OCCUPATIONAL MEDICINE AND

FITNESS FOR DUTY

BYN. MICHAEL BADDAR, M.D., M.P.H.

SERVING HAMPTON ROADS FOR OVER TWENTY FIVE

YEARS

□ I&O Medical Centers-Peninsula North 757-240-5580Serving the City of Newport News and York County

□ I&O Medical Centers-Peninsula South 757-825-1100Serving the Cities of Hampton and Newport News

□ I&O Medical Centers-Southside East 757-460-0700Serving the cities of Virginia Beach and Norfolk

□ I&O Medical Centers-Southside West 757-487-9600Serving the cities of Chesapeake, Portsmouth, and Suffolk

FITNESS FOR DUTY

JOEM-JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE

ACOEM-AMERICAN COLLEGE OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE

FITNESS FOR DUTY-SEPTEMBER 2015 ISSUE

□ELECTROCARDIOGRAPHIC RESPONSES DURING FIRE SUPPRESSION AND RECOVERYAMONG EXPERIENCED FIREFIGHTERS

□THE RELATIONSHIP BETWEEN BODY MASS INDEX AND WORKERS’ COMPENSATION CLAIMS AND COSTS

FIREFIGHTERS

NFPA 1582

STANDARD ON COMPREHENSIVE OCCUPATIONAL MEDICAL PROGRAM

FOR FIRE DEPARTMENTS

FITNESS FOR DUTY

□STESS TESTING IN FIREFIGHTERS/POLICE AND WORKERS INVOLVED IN SAFETY

□BMI IN DISABILITY AND WORKERS COMPENSATION

□SLEEP, SHIFTWORK, AND SLEEP APNEA

□POLYPHARMACIA AND HIPAA

FITNESS FOR DUTY

The Occupational Physician takes all the relevant data and gives the employee the mechanism to perform the job safely while informing the employer whether the employee has met those goals without breaching confidentiality

STRESSS TESTING IN FIREFIGHTERS/POLICE AND

WORKERS INVOLVED IN SAFETY

□WHY we should consider stress testing□WHAT are we really measuring□HOW do we go about measuring□WHERE can we use the information

WHY THE CONCERN

“Heart disease causes nearly half of

line-of-duty death among firefighters. This epidemiological observation may be related, in part, to high prevalence of cardiovascular risk factors, including obesity, metabolic syndrome, binge drinking, and sleep deprivation.

-Salah Al-Zaiti, JOEM Sept. 2015

PREVALENCE OF ABNORMALITIES

□Exceeding age predicted maximum heart rate – 52.4%

□Significant tachycardia – 97.6%□Pathological ST segments – 26.2%□Heart rate variability – 52.4%□Prolonged QTc interval which indicates

abnormal repolarization and risk of sudden death – 52.4%

CONCLUSIONS

“This study demonstrated that fire suppression, independent from work duration , induces prolonged tachycardia and is associated with transient ECG changes suggestive of myocardial ischemia… among 25% to 50% of active firefighters at low risk for CV disease.”

JOEM September 2015

FITNESS

□A MET is defined as the resting metabolic rate, that is, the amount of oxygen consumed sitting in a chair

□2 METS requires twice the resting metabolism and 3 METS requires three times the resting metabolism

□Housework can vary from 2 to 5 METS□Snow shoveling from 5 to 7 METS

FIREFIGHTING FITNESS

□Estimated METs proposed from studies for firefighting range from 9.6 to 14

□Firefighters should be able to perform above 12 METS without difficulty

□Firefighters with cardio-respiratory fitness below 12 should be started on a program to improve fitness

FITNESS FOR DUTY

□ Is the employee the same as he/she was when they were hired

□ Is the employee taking medication which may impair their judgment

□Do we have a system for identifying potential problems before an incident

BMI AND WORKERS COMP

“Obesity was associated with significantly greater workers’ compensation outcomes (COSTS) in this population of statewide municipal workers.”

-Chenoweth et al., Journal of Occupational and Environmental Medicine, Volume 57, Number 9

SHIFTWORK

□Sleep disturbance

□Occupational stress

□Disruption of social life

□Gastrointestinal disorders

OCCUPATIONAL ACCIDENTS

□Excessive daytime sleepiness and lack of concentration impair work performance

□Sleep apnea (OSA) confers a two to sevenfold increase in the risk of motor vehicle accidents as compared to the general population

SHIFT MALADAPTATION SYNDROME

□Sleep disturbance and chronic tiredness□5 to 20% of shift workers□Alcohol or drug abuse usually related to

self-treatment of insomnia□Higher rates of accidents or near misses□Depression, personality changes□Exacerbation of existing disorders

PHASE DELAY ADJUSTMENTS

□ It is generally more difficult to arise progressively earlier than to delay awakening by an hour

□ Rotating forward from afternoon to nighttime shift is easier than counter clockwise

□ Time recommended for a shift change would be at least 21 days before another rotation forward

□ Short cycle shifts (2-3 days) often more acceptable to workers because of social and family life

BMI

“Health promotion and injury prevention programs, policies, and incentives should be provided to all employees.”

-Chenoweth et al.

WHY AN OCC DOC

□PERSONNEL FILE

□MEDICAL FILE

□ INTERMEDIARY THAT EXPLAINS AND DISTILLS ON A NEED TO K NOW BASIS

THE CIRCLE OF WORK

EMPLOYEE

ASSISTANCE

PROGRAM

PHYSICAL

THERAPISTS

SPECIALISTS

EMPLOYER

FAMILYDOCTOR

EMPLOYEE

OCCDOC

THE NEW OCC DOC

□LIFESTYLE

□EDUCATION

□PREVENTION

□PRIVACY

HIPPA AND PRIVACY

PHYSICAL

THERAPISTS

EMPLOYER

SPECIALISTS

FAMILYPHYSICIA

N

OCCUPATIONAL

PHYSICIAN

OCCUPATIONAL PHYSICIAN AS COORDINATOR OF HEALTH

CARE SERVICESWORKERS

COMPENSATION

DISABILITYMANAGEMENT

GROUP HEALTH CARE