1. Flight Doc RSV
Part 1: 3 Steps for a Base-level Flight Doc to Improve an Occ Health Program
Part 2: Air Force Mold Policy
Part 3: Flight Surgeon Shop Visits
Part 4: When pilots get hit with lasers
Last updated: 21 July 2015

2. Maj Mark Paine NGB/SGPB
Part 1: 3 Steps for a Base-level Flight Doc to Improve an Occ Health Program
Maj Mark Paine
NGB/SGPB

3. 3 Steps to Improve Show up to shops
Ask BEE to pull OEHEDs directly from DOEHRS
Are any fields empty?
Is there any contradictory or senseless info?
Know difference between a “SEG” and a “shop”
Allows you to answer this question: How many SEGs should we have per shop?

4. Step 1: Show up to shops

5. Show up to shops Have BEE invite you every time they go out
Airmen love seeing their doc in the shop
Improves the atmosphere for BEE
In contrast, BEE may be viewed as “inspectors” and not welcome

6. Step 2: Require BEE to pull OEHEDs directly from DOEHRS

7. Occ Health Data Flow BEE (Collect Data) Public Health (Analyze Data)
Flight Doc
(Final decision)

8. Occ Health Data Flow
I just completed a shop visit. I will communicate what I found with an Occupational and Environmental Health Exposure Data (OEHED). We used to call them “2755s”
BEE
(Collect Data)
Public Health
(Analyze Data)
Flight Doc
(Final decision)

9. Occ Health Data Flow Chart
Should I turn in an OEHED from Microsoft Word or DOEHRS?

10. No Choice—BEE must use DOEHRS
Note: DOEHRS is the OEH-MIS

11. 3 Most Common Excuses on why OEHEDS are still pulled from Word
“my flight doc only accepts OEHEDS from Word”
“we need specialized training, funded by the NGB, in order to pull OEHEDS from DOEHRS”
“we don’t need to use DOEHRS because we passed the last inspection using OEHEDS from Word”

12. Why DOEHRS is better than Word, practically speaking
BEE is required to have good data in DOEHRS
BEE can have NO data in DOEHRS and still turn in a professional-looking OEHED in Word
A BEE MUST have good data in DOEHRS if they submit an OEHED from DOEHRS
Because bad DOEHRS data means the OEHED will have blank spots and look silly
It’s embarrassing for a BEE to give Public Health & Flight Docs blank/silly OEHEDs

13. Bottom line: Mandate OEHEDS from DOEHRS
It’s required by AF policy
It forces BEE to do good work in DOEHRS

14. Step 3: Know the difference between a Similar Exposure Group (SEG) and a Shop

15. Shop Shop: A collection of processes…not people Shop Process 1
Hazard(s)
Control(s)
Process 2

16. Similar Exposure Group (SEG)
SEG: A collection of people
SEG
Airman 1
Airman 2
Airman 3

17. How does a shop link to a SEG? Through a process
A process gets linked to a SEG

18. Why is it important to link processes and SEGs?
It enables a risk assessment
Note that the same process can be linked to two different SEGs. It’s possible that the risk will vary, based on the parameters of the SEG.

19. Example 1: Multiple SEGs for 1 Shop
Processes
SEG
Structural Maintenance
Painting
Structural Maintenance Painters
Sanding
Structural Maintenance Sanders
Machining
Structural Maintenance Machiners
Unlikely Scenario

20. Example 2: Multiple Shops for 1 SEG
Processes
SEG
Vehicle Maintenance
Painting
Painters
AGE
Corrosion Control
Unlikely Scenario

21. Common Scenario Example 3: 1 SEG for 1 Shop Shop Processes SEG
Structural Maintenance
Painting
Sanding
Machining
Common Scenario

22. Common Scenario Example 4: 2 SEGs for 1 Shop Shop Processes SEG
Structural Maintenance
Painting
Full time equivalents
DSGs
Sanding
Machining
Common Scenario

23. ANG Occ Health Point of Contention
Should ANG BEEs divide their shops into two SEGs, one for full-time equivalents (FTEs) and one for drill-status Guardsmen (DSGs)? Answer: It’s up to the OEHWG. NGB/SGPB is not able to set a policy.

24. “Editorial”
Disclaimer: this is only the opinion of one BEE, and is not policy. Only an OEHWG can decide how many SEGs a shop will have.
Initially have one SEG per shop. After an IH program matures, break DSGs into a separate SEG. An IH program is mature when your BEE has enough quantitative data to articulate the different risk to FTEs and DSGs.

25. Trick Question Does an OEHED apply to a SEG or a shop?
The answer is SEG

26. Trick Question Does an OEHED apply to a SEG or a shop?
The answer is SEG

27. Questions

28. Part 2: Air Force Mold Policy
Maj Mark Paine
NGB/SGPB

29. References
10 May 2005 memo from HQ USAF/ILE/SGO titled “Interim Policy and Guidance for the Prevention, Surveillance, and Remediation of Water Damage and Associated Mold Contamination in Air Force (AF) Facilities”
AFRL-SA-WP-SR titled “Bioenvironmental Engineer’s Guide to Indoor Air Quality Surveys”
Both references are on the AFMS KX and the NGB/SGPB Bioenvironmental Engineering Sharepoint site (Under “Important Documents”)
Also see Chapter 4 and Appendix A of

30. Key Points No mold testing (unless physician requests it) Key players
CE (HVAC and/or Operations)
Facility Manager
Bioenvironmental Engineering
Mold = Moisture AND Moisture = Mold
Limited regulations…but AF has mold policy
The AF mold policy works…very well

31. Physician’s Role (Mold Policy, Attach 2, p. 5)
1. Initiate Occupational Illness Investigations “If the medical provider believes the symptoms are related to the building, then they should send an AF Form 190, Occupational Illness/Injury Report, or SF-513, Medical Record - Consultation Sheet through PH.” 2. Request BEE to sample (rare in the AF). Request must include exactly what type of mold to sample for and how the results will be interpreted. “Mold sampling should only be accomplished as the result of consultation with the physician/health care provider and an occupational medicine physician or allergist in order to provide information that supports a specific clinical diagnosis or aids in medical treatment.”

32. BEE Role
Never, ever get involved with a mold issue without CE and/or the facility manager
Conduct a visual inspection
Visible mold
Visible moisture damage
Typical actions/recommendations
Eliminate the source of moisture
Remediate in accordance with mold policy
May issue a risk assessment code (based on AF Mold Policy, not regulations)

33. Remediation Examples (Mold Policy Attachment 4)

34. Summary Visual inspections only Mold = moisture
Physicians: recommend investigations
BEEs: recommend to follow mold policy and maybe issue a RAC based on mold policy
CE and facility manager: remediate

35. Maj Mark Paine NGB/SGPB
Part 3: Flight Surgeon Shop Visits (AFI , Flight and Operational Medicine Program (FOMP))
Maj Mark Paine
NGB/SGPB

36. Requirement 1 (not for ARC)
At bases with stand-alone Occupational Medicine (OM) clinics, FSs will work with OM clinic staff to maintain clinical competency regarding occupational health exams and industrial shop visits. (Not applicable for the ARC)

37. Requirement 2
In-Garrison Operations: … “providers should operate at a reduced Full Time Equivalent (FTE) standard with the expectation that the provider team spends up to 50% of their work time outside of the standard clinical setting. The out of office time will be spent interacting with Line personnel, advising the line commander and performing shop visits to better understand and support the occupational/operational stressors in these unique work areas.”

38. Requirement Summary Perform shop visits Interact with Line personnel
Advise line commanders
Better understand and support the occupational/operational stressors

39. How to Visit a Shop Ask BEE to let you know when they go to a shop
You won’t be able to go every time…that’s ok
Ask BEE to walk you through certain shops
Maybe all Cat I shops
Prior to an inspection, BEE usually walks through all shops…ask to go with them

40. Which shops to visit CATM Corrosion Control/Structural Maintenance
Cat I shops
Cat II shops
Any shop you are concerned about

41. Prepare for a Shop Visit
ESOH Service Center Website
Google
Print a copy of the OEHED
If you don’t have time to prep
Go anyway
Ask the Airmen how they are doing

42. What to do in the shop?
Every flight doc has their own style…no single “correct” way to do a shop visit
Validate the information on the OEHED
Listen to the BEE discussion with the Airmen and interject as appropriate
Ask checklist-style questions (see next slide)
If all else fails, say “please let me see your PPE”…it’s a great conversation starter

43. Checklist-style Questions
Reference: “ABC of Occupational and Environmental Medicine” (Snashall & Patel, 2003)

44. Notes
It’s rare to observe processes…you are more likely to talk about processes and then look at the equipment
If you don’t see air sampling on an OEHED, but you think air sampling should be done…then ask the BEE to do it

45. Ear Muffs/Plugs Rules of Thumb
Rating system is NRR
Rule of thumb: 29 and up is good for plugs, 33 is max
Rule of thumb: 28 and up is good for muffs, 30 is max
For double plugs/muffs: take higher NRR and add 3…you don’t add both NRRs together
Common problems
Shops buy cheap muffs that have low NRRs
Shops don’t wear their hearing protection
Rare to find PPE that would be ok if it were 1 NRR higher

46. Noise Surveys Noise source surveys Noise dosimetry
Can be done quickly
Measures levels of noise produced
Purpose: to determine effective PPE
Noise dosimetry
Takes days
Measures levels of noise received by workers
Purpose: to determine if audiograms are needed
Rule of thumb: If you have no intention of removing a shop from the hearing conservation program, then noise dosimetry is a lower priority…air sampling may have a bigger payoff

47. Air Sampling Likely, you won’t find much evidence of it
Total Force problem
Ask your BEE if you would like to see more
Common limiting factors
BEE doesn’t have the supplies on hand
Shop does the process infrequently
BEE doesn’t know when the shop does the process
Lack of familiarity with air sampling or with DOEHRS air sampling process

48. Part 4: When Pilots get hit with Lasers
Follow procedures in the USAFSAM Laser Injury Guidebook
Fill out the incident form online at the ESOH Service Center website

49. When Pilots get hit with Lasers
Follow steps in Section 2.0 of AFRL-SA-WP-SR , USAFSAM Laser Injury Guidebook, available on the ESOH Service Center website:
3 pages of instructions
External examination, near visual acuity test, far visual acuity test, Amsler grid test, examine pupils, perform optic vision tester depth perception test if available, color vision exam, and if available a slit lamp evaluation, retinal exam, and look for vitreoretinal hemmorate, chorioretinal lesions, and consider optical coherence tomography

50. When Pilots get hit with Lasers
BEE or Flight Doc needs to fill out a form on the ESOH Service Center website:
Note: A blank form is on the next slide

52. Summary Follow the procedures in the Laser Injury Guidebook
Fill out the incident form online

53. Exam Question #1/4
How should Occupational and Environmental Health Exposure Data sheets (OEHEDs) be generated?
Microsoft Word
Microsoft Excel
They are not an Air Force Requirement
Defense Occupational and Environmental Health Readiness System (DOEHRS)

54. Exam Question #2/4
What is the investigation technique specified for mold in the Air Force mold policy?
Air sampling
Visual inspection
Surface sampling
Radiofrequency sampling

55. Exam Question #3/4
The most effective thing to bring on an occupational shop visit is:
Stethoscope
Flashlight
Copy of the shop’s OEHED
NIOSH Pocket Guide

56. Exam Question #4/4
What do you do when a pilot has been hit with a laser?
Fill out an incident form on the ESOH Service Center website
Perform medical procedures in the USAFSAM Laser Injury Guidebook
Both A and B
Neither A nor B

57. Answers
1-D
2-B
3-C
4-C