Compensation and Working Conditions Spring 2001 27

Work-related Fatal Injuries in 1998

WILLIAM WEBER

CHERRON COX

Work-related Fatal

Injuries in 1998

Available toxicology reports from 1998 revealed that

alcohol was the controlled substance most often found in

workers suffering fatal injuries in the workplace. Reports

detected as many as four controlled substances in individual decedents for that year.

Drug and alcohol abuse by workers may have serious consequences for both employers

and employees. It can impair job performance, create added expenses for

the employer, or, even worse, result in

a fatal work injury. It is widely acknowledged that both employers and workers benefit from substance free workplaces. To provide better information

about the contribution of substance

abuse to workplace fatalities, the Bureau of Labor Statistics (BLS) analyzed

all work-related fatal injuries in 1998 for

which toxicology studies on the fatally

injured workers were available.

Census of Fatal Occupational In- Census of Fatal Occupational Injuries

The Census of Fatal Occupational Injuries is a Federal-State cooperative

program, conducted in all 50 States and

the District of Columbia, to compile a

complete roster of all fatal work-related

injuries—including those suffered by

farm workers, government workers, and

the self-employed—along with details

of the fatal events. BLS and participating States have conducted the fatality

census annually since 1992. Although

the scope of the fatality census is limited to work-related injuries, States may

submit data on work-related fatal illnesses, such as heart attacks that occur at work, when information is available.

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, or 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. 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.

The fatality data are compiled from

various State and Federal administrative records, such as death certificates,

workers’ compensation reports, medical examiner reports, and reports to

State, local, and Federal government

agencies with jurisdiction over job-related fatalities. These reports contain

information about the industry and

occupation of the deceased worker; the

event or manner in which the injury occurred; the equipment involved in the

work activity; demographic characteristics of the worker; and details about

the fatal incident. BLS also gathered

reports of toxicology studies performed

on workers fatally injured in 1998.

Toxicology reports

Toxicology tests are performed as part

of the death investigation. PatholoWilliam Weber is Assistant Commissioner,

Office of Safety, Health, and Working Conditions, Bureau of Labor Statistics. Cherron

Cox is an economist in the same office.

Telephone: (202) 691-6175

E-mail: Cox_C@bls.gov

Michael Greenberg, MD, MPH, Professor

of Emergency Medicine and Public Health

at Drexel University-Hahnemann School of

Medicine, performed the toxicology data

analysis under contract to the Bureau of

Labor Statistics.
28 Compensation and Working Conditions Spring 2001

gists test the blood, urine, or other body

fluids of the fatally injured worker for

the presence of drugs, alcohol, and

other toxic substances. For a toxicology report to be considered positive

for alcohol or drugs, one or more of the

following substances must be found:

Ethanol, benzodiazepines, opiates, cocaine or its metabolites, amphetamines,

barbiturates, or tetrahydrocannabinol.

Toxicology studies are not required

on all work-related fatalities. Generally,

a toxicology study is performed when:

State legislation requires analysis

based on the nature of the incident;

law enforcement personnel request

analysis as part of an investigation of

the incident; or medical examiners or

coroners request analysis due to circumstances surrounding the death.

Data limitations

These toxicology data have several

limitations. The most important limitation is that toxicology reports are not

available for all fatal work-related injuries. In addition, toxicology reports are

not available for persons who were not

fatally injured but who may have contributed to events leading to the death

of a worker.

Further limitations include the lack

of uniformity of toxicology testing procedures between States and even between local jurisdictions, as well as errors sometimes occurring in classifying

substances.

Toxicology testing procedures. Federal law does not require toxicology

analysis on fatally injured workers. Requirements vary under State laws.

Thus, the test procedures vary from

State to State and can vary between

jurisdictions within a State. For example, some States test for drug or alcohol presence in the urine only, while

others test blood only. Several States

use both urine and blood samples to

identify traces of drugs or alcohol, and

still others base their reports on other

body fluids. Not only do the procedures for toxicological analyses differ

among States, but the reasons for the

use of particular tests differ as well. For

example, some States use toxicology

tests to check for the presence of alcohol but not drugs, or vice versa. On

the other hand, several States

test for both alcohol and drugs.

Improper classification. In some

cases, decedents are classified incorrectly as positive for alcohol or drug

use when, in fact, substance abuse did

not play a role in their fatal mishap. This

situation may occur when a victim of a

fatal injury survives long enough to

receive therapeutic treatment at a hospital, then dies at a later time. Under

these circumstances, drugs found in

the decedent’s body during toxicological analysis likely result from medication received at the hospital and not

from the decedent having been a substance abuser. This information seldom appears in toxicology reports.

Likewise, some cases may be classified incorrectly as negative for alcohol or drug use. This situation also

can happen when a worker dies some

time after the injury. If a seriously injured worker survives for several days,

a toxicology analysis performed after

death may not detect substances

present when the incident occurred.

Findings

Thirty-nine States1 submitted 3,055

toxicology reports for the study. There

were 6,026 work-related fatalities nationwide in 1998, and 5,370 in the 39

States that provided reports. Thus,

toxicology reports were available for

about one-half of all job-related fatal

injuries nationwide for the year, and

for about 57 percent of the fatalities in

the 39 States that provided reports.

Some toxicology reports are protected

by county or State confidentiality policies and, therefore, were not available

for study. Others were not available

because of pending litigation related

to the incident. In addition, a small

number of toxicology reports submitted were for workers with fatal illnesses; they are included in the following data.

Although toxicology reports were

available for only about one-half of fatally injured workers, BLS reviewed the

data for nine of the 39 States (Arkansas, Connecticut, Hawaii, Illinois, Maryland, New Jersey, North Carolina, Virginia, and Washington) that provided

toxicology reports for at least 3 out of 4

fatalities. Toxicology information from

these States gives a somewhat more

complete picture of the contribution of

substance abuse to workplace fatalities. Together, these States submitted

toxicology reports for 81 percent of the

fatal work injuries in their jurisdictions.

The frequency of positive findings and

the relative frequencies of substances

identified were virtually the same for

reports from this group of nine States

as for reports from the full set of 39

States.

Although we cannot say what the

data for the missing cases or States

would show, one assumption might be

that the cases for which we have no

reports are similar to those for which

reports were provided. This assumption, if correct, would imply that alcohol or drugs were present in approximately 19 percent of all fatally injured

workers. The similarity between the

reports with positive toxicology findings from the group of nine States

(which provided reports for 75 percent

or more cases) and reports from the full

set of 39 participating States (which

provided a lower overall percent of

cases) gives some basis for this assumption, which in essence treats

cases with available reports as representative of the universe of cases. To

the extent, however, that testing for

controlled substances was not ordered

because local authorities had reason

to believe drug or alcohol use was not

a factor, this assumption may provide

an upper bound on the share of fatalities involving drug or alcohol use by

affected workers.

An alternative assumption might be

that no fatally injured worker for whom

a report was unavailable had used

drugs or alcohol prior to his or her

death. In this case, the data would imply that drugs or alcohol were present

in approximately 10 percent of fatally

injured workers (593 positive findings

out of 6,026 total fatalities nationwide).

This assumption is clearly somewhat

extreme. Eleven States provided us
 Compensation and Working Conditions Spring 2001 29

Work-related Fatal Injuries in 1998

with no toxicology reports and, even

in the 39 States from which we received

reports, it is unlikely that all cases of

drug or alcohol use were identified. For

these reasons, this alternative assumption almost certainly provides a lower

bound on the share of fatalities that

involved drug or alcohol use by fatally

injured workers.

Whichever of the alternative assumptions just described is closer to

the truth, there is no basis for believing that the types of substances used

by fatally injured workers or their relative frequency of use should differ

greatly from those reported below.

Of the 3,055 toxicology reports

available for study, 593 (19 percent)

showed the presence of alcohol or

drugs in deceased workers.

 Alcohol was the substance found

most often in decedents with positive

toxicology reports (284 cases, or 48

percent of positive test reports available). Alcohol is a depressant that decreases the response of the central nervous system. As little as two alcoholic

beverages can impair coordination and

thinking. Excessive use of alcohol can

cause liver damage and psychotic behavior.

Tetrahydrocannabinol is the primary psychoactive agent in marijuana.

Of the positive toxicology cases, 119

(20 percent of positive test reports

available) revealed the presence of tetrahydrocannabinol. Some possible effects from the use of this substance

are euphoria followed by relaxation;

loss of appetite; impaired memory, concentration, and knowledge retention;

and loss of coordination. Stronger

doses of tetrahydrocannabinol can

cause fluctuating emotions, fragmentary thoughts, disoriented behavior,

and psychosis. Because tetrahydrocannabinol is a drug that is consumed

by smoking, abuse of this substance

can lead to irritation of the lungs and

respiratory system, and may even

cause cancer.

Tests revealed the use of opiates in

107 positive toxicology reports (18 percent of positive test reports available).

Opiates are used medicinally to relieve

pain. Although often prescribed by

physicians, opiates have a high potential for abuse. Common side effects of

this drug are euphoria, drowsiness, respiratory depression, and constricted

pupils. Abuse of opiates can result in

slow and shallow breathing, clammy

skin, convulsions, coma, and possibly

death.

Cocaine, which is both a narcotic

and a stimulant, causes relaxation with

an immediate “rush,” or it may counteract a “down” feeling with an euphoric effect. The use of cocaine increases blood pressure and heart rate.

Overindulgence of cocaine may cause

a rapid or irregular heartbeat, loss of

coordination, blurred vision, dizziness,

restlessness, anxiety, and delusions.

Ninety-three positive toxicology cases

(16 percent of positive test reports

available) revealed the use of cocaine.

Benzodiazepines and barbiturates,

depressants used to relieve anxiety, irritability, or tension, were identified in

71 positive toxicology reports (12 percent of positive test reports available).

Abuse of these substances results in

sensory alteration, anxiety reduction,

and intoxication. Large doses of benzodiazepines and barbiturates can

cause slurred speech, impaired judgement, and loss of motor coordination.

Twenty-eight positive toxicology

reports (5 percent of positive test reports available) revealed amphetamine

and methamphetamine use. These

drugs are stimulants used to increase

alertness, relieve fatigue, and to make

the user feel stronger and more decisive. When these substances are habitually used, abusers may experience

agitation, an increase in body temperature, hallucinations, convulsions, and

possibly death.

Two controlled substances (for example alcohol and a drug, or two drugs)

were present in 87 individual cases (15

percent of positive test reports available). Three substances were found

in each of 20 fatally injured workers.

Toxicology reports showed the presence of four substances in each of two

workers.

Conclusion

The Census of Fatal Occupational Injuries collects data for all fatal work injuries, including those sustained by

farm workers, government employees,

and the self-employed. Data from this

study revealed the presence of drugs

or alcohol, or both, in 19 percent of all

available toxicology reports of workers fatally injured in 1998. Such data

not only reinforce popular views concerning the harm caused by alcohol

and drug abuse, but also stress the

value to employers and employees alike

of maintaining a substance free workplace.

Table 1. Substances identified in positive toxicology reports for work-related

fatalities, 1998

Substances identified Number

Positive toxicology reports ............................................ 593

Alcohol ................................................................... 284

Delta-9-tetrahydrocannabinol ..................................... 119

Opiates .................................................................. 107

Cocaine ................................................................. 93

Benzodiazepines ..................................................... 48

Amphetamine/methamphetamine ................................ 28

Barbiturates ............................................................ 23

Two substances ...................................................... 87

Three substances.................................................... 20

Four substances ..................................................... 2

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

components do not equal totals.

1

 The States that submitted toxicology

reports are: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut,

Delaware, Florida, Georgia, Hawaii, Idaho,

Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota,

Mississippi, Missouri, Montana, Nevada, New

Hampshire, New Jersey, New Mexico, New

York, North Carolina, Ohio, Oklahoma, Oregon, South Carolina, Tennessee, Texas, Virginia, Washington, and Wisconsin.