Block 3: Occupational Health Management - Section 3: Medical Surveillance Programme - Procedure Guidelines

OHM3.3: Core Approach to Medical Surveillance

THERE IS NO LINK YET TO SCREENING - ITS A MISSING LINK

SCREENING ALSO NEEDS TO BE DIFFERENTIATED FROM SURVEILLANCE. WHICH IS TO OBSERVE DATA OVER TIME FOR THE APPEARANCE OF EVENTS, TRENDS, CHANGES ETC. Good point, this is a semantic with which I may run foul from time to time - please blow the whistle when you pick it up!

Core Approach to Medical Surveillance:

Every Medical Surveillance Programme, regardless of the hazards to which the programme is linked, has a core of three phases.

Phase One ("Case Identification"): Objective - "Normal or not"

The objective here is to screen the target group for signs of work-related adverse health effects or for the presence of exclusion factors (WHAT ARE THESE). This comprises clinical and laboratory screening tests conducted by appropriately trained personnel using approved equipment (eg. audiometry, lung function testing device, and laboratory equipment) and methods (eg. ATS, NIOSH, etc.). These tests need to be chosen carefully, and should have a high degree of validity. Usually the tests in phase one have a high degree of sensitivity, with a lower order of specificity. The tests results are captured, then printed and interpreted by an Occupational Medical Practitioner with training in this field. Cases of non-occupational adverse health findings (such as high blood pressure, poor vision, etc.) are excluded from further action, and are offered referral to a medical practitioner (facility) of their choice, for follow-up. Those with adverse health effects thought to be work-related (whether exposure related or a potential exclusion IS THIS THE SAME AS AN EXCLUSION FACTOR? yes, exactly!), progress to Phase Two.

Phase Two ("Case Confirmation"): Objective - "Work related or Not"

The objective here is to confirm work-relatedness for those with suspicious adverse health findings during Phase One. The appropriate tests ?? FURTHER TESTS (these are the "confirmatory" tests required to establish work-relatedness) are applied as necessary, and specialist expertise may be enlisted. These tests are usually more specific for the occupational disease being evaluated, in order to confirm the diagnosis, or simply explore the links of causality, to determine work-relatedness. As with Phase One, those with confirmed work-related abnormalities move on to Phase Three, the rest are referred to their own health care providers.

Phase Three ("Case Management"): Objective: - "Optimal Re-integration"

This is the final and most crucial component of the programme. It focuses on those employees with confirmed work-related health problems. The actions in this phase include:

• Re-integrating the affected employee(s) back into the work environment, in ways that minimise risks to their (or others’) health. Treatment (medical) considerations are decided.
• Planning future company management interventions, to reduce the likelihood of similar diseases affecting other employees (future and current employees). This is prescribed by the hierarchy of controls, namely:
1. Hazard substitution or elimination.
2. Engineering Solutions (isolation & ventilation)
3. Administrative Solutions (job rotation, safe work procedures, hazard communication, etc.)
4. Training and education
5. Personal Protective Equipment
• Addressing the appropriate statutory reporting requirements, as prescribed by:
• The Occupational Health and Safety Act.
• The Compensation for Occupational Injuries and Diseases Act.

REFERENCES

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