Risk Factors Associated with the Manual Handling of Coffins

1. Risk Factors Associated with the Manual Handling of Coffins Amy Jones

2. Contents Background Data Gathering Risk Factors Summary of Risk Factors Recommendations

3. Background • HSL approached by a Local Authority Inspector at Rushmoor Borough Council regarding the issue of manual handling risks to individuals who handle coffins • Little guidance available • Potential problem of recommendations being accepted e.g. by members of the public • Report to provide ergonomic* support * “… the application of scientific information concerning humans to the design of objects, systems and environments for human use.”

4. Data Gathering • Difficulties due to sensitivities surrounding funerals • Site visit to Crematorium in Aldershot – interviews, observation of cremation • Site visits during the HSE Better Backs Campaign • Interviews with staff at Independent Funeral Directors • Observation of burial in Manchester

5. Data Gathering Example from the MAC tool • Simulations using a 3D computer modelling programme • Observational analysis using video footage • Comparison to HSE guidance - Manual Handling Regs, Manual Handling Assessment Chart (MAC) • Rapid Entire Body Assessment tool (REBA)

6. Data Gathering • Scope of study limited to handling during funerals, coffin to hearse and coffin to grave or cremator • There may be additional risk factors not identified within the scope of the study e.g. religious and cultural practices • The risk factors covered may not necessarily be found at other places around the country

7. Posture Lifting from hearse to shoulders Lifting to shoulders = medium risk using the MAC (examine tasks closely)

8. Posture Carrying the Coffin • Slight twisting and sideways bending of trunk • Neck flexion • Load carried to side • Extraneous factors, e.g environmental, communication • REBA tool assesses this as a mediumrisk (necessary action is needed)

9. Posture Lowering Coffin to Catafalque • At the start of the lift the bearers hands are above elbow-shoulder height = mediumrisk using the MAC tool • Back muscles work harder when lifting occurs with the back flexed forwards in addition to supporting ones own weight therefore increasing the compression forces in the spine

10. Posture Coffin to Ground Level • Hand distance from the lower back at the last stage of descent is at a moderate distance as the individual has to bend his trunk forward which is compromised due to the presence of the grave hole. • Lowering from shoulder height to ground level = high risk score in the MAC

11. Posture Summary • Highest risk of Musculoskeletal Disorders (MSDs) e.g. sprains and strains from lifting on/off shoulder, long carry distances, lowering to floor level. • Height of furniture influences posture e.g. low catafalque increases risk of MSDs particularly to the lower back. • Abilities of individuals need to be considered e.g. skill, age, experience, strength, techniques, training • Cumulative damage highly likely for regular exposure, increasing the risk of acute injury to the lower back over a period of time

12. Load • Funeral Directors do not usually know the precise weight of the body (there is a trend of increasing body weight) • Vast differences in weight according to coffin material and weight of the deceased • In this study (from statistics and research) • 35kg average coffin • 50kg top end coffin • 76kg average body weight • 107kg “heavier” body

13. Load • The weight of some coffins handled by a team of 4 will fall within the “high risk” category of MAC. This may expose a significant proportion of the working population to risk of injury. • Team of 6 handling a heavier coffin will reduce the risk but increase the risk from poor co-ordination and control which can influence the lifting posture. • Quality of grip assessed as reasonable however the nature of gloves have a very significant effect on grip quality

14. Relationship between Load/Posture • Coffins are handled above shoulder height and below knee height • 35.5kg per bearer = Exceeds HSE risk filter guidelines by at least a factor of 3 • 23.7kg per bearer (dividing load between 6) = Exceeds HSE risk filter guidelines by at least a factor of 2 HSE Risk Filter Guidelines

15. Relationship between Load/carrying Posture Combination of load/posture scenarios simulated (using 3d computer modelling program JACK) to analyse lower back compression forces

16. Relationship between Load/carrying Posture • Analysis reveals that the estimated compression forces acting on the lower back are low in comparison to the National Institute for Occupational Safety and Health (NIOSH) back compression action limit of 3400 N (representing a nominal risk to the majority of the working population) • The force travels down the body in a vertical line so there is a much smaller moment about the low back than if the load was held away, thus putting much less strain on the lower back

17. Relationship between Load/ Lifting Posture • Posture of a bearer lowering heavier coffins at the gravesite with straighter legs above the NIOSH back compression action limit • May place some individuals at increased risk of sustaining a lower back injury

18. Repetition • Will vary considerably for example from one to six funerals per day • MAC classifies loads between 23-45 kg lifted once per day as medium risk. This decreases to 18-39 kg for lifting once every 30 minutes. Therefore the risk presented by the load and frequency with four bearers lifting coffins at up to four cremations a day = medium risk • Does not take into account difficulties of lifting/carrying on the shoulder therefore regarded as minimum estimate of the risk

19. Burials • A carry distance of over 10 meters presents a high risk to the bearers • Regardless of weight there are a number of factors to consider: • Limited hearse access • Narrow walkways • Re-opening of graves • This may constrain the postures of the bearers exposing them to an increased risk of slips, trips and falls and MSD injury

20. Burials • Ground conditions may be sloping or uneven due to a natural slope in the ground, or due to settling of the earth in adjacent graves • Weather conditions are influential; the likelihood of slips, trips and falls will be increased when the ground is wet and slippery due to rain, ice or wind • Due to working outdoors and often waiting out in the cold, muscles can go cold and fatigued and therefore the risk of injury is increased

21. Chapel/Church • Likelihood of steps to the entrance and inside the building • Low door height (in old churches) requiring the bearers to dip in order for the coffin to pass under the door frame • Narrow aisles (in old churches) report of a problem with a 22-inch wide coffin with bearers either side struggling to pass down a 36-inch aisle

22. Cremation A long carry distance may be encountered from the doors of the chapel to the catafalque Steps may be present up to the catafalque Coffins are usually rather sharp cornered and hard so local contact pressure on the shoulder of the bearer is likely to be high and consequently present a risk of injury in itself

23. System of Work • Reality of Team Working: • Inexperienced bearer teams • Bent postures – risk of MSDs is increased • Lack of communication • Lack of technique • Inadequate training for both relatives and bearers • Risk assessments

24. Summary of Risk Factors • WWeight of load: The weights of some coffins handled by a team of 4, fall within the “high-risk” category in accordance to MAC • LLow back compression forces:Higher than the NIOSH back compression action limit when lowering heavier coffins with straighter legs at the gravesite • CConstrained posture: Combined with the load consequently means the HSE risk filter guidelines are exceeded by at least a factor of three .

25. Summary of Risk Factors • Environmental factors: long carry distances; slip and trip hazards; narrow access; low heights of furniture • Training: Inadequate for both relatives and bearers • Team handling: Lack of technique and communication for inexperienced bearer teams “These risk factors may not necessarily be present in other funeral homes, crematoriums, and burials. There may be additional risk factors that were not identified but are present within the industry”

26. Recommendations • Provide bearers with a coffin’s weight before manual handling. • Trolleys with integrated scales • Manufacturers to provide coffin weights • Consider the use of manual handling aids where possible • Trolley for long carry distances (trial led on a small scale to determine if they are suitable)

27. Recommendations • A fixed bearing team will help to ensure a smooth, well coordinated lift and carry • Adequate handles to serve as an additional handling aid. The use of gloves may also help with a better grip of the coffin • Using a checklist prior to each funeral in order to plan for high-risk environments, loads, etc • Adequate training for both relatives and bearers (with actual coffins in various environments) • Ensure the design of new buildings are fit for purpose

28. Thank you