i n t e g r i t y - s e r v i c e - e x c e l l e n c e usaf medical service occupational health...
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I n t e g r i t y - S e r v i c e - E x c e l l e n c e
USAF Medical Service Occupational Health Program
Lt Col Kenneth L. Cox, USAF, MC, SFS
Chief, Risk Assessment Division
Phone: 210/536-1788
17 April 2002
Armed Forces Epidemiology Board
I n t e g r i t y - S e r v i c e - E x c e l l e n c e
Overview
Definition Occupational Health Program and Drivers Occupational Health Basic Strategy Occupational Health Team and Functions
BEE, Public Health, Physician, Support Staff Occupational Health Working Group (OHWG) Data Collection and Analyses Special Occupational Studies Initiatives and Future Projects
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Occupational HealthDefinition
“. . . Promotion and maintenance of the highest degree of physical, mental and social well-being of workers . . . Prevention among workers of departures from health caused by their working conditions . . . Protection of workers . . . from risk . . .
World Health Organization (1950)
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Occupational Health ProgramPolicy Directives and Drivers
“The Air Force will ensure the occupational health of its people by identifying work-site health hazards, recommending control measures, assessing fitness for work, conducting medical surveillance, educating workers, and providing clinical services.” AFPD 48-1, Aerospace Medical Program
Components outlined in AFI 48-145, Occupational Health Program, 1 Apr 99
AFMAM 48-146, Occupational Health Information Management (under development, to replace AFOSH Std 161-17)
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Occupational Health Surveillance Strategy
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Occupational Health Team
Occupational health consultant physician Public health specialists Bioenvironmental engineer Support specialists Other, depending on local assets/needs
Safety Audiology Primary Care Mgr
Health promotionsCivilian personnelUnion representative
Bioenvironmental EngineerResponsibilities/Functions
Conduct industrial workplace surveys Workplace categorization by potential health risk
— 1-High; requires annual assessment— 2-Medium; requires assessment every 2 years— 3-Low; assessment as needed
Special surveillance assessment matrix
Confidence in Hazard Assessment
Confidence in Existing Controls
Low Medium High
Low A A B
Medium A B C
High B C D
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Bioenvironmental Engineer Responsibilities/Functions (cont)
Goal is to protect the worker Hazard elimination – substitute, stop process Engineering control – ventilation, acoustical material Administrative control – signs, restricted areas Personal protective equipment
Investigate occupational illnesses, incidents, and reproductive health hazards
Fit-test respirators Ergonomic assessments Thermoluminescent dosimetry program
Documentation
AF Form 2755, Workplace Exposure Data Summary
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Public Health Responsibilities/Functions
Propose medical surveillance exam requirements based on BEE survey results
Perform epidemiological trend analysis Investigate & document occupational
illnesses/incidents Identify worker educational requirements
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Occupational Health Consultant Responsibilities/Functions
Review BEE survey data Visit workplaces, with BEE and/or Public Health
Health survey, workplace survey, summary report Determine medical surveillance requirements
Modify and approve public health recommendations Perform occupational health examinations Accomplish fitness-for-duty evaluations Establish/review pregnancy profiles Assess quality of local occupational health program
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Support Staff Responsibilities/Functions
Schedule periodic occupational exams Validate/update workshop personnel rosters Track no shows Communicate results of exam to worker Schedule required follow-ups and monitor until done
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Occupational Health Working Group Sample Agenda and Products
Review recent surveys Establish medical surveillance exam requirements
Identify ergonomics issues Report occupational illness/injury trends Monitor the Hearing Conservation Program
Significant threshold shift log Calculate completion rate for occupational exams Quality control of exams and procedures
Oversees all aspects of occupational health at the base level.
MEMORANDUM FOR RECORD FROM: OCCUPATIONAL HEALTH WORKING GROUP (OHWG) / SGPO SUBJECT: SUMMARY MEDICAL SURVEILLANCE EXAMINATIONS (AF FORM 2766) 1. The OHWG reviewed 15 work zones on 17 Nov 98. The following is a summary of the protocols agreed upon: WIC Name of
shop Exposure summary
Health history
Audio Lab PA CXR
PFT Visual acuity
Resp quest
Physical exam
Other
604A CES Ent Shop
see note (1)
Cat 3
300A Doc Dis- entigrate
cont plc, ann, trm
see note (2)
Cat 2
306A Transport Shop
cont plc, ann, trm
Cat 2
310A Pre-fab Shop
cont plc, ann, trm
Cat 2
313D MRSOC Ops
cont plc, ann, trm
Cat 2
008A Metallize Wire
cont plc, ann, trm
cont plc, ann, trm
cont plc, ann, trm
cont UA Cont PFT
cont plc, ann,dtrm
cont plc, ann, trm
Cat 1 note (3)
032A Bearing Fxn
cont plc, ann, trm
- Cat 2
WIC = work place identifier, PFT = pulmonary function test (spirometry), Resp quest = respirator questionnaire a = added, d = deleted, cont = continued, ann = annual, per = periodically, plc = placement, trm = termination Cat 1 = critical shop, Cat 2 = potentially hazardous shop, Cat 3 = minimally hazardous shop Note (1) - Oversee contractors who perform pest control services. Use filtering facepiece (deleted respirator questionnaire) Note (2) - Use filtering facepiece (deleted respirator questionnaire requirement) Note (3) - Lab, PFT, Respirator Questionnaire, and Physical Exam for workers assigned inside of plasma spray booths only
Documentation
AF Form 2766, Clinical Occupational Health Examination Requirements
AF Injury/Illness Reporting Algorithm
Event or Exposure
Symptoms or +biomonitoring?
Work Related?
Illness or Injury?
Yes
Yes
Yes
Injury Illness
No
No
Not Recordable
Recordable
Ground Safety
(Line)
Public Health
(Medics)
AF Safety Center
AFIERA
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Data Reporting & Enterprise-level Analyses
OSHA-mandated injury reporting via safety offices Base, MAJCOM, AF summary reports
Occupational illness reporting by base public health via AF Reportable Events Surveillance System to AFIERA Data sent to AF Safety Center for combined reporting
Audiometric data transmitted directly to Defense Occupational and Environmental Health and Readiness System (DOEHRS) Data currently inaccessible due to technical problems
Shop survey data entered into Command Core Base level only, no central collection/access
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Special Occupational Studies
JP-8 Acute Effects Study Anthrax Vaccine and Vision in Aviators Kelly AFB Worker Mortality Study Investigations of diverse cancer cluster alarms, e.g.,
Thyroid cancer in aviators at a training base Diverse cancers in an ANG admin building Mesothelioma in a HQ building Lymphoma in a missile squadron
Note: topics usually brought to AFIERA’s attention by concerned field staff or workers
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Initiatives and Future Projects
Improve occupational injury/illness reporting New web-based reportable events system Use ambulatory visit codes to identify possible cases Real-time reports re lost duty days
Computerized occ exams via PIMR Establish an AF repository for Command Core IH
data at AFIERA with centralized trend analysis Continue developing the Global Expeditionary
Medical System (GEMS) to ensure proper reporting of occupational/environmental exposures that occur in deployed settings
Assist in development of Automated Civil Engineer System (ACES) for environmental management data
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Questions???
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Backup Slides
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Current Instructions/Guides
DoD 6055.5-M, Occupational Medical Surveillance Manual
AFOSH 48-119, Hazardous Noise Program AFOSH 48-9, Radio Frequency Radiation Safety
Program AFI 48-125, Personnel Dosimetry Program AFOSH 48-8, Controlling Exposures to Hazardous
Materials
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Current Instructions/Guides (cont)
AFJI 48-110, Immunizations and Chemoprophylaxis AFOSH 48-139, Laser Radiation Protection Program;
ANSI136.1-2000 NFPA 1582, 2000 ed, Medical Requirements for Fire
Fighters AFOSH 48-137, Respiratory Protection Program Interim Guidance for 48-20, Hearing Protection
Program – DoDI 6055.12
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Keeping CurrentInternet Reference Sources
Requires team approach Internet sites
www.osha.gov www.denix.osd.mil afpubs.hq.af.mil sg-www.disa.mil/moasgoa www-4afia.saia.af.mil wwwsam.brooks.af.mil www.afms.mil/afiera/rsh/OccMed