Block 3: Occupational Health Management - Section 3: Medical Surveillance Programme - Procedure Guidelines
OHM3.2: Types of Medical Examinations

Types of Medical Examinations:  HOW DOES FITNESS IN TERMS OF THE INHERENT REQUIREMENTS OF THE JOB

Jonny, please rephrase the note above - is this a question to me, or is it part of the heading?

Medical Surveillance comprises the following types of Medical Examinations:

Routine medical examinations
  • Pre-placement medical examinations.
  • Annual medical examinations.
  • Termination of service.
  • Transfer examination.
Other medical examinations

At the end of each  ???WHICH ONE - ALL OR EACH examination, the medical team will provide a certificate for the worker that will make clear whether the worker is:

THIS SHOULD BE  A NEW PAGE

 

Design of the Medical Surveillance Programme

The Worker-Allocated Surveillance Programme (WASP) is the formal documentation of the Medical Surveillance Strategy, accounting for the information made available from the Risk Assessment, and an understanding of appropriate test selection. The method for design of the WASPs for each exposure group is described in the Medical Surveillance Policy, Guidelines and Procedures.

Note: The technique used to design of the Medical Surveillance Programmes is described in detail in the SOP for the construction of the "Worker Allocated Surveillance Programmes (WASPs)". (This is where a hyperlink to the actual document should be placed.)

TOO MANY ORPHAN REFERENCES  - WASP IS A TOTAL ORPHAN AT THIS STAGE . IT IS CRUCIAL TO WHAT FOLLOWS WHICH CANNOT BE UNDERSTOOD WITHOUT SEEING IT OR KNOWING WHAT IT IS

NEED TO INSERT ALL OF THESE IN SOME WAY OR ANOTHER PREFERABLY AS WORKED EXAMPLES

 

WHAT FOLLOWS BELOW COULD BE A TOP PAGE LEADING TO DEEPER PAGES WITH OREPS ETC.  THE WHOLE THING COULD BE BILLED A WASP?? 

This is a complex process but can be summarised as follows:

Step1: Determine which employee groups require medical surveillance.  IS THE WASP ORIENTED TO THE GROUP OR THE INDIVIDUAL WORKER? They are oriented to exactly the same target as the OREPs, which are "Homegenous Exposure Groups", or groups with similar requirments and exposures. This may be single job categories (eg. fitters), but may also be groups of categories (ie. admin staff, supervisors, senior management).

The key determinants of who should be required to undergo medical surveillance are the findings of the Health Risk Assessment, which are recorded in the Occupational Risk Exposure Profiles (OREPs). Hence in the first step in the design of the medical surveillance programme, the OREPs are consulted, and the data therein is transferred to the WASPs. This is done as follows:

Step 2: Determine which tests are required: TEST SELECTION.

Using the WASPs sheets, and the reference tables in the WASP construction SOP, this step is made relatively painless. The tests comprise combinations of questionnaires, clinical examination and special investigations (x-rays, laboratory tests, audiograms, etc.). It is important that the selected tests are valid. This is determined by their sensitivity and specificity, and the availability of reliable testing facilities (laboratories, testing equipment, trained occupational health programme staff  (including CXR’s, audiograms, PFT’s, etc.). For further information on Sensitivity and Specificity, refer to Appendix 1.  WHAT IS THIS?  WE NEED TO LINK POSSIBLY TO BLOCK 1 EPI 1.9. Oops!! I remember the document, and writing it, but I can't find this reference. Where have you taken these notes from Jonny? Once I am there, I will find the appendix and the stuff on sensitivity & specificity. It would be a good idea to make the link with block 1 (kind of closes a loop).

Step 3: Determine the required STANDARDS for medical adjudication.

Two types of standard are considered:

  1. The medical standards that must be met to "pass" the examination (Job Fitness standards).
  2. The action criteria that must be triggered when biological exposure levels or certain exposure effects are exceeded (Biological Exposure standards). IS THIS THE CORRECT TERMINOLOGY?  IS ONE NOT WANTING JOB FITNESS TRIGGERS IF YOU LIKE?  This is an invented term, describing the "standard" that addresses the thresholds for action with reference to exposure effects and biological marker levels. (ie, determined by EXPOSURE issues, rather than meeting standards of fitness, which is the standard referred to in point1).  

The extensive reference tables in the WASP SOP assist the examining health team in this task. It is not possible to establish every permutation that would constitute a reason for excluding an employee in a policy document. Instead, lists of relevant cautions are flagged in the reference tables, to assist the medical professionals in their adjudication. Usually it is a combination of factors that would result in the exclusion of an employee from a particular occupation.

 

WE WILL NEED TO DECIDE WHAT TO INCLUDE IN DEEPER PAGES HERE OR ELSE DROP REFERENCE TO THE WASP SOP. I think we should rather place a hyperlink to the SOP, and I will take people through the steps by using a worked example. Again, we could even use the factory visit to do this...

Step 4: Determine the TEST FREQUENCY.

This is determined by the degree of risk to which the employees are faced, and the outcomes of the medicals themselves. The higher the risk, the more frequent the tests. The more adverse the outcomes, the more frequent the tests. Test frequencies usually vary from quarterly to every 5 years, but the most common is annual.  SOME OF THIS IS ALSO LAID DOWN IN LAW? Yes, well noted! Mining industry, audiometry, lead, asbestos, driver medicals, amongst others.

Step 5: The ethics of medical testing should be considered, with special regard to: