Conduction of Medical Programs

The workers working in a hazardous environment can encounter a very high level of stress. The tasks that they carry out might expose them to contaminations from different hazards. There is a very high possibility that they might develop stress due to the protective clothing that they wear to protect themselves from fire and other harmful substances.

It is very crucial to implement a Medical Program for the assessment and the monitoring of the worker’s health. This monitoring must be carried out before the employment as well as after the employment of the workers for the provision of emergency treatment when required.

A collection of general guidelines for the designing of a medical program for employees’ health has been proposed in this chapter. This chapter covers the information and prototype protocols for the following

  • Pre-employment Screening
  • Periodic Medical Check-ups
  • Treatment on the basis of Emergency
  • Maintenance of Records

The suggestions in this chapter are based on the assumption that workers in the site have the necessary protection from various exposures through engineering, administrative controls, and specific Personal Protection Equipment, along with an easy access to decontamination methods. However, the purpose of Medical surveillance is just to assist other safety measures in ensuring optimum safety within the work site.

Development of a Medical Program

Considering the particular needs, location and the risk of exposure of the workers, a medical program must be developed for each site. An Occupational Health Physician in conjunction with the Site Safety Officer must be in charge of the development of the Medical Program.

It is also mandatory for the director of the site’s medical program to be board-certified in the fields of medicine along with having a commendable experience in Occupational Health Management Services.

However, a director of such a calibre is difficult to find as there are very few doctors who are trained in Occupational Health Management, particularly in the case of remote work sites. If this happens to be the case, a Local Physician with the assistance of an Occupational Health Consultant might carry out the management and perform relevant examinations.

Moreover, an Occupational Health Nurse can also perform these functions. However, a suitably qualified physician who is responsible for the program must appoint the nurse.

All the tests and medical analysis must be conducted within a laboratory that has a commendable performance in an inter-laboratory testing program. A Medical Program must cover the following components −

  • Surveillance
  • Treatment
  • Record Maintenance
  • Review of the Program

The active involvement of workers is a huge factor that determines the effectiveness of a Medical Program. Moreover, the management should be strongly committed towards the safety and the health of the workers.

The commitment of the management must be evident not only through medical procedures, but also by encouraging its employees to maintain their health by exercise, balanced diet and refrainment from tobacco, alcohol, and other harmful drugs. Particularly, the management should do the following

  • Ask the potential employees to submit a medical record detailing their medical history.

  • Make sure that the records remain confidential.

  • Encourage workers to report any potential exposure, irrespective of the seriousness.

  • Encourage the workers to report any complicated physical condition to the physician.

The training of the employees should be focused on the idea that minor disturbances and the apparent minor complaints may turn out to be quite significant. During the development of a medical program, the site conditions along with monitoring the medical needs of each worker must be taken into consideration as well as the potentials exposures within the site.

Moreover, the routine task of each worker must also be considered. For example, a miner will be exposed to a different set of dangers than a regular field worker. In the same way, an employee dealing with an official task would require less medical attention than a worker working in the field at a higher altitude.

Although it is not possible to identify all the potential contaminants within a worksite, the following are some types of contaminants that are commonly witnessed across various workplaces −

  • Asbestos
  • Aromatic Hydrocarbons
  • Dioxins
  • Heavy Metals
  • Herbicides
  • Halogenated aliphatic Hydrocarbons
  • Organophosphate and carbamate insecticides
  • Polychlorinated biphenylss

While compiling a protocol for testing, it must be kept in mind that the development of the standard medical tests was done within factory settings and other confined environments. Therefore, some of these tests might actually turn out inappropriate for hazardous occupational sites.

The wide variation of risks across different circumstances is yet another factor to consider, not only regarding the type and the intensity of exposure, but also regarding the individual physical factors such as height, weight, sex, diet, stress, allergies, preconceived medication, and off-site exposure.

Effective Medical Program

In this section, we will learn about the various procedures that can be included within a Medical Program to make it effective. Of course, one is free to add or remove certain procedures in the Medical Program, depending on the conditions of the site and the nature of the job, to best suit the safety requirements of a site.

Pre-Employment Screening

The Pre-Employment Screening is conducted for the employees who have been hired and are yet to join the workforce. In the Pre-Employment Screening Phase, the following parameters must be recorded

  • Medical History
  • Occupational History
  • Physical Examination
  • Fitness to work wearing Protective Equipment
  • Basic monitoring for Particular Exposures

Periodic Medical Check-ups

Periodic Medical Check-ups are intended to be performed on the employees within the tenure of their employment; this is considered a must for the field workers. A periodic medical check-up must cover the following −

  • Updating medical and occupational history every year for conditions such as exposures, designations, etc.

  • Higher frequency of testing based on specific exposures.

  • Physical Examination

  • Routine Medical examinations with Yearly testing.

Emergency Treatment

The emergency treatment must confine the following aspects −

  • Provision of first aid within the site.
  • Development of liaison with a local hospital and medical consultants.
  • The arrangement of decontamination measures for the victims.
  • The arrangement of readily available transport of victims.

Non-Emergency Treatment

Non-Emergency Treatments are as necessary as the Emergency ones. A slew of mechanisms must be developed for non-emergency treatments. These treatments can include treatment for minor diseases, infections, and other conditions that might not require the immediate attention of the physicians.

Record Maintenance

Specific records must be maintained with respect to the medical conditions of specific workers. Consider the following aspects related to record maintenance −

  • Maintenance of the records.

  • Recording and reporting injuries and other illness faced by the workers within the site.

  • Regularly reviewing the Site Safety Plan when additional tests are needed..

  • Periodically reviewing the program emphasizing on the present hazards in the site and the hygiene within the site.

Pre-Employment Screening

Pre-employment screening encompasses two major functions −

  • Determining whether the individuals are fit for their duties, considering their ability to work while donned in protective attire.

  • Providing a baseline data for comparing future medical data.

These functions are elaborated below −

Fitness for Duty

Workers at hazardous sites while wearing protective equipment at the same time perform various strain-inducing tasks. The protective equipment is very likely to produce a high amount of stress due to heat that gathers within. For ensuring the workability of the employees covered in protective gear, the pre-employment screening must emphasize the following in the context of medical history −

  • A worker should fill a medical history questionnaire and this questionnaire must be reviewed before any acquaintance with him.

  • It must be noted that special attention must be paid to any prior chemical exposure or contamination in the worker’s previous job.

  • A revaluation of any past illnesses and chronic diseases must be done, specifically regarding diseases such as asthma, eczema, lung diseases and cardiovascular diseases.

  • It must be determined whether a worker is susceptible to any allergies.

  • Various lifestyle habits and hobbies must be recorded.

A few physical examinations must be conducted. Let us now learn what these examinations are −

  • A physical examination comprising of the various organs, specifically emphasizing on pulmonary, musculoskeletal and cardiovascular systems.

  • Recording conditions such as obesity and lethargy, that might lead to heart stroke.

  • Recording conditions such as facial scars, missing body-parts, poor eyesight, etcetera that might hinder the use of a respirator.

Consider the following actions related to the ability to work while wearing Protective Equipment −

  • The individuals who fail to perform based on the medical history and the physical examination must be disqualified.

  • The limitations of the workers while wearing protective equipment must be noted down.

  • Additional testing for the ability to wear equipment must be conducted when necessary.

  • In the case, wearing a respirator is required during the job, the worker’s capability to work must be assessed wearing the respirator.

Baseline Data

A baseline data maintained during the pre-establishment stage is necessary for comparingit with the data that is to be recorded in the future. A biological monitoring test, as well asa medical screening test, might be included in a baseline data assessment. Due to theambiguity of the types of exposures that exist, it is not feasible to prescribe specific tests to all the workers.

Periodic Medical Check-ups

Periodic medical examinations must be conducted from time to time. It is very essential for the determination of biological trends to compare baseline data with the sequential medical reports that are recorded during these medical examinations.

This is primarily conducted to predict any adverse effects that might take place in the future due to the exposure to certain substances. The contents and the frequency of the exams may vary depending on the exposures and the nature of the job.

Generally, various industries conduct these periodic medical examinations annually. However, the frequency of these exams may vary depending on the nature of the contaminants, environment, and the working conditions within the work site.

The periodic medical check-ups may include −

  • Medical evaluation with an emphasis on illness, health status, and probable workrelated symptoms.

  • Physical examination to determine the overall fitness of the workers.

  • Additional medical tests depending on the health condition of the workers.

Termination Medical Examination

When the employment of an employee in a hazardous site ends, a final medical examination must be conducted. However, this examination may only be limited to determine the changes in the medical conditions of an employee, since the last medical examination, if the following three conditions are met −

  • The last examination was held at least six months ago.

  • There is no occurrence of any exposures since the last examination.

  • The worker does not show any symptoms of a contamination since the last examination.

In case, if any of the above conditions are not met, a full medical examination is strongly recommended upon the termination of the employee.

Treatment Based on Emergency

Each site must possess provisions for emergency as well as non-emergency treatment. It is very crucial to plan in advance and anticipate the various hazards that might occur.

During the development of procedures, plans, and the list of equipment, the reach of existing and potential hazards, particularly affecting the site, must be taken into consideration.

These assumptions must not only be made from the worker’s perspective; the visitors, officials, and vendors also need to be considered. The site emergency response programmust integrate emergency treatment into itself. The following guidelines will help in laying down an effective emergency treatment program −

  • A team of site workers should be trained on emergency first aid.

  • The employees should be trained on emergency decontamination along with emergency response plan.

  • An emergency first aid station should be established within the premises of the work site.

  • A physician must be appointed who can be contacted throughout the day.

  • A call on demand team of medical specialists from various fields must be set up for consultation during emergency situations.

  • Emergency contacts such as ambulance, fire brigade and poison control must be at a hand’s reach.

  • Imprint maps and directions to various places in the site.

  • Develop a radio communication system for an emergency.

In case of non-emergency treatments in hazardous sites, arrangements must be done for the workers who are experiencing adverse effects as an outcome of the exposure to various hazardous substances.

Along with the health assessment programs, the management must ensure that any health condition that they might witness due to the exposure to various substances must be taken care of, and certain precautions must be prescribed to reduce further symptoms.

Offsite medical consultants must also examine and treat non-job related medical conditions that the employees might have been facing, which, eventually would hamper their work. A copy of the medical record of the workers should be present within the work site.

Maintenance of Records

It is very crucial to keep proper records in a hazardous site as the nature of the work and the risk levied upon the workers may be alarmingly high depending upon the conditions.

Various employees during their work tenures might put up at different locations and various sites. Moreover, the adverse effects of long-term exposures might not show up for many years. Records help medical care providers in determining the previous exposures that the employee might have had. The following tips are recommended while maintaining records

  • The records of previous employees must be kept for at least thirty years.

  • The records must be assessable to the workers.

  • The records regarding occupational illness and injuries must specifically be maintained.

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