Cumulative trauma disorder (recording) on the OSHA 200 log

NOTICE: This is an OSHA Archive Document, and may no longer represent OSHA Policy. It is presented here as historical content, for research and review purposes only.

March 10, 1993

Thomas Hales, MD
Regional Medical Consultant
PHS/NIOSH
[Recipient address omitted]
Dear Dr. Hales:

Thank you for your letter dated January 15, requesting interpretations regarding the proper recording of several cumulative trauma disorder cases on the OSHA 200 Log. I will address each case by first repeating the scenario, your interpretation, and then our answer.

Case 1 An employee presents to the nurses station presenting with hand and wrist discomfort. The history is consistent with work related symptoms, however the physical examination reveals no objective findings. A hand splint is given to the employee, however, this splint is somewhat flexible, and the employee returns to work.

Your interpretation: Although prescribed to keep the wrist immobilized in a neutral posture, the splint, in fact, is not an immobile device and therefore not recordable.

Answer I do not agree with your interpretation. For OSHA injury and illness recordkeeping purposes, the use of casts, splints and orthopedic devices designed to immobilize a body part are generally considered medical treatment. Wraps or non-constraining devices such as wristlets or elastic bandages are generally considered first aid treatment. Please keep in mind, however, that the distinction between first aid and medical treatment is based upon the type of treatment either actually provided or clearly required, even if not provided. If a health care provider "prescribed" a device to immobilize the wrist, the case should be evaluated as one involving medical treatment.

Case 2 An employee presents to the nurses station presenting with hand and wrist discomfort. The history is consistent with work related symptoms, however the physical examination reveals no objective findings. The nurse places an ice pack on the area, and instructs the employee to apply ice to the area every day after work for a week. Upon return to the nurses station, the condition has resolved.

Your interpretation: Ice applied for the first time is not recordable, however if applied in the nurses station for the second time it would be recordable. The fact that ice was applied by the employee at home without a subsequent visit to the nurse's station makes this "not recordable."

Answer I agree that this case is not recordable. As found in the Ergonomic Program Management Guidelines for Meatpacking Plants, medical treatment is defined to include self-administered treatment when made available to employees by their employer. To be considered medical treatment, the treatment must be self-administered at the medical facility or on the employer's premises when made available by the employer. An example would be cold or heat treatments located near the employee's work station to be used when they are feeling discomfort. If the treatment is self-administered at home, it would be considered first aid. Note: Only one application of ice (or other cold or heat treatments, etc.) is necessary to meet the medical treatment criteria if it is done on a second or subsequent visit to medical personnel.

Case 3 An employee presents to the nurses station presenting with hand and wrist discomfort. The history is consistent with work related symptoms, however the physical examination reveals no objective findings. No first aid or medical treatment is given, however a "preventative" job transfer is assigned to the employee.

Your interpretation: A CTD is determined to exist with: a) symptoms, and b) transfer/rotation to another job, therefore this case is recordable. The word "preventative" should not be used to prevent existing symptoms from getting worse.

Answer I agree with your interpretation. Once a symptom exists (objective or subjective) any treatment or job rotation involved should not be considered "preventative" for recordkeeping purposes. This would be a clearly recordable case involving days of restricted work activity.

I hope you find this information useful. If you have any further questions, please call my staff at Area Code (202) 219-6463.

Sincerely,
Stephen A. Newell
Director
Office of Statistics