The following is a summary of Chapter 14, 'On-site injury management', in Moving in on occupational injury edited by David Worth (Butterworth-Heinemann, 2000).

David Worth begins an article in his book Moving in on occupational injury with a statement that could be mistaken as simple: "For there to be a sustainable placement the worker's capacities must be equal to or greater than the demands of the job … Satisfaction of this equation,” he writes, "depends on the reliability and validity of all the data collected when measuring a worker's capacities and the demands of the job. Therefore it is essential that the assessments of a worker's functional capabilities are precise and accurate, whether performed by the treating doctor, an independent clinical assessment or a functional capacity assessment.”  The data is the thing.

What's the best way to gather accurate data? On-site observation.

Worth uses the example of lifting to illustrate the many variables in a work situation. Considering whether or not a worker has the capacity to lift requires an understanding of the detail of the lifting. “The person's capacity to lift a certain load, through a certain distance, a certain number of times, for a certain length of time, needs to be equally and realistically measured when analysing the demands of the job,” writes Worth. “This includes how much weight is lifted through what distance how many times and for what duration in order to validly compare the person's capacities to the job demands.”

Worth writes that it is necessary to take into consideration all the functions of the job when analysing the requirements or suitability of a job. Worth recommends that there be “a checklist of all the demands of the job, a detailed inventory of the frequency, duration, forces and distanced through which the forces are moved to meet the demands of the job, and an ergonomic evaluation of the physical aspects of the job to discover hazards for which appropriate modifications should be made.” All of which requires a level of observation and analysis more difficult to achieve off-site.

Worth's pre-claim ‘Immediate response model' is as follows:
 

• First aid by the occupational health nurse or other worker trained in first aid
• Triage by health practitioner to determine appropriate direction for injured worker
• Immediate assessment by on-site physiotherapist to assess condition, worker's capacities, job demands and jobs within workers capacity, and modify job methods or processes
• If appropriate, placement in suitable duties
• Refer worker for appropriate management
• Review progress
• Return worker to normal duties and close case.

Following this, he writes that the aims of post-claim management should include assisting the worker to remain at work by preventing re-aggravation of symptoms and assisting in the graduated increase of the work day and work week to achieve a sustainable placement in new, normal duties.

Symptom aggravation needs to be detected early, and on-site assessment is the most effective way to do this. On-site injury management enables on-site method and process modifications, it can resolve psychosocial problems, increase worker endurance, liaise with treating and certifying general medical practitioners or specialists, create and/or restore motivation to return to normal duties and close workers' compensation claims, while building sound and durable relationships between the worker and employer.

The results can include a reduction in the number of open claims, reduction in lost time incidents, a reduction in the total cost of all claims and reduction in hours lost due to workplace injury.

Kerry L. Butler contributes the second half of the chapter with the article ‘An example of on-site physiotherapy services in industry'. Butler's example is the Swan Brewery in Western Australia.

The Swan Brewery (with over 300 employees) was losing money. Its lost time injury frequency rate, workers' compensation premium and incurred costs were all extremely high. New action was required, and this inspired a leap of faith in the direction of a new health and safety system. A safety and health practitioner was employed fulltime and a physiotherapist was employed for a half day a week. “The aim,” writes Butler, “was to reduce both the exorbitant costs of work-related injuries and the number of injuries occurring. To do this, case management, on-site treatment, and injury prevention and training programs were required.” The company took on a multi-disciplinary approach which utilised the expertise of the safety practitioner, a nurse and the physiotherapist.

“The philosophy is that an employee is always more productive when they are at work than when they are not. Therefore if basic treatment can be given on-site, then the employee is at work and productive,” writes Butler.

“Assessments are undertaken with individuals who have some form of physical restrictions in their work duties. The physiotherapist is also an accredited rehab provider and, as such, has an additional task of undertaking in-house rehab programs as required. This entails communication between the occupational health nurse, the treating medical practitioner and the relevant departmental supervisor or manager at the Brewery.

Awareness and communication were the keys to the Swan Brewery's great success following the development and implementation of the new system.

Butler outlines the aims for on-site physiotherapist in industry, including to decreasing cost to industry by:

• Reducing workers' compensation premiums
• Reducing non-compensable costs such as down time, replacement staff, admin costs etc
• Decreasing number of lost time injuries
• Decreasing absenteeism
• Increasing productivity
• Improving case management
• Maximising social benefits for injured employees as a consequence of being kept at work
• Dealing with injuries at earlier stage in many instances resulting in more effective recovery from most injuries.

“There must be a sharing of information, regular communication and a team approach to solving the problems and achieving the aims. Each person adds to the breadth of the approach, resulting in the achievement of sound occupational safety and health goals,” writes Butler. She argues that the benefit of an on-site physiotherapist to industry is largely underappreciated, and their presence a rarity. This despite the fact that, when employed as part of a multidisciplinary approach, the benefits are clear and overwhelming.