IC 9459

INFORMATION CIRCULAR /2001

Department of Health and Human Services

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

Use of Simulation Exercises

for Safety Training in the

U.S. Mining Industry
Information Circular 9459

Use of Simulation Exercises for Safety Training

in the U.S. Mining Industry

By Henry P. Cole, Ed.D., William J. Wiehagen, Charles Vaught, Ph.D.,

and Belinda Sue Mills

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

Pittsburgh Research Laboratory

Pittsburgh, PA

September 2001
This document is the public domain and may be freely copied or reprinted.

Disclaimer: Mention of any company or product does not constitute endorsement by NIOSH.

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DHHS (NIOSH) Publication No. 2001-141
CONTENTS

Page

Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Background ................................................................................... 2

Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Methods ..................................................................................... 3

Purchase order records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Response rate ................................................................................ 3

Questionnaire design and content ................................................................ 4

Data analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Respondent and organization demographics ........................................................ 4

Number and types of workers trained . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

How trainers learned about and first used the exercises ............................................... 5

Numbers and types of exercises ordered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

How the exercises were used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Methods by which instructors evaluated the exercises ................................................ 7

Judgments about the relative usefulness and value of the exercises ...................................... 8

Impact of the exercises upon worker training ....................................................... 8

Instructors' interest in new exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Discussion and recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Lessons learned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Miners' responses to the exercises ................................................................ 9

Instructors' response to the exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

The exercise narratives as real-world models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

How instructors evaluate the simulation exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Utility of pooled exercise performance scores . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Issues and prospects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Appendix A.–Cover letter and Simulation Exercise Survey Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Appendix B.–Frequency of exercises ordered by 52 organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

ILLUSTRATIONS

1. Network of organizations involved in the development and dissemination of the simulation exercises for the 

mining industry ........................................................................ 2

2. Trainees' distribution across job categories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

3. Source from which the respondents learned about the exercises ..................................... 5

4. Frequency of exercise administration methods .................................................. 6

5. Frequency of how organizations used the exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

6. Frequency and type of exercise modifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

7. Instructors' judgment about the usefulness and utility of the instructor's copy .......................... 7

8 Frequency of method by which instructors evaluate exercise effectiveness ............................ 7

9. Instructors' judgment of simulation exercise usefulness compared to other teaching materials .............. 8

10. Instructors' perceived value of the exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

11. Influences of the exercises on organization's training program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

12 Instructors' interest in new simulation exercises and preferred format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

13. Ways in which instructors are willing to help develop new exercises ................................. 9

TABLES

1. Question groupings and questionnaire items .................................................... 4

2. Characteristics of respondents' organizations ................................................... 4

3. Exercise content areas ordered by 52 organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

4. Frequency with which four types of exercise formats were ordered by 52 organizations . . . . . . . . . . . . . . . . . . 6

5. Mining sectors for which respondents wanted new simulation exercises developed ...................... 9

B-1. Frequency list of exercises ordered by 52 organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
USE OF SIMULATION EXERCISES FOR SAFETY TRAINING

IN THE U.S. MINING INDUSTRY

By Henry P. Cole, Ed.D.,1 William J. Wiehagen,2 Charles Vaught, Ph.D.,3

and Belinda Sue Mills4

ABSTRACT

This study reports the results of a survey of organizations that used problem-solving simulation exercises

to support mine health and safety training. The exercises are designed to teach judgment and decision-making

skills within two broad domains: (1) how miners respond to mine emergencies (e.g., first aid, self-rescue, and

escape) and (2) how miners integrate safety concepts within the context and performance of routine production

work. The simulation exercises were distributed by the Mine Safety and Health Administration's National Mine

Health and Safety Academy near Beckley, WV. The present study focused on those organizations that ordered

the exercises from the Academy over a 2-year period (1995-96). Researchers assessed how the materials were

used and trainer perceptions of the impact of these materials on annual mine health and safety training.

A total of 147 organizations ordered the exercises over the 2-year period. Survey responses were obtained

from 52 of these organizations. Sixty percent of the respondents rated the exercises as more useful than

traditional instructional materials, 40% as equally useful, and 0% as less useful. Most trainers (79%) felt that

the exercises help them to make better use of workers’ knowledge and experience during training. Many (71%)

also reported that the simulations helped to improve the effectiveness of their instruction and promoted a

problem-solving approach to their training. Fifty of the fifty-two respondents reported that they would like

to have new simulations developed. A large majority showed a proactive interest in helping to develop and

field test new exercises. Ninety-four percent of the trainers judged the exercises as a good value; 92% planned

to order more simulations in the future. Based on this study, recommendations are offered for the continuation

and expansion of simulation exercises as one method for occupational health and safety training.

1

Professor, Department of Educational and Counseling Psychology, and Department of Preventive Medicine and Environmental Health, University of

Kentucky, Lexington, KY. 2

Industrial engineer, Pittsburgh Research Laboratory, National Institute for Occupational Safety and Health, Pittsburgh, PA. 3

Sociologist, Pittsburgh Research Laboratory, National Institute for Occupational Safety and Health, Pittsburgh, PA. 4

Administrative assistant, Behavioral Research Aspects of Safety and Health (BRASH) Working Group, University of Kentucky, Lexington, KY.
2

University 

of 

Kentucky 

Bureau 

of 

Mines 

Colleges & Vocational 

Technical Schools 

Mine Health & 

Safety Academy 

MSHA District 

Offices 

Mining 

Companies 

State Mining 

Departments 

Labor 

Organizations 

National Mining 

Industry 

Professional 

Safety Organizations 

Coal Operator 

Associations 

Figure 1.—Network of organizations involved in the development and dissemination of the simulation exercises for

the mining industry.

BACKGROUND

From 1984 to 1990, a series of 70 simulation exercises was

developed and field tested with workers in the mining industry

[Cole et al. 1988a,b; 1993; 1996]. The exercises focused mainly

on underground coal mining. The simulations were based on actual injury and disaster events reported in formal investigations by

the Mine Safety and Health Administration (MSHA). The purpose

of the simulation exercises was to teach critical problem-solving

and decision-making skills to help miners prevent emergency

situations and to deal effectively with such events when they arise.

Exercises were developed in three broad content areas: (1) first-aid

care of injured miners, (2) mining technical areas, including safe

work practices, ground control, ventilation, haulage, machinery,

electrical, fires and explosions, escape strategies, etc., and (3) a mix

of first-aid and mine technical content. The exercises are realistic

because they are developed from actual cases. Each exercise

simulates key aspects of the cognitive problem solving and

decision-making useful in preventing or limiting the effects of a

nonroutine mine emergency situation. The exercise decision

alternatives (both good and bad) and their consequences are taken

directly from the real-life behavior reported in official investigations of injury and fatality events. Completing a simulation

exercise provides workers with a dramatic and engaging way to

comprehend lessons learned from past injury events and disasters.

Research to develop the simulation exercises was begun in

1984 by the Behavioral Research Aspects of Safety and Health

(BRASH) Working Group at the University of Kentucky under

a contract with the former U.S. Bureau of Mines (USBM) Pittsburgh Research Center.5

 BRASH and USBM researchers

collaborated for several years to develop the simulation exercises and to field test and evaluate them. The effort was assisted through the cooperation of an extensive network that

included labor organizations, coal operator associations, mining

companies, Federal and State enforcement agencies, vocational

and technical schools that conduct miner training, and other

groups. In 1986, MSHA's National Mine Health and Safety

Academy near Beckley, WV, began distributing, at the request

of mine trainers, thousands of copies of the simulation

exercises for use in annual refresher training classes for miners.

Figure 1 shows the network of organizations and individuals

involved in the development and dissemination of the

exercises.

5 The safety and health research functions of the former U.S. Bureau of

Mines were transferred to the National Institute for Occupational Safety and

Health in 1996.
3

An earlier study [Cole et al. 1996] contributed to the present study in two ways. First, a review of the Academy printing

records from December 30, 1986, to December 30, 1994, revealed that more than 400,000 copies of answer sheets for simulation exercises had been printed and disseminated. The number

of answer sheets used is a better indication of the numbers of

workers reached than the number of problem booklets printed.

Unlike the problem booklets, the latent-image answer sheets are

consumable. When a worker selects and marks with a special

pen his or her decision alternatives on a latent-image answer

sheet, a previously invisible (latent-image) message appears on

the answer sheet that tells the respondent the consequences of

that decision. The sheet, therefore, can be used only once.

Second, interviews with 40 key mining industry health and

safety specialists suggested that the exercises had changed the

way mine safety trainers thought about and conducted annual

refresher instruction [Cole et al. 1996]. Specifically, many instructors reported that the simulation exercises influenced them

to adopt a less didactic and a more participatory learning and

problem-solving approach to their instruction. The interviews

also found that safety trainers had begun to adapt existing exercises to new content areas and formats. Some trainers reported adapting the exercises for use with workers in industries

other than mining. This was confirmed in the present study

when Academy records of who had ordered copies of the

exercises were examined.

GOALS

The goal of the present study was to determine how mine

safety and health instructors were using the simulation

exercises. Specifically, we wanted to learn which exercises

were being used, with what types of workers, how the materials

may have influenced instructor and company training practices,

instructors' perceptions of the value of the simulations, and what

new simulation exercises instructors wished to have developed.

This goal was achieved by three activities:

1. Examining National Mine Health and Safety Academy

records for simulation exercises ordered over a 2-year period

(January 1, 1995, to December 30, 1996). This endeavor identified each instance in which a simulation exercise or its component parts had been ordered and who had ordered the exercise.

2. Constructing a followup survey questionnaire to

collect more information from trainers about the exercises that

they ordered, how they were used, and their influence on

training practices.

3. Administering the survey form, collecting and compiling the data received from respondents, reporting the findings, and making recommendations for the development and use

of new exercises.

METHODS

This section describes how the Academy records were

examined to obtain a sample of companies and organizations

that had purchased simulation exercises. The sampling procedures, the questionnaire structure, and data analysis procedures are also described.

PURCHASE ORDER RECORDS

On two occasions, members of the project team visited the

National Mine Health and Safety Academy to record simulation

exercise purchase order information. Assisted by the Academy

staff, a complete list of all the simulation exercise orders for the

2-year (1995-96) period was compiled. A total of 187 organizations and individuals were included on this master list.

SAMPLE

From the Academy records, the master list was reviewed

and checked for accuracy. Many addresses were incomplete.

Some purchase orders were duplicates for the same company

with different addresses. After extensive checking of company

addresses and telephone numbers by phone calls and internet

searches, we found that some companies no longer existed,

while others had consolidated their multiple locations to one

site. An updated list of 147 companies and organizations was

then created. Two address labels were generated for each of

these organizations, and each was assigned a confidential

(individual) identification number.

An explanatory cover letter and a 27-item, 3-page questionnaire were mailed to each of 147 organizations (see appendix A). A $1 bill was included with each questionnaire with a

note explaining that the money was a token of our appreciation

for completing the questionnaire and that it might be used to

"treat yourself to a cup of coffee or donate the dollar to some

good cause." A second $1 bill was promised upon our receipt

of the completed questionnaire within a 2-week period. A

private individual donated the dollar bills. As questionnaires

were returned to the University of Kentucky, the data were

logged into a computer file.

RESPONSE RATE

Twelve of the questionnaires were returned by the U.S.

Postal Service as "undeliverable." Thirteen incomplete questionnaires were returned. Of these, three included notes that

said the individual had purchased the simulation exercises in
4

order to examine them with the expectation of either adapting or

constructing new exercises for workers other than miners. The 10

remaining incomplete questionnaires usually bore notes that the

person who had ordered the materials was no longer with the

company, and the person responding did not know if, when, or

how the exercises had been used. These 25 cases were removed

from the sample of 147 organizations, which resulted in a revised

sample of 122.

Two followup requests (letter and phone calls) were made to

organizations that did not reply to the first survey. These requests

were made at 3- and 6-week intervals. In some cases, the followup requests determined that exercises were ordered by purchasing

agents, not by employees who had used the exercises. Thus, the

contact person was not able to tell how an exercise was used or

who had used it. In other cases, it was found that trainers who

had used the exercises were no longer with the organization that

had ordered the material. These followups not only shed light on

nonrespondents, but also resulted in the return of a few more

questionnaires, for a total response of 52 (43%).

QUESTIONNAIRE DESIGN AND CONTENT

The questionnaire (see appendix A) was designed to make

it fairly easy for participants to complete. Only two items

(1 and 27) required a constructed response. All other items

could be answered by checking alternatives, although eight

items provided opportunities for comment outside of the

alternatives listed. Table 1 shows the question groupings in

relation to questionnaire items.

DATA ANALYSIS

The questionnaire data were entered into a spreadsheet and

analyzed using a commercial data analysis program. Participants' verbatim responses to open-ended items were identified

by item and organization ID number. Descriptive statistics were

completed for questionnaire items described in table 1.

Table 1.—Question groupings and questionnaire items

Question groupings Questionnaire items

Respondent and organization demographics . . . . . . . . . . . . . . . . . . . . 1, 2.

How trainers learned about and first used the exercises . . . . . . . . . . . 3, 4.

Number and types of workers trained . . . . . . . . . . . . . . . . . . . . . . . . . . 6, 7, 8.

Numbers and types of exercises ordered . . . . . . . . . . . . . . . . . . . . . . . Academy records.

How the exercises were used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5, 9, 10, 11, 12, 13.

Methods by which instructors evaluated the exercises . . . . . . . . . . . . 14.

Judgments about the value of the exercises . . . . . . . . . . . . . . . . . . . . 15, 16, 17, 18, 19, 20.

Impact of the exercises on worker training . . . . . . . . . . . . . . . . . . . . . . 21.

Instructors' interest in new exercises . . . . . . . . . . . . . . . . . . . . . . . . . . 22, 23, 24, 25, 26.

RESULTS

The results are reported in the following sections. Each

section corresponds to a grouping of the questionnaire, as described in table 1.

RESPONDENT AND ORGANIZATION

DEMOGRAPHICS

A total of 52 persons from different organizations returned

completed survey forms. Table 2 shows the demographics of

these organizations, including their location and type of organization. Table 2 reveals that 38 (73%) were located in the

East, 10 (19%) in the West, and the rest in the Midwest and

South. Mining firms, training suppliers, and State and Federal

agencies accounted for 91% of the organizations that used the

exercises.

Thirty-six of the respondents listed the word "safety" in

their titles (safety directors, managers, coordinators, specialists,

or engineers). Seven persons included the word "trainer/

training" in their job title (safety trainer, training coordinator,

training manager, associate dean, and training specialist). Four

listed technical and production-related jobs (production

supervisor, geologist, publications manager, and loadout crew

leader). Two listed personnel and employee development in

their job titles; two others loss control and risk management.

Table 2.—Characteristics of respondents' organizations

Region

 No. of

respondents

Mining

company

Training

supplier

State and

Federal

offices

East . . . . . 38 28 5 4

Midwest . . 3 1 1 0

West . . . . . 10 7 0 0

South . . . . 1 1 0 0

 Total . . . 1

52 37 6 4 1

5 organizations did not report the specific type of organization.

NUMBER AND TYPES OF WORKERS TRAINED

For the 3-year period (1994-96), 48 of the organizations

reported training a total of 31,785 workers with simulation

exercises. Four organizations did not report the numbers of

workers trained. The median number of workers trained was 280.
5

79

14 3 4

Workers Supervisors Managers Other

Figure 2.—Trainees' distribution across job categories

(n ' 31,785).

0 10 20 30 40 50

MSHA Catalog

Conference

Workshop

From a friend

Other

Count

Figure 3.—Source from which the respondents learned about

the exercises.

The fewest number of workers trained by an organization was five.

The maximum number of workers trained by 1 organization was

8,000.

Of the workers trained with the simulation exercises, 79%

were hourly workers, 14% were supervisors, and 3% were managers (figure 2). Other job categories accounted for 4% of those

trained (figure 2). Overall, more than 92% of those trained were

workers at the mine site. Of these, 67% were involved in coal

mining, 15% in nonmetal mining, and 10% in metal mining.

The remaining 8% were not listed as miners. Some of these

workers were involved in the construction industry. Others had

no commodity area listed.

Of the 52 organizations, 33 used the exercises to train

underground miners, 31 to train surface miners, and 25 to train

other mine workers. Only four of the organizations used the

exercises to train nonmining workers. One group trained

vocational-technical students with the exercises.

HOW TRAINERS LEARNED ABOUT AND FIRST

USED THE EXERCISES

MSHA first distributed the mining simulation exercises to the

mining industry in December 1986. Two of the survey questions

asked respondents (1) how they first learned about the exercises

and (2) in what year they first used the simulation exercises.

Five sources from which the respondents could have

learned about the exercises were listed on the questionnaire.

Because any given individual could have learned about the

exercises from more than one source, respondents were asked to

check all the sources that apply. Figure 3 is the frequency of

these five information sources as reported by the respondents.

Most respondents learned about the exercises from MSHA’s

Catalog of Training Products for the Mining Industry. Attending a conference or workshop (most likely a mine trainers

or mine health and safety conference) was another frequent

choice for this item. About one-half of the respondents indicated that they first used the exercises before 1994.

NUMBERS AND TYPES OF EXERCISES ORDERED

Table B-1 in appendix B is a frequency listing of the exercises ordered by the 52 questionnaire respondents. The 52

organizations placed a total of 249 orders for 55 different simulation exercises. The 55 exercises ordered were distributed

across the 7 content areas listed in table 3.

 Table 3.—Exercise content areas ordered by 52 organizations

Primary content of exercise No. of exercises

ordered

First aid care of injured miner(s) . . . . . . . . . . . . . 1

31

Underground mine fires ................... 6

Electrical safety . . . . . . . . . . . . . . . . . . . . . . . . . 5

Rescue and/or mine recovery ............... 5

Roof control and/or roof fall ................ 5

Mine ventilation . . . . . . . . . . . . . . . . . . . . . . . . . 3

Safety and health management ............. 3 1

Exercise content overlaps with other areas (electrical, fire,

ventilation, etc.). Total exceeds 55 because of overlapping nature of

exercise content.

The simulation exercises ordered include four different

formats. Most of the exercises were developed in latent-image

format. This method uses a reusable problem booklet to present

the simulation exercise narrative and a separate consumable

answer sheet. Trainees select from decision alternatives in the

simulation exercise and use a special pen to mark their choices

on the latent-image answer sheet. The pen develops a previously invisible (latent-image) response for each answer selected.

The latent image provides immediate feedback about whether

the alternative is a good or bad decision, as well as the immediate consequences of that decision.

The paper-and-pencil format is similar to the latent-image

format in that the same type of problem booklet is used to

present the exercise scenario. However, the participants record

their choices on a one-page (non-latent-image) answer sheet.

Feedback is provided through a master answer sheet that explains which alternative actions are correct and incorrect, why

this is so, and offers additional information about the potential

consequences of each action.

The four role-play simulations are first-aid exercises. These

require the participants to first diagnose and then to care for a

simulated injury victim. The injuries generally are hidden and

require the first-aiders to conduct a thorough hands-on primary

and secondary survey. Injury labels and cues are hidden on the

person playing the part of the injured miner. When found, these

labels and other cues simulate the feedback provided by an

actual primary and secondary survey. An observation checklist

scores the performance of the participants. When the exercise

is completed, the performance data are used to provide feedback

to the trainee.
6

0 10 20 30 40 50

Count

Group (AS)

Individual

Story

Other

Whole class

Group (PB/AS)

Figure 4.—Frequency of exercise administration methods.

0 10 20 30 40 50

As is

Adapted

As a resource

Other

Count

Figure 5.—Frequency of how organizations used the exercises.

The fourth format is a latent-image, three-dimensional

(3-D) color slide-reel exercise. This format is identical to the

latent- image format with one addition. The illustrations that

would normally be included as drawings in the exercise problem

booklet are presented as 3-D color slides mounted on a circular

slide reel and viewed with a handheld 3-D viewer.

Table 4 lists the frequency with which each of these four

types of exercises was ordered by the 52 organizations. The

large number of latent-image exercises and the smaller numbers

of the other formats that were ordered during this period is

related mainly to the availability and not to a preference for any

given format.

Table 4.—Frequency with which four types of exercise formats

were ordered by 52 organizations

Type of exercise No. ordered

Latent-image . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

Paper-and-pencil ........................... 6

Role play . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Latent-image and 3-D slide reel ................ 2

 Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

HOW THE EXERCISES WERE USED

A series of four questions asked how instructors

administered the exercises, in what ways they may have tailored

or modified the exercises, and if they made use of the

supplemental materials in the instructor's copy that is provided

for each exercise.

Administration

Five methods of administration were listed on the survey

form. The first method called "individual" involves giving one

exercise problem booklet, one answer sheet, and one latentimage pen (for latent-image exercises) to each participant. The

second method called "group AS" involves placing the trainees

in groups of four to five persons, giving each person his or her

own problem booklet, but giving only one answer sheet and

marking pen to each small group. The third method called

"group PB/AS" involves giving each small group (normally two

to five trainees) only one problem booklet, answer sheet, and

marking pen. The fourth method called "whole class" involves

the instructor using one problem booklet to lead the members of

the class through the exercise step by step without the trainees

having either a problem booklet or an answer sheet. The fifth

method called "story" involves the instructor telling the exercise

story and discussing each major decision point and its

alternatives with the class members. The last method was

"other." The first five categories were included on the questionnaire because each of these methods of exercise administration

had been observed in miner training classes [Cole et al. 1988a,b;

1993; 1996]. The "other" category was added to gather information about administration methods that had not been

observed before.

Figure 4 shows the frequency with which these six methods

were used to administer the exercises. The most frequently used

method was the "group AS." Use of this method was motivated

by two factors. First, instructors prefer this method because it

fosters dialog and group decision-making. Collaboration is

required because members of the small groups have to agree on

the selection of their decision alternatives and mark these on one

answer sheet. The second reason was the desire to conserve

latent-image answer sheets. During visits to miner training

classrooms as part of earlier studies [Cole et al. 1988a,b; 1993;

1996], instructors reported that cost savings was one additional

reason for using the group answer sheet method. For example,

the cost of answer sheets for the individual administration of an

exercise to a class of 30 trainees is $15. However, by placing

the 30 trainees into 6 groups of 5 people with each group having

only 1 latent-image answer sheet and 1 pen, the cost per class

for answer sheets is only $3.

The "group PB/AS" was the next most frequent method.

With this method, each group is given only one problem booklet, one answer sheet, and one pen. This method is similar to the

group AS method and was used for the same reasons.

Instructor Modification of the Exercises

One item on the questionnaire asked the respondents if they

used the exercises as they were designed, if they modified the

exercises in some way, or if they used the exercises as resources

from which to construct their own training activities. Figure 5

shows the responses: 44 (85%) of the organizations reported

using the exercises "as is." Ten organizations (19%) reported

adapting or modifying the exercises, and 10 (19%) also reported

using some of the exercises as resources for developing their

own training materials. Some organizations used the exercises

in more than one way; thus, the sum of the values reported

exceeds the number of organizations.
7

0 10 20 30 40 50

Changed questions

Added answers

Changed diagrams

Shortened Exercise

Changed answers

Other

Count

Figure 6.—Frequency and type of exercise modifications.

Instructor's copy

useful

Used notes and master

answer sheets

Did not use notes or

master answer sheet

0 10 20 30 40 50

Count

Figure 7.—Instructors' judgment about usefulness and

utility of the instructor's copy.

0 10 20 30 40 50

Talking and listening 

to trainees

Performance scores

Questionnaire

Other means

Don't evaluate

Count

Figure 8.—Frequency of method by which instructors

evaluate exercise effectiveness.

Among the 52 organizations, a number of respondents

reported making some changes to one or more of the exercises

to customize the training for their workers. Figure 6 displays

the ways in which these trainers modified exercises.

Use of the Instructor Copy and Notes

Each exercise comes with an instructor's copy. The

instructor's copy lists the performance objectives for the

exercise, provides tips about how to use the exercise, includes

a master answer sheet, and includes a set of followup notes that

provide supplemental information about each decision

alternative in the exercise scenario. One item on the questionnaire asked the respondents if they used these supplemental

materials. Another item asked if they found the information in

the instructor's copy to be useful. Figure 7 shows these responses. Forty-seven persons (90%) reported using these resources; only three persons reported not using the notes or

master answer sheets. Fifty (96%) of the respondents reported

that the notes in the instructor's copy were useful.

METHODS BY WHICH INSTRUCTORS EVALUATED

THE EXERCISES

Each simulation has two features that can be used to

evaluate the exercise.

1. Scoring instructions. These are used by the individual

trainee (or group) to calculate their exercise performance score.

A maximum possible score is provided for each exercise, thus

providing a reference for comparison.

2. A one-page questionnaire. The questionnaire has two

parts. The first part records the trainee's demographic information, including job specialties, special training, and experience. The second part asks the trainee to judge the authenticity of the exercise scenario, the degree to which the exercise

taught the trainee something new, and the likelihood that what

was learned from the exercise will be of use.

These two built-in properties of the exercise allow an instructor to assess the effectiveness of the exercise in several

different ways. First, the instructor can look at the performance

scores and determine areas of strength and difficulty. Second,

the instructor can look at the exercise questionnaire and at the

performance scores of persons with different types and levels of

training to determine for which groups the exercise was most

effective and which groups and individuals need more instruction in specific areas. Third, the instructor can examine the

portion of the questionnaire that reports the miners' evaluation

of the authenticity, worth, and utility of the exercise. This information can be used to help validate the exercise, make

decisions about the selection of other exercises to be used in the

future, and make changes or updates to the original exercise.

The survey of the 52 respondents included items to elicit

the frequency with which instructors used these and other

methods to evaluate the effectiveness of the exercises. The

results are presented in figure 8. The evaluation method used by

42 (81%) of the 52 organizations was the instructor observing,

talking to, and listening to the trainees. Twenty-one (40%) of

the respondents reported using the exercise performance score

to evaluate the exercise. Only 11 (21%) reported that they used

the exercise evaluation questionnaire to judge the effectiveness

of the simulations. Nine (17%) of the respondents reported that

they used other methods to assess the effectiveness of exercises.

In the comment portion of this item, some of the other methods

included—

(1) Conducting an oral quiz on contested answers;

(2) Asking the workers how the principles presented in the

exercise apply to their jobs;

(3) Judging how effectively the members of the small

groups worked together in solving the exercise problem;

(4) Holding a class discussion by which to evaluate the

accuracy and usefulness of the exercise; and

(5) Seeking feedback from the workers' managers, supervisors, and other staff about the effectiveness of the exercises

as revealed in worker comments, attitudes, and behavior.

Interestingly, only one organization (1.9%) reported that it

did not try to evaluate the effectiveness of the exercises.
8

More useful

As useful

Not as useful

0 10 20 30 40 50

Count

Figure 9.—Instructors' judgment of simulation exercise

usefulness compared to other teaching materials.

0 10 20 30 40 50

Exercises are a good value

Will use excercises in the future

Ordered excercises in 1997

Will Purchase CD version

Count

Figure 10.—Instructors' perceived value of the exercises.

Used worker knowledge and experience

Adopted problem solving approach

Improved instructor effectiveness

Helped to develop own exercises

Other

No influence

0 10 20 30 40 50

Count

Figure 11.—Influences of the exercises on organization's

training program.

JUDGMENTS ABOUT THE RELATIVE USEFULNESS

AND VALUE OF THE EXERCISES

Respondents were asked to compare the relative usefulness

of the simulation exercises to other common health and safety

training materials like videotapes, slides, overhead projector

transparencies, printed materials, and lecture notes. Three response categories were listed for comparing the simulation

exercises to these types of traditional training materials. The

categories were "not as useful," "as useful," and "more useful."

The results are illustrated in figure 9. Thirty-one (60%) of the

respondents judged the simulation exercises as more useful than

the array of traditional materials. Twenty-one (40%) believed

that the simulation exercises were as useful as the traditional

materials. No one judged the materials as less useful than the

traditional materials.

During the study period, the simulation exercises were

available from the National Mine Health and Safety Academy

at a cost of 50 cents each for one problem booklet, one latentimage answer sheet, and one marking pen. The cost of the

instructor's copy was $1.00. Problem booklets could be ordered

in quantity from the Academy or duplicated locally. Because

the booklets are reusable, most organizations ordered only

enough problem booklets (25-35) to provide each member of a

training class with a copy and ordered only 1 copy of the instructor's copy. Latent-image answer sheets are consumable and

cannot be duplicated locally. The marking pens are also consumable, but can be used by many people before they are

depleted of developing fluid.

The survey form asked respondents to comment on the economic value of the exercises. Forty-nine (94%) of the respondents agreed that the simulation exercises were a good

value (see figure 10). In addition, 48 (92%) stated that they

would order and use more latent-image exercises in the future,

and 29 (56%) reported that as of October-November 1996 they

had already ordered more simulation exercises to be used in

1997. Twenty-five (48%) of the respondents also reported that

they would purchase CD-ROM versions of the exercise in the

future if the exercises were available in this format.

IMPACT OF THE EXERCISES ON WORKER

TRAINING

The survey presented a series of six choices about how the

simulation exercises had influenced the organization's training

program. Respondents were asked to check each statement that

applied to their situation (see item 21 of the survey in appendix A). Figure 11 presents the results for this portion of the

survey.

Forty-one (79%) of the respondents reported that the simulation exercises helped them to make better use of worker

knowledge during training classes. Thirty-seven (71%) reported

that the exercises helped them to adopt a more problem-solving

approach to training. An equal number reported that the exercises helped to improve instructor effectiveness. Twelve (23%)

of the respondents indicated that the simulation exercises helped

them to develop their own new simulation exercises. Five

(10%) reported that the exercises had influenced their training

in other ways. The comment section for this item included

statements like "generated creativity in creating programs,"

"helped get participants involved that otherwise would not be,"

"helped promote team work in problem solving," "promotes

employee discussion," and "improves [instructor] facilitation

skills and trainee involvement."

These results independently replicate the findings from

another study that involved interviews with 40 mine health and
9

0 10 20 30 40 50

Help review new exercises

Help field test new exercises

Attend exercise development

workshops

Count

Figure 13.—Ways in which instructors are willing to help

develop new exercises.

0 10 20 30 40 50

Want new exercises

Format - latent image

Format - computer

Format - role play

Format - paper and pencil

Format - other

Count

Figure 12.—Instructors' interest in new simulation exercises and preferred format.

safety leaders [Cole et al. 1996]. These leaders were asked

about the impact and effectiveness of the simulation exercises

on miner health and safety training in the United States. Only

1 of the 40 persons included in the earlier study was a

respondent in the present study.

INSTRUCTORS' INTEREST IN NEW EXERCISES

The survey included a few items that asked the respondents

to indicate their interest in new simulation exercises and what

format they preferred for these exercises. Respondents were

asked to select as many formats as they wished. Fifty (96%)

individuals reported that they would like to have new simulation

exercises developed. When asked about what exercise formats

they preferred, 41 (79%) selected latent-image, 19 (37%) selected computer-administered, 18 (35%) selected role-play, 15

(29%) selected paper-and-pencil (a format that requires no

latent-image answer sheet), and 2 (4%) indicated "other." These

results are presented in figure 12.

Respondents were then asked in what ways they would be

willing to help develop new simulation exercises. Three options

were provided, and respondents were asked to select all that

applied to their situation. Forty-one (79%) reported that they

would help by reviewing new exercises, 40 (77%) said that they

would assist by field testing the exercises, and 22 (42%) said

that they would assist by attending exercise development workshops. These data are presented in figure 13.

Item 27 of the survey asked the respondents to list new

topics for which they would like simulation exercises

developed. A total of 38 persons (73%) responded with an

extensive list of topics. Table 5 is a summary of the number of

respondents who wanted new exercises, by mining sector. The

table shows that the respondents want new exercises developed

for all sectors, especially surface and underground mining.

Table 5.—Mining sectors for which respondents

wanted new simulation exercises developed

Sector Frequency1 Percent1

Surface . . . . . . . . . . . 35 67

Underground . . . . . . . 30 58

Coal . . . . . . . . . . . . . 17 33

Nonmetal . . . . . . . . . 16 31

Metal . . . . . . . . . . . . . 15 29

Preparation plant . . . 6 12

Other . . . . . . . . . . . . . 15 29

1

Because respondents could list as many topics

as they wished, the totals add up to more than

52 organizations and more than 100%.

DISCUSSION AND RECOMMENDATIONS

Based on the present study and earlier studies [Cole et al.

1988a,b; 1993; 1996], it is clear that the simulation exercises

have favorably impacted mandatory miner refresher training in

the United States. It is also clear that the development and dissemination of the simulation exercises could not have been done

without the collaboration of the many agencies and organizations shown in figure 1. This section addresses two broad issues. These include lessons learned from this 12-year effort and

problems and prospects involved in the continued development

and dissemination of the simulations.

LESSONS LEARNED

The response to the simulation exercises from workers and

trainers in the mining industry has been overwhelmingly positive. The widespread use and impact of the exercises is related

to their origin in real-world cases, the interactive narrative way

in which the cases are presented, and the collaborative learning

and problem solving promoted by the exercises. Pooled data

from miners' performance scores on the exercises also are useful

for identifying and correcting misconception, work organization,

and engineering problems that could contribute to injury events

and disasters.

MINERS' RESPONSES TO THE EXERCISES

In earlier studies [Cole et al. 1988a,b; 1993; 1996], miners

reported that the exercises are interesting, relevant, help them

learn to work together more effectively with each other and their

supervisors, and help them to better recognize and prevent

workplace hazards and injuries. Miners also reported that they

liked being involved in the development, field testing, and
10

improvement of the simulation exercises. Miners appreciate that

when the simulation exercises are used, their personal knowledge and experience becomes an integral and legitimate part of

the classroom problem-solving activity that is central to each

exercise. When the exercises are used in annual refresher training classes, miners become active contributors to the instructional process rather than more passive recipients of didactic

information presented by the instructor.

INSTRUCTORS' RESPONSE TO THE EXERCISES

Instructors confirm the reports of miners about the impact

and effectiveness of the simulation exercises for engaging

workers in meaningful learning that has a positive impact on

safety knowledge and attitudes in daily work activities [Cole

et al. 1996]. Another indicator of trainers' appreciation of the

exercises is the widespread use of the simulations over a 13-year

period. More than 400,000 copies of answer sheets for simulation exercises were used from December 1986, when the

exercises were first released by the National Mine Health and

Safety Academy, to December 1994 [Cole et al. 1996]. The

Academy reported that rarely has the industry shown such a

great interest in any one type of mine health and safety instructional materials.

During the 2-year period (1995-96), the 52 trainers in the

present study reported using an array of 55 exercises with about

32,000 workers. The trainers surveyed also valued the exercises

and their continued use. For example, 96% wanted new exercises developed, 79% wanted new latent-image format

exercises, and 48% expressed an interest in CD-ROM or

Web-based delivery formats. About 77% said that they would

help develop new simulations by field testing new materials, and

42% said that they would participate in exercise development

workshops. More than 94% of the trainers rated the exercises

as a good value. About 60% of the trainers rated the exercises

as "more useful" than other available instructional materials,

40% judged the simulations to be "as useful" as other materials,

and no one rated the simulations as "less useful" than other

instructional materials.

About 79% of the trainers reported that the exercises helped

them to better incorporate miners' knowledge and experience

into a collaborative learning approach to training, and 71% reported that the exercises helped them to adopt a more problemsolving approach to their instruction generally. Slightly more

than 71% of the trainers said that using the simulations improved their effectiveness as instructors, and 23% said that the

exercises helped them to develop their own new simulation

problems and exercises.

THE EXERCISE NARRATIVES AS REAL-WORLD

MODELS

Traditional safety and health training is often rule-bound.

A simple set of procedures is often specified for how to prevent

or deal with some specific problem, whether it is a first-aid

procedure involving a spinal injury or a protocol about how to

escape from a mine fire. Such protocols are appropriate because

they provide a logical framework for how to respond to classes

of events. But the protocols alone are not enough. For example,

studies of miners who escaped from mine fires found that the

standard protocols almost always break down [Cole et al. 1998;

Vaught et al. 1996; Bower and Morrow 1990].

Many researchers have noted that real-world decisionmaking is guided by internalized stories that direct our goals,

judgments, and actions [Bruner 1986; Sarbin 1986; Crites 1986;

Cole 1997]. The use of internalized stories that we have heard,

lived, and told to others provides a way of thinking about the

meaning of past events, projecting goals, and striving for the

future, as well as understanding the meaning of the current

circumstances in which we find ourselves [Cole 1997]. It is

largely through internalized stories (sometimes called culture

tales) that we understand our own and others' conduct in response to predicaments and problems [Crites 1986]. The universal use of narrative by humans to guide and direct goals and

conduct has been referred to as “stories to live by” [Cole 1997].

Narratives have traditionally been used in miner training and in

other classroom settings. For example, trainers often tell "war

stories" as they describe events related to the points that they are

trying to teach. Stories of injury or disaster events are often presented as case studies. Presenting the case is mainly telling the

story of an event followed by a post hoc analysis of what

happened, why it happened, and who was responsible for the

errors made. The emphasis is on hindsight and the analysis of

a past event. Fixing blame about who was at fault often diverts

attention from coming to a better understanding of underlying

factors and issues that contributed to the problem in the first

place. The presentation of a case study in this manner does little

to simulate the foresight that is required for dealing effectively

with an unfolding emergency situation where decisions must be

made with incomplete and often conflicting information.

For these reasons, each simulation exercise is designed as

an unfolding story of an actual event that either had the potential

to or actually evolved into a serious injury event or disaster.

Each simulation exercise story has a plot, characters who have

goals and who encounter obstacles to those goals, and predicaments that cause well-rehearsed protocols to break down.

As in the real-world events depicted, the simulations include

conflicting information about what is happening and what

course of action is necessary to remedy the situation. The

simulation exercises purposefully avoid fixing blame. Rather,

they focus on the proactive and constructive use of foresight to

prevent or limit the effects of a developing problem situation

that threatens health and life. Therefore, the case-based

unfolding simulation narratives help workers and managers to

focus more on proactive prevention than on retroactive faultfinding. The simulations help to bring to the forefront the use

of stories within a carefully planned teaching method, rather

than using off-the-cuff stories as casual addenda to lesson plans.

The simulation exercise narratives are interactive in two

ways. First, the individuals working the exercise interact with
11

the characters, events, and predicaments in the unfolding story,

selecting from among alternative actions at each decision point

and learning the consequences of each of those decisions.

Second, as they work through the exercises in small groups of

three to five persons, the participants also interact with each

other, debating and discussing which actions to take at key

points in the unfolding scenario. As in real life, there is often

too little, too much, or conflicting information. Standard protocols fail, and workers must draw on their own prior knowledge

and experience to solve the problem.

Miners and trainers report that the problem-solving nature

of the exercises helps foster a spirit of collaboration for

solving other problems at the mine site. Many interesting

problems must be solved each day in all workplaces; most of

these solutions require teamwork. The design of the simulation

exercises exemplifies that "good solutions" are not often

"predefined." As in real life, solutions to the problems in the

simulation exercises are not always as simple as traditional,

prescriptive safety training approaches might suggest. Rules are

useful to help guide actions, to help understand risk, and to

visualize plausible outcomes from errors in judgment. But rules

alone cannot formulate creative and effective solutions to most

problems.

HOW INSTRUCTORS EVALUATE THE SIMULATION

EXERCISES

Although two evaluation features are built into the simulation problems, 80% of the organizations relied on other means

to assess the utility of the instruction. These other methods

included instructor observations and interaction with trainees as

the main way to assess exercise effectiveness. Forty percent of

the respondents also used the trainees' exercise performance

scores to evaluate training effectiveness. Only 21% reported

using the trainee's evaluation questionnaire that accompanies

each simulation exercise.

There are several reasons why instructors do not consistently use the built-in evaluation tools.

1. Time is important, and a formal evaluation (either

through assessing scores or the trainee evaluation questionnaire)

takes time. There are many topics to address in annual mine

safety refresher classes. It is hard to assess every instructional

component. In addition, many mine safety trainers ask the

trainees to evaluate the entire refresher training at the end of the

8-hr session, rather than each of the individual instructional

components.

2. Using the exercise to check performance scores of

trainees is especially difficult because most instructors use the

exercises in small group settings. Assessing individual scores

is thus impossible and, one can argue, not even desirable. The

exercises are designed to be teaching tools, not tests. Therefore,

trainers' observations and interactions with trainees carry

significant weight as they are making informed decisions about

learning, not scoring. If the exercises were (wrongly)

administered as tests, it would be possible to fail the test, but

perhaps learn enough to apply the lessons in the real world.

Good training simulations should allow for mistakes. It is even

desirable to make mistakes; this allows one to see the consequence of inappropriate decisions. The notion of having

"good or likely wrong answers" is a key feature of the simulations. Without plausible wrong answers, the simulations

would have considerable less value as teaching instruments.

Making decision errors during a simulation can help prevent a

decision error in a similar real-world event.

3. Trainers may rely heavily on the fact that the exercises

are already field tested and validated. The instructors copies

present the data from the field tests. Perhaps mine trainers

conclude that the materials are valid teaching tools and there is

no need for further formal evaluations within their classes.

Thus, they use the exercises as prescribed and rely on their own

observations to refute or verify the findings and results presented in the instructor's copy.

One important implication from this finding is the need to

make sure that the exercises are researched, authenticated with

experts, and field tested with individual and small groups of

miners. This process produces educationally sound materials

and must be completed before dissemination. The fact that mine

trainers do not have the time to formally collect evaluative data

on individual exercises heightens the importance of conducting

thorough research. An important component of educational research is field testing and revisions of the exercises based on

field trials.

UTILITY OF POOLED EXERCISE PERFORMANCE

SCORES

The exercise performance scores are appreciated by both

miners and their instructors because these scores and the exercise feedback communicate immediately in a powerful,

personal way what miners know and do not know about

preventing or coping with a real-world emergency event [Cole

et al. 1988a,b; Cole 1994; Cole et al. 1998; Wala and Cole

1987; Passaro et al. 1989; Barrett and Kowalski 1995]. The

performance results for a given exercise pooled across many

miners also provide valuable information for researchers and

policy makers. For example, when simulation exercises are

developed based on actual mine events, the decision-making of

miners about particular aspects of the problem can reveal dangerous misconceptions. These include—

1. Mine ventilation principles that can lead to methane

ignitions [Cole et al. 1987; Wala and Cole 1987; Passaro et al.

1989; Barrett and Kowalski 1995];

2. Entrapment in bins and hoppers [Cole 1994];

3. Beliefs and behavior that compromise escapes from

underground mine fires [Cole et al. 1998];

4. Failure to recognize and avoid dangerous mine roof

conditions [Passaro et al. 1994]; and
12

5. Misconceptions and errors that compromise the health

of an injured colleague during first-aid procedures [Cole et al.

1988a].

Properly constructed simulations based on actual hazardous

mine situations and emergency events provide decision-making

tasks that can be used to assess workers' proficiency in preventing or coping with these nonroutine situations. The simulations are tools that both teach and test proficiency in critical

skills [Cole 1994].

When pooled across many miners, performance data from

a simulation exercise can also be used to identify and correct

engineering and work organization factors that contribute to

injury events and disasters. For example, in hands-on simulation exercises using emergency breathing apparatus to escape

from underground mine fires, a series of studies identified

problems in the training protocols for self-contained self-rescuer

(SCSR) donning and use. The studies used miners' performance

data from simulated escape situations to improve SCSR training.

These studies subsequently resulted in empirically based

changes to (1) the training protocols for existing SCSRs, (2) the

improved design of new generation SCSRs, and (3) changes in

the Code of Federal Regulations that direct how SCSR training

shall be conducted [Vaught et al. 1996].

ISSUES AND PROSPECTS

The development and widespread use of simulation exercises in the U.S. mining industry was made possible by

cooperation among the network of organizations shown in

figure 1. The National Mine Health and Safety Academy played

a key role by printing, advertising, and disseminating the

exercises.

To print the necessary quantities of latent-image answer

sheets, the Academy contracted with a vendor (from 1986 to

1998) that used an offset printing process. This process required

a significant order of answer sheets. This worked well for some

exercises, but not for others; the supply simply exceeded the

demand. Thus, during 1998, the Academy decided to

discontinue the printing, marketing, and distribution of the

latent-image simulations. As a result, MSHA provided its inventory of simulation exercises to NIOSH. NIOSH has accepted the function of distributing these materials to the mining

community.

Within the last several years, the latent-image simulation

exercise method has been generalized to several settings outside

of mining. These include hazardous waste storage, removal, and

disposal; agriculture; carpentry and construction; health care;

disability awareness and prevention; high school social studies

instruction about the economics of safe work practices; and

violence prevention and conflict resolution among adolescents.

There seems to be a growing interest in the use of the simulation

exercise method as a way to teach and assess occupational

health and safety skills to a wide range of workers. Demand for

the simulation exercises in the mining industry also remains

high.

Three prospects for the continued development and dissemination of simulation exercises arise from three circumstances. These are (1) the growing interest in simulation exercises as intervention tools by which to promote occupational

health and safety, (2) the rapid growth of Web-based software

and technology by which to develop and deliver interactive narrative simulation exercises, and (3) the use of answer sheet formats that do not use latent-image ink.

The development of a Web site that could include all of the

simulation exercises developed to date may be an effective way

to disseminate the materials. Exercise orders from Academy

records indicate that many trainers first ordered one instructor's

copy for a few exercises and then later ordered problem booklets

and answer sheets for specific exercises. Presumably, the trainers wanted to examine the instructor's copy to learn more about

the exercises and the supporting materials that accompany each

exercise. Internet access to exercise materials would make this

process much more efficient and rapid. Trainers could search

for topics of interest, examine all parts of any exercises, determine what they wanted to use, and immediately download

and print the appropriate materials. This method would also

make distribution of the materials easy, efficient, and

inexpensive because there is no need to inventory and ship the

materials from a distribution center.

Web-site distribution of the materials could also facilitate

record-keeping about the types of organizations using the

exercises. Web-based delivery also would permit ongoing

communication between the developers of the simulation

materials and those who use them. Evaluation of existing

materials, suggestions for their improvement, customizing

existing exercises by industry sector, and developing new

exercises could all be enhanced. The communication network

could enable many health and safety professionals to become

involved in the analysis of training needs for diverse groups of

workers and in the development and field testing of new

exercises. Communication among health and safety professionals who used the Web site could also facilitate sharing

information and ideas about training needs and resources.

A Web-based delivery system could involve more stakeholders in the entire process, not only in the early stages where

exercises are conceptualized, but also in the field testing and

marketing of the materials. Additional delivery and exercise

formats might be explored to engage trainees in discussion, debate, and problem solving as a means to teach important lessons

about workplace health and safety.

If such a Web-based development, marketing, and delivery

system is developed, it should probably include simulation exercises from multiple industry sectors, not just mining. The

materials could be presented in print formats nearly identical to

their existing paper versions and used as source files that could

be downloaded and printed out. A more effective presentation

of the materials could make good use of the interactive audio
13

and visual features of Web-based instruction. Audio and visual

feedback could be provided immediately as a person selects

each decision alternative. The extensive supplemental material

included in the exercise discussion notes could be accessed by

topic anytime the individual needed or wanted more information. Researchers at NIOSH and the University of Kentucky

have developed prototype simulation exercises in multimedia

interactive computer format.

Finally, researchers are exploring the use of other types of

formats and printing methods. These options include using

small printing businesses to better match supply with demand

and alternative formats for the narrative-based learning models

that do not use invisible, latent-image ink. Several non-latentimage simulations have been developed by NIOSH for mining

and by the University of Kentucky for agriculture and

construction.6

ACKNOWLEDGMENTS

The authors gratefully acknowledge the personnel from

MSHA's National Mine Health and Safety Academy near

Beckley, WV, for their dedication and help in gathering the

information that was critical to complete this study. We are especially grateful to Mary Lord, Order Specialist at the Academy.

We also recognize the assistance of Roberta Calhoun, Safety

and Occupational Health Specialist, NIOSH Pittsburgh Research

Laboratory, for her objective review and comment on earlier

drafts of this report.

REFERENCES

Barrett EA, Kowalski KM [1995]. Effective hazard recognition training

using a latent-image, three-dimensional slide simulation exercise. Pittsburgh,

PA: U.S. Department of the Interior, Bureau of Mines, RI 9527.

Bower GH, Morrow D [1990]. Mental models in narrative comprehension. Science 247:44-48.

Bruner JS [1986]. Two modes of thought. In: Actual minds, possible

worlds. Cambridge, MA: Harvard University Press, pp. 11-43.

Cole HP [1994]. Embedded performance measures as teaching and

assessment devices. Occup Med: State of the Art Rev 9(2):261-281.

Cole HP [1997]. Stories to live by: a narrative approach to healthbehavior research and injury prevention. In: Gochman DS, ed. Handbook of

health behavior research IV: relevance for professionals and issues for the

future. New York, NY: Plenum, pp. 325-349.

Cole HP, Wala AM, Haley JV, Vaught C [1987]. Simulations that teach

and test mine emergency skills. In: Faulkner GJ, Sutherland WH, Forshey DR,

Lucas JR, eds. Proceedings of the 18th Annual Institute on Coal Mining Health,

Safety and Research. Blacksburg, VA: Virginia Polytechnic Institute and State

University, Department of Mining and Minerals Engineering, pp. 167-168.

Cole HP, Wasielewski RD, Haley JV, Berger PK [1988a]. First aid role

play simulations for miners. In: Mine Safety Education and Training Seminar.

Pittsburgh, PA: U.S. Department of the Interior, Bureau of Mines, IC 9185,

pp. 78-124.

Cole HP, Wasielewski RD, Lineberry GT, Wala A, Mallett LG, Haley JV,

et al. [1988b]. Miner and trainer responses to simulated mine emergencies. In:

Mine Safety Education and Training Seminar. Pittsburgh, PA: U.S. Department

of the Interior, Bureau of Mines, IC 9185, pp. 56-77.

Cole HP, Lineberry GT, Wala AM, Haley JV, Berger PK, Wasielewski RD

[1993]. Simulation exercises for training and educating miners and mining

engineers. Min Eng 44(11):1397-1401.

Cole HP, Vaught C, Wiehagen WJ, Haley JV, Brnich MJ Jr. [1998].

Decision making during a simulated mine fire escape. IEEE Transactions on

Engineering Management 45(2):153-162.

Cole HP, Wiehagen WJ, Vaught C [1996]. A program of mine emergency

simulation exercises for coal miners: a case study of a 2-year injury surveillance

based industry-wide prevention education program. Pittsburgh, PA: U.S.

Department of Health and Human Services, Public Health Service, Centers for

Disease Control and Prevention, National Institute for Occupational Safety and

Health. Unpublished.

Crites S [1986]. Storytelling: recollecting the past and projecting the

future. In: Sarbin TR, ed. Narrative psychology: the storied nature of human

conduct. New York, NY: Praeger, pp. 152-173.

Passaro PD, Cole HP, Wala A [1989]. Miners' misconceptions of circuits

as a factor influencing underground mining accidents. In: McPherson MJ, ed.

Proceedings of the Fourth Mine Ventilation Symposium at the University of

California, Berkeley. Littleton, CO: Society for Mining, Metallurgy, and

Exploration, Inc., pp. 147-155.

Passaro PD, Cole HP, Wala AM [1994]. Flow distribution changes in

complex circuits: implications for mine explosions. Human Factors 36(4):

745-756.

Sarbin TR, ed. [1986]. Narrative psychology: the storied nature of human

conduct. New York, NY: Praeger.

Vaught C, Cole HP, Wiehagen WJ [1996]. A program to enhance the

self-contained self-rescuer donning proficiency of underground coal miners.

Pittsburgh, PA: U.S. Department of Health and Human Services, Public Health

Service, Centers for Disease Control and Prevention, National Institute for

Occupational Safety and Health. Unpublished.

Wala AJ, Cole HP [1987]. Simulations that teach and test critical skills in

mine ventilation. In: Mutmansky JM, ed. Proceedings of the Third Mine

Ventilation Symposium at Pennsylvania State University. Littleton, CO: Society

for Mining, Metallurgy, and Exploration, Inc., pp. 132-141.

6

 Refer to the following University of Kentucky Web sites:

www.kiprc.uky.edu/materials.html and www.mc.uky.edu/scahip/products.html
14

APPENDIX A.—COVER LETTER AND SIMULATION EXERCISE

SURVEY QUESTIONS

October 15, 1997

MEMORANDUM

TO:

FROM: Henry P. (Hank) Cole

Project Director

Telephone (606)257-7873

e-mail <hcole@pop.uky.edu>

RE: An important request

I am directing a study about the use of the mine emergency simulation exercises that are distributed by the National Mine Health

and Safety Academy in Beckley, West Virginia.

Academy records show that your organization ordered some of these exercises during 1994-96. It would be helpful if you or

some other appropriate person in your organization would read and complete the enclosed questionnaire.

Your answers will be strictly confidential and neither individuals nor organizations will be identified. The results from nearly

200 organizations across the country will be combined and reported as group data.

The study is important because it will tell us how to improve the simulation exercises and also what new exercises to develop to

assist your organization with its health and safety training.

The survey should take only about 5 minutes to complete. It is designed so that most answers can be completed by making

check marks in the appropriate spaces.

As a small token of our appreciation, a $1 bill is enclosed. Please give this to the person who completes the survey form and

returns it to us in the enclosed self-addressed envelope. Upon receipt of the completed survey form in two to three weeks, we

will send another $1 bill to you or to the person who completes the form.

Enclosure: Simulation exercise survey materials and questions

INTRODUCTION

From 1986 to 1995 the University of Kentucky, the Bureau of Mines, and the National Mine Health and Safety Academy

developed many mine emergency simulation exercises for the annual refresher training of coal miners. The exercises teach

problem-solving skills for mine emergency situations. Most of these simulation exercises consist of a problem booklet and a

latent-image answer sheet. When marked with a special pen the latent or invisible answers become visible.

The National Mine Health and Safety Academy in Beckley, West Virginia lists the exercises in their Catalog of Training

Materials. During the last nine years the Academy distributed more than 300,000 copies of the simulation exercise materials.

Review of the Academy records revealed that your firm ordered some of these exercises during the 1994-96 period. The

materials your organization ordered during this time are listed on the enclosed page.
15

We are trying to learn how these materials have been used, with what groups of workers, and with what success. We also want

to know what new simulation exercise topics you want or need so that these might be developed in the future. We need your

help.

First, we need to make sure this information and the enclosed questions get to the person or persons in your organization who

actually used the simulation exercises to train workers. We have attached a single page that lists (1) the exercise materials you

ordered, (2) the quantities that you ordered, (3) the date(s) that the materials were ordered, (4) the address to which the

materials were shipped, and if available, (5) the name of the person who ordered the materials. If you are not knowledgeable

about how the simulation exercises were used in training sessions, would you please give these materials to a person who

knows how and with whom the exercises were used?

Second, would you or another knowledgeable person please answer the questions and return them to us in the enclosed selfaddressed and stamped envelope within the next two weeks?

Your answers to these questions will be confidential. We will not identify individuals or organizations. The responses of

persons from all organizations will be pooled and summarized in our final report. We will also send you a copy of the summary

report.

If you have questions or need clarification, please call Henry Cole (606) 257-7873 or Sue Mills (606) 257-3796 at the

University of Kentucky or William Wiehagen at the Pittsburgh Research Center (412) 892-6468. 

Sincerely,

Henry P. Cole,

Project Director

September 15, 1997

Enclosures: List of simulation exercises ordered by your firm during 1994-1996

Survey Questions

Self-addressed and stamped envelope
16

Simulation Exercise Survey Questions

1. Please list your job title. ____________________________________________________________________________

2. About how many people are employed in your firm? _____________________________________________________

3. How did you first learn about the mining simulation exercises? (check all that apply.)____________________________

___ MSHA Catalog ___ conference ___ workshop ___ friend ___ other

4. In what year did you first start training with the latent-image simulation exercises? ______________________________

5. How did you use the exercises you ordered in 1995-96? (Check all that apply.)

___ used as is to train people ___ adapted and modified and then used to train people

___ used as a resource to construct my own training activities _____ other?________

6. If you used the exercises to train people during the1994-96 period, about how many persons did you train? _________

7. About what percent of these people were: _____ workers _____ front-line supervisors

____ managers ____ others (please identify) ______________________________________________________

8. If you used the exercises for training, whom did you train? (check all that apply.)

___ underground coal miners ___ surface coal miners ___ other mining industry workers 

___ technical/vocational school students ___ nonmining industry workers (please identify) 

_______________________________________________________________________________________________

9. If you used the simulation exercise(s) “as is” or with slight modifications, how did you administer the materials? (check

all that apply.)

___ gave 1 problem booklet, 1 answer sheet, and 1 pen to each person

___ gave 1 problem booklet, 1 answer sheet, and 1 pen to each group of 4 or 5 persons

___ led the whole class through the exercise step by step without the class members having their

own problem booklets, answer sheets, and pens 

___ used the problem book and answer sheet to tell the exercise story and to discuss the problem with the class

members (but did not go through the exercise step by step)

___ other? (please describe) _______________________________________________________________________

10. Did you tailor or customize the exercise(s) in any way? (check one) ___ Yes___ No

11. If “Yes,” how did you modify the exercise(s)? (check all that apply)

___ shortened exercise ___ changed some questions ___ changed some answers 

___ changed some diagrams ___ added new questions ___ added new answers 

___ other (please describe) _________________________________________________________________________
17

12. Did you use the exercise(s) instructor’s notes and master answer sheet? ___ Yes___ No

13. Are the materials included in the instructor’s copy useful? ___ Yes___ No

14. How do you evaluate a simulation after you have used it with a group? (check all that apply)

___ I observe the trainees, talk to and listen to them to judge the value of the activity.

___ I have the trainees complete the one-page exercise questionnaire and examine the results.

___ I examine the trainees’ exercise scores to see what areas they know well and in which areas

they need more instruction.

___ Other? (please list) ___________________________________________________________________________

___ I don’t attempt to evaluate the effectiveness of the simulation exercises. 

15. Compared to other health and safety training materials (like videotapes, slides, overheads, lecture notes, printed

materials), how useful are the latent-image simulation exercises?

(check one) ___ more useful ___ as useful as other materials ___ not as useful

16. Are the latent-image simulation exercise materials a good value? ___ Yes___ No

17. Did you use any latent-image simulation exercises before 1994? ___ Yes___ No

18. Did you order and use any latent-image simulation exercises in 1997? ___ Yes___ No

19. Will you order and use any more latent-image exercises in the future? ___ Yes___ No

20. Would you purchase simulation exercises (similar to the latent-image

materials) if they were available for use on a computer? ___ Yes___ No

21. How have the simulation exercises influenced your training program? (check all that apply)

___ Have not influenced our training program.

___ Helped us to develop other simulation exercises on our own.

___ Helped us to adopt more of a problem-solving approach to training.

___ Helped us to make better use of workers’ knowledge and experience in training.

___ Helped to improve instructor effectiveness in worker training

___ Other? (please list) ___________________________________________________________________________

22. How would you be willing to assist in creating new exercises? (check all activities that apply)

___ attend development workshops ___ review new exercises ___ field test new exercises

23. Would you like a copy of the summary report for this study? ___ Yes___ No
18

24. May we call you about your ideas about the exercises and their use? ___ Yes___ No

If “Yes,” please list phone number and name. (______) _______ - ________________

Name __________________________________________________________________________________________

25. Would you like to have new simulation exercises developed? ___ Yes___ No

26. If “Yes,” what formats would be best for you? (check all that apply)

___ latent-image ___ paper & pencil but not latent-image ___ role play

___ computer 

___ other (please list) ______________________________________________________________________________

27. Please tell us what additional topic areas you would like to have developed as simulation exercises for use in you health

and safety training classes. List the topics on the blank lines on this page. Thank you!
19

APPENDIX B.—FREQUENCY OF EXERCISES ORDERED BY 52 ORGANIZATIONS

Table B-1 is a frequency listing of the exercises ordered by the 52 questionnaire respondents. The 52 organizations placed

a total of 249 orders for 55 different simulation exercises. Of the exercises, 43 were latent-image, 6 were paper-and-pencil, 4 were

role-play, and 2 were latent-image with 3-D slide reels.

Table B-1.—Frequency list of exercises ordered by 52 organizations

Exercise Content Format No. of

organizations

Apparent Diving Accident . . . . . . . . . . . . First aid (spinal injury) . . . . . . . . . . . . . . . . Latent-image . . . . . . 4

Arnel V. Beam . . . . . . . . . . . . . . . . . . . . First aid (pneumothorax) . . . . . . . . . . . . . . Latent-image . . . . . . 1

Basics of Transformers and Ground 

 Fault Monitors . . . . . . . . . . . . . . . . . . . Electrical (technical) . . . . . . . . . . . . . . . . . . Paper-and-pencil . . 7

Belt Fire Exercise . . . . . . . . . . . . . . . . . . Mine fire escape . . . . . . . . . . . . . . . . . . . . . Latent-image . . . . . . 7

Bennie J. Floyd . . . . . . . . . . . . . . . . . . . . First aid (heart attack) . . . . . . . . . . . . . . . . . Latent-image . . . . . . 2

Bernie T. Reddish . . . . . . . . . . . . . . . . . . First aid (crushed limb) . . . . . . . . . . . . . . . . Latent-image . . . . . . 3

Bob Hall . . . . . . . . . . . . . . . . . . . . . . . . . First aid (electrical shock) . . . . . . . . . . . . . . Latent-image . . . . . . 5

Bob Woods . . . . . . . . . . . . . . . . . . . . . . . First aid (electrical shock) . . . . . . . . . . . . . . Latent-image . . . . . . 2

Bull's Double Header . . . . . . . . . . . . . . . Roof control (deep cut) ................ Paper-and-pencil . . 10

Carl T. Donaldson . . . . . . . . . . . . . . . . . . First aid (conveyor belt entanglement and

 rescue).

Latent-image . . . . . . 10

Cecil . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mine fire escape . . . . . . . . . . . . . . . . . . . . . Latent-image . . . . . . 5

Cleo C. Pike . . . . . . . . . . . . . . . . . . . . . . First aid (crushed hand) . . . . . . . . . . . . . . . Role play . . . . . . . . . 2

Continuous Miner Fire . . . . . . . . . . . . . . Firefighting and first aid . . . . . . . . . . . . . . . Latent-image . . . . . . 11

Cutthrough Ventilation Arrangement . . . Mine ventilation (methane ignition) . . . . . . . Latent-image . . . . . . 3

Delta Mine Cutthrough . . . . . . . . . . . . . . Mine ventilation (methane ignition) ....... Paper-and-pencil . . 7

Douglas O. Sanders . . . . . . . . . . . . . . . . First aid (dislocated shoulder) . . . . . . . . . . Latent-image . . . . . . 5

Douglas O. Tackett . . . . . . . . . . . . . . . . . First aid (dislocated shoulder) . . . . . . . . . . Latent-image . . . . . . 5

D. R. Light . . . . . . . . . . . . . . . . . . . . . . . . Roof fall hazards . . . . . . . . . . . . . . . . . . . . Latent-image with

 3-D slide reel.

2

Drainway . . . . . . . . . . . . . . . . . . . . . . . . . Gas inundation . . . . . . . . . . . . . . . . . . . . . . Latent-image . . . . . . 1

Escape From a Mine Fire . . . . . . . . . . . . Escape from a mine fire . . . . . . . . . . . . . . . Latent-image . . . . . . 7

Everett M. Arnold . . . . . . . . . . . . . . . . . . First aid (chest injury) . . . . . . . . . . . . . . . . . Latent-image . . . . . . 1

Fix-It . . . . . . . . . . . . . . . . . . . . . . . . . . . . Electrical cable splice and first aid (electri-

 cal shock).

Latent-image . . . . . . 8

Good Ole Bill . . . . . . . . . . . . . . . . . . . . . Alleged tool theft, due process, communi-

 cation.

Latent-image . . . . . . 3

Harry Harlan . . . . . . . . . . . . . . . . . . . . . . First aid (crushed chest) . . . . . . . . . . . . . . . Latent-image . . . . . . 4

Harry Harlan (role play) . . . . . . . . . . . . . First aid (crushed chest) . . . . . . . . . . . . . . . Role play . . . . . . . . . 1

Harry Hastings . . . . . . . . . . . . . . . . . . . . First aid (crushed chest) . . . . . . . . . . . . . . . Latent-image . . . . . . 8

Hot Shuttle Car . . . . . . . . . . . . . . . . . . . . Electrical hazard . . . . . . . . . . . . . . . . . . . . Latent-image . . . . . . 4

J. J. Johnson . . . . . . . . . . . . . . . . . . . . . First aid (overexertion heart attack) . . . . . . Latent-image . . . . . . 3

J. J. Parsons . . . . . . . . . . . . . . . . . . . . . . First aid (overexertion heart attack) . . . . . . Latent-image . . . . . . 5

J. J. Smith . . . . . . . . . . . . . . . . . . . . . . . . First aid (overexertion heart attack) . . . . . . Latent-image . . . . . . 3

Leroy B. Perkins . . . . . . . . . . . . . . . . . . . First aid (broken ankle) . . . . . . . . . . . . . . . . Latent-image . . . . . . 4

Low Coal Fire . . . . . . . . . . . . . . . . . . . . . Escape from a mine fire . . . . . . . . . . . . . . . Latent-image . . . . . . 2

Lynwood W. Puckett . . . . . . . . . . . . . . . . First aid (electrical shock) . . . . . . . . . . . . . . Latent-image . . . . . . 6

Man in the Bin . . . . . . . . . . . . . . . . . . . . Rescue and first aid (entrapment in a bin) Latent-image ...... 8

Marvin Letcher Highwall . . . . . . . . . . . . . Rescue and first aid (fall of highwall) . . . . . Latent-image . . . . . . 15

Marvin R. Letcher . . . . . . . . . . . . . . . . . . Rescue and first aid (roof fall) . . . . . . . . . . Latent-image . . . . . . 3

Marvin R. Letcher (role-play simulation

 exercise) . . . . . . . . . . . . . . . . . . . . . . . Rescue and first aid (fall of highwall) . . . . . Role play . . . . . . . . . 3

Paul Pancake . . . . . . . . . . . . . . . . . . . . . First aid (machinery runover and crush

 injury).

Latent-image . . . . . . 3

Persephone Mine Explosion . . . . . . . . . . EMT triage . . . . . . . . . . . . . . . . . . . . . . . . . Latent-image . . . . . . 1

Pete's Predicament . . . . . . . . . . . . . . . . Roof control hazard . . . . . . . . . . . . . . . . . . Latent-image . . . . . . 10

Pipe Repair Problem . . . . . . . . . . . . . . . Falling, climbing, fire hazards . . . . . . . . . . . Latent-image . . . . . . 6

Pit Distribution Trouble Shooting . . . . . . Electrical ground fault problem . . . . . . . . . . Latent-image . . . . . . 3

Pot Luck Mine . . . . . . . . . . . . . . . . . . . . . Roof hazards and roof control .......... Paper-and-pencil . . 4
20

Table B-1.—Frequency list of exercises ordered by 52 organizations–Continued

Exercise Content Format No. of

organizations

Problem at Maxmore Mine . . . . . . . . . . . Injury prevention (requires up to 8 hr to

 complete).

Paper-and-pencil . . 1

Problem on Dragline #1 . . . . . . . . . . . . . Electrical hazard and first aid . . . . . . . . . . . Latent-image . . . . . . 1

Raggs and Curly Guarding Exercise . . . Machine guarding . . . . . . . . . . . . . . . . . . . . Latent-image with

 3-D slide reel.

8

Roof Fall Entrapment . . . . . . . . . . . . . . . Roof fall during pillar extraction . . . . . . . . . Latent-image . . . . . . 4

Tipple Heater Exercise . . . . . . . . . . . . . . Electrical technical exercise (NEC

 standards).

Latent-image . . . . . . 2

Traumatic Arm Amputation . . . . . . . . . . . First aid for amputated arm . . . . . . . . . . . . Role play . . . . . . . . . 1

Traumatic Head Injury . . . . . . . . . . . . . . First aid (crushed head) . . . . . . . . . . . . . . . Latent-image . . . . . . 3

Travel Through Smoke . . . . . . . . . . . . . . Escape from a mine fire . . . . . . . . . . . . . . . Latent-image . . . . . . 11

Trouble in the Training Room . . . . . . . . . Sexual harassment (in the context of first-

 aid training).

Paper-and-pencil . . 3

Vulcan Mine Ignition . . . . . . . . . . . . . . . . Methane ignition at the face, first aid, and

 escape.

Latent-image . . . . . . 4

Vulcan Mine Recovery . . . . . . . . . . . . . . Recovery of a mine following a methane

 explosion and evacuation.

Latent-image . . . . . . 3

Water Line Repair . . . . . . . . . . . . . . . . . . CO symptom recognition and exposure,

 and first aid.

Latent-image . . . . . . 1
Delivering on the Nation’s Promise:

Safety and health at work for all people

Through research and prevention

For information about occupational safety and health topics contact NIOSH at:

1-800-35-NIOSH (1-800-356-4674)

Fax: 513-533-8573

E-mail: pubstaft@cdc.gov

www.cdc.gov/niosh

DHHS-(NIOSH) Publication No. 2001-141