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2015 Fall Seminar Recap
The document discusses the role of occupational medicine in assessing fitness for duty, particularly among firefighters and safety personnel, emphasizing the importance of stress testing and cardiovascular health. It highlights the impact of factors like obesity, sleep disturbances, and shift work on employee health and job performance, along with the need for effective health promotion programs. The document also addresses confidentiality in medical evaluations while advocating for comprehensive support from occupational physicians to enhance workplace safety and employee well-being.
2015 Fall Seminar Recap
- 1. OCCUPATIONAL MEDICINE AND FITNESS FORDUTY BY N. MICHAEL BADDAR, M.D., M.P.H.
- 2. SERVING HAMPTON ROADS FOROVER TWENTY FIVE YEARS □ I&O Medical Centers-Peninsula North 757-240-5580 Serving the City of Newport News and York County □ I&O Medical Centers-Peninsula South 757-825-1100 Serving the Cities of Hampton and Newport News □ I&O Medical Centers-Southside East 757-460-0700 Serving the cities of Virginia Beach and Norfolk □ I&O Medical Centers-Southside West 757-487-9600 Serving the cities of Chesapeake, Portsmouth, and Suffolk
- 3. FITNESS FOR DUTY JOEM-JOURNALOF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE ACOEM-AMERICAN COLLEGE OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
- 4. FITNESS FOR DUTY- SEPTEMBER2015 ISSUE □ ELECTROCARDIOGRAPHIC RESPONSES DURING FIRE SUPPRESSION AND RECOVERYAMONG EXPERIENCED FIREFIGHTERS □ THE RELATIONSHIP BETWEEN BODY MASS INDEX AND WORKERS’ COMPENSATION CLAIMS AND COSTS
- 5. FIREFIGHTERS NFPA 1582 STANDARD ONCOMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM FOR FIRE DEPARTMENTS
- 6. FITNESS FOR DUTY □STESS TESTING IN FIREFIGHTERS/POLICE AND WORKERS INVOLVED IN SAFETY □ BMI IN DISABILITY AND WORKERS COMPENSATION □ SLEEP, SHIFTWORK, AND SLEEP APNEA □ POLYPHARMACIA AND HIPAA
- 7. FITNESS FOR DUTY TheOccupational Physician takes all the relevant data and gives the employee the mechanism to perform the job safely while informing the employer whether the employee has met those goals without breaching confidentiality
- 8. STRESSS TESTING IN FIREFIGHTERS/POLICEAND WORKERS INVOLVED IN SAFETY □ WHY we should consider stress testing □ WHAT are we really measuring □ HOW do we go about measuring □ WHERE can we use the information
- 9. WHY THE CONCERN “Heartdisease causes nearly half of line-of-duty death among firefighters. This epidemiological observation may be related, in part, to high prevalence of cardiovascular risk factors, including obesity, metabolic syndrome, binge drinking, and sleep deprivation. -Salah Al-Zaiti, JOEM Sept. 2015
- 10. PREVALENCE OF ABNORMALITIES □ Exceedingage predicted maximum heart rate – 52.4% □ Significant tachycardia – 97.6% □ Pathological ST segments – 26.2% □ Heart rate variability – 52.4% □ Prolonged QTc interval which indicates abnormal repolarization and risk of sudden death – 52.4%
- 11. CONCLUSIONS “This study demonstratedthat fire suppression, independent from work duration , induces prolonged tachycardia and is associated with transient ECG changes suggestive of myocardial ischemia… among 25% to 50% of active firefighters at low risk for CV disease.” JOEM September 2015
- 12. FITNESS □ A METis defined as the resting metabolic rate, that is, the amount of oxygen consumed sitting in a chair □ 2 METS requires twice the resting metabolism and 3 METS requires three times the resting metabolism □ Housework can vary from 2 to 5 METS □ Snow shoveling from 5 to 7 METS
- 13. FIREFIGHTING FITNESS □ EstimatedMETs proposed from studies for firefighting range from 9.6 to 14 □ Firefighters should be able to perform above 12 METS without difficulty □ Firefighters with cardio-respiratory fitness below 12 should be started on a program to improve fitness
- 14. FITNESS FOR DUTY □Is the employee the same as he/she was when they were hired □ Is the employee taking medication which may impair their judgment □ Do we have a system for identifying potential problems before an incident
- 15. BMI AND WORKERSCOMP “Obesity was associated with significantly greater workers’ compensation outcomes (COSTS) in this population of statewide municipal workers.” -Chenoweth et al., Journal of Occupational and Environmental Medicine, Volume 57, Number 9
- 16. SHIFTWORK □ Sleep disturbance □Occupational stress □ Disruption of social life □ Gastrointestinal disorders
- 17. OCCUPATIONAL ACCIDENTS □ Excessive daytimesleepiness and lack of concentration impair work performance □ Sleep apnea (OSA) confers a two to sevenfold increase in the risk of motor vehicle accidents as compared to the general population
- 18. SHIFT MALADAPTATION SYNDROME □ Sleepdisturbance and chronic tiredness □ 5 to 20% of shift workers □ Alcohol or drug abuse usually related to self-treatment of insomnia □ Higher rates of accidents or near misses □ Depression, personality changes □ Exacerbation of existing disorders
- 19. PHASE DELAY ADJUSTMENTS □ Itis generally more difficult to arise progressively earlier than to delay awakening by an hour □ Rotating forward from afternoon to nighttime shift is easier than counter clockwise □ Time recommended for a shift change would be at least 21 days before another rotation forward □ Short cycle shifts (2-3 days) often more acceptable to workers because of social and family life
- 20. BMI “Health promotion andinjury prevention programs, policies, and incentives should be provided to all employees.” -Chenoweth et al.
- 21. WHY AN OCCDOC □ PERSONNEL FILE □ MEDICAL FILE □ INTERMEDIARY THAT EXPLAINS AND DISTILLS ON A NEED TO K NOW BASIS
- 22. THE CIRCLE OFWORK EMPLOY EE ASSIST ANCE PROGRA M PHYSIC AL THERAP ISTS SPECIA LISTS EMPLOY ER FAMILY DOCTOR EMPLOYE E OCCDOC
- 23. THE NEW OCCDOC □ LIFESTYLE □ EDUCATION □ PREVENTION □ PRIVACY
- 24.
- 25. OCCUPATIONAL PHYSICIAN AS COORDINATOROF HEALTH CARE SERVICES WORKERS COMPENSATION DISABILITY MANAGEMENT GROUP HEALTH CARE