Preventing Traumatic Brain Injuries

Header image: U.S. Air Force photo by Tech. Sgt. Michael Holzworth

Quick Answer

Workplace traumatic brain injuries (TBIs) are most commonly caused by falls and struck-by incidents. The most effective prevention combines engineering controls (guardrails, overhead netting, exclusion zones) with proper head protection: specifically Type II safety helmets tested under ANSI/ISEA Z89.1 for impacts from all directions. The CDC identifies TBI as a major cause of death and disability in the United States. It is largely preventable with the right controls and certified PPE in place.

What Is A Traumatic Brain Injury?

A traumatic brain injury (TBI) is caused by a bump, blow, or jolt to the head, or by an object penetrating the skull, that disrupts the normal function of the brain. According to the CDC's Traumatic Brain Injury and Concussion program, TBI is a major cause of death and disability in the United States. TBIs range from mild concussions - which may resolve with rest and monitoring - to severe injuries involving extended unconsciousness, amnesia, permanent cognitive impairment, and death.

Workers who survive a severe TBI frequently face lasting consequences: chronic headaches, memory problems, difficulty concentrating, personality changes, and physical impairments that can end a career and profoundly affect quality of life for decades. For workers in physically demanding trades, the loss of cognitive sharpness and physical coordination from a TBI can make returning to construction or industrial work impossible.

How Workplace TBIs Happen

Falls from elevation are the primary mechanism of work-related TBI. The BLS Census of Fatal Occupational Injuries (2024) recorded 844 fatal falls, slips, and trips across all industries in 2024. Among construction and extraction workers, fall fatalities totaled approximately 370 in 2024. Many of these deaths involved head impacts. Falls from ladders, scaffolding, rooftops, and elevated platforms impose forces on the skull and brain that exceed what unprotected tissue can withstand - even at heights that workers might consider low-risk.

Falling objects are the second major TBI mechanism on construction sites. Tools, hardware, lumber, and materials dropped from elevation accelerate under gravity and can reach lethal velocities before striking workers below. A small tool dropped from 20 feet delivers impact energy comparable to a forceful blow from a blunt instrument. Workers performing ground-level tasks directly below elevated work face this exposure continuously.

Motor vehicle and equipment incidents contribute to workplace TBIs through crashes, rollovers, and ejections. Workers on foot who are struck by vehicles or mobile equipment can sustain head injuries regardless of whether they are wearing hard hats, because vehicle contacts often involve lateral forces on the head and neck.

Crane and hoist loads that swing unexpectedly, structural elements shifting during installation, and equipment contacts in tight work areas round out the common sources of workplace head trauma. No single control addresses all of these - which is why an effective TBI prevention program layers engineering controls, administrative procedures, and properly selected PPE.

The Role Of Head Protection In TBI Prevention

Safety helmets are the required PPE for environments where head impact is possible. OSHA's construction standard at 29 CFR 1926.100 mandates head protection for workers in areas where there is a possible danger of head injury from impact, falling or flying objects, or electrical shock and burns. The standard references ANSI/ISEA Z89.1 as the performance benchmark all compliant helmets must meet.

Helmet type is critical to TBI prevention outcomes. Type I hard hats are tested for impact to the crown - the top of the head - only. They provide no tested protection for lateral, front, or rear impacts. Type II safety helmets are tested for impacts from all directions: top, front, sides, and rear. This distinction is decisive because most real-world head impacts from falls and struck-by events are not straight-down crown strikes. A worker who falls sideways off a ladder, slips and strikes the back of their head on a scaffold tube, or is hit by a swinging load at head height is experiencing a lateral or oblique impact that Type I helmets were never designed to handle.

Modern Type II helmets from manufacturers like Studson incorporate advanced impact-absorbing materials into the helmet structure. The Studson SHK-1 uses Koroyd impact-absorbing technology integrated into the shell - a cellular structure that collapses on impact to absorb and disperse energy, reducing the force transmitted to the skull. This is a meaningful design difference from traditional shell-and-suspension helmet designs that manage impact primarily through the suspension straps.

Fall Prevention Is TBI Prevention

Since falls are the primary mechanism of occupational TBI, preventing falls prevents TBIs. The CDC's guidance on preventing TBI identifies fall prevention as one of the three primary TBI prevention strategies, alongside wearing appropriate helmets and seatbelts. On construction sites, fall prevention follows the OSHA hierarchy of controls:

First, eliminate elevated work where possible. If a task can be done at ground level, it should be. Prefabrication and modular construction methods reduce the amount of work requiring elevation.

Second, engineer out the fall hazard. Install guardrails at all open edges before workers access the level. Cover all floor openings before work begins. Guardrails are passive controls that work without requiring any action from the worker - they are the gold standard for fall prevention.

Third, use administrative controls and PPE. Written safety plans, pre-task briefings, and documented fall protection training under OSHA's fall protection program address residual risk after engineering controls are in place. Personal fall arrest systems (harnesses, lanyards, anchorage points) are the PPE layer. Head protection works as a backup when prevention fails - the helmet is what stands between a falling worker's head and the surface below.

Chin Straps: The Often-Missed Element Of TBI Prevention

A helmet that leaves the head during a fall provides no protection. Chin straps are an underutilized element of TBI prevention on construction sites. OSHA does not universally mandate chin straps, but many site safety plans and federal project specifications require them for work at elevation. When a worker falls, the natural reflex motion and wind resistance can displace an unsecured helmet before the head impacts the surface - leaving the worker with no protection at the moment it is most needed.

A properly adjusted chin strap rated to the manufacturer's specification maintains helmet position throughout a fall or struck-by event. Most modern Type II safety helmets from Studson and Hardknock include or accept accessory chin straps designed for the specific helmet geometry. Chin strap use should be specified in the site safety plan for any work at 6 feet or more, and supervisors should enforce it with the same discipline applied to fall arrest equipment.

Overhead Object Prevention: Protecting Workers Below From Head Injuries

Head protection is only one element of struck-by prevention for workers below elevated work. Engineering controls reduce the probability of objects reaching ground level in the first place. Effective overhead object prevention includes:

Tool tethering: Tethered tools and equipment cannot fall if accidentally released. Tool tethering programs for elevated work are a straightforward, cost-effective engineering control.

Overhead nets and debris screens: Physical barriers below elevated work areas catch dropped objects before they reach workers. Required on many federal construction projects.

Exclusion zones: Controlled areas below overhead work where only essential personnel may enter, and where all personnel must wear proper head protection.

Post-Impact Protocol: No Helmet Survives Two Impacts

Any safety helmet involved in an impact event - a fall, a struck-by, a collision - must be removed from service immediately and replaced, even when no visible damage is present. The energy-absorbing liner and suspension material compress and deform to manage impact energy. After one impact, these components may be permanently compressed and perform well below specification in a second event. Supervisors and safety managers should establish and enforce a clear protocol: impact occurs, helmet comes off, replacement is issued before the worker returns to work.

This is not a cost-saving gray area. A compromised helmet that looks intact is worse than no helmet in one respect: it creates a false sense of protection. The manufacturing date is molded into the shell of every ANSI-compliant helmet. Mark the in-service date on the helmet with a permanent marker. Replace the shell every 5 years from manufacture and the suspension annually, regardless of impact history.

Recognizing TBI Symptoms On The Jobsite

Not every TBI announces itself with obvious symptoms. Workers who sustain head impacts may minimize or dismiss what they are experiencing. Supervisors, crew leads, and co-workers should know the warning signs that require immediate medical evaluation: headache that worsens after the initial impact, repeated vomiting, slurred speech, one pupil visibly larger than the other, seizures, or loss of consciousness. Confusion, memory gaps, and sensitivity to light or sound after a head impact are also serious indicators.

The CDC's guidance on concussion and mild TBI, available through the CDC Traumatic Brain Injury and Concussion program, covers recognition, evaluation, and return-to-activity protocols. Any worker who sustains a head impact should be evaluated by a medical professional before returning to safety-sensitive or cognitively demanding work - not cleared to return by a supervisor or safety officer in the field.

Traumatic Brain Injury Key Statistics

844 fatal falls, slips, and trips across all U.S. industries in 2024 (BLS CFOI 2024). Falls are the primary mechanism of occupational TBI.

370 (approximately) fatal falls among construction and extraction workers in 2024, a 7.5 percent decrease from 400 in 2023 (BLS CFOI 2024).

1,032 total construction and extraction fatalities in 2024. Falls represent the largest single fatal event category within this group (BLS CFOI 2024).

TBI is a major cause of death and disability in the United States (CDC). Workplace falls and struck-by events are two of the most significant occupational contributors. Full fatality data by event type is available through the BLS Injuries, Illnesses, and Fatalities program.

Type II Helmets For TBI Prevention

STUDSON SHK-1 Full Brim Vented - ANSI/ISEA Z89.1 Type II, Class C. Koroyd impact-absorbing technology provides multi-directional energy dispersion. View the SHK-1 Full Brim Vented | Browse the Studson collection.

Hardknock Resolve FullBrim Type II Safety Helmet - ANSI/ISEA Z89.1 Type II. Full brim, chin strap compatible, accessory rail for ear protection and face shields. Available in vented and non-vented. Browse the Hardknock collection.

BDG Safety is a certified SDVOSB distributor of Type II safety helmets for federal contractors, general contractors, and industrial employers. Our founders are Navy veterans who understand head injury risk firsthand. Learn about our team.

Related TBI Prevention Resources

What is a Type II safety helmet? - how ANSI/ISEA Z89.1 Type II certification differs from Type I and why it matters for TBI prevention.

OSHA's Fatal Four - falls and struck-by incidents are two of the four deadliest construction hazard categories.

Leading causes of workplace injuries - BLS data on the full spectrum of fatal and nonfatal occupational injuries.

OSHA head protection standards - the regulatory requirements for head protection in construction and general industry.

Frequently Asked Questions About Preventing Traumatic Brain Injuries

Q: What type of hard hat prevents TBIs?

A: Type II safety helmets rated to ANSI/ISEA Z89.1 provide the broadest TBI protection available in a safety helmet. They are tested for impacts from all directions - top, front, sides, and rear - which is critical because most fall-related and struck-by head impacts are not straight-down crown strikes. Type I hard hats are tested for top impacts only. For environments where falls and struck-by events are possible, Type II is the standard that matches real-world risk.

Q: Can a hard hat prevent a concussion?

A: Safety helmets reduce the force of impact transmitted to the skull and brain, which can reduce the severity of a TBI or prevent one entirely in moderate-force events. They cannot guarantee concussion prevention in all circumstances - a severe fall or high-energy impact can still cause TBI even with a helmet in place. The goal of head protection is to reduce severity and prevent fatal outcomes; it is one layer in a system that must include fall prevention and struck-by controls.

Q: How does a Type II helmet reduce TBI risk compared to a Type I hard hat?

A: Type II helmets are tested for lateral, front, and rear impacts in addition to the crown impact that Type I covers. In a fall or struck-by event, the head rarely strikes on the exact crown. If a worker falls sideways off a ladder and hits the side of their head on a rung or the ground, a Type I hard hat offers no certified protection for that impact. A Type II helmet has been tested to manage exactly that event. Modern Type II helmets also use energy-absorbing materials in the shell itself, not just the suspension system, for improved impact attenuation.

Q: What should I do if a worker sustains a head impact on the job?

A: Remove the worker from active duty immediately and arrange for medical evaluation. Do not allow self-assessment or supervisor clearance in place of professional evaluation - concussion symptoms can be delayed, and a worker who reports feeling fine immediately after an impact may have a serious TBI developing. Retire the helmet involved in the incident: it cannot be assumed to perform to specification on a second impact. Document the incident and the helmet retirement, and issue a replacement before the worker returns to head-hazard environments.

Equip Your Crew To Prevent Traumatic Brain Injuries

BDG Safety specializes in Type II safety helmets for federal contractors, general contractors, and industrial employers who take head injury prevention seriously. We are a certified Service-Disabled Veteran-Owned Small Business built by Navy veterans who understand occupational head injury risk firsthand. We carry Studson and Hardknock Type II helmets with the accessories your crews need: chin straps, face shields, ear protection rails, and headlamp clips.

Ready to upgrade your head protection program? Contact BDG Safety at (619) 992-7621 or info@bulldoggroup.net. We help you specify the right helmet for the right hazard - and deliver on time.

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