Occupational Medical Surveillance and Evaluation Program

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Occupational Medical Surveillance and Evaluation
Program
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OMSEP- guidance

• COMDTINST M5100.47
• Safety and Environmental Health Manual- Chapter
  4
• COMDTINST M6000.1C
• Medical Manual- Chapter12
• See MLCA Web Site for copy to download
• Occupational Safety and Health Act Specific
  OSHA regs

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Medical Surveillance- purpose

• To identify work related diseases or conditions
• at a stage when modifying the exposure or
  providing medical intervention could potentially
• arrest disease progression or prevent recurrences

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OMSEP-revisions

• Enrollment criteria
• Physical examinations
• Examination protocols
• Reporting system
• Roles Responsibilities
• Separation criteria

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Medical Surveillance -Objectives

• identify pre-existing health conditions
• provide risk specific periodic screenings
• monitor clinical laboratory tests and biologic
  functions

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OMSEP-Exam types

• Initial/baseline
• Civilian/military within 30 days
• Employment
• Reassignment (only if new exam protocols
  applies)
• Only required once per career if continually
  enrolled
• Periodic
• Variable/usually annual
• Acute exposure
• Upon notification
• Exit/separation
• End of exposure
• End of employment
• Separation letter

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OMSEP - Exam Protocols

• OMSEP Exam Protocols
• Asbestos
• Benzene
• Chromium Compounds
• Hazardous Waste
• Lead
• Noise
• Pesticides
• Respirator Wear
• Respiratory Sensitizers
• Solvents
• Tuberculosis
• Bloodborne pathogens
• Radiation

• OMMP Exam Protocols (old)
• Asbestos
• Benzene
• Lead
• Noise
• Respirator Wear
• Unspecified

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Who gets enrolled?

• Anyone exposed gt action level for 30 days/year
• Documented or likely to occur for 30 days/year
• ACDU/Reserve/CIV/AUX
• What is exposed?

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Who gets enrolled?

• Some jobs require enrollment unless proved
  unnecessary
• Marine Inspector, Pollution investigators, Marine
  Safety (general), Port safety, marine
  investigator, and fire fighters

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OMSEP- Roles Responsibilities

• Unit
• Appoint OMSEP Coordinator
• Note whos exposed
• Submit enrollments
• maintain unit-level tracking report
• coordinate physical exam process with clinics
• One coord can manage gt1 unit
• transfer member to new unit after member PCS
• Guides _at_ MLCA(kse) CGWEB and OMSEP home
  http//cgweb.lant.uscg.mil/KDiv/kseOMSEPTrainingGu
  ide.htm and http//webapps.mlca.uscg.mil/kdiv/kseO
  MSEP/
• MLC(kse) Detached SEH Office
• Worksite evaluation
• Approve enrollment recommendations

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OMSEP - Roles and Responsibilities

• MLC (k)
• OMSEP tracking report oversight
• Physical exam oversight
• Medical referral oversight
• Maintain electronic tracking system
• Provide guidance and training
• Commandant (CG-1133)
• Policy - Chapter 12 of Medical Manual
• Overall Program Oversight- planning/expertise
• Medical officer support on Occ. Health issues
• Annual report of Occ. Health problems

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ASBESTOS

• Found in floor and roof tiles, popcorn ceilings
  and pipe lagging
• Okay as long as it is intact
• Dangerous if torn, cut, crumbing or disturbed

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ASBESTOS

• Airborne microscopic needles
• Once inhaled, permanent damage
• Asbestosis, Mesothelioma
• Cigarette smoking

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ASBESTOS
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ASBESTOS
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ASBESTOS
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ASBESTOS
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Asbestos Protocol

• Acute exposure must be documented and confirmed
• Once confirmed, member remains on protocol for
  next 30 years
• Not based on say-so

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BENZENE
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BENZENE

• Mandatory for Marine Inspectors prior to 1990
• Otherwise must have a confirmed documented
  exposure
• Long-term career monitoring

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BENZENE
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BENZENE
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CHROMATES
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Hexavalent Chromium Compounds

• Found in some paints, metal alloys and masonry
  cement
• At Risk paint booth operators, aircraft and boat
  painters
• Can cause cancer, occupational asthma,
  dermatitis, skin ulcers
• TLV 0.5 mg/m3 _at_ 30 Days/year

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LEAD
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LEAD
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Lead Hazards

• Inhaled or ingested
• Acute anemia
• Chronic health defects
• Very dangerous to children under six.
• Neurological damage
• Action level 30mg/m3 of air

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Lead Protocols

• Gunners Mates
• Firearms Instructors
• Possibly LE teams
• Painters or anyone chipping lead-based paints
• Educate on workplace hygiene

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NOISE
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NOISE
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NOISE

• All aircrew and most boat crews
• Cutter MKs, GMs, and ETs
• Above 84db 8 hr day/30 day per year
• Impulse noise sound pressure above 140 db/30 day
  per year

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NOISE

• Baseline audiogram and annual audiogram
• Can use audiogram in conjunction with another
  physical exam
• If STS gt25db at 500-3000 HZ is consistent, then
  the member will remain on the HCP even after
  exposure is over.

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HAZARDOUS WASTE
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HAZARDOUS WASTE
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Hazardous Waste Protocol

• Can be used to monitor many non-specific
  industrial exposures
• Acute exposures
• Will also monitor for Benzene

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Blood-borne Pathogens
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Blood borne Pathogens

• Used for Acute exposures only
• No longer automatic for Health Services Techs,
  EMTs or Rescue Swimmers
• Follow treatment plans as outlined in MedMan

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RESPIRATOR WEAR

• WHY?

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Respirator Wear

• Initial physical exam if not current. Initial
  questionnaire
• Questionnaire review every 5 years
• Annual Fit Test

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Respirator wear?

• Start with COMDTINST M6260.2D, Resp. Protection
• Per 62620.2D, dont need to enroll in OMSEP just
  for respirator wear
• But industrial workers may need enrollment in
  another protocol!
• OMSEP protocol is suggested process for physician
  if unable to approve wear based on questionnaire
  in COMDTINST M6260.2D

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Respiratory Sensitizers
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Respiratory Sensitizers

• Many types of chemicals and substances
• 2 part epoxies, wood dust, silicon sprays
• Long term exposure could occupational asthma,
  cancer, etc.

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Solvents
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Solvents

• Can be inhaled or absorbed through skin
• Commonly used by MKs, DCs, ETs and painters.
• Can cause rashes, neurological disorders and
  possibly birth defects in pregnant women

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Pesticides
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Tuberculosis
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Tuberculosis
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Ionizing Radiation
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Potential Exposure

• Medical/Dental Personnel
• Boarding Teams
• Marine Inspectors
• MSSTs

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OTHER
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Acute exposure
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Acute Exposure

• Document exposure
• May require medical evaluation
• Specified in each protocol
• Might not trigger OMSEP enrollment
• See particular protocol, including form in back
  of chapter
• OOD/CDO/SDO/CC/OpCen should have a quick
  reference to know what to do, what forms to fax
  to hospital

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Acute protocol examples
Exposure ?? protocol
Asbestos Asbestos
Benzene Benzene
Chromium(VI) Chromium
Lead Lead
Noise Noise
Pesticides Pesticides
Tuberculosis Tuberculosis
Bloodborne pathogens Bloodborne pathogens
Radiation Radiation
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Acute protocol examples
Exposure ?? protocol
Isocyanate paints polyurethane paints isocyanurate insulation Chem w/ MSDS designation as respiratory sensitizer Respiratory sensitizers
Oil-based paints Oil-based cleaners Alcohols solvents
All other chemicals, including unknowns Hazardous waste
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Significant Event/Acute Exposure Tool
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SE/AE Tracking Tool
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Acute Exposure Form
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Unit Coordinator

• Check in/Check out sheet
• Coordinate with supervisors, safety officers,
  HAZMAT coordinators, RPC, medical
• Keep database current
• Use reports to keep program on track

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Unit Coordinator

• Identifies occupational risks
• Identifies potential enrollees
• Request enrollment
• Maintains database
• Transfers files or request dis-enrollment as
  needed

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Enrollment

• Prior to exposure
• Upon notification of acute exposure under
  direction of MO
• Unit Coordinator requests enrollment
• SEHO approves/disapproves

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Enrollment

• Member remains enrolled until
• Job change eliminates exposure
• Retires, relads, dies
• Protocols may be added or subtracted as needed

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Dis-enrollment

• Unit Coordinator requests, SEHO approves
• When exposure ends
• When member retires, relads or dies
• Not when member PCS!

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PCS to non-exposed jobs?

• Put OMSEP coordinator on check-out sheet. 60
  days recommended.
• If PCS to non-exposed job, conduct
  end-of-exposure physical and disenroll
• If PCS again to exposed job, re-enroll in
  required protocols (periodic), baseline physical
  for new protocols
• If PCS to exposed job, transfer, stay enrolled,
  keep periodic physicals current
• If departed already, or if exposure at next unit
  not known, transfer to new unit for action

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Transfer

• When member PCS
• Unit Coordinator transfers file
• Allows member to stay in OMSEP until new Unit
  Coordinator evaluates if he should be
  dis-enrolled.
• Keeps Baseline PE current

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Make it Easy

• Check in/check out
• Work with supervisors
• Enrollment tool
• Check pending files to see if member is already
  enrolled
• Schedule the physical

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Make it Easy

• Keep the Database current by keeping track of
  transfers, relads
• Run a monthly report to see who is due
• Make sure supervisors tell you when an enrollees
  job changes

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Medical Coordinator

• Ensures proper PE is done
• Ensures member is advised of findings by MO
• Ensures PE is filed in MR
• Ensures PE date is in database

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Medical Coordinator

• Has access to unit data based on AOR
• Can do everything Unit Coordinator can except
  transfer, add, or delete.
• Has access to all unit reports

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Physicals

• Baseline for new enrollees
• Periodic usually annual
• Acute Exposure as needed
• Exit when disenrolling from OMSEP program

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EXIT Physicals

• Gives verification of physical status at the time
  OMSEP is discontinued.
• Needed if member is dis-enrolled due to job
  change, retirement, or relad.
• If RELAD, Exit PE is needed even if no Separation
  PE is required
• OMSEP should be an item on the units transition
  check sheet

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Process

• Supervisor knows whos doing what job
• OMSEP Coord. enters member info
• System sends to SEHO
• SEHO approves (or disapproves w/ explanation)
• OMSEP Coord. arranges physical
• Member goes to physical
• Medical administrator enters date in database
• OMSEP Coord. tracks due dates in database for
  next phys.

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Info path

• Exam results go directly in members CG medical
  record, marked OMSEP
• Not to HQ!
• Not in OMSEP database!
• OMSEP Coord. tracks dates in database
• Need OPFAC, SSN or Last Name to initially enroll
• Once enrolled, lists only last 4 of SSN

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Privacy

• So....
• Medical info in medical record
• Privacy Act, HIPPA protections
• Significant Event Exposure Tracking tool may have
  HIPAA-protected information

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Best work practices

• Clinics recommend arriving extra early or
  arriving with 5447 or 5447A form filled out
• save time do it once in Adobe and update as
  needed
• Dont send member for OMSEP physical instead,
  send member with knowledge of which protocols
  (use database, or just send relevant exam
  protocols from MedMan)

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HANDS ON PRACTICE

• Grab a computer
• Log into the OMSEP Database
• http//cgweb.lant.uscg.mil/KDiv/kseHomePage.htm
• If you dont already have an account, click
  request an account

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Link from http//cgweb.lant.uscg.mil/KDiv/kseHomeP
age.htm
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Submit Request to SEHO
SEHO validates the information to verify if unit
personnel are at risk. E-mail will be sent to
coordinator indicating approval or disapproval
(and why)
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Updating profile page
When personnel return from physical the following
information is required to update profile date of
physical and hearing test if done
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Reports
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Physicals Due
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Physicals Due
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Summary Unit Report
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Reports available
Coming to MRS someday
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OMSEP Compliance Report
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Questions?? ? ?? LCDR J.S. Clark HSC T. C.
Anderson? MLCA(kse) Det NOLAJeffery.S.Clark_at_uscg
.milTyrone.C.Anderson_at_uscg.mil? (504)
253-6512/6514