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Keywords:

  • injury;
  • emergency medicine;
  • consumer product

Abstract

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Limitations
  7. Conclusions
  8. References

Objectives:  The objective was to examine injuries related to the use of a snow blower among patients treated in an emergency department (ED).

Methods:  Data were obtained from the National Electronic Injury Surveillance System (NEISS) for the years 2002–2008. National estimates of ED visits for injuries associated with the use of a snow blower were obtained, and descriptive epidemiologic characteristics assessed.

Results:  From 2002 through 2008, there were an estimated 32,307 ED visits for injuries related to the use of a snow blower in the United States. Older adults had a higher proportion of ED visits for such injuries than younger age groups. The majority of injuries involved injuries to the hand, with 42% of cases diagnosed with fractures and 20% resulting in amputations.

Conclusions:  Findings indicate that injuries from snow blowers remain a public health problem. Efforts to reduce injury incidence are discussed in accordance with inherent challenges of prevention of injuries associated with these products.

ACADEMIC EMERGENCY MEDICINE 2010; 17:566–569 © 2010 by the Society for Academic Emergency Medicine

Despite advances in safety standards, snow blowers continue to constitute a serious injury threat. Research concerning injuries related to snow blowers has consisted primarily of case studies that have focused on hand injuries (namely, amputations and fractures),1–5 which are typically the most serious injuries attributed to snow blowers.6 Population-based studies are lacking concerning the epidemiology of injuries associated with this product. The Consumer Product Safety Commission (CPSC) highlighted injuries from 1990 through 1997.6,7 Findings indicated an annual average of approximately 4,300 injuries, with the most frequent and serious injuries occurring to the hand. Previous case studies focusing on serious hand injuries have shown that the majority were injured while attempting to clear snow from the machine and were subsequently struck by the moving auger blade, resulting in an amputation, laceration, or fracture of the hand, fingers, or both.1–5,7

Since 1975, a voluntary safety standard set by the American National Standards Institute and Outdoor Power Equipment Institute (ANSI/OPEI) was implemented that included an operator presence safety control designed to stop the auger blade from moving whenever it was released by the operator.8 Evidence suggests that this device is subject to a delay in time for the blade to stop rotation once the operator presence control switch is invoked. If the snow blower becomes stuck due to an abundance of snow accumulating in the machine (which is the prompting reason to clear the auger), the blade may store up rotational force and rotate briefly once the obstruction of snow is cleared, thereby increasing the risk of injury.2,3,6 Based on case studies of hand injuries, risk factors and prevention strategies of those injuries have been documented.1–5,7 The main recommendations include never using one’s hand to clear snow from the exit chute, particularly if the machine is still running, regardless of the presence of an operator control mechanism. Due to the lack of recent population-based studies regarding snow blower injuries, and the frequent changes and improvements to the design of such products, we sought to examine current national data to describe injuries related to snow blower use among patients presenting to emergency departments (EDs) in the United States.

Methods

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Limitations
  7. Conclusions
  8. References

Study Design

Data from the National Electronic Injury Surveillance System (NEISS) for the years 2002 through 2008 were analyzed.9 This study received institutional review board approval.

Study Setting and Population

Established in 1972 and operated by the CPSC, the NEISS provides national estimates for initial visits to EDs for injuries related to consumer products. The NEISS surveillance system consists of a nationally representative, stratified probability sample of U.S. hospitals that have a minimum of six beds and house a 24-hour ED. From this sample, the total number of product-related injuries treated in hospital EDs nationwide can be estimated. The NEISS provides data on approximately 500,000 injuries per year treated in EDs that are related to consumer products.

Study Protocol

Cases were defined as anyone treated in an ED for an injury related to the use of a snow blower (product codes 1458, 1459, 1406). Other variables measured included sex, race, disposition, principal diagnosis, and primary body site of injury. Text narratives describing the circumstances of the injury were abstracted from the NEISS and used to eliminate cases deemed as noninjury ED visits related to snow blower use (e.g., shortness of breath or myocardial infarction while using a snow blower).

Data Analysis

Sample weights were applied to the patient visits to produce national estimates. To account for the multistage sampling design of the NEISS, all estimates were calculated using the survey procedures (e.g., SURVEYFREQ) available in SAS Version 9.1.3. Sample size estimates based on fewer than 20 raw cases (or 1,200 weighted cases), or that had a coefficient of variation equal to or greater than 30%, were considered unreliable.10

Results

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Limitations
  7. Conclusions
  8. References

During the study period, an estimated 32,307 (95% confidence interval [CI] = 21,981 to 42,632) ED visits for injuries related to the use of a snow blower occurred in the United States. This yielded an average annual frequency of 4,615 injuries. Males were disproportionately represented, accounting for 90% (95% CI = 87.4% to 93.0%) of all injury visits. The majority of injuries occurred among those aged 40 and older (71%; 95% CI = 66.3% to 75.9%). Few injuries occurred among those aged birth to 19 years (see Table 1). Table 2 depicts the major diagnoses, body part injured, and disposition of injured patients. The most common injuries involved fractures/avulsions (30%; 95% CI = 25.2% to 36.7%), lacerations (23%; 95% CI = 17.8% to 28.2%), and contusions/ abrasions/strains/sprains (19%; 95% CI = 14.8% to 23.4%). Amputations accounted for 12.7% (95% CI = 8.3% to 17.0%) of all injuries, with 100% of all amputations involving the hand or fingers. The majority of patients (92.8%; 95% CI = 88.5% to 97.2%) were treated and released the same day, with 5.7% (95% CI = 3.2% to 8.3%) admitted to the hospital or treated and transferred to another hospital. Overall, all body sites were susceptible to injury. Injuries to the hand and/or fingers represented the highest proportion of injuries (62.1%; 95% CI = 56.6% to 67.5%), with 42% (n = 8,354) of those injuries with a primary diagnosis of fracture or avulsion, 29% (n = 5,811) as lacerations, and 20% (n = 4,089) as amputations. Other body sites injured included the lower trunk (10.8%; 95% CI = 7.8% to 13.8%) and legs and lower extremities (7.4%; 95% CI = 5.5% to 9.4%). Descriptive analyses by age group indicate that among patients presenting with amputations, the highest proportion occurred among those aged 60 years and older (38%; 95% CI = 28.7% to 48.3%). Those aged 40–59 years accounted for the highest proportion of fractures and avulsions, representing 47% (95% CI = 38.9% to 55.9%) of injuries (see Table 3).

Table 1.    Demographics of ED Visits for Injuries Related to Snow Blowers, United States, 2002–2008
VariableNo. of Visits–Weighted (95% CI)Percentage* of Visits (95% CI)
  1. *Percentages may not add up to 100% due to rounding.

  2. †Estimate does not meet standard for reliability or precision.

Total32,307 (21,981–42,632)100
Sex
 Male29,133 (19,727–38,539)90.2 (87.4–93.0)
 Female3,174 (1,850–4,499)9.8 (7.0–12.6)
Age, yr
 Birth–191,895 (1,006–2,784)5.9 (4.2–7.6)
 20–39 7,436 (4,341–10,531)23.0 (19.1–26.9)
 40–59 14,111 (9,164–19,057)43.7 (38.9–48.5)
 60 and older8,865 (6,296–11,434)27.4 (22.1–32.8)
Race
 White19,694 (10,049–29,340)61.0 (43.1–78.8)
 Black or African American1,039 (270–1,808)3.2 (0.8–5.6)
 Other
 Unknown11,131 (5,126–17,137)34.5 (16.8–52.1)
Table 2.    ED Visits for Injuries Related to Snow Blowers: Diagnoses, Body Site Injured, and Disposition, United States, 2002–2008
VariableNo. of Visits–Weighted (95% CI)Total Percentage* (95% CI)
  1. *Percentages may not add up to 100% due to rounding.

  2. †Value does not meet standard for reliability or precision.

  3. ‡Other indicates a combination of those events which did not meet the standard for reliability or precision on their own.

Injury diagnosis
 Fracture/avulsion9,998 (5,978–14,018)30.1 (25.2–36.7)
 Laceration7,423 (4,856–9,990)23.0 (17.8–28.2)
 Contusion/abrasion/strain/sprain6,169 (3,855–8,483)19.1 (14.8–23.4)
 Amputation4,089 (1,998–6,180)12.7 (8.3–17.0)
 Other4,628 (2,616–6,641)14.3 (9.7–19.0)
Body site injured
 Finger or hand20,049 (13,207–26,890)62.1 (56.6–67.5)
 Lower trunk3,477 (1,991–4,963)10.8 (7.8–13.8)
 Legs and extremities2,404 (1,352–3,457)7.4 (5.5–9.4)
 Head and neck2,268 (1,313–3,224)7.0 (4.7–9.4)
 Upper trunk/shoulders2,092 (1,002–3,182)6.5 (3.6–9.4)
 Arms1,748 (868–2,629)5.4 (3.1–7.7)
 Multiple body sites
Disposition
 Treated and released29,932 (20,719–39,145)92.8 (88.5–97.2)
 Hospitalized/transferred and hospitalized1,850 (757–2,942)5.7 (3.2–8.3)
 Other‡
Table 3.    Number and Percentage of ED Visits for Injuries Related to Snow Blowers: Age Group and Diagnoses, United States, 2002–2008
 Age Group (yr), Percentage* of Visits (95% CI)
  1. *Percentages in all columns may not add up to 100% due to rounding.

  2. †Value does not meet standard for reliability or precision.

Diagnosis0–19 (n = 1,895)20–39 (n = 7,436)40–59 (n = 14,111)60 and Older (n = 8,865)
Fracture/avulsion24.6 (17.5–31.8)47.4 (38.9–55.9)21.2 (13.4–28.9)
Laceration9.3 (4.5–14.0)21.5 (13.3–29.7)50.8 (36.9–64.8)18.4 (10.7–26.1)
Amputation25.7 (16.8–34.7)33.6 (23.5–43.8)38.5 (28.7–48.3)
Contusion/abrasion/strain/sprain6.8 (1.9–11.7)31.3 (22.3–40.3)33.0 (24.5–41.6)28.9 (17.6–40.2)

Discussion

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Limitations
  7. Conclusions
  8. References

Compared to published reports by the CPSC,6 we found a slightly higher frequency of ED visits for injuries related to snow blowers. Reports using the same data from the CPSC between 1990 and 1997 indicated an annual average of 4,295 injuries related to snow blower usage.6 The reasons for this are unclear, but may be the result of increased use of (and subsequent exposure to) the product over time. Therefore, we cannot assume that the risks associated with using a snow blower have increased. However, based on the frequency of ED visits, the burden to the medical care community does not show signs of waning over time.

Patients presenting to EDs with snow blower–related injuries tended to be adults, with comparatively few children and young adults being injured. Our analyses of national data on the types of injuries associated with snow blowers tend to expand on and concur with the results of smaller scale case studies that focused exclusively on hand injuries.1–7 We found that the majority of injuries occurred to the hand, with fractures, lacerations, and amputation being the most common forms of injury. For EDs that treat a high volume of snow blower injuries, these findings lend support to the availability of hand trauma specialists. This would be particularly advisable during winter months or more specifically when heavy snow accumulates and snow blower use is likely to be more frequent.

The CPSC determined that, on average, 66% of snow blower injuries were fractures, lacerations, or amputations.6 Our findings indicate that this proportion has not changed. Assuming that fractures and amputations are indicative of the most serious injuries attributed to snow blowers, our findings indicate that the types of injuries have not lessened in severity over time. For hand injuries, the most common risk factor has been shown to be using one’s hand to clear wet snow that is clogged in the discharge chute.1–6 A variety of circumstances have been found to produce hand injuries, including lack of an operator presence control switch and not waiting for the blades to stop coasting once an operator presence control switch is invoked. Furthermore, the most commonly used machines are two-stage snow blowers, in which a front auger picks up the snow and an internal impeller discharges the snow. Research indicates that some users are unaware of the impeller blade and its location on the machine, thereby increasing their injury risk.3

As suggested by the Society for Academic Emergency Medicine (SAEM) Public Health Task Force,10 the emergency physician (EP) is in a prominent position to identify issues that affect policy and improve the health of the patient population. With regard to snow blower injuries, the EP may be the first and possibly only medical contact for persons injured by these devices. As such, educating patients on the hazards of snow blowers in an effort to prevent subsequent injuries is recommended. EPs who treat an abundance of injuries related to snow blowers are in a prime position to advocate consumer groups and manufacturers for better designs to improve the safety of the machines. Novel design changes to snow blowers may be required to reduce the burden of traumatic injuries. As one way to address the risk of hand injuries, a chute cleaning tool, which is a hand-held shovel-shaped device that is attached to the machine for ease of access and use, is now standard on most models. However, the use and effectiveness of this device has not been studied. Behavior change efforts are another plausible option, although most major manufacturers have safety information included in their manuals and on the machines themselves. Timely public service announcements (PSAs) may be effective in reminding users of injury risks; however, evaluation of these strategies, such as the timing, content of PSAs, depth of coverage, and target audiences, is needed. While educational strategies exist, the effectiveness of these strategies is unknown. Hence, evaluation of the current educational techniques may reveal changes needed to improve the effectiveness of these preventive strategies. Current educational strategies cannot be considered a failure or a success because that line of research does not exist. It may be that some components are effective, need to be broadened, or are not reaching the target audience.

Limitations

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Limitations
  7. Conclusions
  8. References

This study was limited by the nature of the NEISS data. While we analyzed the narrative text entries describing each injury incident, the narratives were determined to be too general to elicit circumstances surrounding the injury (e.g., “amputated fingers while using snow blower,”“amputation R 5th finger”). Therefore, little information was present regarding the circumstances surrounding the injury event. It is also likely that the frequency of injuries is underrepresented, and the severity of injuries is actually higher, as NEISS reports only ED visits, not injuries treated elsewhere, or those not seeking treatment. NEISS provides a single diagnosis code. If multiple diagnoses are present, the most serious is listed as the principal diagnosis. Therefore, secondary diagnoses are excluded from our analyses. Last, because we do not know the number of people who use snow blowers or for what length of time, exposure data are void. Accordingly, it is impossible to estimate the true incidence of snow blower–related injuries or the true risk of injury attributed to the use of these products.

Conclusions

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Limitations
  7. Conclusions
  8. References

Snow blowers constitute a serious issue for EPs who treat patients in areas where snow blowers are frequently used. Additional research is needed to evaluate specific interventions to reduce the number and severity of snow blower–related injuries.

References

  1. Top of page
  2. Abstract
  3. Methods
  4. Results
  5. Discussion
  6. Limitations
  7. Conclusions
  8. References
  • 1
    Chin G, Weinzweig N, Weinzweig J, Geldner P, Gonzalez M. Snow blower injuries to the hand. Ann Plast Surg. 1998; 41:3906.
  • 2
    Proano L, Partridge R. Descriptive epidemiology of a cluster of hand injuries from snow blowers. J Emerg Med. 2002; 22:3414.
  • 3
    Master D, Piorkowski J, Zani S, Babigian A. Snow blower injuries to the hand: epidemiology, patterns of injury, and strategies for prevention. Ann Plast Surg. 2008; 61:6137.
  • 4
    Dietzel DP, Gorosh J, Burke EF, Singer RM. Snow blower injuries to the hand. Am J Orthop. 1997; 26:8637.
  • 5
    Millea TP, Hansen RH. Snow blower injuries to the hand. J Trauma. 1989; 29:22933.
  • 6
    U.S. Consumer Product Safety Commission. Snow Thrower Safety Alert. Washington DC: U.S. Consumer Product Safety Commission, 2004.
  • 7
    U.S. Consumer Product Safety Commission. Snow Thrower Related Hazards, 1990–1997. Washington DC: U.S. Consumer Product Safety Commission, 1998.
  • 8
    American National Standards for Snow Throwers. Safety Specifications. New York, NY: American National Standards Institute, Inc., 1995, pp B713.
  • 9
    Consumer Products Safety Commission. National Electronic Injury Surveillance System Sample Design and Implementation. Available at: http://www.cpsc.gov/LIBRARY/neiss.html. Accessed Feb 14, 2010.
  • 10
    Society for Academic Emergency Medicine. What is Advocacy? Available at: http://www.saem.org/saemdnn/Advocacy/tabid/67/Default.aspx. Accessed Feb 14, 2010.