4/2/2014. Pre-employmentemployment

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1 Occ Med: Where Primary Care Meets the Workplace Adding Occ Med to Your Existing Practice Robert Bourgeois, MD, MPH, FACOEM 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. Objectives Learn about different ways to add Occ Med to your practice Evaluate Opportunities in Your Area Different types of examinations a Requirements for performing specialized testing Testing Ancillary Services Why My Practice is Different Doc Dynasty 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 Maritime Examinations Coast Guard Merchant Mariner Requires knowledge of the regulations pertaining to merchant mariners :// asp?tab =4#TabbedPanels1 Requires ability to test vision, blood pressure, height, weight Color Vision testing by AOC (1965), AOC HRR, Ishihara, Farnsworth Lantern, Titmus, Optec 900 (Farnsworth D-15 ONLY for Engineers) 1

2 Crane Operator Physicals Vision, including acuity, color, field of vision & depth perception Hearing Blood pressure Urine dipstick ANSI/ASME B30.5 OSHA 29CFR (c) May May use FMCSA medical guidelines, but NOT the FMCSA CDL Form 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 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) Hearing Generally testing in booth or quiet room Booth & Audiometer should be calibrated Technicians should be trained by CAOHC (Council for Accreditation in Occupational Hearing Conservation) Many types of exams require periodic audiometric testing 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 Urine Drug Testing Drug screening is done for a variety of reasons (DOT and Non-DOT) Pre-employmentemployment Post-accident Reasonable suspicion Random Follow-up Return to Duty School Districts (Student Athletes) 2

3 Medical Review Officer Requires training and certification by examination MROCC AAMRO Necessary to review drug screens required by federal regulation MRO Assistant Training / Certification for Staff / Collector & BAT Training 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 :// ATS Recommendations for Spirometers Spirometers should be calibrated DAILY Respirator Fit Testing Part of 29CFR Personal Protective Equipment Standard Protocols are listed here: :// show document?p id= 9780&p_table=STANDARDS Qualitative - Subjective Quantitative Measured Fit Factor May be performed by nurses or technicians 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, OSHA Surveillance Examinations Multitude of toxic substances Asbestos Cadmium Benzene Lead Coke oven emissions Chromium Benzene Methylene chloride Others 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 time / Temporary / Permanent 3

4 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 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 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 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 Offshore Workers Inland Critters 4

5 Test applicants ability to perform various job using job descriptions supplied by employer Coast Guard describes job tasks that mariners are required to perform Requires some equipment, space, training of technicians 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 5

6 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 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 Routine / Seasonal Immunizations Flu Vaccine Meningitis College Students TB Testing Foreign Travel / Healthcare Workers Hep B Blood borne Pathogens / Healthcare Workers Wellness Programs Clinic Based Single Company or Group Sponsored by Local Hospitals / Groups Consulting based on Insurance Cost Reviews / Interventions 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 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 6

7 Consulting Write / Review Medical Policy Workers Comp Determinations Leave of Absence Policy / Approvals Disability determinations Medical Programs / Surveillance Job Descriptions / Site Visits Consulting Royalty King Troy Landry Questions? 7