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Occupational health in rural general practice 2011
- 1. Occupational Health in Rural General Practice Dr James Douglas, Tweeddale Medical Practice, Fort William, Scotland.UK
- 2. Occupational Health in Rural Practice • Agriculture • Aquaculture • Food processing • Forestry • Tourism • Outdoor Education • Diving • NHS/ Local Government / Utilities
- 3. Occupational Health as a GP in Fort William Fish Farming Diving Medicine Research Occupational Asthma Salmon Processing
- 4. Laggan Dam Lochaber Aluminium Smelter Power House Cell Room
- 5. Principles of Occupational Health • Is this illness or symptom caused or aggravated by the job? • Will this patients illness affect their job and the safety of others?
- 6. Is this illness or symptom caused or aggravated by the job? • Occupational asthma / dermatitis • Occupational Deafness / Vibration Illness • Musculoskeletal Injury • Bladder Cancer / Mesotheiloma • Poisoning – lead, CO,methane,H2S • Zoonosis in rural populations • Infection in NHS
- 7. Will this patients illness affect their job or the safety of others at Alcan? • Hot Metal Work – heat stress and unexpected incapacity • Pot Room Asthma – Hydrogen Fluoride
- 8. Will this patients illness affect their job or the safety of others at Alcan? • Hydro and Estates – lone working and remote accidents • COMAH designation and local community safety
- 9. Will this patients illness affect their job or the safety of others? Clinical work done by all GPs • Unfit to work – med 3 certificate • Return to work – ? phased return plan • Chronic Disease Management – keeping the population at work and in health • Risk assessment of medication or illness - likelihood and consequence • DVLA HGV/PSV medical standards
- 10. Occupational Health Information www.hse.gov.uk
- 11. Occupational Health in Agriculture and Aquaculture Machinery, weather, lone working Disease in the stock and their treatments Pesticides Inhalation of particles Economic pressure of the market
- 12. Occupational Health in Salmon Farming and Processing 2000 rural jobs in Scotland Multi national industry concern for the environment Norway , Chile, Canada, Tasmania
- 13. Hard work on a fish farm
- 14. Sea Lice and Furunculosis
- 15. Where does the pesticide go? Acute and Chronic OP poisoning evidence and opinion
- 16. Fish Farmers PPE for Organophoshates
- 17. Salmon Immunisation to prevent Furunculosis Aeromonas Salmonitica
- 18. Needle-stick injury from oil based vaccine
- 19. Rural GP and their community • Visibility , geographically defined population • “ BA chest” in Inverlochy 1980s as a young GP • COPD in short retirement • Sheep Dip in crofters and neurological effects • Previous recession and new industry for rural Scotland – salmon farming and processing
- 20. Salmon processing causing occupational asthma
- 21. Occupational Asthma clinical history • Asthma caused or aggravated by work • Symptom patterns vary with work in the early stages • 2 weeks to 6 months onset • Early diagnosis essential for individual and whole workforce • Chronic phase diagnosis difficult
- 22. RESEARCH METHODOLOGY • CROSS SECTIONAL SURVEY to identify cases against a diagnostic standard • CASE CONTROL STUDY to determine why patients get the disease • Compare and contrast cases and “non cases” ( controls from the same factory) • Smoking / Atopy / Place of work/ Age /sex • Has engineering modification worked? • The company still need to process and sell fish!
- 23. Why the GP ? surely this is a specialist area and covered by too much Health and Safety activity already! • Local knowledge of patients and work • No chance in diagnosis without the GP being open to the diagnosis • Interesting and about simple clinical care of patients
- 24. Sport Diving in UK • British Sub Aqua Club , Scottish Sub Aqua Club, PADI worldwide franchise. • Some Sport Diving Instructors can be classed as professional divers by HSE • Underwater Archaeology and Scientific Diving has its roots and training systems from sport diving but classed as professional • Clam divers on the margins!
- 25. SPORT DIVING and DIVING SAFETY 10-12 UK fatalities per year , 50 episodes of decompression illness Diving in pairs for rescue Training with increasing challenge from shore dives to wreck diving in Scapa or West Coast - SSAC or BSAC club systems best for safety
- 26. Sport Diving on Thesis Wreck Sound of Mull with Scottish Sub Aqua Club 30 meters depth , cold water, nitrogen narcosis , tides ,boat cover - training and dive planning for safety
- 27. Heat Loss and Hypothermia
- 28. Descent Phase of Dive
- 29. Ascent phase of Dive Cerebral Arterial Gas Embolism
- 30. Ascent phase of dive Pulmonary Barotrauma • Interstital Emphysema • Pneumothorax • Underwater blast injury • Training • Medical Screening
- 31. Ascent phase of dive Decompression Sickness Type 1&2 Acute Decompression Illness • Dissolved nitrogen comes out of solution during ascent after single or multiple long ( > 30 minutes) deep dives ( >25 metres) causing bubbles in the blood and CNS ”the bends” Lemonade analogy for the bends
- 32. Ascent phase of dive Acute decompression Illness “The bends” • An acute neurological emergency – the spinal cord and brain are at risk of permanent damage • Multilevel spinal cord motor and sensory signs – cant walk or balance • 100% Oxygen and transport to chamber by road or helicopter after discussion with recompression chamber Diver decompressing in water using wrist computer
- 33. Ascent phase of dive Acute Spinal Decompression Sickness
- 34. Physical Signs in Neurological Decompression Sickness Affecting Spinal Cord Girdle pain Motor and proprioception deficit Urinary retention Evolving multi site spinal haemorraghe Minutes matter! Entirely a clinical diagnosis – don't delay with scans in A&E
- 35. Treatment of Acute Decompression sickness Breathing 100% O2 for periods at depth
- 36. The diving emergency • Accurate history of depth, times and pattern of collapse post dive helps decide bends or barotraumas for treatment plan. • On scene - give 100% oxygen, oral fluids, aspirin, exclude rare pneumothorax • “999 Coastguard” - for evacuation and communication • Aberdeen Royal Infirmary –01224 681818 ask for Duty Diving Physician for advice
- 37. Summary of Occupational Health in Rural Practice • Care of a community • Visibility of new things and problems eg John MacDonald and tagging calves Iain MacNicol and Glensanda • You are likely to be the only person with knowledge skill and insight • Rare diagnosis • Just do it and be confident in yourself!