Category Archives: Steel

Product Liability Issues Arising From Rail Car Wheel Cracking and Fatigue

Max train

Rail car wheel cracking and fatigue can lead to significant product liability exposure and potential negligence claims.  Unless specifically exempted by another statute or federal regulation, Oregon’s product liability statutes, starting at ORS 30.900, govern product liability actions in Oregon, including products such as railroad car wheels.  This article will explore three important studies regarding rail wheel cracking and fatigue issues and will end by discussing critical product liability issues associated with rail wheels.  In rail wheel cases, the phenomena commonly known as rolling contact fatigue (“RCF”) can lead to cracking and even the uncontrolled discharge of portions or rail car wheels.  In extreme circumstances, the wheel itself may be subject to vertical cracking and disintegration.

Rail Car Wheel Cracking:  Three Scientific Studies

There is a vast body peer-reviewed scientific literature that examines the relationship between various manufacturing processes, uses and stresses on railway wheels, and metal fatigue and cracking.  This article explores three such scientific studies that focus on the susceptibility of railway wheels to wear and RCF damage.  As explained in further detail below, studies have found that rail wheel damage is influenced by the properties of the wheel material, including steel composition and hardening techniques.

Below there are links to each study discussed.  If, however, you cannot access the links and would like to review the studies, please contact Olson Brooksby.

The Molyneux-Berry, Davis, and Bevan Study

This study examined railway wheels on fleets from the UK and concluded that the materials that make up the wheels themselves influence the amount of wear and RCF damage that the wheels are subjected to.  Factors that contribute to wheel damage are the composition of the steel, the process by which wheels are manufactured, and loading during operation.

This study can be found here:

The Liu, Stratman, Mahadevan Study

This study developed a 3D “multiaxial fatigue life prediction model” to calculate the life of a rail car wheel and to assist with predictions regarding the timeline of its fatigue.

This study can be found here:

The Peixoto and Ferreira Study

In this study, fatigue crack growth rate behavior tests were performed according to ASTM E647 (2008).  The purpose of this study was to contribute to the development of accurate models that predict fatigue problems in rail car wheels in order to assist with maintenance and safety standards.

This study can be found here:

Defenses to Rail Wheel Product Liability Claims

A common issue in rail wheel cases is the age of the wheel at issue and the amount of use it has received.  When an older wheel is involved, defense counsel for the manufacturer should look first for a defense based on statute of ultimate repose.  ORS 30.905 provides for a ten year statute of repose.  If the plaintiff does not file a claim for personal injury or property damage within ten years from the date the product was first purchased for use or consumption, the claim is barred.  Oregon has a strong statute of ultimate repose.  There are no “useful safe life” or other exceptions or rebuttable presumptions codified in the statute that provides for an absolute ten years.

Absent an ability to obtain a complete dismissal under the statute of ultimate repose, the three studies discussed above illustrate the variety of causation factors and scientific models concerning rail car fatigue issues.  Manufacturing materials and processes, steel fabrication techniques and materials for both wheels and rails, the nature of the loads, gradients, and cycles are all among the factors that provide fertile ground for defending rail wheel claims.

Steelmaking In The 21st Century: An Ancient Art, A Complex Modern Science, A Danger At Every Stage

Metal briefcase

Product liability lawyers should be familiar with both the dangers and the science of steel manufacturing.  Steel is one of the most indispensable products in the modern world.  Its uses, forms, and composition are limitless.  Like any other product, steel in its final form and use is a “product” subject to the same consumer expectation test in Oregon that applies to household appliances.  However, unlike most other product manufacturing, steel production, which creates the base material for pipe, rails, aviation, and innumerable transportation, mining, oil and gas, and other products, is incredibly dangerous.  Although serious burns might be the most obvious risk, there are also crush, amputation, and a host of other potential injuries which justify the most careful training, exacting safety processes, and best PPE.  This is especially true given the danger posed by the typical 24-hour-a-day production schedules and the undisputed fact that nighttime workers are in more danger than day workers.

Steelmaking Is An Ancient Art

In the ancient world, steelmaking was considered an art, and as the centuries passed, the process became more and more complex.  Steel was known in antiquity and may have been produced by managing bloomeries, or iron-smelting facilities, in which the bloom contained carbon.  Blooms are steel formed into large blocks to which further tempering or chemical procedures can be applied.  The use of blooms persists into the steelmaking of today.

The earliest known example of steel production, thought to be about 4000 years old, is a piece of ironware excavated from an archaeological site in Anatolia (the Asian part of Turkey).  “Ironware piece unearthed from Turkey found to be oldest steel.”  The Hindu (Chennai, India).  The Haya people of East Africa invented a type of furnace that they used to make carbon steel at 3,276 degrees Fahrenheit nearly 2000 years ago.  Africa’s Ancient Steelmakers (,9171,912179,00.html?promoid=googlep).  Time Magazine September 25, 1978.

What Is Steel?

Steel is an alloy of iron and carbon.  Steelmaking is the process of producing steel from iron and ferrous scrap.  In steelmaking today, impurities such as silicon, phosphorus, and excess carbon are removed from the raw iron, and alloying elements such as manganese, nickel, chromium, and vanadium are added to produce different grades of steel.  Limiting dissolved gasses such as nitrogen and oxygen, and entrained impurities or “inclusions,” in the steel is also important to ensure the quality of the products cast from the liquid steel.  B. Deo and R. Boom, Fundamentals of Steelmaking Metallurgy, Prentice and Hall (1993).

Carbon is the primary alloying element, and its content in steel is between 0.002% and 2.1% by weight.  Additional elements are also present in steel, including manganese, phosphorous, sulfur, silicon, and traces of oxygen, nitrogen, and aluminum.  Carbon and other elements act as hardening agents, preventing dislocations in the iron atom crystal lattice from sliding past one another.

Varying the amount of alloying elements and the form of their presence in the steel (solute elements precipitated phase) controls qualities such as the hardness, ductility, and tensile strength of the resulting steel.  Steel with increased carbon content can be made harder and stronger than iron, but such steel is also less ductile than iron.  Ashby, Michael F. and Jones, David R.H.  Engineering Materials 2 (with corrections ed.) Oxford:  Pergamom Press.  ISBN 0-08-032532-7 (1992 [1986]).

Alloys with a higher than 2.1% carbon content are categorized as cast iron.  Because cast iron is not malleable even when hot, it can be worked only by casting, where it has a lower melting point.  Steel is also distinguishable from wrought iron, which may contain a small amount of carbon.

Even in the narrow range of concentrations that make up steel, mixtures of carbon and iron can form a number of different structures with very different properties.  One of the most important polymorphic forms of steel is martensite, a metastable phase that is significantly stronger than other steel phases.  When the steel is in an austenitic phase and then quenched rapidly, it forms into martensite, as the atoms “freeze” in place when the cell structure changes from FCC to BCC.  Depending on the carbon content, the martensitic phase takes different forms.  Below approximately 2% carbon, it takes a ferrite BCC crystal form, but at a higher carbon content, it takes a body-centered tetragonal (BCT) structure.  There is no thermal activation energy for the transformation from austenite to martensite.  Moreover, there is no compositional change to the atoms, which generally retain their same neighbors.  Smith, William F., Hashemi, Jared, Foundations of Materials Science and Engineering (4th ed 2006) McGraw Hill ISBN 0-07-295358-6.

Special Modern High Performance Alloys

There are a number of extremely complex super-alloys and other metals available today for high performance aviation and other uses, including Transformation Induced Plasticity (TRIP) steel and Twinning Induced Plasticity (TWIP) steel.  A complete discussion of these super-alloys merits a separate article, and one will be forthcoming shortly.

Introduction To The Modern Process

In the modern era, there are two major processes for making steel.  The first is basic oxygen steelmaking, which uses liquid pig iron from the blast furnace and scrap steel for the main feed materials.  Alternatively, iron ore is reduced or smelted with coke and limestone in the blast furnace, producing molten iron that is either cast into pic iron or carried to the next stage as molten iron.  In the second stage, impurities such as sulfur, phosphorus, and excess carbon are removed, and the alloying elements such as manganese, nickel, chromium, and vanadium are added to produce the steel required.  The vast majority of steel in the world is produced using the basic oxygen furnace.  In 2011, approximately 70% of the world’s steel was produced in this way.  R. Fruehan, The Making, Shaping and Treating of Steel (11th ed. AIST 1999).

The second major modern process is electric arc furnace (EAF) steelmaking, which either uses scrap steel or direct reduced iron (DRI) as the main feed material.  Oxygen steelmaking is fuelled predominantly by the exothermic nature of the reactions inside the vessel, whereas in EAF steelmaking, electrical energy is used to melt the solid scrap and/or DRI materials.

In recent times, EAF steelmaking technology has moved closer to Oxygen steelmaking as more chemical energy is introduced into the process.  E.T. Turkdogan, Fundamentals of Steelmaking, IOM (1996).  EAF steelmaking is predominantly used for producing steel from scrap and involves melting scrap, and combining it with iron ore.

Alternatively, the oxygen method can involve melting DRI using electric arcs (either AC or DC).  It is common to start the melt with a “hot heel” (molten steel from a previous heat) and use gas burners to assist with the meltdown of the pile of scrap.  EAF furnaces typically have capacities of around 100 tons every 40 to 50 minutes.

Regardless of the process used, through casting, hot rolling and cold rolling, the steel mill then turns the molten steel into blooms, ingots, slabs, and sheet.

At the typical steel mill, the raw materials are batched into a blast furnace where the iron compounds in the ore give up excess oxygen and become liquid iron.  At intervals of a few hours, the accumulated liquid iron is tapped from the blast furnace and either cast into pig iron or directed to other vessels for further steelmaking operations.  During the casting process, various methods are used, such as the addition of aluminum so that impurities in the steel float to the surface where they can be cut off the finished bloom.


The steelmaking process involves exposure to hundreds of tons of molten metals, often poured manually into ceramic, wax, or other casting forms or hot rolled into shapes.  The potential for catastrophic injury or death is everywhere in the steelmaking process, and it is essential that workers be trained and supervised to avoid lapses in safety that could result in such unfortunate occurrences.  Although automation continuously decreases the exposure of workers to significant injury or death as a result of virtually every phase of the process, the utmost care should still be exercised by all who enter a steel mill.

“Secondary Processes” Don’t Translate to Secondary Risks

Steel manufacturers know that the global demand for steel is almost always increasing, and customers require greater engineering performance.  Customers also require variations in the performance characteristics of specialized, costly alloys, which warrant investment in safe, efficient QC testing equipment.  Specialized components, such as those used in aviation, require precision machining.  Aircraft turbine engine compressor blades, for example, may require precision casting to tolerances of seven microns or less.

The urgency to increase production and focus on key production values can sometimes lead to risk of serious workplace injury, often due to under-recognized dangers in secondary processes.  QC testing operations – where injuries often involve equipment that lacks necessary retrofitting with safety devices, or compliance with published ANSI, ASTM, ISO, or other industry standards – is a case in point.

Additionally, secondary processes like QC testing are what might be called “first assignment” areas for new, contract, or temporary workers who all too often are under-trained and unaware of the potential dangers of metal production.

The “class” of worker is noteworthy because the differing ways in which injury compensation is handled have financial implications for the employer.  Basically, employees are limited to the exclusive remedy provision of worker’s compensation law, which does not provide for non-economic damages.  Other classes of workers may be able to sue for non-economic damages, resulting in verdicts or settlements that can cripple a company.

Our firm was involved in a real-world example as counsel for a large steel mill that burns roughly 30,000 quality-control test samples a year.  In that case, eight-foot-long, 500-pound tail samples were cut from sheet steel in the main roller room and were channeled onto a customized metal roller conveyor system that diverted samples to the sample burning room.  A series of gates restrained and managed each sample’s movement along the conveyor until a final gate clamped down on the tail sample so a laser could cut the sample into smaller segments for QC testing.

In this case, however, with the final gate on the conveyor shut, the penultimate gate opened, freeing an uncut tail sample to continue down the conveyor and collide with the slab in the clutch of the final gate.  The uncut slab careened into the air, striking an employee in the head.  The injured employee was hired through a service, and it was his first day on the job.

It was a tragedy in personal terms, and the steel company lived up to its responsibilities to the injured worker.  Additionally, by following a number of prudent practices, both before and after the accident, the company was protected from legal action that might have created a serious financial threat to the business.  Here are some operations and legal steps every metal manufacturer should consider to reduce personal injury on the job and damaging financial liability in secondary process areas:

  • Immediately examine older equipment and put requisite safeguards into place.  It is natural to be focused on mainline production safety and operations.  However, a safety audit may reveal necessary retrofitting in areas such as QC sampling.  In this case, a post-accident engineering study resulted in the installation of horizontal spacers spanning the conveyor track to prevent tail samples from jumping the conveyor.  The spacers were not required by written standard, but they provided extra safety.
  • Ensure compliance with published industry standards.  The litany of ASTM, ANSI, OSHA, ISO, and other standards for production of metal and component parts and machine safety is beyond the scope of this article.  Consider retaining an occupational safety engineer to conduct an audit that closely assesses older QC test equipment.
  • Ensure that contracts with any temporary worker service providers expressly state that the provider will provide worker’s compensation coverage.  For your employees, worker’s compensation is the “sole remedy” for claims in the event of workplace injury.   However, temporary, contract and other classes of workers – again, often placed in secondary process positions – may be able to sue under Employer Liability Law (“ELL”) that can include non-economic damages such as pain and suffering.

To maintain consistent standards of coverage and liability across a mixed workforce, your worker-service contracts need to delineate that your contractor’s worker’s compensation coverage is the sole remedy for temporary workers.  Although plaintiffs may challenge contractual provisions in court, manufacturers should put in place contractual indemnity provisions that result in consistent protection across all worker classes and forms of claims.

  • Ensure that contracts contain an indemnity provision providing that the service provider will fully indemnify the metal manufacturer for injuries of any kind to the temporary worker.  Clauses that provide an exception for the “sole negligence of the manufacturer” can often lead to expensive litigation and leave the door open for exposure.  Protect your company by resisting the inclusion of such language in your service contracts.

To close, as important as it is for metal manufacturers to meet growing demand and concentrate on the principal staffing, processes, and equipment of main-line production, experience indicates that the dynamics and risks associated with secondary production processes also deserve increased attention.

Variables that can affect burn injury cases

Most experienced defense lawyers know that the variables in burn injury cases prevent anything resembling a guarantee of a good result.  The following variables can affect the outcome of a case, including the potential financial exposure that a defendant or its insurer or worker’s compensation carrier may face:

– the different types of skin grafts and skin graft surgical procedures commonly involved in burn cases;

– whether, in high total body surface area (tbsa) burns, complete excision and grafting can be completed in a single principal procedure;

– the treatment technique, surgical technique and treatment philosophy of the physician; and

– the relative size of the burn center, as larger centers tend to be able to perform certain procedures–not because of greater skill, but because of the size and number of  surgical teams necessary.

Skin Graft Classification and Skin Graft Surgical Procedures

In burn injury cases, surgical removal (excision or debridement) of the damaged skin is followed by grafting.  The grafting is designed to reduce the course of hospital treatment and improve function and cosmetic appearance.  There are typically two types of skin grafts–mesh grafts and sheet grafts.  A less-common, third type of graft is a composite graft.

Mesh Grafts

Mesh grafting is known as partial-thickness grafting, or split-thickness grafting.  With mesh grafting, a thin layer of skin is removed from a healthy part of the body, known as the donor site.  It is processed through a mesher, which makes apertures into the graft. The graft then becomes mesh-like, allowing it to expand approximately nine times its original size.  Such grafts are used to cover large areas and the rate of auto-rejection is lower.  Harvesting of these grafts from the same site can occur again after as little as six weeks.  The surrounding skin requires dressings and the donor site heals by reepithelialization.

Using a dermatome, the surgeon usually produces a split-thickness graft which is carefully spread on the bare area to be covered.   It is held in place by a few small stiches or surgical staples.   The graft is initially nourished by a process called plasmatic imbibition in which the graft drinks plasma.  New blood vessels begin growing from the recipient area and into the transplanted skin within 36 hours in what is called capillary inosculation.  To prevent accumulation of fluid, the graft is frequently meshed by making lengthwise rows of short interrupted cuts, each a few millimeters long, with each row offset to prevent tearing.  This allows the graft to stretch and more closely approximate the contours of the affected area.

Sheet Grafts

In the alternative, a sheet graft, which is a full-thickness graft, involves pitching and cutting away skin from the donor section.  Sheet grafts consist of the epidermis and entire thickness of the dermis.  Sheet grafts must be used for the face, head and hands because contraction must be minimized.  If sheet grafting is necessary but the donor sites are insufficient, the outcome is likely to be less satisfactory, and the financial exposure in such cases will be higher.

With sheet grafting, the donor site is either sutured closed directly or covered by a split-thickness graft.  Sheet grafts are more risky in terms of rejection, yet counter-intuitively leave a scar only on the donor section.  Sheet grafts also heal more quickly and are less painful than partial-thickness grafting.

Sheet grafting is usually difficult in severe aviation or manufacturing burns because those involve high-percentage tbsa burns and donor sites are therefore limited.

Composite Grafts

The third type of graft, a composite graft, is a small graft containing skin and underlying cartilage or other tissue.  Donor sites would include the ears and other cartilage to reconstruct, e.g., nasal rim burns.

In High TBSA Burns, When Immediate, Complete Excision and Grafting is Completed in a Single Procedure, Damages Amounts May Be Lower.

In cases involving clearly severe, high tbsa burns, whether full or partial thickness, immediate, complete excision and grafting is usually indicated.  If immediate excision and grafting is complete–that is, done in a single procedure–a much larger surface area surgery can be completed with less blood loss.  This minimizes transfusion needs and dangers and also speeds physiological restoration.

Furthermore, an immediate, complete excision and grafting procedure can often allow use of good skin for grafting that would otherwise need to be excised.  If the procedure is not done immediately, less skin may be available for grafting.  In other words, skin that otherwise may have been healthy and usable when the plaintiff was first admitted to the hospital may die if the procedure is not done immediately, particularly if that skin is close to the burn site.

Immediate, complete excision and grafting also cuts down on the number of procedures and allows important vascular redevelopment to begin occurring sooner and supplying the graft locations with blood flow, which is essential to healing.

 The Treatment Technique, Surgical Technique and Treatment Philosophy of the Physician Can Be Outcome-Determinative

The simple fact is that some surgeons are more skilled than others, so the outcome may be better or worse depending on the skill of the physician.

There are also some advances in burn surgery that particular physicians are able to employ.  For example, in the most serious burn cases, grafts may be taken from other animals.  Such grafts are known as heterografts and, by design, they serve as temporary dressings that the body will unquestionably reject within days to a few weeks.  They are used in severe cases to reduce bacterial concentration of an open wound and reduce fluid loss.

Additionally, some surgeons are able to use cell cultured epithelial autograft (CEA) procedures, which involve removal of skin cells from a patient and the growth of new skin cell sheets in a lab.  Although the new sheets will not be rejected, they are typically only a few cells thick and do not stand up to trauma.  As a result, many such grafts do not take and the procedure must be repeated or an alternate procedure employed.

Furthermore, some physicians prefer to do more sheet grafting versus mesh grafting.  The physicians who prefer mesh grafting like it because they can cover much larger areas in a shorter period of time.  Conversely however, mesh grafting requires more revision surgeries, more of a risk that the grafts don’t take, and more contraction, which is disfiguring and requires further surgery.

Different groups of surgeons have their own philosophies and cultural preferences.  In Portland, Oregon, for example, there is one group of approximately five, highly-skilled burn surgeons who staff the Oregon Burn Center at Emanuel Hospital.  Due to the relatively small size of the burn center, they tend to wait four to seven days before conducting major graft procedures so that they can have a better assessment of the full extent of the injury.

The Relative Size of the Burn Center Can Be Outcome-Determinative

Larger burn centers, such as the ones at UC Davis or Harborview in Seattle, do not necessarily provide better treatment, but they are typically capable of complete excision and grafting at admission when there is a high percentage of the total body that sustains full-thickness burns or a combination of full-thickness and lesser degree burns.  This is a function of burn center size, not the skill of the physicians.  A full excision and grafting procedure is lengthy and generally requires two full surgical teams and at least two attending physicians and two assistant surgeons.  This type of procedure is generally not possible at relatively smaller burn centers such as the Oregon Burn Center.

Using Variables in Burn Cases to Assess Case Value and Adequately Prepare

The variables discussed above vary from case to case.  It is important to assess each one when valuing a burn injury case in order to determine the defendant’s likely exposure and prepare adequately for productive settlement discussions and, if absolutely necessary, trial.


An Introduction to Burn Injury Significance and Burn Centers

Burns Are Significant Injuries and Can Lead to Some of the Highest Jury Verdicts

Olson Brooksby appreciates the potential high-exposure value of burn injury cases.  Scott Brooksby has significant experience in serious, total body surface area (tbsa) burn injury and wrongful death cases.  Our lawyers understand the delicate nature of large burn injury cases and work to minimize exposure to our clients.

Defendants potentially subject to burn injuries should employ best safety practices and make every attempt to avoid such injuries.  Burns are one of the most serious injuries in personal injury cases.  They may be the result of chemical fire or exposure, explosions, paints, solvents, or conventional fire.  Sometimes burns are the result of contact with hot equipment or other product liability related events.  The defense of serious burn injuries, including those related to aviation, product liability and heavy manufacturing is a large part of the defense practice of Olson Brooksby.  A bad burn case in an aviation or heavy manufacturing accident, or as the result of a product liability defect can easily present high financial exposure to manufacturers and/or insurers.  Settlement exposure can climb into the millions or tens of millions, with verdicts at least as high.

Even when there appears to be a strong defense, defendants should not underestimate the overwhelming sympathy a jury will feel when it sees a burn victim, particularly with serious facial burns or burns to the extremities.  A good plaintiff’s lawyer will ask the jury to consider things like the profoundly disfiguring effects of a bad facial burn and the pain that everyday exposure to sunshine will cause its victim for life, or the lifelong gawking stares it will draw.

Similarly tragic are severe burns to the hands, which cannot be restored to even near full function or pre-burn aesthetics and result in pain every time the victim is touched.  When liability is clear, burn cases should be settled because, unlike other personal injury cases, deformities caused by burns can incense juries to the point where they cannot put their emotions aside.  The result can be verdicts in the millions or tens of millions, including punitive damages (particularly if children are involved or there is perceived recklessness).  Although the amount of burn verdicts used to depend on the region of the country where the case originated, such verdicts are now generally high in every jurisdiction.

If the burn injury case must be tried, it must be done with great sympathy for the victim  and careful attention to the medical aspects of the case, including future treatment, which may last decades and cost into the six or seven figures.

When trying a burn injury case, it is important to know where the injury occurred.  If a plaintiff has to be air lifted to a burn center, that can radically change the extent of the injury.  Similarly, it is important to know the details of the burn center where the plaintiff was treated because that can also change the extent of the injury and thus affect the jury verdict amount.

The Location of the Accident Can Change the Extent of the Injury and the Jury Verdict

In those industries where serious conventional burns are common, such as aviation disasters or steel or metal manufacturing, “serious” can arbitrarily be defined as full-thickness burns over 20% or more of the tbsa.  The location of a burn center and the length of time to transport the victim to the burn center can be outcome-determinative.  This is also particularly true where babies and children or those over sixty-five are the victims, or where there are serious burns to the face, head, extremities, or internal organs.

Manufacturers and insurers obviously do not choose where burn centers are located.  After an accident, first responders will obviously make needed decisions about transport.  Most heavy manufacturing, including that of aviation hot section components, is done near large metropolitan areas that typically have at least one burn center.  Perhaps some of the greatest danger lies in cases in remote areas where individuals are subject to burns from allegedly defective products.  For example, a person camping in a remote area of the Western United States who is badly burned by kerosene at a remote campsite may not be able to reach a burn center for hours.  There may be no cellular phone service and a helicopter ambulance may have to be dispatched from hundreds of miles away.

Depending on the severity and tbsa burned, the size and related capabilities of the burn center will have a direct impact on the plaintiff’s recovery, and consequently, the ultimate exposure to the manufacturer and/or insurer in any settlement or verdict.

All Burn Centers are Not the Same–They May Have Varying Treatment Philosophies, Training and Capabilities

The size of the burn center can also be outcome-determinative because smaller centers, such as the Oregon Burn Center at Emanuel Hospital, are generally not large enough to perform a full excision and grafting in high tbsa burn cases.  A full excision and grafting is where they do all of the procedures at once instead of one at a time.  Some burn physicians believe that, depending on the case, better outcomes are achieved through full excision and grafting in high tbsa burn cases.

There are approximately 45 regional burn centers in the United States.  Verification of burn centers is a joint program administered in the form of a rigorous review of the applicant centers by the American Burn Association (ABA) and the American College of Surgeons (ACS).  Many states do not have a regional burn center and most states have only one or two.  California has the most, with seven.  Most burn centers are run by a single group or an extremely limited number of groups of burn surgeons who practice at the facility.

Unlike hospitals, burn centers do not typically extend general privileges to physicians.  Most burn surgeons have been trained as general surgeons, and then have gone on to receive additional specialized training in burns.   Along the population corridor running down I-5 between Seattle and Davis, California there are three verified regional burn centers, one each in Seattle (Harborview), Portland (The Oregon Burn Center at Emanuel Hospital), and The UC Davis Regional Burn Center.

Training and available resources vary from center to center.  Burn centers also tend to have more pronounced treatment philosophies and cultures because they are staffed by relatively few surgeons who generally practice in the same group or just a few groups.  However, although burn center practice varies, it is imperative that those who are seriously burned reach a regional burn center as soon as possible because specialized treatment is inarguably outcome-determinative

The mechanics of injury, lots of fire, accelerant, and contact with temperatures in excess of 1,000 degrees are factors that are considered when determining whether burns are graftable from point of admission.  In any serious burn case, most intermediate facilities such as a conventional hospitals will seek to transfer a seriously burned patient, almost always by air, to a regional burn center as soon as stabilization occurs.


Mitigating Risk of Punch Press Amputations

With the incredible advances in safety equipment in and standards, one would think that punch press amputations would be a thing of the past.  However, they still occur today, and manufacturers with press operations need to be vigilant both about their safety equipment and practices, as well as their record-keeping

Extremely large metal punch presses can range in strength from about ten tons to 50,000 tons.  Larger presses that exceed something in the neighborhood of 150 tons can cost into the seven figures and present a tremendous capital investment burden, particularly for the small or mid-size metal component manufacturer.  Because of the incredibly high cost of this equipment, and because of the long life of the equipment and the possibility of retrofitting with modern safety devices, many ultra-heavy-duty punch presses are still in use today.  It is important that older equipment both be retrofitted with modern safety devices that comport with industry standards and that records of safety modifications or changes be maintained.

Scott Brooksby recently defended a mid-sized manufacturer that operated a hydraulic punch press that had been manufactured in approximately 1928 and was acquired by a client in approximately 1979.  After fifty-one years of continuous use, the punch press was still in excellent operating condition.  One day, for reasons that are not completely clear, the press descended and partially amputated the right hand of the manufacturer’s employee.  In the nearly 30 years before this accident, there had never been a single accident reported on the punch press.

These situations are often complicated by the number of, and nature of, control mechanisms, which can include foot pedals, hand pedals, electronic switches, buttons, or pedals that provide for slow “inch mode” movement, etc.  Often different operators will prefer different methods of use.  In this case, the primary operator was stationed at the front of the machine and would activate the press using an inch mode to set dies and then produce product more quickly as the operator at the rear removed and inserted the die in a continuous cyclical fashion, while the front operator operated the machine with a series of hand and foot pedals.

Although the press was originally built some eighty years before the accident, the manufacturer had diligently retrofitted the press with up-to-date safety modification, including 360-degree light curtains.  A commonly relied on safety device, light curtains are designed to stop descention of the press in the event that a hand or any object penetrated the light curtain.  In this case, the light curtains were installed both on the front and rear.  The light curtain appeared to have been interrupted at the time of the accident.  The precise cause of the accident will likely never be known.

After the press was acquired by the manufacturer, some add-ons and wiring and safety modifications were made.  The precise timing of the modifications was unclear.  The press was retrofitted with light curtains which were designed to prevent inch movement when the light curtains were broken. The front and rear light curtains appear to have been installed at different times. At some point prior to the accident, the light curtains were replaced with updated versions.  As part of routine maintenance procedures, the press was fitted with a new brake in 2004 or 2005. The new brake was not a safety add-on. The brakes on the machine were tested immediately after the accident and found in good order.

When the State Occupational Health and Safety Administration investigated, the accident maintenance records could not be located.

There are two important things to learn from this case:

1. Virtually every steel company, metal company, or manufacturer of component parts using these materials will have old (even decades-old) equipment that is working perfectly well and is perfectly safe by modern standards through the addition of retrofitted safety devices.  However, it is critical that such retrofitting be documented and that the documents be retained indefinitely, or maintained in strict compliance with a formal document destruction policy.

2. In most states, the OSHA agency conducting the investigation will want to interview, and will be entitled by statute or regulation to interview, employees involved in the workplace accident outside the presence of counsel, even if counsel has been retained and requested to be present.  This warrants the cost and discipline associated with diligent training.  Management should consider including a training module so that workers who are interviewed outside the presence of counsel focus only on speaking about what they saw, what they said, or what they heard others say, all limited to a first-hand perspective.




Assess Steel Quality Control Testing For Potential of Personal Injury

Despite the recent domestic economic downturn, global demand for steel, other metals and heavy equipment continues to increase in emerging markets and elsewhere.  With the increasing demand for production, a potential source of personal injury that is often overlooked is quality control testing.  Manufacturers face pressures to produce, poor communication with and between workers, and what can sometimes be decades-old equipment.  This equipment has usually been continuously retrofitted and appears to function perfectly well, but that is not always the case and serious injury can occur during secondary procedures.

For example, Scott Brooksby defended a steel mill against the claim of a temporary worker who was subject to injury when he was struck in the head by a tail sample cut during sample burning operations.  During steel production, tail samples are typically cut from sheet steel.  At temperatures approaching 1300 degrees, the tails, which vary in size, are routed on a conveyor system into a sample burning room so that samples can be taken for routing to the laboratory to conduct tensile, radiographic and other quality control tests.  The conveyor system is a series of metal rollers controlled by a series of steel gates that regulate the tail samples so that they do not collide and cartwheel into the air or fall from the conveyor, posing a danger to workers.

In Scott Brooksby’s case, a steel tail approximately 8 feet long and 1.5 inches thick was cut from a sheet in the main production roller room.  At approximately 1350 degrees Fahrenheit, the sample, which approached 500 pounds, was routed into the sample burner room.  Sample burning and many other quality control processes may take place in smaller rooms adjacent to the main production halls.  The sample tail is diverted from the main hall after being cut from sheet steel via a steel roller conveyor system where it would pass through a series of gates controlled either electronically or by a set of foot or hand pedals.  By the time the eight foot sample reaches the penultimate steel gate it has cooled to approximately 1,000 degrees.  Theoretically, after passage through the final gate, the section is cut into smaller lengths, approximately 18-21 inches long, which can be used to stretch and test tensile strength or other quality control issues.

On this particular day, the final gate, at the sample burner itself (which is a laser torch used to cut the 18-21 inch tails), jammed shut just as the penultimate gate opened, allowing the eight-foot section to roll down the conveyor.  The section collided with the sample still clutched by the final sample burner gate and cartwheeled into the air, striking one of the two operators in the head and causing injury before falling and smashing the electronic control system.  The injured worker’s co-worker was able to deactivate further sample conveyance through use of a retrofitted electronic emergency estop.  The steel mill processed approximately 30,000 samples per year and the age of the conveyor system was unknown, but believed to be in excess of 40 years old.

Such cases can be important reminders that the original testing equipment may function perfectly well, but may be retrofitted with any number of safety devices.  It is critical that the documentation, if available on older machinery, be preserved and that any maintenance records, including the addition of such safety features as light curtains (which did not exist at the time older, but still functional equipment was manufactured).  If a steel or metal mill, foundry, or component manufacturer is operating older equipment, it may be prudent to do a safety engineering study on machinery such as sample burners that exist in virtually every steel mill to determine whether retrofitting available safety devices is an option.  For example, with the conventional sample burning conveyor system, it may be that the equipment is custom designed and custom safety add-ons such as horizontal spacers can be welded or bolted across the top of the conveyor at sufficient intervals so that the potential for a sample tail to cart wheel off the conveyor becomes impossible because any vertical force is arrested inches above the conveyor rollers.

If manufacturers have questions about the adequacy of the retrofitting of safety devices on older equipment, they should consider contacting the workplace safety regulatory agency in their state.  In some states, OSHA will work with companies and may even provide free safety audits during which the party requesting the audit is granted a period of immunity to correct safety violations that are discovered.  Manufacturers should check with their state safety agencies to determine whether such programs are available and should be sure to determine whether immunity from citation is provided in exchange for the voluntary request for inspection.

The additional safety precautions are particularly important in quality control test facilities such as the sample burning room where often less-experienced workers, or temporary workers who may not be sufficiently trained or conscious of the dangers, begin work.

Recall also that any such serious injury must generally be reported to OSHA immediately and certainly within 24 hours.  In such cases OSHA investigators may also appear at the premises unannounced and, in most states, there is no right to have counsel present when OSHA is conducting its initial interviews with employees, so management should consider a plan for unplanned requests for interviews from safety investigators and ensure that employees are instructed in advance to focus on only what they actually saw, heard, or said during such interviews.