The impact of a standard enforcement safety belt law on fatalities and hospital charges in Ohio

Introduction

The purpose of this study was to analyze linked crash and hospital data to determine the effect that enactment of a standard enforcement safety belt law in Ohio would have on hospital charges and direct medical costs due to motor-vehicle crashes, focusing on the impact to the state's Medicaid system.

Method

The linkage and analysis was conducted as part of the Ohio Crash Outcome Data Evaluation System (CODES) program. Current safety belt usage in Ohio stands at 82% with its secondary enforcement safety belt law.

Results

Assuming an increase in usage to 92% through standard enforcement, over $15.3 million in medical costs to Medicaid for injuries that occur in a single year could be prevented over a 10-year period. Cumulative savings could reach more than $91.2 million during the 10-year period. In addition, 161 fatalities could have been prevented in one year had all unbelted occupants who sustained a fatal injury instead chosen to wear their safety belt.

Summary and Impact on Industry

Clearly, substantial progress can be made in reducing the number of deaths and injuries, as well as medical costs associated with motor-vehicle crashes, by strengthening safety belt laws and increasing safety belt usage in Ohio.     

Work-related road safety: A case study of Roche Australia

Fleet, work-related or occupational road safety has the potential to make a major contribution to reducing both human harm and asset damage. To date, however, there would appear to be a dearth of well researched and evaluated case studies in the public domain in this area.This paper provides an on-going, documented, real-world case study of work-related road safety within an Australian company that has sought to manage, monitor and improve its road safety performance over the last 5 years through a range of proactive, fleet manager, insurance and risk-led initiatives.Roche Australia has successfully implemented a Company Motor Vehicle Safety Program with support from its fleet insurers and risk management advisors. Four key initiatives are set out covering: (1) Driver risk assessment, monitoring and improvement. (2) Policy development and communications. (3) Process and outcomes evaluation. (4) Continuous review and refinement of policies, processes, programs and future developments.The program has led to a range of process and performance-based outcomes. Typical barriers to success in work-related road safety have been identified and overcome. Almost 100% risk assessment and improvement process compliance by drivers has been achieved. A predictive relationship between risk assessment outcomes and collision history has been identified. Reductions in insurance claims, collision costs and claims ratio have been sustained. A detailed project plan is in place to continue the program for the next 3 years.The paper concludes that with effective management, a well developed work-related road safety program can result in performance improvements within the initiating organisation. Several limitations in the case study methodology, as well as areas for further work and lessons for policy makers, researchers and practitioners are also identified.     

基于HAZOP分析的加氢装置工程设计方法

加氢装置属甲类火灾、爆炸危险生产装置。为了在设计阶段尽可能消除或控制潜在风险,本文总结了多套加氢装置HAZOP分析报告中的设备类别及其分析内容,提出了基于危险与可操作性(HAZOP)分析的加氢装置工程设计方法。在传统工程设计方法的基础上增加了参数敏感性工程设计方法,依据分析报告中的设计建议,利用ASPEN软件计算过程参数变化对目标参数的影响程度,确定参数稳定操作区域;建立了数据库管理界面实现了加氢装置工程安全设计经验知识的有序管理。应用基于HAZOP分析的加氢装置工程设计方法,有助于将安全隐患问题在设计阶段消除或加以控制,可为降低石化装置改造成本和提高装置的安全水平提供方法依据。     

The impact of implementation of the requirements of Standard No. OHSAS 18001:2007 to reduce the number of injuries at work and financial costs in the Republic of Croatia

This article contains the results of research into the impact of implementation of the requirements mentioned in Standard No. OHSAS 18001:2007 to reduce the number of injuries at work and the financial costs incurred in this way. The study was conducted on a determined sample by a written questionnaire survey method in the Republic of Croatia. The objective of the empirical research is to determine the impact of implementation of the requirements of Standard No. OHSAS 18001:2007 to reduce the number of injuries at work and financial costs in Croatia in business organizations that implement these requirements. To provide a broader picture, the research included the collection and analysis of data on the impact of the Standard No. OHSAS 18001:2007 on accidents and fatalities at work. Research findings are based on the analysis of performed statistical data where correlation and regression analysis has been applied.     

A new intelligent assistant system for HAZOP analysis of complex process plant

There are several problems that should be solved in the practical application of HAZOP analysis, such as the inheritance instrument of experience knowledge, the classification of accident reasons, the recurrence of analysis process and the verification of analysis results. This paper presents a new HAZOP assistant program named HELPHAZOP, which can be used to cope with these problems. With the aid of this program, a number of influence relationship models, which can be utilized to present the relationship structure of the whole system, can be established, and a variety of spread paths, which can be employed to describe the occurrence of the accidents, can be identified. These models and paths can help analyzers to understand the analysis process of different chemical processes and to verify the analysis results. Experience knowledge or information of process parameters stored in this program, including deviations, abnormal reasons, consequences and disaster-causing ways, can contribute to the analysis of some new plants. The program has been applied in the HAZOP analysis process of residuum hydrotreating process. The probability of the human errors which would be happened because of the misunderstanding or the deficiency of plant experience in the HAZOP analysis has been reduced and the accuracy, practicability and analysis efficiency of the accident forecast have been greatly improved.     

A cost–benefit analysis of three older adult fall prevention interventions

IntroductionOne out of three persons aged 65 and older falls annually and 20% to 30% of falls result in injury. The purpose of this cost–benefit analysis was to identify community-based fall interventions that were feasible, effective, and provided a positive return on investment (ROI).MethodsA third-party payer perspective was used to determine the costs and benefits of three effective fall interventions. Intervention effectiveness was based on randomized controlled trial results. National data were used to estimate the average annual benefits from averting the direct medical costs of a fall. The net benefit and ROI were estimated for each of the interventions.ResultsFor the Otago Exercise Program delivered to persons aged 65 and older, the net benefit was $121.85 per participant and the ROI was 36% for each dollar invested. For Otago delivered to persons aged 80 and older, the net benefit was $429.18 and the ROI was 127%. Tai chi: Moving for Better Balance had a net benefit of $529.86 and an ROI of 509% and Stepping On had a net benefit of $134.37 and an ROI of 64%.ConclusionsAll three fall interventions provided positive net benefits. The ROIs showed that the benefits not only covered the implementation costs but also exceeded the expected direct program delivery costs. These results can help health care funders and other community organizations select appropriate and effective fall interventions that also can provide positive returns on investment.     

Project safety as a sustainable competitive advantage

Introduction: To be consistently profitable, a construction company must complete projects in scope, on schedule, and on budget. At the same time, the nature of the often high-risk work performed by construction companies can result in high accident rates. Clients and other stakeholders are placing increasing pressure on companies to decrease those accident rates. Clients routinely demand copies of safety plans and evidence of past results at the “pre-qualification” or “request for proposal” stages of the procurement process. Are high accident rates and the associated costs just a part of business? Findings: Companies that deliver on scope, schedule, and budget have a competitive advantage. Is it possible for projects with low accident rates to use it as a competitive advantage? Is the value added by safety just a temporary or parity issue, or does a successful safety program offer significant advantage to the company and the client? Impact on Industry: This article concludes that in the case of a high-risk industry, such as the construction industry, an organization with a successful safety program can promote safety performance as a sustainable competitive advantage. It is a choice the company can make.     

Overtime work as the antecedent of employee satisfaction,firm productivity,and innovation

Overtime work has been blamed for the deterioration of employee satisfaction and productivity. However, the organization‐level implications of overtime work as a normative expectation remain unclear. In this study, such effects were analyzed through human capital theory and a causal attribution approach. Various organizational outcomes and boundary conditions were explored in explaining these implications. The analysis of time lagged data from 273 firms affirmed that a firm's overtime level was related negatively to employee satisfaction. However, it was positively related to the firm's productivity and curvilinearly (inverted U‐shaped) related to innovation. The effects of the firm's overtime level on firm productivity and innovation were also moderated by organizational trust. This study highlights the costs and benefits of overtime work as tools for utilizing human capital and reveals the critical contingency of organizational trust that enables firms to attenuate the costs of the overtime level and accentuate its potential benefits.     

A framework for evaluating OSH program effectiveness using leading and trailing metrics

Introduction

Many employers and regulators today rely primarily on a few past injury/ illness metrics as criteria for rating the effectiveness of occupational safety and health (OSH) programs. Although such trailing data are necessary to assess program success, they may not be sufficient for developing proactive safety, ergonomic, and medical management plans.

Methods

The goals of this pilot study were to create leading metrics (company self-assessment ratings) and trailing metrics (past loss data) that could be used to evaluate the effectiveness of OSH program elements that range from primary to tertiary prevention. The main hypothesis was that the new metrics would be explanatory variables for three standard future workers compensation (WC) outcomes in 2003 (rates of total cases, lost time cases, and costs) and that the framework for evaluating OSH programs could be justifiably expanded. For leading metrics, surveys were developed to allow respondents to assess OSH exposures and program prevention elements (management leadership/ commitment, employee participation, hazard identification, hazard control, medical management, training, and program evaluation). After pre-testing, surveys were sent to companies covered by the same WC insurer in early 2003. A total of 33 completed surveys were used for final analysis. A series of trailing metrics were developed from 1999-2001 WC data for the surveyed companies. Data were analyzed using a method where each main 2003 WC outcome was dichotomized into high and low loss groups based on the median value of the variable. The mean and standard deviations of survey questions and 1999-2001 WC variables were compared between the dichotomized groups. Hypothesis testing was performed using F-test with a significance level 0.10.

Results/Discussion

Companies that exhibited higher musculoskeletal disorder (MSD) WC case rates from 1999-2001 had higher total WC case rates in 2003. Higher levels of several self-reported OSH program elements (tracking progress in controlling workplace safety hazards, identifying ergonomic hazards, using health promotion programs) were associated with lower rates of WC lost time cases in 2003. Higher reported exposures to noise and projectiles were also associated with higher rates of WC cases and costs in 2003.

Impact on Industry

This research adds to a growing body of preliminary evidence that valid leading and trailing metrics can be developed to evaluate OSH effectiveness. Both the rating of OSH efforts and the regular trending of past loss outcomes are likely useful in developing data-driven improvement plans that are reactive to past exposures and proactive in identifying system deficiencies that drive future losses.     

A learning-by-doing strategy to improve top management involvement in safety

The growth of legal regulations in occupational safety during the 70's alienated to some extent top management from health and safety issues; safety was regarded as an activity of safety professionals and labour inspection. This lack of commitment to safety management led to reduced activity and awareness. However, both research and practice indicate that the role of top management is of crucial importance for achieving results in safety.Having realized the problem and the lack of appropriate training to meet the demands of top management, a program called “One hour for safety management” has been developed. The training is arranged in an “action” setting, during the formal meeting of the executive board of the company. The program consists of four main parts: (1) Principles of modern safety management, (2) The company's accident insurance system, the interdependency between compensation costs and premiums, (3) The safety situation of the company; accidents, premiums and losses, hazards, safety program, and (4) Setting the safety targets and action plans required. More recently, a short audit process has been developed to reveal the important sources of loss and the state of affairs in the company's loss control systems. A special software package includes essential handouts of the safety management meetings complemented by self-auditing tools.The approach initiated or revived top management interest in and awareness of safety in several companies. The success of the meeting seems to depend on several factors, e.g. consultation skills, safety expertise, style of presentation, corporate culture and co-operation in the preparation of the session. The factors that contribute to an effective training for top management should further be analyzed, and the impact of the management training on accident rates is a task for evaluation studies in future.     

Measuring the effectiveness of an industrial lift truck safety training program

A behavior (work) sampling approach was used to both develop and evaluate the effectiveness of an occupational safety training program for industrial lift truck operators. Two studies, each using different experimental designs and performed at two separate warehouses, were conducted, resulting in a total of 96 operators trained. Observations through several months of training program assessment indicated that: (a) occupational safety training, emphasizing modification of operationally defined unsafe work practices derived from task/hazard analysis, can be demonstrated to be effective and to endure beyond cessation of performance feedback; (b) the basis for endurance appears to be continued practice in the modified safe work procedures, coupled with a redefinition of group norms sustained through informal influences such as peer modeling of desired behaviors and continued management support of the program; and (c) a behavior sampling procedure, specifying performancebased criteria, can be used effectively in both the development and evaluation of an occupational-safety training program.     

Cost–benefit analysis approach for the management of industrial safety in chemical and petrochemical industry

The high complexity of chemical and petrochemical installations determines a complex safety management of these establishments, therefore, there is a need to find innovative solutions to guarantee the prevention of failures and losses of containment from process equipment. In this frame, the use of the API Risk Based Inspection (RBI) assessment approach permits a significant reduction of maintenance costs and, simultaneously, the increase of plant's reliability and availability. To increase the level of industrial safety, a proper selection of measures is also needed, even if the adoption of such measures poses costs. Given that resources for the companies are usually limited, a comparison amongst various solutions has to be done with the aim to find the best one, based on a comparison of costs and benefit. To this scope, recently a software, named Inspection Manager, has been developed by ANTEA and implemented thanks to a cooperation with the University of Padova (Italy). The Inspection Manager provides support in the application of the RBI approach by means of the use of plant-specific data, which are stored in its database; its further implementation, presented in this paper, has made it able to support also cost-benefit analysis and, thus, the selection of measures to be adopted to prevent accidental events causing the release of hazardous materials. A case-study is presented to test the new functionality of the tool; after the identification of the most effective measures, a careful cost-benefit assessment has been executed as a basis for decision-making.     

Net-cost model for workplace interventions

PROBLEM: Few methods exist for comprehensively examining the costs and benefits of ergonomic interventions applicable to a variety of economic sectors and settings. METHODS: An instrument for data collection and data analysis at the facility level is presented. In this net-cost model intervention costs are defined by equipment and labor costs for the interventions as well as the avoided costs of lost work time, medical care, and productivity improvements. RESULTS: Net-cost estimates for three case studies show that ergonomic interventions applied appropriately can result in substantial cost savings for the companies. DISCUSSION: It would be prudent to incorporate a protocol for collecting cost and effectiveness data in the standard operating procedures of companies introducing ergonomic interventions. Validation of the net-cost model through prospective studies is necessary. IMPACT ON INDUSTRY: This model may be used to determine the net-cost of implemented or proposed ergonomic interventions in industrial facilities.     

Injury outcomes and costs for cross-median and median barrier crashes

Introduction

The objective of this research was to quantify the injury outcomes and develop reliable and comprehensive injury costs for cross-median crashes (CMC) and median barrier crashes (MBC).

Method

A three-step methodology was developed to quantify the crash costs for each crash severity and type. All CMC and MBC between 2001 and 2007 in Wisconsin were identified and used in this analysis. The Wisconsin CODES database provided comprehensive injury costs based on the injury types and severities suffered by participants in study crashes.

Results

As expected, multi-vehicle CMC result in more total injuries and more severe injuries than single-vehicle CMC. Injury costs for the same injury level on KABCO scale are different for different crash types. Injury costs for concrete MBC are 33% to 50% less than those of multi-vehicle CMC, while the injury costs of concrete MBC for lower severities (B and C) are similar to those of single-vehicle CMC for the same severities; but for incapacitating injuries the costs are 30% less. As expected, concrete MBC result in lower severities than CMC. The costs, by crash severity, vary significantly between different crash types. Concrete median barrier injury crashes are roughly 20% of multi-vehicle CMC costs and 50% of single-vehicle CMC costs.

Conclusions

Results indicate that using one set of crash costs for all crash types biases any evaluation. Therefore, it is recommended that crash-type-specific costs be used in applications such as development of median barrier warrant where specific types of crashes are considered (CMC and MBC).

Impact on industry

Using crash specific costs can lead to a more realistic benefit-cost analysis and enable better decision-making.     

A critical overview of driver recording tools

Introduction: Technological advancements during recent decades have led to the development of a wide array of tools and methods in order to record driving behavior and measure various aspects of driving performance. The aim of the present study is to present and comparatively assess the various driver recording tools that researchers have at their disposal. Method: In order to achieve this aim, a multitude of published studies from the international literature have been examined based on the driver recording methodologies that have been implemented. An examination of more traditional survey methods (questionnaires, police reports, and direct observer methods) is initially conducted, followed by investigating issues pertinent to the use of driving simulators. Afterwards, an extensive section is provided for naturalistic driving data tools, including the utilization of on-board diagnostics (OBD) and in-vehicle data recorders (IVDRs). Lastly, in-depth incident analysis and the exploitation of smartphone data are discussed. Results: A critical synthesis of the results is conducted, providing the advantages and disadvantages of utilizing each tool and including additional knowledge regarding ease of experimental implementation, data handling issues, impacts on subsequent analyses, as well as the respective cost parameters. Conclusions: New technologies provide undeniably powerful tools that allow for seamless data handling, storage, and analysis, such as smartphones and in-vehicle data recorders. However, this sometimes comes at considerable costs (which may or may not pay off at a later stage), while legacy driver recording methods still have their own niches to fill in research. Practical Applications: The present research supports researchers when designing driver behavior monitoring studies. The present work enables better scheduling and pacing of research activities, but can also provide insights for the distribution of research funds.     

A cost analysis of a smoke alarm installation and fire safety education program

INTRODUCTION: While smoke alarm installation programs can help prevent residential fire injuries, the costs of running these programs are not well understood. METHOD: We conducted a retrospective cost analysis of a smoke alarm installation program in 12 funded communities across four states. Costs included financial and economic resources needed for training, canvassing, installing, and following-up, within four cost categories: (a) personnel, (b) transportation, (c) facility, and (d) supplies. RESULTS: Local cost per completed home visit averaged 214.54 dollars, with an average local cost per alarm installed of 115.02 dollars. Combined state and local cost per alarm installed across all four states averaged 132.15 dollars. For every 1% increase in alarm installation, costs per alarm decrease by 1.32 dollars. CONCLUSIONS: As more smoke alarms are installed, the average installation cost per alarm decreases. By demonstrating effective economies of scale, this study suggests that smoke alarm programs can be implemented efficiently and receive positive economic returns on investment.     

Extending the J-value framework for safety analysis to include the environmental costs of a large accident

A severe accident on an industrial plant has the potential to cause, in addition to human harm, general damage and hence expense, associated with ground contamination, evacuation of people and business disruption, for example. The total cost of damages, given the name “environmental costs” in this paper, may be comparable with or larger than the cost of direct health consequences, as assessed objectively by the J-value approach. While the low probability of the accident may mean that the expectation of monetary loss is small, the paper develops a utility-based approach to determine how much should be spent on protection systems to protect against both environmental costs and human harm. The behaviour of the fair decision maker in an organisation facing possible environmental costs is represented by an Atkinson Utility function, which is dependent on the organisation's assets and on the elasticity of marginal utility or, equivalently, the coefficient of relative risk aversion, “risk-aversion” for short. A Second Judgment Value, J₂, may be derived from the spend on the protection system after subtracting the amount sanctioned to prevent direct human harm. This net, environmental expenditure is divided by the most that it is reasonable to spend to avert environmental costs at the highest, rational risk-aversion. The denominator in this ratio is found by first calculating the maximum, sensible spend at a risk-aversion of zero, and then multiplying this figure by a Risk Multiplier to give the maximum, fair amount to avert environmental costs. The Risk Multiplier incorporates a risk-aversion that is as large as it can be without rendering the organisation's safety decisions indiscriminate and hence random. An overall, Total Judgment Value, the J_T-value, may also be calculated, which takes into account the reduction in both human harm and environmental cost brought about by the protection system. The new J_T-value will show similar behaviour to the original J-value, in that J_T-values up to unity will indicate reasonable value for money, while J_T-values greater than unity will indicate a prima facie overspend on protection that will need to be justified by further argument. While the analysis is phrased in terms of environmental costs, the treatment is sufficiently general for all costs, including onsite damages, loss of capability etc. to be included. The new, J_T-value method provides for a full and objective evaluation of the worth of any industrial protection system. A worked example is given.     

An overview to CERSSO's self evaluation of the cost-benefit on the investment in occupational safety and health in the textile factories: "a step by step methodology"

INTRODUCTION: The Pan American Health Organization (PAHO) and CERSSO collaborated to develop a new Tool Kit (TK), which became available in May 2002. PAHO already had a TK in place, and CERSSO requested that one be developed for their needs. CERSSO wanted to enable managers and line workers in garment factories to self-diagnose plant and workstation hazards and to estimate the costs and benefits of investing in occupational safety and health (OSH) as a way to improve productivity and competitiveness. METHODS: For consistency, the collaborating organizations agreed to construct the TK according to PAHO's methodology. The instrument was developed to be comprehensive enough that any user can collect the data easily. It integrates epidemiologic, risk assessment, clinic, engineering, and accountability issues, organized to include step-by-step training in: (a) performing risk assessments in the workplaces (risk factors); (b) making cause-effect relationships; (c) improving decision making on OSH interventions; (d) doing calculations of direct and indirect costs and savings; and (e) doing calculation of the overall cost-benefit of OSH interventions. RESULTS AND CONCLUSIONS: Since July 2002, about 2,400 employees and officials from 736 garment factories, Ministries of Labor, Health, Social Security Institutes, and Technical Training Institutions of Central America and the Dominican Republic have used this instrument. Systematically, they have calculated a positive relationship of the investment (3 to 33 times). Employers are now aware of the financial rewards of investing in OSH. The TK is available in Spanish, Korean, and English. In July 2003, a software program in Spanish and English was developed (180 persons have been trained in the region), which requires less time to execute with better reliability.     

License extensions for clean-record drivers: A 4-year follow-up

Over 4,000,000 of California's 17,000,000 licensed drivers used to come to the California Department of Motor Vehicles (DMV) annually to take written and vision tests in order to renew their driver licenses. In an effort to increase public convenience and reduce costs, extension of the license by mail was implemented for selected groups of drivers with clean records over the life of their previous licenses. Continued implementation of the program was subject to evaluation of its effect on traffic safety. Since clean-record drivers make up about 50% of the renewal population, this program made it possible for some 2,000,000 drivers annually to avoid coming to the DMV for license renewal. Two studies of program safety effects were conducted, one evaluating a 2-year extension (760,000 subjects), and the other a 4-year extension (407,000 subjects). Random assignment to a group offered extension by mail or to a control group undergoing standard renewal testing and procedures was followed by careful tracking of accident and conviction activity. During the 48-month period following mailing of renewal notices or extension offers, the extension group had a slightly higher accident rate than did the in-person renewal group — an increase of 1%, or 13 accidents for every 10,000 extension offers. Although this small increase in accident rate would translate into about 2,500 additional accident involvements per year if applied to the current volume of clean-record drivers eligible for extension, statistical tests of significance indicated that the increase could easily be due to sampling error (p>.10). A supplemental Bayesian analysis resulted in a .24 probability that there was no true increase. The administrative cost savings attributable to the extension program were conservatively estimated to be $3,000,000 per year.     

Physical,psychological and economic burden of two-wheel users after a road traffic injury: Evidence from intensive care units of three EU countries

Introduction: This study aimed to assess the physical, psychological, and economic burden shouldered by severely injured two-wheel users in three European countries as well as the cost resulting from their hospitalization. Methods: A total of seven public hospitals were involved in three countries: Greece, Italy, and Germany. Participants enrolled during a 12-month period starting in April 2013. Eligibility criteria included an injury sustained at Road Traffic Crashes (RTC) irrespective of the type of vehicle, hospitalization 1 day in the Intensive Care Unit (ICU) or sub-ICU, and age 18 years or over. Patients were interviewed at 1, 6, and 12 months upon admission. The study used widely recommended classifications for injury severity (Abbreviated Injury Severity [AIS]; Maximum Abbreviated Injury Severity [MAIS]) and standardized measures such as the Disability Assessment Schedule II (WHODAS 2.0), “Impact of Event Scale” (IES-R), Center for Epidemiological Studies Depression Scale (CES-D Scale). Health Care Expenditure was assessed through the Monash University Accident Research Centre (MUARC's) framework, which included measures of ‘Direct’ and ‘Indirect’ costs. Diagnosis-related groups (DRGs) were used to estimate hospitalization costs. Results: A total of 54 two-wheel users enrolled in the study in all the countries and 32 completed all follow-up questionnaires. Physical disability increased over 12 months following the injury. Post Traumatic Stress Disorder (PTSD) symptoms of avoidance remained at high levels over the study period. PTSD symptoms of intrusion improved significantly during the second half of the year under investigation. The total annual cost of injury for the two-wheel users who were hospitalized in the selected ICU of all the partner countries for severe injury in 2013/2014, was estimated at €714,491 made up of €123,457 direct and €591,034 indirect costs. Men, aged 50–64 years and those who sustained slight injuries primarily at the lower extremities presented higher indirect costs per person. A total of €1032.092 was spent on hospitalization payments. Women, aged 65 + and those who sustained severe injuries at the central body region presented higher direct costs per person. Women, aged 50–64 years, those with severe injuries and a major injury at the central body and the upper body region presented the highest hospitalization costs per person. Conclusions: There is a need for effective strategies to early detect and treat groups at risk of being confronted with prolonged psychosocial and economic consequences. Practical implications: A holistic understanding of the impact of injury on individuals is important in order to achieve effective treatment of psychological co-morbidities in a timely manner.