The occupational health services

Services entrusted with essentially preventive functions and responsible for advising employers, workers, and their representatives in the undertaking of the requirements for establishing and maintaining a safe and healthy working environment, which will facilitate optimal physical and mental health in relation to work and the adaptation of work to the capabilities of workers in light of their state of physical and mental health.

The ILO estimates that only 5-10% of workers in developing countries and 20-50% of those in industrialized countries have access to adequate OHSs.

Further, the levels of OHS coverage have not changed significantly over the last 10 years.

1. OCCUPATIONAL HEALTH SERVICES
Dr. Dalia El-Shafei
Lecturer of Occupational Medicine

2. The Occupational Health Services
Definition
Models of Delivery
O.H. Team
O.H. Elements
Future Trends

3. Servicesentrustedwithessentiallypreventivefunctionsand
responsibleforadvisingemployers,workers,andtheir
representativesintheundertakingoftherequirementsfor
establishingandmaintainingasafeandhealthyworking
environment,whichwillfacilitateoptimalphysicalandmental
healthinrelationtoworkandtheadaptationofworktothe
capabilitiesofworkersinlightoftheirstateofphysicalandmental
health.
TheILOestimatesthatonly5-10%ofworkersindeveloping
countriesand20-50%ofthoseinindustrializedcountrieshave
accesstoadequateOHSs.
Further,thelevelsofOHScoveragehavenotchangedsignificantly
overthelast10years.

5. Company-based & -owned Occupational
Health Services
plant level
plant physicians or
nurses + contract
physician(hours to 2-
3 days/week ).
locations and plants
geographically situated
regional medical directors
EHS or HR department
corporate medical director
(leadership & administrative oversight in
developing health policies and standards
+ interpreting & ensuring compliance with
health-related regulations).

6. OHSisintegratedintothestructureofthecompany.
healthcareprovidersareveryfamiliarwiththe
processesandspecifichazardsuniquetothatindustry.
Theplantphysiciansarepositionedtoperform
periodicwalkthroughsofthefacilityandinteract
frequentlywithsupervisors,industrialhygienists,and
safetyofficers,hencefacilitatingthedeliveryofhealth
care.
medicalpersonnelmaybeviewedasan
agentofthecompanyratherthananadvocateofthe
employeeorpatient,therefore,therecanbedistrust
andreluctanceonthepartofemployeestoshare
healthinformationwiththeseprofessionals.

7. Group Occupational Health Services
Jointlyorganizedbyanumberofenterprises,independently
organizedgroupservicestowhichvariousenterprises
subscribe,orOHSsprovidedbysocialsecurityinstitutions.
Servearangeoforganizationsindifferentindustrial
sectorsorservedifferentcompanieswithinthesame
industrialsector.commoninnorthernEuropeancountries
(e.g.,France,Denmark,Finland,andtheNetherlands).
midsizeandsmallercompaniesbenefitfrom
well-equippedhealthcentersstaffedwithprofessionalswho
arerelativelyknowledgeableabouttheirindustryandthe
hazardsuniquetotheirprocesses.
geographicdistancebetweentheworksite
andtheOHSs.

8. Hospital-and Tertiary Center-based
Occupational Health Services
thefirstpointofcallfor
workerswithseriouswork-relatedinjuries,acutepoisoning,andacute
illnessesbuthaveverylimitedexperienceinotherwork-relatedissuesand
littleornointeractionwiththeworkplace.Businesseswithspecifichazards
thatrequireuniquetreatments(hydrofluoricacid)oftensharemanagement
protocolswithemergencydepartmentsintheeventofacatastrophicevent.
OHdepartmentsthatprimarilyprovideservicesfor
hospitalemployees.Recently,contractwithotheremployersintheareato
providecareforemployeeswithwork-relatedinjuriesandillnesses.
Diagnosesofcomplexcases,investigationsofclusteroutbreaks,clinical
research,andtrainingsitesforoccupationalphysiciansandnurses.

9. Free-standing Occupational Health Clinics
AprivatehealthcenterorganizedtoprovideOHSstoawidevarietyof
clients(singleunit,oroftenregionalornationalchains).
Thelargercentersareusuallystaffedwithphysicians,physician
extenders(i.e.,physicianassistantsandnursepractitioners),OHnurses,
andphysicaltherapists.
Mostprovidedactivities:managementofacuteinjuries,postjoboffer
preplacementevaluations,andmedicalsurveillance.
verylimitedinteractionwiththeplantsandless
familiaritywiththespecificsoftheworkplace.

10. Occupational Health Services Delivered by
Primary Care Physicians
Primarycarephysiciansevaluatetheirpatientsforwork-relatedand
nonwork-relatedhealthissues,andhavenospecificformal
arrangementwiththeemployers.
theprimarycarephysicianisveryfamiliarwithallthe
healthissuesofhisorherpatientthatcanimpactwork
limitedtraininginOHissuesandverylimited
knowledgeoftheworkplaceandpotentialoccupationalexposures.
Still,mayalsoserveasthepart-timeorcontractplantphysicians
andhaveagoodworkingknowledgeoftheplant.Thesephysicians
areinaveryuniquesituationandoftenhavethedualandsometimes
conflictingroleofbeingboththeworker'sprimaryphysiciananda
contractoroftheemployer.

11. Occupational Health Services in Countries
in Transition
ManyoftheeasternandcentralEuropeancountries
currentlyundergoingtransitiontoamarketeconomyinorder
tojointheEuropeanUnionaremovingfromapolicythat
focusesonworkers'protectiontowardoneofpreventionand
healthpromotionintheworkplace.Nowworkingtodevelopa
standardizedsystem,ensuringhealthandsafetyconditionsin
theworkplace.

12. Occupational Health Services in Developing
Countries
Morethan80%oftheworld'sworkforceresidesindevelopingcountries.
A.AbsenceofcomprehensivenationalEHSpolicies,
B.Inadequateresourcefacilities
C.Economicconstraints.
D.VerylimitedexpertiseinthedisciplinesofOH,industrialhygiene,and
safety.
Becauseofthelimitedhealthcaredeliveryservicesandpoorinfrastructure,
physiciansandotherhealthcareprovidersemployedintheworkplaceusually
bythelargercorporationsprovidecomprehensivehealthcareforthe
employeesandtheirimmediatefamilymembers,thusspendingverylittletime
providingtraditionalOHSs.
Incertaininstances,especiallyinremoteareas,employersrunlargeclinicsor
evenhospitalsthatalsoservethegeneralpopulation.

13. Supplementary
H&S
professionals
(Employees, External
contract workers, or
Consultants.)
core staff
•Physical therapists.
•Biostatisticians.
•Epidemiologists.
•Safety engineers.
•Ergonomists.
•Toxicologists.
•Health educators.
•Psychologists.
•Mental health specialists.
•Counselors.
•Work physiologists.
•Emergency medical technicians.
•Clinicians (physicians,
physician assistants,
nurse practitioners,
and nurses).
•Industrial hygienists.
•Other clinical support
staff

14. TheOHSstaffsrole:
-Preventwork-relatedinjuriesanddiseases(employee
education,healthpromotion,medicalsurveillance,and
variousclinicalactivitiestoensurefitnessforduty).
-Managemedicalconditions(diagnosis,treatment,and
rehabilitationofaffectedemployees).
-Identifypotentialhazardsintheworkplaceby
performingqualitativeandquantitativehealthhazard
assessments.

15. TrainingandcurriculaforOHspecialists:
ocompletedbasictraininginmedicineandnursing,then
advancedtraininginoccupationalmedicine,industrial
medicine,orpublichealth,leadingtocertificationinthe
relevantfield.
oButthereareaworldwideshortageofformallytrained
occupationalphysiciansandmostOHSsareprovidedby
physiciansandnursesnotformallytrainedinOH.
oUnfortunately,verylittletimeisspentcoveringthisareainthe
generalmedicalandnursingcurriculaofmostcountries.So,
suchclinicianssupplementtheirknowledgeofthefield
throughcontinuingeducationprovidedbyprofessionalOH
organizations,institutionsofhigherlearningwithOH
faculty,andindustry-sponsoredconferencesand
meetings.

16. Preplacement or
Fitness for Duty
Examinations
Treatment and
Rehabilitation of
Acute Injury and
Illness
Sentinel Case
Detection
Surveillance
Periodic
Examinations
(periodic medical
surveillance)
Other Periodic
Examinations
Disability Review
and Return to
Work
Health
Promotion
Travel MedicineRecordkeeping

17. Preplacement or Fitness for Duty
Examinations
Aworker'sfirstcontactwithamedicalproviderintheOHS.
Hasreplacedthepre-employmentexaminationwhichoften
wasusedtodeterminewhethertomakeajoboffertoa
prospectiveemployee.Ifmedicalproblemswerefound,they
weresometimesusedasareasonfornothiringtheindividual.
Thepreplacementexamination,bycontrast,issupposedto
takeplaceafteraconditionaljobofferhasbeenmadeandis
sometimesthereforereferredtoasapost-offer
examination.
Thecontentofthepreplacementmedicalexaminationis
variable,evidence-basedandrelatedtothepossiblejob
exposuresthatanindividualcouldencounter.

18. The four major components of pre-
placement examination:

19. Treatment and Rehabilitation of Acute
Injury and Illness
When diagnosing and treating an acute injury, the occupational medicine
provider must consider a number of important issues in addition to those of
basic medical management.

20. Sentinel Case Detection
Asentinelevent,indicatingthatahazardexistsinthe
workplacethatisplacingotherworkersatrisk.
Takinganadequatehistoryofthecircumstancesofthe
injurycanprovidesomeclues.
Whenapossiblesentineleventisrecognized,theremaybe
aneedforafocusedinvestigation,similartoanoutbreak
investigationperformedforacommunicabledisease.

21. These efforts are best performed by a multidisciplinary team (health care
professionals, industrial hygienists, and those with epidemiological expertise).

22. Surveillance Periodic Examinations
(periodic medical surveillance)
Whileindustrialhygienemeasuresandengineeringcontrolsare
thebestwaytopreventillnessorinjuryfromanindustrialhazard,
medicalsurveillancetodetectsubclinicaleffectsofahazard
representoneofthemeansofpreventingseriousadverseeffects.
Often,employeesmaybeexposedtomorethanonehazardand
requireanumberofdifferentexaminations.Computerizedrecord
systemsmayassistinthetrackingofsuchrequirementsand
schedulingappropriateexaminations.
Resultsofsurveillanceexaminations(spirometry,audiogram)may
requireevaluationoflongitudinaltimetrendsforaparticular
condition.

23. Other Periodic Examinations
Othermedicalindicationstoperiodicallyevaluateaworker's
fitnessforduty.Periodicexaminationsforsafety-sensitivejobssuch
asmobileequipmentoperatorsandFederalAviationAdministration
physicalsarealsoperformedonaregularbasis.
Thefocusofsuchperiodicexaminationsisnottoremoveanindividual
withamedicalproblemfromtheworkplace,butrathertodetermine
whetheranyexistingimpairmentscanbeadequatelyaccommodated
withoutplacingtheworkerandothers(includingthegeneralpublic)atrisk.
Manyperiodicexaminations,ifnotmandatedbyOSHA,mustbeoffered
totheworkeronavoluntarybasis.Ifsuchexaminationsareseenas
opportunitiesforjobdisqualification,workers(especiallythosewhoneed
themmost)mayoptnottotakepart.
Ideally,theseperiodicexaminationscanresultinearlydetectionof
chronicconditionsintimetoallowforpreventiveinterventionssuchasdiet
modification,exercise,andworkhardeningtotakeplace,allowingaworker
toremainproductivelyandsafelyemployed.

24. Disability Review and Return to
Work
Anemployee'spersonalhealthcareprovidermayhave
lessexperienceinreturn-to-workissuesandmay
inappropriatelygiveapatientpermissiontoreturntowork
orrestrictthepatientfromreturningtoworkforan
excessiveamountoftime.TheOHprovider,bycontrast,
shouldhavesufficientknowledgeofspecificjob
requirementstomakeamoreinformeddecision.Therefore,
manycompanieshavepoliciesrequiringallemployees
returningtoworkafteraprolongedabsencetohavean
evaluationattheOHStodeterminewhethertheycansafely
returnorrequirejobrestrictionsand/ormodifications.

25. Thereissomeevidencethatprolongedabsence
makesreturningtoworklesslikely,andtherefore,
earlyinterventioncanhelpensurethatemployeescan
returntowork(withworkrestrictionsifnecessary)as
soonasitisfeasible.
Incertaincases,anemployeemaybecometotally
disabledfromreturningtowork.Thisisadifficult
decisionbestmadebytheOHproviderafter
consultationwithhumanresources,relevantsafety
managers,jobsupervisors,andthepatient
themselves.

26. Health Promotion

27. Travel Medicine
Withincreasingglobalization,travelmedicineisbecomingan
importantaspectoftheservicesprovidedbyacomprehensiveOHS.
Theoccupationalproviderofferingtravelmedicineservicesmust
keepabreastofcountry-specificrecommendationsandadvisories,
includingquarantinesandtravelbansandrestrictionsdueto
diseaseoutbreaks.(theCentersforDiseaseControlandPrevention
website:http://www.cdc.gov)
Infectiousdiseases,includingtravelers'diarrhea,aresomeofthe
mostcommonmedicalproblemsencounteredbytravelers.
Theleadingcausesoftravel-relatedmortalityaretraumadueto
motorvehicleaccidentsanddrowning.

28. Before travel
•Appropriate
vaccination and
counseling to avoid
travel-related illness.
•Advice and counseling
for family members.
During
travel
After
travel
•Post-travelling
evaluation.

29. Recordkeeping
Inadditiontokeepingacompletemedicalrecordandadequately
storingtheresultsofbaselineandperiodictestingonemployees,
theOHSshouldhavecertainroutineformsandreports.
RetentionofRecords
ManyoftheOSHAstandardsmandatethatrecordsofsurveillance
examinationsandothermedicalevaluationsberetainedforatleast
30yearsafterleavingemployment.
ConfidentialityofRecords
Althoughrecentfederalguidelinesforprivacyofmedicalrecords
outlinedinthehealthinsuranceportabilityandprivacyact
(HIPPA)arefocusedonthegeneralmedicalcaresettingratherthan
theoccupationalmedicinesetting,theOHSshouldupholdthesame
standardsofprivacyandconfidentialityinservicesprovidedandthe
recordofthoseservices.Itisespeciallyimportanttopreventthe
releaseofmedicalinformationtoanemployer.

30. •Astandardformforreportingemployerswhetheranemployeehasbeen
clearedforfullorrestrictedduty,andifhehasbeenclearedforparticular
jobssuchasmobileequipmentoperation,firefighting,andrespiratoruse.
Health Status Form
•Astandardformforreportingsuchresultsishighlyrecommendedto
ensureuniformconformity.
Drug Test Reporting Form
•Usuallydevelopedbyastate'sDepartmentofPublicHealth.Thereisan
increasingtrendtowardelectronicreportingsystems.
•TheOSHArecordkeepinglogmaybemaintainedintheOHS,inwhich
caserecordingofsignificantinjuryandillnesseventsmustbecarriedout
inaccordancewithOSHAspecifications.IftheOSHAlogismaintained
elsewhere,suchasinaplantsafetydepartment,itmaybehelpfultohave
astandardformforthemedicaldepartmenttoreportwork-relatedinjury
andillnessestothatdepartment.
Occupational Injury and Disease Surveillance
Reports
•Summaryreportsofclinicalactivitycanbeanimportantsourceofdataon
clinicutilizationtrends.Theycanbecompiledonamonthlyoryearly
basis,ideallyasadirectoutputofanelectronicrecordssystem.
Clinic Activity Reports

31. Future Trends in the Provision of
Occupational Health Services
Heavy industrial manufacturing
production will continue to
relocate from older factory sites to
newer facilities in other parts of
the world. The occupational
physician based in a plant clinic,
therefore, will become an
increasing rarity as an OHS model.
OH providers should expect to
increasingly handle occupational
medicine problems related to
travel.
The control of occupational
infectious diseases is therefore
likely to become increasingly
important, and preventive services
such as TB screening may be a
necessary part of the OHS of the
future.
New technologies (nanotechnologies) require
sophisticated understanding and new types of
services to prevent occupational illness and
injuries . Other rapidly developing technologies
(robotics)may indelibly alter modern
manufacturing processes and lead to reduction of
certain workplace hazards.
Progress in the field of genomics,including
pharmacogenetic profiling of individuals, may lead
to a greater availability of genetic information
regarding individual susceptibility to particular
workplace hazards or chronic diseases. A two-edged
sword; On the one hand, it may become easier to
identify workers who are at increased risk of
developing occupational and environmental disease,
So, prevention efforts can be better targeted to
protect such individuals. On the other hand, there is
an inherent potential for workplace discrimination
against susceptible individuals.