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Concentra has expanded with a new medical center in Chattanooga! Learn more in
our press release.

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WHAT IS MEDICAL SURVEILLANCE?

Michelle Hopkins
 * 
 * 
 * 



Medical surveillance, as required by the Occupational Safety and Health
Administration (OSHA), is a program of medical examinations and tests designed
to detect and monitor potential health effects from hazardous chemical or
physical exposures in the workplace to enable early treatment or other steps to
protect employee health. Medical surveillance is conducted in conjunction with
other employer measures – such as workplace practices and engineering controls –
to prevent occupational injury and illness. American employees use tens of
thousands of chemicals every day. While many of these chemicals are suspected of
being harmful, relatively few chemicals are regulated in the workplace.

As a result, employees suffer more than 190,000 illnesses and 50,000 deaths
annually related to chemical exposures.1 Workplace chemical exposures have been
linked to cancers and other lung, kidney, skin, heart, stomach, brain, nerve,
and reproductive diseases. Regulated substances are subject to numerous rules,
such as:

 * Permissible exposure limit (PEL) – The legal limit for employee exposure to a
   regulated chemical substance. This limit is the airborne workplace
   concentration of a substance frequently expressed as a time-weighted average
   over an eight-hour day or a 40-hour work week. Many PELs have not been
   updated since 1971, and current scientific data suggest that, in many
   instances, the outdated PELs are not sufficiently protective of employee
   health. The required resource-intensive analysis has slowed the PEL
   rulemaking process to a crawl. Since 1971, OSHA has been successful in
   establishing or updating PELs for only about 30 chemicals.
 * Action level – This is what OSHA uses to determine whether the employer must
   offer employees medical surveillance and increased exposure monitoring.
   Action level pertains to employee exposure, without regard to the use of
   respirators, to an airborne concentration of a substance, averaged over an
   eight-hour period.
 * Excursion limit – The limit on the time an employee’s exposure during a
   single workday may exceed the PEL or time-weighted average. Excursion limits
   are enforced in some states and, on the federal level, for asbestos.

Concentra® provides compliant medical surveillance evaluations that meet OSHA
requirements. In addition, Concentra can provide recommendations to go beyond
OSHA’s minimum requirement for all major workplace exposure monitoring,
including, but not limited to:

 * Hazardous waste operations and emergency response
   OSHA Standard 1910.120
 * Respiratory protection
   OSHA Standard 1910.134
 * Asbestos
   OSHA Standard 1910.1001
 * Beryllium
   OSHA Standard 1910.1024
 * Bloodborne pathogens
   OSHA Standard 1910.1030
 * Respirable crystalline silica
   OSHA Standard 1910.1053


MEDICAL SURVEILLANCE: FIRST STEPS

Before turning attention to medical surveillance physical exams and testing
services you might need, there are four steps that help in creating a medical
surveillance program. These can be done either by the employer alone or while
working with an occupational health provider, like Concentra.

 1. Determine which hazardous substances exist in your workplace.
    This step includes hazard analysis of the substances used as a necessary
    part of production processes or hazardous substances that are a byproduct of
    your operations. Employers may either work with an industrial hygienist or
    perform their own area and personal monitoring of identified hazards to
    determine if the measured levels expose employees to health and safety risks
    or meet OSHA requirements for medical surveillance.
    
    
 2. Become familiar with the pertinent OSHA regulation(s).
    OSHA regulations will outline the permissible exposure limit (PEL) and
    action levels (ALs), as well as the medical screenings or surveillance
    measures that must occur at each level. Many employers choose to go above
    and beyond OSHA’s minimum requirements and use more up-to-date exposure
    levels provided by the National Institute for Occupational Safety and Health
    (NIOSH) and the American Conference of Governmental Industrial Hygienists
    (ACGIH).
    
    
 3. Determine the necessary components of your medical surveillance program,
    including examinations and tests.
    Every substance has unique properties and every employee group can be
    different, so the details that need to be considered to protect employee
    health are complicated.
    
    
 4. Identify employees who need medical surveillance and communicate key aspects
    of the program to them.
    You are probably familiar with OSHA’s basic requirement that employers must
    provide a safe workplace free from recognized hazards, provide safe and
    well-maintained tools, equipment, and protective gear, and offer safety
    training that all employees can understand. Reviewing these Employer
    Responsibilities is a good idea.
    
    You should also be aware that OSHA outlines employer responsibilities
    regarding medical surveillance and employees’ access to medical and exposure
    records. Employers are required to:
    * Preserve and maintain accurate medical and exposure records for each
      employee. In general, the Americans with Disabilities Act requires
      employee medical information to be kept confidential.
    * Inform employees of the existence, location, and availability of medical
      and exposure records.
    * Give employees any informational material that OSHA makes available to
      you.
    * Make records available to employees, their designated representatives, and
      to OSHA, as required.

Without a doubt, these four “first steps” in creating a medical surveillance
program are a heavy lift for many employers. The good news is you don’t have to
do it alone. Concentra has been providing medical surveillance examinations and
other occupational health programs and services for more than 40 years. All of
our medical centers, currently in 44 states, are ready to serve you. When you
contact Concentra, you can set up your medical surveillance examination services
faster than going it alone and with assurance of full compliance. 


MEDICAL SURVEILLANCE FOR THE GROWING THREAT

Manufacturers and importers of chemicals listed on the Toxic Substances Control
Act inventory – and meeting certain thresholds – are required to report this
information to the federal Environmental Protection Agency (EPA) every four
years. The EPA released its latest report (the 2016 Chemical Data Reporting) in
stages. It shows production/use of 8,707 chemicals, with 4,917 sites and 2,247
companies reporting.2 This is up from 7,970 chemicals in the last report four
years earlier.

OSHA medical screening and surveillance standards address numerous hazardous
substances – including a variety of chemical compounds, such as metal oxides,
aromatic amines, industrial agents and solvents, and more. Concentra provides
medical surveillance examination services that also include silica dust,
bloodborne pathogens and, although there is no federal standard, exposure to
heat.

Concentra develops guidelines, interprets regulatory standards and laws, and
fulfills compliance requirements for all regulated exposures pertinent to the
employers and industries we serve. This includes respiratory protection,
bloodborne pathogens, asbestos, lead, beryllium, crystalline silica and a host
of other exposures.

We continuously update our guidance documents for clinicians in Concentra
community-based medical centers, and also offer recommendations for specific
worksite examinations, such as Hazmat, Firefighter, Law Enforcement Officer, and
Commercial Driver. You can read about the components of each of our physical
exams in our article, “What does a physical consist of?”

Concentra provides a range of medical surveillance services:

 * Baseline surveillance exams
 * Follow-up exams (for pesticides only)
 * Periodic surveillance exams
 * Biologic monitoring
 * Exit exams upon leaving an employer

For respiratory protection, Concentra uses the mandated OSHA Respirator Medical
Clearance Evaluation Questionnaire and recommends a targeted physical exam. In
addition, if indicated, the evaluating clinician may conduct ancillary tests
(spirometry, chest X-ray, or resting electrocardiogram).

After reviewing the questionnaire responses, conducting a physical exam, and
reviewing test results, the clinician will provide a written medical opinion to
the employer to address the employee’s ability to wear a respirator. Concentra
also provides respirator fit tests to ensure the respirator fits well for
adequate protection.


CONCENTRA’S UNRIVALED EXPERTISE

Concentra has a resource for medical surveillance that other occupational health
providers lack. It’s our Regulatory, Testing, and Examination (RTE) Medical
Expert Panel (MEP), a team of clinicians and colleagues with special expertise
that focuses on keeping the employers we serve up-to-date on the latest medical
surveillance requirements and compliance.

The RTE Medical Expert Panel is chaired by Ronda McCarthy, MD, MPH, FACOEM,
Concentra’s national director of medical surveillance services. Dr. McCarthy’s
renown in medical surveillance is seen in journal publications of her original
research, national and international speaking engagements, and her leadership
roles in health care, scientific, academic and professional forums focused on
medical surveillance and occupational health for 20 years. Dedicated to
workforce health and safety, Dr. McCarthy works closely with other members of
the RTE Medical Expert Panel, including clinicians, a safety representative, and
a representative from Concentra’s product development team.

--------------------------------------------------------------------------------

 1. Transitioning to Safer Chemicals: A Toolkit for Employers and
    Workershttps://www.osha.gov/dsg/safer_chemicals/index.html. This number is
    derived using the methodology from "Green Chemistry in California: A
    Framework for Leadership in Chemicals Policy and Innovation,"
    
 2. 2016 Chemical Data Reporting Results, U.S. Environmental Protection Agency.
    Accessed September 30, 2019.






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 * Select Medical Holdings Corporation Announces Pricing of Concentra Group
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 * Concentra Expands to Chattanooga, Tennessee
 * Concentra Adds Advanced Primary Care to Close Health and Wellness Gap in the
   Workplace
 * Workplace Safety in the Digital Age
 * Why Proper-fitting PPE Matters
 * Concentra Adds Behavioral Health to Telemedicine Service for Workers’
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