Although the social obligation of most postal administrations—domestic mail collection, sorting, delivery and international mail processing while preserving the security of mail—has remained unchanged over the last century, the methods by which this obligation is carried out have been transformed due to the rapid advances of technology and increases in mail volumes. Australia, France, Germany, Sweden, the United Kingdom and other industrialized countries each process billions of mail pieces each year. In 1994 the US Postal Service delivered almost two hundred billion pieces of mail, an increase in mail volume of 67% since 1980. Competition by private carriers entering the market, particularly for parcel delivery and express delivery service, as well as from other technological advancements, such as facsimile (fax) machines, computer modems, electronic mail, electronic transfer of funds and satellite systems, have also changed personal and business communications. Since private carriers carry out many of the same operations as postal services, their workers face many of the same hazards.
Most postal administrations are government-owned and operated, although this is changing. For example, Argentina, Australia, Canada, Germany, the Netherlands, Sweden, the United Kingdom and the United States have, to varying degrees, privatized their postal operations. The franchising or contracting of work and services is becoming increasingly common among the postal administrations in the industrialized world.
Postal administrations, especially in industrialized nations, are often one of the largest employers in the country; they employ up to several hundred thousand people in some countries. Although advances in technology have not dramatically changed how postal administrations are structured, they have altered the methods by which mail is sorted and delivered. As postal services have long been highly labour intensive (with wages and benefits accounting for up to 80% of total operating costs in some countries), efforts to reduce these costs as well as to improve productivity and increase operating efficiency have promoted technological advancement through capital investments. For many industrialized nations the objective is to fully automate the processing of mail up to the point of delivery.
Postal operations are divided into three main phases: collection, sorting and delivery. Administrative and maintenance services are also integral aspects of postal operations. The technological changes in operating methods, especially for the sorting phase, have led to a declining demand for workers. As a result, workers are more isolated because less staffing is required to operate the newer postal equipment. Enhanced technology has also led to a reduction of requisite skills in the workforce as computers have replaced such tasks as memorizing postal codes and performing diagnostic tests on mechanical equipment.
Shift work is still a common practice in postal operations as most mail is collected at the end of the day and then transported and sorted at night. Many postal administrations provide home and business mail delivery six days a week. The frequency of service requires most postal operations to run twenty-four hours a day, seven days a week. Consequently, the psychological and physical stress from shift work and night work still remain problems for many postal workers, particularly during the busy night shift in large processing centres.
Most postal administrations in the industrialized world are organized with large processing centres supporting small retail and delivery offices. Often several stories high and occupying several thousands of square metres, processing centres are equipped with large pieces of machinery, material handling equipment, motor vehicles and repair and paint shops similar to work environments in other industrial workplaces. Smaller retail offices, however, are generally cleaner and less noisy and more akin to office environments.
Hazards and Their Prevention
While technology has eliminated many dangerous and monotonous tasks performed by postal workers, different hazards have emerged that, if not properly addressed, may jeopardize the health and safety of postal workers.
For employees who work at retail postal counters, job tasks depend on the size of the post office and the type of services offered by the postal administration. General duties of the retail employee include selling stamps and money orders, weighing and pricing letters and parcels and providing postal information to customers. Since retail personnel are directly involved in the exchange of money with the public, the risk of violent robbery is increased for these workers. For retail personnel who work alone, in proximity to high crime areas or late at night or early in the mornings, workplace violence can be a major occupational hazard if appropriate protective measures are not taken. The potential for such workplace violence also contributes to undue mental stress. Also, the day-to-day pressure from dealing with the public and the responsibility for relatively large amounts of money are contributing stress factors.
Environmental conditions and the physical layout of the retail employee’s workstation may also contribute to health and safety hazards. Indoor air quality problems, such as dust, the lack of fresh air and temperature variations may cause discomfort for the retail clerk. Poorly designed work stations that require the operator to work in awkward postures due to the placement of retail equipment (e.g., cash register, scale, mail and parcel containers), prolonged standing postures or sitting in uncomfortable and unadjustable chairs, and lifting heavy parcels can lead to musculoskeletal disorders.
Preventive measures that address these hazards include improving security by installing bright external and internal lighting, doors, windows and partitions of bullet proof glass and silent alarms, ensuring that clerks do not work alone, providing emergency and defensive response training and ensuring that the public has limited and controlled access to the facility. Ergonomic and indoor air quality assessments may also contribute to the improvement of the working conditions for retail personnel.
The transition from manual operations to mechanized and automated systems has greatly affected the handling and sorting phase of postal operations. For example, whereas postal workers were once required to memorize various codes that corresponded to address delivery routes, that task is now computerized. Since the early 1980s, technology has improved so that many machines can now “read” an address and apply a code. In the industrialized countries, the task of sorting mail has shifted from humans to machines.
Although technology has reduced the amount of manual letter and small parcel sorting, it has had less of an impact on the movement of containers, bundles and sacks of mail inside a postal facility. Mail that is transported by trucks, planes, rail or ship into large processing and sorting centres may be internally transferred to different sorting areas by complex conveyor or belt systems. Fork-lift trucks, mechanical dumpers and smaller conveyors assist postal employees in unloading and loading trucks and placing the mail onto the complex conveyor systems. Some material handling tasks, however, especially those performed in smaller postal facilities, must still be performed manually. Culling operations that separate mail to be processed by machine from mail that which must be sorted by hand is one task that has not been fully automated. Depending on the postal administration’s regulations or national health and safety regulations, limits on load weights may be imposed to prevent employees from having to lift and carry containers of mail and parcels that are too heavy (see figure 1).
Figure 1. Manual lifting of heavy parcels is a serious ergonomic hazard. Weight and size limits on parcels are necessary.
Material handling tasks also expose postal workers to electrical hazards and machine parts that may injure the body. Although paper dust is a nuisance to almost all postal workers, employees who primarily perform material handling tasks commonly inhale dust when they first open mailbags, containers and sacks. Material handling workers are also the first employees to come into contact with any biological or chemical materials that may have spilled during transport.
Efforts to reduce fatigue and back injuries include automating some of the manual lifting and carrying tasks. Transporting pallets of mail by forklifts, using rolling containers to transport mail inside a facility and installing automatic container unloaders are methods of automating material handling tasks. Some industrialized nations are utilizing robotics to assist in material handling tasks such as loading containers onto conveyors. Regulating the amount of weight workers lift and carry and training workers in proper lifting techniques may also help to reduce the incidence of back injury and pain.
To control exposure to chemicals and biological matter, some postal administrations place prohibitions on the type and amount of hazardous materials that can be sent by mail and also require these materials to be identifiable to postal workers. Since some mail will undoubtedly be sent without proper warnings affixed, workers should be trained in responding to releases of potentially hazardous materials.
As sorting technology improves, manual letter sorting is rapidly being phased out. Some manual letter sorting, however, is still necessary in many postal administrations, particularly in the developing countries. Manual letter sorting involves workers placing individual letters into slots or “pigeon holes” in a case. The worker then bundles the mail from each slot and places the bundles into containers or mail bags for dispatch. Manual sorting is a repetitive activity that the worker performs while either standing or sitting on a stool.
Manual parcel sorting is also still performed by postal workers. Since parcels are generally larger in size and much heavier than letters, workers must often put the parcels into separate hampers or containers that are arranged around them. Workers who perform manual parcel sorting often are at risk for cumulative trauma disorders affecting the shoulders, arms and back.
Automation has addressed many of the ergonomic hazards associated with manual letter and parcel sorting. Where automation technology is not available, workers should have the opportunity to rotate to different tasks to relieve fatigue from one particular body area. Appropriate rest breaks should also be provided to workers performing repetitive tasks.
In modern, mechanized sorting systems, workers sit at a keyboard while letters are mechanically passed in front of them (figure 2). Coding desks are arranged either side-by-side or behind one another in a line. Operators must often memorize hundreds of codes that correspond to different zones and enter a code for each letter on a keyboard. Unless adjusted properly, the keyboards may require the operator to use more force to depress the keys than modern computer keyboards. Approximately fifty to sixty letters each minute are processed by the operator. Based upon the code entered by the operator, the letters are segregated into different bins and then removed, bundled and dispatched by the postal workers.
Figure 2. Coding desk operators sorting letters with the aid of computerized machines.
Ergonomic hazards that lead to musculoskeletal disorders, particularly tendinitis and carpal tunnel syndrome, are the biggest problem for mechanized sorting operators. Many of these machines were designed several decades ago when ergonomic principles were not applied with the same degree of diligence as they are today. Automated sorting equipment and VDUs are quickly replacing these mechanized sorting systems. In many postal administrations where mechanized sorting is still the primary system, workers may rotate to other positions and/or take breaks at regular intervals. Providing comfortable chairs and adjusting the keyboard force are other modifications that can improve the job. Although a nuisance and discomfort to the operator, noise and dust from the mail are generally not major hazards.
Visual display units
Visual display unit-based sorting terminals are beginning to replace mechanized sorters. Instead of the actual mail pieces being presented to the operator, enlarged images of the addresses appear on the screen. Much of the mail that is processed by VDU sorting has been previously rejected or culled as not machineable by the automatic sorters.
The advantage of VDU sorting is that it does not need to be located in close proximity to the mail. Computer modems can send the images to the VDUs that are located in another facility or even a different city. For the VDU operator, this means that the work environment is generally more comfortable, with no background noise from sorting machines or dust from mail. However, sorting with the VDU is a very visually demanding job and often involves only one task, keying from images of letters. As with most sorting tasks, the job is monotonous but at the same time requires intense concentration from the operator in order to maintain the required productivity levels.
Musculoskeletal discomfort and eye strain are the most common complaints of VDU operators. Steps to reduce physical, visual and mental fatigue include providing adjustable equipment, such as keyboards and chairs, maintaining adequate lighting to reduce glare and scheduling regular breaks. In addition, since VDU operators often work in an office-type environment, consideration should be given to indoor air quality complaints.
The most advanced type of sorting reduces the need for workers to be directly involved in the coding and segregation of individual mail pieces. Generally only 2 or 3 workers are required to operate an automatic sorter. At one end of the machine, a worker loads mail onto a mechanical belt that feeds each letter in front of an optical character reader (OCR). The letter is read or scanned by the OCR and a bar code is printed on it. The letters are then automatically segregated into dozens of bins located at the other end of the machine. Workers then remove the bundles of segregated mail from the bins and transport them to the next stage of the sorting process. Larger automated sorters can process between 30,000 and 40,000 pieces of mail per hour.
Although such automation no longer requires a keyboard to encode mail, workers are still exposed to monotonous, repetitive tasks that put them at risk for musculoskeletal disorders. Removing the bundles of segregated mail from the different bins and placing them into containers or other material handling equipment puts physical stress on the operator’s shoulders, back and arms. Operators also complain of wrist and hand problems from constantly grasping handfuls of mail. Dust exposure is sometimes more problematic for automated sorter workers than other postal employees because of the larger volume of mail processed.
Many postal administrations have only recently acquired automated sorting equipment. As complaints of musculoskeletal discomfort mount, equipment designers and engineers will be forced to incorporate ergonomic principles more thoroughly in their attempts to balance productivity needs with the well-being of employees. For example, in the United States, government safety and health officials have concluded that some of the automated mail-sorting equipment poses serious ergonomic deficiencies. While attempts can be made to modify either the equipment or work methods to reduce the risks of musculoskeletal discomfort, such modifications are not as effective as the proper design of equipment (and work methods) in the first place.
Another problem is the risk of injury during the clearing of jams or during maintenance and repair operations. Proper training and lockout/tagout procedures are needed for these operations.
Postal operations rely upon many methods of transportation to distribute mail including air, rail, water and highway. For short distances and local delivery, mail is transported by motor vehicles. Mail travelling generally less than several hundred kilometres from large processing centres to smaller post offices is usually carried by trains or large trucks, while air and sea travel is reserved for the longer distances between large processing centres.
As the use of motor vehicles for delivery services has increased dramatically during the past two decades, accidents and injuries involving postal trucks, jeeps and automobiles have become for some postal administrations the biggest and most serious occupational safety and health problem. Vehicular accidents constitute the main cause of workplace fatalities. Additionally, while the increased use of motor vehicles for delivery and the installation of more street mail storage boxes have helped to reduce the amount of time letter carriers spend walking, musculoskeletal discomfort and back injuries still are problematic due to the heavy bags of mail that they must carry on their routes. Also, robberies and other violent attacks against letter carriers are on the rise. Injuries caused by slips, trips and falls, particularly during adverse weather conditions, and dog attacks are other serious hazards experienced by letter carriers. Unfortunately, other than increased awareness not much can be done to eliminate these particular hazards.
Steps designed to reduce the likelihood of vehicular accidents include installing anti-lock brakes and extra mirrors to improve visibility, increasing seat belt usage, improving driver training, conducting more frequent vehicle maintenance inspections and improving roadways and vehicle design. To address the ergonomic hazards associated with lifting and carrying mail, some postal administrations provide carts with wheels or specialized mail bags where the weight is more evenly distributed across the worker’s shoulders instead of concentrated on one side. To reduce the risk of workplace violence, letter carriers may carry two-way communication devices and their vehicles may be equipped with a tracking system. In addition, to address environmental concerns and concerns of exposure to diesel exhaust, some postal vehicles are powered by natural gas or electricity.
Repair and Maintenance
Workers that are responsible for the day-to-day upkeep, cleaning and repair of postal facilities and equipment, including motor vehicles, face similar hazards as maintenance employees in other industrial operations. Exposure to welding operations, electrical hazards, falls from scaffolding, chemicals found in cleaning fluids and machine lubricants, asbestos from brake linings and dust are examples of hazards associated with maintenance tasks.
National, state or provincial, municipal and other local government units employ inspectors in a variety of agencies to verify compliance with laws, ordinances and regulations intended to promote and protect the health and safety of both workers and the public. This is government’s traditional role of enacting laws to address socially unacceptable risks and then to assigning agencies to establish programmes to achieve conformance with the regulatory standards. The inspector or investigator is the key person on the front-line in enforcing regulatory standards.
An example of such a legislative mandate is the role of inspection of workplaces for health and safety practices. Worksite inspectors visit workplaces to verify compliance with regulations governing the workplace, potential occupational and environmental hazards, the tools, machines and equipment being used, and the way the work is done, including the use of personal protective equipment (PPE). The inspectors have the authority to initiate penalties (citations, monetary fines and, in egregious cases, criminal prosecution) when deficiencies are encountered. Under laws enacted in some localities, regional authorities share responsibilities for carrying out inspections with federal powers.
Other areas in which governmental agencies have inspection responsibilities include environmental protection, regulation of food and drugs, nuclear energy, interstate commerce and civil aviation, public health and consumer protection. Engineering and building inspections are generally organized at the local level.
Throughout the world the basic functions and protections addressed by inspection services are similar although the particular legislation and governmental structures vary. These are discussed elsewhere in this Encyclopaedia.
To protect workers and property, to avoid statutory penalties and the adverse publicity that accompanies them and to minimize legal liability and the costs of workers’ compensation benefits, private sector enterprises often conduct in-house inspections and audits to ensure that they are complying with the regulations. These self-audits may be conducted by appropriately qualified staff persons or outside consultants may be retained. A notable recent trend in the US and some other developed countries has been the proliferation of private consulting organizations and academic departments which offer occupational health and safety services to employers.
In general, inspectors are faced by the very same hazards they are charged to identify and correct. For example, workplace health and safety inspectors may visit worksites that have toxic environments, harmful noise levels, infectious agents, radiation, fire or explosion hazards and unsafe buildings and equipment. Unlike workers in a fixed environment, the inspectors must anticipate the kinds of hazards they will encounter on a given day and make sure that they have the tools and PPE they might need. In each instance, they must prepare themselves for a worst-case scenario. For example, when entering a mine, inspectors must be prepared for an oxygen-deficient atmosphere, fires and explosions and cave-ins. Inspectors checking isolation units in health care facilities must protect themselves against contagious organisms.
Occupational stress is a prime hazard for inspectors. It stems from a number of factors:
Agencies employing inspectors must have clearly written health and safety policies describing appropriate measures to protect the health and well-being of inspectors, particularly those working in the field. In the US, for example, OSHA includes such information in its compliance directives. In some instances, this agency requires inspectors to document their use of the appropriate protective equipment while performing an inspection. The integrity of the inspection may be compromised if the inspector himself or herself violates health and safety rules and procedures.
Education and training are the key to preparing inspectors to properly protect themselves. When new standards are promulgated and new initiatives or programmes undertaken, the inspectors should be trained in preventing illness and injury to themselves as well as being drilled in the new requirements and enforcement procedures. Unfortunately, such training is rarely offered.
As part of programmes for learning to cope with work stress, also rarely offered, inspectors should be trained in communication skills and contending with angry and abusive people.
Table 1 lists some of the categories of government inspectors and hazards to which they may be exposed. More detailed information about the recognition and control of such hazards is to be found elsewhere in this Encyclopaedia.
Table 1. Hazards of inspection services.
Occupational safety and health compliance officers
Investigate and cite safety and health hazards
A wide variety of safety and health hazards
Investigate agricultural and farmworker health and safety
Agricultural equipment, chemicals, pesticides, biological agents and
Investigate industrial and agricultural sites for contaminated air, water and soil
Chemical, physical, biological and safety hazards
Investigate nursing homes and hospitals for compliance with hospital safety and health standards
Infectious, chemical, radioactive and safety hazards
Investigate and cite food product safety and establishments
Insects, vermin and associated microbiological agents; chemical agents; violence and dogs
Engineering and building inspectors
Investigate for compliance with building construction and fire operation and maintenance codes
Unsafe structures, building and construction equipment and materials
Investigate for contraband and hazardous materials entering territorial boundaries
Explosives, drugs, biological and chemical hazards
A recent phenomenon in many countries that is disturbing to many is the trend toward deregulation and decreased emphasis on inspection as an enforcement mechanism. This has led to the under-financing, degrading and downsizing of agencies and erosion of their inspection services. There is a growing concern not only for the health and safety of the cadres of inspectors but also for the health and well-being of the workers and the public they are charged to protect.
Rangers in parks in large Irish cities are employed to “keep the peace”, to “liaise with the public” (i.e., discourage vandalism and respond to any complaints that might be made) and to perform “light cleaning duties” (i.e., cleaning up rubbish and garbage such as broken bottles, needles and syringes discarded by drug abusers and used condoms). Their hours are unsociable: they report around mid-day and remain on duty until dusk when they are supposed to lock the park gates. This means long hours in the summertime that are somewhat compensated for by the shorter days in winter.
The majority of the parks have only one ranger who works alone, although there may be other local authority employees doing landscaping, gardening and other jobs in the park. Usually the only building in the park is the depot where gardening equipment is kept and where the staff may go for shelter in very severe weather. To avoid spoiling the ambiance, the depots are usually located in sequestered areas out of the public view where they are subject to misuse by vandals and marauding gangs of youths.
The park rangers are frequently exposed to violence. An employment policy that favoured the hiring of individuals with mild disabilities as rangers was recently supplanted when it was realized that public knowledge of such problems made these rangers ready targets for violent assault. Public authorities were not covered by the Irish health and safety legislation which, until recently, was applicable only to factories, building sites, docks and other process industries. As a result, there were no formalized arrangements for dealing with violence against park workers who, unlike their counterparts in some other countries, were not provided with firearms or other weapons. Nor was there any access to post-violence counselling.
The tendency to assign rangers who lived in the immediate neighbourhood to a particular park meant that they were more likely to be able to identify the trouble-makers likely to have been the perpetrators of violent acts. However, this also increased the danger of reprisals to the ranger for having “fingered” the culprits, making him or her less inclined to make formal complaints against their assailants.
Lack of an adequate police presence in the parks and the very early release from prison of convicted perpetrators were often crushing blows to the morale of the victims of the violence.
The trade unions representing the rangers and other public authority personnel have been active in promoting efforts to deal with violence. They now include training in recognizing and preventing violence in the courses they sponsor for safety representatives.
Even though the Irish health and safety legislation now covers public authority workers, the creation of a national committee to deal with both the control of violence and the provision of aftercare for its victims would be beneficial. While guidelines on preventing violence are now available to assist those engaged in assessing the risks of violence in workplaces, their use should be made mandatory for all occupations where violence is a risk. Furthermore, increased resources for and enhanced coordination with the city’s police force are desirable for dealing with the problem of violence and assault in the public parks.
Training in how to deal with individuals and groups likely to be violent should be make available to all workers who face this risk in their jobs. Such training might include how to approach and deal with individuals presenting indications of violent assault as well as self-defence manoeuvres.
Improved communications for reporting problem situations and requesting help would also be helpful. Installing telephones in all park depots would be a useful first step while “walkie-talkie” radios and cellular telephones would be useful when away from the depot. Video camera systems for surveillance of sensitive areas, such as the park depots and sports facilities, might help to deter violence.
Public and government services encompass a wide variety of industrial and occupational categories. For example, included are workers employed within telecommunications and postal services, inspection and field services, as well as sewage treatment, recycling, landfill and hazardous waste operations. Depending on the individual country, industrial categories such as telecommunications and postal services may be located within either the public or private sector.
Occupational and environmental safety and health hazards in public and government services include exposure to chemicals, ergonomics, blood-borne pathogens, tuberculosis, machinery hazards, violence, motor vehicles and flammable materials. In the future, as public and government services continue to grow and become more complex, it is anticipated that occupational safety and health hazards will increase and become more widespread. In turn, led by tripartite (labour, management and government) initiatives, improvements in occupational safety and health hazard recognition and control will provide improved resolution of identified hazards.
Health Problems and Disease Patterns
Patterns or identifiable trends of occupational health problems have been associated with the type of work (i.e., use of visual display units (VDUs) or chemicals), as well as where the work is performed (i.e., indoors or outdoors).
The primary hazards associated with indoor work are poor or inadequate physical and work organization ergonomics, inadequate indoor air quality or heating, ventilation and air conditioning systems, chemicals, asbestos, workplace violence and electromagnetic fields (low-level radiation).
Health symptoms and disorders or illnesses have been associated with exposure to these hazards. Since the mid-1980s, a large number of ergonomic-related upper extremity physical illnesses have been reported. Disorders include carpal tunnel syndrome, ulnar deviation, thoracic outlet syndrome and tendinitis. Many of these are related to the introduction of new technology, particularly VDUs, as well as the use of hand tools and equipment. Causes of identified illnesses include physical and work organization factors.
Since the engineering and construction of “tight-buildings” in the 1970s, a pattern of increasing incidence of upper respiratory and dermatological health symptoms and illnesses has been observed. Such health problems are associated with improper maintenance of the heating, ventilation and air conditioning systems; chemical contaminants and microbiological agents; and the inadequate provision of fresh air and air flow.
Exposure to chemicals in indoor work environments has been linked to upper respiratory and dermatological health symptoms and illnesses. A variety of different chemical contaminants are emitted from copying machines, furniture, carpets, cleaning materials (solvents) and the heating, ventilation and air conditioning system. One particular syndrome, multiple chemical sensitivity, has been associated with chemical exposures in indoor work environments.
Asbestos exposure may occur when building renovation and service work are performed and asbestos products or materials are deteriorated or damaged, thus causing asbestos fibres to become airborne.
Since the 1980s, workplace violence and associated safety and health problems have become increasingly widespread. Work environments where increasing rates of workplace violence have been documented are characterized as follows: handling money, working with the public, working alone, coming into contact with patients or clients who may be violent and dealing with customer or client complaints.
Health concerns include physical harm and death. For example, homicide was the second leading cause of death in the US workplace in 1992, accounting for 17% of all workplace deaths. In addition, from 1980 to 1989 homicide was the leading cause of death in the workplace for women, as discussed in more detail in the chapter Violence in this Encyclopaedia.
Work with and exposure to electronic equipment and related electromagnetic fields or non-ionizing radiation has become commonplace, as is exposure to high frequency non-ionizing radiation emitting products such as laser and microwave transmission equipment, radio-frequency heat sealers and electric tools and generation equipment. The relationship between such exposures and consequent health effects such as cancer, visual and skin disorders is not yet clear and much research is still needed. Several chapters in this Encyclopaedia are devoted to these areas.
Outdoor work environment occupational hazards include exposure to chemicals, lead, hazardous and solid waste, environmental conditions, inadequate ergonomics, motor vehicles, electrical and mechanical equipment and electromagnetic field emissions.
Exposure to chemicals occurs in several identified occupational categories including waste disposal operations, water and sanitation services, sewage treatment, domestic waste collection, postal collection and technician jobs in telecommunications. Such exposure has been related to upper respiratory, dermatological, cardiovascular and central nervous system illnesses. Exposure to lead occurs among telecommunications workers while performing splicing operations with and removing lead telecommunications cables. Such exposure has been liked to a variety of health symptoms and illnesses, including anaemia, peripheral and central nervous system disorders, sterility, kidney damage and birth defects.
Hazardous work environments are common to waste disposal operations, water and sanitation services, sewage treatment and domestic waste collection. Occupational safety and health hazards include microbiological and medical waste, chemicals, inadequate ergonomics, motor vehicles, confined spaces and electrical and mechanical equipment. Identified health symptoms and illnesses include upper respiratory, dermatological, upper and lower extremity musculoskeletal, cardiovascular, central nervous system and visual problems. Additional concerns include lacerations, heat exhaustion and stroke.
Inadequately designed workplace tools and equipment are common to all outside public and government service occupations. Hazards comprise poorly designed hand and power tools, machinery and motor vehicles. Associated health problems include upper and lower extremity musculoskeletal symptoms and illnesses. Safety-related concerns include visual problems, strains, sprains and fractured and broken bones.
Hazards associated with motor vehicles include poorly designed equipment (e.g., hoppers, compaction boxes and aerial equipment), as well as improperly operating machinery and equipment. Associated health problems comprise musculoskeletal injuries and death. Motor vehicle accidents account for the greatest number of injuries and fatalities outdoors.
Hazards associated with electrical and mechanical equipment include poorly designed equipment, electrical shock and electrocution, as well as chemical exposures. Health problems include strains, sprains, broken bones, central nervous and cardiovascular system disorders, as well as upper respiratory and dermatological disorders and death.
Work with or in close proximity to electrical transmission equipment and the associated electromagnetic fields of non-ionizing radiation emissions has been linked with the occurrence of certain central nervous system symptoms and disorders as well as cancer. However, scientific and epidemiological research has, as of yet, not clearly defined the degree of harm posed by electromagnetic fields.
Outdoor public and government services activities present several environmental and public health problems. For example, chemicals, microbiological agents, sewage and domestic waste may be used and disposed of improperly, thus finding their way into the water table as well as streams, lakes and oceans, causing environmental contamination. In turn, such waste may lead to the contamination of public water supplies as well as the creation of toxic dumps or sites. Such contamination has been related to the deterioration and destruction of the environment as well as public health. Associated human health effects include dermatological, central nervous and cardiovascular system health symptoms and disorders, as well as certain types of cancer.
The visual arts produce a wide range of potential environmental problems and raise a number of public health issues. The visual arts use a broad range of chemicals and techniques which can create air and water pollution problems similar to that of the comparable industrial processes, only on a much smaller scale.
Hazardous waste produced by artists can include: (1) toxic and extremely toxic wastes, including solvents, lead compounds, chromates and cyanide solutions; (2) flammable waste, including flammable and combustible liquids (e.g., rags soaked with oil and turpentine), oxidizing substances such as potassium chlorate and dichromates, and ignitable compressed gases; (3) corrosive waste, including acids with a pH less than 2 and alkalis with a pH greater than 12; and (4) reactive wastes, such as organic peroxides, cyanide solutions and sulphide solutions. Artists and artisans are less likely, however, to know how to dispose of this waste or even to know what is hazardous. The most common method of waste disposal for artists is pouring down the sink or onto the ground, tossing in the garbage or evaporation. Although the individual amounts of pollutants are small, cumulatively they can result in significant pollution.
In the United States and Canada and many other countries, artists working in their homes are usually exempted from industrial hazardous waste regulations under a household hazardous waste exemption. Many localities, however, do provide special household hazardous waste days when households can bring their hazardous waste to a central site for collection. However, even in countries which do regulate artists as small businesses, there is little enforcement of hazardous waste regulations for these cottage industries.
Types of waste management methods available include many of the same ones used by industry, including source reduction, waste separation and concentration, recycling, energy and material recovery, incineration or treatment, and secure land disposal. Some of these methods are more available to artists than others.
The best way of managing hazardous waste is to actually eliminate or minimize its production by substituting materials which are less toxic—for example, using lead-free glazes instead of leaded glazes in pottery and enamelling, and using water-based screen printing inks and other coating materials instead of solvent-based ones.
Separating hazardous materials from non-hazardous materials—for example, separating solvent-based paints and water-based paints—can be a simple method to reduce the amount of hazardous waste and prevent it from contaminating regular garbage.
Traditional industrial methods of concentration, such as evaporation of large volumes of photographic wastes, are usually not feasible for artists.
Recycling can involve the reusing of materials (such as solvents used for oil painting cleanup) by the individual, or the passing of unwanted materials to someone else who can use them. Large printmaking facilities, which generate many solvent- or oil-soaked rags, can contract for laundering and reuse them.
Treatment can involve several processes. The most common one used by artists is neutralization of acids or alkaline solutions. Incineration is usually restricted to burning wood dust. Evaporation of solvents is also commonly done. This reduces the amount of hazardous waste potentially contaminating water supplies, although it does contaminate the atmosphere to some degree.
The least favourable option is secure land disposal in a proper hazardous waste disposal site. This is usually not a viable option for artists, especially in developing countries.
A public health issue that is common to many of the visual arts is the problem of the exposure of children to toxic chemicals found in many art materials, including those intended for use by children. Examples include solvents in permanent felt-tip markers and lead in ceramic glazes. Children and other family members can be exposed to hazardous substances and conditions in the home.
A widespread problem in many countries is lead poisoning, including fatalities from cooking and storing food in containers that have been made with lead-containing pottery glazes. In the commercial industry, the problem of lead leaching from glazed pottery has been mostly eliminated through government regulations and good quality control. The World Health Organization has standards for lead and cadmium leaching from pottery intended for food and drink use. The cost of the testing required, however, is not feasible for craft potters, and therefore craft potters should use only lead-free glazes for food and drink containers.
Performing and Media Arts
Theatres, scenery shops and motion picture and television production areas also can produce hazardous waste, since they use many of the same chemicals as are used in the visual arts. The same solutions apply. In particular, the widespread shift from solvent-based paints to water-based paints has greatly decreased the amount of solvent pollution.
One of the main public health issues for theatres (and other places of public assembly) is fire safety. Many theatres and other performance spaces, especially small, non-commercial ones, do not meet applicable fire codes and are dangerously overcrowded. There have been many disastrous fires with numerous fatalities in the performing arts. The use of fogs and smokes for special effects in theatre and opera can also pose the risk of asthma attacks in asthmatic audience members in the front of the theatre if the building does not have adequate exhaust ventilation to prevent the fog or smoke from affecting the audience.
Entertainment industries such as amusement and theme parks can face all the solid waste and other pollution problems of a small town. Zoos, circuses and other types of entertainment involving animals can have many of the same pollution problems as livestock raising, but on a smaller scale.
A public health concern at all entertainment events where food is sold is the possibility of developing salmonella poisoning, hepatitis or other diseases if there are not adequate public health controls.
Crowd control is another major public health concern in many large entertainment events, such as certain types of popular concerts and sports events. Widespread use of drugs and alcohol, overcrowding, allowing extensive standing room (festival seating) and lack of adequate preplanning have led to many incidents involving riots and panic, with resulting multiple injuries and fatalities. In addition, lack of adequate construction standards has caused fires and collapses of seating areas in several countries. There is a need for better regulations and provision of proper crowd control measures in these situations.
Visitors to parks and zoos can also present hazards to themselves. There have been many incidents where zoo visitors have been maimed or killed after entering animal enclosures. Visitors who get too close to wild animals in the parks have also experienced attacks, many of which have been fatal. The problems of inexperienced parks visitors getting lost, caught in storms, or falling from mountains is also a constant public health risk which can use up extensive resources for rescue.
The sex industry, especially prostitution, is particularly infamous for the possibility of patrons being robbed and possibly contracting sexually transmitted diseases. This is particularly true in countries where prostitution is not legally controlled. Criminal activities are often associated with prostitution.
This grouping of extremely varied and miscellaneous entertainment occupations includes work locations such as bars, nightclubs, discotheques, dancehalls, topless bars, go-go clubs, casinos, bingo and gambling parlours, and pool halls, as well as cinema theatres. Occupations include bartenders, waiters, hostess/host, card dealers, bouncers (security personnel), musicians, dancers, strippers and movie projectionists. Hotels and restaurants often have night entertainment venues within them. There are several categories of hazards common to almost all nightlife entertainment workers.
Shiftwork. Entertainment workers such as bartenders may have routine nightshifts, while musicians working in a club may have irregular shifts. Various physiological, psychological and social effects are associated with nightshift or irregular shiftwork. Often bartenders and cocktail waitresses work shifts that are 10 to 14 hours long.
Violence. Workplace violence is a major problem in establishments that serve alcohol, as well as in gambling enterprises. The United States National Institute for Occupational Safety and Health studied homicide rates among workers in the United States during 1980–1989. They found bartenders to be ranked the eighth highest occupational group, with a homicide rate of 2.1 per 100,000, compared to the average homicide rate of 0.7 homicides per 100,000 for all workers. The exchange of money with the public, often working alone or in small numbers and working late at night or early in the morning, as well as working in high-crime areas, were all found to be factors related to the high rate. Preventive measures for lowering the violence rate include increasing the visibility of the workplace, such as by installing better lighting. The amounts of cash on hand should be minimized and signs posted which clearly indicate that little or no cash in on hand. Silent alarms and hidden cameras can be installed and workers can be trained in non-violent response techniques for emergencies, such as robberies. Arrangements can be made for having routine police checks on workers’ safety, and workers may even be provided bullet-proof barriers and vests if needed.
Fire Safety. Many smaller nightclubs, dancehalls, movie theatres and bars may not meet with local assembly, building or fire code requirements. There have been several high-profile fatal fires in urban clubs, which are often more crowded than permissible by law. Adherence to fire and assembly codes, a fire safety and emergency programme and availability of fire extinguishers and training in their use, as well as other emergency procedures, can reduce risks (Malhotra 1984).
Second-hand smoke. In many locations where there is nightlife entertainment, second-hand cigarette smoke is a significant hazard. The risk of lung cancer and heart disease is increased with exposure to cigarette smoke in the workplace (NIOSH 1991). The risk of laryngeal cancer, also associated with tobacco use, is elevated in bartenders and food servers. Often, smaller bars and night entertainment clubs do not have adequate ventilation for cigarette smoke. In many countries, efforts are being made to regulate exposure to second-hand smoke; but such governmental restriction are not universal. Ventilation and air cleaning devices, such as electrostatic precipitators, as well as the restriction of smoking will decrease exposure.
Alcohol and drug abuse. Working in certain occupations has been found to be correlated to increased alcohol consumption, and one suggestive study has found that death from liver cirrhosis, a disease associated with alcohol consumption, is elevated among waiters, bartenders and musicians (Olkinuora 1984). In nightlife entertainment work there is easy access to alcohol and a social pressure to drink. Often there is isolation from a usual homelife because of working during the night shift or because of touring through different locations. Poor management and lack of supervision can contribute to the problem. Performance anxiety (in the case of musicians), or the need to stay awake during night shift, as well as the fact that patrons may be apt to abuse drugs, can also increase the risks for drug abuse among workers in the nightlife environment. The risks for alcohol and drug abuse intervention programmes can be decreased by well-designed training programmes which assist workers dealing with these problems.
Noise. Excessive noise exposure can be a problem in bars and restaurants. While the problem of noise is obvious in discotheques and music clubs which feature excessively high sound levels, noise overexposure can also be a problem in bars and other locations in which there is only pre-recorded or jukebox music, which can also be played very loudly. Sound levels of over 100 decibels (dB) are common in discos (Tan, Tsang and Wong 1990). One survey of 55 nightclubs in New Jersey in the United States revealed noise levels from 90 to 107 dB. Placement of speakers and jukeboxes away from work stations can reduce worker exposure, and acoustic baffling and barriers can also help. In some cases a general reduction in volume may be possible. If possible, wearing ear plugs can reduce worker exposure.
Dermatitis. Nightlife workers share many skin problems with food handlers. Skin infections, such as candidiasis of the hands, can arise from extensive contact with soiled glassware, washing and cleaning fluids and water. Automatic dish- and glass-washing equipment can address this problem. Food sensitivities are also known, such as contact dermatitis in a bartender with a sensitivity to lemon and lime peels (Cardullo, Ruszkowski and Deleo 1989). Bartenders have developed eczema from handling mint. Other specific sensitivities leading to dermatitis have been reported, such as dermatitis in a professional blackjack dealer who developed a sensitivity to chromate salts used in the green dye for the felt on gaming tables (Fisher 1976).
Musculoskeletal problems. Repetitive motion injuries and other problems associated with workplace design can be found among nightlife workers. For example, musicians and dancers are prone to specific musculoskeletal problems, as discussed elsewhere in this chapter. Bartenders who continually wash glassware and card dealers who must shuffle and deal cards for games in casinos have been found to suffer from carpal tunnel syndrome. More frequent breaks during shifts, in addition to job and task redesign, may reduce these hazards. Bartenders, cocktail waitresses, casino dealers and food servers often must stand for their entire workshift, which may be 10 to 12 hours long. Excessive standing can result in back strain and other circulatory and musculoskeletal problems. Corrugated rubber floor mats and comfortable, supportive shoes can lessen the strain.
Film projection booths. Projection booths are small and problems of excessive heat can arise. Older film projection booths use a carbon arc light source to project images, while more modern booths employ xenon lamps. In either case, ultraviolet (UV) radiation and ozone gas exposure can occur. Levels of ozone that ranged from 0.01 to 0.7 parts per million have been reported. The ozone is generated by the UV radiation, which ionizes oxygen found in the air. (Maloy 1978). In addition, use of carbon arc light sources is associated with rare earth metal fumes, carbon dioxide, carbon monoxide, ozone, electromagnetic radiation (EMF) and heat exposures. Local exhaust ventilation is required.
Special effects. Many different special effects can be used in clubs and discotheques, including, various smokes and fogs, laser light shows and even pyrotechnics. Adequate training in laser operation and safety and other special effects is necessary. UV light emitted from “black” lights may pose additional hazards, especially to strippers and go-go dancers (Schall et al. 1969). It has been suggested that a glass barrier between the black light and the performers would help decrease the hazards. These effects are described in more detail in other articles in this chapter.
The sex industry is a major industry both in developing countries, where it is a major source of foreign currency, and in industrialized countries. The two main divisions of the sex industry are (1) prostitution, which involves the direct exchange of a sexual service for money or other means of economic compensation and (2) pornography, which involves the performance of sex-related tasks, sometimes involving two or more people, for still photographs, in motion pictures and videotapes, or in a theatre or nightclub, but does not include direct sexual activity with the paying client. The line between prostitution and pornography is not very clear, however, as some prostitutes restrict their work to erotic acting and dance for private clients, and some workers in the pornography industry go beyond display to engaging in direct sexual contact with members of the audience, for example, in strip- and lap-dancing clubs.
The legal status of prostitution and pornography varies from one country to another, ranging from complete prohibition of the sex-money exchange and the businesses in which it takes place, as in the United States; to decriminalization of the exchange itself but prohibition of the businesses, as in many European countries; to toleration of both independent and organized prostitution, for example, in the Netherlands; to regulation of the prostitute under public health law, but prohibition for those who fail to comply, as in a number of Latin American and Asian countries. Even where the industry is legal, governments have remained ambivalent and few, if any, have attempted to use occupational safety and health regulations to protect the health of sex workers. However, since the early 1970s, both prostitutes and erotic performers have been organizing in many countries (Delacoste and Alexander 1987; Pheterson 1989), and have increasingly addressed the issue of occupational safety as they attempt to reform the legal context of their work.
A particularly controversial aspect of sex work is the involvement of young adolescents in the industry. There is not enough space to discuss this at any length here, but it is important that solutions to the problems of adolescent prostitution be developed in the context of responses to child labour and poverty, in general, and not as an isolated phenomenon. A second controversy has to do with the extent to which adult sex work is coerced or the result of individual decision. For the vast majority of sex workers, it is a temporary occupation, and the average worklife, worldwide, is from 4 to 6 years, including some who work only for a few days or intermittently (e.g., between other jobs), and others who work for 35 years or more. The primary factor in the decision to do sex work is economics, and in all countries, work in the sex industry pays much better than other work for which extensive training is not required. Indeed, in some countries, the higher-paid prostitutes earn more than some physicians and attorneys. It is the conclusion of the sex workers’ rights movement that it is difficult to establish issues like consent and coercion when the work itself is illegal and heavily stigmatized. The important thing is to support sex workers’ ability to organize on their own behalf, for example, in trade unions, professional associations, self-help projects and political advocacy organizations.
Hazards and Precautions
Sexually transmitted diseases (STDs). The most obvious occupational hazard for sex workers, and the one which has received the most attention historically, is STDs, including syphilis and gonorrhoea, chlamydia, genital ulcer disease, trichomonas and herpes, and, more recently, the human immunodeficiency virus (HIV) and AIDS.
In all countries, the risk of infection with HIV and other STDs is greatest among the lowest-income sex workers, whether on the street in the industrial countries, in low-income brothels in Asia and Latin America or in residential compounds in impoverished communities in Africa.
In industrialized countries, studies have found HIV infection among female prostitutes to be associated with injecting drug use by either the prostitute or her ongoing personal partner, or with the prostitute’s use of “crack”, a smokeable form of cocaine—not with the number of clients or with prostitution per se. There have been few if any studies of pornography workers, but it is likely to be similar. In developing countries, the primary factors are less clear, but may include a higher prevalence of untreated conventional STDs, which some researchers think facilitate transmission of HIV, and a reliance on informal street vendors or poorly equipped clinics for treatment of STDs, if treatment involves injections with unsterile needles. Injection of recreational drugs is also associated with HIV infection in some developing countries (Estébanez, Fitch and Nájera 1993). Among male prostitutes, HIV infection is more often associated with homosexual activity, but is also associated with injecting drug use and sex in the context of drug dealing.
Precautions involve the consistent use of latex or polyurethane condoms for fellatio and vaginal or anal intercourse, where possible with lubricants (water-based for latex condoms, water or oil-based for polyurethane condoms), latex or polyurethane barriers for cunnilingus and oral-anal contact and gloves for hand-genital contact. While condom use has been increasing among prostitutes in most countries, it is still the exception in the pornography industry. Women performers sometimes use spermicides to protect themselves. However, while the spermicide nonoxynol-9 has been shown to kill HIV in the laboratory, and reduces the incidence of conventional STD in some populations, its efficacy for HIV prevention in actual use is far less clear. Moreover, the use of nonoxynol-9 more than once a day has been associated with significant rates of vaginal epithelial disruption (which could increase the female sex worker’s vulnerability to HIV infection) and sometimes an increase in vaginal yeast infections. No one has studied its use for anal sex.
Access to sex worker–sensitive health care is also important, including care for other health problems, not just STDs. Traditional public health approaches that involve mandatory licensing or registration, and regular health examinations, have not been effective in reducing the risk of infection for the workers, and are contrary to World Health Organization policies that oppose mandatory testing.
Injuries. Although there have not been any formal studies of other occupational hazards, anecdotal evidence suggests that repetitive stress injuries involving the wrist and shoulder are common among prostitutes who do “hand jobs”, and jaw pain is sometimes associated with performing fellatio. In addition, street prostitutes and erotic dancers may develop foot, knee and back problems related to working in high heels. Some prostitutes have reported chronic bladder and kidney infections, due to working with a full bladder or not knowing how to position oneself to prevent deep penetration during vaginal intercourse. Finally, some groups of prostitutes are very vulnerable to violence, especially in countries where the laws against prostitution are heavily enforced. The violence includes rape and other sexual assault, physical assault and murder, and is committed by police, clients, sex work business managers and domestic partners. The risk of injury is greatest among younger, less experienced prostitutes, especially those who begin working during adolescence.
Precautions include ensuring that sex workers are trained in the least stressful way to perform different sexual acts to prevent repetitive stress injuries and bladder infections, and self-defence training to reduce vulnerability to violence. This is particularly important for young sex workers. In the case of violence, another important remedy is to increase the willingness of police and prosecuting attorneys to enforce the laws against rape and other violence when the victims are sex workers.
Alcohol and drug use. When prostitutes work in bars and nightclubs, they are often required by management to encourage clients to drink, as well as to drink with clients, which can be a serious hazard for individuals who are vulnerable to alcohol addiction. In addition, some begin to use drugs (e.g., heroin, amphetamines and cocaine) to help deal with the stress of their work, while others used drugs prior to beginning sex work, and turned to sex work in order to pay for their drugs. With injecting drug use, vulnerability to HIV infection, hepatitis and a range of bacterial infections increases if drug users share needles.
Precautions include workplace regulations to ensure that prostitutes can drink non-alcoholic beverages when with clients, the provision of sterile injection equipment and, where possible, legal drugs to sex workers who inject drugs, and increasing access to drug and alcohol addiction treatment programmes.
Sports activities involve a great number of injuries. Precautions, conditioning and safety equipment, when used properly, will minimize sports injuries.
In all sports, conditioning year round is encouraged. Bone, ligaments and muscles respond in a physiological fashion by gaining both size and strength (Clare 1990). This increases the athlete’s agility to avoid any injurious physical contact. All sports requiring weightlifting and strengthening should be under the supervision of a strength coach.
Contact sports such as American football and hockey are particularly dangerous. The aggressive nature of football requires the player to strike or tackle the opposing player. The focus of the game is to possess the ball with the intent of physically striking anyone in one’s path. The equipment should be well-fitting and offer adequate protection. (figure 1). The helmet with appropriate face mask is standard and is critical in this sport (figure 2). It should not slide or twist and the straps should be applied snugly (American Academy of Orthopedic Surgeons 1991).
Figure 1. Snug fitting football pads.
Source: American Academy of Orthopedic Surgeons 1991
Figure 2. American football helmet.
Source: Clare 1990
Unfortunately, the helmet is sometimes used in an unsafe manner whereby the player “spears” an opponent. This can lead to cervical spine injuries and possible paralysis. It can also lead to careless play in sports like hockey, when players feel they can be more free with the use of their stick and risk slashing the face and body of the opponent.
Knee injuries are quite common in football and basketball. In minor injuries, an elastic “sleeve” (figure 3) which provides compressive support may be useful. The ligaments and cartilage of the knee are prone to stress as well as impact trauma. The classic combination of cartilage and ligamentous insult was first described by O’Donoghue (1950). An audible “pop” may be heard and felt, followed by swelling, if there are ligament injuries. Surgical intervention may be needed before the player may resume activities. A derotational brace may be worn post-operatively and by players with partial tear of the anterior cruciate ligament but with enough intact fibres able to sustain their activities. These braces must be well padded to protect the injured extremity and other players (Sachare 1994a).
Figure 3. Patella cut-out sleeve.
Huie, Bruno and Norman Scott
In hockey, the velocity of both the players and the hard hockey puck warrants the use of protective padding and helmet (figure 4). The helmet should have a face shield to prevent facial and dental injuries. Even with helmets and protective padding to vital areas, severe injuries such as fractures of extremities and spine do occur in football and hockey.
Figure 4. Padded hockey gloves.
Huie, Bruno and Norman Scott
In both American football and hockey, a complete medical kit (which includes diagnostic instruments, resuscitation equipment, immobilization devices, medication, wound care supplies, spine board and stretcher) and emergency personnel should be available (Huie and Hershman 1994). If possible, all contact sports should have this available. Radiographs should be obtained of all injuries to rule out any fractures. Magnetic resonance imaging has been found to be very helpful in determining soft tissue injuries.
Basketball is also a contact sport, but protective equipment is not worn. The focus of the player is to have possession of the ball and their intent is not to strike the opposing players. Injuries are minimized due to the player’s conditioning and speed in averting any hard contact.
The most common injury to the basketball player are ankle sprains. Evidence of ankle sprains has been noted in about 45% of players (Garrick 1977; Huie and Scott 1995). The ligaments involved are the deltoid ligament medially and the anterior talofibular, posterior talofibular, and calcaneofibular ligaments laterally. X rays should be obtained to rule out any fractures which may occur. These radiographs should include the entire lower leg to rule out a Maisonneuve fracture (VanderGriend, Savoie and Hughes 1991). In the chronically sprained ankle, use of a semi-rigid ankle stirrup will minimize further insult to the ligaments (figure 5).
Figure 5. Rigid ankle stirrup.
Finger injuries may result in ruptures of the supporting ligamentous structures. This can result in a Mallet finger, Swann Neck deformity and Boutonierre deformity (Bruno, Scott and Huie 1995). These injuries are quite common and are due to direct trauma with the ball, other players and the backboard or rim. Prophylactic taping of ankles and fingers helps minimize any accidental twisting and hyperextension of the joints.
Facial injuries (lacerations) and fractures of the nose due to contact with opponents’ flailing arms or bony prominences, and contact with the floor or other stationary structures have been encountered. A clear light-weight protective mask may help in minimizing this type of injury.
Baseballs are extremely hard projectiles. The player must always be cognizant of the ball not only for safety reasons but for the strategy of the game itself. Batting helmets for the offensive player, and chest protector and catcher’s mask/helmet (figure 6). for the defensive player are required protective equipment. The ball is hurled at times in excess of 95 mph, sometimes resulting in bone fractures. Any head injuries should have a full neurological work-up, and, if loss of consciousness is present, radiographs of the head should be taken.
Figure 6. Protective cather's mask.
Huie, Bruno and Norman Scott
Soccer can be a contact sport resulting in trauma to the lower extremity. Ankle injuries are very common. The protection that would minimize this would be taping and the use of a semi-rigid ankle stirrup. It has been found that the effectiveness of the taped ankle diminishes after about 30 minutes of vigorous activities. Tears of the anterior cruciate ligament of the knee are often encountered and most likely will require a reconstructive procedure if the player wishes to continue participating in this sport. Anterior medial tibial stress syndrome (shin splints) is extremely common. The hypothesis is that there may be an inflammation to the periosteal sleeve around the tibia. In extreme situations, a stress fracture may occur. The treatment requires rest for 3 to 6 weeks and the use of non-steroidal anti-inflammatory drugs (NSAID), but high-level and professional-level players tend to compromise the treatment once the symptoms diminish as early as 1 week and thus go back to the impact activity. Hamstring pulls and groin pulls are common in the athletes who do not permit enough time to warm and stretch the musculature of the legs. Direct trauma to the lower extremities, particularly the tibia, may be minimized with the use of anterior shin guards.
Skiing as a sport does not require any protective equipment, although goggles are encouraged to prevent eye injuries and to filter out the sun’s glare off the snow. Ski boots offer a rigid support for the ankles and have a “quick-release” mechanism in the event of a fall. These mechanisms, although helpful, are susceptible to circumstances of the fall. During the winter season, many injuries to the knee resulting in ligament and cartilage damage are encountered. This is found in the novice as well as the seasoned skier. In professional downhill skiing, helmets are required to protect the head due to the velocity of the athlete and the difficulty of stopping in the event the trajectory and direction are miscalculated.
Martial Arts and Boxing
Martial arts and boxing are hard contact sports, with little or no protective equipment. The gloves used on the professional boxing level are, however, weighted, which increases their effectiveness. Head guards at the amateur level help soften the impact of the blow. As with skiing, conditioning is extremely important. Agility, speed and strength minimize the combatant’s injuries. The blocking forces are deflected more than absorbed. Fractures and soft tissue insults are very common in this sport. Similar to volleyball, the repetitive trauma to the fingers and carpal bones of the hand results in fractures, subluxation, dislocation and ligamentous disruptions. Taping and padding of the hand and wrist may provide some support and protection, but this is minimal. Studies have shown that long-term brain damage is a serious concern for boxers (Council on Scientific Affairs of the American Medical Association 1983). Half of a group of professional boxers with more than 200 fights each had neurological signs consistent with traumatic encephalopathy.
Horse racing at the professional and amateur levels requires a riding helmet. These helmets offer some protection for head injuries from falls, but they offer no attachment for the neck or spine. Experience and common sense help minimize falls, but even seasoned riders can sustain serious injuries and possibly paralysis if they land on their head. Many jockeys today also wear protective vests since being trampled under horses’ hooves is a major risk in falls and has resulted in fatalities. In harness racing, where horses pull two-wheeled carts called sulkies, collisions between sulkies has resulted in multiple pile-ups and serious injuries. For hazards to stable hands and others involved in handling the horses, see the chapter Livestock rearing.
As a general rule, immediate icing (figure 7), compression, elevation and NSAIDs following most injuries will suffice. Pressure dressings should be applied to any open wounds, followed by an evaluation and suturing. The player should be removed from the game immediately to prevent any blood-borne contamination to other players (Sachare 1994b). Any head trauma with loss of consciousness should have a mental status and neurological work-up.
Figure 7. Cold compressive therapy.
Professional athletes with asymptomatic or symptomatic cardiac conditions may be hesitant in disclosing their pathology. In recent years, several professional athletes have been found to have cardiac problems that resulted in their deaths. The economic incentives of playing professional-level sports may inhibit athletes from disclosing their conditions for fear of disqualifying themselves from strenuous activities. Carefully obtained past medical and family histories followed by EKG and treadmill stress tests prove to be valuable in detecting those who are at risk. If a player is identified as a risk and still wishes to continue competing regardless of the medical-legal issues, emergency resuscitative equipment and trained personnel must be present at all practices and games.
Referees are present not only to keep the flow of the game going but to protect the players from hurting themselves and others. Referees, for the most part, are objective and have the authority to suspend any activity should an emergency condition arise. As with all competitive sports, emotion and adrenaline are flowing high; the referees are present to help the players harness these energies in a positive fashion.
Proper conditioning, warm-up and stretching prior to engaging in any competitive activity is vital to the prevention of strains and sprains. This procedure enables the muscles to perform at peak efficiency and minimizes the possibilities of strains and sprains (micro-tears). Warm-ups may very well be a simple jog or callisthenics for about 3 to 5 minutes followed by gentle stretching out of the extremities for an additional 5 to 10 minutes. With the muscle at its peak efficiency, the athlete may be able to quickly manoeuvre away from a threatening position.
Bullfighting, or the corrida as it is commonly called, is popular in Spain, Spanish-speaking countries in Latin America (especially Mexico), southern France and Portugal. It is highly ritualized, with pageants, well-defined ceremonies and colourful traditional costumes. Matadors are highly respected and often begin their training at an early age in an informal apprenticeship system.
Rodeos, on the other hand, are a more recent sports event. They are an outgrowth of skills contests between cowboys illustrating their everyday activities. Today, rodeos are formalized sports events popular in the western United States, western Canada and Mexico. Professional rodeo cowboys (and some cowgirls) travel the rodeo circuit from one rodeo to another. The most common rodeo events are bronco riding, bull riding, steer wrestling (bulldogging) and calf roping.
Bullfights. Participants in a bullfight include the matadors, their assistants (the banderilleros and picadors) and the bulls. When the bull first enters the arena from the bull pen gate, the matador attracts its attention with a series of passes with his large cape. The bull is attracted by the movement of the cape, not the colour, since bulls are colour-blind. The matador’s reputation is based on how close he gets to the horns of the bull. These fighting bulls have been bred and trained for centuries for their aggressiveness. The next part of the bullfight involves the weakening of the bull by mounted picadors placing lances in the bull, and then banderilleros, working on foot, placing barbed sticks called banderillas in the bull’s shoulder in order to lower the bull’s head for the kill.
The final stage of the fight involves the matador trying to kill the bull by inserting his sword blade between the shoulder blades of the bull into the aorta. This stage involves many formalized passes with the cape before the final kill. The greater the risks taken by the matador, the greater the acclaim, and of course the greater the risk of being gored (see figure 1). Bullfighters generally receive at least one goring per season, which could involve as many as 100 bullfights per year per matador.
Figure 1. Bullfighting.
The primary hazard facing the matadors and their assistants is being gored or even killed by the bull. Another potential hazard is tetanus from being gored. One epidemiological study in Madrid, Spain, indicated that only 14.9% of bullfighting professionals had complete anti-tetanus vaccination, while 52.5% had suffered occupational injuries (Dominguez et al. 1987). Few precautions are taken. The mounted picadors wear steel leg armour. Otherwise, the bullfighting professionals depend on the training and skills of themselves and their horses. One essential precaution is adequate planning for onsite emergency medical care (see “Motion picture and television production” in this chapter).
Rodeos. The most hazardous common rodeo events are bronco or bull riding and steer wrestling. In bronco or bull riding, the purpose is to stay on the bucking animal for a predetermined time. Bronco riding can be either bareback or with a saddle. In steer wrestling, a rider on horseback attempts to throw the steer to the ground by diving off the horse, grabbing the bull by its horns and wrenching it to the ground. Calf roping involves roping a calf from horseback, jumping off the horse and then hog-tying the front and back legs of the calf together in the shortest possible time.
Besides the rodeo contestants, those at risk include the pickup riders or outriders, whose role is to rescue the thrown rider and capture the animal, and the rodeo clowns, whose job is to distract the animal, especially bulls, to give the thrown rider a chance to escape (figure 2). They do this while on foot and dressed in a colourful costume to attract the animal’s attention. Hazards include being trampled, being gored by the bull’s horns, injuries from being bucked off, knee injuries from jumping off the horse, elbow injuries in bronco and bull riders from holding on to the animal with one hand and facial injuries from bulls tossing their heads back. Injuries also occur from bronco or bull riders being smashed against the sides of the chute while waiting for the gate to open and the animal to be released. Severe injuries and fatalities are not infrequent. Bull riders sustain 37% of all rodeo-related injuries (Griffin et al. 1989). In particular, brain and spinal cord injuries are of concern (MMWR 1996). One study of 39 professional rodeo cowboys showed a total of 76 elbow abnormalities in 29 bronco and bull riders (Griffin et al. 1989). They concluded that the injuries were a result of constant hyperextension of the arm gripping the animal, as well as injuries in falls.
Figure 2. Rodeo clown distracting a bull from a fallen rider.
The main way of preventing injuries lies in the skills of the rodeo cowboys, pickup riders and rodeo clowns. Well-trained horses are also essential. Taping elbows and wearing elbow pads has also been recommended for bronco and bull riding. Safety vests, mouth guards and safety helmets are rare, but becoming more accepted. Face masks have occasionally been used for bull riding. As in bullfighting, an essential precaution is adequate planning for on-site emergency medical care.
In both rodeos and bullfighting, of course, the animal keepers, feeders and so on are also at risk. For more information on this aspect, see “Zoos and aquariums” in this chapter.
The common product shared between circuses and amusement and theme parks is creating and providing entertainment for the public’s enjoyment. Circuses can take place in a large temporary tent equipped with bleachers or in permanent buildings. Attending a circus is a passive activity in which the customer views the various animal, clown and acrobatic acts from a seated position. Amusement and theme parks, on the other hand, are locations where customers actively walk around the park and can participate in a wide variety of activities. Amusement parks can have many different types of rides, exhibits, games of skill, sales booths and stores, grandstand shows and other types of entertainment. Theme parks have exhibits, buildings and even small villages that illustrate the particular theme. Costume characters, who are actors dressed in costumes illustrating the theme—for example, historical costumes in historic villages or cartoon costumes for parks with a cartoon theme—will participate in shows or walk around among the visiting crowds. Local country fairs are another type of event where activities can include rides, animal and other side shows, such as fire-eating, and agricultural and farm animal exhibitions and competitions. The size of the operation can be as small as one person running a pony cart ride in a parking lot, or as large as a major theme park employing thousands. The larger the operation, the more background services that can be present, including parking lots, sanitation facilities, security and other emergency services and even hotels.
Occupations vary widely as do the levels of skills required for individual tasks. People employed in these activities include ticket sellers, acrobatic performers, animal handlers, food service workers, engineers, costume characters and ride operators, among a long list of other workers. The occupational safety and health risks include many of those found in general industry and others that are unique to circuses and amusement and theme park operations. The following information provides a review of entertainment-related hazards and precautions found within this segment of the industry.
Acrobatics and Stunts
Circuses, in particular, have many acrobatic and stunt acts, including high-wire tightrope walking and other aerial acts, gymnastic acts, fire-juggling acts and displays of horsemanship. Amusement and theme parks can also have similar activities. Hazards include falls, misjudged clearances, improperly inspected equipment and physical fatigue due to multiple daily shows. Typical accidents involve muscular, tendon and skeletal injuries.
Precautions include the following: Performers should receive comprehensive physical conditioning, proper rest and a good diet, and show schedules should be rotated. All equipment, props, rigging, safety devices and blocking should be carefully reviewed before each performance. Show personnel should not perform when they are ill, injured or taking medication which may affect required abilities to safely meet the needs of the show.
Animals are most commonly found in circuses and county fairs, although they can also be found in activities such as pony rides in amusement parks. Animals are found in circuses in wild-animal training acts, for example, with lions and tigers, horse riding acts and other trained animal acts. Elephants are used as show performers, rides, exhibits and work animals. In country fairs, farm animals such as pigs, cattle and horses are exhibited in competitions. In some places, exotic animals are displayed in cages and in such acts as snake handling. Hazards include the unpredictable characteristics of animals combined with the potential for animal handlers to become overly confident and let their guard down. Serious injury and death are possible in this occupation. Elephant handling is considered one of the most dangerous professions. Some estimates indicate there are approximately 600 keepers in the United States and Canada. During the course of an average year there will be one elephant handler killed. Venomous snakes, if used in snake-handling acts, can also be very dangerous, with possible fatalities from snake bites.
Precautions include intense and ongoing animal-handling training. It must be instilled in employees to remain on their guard at all times. The use of protected contact systems is recommended where keepers work alongside animals capable of causing serious injury or death. Protected contact systems always separate the animal handler and the animal by means of bars or closed-off areas. When animals perform on stage to live audiences, noise and other stimuli conditioning must be a part of the required safety training. With venomous reptiles, proper anti-venom antidotes and protective equipment such as gloves, leg guards, snake pincers and carbon dioxide bottles should be available. Care and feeding of animals when they are not being exhibited also requires careful attention on the part of the animal caretakers to prevent injury.
Costume characters acting the role of cartoon figures or historical period characters often wear heavy and bulky costumes. They can act on stages or mingle with the crowds. Hazards are back and neck injuries associated with wearing such costumes with uneven weight distribution (figure 1). Other exposures are fatigue, heat-related problems, crowd pushing and hitting. See also “Actors”.
Figure 1. Worker wearing a heavy costume.
Precautions include the following: Costumes should be correctly fitted to the individual. The weight load, especially above the shoulders, should be kept at a minimum. Costume characters should drink plenty of water during periods of warm weather. Interaction with the public should be of short duration because of the stress of such work. Character duties should be rotated, and non-costumed escorts should be with characters at all times to manage crowds.
Figure 2. Loading pyrotechnics for fireworks show.
Precautions include the following: Only appropriately trained and licensed pyrotechnicians should detonate explosives. Storage, transportation and detonation procedures must be followed (figure 3). Applicable codes, laws and ordinances in the jurisdiction where operating must be adhered to. Pre-approved personal safety equipment and fire extinguishing equipment must be at the detonation site where there is immediate access.
Figure 3. Bunker storage for fireworks.
Food can be bought at circuses and amusement and theme parks from individuals with trays of food, at vendor carts, booths, or even restaurants. Hazards common to food service operations at these events involve serving large captive audiences during high periods of demand in a very short period of time. Falls, burns, cuts and repetitive motion trauma are not uncommon in this occupational classification. Carrying food around on trays can involve back injuries. The risks are increased during periods of high volume. A common example of injury occurring in high-volume food service areas is repetitive motion trauma that can result in tendinitis and carpal tunnel syndrome. One example of a job description where such injuries occur is an ice-cream scooper.
Precautions include the following: Increased staffing during high-volume periods is essential to the safety of the operation. Specific duties such as mopping, sweeping and cleaning should be addressed. Precautions for repetitive motion trauma: regarding the example given above, using softer ice cream can make scooping less strenuous, employees can be regularly rotated, scoops can be warmed to promote easier penetration of the ice cream and the use of ergonomically designed handles should be considered.
Scenery, Props and Exhibits
Stage shows, exhibits, booths, artificial scenery and buildings must be built. Hazards include many of the same hazards as found in construction, including electrocution, severe lacerations, and eye and other injuries associated with the use of power tools and equipment. The outdoor building and use of props, scenery and exhibits increases the potential hazards such as collapse if construction is inadequate. Handling of these components can result in falls and back and neck injuries (see also “Scenery shops” in this chapter).
Precautions include the following: The manufacturer’s warnings, safety equipment recommendations and safe operating instructions for power tools and machinery must be followed. The weight of props and their sections should be minimized to reduce the possibility of lifting-associated injuries. Props, scenery and exhibits designed for outdoor use must be reviewed for wind load ratings and other outdoor exposures. Props designed for use with live loads should be appropriately rated and the built-in safety factor verified. Fire rating of the material should be considered based on the intended use, and any fire regulations that may be applicable must be followed.
Ride Operators and Maintenance Personnel
There are a wide variety of amusement park rides, including Ferris wheels, roller coasters, water flume rides, looping boats and aerial tramways. Ride operators and maintenance personnel work in areas and under conditions where there are increased risks of serious injury. The exposures include electrocution, being struck by equipment and caught in or between equipment and machinery. Besides the rides, ride and maintenance personnel must also operate and maintain the associated electrical power plants and transformers.
Precautions include an effective programme that can reduce the potential for serious injury in a lock out, tag out and block out procedure. This programme should include: personally assigned padlocks with single keys; written procedures for working on electrical circuitry, machinery, hydraulics, compressed air, water and other sources of possible energy release; and tests to ensure that the energy supply has been shut off. When more than one person is working on the same piece of equipment, each person should have and use his or her own lock.
Circuses and many amusement rides can travel from one location to another. This can be by truck for small operations, or by train for large circuses. Hazards include falls, severed body parts and possible death during erection, dismantling or transportation of equipment (figure 4). A particular problem is expedited work procedures, resulting in skipping time-consuming safety procedures, in an effort to meet play date deadlines.
Figure 4. Erecting an amusement park ride with a crane.
Precautions include the following: Employees must be well trained, exercise caution and follow manufacturer’s safety instructions for assembly, dismantling, loading, unloading and transportation of the equipment. When animals are used, such as an elephant to pull or push heavy equipment, additional safety precautions are required. Equipment such as cables, ropes, hoists, cranes and fork-lifts should be inspected before each use. Over-the-road drivers must follow highway transportation safety guidelines. Employees will require additional training in safety and emergency procedures for train operations where animals, personnel and equipment travel together.