Public Health Project 2010-2011

Power Tools that dont lend a Helping Hand

Amit Anand, Nicholas Campion, James Cheshire, Thomas Haigh, James Leckenby Third Year Medical Students University of Birmingham

Word Count: 5317

Power Tools that dont lend a Helping Hand 2011 Abstract

Objectives: To identify demographic and behavioural trends associated with hand injuries sustained by power tool use, and to conduct a relevant treatment outcome analysis. We hope that our findings will motivate further investigation into preventative measures that are specific to the identified at risk groups. Design: A cross-sectional data analysis of the Home and Leisure Accident (HASS/LASS) database between 2000 and 2002, specifically looking at domestically sustained power tool injuries to the hand. Setting: The Department of Trade and Industry (DTI) selected 16 hospital A&E departments widely representative of the UK demographic population. Population: The data provided by DTI sampled 4131 cases of power tool injuries sustained in the domestic setting serious enough to warrant A&E admission. This dataset was refined to only include cases specifically looking at power tool injury to the hand, producing the final study sample of 1806 cases. Measurements: Specially-trained HASS/LASS interviewers identified newly-admitted A&E patients suffering from domestically sustained accidents and interviewed them using a standardised questionnaire documenting the following details: patient age and sex, year of Injury, history of the accident and location, body part injured and injury sustained, behaviour preceding the incident, injury sustained and outcome following assessment at A&E. Results:
Demographic analysis: Men sustained 89.5% of all hand related DIY power tool injuries. Most

injuries (75.4%) occurred in the 30-69 year age group. The elderly age bracket (70+ years) showed the lowest frequency of hand injuries admitted to A&E (11.2%), but the highest proportion of injuries requiring follow up in secondary care (44.8%, p=0.002). Altogether, 37% (p=0.002) of hand injuries sustained across all age groups resulted in hospital care, with a further 22.8% (p=0.002) requiring care in the community. The power tools most commonly causing injury were found to be circular saws (28.6%) and hedge trimmers (27.4%), cumulatively accounting for the majority (56%) of hand injuries studied. Hedge trimmers, were accountable for the majority of injuries amongst females (56.6%) whilst circular saw accounted for the majority (30.9%) amongst males.

Power Tools that dont lend a Helping Hand 2011

Injury Analysis: Circular saws and hedge trimmers accounted for 66.7% (p=0.002) of specialist care review, and 87.7% (p=0.002) of immediate specialist attention. Behavioural Analysis: Atypical positioning was the commonest behavioural cause (20.4%) of injury followed by complacency (16.4%) and distraction/inattention (10.1%). Males were found to be more complacent (16.1% in men vs. 13.3% in women), while women suffered more injuries due to distraction and inattention (20% in women vs. 7.9% in men). Females showed better adherence to safety measures as 0% of injuries sustained in women were due to lack of safety measures. Complacency accounted for 17% of injuries sustained in the younger age group (p=0.015). Despite this they were better at adhering to safety measures than their elder counterparts (0.4% in young vs 2.5% in middle aged). Conclusion: In an economic climate lending itself to increased DIY activity, this research should be a focus in emergency medicine. This is the only study that identifies demographic and behavioural trends leading to hand injuries from such a broad spectrum of power tools. Injuries in the elderly population most commonly require secondary care; a significant finding considering the healthcare burden from an ageing population. A majority (51.4%) of hand injuries are avoidable in that they have a behavioural root cause. Thus, implementing appropriate preventative measures will not only significantly reduce the number of injuries presenting to A/E, but also the overall demand placed upon the NHS.

Power Tools that dont lend a Helping Hand 2011 Introduction

The great columns of Rome, the finishing touch to the Mona Lisa, the cups of tea a mother makes for her family first thing in the morning. We might queue to take photographs, gaze in amazement or simply smile a gentle curve of appreciation. Yet never is this directed to the miracle of normally functioning hands, never do we recall the essential ingredient in the recipe of such marvels. Human hands are at the core of all our accomplishments, whether they shape history or just the mood of a single individuals day. They are indispensable to our creativity and achievements. The monuments we build, the discoveries we make, the relationships we establish, all act as demonstrations of their understated ability.

Twenty percent of patients attending A&E have hand injuries, equating to more than 1.36 million attendances in the UK per year [1]. The hands prove to be greatly vulnerable to injury during Do-it-Yourself (DIY) activities due to their necessity in most tasks and their close proximity to the hazardous components of the power tools. UK studies show that hand trauma is a consequence in approximately a quarter of all DIY activities [2] equating to upwards of 200,000 hospital visits each year; of which, 87,000 are specifically due to power tools [3]. These figures are likely to remain high according to The Royal Society for the Prevention of Accidents (RoSPA), who state that the current economic climate has led to an increase in people choosing to undertake DIY activities rather than hiring a professional labourer. An audit of hand injuries [4] identified serious shortcomings in service provision; stating that treatment was often delayed by over 24 hours due to lack of available theatres (62%) and shortage of staff (13%). The predicted increase in hand injuries and current lack of services available highlights the importance of devising preventative measures. This is particularly relevant as a UK economic analysis showed that costs of this kind of injury tripled between 1990 and 2000, amounting to a over 100 million in healthcare costs in 2000 [5]. Hand trauma can have a major impact on an individuals life. Frank et al. states that the socioeconomic impact of these injuries is immense, explaining that patients can suffer from significant losses in wages and potential earnings [6]. Additionally, patients are vulnerable to psychosocial implications as the human hand is so instrumental in independence and care giving [7, 8]. It is evident that the prevention of hand injuries sustained domestically can not only have significant benefits to an individuals life but also to the healthcare system as a whole. For this reason, such injury prevention should be a focus in emergency medicine. Previous preventative

Power Tools that dont lend a Helping Hand 2011

strategies have already shown to be effective; however, there is a distinct lack of understanding surrounding the behaviours leading to injury. The behavioural and demographic analysis our study conducts establishes which specific behaviours lead to injury and the at risk population groups. This understanding provides another facet from which specific preventative measure can be developed.

Overview of Existing Research

Our literature review served to gain insight into current and already-documented trends in patterns and behaviour associated with non-work related power tool hand injuries. To achieve our objective, a PubMed search with MeSH headings hand injury AND accidents, home identified several American papers that demonstrated consistent views in sex and age distributions in those acquiring domestically sustained hand injuries. Frank et al, conducted two retrospective studies using the same patient group affected by circular-saw related injuries [6, 9]. This patient group showed an overwhelming male dominance (93%) in which the majority of cases were in older age groups. Conn et al. also showed a male dominance (75%) in their cross-sectional study population of finger amputation patients that presented to A&E [10]. The highest rates of injuries in their study group had occurred between the fourth to the six decade of life (11.2-14.9 amputations per 100 000 population). Our review showed no established pattern with regards to which hand is more commonly injured. While Frank et al. and Bonte and Goldberg show almost uniform distribution of injuries between the dominant and non-dominant hands [9, 11], Hoxie et al. and Hussey report higher incidence of injuries in the non-dominant hand. [12] The pattern of digit involvement is documented in the work of Frank et al., which is depicted in the diagram below.

Power Tools that dont lend a Helping Hand 2011

Figure 1: a) Distribution of injuries to one finger only; b) distribution of simultaneous injuries to two fingers; c) distribution of simultaneous injuries to three fingers

The studies discussed are limited in that they only assess the pattern of injury specific to a single power tool. To develop an understanding of trends in hand injury from a broader sample of power tools, the terms DIY, power tools and hand injury were inserted into an advanced scholarly search engine. A British, cross sectional study by Williams and Power [13] was recovered and cited circular saws (21%), hedge trimmers (21%) and electric drills (17%) as the power tools most commonly associated with such injury. Although their study suggests that power tools only account for 25% of domestically sustained hand injuries, 94.6% of these cases went on to require specialist care, indicating the high level of healthcare provision attributed to these injuries. There are evident limitations in the studies reviewed. Conn et als surveillance database, for instance, demonstrated so much insufficiency in patient records that in a quarter of cases (25.2%) the digits involved were not specified [10]. As their surveillance system only gathered data for finger amputations treated in A&E, those treated in outpatient clinics were not included. Likewise, it is difficult to have complete confidence in the results from Frank et als study as circular saws, in America, have been attributed to self-inflicted harm in cases of insurance fraud [14]. Since they included subjects with insufficient medical documentation and there was negligent accident analysis, this limitation cannot be completely ruled out [9]. In all of these studies, there is a lack of clear insight into the behavioural components that lead to injury. Conn et al. notes: Studies are needed to assess how human factors increase the
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Power Tools that dont lend a Helping Hand 2011

likelihood of injury to fingers when power tools are used. *10+ Speed attempts to address this gap in knowledge by proposing several psychosocial factors that play a role in the way people approach DIY tasks, including complacency and price. Speed reports that those who lack DIY experience are more cautious in carrying out tasks, while those with more DIY-experience tend to underestimate the difficulty of the procedure, and show more complacency towards the recommended safety measures. Frank et al. supports this notion, highlighting that 75% of his injured study population had more than 10 years of experience of power tool use; 64% admitting to using their circular saws on a regular basis [6]. Only one of the patients injured in their study group was a first-time user. In 13 cases (11%), the subject was so complacent, that they removed the safety devices (e.g. blade guards) prior to conducting the task [6]. Speed subsequently states that one of the triggers to engage in DIY tasks is to save on costs involved in hiring professional labour. Frank et al. notes that this is particularly true in todays economic climate, where circular saws, particularly the smaller and cheaper consumer models, enjoy an upsurge of sales. In fact, 22 (19%) of the cases in their study reported that the saws were self-constructed. *9+ Speed explains that while cheaper equipment is favoured, it is less likely to meet the required safety standards, and thus more likely to lead to avoidable hand injury [15]. Additionally, our literature review also identified inattention and distraction, intoxication, and lack of peer supervision as other significant behavioural factors causing hand injuries. Frank et al. described four patients (4%) that admitted that distraction may have led to their injury, eight cases (7%) had consumed alcohol, and there was a lack of supervision in 75% of cases [9]. While the literature shows a degree of behavioural analysis related to DIY hand injury, it is often limited in content, and typically specific to a single power tool. We hope to address this gap in knowledge and develop a thorough understanding of the behaviours that lead to hand injury on a backdrop of a broad spectrum of power tools. This research will serve to motivate further investigation into preventative measures to reduce the occurrence of this kind of injury. A review of relevant literature assessing the effectiveness of preventative measures shows optimistic findings. A PubMed search of the following MeSH headings: Accident Prevention AND Hand Injuries, returned with a cohort study by Lipscomb et al. which highlighted the importance of education, showing a 31% reduction in the incidence of hand injuries after the subjects attended an apprenticeship education programme [16]. Frank and Ekkernkamp highlight the effectiveness of improved engineering, reporting no reoccurrence of injury following the modification of a faulty safety feature in a vole captive bolt device [17]. Finally, a case-crossover

Power Tools that dont lend a Helping Hand 2011

study by Sorock et al demonstrates the effectiveness of appropriate enforcement of safety equipment, reporting a 60-70% reduction in risk of laceration and puncture injury after using gloves in an industrial setting [18]. By developing an understanding of the demographics and behaviours related to such injury, we hope that our work will aid in developing specific preventative measures. The evident benefits in previous prevention strategies, discussed above, justify the importance of our research.

Aims and Objectives

We hope to determine:

Demographic trends of hand injuries related to power tool use in the domestic setting. Trends in treatment outcome related to specific power tool use. Behavioural patterns that lead to power tool-related DIY injury

We hope that our research will motivate further investigation into preventative measures specific to the identified at risk groups, and their behavioural patterns.

Null Hypotheses
There is no difference in age or gender distribution of hand injuries. No one tool is responsible for the majority of incidents. There is no relationship between injury from a specific tool and age or gender. There is no relationship between injury from a specific power tool and the resultant treatment outcome. There is not one specific behavioural pattern responsible for DIY related hand injuries.

Power Tools that dont lend a Helping Hand 2011 Methods

The raw data analysed in this study was originally collected for the Department of Trade and Industrys (DTI) 24th Report of the Home and Leisure Accident Surveillance System (HASS/LASS), a nationwide database recording domestically sustained injuries serious enough to warrant hospital visitation between 2000 and 2002. This information, provided by RoSPA, is the most up-to-date data of its kind, as the DTI ceased data collection by HASS/LASS in 2003. The HASS/LASS Database The dataset sampled 16 hospitals across the UK (appendix, table 1), selected on the basis that they tended to more than 10,000 A&E cases/year, operated a 24-hour service, and took ambulance cases. To ensure that the hospitals were widely representative, they were based in different geographical regions (urban and rural), served different population volumes, and consisted of different-sized A&E units. Specially-trained HASS/LASS interviewers were allocated to the A&E units of the participating hospitals. They identified newly-admitted patients suffering from domestically sustained accidents and interviewed them using a standardised questionnaire (appendix, questionnaire 1). The data was immediately entered onto a dedicated HASS/LASS computer in the hospital, and transferred onto a central DTI database. Each patient account on the database remained confidential, and was organised in tabular form to include the following details: Patient age and sex Year of Injury History of the accident and location Body part injured and injury sustained Behaviour preceding the incident Mechanism of injury Outcome following assessment at A&E

Manipulation of Dataset The data was first refined to only include the cases specific to our project. To do this, Power Tools in Domestic Setting was entered into the database search engine, allowing the exclusion of any injuries not sustained by power tool use and occurring in non-domestic settings (appendix, table 2). This

Power Tools that dont lend a Helping Hand 2011

search produced a sample of 4131 cases, which was further narrowed to a final set of 1806 cases when refined to only include injuries specific to the hand (appendix, table 3). To investigate the specific behaviours and power tools most commonly involved in injury, we closely analysed the histories that were provided in the database. From this information, we were able to add two further columns to our data set: a) the power tool involved; and b) patient behaviour that preceded the incident. These columns were then codified (appendix, table 4) and entered into Statistical Package for the Social Sciences (SPSS) for statistical processing. Similarly the treatment outcomes for each injury were codified after being categorised into broader outcome groups for the ease of statistical analysis. Five broad categories were established from the numerous original categories (appendix, table 5): 1) community care, 2) no treatment after A&E visit, 3) hospital care, 4) immediate specialist attention required, and 5) unspecified. This kind of broad categorisation was also done to make age groups: young (0-29), middle-aged (30-69), and elderly (70+). In some of the data analyses, we combined cases that fell into the categories hospital care and immediate specialist attention required into a single specialist care group, to draw comparisons between those cases that required secondary follow-up care, and those that did not. Once the data was fully coded and entered into SPSS, descriptive statistics functions were used to produce frequency tables and cross table comparisons. The chi squared test function was used to obtain p values for our comparative data.

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Power Tools that dont lend a Helping Hand 2011 Results

Demographic Results A demographic analysis revealed that men sustain 89.5% [appendix, table 6] of all hand related DIY power tool injuries, and that most injuries (75.4%) occurred in the 30-69 year age group [appendix, table 7]. A detailed analysis showed that, specifically, the 50-59 year age bracket [appendix, table 8] were the most susceptible to hand injuries, accounting for 20% of all injuries sustained. The elderly age bracket (70+ years) showed the lowest frequency of hand injuries admitted to A&E (11.2%) [appendix, table 9], but the highest proportion of injuries requiring hospital care (38.4%, compared to 37.3% amongst middle-aged injuries, and 34.0% amongst injuries in the young, p=0.002) , and immediate specialist care (6.4%, compared to 2.6% and 0.4%, p=0.002) [see figure 2 below; appendix, table 9]. Altogether, 37% (p=0.002) of hand injuries sustained across all age groups resulted in hospital care, with a further 22.8% (p=0.002) requiring care in the community [appendix, table 9].

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0-29 30-69
Value Pearson Chi-Square Likelihood Ratio N of Valid Cases 24.050
a

UNSPECIFIED NO TREATMENT REQUIRED AFTER A+E VISIT IMMEDIATE SPECIALIST ATTENTION REQUIRED HOSPITAL CARE COMMUNITY CARE

70+
df 8 8 Asymp. Sig. (2-sided) p = 0.002 .003

23.677 1806

Figure 2: Histogram showing Healthcare Outcome in relation to Patient Age

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Power Tools that dont lend a Helping Hand 2011

The power tools most commonly causing injury were found to be circular saws (28.6%) and hedge trimmers (27.4%), cumulatively accounting for the majority (56%) of hand injuries studied [appendix, table 10]. These tools accounted for the highest incidence of injury amongst the middleaged population (29.4% and 27.2% of injuries, respectively) and the elderly population (42.9%, and 29.1%) [appendix, table 10]. In the youngest age group, however, hedge trimmers accounted for the largest proportion of injuries (26.6%) followed by drill-related injury (25.3%), which otherwise accounted for 19% of all injuries [appendix, table 10]. Hedge trimmers, which evidently account for a substantial proportion of hand injuries across all age groups, were shown to be responsible for the majority of injuries amongst females (56.6%) [appendix, table 6]. Amongst males, however, circular saws were the commonest power tools associated with injury (30.9%) [appendix, table 11].

Injury Results An outcome analysis showed that circular saws and hedge trimmers accounted for 66.7% (p=0.002) of specialist care review, and 87.7% (p=0.002) of immediate specialist attention [see figure 3 below; appendix, table 12]. In 2002 there was an increase in the proportion of injuries sustained that required specialist review, and a reduced proportion of injuries managed at the community level, compared to 2000 (p = 0.105) [Appendix, table 13].

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Power Tools that dont lend a Helping Hand 2011

Chi-Square Tests Value Pearson Chi-Square 22.671

a

df 7

P value .002

Figure 3: A histogram depicting number of cases and treatment outcome by power tool.

Behavioural Results The aim of our behavioural analysis was to broadly determine whether the majority of the injuries sustained resulted from a fault in the patients conduct; or due to a fault in the tools mechanism whilst in use. The former cause of injury was classified as behavioural, and the latter was termed mechanical. Finally, a third category termed unspecified contained accounts that were difficult or too vague to classify with confidence. The group that was responsible for the highest proportion of injuries was the behavioural group, accounting for the majority (51.4%) of injuries sustained [see figure 4 below; appendix, table

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Power Tools that dont lend a Helping Hand 2011

14]. It is important to note, however, that with the limitations in our dataset, it was impossible to attribute a specific cause to all injuries studied; hence our unspecified category accounted for 34.2% of our data [appendix, table 14].

Figure 4: Bar Chart showing Relative Causes of Hand Injury

Amongst those cases with an attributable cause to injury, a detailed analysis showed that atypical positioning was the commonest behavioural cause (20.4%) [appendix, table 15], and the leading cause of injury amongst middle-aged individuals (20.2%, p=0.015) [appendix, table 16]. The tools that most commonly associated atypical positioning injury included hedge trimmers (32%), drills (25%), and circular saws (20.6%) [appendix, table 15]. Cases acquiring injuries from these tools collectively accounted for 79.8% of injury requiring secondary care follow-up (p=0.002) [appendix, table 17]. Thus, atypical positioning accounted for the greatest proportion of healthcare provision, responsible for 30.2% of cases with an attributable cause requiring follow-up specialist attention (appendix, table 12). Complacency (16.4%) and distraction/inattention (10.1%) were the most common behavioural causes leading to injury after atypical positioning [appendix, table 15]. Both were shown to be most commonly associated with injury from hedge trimmers, accounting for 30.9% and 23.3% (respectively) of cases with attributable cause [appendix, table 15]. These behaviours showed marked gender differences: amongst those injuries serious enough to warrant specialist attention, males were more complacent relative to their female counterparts (cause of 16.1% of injuries in men compared to 13.3% in women, p=0.081) [appendix, table 20], while women suffered more from

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Power Tools that dont lend a Helping Hand 2011

injury by distraction and inattention (20% compared to 7.9%, p=0.081). Interestingly females showed better adherence to safety measures as 0% of injuries sustained in women were due to lack of safety measures [appendix, table 20, p=0.081]. Complacency was significantly marked amongst the youngest population studied, accounting for 17% of injuries sustained in this age group (p=0.015) [appendix, table 21]. Whilst the young were more complacent, they were better at adhering to safety measures than their elder counterparts. Only 0.4% of injuries occurred due to lack of safety measures in the young, while a lack of safety measures accounted for 2.5% of cases in the middle aged group and 3% of cases in the elderly (p=0.015) [appendix, table 21]. Malfunction made up 3.3% of all injuries sustained to the hand, the highest occurrence being in drills (12.2%) accounting for more than twice as many injuries proportionately compared to other power tool malfunction [appendix, table 21]. This would suggest that stricter regimes in quality assurance at the manufacturing level of these drills may need to be implemented.

Discussion
From a database of 4131 cases we determined that 1806 were relevant to this study. On the basis of these cases we conducted our demographic analysis, severity analysis and behaviour analysis. Demographic Analysis An overwhelming majority of injuries resulting from power tool use were found to occur in men (89.5%) between the ages of 30-69 (75.4%), suggesting that high-risk domestic DIY tasks are performed chiefly by this population. The injuries sustained in this study group were most

commonly caused by circular saws and hedge trimmers (54.8%). A relevant outcome analysis identified that this age group accounted for the highest volume of cases (860) requiring secondary care after A/E admission. While this may be true, a greater proportion of the elderly population (of 70+) required secondary care (44.8%, p = 0.002); again, mostly due to circular saws (42.9%) and hedge trimmers (29.1%). These results have a significant implication to healthcare provision when considering an ageing population. According to current literature, an increasing trend of DIY tool use is predicted by most authors in accordance with the current economic climate. The UK National Estimates of power tool related injuries between 2000 and 2002 (provided by RoSPA, n = 4131) back up these predictions by showing increasing national estimates of such injuries: 24,605 in 2000 rising to 28,270 in 2002. When we investigated the frequency of power tool injury specific to the hands in our study population (n =

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Power Tools that dont lend a Helping Hand 2011

1806) over this time period, a statistically insignificant (p = 0.267) decreasing trend was described, contradicting current literature.

Severity Analysis Our demographic tables show that circular saws and hedge trimmers accounted for the majority of hand injuries acquired (cumulatively, 56%); on further analysis, these power tool injuries also accounted for the highest proportion of secondary care attention required (66.7%, p=0.002). These results illustrate the burden these tools have upon the healthcare system, not just in the shear load of cases requiring attention, but also the high level of healthcare provision which they demand. This is further exemplified in that these tools accounted for 87.7% (p=0.002) of the most severe hand injuries sustained (those requiring immediate specialist attention). A trend analysis in the outcomes of these injuries over the years shows that this burden is likely to increase in the future. Between 2000 and 2002, there was seen to be a statistically significant increase in the cases requiring immediate specialist attention: a rise from 19 cases in 2000 to 22 in 2002 (p=0.044).

Behaviour Analysis When the causes of injuries were grouped into their broader categories (behavioural, mechanical, and unspecified), the majority of hand injuries (51.4%) could be attributed to a behavioural cause. As behavioural causes to injury can be modified, our data would suggest that the majority of hand injuries sustained using power tools at home are avoidable. The specific behaviours most responsible for injury were: atypical positioning (20.4% of all injuries), complacency (16.4%), and distraction/inattention (10.1%). This information provides a basis from which safety and preventative measures can be suggested; for example, preventing injuries from atypical positioning and distraction/inattention can be reduced by promoting supervision or peer support when conducting DIY. Likewise, complacency can be reduced with the provision of sufficient training and education. Our data goes on to suggest that such preventative measures can greatly reduce the burden of such injury to our healthcare system. Of those injuries requiring follow-up after initial presentation, it can be seen that, most of the time, community-level management is not sufficient for those with a behavioural cause. A degree of specialist attention is required for the greater part of these injuries; a cost which we have already shown to be avoidable provided that safer powertool behaviour is promoted and improved.

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Power Tools that dont lend a Helping Hand 2011

Limitations As we were not personally able to validate each of the cases, our results carry the same limitations as those in the HASS/LASS dataset. There were considerable limitations observed; for instance, a number of accounts showed discrepancy in gender description in the provided history and what was written under the gender subheading. When this occurred we used the information provided in the gender column. Additionally, we also noted a number of duplicate accounts. To avoid bias, we included all accounts in our results. A lack of sufficient detail in some of the accounts introduced other drawbacks in our study. On occasion, the information was so limited that the power tool used was not clear. For instance electric saw was often recorded; when this occurred, we reclassified the power tool as circular saw, potentially leading to an overrepresentation of circular saw incidents. Assumptions also played a role whilst categorising each case into the various behaviour categories. Histories would often have little information on the circumstances leading to injury, only including terms such as caught when describing causative events. It was agreed that the term caught meant that an individual was being complacent, as the patient could have taken more care. This, of course, may have not been the interpretation intended. Where these inferences could not be made, the lack of sufficient detail led to the creation of an unspecified category in our behaviour analysis. This subjected the data to additional bias as it may have led to an underestimate of the relevant categories. Finally, insufficient detail under outcome following admission to A&E occasionally made it difficult to definitively state each patients treatment outcome. This shortcoming could have been improved using the OPCS-4 coding system which documents all operations, procedures and interventions carried out on a patients during a hospital admission; translating each entry into an alphanumeric code. Its Incorporation would have allowed for more accurate and efficient analyses.

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Power Tools that dont lend a Helping Hand 2011 Recommendations (for future research)
While our study investigates several key research areas related to domestically sustained hand injuries, our literature review revealed several other areas worthy of investigation. A key at-risk population identified by Conn et al. were children younger than 5-years old who accounted for the highest rate of finger amputations in American emergency departments annually. More research focused at developing preventive measures is especially important in such a young age group as these injuries can carry significant life-long functional restrictions. Additionally, Williams and Power showed that an overwhelming majority of domestically sustained hand injuries are from manual tools, not power tools. The study showed that a Stanley Knife, on its own, caused as many hand injuries leading to A&E admission as all power tool combined. Thus, it can be easily inferred that the healthcare burden from manual tools is still extraordinary and worthy of further investigation. Our research provides a basis to several areas of further investigation. As alluded to in our introduction, the economic impact of these types of injuries is significant. Our data not only suggests that these injuries contribute to a significant financial burden to the NHS currently, but that this burden is likely to increase with an ageing population. Investigation directed at the current and expected costs surrounding these injuries would complete our understanding of their burden. Additionally, we found that the malfunctioning of the power tool accounted for 3.3% of all injuries sustained to the hand, namely in activity involving drills. This finding lends itself to further investigation into the quality assurance criteria involved in tool engineering. As a continuation to this project, we are currently undertaking a study looking to identify measures to prevent the occurrence of power tool related hand injuries in the domestic setting. From the trends that we have described in the mechanisms and behaviours leading to injury, a questionnaire has been developed and distributed amongst healthcare personnel who deal with hand injuries on a regular basis. The aim of this questionnaire is to gather expert opinions regarding the commonest causes of injury, and their suggestions of how to prevent such injury from occurring. The study will be conducted using the Delphi technique, where the questionnaire will circulate amongst the expert panel for a number of cycles, each time being refined and narrowed to only include opinions and suggestions that are widely accepted by the group. The end result will be a common consensus as to what the most common root-cause to injury is, and the important preventative measures that are needed to prevent this from occurring.

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Power Tools that dont lend a Helping Hand 2011 Conclusion

In an economic climate lending itself to increased DIY activity, it is important to develop an understanding of the demographic and behavioural trends in hand injuries caused by power tools. This is the only study that has been able to identify such trends leading to hand injuries from such a broad spectrum of power tools. Our study has shown that while men between the ages of 30-69 account for the highest volume of such cases, it is the elderly population (70+) that are most burdensome to our healthcare service; a key finding considering an ageing population. Likewise, circular saws and hedge trimmers have been shown to cause the most healthcare burden, both in volume of cases and secondary care required. The majority (51.4%) of hand injuries are avoidable due to their behavioural root cause. The commonest modifiable behaviours leading to injury are atypical positioning (20.4%) and complacency (16.4%). Implementing specific prevention strategies, such as education and training, can reduce the incidence of these injuries and the subsequent demand placed upon the healthcare system

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Power Tools that dont lend a Helping Hand 2011 Bibliography:

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10. Conn J, Annest J, Ryan G et al. Non-Work-Related Finger Amputations in the United States, 20012002. Annals of Emergency Medicine 2005; 45(6):630-5. 11. Bonte W, Goldberg R. Accidental circular saw injuries. Journal of Legal medicine 1982; 89(3):17380. 12. Hoxie S, Capo J, Dennison D, Shin A. The Economic Impact of Electric Saw Injuries to the Hand. Journal of Hand Surgery. 2009; 34(5): 886-889. 13. Williams S, Power D. Hand injuries from tools in domestic and leisure settings: relative incidence and patterns of initial management. Journal of Hand Surgery (European Volume) 2011 14. Bonte W. Self-mutilation and private accident insurance. Journal of Forensic Science 1983; 28(1):70-82.
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15. Speed M. Consumer Knowledge of Tool and DIY Safety. UK Department of Trade and Industry. 2002 16. Lipscomb H, Nolan J, Patterson D et al. Prevention of traumatic nail gun injuries in apprentice carpenters: use of population-based measures to monitor intervention effectiveness. American Journal of Industrial Medicine 2008; 51(10):719-27. 17. Frank M, Ekkernkamp A. Small change, big impact: prevention of vole captive bolt device hand injuries. Journal of Trauma 2010; 69(2):478. 18. Sorock G, Lombardi D, Peng D et al. Glove Use and the Relative Rick of Acute Hand Injury: A Case Crossover Study. Journal of Occupational and Environmental Hygiene 2004; 1(3):182-190

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Power Tools that dont lend a Helping Hand 2011 Appendices

Table 1 - The hospital Accident and Emergency departments participating in the surveillance system between 2000 and 2002.

Hospitals Sampled
Airedale, Keighley Blackburn Royal Infirmary, Lancs Daisy Hill, Newry George Elliot, Nuneaton Hereford City General, Hereford Kings College, Denmark Hill Luton & Dunstable, Beds Macclesfield General, Cheshire Monklands General, Airdrie Norfolk & Norwich, Norwich North Devon, Barnstaple North Tees General, Stockton Prince Charles, Merthyr Tydfil Royal Berkshire, Reading Selly Oak, Birmingham Skegness and District, Lincs St. Helier, Carshalton Worthing

N.b Two hospitals left the sample during the 2000-2002 reporting period without being replaced. Monklands provided data until the end of June 2001, and Royal Berkshire left the sample at the end of 2001.

22

Power Tools that dont lend a Helping Hand 2011

Table 2 - The exclusion criteria for location of injury. Table 2: Exclusion Criteria filtering location of Injury - Air Museum - Airport - Backlane - Boat Yard - Business/Public Building/ Bank - Car park, Bus Station, Service Station - Education Area - Factory, Warehouse, Workshop, Plant - Field - Filling Station - Holiday Play Scheme - IED - In Sea, Lake, River, Canal, Marsh, Water - Inside School, University, College - Leisure, Public Building, Library, Church - Boat, Ship, Draft, Airbed - Other Industrial Production Area - Other Leisure Facility - Other Location - Other Natural Area - Other Road Area - Other Trade/ Service Area - Parkland/ Cemetery Gardens - Public Playground - Riding School - Rural Road, Pavement, Grass - School Grounds - Shopping Area - Sport Field/ Hall - Swimming Pool - Ulcultivated Fiels/ Woods - Unknown - Unspecified - Waterside/ Beach - Woods - Workshop

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Power Tools that dont lend a Helping Hand 2011

Table 3 - Inclusion criteria for classifying hand injuries Table 3: Inclusion Criteria for Classifying Hand Injuries - Both Hands - Fingers, Thumb, Digit, Phalange - Wrists - Nail

Table 4 - Behaviour coding legend Code 1.1 Behaviour Unspecified (patient does not know how the injury occurred or the history provided by the data was insufficient to ascertain how the injury came about) Other Inexperience (drill bit coming out, drill getting stuck in material, igniting self, not realising being burnt by power tool) Complacency (hand behind drill, fingers too close to saw, poor lighting, patient intoxicated, holding object being cut) Distraction/Inattention (includes not realising machine was on, loss of concentration, patient missing material, not paying attention, multitasking) Lack of Safety Implementations (hand being dragged into saw by gloves or wood) Atypical Hand Position (includes slip/slipping, fell, lost balance, loss of grip, machine not stabilised, catching falling tool) Indirect Mechanical injury (being hurt by material, by power tool when not being used, indirect, hurt from hot surface) Direct Mechanical Injury (Vibration injury, kick back, injured while cleaning, steam from power tool, hot water) Malfunction (tool snapping, electric shock)

1.2 Patient Behaviour 2.1

2.2

2.3

2.4

2.5

Mechanical 3.1

3.2

3.3

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Power Tools that dont lend a Helping Hand 2011

Table 5 - Categorising of Treatment Outcome Referral Categories
Immediate Specialist Attention Required Admitted to Specialist Hospital Referred to Orthopaedics Referred to Plastic Surgery Referred to Brighton Plastics Referred to St Georges Plastics Dept To be admitted to Specialist Hospital

Hospital Care Discharged IP, Referred Outpatient Clinic Inpatient- Unspec Outcome Inpatient, then transf to other hosp IP for less than one day Referred to any outpatient clinic Other outcome Newark hospital Referred to other hospital Review at a & e 3 days Review 3 days Review a & e 4 days See in 6 days To be admitted to ward next day Treated in triage Admit to coombes Admitted to other hospital Discharged IP-No more treatment required

Community Care Discharged IP- Referred to GP Occupational health Referred to GP

No treatment required after a/e visit Examined but no treatment given Treated; no more treatment required Review a & e Review a & e Review a&e Review in a/e Review in a and e

Unspecified Patient did not wait Other Outcome Unknown Outcome

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Power Tools that dont lend a Helping Hand 2011

Table 6 - Frequency of injuries sustained by men and women
Cumulative Frequency FEMALE MALE Total 189 1617 1806 Percent 10.5 89.5 100.0 Valid Percent 10.5 89.5 100.0 Percent 10.5 100.0

Table 7 - Frequency of injuries sustained by age group

Age group 0-29 30-69 70+ Total Frequency 241 1362 203 1806 Percent 13.3 75.4 11.2 100.0

Table 8 - Frequency of injuries sustained by age group

Frequency Valid 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90+ Total 23 53 165 356 334 362 310 159 37 7 1806 Percent 1.3 2.9 9.1 19.7 18.5 20.0 17.2 8.8 2.0 .4 100.0

26

Power Tools that dont lend a Helping Hand 2011

Table 9 - Frequency of patient outcome with respect to age

AgeSmall OUTCOME 0-29 (Young) IMMEDIATE SPECIALIST ATTENTION REQUIRED HOSPITAL CARE Count % within AgeSmall Count % within AgeSmall COMMUNITY CARE Count % within AgeSmall NO TREATMENT REQUIRED AFTER A+E VISIT UNSPECIFIED Count % within AgeSmall Total Count % within AgeSmall 10 4.1% 241 100.0% 51 3.7% 1362 100.0% 6 3.0% 203 100.0% 67 3.7% 1806 100.0% Count % within AgeSmall 1 .4% 82 34.0% 47 19.5% 101 41.9% 30-69 (Middle Aged) 35 2.6% 508 37.3% 317 23.3% 451 33.1% 70+ (Elderly) 13 6.4% 78 38.4% 48 23.6% 58 28.6% Total 49 2.7% 668 37.0% 412 22.8% 610 33.8%

Chi-Square Tests Value Pearson Chi-Square 24.020

a

df 8

P value .002

27

Power Tools that dont lend a Helping Hand 2011

Table 10 - Frequency of tool type used with respect to age group
AgeSmall TOOL TYPE 0-29 (Young) CHAINSAW Count % within AgeSmall CIRCULAR SAW Count % within AgeSmall DRILL Count % within AgeSmall GRINDER Count % within AgeSmall HEDGE TRIMMER Count % within AgeSmall MISCELLANEOUS Count % within AgeSmall WALLPAPER STRIPPER Count % within AgeSmall WELDER Count % within AgeSmall Total Count % within AgeSmall 16 6.6% 28 11.6% 61 25.3% 33 13.7% 64 26.6% 16 6.6% 20 8.3% 3 1.2% 241 100.0% 30-69 (Middle Aged) 63 4.6% 401 29.4% 261 19.2% 187 13.7% 371 27.2% 26 1.9% 35 2.6% 18 1.3% 1362 100.0% 70+ (Elderly) 9 4.4% 87 42.9% 22 10.8% 16 7.9% 59 29.1% 6 3.0% 4 2.0% 0 .0% 203 100.0% Total 88 4.9% 516 28.6% 344 19.0% 236 13.1% 494 27.4% 48 2.7% 59 3.3% 21 1.2% 1806 100.0%

28

Power Tools that dont lend a Helping Hand 2011

Table 11 - Frequency of injuries sustained by particular tools in males and females
SEX FEMALE TOOL TYPE CHAINSAW Count % within SEX CIRCULAR SAW Count % within SEX DRILL Count % within SEX GRINDER Count % within SEX HEDGE TRIMMER Count % within SEX MISCELLANEOUS Count % within SEX WALLPAPER STRIPPER Count % within SEX WELDER Count % within SEX Total Count % within SEX 9 4.8% 16 8.5% 17 9.0% 9 4.8% 107 56.6% 16 8.5% 14 7.4% 1 .5% 189 100.0% MALE 79 4.9% 500 30.9% 327 20.2% 227 14.0% 387 23.9% 32 2.0% 45 2.8% 20 1.2% 1617 100.0% Total 88 4.9% 516 28.6% 344 19.0% 236 13.1% 494 27.4% 48 2.7% 59 3.3% 21 1.2% 1806 100.0%

29

Power Tools that dont lend a Helping Hand 2011

Table 12 - Frequency of injuries sustained from specific tools with respect to outcome of the patient
OUTCOME IMMEDIATE SPECIALIST HOSPITAL CARE TOOL TYPE CHAINSAW Count % within OUTCOME CIRCULAR SAW Count % within OUTCOME DRILL Count % within OUTCOME GRINDER Count % within OUTCOME HEDGE TRIMMER Count % within OUTCOME MISCELLANEOUS Count % within OUTCOME WALLPAPER STRIPPER Count % within OUTCOME WELDER Count % within OUTCOME Total Count % within OUTCOME 31 4.6% 282 42.2% 93 13.9% 69 10.3% 153 22.9% 15 2.2% 14 2.1% 11 1.6% 668 100.0% ATTENTION REQUIRED 4 8.2% 35 71.4% 1 2.0% 0 .0% 8 16.3% 1 2.0% 0 .0% 0 .0% 49 100.0% SPECIALIST CARE 35 4.9% 317 44.2% 94 13.1% 69 9.6% 161 22.5% 16 2.2% 14 2.0% 11 1.5% 717 100.0%

Chi-Square Tests Value Pearson Chi-Square 22.671

a

df 7

P value .002

30

Power Tools that dont lend a Helping Hand 2011

Table 13 - Frequency of outcomes within each year

YEAR 2000 OUTCOME COMMUNITY CARE Count % within YEAR HOSPITAL CARE Count % within YEAR IMMEDIATE SPECIALIST ATTENTION REQUIRED NO TREATMENT REQUIRED AFTER A+E VISIT UNSPECIFIED Count % within YEAR Total Count % within YEAR 17 2.7% 639 100.0% 23 3.9% 588 100.0% 27 4.7% 579 100.0% 67 3.7% 1806 100.0% Count % within YEAR Count % within YEAR 159 24.9% 227 35.5% 19 3.0% 217 34.0% 2001 130 22.1% 221 37.6% 8 1.4% 206 35.0% 2002 123 21.2% 220 38.0% 22 3.8% 187 32.3% Total 412 22.8% 668 37.0% 49 2.7% 610 33.8%

Chi-Square Tests Value Pearson Chi-Square 13.219

a

df 8

P value .105

Table 14 - Behaviour frequency

Frequency UNSPECIFIED BEHAVIOURAL MECHANICAL Total 629 928 249 1806 Percent 34.8 51.4 13.8 100.0

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Power Tools that dont lend a Helping Hand 2011

Table 15 - Behaviour type frequency with respect to particular tool used
TOOL TYPE BEHAVIOUR CHAINSAW UNSPECIFIED OTHER INEXPERIENCE COMPLACENCY DISTRACTION/ INATTENTION LACK OF ADEQUATE SAFETY MEASURES AYTPICAL POSTIONING INDIRECT MECHANICAL INJURY DIRECT MECHANICAL INJURY MALFUNCTION Total Count % within TOOL TYPE Count % within TOOL TYPE Count % within TOOL TYPE Count % within TOOL TYPE Count % within TOOL TYPE Count % within TOOL TYPE Count % within TOOL TYPE Count % within TOOL TYPE Count % within TOOL TYPE Count % within TOOL TYPE Count % within TOOL TYPE 36 40.9% 0 .0% 1 1.1% 13 14.8% 5 5.7% 3 3.4% 16 18.2% 6 6.8% 6 6.8% 2 2.3% 88 100.0% CIRCULAR SAW 260 50.4% 0 .0% 9 1.7% 60 11.6% 45 8.7% 20 3.9% 76 14.7% 16 3.1% 30 5.8% 0 .0% 516 100.0% DRILL 63 18.3% 4 1.2% 14 4.1% 60 17.4% 28 8.1% 2 .6% 92 26.7% 15 4.4% 24 7.0% 42 12.2% 344 100.0% GRINDER 87 36.9% 1 .4% 2 .8% 40 16.9% 12 5.1% 5 2.1% 51 21.6% 5 2.1% 20 8.5% 13 5.5% 236 100.0% HEDGE TRIMMER 138 27.9% 4 .8% 5 1.0% 110 22.3% 83 16.8% 10 2.0% 118 23.9% 11 2.2% 14 2.8% 1 .2% 494 100.0% MISCELLANEOUS 10 20.8% 3 6.3% 3 6.3% 4 8.3% 5 10.4% 0 .0% 5 10.4% 11 22.9% 6 12.5% 1 2.1% 48 100.0% WALLPAPER STRIPPER 20 33.9% 0 .0% 1 1.7% 4 6.8% 3 5.1% 0 .0% 10 16.9% 10 16.9% 11 18.6% 0 .0% 59 100.0% WELDER 3 14.3% 0 .0% 6 28.6% 5 23.8% 1 4.8% 1 4.8% 0 .0% 4 19.0% 1 4.8% 0 .0% 21 100.0% Total 617 34.2% 12 .7% 41 2.3% 296 16.4% 182 10.1% 41 2.3% 368 20.4% 78 4.3% 112 6.2% 59 3.3% 1806 100.0%

32

Power Tools that dont lend a Helping Hand 2011

Table 16 - Behaviour frequency causing injury with respect to age
AgeSmall 0-29 (Young) UNSPECIFIED Count % within AgeSmall OTHER Count % within AgeSmall INEXPERIENCE Count % within AgeSmall COMPLACENCY Count % within AgeSmall DISTRACTION/ INATTENTION LACK OF ADEQUATE SAFETY MEASURES AYTPICAL POSTIONING INDIRECT MECHANICAL INJURY DIRECT MECHANICAL Count INJURY MALFUNCTION % within AgeSmall Count % within AgeSmall Total Count % within AgeSmall 14 5.8% 5 2.1% 241 100.0% 84 6.2% 49 3.6% 1362 100.0% 14 6.9% 5 2.5% 203 100.0% 112 6.2% 59 3.3% 1806 100.0% Count % within AgeSmall Count % within AgeSmall Count % within AgeSmall Count % within AgeSmall 80 33.2% 1 .4% 9 3.7% 41 17.0% 32 13.3% 1 .4% 39 16.2% 19 7.9% 30-69 (Middle Aged) 457 33.6% 10 .7% 32 2.3% 222 16.3% 126 9.3% 34 2.5% 293 21.5% 55 4.0% 70+ (Elderly) 80 39.4% 1 .5% 0 .0% 33 16.3% 24 11.8% 6 3.0% 36 17.7% 4 2.0% Total 617 34.2% 12 .7% 41 2.3% 296 16.4% 182 10.1% 41 2.3% 368 20.4% 78 4.3%

BEHAVIOUR

Chi-Square Tests

Value Pearson Chi-Square 33.318

a

df 18

P value .015

33

Power Tools that dont lend a Helping Hand 2011

Table 17 - Frequency of specific tools with respect to outcome of the patient
OUTCOME IMMEDIATE SPECIALIST HOSPITAL CARE TOOL TYPE CHAINSAW Count % within OUTCOME CIRCULAR SAW Count % within OUTCOME DRILL Count % within OUTCOME GRINDER Count % within OUTCOME HEDGE TRIMMER Count % within OUTCOME MISCELLANEOUS Count % within OUTCOME WALLPAPER STRIPPER Count % within OUTCOME WELDER Count % within OUTCOME Total Count % within OUTCOME 31 4.6% 282 42.2% 93 13.9% 69 10.3% 153 22.9% 15 2.2% 14 2.1% 11 1.6% 668 100.0% ATTENTION REQUIRED 4 8.2% 35 71.4% 1 2.0% 0 .0% 8 16.3% 1 2.0% 0 .0% 0 .0% 49 100.0% SPECIALIST CARE 35 4.9% 317 44.2% 94 13.1% 69 9.6% 161 22.5% 16 2.2% 14 2.0% 11 1.5% 717 100.0%

Chi-Square Tests Value Pearson Chi-Square 22.671

a

df 7

P value .002

34

Power Tools that dont lend a Helping Hand 2011

Table 18 - Frequency and type of care received with respect to behaviour causing injury
HIC2 BEHAVIOUR COMMUNITY CARE UNSPECIFIED Count % within BEHAVIOUR OTHER Count % within BEHAVIOUR INEXPERIENCE Count % within BEHAVIOUR COMPLACENCY Count % within BEHAVIOUR DISTRACTION/ INATTENTION LACK OF ADEQUATE SAFETY MEASURES AYTPICAL POSTIONING INDIRECT MECHANICAL INJURY DIRECT MECHANICAL INJURY MALFUNCTION Count % within BEHAVIOUR Count % within BEHAVIOUR Count % within BEHAVIOUR Count % within BEHAVIOUR Count % within BEHAVIOUR Count % within BEHAVIOUR Total Count % within BEHAVIOUR 131 21.2% 3 25.0% 8 19.5% 76 25.7% 48 26.4% 7 17.1% 89 24.2% 19 24.4% 21 18.8% 10 16.9% 412 22.8% NO TREATMENT AFTER A+E VISIT 156 25.3% 7 58.3% 16 39.0% 97 32.8% 65 35.7% 17 41.5% 147 39.9% 35 44.9% 44 39.3% 26 44.1% 610 33.8% SPECIALIST CARE 297 48.1% 2 16.7% 13 31.7% 114 38.5% 64 35.2% 14 34.1% 127 34.5% 24 30.8% 43 38.4% 19 32.2% 717 39.7% UNSPECIFIED 33 5.3% 0 .0% 4 9.8% 9 3.0% 5 2.7% 3 7.3% 5 1.4% 0 .0% 4 3.6% 4 6.8% 67 3.7% Total 617 100.0% 12 100.0% 41 100.0% 296 100.0% 182 100.0% 41 100.0% 368 100.0% 78 100.0% 112 100.0% 59 100.0% 1806 100.0%

35

Power Tools that dont lend a Helping Hand 2011

Table 19-Frequency of outcome of the patient with respect to sex
SEX FEMALE OUTCOME IMMEDIATE SPECIALIST ATTENTION REQUIRED HOSPITAL CARE Count % within SEX Count % within SEX COMMUNITY CARE Count % within SEX NO TREATMENT REQUIRED AFTER A+E VISIT UNSPECIFIED Count % within SEX Total Count % within SEX 3 1.6% 189 100.0% 64 4.0% 1617 100.0% 67 3.7% 1806 100.0% Count % within SEX 2 1.1% 58 30.7% 38 20.1% 88 46.6% MALE 47 2.9% 610 37.7% 374 23.1% 522 32.3% Total 49 2.7% 668 37.0% 412 22.8% 610 33.8%

Chi-Square Tests Value Pearson Chi-Square 17.852

a

df 4

P value .001

36

Power Tools that dont lend a Helping Hand 2011

Table 20 - Frequency of type of behaviours causing injury occurring in men and women
SEX FEMALE BEHAVIOUR UNSPECIFIED Count % within SEX OTHER Count % within SEX INEXPERIENCE Count % within SEX COMPLACENCY Count % within SEX DISTRACTION/INATTENTI ON LACK OF ADEQUATE SAFETY MEASURES AYTPICAL POSTIONING Count % within SEX Count % within SEX Count % within SEX INDIRECT MECHANICAL INJURY DIRECT MECHANICAL INJURY MALFUNCTION Count % within SEX Count % within SEX Count % within SEX Total Count % within SEX 24 40.0% 0 .0% 0 .0% 8 13.3% 12 20.0% 0 .0% 10 16.7% 2 3.3% 1 1.7% 3 5.0% 60 100.0% MALE 273 41.6% 2 .3% 13 2.0% 106 16.1% 52 7.9% 14 2.1% 117 17.8% 22 3.3% 42 6.4% 16 2.4% 657 100.0% Total 297 41.4% 2 .3% 13 1.8% 114 15.9% 64 8.9% 14 2.0% 127 17.7% 24 3.3% 43 6.0% 19 2.6% 717 100.0%

Chi-Square Tests Value Pearson Chi-Square 15.400

a

df 9

P value .081

37

Power Tools that dont lend a Helping Hand 2011

Table 21 - Frequency of behaviour causing injury with respect to age
AgeSmall 0-29 (Young) UNSPECIFIED Count % within AgeSmall OTHER Count % within AgeSmall INEXPERIENCE Count % within AgeSmall COMPLACENCY Count % within AgeSmall DISTRACTION/ INATTENTION LACK OF ADEQUATE SAFETY MEASURES AYTPICAL POSTIONING INDIRECT MECHANICAL INJURY DIRECT MECHANICAL Count INJURY MALFUNCTION % within AgeSmall Count % within AgeSmall Total Count % within AgeSmall 14 5.8% 5 2.1% 241 100.0% 84 6.2% 49 3.6% 1362 100.0% 14 6.9% 5 2.5% 203 100.0% 112 6.2% 59 3.3% 1806 100.0% Count % within AgeSmall Count % within AgeSmall Count % within AgeSmall Count % within AgeSmall 80 33.2% 1 .4% 9 3.7% 41 17.0% 32 13.3% 1 .4% 39 16.2% 19 7.9% 30-69 (Middle Aged) 457 33.6% 10 .7% 32 2.3% 222 16.3% 126 9.3% 34 2.5% 293 21.5% 55 4.0% 70+ (Elderly) 80 39.4% 1 .5% 0 .0% 33 16.3% 24 11.8% 6 3.0% 36 17.7% 4 2.0% Total 617 34.2% 12 .7% 41 2.3% 296 16.4% 182 10.1% 41 2.3% 368 20.4% 78 4.3%

BEHAVIOUR

Chi-Square Tests Value Pearson Chi-Square 33.318

a

df 18

P value .015

38

Power Tools that dont lend a Helping Hand 2011

Authors Contributions
Every member of this group contributed in their only particular way towards each section of this project. It was a group effort. Author Amit Anand Contribution - Discussion - Introduction - Conclusion - Shortcomings - Appendices - Methods Nicholas Campion - Discussion - Data Analysis and Results - Appendices - Communication with Supervisor - Literature Review James Cheshire - Discussion - Introduction - Shortcomings - Conclusion - Appendices - Methods Thomas Haigh - Literature Review - Abstract - Aims and Objectives - Recommendations for Future Research - Appendices - Methods James Leckenby - Literature review - Data Analysis and Results - Appendices - Communication with Supervisor Project design, data gathering, and all other sections were done by all of us. Every member of the group has both read and agreed the final version. Signatures:

Amit Anand

Nicholas Campion

James Cheshire

Thomas Haigh

James Leckenby

39