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Objectives Why Occ Med? History of Occupational Medicine

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Objectives Why Occ Med? History of Occupational Medicine American Osteopathic College of Occupational and Preventive Medicine Basic Course in Occupational and Environmental Medicine, Part I March 14, 2012, St. Petersburg, Florida Objectives – Understand the scope and practice of OM – Name 2 historical OM figures – Identify significant laws – Name one major preventive health initiative in which OM plays an important role – Enumerate OM services delivery methods Scott C. Jones, DO, MPH, FAOCOPM – Explain the essential and elective components of St. Petersburg, Florida an OM practice March 14, 2012 American Osteopathic College of Occupational and Preventive Medicine Definition of Occupational Medicine Why Occ Med? • The ONLY medical specialty trained in the • The branch of medicine that deals with the interaction between the worker and the work prevention and treatment of occupational injuries place! and diseases. • OccDocs MUST know the work environment of • An occupational disease is one that is associated their patients! with a particular occupation and occurs in the workplace. • Companies MUST know their OccDocs! • Some occupations confer specific risks, such as the prevalence of black lung in coal miners. Now for some Occ Med History… History of Occupational Medicine Pliny the Elder 23 - 79 AD • “The fumes from silver mines • Mirrors the history of medicine are harmful to all animals…” • “…when well shafts have • Hippocratic teaching (460-377 BC) about observation been sunk deep, fumes of and balance, not superstitious sulfur or alum rush up to – “Observe the patient’s condition and their response to meet the diggers and kill disease, rather than the disease itself.” them.” • Animal bladder “veils” to protect miners A-1 American Osteopathic College of Occupational and Preventive Medicine Basic Course in Occupational and Environmental Medicine, Part I March 14, 2012, St. Petersburg, Florida Galen 131 - 200 AD Rhazes c850 - 923 • Physician to the gladiators • Documented occupations of under Marcus Aurelius patients • Accomplished surgeon, wrote – Cotton merchant about procedures and – Cloth merchant instruments – Goldsmith – • Wound treatment in the work bookseller place • Observations of mine workers exposed to acid mists Bernardino Ramazzini 1633 - 1714 “Disease of Scribes and Notaries” • “To the questions • “An acquaintance of mine, a notary by recommended by Hippocrates, profession, still living, used to spend his whole he [physician] should ask one life continually engaged in writing, and he more – What is your made a good deal of money from it; first he occupation?” began to complain of intense fatigue in the • Pioneered field of Ergonomics whole arm, but no remedy could relieve this, … • Visited workers and workplaces “Disease of Scribes… ” Recommended Reading • “…and finally the whole right arm became • Lancet article: Lancet 19999;354:858-61 completely paralyzed. In order to offset this infirmity he began to train himself to write with the left hand, but it was not very long before it too was attacked by the same malady.” A-2 American Osteopathic College of Occupational and Preventive Medicine Basic Course in Occupational and Environmental Medicine, Part I March 14, 2012, St. Petersburg, Florida Percival Pott 1714 - 1788 Thomas Morrison Legge 1863 - 1932 • First medical inspector of • Scrotal cancers in chimney factories in England sweeps • Lead Poisoning and Lead • “pioneer of observational Absorption epidemiology” • Recommended banning indoor • “Father” of environmental lead paint carcinogenesis • Occ med in medical school curriculum Alice Hamilton 1869 - 1970 Alice Hamilton Award • pioneer of toxicology From CDC/NIOSH Website: • 1919 first woman appointed to faculty at Harvard Medical • Alice Hamilton Awards School, Department of Industrial The Alice Hamilton Awards for Occupational Safety and Health recognize the scientific excellence of technical and instructional materials by NIOSH Medicine scientists and engineers in the areas of biological science, engineering and • national expert on exposures to physical science, human studies, and educational materials. toxic chemicals in the workplace, • The Awards honor Dr. Alice Hamilton (1869 - 1970), a pioneering especially lead researcher and occupational physician, and are presented each year by NIOSH on the basis of rigorous reviews by panels of scientific experts from • active role in exposing the 1924 outside the Institute. Ethyl leaded gasoline and 1928 "radium girls" industrial disasters http://www.cdc.gov/niosh/hamilton/defa ult.html Scott C. Jones, DO, MPH 1959 - present • Board Cert. Occ Med • DOCPCMS • Medical Director – BJC CHS – St. Louis Metro Police Dept – St. Louis County Police Dept – Metro Bistate • Compensation Systems – State WC – FELA – Jones/Longshoremans’ A-3 American Osteopathic College of Occupational and Preventive Medicine Basic Course in Occupational and Environmental Medicine, Part I March 14, 2012, St. Petersburg, Florida Historical Events Historical Events • Factory Act of 1867 • Worker Compensation Laws – Restricted hours during – No fault insurance coverage for injured workers which children, young – Early 1900’s workers and women – State based programs and laws were permitted to labor – Employee right-to-choose; right-to-know – Any contested cases are adjudicated by state compensation boards – Burden of proof on worker Historical Events Historical Events • Occupational Medicine became specialty 1954 • EPA established 1970 – • OSHA established 1970 – safe working environment – Regulates pesticides, • NIOSH established 1970 – research agency – Enforces Toxic Substance Control Act (TSCA) – Noise Control Act – And many more since then Occupational Health Services Team Approach • Physician • Safety Officers • • What does one do in occupational medicine? • Occupational Health Industrial Hygienist Nurse • Management (plant • What is the scope of services? • PAs and NPs manager, HR dept) • Ergonomic team • Physical Therapist • Environmental team • Quality Care: Clinical v. Occ Med • Case Manager • TPAs – Internal • Insurance Cos. – External A-4 American Osteopathic College of Occupational and Preventive Medicine Basic Course in Occupational and Environmental Medicine, Part I March 14, 2012, St. Petersburg, Florida Types of Services Clinical Services • Clinical • Examinations • Ancillary – Pre-placement – Return to work • Preventive – Fitness for duty • Health Promotion Programs – Respirator clearance • Health and Productivity Management – Periodic Surveillance • Worker Health as force for National Health – Disability examinations Policy reform – IME • Injury Care Ancillary Services Preventive Health Services • Audiometric • Health Promotion Programs – Smoking cessation • Spirometry – Stress reduction • Visual testing – Nutritional counseling • Laboratory testing – Mental Health and Depression – Sedentary Lifestyle interventions • X-rays • Periodic evaluations • Physical Therapy – Risk assessment • MRO Drug Testing – Lifestyle factors – Appraisals of health (HRAs) Healthy People 2020 Healthy People 2020 Access Health Services Family Planning Lesbian, Gay, Bisexual, and Transgender Preparedness New Adolescent Health New Food Safety Health New Public Health Infrastructure Arthritis, Osteoporosis, and Chronic Back Genomics New Maternal, Infant, and Child Health Respiratory Diseases Conditions Global Health New Medical Product Safety Sexually Transmitted Diseases Blood Disorders and Blood Safety New Health Communication and Health Mental Health and Mental Disorders Sleep Health New Cancer Information Technology Nutrition and Weight Status Social Determinants of Health New Chronic Kidney Disease Healthcare-Associated Infections New Occupational Safety and Health Substance Abuse Dementias, Including Alzheimer’s Disease Health-Related Quality of Life & Well- Older Adults New Tobacco Use New Being New Oral Health Vision Diabetes Hearing and Other Sensory or Physical Health Disability and Health Communication Disorders Early and Middle Childhood New Heart Disease and Stroke Educational and Community-Based HIV Programs Immunization and Infectious Diseases Environmental Health Injury and Violence Prevention Topics marked "New" are topic areas that were not included in Healthy People 2010. * http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx A-5 American Osteopathic College of Occupational and Preventive Medicine Basic Course in Occupational and Environmental Medicine, Part I March 14, 2012, St. Petersburg, Florida Types of Occ Med Practices Basic Function of Occ Physician • Multi-specialty group practices • Provide high-quality medical services • Corporate-based clinics – i.e. give good EBM care • Private practice • Understand company’s objectives • Hospital based programs – Medical conscience for employers • University/ Teaching/ Residency • Aid in regulatory compliance – • Primary care offices OSHA, EPA, DOT • Marketing and billing Work-Site Visit Work-Site Visit • First impressions count • Observe workers working • Number of employees • Observe workers arriving, on breaks and leaving • Number of shifts • Physical environment: temp., odor, vibration, noise • Union or non-union shop • General safety – machine guards, safety showers, • Health/medical services available signs, trip hazards • Essential Functions in Job Descriptions • Eating area, wash room • Review the Material Safety Data Sheet – MSDS • Ergonomic issues – heavy lifting, repetitive motion, • General housekeeping (spills, cleanliness) awkward positions Work-Site
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