pre manufactured kitchen cabinets

>>ms creagh: goodmorning everyone. welcome to this workcoverqueensland facilitated webinar, and thank youfor joining us today as we discuss how minorinjuries add up, simple solutions to reduceyour injuries and costs. my name is helen creagh,and i am a customer experience manager atworkcover queensland, and i will be your moderatorfor today's sesson. before we start though iwould like to quickly take

you through how thiswebinar format works, and specifically how you caninteract during the session. on the current slide youwill see an image of the webinar control panel. you can select 'audio'on the control panel and change between computeraudio and telephone, depending on yourpreferred method. if you have headphones andspeakers connected to your computer, please select'mic and speakers',

otherwise choose'telephone' to access the dial in details. you can hide and unhidethe control panel using the coloured arrow. this will make sure youcan see the entire screen. and if you have a commentor question for the presenter or moderator,please type your comment or question in the bottompanel and press send to submit. your comments andquestions will then appear

in the middle section. please send through yourcomments and questions as the session progresses,as there will be time allocated at the end ofthe presentation for our guest presentersto respond. i kindly ask that allquestions are kept to general issues as opposedto specific claim issues. and if we can't get to allof the questions in q/a time, we will follow upwith some summary points

and faqs after wefinish the webinar. webinar recording andpresentation will be on workcoverqld.com.auin the coming days, and an email will be sentto all participants when this goes live. if we don't get toall your questions, we will collect them andpublish answers on our website afterwards. so we can continuallyimprove our level of

service, we would alsoappreciate you completing a short survey at theend of the webinar. okay, so let's meet ourpresenters for today. we have four presentersfor today's webinar who will approach the topicfrom different and specialised areas. so joining us ispeter westcott, principal inspector forworkplace health and safety queensland.

peter will provide injuryprevention strategies to reduce foreign body andlaceration injuries. he will discussbest practice, current pperecommendations, and how to develop asafety leadership culture. we also have with usdr cameron mackay, who specialises inhand and reconstructive surgery, and willhighlight the benefits of early medicalintervention,

including proper diagnosisand planning for minor lacerations, concealedtendon and finger tip nail bed injuries. he will also discuss howlate presentation and underlying healthcomplications can lead to poor return towork outcomes. in addition, we welcomebrent cunningham, who's an exercisephysiologist with konekt. brent will provideparticipants with

contamination managementstrategies for lacerations in dirty workplaces,good versus bad suitable duties, and what to lookfor when injuries are not progressing, or are morecomplex or severe than initially presented. and finally joining ustoday is ross mcconaghy, partner at jensenmcconaghy lawyers. ross has 26 years'experience in insurance and personal injury law,and he will provide an

overview of thecommon law process. he will use minorinjury case studies, discuss thedamages scenario, exploring both theemployer and worker obligationsand negligence, and the cost impact. so why are minorinjuries important? in 2015 and 2016 withinthe manufacturing sector more than 31% of allinjuries arose out of

wounds and lacerations. this was the second mostcommon injury type after musculoskeletal injuries. but this trend is notisolated to manufacturing. similar injury types andfrequency can also be seen within agriculture, retail,wholesale, construction, mining and labour hire. and while seeminglyinnocuous injuries, they resulted in over$13 million in compensation

payments, and an averageof 14 days off work. so how can suchinsignificant injuries as a laceration,foreign body, or a nail bed injury,have such a large impact? well, that is what we arehere to explore today. and by the end of thewebinar you should have some ideas onprevention strategies, best practicerehabilitation in the workplace followinga minor injury,

surgical interventionsand complications, and possiblecommon law impact. so with that, i willhand you across to peter, who will commencethe webinar. >>mr westcott: goodmorning everyone. i'm a principal inspectorwith workplace health and safety queensland, basedat mt gravatt, brisbane. today the topics covered,i'm going to briefly in my time slot talk aboutunderstanding your

obligations,foreseeable incidents, injury prevention and ppe. i'll be touching onsafety leadership at work, defining and exemplifyingan example of best practice, and finishingoff with a summary. i've purposely put thesefigures back up again, as you can see. the figures are justsimply too many. the financialcosts are high,

the productivitylost immeasurable. the figures fromwounds and lacerations, which has similarunacceptable costs in terms of your mostvaluable resource, being people, and againfinancial costs eating away at your bottom line. so what can wedo about it? let's take a look atthe following slides. okay. section 19.

this is straight out ofthe work health and safety act. it basically says thatyou have an obligation to ensure, so far asreasonably practicable, the health and safetyof workers and others. okay. in a general sense,the person conducting a business or undertakingis normally the business owner, whose businessactivities can affect workers and others from ahealth and safety perspective. you should note that aperson in control cannot

transfer this duty,meaning he can't subcontract it out, orhand it over to someone else. an example of a personcould be a sole trader, a partnership, a company or even a trustee of a family trust. the list goes on. in terms of obligations, i've discussed the first dot point. you'll see that it goeson to the next four. we've gotupstream parties. think of you putting in anair conditioning plant at

your workplace. someone's got to design,manufacture, import, supply, install,construct, et cetera. officers within yourorganisation can have an obligation. workers havean obligation, as well as other persons. in the interests of time,i put this slide up, which clearly showsthere's a lot of

obligation going on. if you run youreye down the slide, you'll see that you'vegot to create a safe work environment, safeplant and structures, safe systems ofwork, safe use, handling andstorage of plant, have adequate facilitiesfor your workers. more importantly, provideinformation, training, instruction andsupervision that you

expect your workersand people to do, and in some cases monitorwork health and workplace situations - conditions,i should say. an example of that wouldbe working with lead. section 17 of the actbasically says you've got to eliminate risks so faras reasonably practicable. if it is notreasonably practicable, you've got to try andminimise those risks so far as reasonablypracticable.

now, duty holders includeworkers, team leaders, supervisors and managers. we all have theresponsibility to eliminate risks to healthand safety so far as is reasonably practicable. i put this slide upjust to sort of try and simplify these concepts. on the left you'vegot deciding what is reasonablypracticable to do,

so you've got a processat your workplace. you've got to consider thelikelihood of the hazard, or the risk occurring,what's the degree of harm, the knowledge aboutthe hazard or risk, the availability and suitabilityof ways to eliminate. and then, and only then,after assessing the extent of the risks, youcan consider cost. the next slide here isa rather busy slide. i put it in there,but you'll see by the

following slide i'll breakit down a little bit. this is basicallysomething called the hierarchy ofcontrols, section 36. it basically statesclearly of what an obligation holder mustdo, if it's not reasonably practical toeliminate a risk. inspectors know andunderstand reality on the ground that workplacessometimes simply cannot eliminate risk, howeverthere is a legal

requirement that thishierarchy of controls be applied where possible. now, this is the slidei was talking about. you'll see basically whati've done is taken those hierarchy of controls and putthem into an inverted triangle. in the safe zonewe've got elimination. obviously in a perfectworld that would be great. but it also includessubstitution, isolation andengineering controls.

below that, i put thetraining and admin and ppe in the danger zone. now, don't conclude fromthat that that's a bad thing. all i'm saying is that theitems in the green section of the triangleare hard defences, whereas the two itemsbelow the black line, the orange, yellow,whatever it is, and red, indicates softer defencesfor workers who are exposed to risk.

before providing somehelpful hints for you to consider, i would liketo highlight a couple of examples that demonstratehow easily a worker can be injured when obligationsare either ignored or inadvertentlyconsidered - sorry, inadequately considered. the first point there,defective guarding, i.e. a cabinet makerworkplace had a variety of plant for use by workers.

one of those items wasa drop saw which was regularly used by workers. the drop saw wasdefective in two ways. there was no maintenanceto its plastic guard, in other words it wouldnot move smoothly due to the material build up in thesaw's guarding pivot point. and the second, thesection of guarding had a hole in it, exposingthe rotating blade. such hole wassimply taped over.

now, before i concludeon that example, i'll just showyou some photos. that's an actualphoto of the saw. you can see where they'vecracked the guard and put some tape over itto cover the hole. the photo on the right isthe actual hole with the tape removed. a 30 year old workerused the drop saw, found that the guard wassticking in position,

and then assisted theguard movement with his left hand, resultingin the worker's thumb penetrating through thetape and into direct contact with therotating blade. this caused severelacerations to the worker. had such guard beencorrectly rectified, either competentlyrepaired or replaced to manufacturer'sspecifications, this incident wouldsimply have not occurred.

so what's the learningoutcome of that? simply, due diligence. there was no safe workprocedure instructions for correct usage, and regularmaintenance simply didn't occur. had those twobeen covered, it would haveprevented it. the second example iwant to give of what a foreseeable incident isrelates to a workplace that stored and handledand distributed hazardous

substances to clients. they had actuallydeveloped a safe work procedure for workers tofollow in order to manage risks associated withpreventing workers from coming into contactwith harmful substances. this safe work procedurespecified that workers were to wear, firstly,safety glasses, and secondly, safetygoggles in order to protect workers' eyes.

in principle, it soundedlike a double precaution was adopted by theobligation holder. however, in practicalterms the use of both devices created a furtherunidentified hazard, with the arm of the safetyglasses preventing the goggles from sitting flush onthe surface of the worker's face. this caused a gap, andunfortunately provided a route for an uncontrolledspray of chlorine to enter

and injure theworker's eyes. the learning outcomethere, again, due diligence regardinginformation gathered and the safe workinstruction given, together with adequatetraining and supervision would have preventedthe incident. personal protectionequipment. the film attached to thiswebinar gives several examples of where personalprotection equipment has

assisted ininjury prevention. there's the window anddoor supplier who used a stanley type knife fittedwith a ceramic blade, which were a hit withworkers and employers, as they resulted inlowering the hand injury incident rates. there's another examplethere of a metal industry employer's use of acertain type of glove that significantly reducedlaceration injuries.

and, thirdly, a steelfabricator who deployed a specifically designedplasma cutter to get workers away from the moredangerous task of cutting steel. ppe, in all its forms,although technically a softer defence in thehierarchy of controls, can provide goodprotection under planned and foreseeablecircumstances. however, where assumptionsare made about the effectiveness of ppe, theoutcomes for the end user

are never good. for example, i recallinspecting a workplace where ordinary p2 dustmasks were issued to workers as a defenceevent against possible inhalation of adangerous gas by workers. such action provedhighly ineffective in safeguardingworkers' health. after appropriate riskassessments were conducted based on the actualcontents of a safety data

sheet, and the actual workprocesses required at the workplace, the obligationholder was able to ensure that appropriate canisterstyle face masks were acquired, backed up witha lot of information, instruction, trainingand supervision. so where ppe hasbeen identified as a requirement inyour work process, it's very importantto ensure that both management andworkers understand the

manufacturers'instructions and specifications about proper useand worker protection. it's always good to liaisewith suppliers of ppe. you'll find that most ofthem are very helpful. refer to australianstandards where possible, and get to know yourlocal inspector. a recent preventing eyesand injuries campaign conducted by workplacehealth and safety inspectors found that 34%of workplaces visited only

had ad hoc processes orgaps which included no risk assessmentdocumentation, ad hoc trainingand supervision, improvements to hand toolsand plant equipment only made after an incident. so in other words, it wasdone reactively instead of proactively. ppe provided wasnot fit for purpose. the hierarchy of controlwas not followed,

and there was poorconsultation practices. okay. why is that bad? because whenthere's an incident, and the ambulance has comeand gone, we're notified, we're sent toyour workplace, and it's not a goodscenario for an attending inspector to discoverexactly what's [ inaudible ]. okay. there's an expressionthat goes 'people don't know what they don't know'.

for those seeking tobegin or improve safety in general at your workplace,there is a need to begin at the beginning. to prevent injuryto workers, an obligation holderneeds to compile a list of hazards that can cause orpotentially cause death or serious injury to workers. this slide represents pageone of a simple two page hazard identificationchecklist,

which is a great wayof compiling a list of hazards that requires some form of control to keep people safe. the checklist is freelyavailable to download from our website by typing in 'hazard identification checklist'. okay. this next slide looksa little bit busy, but i just wanted to takeyou very quickly through the simple developmentof a safe work procedure. and you can seethere's three columns. it's a simpletask analysis,

what is the stepof the task? this relates to useof an angle grinder. and obviously the firsttask there, turn it on. it talks about what can gowrong in the second column. the third column talksabout what to do about it. and when you take thefirst column and the third column, that becomesyour safe work procedure. again, the task there ofgrinding the material, it talks about whatcan go wrong, noise,

projectiles hitting the operatorin the eye, et cetera. and then on theright hand side, always wearing eyeand ear protection, and an apron to protectagainst sparks during operation, et cetera. and the final, turnoff the angle grinder, trips on residue ofwaste is a hazard, and then in thewhat to do about it, check leads for damage,check disc and replace,

if necessary. and that's what it lookslike when it's finalised. it's only a sample. the next example, thisone's in word format, it's not assigned to anyparticular workplace. the reason i show that oneis down the bottom of that particular procedureyou'll see signature spaces for managers,workers, et cetera. my heart's always a littlebit happy there when i see

that sort of thing on aprocedure because it tells me, as an inspector,there's been some sort of interaction betweenmanagement and workers, and there's an agreement. and you'll see at the verybottom there's actually a review date, just incase things change. moving on to thisconcept of culture. on our website, if youwere to type in 'safety leadership at work',there's a program that is

free to join, and ittalks about two things. now, think ofyour workplace, where you are right now. it has a certain climate. what does climate mean? your experienceswith systems, practices andthe environment, how you make a dollar,how co-workers and leaders behave on any given day.

it's a bit like theiceberg you see in the powerpoint here,in the slide. below that line is a cultureof why things are done. there's unwritten ruleshow things are done, and there's either ashared or not shared importance and value. the safety leadership atwork program will assist you in so many ways. its goals are to developsafety leadership capacity

in your business, improveyour safety culture and reduce your work relatedinjuries and fatalities. safety leadership at work,it allows safety leaders to develop over time bylearning from others, it gives membersdirect access to peers, and encourages activeparticipation by sharing experiences. and above all, it's free. this looks like avery busy diagram,

but if i draw yourattention to the centre square, essentially it'sdriven by four main things. it's about demonstratingsafety leadership. it takes into account thedrivers of safety climate. it talks about involving othersin safety leadership. and demonstrating safetyleadership at all levels. moving on tobest practice. i have thrown in adefinition there. i did a bit of research,there are so many

definitions of'best practice', but essentially bestpractice is talking about a method or techniquethat has been generally accepted as superior toany alternatives because it produces results thatare superior to those achieved by other meansand because it's become a standard way of doingthings, for example, a standard way ofcomplying with legal or ethical requirements.

in terms of best practicefrom an inspector point of view, in my previousinvestigations into serious injuriesand fatalities, i've found that the rootcause more often than not comes down to a termwhat i call the three cs, which isessentially culture, communicationand complacency. injury prevention is abouthaving a safety system of work at your workplace.

on the surface it's aboutunderstanding that there is legislation thatrequires obligation holders to do somethingto ensure a safe work environment and itsworkers and others. and then i've put in these- if you look at the slide you'll see thefive squares. so if you're atbest practice, you've been through aprocess that includes risk identification,assessment and control.

you've got safe workmethod statements that workers understandand endorse. you've applied thehierarchy of hazard control to the best of yourabilities within the context. you've consultedwith workers. and you've providedtraining and workers have been deemed competentin the relevant tasks. i like to give an exampleof best practice in reality. this particular slide yousee up there is a category 3

winner of the 2016 safework and return to work awards winner. it's a company by thename of metro facades. and what they do isspecialise in installing building facades, particularlyglass curtain walling. and senior managementworked with engineers and staff for a number ofyears to create a launch pad which is a systemto install glass curtain walling from inside abuilding with the use of

miniature cranes. the system eliminates theneed for workers to be exposed to fallsfrom heights, and reduces the need forworkers to hold, restrain, position andmanoeuvre the panels, which can weigh upto 400 kilos each. so in summary, section 27of our act talks about everyone having anobligation to ensure that they exercisedue diligence.

what is due diligence? the slide that i've putup here, my final slide, talks about you have anobligation to acquire knowledge of workplacehealth and safety matters. you need to understand thenature of the operation and associatedhazards and risks. you need to ensureresources and processes to eliminate orminimise those risks. you need to ensureprocesses for receiving,

considering or respondingto information in a timely way. you need to ensurethat processes and implementation forcomplying with those duties arethought through, and you need toverify compliance. by adopting these pointsand combining them with a healthy safetyleadership culture, through adherence tobest practice principles, you will well be on yourway to significantly

reducing your injuryrate at your workplace. thank you so muchfor your time today. >>ms creagh: lovely, thankyou so much peter for covering off the firstpart of our webinar. i'm going to hand overnow to dr cameron mackay. just a slight contentwarning for anyone out there, we do have somequite visual content coming up, so justa warning on that. thank you.

>>dr mackay: thanks helen. hopefully it's not tooconfronting for everybody. so my talk today is - imean i've called it "it's just a finger!" because that seems to bea fairly common thing. i mean, firstly, hand injuriesare very common themselves. but it's fairlycommon to think, "oh, it's just a finger, why isthis taking such a long time?" so we're just going tolook through a few common

problems in hand injuryand talk about why little things in hands canhave a big impact, and then talk about a fewthings at the end about how we might streamlinethings and make it better. to kick off we'll talkabout a case study, and we've gota lot to cover. i could talk about thisfirst slide for 25 minutes to an hour, but we'llgo on from here and just mention this first caseof a 25 year old labourer.

he's got a smalllaceration from glass. he's a demolition worker. he was seen at a clinicand it was washed and sutured, the fingerswere strapped. ten days later the suturescome out and he's got a lot of pain. pain more is than thedoctor seeing him expects, so he's referred himto a pain clinic. and he sees the doctorsin the pain clinic,

he's startedon medication, but after threemonths, no progress. so eventually he still- he gets his finger and it's painful, contracted,he's in conflict by that stage with the employerbecause he hasn't been back to work so theemployer sacks him. he goes to anindependent review, there's no notesavailable for the patient, there's no diagnosis,so the new diagnosis is

offered, a reconstructionfails and he ends up with an amputation. so what went wrong? and the answer is prettyobvious that everything went wrong in that case. the rest of the talkfocuses on what we actually need to doin cases like that, and how we can prevent them frombecoming a disaster. the first thing to talkabout is the hand and why

it's unique. this slide shows,for starters, there's a lot ofaction in the hand. it's small relative tothe rest of the body, but there's lots ofmuscles, tendons, nerves, arteries, lots of activityhappening in the hand. and what's more, all ofthis action is very close to the surface, so itdoesn't take much in terms of a crush injury or alaceration to get down to

important structures. so if we look atthe fingertip, as another example, wecan see in the fingertip alone, very close,there's tendons, nerves, there's bone exposed andcountless nerve endings. this very strange lookingnext picture is another representation of whythe hands are important. this is a graphicrepresentation of what the brain representationof the body looks like.

it's calledthe homunculus. and we look at how relativelymassive the hands are. all of this relates to thenumber of nerve endings and sensory information comingfrom that area of the body. so we can see if we injurethe hand versus the elbow, the sensory perception of thatis going to be enormous. so even very minorinjuries - and if we look at the first little slidehere - something such as this can create quite abit of discomfort in the

initial healing phase. the overall aim in handinjury though is maximum return of functionin minimum time. now, that might not benormal function in a mutilating injury, but wewant them to do as much as they possibly can. this slide hasgone a bit haywire, but it shows the cycle ofdeterioration in the hand. swelling and immobilityand inflammation in a hand

all creates scar, whichcreates stiffness, which in a hand hasserious effects on function. so hand injury 101, what arethe essential elements? and i've tried to break it downto very simple things today. firstly, we needa diagnosis. that sounds very obvious,but in the first case study we spoke about todaywe didn't have a diagnosis until well into the case. we had not properlydiagnosed what went on.

but we need a diagnosisas the first thing. then we can plan, and wecan execute that plan. and, thirdly, we need todocument what's happening along the way. and i'm sure we'll heara lot more of that at the end of today's presentationabout documentation. these seem simple. we'll go on to talk about whythey might be difficult. diagnosis. obviously treatmentcan't proceed without one,

and missed diagnosescompound the problem. so, again, we saw thatfrom the previous - the first case example, thediagnosis was missed which meant that a small tendon injuryturned into an amputation. then we've gotfalse diagnoses. 'rsi' is not a diagnosis. repetitive straininjury is history. rsi doesn't tell usanything that we can treat, and 'sprain'is pretty borderline.

again, it doesn't tellus anatomically anything about what injury we'reactually trying to treat. so the quality of thediagnosis is paramount. and the small anecdotehere is if you take a real estate agentand a carpenter, and you need somethingwith your house, it's going to depend -it's going to vary what you actually needdepending on which one of those people youwant to talk to.

so if your balconycollapses you're going to want to talkto the builder. the real estate agent is justnot going to be good enough. diagnosis and quality ofdiagnosis is paramount, and that needs to bebased on fact and skill. this is more of a medical oneabout mris which are a bugbear. they can create a lotof over-diagnosis and confusion, which can createhostility and conflict. the mris can show up a lot ofthings that are irrelevant.

if you mrieveryone's wrist, we'll all havesomething wrong with us. this is the first part of thegory slides about diagnosis. so, on first glance, thediagnosis is obvious, nail in handfrom nail gun. a fairly common injury. i see quite a few of thesea year, unfortunately. and we can maybe get moreof a diagnosis by doing an x-ray - nail in hand,not involving bone.

but that's probably stillnot enough if we're going to manage thisinjury appropriately. so surgical explorationis what's required. what we can see here, veryinterestingly as we look at the wound - and it popsup in a moment - is the nail has passed directlyin between the nerve to the fingers and theartery to the fingers. thankfully for this workerit hasn't injured them. but that nerve's goingto be very bruised,

and probably the workerwill have numbness for a few months in one halfof the finger at least. what's important here isif we'd not gone in and worked this out, we'd beat three months with a worker with a numb fingerwondering what's happening and have noanswers for them. and then we end up inthe position where we're considering delayed surgicalexploration of the nerve. a proper diagnosis at thestart means we can make

sure the workerwill recover. medically, we need thatdiagnosis to expedite treatment. we don't want thehand getting stiff, because scar in the handis very difficult to overcome later. so we want to avoidthat cycle of things we discussed earlier, anda very careful balance between keeping thingsstill so it can heal, but keeping it moving sowe don't get stiffness.

and that's where the realart of hand rehabilitation comes in. timelines arevery important. we can't speed up biology. it takes as longas it takes. i tell a lot of mypatients it's like watching paint dry, andi can't speed it up. so, particular injuriestake a certain time to heal. but those timelinesaren't all bad.

they sometimes give usgood structure around which we can build aprogram of rehabilitation and return to work. for example, thishere, a dislocation, it's going to take sixmonths to rehabilitate this injury. that's the way it is. from the name of thistalk, it's just a finger. it's just a finger, butthat's going to get stiff,

it's going to be sore, it'sgoing to take a long time. now, that's not six monthsto get back to work, it's six months oftherapy and grief. this one, with anassociated fracture, is going to takeeven longer. and these are a realproblem for people, particularlymanual workers. and if not done well,this is a fixed flexion contracture from justthat sort of injury,

and it's already hadsomeone try and operate on it, and it's lockedin this position. it's unsalvageable, andprobably this worker will ask for an amputation. they can't put theirgloves on anymore. and thinking about thatas a practical aspect of manual work, witha finger that bent, you can't do your job. so the plan needsto be holistic,

and it needs to be early. and a cornerstone of mytreatment is i outline the path of the program tothe worker very early on. and i have them very early backto a suitable duties program. now, that creates quite afew fights between me and some of my injuredworkers, but it is, overall, the bestthing for them. it's very easy for meto say that if they've injured one hand, they'recapable of using the rest

of their body. but then it becomes avery tricky period of management between theworker, the employer, and the insurer, inworkcover usually, about how they'regoing to balance that. and a lot of hostilitydevelops when a worker is put on suitable duties,and an employer is hostile to that, or they don't listento the restrictions. so that is where we allneed to work together.

the therapy then in thebackground is intensive, and any deviation needsto be managed early. so if they go off thereservation and they're not progressing, that needsto be handled early on. from an occupational andpsychological point of view, we need to know whatthey're doing so we can get them back. if they're not suitablefor their normal job, and they're going tobe a three to six month

rehabilitation, then ahost placement can be considered early. total incapacity is veryrarely in hand injuries very rarely morethan a week, and only if they'reinpatients or really struggling with therapy. i don't think it's veryhealthy at all for anybody to be a total incapacity. it's just not true, ifyou've got one injured

hand, the restof you is fine. however, if you'vegot lots of pain, lots of therapy, andyou're psychologically stressed, we need totake that into account. there will be economichardship we have to think about, cultural issuesand chronic pain. this is a little slidei doctored up to try and demonstrate my thoughtsof the very early part of injury management.

down the bottomwe have weeks. and very early on thepatient is extremely interested intheir injury. they're worried about howthey're going to recover, they're worried aboutwhat's going to happen to them, will theylose their finger, will they ever beable to use it again, and work is the last oftheir concerns, early on. as we reach two to threeweeks and things are

healing and they can seetheir finger is going to be okay, they'll start tothink about work again, and that's the sweet spotfor getting them back into doing something. if they then startto progress and age, at six weeks if they'renot back at work, or there's beenhostility at work, or they've runinto some troubles, they'll start to losea bit of interest,

and potentially start toconsider other avenues of complaint or compensation. that's notalways the case, but very rarely wouldpeople be considering other avenues in thefirst three to five weeks. hand therapy is intensive,and you might wonder when you've got an injuredworker why they're always there, but there's lotsto do, lots to manage. swelling,stabilise things,

keep things movingwhere we can, desensitising thosesensitive fingertips - if you remember thehomunculus with the huge hands - fingertips whencrushed get really sore, very sensitive to touch,and we have to work on that. work hardening,counselling and hypnotic suggestion is myfavourite thing, where all comments arepositive, not negative. now, that's not universal,but the best therapists

are the ones that do that. "oh, that's normaljoe, it's fine, it's going to be okay, it's justa tingling sensation." work them through it. in my therapy, it's avery quick - in my clinic, in the very quickpicture of my clinic, the therapists work in aroom next to my office, and i patrol it like asergeant major and make sure everyone's ontrack at each visit.

maybe i'm abit dominating, but i want to make surethat there's no deviation from the path, andeveryone's as happy as they can be. we often have our heateddiscussions about suitable duties programsin this room. from a managementpoint of view, we support our repairs,we mobilise what we can, we stabilisewhat we need to.

we are positiveabout the recovery, and have a joint, unified planabout how it's going to go. documentation isthe last point, and i'm sure we'll hearabout this again later. every workplace injuryis a medico-legal case, and the documentationhas to reflect this, though it's very uncommon. it's very difficult lateron for an independent examiner or someone laterto pick up a case of three

or four months wherenothing has been documented. the hardest ones are wheresomeone is injured at work, and it's been sweptunder the mat for three months, someone has forkedout for someone's medical bills for three months,and then it's gone hostile and there's nothingwritten down. it's very difficultto pick up medically, and it's difficult to pickup from a case point of view. if everythingis written down,

even if thingsgo off the rails, an independent viewer canpick up at three months and work out exactlywhat happened. and often the initialmedical reports give a very good clue as towhether the deviation has been on behalf ofmedical issues, or on behalf of hostility. this is a verybrief comment, 'there's nothing wrong with anegative laparotomy'.

that means there'snothing wrong with, in a trauma settingin a big hospital, of opening someone's bellyif you're worried to make sure they're not bleedingfrom a ruptured spleen. what that means in oursetting is there's nothing wrong with over-callingsomething at the time and having something checkedby a specialist who can just make sure thateverything's on track and there's nothingserious going on.

if it was over-called, andthat small laceration in the finger didn't injurethe tendon, that's fine, but at least we knowthat it's not a problem. so what couldpossibly go wrong? common pitfalls, as isaid, neglect, neuromas, which are scars on nerves. that conflict in theworkplace is a disaster for hand management. legal coaching - now thatmight get me into some

trouble - but that'seither professional or at the watercooler, you know, if they're talking to joebloggs who scored 20 grand from his injurylast year, we can see, clinically, a deteriorationin their rehabilitation. so we need to get theirrehabilitation underway before any ideas aboutthat start, and it's rare, but it happens. and biology.

some injuries just takea lot longer than others. our fingertip crushestake a long time because they're sensitive. those joints that i showedyou, the first knuckle, the pip joint, takes along time because they're very irritable. this picture you seeis a case of neglect. a relatively minorforearm laceration, put in a plasterfor five weeks,

and he comes outlooking like that. it's painful, stiff,swollen, contracted, and from there, an 18 monthrecovery to a poor result. small lacerations cancause big problems. you can hardlysee this cut here, but that has cutcompletely the extensor tendon, which liesdirectly underneath. here's anotherexample, same thing, very small cut,no extension,

and this patient is tryingto fully extend the middle finger, nothing there. so, small laceration,big problem. similarly here, thisis a mallet finger. so the bone has beenfractured - i'll just let the slides catchup - the bone has been fractured in thismallet finger. you can see the fingeris dropped off there. on x-ray we can seethe bone is fractured,

and what that's done, it'spulled off the extensor tendon, or the tendon thatbends the finger back. so this finger will remainin that permanently flexed position unless it'streated properly. so a small injury, it canbe treated in a splint. if it's not achieved,there will be a deforming in the finger, andultimately it collapsed. osteomyelitis isthe next slide, which means aninfection in the bone.

in this case, asmall laceration, or seemingly smalllaceration to the digit, but it's gone down toand gone into the bone. and what's happenedis that without proper treatment the bonehas become infected, and this ultimately requiresan amputation of the digit. small cut resultingin amputation from under-treatment. other examples thateveryone may have heard

of, things like carpaltunnel syndrome, de quervains tenosynovitisof the thumb tendons, trigger fingers, anddorsal wrist ganglion, all very commonconditions that we'll see. and, equally, they allneed the same things - proper diagnosis, a plan,a unified recovery plan, any deviation earlyand treatment, and then the properdocumentation. any one of these taskscan go well off the rails.

here's a secondcase to consider, having mentioned that. a worker is injured whenlifting objects off an assembly line. they go to the doctor,they're diagnosed with de quervains tenosynovitisof the thumb. then they're notseen for four months. they present backafter four months of physiotherapy with threedifferent therapists.

they've had acupuncture,laser therapy, massage, taping, crystals,you name it, they've had the lotover four months. and they comeback and present, and are sent on forindependent review with very negative ideasabout the condition. i talked before about positivehypnotic suggestion. the reverse also counts. so this, they comein making statements,

"i'm over-compensatingwith my muscles. we are tryingnot to do that. i know that i'm doing thiswrong." and all of these statements don't comefrom the patient, they come from one ofthe three therapists. again, the diagnosis isfairly straightforward, the treatmentwasn't there. they remain off work,they're frustrated. and what went wrong herewas not in the diagnosis -

that was correct - whatwent wrong here was the plan. so the plan initiallymay have been correct, but after a non-responseof three weeks, it needed tobe dealt with. so, what can we do better? as i said, the key isdiagnosis, and again, this seems very,very simple, but only yesterday i had acase come through where at one year thereis no diagnosis,

and the worker isstill struggling. so having a diagnosis,what is the injury? and wrist sprain, sorefinger won't cut it. we need to know exactlywhat's going on, so then we candevelop a plan. a plan of management thatinvolves hand therapy, a suitable duties program,a graded return to work, work hardening, andultimately try and get them back to that maximumreturn of function in

minimum time. all of this should bewritten down so if things go off the rails we canmonitor our progress, and independent assessorscan come in later, both medical and legal,and find out exactly what's happened and where thingshave gone right or wrong. and the basis of this isa clinical or medical case report, which forms thestart point of any of these cases.

the progress from thereneeds to be monitored closely, and any deviationfrom what we expect to happen should be identifiedearly and acted upon. that's all i've got. i think i've gonein under time, and we'll deal withany questions later. back to helen. >>ms creagh: lovely. thank you somuch, dr mackay.

certainly some verydetailed information in that presentation. and there's been somequestions coming through. just confirming that thecontent of the slides generally will be madeavailable after the webinar, just notthe photographs, i've been advised, butthe content will be made available and theparticipants will receive an email when that'savailable to access.

now i'd like to hand overto brent from konekt, who will take us throughto rehabilitation. >>mr cunningham:thank you, helen. good afternoon everyone, thankyou for your attendance. i'm an exercisephysiologist with konekt, working as arehabilitation consultant, and today i was going togo through and discuss what rehabilitation is,contamination management, indications ofpoor progression of

rehabilitation, as well assome examples of good and bad suitable duties. as you would haveheard in the previous presentations, there is alot to consider from both an injured workerperspective and an employer perspective whenrehabilitating an injury and returning to work. as we saw earlier on,common trends in the manufacturing industryand, in general,

any sort of industryare lacerations, foreign bodies, andminor crush injuries. and i wanted to go throughand talk about some of the considerations with therehabilitation process and these injuries. with lacerations, they canhave varying degrees of significance, andthis can impact on the rehabilitation process. with the medicalguidelines,

each individual'srehabilitation could look quite different, andthe impact on their functionality couldalso be quite different. what we'll try to do withrehabilitation and return to work is return peopleto work as early as possible. as we know, the longera person is off work, the harder it is forthem to return to work. but this process can beso individualised that it needs heavy consideration fromall stakeholders involved.

when exploring return towork or rehabilitation for an injured workerwith a laceration, we need to considerthe impact on their functionality, as well asthe medical timeframes for healing, what theirrequirements are for that specific rehab. but, generally, we wouldtry to encourage them to return to functioningas quickly as possible, and within whatever waythat we could do that.

generally, if we canexplore different types of duties within thatenvironment for a period of time, then that is anindication that we can have them back in theworkplace in a meaningful role, and performing somesort of duty that will improve theirfunctionality, and help with that return towork process ultimately. as a rehabilitationconsultant, we're there to assistboth the employer and the

injured workerthrough the process, and liaise with thetreating doctor, the specialist and allstakeholders to ensure that the processis transparent, everyone is involved,and so we can have a successful andpositive outcome. another injury that iscommonly seen are foreign bodies, and foreign bodiescan usually affect the eye. they seem to have adifferent impact on each

person, and thereforeimpact on the duration of their return to work,as well as the potential duties that theycan return to. we need to understand whatrequirements they have with their eyesin that role, understanding the visualacuity and perhaps the depth perceptionrequirements, and this could impactquite heavily on any sort of safety critical rolewhere they are required to

use their eyesight forcomplete safety overseeing of that role. so here we need tounderstand what potential duties theycould be doing, how we couldmodify the duties, and understand theppe requirements, especially if they arerequired to perform high risk activities - whichthere are a few examples of there - and you wouldhave heard from peter

earlier on theimportance of ppe and the considerations of riskytasks within the workplace. crush injuries can bequite significant in that they affect varioustissues within the body, and the rehabilitationprocess for these injuries can be quite slow, andhave a very staggered and graduated progress. when there's acrush injury, we need to consider whatimpact there is on their

functionality, what isavailable within that work environment, and if infact there are any duties available within that workenvironment to accommodate the level of disabilitythey may be experiencing, whether that's for a periodof time or permanent. in doing this, we canthen ensure that we're understanding what tasksthey can be meaningfully engaged in throughout theday to ensure that they're able to function asthey once normally did,

but perhaps in amodified capacity. and alternative avenueswe can explore for this process are ot assessmentsof their functionality, advice from the treatingdoctor and specialists, and also the greaterimpacts on their adls, activities ofdaily living, such as driving and anypotential modifications that may be made to theirvehicle to allow them to transport to and from workor facilitate the process

of them going abouttheir life as normal. not only is medication aconsideration with crush injuries, but also aconsideration with any form of injury andrehabilitation within in the workplace, to ensurethat the medication doesn't have anysignificant impacts on their ability to safelyperform the duties that they were doing, and ifit does have impacts, considering what timeduring the day these

impacts occur, howit does impact them, the influences that willhave on their return to work, and understandingthis process to structure a return to work planthat's going to be positive for the injuredworker and the employer alike. one of the areas thatwe're going to cover today is contaminationmanagement and the strategies that wecommonly use for contamination management,as this can be quite

various, andwith lacerations, precluding a person fromwork because they have a laceration due to theconcerns of contamination is quite frequentlyseen in our industry, however it doesn't alwayshave to be the case. it's about delving deeperto understand the impact the laceration has ontheir functionality, and how we can go aboutaddressing the laceration and wound managementwhilst they are engaged in

some form of meaningfulduty or suitable duty. i've placed a fewstrategies at the top there that we'verecommended, such as leather coveringsfor the actual wound site or laceration, undergoingmore frequent dressing changes, utilising cottonglove inserts inside their ppe, the gloves thatthey're normally using if they are using thosesort of gloves, larger gloves to allow forthe bandaging and wound

management underneath, andhaving available first aid resources as well astrained first aid officers to assist with anypotential reopening of the laceration and go aboutthe correct medical treatment processesif this does occur. i've provideda few examples, as it can vary so muchwith lacerations in the workplace, of differentlacerations that we've seen, and howthese were managed.

there is both positiveand negative examples. one example was alaceration occurred to a male's fingerin a workshop, and the rehabilitationconsultant became involved, organisedweekly dressings with the practice nurse, ratherthan attending the hospital, which couldn't bedone on an as frequent basis. there was alsoidentification of strategies for the woundmanagement and laceration

contamination management,having available several pairs of cotton insertsfor the glove to facilitate them alwayshaving a clean pair of gloves. and as a result, inaddition to the medical treatment andwound management, they were able to returnto work in suitable duties within one week ofsustaining the injury. so, as we know, the longera person is off work, this is an example ofwhere we were able to get

them back into theworkplace and the environment, but in a waythat's suitable for them and the rehabilitationthey're undergoing. another example is apartial finger amputation that occurred within themanufacturing workshop. the injured workerwas taken to hospital, provided with fourweeks off work. as a result, thewound became infected, and the injured workerunderwent a specialist

review which suggestedthat perhaps stitching the fingers together mighthave been a way to assist with managing thewound at the time. when the rehabilitationconsultant became involved with the employer and theinsurer to understand the process, they identifiedthat there was in fact a requirement for an urgentreferral to a hand clinic to discuss the injurywith the specialist. this occurred the dayafter meeting with the

injured worker. ultimately the injuredworker was operated on, an amputation occurred,however it wasn't as severe as it could have beenhad the process been delayed. and following surgery anexample of contamination management was leathercapping to the area, cotton glove inserts,larger gloves to allow for the leather capping andthe wound management dressing, and grading a suitableduties plan over time.

another example, quite ahorrific and poor example of wound andcontamination management, is a male worker in asawmill that had quite lax regulations surroundingtheir workplace health and safety, where he had aserious de-gloving injury to his calf when a faulty- a known faulty forklift dropped its load, destroyingthe calf muscle. as there were no firstaid supplies available, they actually wrapped thewound in rags that were

used to mop up greaseand oil and they were transported to hospital ina ute rather than calling an ambulance. as a result, there wasa secondary infection, which had quite abig impact on that individual'sfunctionality. but an example could havebeen having first aid supplies available,trained first aid officers and calling an ambulanceto assist with that

contamination management. and the final example isquite a good example of a female that sustained anunexpected needle stick injury withinher workplace. the first aid officeridentified that it was quite serious, providedthe appropriate puncture site treatment, and tookthe injured worker to hospital, where theyunderwent screening for the diseases followingthe needle stick injury,

and in accordance withthe medical requirements, they were scheduled forappropriate checkups to ensure the diseaseincubation periods were screened for. an example of a way arehabilitation consultant can assist with thereturn to work process is initially performing awork site assessment. and i've got an examplethere of how a work site assessment canbe beneficial.

but ultimately it's thereto understand the roles and duties and tasksthat that employer has available, and the demandsof these tasks day to day so that we can developan understanding of what would be appropriatebased on the level of functionality foran injured worker, and how best to structurethe plans over time, knowing what duties andtasks we can grade them through, or alternativeduties that they may have

available if an injuredworker is unable to return to the same dutiesthey once were doing. ultimately from thisprocess - as you heard peter talk about - taskanalyses can assist with developing ajob dictionary. and this is essentially alibrary of different roles that the employer hasavailable that can be a quick resource if youare working with someone that's returning to work.

an example of thisisn't specific to the manufacturing industry,but a 33 year old male who was working remotely wasperforming a form of burn off and accidentally added anaccelerant to the process. as a result, there weresignificant third degree burns affecting variousparts of the body and an outcome of that was hisfine motor skills and thermoregulationwere affected. he wasn't able to returnto the similar duties that

he previously wasdoing, however, through a worksite assessment and identification ofa host employer, they were ableto understand the requirements of thepotential alternative duties and, from that,identify that where they previously were goingto place the workstation within the warehouse onthe floor that was quite warm, identified that abetter ventilated work

station was moreappropriate, times during the days thatit was more appropriate to perform duties to assistwith the thermoregulation process and to understandthe scar tissue management requirements, and ensurethat the duties and times during the day were notgoing to impact on the scar tissue management. and as a result, theinjured worker was successfully employedby that host employer.

i'll briefly just touchon rehabilitation, as it can be commonlythought of as the physical or non-physicalrehabilitation that an injured worker undergoes. however, rehabilitationis an all-encompassing process that within theoccupational industry it looks at thebio-psychosocial factors involved, so understandingnot only the medical and treatment requirementsfor that individual,

but also the impactson their thoughts and perceptions ofthe workplace, the impacts ontheir family life, as well as litigation andcompensation requirements. when a rehabilitationassessment is undertaken, it is holistic in termsof encompassing and understanding the fullaspects of the injury on that injured worker andhow that influences the return to work, theemployer and their

requirements, as well asthe individual's life and quality of life. every rehabilitationprocess will be individualised, as there'sno cookie cutter or one size fits all withrehabilitation, and throughout the processensuring that the process is transparent,there's open lines of communication between allstakeholders to ensure there's a successful return towork and injury recovery.

and with thebio-psychosocial flags, they can give us anindication of areas that we can monitor throughoutthe rehabilitation process to ensure that it is infact progressing towards the specific goal setfor that individual, or if it isn't,identifying the flags and barriers that arearising, and using early intervention to overcomethose potential issues. rehabilitation, just a quickoverview of the process.

generally an initialneeds assessment will be completed - whichencompasses a lot of what i discussed on theprevious slide - essentially understandingall the requirements and impacts of that injuryon that injured worker, engaging with all thestakeholders, the doctor, the employer and theinjured worker and family alike, identifying if awork site assessment is required to assist indeveloping a suitable

duties program, anddevelopment of the suitable duties program. and through this process,using the work site assessment orunderstanding of the employer fromprevious injuries, we can identify dutieswithin the workplace that they were doing,modifying them, alternative dutiesthey have available, ultimately alternativeemployment using a host

employer, as well as thebarriers to return to work and how to bestovercome them, and identify the workcapacity requirements and how to structure a workconditioning program to assist with this process. and i'll touch on good andbad suitable duties later on in the presentation. throughout the process,we will monitor the flags against the goals,recommended medical

healing timeframes andrehabilitation timeframes, and using communication,liaise with all stakeholders to ensurethat everyone is aware of the process and howit's progressing, or what in fact ishappening with the rehabilitationat that time. how do we keepemployees at work? this can be quite achallenging issue if, for example, there arevarious structured tasks

within that workplace. so if there isn't a lotof room to move with the tasks in thework environment, then what we need are moreappropriate and meaningful duties elsewhere, orpotentially if they do have the option foralternative duties within the workplace, what thetraining requirements and support requirements are forthem to transition across. for example, a processworker transitioning into

an administration rolemight require further training and support,understanding of how that would work, or it may notbe an appropriate type of role for him, or theymay not feel meaningfully engaged within theseduties so we need to explore alternativeoptions. this is best done throughconsultation with all the stakeholders, face toface with the employer and employee to understandthe work environment,

how that would work, whatthe employee looks like in that work environment, andwhat potential avenues can be explored, alternativeemployment options. this is indicators oflimited progression. so through monitoring thebio-psychosocial flags throughout the rehab, wecan identify potential disengagement withwork, changes in the psychological healthof the injured worker, the potential barrierswith the progression of

rehabilitation, as wellas any breakdown in communications affectingthe return to work. and i've provided a fewcase studies and also some strategies on how tolook and monitor these potential barriers thatare arising and limiting the progression of rehab andthe return to work process. an example is a 41 yearold male was on a return to work process for quitea long period of time, and remaining on the samehours and suitable duties.

in addition to the doctorsuggesting that the rehab should have progressedpast this stage, the rehab consultantand insurer and employer weren't able to progressthe return to work hours, and as a result theyidentified that the injured worker was infact on reduced benefits, which was a financialchallenge for him and his partner in terms ofaffording after school care. so they identified this barrierand came up with a strategy.

so the strategy was tojust increase the hours, but increase the startingtime or shift the starting time to earlier in the dayto facilitate the injured worker being able to stillcollect his child from school and avoid payingafter school care. a strategy that could beused through the rehab consultant process ismonitoring psychosocial tools. so looking at pain scores,mental health scores, and this could give us anidea of progression from

initial as throughto progressive times, or as well as using itwhen we feel like barriers may be arising. an example of good and badsuitable duties is that a good idea of suitableduties would be a plan that's identified through consultationwith all stakeholders. so consideration isgiven to all facets of rehabilitation, theinjured worker's capacity, and how this impacts onthe duties they once were

performing, as well astheir return to work, ensuring that it'sspecific to the individual, that thereis improvisation there. so sometimes a bit ofcreative thinking can go a long way in terms of gettingan employee back to work. and support ofall parties, especially the directline supervisor, to ensure that they're involvedin valuing the process. this will help with theseamless process with

return to work. bad suitable duties arein fact the opposite, but also having vague ornon-specific goals and duties, as well as notinvolving the injured worker in the process. as we know, meaningfulengagement can be quite positive in terms ofadding value to their ultimately with suitableduties we always look for best practice.

so duties thatare appropriate, duties that can be easilyswitched to with minimal training requirements, butalso ensuring that if that is the case, that they dohave the support with any further training, andmonitoring the flags and the process throughoutto ensure if there's any barriers arising, which thereare a few examples there. i've provided an example of goodand bad suitable duties. i will just runthrough one of each.

so a good example ofsuitable duties is a bus manufacturer that requiredan employee to undergo suitable duties, use theprocess as a way to use the injured worker as amentor to trainee staff. so in order to use them asan assistant to teach them all the duties, eventhough they could only perform modifiedaspects of those duties, to ensure that the mostexperienced workers, even though they mayhave been injured,

were meaningfullycontributing to the business, at the same timeas training the new staff. and a bad example therewas a registered nurse was placed in an alternativerole due to her injury, and although she wasengaged with the role and wanting to do thebest she could, she didn't receive thetraining and additional training that she requiredto complete that role competently, and as aresult she developed

secondary mental healthfactors in addition to her physical injury. so summarising, with therehabilitation process, always utilising earlyintervention and reporting of the injury can ensurethat the process commences a lot earlier, there'sguidance throughout the process supporting boththe employee and the employer, and to assistwith identifying any additional requirements orassessment requirements.

>>ms creagh: lovely.thank you so much, brent. okay, and concludingour webinar for today, i'd like to introduceross mcconaghy from jensen mcconaghy lawyers.thank you. >>mr mcconaghy: thanksvery much helen, and good afternoon,ladies and gentlemen. as i think was welldemonstrated in dr mackay's graph, onceinjury, treatment, rehabilitation and returnto work issues have been

dealt with, attentionoften then turns to legal redress, and that's wheremy role as a workcover panel lawyer commences. by the time it reaches meof course things have been sanitised, and nothing isquite as messy as it was at the stage that dr mackaymight have become involved. as you've heard, minorinjuries can develop into serious problemsfor employers. they can often lead tosignificant damages and

awards under ourcommon law system. this afternoon i'll givea quick overview of the queensland common lawsystem as it relates both to liability determination andthe assessment of damages. and i'll then finishwith some case studies. okay, the firstthing to be aware of, if you're notalready aware of it, is that your workcoverpolicy covers both your statutory no-fault benefit andcommon law damages liability.

only a relatively smallpercentage of claims that were subject to statutorybenefits will proceed into the common law system. i think roughly arounda quarter at the moment. we talk aboutcommon law claims. what is common law? well, essentially it'sthe law created by judges, as distinct from lawsdeveloped by parliament. the established principlesfrom those judge-made

decisions govern howcurrent cases are treated, subject to somestatutory modification. now, in queensland werefer to it as a common law system, but it is inreality a hybrid model which is based upon commonlaw principles modified by statute, both in relationto how liability is to be determined, and also inrelation to how damages are to be assessed. well, why do injuredworkers pursue common law

damages andwhat's the catch? why doesn't everybody? well, the attraction isthat damages claimed under the common law scheme aregenerally much greater than compensation thatmight be available through the no-faultstatutory scheme. for example, the statutoryscheme doesn't compensate an injured worker fortheir future lost earnings or lost earningpotential or capacity.

the catch, however, isthat the injured worker has to prove that theemployer was negligent in some way, and that negligenceled to the injury. so what does an injuredworker need to establish in order to successfully pursuea common law damages claim? essentially they mustestablish firstly that the risk of injury wasreasonably foreseeable. that's in the sense thatit was neither farfetched nor fanciful, thatthat risk was not

insignificant, that theinjury was preventable, and that if the workeralleges some precautionary measure should have beentaken by the employer, that precautionarymeasure which would have, or it's alleged would haveprevented the injury was a reasonable responseto the risk, and finally that theinjury was caused by the materialisation ofthe risk in question, which is what we referto as legal causation.

it's well-established inaustralia that apart from any statutory duties thatmight be owed under the relevant workplacehealth and safety laws, that all employers owetheir workers at common law a duty of care totake reasonable steps to prevent or reducethe risk of injury. that's the general expressionof the duty of care but within that duty thereare a number of specific duties that havedeveloped over time,

and i've listedsome of them there. that's not anexhaustive list, but for exampleto provide, maintain and enforcea safe system of work, to provide safe andappropriate plant and equipment free frompatent defects, to provide safe premises,to instruct workers in the safe performanceof their work, and to provide adequatesupervision and assistance.

now, an injured workerwill only succeed in a common law damages claimif he or she can establish that the employer hasin some way breached a relevant duty ofcare owed by it, and an employer will havebreached its duty of care where those three matters listedon the slide are satisfied. firstly, the risk ofinjury to the worker was reasonably foreseeableand not insignificant, and there were measuresavailable to the employer

to protect theworker from the risk, and the employerunreasonably failed to adopt those measures. now, not all risks inthe workplace require a response fromthe employer. if the risk of injuryis insignificant or not reasonably foreseeable, thenno response may be required. now, again, apart from anystatutory duties that a worker may have inrelation to their own

workplace healthand safety, there are alsocommon law duties. and in the event that aninjured worker has been found to breach oneof those duties, then they're exposed toa finding of what we call contributory negligence,and the result of that is that their damages will bereduced by the extent to which a court determinesthat their own negligence has contributedto the injury.

the first four examplesi've listed on the slide are probably the mostrelevant for today's purposes, where,for example, the worker has failedto comply with safety instructions givenby an employer, or where the worker hasfailed to use protective clothing and equipmentprovided by the employer in a way in which theworker has been instructed to use them, where theworker has failed to use

anything provided by theemployer that was designed to reduce the worker'sexposure to a risk of injury, or where theworker has inappropriately interfered with ormisused something that was designed to reduce theirexposure to a risk of injury, for exampleremoving a safety guard from a lathe or someother type of machinery. okay, so once liabilityhas been established, how are damagesthen assessed?

the assessment is brokendown into what we call 'heads of damage'. part of this is alittle bit of science, there's a littlebit of maths, and there's a little bitof intuition and crystal ball gazing. the first component orhead of damage is what we refer to asgeneral damages. they are damages whicharen't quantifiable by

reference to economic lossor some cost that's been incurred, it's what wemore particularly refer to as pain and suffering andloss of enjoyment of the amenities of life. in the old days, priorto some amendments to our legislation going backabout 15 years ago or so, general damages wereassessed simply by referring to previouscourt-made judgments. now, in queensland, weoperate under what we call

the isvs, theinjury scale values, where we have reference toa 0 to 100 point sliding scale, an injuryattracting 0 points being one with literallyno injury, to an injuryattracting 100 points, which is an injury ofthe most terrible type of injury that couldpossibly be imagined. so somewhere along thatsliding scale we have to drop the pin, effectively,and determine what the

relevant isv is, and eachof those points attracts a statutory valuein monetary terms. so that's a relativelystraightforward assessment these days, and it's madeby reference to things like assessments ofpermanent impairment under the ama guides,for example. past economic loss,that's really simply a calculation of the lostearnings occasioned by the injury that'soccurred in the past.

future economic loss, don'tlet the title deceive you. a person who has returnedto full employment on their pre-accident incomecan nonetheless still receive, and oftenwill receive, an award of damage forfuture economic loss. now, the concept behindthat is that what that person is beingcompensated for is not the - well, it can be, but isnot solely the actual loss that they will incur,but it's also the loss of

their earning capacity. so, for example, if youhave a manual worker who sustains an injury whichnonetheless allows them to continue workingin their role, but precludes themfrom a range of other occupational pursuits,that person is entitled to be compensated for therestriction in their earning potential. and what that might be isdependent on a whole range

of factors. past special damages. special damages is simplya fancy name for out of pocket expenses, soit's medical expenses, pharmaceutical,rehabilitation costs, all those sorts of things. and future special damagesare those costs likely to be incurred in the futuredirectly attributable to the injury.

the basic concept ofdamages is that they're intended to place theinjured worker as near as possible, inmonetary terms, in the same position theywould have been as if the injury had never occurred. that's the best oursystem can come up with, it's the best any systemin the world has been able to come up with. you can't physically putthe person back into the

position they were in, butthe best we can do is to compensate themin monetary terms. damages are assessed ona once and for all basis. the injured worker onlygets one bite of the cherry, they don't get tocome back and sue again and again if they're notsatisfied with the damages they receivedthe first time. and damages aren'tsubject to taxation. that's because they'reassessed on a net,

after tax basis, andif they were subject to taxation then the injuredworker would be unjustly out of pocket. damages can also includeinterest on past losses, that's at a setstatutory rate, and in some cases thereis also an opportunity for damages to be awarded forthe value of care services provided by, for example,family members and friends or external commercialcare providers.

pre-existing conditions. this is something thatoccurs quite often, and i'm sure many of youhave had experience of this where youmight have a worker, particularly amature worker, who has sufferedno symptoms at all, injures their back andthen once they undergo assessment it'sdiscovered, for example, that they might haveadvanced degeneration in

the lumbar spine, orsomething similar. now, that person may wellhave gone through life, as many of us do, withdegenerating spines with no symptoms whatsoever. the workplaceincident occurs, and then thatperson has symptoms, which may or may not havedeveloped in the fullness of time absentthe work event. now, our role as defendantlawyers is to try to

establish how thatpre-existing condition might have affected theworker in the future if the incidenthadn't occurred, if that's what we'regoing to allege, that at some point thatworker, for example, might have had difficultycontinuing on in their pre-accident role simplyby virtue of the state of their spine. that requires expertmedical evidence,

which is often verychallenging because the law requires there to bea reasonable degree of precision, and of coursewhat we're asking of the doctors in those cases is totell us when those symptoms would have come to light witha degree of precision. of course, that'snigh on impossible. in other cases you mightencounter a situation where a worker alreadyhas some condition, illness orpre-existing injury,

which makes the injurysustained in the relevant event far more seriousthan what it might have been in a person who wasotherwise able bodied, and that's what we refer toas the 'eggshell skull rule'. a very simple and obviousexample of that might be a worker with visionimpairment in one eye who sustains a permanentinjury to their good eye, and now the impact uponthat worker is far more devastating than itmight be for a person,

for example, with normaleyesight in both eyes who sustains aninjury to one eye. so that's the luck ofthe draw, unfortunately, and the damages that flowfrom the first example obviously are going to be fargreater than in the second. i'll move on to someactual case examples. the first is a youngboilermaker who suffered a compound fracture of hisindex finger on his left hand, which washis dominant hand.

he was assessedun-controversially with an 8% impairment. now, as a result of thatfinger injury he has ongoing discomfort andstiffness in that finger, which is relativelyunrelenting. he is a stoic individual,he returned to full employment, he had minimaltime off work - i think around three months -but he went back to his employer who wasthankfully a very

accommodating employer,and returned to his pre-accident role on hispre-accident earnings. now, the difficultyfor that fellow is the principal task inhis role was welding, and his left index fingerwas his welding finger. so he had to adapt towelding with his right hand, his non-dominanthand and, unfortunately, as a result of that the qualityof his welding has declined. now, also involved in hisrole is manually handling

obviously large weightsand sheets of steel, and he hasdifficulty with that. now, for that fellow, ifhe was to find himself out of employment, he would beat a distinct disadvantage on the open labour market. now, in that case,just talking about ppe, he was wearing hisassigned welding gloves, but unfortunately theydidn't provide any protection againstcrush injuries.

he was performing a taskthat he had performed many times, and in the way thathe'd been shown how to do it. he was cutting a sheetof steel plate which was rather large, abouta metre across, but unfortunately inthe process of that, one side of the sheet gaveway and his finger was caught in a pinch point. now, there was availablean overhead gantry with a magnetic lifting device,but unfortunately he'd

never beeninstructed to use it. there was no riskassessment or safe work procedure whichidentified that risk, nor which required him touse mechanical assistance. now, in that case hisdamages award was in excess of $150,000. the second case isreally, i guess, an instruction inappropriate ppe. this fellow,coincidentally,

was another boilermakerwho received a penetrating eye injury using a hot sawto cut a length of steel bar. he was wearing hisprotective eyewear, but the steel splinter wasstill able to make its way into his eye. the employer in thatcase thought they'd done everything properly, and it wasvery difficult to be critical. they had done arisk assessment, there was a safework procedure,

there was a requirementto wear protective eyewear which was enforced. unfortunately forthis employer, it was the wrongkind of eyewear. now, had they madeinquiries of, for example, the manufacturer,workplace health and safety queensland, ifthey'd had reference to relevant australianstandards, they would haveascertained that the type

of eyewear he shouldhave been wearing was a different kind, so a verysimple inquiry might have avoided thatinjury altogether. the third example is a36 year old female kitchen hand who suffered aserious laceration to her hand when she reached outto catch a falling drip tray which had avery sharp edge. now, she sustained a nastylaceration to the webbing between her index andmiddle fingers and then,

unfortunately,developed an infection, and then subsequentlycarpal tunnel syndrome. and there was medicalevidence which established a causal connection tothe original work injury. the liability in that casehad been conceded by the employer because therewere steps which could have been taken - verysimple steps which could have been taken by theemployer to avoid the requirement for her to beputting her hands anywhere

near the sharp edgesof the drip tray. that woman, justout of interest, was awarded in excess ofhalf a million dollars by the brisbanesupreme court. the last example is afairly dramatic example. this is a31 year old fellow. he was a labour hireworker whose task day in day out, effectively, wasto use a pneumatic wrench or metal gun to affix nutsonto large bolts on pipe moulds.

so he did thateight hours a day, five days a week for sixmonths without rotation. he developed, towardsthe end of that period, symptoms in both forearmsand was subsequently diagnosed with carpaltunnel syndrome. unfortunately for him, hedeveloped complex regional pain syndrome and went onto develop some sort of bone necrosis, whichresulted in one of his arms being amputatedbelow the elbow,

and he is missing severalfingers of his other arm, which iseffectively useless. that's a classic and verysobering reminder of the necessity to rotate anyworkers that you might have who are performingtasks which are repetitive. so, i guess the moralsof those stories, and touching upon someof the matters that peter addressed at theoutset, firstly, and from the lawyers'point of view,

we love pieces of paper. we love paper withwriting on it, it's even betterif it's signed. so risk assessments, it'svery important in your workplaces to assess thetasks that are carried out by each of your workers,what's involved in those tasks, what are the risksarising out of those tasks. if there are risks,develop safe work procedures in theformat, for example,

that peter suggested whichmight minimise or reduce the risk of thoseinjuries materialising. next is to implementthat system. it's no good having abookshelf full of safe work procedures that none ofyour workers know about. they've got to be trainedand it's got to be enforced. and that's the lastpoint, which is continuous enforcement, andreinforcement of those procedures, and if peoplearen't adhering to the

safe work procedures, thenappropriate disciplinary action. on that note, i'llhand back to helen. thank you verymuch for listening. >>ms creagh: lovely.thank you very much, ross. okay, so that concludes ourfour presenters for today. we have received somequestions during the presentations, and justbeing mindful of time, we will cover perhapstwo or so questions, and then we will be ableto publish some more

specific answers toquestions which came through on our website whenthe webinar does go live. so we do have a couple ofquestions which have come through for dr mackay, and iwill just pose one here for you. the first one is, "canyou please give any suggestions on how towork with a surgeon who is reluctant to allow aninjured worker to go onto a suitable duties plan,particularly when it is the non-dominant handthat is injured?"

>>dr mackay: yes, that'sa tricky question because people will varyin their practices. the first thing is it willdepend on how the patient or how the workeris about it. so if the worker'son par with you, the easiest thing to dois for them to bring it up with the surgeon they'dlike to go to work, and if that doesn't work,they can easily get a second opinionfrom a treating.

and outside of that,particularly in workcover and insurance cases,it's not under mbs, so they don't need areferral from a gp, they can seek a second opinionwithout referral from the gp. the third way of goingabout it is to develop a relationship withmedical practitioners and specialists that youuse all the time, be it for knee orshoulder or hand injury, and have someone that isyour go-to person that you

have an establishedrelationship with and that you can ring and say,"i've got an injured worker, can i bring themin monday and work out a plan," and they can managethe rehabilitation with you from there.it's so much easier. >>ms creagh:excellent, thank you. and i have asecond question. this is in relation toresponsiveness for employers. "so if a gp cleans oneof the worker's wounds,

how does an employer knowif the quality of the gp's work is sound, or when a specialistintervention is needed?" >>dr mackay: yes, thesituation there is fairly similar and,again, difficult. again, if you've got anestablished relationship with someone, you can getthe primary or emergency management at an emergencydepartment or a gp and then move on to someonethat you know and have a relationship with to checkthings over and make sure

it's on track. you could ask the gp. just say, "look, we'd liketo see someone about it." a lot of gps mightget offended by that, so in the first instancehave the primary management given andthen look to having a specialist referraleither by the gp or independently, ifyou're suspect. but i would encourage- as i said,

the diagnosisis paramount, so if you're uncomfortableand you think, "no, i really would like myworker to see a specialist about this," discuss thatwith the worker and say, "i think you should see aspecialist and make sure we're on track," and mostworkers would be happy for that in that early periodwhen i said that the injury is paramountin their thoughts. if you said, "i want youto see a specialist about

this, i thinkit's a good idea," i think most workerswill go along with that knowing they'regetting optimum care. so i think the first thingis to be on the front foot about it and just makingsure you've got everything tied up and established. that will only ever looklike diligence on your behalf. >>ms creagh: excellent.thank you very much. okay, we have a question foranother one of our panel.

this is a legal questionwhich has come through for ross mcconaghy. ross, we have aquestion which says, "does contributorynegligence consider what the worker ought to reasonablyknow, i.e. gravity?" >>mr mcconaghy:thanks helen. yeah, that questionprobably goes more to primary liability, andi mentioned earlier the steps that employers arerequired to take and what

is a reasonableresponse to a risk, and that in some casesno response is required. excuse me. there's no duty,for example, to necessarily take anyprecautions against risks that are obvious. as long as human beingswalk upright they're going to injure themselves inany myriad number of ways. the test ultimately is forthe employer to do what is

reasonable, and it'snot a duty to absolutely guarantee thesafety of a worker, the duty is to takereasonable steps. so the risk of fallingdown, for example, or falling down aperfectly normal flight of stairs, if that'spart of their role, it requires no particularresponse from the employer. okay, that is probablyall we have time for with regards to live questions.

we do have some otherexcellent questions which have come through whichare probably more specific relative to particularworking environments and specific workingconditions, and we'll attempt toaddress those specific questions and provide someresponses when we have the webinar go liveon the website. so, in conclusion, i'djust like to thank you all for attendingtoday's session.

so, as we mentioned, arecording and copy of the presentation will be madeavailable on our website over the next few days. we would also welcome anyfeedback that you have on today's session, orsuggestions for topics, or formats forfuture sessions. there will be a shortsurvey which will pop up at the end of the webinarand it will give you an opportunity to providefeedback or suggestions on

today's session orfor future ones. so thank you again for allof your attendance today, and i thank our panel forall of their participation, and we will be lookingforward to you joining us for all future webinars andeducational sessions.

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