National Pesticide Practice Skills Guidelines for Medical & Nursing Practice A Project of the National Strategies for Health Care Providers: Pesticides Initiative National Pesticide Practice Skills Guidelines for Medical & Nursing Practice A Project of the National Strategies for Health Care Providers: Pesticides Initiative January 2003 For more information: Tel: 202-833-2933 x535 Fax: 202-261-6464 Email: [email protected] Web: www.neetf.org/health/providers/index.shtm The National Environmental Education & Training Foundation 1707 H Street, NW, Suite 900 Washington, DC 20006-3915 Support for this project was made possible through Cooperative Agreement CR 827026-01-0 between the Office of Pesticide Programs of the U.S. Environmental Protection Agency and The National Environmental Education & Training Foundation.The conclusions and opinions expressed herein are those of the authors and do not necessarily represent the views and policies of the U.S. EPA. Extensive resources on pesticides can be found at www.neetf.org/Health/Resources/healthcare.htm Reviewers This document has been reviewed in draft form by individuals chosen for their unique perspectives and technical expertise.The purpose of this independent review was to elicit candid and critical comments that would assist in making this published document as sound and effective as possible. We thank the following individuals for their review of this document: John Balbus, MD, MPH ..........................................George Washington University, School of Medicine Patricia Bauman......................................................The Bauman Foundation Geoffrey M. Calvert, MD, MPH, FACP................National Institute for Occupational Safety & Health Kerry Hoffman-Richards, PhD ............................Pennsylvania State University, Pesticide Education Program Ruth Kahn, DNSc.....................................................Health Resources and Services Administration, Bureau of Health Professions, Division of Medicine Philip J. Landrigan, MD, MSc...............................Mount Sinai School of Medicine Ann Linden CNM, MSN, MPH..............................Liaison for American College of Nurse-Midwives Paul Locke, JD, DrPH ..............................................Trust for America’s Health Edward Master, RN, MPH......................................U.S. Environmental Protection Agency, Region 5 Robert K. McLellan, MD, MPH .............................Institute and Center for Human Development and Environmental Health Service Ameesha Mehta-Sampath, MPH.......................U.S. Environmental Protection Agency, Region 2 Melissa Melum RN, BSN........................................University of Maryland, School of Nursing, Environmental Health Education Center Claudia Miller, MD, MS...........................................The University of Texas, Department of Family and Community R Medicine; South Texas Environmental Education & Research e vie Program Lillian Mood, RN, MPH, FAAN..............................Retired Public Health Nurse & Community Liaison w ers Patrick O’Connor-Marer, PhD .............................University of California, IPM Education and Publications Donna Orti, MS, MPH.............................................Agency for Toxic Substances & Disease Registry Dorothy Powell, EdD, RN, FAAN .........................Howard University, College of Pharmacy, Nursing & Allied Health Science Mark Robson, PhD, MPH.......................................University of New Jersey, School of Public Health Elaine Rubin, PhD ...................................................Center for Interdisciplinary, Community-Based Learning and Association of Academic Health Centers Barbara Sattler RN, PhD........................................University of Maryland, School of Nursing Gina Solomon, MD, MPH......................................Natural Resources Defense Council David Stevens, MD .................................................Association of American Medical Colleges 2 Michael Stimmann, PhD.......................................University of California, Davis, Center for Pest Management Daniel Sudakin, MD, MPH ....................................Oregon State University, Department of Environmental & Molecular Toxicology David Wallinga, MD, MPA.....................................Institute for Agriculture and Trade Policy Although the reviewers listed above have provided constructive comments and suggestions, they were not asked to endorse the content nor did they see the final draft of the document before its release. Responsibility for the final content rests with the authors and The National Environmental Education & Training Foundation. Extensive resources on pesticides can be found at www.neetf.org/Health/Resources/healthcare.htm Authors Project Coordinators: Practice Team: Andrea R. Lindell, DNSc Bonnie Rogers, Dr.PH, COHN-S, LNCC, FAAN Past President, American Association Past President, American Association of of Colleges of Nursing Occupational Health Nurses Dean, College of Nursing University of North Carolina School of Public Senior Associate Vice President Health University of Cincinnati Chapel Hill, North Carolina Cincinnati, Ohio Cathy Simpson, MD, MPH George M. Bernier, Jr., MD Wayne State University School of Medicine Professor of Medicine and Emeritus Dean Detroit, Michigan University of Texas Medical Branch Galveston,Texas Pesticide Extension Representative: Education Team: Amy E. Brown, PhD Candace Burns, PhD, ARNP President, American Association of Pesticide uthors Representative, National Organization of Nurse Safety Educators A Practitioner Faculties Associate Professor, Department of Entomology University of South Florida College of Nursing University of Maryland Tampa, Florida College Park, Maryland James R. Roberts, MD, MPH Assistant Professor, Department of Pediatrics Medical University of South Carolina Charleston, South Carolina 3 The participants gratefully acknowledge the contributions of the staff of the U.S. Environmental Protection Agency and The National Environmental Education & Training Foundation for their ded- ication and support of the project. Extensive resources on pesticides can be found at www.neetf.org/Health/Resources/healthcare.htm Table of Contents Foreword _______________________________________________________________________5 Introduction _____________________________________________________________________6 A Pesticide Primer _______________________________________________________________10 Literature Review _______________________________________________________________ 18 Incorporating Pesticides into Practice Skills __________________________________________ 22 Points of Contact for Training/Refreshing Practitioners______________________________ 22 T able of C Adult Education Principles ____________________________________________________ 23 Pesticide Practice Skills Guidelines for Medical & Nursing Practice: on Content and Resources for Practice Settings__________________________________________ 27 t en Practice Skill I:Taking an Environmental History ___________________________________ 30 ts Practice Skill II: Awareness of Community and Individual Pesticide Risk Factors _________ 36 Practice Skill III: Knowledge of Key Health Principles _______________________________ 40 Practice Skill IV: Clinical Management of Pesticide Exposure _________________________ 43 4 Practice Skill V: Reporting Pesticide Exposure and Supporting Surveillance Efforts _______ 69 Practice Skill VI: Providing Prevention Guidance and Education to Patients _____________ 72 Extensive resources on pesticides can be found at www.neetf.org/Health/Resources/healthcare.htm Foreword Pesticide poisoning in the United States remains under-recognized and under-treated. The lack of attention to pesticide poisoning persists despite the ubiquity of pesticides in our homes, work- places, and communities, and despite the considerable potential for pesticide-related illness and injury. Communities expect that their primary care providers will be prepared to deal with pesticide-related health conditions, as well as other environmental illnesses, but often times they are not. This document is part of a national initiative aimed at changing the current situation. The National Strategies for Health Care Providers: Pesticides Initiative has set forth a strategic direction for the nation to improve the recognition, management, and prevention of pesticide-related health conditions.The vision is for all primary health care providers to: I Possess a basic understanding of the health effects associated with pesticide exposures as well as broader environmental exposures. I Take action to ameliorate such effects through clinical and prevention activities. d Achieving this vision means incorporating some changes in educational institutions related to the or w health professions – medical schools, nursing schools, residency, and practicum programs – to e or equip students better to deal with pesticide-related exposures and health conditions. It also F means a concerted effort on the part of health care professionals to advance their awareness and skills in recognizing and managing pesticide-related illnesses. These guidelines outline the knowledge and skills that health care professionals need to have about pesticides. We recognize the multitude of demands on practitioners to stay abreast of rapid advances in research and technology. Nevertheless, pesticides continue to warrant an increased level of concern – both in order to provide