One possible factor may be the impact of European Union legislation in 1992 on the â€œControl of Hazards on Temporary and Mobile Construction Sites.â€ This directive required all member countries to enact regulations to require construction owners, designers and contractors to consider safety issues from design to the execution of construction projects.
This â€œsafety in designâ€ approach is only rarely discussed in U.S. circles, and, to my knowledge, it has never received any serious attention as a possible regulatory approach.
My review so far also suggests strongly that the state of the art in injury research is still quite rudimentary. We know, for example, that fatality and injury rates in construction can vary tremendously for different jobs, and for different employers. But with rare exceptions, little is known in a rigorous way about the risk factors that are at play in the relationships between trades, tasks and injury rates.
What is the role of fatigue? Training? Inexperience? Equipment design? Different components of safety programs or systems?
We hardly know these answers, except in the most general way, so interventions are difficult to implement. No wonder the old idea that construction injuries and deaths are â€œjust accidents,â€ or fate, is still so prevalent today.
Very real risksThe real surprises come when one explores what we know today about construction health hazards. I assume that most readers of this column, like me, have only had very limited experience evaluating construction environments. If so, your unconscious bias is probably to think of construction as an occupation that occurs mostly outdoors, where exposures to toxic substances are only sporadic and unlikely to pose serious risks. Yet that is simply not the case. In many instances, construction workers face very real risks of occupational disease.
Silicosis is increasingly recognized as a serious risk for construction workers. Reports by NIOSH and many others indicate that more silicosis deaths were associated with the construction industry than any other. Numerous recent studies also demonstrate excessive exposures among several trades (masons, bricklayers, others) and numerous tasks, especially those involving machining of concrete materials with power tools (saws, drills, tuckpointers, etc.).
Moreover, despite the well-known risks of sandblasting, the practice is still common in the U.S. and often results in exposures high enough to trump the protection offered by respiratory protective equipment. Blasting with other abrasives on concrete surfaces can produce the same conditions.
Tuberculosis and chronic pulmonary disease are also more frequent among construction workers, suggesting a role for silica dust.
Whatâ€™d you say?Hearing loss is another disease that is now widely recognized as very common among construction workers, both in the U.S. and in other countries. The patterns of exposure to high noise levels, however, are not well understood, and thus difficult to control. Investigators in a recent study found that pneumatically operated tools and heavy equipment had the highest exposure levels. No surprise there. But it was surprising that high noise levels were not predicted by trade, but only by construction method, stage of construction and work tasks and tools. To add a complication, hearing protection programs are especially difficult to implement for the highly mobile construction workforce.
Dealing with unpredictabilityOne common thread runs through construction health hazards: In practically every instance, hazardous exposures are sporadic, and often of high intensity and relatively short duration. From a compliance standpoint, an excessive exposure might not even exist by the time an OSHA or company hygienist receives the results of monitoring samples and returns in a few days to control it.
Unpredictability might form the basis for approaches to reduce construction health risks. â€œBandingâ€ techniques have received much recent attention in the United Kingdom and elsewhere in Europe. With this approach, the anticipated exposure and risk of a particular task are investigated a priori. If found unacceptable, appropriate controls are designed, and they are automatically applied whenever the task is performed in a similar manner, without attempting to repeat the exposure and risk assessment every time.
Itâ€™s the reverse of the â€œinnocent until proven guiltyâ€ compliance model of present-day industrial hygiene in the U.S. OSHA chief John Henshaw recently gave banding an encouraging public endorsement, albeit without any explicit promise of action on it.
Construction might be the best example of an industry where this approach should take precedence. After all, we do not measure the distance to the ground to estimate the risk of injury for every construction worker before requiring that they tie-off with fall arrest devices every time they are working at heights. Why should we allow a mason to use a power saw on concrete without adequate controls, when we know that the exposures will be extremely high, and that his trade requires him to perform that task repeatedly throughout his working life?
But adopting a banding strategy for construction will require a fundamental change in the framework of our regulatory apparatus â€” and a lot of research and consensus-building to decide which tasks require which levels of controls.
Are we up to it?