DOI Medical Handbook
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U.S. DEPARTMENT OF THE INTERIOR OFFICE OF OCCUPATIONAL HEALTH AND SAFETY Fourth Edition OCCUPATIONAL MEDICINE PROGRAM HANDBOOK September 2009 This Occupational Medicine Program Handbook was prepared by the U.S. Department of the Interior’s Office of Occupational Health and Safety, in consultation with the U.S. Office of Personnel Management and the U.S. Public Health Service’s Federal Occupational Health Service. This Fourth Edition of the Handbook represents the continuing efforts of the contributing agencies to provide and to improve occupational health services for DOI employees. It reflects the comments and suggestions offered by users over the twelve years since it was first introduced, having been developed to address the findings, concerns, and recommendations summarized in the final report of a program review completed in 1994 by representatives of the Uniformed Services University of the Health Sciences. That report, entitled “A Review of the Occupational Health Program of the United States Department of the Interior,” was prepared by Margaret A.K. Ryan, M.D., M.P.H., Gail Gullickson, M.D., M.P.H., W. Garry Rudolph, M.D., M.P.H., and Elizabeth Odell. The report led to the establishment of the Department’s Occupational Health Reinvention Working Group, composed of representatives from the DOI bureaus and operating divisions. The recommendations from the Reinvention Working Group final report, published in May of 1996, were addressed and are reflected in what became this Handbook. First published in 1997, the Handbook underwent major updates in July of 2000, and again in October of 2005. This 2009 edition of the Handbook incorporates updates and enhancements that have been made in DOI policies and occupational medicine practice since the last edition. A listing of the updates that have been made since the 2005 edition of the Handbook is provided in Tab 2, and the dates shown in the footers indicate the date the content of each particular section most recently was modified. Please note that this Handbook does not necessarily represent the views or the authority of the Department of the Interior. With programmatic oversight by the DOI Office of Occupational Health and Safety, it represents only the opinions and recommendations of the authors. Information provided from professional or government sources is cited throughout the document, but users of this Handbook are encouraged to contact their agency’s reviewing medical officer, safety officer, or personal health care provider for medical advice and guidance regarding specific medical conditions or questions. OCCUPATIONAL MEDICINE PROGRAM HANDBOOK CONTENTS Section/Topic Tab Introduction and Scope of the Handbook 1 HandbookAdministration 2 Distribution Maintenance Summary of Updates to this Version Responsibilities 3 DOI Office of Occupational Health and Safety DOI Office of Personnel U.S. Public Health Service Bureau Senior Management Bureau Area/Regional Management Local Offices Roles 4 Occupational Health Programs Manager DOI Medical Officer Agency and/or Program Medical Officer(s) (AMO(s)) Human Resource Officer(s) Safety Officer(s) Health Care Providers Medical Service Providers 5 Acquiring or Accessing Services Examining Health Care Provider Qualification Standards/Credentials Certification of Other Clinical Staff Certification of Laboratories Certification of Clinical Equipment Referrals to Sub-Specialists Data Systems OHS; 09/09 i Medical Records - Employee Medical File System 6 Management and Records Maintenance Confidentiality/Release of Records General Medical Program Guidance 7 Establishing and Providing Services Medical Review Program - Overview Basic Requirements for Examination Procedures Discretionary Services Periodic Health Exams Routine Occupational Health Center Services Health Promotion Emergency Medical Care Specific Medical Program Guidance 8 How to Establish or Change Physical Qualification Standards for Hazardous and/or Arduous Positions Required Services - General Employee/Applicant Responsibilities Pre-Placement Union-Mandated Medical Surveillance Determination of Need for Employee Enrollment OSHA-Mandated Medical Surveillance Other Medical Surveillance Fitness for Duty (Medical Employability Determinations) Law Enforcement Officers Wildland Firefighters Divers Inspectors Hazardous Waste Workers Pilots / Aviators Tower Climbers Crane Operators Laboratory Workers Other Guidance, Based on Position Requirements or Work Place Stressors Respiratory Protection Hearing Conservation Chemical Stressors OHS; 09/09 ii Specific Medical Program Guidance (continued) Physical Stressors Physical Exertion and Heat Stress Ultraviolet Light Vermiculite Cold Exposure Biological Stressors Lyme Disease Vaccine-Preventable Diseases Bloodborne Pathogens Tuberculosis Rabies Hantavirus Poisonous Plants West Nile Virus Indoor Air Quality - Mold DOT Vehicle Operators (Medical Clearance for Commercial Driver’s License) Driving for Work Purposes (Where CDL is not required) Automatic External Defibrillators Special Emphasis Program Guides 9 Mandatory Health Education / Training Reasonable Accommodation Time and Attendance / Conduct / Performance Psychological Fitness-for-Duty / Removals Drug and Alcohol Testing Employee Assistance Program Services Recordable Injuries and Illnesses Agency Continuous Quality Improvement Program 10 for Medical Services Data Systems and Analysis 11 Specific Program Criteria, Attachments and References 12 OWCP and Employee Relations Reasonable Accommodation for Emotional and Psychiatric Disorders Medical Employability Determinations Discretionary Medical Services Guide Periodic Health Exam Routine Occupational Health Center Services OHS; 09/09 iii Attachments and References (continued) Medical Examination and Medical Clearance Program Guides General Pre-Placement Medical Evaluations General Medical Surveillance Guidance DOI Medical History and Examination Form Privacy Act Notification Form Authorization for Disclosure of Information Law Enforcement Officers Wildland Firefighters Divers Inspectors Hazardous Waste Workers Pilots / Aviators Tower Climbers Crane Operators Laboratory Workers Other Guidance That May be Pertinent, Depending On Individual Position Requirements or Work Place Stressors Medical Clearance for Respirator Use Hearing Conservation Hearing Loss Guide for Federal Managers Physical Stressors (Physical Exertion and Heat Stress, Ultraviolet Light, Vermiculite, and Exposure to Cold) Biological Stressors (Lyme Disease, Vaccine-Preventable Diseases, Rabies, Hantavirus, Poisonous Plants, West Nile Virus, Indoor Air Quality - Mold) DOT Vehicle Operators (Medical Clearance for Holders of a Commercial Driver’s License) Recordable Injuries and Illnesses Automatic External Defibrillators First Aid Kits Tuberculosis Medical Conditions That May Effect Safe and Efficient Job Performance 13 The Addendums in this Tab are derived from a series of issue papers that have been prepared by the DOI Medical Officer on topics that have been of interest or concern to one or more agencies or programs since the inception of this Handbook. The original issue papers have been modified to reflect the more general audience of this Handbook, rather than the specific program for which they were written originally. Stinging Insect Allergy Cardiac Risk Assessment and Clearance OHS; 09/09 iv Medical Conditions (continued) Color Vision Evaluation Drug and Alcohol Evaluation EKG Evaluation When an Employee Doesn’t Meet the Agency’s Hearing Standard (An Overview for Federal Supervisors and Medical Standards Program Managers) Hearing Aids and Directional Hearing Refraction-Correcting Surgical Procedures (e.g., LASIK) Periodicity of Physical Examinations Pulmonary Function Testing Pulse Evaluation Seizures and Medical Clearance Sleep Apnea Use of Coumadin (or “blood thinners”) OHS; 09/09 v OCCUPATIONAL MEDICINE PROGRAM HANDBOOK Introduction and Scope of the Handbook Tab 1 This Handbook represents a culmination of efforts to improve occupational health services for the employees of the Department of the Interior (DOI). As a prelude to the Handbook’s development, the Department established an Occupational Health Reinvention Work Group, composed of representatives from DOI bureaus and operating divisions. In a series of meetings in 1995 and 1996, the Reinvention Work Group developed and articulated a direction for DOI occupational health programs and services that was then developed as a vision statement. Further guidance was developed in the form of a mission statement and a strategic plan with goals for the DOI Office of Occupational Safety and Health (now the Occupational Safety and Health Group of the Office of Occupational Health and Safety). These important directions for the program are presented here: VISION STATEMENT Occupational Health Reinvention All Department of Interior employees, volunteers, contractors, and visitors are provided a work or recreation environment free of health hazards that may cause injury or illness. Further, occupational health hazards are identified and evaluated using professional industrial hygiene concepts. Measures are then instituted to eliminate or minimize potential adverse effects by means of appropriate training, protective equipment and medical services. MISSION STATEMENT The Office of Occupational Safety and Health provides program direction, develops policy, and facilitates the decision-making process to achieve a safe and healthful occupational and recreating environment. In addition, the Office: o provides consultative