Occupational health providers are resources for their clients regarding issues in the workplace. With the current threat of bioterrorism, occupational health providers need to be aware of programs that are, or will soon be, available to assist them with this problem. In addition, for those providers who are hospital-based and JCAHO-accredited, the Joint Commission on Accreditation of Healthcare Organizations issued an advisory letter in late 2001 outlining emergency management standards. While several months have passed since the events of September 11th, the threat of bioterrorism remains. On January 31, 2002 Secretary of Health and Human Services Tommy Tomkins began distributing more than $1 billion to states and cities to improve the public health system’s preparedness for bioterrorism. The Secretary said it was "the largest one-time investment in our nation’s public health system ever."

This article will serve as a guide to the Internet resources that are available to help occupational health providers with the evolving needs of their clients in the area of bioterrorism and other hazards in the workplace. Providers will need to visit these sites to remain updated in order to be able to advise employers and other physicians on this issue.

The American College of Occupational Health and Environmental Medicine (ACOEM) has established a web site that is an extensive resource for occupational health providers who are establishing a plan to respond to emergencies or who treat workers who have been involved in such an emergency. See www.acoem.org for additional details.

The Center for Civilian Biodefense Strategies, located in the School of Public Health and Medicine at the Johns Hopkins University, is seeking to increase national and international awareness of, and response to, the medical and public health threats posed by biological weapons. For further information, please visit www.hopkins-biodefense.org.

The Centers for Disease Control (CDC) have updated their response plan for smallpox due to the threat of the use of smallpox as a bioterrorism agent. Although smallpox was globally eradicated in the seventies, there is a concern that the virus exists in laboratories other than the two WHO-designated respositories. The "Interim Smallpox Response Plan and Guidelines" outlines the public health strategies and response to a smallpox emergency. It includes a review of the virus and its symptoms, the use of the smallpox vaccine, and outbreak containment. It is available at www.cdc.gov.

The Occupational Safety and Health Administration (OSHA) has initiated a web site entitled "Protecting the Worksite Against Terrorism: Anthrax." OSHA has developed a Risk Reduction Matrix to offer basic advice and suggest protective measures that are expected to reduce the risk of exposure in light of current concerns about the presence of anthrax spores in the workplace. This information is available at www.osha.gov/bioterrorism/anthrax.

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On December 19, 2001 the U.S. Department of Labor announced a new training partnership with Laborers’ International Union to develop an anthrax/biohazard cleanup training curriculum. The course material will be developed and tested through the combined expertise of the Labor Department’s OSHA, the Laborers, and other appropriate government entities. The final training curriculum will be available for distribution across the country: www.osha.gov/media/oshnews/dec01/national-20011219.html.

In November, 2001 the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) sent an advisory letter to the hospitals and other entities that it monitors outlining emergency management standards. Unannounced visits to hospitals since January 1, 2002 are reported to include a special focus on emergency preparedness. Priorities include not only training and preparedness at the hospital but also analyzing community and state effectiveness. See www.jcaho.org.

NIOSH’s Surveillance Strategic Plan calls for a comprehensive, nationally-representative hazard survey. The first industry to be studied is the health services industry. NIOSH (National Institute for Occupational Safety and Health) is seeking input from academicians, researchers, practitioners, government agencies, and others to identify occupational hazards in the health services industry. Visit www.cdc.gov/niosh/02-608.html for more details.

NIOSH conducts a Health Hazard Evaluation (HHE) of a workplace as a result of a concern expressed by workers, employers, or employee representatives. These evaluations include studying exposure to chemical or biological contaminants as well as exposures to heat, noise, radiation, or musculoskeletal stresses.

Employees, employee representatives, and employers might consider requesting a Health Hazard Evaluation in the following circumstances:

• when employees have an illness from an unknown cause;

• when employees are exposed to an agent or working condition which is not regulated by OSHA;

• when employees experience adverse health effects from exposure to a regulated or unregulated agent or working condition;

• when medical or epidemiological investigations are needed to evaluate the hazard;

• when there is concern that the incidence of a particular disease or injury is higher than expected in a group of employees;

• when the exposure is to a new or previously unrecognized hazard;

• when the hazard seems to be resulting from the combined effects of several agents.

NIOSH will determine if the request is valid and, if so, will determine whether it is more appropriate for some other agency to respond. If requested, the name(s) of the person(s) making the request will be kept confidential. Personal information from records, questionnaires, or interviews with NIOSH investigators and individual medical results will be safeguarded in accordance with the Privacy Act.

The HHE program offers a unique occupational health service that permits those involved to benefit from a scientific and professional evaluation of agents for which OSHA has no standards. It should be noted that the HHE is not intended to provide routine assistance to employers to evaluate common types of hazards, but rather to provide assistance to evaluate exposures and/or conditions outside the scope of current OSHA regulations. For more information go to www.cdc.gov/niosh/hhe.

We recommend that occupational health clinic staff responsible for emergency preparedness visit these web sites and keep paper copies of information that they may need. Should an emergency occur, there may be communication delays in accessing the sites. By establishing a plan and keeping up-to-date on changes that are occurring at these web sites, clinic personnel will be prepared to assist their clients should the need arise. 

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About the author:
MAUREEN SUMMERS, RN, MBA, CHE
is the editor of the Occupational Health Tracker. She is a certified healthcare executive with extensive clinical and management experience in occupational health and rehabilitation. Ms. Summers has an active occupational health consulting business based in Kennebunk, Maine. She welcomes communication from Tracker readers and/or potential authors. You may contact her at 207.985.4918 or via e-mail: editor@systoc.com.