Occupational Medicine
Outcomes of occupational medicine
• Describe occupational challenges to health workers and find sources of information
when personal health is at risk
• Take occupational history based on knowledge of common or notable workplace
hazards
• Assess patient’s capacity for work based on his abilities and demand of work
• Offer advice on prevention of work related health issues
• Recognize when and how to involve a third party in caring for patient
What does it entail?
• Treating workers with injuries
• Planning return to work for workers recovering from injury or illness
• Assessing person’s fitness for safety-critical work and other jobs
• Advising patient with disability about his or her work capacity
• Taking account of workplace exposures for workers with illness that appears to be
work-related
• Taking action to assist patients to resource the care for their injury or illness through
relevant insurance
• Tertiary prevention in return to work and secondary prevention through screening and
health surveillance
• Attaining a patient-doctor-employer relationship as some employers will help
o Approaching employer requires ethics, advocacy and leadership
Other roles available:
• Nurses: practice to give advice as well
• Occupational hygienists: expert in assessing and controlling exposure to
substances, noise and radiation
• Ergonomists: assess and ameliorate problems with manual handling, lighting, glare,
seating and pacing of work
Factors to consider:
• Giving treatment
• Assessing fitness for safety-critical work
• Planning return to work
• Advising on patient’s capacity for work
• Checking for possible work-relatedness
• Assisting the patient to resource his care
Conditions to consider for occupational health:
• MI
• Sleep apnoea
• CVA
• Insulin
• Asthma/COPD
• Dermatitis (hairdressers, latex allergies, healthcare workers etc)
• Recurrent headaches
History:
• History:
o As per normal and more on the problems, starting with HOPC
o Occupational history should extend into:
§ Fitness for work: Assessing abilities of patient and how this
matches with requirements of patient’s job or with patient’s return to
work
§ Aetiology: Trying to discover if the cause of the condition is work
related
o Always ask about:
, § Present HOPC
§ Current level of disability and financial aspects
§ Nature and description/demands of jobs: what troubles you
most?
§ Fitness for work
• Description of the job
o Job description: tasks, hours, how long, any previous jobs?
o What do you actually do?
o What problems have you been facing with your problem?
o Do you think there are any possible causes from your work?
o Ask about whether compensation, supervisor has been informed?
• Description of occurrence:
o When did your problem start?
o Did it come on slowly or fast?
o Did anything different happen at work around this time?
o Do you think that something at work has made you sick?
o What does the process make or do? (cleaning, grinding, injecting, moulding)
o What went wrong? What happened?
o How many people were affected?
o In what way?
o What action was taken by those in charge?
o Was there an odour?
o How big was the spill (describe area, tank volume, colour, sting the eyes?
o What equipment was damaged
o How is the substance normally used
o Do you have information about the chemical?
o Did you wear protective clothing?
o What first aid or other treatment has been given?
• Focusing on relevant areas of employment:
o Does symptoms gets worse through the day?
o Does symptoms get better when you are away from work?
o Measures undertaken by employers to control exposure
o Psycho-social factors
• Fitness for work:
o Left or right handedness
o Present capacity for work
o Coping with tasks at home similar to work?
o Mode of travelling to work
o Always separate the inherent and discretionary activities of your patients as
patients are likely to conflate/combine inherent requirements with
discretionary activities.
§ Discretionary activities may show enthusiasm for their work but
knowing the inherent requirements helps decide if patient can return
to work.
o Always ask for financial status and whether they are coping?
o Are they looking for any occupational compensation?
• Investigations, diagnosis and advices
o Suggest going down to work place to see what can be modified
o Suggest further treatment
o Suggest to tell supervisor about the problem
Health and work has a very close relationship:
• Measure of health is the extent to realize aspirations and satisfy needs and
change/cope with environment
• Always treat the main cause and this may be genetic, environment, work-related etc
• Always treat completely, otherwise recovery is incomplete and patient’s tolerance for
work may relate both to physiology of healing as well as to his/her illness beliefs,
family situation and attitude to work
Benefits of work
, • Good for individual physical and mental health and wellbeing.
• Long term unemployment or prolonged sickness absence can diminish physique and
bring anxiety or gloom
• However, work can also harm the employee and it is good to address with the
employer before employee returns
• When health permits, employees should return to work asap because:
o Therapeutic: promote recovery and rehabilitation
o Minimizes harmful physical mental and social effects of long term sickness
absence
o Reduce long term incapacity
o Reduce poverty and improves quality of life and well being
Terminology
• Hazard: something with potential to harm
• Risk: probability and severity of harm that will occur
• Exposure: presence of hazard in a form that makes employees vulnerable to harm
unless he or she is protected
• Exposure level: concentration, intensity, amount of substance/micro-organism/energy
in the vicinity of person
• Safe: of acceptable risk. Another follow up: to whom? Different age/baseline
characteristic groups?
Workshop 2: Hazards
Physical: trauma, noise, heat, cold stress, radiation, electricity
Substance/chemical: gases, vapours, liquids, aerosols, skin-absorbed
Biological: microorganisms and prions borne by air and water, food and vectors
Poor work design: tasks causing muscle strain, poor posture
Psychosocial: high work demand, job security, poor relationship
Classifying hazards: Terms applied to occupational hazards may be classified. One attempt
follows.
• Characterise the danger, e.g. acute, exposure
• Refer to mode of use, e.g. solvent, pesticide
• Describe the physical form, e.g. gas, fibre
• Describe mode of spread of germs, e.g. aerosol
• Refer to ability to change or react, e.g. oxidant
• Classify the family, e.g. hydrocarbons, viruses
• Name the agent, e.g. toluene, Legionella
• Describe circumstances of likely harm, e.g. confined space
• Refer to entry to body, e.g. skin-absorbed
• Indicate effect, e.g. irritant, carcinogen
• Indicate how body handles it, e.g. oxidise, clearance
• Describe method of measurement
• State results of measurement, e.g. decibel, milligrams per cubic metre
• Classify means of control, e.g. ventilation
• Refer to standards of control, e.g. exposure standard
History:
• You need to ask her how long, how much, how often, confined space or not,
protective equipment, any extraction systems to remove dangerous fumes etc,
Physical trauma:
• Manual handling
• Fall from heights
• Heavy things that move
, Hot conditions:
• External conditions
o Radiant heat: infrared radiation of heat from large hot surfaces
o High air temperature: summer conditions
• Within the body: high physical activity (metabolism increase)
Cooling mechanisms:
• Evaporation of sweat: heat lost from body in converting sweat into vapour
Cold conditions:
• Indoor food packers, meat packers can develop frostbites
• Arteriolar flow to exposed digits is reduced by combination of cold and
vibration as can occur from drilling of rock in quary on cold mornings: Increase
risk of RAYNAUD phenomenon
• Core temperature falls by 1 degree, oxygen consumption falls by 7%
o Below 35 degrees: dull consciousness causing disorientation, irrational
thinking, forgetfulness, hallucinations
o Below 30 degrees: semi-consciousness and confusion can occur, as
myocardial repolarisation is slowed, VF is a risk
Electrical injury:
• AC: tetany and sweating
• DC: tissue damage from heat produced as current passes through high resistance,
causing heat coagulation and charring. Vascular damage and thrombosis cause
further damage through necrosis
• Lightning injuries tend to cause asystole and tearing of tissue due to shock wave
ripple through the body
• Taser: high voltage, low current, producing overwhelming pain and involuntary
muscle contraction causing person to fall
Sustained exposure to loud noises
• High frequency hearing loss by damaging external hair cells of cochlea (lower
parts), affecting consonants which are sounds that give meaning to words
• Intensity: similar to loudness measured in dB which are logarithms
o Doubling sound loudness, you add 3 dB
• Frequency: pitch, higher frequency, higher pitch
• Duration: measured in hours or days
• Hearing regulations is cannot be exposed over 80dB
• Audiometric appearance of noise-induced hearing impairment causes a raised
threshold of hearing most marked at pure-tone frequency of 4 kHz.
The bends:
• Occurs in too-rapid ascent form dives
• Nitrogen dissolved in blood forms bubbles at depth and if ascend too fast, may cause
arterial air emboli causing aseptic necrosis in articular cartilage of long bones
Lasers:
• Intense UV or infrared rays in continuous or Pulsed forms.
o Laser UV coagulates proteins of cornea
o Longer wavelength of visible light or infrared will burn retinal tissue
causing scotomas
• Greatest risk from single high intensity exposure.
• Laser should be turned off in rain or fog because beams can be refracted by
atmospheric droplets and scatter into eyes of passer-bys
• Prolonged exposure will cause retinal tissue to burn rather than cause tumours
Ionising radiation:
Outcomes of occupational medicine
• Describe occupational challenges to health workers and find sources of information
when personal health is at risk
• Take occupational history based on knowledge of common or notable workplace
hazards
• Assess patient’s capacity for work based on his abilities and demand of work
• Offer advice on prevention of work related health issues
• Recognize when and how to involve a third party in caring for patient
What does it entail?
• Treating workers with injuries
• Planning return to work for workers recovering from injury or illness
• Assessing person’s fitness for safety-critical work and other jobs
• Advising patient with disability about his or her work capacity
• Taking account of workplace exposures for workers with illness that appears to be
work-related
• Taking action to assist patients to resource the care for their injury or illness through
relevant insurance
• Tertiary prevention in return to work and secondary prevention through screening and
health surveillance
• Attaining a patient-doctor-employer relationship as some employers will help
o Approaching employer requires ethics, advocacy and leadership
Other roles available:
• Nurses: practice to give advice as well
• Occupational hygienists: expert in assessing and controlling exposure to
substances, noise and radiation
• Ergonomists: assess and ameliorate problems with manual handling, lighting, glare,
seating and pacing of work
Factors to consider:
• Giving treatment
• Assessing fitness for safety-critical work
• Planning return to work
• Advising on patient’s capacity for work
• Checking for possible work-relatedness
• Assisting the patient to resource his care
Conditions to consider for occupational health:
• MI
• Sleep apnoea
• CVA
• Insulin
• Asthma/COPD
• Dermatitis (hairdressers, latex allergies, healthcare workers etc)
• Recurrent headaches
History:
• History:
o As per normal and more on the problems, starting with HOPC
o Occupational history should extend into:
§ Fitness for work: Assessing abilities of patient and how this
matches with requirements of patient’s job or with patient’s return to
work
§ Aetiology: Trying to discover if the cause of the condition is work
related
o Always ask about:
, § Present HOPC
§ Current level of disability and financial aspects
§ Nature and description/demands of jobs: what troubles you
most?
§ Fitness for work
• Description of the job
o Job description: tasks, hours, how long, any previous jobs?
o What do you actually do?
o What problems have you been facing with your problem?
o Do you think there are any possible causes from your work?
o Ask about whether compensation, supervisor has been informed?
• Description of occurrence:
o When did your problem start?
o Did it come on slowly or fast?
o Did anything different happen at work around this time?
o Do you think that something at work has made you sick?
o What does the process make or do? (cleaning, grinding, injecting, moulding)
o What went wrong? What happened?
o How many people were affected?
o In what way?
o What action was taken by those in charge?
o Was there an odour?
o How big was the spill (describe area, tank volume, colour, sting the eyes?
o What equipment was damaged
o How is the substance normally used
o Do you have information about the chemical?
o Did you wear protective clothing?
o What first aid or other treatment has been given?
• Focusing on relevant areas of employment:
o Does symptoms gets worse through the day?
o Does symptoms get better when you are away from work?
o Measures undertaken by employers to control exposure
o Psycho-social factors
• Fitness for work:
o Left or right handedness
o Present capacity for work
o Coping with tasks at home similar to work?
o Mode of travelling to work
o Always separate the inherent and discretionary activities of your patients as
patients are likely to conflate/combine inherent requirements with
discretionary activities.
§ Discretionary activities may show enthusiasm for their work but
knowing the inherent requirements helps decide if patient can return
to work.
o Always ask for financial status and whether they are coping?
o Are they looking for any occupational compensation?
• Investigations, diagnosis and advices
o Suggest going down to work place to see what can be modified
o Suggest further treatment
o Suggest to tell supervisor about the problem
Health and work has a very close relationship:
• Measure of health is the extent to realize aspirations and satisfy needs and
change/cope with environment
• Always treat the main cause and this may be genetic, environment, work-related etc
• Always treat completely, otherwise recovery is incomplete and patient’s tolerance for
work may relate both to physiology of healing as well as to his/her illness beliefs,
family situation and attitude to work
Benefits of work
, • Good for individual physical and mental health and wellbeing.
• Long term unemployment or prolonged sickness absence can diminish physique and
bring anxiety or gloom
• However, work can also harm the employee and it is good to address with the
employer before employee returns
• When health permits, employees should return to work asap because:
o Therapeutic: promote recovery and rehabilitation
o Minimizes harmful physical mental and social effects of long term sickness
absence
o Reduce long term incapacity
o Reduce poverty and improves quality of life and well being
Terminology
• Hazard: something with potential to harm
• Risk: probability and severity of harm that will occur
• Exposure: presence of hazard in a form that makes employees vulnerable to harm
unless he or she is protected
• Exposure level: concentration, intensity, amount of substance/micro-organism/energy
in the vicinity of person
• Safe: of acceptable risk. Another follow up: to whom? Different age/baseline
characteristic groups?
Workshop 2: Hazards
Physical: trauma, noise, heat, cold stress, radiation, electricity
Substance/chemical: gases, vapours, liquids, aerosols, skin-absorbed
Biological: microorganisms and prions borne by air and water, food and vectors
Poor work design: tasks causing muscle strain, poor posture
Psychosocial: high work demand, job security, poor relationship
Classifying hazards: Terms applied to occupational hazards may be classified. One attempt
follows.
• Characterise the danger, e.g. acute, exposure
• Refer to mode of use, e.g. solvent, pesticide
• Describe the physical form, e.g. gas, fibre
• Describe mode of spread of germs, e.g. aerosol
• Refer to ability to change or react, e.g. oxidant
• Classify the family, e.g. hydrocarbons, viruses
• Name the agent, e.g. toluene, Legionella
• Describe circumstances of likely harm, e.g. confined space
• Refer to entry to body, e.g. skin-absorbed
• Indicate effect, e.g. irritant, carcinogen
• Indicate how body handles it, e.g. oxidise, clearance
• Describe method of measurement
• State results of measurement, e.g. decibel, milligrams per cubic metre
• Classify means of control, e.g. ventilation
• Refer to standards of control, e.g. exposure standard
History:
• You need to ask her how long, how much, how often, confined space or not,
protective equipment, any extraction systems to remove dangerous fumes etc,
Physical trauma:
• Manual handling
• Fall from heights
• Heavy things that move
, Hot conditions:
• External conditions
o Radiant heat: infrared radiation of heat from large hot surfaces
o High air temperature: summer conditions
• Within the body: high physical activity (metabolism increase)
Cooling mechanisms:
• Evaporation of sweat: heat lost from body in converting sweat into vapour
Cold conditions:
• Indoor food packers, meat packers can develop frostbites
• Arteriolar flow to exposed digits is reduced by combination of cold and
vibration as can occur from drilling of rock in quary on cold mornings: Increase
risk of RAYNAUD phenomenon
• Core temperature falls by 1 degree, oxygen consumption falls by 7%
o Below 35 degrees: dull consciousness causing disorientation, irrational
thinking, forgetfulness, hallucinations
o Below 30 degrees: semi-consciousness and confusion can occur, as
myocardial repolarisation is slowed, VF is a risk
Electrical injury:
• AC: tetany and sweating
• DC: tissue damage from heat produced as current passes through high resistance,
causing heat coagulation and charring. Vascular damage and thrombosis cause
further damage through necrosis
• Lightning injuries tend to cause asystole and tearing of tissue due to shock wave
ripple through the body
• Taser: high voltage, low current, producing overwhelming pain and involuntary
muscle contraction causing person to fall
Sustained exposure to loud noises
• High frequency hearing loss by damaging external hair cells of cochlea (lower
parts), affecting consonants which are sounds that give meaning to words
• Intensity: similar to loudness measured in dB which are logarithms
o Doubling sound loudness, you add 3 dB
• Frequency: pitch, higher frequency, higher pitch
• Duration: measured in hours or days
• Hearing regulations is cannot be exposed over 80dB
• Audiometric appearance of noise-induced hearing impairment causes a raised
threshold of hearing most marked at pure-tone frequency of 4 kHz.
The bends:
• Occurs in too-rapid ascent form dives
• Nitrogen dissolved in blood forms bubbles at depth and if ascend too fast, may cause
arterial air emboli causing aseptic necrosis in articular cartilage of long bones
Lasers:
• Intense UV or infrared rays in continuous or Pulsed forms.
o Laser UV coagulates proteins of cornea
o Longer wavelength of visible light or infrared will burn retinal tissue
causing scotomas
• Greatest risk from single high intensity exposure.
• Laser should be turned off in rain or fog because beams can be refracted by
atmospheric droplets and scatter into eyes of passer-bys
• Prolonged exposure will cause retinal tissue to burn rather than cause tumours
Ionising radiation:
