Concussions in the Workplace: What You Need to Know

We use our brains for every single thing we do – whether those actions are conscious and voluntary, such as making a cup of coffee, or unconscious and involuntary, such as breathing. Our brains are constantly working to help us survive and thrive. Your brain is the most powerful tool you possess, but it is not invincible and, therefore, it is necessary to take every precaution to keep your brain safe in everything you do.

Acquired Brain Injuries, those that are not hereditary, congenital, or degenerative, are often viewed as a silent epidemic, as many people are unaware of how common, life-threatening, and debilitating these injuries are. Studies show that more than one million Canadians are living with a brain injury of some degree, with 200,000 concussions being reported annually¹. To prevent brain injuries in the workplace, employers and employees should know the risks and how to respond to head injury incidents. If an accident does occur, there are strategies that can be used to help those with concussions stay at work or return to work in a healthy manner.

What Is a Concussion?

A concussion is the most common form of brain injury and usually occurs after a blow to the head. While considered a mild traumatic brain injury (mTBI), without proper attention, the damage to your brain from a concussion can worsen and become permanent damage with long-term consequences. Post-concussion syndrome (PCS) is when symptoms of concussion persist beyond the regular recovery time. Approximately 50% of patients with a concussion have symptoms of PCS after one month and 15% have symptoms at one year².

Some of the symptoms of a mTBI include:

• Noise and light sensitivity
• Dizziness
• Headaches
• Nausea or vomiting
• Fatigue
• Vision problems
• Attention or concentration problems
• Problems with short- or long-term memory
• Anxiety
• Irritability
• Sleeping problems

Brain Injuries in the Workplace

Concussions are common in the workplace. Although the causes depend on the industry and occupation, the most common causes of workplace brain injuries are falls, being struck by or against and object, and motor vehicle collisions³.

Concussions/mTBIs impact cognitive, physical, emotional, and behavioural functioning. Those with symptoms may have difficulty engaging in regular daily activities and performing the essential demands of their role. Occupational Therapists can help assess, accommodate, and gradually reintroduce employees into the workplace. They can help with symptom management strategies, fatigue management and sleep hygiene education, activity scheduling, cognitive rehabilitation, negotiating modified work activities with employers, and adapting the physical work environment.

While the symptoms are often invisible and can go undetected, concussions can hinder a worker’s timely return to work. It is important for workers with brain injuries to gradually resume their pre-injury activities within the first few days to weeks of their injury, as activity is more likely to speed up rather than delay recovery⁴. Delayed return to work can have severe consequences for affected individuals, including more physical ailments and psychosocial consequences. Studies show that “brain injury patients who are employed report better health status, improved sense of well-being, greater social integration within the community, less usage of health services, and a better quality of life than those who are not employed”.⁴

What Can Employees Do?

Prevention is key for minimizing risks of acquiring a brain injury.

• Always be wary of your surroundings – if you are in a new environment, always be aware of potential risk.
• If the activity calls for it – wear a helmet!
• If you have sustained a concussion – take it easy! Individuals who have suffered a concussion are at greater risk for a more serious acquired brain injury. Attempting to go back to work or engaging in physical activity too quickly after a concussion can cause further damage resulting in long-term negative effects. A gradual approach to returning to full activity is most effective.
• Follow safety precautions and know your safety plan in the workplace – if you are required to wear protective equipment, make sure you are properly equipped and know the risks associated with your job.
• Use the proper equipment for all tasks in the workplace – this includes using proper stepping stools and ladders as opposed to chairs.
• Know your rights – if you feel unsafe doing a particular job, unless it is stated otherwise in a job contract, you have the right to refuse work.

What Can Employers Do?

All workplace injuries are preventable, and as an employer you need to be informed of safety precautions and ensure your employees are following protocols in place for safety reasons. The best way to prevent head injuries in the workplace involve identifying potential hazards and mitigating exposure. However, if an employee receives injury to their head in your workplace, you can follow the Glasgow Coma Scale (GCS) to determine the severity of the injury⁵.  The scale involves three main criteria: verbal response, eye opening and motor response.

Verbal Response:

• 1 = none (generally means they are unconscious)
• 2 = sounds but no words (groaning, yelling)
• 3 = incoherent words (saying words but not forming sentences, making no sense)
• 4 = confused conversation (making sentences that make no sense, not on topic)
• 5 = normal

Eye Opening:

• 1 = eyes not open (unconscious)
• 2 = in response to acute pain (only open eyes when touched, pinched, etc.)
• 3 = in response to the sound of a voice (open eyes to acknowledge being spoken to)
• 4 = spontaneous (blinking as normal)

Motor Response:

• 1 = none (unconscious)
• 2 = rigid posture with arms and legs straight, head and neck arched back (conscious and in pain)
• 3 = abnormal posture with arms bent toward chest, fists clenched (conscious, trying to relieve pain)
• 4 = whole body pulls away from pain (attempt to get away from physical contact)
• 5 = moves affected extremities away from pain (normal response)
• 6 = normal (regular posture, no pain)

The numbers shown above are used to tally up a score to determine severity of injury. The lowest a person can score is a 3, which means they are unconscious and you should call an ambulance immediately. Anything below 9 is considered severe. A score of 9-12 is considered a moderate injury. A score of 13-15 is considered a minor bump on the head – the person is most likely okay and may need some extra monitoring.

In any case, an individual who has a head injury at work should report it immediately, document the incident, and seek medical attention if necessary. As an employer, it is crucial you look out for warning signs of a concussion and seek professional medical help immediately if needed.

How Can Gowan Consulting Help?

Not all brain injuries are fatal or completely debilitating, and many individuals with acquired brain injuries continue to work following their injury. We have a team of highly trained Occupational Therapists who can help individuals who have acquired brain injuries in the workplace. Whether it’s a matter of an accommodation, return-to-work, or a functional cognitive assessment, our team works in collaboration with employers to ensure all employees are set up for success and maximum productivity. If you would like further information on our services, please contact us! We would love to work together for your healthy business!

References

[1] Brain Injury Canada. (2023, March 21). Statistics. https://braininjurycanada.ca/en/statistics/

[2] Eric L Legome, M. (2022, August 22). Postconcussion syndrome. Medscape. https://www.medscape.com/answers/828904-158205/what-is-the-prevalence-of-postconcussion-syndrome-pcs

[3] Canadian Centre for Occupational Health and Safety. (2023, May 18). CCOHS: Health and Safety Report - past issues. Government of Canada, C. C. for O. H. and S. https://www.ccohs.ca/newsletters/hsreport/issues/2015/05/ezine.html

[4] Ontario Neurotrauma Foundation. (2018, May). Guideline for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms: Healthcare Professional Version, Third Edition. Brain Injury Guidelines. https://braininjuryguidelines.org/concussion/fileadmin/Guidelines_components/12sections/Section_12.pdf

[5] KBG Injury Law. (2021, December 15). Use Your Head: Workplace Safety to Prevent Workplace Injuries. https://resultsyoudeserve.com/blog/use-head-workplace-safety-prevent-head-injuries/