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

Medical Aspects of Chemical Warfarenation appropriate for their new category. In general,employees who move up or down in category must betreated as though they are entering initial surveillanceor terminating surveillance. In addition, workers maymove into and out of surveillance categories withoutactually leaving employment. These transitions, oftenoverlooked, are a difficult aspect of managing chemicalsurety. Overall, there is growing interest in simplifyingmedical surveillance categories. Meanwhile, thesurety officer must ensure that the IMA is aware ofchanges in employment duties that may affect medicalsurveillance. Inaccurately categorizing workers canresult in inadequate surveillance as well as excessivecost and effort.Potential Exposure EvaluationsAny agent exposure, suspected exposure, agentspill or release, or other abnormal situation that mayresult in personnel injury must be reported to supervisorypersonnel immediately after emergency action istaken. Personnel with possible agent exposures mustreport for medical evaluation as soon as possible. Thescope and frequency of examination and the retentionof physical examination records should follow theguidance of DA PAM 40-8 3 and DA PAM 40-173. 4 Allpersonnel exposed or potentially exposed to nerveagent must have a cholinesterase level drawn the dayprior to release from duty. All personnel working withchemical agents should be given an off-duty telephonenumber to report suspected exposures. Employeeswho have been in areas of possible chemical agentexposure (for example, downwind of an agent releaseor in known areas of agent contamination) mustremain at the installation for at least 30 minutes afterleaving the contaminated area, during which thesupervisor or designated representative will observethem for symptoms of agent exposure. If signs of agentexposure are noted, the worker will be immediatelyreferred to the medical facility.Respirator ClearancesOnce workers have passed the medical history andphysical exams, the medical officer must determinetheir ability to function in respiratory protective equipment.This check can be done by either pulmonaryfunction testing or a “use” test. Both tests are easilyperformed in an occupational health clinic, and eachprovides important data. The pulmonary function testprovides vital information about lung capacity andmay expose underlying clinical disease, such as earlychronic obstructive pulmonary disease. However,pulmonary function tests may be subject to operatorerror and depend on patient cooperation, and theydo not predict how well employees will actuallyperform their duties. A use test, on the other hand, ishighly subjective but provides a real-world measureof performance. Although it is impractical to simulateevery possible job function and level of PPE in theclinic, an innovative provider can devise physicalperformance measures that simulate actual employeetasks. For example, a worker can don PPE and carryobjects around the clinic while staff records signs andsymptoms of cardiovascular or pulmonary stress.The physician must be available during such tests toprovide advanced care if the worker does not toleratethe testing. If testing tolerance is in doubt, it should bedeferred until a more controlled testing environmentcan be provided, or omitted altogether. For example,a worker with a questionable history (eg, with anginaor a previous myocardial infarction) should not berequired to complete a use test prior to pulmonaryfunction testing. Input from industrial hygienists andsupervisors concerning the employee’s required taskswill produce more useful results than a generic usetest. The outcome of either test must be documentedin the individual’s medical record.Screening for Substance Abuse and DependencySubstance abuse is inconsistent with the highstandards of performance, discipline, and attentionto detail necessary to work with chemical agents. TheArmy Substance Abuse Program 12 promotes healthylife choices, quality of life, and Army values throughsubstance abuse prevention and risk-reduction educationand training. All soldiers receive a minimum of 4hours of alcohol and other drug awareness training peryear, and Army civilian employees receive a minimumof 3 hours of such training per year.All active duty soldiers are randomly drug testedat least once a year. Civilian drug abuse testing isconducted according to statutory and applicablecontractual labor relations. However, Army civilianemployees must refrain from alcohol abuse or usingdrugs illegally, whether on or off duty. Supervisorsmust refer any civilian employee found violating therule to the installation employee assistance programcoordinator.Army Substance Abuse Program policies are designedto fully support the CPRP. Both military andArmy civilian employees undergo drug screening priorto placement in the CPRP. Thereafter, CPRP militarypersonnel are drug tested at least once in a 12-monthperiod. Army civilian employees enrolled in the CPRPserve in sensitive positions called testing-designatedpositions. By Executive Order 12564, The Drug-free602