Traumatic Brain Injuries

Years ago, my friend was in a car crash. A woman, distracted by her children ran a stop sign and hit his car. He was not wearing a seatbelt and violently struck his head against the windshield.

He was alert and conscious, and despite his protestations was taken to the hospital where a team of medical professionals did a battery of tests and determined that miraculously he had suffered nothing more than a mild bump on the head. A couple of hours later his mother picked him up from the hospital and he returned home to her. As he sat at the kitchen table and related what had happened, he suddenly slumped forward and fell face first, dead, on the table.

An autopsy later revealed that the accident had caused a small contusion that caused bleeding in the brain, which ultimately killed him. This is a cautionary tale that demonstrates that even in cases where one does everything right – seeking immediate medical treatment, following the doctors’ instructions, etc – it can still end in death.

According to the website Brain Injury Facts¹ “In the European Union, brain injury accounts for one million hospital admissions per year. Causes of Traumatic Brain Injury (TBI) include:

• • Motor vehicle crashes account for 50% of all TBIs – this includes autos, trucks, motorcycles, bicycles, and pedestrians hit by vehicles Traumatic Brain Injuries
• The leading causes of TBI vary by age – falls are the leading cause of TBI among persons aged 65 years and older; transportation is the leading cause of TBI among persons under the age of 65 years
• Estimates suggest that sports related brain injuries account for close to 300,000 injuries each year, with winter sports such as skiing and ice-skating accounting for close to 20,000 brain injuries.”²

The best protection from injuring your head is to simply keep your head out of places it shouldn’t be, but failing that, ensure that you are using the most appropriate Personal Protective Equipment. Head injuries can range from relatively mild cuts and abrasions to decapitation, with a host of serious injuries in between.

“many workers are injured and killed by dropped tools and materials, and depending on the weight of the object dropped a hard hat may or may not save your life”

This is not intended to sound flippant or glib. One of the single biggest causes of head injuries is people being in places where a dropped tool, falling material, or even a falling worker, comes in contact with a person who was walking through an area that was restricted and which they neither had authorisation, nor more importantly a reason that required them to be in the area despite being authorised. So, to that end I can’t stress enough the importance of adhering to all posted warnings and restrictions; don’t enter areas where overhead work is underway, irrespective of whether or not crews are actively working in the area. Similarly, stay out of areas where maintenance is being performed unless you are authorised and required to be in the area – not all head injuries are caused by overhead hazards.

The possible causes of head injuries?

There are many ways that you can injure your head on the job. Falling objects, bumping into something, being struck with an object, falling against something and striking your head, decapitation, and even being thrown from a vehicle. Happily, these injuries are easy to prevent by following some very basic guidelines.

Don’t drive like a fool

The majority of serious head and brain injuries are the result of traffic accidents, and if you are commuting to or from your job and are injured in a traffic accident it is considered a recordable workplace accident.

Be alert to other people who are driving like fools

In today’s world of distraction you need to drive defensively and be ever alert to the inexplicably stupid things that other drivers do during the morning commute.

Conduct a risk assessment of the job you are doing

If you’re like me, and I’m not saying that you necessarily are, conducting a risk assessment on a job you have done many times seems like a big waste of time. In reality, however, risk assessments are essential because the conditions under which you perform routine tasks are never exactly the same. In many cases, workers who have tied off to an appropriate anchor point overlook the hazards beneath them and if they do fall, while their fall protection will save them from a death or serious injury it will do nothing to protect them from banging their head and body parts against beams, machinery, cranes or other vehicles, and many other hazards. To protect yourself from this kind of injury remember to ensure that you have a clear fall to the floor or ground when tying off and also to consider the swing radius if you do fall, since swinging into an object and whacking your head can cause a serious injury or even death.

Stay out from under overhead work

This should be instinctual: standing beneath or travelling under people working is a bad idea.

If a cable breaks and sends a crane’s load tumbling down to where you are standing, your chance of survival is slim and your chances of escaping unharmed are even worse. It doesn’t have to be a crane dropping its load to cause you serious head injury. Many workers are injured and killed by dropped tools and materials, and depending on the weight of the object dropped a hard hat may or may not save your life. Rest assured, however, not wearing one will likely make the injury far worse.

I know of a case where two 19 year old workers were killed as they ate their lunch at a picnic table that had been placed beneath a several ton load of suspended steel. The picnic table had been removed from the area several times, but as is so often the case someone invariably moved it back. Why? Because the space was clear, clean, and had relatively low traffic in the area. As I understand the situation, this load had been suspended for weeks, and nothing was done to prevent or restrict access to the area, or if it had, the dangers were never made explicitly clear that if you eat lunch under a suspended load and the cables securing it break or the machinery malfunctions there is virtually no chance that you will survive. If you walk under a suspended load you probably won’t be killed, but, is “probably won’t get killed” a risk you want to take for a clean place to have lunch? I would guess these two would decide not to do what they chose to do – and I can’t say for certain that they had any clue of the danger they were in.

“when you aren’t fully cognisant of the dangers around you it’s easy to be injured in a variety of ways, but head injuries range from the serious to the gruesome”

Slow down

Slips, trips, and falls, and struck by or against type injuries usually have a common component, someone is moving too quickly and loses situational awareness. When you aren’t fully cognisant of the dangers around you it’s easy to be injured in a variety of ways, but head injuries range from the serious to the gruesome. Hard hats and bump caps give you some protection from head injuries, but that protection is far from complete and if anything, the most common scenario will be a lessening of the injury, rather than completely negating the injury itself.

Some may argue that hurrying isn’t always the causative factor and they would be right. A good friend of mine worked at a car dealership and when he got out of the car one icy morning he stepped out of his vehicle and his feet slipped out from under him, hurling him to the ground and knocking him unconscious. He fell between two parked cars and was undiscovered until he regained consciousness. I doubt that his employer reported the injury and he had to see a doctor on his own time. He was diagnosed as having a mild concussion. But even as my friend’s tragic story earlier illustrates, you don’t have to be rushing to slip and fall; hurrying simply amplifies the risk that you will be injured and reduces your ability to be fully situationally aware.

Head injuries

Not all head injuries are acute; many head injuries, especially repeated head injuries, can take years before the symptoms of a brain injury manifest. We will focus on the most common because most of us don’t work in professions where repeated blows to the head are just part of the job description – prize fighters for example – although I confess to having many days where I felt like I had been beating my head against a wall.

Probably the most widely known head injury is a concussion. A concussion is a brain injury caused by a pretty significant blow to the head, usually a blunt-force trauma. Many people, even in the medical profession, consider a concussion a “mild injury”, but there is a growing body of evidence that repeated concussions – even the mildest – can have long-term and lasting negative consequences. So while professional athletes are often the victims of this phenomenon, any worker that is at risk of getting hit on the head could succumb. Perhaps the easiest way to understand what happens in a concussion is that your brain rattles around inside your skull and becomes bruised. This bruising in itself is not necessarily serious, but when it happens often it can have serious lifelimiting side effects.3

Chronic Traumatic Encephalopathy (CTE)

Chronic Traumatic Encephalopathy (CTE) is a degenerative brain disease found in people with histories of suffering from repetitive brain traumas. In in this kind of injury, Tau, a protein, forms clumps that slowly kill the brain cells. This brain damage causes progressive memory loss, depression, suicidal behaviour, poor impulse control, aggressiveness, Parkinsonism and dementia. CTE is typically associated with athletes in high contact sports, but it is a growing problem among veterans. Even so, among workers who routinely work in areas where mobility is limited there is a strong likelihood that workers can smack their heads against pipes, beams or other structural components so they are also at risk for this type of injury. What’s more, research has shown that CTE is not necessarily caused by a concussion and is actually more likely to be caused by repetitive hits to the head over a period of years. Remember, this type of injury doesn’t require a daily pounding to develop – any bump on the head can be serious.

Depression

According to the American Psychiatric Society, depression is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Over 50 percent of suicides are committed by people who suffer from major depression.

Dementia pugilistica

As the name implies dementia pugilistica refers to the brain damage frequently seen in retired boxer or martial artist. These so-called “punch-drunk” fighters may suffer tremors, difficulty moving or limited mobility, slurred speech, and other symptoms of traditional dementia. Like repeated concussions, this brain injury is the result of many minor brain injuries versus a single major trauma.

Neurocognitive impairments

The signs and symptoms of a concussion can often affect one’s 80 cognitive abilities, resulting in an inability to concentrate, confusion, irritability and loss of balance.⁴ A person who is the victim of more than a single traumatic brain injury is at greater risk of having these symptoms manifest and perhaps even worsen over time.

Slower neurological recovery

Every year, millions of people sustain concussions, but the risks of a prolonged recovery after repeat concussions still remains new territory. Nevertheless, a study suggests that a history of multiple concussions may be associated with a slower recovery of neurological function after another concussion. It also suggests that repeat concussions may result in permanent neurocognitive impairment. That’s why it’s utterly important to never return to sports or dangerous activities until you have fully healed.

“head injuries are nothing to trifle with, and it’s important that you take every measure practicable to ensure you don’t end up with a head injury”

Fractured skull

Another fairly common head injury is a fractured skull. Just as the name implies a blow to the head can cause a crack in the bones of the skull.

According to Healthline.com⁵, “A fracture isn’t always easy to see. However, symptoms that can indicate a fracture include:

• Swelling and tenderness around the area of impact
• Facial bruising
• Bleeding from the nostrils or ears

Treatment depends on the severity of the fracture. Pain medication may be the only treatment necessary in mild fractures, while neurosurgery may be required for more serious injuries.” Treating pain with opioids has created epidemics of addiction in many parts of the world and yet this addiction, while caused by a workplace injury, is often disregarded in discussions of workplace head injuries.

Fractured skulls can be caused by dropped objects, falling against a heavy object, mouthing off to me on the playground at school, or a myriad other causes, but they all have one thing in common, the force of the impact must be sufficient to break the cranial bone that comprises the skull.

“head injuries that don’t rob you of your life may easily rob you of your mental faculties, and leave you with debilitating side effects”

Crushing

A less common head, but more gruesome head injury is having one’s head crushed. Having a body part crushed is always a serious injury and difficult to treat, but having one’s head crushed is almost always fatal, and when it is not, treatment is seldom sufficient to return the injured party to complete health. I know of several cases where a worker’s head was crushed and they generally fall into one of two categories: working while failing to properly isolate and control energy on equipment; and having one’s head run over either because the worker was asleep or unconscious in an area of low visibility, or the driver lost visibility of a worker and ran him or her over.

Summary

As I stated at the beginning of this article head injuries are nothing to trifle with, and it’s important that you take every measure practicable to ensure you don’t end up with a head injury. Head injuries that don’t rob you of your life may easily rob you of your livelihood, your mental faculties, and even leave you with irreversible and debilitating side effects.