Medical Aspects of Chemical Warfare (2008) - The Black Vault

Occupational Health and the Chemical Surety Missionbeneficial (Figure 18-5).“Screening” is defined as the search for a previouslyunrecognized disease or pathophysiologicalcondition at a stage when intervention can slow, halt,or reverse the progression of the disorder. Medicalsurveillance is considered a type of screening becauseit seeks to identify work-related disease at an earlystage. 7 Screening for medical and physical standards,a practice distinct from yet related to medical surveillancefor occupational exposure to toxic chemicals,is sometimes necessary for a worker to be placed, orremain in place, in a particular position. In additionto this duty, another related function of the CSMSPDis to provide medical support for the administrativechemical personnel reliability program (CPRP). An officiallydesignated physician or other qualified medicalstaff member (physician’s assistant, dentist, or dentalassistant) must screen personnel for medical aspectsof reliability for the CPRP. When making medical recommendationsrelated to reliability, the CSMSPD mayoffer guidance to a non-medically trained certifying orreviewing official, whereas the treating provider hascomplete discretion and authority (as allowed by hisor her current clinical privileges) in the medical evaluationand treatment of chemical injuries. Additionalexaminations, independent of medical surveillance,may also be required. These include evaluating a potentialworker’s fitness for PPE and ability to meet thefunctional requirements of the job.Administrative and engineering controls, followedby individual protective measures such as PPE, arethe primary disease prevention methods; medicalscreening is an adjunct method. The importance ofthis hierarchy must be continually stressed. An individualwho shows signs or complains of symptoms ofoccupationally related illness should be identified asa possible sentinel case. Not only must the individualbe treated, but the cause of the complaint must also bethoroughly investigated by the IMA, the industrial hygienist,and safety personnel. The cause may be relatedto improper work practices of the affected individual orto a failure of engineering devices or personal protectivemeasures. In the latter case, further morbidity canbe avoided if the problem is promptly identified.The IMA (usually the CSMSPD) or contract physicianis responsible for establishing and supervising themedical surveillance system for toxic chemicals, includingnerve and mustard agents. Not all individualsworking at the installation, or even in a particular workarea, need to be on the same surveillance program. Thetype of work, work area, and required PPE are factorsthat determine the type and frequency of surveillance.Determining the level of medical surveillance is an importantstep, usually achieved with input from medicaland safety personnel. In accordance with DA PAM40-8 3 and DA PAM 40-173, 4 the ultimate determinationof appropriate medical surveillance categories is theresponsibility of surety or safety personnel.The distinction between medical surveillance andpersonnel reliability is often overlooked. The level ofmedical surveillance is determined by the occupationalhazards of the job, whereas the placement of a workerin the CPRP is a function of the level of responsibilityand critical functions of his or her job. A worker maybe in a medical surveillance program, a personnel reliabilityprogram, in both, or in neither. For example, alocksmith working at an office far from a chemical storagearea may not require medical surveillance, but hisor her position is critical to safe chemical operations.Therefore, the locksmith must be included in the CPRP.When making medical recommendations regardingchemical surety issues, providers are referred to as thecompetent medical authority.For additional information on occupational medicineprograms, the installation medical authority(IMA) should seek advice from the regional medicalcenter or medical department activity. The Occupationaland Environmental Medicine Division of theUS Army Center for Health Promotion and PreventiveMedicine at the Edgewood Area of Aberdeen ProvingGround, Maryland, may also be of assistance. Moreover,the Code of Federal Regulations, title 5, part 339 8contains detailed guidance on determining physicaland medical requirements and conducting medicalexaminations. Medical personnel should have at leasta basic working knowledge of the Americans withDisabilities Act 9 to ensure that their programs do notdiscriminate based on a disability.Preplacement ExaminationBefore evaluating a worker’s history and completinga physical examination, physicians should acquirean accurate and current job description listing thespecific tasks the worker will be required to do. Thecivilian personnel office can usually provide thisinformation. The type of respiratory protection andprotective clothing required must also be ascertained,because these will affect an individual’s ability toperform the job. Position descriptions with physicalrequirements should be viewed carefully; supervisorsare responsible for ensuring that position descriptionsare current and accurate.Not all individuals are required to wear protectiveclothing all the time. Frequency of use, exertion level,and environmental conditions have a dramatic influenceon how well an individual performs in PPE. Forexample, a worker in a temperate desert climate such599