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

Occupational Health and the Chemical Surety Missionseveral months may indicate that the frequency ofmedical examinations can be safely decreased, providedthe work situation remains constant.The interval medical history and physical shouldfocus on changes in health status, illness, and possiblework-related signs and symptoms. To effectively identifyoccupational conditions or disease, the examiningphysician must be aware of the work environment andpotentially hazardous exposures; if chemical suretyworkers show a change in health status in the periodicevaluation, it is necessary to evaluate the worksite.Depending on the identified conditions, additionalworkers may require examination. At a minimum,examining physicians should communicate with industrialhygiene personnel to determine whether therehas been a change in the work environment that couldbe causally related.Previously, DA PAM 40-8, modified November 2007,Occupational Health Guidelines for the Evaluation andControl of Occupational Exposure to Nerve Agents GA, GB,GD, and VX, 3 dictated that four categories of personnelare required to have RBC-ChE measured (Exhibit18-2). 3,11 As of 2006 installations with chemical suretymissions are required to adhere to the ImplementationGuidance Policy for Revised Airborne Exposure Limits forGB, GA, GD, GF, VX, H, HD, and HT. 4 RBC-ChE baselinemonitoring is one significant change in these documents;using soap and water in place of dilute bleachfor personnel decontamination is another. Currently, anindividual in category I must have a monthly measurementof the RBC-ChE level; an individual in categoryII must have an annual RBC-ChE measurement.Termination ExaminationsAt the termination of employment or duty in achemical surety position, all employees must have amedical examination. Unless otherwise specified by alocal regulation, this examination may be done up to30 days before or after termination of employment. Ifan employee is exposed after the termination examination,it will be necessary to thoroughly documentand evaluate that specific exposure. In most cases,such exposure is unlikely; completing the terminationexamination within the 30 days before departure isadvisable so that the employee does not have to returnto the worksite. Employees have the right to refuseany examination, but the provider should encouragethose terminated to undergo the final examinationbefore separation.Workers whose surveillance category changes as aresult of a job change must receive a medical exami-Exhibit 18-2Categorization of workers based on their likelihood of exposure tochemical agentsCategoryIncludesI (formerly Category A)II (formerly Category B)Personnel with a high risk of potential exposure due to the nature of the agent operationsbeing conducted. Examples of such operations might include (but are not limited to) storagemonitoring inspections of M55 rockets, periodic inspections, toxic chemical munitionsmaintenance operations that involve movement of munitions from storage locations, workin known contaminated environments, and first-entry monitoring. Personnel may be routinelyrequired to work for prolonged periods in areas with high levels of nerve agentswhere the use of either toxicological agent protective ensembles or protective ensembleswith a self-contained or supplied-air breathing apparatus may be required.Personnel with both a low risk or infrequent potential exposure to nerve agents in routineindustrial, laboratory, or security operations. Examples of such operations might include(but are not limited to) daily site security checks and accident/incident response by initialresponse force members. Prolonged wear of protective ensembles during training andemergency responses may be required.III (formerly Category C) Personnel with minimal probability of exposure to nerve agents, even under accidentconditions, but whose activities may place them in close proximity to agent areas.IV (formerly Category D) Transient visitors to agent areas where a potential for exposure exists and who are notincluded in the medical surveillance program for nerve agents at the visited installation.601