Occ Med WWW Links

A1. Regulations and Government Agencies

Comply with and explain applicable regulations, as well as their interpretation and enforcement, to employers and employees.

A1. 1a- OSHA regulations, including the General Duty Clause.

Hazard Communication
NHCA ALERT OHSA Recordkeeping
Occupational Safety & Health Administration - OSHA HOME PAGE
OSHA - Hazard Communication Course
OSHA First Aid Recordkeeping Summary
OSHA Medical and First Aid
OSHA Record Keeping Guidelines
OSHA Recordkeeping Changes
OSHA Recordkeeping overview
OSHA Standards Oveview & Occ Med

A1. 1b- Legislation and regulations protecting the employment rights of persons with disabilities (eg, ADA).

Americans with Disabilities Act - U of Iowa
Americans with Disabilities Act Document Center

A1. 1c- DOT regulations, including those of Federal Highway Administration and the Federal Railroad Administration.

DOT-FHWA Medregs
Federal Motor Carrier Safety Administration - Regulations
Transportation Medicine

A1. 1e- EPA regulations.

ENVIRONMENTAL COMPLIANCE REQUIREMENTS - Bechtel Jacobs
Environmental Health Legislation

A1. 1f- Family Medical Leave Act.

Family Medical Leave Act - menu
Family Medical Leave Act Summary
FMLA Complete Reference Guide and Procedures (UI Employment Relations)
FMLA Medical certification form

A1. 1g- Other federal regulations.

CFR Code of Federal Regulations Titles on GPO Access

A1. 1h- State and local regulations.

A1. 2a- Explain the rights of an employee or citizen in requesting assistance from a government agency or in filing a complaint

Pregnancy Discrimination

A1. 3a- Respond to the requirements of employee/community right-to-know regulations and advise individuals about their rights to access information

Community Right to Know (EPCRA)
NJ Worker and Community Right to Know Act
RTK - Hazardous Substance Fact Sheets
The Emergency Planning & Community Right-to-Know Act

A1. 4a- Understand, develop protocols, and protect patients’ legal rights to confidentiality of medical records information, while reporting necessary information to employers and others

ACOEM Confidentiality of Medical Information in the Workplace
AHIMA's Recommendations to Ensure Privacy and Quality of Personal Health Information on the Internet
AMA (Legal Issues) Patient Confidentiality
Confidential Health Information and the Internet
HHS Proposes Changes That Protect Pirvacy, Access to Care
HIPAA Final Privacy Rules
Medical Privacy Rules - HHS Guidelines Clarifying
Myths and Facts about the HIPAA Privacy Regulation
Patient Record Confidentiality - AMA
Patient Rights - Privacy
Protecting the Privacy of Patients' Health Information - HHS
Standards for Privacy of Individually Identifiable Health Information - HHS

A1. 5a- Understand the basic elements of workers’ compensation (WC) law, complete the necessary forms, and file WC claims and receive reimbursement

All 50 States' and D.C.'s Home Pages and Workers' Compensation Agencies
BWC - Injured Worker Information Index
BWC - Managed Care Information
BWC - What will happen AFTER I file a claim
BWC Telephone Numbers
BWC-After a Work Injury occurs
Ohio BWC Home Page
Provider Manual - HCFA 1500 form
State Workers' Compensation Laws
The Industrial Commission of Ohio homepage
Workers' Compensation Basics - California
Workers' Compensation from Emergency Medicine - Legal Aspects Of Emergency Medicine

A1. 6a- Report cases of occupational injury, illness, and/or death according to existing regulations

First Report of Injury (FROI) - Introduction

A2. Environmental Health and Risk Assessment

Environmental Health and Risk Assessment - Society has become increasingly concerned about contamination of the environment and its resultant effects on health. OEM physicians rely on the principles of environmental toxicology and risk assessment

An Introductory Lecture to Environmental Epidemiology Part 1. Introductory Examples
An Introductory Lecture to Environmental Epidemiology. Part 2. Time Series Studies
An Introductory Lecture to Environmental Epidemiology. Part 3. Issues in Design.
An Introductory Lecture to Environmental Epidemiology. Part 4. Some Issues in Exposure Assessment
An Introductory Lecture to Environmental Epidemiology. Part 5. Ecological Studies.
ATSDR - Case Studies in Environmental Medicine
ATSDR - Environmental Data Needed for Public Health Assessments
ATSDR Env Health Tutorials
ATSDR Science center
Environmental Epidemiology on Small Areas
Environmental Medicine (1995), Table of Contents
EPA's Integrated Risk Information System (IRIS) - Home Page
OPPT Chemical Fact Sheets Office of Pollution Prevention and Toxics US Environmental Protection Ag
Summary - Environmental Public Health Surveillance
Welcome to EnviroDx Enivronmental Medicine 2 Cases
Workshop 1 - Surveillance System Structure
Workshop 2 - Data Collection and Analysis - Envir Public health
Workshop 3 - Surveillance System Outputs Form and Content of Reports and Alerts

SUB-TOPIC A2. 1- Identify sources and routes of occupational and environmental exposure and recommend methods of reducing environmental health risks.

Assessment and Remediation of Contaminated Sediments (ARCS) Program
Exposure History, Taking ATSDR (online book)

A2. 1a- Identify and manage population exposure to environmental toxins (eg, heavy metals, solvents, pesticides, asbestos, silica, carbon monoxide, hydrogen sulfide, dioxin, PCBs).

Epidemiology of Minamata Disease
Toxic Oil Syndrome

A2. 1b- Identify and manage concerns about the health effects of human exposure to contaminated water, sewage, and human waste.

Cryptosporidium- The Milwaukee Case

A2. 1c- Explain outdoor air pollution sources and health effects.

Air Quality - the Six Common Air Pollutants
Plain English Guide to The Clean Air Act
Regulatory Air Models (Dispersion, Receptor Models)

A2. 1d- Explain the causes, health effects, and controls for indoor air pollution, including "sick building syndrome" and "building-related illness."

EPA's Indoor Air Quality (IAQ) Home Page
Indoor Air Quality (IAQ) in Homes-Residences - EPA
Indoor Air Quality Publications - Online from EPA
Mitigating IAQ Problems - CDC

A2. 1e- Explain water pollution sources and health effects.

Drinking water analysis
WHO Guidelines for Drinking Water Quality Training Pack - Table of contents

A2. 1f- Explain health risks associated with exposure to hazardous waste.

Superfund Ecology Technical Center Glossary

A2. 1g- Explain the risks associated with household chemicals.

Household Chemicals Checklist, CHMC
Household Poisonous Plants
Making Your Home Environment More Healthy!
Poisoning Brochure
POISONOUS AND TOXIC SUBSTANCES in the Home

A2. 1h- Explain and control the health risks associated with exposure to radon and ultraviolet radiation.

Residential Radon and Lung Cancer Case-Control Study

A2. 1I- Explain the psychological effects associated with acute or chronic exposure to actual or perceived environmental hazards.

Environmental Medicine Treatment Clinic - Dr. Rea
MCS - ACOEM
MCS - Interagency Workgroup on 1998
Multiple chemical sensitivities-index.html

SUB-TOPIC A2. 2- Perform a risk assessment (formal and informal).

Epidemiology and Risk Assessment (4th of 10 Lectures on Toxicologic Epidemiology)
Proposed Guidelines for Carcinogen Risk Assessment
Public Health and Risk Assessment(2nd of 10 Lectures on Toxicologic Epidemiology)
Risk Assessment - Carcinogens
Toxicology and Risk Assessment(3rd of 10 Lectures on Toxicologic Epidemiology)

A2. 2a- Explain the basic methodology of risk assessment.

A2. 2b- Identify exposure-related health hazards.

SUB-TOPIC A2. 3- Communicate to target groups, including health professionals, the public, and the media, in a clear and effective manner, both orally and in writing, the levels of risk from real or potential hazards and the rationale for selected interventions.

ATSDR - Health Risk Communication Primer
Risk Communication

A2. 3a- Manage communication and reactions to a perceived or actual cluster of disease.

A2. 3b- Manage communication and reactions to an episode of mass psychogenic illness.

A2. 3c- Manage communication and reaction to widespread exposure or perceived exposure to toxic materials.

A2. 3d- Explain the health impact of global environmental changes, including global warming, ozone depletion, ultraviolet radiation exposure, and persistent organic chemicals.

EPA & Ozone Depletion
EPA Global Warming Site Climate

A2. 3e- Manage communication with communities affected by pesticide applications, hazardous waste sites, transportation accidents, and other environmental and industrial exposures.

A2. 3f- Explain the controversies associated with electromagnetic field exposure.

Health Effects of Power Lines - NIEHS

A2. 4a- Interpret and explain the results of environmental monitoring studies.

Environmental Monitoring and Assessment Home Page (EMAP)

A3. Clinical Preventive Services

Clinical Preventive Services - The OEM physician has the knowledge and skills to define, develop, and administer programs to improve the health of employee and dependent populations, as well as counsel employees about their lifestyle risk factors and

Canadian Task Force on Preventive Health Care - Evidence Based Medicine
Guide To Clinical Preventive Services 1989; An Assessment of the Effectivenes
Guide to Clinical Preventive Services Second Edition (1996)

A3. 1a- Design, implement and evaluate worksite health-promotion and disease-prevention programs, incorporating DHHS and other authoritative guidelines as appropriate.

A3. 2a- Describe the appropriate use and limitations of health risk assessment and screening for well populations and the applications of screening, assessment, and early intervention for targeted high-risk groups.

A3. 3a- Interpret abnormal laboratory findings in asymptomatic workers and recommend further evaluation and/or treatment as indicated.

A3. 4a- Counsel employees about health risks and lifestyle.

A4. Management and Administration

Management and Administration The OEM physician has the administrative and management knowledge and skills to plan, design, implement, manage, and evaluate comprehensive occupational/environmental health programs, projects, and protocols that enha

Accounting
Business Open Learning Archive - BOLA UK
Business Structures
Health Information Management Web List of Links
New Business Issues - IRS
Office Depot Online - Free Downloadable Forms
Risk Management for Business
SBA Online Library - Publications Room
Small Business Information - ChamberBiz
Small Business Letters & Forms_ BusinessTown
Small Business Owner's Toolkit

A4. 2a- Design and evaluate clinical practice guidelines (see T04. 11a), quality management/quality improvement programs (see A8. 7a), utilization management, case management, and other activities to enhance an organization’s performance

Practice parameters for Medical Decision Making - ACMQ
Utilization Review - Managed Care

SUB-TOPIC A4. 3- Use appropriate management principles in conflict resolution, negotiation, consensus building, problem-solving, team building, and change management.

Management Styles - BOLA
Power, Organizations and Management - BOLA

A4. 3a- Partner with employers, labor unions, and others in addressing the health, safety and welfare of employees, their dependents, and retirees.

Labor Relations-Union Issues

A4. 4a- Use personnel management principles in selection, retention, promotion, motivation, appraisal, and discipline of employees, and in managing workforce diversity

Avoiding Employee Theft
Guide to Progressive Discipline for Supervisors and Managers
Human Resources - Employee Labor Relations - U of Iowa
Parting Ways_ Effective Termination Techniques
Personnel Policies for UC Staff Members
Preventing Employee Fraud
Small Business - Legal - Nolo
WORK RULES at UNIVERSITY OF IOWA

A4. 5a- Identify potential customers and develop a marketing plan for an occupational/environmental health program

Marketing Plan - SBA

A4. 6a- Communicate technical and clinical information to professional and lay audiences.

A4. 6b- Give presentations to employees, employers, labor unions, and others on occupational and environmental health and safety topics.

SUB-TOPIC A4. 7- Determine management information needs and apply medical informatics, electronic health and patient care data, management information systems, and other computer technologies to an OEM program.

AltaVista
Dogpile. All results, no mess.
Medical Informatics - Managing The ED
Yahoo!

A4. 7a- Apply information systems to medical surveillance programs (eg, scheduling exams, documenting clinical data, and tracking, reporting and analyzing outcomes).

A4. 7f- Use information technology (eg, e-mail, local and wide area networks, Internet) to communicate with colleagues, clients, and others.

Email and Patients
McAfee - Virus Scan Update Download

A4. 7g- Use information technology to write reports (eg, word processing), as well as to manage and present data (spreadsheets, databases, presentation graphics).

Microsoft Support Knowledge Base

SUB-TOPIC A4. 8- Manage data effectively.

A4. 8a- Design a data-collection strategy.

A4. 8b- Collect and prepare data for analysis.

A4. 8c- Analyze data and present results in tabular, graphical, and verbal formats.

A4. 9a- Establish protocols to manage patient records and protect confidentiality (see A1. 4a)

A4. 10b- Respond to patient dissatisfaction or complaints.

A4. 10c- Understand prevention of malpractice (altered).

SUB-TOPIC A4. 12- Prepare a business plan for an occupational health service, program, or project.

Business Plans - sample from IRS
Business Plans from SBA
SBA - Business Plans Tutorial
Sensitivity Analysis - Decision Analysis.xls
The Elements of a Business Plan.doc

A4. 12a- Define an organization’s or program’s vision, mission, goals, objectives, and strategies.

Clear Mission Statements
How to Write a Mission Statement
Mission Statements

A4. 12b- Perform a SWOT (strengths, weaknesses, opportunities, threats) analysis.

SWOT Analysis - Tutorial

A4. 12c- Prepare an operational budget for an occupational/environmental health service or program.

Costing Methodology
Lecture Costs.xls
Practice Expense Measurement - Pulmonary Practices

A4. 12d- Define staffing and personnel requirements for an occupational/environmental health service.

A4. 12e- Specify facilities, equipment, and supplies required by an occupational/environmental health service.

Doc's Depot Medical and Office Supply Catalog

A4. 12f- Establish a pricing structure for occupational health services, including fee-for-service and capitated arrangements.

Capitation and Risk - AMA
Contract Negotiations (incl. Managed Care Contracts)
Discounted Fee for Service and MCOs - AMA

A4. 12g- Understand the 3 main types of Financial statements

Occ Med Business - Integrated Spreadsheet.xls

A4. 12h- Understand Fixed and Variable Costs, Break-even analysis, and Profit-Loss Forecasting

Break Even Analysis
Internal Rate of Return
NPV - Discounting Future Income
NPV and IRR -- Measures for Evaluating Investments
Revenue Projections.xls

A4. 13a- Comply with WC health care services rules, reimbursement, and reporting requirements (see A1. 5a)

A4. 14a- Develop and implement corporate health policies, procedures, protocols, and guidelines

Corporate Health Checklist
Corporate Health Model
Corporate Health Policy
Corporate Workplace Health - Netherlands

A4. 15a- Work effectively as a team member with administrators, occupational health nurses, nurse practitioners, and physician assistants, demonstrating an understanding of their roles in an occupational health service

SUB-TOPIC A4. 16- Design cost-containment strategies for WC, health benefits, and disability management programs to allocate and manage clinical and financial resources.

Financial Management in Small For-Profit Businesses
How Your Worker's Compensation Premium is Modified by Claims Experience
Introduction to Health Economics
Medical Cost Containment - Colorado
Ohio Manufacturor's Report (OMA) MCO Performance Report 2000.
Overall MCO Performance Excellence - Ohio
Risk Management resources - Ohio Manufacturers Association
Work Comp Cost Benchmarks - WCRI
Work Injuries - Managing
Workers' Compensation benefits and Costs

A4. 16a- Obtain necessary demographic and cost data.

BWC - MCO Report Card
BWC - Premium Determination
Workers Compensation Costs - National Academy of Social Insurance

A4. 16b- Ensure patient/individual confidentiality in the process. (see A1. 4a)

SUB-TOPIC A4. 17- Evaluate the effectiveness of occupational health services and risk reduction methods.

Evidence-Based Medicine

A4. 17a- Design and implement process and outcome measures and be able to benchmark with other organizations.

Benchmarking
Benchmarking - Reality Check
Benchmarking Occupational Health and Safety
Preventing Illness & Injury -- Benchmarking - Ontario Canada

A4. 17c- Demonstrate program cost-effectiveness.

Cost Effective - Benefit.xls

SUB-TOPIC A4. 18- Participate in the development of emergency or disaster plans for the workplace and/or the community.

Disaster Planning from Emergency Medicine - Emergency Medical Systems
Disaster Preparedness Manual
Emergency Response to Chemical-Biological Terrorist Incidents
EMS and Terrorism from Emergency Medicine - Emergency Medical Systems
Environmental Emergency - LLNL

A4. 18a- Applying knowledge of occupational hazards, the workplace, and local medical and community resources, review and report on an actual disaster response plan (altered).

A4. 18b- Review and report on actual emergency response plans ranging from developing patient treatment protocols for a specific chemical to evacuation and community planning for catastrophic industrial emergencies (altered).

A4. 19a- Work effectively with both labor and management to maximize workplace health, safety, and productivity

A5. Medical/Legal

Medical/Legal - The OEM physician is a recognized expert on issues relating to the causation of occupational and environmental injuries and illnesses, as well as the ability to perform work with or without reasonable accommodations. As a result,

Public Health Law - recent Important Cases

A5. 1a- Perform independent medical evaluations

A5. 2a- Provide expert opinions and testimony on OEM issues

ACOEM - Position Statements- Ethics for Occ Med Expert Witnesses
Expert Witnesses and IME reports - Books
The 10 Biggest Mistakes Experts Make During Depositions

A5. 3a- Write medical-legal reports

A5. 4a- Provide peer reviews

A6. Research and Education

Research and Education - The profession of medicine requires ongoing scholarly inquiry, lifelong learning, and the ability to teach others. The techniques and methodologies of research and education are required of a competent OEM physician in or

ACOEM recommended books
ScienceWise
U.C. - Academic Calendar
U.C. - Bookstores
U.C. - Schedule of Classes

A6. 1a- Use occupational and environmental information resources to conduct a literature search or to research the health effects of a chemical substance.

How to Conduct a Meta-Analysis
U.C. - Libraries

A6. 2a- Interpret and apply the medical, toxicological, and environmental literatures

SUB-TOPIC A6. 3- Design and conduct a scientific investigation.

A6. 3a- Formulate a hypothesis.

A6. 3b- Perform a literature review.

A6. 3c- Select and apply research design methods.

Epidemiologic Design I - Descriptive Studies
Epidemiologic Design II - Analytic Studies
Injury Epidemiology
Introduction to Injury Epidemiology

A6. 3d- Seek and secure human or animal subjects review panel approval when indicated.

A6. 3e- Identify and secure necessary resources.

A6. 3f- Collect and prepare data for analysis.

A6. 3g- Analyze data and present results in tabular, graphical, and verbal formats.

A6. 3h- Draw conclusions, and discuss the implications of the research findings.

A6. 4a- Write a report suitable for publication

How to start to write a scientific paper

A6. 5a- Give a lecture and evaluate learning outcomes (altered)

SUB-TOPIC A6. 6- Interpret and present technical and clinical data for a variety of audiences.

A6. 6a- Apply principles of adult learning.

Journal of Occupational and Environmental Medicine

A6. 6b- Handle oral presentations in a professional manner.

A6. 6c- Prepare effective written reports for a variety of audiences.

A6. 6d- Defend conclusions and recommendations, using appropriate data and logical reasoning.

Probability of Causation

A6. 6e- Evaluate learning outcomes.

ACGME Program Requirements

A7. Social Sciences

Social Sciences - Cultural, ethnic, socioeconomic, and occupational characteristics can influence a worker’s definition and reaction to health, illness and injury. The OEM physician applies medical anthropologic and sociologic insights in order to communi

Cross Cultural Health Care Program (CCHCP) - CCHCP Library
Cross Cultural Health Care Program (CCHCP) - Ethnic Health Advocacy
Cross Cultural Health Care Program (CCHCP) - Links and Resources
Cultural Competence - BPHC
Cultural Diversity A Guide for Health Professionals - Home Page
EthnoMed Home Page
National Center for Cultural Competence
National Centre for Social Research Publications Health
Part 2 Linking Poverty to Child Outcomes - Income and Child Well-being A new perspective on the pove
Pearls of Cross Cultural Care
TRANSCULTURAL AND MULTICULTURAL HEALTH LINKS

A7. 1a- Identify social, cultural, and ethnic issues that relate to policies, risks, research, and interventions in occupational and environmental medicine

A7. 2a- Recognize the effects of cultural, ethnic, and social factors, including health beliefs and practices, on the health and safety of workers

A7. 3a- Accommodate cultural, ethnic, educational, and language variations among workers when providing information on occupational hazard prevention, disease prevention, and health promotion

A7. 4a- Provide clinical care and health counseling with an awareness of how cultural and social beliefs influence patient knowledge, attitudes, and behaviors.

A8. Professionalism

Professionalism - The OEM physician uniquely interacts with patients, employees, employers, labor unions, attorneys, payers, and others in the community on issues relating to workers, the workplace, and the community environment. The attitudes, b

ACOEM - Code of Ethical Conduct

SUB-TOPIC A8. 1- Recognize and address ethical dilemmas in the practice of OEM, using relevant guidelines, such as the ACOEM, Association of Occupational and Environmental Clinics, International Commission on Occupational Health, and AMA codes of ethics.

A8. 1a- Educate employers, clients, attorneys, employees, and their representatives on the ethical issues and the codes that apply to the practice of OEM.

SUB-TOPIC A8. 2- Apply principles of risk management to the practice of occupational and environmental medicine.

A Medical Malpractice Primer, Part I
A Medical Malpractice Primer, Part II
Handling Malpractice Litigation
Hospital Risk Factors - Office Procedures
Malpractice - Medical Team Relationships
Malpractice Insurance Pitfalls
Medical Office Risk Factors, Part I
Medical Office Risk Factors, Part II
Medical Office Risk Factors, Part III
Medication Errors
Professional Liability Insurance
Relationship Issues, Part I
Relationship Issues, Part II
Relationship Issues, Part III
Risk Management

A8. 2a- Ensure that patients clearly understand their medical conditions, their recommended and prescribed treatments, their work status (ie, restrictions and accommodations), and the urgency of any follow-up plans.

A8. 2b- Maintain clear, concise documentation of patient and employee encounters, including telephone encounters and encounters with company representatives on patient issues. Demonstrate that assessments and plans follow logically from clinical findings

A8. 2c- Review all diagnostic, screening, and surveillance studies ordered in the context of the individual’s medical and occupational profile, including examining data for temporal or work-group trends, and do so in a timely manner

A8. 2d- Maintain communication with referral physicians that is adequate to ensure follow up on important clinical findings.

A8. 2e- Consistently use informed consent and release of information documentation when indicated and ensure patient understanding before they apply their signature.

A8. 2f- Interact with individuals with a clear understanding of when a doctor-patient relationship exists and when it does not

A8. 2g- Use appropriate procedures when terminating a doctor-patient relationship with difficult, non-compliant, or otherwise incompatible patients.

Handling Non-Compliant Patients - Termination of Dr-Pt. relationship

A8. 3a- Interact with patients, employees, employers, and other clients to achieve health-related goals.

A8. 4a- Maintain current medical, scientific, and regulatory knowledge, recognizing one’s limits and seeking additional resources as needed.

A8. 5a- Communicate current medical, environmental, and/or other scientific knowledge effectively to target groups, including patients, employees, employers, unions, community groups, and the media.

A8. 6a- Document patient encounters accurately and completely

A8. 7a- Understand Total Quality management, Continuous Quality Improvement, and Apply time-management principles incl. PERT/CPM, Gannt charts

CQI - Healthcare - NEJM 1989
Healthcare Management Engineering (TQM/PERT…)
Pert - Gannt.xls
Project Planning Gannt, CPM, PERT
TQM - Deming The 14 Points
TQM - Healthcare

A8. 8a- Develop and implement a personal lifelong learning plan.

ABPM Res Letter Template
ACGME Outcome Project
ACOEM - Careers in Occupational Medicine
AOEC - Lending Library
PFDPF Home Page
Search Online Books - National Academy Press
UC AIT&L Current Class Schedule - Microsoft

T01. Disability and Work Fitness

Disability Management and Work Fitness - The OEM physician has the clinical and administrative knowledge and skills to assist employees and employers to ensure that recovery from illness or injury is as rapid and complete as possible. With broad

Disability Management - Disability, Employment, & Related Links - Disability, Medical, & Legal - Vol

SUB-TOPIC T01. 1- Design and implement integrated systems of disability prevention and management.

Managing Rehabilitation for Injured Workers - British Columbia

T01. 1a- Develop protocols for early identification of the disabled employee and the risk factors for delayed recovery.

T01. 1b- Assure quality in the diagnostic process.

T01. 1c- Identify the impact of psychological conditions, substance abuse, and family stresses on the natural history of illness and injury (altered).

T01. 1d- Establish and apply protocols for the implementation of appropriate therapeutic plans.

T01. 1e- Track progress against prognostic indicators.

T01. 1f- Identify and manage delayed recovery.

T01. 1g- Communicate recommendations for temporary (transitional work) or permanent accommodations for disabled workers.

T01. 1h- Prescribe preventive maintenance plans for recovered employees and track compliance.

SUB-TOPIC T01. 2- Design protocols to evaluate employees for conditions creating an undue risk to self or others in the workplace, in compliance with the Americans with Disabilities Act (ADA).

T01. 2a- Design plant specific programs for pre-placement and return-to-work evaluations.

T01. 2b- Explain and make clinical decisions as well as placement/accommodation recommendations relating to the concept of "direct threat" as defined under the ADA.

SUB-TOPIC T01. 3- In compliance with regulations, including the ADA, conduct clinical evaluations to assess level of impairment and fitness for duty

T01. 3a- Translate impairment assessments into safe work functional capacity statements for the use of employers in placing employees in jobs.

T01. 3b- Express impairment in terms required by relevant legal or benefit systems.

Disability Guidelines - Calif. Industrial Medical Council

T01. 3c- Perform Department of Transportation (DOT) examinations.

T01. 3e- Perform fitness for duty examinations and baseline clinical assessments for workers who perform heavy exertional work or work that stresses the musculoskeletal system.

T01. 3f- Perform fitness for duty examinations and baseline clinical assessments for workers potentially exposed to chemicals on the job.

T01. 3g- Perform fitness for duty examinations and baseline clinical assessments for hazardous waste workers.

T01. 3h- Perform fitness for duty examinations and baseline clinical assessments for pregnant workers.

T01. 3I- Perform fitness for duty examinations and baseline clinical assessments for persons with disabilities or medical conditions which may require special accommodations.

T01. 3j- Perform fitness for duty evaluations for employees who have recently undergone surgery, been hospitalized, or otherwise have recovered or are recovering from a significant medical condition.

T01. 3l- Establish physical and psychological fitness for travel, and recommend accommodations as indicated.

T01. 3m- Perform fitness for duty examinations for employees working in any other environment or capacity.

T01. 3o- Assess impairment ratings in accordance with the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment.

T02. Public Health and Surveillance

Public Health and Surveillance - The OEM physician has the knowledge and skills to recognize and address conditions of public health importance with an emphasis on prevention, as well as to monitor populations for indicators of occupational/envir

CDC - Public Health Achievements in the 20th Century
Hardin MD Public Health & Preventive Medicine
Public Health Foundation Links to Public Health Related Sites
UC Berkeley. Public Health Library. Public Health Resources on the Internet

SUB-TOPIC T02. 1- Develop, implement, evaluate, and refine screening programs for groups to identify risks for disease or injury and opportunities to promote wellness.

Screening
Screening and Disease Prevention

T02. 1a- Characterize the population to identify target exposures, risk factors, and/or conditions of concern.

T02. 1b- Assess the utility of screening tools.

T02. 1c- Assess the screening programs using standard criteria.

The Canadian Handbook on Health Impact Assessment

T02. 1d- Assess resources.

T02. 1e- Create structures (clinic staffing, etc)

Public Health in America
Public Health Infrastructure

T02. 1f- Report results.

T02. 2a- Review proactive systems of care that effectively reach all members of a population, including those at high risk and those who do not normally seek care (altered)

SUB-TOPIC T02. 3- Design and conduct surveillance programs in workplace and/or community settings.

Health Surveillance
Medical Surveillance and the Biosafety Program - References
Medical Surveillance in Work-Site Safety and Health Programs - May 1, 2000 - American Academy of Fam
Medical Surveillance Program - Testing-Regulations
NIOSH Surveillance Systems
Occupational Medical Surveillance Manual, May 1998 - DoD 6055.5-M
OSHA Medical Screening-Surveillance

T02. 3a- Develop and implement medical surveillance programs in the workplace and/or in communities exposed to environmental contamination.

T02. 3b- Utilize biomarkers to identify exposure, within limitations of the methodology, and interpret results in both clinical and public health contexts.

T02. 3c- Intervene in response to positive findings when indicated, in order to measurably improve health outcomes.

T02. 3d- Evaluate the effectiveness of surveillance and screening programs.

IWH Publications - Evaluating the effectiveness of strategies for preventing work injuries

T02. 4a- Recognize and investigate potential sentinel events

Sentinel Events, Root Cause Analysis and Peer Review in Healthcare FAQs
The Epidemiology of Human-Animal Interactions Part III Animals as Sentinels of Environmental Hazards

T02. 5a- Apply validated epidemiologic and biostatistical principles and techniques to analyze injury/illness data in a defined worker and community populations

Commonly Used Statistical Tests
Data Collection and Sampling
Descriptive Statistics
Pitt Lectures on Epidemiology
Rates, Ratios, and Proportions
Standardization of Rates
Surveys Sample Size revised

T02. 6a- Design and/or conduct an outbreak and/or cluster investigation

Disease Clusters in Occupational and Environmental Health

SUB-TOPIC T02. 7- Apply individual or community-based interventions to prevent or mitigate exposure and/or resultant health effects.

1998 Accident Facts
Dangerous Jobs

T02. 7a- Characterize the population to identify target conditions or exposures.

T02. 7b- Prioritize areas for prevention and mitigation.

T02. 7c- Identify efficient and effective interventions.

Framework for Program Evaluation in Public Health

T02. 7d- Develop a strategy or plan for intervention.

T02. 7e- Implement the interventions.

T02. 7f- Evaluate the effectiveness of prescribed interventions.

T02. 8a- Review and report on a medical response plan for mass casualty events in industry or in the general environment (altered).

Terrorism - Nuclear, Bacterial, Chemical

T03. Hazard Recognition, Evaluation and Control

Hazard Recognition, Evaluation, and Control - The OEM physician has the knowledge and skills to: (1) recognize and evaluate, or assist in evaluating, potentially hazardous workplace and environmental conditions; (2) recommend or implement control

Army Industrial Hygiene Homepage
Hazard and Risk
Haz-Map Bibliography and Web Links

SUB-TOPIC T03. 1- Characterize existing and potential occupational and environmental hazards within a defined population.

AOEC Exposure Codes
Dictionary of Occupational Titles (DOT)
Standard Industrial Classification (SIC) Codes
Standard Occupational Classification (SOC) Codes

T03. 1a- Perform a workplace walk-through assessment of occupational health and safety concerns.

Guidelines for Confined Entry Work
Identifying Plant Hazards Checklist - Australia
Office Hazard Identification - Australia

T03. 1b- Perform an environmental site visit.

T03. 2a- Evaluate and interpret the results of industrial hygiene surveys

Air Sampling - by Chemical

T03. 3a- Evaluate the health effects of toxic chemical exposures, including mixtures

T03. 4a- Interpret and apply Occupational Safety and Health Administration (OSHA) permissible exposure limits (PELs), the American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit values (TLVs) and biologic exposure indices (BEIs), Envi

NIOSH- Online NIOSH Pocket Guide to Chemical Hazards-chemical name and synonym index

T03. 5a- Apply ergonomic principles to optimize comfort and reduce risk at work, including evaluation and redesign of hazardous lifting jobs, repetitive motion work, and jobs with special visual demands

ERGONOMICS - A BASIC OVERVIEW
Ergonomics Program - LLNL
NIOSH Elements of Ergonomics Programs - Workplace evaluations
The RSI Network
Typing Injury FAQ Home Page

SUB-TOPIC T03. 6- Recognize and reduce exposures to certain physical hazards.

Cold Injury
Electrical Injuries from Emergency Medicine - Environmental
Extreme Cold
Extreme Heat
Frostbite from Emergency Medicine - Environmental
Heat Exhaustion and Heat Stroke from Emergency Medicine - Environmental

T03. 7a- Explain health-related information on a material safety data sheet (MSDS) to workers and patients

Vermont SIRI MSDS Collection

T03. 8a- Advise patients regarding industrial hygiene controls, such as work practices, respirator use, and engineering controls

ASHRAE Research &
Control of risks to health from work
Industrial Hygiene Controls - Controlling Chemical exposures
Personal Protective Equipment - OSHA

T03. 9a- Recommend and implement policies and control measures to reduce or mitigate safety and health hazards

Employee Safety Instructional Manual - Cincinnati
ES&H Manual - Lawrence Livermore
Occupational Health and Safety Manual - BC teachers
OCCUPATIONAL SAFETY AND HEALTH POLICY - Bechtel-Jacobs
Preparation of Work Procedures
Safer Workplace recommendations

SUB-TOPIC T03. 10- Design and manage a hearing conservation program for workers exposed to loud noise.

Effective Hearing Conservation Programs - NIOSH
Hearing Conservation Program
NIOSH- Rec. Standard--Occupational Noise Exposure, 1998
OCCUPATIONAL NOISE EXPOSURE STANDARDS
Occupational noise exposure. - OSHA 1910.95
OSHA - Hearing Conservation

T03. 10a- Advise employees and employers regarding the use of hearing protection.

T03. 10b- Design programs to comply with the OSHA noise standard.

Text of the OSHA Noise Exposure Standard

T03. 11a- Recommend appropriate environmental monitoring studies

T03. 12a- Describe the key elements of a good respirator program

NIOSH Respirator Use Policy Statement
OSHA Respirator Questionnaire
Respiratory Protection Program - NJ

T03. 13a- Assist employees and employers with the management of the effects of shift work, jet lag, and other chronobiological stressors

T03. 14a- Identify and minimize exposure to ionizing radiation (eg, radon, x-ray, radioisotopes).

10 CFR 835 - Occupational Radiation Protection DOE
19941221 - Gaseous Diffusion Plants.
CalTOX, A Multimedia Total Exposure Model For Hazardous Waste Sites (Version 2.3) (on diskette)
DOE Openness - Search
EPA Radfacts
Exposure to Radiation in an Emergency - LLNL
Fernald Site IntraNet
Guidance for Radiation Accident Management
Health Effects of Exposure to Radon BEIR VI - Executive Summary
Hospital Emergency Care of the Radiation Accident Patient
Iodine-131 from Nevada Nuclear-Bomb Tests (1999)
Ionizing radiation. - 1910.1096 OSHA
Military radiation exposure
NIOSH-Health Care Workers Guidelines-Ionizing Radiation
Nuclear Criticality - LLNL
Radiation Protection - LLNL
Radiation Protection Implementation Guides -DOE
RADIOLOGIC CASUALTIES - CHERNOBYL
Radiological Emergencies
The DOE Worker Health and Safety Web Site
Thorium - ATSDR - Public Health Statements
Thorium RPD Vol 97 No 2 (2001)

T03. 14b- Identify and minimize exposure to non-ionizing radiation (eg, ultraviolet, infrared, microwave, radiofrequency, electromagnetic).

LASER HAZARDS - Ocular
Lasers - Lawrence Livermore
Nonionizing Radiation and Fields (les than 300 GHz) - LLNL

T03. 14c- Appropriately engage the services of a radiation protection officer and health physicist.

T03. 14d- Prevent, diagnose, and manage health effects associated with high-altitude living and working.

Altitude Illness - Cerebral Syndromes from Emergency Medicine - Environmental
Altitude Illness - Pulmonary Syndromes from Emergency Medicine - Environmental

T03. 14e- Explain the hazards of barotrauma and decompression sickness.

Barotrauma from Emergency Medicine - Environmental
Decompression Sickness from Emergency Medicine - Environmental
Dysbarism from Emergency Medicine - Environmental

T04. Clinical - General

Clinical—General - The OEM physician has the clinical knowledge and skills to provide high quality, cost-effective medical care in diagnosing and treating occupational and environmental injuries and illnesses. The physician provides care with an

Abnormal Liver Function Tests - Solvents
Liver Function Tests Abnormalities
Multiple Chemical Sensitivity - ACSH Booklet
OSHA Search Page
Physician's role in helping patients return to work

T04. 1a- Obtain brief, as well as comprehensive, patient histories, with an emphasis on occupation and exposure

Recognizing Occupational Disease-- Taking an Effective Occupational History - September 15,
Taking an Occupational History

T04. 2a- Perform complete or focused physical examinations as indicated

T04. 3a- Select appropriate diagnostic studies in the evaluation of patients

Lab Tests Online
Medical Tests - WebMD - Encyclopedia - Adam

T04. 4a- Identify the potential relationship between patient symptoms and occupational/environmental exposures

T04. 5a- Diagnose and manage occupational/environmental illnesses and injuries, with the use of consultants in related disciplines when indicated

T04. 6a- Identify non-occupational/environmental factors that may contribute to occupational/environmental disease or injury

T04. 7a- Refer and follow up or manage patients with serious occupational or environmental injuries and illnesses

T04. 8a- Elicit patients’ concerns about exposures and establish a therapeutic alliance incorporating risk communication

T04. 9a- Report all findings to affected individuals and pertinent information to organizations and employers as appropriate (considering medical confidentiality issues), advocating for the health and safety of patients and employees (see A1. 4a)

T04. 10a- Evaluate and treat medical conditions commonly seen by a general medical practitioner

T04. 11a- Apply clinical practice guidelines in one’s practice of medicine

Evidence-based Practice - AHRQ
Health Services-Technology Assessment Text (Clinical Guidelines) - NLM
Medical Treatment Guidelines - Colorado
Milliman and Robertson - Pros and Cons - AAOS January 1998
National Guideline Clearinghouse - Evidence Based
Return-to-Work - Milliman and Robertson
Worker's Comp Guidelines - Colorado
Workers Compensation - Milliman and Robertson Guidelines

SUB-TOPIC T04. 12- General Medicine

T04. 12a- Prescribe and evaluate the use of medications effectively in the Practice of Medicine

Clinical Pharmacology Monograph Service
Drug search results page
ePocrates, Inc. ePocrates RxÖ clinical drug database for the Palm
Martindale's Health Science Guide Pharmacy Center
Medications in Mental Health
MEDLINEplus Drug Information

T04. 12b- General Medicine - Online searches for information

Electronic Resources
Entrez-PubMed
Healthworks - Medical Information on the Internet
Medline Search Form
MEDLINEplus Health Information from the National Library of Medicine - Home Page
PubMed

T04. 12c- General Medicine - Links

Biomedical and Nursing Databases
Hospitals - USA
Indiana Physician Guide
JAMA
Mayo Clinic Medicine Center - Search By Name
Medical tests Guide - WebMD - Yale
The Merck Manual of Medical Information - Home Edition
THE MERCK MANUAL, Sections
U.C. Berkeley. Public Health Library. Alternative Medicine Resources
Virtual Hospital Home Page
Virtual Naval Hospital
Virtual Naval Hospital Providers HomePage
Welcome to Harrisons's Online

T04. 12d- General Medicine - Organizations

American Academy of Family Physicians
OSMA Welcome to the OSMA

SUB-TOPIC T04. 13- Occupational and Environmental Medicine - Online resources

T04. 13a- OEM - Organizations

American Board of Preventive Medicine
American College of Occupational and Environmental Medicine
Association of Occupational and Environmental Clinics
Intl Assoc of Fire Fighters

T04. 13b- OEM - Set of Useful Links

AOEC Educational Resources - Lending Library
Duke Occ. & Environ. Medicine WWW page
Index of Occupational-Environmental Health Resources
NIOSH-OSHA-DOE Health Guidelines - Alphabetical Listing
Occupational & Environmental Medicine - Teaching Resources
Occupational and Environmental Medicine Resources - Kelafant
SAFETY and OEM Discussion list archives
The Occ-Env-Med-L Archives
University of Wisconsin EHS Links

T05. Clinical - Cardiology

Clinical—Cardiology - Individuals with underlying cardiac risk factors and disease may encounter special concerns in safety-sensitive jobs, while working around certain chemical agents, and in performing exertional labor. OEM physicians assi

AED Guidelines
Cardiology

T05. 1a- Recognize, evaluate, and manage the cardiac effects of chemical asphyxiants such as carbon monoxide, methylene chloride, and cyanide

Hydrogen Cyanide
Occupational Exposure to Methylene Chloride
Toxicity - Cardiac, Carbon Monoxide

T05. 2a- Evaluate a person’s ability to perform exertional work after a major cardiac event such as a myocardial infarction or coronary artery bypass graft surgery

Exercise Testing GuidelinesAfter Myocardial Infarction
Guidelines for Assessing and Managing the Perioperative Risk from Coronary Artery Disease Associated
MI, Discharge Guidelines
Perioperative Assessment and Management of Risk from Coronary Artery Disease

T05. 3a- Address employment concerns for patients with cardiac conditions such as hypertension, coronary artery disease, heart failure, arrhythmias, etc

Cardiology Clinical Guidelines - Amer Coll Cardiology

T05. 4a- Perform or arrange for cardiovascular diagnostic tests when indicated to evaluate fitness for duty

T05. 5a- Identify abnormal electrocardiograms and refer for follow-up as appropriate

EKG Interptretation - Virtual Naval Hospital
Electrocardiogram (ECG, EKG) library

T06. Clinical - Dermatology

Clinical—Dermatology - Occupational dermatoses are one of the leading causes of occupational disease in the United States. Dermatoses also occur as a result of exposure to hazardous compounds in the home environment. OEM physicians can provi

Atlas of Dermatology
Burns, Thermal from Emergency Medicine - Environmental
Dermatology

SUB-TOPIC T06. 1- Differentiate occupational skin disorders by history, examination, and diagnostic evaluation.

T06. 1a- Diagnose and determine the cause of allergic contact dermatitis (including urticaria), particularly those caused by common antigens such as latex, epoxy monomer, and nickel.

Latex Allergy - CDC
Latex Allergy Links
Mgmt of Natural Rubber Latex Allergy -NJ

T06. 1b- Diagnose primary irritant-induced dermatoses.

T06. 1c- Diagnose actinic skin damage, as well as photosensitization dermatitis, including cases due to exposure to coal tar, psoralens, and polychlorinated biphenyls (PCBs).

T06. 1d- Diagnose occupational acne, including chloracne.

T06. 1e- Differentiate work-aggravated dermatoses.

T06. 1f- Diagnose occupational cutaneous infections (eg, herpetic whitlows).

T06. 1g- Identify skin neoplasias, especially as caused by coal tar, ultraviolet radiation, or ionizing radiation.

Melanoma Information Page

T06. 1h- Diagnose occupational pigmentary disorders, including vitiligo.

SUB-TOPIC T06. 2- Manage occupational and environmental skin injuries and dermatoses.

T06. 2a- Treat and prevent recurrence of contact dermatitis.

T06. 2b- Treat chemical burns, including those caused by caustics, acids, and hydrofluoric acid.

Burns, Chemical from Emergency Medicine - Environmental
Hydrofluoric Acid Burns from Emergency Medicine - Environmental

T06. 2c- Manage occupational bullae and calluses.

T06. 2d- Manage folliculitis barbae in workers who may be required to shave.

T06. 3a- Identify and control occupational/environmental risk factors for the development of skin disorders

SUB-TOPIC T06. 4- Use patch tests to evaluate patients with contact dermatitis and other conditions.

T06. 4a- Interpret patch test reports obtained from a dermatologist and use as a basis for establishing the etiology and nature of contact dermatitis and other potentially atopic conditions.

T07. Clinical - Emergency Medicine and Surgery

Clinical—Emergency Medicine and Surgery - The OEM physician has the knowledge and skill to provide acute medical care for a wide variety of common injuries and illnesses, as well as to stabilize and refer individuals for emergency care.

Acute MI, Treatment (AHA)
eMedicine Online Text - Emergency Medicine
Emergency Management - LLNL
Emergency Medicine - Table of Contents
Emergency Medicine Residents Page
Emergency Response Guidebook
Managing Hazardous Materials Incidents - Hospital Emergency Departments
Medical Management Guidelines for Acute Chemical Exposure
Poisoning - WebMD - Encyclopedia
Surgeries - WebMD - Encyclopedia

T07. 1a- Establish emergency procedures and protocols for the clinical management of individuals involved in hazardous materials incidents, including substance-specific first-aid and medical management protocols

Hazardous Material Protocols

T07. 2a- Define the basic procedures associated with disaster planning and the delivery of emergency medical services

T07. 3a- Identify medical and surgical emergencies and manage or refer as indicated

T07. 4a- Provide acute medical and surgical care in an emergency situation, including the treatment of traumatic injuries and lacerations, referring as indicated.

ACLS Algorithms
Single-Rescuer Adult Basic Life Support
Universal Advanced Life Support Algorithm

T07. 5a- Diagnose and manage the work-related implications of surgical conditions

SUB-TOPIC T07. 6- Diagnose and manage injuries associated with physical hazards including:

T07. 6a- Heat (eg, heat stress, heat stroke, heat syncope, heat exhaustion, and heat cramps).

T07. 6b- Cold (eg, hypothermia, frostbite, chilblains, and immersion foot).

T07. 6c- Radiation.

T07. 6d- Lasers.

T07. 6e- Vibration.

T08. Clinical - Hematology / Oncology

Clinical—Hematology/Oncology - Occupational and environmental exposures may have potential to cause adverse hematologic effects or may be carcinogenic. The OEM physician has the knowledge and skills to evaluate, diagnose, and prevent the hem

T08. 1a- Interpret hematologic laboratory studies in the context of medical surveillance and post-exposure examinations

T08. 2a- Perform clinical evaluations to detect the health effects of exposure to hematologic toxins such as benzene, lead, and arsine

Arsine
Benzene and Leukaemia
Benzene Case Study

T08. 3a- Evaluate patients, clinical data, and exposure data to render opinions regarding causation in cases of suspect occupational or environmental cancer.

Carcinogens (Cancer-Causing Agents)
Carcinogens (Cancer-Causing Agents) by Occupation
Carcinogens (Cancer-Causing Agents) I
Causation of Cancer Nature vs. Nurture

T09. Clinical - Ear, Nose, and Throat

Clinical—Ear, Nose, and Throat - The OEM physician has the clinical knowledge and skills to identify, evaluate, diagnose, and manage the care of patients with common occupational and environmental otolaryngological conditions.

audiological tests
Ear Nose and Throat Patient Information
Otitis Externa
Otolaryngology and Facial Plastic Surgery

T09. 1a- Diagnose and manage nasopharyngeal conditions caused or aggravated by occupational and environmental exposure, including allergies, rhinitis, pharyngitis, laryngeal polyps, and granulomata

SUB-TOPIC T09. 2- Evaluate and manage a patient with hearing loss or other occupationally related otologic conditions.

NIOSH - A Practical Guide to Preventing Hearing Loss - 96-110

T09. 2a- Identify, clinically manage, and prevent further injury to individuals with noise-induced hearing loss.

Noise-Induced Hearing Loss

T09. 2b- Evaluate and manage individuals with external otitis related to, or complicated by, the use of hearing protection.

T09. 3a- Perform and interpret an audiogram, identify a standard threshold shift, and implement appropriate treatment and preventive interventions

T10. Clinical - Infectious Disease

Clinical—Infectious Disease - Bloodborne, waterborne, and airborne pathogens pose unique challenges for travelers and in occupational and/or environmental settings. Early recognition and preventive action by the OEM physician can minimize th

CDC Bioterrorism Page
CDC Division of Healthcare Quality Promotion Home Page
CDC Guideline for Infection Control in Healthcare Personnel, 1998
CDC mostly ID Health Topics A to Z
FDA - Bioterrorism
Guidelines for Infection Control in Health Care Personnel, 1998
Infections - Healthcare Worker Restrictions
Infectious Diseases
MMWR Immunization of Health-Care Workers 12-97
US Army Center for Health Promotion and Preventive Medicine
Varicella Pt. Info - CDC

T10. 1a- Identify, manage, and prevent bloodborne, airborne, waterborne, foodborne, and fomiteborne pathogen exposure and associated illnesses

Additional Options for Preventive Treatment for Persons Exposed to Inhalational Anthrax
Anthrax Bioterrorism Virtual Flight Surgeons Aviation Medicine FAA Medical
Anthrax PreventiveTreatment - Options.PDF
CDC - Foodborne Illnesses
CDC - Viral Hepatitis C
FDA-CFSAN Bad Bug Book Introduction to Foodborne Pathogenic Microorganisms and Natural Toxins
Hepatitis C Part I. Routine Serologic Testing and Diagnosis - January 1, 1999 - American Academy of
Hopkins HIV postexposure prophylaxis
Monitoring and Follow-Up Evaluation for TB Treatment
PHS Guidelines for Management of Health-Care Worker Exposures to HIV
Prevention of Bacterial Endocarditis
Public Health Service Guidelines for the Management of Health-Care Worker Exposures to HIV and Recom
Recommendations for Prevention and Control of Hepatitis C Virus ...
Serious Adverse Events Attributed to Nevirapine Regimens for Postexposure Prophylaxis
Updated U.S. Public Health Service Guidelines for the Management of Occ Exposures to HBV, HIV, etc

T10. 2a- Identify, manage, and prevent diseases of travelers

Blue Sheet - CDC Travelers' Health
CDC Travelers' Health
MCW HealthLink Travel Medicine
Travel Health Online
Virtual Hospital Travel Medicine

T10. 3a- Order appropriate immunizations for employees and travelers

Measles, Mumps, and Rubella -- Vaccine Use and Strategies for ...
MMR Info sheet
TB skin testing

T10. 4a- Identify, manage, and prevent infestations and zoonotic conditions

ZOONOTIC DISEASES

T10. 5a- Identify, manage, and prevent health effects associated with poor sanitation, exposure to human waste, and/or water contaminated by human pathogens

T10. 6a- Identify, manage, and prevent building-related infectious diseases

Fungi in Indoor Environments
Remediation of Fungi

T10. 7a- Identify, manage, and prevent sexually transmitted infections and diseases

Sexually Transmitted Diseases Bacterial -Part I-
Sexually Transmitted Diseases Bacterial -Part II-
Sexually Transmitted Diseases Viral -Part I-
Sexually Transmitted Diseases Viral -Part II-

T11. Clinical - Musculoskeletal

Clinical—Musculoskeletal - Musculoskeletal injuries comprise a majority of the acute occupational injuries seen by the OEM physician and cause major productivity, financial, and human losses for employees and employers alike. Thorough unders

Anatomy & Biomechanics of the Shoulder. Part I.
Anatomy & Biomechanics of the Shoulder. Part II.
Chapter-Thoracolumbar Spine Trauma
COCHRANE BACK GROUP abstracts
Complete Muscle Tables for the Human Body
GUIDELINES FOR THE INITIAL EVALUATION OF THE ADULT PATIENT WITH ACUTE MUSCULOSKELETAL SYMPTO
Low Back Pain Guidleines - ACHPR
NIOSH-musculoskeletal
Orthapedic Resource Links
Orthopedic Surgery
Physical Medicine and Rehabilitation
Sports Medicine
Virtual Naval Hospital_ Aeromedical Reference and Waiver Guide_ Orthopedics
Wheeless' Textbook of Orthopaedics

T11. 1a- Perform focused and comprehensive musculoskeletal evaluations of the spine and extremities, including the history, physical examination, laboratory studies, and the investigation of occupational risk factors

T11. 2a- Select and interpret appropriate diagnostic tests in the evaluation of patients with musculoskeletal conditions involving the spine and extremities, with particular attention to low back conditions

SUB-TOPIC T11. 3- Identify, manage, and prevent acute and chronic musculoskeletal disorders and their associated disabilities, and determine when such conditions are work-related.

Muscle pain - Neurology - Wash Univ
Orthopedics - 5minconsult

T11. 3a- Diagnose, manage, and prevent spine disorders, including low back pain.

Low Back Pain
Management of Low Back Pain at Work - UK
TOC 14. Acute Low Back Problems in Adults (Clinical Guide)

T11. 3b- Diagnose, manage, and prevent cumulative trauma disorders, with attention to specificity of diagnosis and etiology, and both occupational and non-occupational risk factors.

T11. 3c- Diagnose, manage, and prevent joint and extremity injuries and disorders.

T11. 4a- Prescribe rehabilitation services and ergonomic interventions for an injured worker

T11. 5a- Refer occupational musculoskeletal conditions for appropriate surgical intervention when indicated

T11. 6a- Assess and manage post-treatment, including post-operative, return-to-work for musculoskeletal injuries

T11. 7a- Identify delayed recovery and manage chronic musculoskeletal pain syndromes

Choosing a Multidisciplanary Pain Program
Chronic Pain Research SNCPR Home Page
Definitions Related to the Use of Opiates for the treatment of Pain
Diagnostic Criteria - American College of Rheumatology
Fibromyalgia - Amer Coll of Rheumatology
Oswestry Pain Questionnaire

T12. Clinical - Neurology

Clinical—Neurology - Occupational and environmental exposures can cause acute and chronic effects on the central and peripheral nervous systems. Both occupational and non-occupational neurologic conditions may also impact an employee’s abili

CRPS (RSD)
Neurology
Neuromuscular Home Page
Neurosurgery
Porphyria
Reflex Sympathetic Dystrophy - NINDS

T12. 1a- Perform focused neurological and mental status examinations in the evaluation of occupational/environmental injuries or illnesses

SUB-TOPIC T12. 2- When indicated, select and utilize the results of neurological and mental status examination procedures or consultations in the evaluation of occupational or environmental injuries or illnesses. Such studies may include:

T12. 2a- Magnetic resonance imaging.

MRI PHYSICS A Nuts and Bolts Approach

T12. 2b- Computed tomography.

T12. 2c- Central nervous system (CNS) electrodiagnostic studies (eg, electroencephalogram, evoked potentials).

PET
SSEP - Neurology

T12. 2d- Peripheral nerve electrophysiologic studies (eg, nerve-conduction studies; electromyography).

Carpal Tunnel
Carpal Tunnel Syndrome
Carpal Tunnel Syndrome at LSU
Electrodiagnostic Studies in Carpal Tunnel Syndrome
EMG Guidelines
EMG Manuals
Peripheral Neuropathy Lectures

T12. 2e- Neuropsychological batteries.

Neuropsychological testing Guidelines

T12. 3a- Manage the interface between medical care and the workplace for neurologic conditions such as seizure disorders, cerebrovascular accidents, neuromuscular disorders, and mental impairments

T13. Clinical - Ophthamology

Clinical—Ophthalmology - The OEM physician has the clinical and administrative knowledge and skills to: (1) evaluate and treat occupational eye injuries; (2) develop and implement vision screening and protection programs; and (3) use informa

Ophthalmology

SUB-TOPIC T13. 1- Interpret routine visual screening results in establishing fitness for duty in various occupational settings.

T13. 1a- Screen for near, distance, and color vision.

T13. 1b- Identify the visual requirements for various occupations (including regulatory requirements), and correlate these requirements with job tasks and job hazards in determining fitness for duty and accommodations.

T13. 2a- Identify the need for specialized ophthalmologic services and surveillance (eg, lasers, ethambutol use)

LASER MANUAL APPENDIX -H Surveillance

SUB-TOPIC T13. 3- Recognize and treat occupational eye diseases and injuries and refer to an ophthalmologist when appropriate.

Eyelid Disorders Diagnosis and Management - June 1998 - American Academy of Family Physicians
Ocular injuries

T13. 3a- Diagnose and manage infectious and irritative conjunctivitis.

Allergic Conjunctivitis and Vernal Keratoconjunctivitis
Bacterial Conjunctivitis
eMedicine - Conjunctivitis

T13. 3b- Diagnose and treat ultraviolet photokeratitis.

Ultraviolet Keratitis - Ophthalmology

T13. 3c- Identify and remove superficial foreign bodies from the eye, with follow-up care as indicated.

Assessment of Ocular Foreign Bodies
eMedicine - Corneal Abrasion
eMedicine - Corneal Ulceration and Ulcerative Keratitis Article by Wesley S Grigsby, MD
Foreign Body Removal

T13. 3d- Identify and treat ocular chemical exposures and burns (including alkali, acid, and hydrofluoric acid).

eMedicine - Burns, Ocular

T13. 3e- Use fluorescein stain to evaluate the cornea when indicated.

Fluorescein and Lid Eversion Procedures

T13. 6a- Assess the workplace for potential hazards to the eye and address issues of eye protection, including the use of safety glasses and contact lenses.

Protecting Your Eyes From Everyday Hazards

T14. Clinical - Psychology

Clinical—Psychiatry - The OEM physician has the clinical and administrative knowledge and skill to: (1) recognize, evaluate, and assist in the management or triage of workers with psychological or drug-related problems presenting in the work

Psychiatry

T14. 1a- Take a psychiatric and psychosocial history and perform a mental status examination

T14. 2a- Identify the troubled or psychologically impaired employee and manage or refer appropriately to community resources, including employee assistance programs

T14. 3a- Identify and interpret danger signs of the violent, homicidal, or suicidal employee, manage the situation, and refer appropriately. Participate in the design of violence prevention and response programs

SUB-TOPIC T14. 4- Identify and manage the impact of psychological conditions on ability to work and on the natural history of occupational and environmental illnesses and injuries.

T14. 4a- Specify restrictions and accommodations for employees with psychiatric conditions, in compliance with the ADA.

T14. 4b- Specify restrictions and accommodations for employees taking psychotropic medications.

T14. 4c- Identify and treat or refer individuals with psychopathology aggravating and/or presenting as other medical conditions.

T14. 5a- Diagnose and manage workers who may be under the influence of psychoactive chemicals at work (eg, industrial exposure, medications, recreational drugs, alcohol)

Faq's Page
MRO - NCADI CSAP Technical Report - 15
MRO Checklist - Adultered-Substituted-Cancelled
MRO Checklist - Positive-Cancelled

T14. 7a- Identify and assist in the management of psychological stressors in the workplace

T15. Clinical - Pulmonary

Clinical—Pulmonary - With a thorough understanding of the anatomy, physiology, and pathology of the respiratory system, the OEM physician is able to assess the causes and occupational impact of respiratory disorders and pulmonary impairment. The OEM

American Thoracic Society - About ATS
Bronchiolitis obliterans organizing pneumonia
Dyspnea Mechanisms, Assessment, and Management
Pulmonary
Smoke Inhalation from Emergency Medicine - Environmental

SUB-TOPIC T15. 1- Prevent, identify, diagnose, treat and/or refer occupational/environmental lung disorders, including:

IAQ Questionnaire - NIOSH

T15. 1a- Occupational asthma and bronchoreactivity (eg, toluene diisocyanate sensitization, exposure to inhaled allergens, byssinosis, reactive airways dysfunction syndrome [RADS]).

Asthma Questionnaire - NIOSH
ATS Questionnaire - NIOSH

T15. 1b- Pneumoconioses (eg, silicosis, coal workers’ pneumoconiosis, asbestosis, hard-metal disease, benign radio-opaque pneumoconiosis, chronic beryllium disease).

1996 WoRLD Report --- Asbestosis Mortality
Asbestos Definitions - DEHS, UMN
Asbestos Questionnaires; Mandatory - 1910.1001AppD
Asbestosis
ATSDR - Public Health Statements Asbestos
Chronic Beryllium Disease Prevention Program - DOE
Fernald Beryllium Program
Idiopathic Pulmonary Fibrosis - Diagnosis and Treatment
Silicosis
Virtual Hospital ElectricDiffuseLung The Diagnosis of Diffuse Lung Disease Asbestosis

T15. 1c- Irritant inhalations (eg, acids, alkalis, oxides of nitrogen, phosgene, phosphine).

T15. 1d- Chronic obstructive pulmonary disease (COPD).

COPD - Standards for the Diagnosis and Care of Patients with Chronic Obstructive Pulmonary Disease (

T15. 1e- Hypersensitivity pneumonitis.

T15. 2a- Develop a differential diagnosis for occupational/environmental lung disorders

Brochoalveolar Lavage - Clinical Role of
Bronchiolotis obliterans
Diffuse infiltrative lung disease
Pathology of Interstitial Lung Disease

T15. 3a- Manage work restrictions for both occupational and non-occupational lung diseases

New York City Department of Health - Tuberculosis (TB) Medical Fact Sheet 3c - Identify and Treat

T15. 4a- Perform and interpret a spirogram according to American Thoracic Society standards

SUB-TOPIC T15. 5- For the work-up of pulmonary conditions, order and interpret the appropriate diagnostic tests, including:

T15. 5a- Pulmonary function testing.

ACOEM - Spirometry in the Occupational Setting
Pulmonary Function Tests Spirometry

T15. 5b- Imaging studies (eg, chest radiographs, magnetic resonance imaging, computed tomography, plain tomography).

T15. 5c- Peak-flow testing and post-shift spirometry in the assessment of exposure-related bronchoreactivity.

T15. 5d- Post-bronchodilator pulmonary function testing in the assessment of bronchoreactivity.

T15. 5e- Methacholine and specific challenge testing in the assessment of exposure-related bronchoreactivity.

Guidelines for Methacholine and Exercise Challenge Testing

T15. 5f- Exercise disability tests in the assessment of pulmonary impairment.

T15. 5g- Allergy testing.

T15. 6a- Interpret x-ray results reported by an International Labor Organization (ILO) B-Reader

BForm

T15. 8a- Perform respirator certification examinations tailored to the anticipated workplace exposures, to the exertional demands of the job, and to the type of respiratory protection used

Respiratory Protection Guidelines - ATS

T15. 9a- Design and oversee a medical surveillance program designed specifically to prevent occupational lung disease

T15. 10a- Review, interpret, and explain the public health and clinical implications of epidemiological studies that address occupational lung hazards

T16. Clinical - Reproductive Medicine

Clinical—Reproductive Medicine - The OEM physician has the clinical knowledge and skill to advise patients about reproductive risks of occupational and environmental exposures; the effects of exposure and work on fertility, pregnancy, and the fet

NIOSH-The Effects of Workplace Hazards on Female Reproductive Health
NIOSH-The Effects of Workplace Hazards on Male Reproductive Health

T16. 1a- Identify potential adverse reproductive outcomes to both men and women from chemical, biological, physical, biomechanical, and psychological exposures and provide advice to employees and employers regarding the management of such exposures

ACOEM - Position Statements- Reproductive Hazards

T16. 2a- Advise individuals and communities about the reproductive implications of environmental exposure

T16. 3a- Recommend appropriate accommodations and job placements for pregnant employees

T16. 4a- Advise on corporate policies and procedures relating to the protection of fertility for both men and women and for the placement of pregnant or lactating workers

T16. 5a- Identify and utilize up-to-date sources of reproductive toxicology information

Reprotox, An Online Reproductive Toxicology Resource

T16. 6a- Establish a working relationship with the employee’s treating physician in the management of work-related reproductive concerns

T17. Clinical - Toxicology

Clinical—Toxicology - Hazardous material exposures occur at work, at home, and in the general environment. Clinical acumen as well as knowledge of hazardous material databases equip the OEM physician to identify, manage, and prevent occupational

Epidemiologic Side of Toxicology (6th of 10 Lectures on Toxicologic Epidemiology)
Hazardous Chemicals and Occupational Diseases - Database
Hepatotoxic Industrial Chemicals
Human Exposure Assessment I (7th of 10 Lectures on Toxicologic Epidemiology)
Human Exposure Assessment II (8th of 10 Lectures on Toxicologic Epidemiology)
Medical
Methemoglobinemia Primary Industrial Chemicals and Non-Occupational Exposures
NIOSH-Documentation for Immediately Dangerous To Life or Health Concentrations(IDLHs)-chemical list
Pesticide Information Profiles
Search the EMCI Chemical References Web Pages
Table of Contents California Air toxics - CAS Numbers
The Medical and Public Health Law Site
Toxicologic Side of Epidemiology (5th of 10 Lectures on Toxicologic Epidemiology)
Toxicology and Epidemiology(1st of 10 Lectures on Toxiciologic Epidemiology)

SUB-TOPIC T17. 1- Determine the nature and extent of potential occupational and environmental chemical exposures, considering routes of exposure and routes of absorption.

T17. 1a- Use appropriate written and computerized databases (eg, MSDSs, Registry of Toxic Effects of Chemical Substances [RTECS]) to identify the hazardous ingredients of chemical agents.

ATSDR - Minimal Risk Levels for Hazardous Substances (MRLs)
ATSDR - ToxFAQs (TM) Hazardous Substance Fact Sheets
HSDB Basic Search
NCMS Solvents Database
RTK - Hazardous Substance Fact Sheets
Search NTP Web Site
TOXNET Home
U.S. EPA Integrated Risk Information System (IRIS)

T17. 1b- Identify the physical characteristics of hazardous agents (eg, liquid/gas/vapor/particulate).

T17. 1c- Estimate the likely degree of absorption based upon circumstances of exposure, considering factors such as the nature of the substance, the route of exposure, concomitant exposures, and characteristics of the patient (eg, age, susceptibility fact

SUB-TOPIC T17. 2- Detect, insofar as possible, pre-clinical or clinical effects arising from chemical exposure and implement appropriate preventive measures.

Information on Hazardous Chemicals by Class
NIOSH - Health Effects of Occupational Exposure to Asphalt

T17. 2a- Identify, obtain, and evaluate biomarkers or other tests to assess exposure and/or health effects, including biological monitoring techniques that assay the substance, its metabolites, or other indices.

Biological Monitoring in Occupational Settings
Biomonitoring - overview

T17. 2b- Identify clinical or biochemical evidence of target organ damage when an exposure hazard is recognized.

SUB-TOPIC T17. 3- Evaluate, treat, and/or properly refer persons whose health may be affected by acute or chronic contact with occupational and environmental chemicals.

Guidelines for Acute Chemical Exposure

T17. 3b- Identify the likely toxic exposure on the basis of clinical signs and symptoms.

T17. 3c- Identify chronic health effects (eg, hepatotoxicity, asthma, central and peripheral nervous system toxicity, interstitial fibrosis) resulting from toxic exposure and obtain necessary confirmatory testing.

T17. 3d- Manage medical care and secondary preventive measures for individuals chronically affected by toxic exposure.

SUB-TOPIC T17. 4- Assess clinical, worksite, and environmental data, along with literature reviews in the performance of patient evaluations.

T17. 4a- Obtain detailed exposure information including exposure histories, MSDSs, industrial hygiene reports, and other data.

T17. 4b- Evaluate the severity of exposure to hazardous agents, considering dose/response relationships

Dose-Response Relationships In Toxicology

T17. 4c- Interpret exposure data in the context of the scientific literature (human and animal) and the patient’s presentation.

T17. 5a- Understand, explain, and be able to apply toxicokinetic data (including absorption, metabolism, storage, and excretion) to clinical and employment-related decision-making

T17. 6a- Determine if a person has a health condition that increases risk from the effects of exposure to chemical, physical, or biological agents

T17. 7a- Distinguish health effects of exposure to chemicals from other etiologies

T17. 8a- Manage an effective therapeutic alliance with the patient whose health is affected by toxic exposure or who fears that his or her health may beaffected by toxic exposure