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USAF Medical Service Occupational Health Program

Lt Col Kenneth L. Cox, USAF, MC, SFS

Chief, Risk Assessment Division

Kenneth.Cox@brooks.af.mil

Phone: 210/536-1788

17 April 2002

Armed Forces Epidemiology Board

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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