Occupational medicine: CURRENT ROLE IN EMERGENCY MEDICINE

1. Ma. Gia Baquiran- Sison, MD MOH DPCOM Diplomate, Philippine College of Occupational Medicine Consultant, World Health Organization, Western Pacific Region Medical Director, Meralco Corporate Wellness Center Consultant, Makati Medical Center Masters in Occupational Health, University of the Philippines Manila Masters in Occupational Medicine, University of Illinois Chicago Occupational medicine: CURRENT ROLE IN EMERGENCY MEDICINE

2. Outline of Presentation • Definition of the practice of Occupational Medical • The Role of Emergency Medicine in Occupational Medicine • Global trends and Conditions that affect Occupational Medical Practice • Local trends in Occupational Medicine in the Philippines • Emerging health trends in the workplace • Conclusion and Recommendations

3. What is the practice of Occupational Medicine? • Occupational Medicine is a medical discipline that emphasizes prevention and deals clinically and administratively with the health needs of both individuals and groups with respect to their working environment and includes recognition, evaluation, control, management and rehabilitation of occupationally-related diseases and injuries.

4. Role of ER Medicine in Occupational Medicine • 1985: ACEP established the Occupational Medicine Committee to evaluate and develop the role of the ER physician in Occupational Medicine. • 1986: ACEP defined 6 areas of Emergency Medicine which is inclusive of an area in Occupational Medicine

5. Role of ER Medicine in Occupational Medicine • ACEP statement: “ The ER physician with additional qualifications and/or special competencies may engage in the provision of initial care and continuing Occupational Medicine services including illness and injury prevention, case management and patient rehabilitation.

6. Initial Management of Patients at the ER presenting with a Work-related Injury or Illness • Established policy of ACEP last 1998 • Delineates ER physicians’ responsibilities in the following areas: • Provision of emergency evaluation and treatment • Determination of medical causation • Establishment of physical limitations • Communication with the employer • Arrangement of appropriate follow-up care

7. Global Trends and Conditions Affecting Occupational Medical Practice • Migration of Industry to developing countries • Migration of workers – OFW’s, seamen • Increase in the Business process outsourcing ( BPO) business • Demographic changes in nearby countries • Emerging new diseases and conditions • Increased Travel

8. Top Outsourced Industries in the Philippines • Manufacturing Industry – microchips, cars, telecommunication equipment • Agricultural Industry – pineapple, vegetable oil, biofuels • Service Industry – BPO (call centers), medical transcription and coding, accounting/billing • Health Services – medical tourism • Retirement Industry

9. Local Trends in Occupational Medicine in the Philippines • Increase in BPO companies (call centers) – SHIFT WORK problems • Computer chip industry relocations • Heavy industries (shipbuilding, oil refineries) to Export processing zones • Outsourcing of health services by companies • Growth of HMO’s and health plans • Enforcement of Occupational Health Laws as mandated by the Department of Labor and Employment

10. Philippine Labor Standards in the Occupational Health Practice • Based on Rule 1960 of the DOLE-BWC Standards in Occupational Health and Safety and the Philippine Labor Code • In all workplaces where there is more than 1 work shift in a day, the employer shall in addition to the requirements of the rule, provide the services of a fulltime first-aider for each work shift. • Workers 10-50: first aider • 50-200: full time registered nurse • 201-300: full time RN, parttime MD, parttime dentist • 301 above: full time RN, full time MD, full time dentist

11. EMERGING HEALTH TRENDS IN THE WORKPLACE

12. General Features • Work as one of the causes. • Both workers and non-workers are affected. • Increase in the NCDs (diabetes, hypertension, coronary artery disease in the young) • Has impact in health cost utilization • Emphasis must always be towards the preventive side and fitness to work should be highly considered.

13. Top Occupational Health Issues in the Workplace • Infectious diseases • Bronchial asthma • Skin diseases • Cardiovascular diseases • Gastrointestinal-related diseases • Cataract, deafness • Acute poisoning Based on the Philippine National OSH Profile, Sept. 2010

14. Occupational Health Issues in the Business Process Outsourcing • Increasing number in NCDs (diabetes, hypertension in the young) • Shift work related health issues • Ergonomic-related health issues such as Repetitive Strain Injuries (RSI) • Psychosocial factors (job satisfaction, personality traits, perception of intensified workload, job control)

15. Sample Shift Schedules in the BPO Industry • 8 hour shift/ 37.3 hours per week/ 6 days on, 3 days off • 10 hour shift/ 40 hours per week/ 6 days on, 1 day off • 24 hours shift/ 56 hours on the average per week/ 7 days on but rotated every 9 days

16. Re-Emerging Health Issues in the Workplace • Increase in HIV-AIDS • Increase in Respiratory diseases, UTI, Gastrointestinal-related diseases, Cardiovascular diseases • Persistence of Obesity as number one in annual physical examinations • Resurgence of PTB • Substance abuse

17. Sample health profile of COMPANY x

18. Demographics: Population

19. Demographics: Gender

20. Demographics: Marital Status

21. Demographics: Age

22. Demographics: Body Mass Index (BMI)

23. Demographics: BMI by Gender

24. Demographics: BMI by Age

25. Smoking History

26. Smoking History by Age

27. Drinking History

28. Drinking History by Gender

29. Drinking History by Age

30. Prevalent Illnesses based on Annual Physical Examination

31. Medical Conditions by Gender

32. Medical Conditions by Age

33. Medical Conditions by Drinking History

34. Medical Conditions based on Smoking History

35. Top Illnesses based on Doctors’ Diagnosis • Acute Tonsillopharyngitis • Upper Respiratory Illness • Gastrointestinal-related Disorders • Tension Headache/ Migraine • UTI • Hypertension • Conjunctivitis • Musculoskeletal strain • Systemic Viral Illness • OB-related

36. Top Reasons for ER Conduction • Gastrointestinal-related disorders • Cardiovascular-related disorders • Respiratory-related • Pregnancy-related • Asthma • Accidents • Anaphylaxis

37. Top Reasons for Sent Home Cases • Conjunctivitis • ATP • GI-related Disorders • URTI • Tension Headache/ Migraine • Systemic Viral Illness • Hypertension • Musculoskeletal disorders • Dental-related disorders • UTI

38. Occupational-related Contributing Factors • Repetitive activities • Shiftwork-related • Forceful exertion • Awkward/static posture • Temperature extremes • Localized mechanical stress • Lifestyle-related factors such as eating habits, smoking and drinking

39. New Trends in Occupational Health • To predict individual susceptibility to a substance/ certain disorders • To estimate internal exposure or early biological effects by molecular bio- markers or biological monitoring • Monitor exposure especially for carcinogens like toluene and pesticides

40. New Trends in Occupational Health • Introduction of Medical Case Management • Fitness for Work specialty • Enforcement of health and wellness programs in the workplace

41. References in Occupational and Environmental Health • Medline via PubMed: www.ncbi.nlm.nih.gov/entrez/query.fcgi • TOXLINE and Hazardous Substances Data Bank: http://toxnet.nlm.nih.gov/index.html • IRIS (Integrated Risk Information System): toxic doses of substances in the environment • NIOSHTIC-2: www.2a.cdc.gov/nioshtic-2

42. CONCLUSION Knowledgeable in global trends and their effects on Occupational Medical Practice Recent trends and developments in Occupational and Environmental health Managed care and its tools to ensure quality of care and cost-effectiveness Medical professionals should be advocates of change in the workplace and be of GOOD influence to patients/workers

43. THANK YOU