Module 6: Occupational Health Management - Section 3: Medical Surveillance Programme

Appendix 4: Determining Work Relatedness - Action Plan

Determining Work Relatedness:

THERE NEEDS TO BE A LINK BETWEEN INDIVIDUAL CASE  - USE SCHEDULE 3 OF COIDA OR THE 2002 ILO SCHECULE IN RECOMMENDATION 194 AS A LOOKUP TABLE.  AS FOR OTHER SUSPECTED ODS ONE CAN APPLY EPIDEMIOLOGIC KNOWLEDGE IN THE MAKING FOR THE GROUP AS OPPOSED TO THE INDIVIDUAL USING THE BRADFORD HILL CRITERIA.

I DON'T LIKE THIS SECTION OF THIS PAGE.  THE CRITERIA APPLY TO GROUPS AND NOT TO AN INDIVIDUAL WHO IS BEING CASE MANAGED.  ONE NEEDS TO REFER TO THE LITERATURE - STATE OF THE SCIENTIFIC KNOWLEDGE/CONSENSUS AT THE TIME.   TIME ORDERING, STRENGTH OF ASSOCIATION AND BIOLOGICAL GRADIENT ARE THE MOST IMPORTANT.

This is the most important task of the case management phase. It is not always easy. A listing of the elements that should be considered when determining whether or not an outcome is work-related are listed in Appendix 2. In practice, it is rare that all of the Bradford-Hill criteria are considered. A summary of the most important criteria would include:

• Biological plausibility: Does the outcome match what is known of the pathophysiology or toxicology of the hazard?
• Appropriate time relationships: Does the latent period between the earliest exposure and the effect manifestation match what would be expected, given the known biology of the disease in question?
• Biological gradient: Is their a dose response relationship with which the exposure and the outcome can be linked? In the absence of a putative exposure, there can be no occupational disease.
• Coherence of the evidence: This term refers to the coherence of all the elements of these criteria when they are summed up together. The more coherence that is found, the greater the strength of the association. However, notwithstanding this, the final decision is always a judgement call informed by epidemiological and other evidence and consequently retains an element of uncertainty.

Action Plan if an Occupational Disease is Discovered:

HOW IS IT RECOGNISED  - SEE TOP OF THIS PAGE

The following steps should be considered, when an occupational disease is discovered:

Incident Investigation

• Investigate to establish cause of exposure and deviation from standard.
• Initiate measures to identify employees from similar exposure profiles that may also have acquired the occupational disease.

Risk Control:

• Implement the necessary hierarchy of controls that address the circumstances that led to the exposure.
• Establish education and training programme to re-emphasise the effects of exposure and the need for control measures.

Employee Care:

• If necessary, remove employee from ongoing exposure.
• If necessary, provide necessary medical therapy and rehabilitation.
• Establish a follow-up schedule to monitor the employee’s progress into the future.
• Option for worker to seek a second medical opinion.

Communication:

• To affected individual, accompanied with counselling (Individual medical results).
• To management (whether worker fit to work and/or notified if worker has an occupational injury or disease).
• To the Department of Labour (Occupational Health and Safety Act section 25).
• If necessary, submit case to the offices of the Compensation Commissioner.
• Group results IS THIS FROM A SIMILARLY EXPOSED GROUP? made available to all parties in an understandable manner outlining disease trends and identifying areas needing remediation. 

REFERENCES

1. APPENDIX 2: Screening.
2. APPENDIX 3: Establishing Work-Related Causality.
3. Flow of a Standard Medical Surveillance Programme.