Occupational Health Medical Surveillance Session

Occupational Health Medical Surveillance Session
11/13 March 2014 Naval Safety and Environmental Training Center Professional Development Conference JP

Primary Objectives Provide a baseline level of knowledge regarding the Navy and Marine Corps medical surveillance programs Present findings and lessons learned regarding the Medical Surveillance Reporting initiative Inform program stakeholders of resources available to assist with program management and improved customer support JP

Session Overview Medical Surveillance Overview
Background on the Navy medical surveillance reporting initiative USMC medical surveillance reporting initiative Strategies to improve program management and compliance Medical surveillance training and education resources Q & A JP

Presenters LCDR Rollin Clayton, MSPH, CSP Commercial: (703) 604-4603
Navy Industrial Hygiene Officer supporting Headquarters, United States Marine Corps Chair of the Marine Corps Medical Surveillance Working Group Commercial: (703) With us today we have LCDR Rollin Clayton. LCDR Clayton is a Navy Industrial Hygiene Officer working at Headquarters Marine Corps Health Services. He is the Chair of the Marine Corps Medical Surveillance Working Group and provides oversight for Marine Corps efforts behind this program. NEXT SLIDE JP

Presenters Ms. Lori O’Berry, COHN-S Commercial: (757) 953-0728
Occupational Health Nursing Consultant and Program Manager for NMCPHC Commercial: (757) Ms. Lori O”Berry is a Certified Occupational Health Nurse Specialist and she has worked for all three services in this role. Lori currently serves as the Occupational Health Nursing Consultant and Program Manager for Navy and Marine Corps Public Health Center in Portsmouth, VA. Her department provides resources for occupational health nurses to include the “Medical Surveillance Procedures Manual and Medical Matrix.” NEXT SLIDE JP

Presenters LCDR Charles (Chuck) Wilhite, CSP, MSPH
Force Safety Officer/Industrial Hygiene Officer at Submarine Forces Pacific Prior INSURV inspector Prior Preventive Medicine Technician Commercial: (808) LCDR Chuck Wilhite is the Force Safety Officer at Submarine Forces Pacific in Pearl Harbor, HI and was a prior inspector of shipboard medical surveillance programs at the Board of Inspection and Survey (or INSURV). He is also a prior Navy Preventive Medicine Technician. As the SUBPAC Safety Officer, he provides safety and occupational health program oversight to the numerous submarines and squadrons under his purview. NEXT SLIDE JP

Presenters Kathleen Edwards, RN, BSN, COHN-S
Occupational Medicine Program Manager for Navy Medicine West, San Diego, CA Commercial: (619) Ms. Kathy Edwards is a Certified Occupational Health Nurse Specialist. She served as the Department Head for Occupational Medicine at Naval Medical Center San Diego for 20 years ( ) and was a Navy nurse for 10 years prior to that. Kathy is currently the Occupational Medicine Program Manager for Navy Medicine West where she provides oversight and program management to the 10 Medical Treatment Facilities under NAVMEDWEST. NEXT SLIDE JP

Presenters CDR John Porter, MS, CIH, REHS
Deputy Director, Occupational Health & Industrial Safety Programs at Naval Safety Center Navy Industrial Hygiene Officer Commercial: (757) , ex. 7177 My name is CDR John Porter and I am an Industrial Hygiene Officer currently serving as the Deputy Director for the Occupational Health and Industrial Safety Programs Directorate at the Naval Safety Center in Norfolk, VA. Our directorate is responsible for establishing Safety and Occupational Health (SOH) policy, doctrine and guidance throughout the Navy. We also maintain the Medical Surveillance Toolbox on the Naval Safety Center’s website. NEXT SLIDE JP

POLLING QUESTION #1 Before we begin let’s have our first two polling questions. These will help us learn how to best focus the material in our presentation. You should see a window containing this question on your screen. This question is intended to gauge the level of knowledge you believe you currently have regarding the medical surveillance program and the topics that I alluded to in the Overview slide. Please take a moment to give the answer the best reflects what you believe to be your current level of knowledge. (Wait for real-time results to stabilize). Provide a general comment on results (hopefully many will say they don’t have robust knowledge on the topic so that we can educate them during our presentation). NEXT SLIDE Polling Question #1 What do you consider your level of training and/or knowledge on the medical surveillance program to be right now? - Very knowledgeable. I am an expert. - Somewhat knowledgeable. I have a good understanding of the program but there are some elements that I could learn more about. - Not very knowledgeable. I have a basic understanding but would have difficulty explaining the program and all of its elements. - Have little to no knowledge. I have had little or no training/background or understanding of the program. I am pretty much starting at square one. JP

POLLING QUESTION #2 JP Answer: B
Who is responsible for ensuring that Navy military and civilian personnel who require medical surveillance are enrolled in the appropriate program (exposure or job-dependent), and tracked to ensure they receive the applicable exams at the proper times? Navy Medicine has overall responsibility Each command is responsible for their own personnel Naval Safety Center The individual Sailor or DON civilian who requires medical surveillance None of the above As I stated in the last polling question, I know nothing about medical surveillance Answer: B Each of these does have a role, however, each command is responsible for their own personnel. It’s a common misconception that it’s the responsibility of an external organization (such as medical). However, per OPNAVINST G, paragraph 0205(b) states that regions and activities are responsible for implementing all aspects of the Navy Safety and Occupational Health program. Medical surveillance is an essential component of the SOH program. Navy Medicine does have a role; they help commands identify which tasks and operations require medical surveillance. However, Navy Medicine doesn’t know which specific personnel perform those tasks at each command. The command is then responsible for identifying the specific personnel who perform those tasks, enrolling them into the appropriate program, and tracking them to ensure they receive the appropriate exams when they need them. JP

Introduction to Medical Surveillance and Certification Examinations
Lori O’Berry BSN, MPA, COHN-S Occupational and Environmental Medicine Navy and Marine Corps Public Health Center Now what we have a general idea of the knowledge level in the room, I’d like to hand the microphone over to MS Lori O’Berry so that she can give a brief introduction to medical surveillance and certification examinations. “The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U. S. Government.”

Medical Surveillance This presentation is based on the following:
Medical Surveillance brief given by CDR P. Seeman for Safety PDC, March 2013 Navy and Marine Corps Public Health Center (NMCPHC) Technical Manual, NMCPHC- TM OM 6260 Medical Surveillance Procedures Manual and Medical Matrix, Edition 11 Navy Safety and Supervisor’s Guide to Medical Surveillance, 2013 Product of the Navy Medical Surveillance Working Group Also know as the Medical Matrix Manual

Medical Surveillance The U.S. Navy is concerned about the well-being of its military and civilian personnel and effective medical surveillance is a key component to ensuring their health. All medical surveillance stakeholders must work in concert to maximize the effectiveness of the Navy's program.

Medical Surveillance An Occupational Medical Surveillance program, which includes medical screening and/or examination, is one of several tools aimed at protecting workers, Active duty or civilian service, who are exposed or potentially exposed to hazardous substances in the workplace.

Medical Surveillance Medical surveillance also helps determine whether controls used in the workplace to reduce exposures to personnel (such as exhaust ventilation which is used to remove hazardous fumes or vapors) or Personal Protective Equipment (PPE), such as respirators, are working effectively. Whether they be Administrative, Engineering, or Replacement

Surveillance Examinations
Selection of personnel for medical surveillance program is based primarily on the results of the industrial hygiene survey. This is known as “hazard based” medical surveillance. Target an intervention to the affected individual and others who are at risk of developing the same disorder.

Surveillance Examinations
Part of a comprehensive process that helps to: bring about changes that prevent exposure to health hazards enhance the quality of working conditions Ensure that the employee’s health, and well- being, are not impacted by on the job exposures

Types of Examinations Baseline Examination
performed before an employee begins work Periodic Examination performed at regular, specified intervals Termination Examination document the worker’s state of health at end of employment or exposure a. Baseline Examination (Pre-placement or Pre-Assignment): A Baseline examination is performed before the employee starts work in a position to ensure that they are medically qualified to perform the job’s required duties or to establish a baseline (reference point) where IH personnel have identified Work-related exposures b. Periodic Examination: A Periodic examination is performed at regular, specified intervals (often annually) while the worker performs jobs or tasks requiring medical surveillance or certification. The periodic exam results are commonly compared to the baseline to identify potential health effects caused by an exposure (e.g. comparing a baseline audiogram with a periodic audiogram to identify hearing loss). c. Termination Examination: Termination exams are important because they document the worker's state of health at the end of employment or exposure. A Termination exam is required when the worker leaves certain medical surveillance programs due to a change in jobs, a change in exposure, or upon discharge from the Navy. Situational examination

Certification Examinations
Certification Examinations (aka Specialty Examinations). These physical exams are performed when medical standards exist for workers assigned to a position. These standards come from many sources. Provider determines if worker is medically capable of performing the tasks of the job.

Certification Examinations
Requirement for the certification exam is usually found in the instruction for the work process, equipment, or employee’s position description. Work involves specific health requirements. Assessment of the employee’s ability to safely perform tasks of the job.

Authorities Mandated by regulations Code of Federal Regulations
Department of Defense OPNAVINSTs Program Specific Instructions/requirements To further assist you in understanding the process of Medical Surveillance, the Safety Center has developed the Medical Surveillance Toolbox.

Elements of a Medical Surveillance/ Certification Program
There are 7 basic elements which include: a. identification d. completing exams b. training e. communication c. enrollment and f. reporting tracking g. oversight a. Identification (1) Accurately identifying personnel who require medical surveillance or certification is essential. Unnecessarily or incorrectly enrolling personnel into programs leads to increased costs and unnecessarily burdens both the supporting medical clinic and the command. Enrollment in medical surveillance should always be based upon established exposure or certification program requirements. (2) Hazard (Exposure)-Based Exams: The command IH survey report is the primary reference for identifying medical surveillance requirements based on actual, or potential, overexposures to various health stressors (such as lead, chromium, noise, etc.). (3) Certification (Specialty) Programs: Commands should refer to, and Safety Officers/Managers and MDRs should be familiar with, the guiding references for certification programs applicable to their commands. The Navy Certification Examination Guidance matrix is designed to help identify which exams may be applicable. The Medical Matrix lists many of the guiding references for certification programs that require medical exams (the applicable references are located at the end of each exam section). (4) Commands should contact their supporting IH or OH clinic if they have questions regarding which personnel should be enrolled in a specific program(s). b. Training: A command will not have an effective program unless the key personnel have a good understanding of medical surveillance and certification roles, responsibilities, requirements and elements. This Guide may be used to train Safety Officers/Managers, MDRs, and supervisors c. Enrollment and Tracking: Enrollment means that the member has been identified as needing medical surveillance; tracking means that the member’s name has been entered in the command’s tracker and that they are proactively followed to make sure that they complete the applicable exams in a timely manner(3) Tracking methods include computer spreadsheets or electronic databases such as the Enterprise Safety Applications Management System (ESAMS), SNAP Automated Medical System (SAMS), etc. Commands may use whatever tracking system they choose, however, an electronic database can streamline the process and make enrollment and tracking more efficient and effective. (4) Supervisors are the backbone of the medical surveillance program (as they are for all SOH programs). A command cannot have an effective program without strong supervisor involvement. (5) The Department of the Navy (DON) Supervisor’s Medical Surveillance and Certification Exam Referral form was developed to capture and document essential medical surveillance information and to streamline communication between key stakeholders who are internal or external to the command. Commands and clinics should use this form to maximize accuracy in enrollment and tracking. e. Completing Exams: The supporting OH clinic performs most medical surveillance and certification exams, though certain exams can be performed by the afloat MDR. f. Communication: Essential information such as which exams workers require, exam completion dates and dispositions (i.e. medically qualified, not medically qualified, qualified with limitations, etc.), next exam due dates, and abnormal findings that may indicate inadequate workplace exposure controls must be communicated between supervisors and safety officers/managers, afloat MDRs, and clinics. As stated above, the Supervisor’s Medical Surveillance and Certification Exam Referral form captures and documents the essential program enrollment information and streamlines communication between all key stakeholders. g. Annual requires commands to review medical surveillance and certification exam completion annually as part of each command’s safety self-assessment and to report their compliance status through their administrative chain of command using the standardized (2) Specific roll-up procedures are released in the Fall of each year by the Naval Safety Center and are posted on the Naval Safety Cen h. Oversight: Commanding Officers ensure the proper functioning of medical surveillance pertinent to their commands. Immediate Superiors In Command (ISICs) ensure that subordinate commands implement all required SOH programs, including medical surveillance. Headquarters commands (Echelon 2) conduct assessments of the effectiveness of the command’s overall SOH program by performing subordinate command SOH management evaluations and reviewing selfassessments.

Roles and Responsibilities
Management AND Safety Assess control measures and PPE; obligation to alter the conditions that lead to adverse health effects Employee Keep appointments with healthcare provider and complete required examinations and tests Be knowledgeable of Medical Surveillance requirements Healthcare Provider Make consistent and well documented decisions concerning the employee’s suitability for work

Tips for a Successful Program
Assess workplace Define baseline situation; identify work and work processes and equipment used Obtain IH survey (recommendations) Communicate and involve stakeholders Know the regulations Set goals Take responsibility Obtain current IH survey. Read it and ask the IH questions regarding the findings in the survey Communicate, communicate you are not in this alone!!

Conclusion Goal is to provide a safe and healthy environment, prevent work-related diseases, and to ensure that the worker is not adversely impacted by the job. Ensure that workers are protected from accidental death, injury, and illness caused by hazardous occupational and environmental exposures.

Conclusion (continued)
The Key, once again, to a successful Occupational Safety and Health Program is: COMMUNICATION! Communicate with your Industrial Hygienist and your Occupational Medicine Clinic

Polling Question #3 Medical surveillance and certification examinations are a stand-alone process. If personnel are completing their exams then that command’s program management is effective. A. True B. False Answer is B. Ensuring that personnel complete required exams is important. However, there are other elements that are essential to a well-managed program. These include: Does the command track the exam’s general results? Was a problem found that needs to be followed up on? For example, assume that a periodic audiogram has identified hearing loss in a Sailor or DON civilian who works in a noise hazardous area. It’s not just important to document whether hearing loss has occurred, but also to determine WHY it occurred and WHAT can be done to address the root causes. Is the worker being exposed to additional noise hazards than those already identified? Are there engineering controls to reduce the worker’s exposure to that noise? Are the engineering controls fully effective or are administrative or PPE controls required? Is the worker wearing the required hearing protection? Are they wearing it correctly? Does the hearing protection required need to be reassessed to ensure it provides the appropriate level of protection? Does the worker require temporary removal from the noise hazardous area while the problem is assessed and solved? Does the worker require permanent removal from the noise hazardous area? JP

Medical Surveillance Reporting Initiatives Background
CDR John Porter, CIH Naval Safety Center JP

Reporting Initiative Background
Spring 2010: BUMED estimated a 33% completion rate for required Navy-wide medical surveillance exams Aug 2010: ASN (EI&E) requested that CNO and CMC “develop a plan to ensure timely completion of required exams and provide oversight of its implementation” An accurate Navy-wide exam completion rate was complicated by stove-piped data systems JP

Reporting Initiative Methods
We needed to determine program compliance Developed a standardized reporting spreadsheet 124 exams Reporting Spreadsheet automatically calculated exam “completion rates” JP

Medical Surveillance Exam Completion Report
Back JP

Completion Rate Calculation
JP

Reporting Initiative Background
NAVADMIN 213/12 Required all Navy commands to develop a baseline exam completion report and route through Immediate Superior in Command (ISIC) Echelon 2 commands consolidate subordinate inputs and forward to NSC by 15 Oct 2012 Required future annual reports to be submitted during the safety self-assessment process starting in 2013 JP

Reporting Initiative Output
Consolidated reports were received from 26 Echelon 2 commands NSC used Echelon 2 consolidated reports to develop a Navy-wide composite report Compliance rates based on estimated personnel in program and estimated number in periodicity for exam Remember some exams are one time only, some are periodic JP

CY12 Composite Report Summary
JP

CY12 Composite Report Summary- Top 25
Program Name / Number Exam Type Navy-Wide Denominator (#Required) Navy Wide Numerator (# Completed) Navy-Wide Compliance Estimate Noise Physical 144,698 123,858 86% Respirator User Certification 81,911 75,120 92% Health Care Worker 33,939 31,020 91% Blood and Body Fluids Chemical 25,508 19,591 77% Radiation (Ionizing) 20,573 19,096 93% Aviation 20,027 19,608 98% Forklift Operator 20,087 18,219 Explosive Handler 16,730 14,339 Heat 14,546 12,442 Submarine Duty 9,489 9,306 Lead (Inorganic) 7,910 6,696 85% Weight Handling Equipment 9,377 7,980 Police/Guard/Security 7,661 5,926 Motor Vehicle Operator (Other than DOT) 7,265 5,574 Food Service Personnel 7,803 6,995 90% Wastewater/Sewage Worker 6,537 6,154 94% Chromic Acid/Chromium 6,087 5,393 89% Radiation (Class 3b and 4 Laser) 5,651 3,803 67% Noise (Follow Up of STS) 5,235 4,811 Firefighter (Pre-placement and Periodic) 5,224 8,455 Asbestos Past Worker (10+ years since last exposure) 5,119 3,807 74% Hazardous Waste and Emergency Response 4,923 3,974 81% Explosives Vehicle Operator 4,846 4,348 Mixes Solvents Mixed Exposure 4,486 3,788 84% Child Care Worker 4,304 3,323 The top 25 medical surveillance programs by population enrolled. Note over half of Top 25 are certification exams. JP

Overall Findings The composite report estimates higher compliance than the original 33% value 87% overall 86% audiograms These are estimates We were also able to estimate the number of medical surveillance requirements for each program Good news was that overall Navy compliance was relatively high, however, the data also showed that some individual program compliance was low and also that some compliance rates at the local command level were low. JP

Composite Report Limitations
Compliance estimates are based on self-reporting Many commands weren’t tracking this program Lack of program manager training Currently no method for Naval Safety Center to validate data JP

Reporting Method Strengths
Overcomes stove-piped systems Indicates which programs are doing well or poorly at a glance Offers ISICs and HQ commands an option for oversight Allows each level in the chain of command to hone in on poorly performing commands and help them improve JP

Future Reporting Periodic Reporting
Starting in 2013, reporting was part of safety self-assessment process Involved an updated 2013 reporting spreadsheet Results will be submitted along with the self-assessment results Guidance was provided via ALSAFE 054/13 ALSAFE 054/13 requires Echelon 2 commands to consolidate subordinate inputs and forward to NSC by 15 April 2014. CY13 added additional completion percentages to the overall and audiogram completion percentages: Chemical Physical Mixed Exposure Certification JP

CY13 Composite Report Summary
CY13 added additional completion percentages to the overall and audiogram completion percentages: Chemical Physical Mixed Exposure Certification Back JP

Review Questions on Medical Surveillance Reporting Initiative Background
JP

Specific Findings and Lessons Learned
Baseline Medical Surveillance Reporting Initiative 2012 Now we’d like to cover some of the findings and lessons learned identified during the CY12 medical surveillance reporting initiative. Kathy Edwards is our first presenter. JP

Identification of Personnel for Medical Surveillance
Presented by Kathleen Edwards, BSN, COHN-S Occupational Medicine Program Manager Navy Medicine West San Diego, CA KE

Identification of Personnel
Reporting Feedback: Many commands have a difficult time determining which personnel require enrollment in a medical surveillance program(s) Many active duty are not being identified KE

QUESTION? When you first saw the reporting tasker, what was your first thought? Its not my job to know who is in these programs? What are all these programs? Why are they asking Safety, this is for medical? All of the above? KE

Right Answer?? “It takes a village”
Safety has ownership of the reporting All stakeholders own a piece of the process Stakeholders include: Safety Supervisors Industrial Hygiene Medical/Occupational Health Clinics KE

Identifying Personnel In Medical Surveillance Programs
KE

Processes Educate supervisors about the Medical Surveillance program and how to use the resources. Supervisors assess each employee to determine medical surveillance/job certification placement Communicate identification to Command Medical Surveillance Program Manager Annual review between supervisor and Medical Surveillance Program manager KE

Resources Employee position description (often identifies duties requiring certification) Command IH Survey for stressor based medical surveillance recommendations Navy Certification Guidance Matrix for certification examinations (NAVSAFECEN Med Surv Toolbox) KE

Navy Manual of the Medical Department
Resources (con’t) Medical Surveillance Procedure and Medical Matrix (both med surv/cert) (NAVSAFECEN Med Surv Toolbox) Navy Manual of the Medical Department Base Licensing Office (CDL,forklift, MVO, etc) Occupational Health Clinic KE

Identification Information Needed
Name Job Title Does the employee do any of the work processes identified in the IH survey as needing medical surveillance? Does the employee perform any duties that require certification as per certification matrix? Identify Medical Surveillance Program #s What is the periodicity of the exams? KE

IH Survey Medical Surveillance Recommendations (Example 1)
HAZARDOUS OPERATIONS REQUIRING MEDICAL SURVEILLANCE Location/Code Hazardous Operation Med. Surveillance Frequency/Type Bldg. 1157/R30 Operate woodworking tools Baseline/annual/termination Hearing Conservation Builders Shop (noise and vibration) Baseline/annual Hand-Arm Vibration (instructors) Wood Working Area Bldg and 345/R30 Operate heavy equipment Baseline/annual/termination Hearing Cons. Embarkation (vibration) Baseline/annual/ Hand-Arm Vibration Baseline/annual Whole Body Vibration Bldg. 1158/R30 Operate woodworking tools Baseline/annual/termination Hearing Cons. Engineering Aide Shop (noise) Bldg. 1158/R30 Welding, operate metal working Baseline/annual/termination Hearing Cons. Steel Working Shop Tools (noise and vibration) Baseline/annual Hand-Arm Vibration Bldg. 1158/R30 Welding (metal fumes) Baseline/periodic Respirator User (if respirators Steel Working Shop are worn) Bldg. 1191/R43 Operate power tools Baseline/annual/termination Hearing Cons. Equipment (noise and vibration) Hearing Conservation Baseline/annual Hand-Arm Maintenance Shop Vibration (instructors only) KE

Report Section Shop Work Task Recommended Medical Surveillance Number of Personnel 2 N91, Force Protection Military Working Dogs Personnel Animal Associated Diseases (#207) 5 4 Port Operations Dive Locker Diver/Hyperbaric Worker (#705) 8 Respirator User SCUBA (#716) 7 NB92 Fleet Readiness Bowling Maintenance Hearing Conservation (#503) KE

PROGRAM (Number) Work Center Personnel Noise (#503) Cranes & Boats (EC01)/9 Docking (EDC1/ER02)/17 Deck (DA01)/42 Engineering (EC01)/8 Auxiliaries (EA01)/9 85 Respirator (#716) All personnel involved with mechanical grinding, sanding and needle gunning of painted surfaces or painting of interior spaces/ 17 Blood & Body Fluids (#178) Medical (MH01)/1 1 Health Care Worker (#719) Sewage Worker (#702) Docking (EDC1/ER02)/4 4 KE

Navy Certification Guidance Matrix
Certification Examination Name Certification Program Applicability Guidance Periodicity Afloat Military Afloat Civilian Ashore Military Ashore Civilian AVIATION Y N/A < Age 50: every 5 years > Age 50: annual BARBER AND BEAUTY SHOP EMPLOYEES Preplacement Baseline CHILD CARE WORKER Annual DIVER/HYPERBARIC WORKER Diver Candidates: Upon application to diving duty Designated Divers: < Age 50: every 5 years > Age 50 < Age 60: every 2 years > Age 60: annual EXPLOSIVE HANDLER < Age 60: every 5 years > Age 60: annually EXPLOSIVES VEHICLE OPERATORS Civilians: < Age 60: every 2 years > Age 60: annual Active Duty Military: every 5 years FIREFIGHTER (COMPREHENSIVE) Annual This exam incorporates many elements from several other certification exams. See the "Medical Matrix" for more information. FOODSERVICE PERSONNEL Preplacement FORKLIFT OPERATOR < Age 60: every 5 years > Age 60: annual FREON (HALOALKANE) WORKERS See Comment #1 HAZARDOUS WASTE WORKERS AND EMERGENCY RESPONDERS HEALTH CARE WORKERS (HCWs) MOTOR VEHICLE OPERATERATORS (DOT) See comment #2 N Every 2 years MOTOR VEHICLE OPERATOR (OTHER THAN DOT) See comment #3 Every 4 years NAVAL CRIMINAL INVESTIGATIVE SERVICE < Age 37: every 3 years 38 to 40 years of age: every 2 years > Age 41: annual POLICE/GUARD SECURITY RESPIRATOR USER CERTIFICATION EXAM See comment #4 Civilians: Age 15 to 34: every 5 years Age 35 to 44: every 2 years >Age 45: annual SCBA user: annual Military: See comment #4 SUBMARINE DUTY Active duty submarine qualified: Every 5 years Everyone else: Prior to embarkation on submarine WASTEWATER/SEWAGE WORKER Every 5 years WEIGHT HANDLING EQUIPMENT (MANAGEMENT OF) Note: Applies to crane Operators WELDERS/BRAZERS/NON-DESTRUCTIVE INSPECTION TECHS KE (Navy Safety Center Med Surv Toolbox)

Navy Medical Surveillance Matrix (Example part 1)
KE

Navy Medical Surveillance Matrix (con’t)
KE

Enrollment and Tracking
PERSONNEL IDENTIFICATION Enrollment and Tracking KE

Program Enrollment and Tracking
Presented by LCDR Chuck Wilhite, MSPH, CSP, MSC, USN TYCOM Safety Officer Commander, Submarine Forces Pacific Pearl Harbor, HI CW

Program Enrollment and Tracking
Reporting Feedback: Many commands had trouble understanding The program enrollment process Methods available to effectively track medical surveillance enrollment and exam/screening completion CW

Reporting Initiative Findings
Program Enrollment Starts with Industrial Hygiene Survey report (IHS) and Safety Officer and Management working as a team Personnel for inclusion are identified in IHS work center assessments and via Medical Surveillance recommendations Workplace Manager/Safety Officer works with Medical to schedule physical exams and required certifications CW

Polling Question #4 If you are responsible for tracking medical surveillance at your command, which system(s) or methods do you use? ESAMS Excel spreadsheet SMS OSHSYS MES Other? CW

Reporting Initiative Findings
Program Tracking Safety Officer, Medical personnel and management should collectively track employees status to ensure medical/certification compliance Tracking accomplished via ESAMS, SAMS, .xls, Access database, or other methods Records should be maintained and readily available for inspection/audits/investigations CW

Program Oversight Reporting Feedback: Some ISICs were unsure as to how to effectively inspect and oversee medical surveillance programs at subordinate commands CW

Program Oversight If at an ISIC/TYCOM, have units submit monthly or quarterly occupational health physical exam/certification status Maintain benchmark at 90% Utilize INSURV/MRI/Medical Surveillance tool box/checklists to ensure your units meet fleet standards Conduct random inspections and encourage self-audits to ensure compliance CW

Stakeholder Training Reporting Feedback: Several command program managers stated that their training did not fully prepare them to manage an effective medical surveillance program JP

Stakeholder Training Some program managers and other stakeholders didn’t have a good awareness of the program or strong knowledge regarding requirements Lack of training courses or resources that comprehensively cover topic We will talk more about stakeholder training in a later section. JP

Documenting Medical Surveillance Examination Completion and Disposition

Documenting Exam Completion and Disposition
Reporting Feedback: Many commands had trouble determining when, or if, personnel completed all medical exam requirements = compliance Many commands were unaware as to whether medical exams/screening identified issues which would require further action KE

WHO NEEDS TO KNOW WHAT? Supervisors need to know:
Date exam was completed Is the employee qualified to continue work When is the next exam due Is there any required follow-up Medical Surveillance Program Managers need to know: Exam completion date KE

Medical Documentation
Medical Surveillance/certification examinations are documented in the active duty/civilian employee’s medical record. When monitoring is done on an employee by IH, the results and recommendation for surveillance are entered into the individual’s medical record. OH Clinics do not have a database of personnel enrolled in medical surveillance or job certification programs. Medical does have the responsibility to communicate back to the supported activity the disposition of the worker. KE

Communication Work with OH clinic on process
Currently tremendous variance in process Worker cards Dispensary chits Medical referral form Command specific forms ESAMS Medical Surveillance Referral form (5100/T) Developed by Navy and USMC Medical Surveillance Working Groups Intended to Improve communications between command/clinics Assist line supervisors and command program managers in documenting and tracking personnel KE

Privacy Protected Information
Medical information regarding the employee will not be shared (HIPPA, PHI) Employer will be informed of qualification status (disposition) Follow-up appointments are sometimes needed before final disposition can be made. Employee has the right to share their information with supervisor, but not coerced KE

Review Questions on Specific Findings and Lessons Learned
Now to talk about the Marine Corps’ findings pertaining to their initiative, I’d like to introduce LCDR Rollin Clayton from Marine Corps Headquarters Health Affairs office. JP

USMC OCCUPATIONAL HEALTH MEDICAL SURVEILLANCE PROGRAM PLAN UPDATE
HQMC Health Services LCDR Rollin Clayton, MSC, USN RC

PURPOSE: UPDATE ON THE MARINE CORPS OCCUPATIONAL HEALTH MEDICAL SURVEILLANCE PROGRAM DISCUSSION: IN A 04 AUG 2010 MEMORANDUM, ASN (EI&E) TASKED CHIEF OF NAVAL OPERATIONS (CNO) AND THE COMMANDANT OF THE MARINE CORPS (CMC) TO DEVELOP A COMPREHENSIVE MEDICAL SURVEILLANCE PROGRAM PLAN THAT ENSURED APPROPRIATE IMPLEMENTATION OVERSIGHT AND TIMELY EXECUTION OF REQUIRED MEDICAL SURVEILLANCE. THE ASSISTANT COMMANDANT OF THE MARINE CORPS CHARTERED A USMC OCCUPATIONAL HEALTH MEDICAL SURVEILLANCE WORKING GROUP ON 21 JANUARY 2011 TO ADDRESS THESE CONCERNS. 1. Purpose. The Assistant Secretary of the Navy for Energy, Installations, and the Environment (ASN (EI&E) tasked the Chief of Naval Operations (CNO) and the Commandant of the Marine Corps (CMC) to develop a comprehensive Medical Surveillance Program Plan that will ensure the required medical surveillances are performed in the correct timeframe and provide oversight of its implementation. 2. Background a. ASN (EI&E) was informed by the Bureau of Medicine and Surgery (BUMED) that less than 33% of required Department of the Navy (DON) medical surveillances are completed and, according to a 2007 Center for Naval Analysis (CNA) study, the Department of Veterans Affairs (DVA) paid over $200 million for hearing loss claims to Navy and Marine Corps veterans in 2005, and that hearing loss claims continue to grow. b. Medical surveillance programs are designed to monitor the readiness of individuals who are required to work in areas where significant exposure to hazardous chemicals or physical agents occur. Successful medical surveillance programs provide an early indication of degradations in personnel readiness, disease, or body burden before actual illness, disease, or injury occurs. This allows for the timely implementation of corrective actions to prevent any long-term effects. c. The Marine Corps Occupational Safety and Health Program Manual, NAVMC DIR , Chapter 11, paragraph (2) states; “these programs shall be based on the industrial hygiene recommendations. The installation safety manager or unit safety officer shall ensure that affected Marine Corps personnel are entered in the medical surveillance program.” 3. Discussion a. There are numerous information technology systems being used to track and manage medical surveillance information depending on requirements and user needs. Some of these systems are as follows: Medical Readiness Reporting System (MRRS) Enterprise Safety Applications Management System (ESAMS) Armed Forces Health Longitudinal Technology Application (AHLTA) Defense Occupational and Environmental Health Readiness System (DOHERS) Hearing Conservation (HC) Advanced Skill Management System PC Matrix Web Enabled Safety System(WESS) b. The systems listed above do not all interface with one another and do not reach across the Services or the various user organizations. 4. Ongoing Efforts a. Established an Occupational Health Medical Surveillance Working Group (OHMSWG) chartered by the ACMC and oversight by the DMCS. The working group has: (1) Developed a list of current databases being used to track occupational health medical surveillance. (2) Mapped existing occupational health medical surveillance databases and how they are currently being used. (3) In the process of recommending a medical surveillance tracking system to be used by the Marine Corps. (4) MARADMIN 581/12 Occupational Health Medical surveillance Examinations Programs Tracking and Reporting released 11 October USMC requirements for tracking and reporting medical surveillance compliance rates using occupational health medical surveillance databases. (5) Provided a list of Medical Matrix Medical Surveillance Programs for adding to MRRS (6) Provided draft medical surveillance business rules for adding to MRRS (7) Provided example of report format to MRRS RC

USMC OHMSWG: THE USMC OCCUPATIONAL HEALTH MEDICAL SURVEILLANCE WORKING GROUP (OHMSWG) MEETS VIA TELECONFERENCE MONTHLY TO ADDRESS THE ISSUES DESCRIBED IN THE CHARTER AND THE POA&M. THE USMC OHMSWG INCLUDES THE FOLLOWING ORGANIZATIONS: HQMC HEALTH SERVICES (HS) COMMANDANT OF THE MARINE CORPS SAFETY DIVISION CMC (SD) HQMC PLANS, POLICY, AND OPERATIONS (PP&O) MARINE FORCES COMMAND HEALTH SERVICES MARINE CORPS INSTALLATIONS EAST NAVY AND MARINE CORPS PUBLIC HEALTH CENTER NAVY MEDICINE INFORMATION SYSTEMS SUPPORT ACTIVITY ASSOCIATE MEMBERS (BUMED, OPNAV 09F) RC

USMC OHMSWG: ALL FOUR OHMSWG POA&M ITEMS HAVE BEEN COMPLETED: USMC OCCUPATIONAL HEALTH MEDICAL SURVEILLANCE WORKING GROUP AND CHARTER ESTABLISHED LIST OF CURRENT DATABASES TRACKING OCCUPATIONAL HEALTH MEDICAL SURVEILLANCE COMPLETED IDENTIFIED OCCUPATIONAL HEALTH MEDICAL SURVEILLANCE DATABASE UTILIZATION RECOMMENDED MRRS FOR DATABASE INTEGRATION AND CONSOLIDATION (RECOMMENDATION EXECUTION HAS NOT ACHIEVED CONSENSUS) RC

COMPUTER SYSTEMS: THERE ARE FIVE PRIMARY COMPUTER SYSTEMS USED TO TRACK OCCUPATIONAL HEALTH MEDICAL SURVEILLANCE WITHIN THE USMC: ENTERPRISE SAFETY APPLICATIONS MANAGEMENT SYSTEMS (ESAMS) DEFENSE OCCUPATIONAL AND ENVIRONMENTAL HEALTH READINESS SYSTEM HEARING CONSERVATION (DOEHRS-HC) ADVANCED SKILLS MANAGEMENT SYSTEM (ASM) OCCUPATIONAL SAFETY AND HEALTH SYSTEM (OSHSYS) MEDICAL READINESS AND REPORTING SYSTEM (MRRS). ALL OF THESE SYSTEMS MEET SPECIFIC USER NEEDS AND WERE DEVELOPED FOR A SPECIFIC PURPOSE THESE SYSTEMS DO NOT CURRENTLY TRANSFER INFORMATION TO ONE ANOTHER ELECTRONICALLY RC

SHORT RANGE GOALS: COMMANDS SHALL USE EXISTING COMPUTER SYSTEMS AND SPREADSHEETS TO TRACK OCCUPATIONAL HEALTH MEDICAL SURVEILLANCE COMPLETION RATES UNTIL MEDIUM AND LONG RANGE SOLUTIONS ARE DEVELOPED. STATUS: ONGOING. REQUIREMENTS FOR TRACKING THESE RATES WILL BE DELINEATED IN A MARADMIN. STATUS: MARADMIN 581/12 RELEASED 11 OCT 2012. DEVELOP AN EXCEL SPREADSHEET REPORT TO ASSIST COMMANDS IN COMPILING BASELINE, PERIODIC, AND TERMINATION EXAMINATION COMPLETION RATES. STATUS: COMPLETED. EXCEL SPREADSHEET REPORT AVAILABLE TO COMMANDS VIA THE CMC SAFETY DIVISION WEBPAGE. STATUS: COMPLETED. 100% COMPLETION RATES FOR THOSE ENROLLED IN THESE PROGRAMS. COMMANDS THAT DROP BELOW 90% WILL BE REQUIRED TO DEVELOP A POA&M TO GET BACK INTO COMPLIANCE. STATUS: ONGOING AT COMMAND LEVEL. RC

MEDIUM RANGE GOALS: IDENTIFY A WEB-BASED CENTRALIZED MEDICAL SURVEILLANCE DATABASE SYSTEM TO TRACK ALL OF THE OCCUPATIONAL HEALTH MEDICAL SURVEILLANCE EXAMINATIONS LISTED IN THE MEDICAL SURVEILLANCE MATRIX AND BASELINE, PERIODIC, AND TERMINATION DATE FIELDS. STATUS: NO CONSENSUS ON SYSTEM. MEDICAL SURVEILLANCE DATABASE SYSTEM PROGRAMMED SO THAT EXAMINATION COMPLETION RATES PERCENTAGES ARE AUTOMATICALLY CALCULATED. STATUS: NO CONSENSUS ON SYSTEM. THE MEDICAL SURVEILLANCE DATABASE SYSTEM NEEDS TO WORK WITH THE COMPUTER SYSTEMS PREVIOUSLY LISTED SO THAT INFORMATION CAN FLOW FROM THEM ELECTRONICALLY.

DESIRED LONG RANGE OUTCOME: SEAMLESS SHARING OF DATA BETWEEN VARIOUS SYSTEMS SUCH AS SAFETY, PERSONNEL, AND MEDICAL PROVIDING USEFUL INFORMATION THAT CAN BE USED TO ENHACE THE WELL-BEING AND READINESS OF THE FORCE STATUS: VARIOUS EFFORTS IN EARLY STAGES OF MAPPING EXECUTIVE INFORMATION AND DECISION SUPPORT SYSTEM REQUIREMENTS AND PROCESSES. RC

RC

DISCUSSION: MEDICAL SURVEILLANCE PROGRAMS ARE DESIGNED TO MONITOR THE READINESS OF INDIVIDUALS WHO ARE REQUIRED TO WORK IN AREAS WHERE SIGNIFICANT EXPOSURE TO HAZARDOUS CHEMICALS OR PHYSICAL AGENTS MAY OCCUR. THE MARINE CORPS OCCUPATIONAL SAFETY AND HEALTH PROGRAM MANUAL, NAVMC DIR , CHAP 11, PARA 11001(2) STATES: “THESE PROGRAMS SHALL BE BASED ON THE INDUSTRIAL HYGIENE RECOMMENDATIONS. MARINE CORPS ORDER B UPDATED 28 JULY 2011, STATES: THE COMMAND GROUND SAFETY OFFICER OR MANAGER SHALL ENSURE THE FOLLOWING GROUND SAFETY COMPONENTS ARE ACCOMPLISHED; “BY NAME LIST OF PERSONNEL WHO REQUIRE MEDICAL SURVEILLANCE. A SUCCESSFUL MEDICAL SURVEILLANCE PROGRAMS PROVIDE AND EARLY INDICATION OF DEGRADATIONS IN PERSONNEL READINESS, DISEASE, OR BODY BURDEN BEFORE ACTUAL DISEASE OR INJURY OCCURS. THIS ALLOWS FOR THE TIMELY IMPLEMENTATION OF CORRECTIVE ACTIONS TO PREVENT ANY LONG TERM-EFFECTS. THE INSTALLATION SAFETY MANAGER OR UNIT SAFETY OFFICER SHALL ENSURE THAT AFFECTED MARINE CORPS PERSONNEL ARE ENTERED IN THE MEDICAL SURVEILLANCE PROGRAM.” THE LIST SHALL INCLUDE THE EXPIRATION DATES OF TRAINING AND CERTIFICATIONS AND BE PROVIDED TO THE RESPONSIBLE WORKPLACE SUPERVISORS.” RC

Strategies for Success OH Perspective

Strategies for Success OH Perspective
Assign responsibilities Supervisors – employee assessments Med Surv Program Manager – enrollment and tracking Train those responsible Medical Surveillance Program Processes How to find resources (Navy Safety Center Tool Box) Hold individuals accountable to sustain program Performance objective KE

Strategies for Success OH Perspective (cont’d)
Cultivate your multidisciplinary team - outreach Safety Personnel Workplace Supervisors Industrial Hygienists Occupational Health Nurse/provider Program managers such as licensing officers Ensure the IH survey data gets to the workplace supervisor and they know how to use Educate workers on why they are enrolled in surveillance programs and their responsibility Prioritize medical appointments – minimize “no-shows” as they impact on command readiness. KE

Strategies for Success Afloat Perspective
Presented by LCDR Chuck Wilhite, MSPH, CSP Force Safety Officer Commander, Submarine Forces Pacific Pearl Harbor, HI CW

Strategies for Success Afloat
By policy in OPNAVINST E, the ship’s Medical Department Representative (MDR) manages program MDR should contact division and gets names of personnel requiring medical surveillance exams MDR utilizes SAMMS to track personnel and works closely with supervisors to ensure exams/certifications are completed MDR takes advantage of opportunities to “corral” personnel to medical, (e.g., grab patients in p-ways, before holiday leave, etc.) CW

Polling Question #5 Do you feel you received sufficient training via IDC or PMT "C" School, Occ. Hlth. Nursing degree/INDOC, Occ. Medicine Residency, Safety Officer/Manager training, etc., to run an effective medical surveillance program? - Absolutely. I received everything I needed in school. - Yes. I did learn several things but I still had questions on a few items that I didn't fully understand. - Somewhat. I did learn a thing or two but didn’t fully understand the overall program, specific program elements, and/or how I could use the training to help me improve my program - No. My training did not cover this topic in enough detail CW

Strategies for Success Afloat (Cont’d)
MDR keeps a visual statistic sheet on bulkhead, above desk, to see where compliance % is at for each program Goal: 90% and above Post Medical Surveillance enclosure from IHS on bulkhead to identify personnel who require inclusion into occupational health PEs/certifications at check-in CW

Strategies for Success Afloat (Cont’d)
Above all else, take PRIDE in your work! Set the bar for all other ships/clinics you “compete” with Make it your goal to have the highest compliance rate of all your peers Be the best HM/PMT/Nurse you can be, attack challenges and find ways to solve compliance issues. Don’t settle for anything less! CW

Economic Decisions: Was it worth it?
Upon review of initial Medical Surveillance Data, the following was noted: Multiple shipyard workers were enrolled in Occ. Hlth. Medical Surveillance that didn’t need to be, (e.g., Respirator, Noise) An average of $250K/yr savings was noted when these personnel were dis-enrolled/shipyard. 2-3 Man-hours were saved by both the shipyard and medical clinics per worker. CW

Strategies for Success A Stakeholder Training Perspective
Presented by CDR John Porter, CIH Deputy Director Occupational Health and Industrial Safety Programs Naval Safety Center Norfolk, VA JP

Strategies for Success Stakeholder Training
Medical Surveillance Toolbox web page Frequently Asked Questions (FAQs) Certification Exam Guidance Matrix Program Quick Notes Supervisor’s Guide to Medical Surveillance Webpage is broken down into three sections: Medical Surveillance Tracking and Reporting; Training Resources; and Instructions. I’ll briefly highlight the following four items: FAQs; Certification Examination Guidance Matrix; Program Quick Notes; and the Navy Safety and Supervisor’s Guide to Medical Surveillance. JP

Polling Question #6 Are you familiar with/have you used any of the resources located on the Naval Safety Center’s Medical Surveillance Toolbox? - Yes, and I found it helpful - Yes, but I didn’t find it helpful - No, but I had heard of it - No, I’ve never heard of it until now JP

JP FAQs document screen shot.
Lists questions that we received from all levels of stakeholders during the reporting initiative. The thought is that if one person had the question then more likely do as well. JP

Navy Certification Guidance Matrix (Navy Safety Center Med Surv Toolbox) Certification Examination Name Certification Program Applicability Guidance Periodicity Afloat Military Afloat Civilian Ashore Military Ashore Civilian AVIATION Y N/A < Age 50: every 5 years > Age 50: annual BARBER AND BEAUTY SHOP EMPLOYEES Preplacement Baseline CHILD CARE WORKER Annual DIVER/HYPERBARIC WORKER Diver Candidates: Upon application to diving duty Designated Divers: < Age 50: every 5 years > Age 50 < Age 60: every 2 years > Age 60: annual EXPLOSIVE HANDLER < Age 60: every 5 years > Age 60: annually EXPLOSIVES VEHICLE OPERATORS Civilians: < Age 60: every 2 years > Age 60: annual Active Duty Military: every 5 years FIREFIGHTER (COMPREHENSIVE) Annual This exam incorporates many elements from several other certification exams. See the "Medical Matrix" for more information. FOODSERVICE PERSONNEL Preplacement FORKLIFT OPERATOR < Age 60: every 5 years > Age 60: annual FREON (HALOALKANE) WORKERS See Comment #1 HAZARDOUS WASTE WORKERS AND EMERGENCY RESPONDERS HEALTH CARE WORKERS (HCWs) MOTOR VEHICLE OPERATERATORS (DOT) See comment #2 N Every 2 years MOTOR VEHICLE OPERATOR (OTHER THAN DOT) See comment #3 Every 4 years NAVAL CRIMINAL INVESTIGATIVE SERVICE < Age 37: every 3 years 38 to 40 years of age: every 2 years > Age 41: annual POLICE/GUARD SECURITY RESPIRATOR USER CERTIFICATION EXAM See comment #4 Civilians: Age 15 to 34: every 5 years Age 35 to 44: every 2 years >Age 45: annual SCBA user: annual Military: See comment #4 SUBMARINE DUTY Active duty submarine qualified: Every 5 years Everyone else: Prior to embarkation on submarine WASTEWATER/SEWAGE WORKER Every 5 years WEIGHT HANDLING EQUIPMENT (MANAGEMENT OF) Note: Applies to crane Operators WELDERS/BRAZERS/NON-DESTRUCTIVE INSPECTION TECHS Why is this Guide Important? Remember when we talked earlier about the CY12 Composite Report Summary and the Top 25? Well over half of the Top 25 examinations were Certification exams. This guide was developed to help raise supervisors and program managers awareness of these exams. Most medical surveillance recommendations come from the industrial hygiene survey, but most surveys do not include certification exams in their medical surveillance recommendations. This guide will help supervisors by: 1) raising their awareness that these exams exist for certain job titles and 2) allowing them to see which workers afloat and ashore or military and civilian are required to receive these exams. JP

This Quick Notes is intended to help afloat program managers get a basic awareness of the program and to know where they can turn for support. JP

Screen shot of the Navy and USMC Safety and Supervisor’s Guides to Medical Surveillance.
These documents can be downloaded from the Naval Safety Center and from the USMC Safety Division websites. Naval Safety Center: Safety Division: JP

Briefly go over TOC. NEXT SLIDE JP

Management Resources Supervisor’s Medical Surveillance and Certification Exam Referral form SECNAV 5100/1T Designed to improve deficient areas Identification of personnel Enrollment in appropriate program(s) Documentation of exam completion and disposition Communication between stakeholders within a command and between command and OH clinic The Supervisor’s Medical Surveillance and Certification Exam Referral form is intended to address many of the deficiencies identified during the Navy and Marine Corps’ medical surveillance reporting initiatives. The form was designed to improve documentation and record-keeping at the command level, as well as to improve communications between critical stakeholders (worker, supervisor, safety, medical (when applicable)) as well as between the command stakeholders and their supporting OH clinic. The form fields document the information which is critical to good program management: Who is the worker What medical surveillance exam(s) do they require Who are the command POCs (supervisor, safety) whom the supporting clinic can communicate with What exams were performed and when When is the next exam(s) due What are the general results of the exam (was there a problem? If so, how does it need to be addressed) All of these elements are critical in running a good program and to properly protect the worker by identifying physiological changes resulting from potentially hazardous exposures as early as possible. JP

DEMONSTRATION Supervisor’s Medical Surveillance and Certification Exam Referral Form (SECNAV 5100/1T) Presented by Kathleen Edwards, BSN, COHN-S Occupational Medicine Program Manager Navy Medicine West San Diego, CA Ask the room moderator to pull the form up and to share their computer screen with the attendees. Start off by informing the group that the “T” in the form’s designation means “Test”. The “T” will fall off of the form designation once it’s signed into policy and it will become simply SECNAV 5100/1. So, if they see a form designated SECNAV 5100/1 in the near future, it’s not a different form, it’s actually the same one we’ll talk about today. Give a brief demonstration on what the form looks like, what information it’s intended to document, and the various capabilities it has to maximize data accuracy and communications. Place special emphasis on how to use the pulldown menus in Block 3, how to sign with a digital signature, and how to to other stakeholders. Be sure to inform the viewers that the form can be printed out and hand-carried if that’s the only communication method available, however, it was primarily designed to be communicated electronically. KE

POLLING QUESTION #7 Have you utilized the SECNAV 5100/1T form to help you document and track medical surveillance requirements for your command or to support your customers? Yes, I’ve used it and it worked well Yes, I’ve used it but it didn’t make the program management more effective No, I’ve not used it but I’m very interested in doing so JP

SECNAV 5100/1T Form- The Way Ahead
Planned for incorporation into SECNAV safety policy Policy will require services to utilize form Incorporated into OPNAVINST H draft A SECNAV ALNAV is being developed as a short-term measure This will require use of the form starting in the near-term Use of the form by both services will be required when SECNAV K is finalized and signed. The Navy is already incorporating a requirement for the form’s use into the draft OPNAVINST H update. Both of the aforementioned instruction drafts will take time to complete and undergo the required levels of review. To address this, DASN Safety plans to release a SECNAV ALNAV that places the requirement on both services to use the form. This will likely happen within the next several months. An ALNAV is a message from SECNAV to the Navy and Marine Corps which can be informational or directive. In this case, it would be directive. The ALNAV and instruction requirements will require use of the form by commands as well as their supporting OH clinics. i.e. everyone will have to use the form to document medical surveillance requirements and actions taken. Commands and clinics will have several options available on how they communicate the form: Electronic communication will be required when feasible. This can include (encrypted is recommended) or communication through an electronic system such as ESAMS. ESAMS has been updated to incorporate the form’s data fields so that ESAMS users can assign medical surveillance to their personnel. OH clinics can coordinate access to their customers’ ESAMS profiles (work with HGW) and can then input their updates into the appropriate customer’s profile Commands and clinics who coordinate use ESAMS in this manner (by both parties) will meet the necessary requirements (i.e. they don’t have to use the actual form) If a command and their supporting clinic decide not to use ESAMS this way, then they must use the form They may use another electronic system as long as that system documents all of the form’s data fields Some commands and clinics may not be able to communicate the form data electronically. In these cases, a hardcopy of the form may be used. We strongly encourage commands and clinics to begin identifying which communication method will work best for them. JP

Open Discussion All

Thank you for Attending!!
JP

Occupational Health Medical Surveillance Session

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