What to Expect if Ebola Hits the U.S. (minus the hype)

August 13, 2014 | Frank Irving – Editor

illustration of ebola symptomsA natural level of concern rises when seeing news flashes about the historic outbreak of Ebola viral hemorrhagic fever (VHF), which has killed more than 1,000 people in West Africa. At the same time, physicians and their patients should know what’s happening at various levels to prevent the disease from emerging in this country.

“The bottom line with Ebola is we know how to stop it: traditional public health. Find patients, isolate and care for them; find their contacts; educate people; and strictly follow infection control in hospitals. Do those things with meticulous care and Ebola goes away,” said Tom Frieden, MD, MPH, director of the Centers for Disease Control and Prevention. “To keep America safe, healthcare workers should isolate and evaluate people who have returned from Guinea, Liberia, and Sierra Leone in the past 21 daysand have fever or other symptoms suggestive of Ebola. We will save lives in West Africa and protect ourselves at home by stopping Ebola at the source.”


Could This Chairless Chair Cut Workers’ Comp Claims?

Could sitting down on the job reduce injuries while promoting health and productivity?

Man using chair less chair exoskeleton“In addition to resting your leg muscles, it also provides optimal posture,” Noonee’s co-founder Bryan Anastisiades tells CNN. “It keeps your back straight and can reduce the occurrence of bad postures for both healthy workers and those recovering from muscle related injuries.” A large percentage of workplace injury and illness is caused by musculoskeletal disorders (MSDs), which are often as a result of poor posture, standing all day, etc.

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Both Audi and BMW will be trialing the Chairless Chair on their production lines later this year. There’s no word on pricing or general availability, but I doubt it’ll be that expensive; it’s actually a fairly simple piece of gear.Noonee is initially targeting production line workers, fruit pickers, surgeons, and other groups of workers who spend hours standing every day – but the CEO, Keith Gunura, also mentions consumer uses, such as riding on a crowded train.

Ultimately, though, I’m still a bit uncertain about how seriously we can take a company who has trademarked the term “Chairolution.”

Early MRI for Lower Back Pain Often Yield Expensive, Unnecessary Treatment and Longer Disability Periods

Must be music to my chiropractor’s ears!


colorful x-ray illustration of spineHopkinton, MA (WorkersCompensation.com) – Research conducted by the Liberty Mutual Research Institute for Safety finds that inappropriate early use of Magnetic Resonance Imaging (MRI) to diagnose work-related lower back pain correlates with higher medical costs, unnecessary and ineffective procedures, and prolonged disability.

The most recent study published in Spine (© 2014 by Lippincott Williams & Wilkins) examined more than 3,000 workers compensation claims for disabling lower back pain over the course of a full year. Claims in which MRI was performed either within the first 30 days of pain onset or when there was no specific medical condition justifying the MRI yielded significantly higher medical costs, even after controlling for severity. The study found these early or non-indicated MRIs led to a cascade of medical services in the six-month period post-MRI that included electromyography, nerve conduction testing, advanced imaging, injections or surgery. These procedures often occurred soon after the MRI and were 17 to nearly 55 times more likely to occur than in similar claims without MRI.

“Being a highly sensitive test, MRI will quite often reveal common age-related changes that have no correlation to the anatomical source of the lower back pain,” said Glenn S. Pransky, MD, MOccH, Center for Disability Research. “Leading evidence-based practice guidelines for lower back pain recommend against early MRI except for ‘red flag’ indications, such as severe trauma, infection or cancer. These guidelines suggest that, following a month trial of conservative treatment, MRI may then be considered if symptoms of sciatica/radiculopathy persist, but only to guide epidural steroid injections, or to provide more information if surgery is being considered. Because of a lack of evidence for improving care, the guidelines recommend that MRI is not indicated for non-radicular, non-specific back pain.”

Barbara S. Webster, lead author of the Research Institute’s studies said, “Adhering to guideline recommendations lessens this cascade effect of medical care where potentially unnecessary tests or procedures drive-up medical costs without evidence that they help to effectively treat the pain or shorten disability duration.”


CA Labor Agency Coordinates Interagency Action on the Underground Economy

Do you believe that the California’s “underground” impacts you and/or your business? Before you answer, you might want to read this!

illustration of guy with overcoat open revealing variety of merchandise for saleSacramento, CA (WorkersCompensation.com) – The underground economy affects all Californians. While the actual impact is difficult to measure, the effects are costly and evident. Compliant businesses cannot compete against those who have gained an unfair advantage by evading their responsibilities. Workers are denied correct wages for an honest day’s work, put at risk in unsafe work environments, and excluded from social insurances such as workers’ compensation, disability insurance, and social security. Additionally, all Californians feel the effects of shortfalls in tax revenue receipt and taxpayers are further burdened by the increased costs of social insurances.

California’s Solution

The Labor and Workforce Development Agency convened state and federal enforcement agencies last Wednesday to discuss ongoing challenges and opportunities to combat the underground economy. The Labor Enforcement Task Force (LETF), led by the Department of Industrial Relations (DIR), and the Joint Enforcement Strike Force (JESF), headed by the Employment Development Department (EDD), presented recent successes through joint collaboration and targeted inspections. Representatives from DIR, EDD, Contractors State License Board, California Unemployment Insurance Appeals Board, Agricultural Labor Relations Board, California Department of Insurance, California Department of Justice, State Compensation Insurance Fund, California Department of Consumer Affairs, Alcohol Beverage Control Board, Franchise Tax Board, U.S. Department of Labor, FBI, and IRS participated in the roundtable discussion.

DIR Director Christine Baker described how streamlining the administration of enforcement activity “has reduced agency overlap in the field, resulted in better coordination of limited resources, and improved efforts to target non-compliant businesses.” In fact, 40 percent of joint LETF inspections have resulted in violations with every agency participating in the inspection. Collaboration has been successful in multiple areas, as noted by EDD Director Patrick Henning, “including increased data sharing, greater coordination with District Attorneys for criminal investigations, and combined resources for cross-training.”


Chest Pain and What We Can Learn From Changing Flat Tires.

“Daddy, I think we have a flat tire.”

flat tire illustrationI just rolled out of the garage with my 4th grade daughter. It was Tuesday morning. Usual daily routine. Drop her off at school then go to work. A little different today as I was to lead an important meeting.

How could she possibly know what a flat tire sounds like? Now? Right now? She’s probably mistaken. It can’t be a flat tire.

“Whopp, whopp, whopp.” The car was tilted down towards the passenger side.

Rats! Not good. Never a good time to have a car problem.

Get out of the car. Yep, flat tire.


Change flat tire to chest pain. Alter visit by auto club to evaluation by EMS and emergency medicine. Consider tire store and advisor as a primary care office and doctor with continuity of care and electronic medical record. Replace repair versus replace to medical management versus a cardiac stent. A commonality is asking loved ones or spouse for advice. Use of Google to sort through different options.


Ask daughter to get out of the car. Wife hasn’t left for the office yet. Can she take her to school instead? Call the auto club for help in changing the tire. If quick enough, I might still make the meeting without getting dirt and grime all over my clothes.

Daughter and wife roll out of the garage. Auto club truck appears about 30 minutes later. Tire replaced. Marvel how quickly he changes the tire. He notes that our spare tire is a full tire, unlike other car companies which now have a smaller spare tire. Thank you Toyota! Appears that the flat was due to a nail. How did that get there? I make the meeting.

The question is what to do now? I’ve had a flat time one other time.  Patch? Replace?

How safe it a patched tire? I had this discussion with my wife in the past. As a doctor, she has high expectations on everyone and everything. Given a choice, isn’t newer better and safer? After all, don’t the kids deserve the best? Are you absolutely sure it is safe? Chance of blowout? Don’t you commute an hour daily on the freeway? Is it a good idea to take a chance?

If you Google “safety of a patched tire,” you get 316,000 results in 0.33 seconds. Which link to read? Didn’t know there was a debate between plugging and patching. The number one search hit from About.com notes “there is legislation pending in New York State that would make all plug repairs illegal. Certainly a patch is by far the best way to repair any hole in a tire, but are plugs really unsafe?” MotorWeek says the ideal thing is a plug patch. Add two more words to my Google search — “Consumer Reports” — and now 8.5 million results in 0.41 seconds have been found. First three hits are about tire sealants, the safety of worn tires, and how owners tire of run-flat tires.

Redo a Google search with “consumer reports flat tire repair.” 791,000 results in 0.42 seconds. Repairing flat tires is heating up the industry from December 2011. Not exactly reassuring:


Is Your Workplace Truly Drug-Free?


We Conduct Drug Testing yellow and black signAs an employer, you want to give your employees the benefit of the doubt.
Sure, you want to believe that all your workers come to work each and every day drug-free, but can you say that with 100 percent certainty?
According to the National Council on Alcoholism and Drug Dependence (NCADD), drug abuse in the workplace costs business owners $81 billion annually.

With that staggering figure in mind, you as an employer have to do everything possible to make sure your business stays drug free.

Workers Comp Impacted

If you did not already know this as an employer, take note that running a drug-free workplace allows you to reduce your required workers comp premiums. In what should be common sense, no drugs in the workplace (included to mean employees do not report for work under the influence) means reduced risk for the on-the-job accidents.

Looking nationwide, if Georgia employers have their drug-free workplace program certified by the Georgia State Board of Workers Compensation, they get in return a seven and one-half percent (7.5%) reduction on their workers comp premium. When the employer submits a copy of their certificate of a drug-free workplace yearly to their comp insurance carrier, they continue to receive the 7.5% decrease in their total work comp premium.


NFL Wearables Could Be Personal Black Box for Workplace Accidents


RFID tag illustrationIt came to me just this morning, while I was reading an article about the NFL boosting their statistics tracking and accuracy with the use of RFID tags in the players shoulder pads. It seems these amazing little chips will allow NFL statisticians to know “real-time position data for each player”, as well as “precise info on acceleration, speed, routes and distance”. This is part of the NFL’s “Next Gen Stats” initiative for their fans.

For those who are unaware, RFID (Radio Frequency Identification) technology is the hot new thing. Essentially an RFID tag contains a passive ID chip that can be activated by receivers as it passes near them. It requires no battery power, and is highly reliable. Stores like Walmart now use them extensively to track and monitor inventory changes. Even my Florida SunPass tag uses one. The small sticker on my windshield allows me to zip through tolls and access parking at Tampa International Airport without talking to anyone or even rolling down my window. Of course, it also allows the state to bill me for that activity, and serves to notify the NSA that I am on the move again. But they probably already knew that. The complete loss of privacy is a small price to pay for not having to chat up a friendly toll taker.

I am so glad the NFL has gone with RFID. It is a much more reliable technology than those old scanner barcodes. That was a disaster – having to get the player to run into the end zone 6 times before the scanner could capture the touchdown – but I digress…..

While the source article was prattling on about all the useless stats fans could now have access too, I was thinking in an entirely different direction. I recognized that the NFL has inadvertently invented the personal “Black Box” for workplace accidents. Think about it. This is a technology that could be employed in offices and factories all over the country.

Employers could easily monitor “real-time position data for each employee”, as well as “precise info on acceleration, speed, routes and distance” as they move throughout the day. An RFID enabled wearable could tell accident investigators if an employee was running when they slipped and fell down the stairs, as well as how many rotations they took as they progressed to the bottom.  They could determine that an employee was idle in the break room at the time they claimed to be straining their back on the loading dock.  And biometric sensors added to the RFID wearable could actually cross reference stress levels and physiological indicators to the time and location of the accident, giving a clearer view of events than ever before possible.

It is just like data used from airplane black boxes to reconstruct what actually happened to cause an accident. I am telling you, this technology could be a tremendous boon for risk managers and accident investigators everywhere. But why should they have all the fun?

Safety professionals could leverage the same technology to prevent accidents in the first place. Restaurant servers would no longer have to yell “corner” or “door” when traversing areas with visual limitations. Their RFID enabled monitors would send real time location updates of other employees in the vicinity to their heads up display located within their Google Glass. The system would issue potential collision warnings similar to those in today’s aviation industry.  I’m telling you, Big Brother really may have all the answers after all.