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June 2015

Why the Scaleni Deserve a Good Stretch

  Greg LaRochelle 2014 Posted by Greg LaRochelle

Scaleni what? While the scaleni (plural), or scalene muscles, aren’t as familiar as the pecs, abs, and biceps, or for that matter the glutes, quads, and triceps, they are an important muscle group from the standpoint of their location in relationship to a major neurovascular bundle. The scaleni are comprised of the anterior, middle, and posterior scalene muscles which originate from the transverse processes of the cervical vertebrae and descend at a slight angle to insert on either the first or second rib. As paired, lateral neck muscles, they are flexors and rotators of the head and neck and also function as accessory muscles of inspiration. Passing between the anterior and middle scalene is the brachial plexus of nerves and the subclavian artery. The brachial plexus innervates the upper extremity and the subclavian artery supplies blood to the arms with some branches of the right vessel supplying a portion of the head and thorax.

Blog Neck Image

With today’s prevalence of computer and cell phone use, a forward head posture is oftentimes assumed which together with a lack of back muscle strength can lead to contracted scalene and pectoralis muscles.  This taut condition can lead to compression on the neurovascular bundle where it passes through the anterior and middle scalene muscles. Clinically, this is described as thoracic outlet syndrome with pain exhibited in the hand, forearm, upper arm, or pectoral region. The symptoms of pain in the hand can be similar to that of carpal tunnel syndrome with aching, burning, numbness, and a pins and needles sensation or paresthesia.

While stretching is not a substitute for a comprehensive ergonomics program, as an adjunct, a micro-stretch exercise program can afford some relief to muscle fatigue by inviting increased blood flow into the tissue. Specifically for the scalene muscles, the shoulders need to remain in a relaxed, neutral position while tilting the head to the side to approximate the ear towards the shoulder with a 10 second hold at the end of range of motion then repeated for the other side. A “reach for the sky” stretch with arms extended up over the head followed by slowly lowering the arms down to the side of the torso is beneficial for stretching the pectoralis muscles and opening the chest.

For more information on stretching, check out MEMIC’s Safety Director Resource Library.

Confined Spaces in Construction: The "Whole" Story (Cont.)

Stephen Badger 2014 Posted by Stephen Badger, CSP, OSHT

OSHA's New Confined Space Regulations (Part 2 of 3)

Part 1 of this Three Part Series on Confined Spaces in Construction identified the existing confined space standard in Construction (29 CFR 1926.21(b) and the newly adopted Final Rule 29 CFR 1926 Subpart AA that goes into effect in August 2015. This installment reviews a few of the key definitions and concepts related to the new standard.

In the definition section of the Final Rule, OSHA identifies a competent person as “one who is capable of identifying existing and predictable hazards in the surroundings or working conditions which are unsanitary, hazardous, or dangerous to employees, and who has the authorization to take prompt corrective measures to eliminate them.” While the concept of a competent person is not new within the OSHA standards, this is the first time it has been included in any of the confined space standards.

OSHA defines a controlling contractor as “the employer that has overall responsibility for construction at the worksite. Note: If the controlling contractor owns or manages the property, then it is both a controlling employer and a host employer.”2 The term controlling contractor isn’t new to the multi-employer worksite citation process or 29 CFR 1926 Subpart R but this “entity” will be responsible for certain activities before and during mobilization to a worksite.

The definition of host employer is important to facility owners/operators as this entity has the responsibility of notifying contractors about the hazards within their confined spaces. OSHA’s definition and note follows: “Host employer means the employer that owns or manages the property where the construction work is taking place. Note: If the owner of the property on which the construction activity occurs has contracted with an entity for the general management of that property, and has transferred to that entity the information specified in §1203(h)(1), OSHA will treat the contracted management entity as the host employer for as long as that entity manages the property. Otherwise, OSHA will treat the owner of the property as the host employer. In no case will there be more than one host employer.”3

Part 3 of this series will explore key sections of the Final Rule and how they will affect employees, employers and facility owners.






Taking Care of Those Who Take Care of Us

Beth Stowell Posted by Beth Stowell, BS, MPH, COHN-S, CHSP

As highlighted in a recent NPR series on injured nurses, those who take care of us professionally have not always received the best injury prevention training and technology while on the job. Healthcare workers suffer higher rates of musculoskeletal injuries than any other occupation; these injuries are often caused by manually lifting and moving patients in hospitals or residents in elder care facilities. Direct and indirect costs associated with back injuries in the healthcare industry are estimated by the National Institute for Occupational Safety and Health (NIOSH) to be a staggering $20 billion annually!

To help reduce these healthcare worker injuries through improved safe patient handling, MEMIC is now providing newly designed safe assist belts (commonly referred to as gait belts) to several hundred of our healthcare policyholders across the Eastern Seaboard. Safety management consultants hand deliver the belts and provide training on the proper use of these ergonomically improved gait belts.

I’ve already delivered a safe assist belt to Eric Pooler, the administrator at Southridge Rehabilitation and Living Center in Biddeford, Maine. He told me what I’ve heard echoed at many healthcare facilities; the older style gait belts are not easy to use and are not well-liked by the staff nor the residents. He believed they would find success with the new belts because they are much easier to use. The residents may actually start asking for them because they are much more comfortable.

I showed Eric how using the legs (instead of arms and back) with a push-pull method, enhanced by the ergonomic design and vertical handles of the safe assist belt, is far easier and less stressful on the caregiver’s body than the riskier lifting methods that are too often practiced with conventional gait belts. The safe assist belts are also wider than conventional gait belts with extra padding and a slip resistant lining for enhanced patient comfort.

Beth Stowell Gait Belts
[MEMIC safety management consultant Beth Stowell providing a safe assist belt to Eric Pooler, administrator at Southridge Rehabilitation and Living Center in Biddeford, Maine.]

Over the years patient handling has changed tremendously. When I started in nursing school the ‘hook and toss’ method of raising people up by their armpits was the norm, but that method can actually do damage to the patient’s or resident’s shoulders. As a result, the traditional gait belt, which wraps around a patient’s waist and was originally intended for caregivers to assist the patient with walking and ambulation, became a common method for patient lifting. The misuse of the device as “patient handles” to lift patients increases the chance of injury to the caregiver and can be uncomfortable for the patient.

MEMIC has had great success in supporting cultural changes in healthcare facilities. MEMIC is now investing more than ten thousand dollars in the safe assist belt program so that caregivers and employers will see the benefits these advanced safe assist belts have in providing superior care and reducing injuries. MEMIC has also negotiated a discount rate from the manufacturer to make it that much easier for facilities to replace their older belts and lifting methods. Advances in safe patient handling through improved tools, like the safe assist belt, and reinforced by improved training is truly a win-win-win for patients, healthcare workers and their employers.

Click here for more information on the safe assist belt.

  MEMIC Team Gait Belts
[MEMIC safety management consultants for the territories of Florida, Virginia, Maryland, Pennsylvania, New Jersey, New York, Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire and Maine pick up safe assist belts at MEMIC’s Albany, New York office.]




Confined Spaces in Construction: The "Whole" Story

Stephen Badger 2014 Posted by Stephen Badger, CSP, OHST

OSHA’s New Confined Space Regulations (Part 1 of 3)

For years, many of us in the Construction field have heard the same old excuses from contractors working unsafely in confined spaces. Statements like “We don’t have a confined space standard in Construction”, have been heard countless times by safety consultants and Compliance Officers alike.

In reality, OSHA has had confined space rules for many years that have been all but overlooked because it consisted of just two sentences. 29 CFR 1926.21 (b)(i) requires that “All employees required to enter confined or enclosed spaces shall be instructed as to the nature of the hazards involved, the necessary precautions to be taken, and in the use of protective and emergency equipment required. The employer shall comply with any specific regulations that apply to work in dangerous or potentially dangerous areas.”

While underwhelming in details, the regulation does require construction employers to determine what hazards might be lurking in a confined space and instruct their employees on how to recognize and avoid these hazards. Because of this lack of detail many contractors chose to adopt the General Industry standard for confined spaces (29CFR1910.146) as this has been considered “best practices” for entering these spaces.

On May 1, 2015 OSHA announced the Final Rule for Confined Spaces in Construction (29 CFR 1926 Subpart AA).1 In a prepared statement Dr. David Michaels (Assistant Secretary of Labor for Occupational safety and Health) stated that it is expected that nearly 800 serious injuries a year will be prevented in confined spaces by the new rule and the standard will be effective on August 3, 2015.2

In the next two installments we will look at some of the new definitions associated with confined spaces and some of the new rules that contractors will be required to follow.




Fluid Injection Injury Prevention

Dan Clark 2014 Posted by Dan Clark, CECD

Hydraulic and diesel fuel systems on forestry and construction machines operate at very high pressure, ranging from 600 psi to 12,000 psi. A loose connection or hose defect could result in a high velocity stream of fluid that can penetrate human skin as if it were a hypodermic needle. Skin penetration can occur up to 4” away from the fluid source.

An accidental fluid injection beneath the skin might only initially produce a slight stinging sensation. There is a danger in ignoring this type of incident, thinking it will get better in time; most often, it won’t. The fluid injection wound may begin to throb painfully within a short time, indicating that tissue damage has already begun. Fluid injected directly into a blood vessel can spread quickly throughout the body. The human body has little ability to purge these types of fluid.

A fluid injection can become very serious or even fatal if not dealt with promptly and properly. Left untreated by a medical doctor, familiar with this type of injury, fluid injection can result in disfigurement or amputation of the affected body part.

Employers using these machines should create an emergency plan to follow should this type of injury occur to a member of your crew. The best defense against suffering the effects of fluid injection is to prevent the accident from occurring in the first place. Following are a few safety precautions:

  • Never grab any hydraulic or diesel fuel connectors or hoses under pressure.
  • Stop the engine and safely relieve all pressures before working on a line.
  • Keep all body parts well away from the area of suspected leak.
  • Never search for leaks with your hands or other body parts.
  • Recognize that heavy gloves or your clothing may not protect you from a fluid injection.
  • Be sure to wear safety goggles.
  • Use a long piece of wood or steel to move hoses when redirecting a fluid stream before line pressure can be eliminated.

For more information on fluid injection injuries, check out the resources from The National Institutes of Health and tool box talks available from