Services entrusted with essentially preventive functions and responsible for advising employers, workers, and their representatives in the undertaking of the requirements for establishing and maintaining a safe and healthy working environment, which will facilitate optimal physical and mental health in relation to work and the adaptation of work to the capabilities of workers in light of their state of physical and mental health. The ILO estimates that only 5-10% of workers in developing countries and 20-50% of those in industrialized countries have access to adequate OHSs. Further, the levels of OHS coverage have not changed significantly over the last 10 years.

1. OCCUPATIONAL HEALTH SERVICES
Dr. Dalia El-Shafei
Lecturer of Occupational Medicine

2. The Occupational Health Services
 Definition
 Models of Delivery
 O.H. Team
 O.H. Elements
 Future Trends

3.  Services entrusted with essentially preventive functions and
responsible for advising employers, workers, and their
representatives in the undertaking of the requirements for
establishing and maintaining a safe and healthy working
environment, which will facilitate optimal physical and mental
health in relation to work and the adaptation of work to the
capabilities of workers in light of their state of physical and mental
health.
 The ILO estimates that only 5-10% of workers in developing
countries and 20-50% of those in industrialized countries have
access to adequate OHSs.
 Further, the levels of OHS coverage have not changed significantly
over the last 10 years.

5. Company-based & -owned Occupational
Health Services
plant level
plant physicians or
nurses + contract
physician (hours to 2-
3 days/week ).
locations and plants
geographically situated
regional medical directors
EHS or HR department
corporate medical director
(leadership & administrative oversight in
developing health policies and standards
+ interpreting & ensuring compliance with
health-related regulations).

6.  OHS is integrated into the structure of the company.
 health care providers are very familiar with the
processes and specific hazards unique to that industry.
 The plant physicians are positioned to perform
periodic walkthroughs of the facility and interact
frequently with supervisors, industrial hygienists, and
safety officers, hence facilitating the delivery of health
care.
medical personnel may be viewed as an
agent of the company rather than an advocate of the
employee or patient, therefore, there can be distrust
and reluctance on the part of employees to share
health information with these professionals.

7. Group Occupational Health Services
Jointly organized by a number of enterprises, independently
organized group services to which various enterprises
subscribe, or OHSs provided by social security institutions.
Serve a range of organizations in different industrial
sectors or serve different companies within the same
industrial sector. common in northern European countries
(e.g., France, Denmark, Finland, and the Netherlands).
midsize and smaller companies benefit from
well-equipped health centers staffed with professionals who
are relatively knowledgeable about their industry and the
hazards unique to their processes.
geographic distance between the worksite
and the OHSs.

8. Hospital- and Tertiary Center-based
Occupational Health Services
the first point of call for
workers with serious work-related injuries, acute poisoning, and acute
illnesses but have very limited experience in other work-related issues and
little or no interaction with the workplace. Businesses with specific hazards
that require unique treatments (hydrofluoric acid) often share management
protocols with emergency departments in the event of a catastrophic event.
OH departments that primarily provide services for
hospital employees. Recently, contract with other employers in the area to
provide care for employees with work-related injuries and illnesses.
Diagnoses of complex cases, investigations of cluster outbreaks, clinical
research, and training sites for occupational physicians and nurses.

9. Free-standing Occupational Health Clinics
A private health center organized to provide OHSs to a wide variety of
clients (single unit, or often regional or national chains).
The larger centers are usually staffed with physicians, physician
extenders (i.e., physician assistants and nurse practitioners), OH nurses,
and physical therapists.
Most provided activities: management of acute injuries, post job offer
preplacement evaluations, and medical surveillance.
very limited interaction with the plants and less
familiarity with the specifics of the workplace.

10. Occupational Health Services Delivered by
Primary Care Physicians
Primary care physicians evaluate their patients for work-related and
non work-related health issues, and have no specific formal
arrangement with the employers.
the primary care physician is very familiar with all the
health issues of his or her patient that can impact work
limited training in OH issues and very limited
knowledge of the workplace and potential occupational exposures.
Still, may also serve as the part-time or contract plant physicians
and have a good working knowledge of the plant. These physicians
are in a very unique situation and often have the dual and sometimes
conflicting role of being both the worker's primary physician and a
contractor of the employer.

11. Occupational Health Services in Countries
in Transition
 Many of the eastern and central European countries
currently undergoing transition to a market economy in order
to join the European Union are moving from a policy that
focuses on workers' protection toward one of prevention and
health promotion in the workplace. Now working to develop a
standardized system, ensuring health and safety conditions in
the workplace.

12. Occupational Health Services in Developing
Countries
 More than 80% of the world's workforce resides in developing countries.
A. Absence of comprehensive national EHS policies,
B. Inadequate resource facilities
C. Economic constraints.
D. Very limited expertise in the disciplines of OH, industrial hygiene, and
safety.
 Because of the limited health care delivery services and poor infrastructure,
physicians and other health care providers employed in the workplace usually
by the larger corporations provide comprehensive health care for the
employees and their immediate family members, thus spending very little time
providing traditional OHSs.
 In certain instances, especially in remote areas, employers run large clinics or
even hospitals that also serve the general population.

13. Supplementary
H&S
professionals
(Employees, External
contract workers, or
Consultants.)
core staff
• Physical therapists.
• Biostatisticians.
• Epidemiologists.
• Safety engineers.
• Ergonomists.
• Toxicologists.
• Health educators.
• Psychologists.
• Mental health specialists.
• Counselors.
• Work physiologists.
• Emergency medical technicians.
• Clinicians (physicians,
physician assistants,
nurse practitioners,
and nurses).
• Industrial hygienists.
• Other clinical support
staff

14. The OHS staffs role:
- Prevent work-related injuries and diseases (employee
education, health promotion, medical surveillance, and
various clinical activities to ensure fitness for duty).
- Manage medical conditions (diagnosis, treatment, and
rehabilitation of affected employees).
- Identify potential hazards in the workplace by
performing qualitative and quantitative health hazard
assessments.

15. Training and curricula for OH specialists:
o completed basic training in medicine and nursing, then
advanced training in occupational medicine, industrial
medicine, or public health, leading to certification in the
relevant field.
o But there are a worldwide shortage of formally trained
occupational physicians and most OHSs are provided by
physicians and nurses not formally trained in OH.
o Unfortunately, very little time is spent covering this area in the
general medical and nursing curricula of most countries. So,
such clinicians supplement their knowledge of the field
through continuing education provided by professional OH
organizations, institutions of higher learning with OH
faculty, and industry-sponsored conferences and
meetings.

16. Preplacement or
Fitness for Duty
Examinations
Treatment and
Rehabilitation of
Acute Injury and
Illness
Sentinel Case
Detection
Surveillance
Periodic
Examinations
(periodic medical
surveillance)
Other Periodic
Examinations
Disability Review
and Return to
Work
Health
Promotion Travel Medicine Recordkeeping

17. Preplacement or Fitness for Duty
Examinations
 A worker's first contact with a medical provider in the OHS.
 Has replaced the pre-employment examination which often
was used to determine whether to make a job offer to a
prospective employee. If medical problems were found, they
were sometimes used as a reason for not hiring the individual.
The preplacement examination, by contrast, is supposed to
take place after a conditional job offer has been made and is
sometimes therefore referred to as a post-offer
examination.
 The content of the preplacement medical examination is
variable, evidence-based and related to the possible job
exposures that an individual could encounter.

18. The four major components of pre-
placement examination:

19. Treatment and Rehabilitation of Acute
Injury and Illness
 When diagnosing and treating an acute injury, the occupational medicine
provider must consider a number of important issues in addition to those of
basic medical management.

20. Sentinel Case Detection
 A sentinel event, indicating that a hazard exists in the
workplace that is placing other workers at risk.
 Taking an adequate history of the circumstances of the
injury can provide some clues.
 When a possible sentinel event is recognized, there may be
a need for a focused investigation, similar to an outbreak
investigation performed for a communicable disease.

21. These efforts are best performed by a multidisciplinary team (health care
professionals, industrial hygienists, and those with epidemiological expertise).

22. Surveillance Periodic Examinations
(periodic medical surveillance)
 While industrial hygiene measures and engineering controls are
the best way to prevent illness or injury from an industrial hazard,
medical surveillance to detect subclinical effects of a hazard
represent one of the means of preventing serious adverse effects.
 Often, employees may be exposed to more than one hazard and
require a number of different examinations. Computerized record
systems may assist in the tracking of such requirements and
scheduling appropriate examinations.
 Results of surveillance examinations (spirometry, audiogram) may
require evaluation of longitudinal time trends for a particular
condition.

23. Other Periodic Examinations
 Other medical indications to periodically evaluate a worker's
fitness for duty. Periodic examinations for safety-sensitive jobs such
as mobile equipment operators and Federal Aviation Administration
physicals are also performed on a regular basis.
 The focus of such periodic examinations is not to remove an individual
with a medical problem from the workplace, but rather to determine
whether any existing impairments can be adequately accommodated
without placing the worker and others (including the general public) at risk.
 Many periodic examinations, if not mandated by OSHA, must be offered
to the worker on a voluntary basis. If such examinations are seen as
opportunities for job disqualification, workers (especially those who need
them most) may opt not to take part.
 Ideally, these periodic examinations can result in early detection of
chronic conditions in time to allow for preventive interventions such as diet
modification, exercise, and work hardening to take place, allowing a worker
to remain productively and safely employed.

24. Disability Review and Return to
Work
 An employee's personal health care provider may have
less experience in return-to-work issues and may
inappropriately give a patient permission to return to work
or restrict the patient from returning to work for an
excessive amount of time. The OH provider, by contrast,
should have sufficient knowledge of specific job
requirements to make a more informed decision. Therefore,
many companies have policies requiring all employees
returning to work after a prolonged absence to have an
evaluation at the OHS to determine whether they can safely
return or require job restrictions and/or modifications.

25.  There is some evidence that prolonged absence
makes returning to work less likely, and therefore,
early intervention can help ensure that employees can
return to work (with work restrictions if necessary) as
soon as it is feasible.
 In certain cases, an employee may become totally
disabled from returning to work. This is a difficult
decision best made by the OH provider after
consultation with human resources, relevant safety
managers, job supervisors, and the patient
themselves.

26. Health Promotion

27. Travel Medicine
 With increasing globalization, travel medicine is becoming an
important aspect of the services provided by a comprehensive OHS.
 The occupational provider offering travel medicine services must
keep abreast of country-specific recommendations and advisories,
including quarantines and travel bans and restrictions due to
disease outbreaks. (the Centers for Disease Control and Prevention
website: http://www.cdc.gov)
 Infectious diseases, including travelers' diarrhea, are some of the
most common medical problems encountered by travelers.
 The leading causes of travel-related mortality are trauma due to
motor vehicle accidents and drowning.

28. Before travel
• Appropriate
vaccination and
counseling to avoid
travel-related illness.
• Advice and counseling
for family members.
During
travel
After
travel
• Post-travelling
evaluation.

29. Recordkeeping
 In addition to keeping a complete medical record and adequately
storing the results of baseline and periodic testing on employees,
the OHS should have certain routine forms and reports.
 Retention of Records
Many of the OSHA standards mandate that records of surveillance
examinations and other medical evaluations be retained for at least
30 years after leaving employment.
 Confidentiality of Records
Although recent federal guidelines for privacy of medical records
outlined in the health insurance portability and privacy act
(HIPPA) are focused on the general medical care setting rather than
the occupational medicine setting, the OHS should uphold the same
standards of privacy and confidentiality in services provided and the
record of those services. It is especially important to prevent the
release of medical information to an employer.

30. • A standard form for reporting employers whether an employee has been
cleared for full or restricted duty, and if he has been cleared for particular
jobs such as mobile equipment operation, firefighting, and respirator use.
Health Status Form
• A standard form for reporting such results is highly recommended to
ensure uniform conformity.
Drug Test Reporting Form
• Usually developed by a state's Department of Public Health. There is an
increasing trend toward electronic reporting systems.
• The OSHA recordkeeping log may be maintained in the OHS, in which
case recording of significant injury and illness events must be carried out
in accordance with OSHA specifications. If the OSHA log is maintained
elsewhere, such as in a plant safety department, it may be helpful to have
a standard form for the medical department to report work-related injury
and illnesses to that department.
Occupational Injury and Disease Surveillance
Reports
• Summary reports of clinical activity can be an important source of data on
clinic utilization trends. They can be compiled on a monthly or yearly
basis, ideally as a direct output of an electronic records system.
Clinic Activity Reports

31. Future Trends in the Provision of
Occupational Health Services
Heavy industrial manufacturing
production will continue to
relocate from older factory sites to
newer facilities in other parts of
the world. The occupational
physician based in a plant clinic,
therefore, will become an
increasing rarity as an OHS model.
OH providers should expect to
increasingly handle occupational
medicine problems related to
travel.
The control of occupational
infectious diseases is therefore
likely to become increasingly
important, and preventive services
such as TB screening may be a
necessary part of the OHS of the
future.
New technologies (nanotechnologies) require
sophisticated understanding and new types of
services to prevent occupational illness and
injuries . Other rapidly developing technologies
(robotics) may indelibly alter modern
manufacturing processes and lead to reduction of
certain workplace hazards.
Progress in the field of genomics, including
pharmacogenetic profiling of individuals, may lead
to a greater availability of genetic information
regarding individual susceptibility to particular
workplace hazards or chronic diseases. A two-edged
sword; On the one hand, it may become easier to
identify workers who are at increased risk of
developing occupational and environmental disease,
So, prevention efforts can be better targeted to
protect such individuals. On the other hand, there is
an inherent potential for workplace discrimination
against susceptible individuals.