26 Compensation and Working Conditions Fall 1999

Analysis of

Toxicology Reports

from the 1993-94

Census of Fatal

Occupational Injuries

Safety and Health

Toxicology reports can give us some insights

into fatal occupational injuries. However, lack

of uniformity in reporting toxicology results

across States limits the usefulness of the data.

MICHAEL GREENBERG

RICHARD HAMILTON

GUY TOSCANO

Michael Greenberg, MD, MPH, is a professor of Emergency Medicine

and Public Health at MCP-Hahnemann University, School of Medicine,

Philadelphia, PA. Richard Hamilton, MD, is an assistant professor of

Emergency Medicine and Public Health at the same university. Guy

Toscano is an economist in the Office of Safety, Health and Working Conditions, Bureau of Labor Statistics.

Telephone: (202) 691-6165

E-mail: Toscano_G@bls.gov

Workers under the influence of drugs or alcohol are a serious concern in the workplace today. Although the magnitude of the substance abuse problem at work is difficult to

measure, the goal of maintaining alcohol and drug free workplaces has been addressed repeatedly by industry and government alike.

An informative approach to defining the magnitude of

the problem of drug and alcohol use among workers is to

evaluate the traumatic deaths that occurred in the workplace

and attempt to correlate those deaths with the recent use of

drugs or alcohol. To this end, an evaluation of toxicology

data for individuals who died as a result of fatal occupational injuries and whose toxicology reports were submitted

to the Bureau of Labor Statistics (BLS) for the Census of

Fatal Occupational Injuries (CFOI) has been completed for

the reporting years 1993 and 1994.

The Census of Fatal Occupational Injuries is the primary

source of information on fatal work injuries in the United

States. Diverse data sources are used to compile comprehensive information on each occupational fatality, including

industry, occupation, type of event, equipment involved,

demographic characteristics, and circumstances of the fatal

incident. Summary data are issued annually about 8 months

after the end of the calendar year.

Methods

In the fatality census program, participating State agencies

attempt to collect comprehensive information on all fatal

work injuries. The source documents used to identify and

describe occupational fatalities often include toxicology information about the decedent. The toxicology reports provide information on whether alcohol, drugs, and other toxic

substances were present in the deceased and, if so, at what

levels. A variety of sources provided toxicology results:

Police accident reports, medical examiner and coroner reports, autopsy reports, and follow-back questionnaires. In

addition to unintentional fatal injuries such as falls and motor vehicle crashes, the study also covered intentional injuries such as suicides and homicides that occurred during the

time the victim was at work.

During 1993 and 1994, 6,331 and 6,632 fatal occupational injuries, respectively, were reported nationwide.

Thirty-two States gathered toxicology reports for 1,899 fatalities in 1993; 23 states did so for 1,242 fatalities in 1994.

Based on the information available, the majority of the

toxicological analyses were performed using specimens that

were obtained post-mortem or during resuscitative efforts in
 Compensation and Working Conditions Fall 1999 27

Analysis of Toxicology Reports

the pre-hospital or emergency department phase of care.

Cases that showed positive results for nicotine and caffeine were excluded from the analysis because neither is

generally associated with cognitive or psychomotor impairment. Cases that showed exposures from toxic substances

in the work environment, such as carbon monoxide and other

noxious gases, also were excluded.

Toxicology data limitations

Toxicology reports were available for approximately onefourth of the occupational fatalities in the study periods.

Some toxicology reports are not available for research because of confidentiality policies in the county or State in

which the fatality occurred, or because of pending litigation

related to the incident.

Collecting toxicology data and accurately categorizing

the effects substance use may have had on fatal occupational

injuries is especially challenging to the State agencies that

participate in the BLS fatality census. It would be optimal

for all States to collect and report this information for all

fatal work injuries in a uniform fashion to make region-toregion, State-to-State, and case-to-case comparisons possible.

Because drug use patterns may vary by region of the country, industry, or occupation of the workers, the fact that toxicology reports were not available for large numbers of fatalities limits the analysis of substance use patterns. Data

from missing reports could significantly change the results

of this analysis.

Furthermore, toxicology reports are collected only for

deceased workers. Reports are not collected for coworkers,

perpetrators of violence, or others whose actions may have

contributed to the fatal incident.

In addition to the lack of universal reporting in the study,

the lack of uniformity in drug and alcohol testing of decedents affects the ability to draw conclusions about the data.

Not all decedents reviewed in this study were tested for all

substances: Some were checked only for the presence of alcohol, whereas others were tested for both drugs and alcohol. Some jurisdictions test and report drug presence in urine

only, others test and report blood test results only, and others

may do both. Still other jurisdictions test and report on other

body fluids such as vitreous humor alcohol levels.

Also, it is generally accepted that the toxicokinetics of

post-mortem drug and alcohol levels are poorly defined. It

is unknown at present what percentage may be due to postmortem fluid shifts, post-mortem absorption, and even postmortem putrefaction.

Finally, some of the decedents in the study died immediately as the result of the incident, and others survived the

initial event only to die in the hospital later. Of the latter

group, some of the drugs reported may be from therapeutic

interventions. For example, an individual who is injured in

an automobile accident while working and survives several

days in the hospital intensive care unit may receive opiate

drugs for pain relief or anesthetic purposes. Unless this is

well documented in the toxicology reports, these cases could

be falsely classified as possible drug abuse involving opiates. Alternatively, such a patient may not have been screened

specifically for alcohol or illicit drugs, in which case the toxicology report would miss the presence of these substances.

Consequently, the data do not support conclusions about the

degree or level of drugs of abuse for some decedents.

Results

Overall, about one-fifth of the toxicology reports submitted showed positive readings for alcohol or one or more

drugs. This is about 5 percent of total fatal work injuries.

(See table 1.)

Table 2 shows the substances identified in the toxicology

reports. Alcohol was the most common substance found in

deceased individuals with positive toxicology results. In

1993, 47 percent of the 277 positive toxicology cases indicated the presence of alcohol, compared to 44 percent of the

339 positive toxicology cases in 1994.

Table 3 shows the toxicology results by occupation. Construction trade workers, truckdrivers, and farmers accounted

for almost two-thirds of the positive cases.

TABLE 1. Toxicology reports for workplace deaths, 1993-94

Toxicology reports 1993 1994

States providing toxicology reports ...... 32 23

Total fatalities ........................................ 6,331 6,632

Percent of total fatalities involving

 positive toxicology reports ........... 4.4 5.1

Toxicology reports reviewed ................. 1,899 1,242

Positive toxicology reports .............. 277 339

Percent of reviewed toxicology

 reports that were positive .............. 14.6 27.3

TABLE 2. Substances identified in positive toxicology reports

for deceased individuals, 1993-94

 Positive toxicology

 reports .................... 277 100.0 339 100.0

Alcohol ........................... 130 46.9 150 44.2

Opiates .......................... 35 12.6 39 11.5

Benzodiazepines ........... 24 8.7 22 6.5

Antihistamines ............... 3 1.1 10 2.9

Cocaine .......................... 42 15.2 51 15.0

THC................................ 42 15.2 44 13.0

Amphetamine

 /Methamphetamine...... 18 6.5 12 3.5

Barbiturates ................... 6 2.2 16 4.7

Other substances: pcp,

 benzene,

 methaqualone,

 propoxyphene

 methanol ...................... 3 1.1 6 1.8

NOTE: Due to the presence of more than one substance in

some of the decedents, components do not equal totals.

Substances identified

1993 1994

Number Percent Percent Number
28 Compensation and Working Conditions Fall 1999

The following characteristics were also analyzed: Toxicology results by day of the week, month, time of day, employee status, years of employment, gender, age, race, injury type, event, and size of employer. The percent of positive

test results by gender closely approximates occupational fatalities by gender. (See table 4.)

Similar patterns resulted for other worker characteristics.

For example, the distribution of positive toxicology reports

by type of fatal event also follows the pattern of events for

all worker fatalities. For both years, motor vehicle incidents,

homicides, and falls were the leading events for all fatal work

injuries. Likewise, the leading events contributing to jobrelated fatalities with positive test results for each reporting

year were motor vehicle incidents, homicides, and falls. (See

table 5.)

Data source

The Bureau’s Census of Fatal Occupational Injuries collects data for all fatal work injuries, including self-employed

persons, farm workers, and government employees. For a

fatality to be included in the census, the decedent must have

been employed at the time of the event—that is, working

for pay, compensation, or profit; performing a legal work

activity; and present at the site of the incident as a requirement of his or her job. Fatalities that occur during a person’s

commute to or from work are excluded from census counts.

TABLE 3. Percent distribution of positive toxicology reports by

occupation, 1993-94

Occupation 1993 1994

Total fatalities ............................. 6,331 6,632

Positive toxicology reports ......... 277 339

Percent ................................................. 100 100

Construction trade ........................... 25 22

Truckdrivers ..................................... 18 19

Farmers ........................................... 17 15

Sales ............................................... 13 10

Mechanics ....................................... 8 10

Laborers .......................................... 6 10

Fishers ............................................. 6 8

Police ............................................... 5 4

Health care workers ........................ 2 2

TABLE 4. Occupational fatalities and number and percent of

positive toxicology reports by gender, 1993-94

1993

Male ......................... 5,842 92 263 95

Female .................... 489 8 14 5

1994

Male ......................... 6,104 92 319 94

Female .................... 528 8 20 6

Positive toxicology

reports Fatalities

Number

Gender

Percent Number Percent

TABLE 5. Percent distribution of fatalities and positive

toxicology reports by event and exposure, 1993-94

Total .................... 6,331 277 6,632 339

Percent .......................... 100 100 100 100

Highway crashes ...... 20 22 20 18

Homicides ................ 17 10 16 12

Falls .......................... 10 8 10 6

Electrocutions .......... 5755

Struck by vehicle ...... 6766

Struck by object ....... 9695

Other or unknown ..... 33 40 34 48

1993 1994

Event or exposure

Positive

toxicology

reports

Fatalities Fatalities

Positive

toxicology

reports

To ensure an accurate count of fatal occupational injuries,

the program requires that the work relationship for each case

be substantiated by two or more independent source documents.

Michael Greenberg, MD, MPH, Professor of Emergency

Medicine and Public Health at MCP-Hahnemann University, School of Medicine, and Richard Hamilton, MD, Assistant Professor of Emergency Medicine and Public Health

at the same university, performed the toxicology data analysis under contract to BLS. Information on job-related fatalities can be obtained from the Bureau of Labor Statistics’

Internet site at http://stats.bls.gov/oshhome.htm, or via

e-mail at CFOIstaff@bls.gov.