1. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 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 Armed Forces Epidemiology Board

2. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 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

3. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 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)

4. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 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)

5. I n t e g r i t y - S e r v i c e - E x c e l l e n c e Occupational Health Surveillance Strategy

6. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 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

7. 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 LowMediumHigh LowAAB MediumABC HighBCD

8. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 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

9. Documentation AF Form 2755, Workplace Exposure Data Summary

10. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 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

11. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 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

12. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 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

13. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 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.

15. Documentation AF Form 2766, Clinical Occupational Health Examination Requirements

16. AF Injury/Illness Reporting Algorithm Event or Exposure Symptoms or +biomonitoring? Work Related? Illness or Injury? Yes InjuryIllness No Not Recordable Recordable Ground Safety (Line) Public Health (Medics) AF Safety Center AFIERA

17. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 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

18. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 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

19. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 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

20. I n t e g r i t y - S e r v i c e - E x c e l l e n c e Questions???

21. I n t e g r i t y - S e r v i c e - E x c e l l e n c e Backup Slides

22. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 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

23. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 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

24. I n t e g r i t y - S e r v i c e - E x c e l l e n c e 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