A New Partnership Focuses on the Occupational Safety and Health Needs of Lone Workers

 

Working alone is common in many industries and may introduce safety and health risks for workers. In 2023, the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) formed a partnership to improve safety and health for lone workers by developing and disseminating information about the risks of working alone and promising prevention strategies.

What is lone work?

NIOSH and OSHA do not currently have a standard definition of lone work. Based on information in the literature, and for the purpose of this blog, we are defining lone work as a potentially hazardous working condition that occurs when an individual cannot be seen or heard by another worker and where assistance is not readily available. Lone workers are found in every major U.S. industry. Their work sites can be fixed (e.g., factory, warehouse) or mobile (e.g., construction site, taxi). Lone work may occur in remote locations (e.g., oil and gas well sites, rural highways), at worksites where the employee is physically separated from their coworkers (e.g., farms, large industrial facilities), or when working with the public (e.g., convenience stores, home healthcare). Lone workers may be at increased risk of exposure to workplace hazards due to lack of assistance and supervision and the limited means of communication including receiving help in an emergency. Lone work may be a permanent or temporary arrangement.

How many lone workers are there and where do they work?

The number of employees in the United States who work alone is unknown because most occupational health information systems (e.g., workers’ compensation data, autopsy reports, OSHA investigations) do not systematically collect information on whether an individual was working alone at the time of an incident. However, a report describing lone worker solutions estimated that there were 53 million lone workers in the United States, Canada and Europe[1], comprising approximately 15% of the overall workforce[2]. The number of lone workers in the United States is expected to increase due to automation and as leaner staffing models become more common in modern industrial settings[3].

What are the potential risks to lone workers?

Lone workers can encounter the same spectrum of workplace hazards as individuals in busy workplaces surrounded by co-workers. Some hazards, such as exposure to violence, may become more likely when a worker is alone. Convenience store cashiers, for example, may appear “easy targets” if they are alone[4],[5]. As another example, home healthcare workers who experience violence are at higher risk because no coworker is present to assist them.

Working alone may also increase workers’ subjective feelings of loneliness[6]. Loneliness is associated with significant long term health risks and could be an important factor to address among employees[7]. Social isolation, which is the objective experience of having few social relationships and infrequent social interaction, is independently associated with long term health risks, as well6. A 2023 NIOSH science blog explored social connection and the influence of work on individual and community health. Workers who are socially isolated or alone may not have the practical benefit of co-workers, health and safety professionals, or supervisors to help or support them in meaningful ways. For example, lone workers may have difficulty identifying the safest work practices when something unexpected happens that isn’t covered by a workplace policy. For this very reason, researchers and practitioners have emphasized the importance of a strong safety culture and safety climate to protect lone workers.[8],[9]

Perhaps most importantly, especially for workers in high-hazard industries, working alone can delay or deny a robust response to a workplace emergency. Investigations of “unwitnessed” fatalities, in which a worker did not report at the end of the shif [10] or whose body was discovered by a coworker[11], tragically illustrate what can happen when no co-workers are present to assist with life-saving actions. Research studies have shown that timely access to emergency services can improve the probability of surviving a heart attack or traumatic injury.[12]^,[13]

Lone Worker Case Study: Farm worker heat-related fatality The NIOSH Fatality Assessment and Control Evaluation (FACE) Program and State FACE Programs study workplace fatalities and prepare reports with recommendations to prevent similar deaths. The following report is the product of one of our Cooperative State partners, the Oregon FACE Program*. On June 26, 2021, a 38-year-old Hispanic farm labor worker was found unresponsive in the field where he was working. He was part of a five-person work crew installing irrigation lines at an Oregon nursery. The crew had been working on the site since 5 am. They took a morning break at 10 am and a lunch break at noon. When it was time for the afternoon break at 3 pm, the employee did not report back to the van with the other employees. They tried calling his phone, but he had left it in the work passenger van. The crew notified the supervisor about the missing employee. Other work crew employees went into the field to look for the missing farm worker and found him unconscious and face down where he had been working. The other work crew members moved him to a shaded area nearby. Emergency response was called and arrived at the scene in approximately 10 minutes. According to the Medical Examiner’s Report, the cause of death was exogenous hyperthermia (heat stroke) and dehydration. These conditions were caused directly by heat exposure, physical exertion, and inadequate hydration. The weather on the day of the incident was a major contributing factor. According to Weather Underground and the National Weather Service, the high temperature recorded at the closest weather station reached 105°F on June 26, 2021. During this time, temperatures were much higher than is typical in this region, where the average temperatures in June range between 60°F and 70°F. The Oregon FACE investigators concluded that “Inadequate communication with a supervisor or electronic tracking of heat stress symptoms” was one of several contributing factors to this fatality. One of the recommendations included in the final report was “Employers should implement communication methods, buddy system, or electronic tracking of employees that are exposed to conditions that could contribute to heat stress.” This incident illustrates the variety of settings in which workers may be alone, even when part of a group, and at increased risk of injury or death. * The findings and conclusions in this FACE report are those of the individual Cooperative State partner and do not necessarily reflect the views or policy of the National Institute for Occupational Safety and Health.

What OSH regulations in the United States apply to lone workers?

Regulations dedicated to protecting lone workers exist around the world. The United States does not have a comprehensive legal standard or rule addressing working alone. It is generally not against the law in the United States, however, OSHA standards prohibit lone work in certain circumstances. Those include when workers enter an immediately dangerous to life or health atmosphere (29 CFR 1910.134, 29 CFR 1926.1211), when working in confined spaces (29 CFR 1910.146, 29 CFR 1926.1204) or in hazardous waste and emergency response operations (29 CFR 1910.120, 29 CFR 1926.65), and while performing work near energized parts (29 CFR 1910.269, 29 CFR 1926.960). OSHA’s General Duty Clause may apply where lone worker hazards are not addressed in specific standards (29 USC 654). As another example, the Mine Safety and Health Administration (MSHA) prohibits covered miners from working alone in any area where hazardous conditions exist that would endanger worker safety unless they can communicate with others, can be heard, or can be seen (30 CFR 56.18020, 30 CFR 57.18020, 30 CFR 57.18025).

What can be done to protect lone workers?

Controlling workplace hazards is important for all workers, including for lone workers. Implementing effective control strategies, based on the hierarchy of controls[14], is a sound approach to reducing risks to lone workers. While many companies are voluntarily adopting measures to protect lone workers, there is limited published research that evaluates the implementation and effectiveness of lone worker controls in the workplace. Future research could explore available lone worker controls as well as the issues that companies may consider before implementing such controls. Examples include: the functionality and effectiveness of lone worker technologies, especially in remote and rural locations; the cost of purchasing and maintaining technologies; employee buy-in and utilization of employer-provided technologies; and how to use the large volume of data generated by lone worker technologies to inform lone worker programs. Additionally, some technologies designed to improve emergency medical response times (e.g., lone worker monitoring devices) may introduce psychosocial stressors for workers who may feel as though they’re being constantly monitored by their employer[15].

What questions remain?

Lone work is not new, but there is surprisingly limited peer-reviewed research on the topic. Many questions remain for those who want to better understand who works alone, in what settings, the hazards that lone workers may face, and how best to protect those who work alone. Occupational health information systems could be updated to include a lone worker variable, which would allow researchers to explore the associations between lone work and adverse outcomes. Similarly, the risks lone workers face have not been fully documented and there is limited information on effective control strategies. Finally, lone worker technologies need to be rigorously evaluated and results shared so that employers and researchers can assess effectiveness. The OSHA/NIOSH lone worker partnership would like to collaborate with companies, workers, vendors, public health agencies, and other researchers to help answer these questions.

 

Ryan Hill, MPH, is the Director of the NIOSH Western States Division and the Manager of the NIOSH Oil and Gas Extraction Sector Program and the Manager of the NIOSH Transportation, Warehousing, and Utilities Program

Ken Scott, PhD, MPH is a Senior Epidemiologist at the NIOSH Western States Division

Chandran Achutan, PhD, is a Lead Research Health Scientist with the Division of Science Integration and co-coordinator of the NIOSH Wholesale and Retail Trade sector council

Debbie Hornback, MS, is a Health Communication Specialist in the NIOSH Division of Science Integration

Todd Jordan, MSPH, CIH is the Director of OSHA’s Health Response Team in the Directorate of Technical Support and Emergency Management

Trapper Braegger, CIH, CSP, is an Industrial Hygienist for the OSHA Health Response Team

 

References

[1] Verdantix [2019]. Buyer’s guide: Lone worker solutions. Available at: https://www.verdantix.com/report/environment-health-safety/buyer-s-guide-lone-worker-solutions. Accessed May 10, 2024.

[2] Verdantix [2021]. Strategic focus: Reducing lone worker injury and fatality risks. Available at: https://www.verdantix.com/report/environment-health-safety/strategic-focus-reducing-lone-worker-injury-and-fatality-rates. Accessed May 10, 2024.

[3] Hyten C, Sevin B, and Agnew J [2017]. Lone Worker Safety Behavior-Based Self-Management Anchored in Personal Values. American Society of Safety Professionals, Professional Safety, Vol. 62, No. 1. https://www.jstor.org/stable/48688763

[4] Amandus H, Hendricks S, Zahm D, Friedmann R, Block C, Wellford C, et al. [1997] Convenience store robberies in selected metropolitan areas. Risk factors for employee injury. J Occup Environ Med. 1997 May;39(5):442-7. doi: 10.1097/00043764-199705000-00010.

[5] Faulkner K, Landsittel D, Hendricks S. [2001] Robbery Characteristics and Employee Injuries in Convenience Stores. Am. J. Ind. Med., 40: 703-709. doi.org/10.1002/ajim.10011

[6] D’Agostino A, Pepi R, Monti M, Starcevic V [2020] The Feeling of Emptiness: A Review of a Complex Subjective Experience. Harv Rev Psychiatry. 2020 Sep/Oct;28(5):287-295. doi:10.1097/HRP.0000000000000269.

[7] Holt-Lunstad J, Smith T, Baker M, Harris T, Stephenson D [2015] Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015 Mar;10(2):227-37. doi:10.1177/1745691614568352.

[8] Olson R, Anger W, Elliot D, Wipfli B, Gray M [2009] A new health promotion model for lone workers: results of the Safety & Health Involvement For Truckers (SHIFT) pilot study. J Occup Environ Med. 2009 Nov;51(11):1233-46. doi: 10.1097/JOM.0b013e3181c1dc7a.

[9] Lee J, Huang Y, Robertson M, Murphy L, Garabet A, Chang W [2014] External validity of a generic safety climate scale for lone workers across different industries and companies. Accid Anal Prev. 2014 Feb;63:138-45. doi: 10.1016/j.aap.2013.10.013.

[10] Cierpich H [2022] Forklift Operator Dies After Falling Into a Recycling Baler – California. California State FACE Program, case report: 22CA001. Available at: https://www.cdc.gov/niosh/face/pdfs/22CA001.pdf.

[11] Harrison R, Retzer K, Kosnett M, Hodgson M, Jordan T, Ridl S, Kiefer M [2016] Sudden Deaths Among Oil and Gas Extraction Workers Resulting from Oxygen Deficiency and Inhalation of Hydrocarbon Gases and Vapors – United States, January 2010-March 2015. MMWR Morb Mortal Wkly Rep. 2016 Jan 15;65(1):6-9. doi: 10.15585/mmwr.mm6501a2.

[12] Lambert L, Brown K, Segal E, Brophy J, Rodes-Cabau J, Bogaty P [2010] Association between timeliness of reperfusion therapy and clinical outcomes in ST-elevation myocardial infarction. JAMA. 2010 Jun 2;303(21):2148-55. doi: 10.1001/jama.2010.712. PMID: 20516415.

[13] Brown J, Rosengart M, Billiar T, Peitzman A, Sperry J [2017] Distance matters: Effect of geographic trauma system resource organization on fatal motor vehicle collisions. J Trauma Acute Care Surg. 2017 Jul;83(1):111-118. doi: 10.1097/TA.0000000000001508.

[14] NIOSH [2024] About Hierarchy of Controls. Available at: https://www.cdc.gov/niosh/hierarchy-of-controls/about/index.html. Accessed June 7, 2024.

[15] Glavin P, Bierman A, Schieman S. [2024] Private Eyes, They See Your Every Move: Workplace Surveillance and Worker Well-Being. Social Currents, 0(0). https://doi.org/10.1177/23294965241228874.