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The primary goal for pre-deployment (or
comparable pre-exposure) medical screening programs is to evaluate a
worker’s fitness to perform potentially hazardous or stressful
work safely. Additionally, pre-deployment medical screening can be used
to assess minimal physical and emotional requirements to perform work
activities, the ability to use personal protective equipment (PPE), and
the worker’s immunization status. Pre-deployment medical screening
also documents the workers’ health status for use as a baseline
when interpreting the results of any subsequent evaluations. Screening
can also be used to identify risk factors that should be mitigated before
or during disaster work. Finally, while not a primary purpose in this
context, screening may help detect subclinical or unrecognized disease
for early intervention.
Pre-deployment screening is particularly important for work in areas
affected by natural disasters because the potential for exposure to hazardous
conditions or agents may not be easily predicted, adequately characterized,
or effectively controlled. When exposure information is lacking, medical
screening programs may be one of the few recourses for assessing occupational
health effects related to disaster work; valid interpretation of post-work
health effects requires baseline information for comparison.
At a minimum, workers should be screened for fitness, and baseline information
should be obtained for all hurricane disaster workers before the start
of response work. The level or extent of screening appropriate for a
given work activity will depend on multiple factors, in particular the
type of work activity anticipated and the extent to which hazardous conditions
can be predicted.
This document provides interim guidance on medical screening for workers
before beginning disaster response activities and is based on information
available as of October 27, 2005; it will be updated or revised as appropriate,
as additional information becomes available. This guidance does not address
issues related to the post-deployment period, which are addressed separately
(http://www.cdc.gov/niosh/topics/flood/MedScreenWork.html). It is intended
for occupational health professionals and other clinicians who are responsible
for medical oversight of workers who will be deployed.
Reasons for screening
- Document baseline health parameters
- Identify individuals with health
concerns that need to be addressed
- Identify individuals with specific
susceptibilities whose activities may need to be restricted or modified
- Identify
individuals not suitable because of health reasons for anticipated
tasks
- Identify medications being taken and side effects of such medications
that may affect or be affected by deployment
- Identify immunization needs
- Identify training needs
Who needs to be screened
- All workers who will be deployed or will move from usual activities
to response activities
- Workers who are not in existing medical screening programs should
be screened
- Workers who are currently in medical screening programs for their
work should be re-screened if it is feasible, but may not need
additional screening if circumstances require immediate deployment
or re-assignment
What type of screening should be done?
- Screening approaches will vary depending upon the anticipated activities,
working conditions, and potential exposures
- Pre-deployment (or pre-exposure) biological monitoring for exposure
to hazardous chemicals is not generally recommended. Such monitoring
is not practical for unanticipated exposures to hazardous chemicals.
When exposures to specific chemical agents are predictable, workers
should be adequately protected. However, there may be some instances
in which obtaining baseline specimens prior to deployment for work
in environments with predictable exposures may be helpful in subsequently
assessing whether the protections used during this work are adequate
and performing as intended.
When to screen?
- Because the primary reason for pre-deployment medical screening is
to evaluate workers’ fitness to perform potentially hazardous
or stressful tasks safely, screening immediately before deployment
is optimal.
- Workers
who will be performing their usual work and are currently in work-related
medical screening programs may not require repeat pre-deployment
screening; however, such screening may have benefits, and attempts
should be made, prior to or as soon after the deployment date as practicable,
to evaluate changes in health status that may have occurred in these
individuals since their last screening.
- For those already deployed and not in any
existing work-related medical screening program, screening should
be done as soon as practicable.
- Further screening may be necessary during
deployment, depending on results obtained during pre-deployment
screening.
Minimum screening information
The specific types of information elicited may be modified based on
anticipated work characteristics and deployment location; however, the
following data elements should be obtained for all individuals:
Personal information
Identifying and Contact Information
- Name, address, appropriate telephone number(s), e-mail
addresses (work, personal)
- Age, date of birth, birthplace, sex, social
security number
- Contact information for someone who will know where
the worker is 6 months after leaving response work
- Response organization:
- Employer vs. volunteer organization
(indicate which)
- Name and address
- Contact person’s name and telephone
number
Usual work
- Industry, occupation, job tasks, number of years
Special needs
Health status
- Pre-existing medical and mental health conditions
- Symptoms
currently experienced
- Medications and side effects
- Other specific risk factors
(will depend on job, e.g., use of personal protective equipment,
exposures)
- Immunization
status: routine adult and any special risk (e.g., health care worker)
- Pregnancy
status (female workers)
- Assure worker has enough prescription medications
to last the expected duration of deployment (with a comfortable
safety margin in case of delayed return to home)
- Include question(s) to elicit
whether workers have physical or mental health concerns that they
would like to be addressed
Response-related information
Response work
This information should be provided by the worker’s
agency, organization, or employer.
- Expected deployment location (as specific as possible)
- Anticipated
tasks and circumstances under which tasks will be performed.
- Anticipated
date of deployment.
- Anticipated duration of deployment
- Anticipated need for,
use, and type of PPE
- Adequacy of training for tasks
- Characteristics of expected
work locations and relationship to known or suspected hazardous
agents or conditions
- Anticipated shift schedules: hours per day, days per
week, rotation schedules
Additional screening information needs
Some workers with significant pre-existing medical or mental health
conditions may need more extensive screening. Other workers may need
additional screening because of the likelihood of working in hazardous
conditions. Additional screening may include a more comprehensive medical
history and review of systems, a physical examination, or, in some instances,
laboratory testing, as indicated by clinical judgment and good occupational
medical practice. The specific content should be determined by the following
factors:
- Report of or concern about pre-existing illness, symptoms, physical
impairment, or emotional sensitivities that may be adversely affected
during deployment
- Use of certain PPE such as respirators
- Anticipated tasks, working conditions,
locations, or exposures that are known to be hazardous or have
specific exposures that may warrant medical monitoring
Follow-up to screening/outcomes
Possible determinations from the initial basic screening are:
- Cleared for deployment with no restrictions
- Cleared for deployment with
specified restrictions on types of activities/exposures
- Recommended
for training prior to clearance
- Recommended for further medical screening
- Not cleared for deployment
Other considerations
- Simple and concise screening instrument(s)
- Designated custodian for the
information collected
- Policies in place to assure confidentiality of
information collected
- Appointed program administrator
- Clear identification of those with access
to data results
- Data collection locations convenient to workers (e.g.,
central location where workers report)
- Private area for conducting screening
to maintain privacy
- Secure space to maintain records containing confidential
information
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Disaster Safety
Related Resources:
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This
document is also available in PDF format.
preexposure.pdf
31 KB (5 pages)
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