IOGP Fatality and Permanent Impairment injury definitions

November 2022

1.   Introduction

IOGP Fatality and Permanent Impairment (FPI) injury definitions are designed for use in energy industry reporting. They are deliberately concise and concept based. Examples and an associated Frequently Asked Questions resource will help support specific case decision making. The concepts are provided in plain language to facilitate reliable interpretation and application across a wide scope of potential scenarios, by industry personnel without health qualifications. The permanent impairment injury definition should be determinable from a basic assessment of known injuries assisted by injury reports, medical certificates and/or worker self-reports of current status.

These definitions are aligned to recognised international systems of classification including the

  • American Medical Association Guides: The Sixth Edition
  • World Health Organization (WHO) International Classification of Functioning, Disability, and Health (ICF)

2.   Disclaimer

FPI criteria are not legally binding injury severity classifications and are not intended for use in relation to compensation payment calculations, legal or regulatory purposes. Quantification of impairment level for compensatory purposes should be undertaken by a certified assessor against local regulatory requirements.

3.   Definitions

3.1    Fatality

A death as a result of a work-related incident. ‘Delayed’ deaths that occur within 180 days post incident are to be included if the death was a direct result of the incident (refer to the Annual IOGP Safety Performance Indicators User Guide for the definition and further guidance on fatality, ‘delayed’ deaths, work related and injury).

3.2    Permanent Impairment (PI)

A direct work-related injury outcome that prevents a return to the person’s previous (pre-incident) whole person function within 180 days as a result of an acute, single incident resulting in any of the following:

  • Permanent loss of body parts
  • Permanent reduction of organ’s physiological function
  • Permanent reduction in skin and musculoskeletal function
  • Permanent reduction in psychological, social, or cognitive function

Note: “Whole person function” relates to a person’s biological/physical status as well as their emotional and social functioning.

The definition is not inherently time bound but for complex injuries with potential recovery permanent impairment definitions are not advised to be finalised before 180 days post incident.

A state of Maximum Medical Improvement (MMI) is achieved when a person has received all available medical intervention and rehabilitation options with no further status improvement deemed likely. On a case-by-case basis, if the specific information on the recovery prognosis is not available, a medical professional opinion should be used for determination of permanent impairment.

Beyond 180 days any further medical care delivered is deemed supportive and/or symptoms-based management rather than curative.

Impairment is defined both against ability to return to the previous work role and ability to perform the activities of daily living (ADL).

3.3       Injury work relatedness

An injury case is deemed work related when an acute/single incident (also referred to as a work-related injury resulted from instantaneous event or exposure, as per OSHA definition) in the work environment is the discernible cause of the FPI. Work relatedness of a secondary health outcome that may create permanent impairment requires a clear injury mechanism that explains the secondary outcome. In uncertain cases this will require expert medical opinion to confirm or refute the work incident as the root causative factor. For additional information see the IOGP Safety Performance User Guide. See classification examples.

3.4      FPI criteria

Within the FPI reporting methodology the following definitions are used:

  • Actual FPI: An incident that results in a fatality or permanent impairment
  • Potential FPI: An incident that results in an injury (first aid and recordable) that could have realistically resulted in a fatality or permanent impairment
  • Near Miss FPI: An event that could have realistically resulted in a fatality or permanent impairment where there was no actual injury

Note: IOGP defines a High Potential Event as any incident or near miss that could have realistically resulted in one or more fatalities. An actual, potential or near miss FPI may or may not be a high potential event.

3.5    Permanent Impairment criteria

The Permanent Impairment metric is met by any of the below criteria singularly or in combination. Impairment may occur to physical, psychological or social function if it related to an acute/single incident.

3.5.1.     Permanent loss of body parts

Permanent loss of body parts as a result of an acute/single incident due to mechanical trauma, thermal trauma, radioactivity, vibration, chemical exposure or other. Examples:

  • Amputations with loss of bone inclusive of one or more joints (not able to be reattached)
  • Loss of eye(s)
  • Loss of internal organs e.g. kidney, spleen (may also meet criteria 3.4.2)
  • Loss of facial structures, example: nose, ears, leading to disfigurement
  • Loss of genitalia or other sexual organs

Successful use of limb prosthesis to improve function does not negate a permanent impairment definition.

On a case-by-case basis, when diagnoses of permanent impairment is unclear, a medical professional opinion should be used to determine permanent impairment.

3.5.2.     Permanent reduction of organ function

Permanent reduction in an organ’s physiological function as a result of an acute/single incident due to a mechanical trauma, thermal trauma, radioactivity, vibration, chemical exposure or other. Examples:

  • Eye injury with loss of vision
  • Bowel injury requiring permanent stoma
  • Spinal injury requiring use of wheelchair
  • Brain injury causing epilepsy (recurrent seizures)
  • Heart injury with impaired exertion tolerance / measurable loss of function
  • Lung injury, including inhalation, with impaired exertion tolerance/measurable loss of function. Loss of smell that creates a safety concern or significant personal impact
  • Loss of hearing or persistent tinnitus (ear ringing) post injury after exposure to a blast
  • Post injury complex pain disorders with uncontrolled pain and/or disrupted nerve and musculoskeletal function
  • Genital or other sexual organ injury leading to loss of function

On a case-by-case basis, when diagnoses of permanent impairment is unclear, a medical professional opinion should be used to determine permanent impairment.

3.5.3.     Permanent reduction in skin and/or musculoskeletal function

Permanent reduction in skin and/or musculoskeletal function as a result of an acute/single incident due to a mechanical trauma, thermal trauma, radioactivity, vibration, chemical exposure or other. Examples:

  • Burns: deep burns (2nd or 3rd degree) with scarring or skin grafts that impair body movement or other function, or cause disfigurement or change to physical appearance.  This includes a reduction of skin integrity, hypersensitivity to touch or skin fragility leading to friction ulceration.
  • Tendon/ligament tear with ongoing pain and/or inadequate joint range of movement for normal work or general function such as cannot reach overhead, cannot squat or kneel.
  • Traumatic soft tissue injury to shoulder/knee/elbow with ongoing pain and/or inadequate joint range of movement.
  • Fracture with ongoing impairment to mobility.
  • Amputation with successful reattachment but reduced function.

On a case-by-case basis, when diagnoses of permanent impairment is unclear, a medical professional opinion should be used to determine permanent impairment.

3.5.4.     Permanent reduction in psychological, social or cognitive function

Permanent reduction in psychological, social or cognitive function as a result of an acute/single incident with psychological trauma including an inability to self-care and/or an inability to maintain previous work, social and community relationships post incident. Examples:

  • Brain injury with ongoing impact to emotional regulation, speech, memory, or other cognitive dysfunction
  • Post injury psychiatric disorders including Post Traumatic Stress Disorder (PTSD) with inability to return to previous work role and/or schedule

On a case-by-case basis, when diagnoses of permanent impairment is unclear, a medical professional opinion should be used to determine permanent impairment.

4.   Classification examples

4.1    Work related fatality

Person is crushed under a heavy metal plate. They are rescued and admitted to hospital for surgical repair of broken bones and ruptured soft tissue organ injuries. After 2 weeks they suffer multiorgan failure and died as a direct result of the severe nature of their injuries. This is a work-related fatality.

4.2    Non work related fatality

Person suffers a fall down stairs at work and breaks their right radius (wrist). They are discharged from hospital after surgery with metal fixation of the wrist and require a plaster cast and home-based care for 6 weeks. 2 weeks after discharge they suffer a heart attack and died. There is no medical link to suggest the injury was an attributable factor to trigger the heart attack. The death was due to an underlying personal condition and is not a work-related fatality even though they passed away within 30 days of an incident.

4.3    Permanent impairment mobility

A person in an office-based role is run over by a company vehicle on a company worksite. Due to spinal injuries, they require a wheelchair permanently. They can return to work and perform their office-based role without modifications but face significant challenges in their ability to self-care and perform the other activities of daily life. The injury caused a permanent impairment.

4.4    Brain injury

A person suffers a head injury from a heavy dropped object and is knocked unconscious. They are evacuated to a hospital and found to have a bleed on the brain and increased intracranial pressure. They require brain surgery to drain the bleeding and are placed in a therapeutic coma to optimise recovery. They are monitored and within one week are alert and able to converse but have no memory of the incident.

  1. If they required short-term seizure control medication, rehabilitation and psychological therapy post discharge but have fully recovered from any seizures, mood disturbance, emotional regulation or cognitive function and not require further medication or therapies beyond 180 days. – NOT PI
  2. If they were unable to return to a normal work role and schedule within 180 days due to one or more of the following: medication with impairing side effects, seizures, mood disturbance, emotional regulation or cognitive function decline. – PI

4.5    Post Traumatic Stress Disorder (PTSD)

A person was involved in rescuing a co-worker from an explosion / fire scenario and suffered 1st degree burns to their left arm. It required dressings and had a full recovery to normal skin function in 6 weeks. During the incident they witnessed their co-worker suffer extensive 3rd degree burns. That co-worker subsequently died. This affected the person psychologically with recurrent flashbacks to the incident scene and created a general anxiety state. They felt unable to return to the workplace and were suffering severe distress. They are referred for specialist psychiatric and psychological evaluation and management and are given a diagnosis of post incident Post traumatic Stress disorder PTSD.

  1. If they required PTSD care and return to a normal work schedule and social function within 180 days. – NOT PI
  2. If they require ongoing intensive PTSD care OR were unable to return to a normal work role and schedule OR faced ongoing social dysfunction impacts at 180 days. – PI

4.6    Loss of hearing post acoustic trauma

Cumulative work-related noise exposure and hearing loss (medical definition) is not covered in the FPI metric definition as it does not result from an acute/single incident. An acute acoustic trauma during an incident with immediate loss of hearing and/or tinnitus may meet Permanent Impairment definition.

Potential outcomes:

  1. A Temporary Threshold Shift (TTS) that recovers with a return to baseline hearing and or normal hearing if no baseline measurement available. – NOT PI
  2. A measured loss, partial or complete, of hearing function (medical definition) at 180 days post incident. – PI

Clarification: Subsequent use of hearing aids does not negate a PI definition.

4.7    Injection of foreign material

A person is adjusting the nozzle of a pressurised paint gun and inadvertently sprays lead based paint into their right hand. It penetrates the skin and creates significant soft tissue damage. They required significant surgical intervention, and the wound required a skin graft.

Potential outcomes:

  1. If the graft heals well and the person requires hand rehabilitation therapy but was able to return to a normal work schedule and full hand function within 180 days. – NOT PI
  2. If the person requires ongoing therapy or is unable to return to a normal work function due to loss of hand strength or range of movement within 180 days. – PI

4.8    Joint replacement or reconstruction post injury

A person slips off a ladder and sustains a pelvic fracture. They inform you their specialist has stated they need a hip replacement. Does this hip replacement automatically constitute a PI as it could be considered an amputation (removal of damaged joint and replaced with a prosthetic)?

No, the inherent impact of a prosthetic replacement of an external limb is considerably more impairing than an internal joint replacement where the functionality is generally equivalent or improved.  These are complex scenarios and the two key determinants are:

  • Work relatedness – based on professional medical judgement that the primary reason for the joint replacement was the work-related incident and not underlying degeneration. Joint replacement surgery is not a standard expectation of a single event trauma. Joint replacements are traditionally outcomes of chronic wear of the joint over time. Severe injuries may theoretically damage joint structures to such degree that they cannot be repaired, rather need replacement.
  • Function – based on successful return to work and social function within 180 days.

Potential outcomes:

  1. If it was determined as work related and the hip was reconstructed or replaced and returned to full functionality within 180 days. – NOT PI
  2. If it was determined to be work related and the hip was reconstructed or replaced but did not return to full functionality within 180 days. – PI

In these scenarios companies are advised to obtain an independent medical professional opinion to determine if there is a causative connection between the injury and the stated need for a joint replacement.

5.   FAQ

  1. How would PI for acute acoustic trauma be determined if there is no baseline hearing test to compare to?
    Refer to Example Section 4.6.
  2. Could a person suffer 2 PI incidents?
    Yes, a person may have a series of permanent impairment incidents. A new permanent impairment will only be determined as a comparison of the new incident outcome against the baseline function immediately prior to the incident. If they had a second incident that creates an additional impairment of function compared to the newly established baseline state this would be a second permanent impairment injury. Fictional case examples to clarify:
    • If a person suffered an amputation of the complete left hand – PI.
      If they returned to work and then suffered a second injury with crush of left arm with further full amputation of the limb it would be a second PI. This is because they suffered further impairment compared with their pre-incident status.
    • A wheelchair bound person had an incident at work due to a structural failure of a ramp and they fell out of the chair during the ramp collapse. On medical review they are found to have fractured their left wrist and bruised their back. The wrist recovers well with plaster and the bruised area in the spine also recovers with no change in the functional status of their legs or ongoing pain. – NOT PI because the person remains wheelchair bound but this was their status pre-incident.

Last edited 10 November 2022

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