Return-to-Work Programs

Joe "EMT" and his partner are moving a patient on a stretcher across a sidewalk when one of the wheels slips off the edge of the sidewalk. Joe quickly reacts by shifting his body position to maintain his balance. As he does so, he feels a slight tearing sensation in his left flank region. Thinking little of the situation, the crew continues and transports the patient without further incident to the hospital. As the day progresses, Joe becomes more uncomfortable with increasing pain in his flank area. He reports the incident to his supervisor and documents a report. Following his agency's policy, Joe is sent for a medical evaluation, where he is diagnosed with a sprain on his left side and placed on limited/light duty. Joe reports the physician's medical findings to his supervisor, who says, "Limited what?"

Scenarios like this are not uncommon in EMS. How does your organization address return-to-work issues? As worker's compensation insurance rates climb, EMS agencies are forced to explore seldom-considered avenues to control costs. Back-to-work programs, when implemented appropriately, can offer rewards to both the employee and employer. Whether formal or informal, return-to-work programs are an integral part of any loss-control program. Sub-classified under the heading of loss management, return-to-work programs encompass specialty physician consultation, rehabilitation, limited/light duty activities and employee education. The goal is to return the employee back to his/her pre-existing condition and environment as soon as possible. Proper, thorough and aggressive interventions are core objectives to facilitate this goal.

Return-to-Work Programs

Return-to-work programs are intended to get employees functioning within their respective work environments, with the ultimate goal of returning to full capacity in a relatively acceptable time period. Insurance companies believe that employees return to work 6–10 times faster when they participate in a return-to-work program. According to one expert, "Businesses strive to be fully staffed and operate efficiently, but injuries and illnesses among employees are a fact of life. When a company properly addresses these obstacles and helps employees return to work, results include positive productivity, profitability and employee relations."1 This insight and related expectations should be tailored to EMS operations. According to a study by UNUM Life Insurance Company of America, 93% of Americans want to return to work after a disabling event.1

The philosophy behind return-to-work programs suggests that employees will work safely while progressing to their previous abilities. Programs should be temporary, meaningful and productive. Employees should be educated on the process and permitted to gradually progress. Monitor and evaluate such progression to ensure the employees' safety and ability to conduct various job responsibilities.

Establish time frames to steer the process and facilitate a mutually beneficial response to the program. Setting a time frame forces the employer to monitor and manage the claim within the agreed-upon time frame, and clarifies to the employee that the alternate duties are not permanent and he/she is expected to make the transition back into a regular full-time job within a set number of days.2

The National Safety Council (NSC) stresses considering return-to-work examinations to assess the employee's ability to perform the job functions after being away from the environment for a prolonged period of time. The NSC points out that employees should be carefully phased back into the work environment, particularly following prolonged injury or illness.3

Specialty Physician Panels

Knowing the injuries and illnesses most likely to occur among your workforce plays a vital role in effectively and efficiently returning personnel to productive activity. Some worker's compensation programs require employers to provide a physician panel for work-related injuries/illnesses. Specialty physician panels can expedite the process by matching common injuries/illnesses with the respective specialist. For example, if sprains and strains are a frequent cause of work loss, an orthopedic specialist would be a qualified panelist.

Rehabilitation

The rehabilitation process needs to be monitored by a physician knowledgeable about the work performed by EMS personnel. When physical therapy is required, exercise programs should be tailored to specific job functions. These exercises can often be practiced on the job. Aggressive rehabilitation can effectively heal many injuries and illnesses. The rehabilitation process can be coupled with a light-duty program that permits the employee to return to active duty in an often reduced time frame.

Limited-Duty Activities

Not every employee will be able to return to pre-existing work conditions. Return-to-work programs should consider common scenarios and plan accordingly. The NSC identifies two alternative job descriptions as sedentary and limited-mobility tasks.4 Employers must ensure that an employee is capable and qualified to perform assigned duties. Work functions should be monitored by the primary physician and benchmarked to specific objectives and time frames.

Summary

Injury and illness related to the work environment are inevitable. The development and implementation of a back-to-work program is beneficial to everyone. Regardless of how an injury or related health issue occurs, returning the affected person back to his pre-existing condition is paramount.

Resource

Additional information on return-to-work programs can be found online at www.worksafebc.com.

References

1. Shehan T. Employer and employee benefit from a return-to-work program. American City Business Journals, Inc., 2003.
2. Cavignac J. An Effective Return to Work Program, January 10, 2004.
3. National Safety Council. Occupational Health & Safety, 2nd Edition, p. 39, 1994.
4. ibid., p. 179.