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Casino Employee Occupational Health and Safety
In 1970, the the United States Congress empowered the Occupational Safety and Health Administration (OSHA) to oversee whether employers were providing a safe and healthy workplace environment. OSHA is empowered to educate employers and workers, set workplace standards, and enforce violations. OSHA requires casinos to have a written safety plan specific to their location which commonly addresses topics that put workers at risk such as ergonomics, blood born pathogens, personal protective equipment, food service, housekeeping, and slips/trips/falls. Taken from regulations for sporting events, there are additional requirements for casino employees working in entertainment to help workers avoid hazards, injuries, and illness caused by theatrical scenery/rigging/props, wardrobe/hair/makeup, and audio/camera/projection/video/lighting. As of January 1, 2018, workers in Nevada have a 10 hour training course on these subject they must complete within 15 days of being hired. They must renew this certification every 5 years. These rules are in place to prevent workplace hazards, injuries, and deaths which have occurred during performances.

The U.S. Centers for Disease Control and Prevention (CDC) research agency the National Institute of Occupational Safety & Health (NIOSH) will conduct free workplace Health Hazard Evaluation (HHE) under 29 U.S.C. 669(a)(6) to identify workplace health hazards and make recommends to reduce hazards.

NIOSH has evaluated casinos in the United States regarding employee exposure to second hand smoke, noise, and metal coin dust.

In the United States, there are approximately 360,000 casino employees with the largest proportion (over 170,00) working in Nevada.

For workers in the United States, the most common injury is slip and falls (33%) followed by overexertion from lifting, carrying, pushing or pulling objects (23.4%).

Occupational Health and Safety Hazards Faced by Casino Employees

 * 1)  Second hand smoke  contains over 7,000 chemical, 700 of which are known to cause cancer.  It is the number one cause of preventable death in the United States causing 41,000 deaths among adults each year. The Surgeon General of the United States determined in 2006 that exposure to second hand smoke is not safe at any level as   smoke cannot be filtered by ventilation systems  and separate "no smoking" areas do not keep smoke out.   More typically, the heating and cooling systems distribute smoke throughout the building, rather than removing it.  Employees working in casinos have historically had higher levels of exposure to nicotine than other employees in the United States who reported exposure to second hand smoke. Second hand smoke among casino workers is estimated to cost $112 per casino worker, per year in direct medical costs.    In 1995, when NIOSH evaluated non-smoking casino workers who worked in casinos that allowed smoking, NIOSH found these workers were exposed to elevated levels of nicotine in the air.   The American Conference of Governmental Industrial Hygienists (ACGIH) publishes Threshold Limit Values (TLVs) for chemical and physical agents as well as Biological Exposure Indices (BEIs) each year that establishes a maximum exposure recommendation based on our current scientific knowledge.  As of 2018, the ACGIH recommends employees not be exposed to an 8 hour time-weighted average (TWA) of more than 0.5 μg/m3 to prevent damage to the gastrointestinal tract, heart, brain or spinal cord.  In studying these non-smoking casino workers, NIOSH found they were exposed to nicotine levels in the air of 6-12 μg/m3.  The investigators also took urine samples of the workers to estimate the internal dose the workers were absorbing and found they had blood cotinine (a metabolite of nicotine) levels of 1.85 ng/ml after their shift.  NIOSH monitored employees working in both "smoking" and "non-smoking" sections of the casino and found elevated levels of exposure in both, as measured in the air (externally) and in the worker's blood (internally). While all areas measured were above the recommended exposure limit, the highest concentrations were found at the poker tables.  The national average at the time for non-smokers exposed in their work or home was 0.93 ng/ml.  As a result of this study, NIOSH recommended that employees not be involuntarily exposed to smoke in the workplace.  However, NIOSH is only a research agency and their recommendations do not have the force of law or ability to force employers to comply. Studies in casinos before and after smoking bans were enacted showed a decrease of 85-95% in cancer causing agents.  Based on these studies, NIOSH expanded it's recommendation to make casinos in the United States 100% smoke free in 2009.
 * 2)  Repetitive motion injuries : Efficiently dealing or running table games often require workers to perform the same motion over and over for many hours.  The repeated lifting and reaching needed to successfully run table games may lead to musculoskeletal injury (MSI).  Considering workplace ergonomics can not only keep the employees safe, but can also keep the patrons comfortable, which will keep them at the tables longer.  To prevent slip and falls, casino employers should establish well marked walking routes with changes in height marked by a visual signal.  Employees should also be allowed to wear shoes with proper traction.  Musculoskeletal injuries in casino workers are most common in the upper extremity, back, and legs. A table with a softer edge for the dealer to lean against will decrease nerve compression in the upper extremity.  Carpal tunnel, a disorder caused by compressing the median nerve as it passes through the wrist into the hand, has been found more frequently in table game dealers.   The American Conference of Governmental Industrial Hygienists provides a threshold limit value (TLV) for the upper extremity is is 0.78 and the action level is 0.56.
 * 3)  Shift work : Those who work the night shift are known to be at increased risk of insomnia, general morbidity, and all cause mortality.  Studies of casino shift workers have found increased emotional and behavioral problems in their children as well as six time higher rate of divorce in men with children who have been married less than 5 years.   Women with children were also three times more likely to get divorced while performing shift work at casinos.   However, there was no increased rate of divorce in couples without children who performed shift work at casinos.    Employers should try to minimize this risk by keeping each worker on a consistent shift, rather than rotating them between days and nights.  If shift rotation must occur, it is better to rotate employees forward from day into evening shifts.
 * 4)  Slip, trips, and falls : According to the United States Bureau of Labor and Statistics, slip, trips, and falls were the leading cause of days away from work (DAFW) in 2017 causing 20,000 workers to miss one or more days.  While only 1 in 6 slips and falls will result in missed days of work, those who do miss work are often absent for a lengthy period (11 days on average).
 * 5)  Burns : In casinos, these most commonly occur in preparation or delivery of foods, beverages, or oils since liquid or steam at only 155° Fahrenheit can burn or scald the skin.  These burns can often be avoided with special precautions taken when cleaning deep fryers or pressure cookers.  If possible full containers of liquids should not be carried as they can spill, especially on slippery or cluttered floors.
 * 6)  Assault/Battery : Emotions can run high during gambling and this combined with alcohol which is often provided for free while playing can lead patrons to become aggressive and agitated toward the staff or other players.  Casinos also frequently have large amounts of money present increasing the possibility of a robbery that can put an employee in a dangerous situation.  Since there may be blood after a fight,  employees should be trained how to take appropriate measures to protect against blood born pathogens.
 * 7)  Work stress : Casino workers have had panic attacks at work when the casino is understaffed.
 * 8)  Gambling addictions : Casino employees are known to be at higher risk for gambling problems than the average person.  Employers should offer education as a preventative strategy as well as treatment for employees who become addicted.  Casino managers can protect their employees and patrons by tracking and excluding gambling addicts as well as limiting the amount one can lose in any 24 hour period.
 * 9)  Alcoholism : Casino employees are known to be at higher risk for alcohol problems than the average person.  Employers should offer education as a preventative strategy as well as treatment for employees who become addicted to alcohol.
 * 10)  Depression : Casino employees are known to be at higher risk for depression than the average person.  Employers should offer education as a preventative strategy as well as treatment for employees who develop depression.
 * 11)  Noise induced hearing loss :  Casinos can protect their employees from high levels of ambient noise by locating their performing entertainment and slot machines in a separate physical location. NIOSH has conducted one noise evaluation of a casino in 2003, but did not find any evidence that noise in that casino was loud enough to put employees at risk of hearing loss.  As a preventative measure going forward, NIOSH recommended that noise levels be reevaluate whenever a new piece of equipment is installed or whenever employees express concerns about the noise level.  NIOSH generally recommends that such noise assessments be conducted on the busiest nights of the week or whenever the noise is likely to be loudest as that is the time of greatest risk to workers and patrons.  The ACGIH 8 hour Threshold Limit Value (TLV) for sound is 85 A-weighted decibel (dBA).  Exposure at or below this level of sound is expected to protect most workers from noise induced hearing loss over a 40 year career. Noise induced hearing loss typically begins in the higher frequencies of 4 or 6 kHz and the progresses to the  0.5, 1, 2, and 3 kHz which are the frequencies of most conversations.   ACGIH's exposure limits are recommendations based on the most current science, though OSHA's standard still allows employers to expose workers to a maximum permissible exposure level (PEL) of 90 dBA for 8 hours each day under 29 CFR 1910.95.  OSHA also a 5 dBA exchange allowing this to increase to 100 dBA for 4 hours of work or decrease to 85 dBA when working a 16 hour shift.  Casino workers were generally found to be exposed to an 8-hr TWAs noise level of 76.4-81.8 dBA.  Another key takeaway of the noise evaluation of the casino was that the highest noise detected was in the children's arcade with levels reaching 78 – 84 dBA.
 * 12)  Cancer : The primary risk factor for casino workers is thought to be due to second hand smoke which can increase the risk of both lung cancer and breast cancer (42% higher) above the general population's risk.   In addition to second hand smoke, an increased frequency of breast cancer of 35%  has also been found in women who work night shifts.   Female working night shift in casinos can lower their risks of breast cancer by limiting alcohol intake, staying physically active, and maintaining a healthy weight.
 * 13)  Metal dust from coin counting : In 2000, NIOSH was asked to evaluate a casino for metal dust after employees reported eye, nose, and airway irritation that they thought might be related to the process used to count metal coins.  NIOSH evaluated the air and employees for nickel, copper, and zinc because these metals make up the vast majority of modern US coins.  All levels were below the NIOSH recommended exposure limit (REL), specifically nickel was 7 μg/m3 (REL 15 μg/m3), copper was 24 μg/m3 (REL 1,000 μg/m3), and zinc was below the limit of detection (REL 5,000 μg/m3).

Occupational Health and Safety Hazards and Best Practices to Prevent Harm by Job Position

 * 1)  Card Dealers : Musculoskeletal injury (MSI) is a common way dealers can be injured performing their routine duties.  Ergonomics tries to prevent these injuries by "fitting the job to the worker."  This involves educating workers about how best to safely perform their job and prevent injury as much as it does providing them with any special or protective equipment.  The human body is less vulnerable to injury when in a neutral posture.  Beware that your risks of overuse injury increase when there are fewer players at the table as the variation in your body motions decrease.  Stretching frequently or shifting your position during breaks in the game will decrease static posture. It is worth noting that dealing different card games poses different risks: for example black jack dealers deal more cards per shift than baccarat dealers.  Therefore, a safety determination for one game does not assure a similar safety profile in other similar games.  Rotation of dealers between different tables allows workers to engage different muscle groups. Common postures that put dealers at risk are listed below along with how best to minimize the risk of harm:Card Dealing Ergonomics.jpg
 * 2) *  Dealing cards  - minimize bending your wrist by flicking the cards forward using your index and middle fingers. Keep your wrists straight (do not flex or bend them). Turn to face your players or use your peripheral vision, rather than turning your head which can strain your neck.
 * 3) *  Retrieving cards from the shoe  - the cards and shoe should be at or just below elbow height and adjusted so that you can keep your elbows close to your body and do not have to move your elbows out to the side to deal or shuffle. Position the shoe so that you can use it comfortably with players in your line of sight without twisting your back, wrists, or hands.  Alternatively, a shoe below the table allows the dealer to rest their hands on a flat surface.  Keeping your joints in as straight a line as possible will decrease overuse injuries.




 *  Reaching forward to collect cards or bets while standing  - your waist should be even with the height of the table. An adjustable height step box for dealers is more appropriate than an adjustable height table, which could put patrons at risk of an awkward posture. Alternatively, patrons could be provided with chairs that adjust in height.  If possible, use a step/footrest under the table to allow you to lean forward onto the elevated leg as you reach forward.  A step/footrest also allows you to change your posture regularly to avoid becoming static.  If cards are beyond your reach, ask players to slide them toward you.  Standing tends to decrease static posture and relieve joint pain throughout the body. However, standing also increases pressure on your feet. Therefore, it is a good idea for employers to allow employees to wear supportive footwear.
 *  Reaching forward to collect cards or bets while seated  - adjust the chair such that it supports your lower back and your feet are supported with your knees flexed to 90 degrees. Use a chair that swivels to turn and face the player with whom you are interacting. Seated Dealing Cards Ergonomics.jpg


 * 1)  Croupier (Roulette) : Make sure commonly used items are within comfortable reach. When handing out or retrieving bets move along the length of the table so that you don't have to twist or reach.  Using your arm to start the wheel spinning and use a "snap" technique to spin the ball in the opposite direction, rather than your wrist.
 * 2)  Bellhops/Luggage Handlers : If work involves lifting or moving objects, then employees should be trained in safe manual handling procedures. Be careful to avoid awkward postures when loading or unloading luggage by having your feet facing the luggage and firmly planted on the ground.  It is important to shorten the distance between you and the luggage by pulling it toward you or moving toward it because the further the weight is from your body, the more strain you put on your back. Although you may not feel pain while performing the movement, you can still put your joints at risk by lifting luggage awkwardly, especially if it is heavy.     Use a luggage cart whenever the luggage does not have wheels or when moving more than 2 bags.  When loading a luggage cart, attempt to store larger bags upright and on the bottom and medium bags at waist height and on top.  As often as possible, avoid loading any bags higher than your shoulders as our ability to lift safely decreases substantially at this height.  Loading the cart in this manner will also allow you to push, rather than pull the cart and will keep your field of vision clear.  Pushing will protect your back and upper extremity from injury.  Remember to use both hands touching the cart slightly below elbow level and generate power to push from your legs.   If your luggage cart is not functioning properly due to misaligned or malfunctioning wheels, request it be serviced because a malfunctioning cart can lead to awkward forces being applied to your body.
 * 3)  Housekeepers/Room attendants :  It is important to make sure that you can see where you are going.  Push your service cart with both hands just below shoulder level, rather than pulling it behind you.  If your cart is not functioning properly due to misaligned or malfunctioning wheels, request it be serviced because a malfunctioning cart can lead to awkward forces being applied to your body.  Use both arms to vary and lessen the load on either arm when doing tasks such as scrubbing, folding, vacuuming, and making beds.  Employers should allow employees to wear comfortable shoes to reduce strain on their back and knees.  If your work requires you to kneel, cushion your knees with a mat, towel, or knee pads.  Maintain a straight back when making a bed by dropping to one knee to tuck in sheets, rather than bending your back.  When changing duvets or pillows, turn the covers inside out to change them, rather than stuffing them back inside.  This will reduce the force applied to your arm.   Use a tool with a long handle or a step stool to clean hard or awkward to reach places like bathtubs and mirrors that extend above your head.  When cleaning the shower or tub, stand inside to make it easier to reach.  To avoid falling, never stand on the toilet or edge of the tub as it can be slippery. Housekeepers are often expected to clean biological material (blood, vomit, excrement) and if so, workers should receive proper training and protective equipment.  Housekeepers need to be alert to possible abuse by guests and casino managers need to have a plan in place to keep workers safe from guests.
 * 4)  Front Desk Staff : If standing for a prolonged period of time use anti-fatigue matting under your feet to provide cushioning or stand with one foot elevated to shift your weight periodically from side to side (see illustration above for card dealers).  Employers should allow employees to wear comfortable shoes that provide them with enough cushioning.  If you are too short to comfortably see and reach over the desk, ask for a platform to stand on or an adjustable chair with a footrest that your legs can reach.  Make sure that frequently used items are within easy reach and in your line of sight that avoids twisting you back or rotating your neck.  The telephone and computer require continuous attention to this recommendation.  A goal is to have your computer monitor at or just below eye level and your keyboard just below or even with elbow height.  Do not hold the phone by pinching the telephone between your ear and shoulder, but rather hold it or ask for a lightweight headset to prevent developing neck pain.
 * 5)  Host/Hostess/Server/Attendant :Serving Ergonomics.jpg toward the customer or around the table if possible to refill drinks or remove plates so as to avoid straining to reach.  You are at higher risk when the pitcher or plate are full as they are heavier and your arm is outstretched moving the weight away from your body.  Employers should allow employees to wear comfortable shoes to reduce strain on their back and knees which can lead to injury over time.  Trays should be carried with the arm in a neutral position, which is typically with your elbow bent to 90° and the palm of your hand facing upward as close to the body as possible.  To bring the weight of the tray closer to your body carry the weight on both your forearm and hand, rather than just your hand alone.  Avoid awkward positions that can strain your body such as carrying the tray on your finger tips or above your shoulder.  To avoid awkward positions or straining muscles unnecessarily, place heavy items close to the center of the tray or closer to your body such that they are over your forearm.
 * 1)  Host/Hostess/Server/Attendant :Serving Ergonomics.jpg toward the customer or around the table if possible to refill drinks or remove plates so as to avoid straining to reach.  You are at higher risk when the pitcher or plate are full as they are heavier and your arm is outstretched moving the weight away from your body.  Employers should allow employees to wear comfortable shoes to reduce strain on their back and knees which can lead to injury over time.  Trays should be carried with the arm in a neutral position, which is typically with your elbow bent to 90° and the palm of your hand facing upward as close to the body as possible.  To bring the weight of the tray closer to your body carry the weight on both your forearm and hand, rather than just your hand alone.  Avoid awkward positions that can strain your body such as carrying the tray on your finger tips or above your shoulder.  To avoid awkward positions or straining muscles unnecessarily, place heavy items close to the center of the tray or closer to your body such that they are over your forearm.