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How to Handle a Head Case

Posted 8/29/2017 by UHBlog

Concussions and other forms of traumatic brain injury aren’t limited to football players. Talk to our occupational health experts about their complications and when it’s safe to return to work.

How to Handle a Head Case

A workplace head injury is one of the most serious of all on-the-job injuries. It can impact an employee’s ability to think, move, see and hear, and it can cause behavior and emotional changes. For that reason, a head injury is often called an invisible injury.

”We call head injuries an invisible injury because it can be difficult to gauge the severity of the injury,” says occupational medicine specialist Paul Miotto, MD. ”It’s not like a broken bone where we might be able to see swelling or a bone sticking out.”

According to the Centers for Disease Control and Prevention (CDC), head injuries are caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. Head injuries can result in lacerations, concussions and other forms of traumatic brain injury (TBI). The severity of a TBI may range from mild to severe, which can impact the person's mental status or consciousness after the injury.

In 2010, 2.5 million TBIs occurred either as an isolated injury or along with other injuries. The CDC reports that falls account for nearly half of all head injuries. Some other causes of TBI include being struck by or against an object and motor vehicle crashes.

Even people who work in offices are susceptible to head injuries, Dr. Miotto says.

“In offices, people may be bent over in their chair reaching for something, then come up quickly. They might hit their head on a key that’s sticking out or a cabinet drawer that's left open,” he says. “Or they crawl under their desk for something, and the phone rings. They might whack their head under the desk trying to answer it, knocking themselves out.”

While the CDC says that, in general, people who suffer a TBI recover from their symptoms, for some people the symptoms can last days, weeks or longer. According to Dr. Miotto, common symptoms of a traumatic brain injury fall into four categories – thinking/remembering, physical, emotional/mood and sleep – and can include:

  • Nausea
  • Headache
  • Being confused and seeing ”stars”
  • Slurred speech
  • Inability to stand without falling back down
  • Mental fogginess, such as forgetting how to turn on a computer
  • Personality changes, which might include anxiety or restlessness
  • Lethargy (sluggish, sleepy, gets tired easily)

”Employers have to be wary of any of these symptoms in a person who has suffered a blow to the head," he says. "As an employer, you don't want to leave the person alone.”

Instead, Dr. Miotto suggests following these protocols to help the injured person.

  • Stay next to the employee. Be there to calm and reassure the person, especially if there is a lot of bleeding.
    “That part of the body – the head – really bleeds a lot,” he says. “It’s important to control the bleeding and not panic. Put a dressing on the injury, apply pressure and seek medical attention.”
  • Drive with the employee. Don't let the person drive alone to the hospital. The person might seem fine at work but could pass out later.
  • Call 9-1-1. Depending on the type of injury, stabilize the employee’s head and neck and don't move him or her. Even if the injured person doesn't go to the hospital, it's still important for him or her to see a health care provider.
    ”You want to err on the side of being a lot more cautious,” Dr. Miotto says. ”Their doctor can help make a determination about the severity of the injury through an X-ray, CT scan or MRI. Even if they don't go to the hospital, the health care provider can provide close follow-up for the next few days, when their symptoms might change.”
  • Reintegrate the employee at work. Another reason to involve your health care provider is so that you properly reintegrate the employee back into the workplace while meeting the mandates of the Americans with Disabilities Act, where a brain injury is a form of a disability.
    Reintegrating an employee back into the workplace might include modifications such as:
    • Not driving
    • Eliminating heavy lifting
    • Not exposing the worker to bright lights or noise
    • Limiting work hours
    • Reducing the person's workload

“Your workplace will need to make accommodations to help the employee return to work,” he says. “The big problem with a head injury is that everyone responds differently. It's not like a finger fracture where we can expect that at two weeks the recovery will look like this and at six weeks the recovery looks like this, etc. That’s why it’s important to work with a health care provider. We can help you bring the employee back to work safely.”

To learn more about University Hospitals’ occupational health and safety services, connect with University Hospitals Employer Solutions for more information.

Paul Miotto, MD, is an occupational medicine specialist and Medical Director for University Hospitals Occupational Health at University Hospitals Elyria Medical Center Occupational Medicine. You can request an appointment with Dr. Miotto or any other doctor online.

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