Integrating Occupational Medicine Into Your Practice · 2015-06-26 · Integrating Occupational...
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Integrating Occupational Medicine Into Your Practice Robert Bourgeois, MD, MPH, FACOEM BOURGEOIS MEDICAL CLINIC Morgan City, Louisiana [email protected] Copyright RMB 2015
Transcript of Integrating Occupational Medicine Into Your Practice · 2015-06-26 · Integrating Occupational...
Integrating Occupational
Medicine Into Your Practice
Robert Bourgeois, MD, MPH, FACOEM
BOURGEOIS MEDICAL CLINIC Morgan City, Louisiana [email protected]
Copyright RMB 2015
Disclosure
I have no financial interests or other relationship with manufacturers of commercial products, suppliers of
commercial services, or commercial supporters. My presentation will not
include any discussion of the unlabeled use of a product or a product under
investigational use.
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Objectives • Learn about different ways to add Occ
Med to your practice – Evaluate Opportunities in Your Area – Different types of examinations – Requirements for performing specialized
testing – Testing – Ancillary Services
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Why My Practice is Different “Doc Dynasty”
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Types of Exams - Transportation
• Commercial Drivers – FMCSA - CDME – FTA – Intrastate / School Bus Drivers
• Railroad • Coast Guard
– Merchant Mariner Medicals / STCW
• FAA – Pilots / Air Traffic Controllers Copyright RMB 2015
Maritime Examinations Coast Guard – Merchant Mariner
• Requires knowledge of the regulations pertaining to merchant mariners – http://www.uscg.mil/hq/cg5/nvic/pdf/2008/NVIC%2004-
08%20CH%201%20with%20Enclosures%2020130607.pdf – http://www.uscg.mil/nmc/medical/pdfs/information_for_p
hysicians.pdf – http://www.uscg.mil/forms/cg/CG_719K.pdf – Color Vision testing by AOC (1965), AOC HRR,
Ishihara, Farnsworth Lantern, Titmus, Optec 900 (Farnsworth D-15 – ONLY for Engineers)
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Crane Operator Physicals • Vision, including acuity, color, field of
vision & depth perception • Hearing • Blood pressure • Urine dipstick • ANSI/ASME B30.5 • OSHA 29CFR1915.117(c) • May use FMCSA medical guidelines, but
NOT the FMCSA CDL Form Copyright RMB 2015
Components of Various Exams • Vision • Hearing • Blood testing – exposures or wellness • Urine Screening
– Drugs / Exposure surveillance
• Pulmonary function testing • Respirator fit testing • Graded Exercise Testing
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Vision • Many different ways to test vision
– Vision Screeners – OPTEC, Titmus
• Some exams require specific tests • Considerations for
– Visual Acuity – Distance, Near, Intermediate – Color – Ishihara, Lantern, D-15 – Field of vision – Depth perception – Testing Near vs. Far – Retinal Exams – LASER, Diabetics (DOT)
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Hearing • Generally in audio booth or quiet room • Booth & Audiometer should be calibrated • Technicians should be trained by CAOHC
– Council for Accreditation in Occupational Hearing Conservation
– http://www.caohc.org/
• Many types of exams require periodic audiometric testing
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Lab Testing
• Type of testing dependent upon type of exam – Surveillance – Lead, Cadmium… – Annual exams - HA1C, TB – Executive exams – Wellness exams – Post-exposure to blood borne pathogens
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Urine Drug Testing • Drug screening is done for a variety of
reasons (DOT and Non-DOT) – Pre-employment – Post-accident – Reasonable suspicion – Random – Follow-up – Return to Duty – School Districts (Student Athletes)
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Medical Review Officer • Requires training and certification by
examination – MROCC https://www.mrocc.org/ – AAMRO
• Necessary to review drug screens required by federal regulation
• MRO Assistant Training / Certification for Staff / Collector & BAT Training
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Pulmonary Function Testing • Component of many types of exams • Technicians should be trained by NIOSH
approved course • Link below gives the sponsors for NIOSH
approved courses • http://www.cdc.gov/niosh/topics/spirometry/sponsors.html
• ATS Recommendations for Spirometers • Spirometers should be calibrated DAILY
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Respirator Fit Testing • Part of 29CFR1910.134 – Personal
Protective Equipment Standard • Protocols are listed here: • http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=
9780&p_table=STANDARDS
• Qualitative - Subjective • Quantitative – Measured “Fit Factor” • May be performed by nurses or
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Surveillance Examinations
• OSHA – Hearing conservation – Annual audiogram – Respirator questionnaires / Fit Testing
• OSHA website describes physical exam requirements and tests necessary – Asbestos, Lead, Beryllium, Cadmium, Arsenic,
Pneumoconiosis, …
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OSHA Surveillance Examinations
• Multitude of toxic substances • Asbestos • Cadmium • Benzene • Lead • Coke oven emissions • Chromium • Benzene • Methylene chloride • Others
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Fitness For Duty Evaluations
• Prior to Job Placement – New Hire or Change in Job Requirements – Overseas / Remote Locations / Hazardous Duty
• Return to Work after Injury or Illness – Work Related or Non-Occupational
• Job Modifications – May be Part-time / Temporary / Permanent
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Fitness for Duty Evaluations
• Fitness for Duty – Location Issues – Remote Duty – No
Immediate Access to Medical / Dental Care – Job Requirements – Need Good Job
Descriptions – Physical / Mental / Emergency – Medical Conditions – Cardiac, Diabetes,
Pulmonary, Sleep Apnea, Neurological – Medications – Safety Sensitive
• Issue May Be Condition and / or Medication
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Fitness for Duty Considerations
• PPE – Respiratory, Protective Clothing • Additional PPE - Fire Retardant Clothing,
Fall Protection, Floatation, Survival Suits • Extremes of Temperature / Humidity • Working at Heights / Over Water • Claustrophobic Work Spaces • Long Hours / Rotating Shift Work
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Fitness for Duty Issues
• On Same Drill Ship – Maritime Crew – Deck Officers / Engine Room
Seamen – Drilling Crew – Tool Pusher / Roustabout /
Driller / OIM / – Administrative / Company Reps / HSE / Medic
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Fitness for Duty – Drill Ship
• ALL with Basic Risks / Concerns • Remote Location • Limited Medical Care • Must Be Able To Perform Emergency
Procedures – Can You Save Yourself or Save Others? – Climb Ladders, Fight Fires, Emergency Egress
• Never “Off Duty”
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Offshore Workers
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Inland Critters
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Functional Testing
• Test applicants’ ability to perform various job using job descriptions supplied by employer
• Coast Guard physical describes job tasks that mariners are required to perform
• Requires some equipment, space, training of technicians
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Functional Testing
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Functional Testing
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Functional Testing
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Functional Testing
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Workers’ Compensation • Injury / Illness Evaluations
– Treatment for Injury / Illness
• Consultations – Injury – Illness – Work Status
• Fitness for Duty – Know Job Description – Job Modifications – Most Other Docs with No Occ Med Experience
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Worker’s Compensation
• OSHA Recordkeeping – Recordable vs. Compensable
• Boat Captain with an Injury – Multiple Agencies – DOT – Drug Screen – USCG / Homeland Security – License / Medical – OSHA - Recordkeeping
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Travel Examinations & Immunizations
• For those working or vacationing in foreign countries
• Should keep various immunizations on hand • Individualized Travel Consultations
– Yellow fever – (Requires clinic stamp)
– Hepatitis A & B – Typhoid – Meningococcal
– Polio – Tetanus / Tdap – Flu – Provide prophylaxis for
malaria
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Routine / Seasonal Immunizations
• Flu Vaccine • Meningitis – College Students • TB Testing – Foreign Travel / Healthcare
Workers • Hep B – Blood borne Pathogens /
Healthcare Workers
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Wellness Programs
• Clinic Based • Single Company or Group • Sponsored by Local Hospitals / Groups • Consulting based on Insurance Cost
Reviews / Interventions
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Mobile Services • Provide on-site services for select
companies – Audiometry – Pulmonary function testing – Respirator fit testing – Drug screening – urine or hair – Breath alcohol testing – Physical examinations – Immunizations
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Mobile Services
• May require investment in trailer or motorized vehicle to transport audiometric booth
• May require duplicate equipment (audiometers, spirometers, fit testing equipment)
• On-site examinations may not be feasible for offices with solo practitioners Copyright RMB 2015
Consulting
– Write / Review Medical Policy – Workers Comp Determinations – Leave of Absence Policy / Approvals – Disability determinations – Medical Programs / Surveillance – Job Descriptions / Site Visits
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Consulting Royalty “King” Troy Landry
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Questions?
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