Armed Forces Epidemiology Board
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USAF Medical Service
Occupational Health Program
Lt Col Kenneth L. Cox, USAF, MC, SFS
Chief, Risk Assessment Division
Kenneth.Cox@brooks.af.mil
Phone: 210/536-1788
17 April 2002
Overview
 Definition
 Occupational
Health Program and Drivers
 Occupational Health Basic Strategy
 Occupational Health Team and Functions

BEE, Public Health, Physician, Support Staff
 Occupational
Health Working Group (OHWG)
 Data Collection and Analyses
 Special Occupational Studies
 Initiatives and Future Projects
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Occupational Health
Definition
“. . . Promotion and maintenance of the highest degree
of physical, mental and social well-being of workers
. . . Prevention among workers of departures from
health caused by their working conditions . . .
Protection of workers . . . from risk . . .
World Health Organization (1950)
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Occupational Health Program
Policy Directives and Drivers
 “The
Air Force will ensure the occupational health of
its people by identifying work-site health hazards,
recommending control measures, assessing fitness
for work, conducting medical surveillance,
educating workers, and providing clinical services.”
AFPD 48-1, Aerospace Medical Program
 Components
outlined in AFI 48-145, Occupational
Health Program, 1 Apr 99
 AFMAM 48-146, Occupational Health Information
Management (under development, to replace AFOSH
Std 161-17)
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Occupational Health
Surveillance Strategy
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Occupational Health Team
 Occupational
health consultant physician
 Public health specialists
 Bioenvironmental engineer
 Support specialists
 Other, depending on local assets/needs



Safety
Audiology
Primary Care Mgr
Health
promotions
Civilian personnel
Union representative
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Bioenvironmental Engineer
Responsibilities/Functions
 Conduct

industrial workplace surveys
Workplace categorization by potential health risk
— 1-High;
requires annual assessment
— 2-Medium; requires assessment every 2 years
— 3-Low; assessment as needed

Special surveillance assessment matrix
Confidence in
Hazard
Assessment
Confidence in Existing Controls
Low
Medium
High
Low
A
A
B
Medium
A
B
C
High
B
C
D
Bioenvironmental Engineer
Responsibilities/Functions (cont)
 Goal




is to protect the worker
Hazard elimination – substitute, stop process
Engineering control – ventilation, acoustical material
Administrative control – signs, restricted areas
Personal protective equipment
 Investigate
occupational illnesses, incidents, and
reproductive health hazards
 Fit-test respirators
 Ergonomic assessments
 Thermoluminescent dosimetry program
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Documentation
AF Form 2755,
Workplace
Exposure Data
Summary
Public Health
Responsibilities/Functions
 Propose
medical surveillance exam requirements
based on BEE survey results
 Perform epidemiological trend analysis
 Investigate & document occupational
illnesses/incidents
 Identify worker educational requirements
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Occupational Health Consultant
Responsibilities/Functions
 Review
BEE survey data
 Visit workplaces, with BEE and/or Public Health

Health survey, workplace survey, summary report
 Determine

medical surveillance requirements
Modify and approve public health recommendations
 Perform
occupational health examinations
 Accomplish fitness-for-duty evaluations
 Establish/review pregnancy profiles
 Assess quality of local occupational health program
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Support Staff
Responsibilities/Functions
 Schedule
periodic occupational exams
 Validate/update workshop personnel rosters
 Track no shows
 Communicate results of exam to worker
 Schedule required follow-ups and monitor until done
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Occupational Health Working Group
Sample Agenda and Products
 Review

recent surveys
Establish medical surveillance exam requirements
 Identify
ergonomics issues
 Report occupational illness/injury trends
 Monitor the Hearing Conservation Program

Significant threshold shift log
 Calculate
completion rate for occupational exams
 Quality control of exams and procedures
Oversees all aspects of occupational health at the
base level.
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M EM O R A N D U M FO R R EC O R D
F R O M : O C C U P A T IO N A L H E A LT H W O R K IN G G R O U P (O H W G ) / S G P O
S U B JE C T : S U M M A R Y M E D IC A L S U R V E ILLA N C E E X A M IN A T IO N S (A F F O R M 2766)
1. T he O H W G review ed 15 w ork zones on 17 N ov 98. T he follow ing is a sum m ary of the protocols agreed upon:
W IC
N am e of
sh op
E xp osu re
su m m ary
H ealth
h istory
A u d io
L ab
PA
CXR
PFT
V isu al
acu ity
R esp
q u est
C E S E nt
see note
S hop
(1)
300A
D oc D iscont plc,
see note
entigrate
ann, trm
(2)
306A
T ransport
co nt plc,
S hop
ann, trm
310A
P re-fab
cont plc,
S hop
ann, trm
313D
M RSOC
cont plc,
O ps
ann, trm
008A
M etallize cont plc,
cont plc, cont plc, cont U A
C ont
cont plc,
W ire
ann, trm
ann, trm
ann, trm
PFT
ann,dtrm
032A
B earing
cont plc,
Fxn
ann, trm
W IC = w ork place identifier, P F T = pulm onary function test (spirom etry), R esp quest = respirator questionnaire
a = added, d = deleted, cont = continued, ann = annual, per = period ically, plc = placem ent, trm = term ination
C at 1 = critical shop, C at 2 = potentially hazardous shop, C at 3 = m inim ally hazardous shop
P h ysical
exam
604A
O th er
C at 3
C at 2
C at 2
C at 2
C at 2
cont plc,
ann, trm
N ote (1) - O versee contractors w ho perform pest control services. U se filtering facepiece (deleted respirator questionn aire)
N ote (2) - U se filtering facepiece (deleted respirator questionnaire requirem ent)
N ote (3) - Lab, P F T , R espirator Q uestionnaire, and P hysical E x am for w orkers assigned inside of plasm a spray booths only
C at 1
note (3)
C at 2
Documentation
AF Form 2766,
Clinical
Occupational
Health
Examination
Requirements
Event or
Exposure
Yes
AF Injury/Illness
Reporting Algorithm
Symptoms or
+biomonitoring?
No
Yes
Not Recordable
No
Work
Related?
Yes
Ground
Safety
(Line)
Injury
Illness or
Injury?
AF Safety
Center
Public
Health
Illness
(Medics)
AFIERA
Recordable
Data Reporting &
Enterprise-level Analyses
 OSHA-mandated

injury reporting via safety offices
Base, MAJCOM, AF summary reports
 Occupational
illness reporting by base public health
via AF Reportable Events Surveillance System to
AFIERA

Data sent to AF Safety Center for combined reporting
 Audiometric
data transmitted directly to Defense
Occupational and Environmental Health and
Readiness System (DOEHRS)

Data currently inaccessible due to technical problems
 Shop

survey data entered into Command Core
Base level only, no central collection/access
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Special Occupational Studies
 JP-8
Acute Effects Study
 Anthrax Vaccine and Vision in Aviators
 Kelly AFB Worker Mortality Study
 Investigations of diverse cancer cluster alarms, e.g.,




Thyroid cancer in aviators at a training base
Diverse cancers in an ANG admin building
Mesothelioma in a HQ building
Lymphoma in a missile squadron
Note: topics usually brought to AFIERA’s attention
by concerned field staff or workers
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Initiatives and Future Projects
 Improve



occupational injury/illness reporting
New web-based reportable events system
Use ambulatory visit codes to identify possible cases
Real-time reports re lost duty days
 Computerized
occ exams via PIMR
 Establish an AF repository for Command Core IH
data at AFIERA with centralized trend analysis
 Continue developing the Global Expeditionary
Medical System (GEMS) to ensure proper reporting
of occupational/environmental exposures that occur
in deployed settings
 Assist in development of Automated Civil Engineer
System (ACES) for environmental management data
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Questions???
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Backup Slides
Current Instructions/Guides
 DoD
6055.5-M, Occupational Medical Surveillance
Manual
 AFOSH 48-119, Hazardous Noise Program
 AFOSH 48-9, Radio Frequency Radiation Safety
Program
 AFI 48-125, Personnel Dosimetry Program
 AFOSH 48-8, Controlling Exposures to Hazardous
Materials
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Current Instructions/Guides
(cont)
 AFJI
48-110, Immunizations and Chemoprophylaxis
 AFOSH 48-139, Laser Radiation Protection Program;
ANSI136.1-2000
 NFPA 1582, 2000 ed, Medical Requirements for Fire
Fighters
 AFOSH 48-137, Respiratory Protection Program
 Interim Guidance for 48-20, Hearing Protection
Program – DoDI 6055.12
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Keeping Current
Internet Reference Sources
 Requires
team approach
 Internet sites







www.osha.gov
www.denix.osd.mil
afpubs.hq.af.mil
sg-www.disa.mil/moasgoa
www-4afia.saia.af.mil
wwwsam.brooks.af.mil
www.afms.mil/afiera/rsh/OccMed
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