ABSTRACT Background Private Emergency Medical Services serve a vital role in the community, as such they are subject to job related stress. Currently, there is a limited amount of research related to the stressors related to the job. Objective The purpose of this study was to define the type of daily stressors faced by Private EMS personnel and investigate how they impact their Sense of Coherence. Study Design A mixed methods approach was used in this study to obtain the necessary data. Semi-structured one-on-one interviews were conducted with current employees of an EMS agency that provides 911 service in their area. After the interviews, the participants were administered a survey. Participants/setting Current EMS employees were invited to participate in an interview, in a location and time of their choosing. Both Paramedics and Emergency Medical Technicians (EMT) were invited to participate. Results Critical call incidents, while impacting the mental health of EMS provides, it does not impact them with the same magnitude of operational stress. Operational stress originates from the daily task, interactions and availability of resources. Operational stress was demonstrated to have a large impact on Sense of Coherence. Conclusion Operational stress can have a larger impact on Sense of Coherence of EMS personnel. Research is needed to determine which EMS model helps mitigate the impacts of operational stress on the EMS personnel.

Over the past 20 years, adult obesity has increased in the United States, especially among the Hispanic/Latino population. In 2010, the Occupational Safety and Health Administration Environmental and Safety News, reported that younger workers, ages 18 to19 years of age, worked in the most high-risk occupations such as agriculture, construction, fishing, and manufacturing. The reported fatality rates for these occupations were 5.6 times greater for Hispanic workers compared to other race/ethnicity groups reported by the Bureau of Labor Statistics in 2013. This study determined whether obesity contributed to workplace injury or mortality in hazardous occupations, using federal, state, and independent national databases. The independent variable was obesity, the dependent variable was injury in hazardous occupations. In addition, age, gender, race/ethnicity, socioeconomic level, educational level, and cultural context were used as mediating variables. The target population included all workers ages 18 to 65 years of age in hazardous occupations. Analysis of databases from NHANES, BRFSS, NIOSH, OSHA, and the BLS was conducted using descriptive statistics for frequency of the mediating variables' relationship to workplace injury. This study highlighted the prevalence of obesity in the Hispanic/Latino population and increased incidence of workplace injury in hazardous occupations, but found no significant relationship between the variables using the BFRSS Web Enabled Analysis Tool for linear regression and cross-tabulation. Establishing a relationship between obesity and increased injury for the Hispanic/Latino population in high-risk occupations for preventative measures will enhance positive social change within this underrepresented population in research.

Lack of effective occupational safety and health (OSH) strategies is a reason that workplace accidents in the mining and quarrying industry remain high, making the industry one of the riskiest operations worldwide. The purpose of this multiple case study was to explore successful strategies mining and quarrying leaders in Zimbabwe used to improve OSH. The key research question addressed successful strategies leaders in the mining and quarrying industry use to improve employee occupational safety and health in Zimbabwe. Six successful business leaders from 3 mining and quarrying mines in Zimbabwe demonstrated an exception to unsafe practices, particularly through their exceptional OSH improvement records. The conceptual framework of the study was Deming's plan-do-study-act cycle theory. Data were gathered through review of company documents, and in-depth interviews with 6 mining and quarrying leaders in Zimbabwe who had successfully improved OSH strategies in the workplace. Transcribed interview data were classified, coded, and analyzed. Themes that emerged included organizational culture, compliance with rules and regulations, and accident prevention. The results of the study indicate that successful OSH leaders designed the workplace, trained and developed employees, and empowered and equipped employees with the relevant skills and knowledge. The findings support positive social change by providing mining and quarrying leaders with knowledge and skills to improve OSH strategies in the workplace, thereby promoting a safe workplace and zero accident tolerance in the workforce and the community.

The study's purpose is evaluating the relationship between locus of control and selfesteem in relation to the registered nurse's experience and perception with lateral and vertical incivility. There is a lack of research concerning nurse-to-nurse incivility within the nursing profession. The hypothesis examined whether dynamics of locus of control and self-esteem could provide insight into the personality dynamics influencing incivility in the workplace. This non-experimental quantitative study used 2 self-evaluation tools and 1 demographic survey tool to collect data via Survey Monkey, a commercial data collection company. Participants were 65 randomly selected faculty (n = 36) and graduate students (n = 29) from schools of nursing in Southern California, all active practitioners. Descriptive statistics provided the demographic data and RNs' experience of incivility analysis. Inferential statistics, t-test, and Pearson's correlation analyzed the relationships between study variables. Study results indicated no significant negative relationship between RNs' perceived experience with lateral and vertical incivility, and RNs' level of self-esteem and locus of control. Participants indicated a greater than 80% experience with incivility in the work place either directed at the participant or towards a colleague. The study results will be of interest to health provider managers as a means of insight into the pervasiveness of incivility in the workforce. The study indicated the problem of professional incivility is widely encountered, it rules out the hypotheses that self-esteem and locus of control are related to the problem, and it encourages the need for further study as to the etiology and dynamics of the problem.

Inadequate leadership is the reason workplace accidents in the mining industry remain high, making the industry one of the most hazardous operational activities in the world. Unsafe leadership practices may result in death or injury to workers. A group of 30 mining company leaders from 3 gold mines in Zimbabwe revealed an exception to these hazardous practices, however, notable through their outstanding safety improvement records. To better understand what these practitioners were doing, this multicase study research design explored their strategies to improve the workplace safety environment in the mines. Data were collected using audio-recorded semistructured interviews and document analyses. Shewhart's plan-do-check-act conceptual framework anchored the study. Data analysis followed the thematic data analytic approach involving classification, coding, and interpretation to identify common themes. The following themes emerged: planning and organizing, leading, and risk management. The findings indicate that the business leaders created a safe work environment by planning the work to be performed; how the task would be executed; and when, where, and who performed the task. The results of study also indicate that leaders designed the work environment, trained, empowered, and equipped employees with the relevant skills, and provided appropriate technology and personal protective equipment to improve workplace safety. Finally, the research findings indicate that leaders embedded risk management principles and practices in every process or activity, and continuously learned from each event to create a safe work environment. The findings promote social change by encouraging safe behavior and risk-based thinking and practices in the workforce and the community.

Spray Polyurethane Foam insulation (SPF) kits are currently being marketed and sold to do-it-yourselfers to meet various insulating needs. Like commercial SPF systems, the primary health concern with SPF kits is user overexposure to the isocyanates during product application. The potential health risk associated with SPF applications is driven by several factors including (but not limited to): the toxicity of isocyanates; the potentially high exposure intensity; the quantity of isocyanates used in the process; the enclosed nature of the environment in which the product could be applied; the potentially high exposure duration/frequency; and the limited availability of control measures to reduce agent intensity (e.g., personal protective equipment, dilution ventilation). To better understand the potential hazards associated with the use of SPF kits, the current study was designed to provide an initial characterization of user exposure to airborne particulate during the application process. Specifically, the study would aim to answer the following: * What is the particle size distribution of the aerosol a SPF kit user is exposed to during application? * What is the airborne particle mass concentration a SPF kit user is exposed to during application? To answer these questions, a single commercially available SPF kit was selected for use and a mock residential environment was constructed to support repeated applications of SPF. Size-selective and total dust air sampling were conducted during the applications to determine the particle size distribution and mass concentration of aerosols generated by the selected kit. The particle size distributions developed from the size selective sampling results showed the presence of airborne particulate capable of penetration to the gas exchange regions of the respiratory tract. The average mass median diameter and geometric standard deviation of the particle size distributions were 4.6 µm and 2.7 respectively. The total dust sampling results showed mean airborne concentrations of 10.40 mg/m3. Based on the sampling results the study, personal air monitoring is needed to assess the degree of user exposure to methylene diphenyl diisocyanate (MDI) and to provide information for the selection of exposure control methods.

Failure to maintain thermal equilibrium can cause uncontrollable increases in body core temperature beyond critical upper limits. In selecting clothing, consideration must be given to the heat transfer properties of clothing that may restrict the cooling capacity of the human body under heat stress conditions, most importantly, apparent total evaporative resistance (Re,T,a). This study calculated and compared Re,T,a for five clothing ensembles under varying heat stress conditions, including three relative humidity (RH) levels and three stages of heat stress to determine if Re,T,a values varied or remained the same with changes in heat stress conditions. A four-way mixed model analysis of variance demonstrated significant differences for estimated Re,T,a values among ensembles, RH levels, heat stress stages, and interactions among ensembles and RH levels and ensembles and heat stress stages (p < 0.0001). No significant interaction among RH levels and heat stress stages was found (p = 0.67). A Tukey's Honestly Significant Difference multiple comparison test was used to identify where significant differences occurred (p < 0.05). The results of the study indicated that Re,T,a values do change with RH levels and stages of heat stress and that the theoretical framework for explaining heat-exchange in hot environments is not yet well-established. Also confirmed was the dominance of the convection pathway over the diffusion pathway in hot environments.

Clothing directly affects the level of heat stress exposure. Useful measures to express the thermal characteristics are WBGT (wet bulb globe temperature) clothing adjustment factor (CAF) or apparent total evaporative resistance (Re,T,a). The CAF is assigned through laboratory wear trials following a heat stress protocol in which the air temperature and humidity are progressively increased until the participant clearly loses the ability to maintain thermal equilibrium. The critical condition is the point of thermal transition and from these conditions both the CAF and Re,T,a are computed. The first objective of this study is to compare the thermal characteristics of a coverall made from a prototype fabric to work clothes and a commercial limited-use coverall using CAF and Re,T,a. A second objective is to demonstrate that the Re,T,a of work clothes is the same for progressive or steady-state heat stress protocols. Five participants (4 men and 1 woman) walked on a treadmill at 1.25 m/s at an average metabolic rate of 175 W/m2. Each participant completed at least one progressive heat stress protocols in work clothes, Tyvek® 1422A coveralls [Tyvek® is a registered trademark of DuPont], and a developmental nonwoven polyolefin prototype ensemble provided by DuPont. In addition, four participants completed steady-state protocol in work clothes. Participants did not complete an acclimation period prior to the trials and each trail was separated by at least 40 hours. There are no within participant differences in metabolic rate among ensembles and protocols. There are no differences between the critical WBGT in the current participants and previously acclimatized participants from other studies suggesting that the participants responded as if they were acclimatized. Based on a mixed effects model, there are significant differences between work clothes and Tyvek® 1422A for Re,T,a (0.0103 and 0.0141 m2/W kPa, respectively) and critical WBGT. The CAF for Tyvek is 2.3 °C-WBGT. For the DuPont prototype ensemble, the apparent total evaporative resistance is 0.013 m2kPa/W and the CAF is 0.5 °C. The prototype ensemble shows no difference from work clothes or Tyvek® 1422A in critical WBGT and no difference from work clothes in Re,T,a. Overall, the prototype coveralls exhibited thermal characteristics that would have a lower level of heat stress than the Tyvek 1422A and not significantly different from work clothes. The values for Re,T,a for work clothes were not different between the steady state and progressive protocols. The steady-state protocol near the critical condition can be used for determination of Re,T,a. This opens up the possibility of estimating Re,T,a from studies that do not use the progressive protocol.

More than 100 million American workers, 7 million workplaces, and 945,000 hazardous chemical products are covered under the Hazard Communication Standard (HCS), regulated by the Occupational Safety and Health Administration. There were a total of 1,183,500 recordable non-fatal illnesses and injuries in private industry workplaces in 2006 resulting in days away from work. Of these, 19,480 were due to chemicals and chemical products. In addition, there were a total of 5,703 work-related fatalities in 2006. In 191 of these, chemicals and chemical products were listed as the primary source of injury and as the secondary source of injury in 104 cases. The economic impact of both fatal and non-fatal occupational injuries amounted to $164.7 billion in 2006. OSHA established the HCS in order to ensure that workers are informed of the hazardous chemicals with which they work, yet OSHA admits that many adults may have difficulty reading material that communicates hazards. Violations of OSHA's HCS were the third most cited violation in 2007. Since only 12 percent of the adults surveyed in the United States demonstrated Proficient health literacy, the state of affairs poses a serious problem for hazard communication, which nurses and nurse practitioners are often responsible for conveying. Health tasks that require Proficient health literacy include "drawing abstract inferences, comparing or contrasting multiple pieces of information within complex texts or documents, or applying abstract or complicated information from texts or documents". Donabedian's Structure-Process-Outcome framework served as the conceptual basis for this study. Twelve research studies (nine journal articles and three doctoral dissertations) published between 1993 and 2003 were reviewed. None of these studies measured the participants' literacy level. The purpose of this single administration, cross-sectional study was to examine literacy levels as a hypothesized predictor of test scores of employees presenting to the Lakeside Occupational Medical Center, Downtown Clinic, for a physical examination, immunization, drug screening, or follow-up appointment. MSDS test scores served as the dependent variable and were measured by an investigator-made test consisting of seven passages, taken from seven separate MSDSs for sodium hypochlorite, each from a different manufacturer. Sodium hypochlorite is commonly utilized in numerous industries including the janitorial, pulp, paper, textile, dairy, and water-cooling industries and is known to cause work-related health effects such as asthma and irritation of the eyes and throat. Each passage was followed by five multiple choice questions. Literacy levels were measured utilizing the Short Test of Functional Health Literacy in Adults (STOFHLA). The readability level of the written material was measured utilizing the Simplified Measure of Gobbledygook (SMOG) and the Flesch-Kincaid Grade Level (FKGL). The characteristics of age, highest grade level completed, native language, and job category were measured by a demographic sheet. The results indicate that there was a significant positive correlation between the total STOFHLA scores and the total scores on the MSDS test. Therefore, hypothesis number 1 was supported. Findings on the readability level of the examples of the MSDSs to the participant's overall MSDS score were inconclusive. However, the format of the MSDS, specifically the number of lines/sentence and the number of words that are 3 syllables or more, may influence comprehension. Therefore, written hazard communication material should be written in short sentences and use words less than 3 syllables. This way the likelihood of the material being understood by the worker will be increased. Further research aimed at understanding exactly how reading grade level and sentence structure impacts comprehension of hazardous materials information is needed.

Protective clothing ensembles are worn by workers as a barrier to chemical and physical hazards, but can restrict heat loss and increase worker heat stress. The question of whether a respirator adds to heat stress or strain burden is a continuing concern among occupational health professionals. The purpose of this study was to determine if there are differences in heat stress or strain among the current Toxicological Agent Protective (TAP) ensemble and two ensemble variations used in demilitarization of chemical weapons. Four acclimatized adult males wore five ensembles in a balanced design while walking in a climatic chamber at a metabolic rate of about 170 W m-2. Heat stress (critical wet bulb globe temperature-WBGTcrit, evaporative resistance-Re,T,a, Clothing Adjustment Factor [CAF]) and heat strain (physiological strain index [PSI]) were compared against work clothes (WC) without respirator (a baseline ensemble); the current TAP apron over cloth coveralls with respirator (TAP+CA); the current TAP apron over cloth coveralls with respirator plus Tychem F® chemical barrier pants (TAP+CA+P); and Tychem F® Coveralls over cloth coveralls with respirator (VB+CA). A no-respirator comparison with the Tychem F coveralls (VB+CA-noR) was added to evaluate the contribution of a full-face negative pressure air-purifying respirator to heat stress. A progressive heat stress protocol was used to determine WBGTcrit, Re,T,a, CAF, and PSI. The results (WBGTcrit [°C-WBGT], Re,T,a [kPa m2 W-1], and PSI) were WC (35.5, 0.0112, 2.0), TAP (31.6, 0.0175, 1.8), TAP+P (27.7, 0.0240, 1.9), VB+CA (25.9, 0.0287, 1.8), and VB+CA-noR (26.2, 0.0293, 1.8). Mixed effects ANOVA was used to assess ensemble effects. Tukey's test was used to determine where significant differences occurred. WBGTcrit was the WBGT at the upper limit of thermal balance. Re,T,a increased while WBGTcrit progressively decreased going from WC to TAP+CA to TAP+CA+P to VB+CA. WBGTcrit was different between Work Clothes and TAP+CA and between WC and TAP+CA and the other ensembles. Re,T,a was different among all ensembles, except no differences in WBGTcrit and Re,T,a were observed between the presence and absence of a respirator with VB+CA. There were no differences among all ensembles for rectal temperature, heart rate, and PSI. Based on both WBGTcrit and Re,T,a, there were significant increases in heat stress going from WC to TAP+CA to TAP+CA+P to VB+CA. No differences in WBGTcrit, Re,T,a, and PSI were found for the presence or absence of a respirator, indicating no additional heat stress or strain burden. CAF is the WC WBGTcrit minus the ensemble WBGTcrit.. The recommended clothing adjustment factors (CAFs) are 0°C-WBGT for WC, 4 °C-WBGT for TAP+CA, 8 °C-WBGT for TAP+CA+P and 10 °C-WBGT for VB+CA. As vapor-barrier ensembles are sensitive to humidity, adding 2 °C-WBGT to VA+CA for a CAF of 12 °C-WBGT is recommended. This implicates the type of protective clothing ensemble worn will play a much bigger role in workplace heat stress effects and risk than the wear of a respirator.