assessment tool as long as the values are only used for the intended job task. This tool may not take into account all aspects of the task being performed; however it does provide a starting point where the highest potential for injury can occur.
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Figure 2. Rapid Entire Body Assessment Worksheet
NIOSH lifting equation. The NIOSH lifting equations is a tool used to identify, evaluate or classify risks associated with a lifting task. This equation will calculate the Recommended Weight Limit (RWL) and the Lifting Index (LI). The RWL is the recommended weight of the load that nearly all healthy workers could lift over a period of time (up to eight hours) without an increased risk of developing lifting related low back pain or injury, given all other task parameters remain unchanged. The LI is a relative estimate of the physical stress associated with a manual lifting job. As the magnitude of the LI increases, the level of the risk for a given worker increases, and a greater percentage of the workforce is likely to be at risk for developing lifting-related low back pain. This tool is used for: 25
Estimating the risk of a two-handed, manual lifting task. Evaluating a job characterized by multiple lifting tasks. Evaluating a lifting task that may include trunk rotation, different types of hand coupling, repetitiveness, and duration. Determining a relatively safe load weight for a given task. Determining a relatively unsafe load weight for a given task. Deciding the appropriate style of abatement for a job that has been identified as having a lifting hazard. Comparing the relative risk of two lifting tasks. Prioritizing jobs for further ergonomic evaluation (Ergoweb, 2010). Key variables for the NIOSH lifting equations are Load Constant (LC), Horizontal Multiplier (HM), Vertical Multiplier (VM), Distance Multiplier (DM), Asymmetric Multiplier (AM), Frequency Multiplier (FM), and Coupling Multiplier (CM). Ergonomic Controls To reduce injury, we must reduce hazards and at-risk behaviors. Once hazards are identified they should be reduced or eliminated. This can be done by either designing engineering controls, administrative controls or training, and finally if none of the above controls are possible, personal protective equipment should be used (Roberts, 2007). Engineering controls are used to eliminate the risk of injury by redesigning the process or the equipment. Administrative controls eliminate or reduce the risk of injury by removing the worker from the process. Personal protective equipment is used to reduce the hazards an employee is exposed to, but does not eliminate the hazard. For this control to be effective, the employee must adhere to use, care and training for each PPE used. 26
Engineering Controls Engineering controls are the most preferred method for controlling ergonomic risk factors because they are more permanent and effective (OCAW, 2010). Engineering controls are physical changes to workstations, equipment, facilities, or production that reduce or prevent an employees exposure to risks. Engineering controls include modifying, redesigning or replacing: Work stations and work areas Materials/objects/containers design and handling Hand tools used Equipment (OWAC, 2010) Engineering controls tend to be the most effective form to reduce workplace hazards, employee hazards, and overall risk, however this form tends to be time consuming and more expensive than the other two. Engineering controls utilize an engineer to redesign the equipment or process to fit the individual needs of the employees. Engineering control strategies used to reduce the ergonomic risk factors can include the following: Modifying tables to adjust in height to meet the needs of all employees. Modifying working surfaces to tilt toward an employee. This will allow individuals to work on a surface in a more natural posture. Reducing or eliminating the use of hand tools and changing them to low vibration power tools. The use of a hydraulic lifting devise to eliminate the need for employees to manually lift items above their shoulder, away from there body or in awkward positions. Designing a work area that is uncluttered, and creates a streamline process. This will eliminate or reduce excess manual lifting or moving of products. 27
Employees are a key asset to the implementation of engineering controls due to there knowledge of the processes, materials and job demands. The utilization of employees during the design phase, the testing phase and the rollout phase can help to ensure employee acceptance and to insure the needs of the employees are met. Administrative Controls Administrative control is defined as any procedure that significantly limits daily exposure by control or manipulation of the work schedule or manner in which work is performed (Workrite, 2010). Administrative controls include but are not limited to: Job rotation, use of rest breaks or alternative tasks. Job enlargement to increase task variability. Redesign of work methods. Adjustment of work pace or number of repetitions (Workrite, 2010). Reduction of overtime. Training. Although engineering controls is the preferred method of reducing work place hazards, administrative controls can be effective when it is impossible to engineer out a hazard. An example where engineering controls would not be the preferred method would be the cargo bins of commercial airlines. You can not make the cargo bins taller with out redesigning the entire fuselage of the aircraft, if you make the fuselage larger you need larger engines, larger engines require more fuel and so on. In this example engineering controls are not feasible, with the preferred methods being administrative controls and Personal Protective Equipment (PPE). 28
Personal Protective Equipment (PPE) Personal Protective Equipment is any item worn by an employee that would help reduce or control the risk factors while performing their job duties. Respirators, ear plugs, safety goggles, chemical aprons, safety shoes and hard hats are all examples of PPE. This method should be used as a principle means of control only as a last resort when neither engineering nor administrative controls are possible, or in the event of an emergency (OCAW, 2010). This type of control does not reduce the hazard it only offers a barrier between the employee and the hazard. The most effective method of reducing or eliminating ergonomic hazards is to fix the hazard, not the worker, through engineering or administrative controls (OCAW, 2010). Summary Restricted posture lifting, repetition, forceful lifting, overexertion, frequent heavy lifting, pulling and pushing effect the human body differently; however each can be attributed to the onset of musculoskeletal disorders. This disorder is of great concern for the aviation industry where engineering controls are limited. This industry must rely on administrative controls, employee self monitoring and PPE to effectively reduce the injury rate. There are three distinct assessment methods used in this study, RULA, REBA and the NIOSH lifting equation which are essential for creating a baseline for comparison after the controls have been implemented. In correlation with these assessment tools, ergonomic instruments such as the manual goniometer, video analysis, digital inclinometer, and the hydraulic push pull dynamometer are used insure the assessment methods are properly compiled. Once the exposures and risks have been identified and evaluated establishment of the hierarchy of control are used to reduce or eliminate the risk exposures. The hierarchy of controls include, engineering controls, administrative controls and personal protective equipment. The 29
least effective of the controls are the personal protective equipment. Although PPE provides a barrier between the employee and the work hazard it does have some drawbacks. Theses drawbacks come from the employees willingness to participate and accept the changes, recommendations and guidelines. The use of quantitative and qualitative assessments will allow this company to reduce the risk exposures to their employees by being able to test, analyze and recommend changes to the current work practice. 30
Chapter III: Methodology The purpose of this study is an ergonomic analysis of the current lifting techniques involved during the luggage loading process inside a commercial aircraft cargo bin at Company XYZ. In order to analyze the ergonomic risks associated with the loading process several tools will be used to determine the severity of risk factors associated with awkward postures, force, repetition and heavy lifting away from the body. This chapter will explain the subjects tested, the instrumentation used, data collection procedures, data analysis, and the limitations of the analysis. The steps of this study were as follows: A behavior observation was conducted over a two week period with out constructive interactions from the observer. Conducting a RULA, and REBA analysis and the NIOSH lifting equation to record and compare job functions and the types of motions used during the cargo bin loading process. Perform video analysis to determine flexion, extension, force and foot coupling using a manual goniometer, digital inclinometer, and hydraulic push-pull dynamometer. Subject Selection and Description There were two subjects observed and analyzed for this study. Subject 1 is a male, 46 years old, 61 tall and weighs 230 pounds. Subject 2 is a female, 40 years old, 58 tall and weighs 196 pounds. A behavior observation was conducted over a two week period without constructive interactions from the observers. Both subjects were asked to perform the same job functions of loading and packing luggage into the SAAB 340 cargo bin (see Figure 3 and Figure 4 for a visual description of the cargo bins). Both subjects are full time employees working four flights a day for five days a week. The average amount of luggage each subject moves per flight 31
is 39.33 bags with an average weight of 50 pounds per bag. Over a one year period this would amount to working 1,000 flights and packing 39,330 bags for a total weight of 983.25 tons. Subject one was observed performing luggage loading procedures in cargo bin one on his knees with maximum trunk rotation. Subject two was observed performing this same task in an erect position bending with the lower back and rotating the trunk. Since the maximum height of either cargo bin is 64 (54) both subjects were observed deviating from proper lifting techniques to accommodate the confined and restricted space.
Figure 3. Top view of cargo bins one and two.
32
Figure 4. Three dimensional side view of cargo bins one and two. Instrumentation The specific tools used in this study include the RULA assessment survey, the REBA assessment survey, the manual goniometer, a behavior observation, hydraulic push-pull dynamometer and the NIOSH lifting equation. The two assessment surveys used in this study are essentially alike, though each focuses on different adherent risks. They all rate movements of the body to determine the potential severity of a work process, assign a number rating and a risk level. For this study one survey would suffice however all three were used to compare the findings for accuracy. The REBA focuses on the entire body with an emphasis on flexion and extension. The RULA focuses on the muscular effort which is associated with posture, force, and static or repetitive work which may contribute to muscle fatigue on the upper limbs. The final scoring system of each tool will yield different numbers and scoring categories, but they should conclude similar recommendations and outcomes. A behavior observation was conducted over a two week period with out constructive interactions from the observers. This observation was non invasive, offered no opinions and 33
fielded no questions. The observation was strictly used to study the current work habits of the two subjects during normal operating procedures. The results from the behavior observation exercises will help the researcher determine the ergonomic risk factors that are present in Company XYZs cargo bin loading process. The NIOSH lifting equation is a tool for assessing the physical stress of a two handed manual lift task. As with any tool, its application is limited to the conditions for which it was designed (Ergoweb, 2010). Although this equation was not designed to assess tasks in a constrained or restricted work space, it was still performed to help validated the other surveys. Three instruments will be used to produce ranges of motion, postural angles, and forces exerted to load luggage inside the height restrict cargo bins of Company XYZ. The manual goniometer is similar to a protractor which is used to determine postural angles. The digital inclinometer is another tool used to determine postural angles. These two tools used to measure postural angles where compared to each other to verify the accuracy of the angles observed and recorded. The hydraulic push pull dynamometer measures the amount of force needed to lift push or pull an object and can only take measurement in one direction at a time. Data Collection Procedures Completing the REBA Survey. The following are recommended steps for the proper completion of a REBA survey. 1. Observe the entire task procedures to become familiar with the work practices. 2. Posture, force, coupling, duration and repetition activities involved with the loading process inside the cargo bins will be selected and recorded in the appropriate boxes. 3. Postures are scored and totaled for sections A and B. 4. Sections A and B are then combine to form a single score. 34
5. An activity score is then calculated. 6. The final REBA score combines table C score with the activity score. 7. Changes to procedures or action levels are determined by the final score. 8. Risk levels are based on the final REBA score and range from negligible, low, medium, high and very high. 9. Complete another REBA survey after desired changes have been made to determine if those changes reduced or eliminated the risks identified. Completing the RULA Survey. The following are recommended steps for the proper completion of a RULA survey. 1. Observe the entire task procedures to become familiar with the work practices. 2. The part of the job duty to test is identified which includes the postures to assess. 3. The observer will score the postures and forces on the RULA diagrams for the postures of each chosen body part. 4. Scores are then put into a table by following the instructions listed on the RULA score sheet. 5. Changes to procedures or action levels are determined by the final score. 6. Complete another RULA survey after desired changes have been made to determine if those changes reduced or eliminated the risks identified. NIOSH Lifting Equation. The NIOSH lifting equations is a tool used to identify, evaluate or classify risks associated with a lifting task. The NIOSH Lifting Equation will calculate the Recommended Weight Limit (RWL) and the Lifting Index (LI). The RWL is the recommended weight of the load that nearly all healthy workers could lift over a period of time (up to eight hours) without an increased risk of developing lifting related low back pain or injury, 35
given all other task parameters remain unchanged. The LI is a relative estimate of the physical stress associated with a manual lifting job. As the magnitude of the LI increases, the level of the risk for a given worker increases, and a greater percentage of the workforce is likely to be at risk for developing lifting-related low back pain. From the NIOSH perspective, it is likely that lifting tasks with a LI > 1.0 pose an increased risk for lifting-related low back pain and injury for some fraction of the workforce. NIOSH considers that the goal should be to design all lifting jobs to achieve a LI of 1.0 or less. This tool is used for: Estimating the risk of a two-handed, manual lifting task. Evaluating a job characterized by multiple lifting tasks. Evaluating a lifting task that may include trunk rotation, different types of hand coupling, repetitiveness, and duration. Determining a relatively safe load weight for a given task. Determining a relatively unsafe load weight for a given task. Deciding the appropriate style of abatement for a job that has been identified as having a lifting hazard. Comparing the relative risk of two lifting tasks. Prioritizing jobs for further ergonomic evaluation (Ergoweb, 2010) Key variables for the NIOSH lifting equations are Load Constant (LC), Horizontal Multiplier (HM), Vertical Multiplier (VM), Distance Multiplier (DM), Asymmetric Multiplier (AM), Frequency Multiplier (FM), and Coupling Multiplier (CM) This study used the RULA, REBA and the NIOSH lifting equations and four ergonomic instruments to collect and review the data. These methods included the Hydraulic Push-Pull Dynamometer to determine the force needed to lift an object of known weight. The digital video 36
recorder to assess repetition, duration, body posture, hand coupling, uni-lateral and bi-lateral foot placement. A digital camera was used to capture body posture, and then used those digital photos to access angles of body posture by using the goniometer and digital inclinometer for spine angle flexion. Data Analysis Manual Goniometer/Video Analysis/Digital Camera. The manual goniometer used in this study was for the purpose of measuring the total flexion and extension angles of the back. A goniometer is used to measure, in degrees, active or passive joint range of motion. This is pertinent to workplace design and functional reach. It can also measure progress in return of range of motion after an injury (Michael, 2002). This tool is useful in the determination of the exact range of motion and when combined with the use of video or digital pictures can track the full range of motion through the entire process. Comparing the data recorded in the study using the goniometer to reasonable range of motion limits you are able to determine if limits were exceeded. Video analysis is the process of using a camera or digital video recorder to tape the loading process. Multiple angles should be taped in order to get the most accurate joint angles, extensions and flexions. Using a video recorder will allow the research to study the process in real time speed or reduced speed. This also assists the researcher in breaking down the step by step processes. 1. Observe the entire task procedures to become familiar with the work practices. 2. Set two video recorders up one at a ninety degree angle and one directly behind the two subjects as they performed their job tasks. Record the movements performed during the loading procedures. 37
3. Take digital photos throughout the loading process to help determine angles of extension, flexion, abduction, adduction and reach. 4. Measure the joint angle by aligning the fulcrum of the goniometer with the fulcrum of the joint to be measured. 5. Align the fixed arm of the goniometer with the limb being measured. 6. During the movement of the joint note the beginning point and the end point of the joint being measured. 7. The degree between the beginning point and the end point determines the entire range of motion. 8. A video monitor will be used to review the data and to help determine joint range of motion and joint angles. Digital Inclinometer. The digital inclinometer is an instrument for measuring angles of slope and inclination of an object by creating an artificial horizon. For this study the digital inclinometer was used to determine angles of the back and neck during standing loading operations in the height restricted cargo bins. Hydraulic Push-Pull Dynamometer. The Hydraulic Push-Pull Dynamometer was used to determine the amount of force that each employee had to exert when lifting a piece of luggage while performing the cargo loading tasks inside the height restricted cargo bins. This device usually embodies a spring to be compressed or weight to be sustained by the force applied, combined with an index, or automatic recorder, to show the work performed (Michael, 2002). This is an essential part of this research since force, repetition and awkward angles in and of themselves may not cause injury, however in combination will greatly increase the risk of injury. The procedure used is as follows. 38
Hook the force gauge to a known object weighing 50 pounds (average weight of a piece of luggage) and measure the force required for subjects one and two to lift that object. Limitations This study is limited to only the lifting techniques inside the cargo bins of a commercial aircraft. No considerations will be made for lifting techniques outside the defined research area. This study is limited to a specific time frame for observation and data collection. Since the turn time of the aircraft used in the study is only 20 minutes all data collection had to be conducted during this time. Turn time by definition is the amount of time it takes to service the aircraft from off loading passengers and luggage to on loading passengers and luggage or from the moment the brakes are set to the time they are released. Other limitations to this study are the security requirements set by the Federal Aviation Administration, Company XYZ security department and the airport authorities. The subjects tested must be willing participants who perform their duties in the same fashion as if they were not being studied. This study is only for the purpose of identifying alternate lifting techniques to be used in the height restricted spaces of a commercial aircraft cargo bin. These techniques will offer alternate methods of properly lifting to reduce the risk exposures, lower the back and shoulder strains and sprains and to provide guidance for training exercises. Summary This chapter contained the purpose of the methodology, how the data was collected and how that collected data was analyzed. The redundancy in data collection was to verify and compare findings for accuracy and to be able to show that multiple testing procedures can result in similar findings. 39
Chapter IV: Results The purpose of this study was to analyze current lifting techniques inside the height restricted cargo bins at Company XYZ in order to determine the extent that ergonomic-based risk factors are present. The results of this study directly addressed the three main objectives: 1. Conduct an analysis of safety metrics of Company XYZ to better understand their safety related performance and historical trends. 2. Conduct a review of national aviation accidents statistics to use as a basis for comparison to Company XYZ. 3. Conduct task analysis of manual material handling activities performed by employees in height restricted cargo bins at Company XYZ. Objective One To conduct an analysis of safety metrics of Company XYZ to better understand their safety related performance and historical trends. For this objective four years were collected for a fair comparison with the industry average and to understand any trends. The total recordable case rate (TRCR) as well as the days away restricted or transfer rate (DART) for Company XYZ is listed in Table 1 and was obtained from the OSHA website. 40
As you can see in Table 1 the TRC rate and the DART rate mirror each other. If the TRC rate goes up from the previous year so too does the DART rate. Both these rates are reactive loss or lagging indicators which are after-the-fact measurements that gauge past performance. This reactive approach provides better administration and temporary relief, but the effort and investment must continue indefinitely because the root causes of the injuries are never addressed (EHS Today, 2010). This type of measurement is dependent on incidents to drive their safety activities and may reflect no more than random fluctuations and is not a valid indicator of safety improvement (Dial, 1992). Table 1 Company XYZs Performance Trends
Year
TRCR
DART
2007
2006
2005
2004
15.22
17.72
20.33
13.33
12.24
13.97
15.62
11.04
Objective Two Conduct a review of national aviation accidents statistics to use as a basis for comparison to Company XYZ. In Table 2 the total recordable case rate is compared for all employees in the aviation industry for the same time period as Company XYZ. These average industry rates are for organizations of greater than 1000 employees to have an accurate comparison with Company XYZ. These rates were all obtained from the Bureau of Labor and Statistics (BLS). Again, 41
these are reactive loss or lagging indicators which are after-the-fact measurements that gauge past performance. As you can see in Table 2 the TRC rate and DART rates for the industry average do not fluctuate as greatly, this is due to the large amounts of data used for the calculation in the national industry average. Table 2 Industry Average
Year
1000+ Employees TRCR
100+ Employees DART
2007
2006
2005
2004
10.6
10.6
10.3
10.6
8.2
8.5
7.9
8
Table 3 compares the industry average TRCR to Company XYZs TRCR for the years of 2004-2007. This side by side comparison clearly shows that Company XYZ is consistently higher than the industry average for companies of similar size. The TCR considers only incidents in which workdays were lost and is another reactive measuring tool. As you can see in Table 3, the industry average for TRC rate stayed relatively flat, where as Company XYZs TRC rate fluctuated considerably. Incident rates take on more meaning for an employer when the injury and illness experiences of their firm is compared with that of other employers doing similar work with 42
workforces of similar size (Bureau of Labor and Statistics, 2010). With this side by side comparison it is easy to see where Company XYZ compares to the industry average. As you can clearly see between 2004 and 2005 the industry average went down, where as Company XYZs rates jumped considerably. The same holds true for 2005 to 2006 where the industry average when up but Company XYZs average when down. Table 3 TRCR Comparison Total Recordable Case Rate (TRCR)
Year
Industry Average
Company XYZ
2007
2006
2005
2004
10.6
10.6
10.3
10.6
15.22
17.72
20.33
13.33
Table 4 compares the industry average DART rate to Company XYZs DART rate for the years of 2004-2007. The DART rate looks at the amount of time an injured employee is away from his or her regular job. This side by side comparison clearly shows that Company XYZ is consistently higher than the industry average for companies of similar size. This table also shows that Company XYZ has made some improvements; the numbers do not mirror the industry average. As you can clearly see between 2004 and 2005 the industry average went down, where as Company XYZs rates jumped considerably. The same holds true for 2005 to 2006 where the industry average when up but Company XYZs average when down. 43
Table 4 DART Rate Comparison Days Away Restricted or Transfer (DART)
Year
Industry Average
Company XYZ
2007
2006
2005
2004
8.2
8.5
7.9
8
12.24
13.97
15.62
11.04
Objective Three Conduct task analysis of manual material handling activities performed by employees in height restricted cargo bins at Company XYZ. These qualitative tools consisted of the RULA, REBA and NIOSH lifting equation. The RULA was used for the on load and off load process of the male subject in the kneeling position. The REBA was used for the on load and off load process of the female subject in the erect position. The NIOSH lifting equation was used for both subjects to determine the lifting indexes for both individuals. The following are the results of the analysis. RULA (Rapid Upper Limb Assessment). The RULA Survey was used in determining the major risk factors of the kneeing position job function. This evaluated the neck, trunk and legs postures, with a score of greater than 7 for this body posture. The agents knees are directly on the floor, his legs flexed 90 degrees, his back in an up right neutral position with his body perpendicular to the front (left) side of the cargo bin. The agents arms are up against his trunk 44
in a neutral position. A bag is placed parallel to his body approximately 12 to 14 inches in front of him with the handle up. With both arms in a neutral position, he extends his right shoulder and upper arm forward, flexes his elbow approximately 90 degrees, pronates his forearm and in a pronation hand position uses a power grip to grasp the top handle. He extends his left shoulder and upper arm forward and down, supinates his left forearm and with a supination hand position cradles the middle lower part of the bag. The hands, forearms and elbows are in an adducted position with the trunk in a neutral position. The agents forearm is 14 inches long creating a 4.66 to 1 ratio and generating 233 pounds of upward force. The bag is lifted up approximately 10 inches off the ground parallel to his body. In one motion, he rotates his forearms and wrists clockwise into a neutral position, with his elbows flexed approximately 90 degrees and brought back to a neutral position. He twists his trunk clockwise approximately 40% ROM, extends his shoulders and arms, with extension of his wrists into an ulnar deviated position. His thoracic and lumbar areas of his back are flexed 15 to 20 degrees, with both elbows slightly abducted. The bag is now parallel to the floor. As the agent lowers the bag to the floor, he flexes his thoracic and lumbar areas of his back, he extends his shoulders forward, has full ulnar deviation of both wrists and both elbows abducted. Once the bag has been set down, both hands release and return to a neutral position. The thoracic and lumbar areas return to a neutral position along with the shoulders, upper arms and forearms. This is a repetitive task which occurs approximately 40 times over a 10 minute period. REBA (Rapid Entire Body Assessment). This assessment was used on the female employee in the erect position. After the assessment on this job task, the analysis found that this job is in the High risk level (REBA score is 9). The erect body position of this job function found that both right and left upper arms were in 45 ~ 90 degree flexion position. Also, both 45
right and left lower arms were in between 60 degree to 100 degree flexion. Due to the height of cargo bin (64 inches), the agent was forced to flex her neck 20 degrees or greater throughout entire task. Her legs were in a bilateral foot coupling with over 30 degree knee flexion. She did deviate both her wrists over 15 degrees of flexion/extension. Both shoulders were raised between a 45 to 90 degrees angle when lifting each baggage. Because of the different styles and shapes of the baggage, the analysis of this was rated as a fair risk level. NIOSH Lifting Equation. Using the NIOSH lifting equation the following was determined: 1. NIOSH lifting equation analysis for the male worker in a kneeling position i. LC (51LB) * HM (10/13) * VM (1-(.0075*[10-30])) * DM (.82 + (1.8/36) * AM (1-(.0032*45) * FM (.97) * CM (1.00) ii. RWL=24.08 iii. Lifting Index = 2.076 2. NIOSH lifting equation analysis for the female worker in a standing position i. LC (51LB) * HM (10/24) * VM (1-(.0075*[1-30])) * DM (.82 + (1.8/60) * AM (1-(.0032*45) * FM (.41) * CM (1.00) ii. RWL= 7.717 iii. Lifting Index = 5.966 Key variables for the NIOSH lifting equations are Load Constant (LC), Horizontal Multiplier (HM), Vertical Multiplier (VM), Distance Multiplier (DM), Asymmetric Multiplier (AM), Frequency Multiplier (FM), and Coupling Multiplier (CM). Additional task analysis tools used for objective three were video recording and digital pictures to analyze various body positions, angles, and rotations. These were measured and 46
determined by using a manual goniometer, digital inclinometer, and hydraulic push-pull dynamometer. The results of the video and digital analysis are as follows. Posture. Various postural issues associated with the baggage handling were identified through visual, video and digital analysis. Kneel: o Due to the height of cargo space, the male employee in this study was forced to kneel both of his knees at 90 degree. o The kneeling posture without using knee pads places static stress on male employees skeletal and muscular system which can result injuries such as Bursa Inflammation. Bursa inflammation is caused by repetitive kneeling and crawling on the knees. The bursa or space between the skin and kneecap becomes inflamed and fills with fluid. It is a localized injury and does not involve the knee itself. o Also due to the height of cargo space, female employee in this study sometimes needs to flex her knees down to reach baggage. Flexion on neck: o Due to the height of cargo space, female works was forced to flex her neck at 20 ~ 30 degrees when performing tasks. o Constant flexion of female employees neck at 20 degrees while carrying heavy objects compresses her nerves and blood vessels between neck and shoulder and can result in Thoracic Outlet Syndrome.
47
Flexion on spine: o Female employee flexes her spine at between 80 ~ 100 degrees to reach the baggage on the cargo floor. Also, the female employee constantly flexed her spine about 20 degrees in the confined cargo space. o Repetitively flexing the spine can result various back injuries. This type of posture should be avoided or minimized whenever possible. Finger press: o Both male and female employees were placing and packing the baggage by using either or both hands/finger to press baggage down or forward. o Both male and female employees overexert their palms and fingers to press luggage forward and down. This can cause their synovial sheath to become swollen, whereby the tendon becomes locked in the sheath. Eventually, it will cause cumulative trauma disorder like Trigger Finger. Abduction of both arms: o In order to reach and pack the baggage, both female and male employees had both arms abducted between 70 ~ 100 degrees to reach the luggage. o Excessive abduction of both arms during the reaching and packing of the luggage can cause Medial Epicondylitis by overuse of the flexor muscles. 48
Power Grip: o This posture was found on both female and male employees. Unilateral foot coupling: o This body posture was found only in the female employee. This caused extra weight to be placed on the right leg and foot. o Bi-lateral foot posture was found in the video analysis of the female employee. This type of posture is not suggested due to the extra amount of weight placed on the legs skeletal and muscular system. Trunk rotation: o In two of the video clips analyzed, the male worker tended to rotate his trunk more frequently than the female. This type of posture should be limited, avoided or greatly minimized. o High frequency of trunk rotation posture in the male compresses the spinal disc. Overuse of the trunk muscles is not suggested and should be avoided or greatly minimized. Hydraulic Push-Pull Dynamometer. This was used to determine the amount of force that each employee has to exert to perform the cargo loading task. It was determined that 50 pounds of upward force was needed to lift an average 50 pound piece of luggage. The upward force generated from length of the forearm was calculated and is as follows. For the female in a standing position, 183 lbs of upward force is generated from the equation or a 3.66 to 1 ratio. For the male in the kneeling position, 230 lbs of upward force is generated from the equation or a 4.66 to 1 ratio. 49
Posture Repetition. The rate of lifting is approximately 16 times per minute for the male workers and eight times per minute for the female worker. The average loading time for entire process is 15 minutes. Therefore, the total time frame for the lifting activity is 240 times for the male and 80 times for the female. Table 5 shows the average repetitions of the potential ergonomic postures and movements as determined from video analysis. Table 5 One Minute Repetition Average Repetitions Per Minute Male Female
Trunk Rotation
Trunk Flexion
Trunk Extension
Finger Press
Abduction
Power Grip
Unilateral Foot Coupling
6
2
4
13
13
15
0
1
10.5
4
8
16
8.5
3.5
Duration of work performed. Each full time employee works four flights per day, with an average time for each flight being 15 minutes for the loading process. Employees are exposed to heat and cold stress when performing cargo loading tasks, during the winter months cold stress can be up to 30 minutes in duration. The average duration at any given point ranges from zero to 15 minutes for these loading tasks. This depends highly on the number of bags that need to be loaded into the cargo bin; this is the short term duration. Long term duration for a full time 50
employee working four flights per day, 1,000 flights per year, would be moving approximately 39,330 bags one time or 983.25 tons. Discussion The results of the methodology used in this study indicate that there are a variety of ergonomic risk factors the workers are subjected to while performing lifting techniques inside a height restricted cargo bin. Although Company XYZ does not have the ability to engineer these risk factors out due to the design of the aircraft, they do have administrative controls in place. These include training on proper lifting techniques, training on proper stretching techniques, and a program that requires stretching to be completed prior to each loading event. A discussion of the REBA and RULA assessment methods and NIOSH lifting equation will demonstrate how the data from each method closely correlates. The REBA was performed on the female subject during the loading process from an erect position. A REBA score of nine was determined by video analysis which correlated with unilateral foot coupling, neck flexion, back flexion and rotation and adductions of the arms and shoulders. This score of nine puts these job function movements in a high risk for MSD and should be investigated further with changes happening soon. Due to bi-lateral foot coupling fixed or constraint posture is occurring. Splittstoeser, et al., (2007) stated that forces from the active trunk muscles are the primary determinant of spinal load, increased muscle loading associated with restricted postures impose increased spinal loading. Fixed or constrained posture is a body position that overloads muscles and tendons or loads joints in an uneven or asymmetrical manner, typically from the deviation of the neutral positions of the different body parts. Like the results of the RULA assessment, Keyserling, et al. (1991) determined that awkward trunk postures, such as flexion, lateral bending, and twisting, increase the likelihood of 51
back injuries, particularly during lifting. The particular injuries discussed were lower back strains and sprains. The RULA was performed on the male subject during the loading process from a kneeling position. A RULA score of seven was determined by video analysis which directly correlated with the repetition of back rotation, shoulder abduction during rotation while lifting heavy objects above the chest and high knee pressure. Shoulders lifting above chest identified that the arms, elbows, and wrists are at a high risk for developing MSDs due to the abducted arm postures, and the flexion and extension of the wrists. This score indicates that further investigation should take place and a change should be made immediately. The risk factors that have been identified by this assessment method correlate with the information discussed in Chapter Two of this study by Keyserling, et al. (1991). There is also evidence for a positive association between highly repetitive work and shoulder MSDs (National Institute for Occupational Health and Safety, 1997). Repetitive motion is a persistent and continual movement that can cause localized musculoskeletal injuries or illness. This type of motion is a large part of the luggage handlers duty during the loading process of the cargo bins. Awkward shoulder postures are a result of the height restrictions these employees face while performing lifting techniques inside the cargo bins. The NIOSH lifting equation was performed on both subjects to give a quick determination of which lifting technique is the least harmful. It was determined that kneeling was the least detrimental. This analysis discovered that there are numerous inherent risks involved in lifting inside the height restricted cargo bins. The most prevalent as determined by the RULA and REBA are back and neck sprains and strain, and shoulder disorders. 52
Chapter V: Summary, Conclusions and Recommendations The aviation industry has one of the highest rates for back strains, shoulder strains and long term MSDs. Company XYZ has experienced a higher than industry average injury rate due to the limited height in the cargo bins and the restricted posture lifting. The continued presence of higher than industry average back and shoulder strains and sprains in the height restricted cargo bins at Company XYZ is placing the organization at risk of incurring continued employee injury and other workers compensation related forms of loss. Therefore the purpose of this analysis is to determine the root causes of back injuries sustained during the loading process inside the height restricted cargo bins. From this root cause analysis an ergonomic solution can be derived to help reduce the severity of back injuries or ultimately eliminate them. In order to achieve this purpose, three goals were developed: 1. Conduct an analysis of safety metrics of Company XYZ to better understand their safety related performance and historical trends. 2. Conduct a review of national aviation accidents statistics to use as a basis for comparison to Company XYZ. 3. Conduct task analysis of manual material handling activities performed by employees in height restricted cargo bins at Company XYZ. Methods and Procedures The methodology used for objective one was the collection of four years of historical DART and TRC rates. These rates were critical for determining trends with in Company XYZ and were used for a fair comparison with the industry average. Objective two was to collect the comparable four years of data as in objective one. This was necessary for a fair comparison between Company XYZ and the industry average. Once the data from objective one and two 53
had been collected a table was created to show side by side trends for the DART and TCR rates over the same four years. For objective three the methodology was to collect data through an initial behavior observation which was conducted over a two week period with out constructive interactions from the observer. During this observation video and digital photo were taken and later analyzed to determine flexion, extension, force and foot coupling using a manual goniometer, digital inclinometer, and hydraulic push-pull dynamometer. Forces applied during the lifting tasks were measured using a hydraulic push-pull dynamometer. The manual goniometer used in this study was for the purpose of measuring the total flexion and extension angles of the back, and the digital inclinometer was used to measure angles of slope and inclination of an object. Conduct a RULA, and REBA analysis and the NIOSH lifting equation to record and compare job functions and the types of motions used during the cargo bin loading process. The Rapid Upper Limb Assessment (RULA) and the Rapid Entire Body Assessment (REBA) techniques were performed by observing the participants, and inputting the identified force and posture angles into the REBA and RULA assessment techniques. The NIOSH lifting equation was also used to identify, evaluate and classify risks associated with a lifting task. Although this equation was not designed to assess tasks in a constrained or restricted work space, it was still performed to help validated the other surveys. Major Findings Objective one was a year over year comparison of TRC and DART rates from 2004 through 2007. From the data collect it was found that 2004 was the lowest year for both rates, the following two years the rates climbed and then began to drop in 2007. Although the rates began to decline in 2007 the numbers were still significantly higher than the rates of 2004. The 54
results of these numbers indicate that work still needs to be done to determine the specific reasons for each years rise or decline in rates. For objective two the industry average was compared to Company XYZs TRC and DART rates. The findings from the side by side comparison show that Company XYZ is significantly higher in both rates and did not follow the industry trend. These numbers may reflect the fact that Company XYZ operates smaller sized aircraft with height restricted cargo bins. Object three the RULA Survey was used in determining the major risk factors of the male employee in the kneeing position job function. This evaluated the neck, trunk and legs postures, with a score of greater than 7 for this body posture, which indicates that further investigation is needed and immediate change should be implemented to minimize upper extremity exposures. The REBA survey was used in determining the major risk factors of the female employee in the erect position. After the assessment on this job task, the analysis found that this job is in the High risk level (REBA score is 9), which indicates that the process needs to be investigated, and the process should be altered. The NIOSH lifting equation was performed on both test subjects while performing their preferred lifting technique. The male was evaluated in the kneeling position with a RWL of 24.08 and a lifting index of 2.076. The female was evaluated in the standing erect position and had a RWL of 7.717 and a lifting index of 5.966. The NIOSH Lifting Equation will calculate the Recommended Weight Limit (RWL) and the Lifting Index (LI). The RWL is the recommended weight of the load that nearly all healthy workers could lift over a period of time (up to eight hours) without an increased risk of developing lifting related low back pain or injury, given all other task parameters remain unchanged. The LI is a relative estimate of the physical stress associated with a manual lifting job. As the magnitude of the LI increases, the level of the risk for a given worker increases, and a greater percentage of the workforce is likely to be at risk for 55
developing lifting-related low back pain. From the NIOSH perspective, it is likely that lifting tasks with a LI > 1.0 pose an increased risk for lifting-related low back pain and injury for some fraction of the workforce. The NIOSH considers that the goal should be to design all lifting jobs to achieve a LI of 1.0 or less. Conclusions Based on the data collected in this study, the following conclusions can be made about the workers performing lifting techniques inside the height restricted cargo bins of Company XYZ: Reviewing the average DART rate and TRC rate for this industry over a four year period and comparing that to the average rates of Company XYZ the records revealed that injuries in the past four years have occurred at a considerable higher rate then the industry average. This increase in injury occurrence can be attributed to the height restricted cargo bins at Company XYZ compared to average industry cargo bin height. It has been shown that Company XYZ has a higher DART and TCR rate than the industry average which is also quite high compared to other industries. Therefore I can conclude that the industry as a whole is suffering higher injury rates due to the awkward positions needed to perform repetitive lifting during the loading process inside cargo bins. The REBA, RULA assessment tools and NIOSH lifting equation used in this study identified that the current lifting techniques used inside the height restricted cargo bins are at a high risk for the occurrence of MSDs. It is concluded from these 56
assessment tools that high repetitive awkward positions are needed for the workers to perform their job functions inside the height restricted spaces. Based on the REBA, RULA and NIOSH assessment methods, DART and TRC rates the risks associated with the current lifting techniques inside the height restricted cargo bins are repetitive motions, and awkward postures. Through the identification of past injuries, present risk factors, visual observation, it is possible to conclude that ergonomic issues are present with the process of proper lifting inside height restricted cargo bins. Ulnar deviation does exist in both the kneeling and standing job functions as proven through video and digital photos. Trunk and neck flexion exists in both the kneeling and standing job functions as proven through video and digital photos. Although there are studies on lifting techniques in height restricted spaces, this researcher found a very limited amount specific to lifting techniques inside the height restricted spaces of commercial aircraft cargo bins. From this, one can conclude that adequate information pertaining to this specific study was not available to compare this study against. Recommendations Based on the conclusions of this study and the hierarchy of controls, the following control measures are recommended to reduce the exposure of ergonomic-based risk factors and the occurrence of musculoskeletal disorders while performing lifting techniques inside the height restricted cargo bins of Company XYZ: 57
Engineering Controls Since engineering controls for the changes of cargo bin heights are not a viable option, the total elimination of back and shoulder strains is not attainable through this method. Remodeling the height of baggage carts by using hydraulic pressure to adjust the height of bed of the cart to accommodate 5 th ~ 95 th percentile height of workers. With the ability to raise and lower the height of the cart to accommodate each individual you will greatly reduce the need for lifting from below the waist, excessive flexion of the back and provide a better opportunity for two handed lifts. Modification to the belt loader to adjust the height levels at which the bags are brought into the cargo bins. This would allow the loading agents to pick the bag up at the same height that would be needed to stack the baggage in the cargo bin. Administrative Controls Administrative changes can help in the reduction of back and shoulder injuries by practicing proper lifting techniques and performing stretching exercise before performing these job functions. Pre and post stretching activities are a proven method used in the fitness industry to help reduce the chances of muscle sprains and strains. Supervisors would be required to train, monitor and inform employees that proper stretching exercise can reduce the possibility of injuries. They will be trained as a trainer and will be required to monitor this on a daily basis. 58
Proper lifting techniques. Each employee to include management will be trained on proper lifting techniques, which would include foot position, two handed lifts, one handed supported lift and lifting from a squatting position. These techniques will be monitored and enforced by direct supervisors with recurrent training required yearly. Routine medical check ups with an appropriate health care provider. Acquiring recommendations from the appropriate health care provider regarding existing and potential risks of injuries can be a proactive approach to preventing serious injuries. Job rotation: This method of control is very useful at larger metropolitan airports. Due to fewer numbers of employees at the Regional Airports, this method may be not suitable. Regional airport employees perform all job functions and are not assigned to one specific job. Task rotation: This method is more likely to have a positive impact on the reduction of sprains and strains. Rotating the specific tasks performed from kneeling to standing while loading luggage will help limit specific movements. Personal Protective Equipment Personal protective equipment will only be used to help minimize the deviation of the wrists, the rotation of the trunk and the flexion of the back. This will be accomplished through the use of knee pads, back belts and wrist splints. Knee pads: This method of control can reduce the force that is being placed on both knees. Knee pads also reduce the physical contact between the body and cargo floor which eliminate temperature extremes (both heat/cold) from 59
contacting with human body. Knee pads can also eliminate cuts from the sharp edges that form between aluminum cargo floor seams. Back belt: Although the use of back belts is still controversial. We believe that back belt will help stabilize and limit the back from twisting. For this reason, we will still use this method of control to limit the frequency and degree of trunk rotation from neutral. Employees will wear the back belt only when they are performing cargo loading or cargo bin tasks. Wrist Splints: Similar to the back belt. We will use wrist splints only to help stabilize and limit the frequency of wrist rotation and ulnar deviation. Again, this type of control will only be use while baggage handling tasks are being performed. Recommendations for Further Study The scope of this study was extremely specific to one aircraft type and the two cargo bins that are standard in this aircraft. Because of this narrow study other areas of have been identified for further research. The following areas should be considered for further investigation to identify the ergonomic-based risk factors that are present: Determine if PPE recommended for use in this study lowered the severity results in RULA, REBA and NIOSH lifting equation. Perform analysis after proper lifting techniques have been taught and are in use with pre and post stretching activities to determine if lifting techniques have been altered from this study. Expand the research to include other aircraft types, and their cargo bins. 60
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