Awareness surrounding traumatic brain injuries (TBIs) and chronic traumatic encephalopathy (CTE) has grown over the last decade as we’ve heard stories of high-profile football players and military veterans whose lives were either cut short or forever changed by these conditions.

But other workers, particularly those in the construction industry, are also at increased risk for TBIs and CTE, explain Dr. John S. Gaal, a longtime construction educator, and Cal Beyer, a management consultant in the construction risk/insurance industry. Gaal lost his son, John Jr., to suicide as a result of TBIs and CTE in March of 2017. He and Beyer interviewed a panel of medical experts and researchers to help raise awareness of the causes and consequences of TBIs and CTE, and their responses are reflected in an article in the November issue of Benefits Magazine.

The experts discuss the prevalence of these conditions, describe the results of their research and discuss the role that employers can play to reduce the impact.

Frequency of TBIs

According to the Centers for Disease Control and Prevention (CDC), approximately 150 people die each day from the effects of TBIs, which most frequently result from slips, trips and falls from various heights. Other common causes of TBIs are motor vehicle accidents and “struck-by incidents” occurring on construction jobsites, frequently from dropped, untethered tools or where protective systems are not in place.

Risks in the Construction Industry

The construction industry had the most fatal and nonfatal TBIs among U.S. workplaces, according to CDC. More than 2,000 construction workers died—from 2003-2010—representing approximately 25% of all construction fatalities. The construction industry also actively recruits and hires workers whose prior work background may have exposed them to concussions and other forms of TBI, namely military veterans and former high school and collegiate athletes.

Impact on Mental Health

Between one-quarter and one-half of TBIs will be followed by major depression in the first year after the event. Other possible impacts can include pseudobulbar affect, which is described as a discrepancy between the way emotion is displayed and the way it is experienced and can be associated with impulsive and risky behaviors. Generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder (PTSD), problematic substance use and increased risk of suicide also can occur following a TBI.

What Can Employers Do?

First, employers should seek proper medical help for a worker who recently may have experienced a head injury if any of these symptoms arise:

  • Irritability
  • Light sensitivity
  • Confusion
  • Forgetfulness.

Following initial treatment, accommodations should be made in the workplace. Karen McAvoy, Psy.D., one of the experts interviewed by Gaal and Beyer, explains how employers can apply the REAP model to the workplace and apprenticeship training programs when workers experience a concussion. McAvoy is the author of REAP, a community-based interdisciplinary team approach to concussion management customized in more than 15 states.

She offers the following points:

Being able to manage symptoms is the first hurdle. If persons with a concussion struggle with intense symptoms, they will not feel well enough to even be at a work, school or an apprenticeship setting. A job, school or apprenticeship program needs to first provide a “soft landing” for persons with symptoms by providing frequent, short rest breaks

Once a person can keep symptoms at bay, the amount of mental exertion needs to be removed and reduced. Just like we ask teachers to remove nonessential in-class/homework and reduce semiessential in-class/homework for students with concussion at school, bosses, supervisors and instructors must be mindful about the amount of work expected in a work or training setting during recovery.

Finally, the essential elements of a job, lesson and/or training need to be met for the person with a concussion to get a fair paycheck or grade or certificate. Supervisors need to ask: What level of mastery needs to be demonstrated and how should the person with a concussion show that mastery? If there are alternative ways for a person to show they are meeting the requirements of the job, lesson, or training (albeit perhaps on a smaller scale, temporarily), progress can continue at work, at school and in an apprenticeship training program even during recovery from a concussion.


“Employers as well as employee benefits plan administrators and/or trustees must recognize the significant human toll that TBIs take on the quality of life for affected employees and families,” Gaal and Beyer write. This toll can include reduced life expectancy, premature death, physical disability, cognitive impairment and mental health conditions including depression, PTSD and even suicide.

“It is important for all employees in all industries to recognize the risks of TBIs and to take measures to prevent and properly manage known or suspected TBIs sooner rather than later,” Gaal and Beyer conclude.

Kathy Bergstrom, CEBS
Senior Editor, Publications at the International Foundation of Employee Benefit Plans

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Kathy Bergstrom, CEBS

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