Decades of research and calls for more nail gun safety
April 1987: University of British Columbia medical researchers John Le Nobel and Peter Wing identified 1,977 nail gun injuries between 1973-1982 from claims filed with British Columbia's Workers Compensation Board. They investigated 32 cases where men shot nails into their knees, reporting their findings and expressing concerns in Clinical Orthpaedics. A third were hurt during their first week using the tool. The researchers called for more training and "stricter regulation," recommending: "a triggering method that would permit only single firing of nails, rather than a rapid succession, would improve safety."
October 1992: Drs. Nick Kenny, PR Kay, and JF Haines of the Orthopaedic Surgery Department at Trafford General Hospital in Manchester, England, report in the British Journal of Hand Surgery on three cases of nail gun injury to the non-dominant hand. They stress the tool's hazards and discuss possible complications of surgical nail removal.
December 1993: Drs. Kenny, Haines and Donal O'Donaghue, report that during a 14-month period, the emergency department saw 12 patients with industrial nail guns injuries.
"Some patients said that the contact pressure required to activate the gun was low, and occasionally a gun would misfire with simple movement through space and without being in contact with a solid structure."
"All patients required surgical removal of the nails, which in some cases had penetrated deeply. … All patients stated that they had received training in the use of nail guns but they considered it inadequate.
"The pattern of these injuries … suggest that the safety mechanisms on the guns and the protective clothing worn by operators of the guns do not prevent injuries. We call for a review of operator training and the design of both the safety mechanisms and the protective clothing worn by operators."
March 1995: Doctors at the Tahoe Forest Hospital in Truckee, writing in the Journal of Trauma, discuss the case of a 32-year-old man who shot himself in the heart, lung and aorta with a nail gun after a co-worker accidentally hit his nail gun with a beam. Authors (Kenneth W. Kizer, then of the UC Davis School of Medicine, and three others) conclude: "Given the remote settings in which these devices are often used, we would concur with (Dr. Nick) Kenny's suggestions that increased attention be directed toward the prevention of nail gun injuries through enhanced operator training and a review of the device's safety mechanisms."
September 1996: Two doctors from the University of Texas Health Science Center report four consecutive cases of nail gun injuries to the eye. Three of four recovered good vision after surgery. They nevertheless recommend using safety glasses and adhering to safety precautions, saying such injuries can have "disastrous visual consequences."
July 1997: In the Journal of Trauma, Dr. Giampiero Alberico of the Emergency Department of S. Massimo Hospital in Penne, Italy, describes the case of a 54-year-old hurt while trying to attach metal plates to a wall in his yard with a nail gun. The man felt a sharp pain in his neck and fell to the ground. He thought he was hit by concrete fragment, but an X-ray found a nail entered his neck and became lodged in his lung. "Additional safety mechanisms should be introduced to reduce the risk of injuries," he wrote
December 1999: Drs. Anne-Corinne Beaver and Michael L. Cheatham of the Surgical Education Department at the Orlando Regional Medical Center in Florida report in the American Surgeon that during a 20-month period, eight patients were admitted to their Level I trauma center with potentially life-threatening nail gun injuries to their brain, eye, neck, heart, lung and femoral artery.
They say that nail guns have "significant potential for causing severe debilitating injury and death." These findings, they add, indicate a need for improved safety features and user education. They also predict: "The incidence of nail gun injuries will likely continue to rise with increased use of these tools by both the construction industry and the weekend do-it-yourselfer. … Manufacture of nail guns with permanent safety features and improved training of nail gun operators is warranted."
That same month, the Washington State Department of Labor and Industries publishes a detailed technical report on the prevalence of nail gun injuries in that state between 1990-1998. For the nine years, it finds, there were 3,616 accepted state fund claims for nail gun injuries. No fatalities were reported, but total costs were $6,232,392 or about $692,488 a year.
To reduce the number and severity of nail gun injuries, the report recommends: "Use the sequential trigger … manufacturers should work with users and health and safety professionals to better balance the speed and productivity of using 'bump' mode with the accuracy and potential of fewer acute trauma injuries using the 'sequential' mode." (Bump mode is firing the nail gun by bumping the safety bracket along the work piece while holding down the trigger.) Their research was published by the American Society of Safety Engineers magazine in January 2001.
December 2001: The Atlanta Journal-Constitution reports that up to a dozen patients that year showed up at Grady Memorial Hospital, Georgia's busiest trauma center, with eye and facial nail gun injuries. A high number of them are Latinos.
Dr. Geoffrey Broocker says the number of injuries is considerably higher than in previous years. Many eye injuries happened to workers who were not wearing eye protection. Some delayed getting medical attention because they were not citizens and had no health insurance – delays that can permit infection to develop and severely damage an eye. The paper reports that the Mexican consul, Remedios Gomez Arnau, has started to work with OSHA to curb an increase in injuries to Latino workers nationwide.
March 2002: Canadian Medical Association Journal Editorial Fellow Eric Wooltorton reports that nail guns have a ballistic potential comparable to conventional firearms and warns they have caused direct and indirect nail gun injuries to children and innocent bystanders after passing through walls. Recommends the safe storing and securing of nail guns and cartridges "as they would any firearm and ammunition."
November 2002: Dr. Gregory Buchalter of the University of Utah Phoenix Indian Medical Center, writing in the Ear, Nose & Throat Journal, offering a contrary view to Beaver et al. from 1999: "Any physician who is called on to manage a nail gun injury to the head or neck should understand that most likely the patient will have sustained a surprisingly limited amount of tissue injury, owing to the relatively low velocity of the projectile compared with that delivered by firearms."
However, Buchalter notes that: "Most nail guns are designed with a safety mechanism to prevent unintentional firing. … When a nail gun is carried with its trigger depressed, an inadvertent firing can occur if the switch is accidentally engaged."
That same month, Graeme Johnstone, state coroner for Victoria, Australia, publishes a 12-page report about the 1998 nail gun-related death of worker Peter Sullivan, who died of deep venous thromboses after a nail injured his left thigh. Noting with concern that there had been 94 traumatic nail gun injuries and scores of workers compensation claims between 1998 and 2002, Johnstone called for a government and industrywide review of nail gun design features and work practices. "The safety features of the particular gun used by Mr. Sullivan (a Hitachi NT65AB) did not avoid the accidental discharge into his leg," Johnstone wrote, adding that seemingly "minor injuries" like Sullivan's need to be considered "a major injury" because of the blunt force of the power tool.
May 2003: Writing in Applied Occupational and Environmental Hygiene, a trade publication, John M. Dement and Hester Lipscomb, of the Duke University Medical Center and University of North Carolina at Chapel Hill, studied nail gun injuries among 21,000 union carpenters in Ohio and North Carolina. The Ohio injries took place between Jan. 1, 1994, and Sept. 30, 1997; those in North Carolina between July 1996 and November 1999. The cases were matched them to workers' compensation claims. The authors found that nail gun injuries accounted for 4 percent of compensation claims and that paid time off work cost an average of $9,237 per case.
Their data also found 80 to 89 percent of injuries were puncture wounds, and the researchers suggested that 69 percent of the puncture injuries were caused by inadvertent gun discharge or misfire, "preventable in large part by the use of sequential triggers."
June 2003: Using data that estimated there were 32,000 nail gun injuries in the United States that were treated in hospital emergency rooms in 2001, the Consumer Product Safety Commission pegged the total cost of nail gun injuries at $338 million.
June 2004: A five-year study of 600 nail gun-related injuries by emergency medicine specialist Dr. Jonathan Knott of Australia's Royal Melbourne Hospital, reported in Occupational Health News, finds that 75 percent of the injuries occurred in the construction industry. Three-quarters of the accidents involving injuries to the hand and finger, mostly on the non-dominant hand, were linked to "bump firing."
The common method using the tool – with bump firing – may be increasing the risk of injury, Knott reports, adding that while bump firing speeded up construction, it increased the dangers.
"It's not clear how much training is given," Knott writes. "Maintenance of adequate workplace standards, education and training may decrease the risk of related injury and avoid potentially lethal outcomes."
June 2005: Writing in the journal Injury Extra, Drs. Timothy A. Pritts, Douglas Knight and Bradley Davis of the University of Cincinnati Medical School review the case of a 23-year-old man who shot himself in the heart with a nail gun. He survived after the nail was removed and his heart was surgically repaired.
The researchers examined 20 reported cases of nail gun shots to the heart; they found an 80 percent survival rate. They note that even "presumed minor" nail gun injuries to the hands and fingers "are associated with significant social and economic effects since the majority of these injuries result in significant amount of lost work."
Despite improvements in nail gun safety that aim to prevent misfires, the device's safety nozzle does not completely remove the risk of accidental injury, and they say, "Continued efforts at (injury) prevention are required that will hopefully lead to a significant reduction in these potentially fatal injuries."
June 2006: Writing in the American Journal of Industrial Medicine, Duke University researchers Hester Lipscomb and John Dement team up with St. Louis carpenters James Nolan and Dennis Patterson to report that 45 percent of carpenter apprentices had suffered a nail gun injury in the past year, a rate considerably higher than previously recognized.
After adjusting for experience and training, they also discovered that the injury rate for workers using contact trip nail guns was double that for workers using safer sequential triggers.
"These data clearly indicate that measures currently in place to prevent injuries from nail guns are not adequate to protect apprentice carpenters," they write. "Prevention of nail gun injuries in this population should focus on advocating for, or perhaps regulating, the use of the safer sequential trigger preventing unintentional firing and early training in tool use.
"Because of the high prevalence of these tools with contact trip triggers the greatest number of injuries among these apprentices could be prevented with an engineering solution. It is unfortunate that an existing engineering control for this common tool is not the norm on most residential work sites."
April 2007: A Centers for Disease Control and Prevention report notes that consumer nail gun injuries skyrocketed 200 percent between 1991 and 2005, corresponding to an increase in availability of inexpensive nail guns and air compressors in home hardware stores.
In 2005, 13,400 consumers and 28,600 workers were hurt and visited emergency rooms for treatment, the report noted, including 1,200 women.
That number represented an increase of 39 percent for workers from 2004. Of the 28,600 workers, 1,500 were hospitalized for puncture wounds or after having embedded nails removed. Because consumers use the tools for far fewer hours than professional carpenters, their actual injury rate might be much higher, the report states.
The CDC report states that training that emphasizes safe working practices might help reduce injuries among workers, but says use of sequential triggers is likely to be more effective, particularly for consumers who do not usually receive training in tool use.
May 2007: Advanced Safety & Health, LLC, an occupational safety and health consulting company with offices in Kentucky and Pennsylvania, publishes a newsletter for its clients titled, "A Call for Gun Control." They weren't talking about firearms, but nail guns. The newsletter emphasizes the grim numbers in the CDC report, discusses the safer sequential trigger and urges clients to review nail gun safety to avoid serious injuries and even death.
That same month, Dr. Stephen Monteith presented his study of a dozen brain injuries caused by nail guns to colleagues at the Royal Australasian College of Surgeons annual meeting. He raised the possibility of limiting the sale and use of the tool to builders only.
June 2007: Drs. George Testerman and Laura Dacks, writing in the Southern Medical Journal, report that penetrating brain injury resulting from nail gun use has become "a well-characterized entity, one that is increasing in frequency as the guns become more powerful and more readily available to the public."
November 2007: Drs. Brandon R. Horne and Fred Corley at the University of Texas Health Science Center's Orthopedics Department, write in the journal Injury that they reviewed 88 nail gun injuries at their San Antonio hospital over a four-year period and found the majority were to hand and knee (38.6 percent and 28.1 percent) respectively.
They note that the "increased productivity" in construction work has come "with an increasing number of injuries associated with the device."