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

Part 1: 3 Steps for a Base-level Flight Doc to Improve an Occ Health Program

Maj Mark PaineNGB/SGPB

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?

Step 1: Show up to shops

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

Step 2: Require BEE to pull OEHEDs directly from DOEHRS

Occ Health Data Flow

BEE(Collect Data)

Public Health(Analyze Data)

Flight Doc(Final decision)

Occ Health Data Flow

BEE(Collect Data)

Public Health(Analyze Data) Flight Doc

(Final decision)

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”

Occ Health Data Flow ChartShould I turn in an

OEHED from Microsoft Word or DOEHRS?

No Choice—BEE must use DOEHRS

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”

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

Bottom line: Mandate OEHEDS from DOEHRS

• It’s required by AF policy• It forces BEE to do good work in DOEHRS

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

Shop

• Shop: A collection of processes…not people

Shop– Process 1

» Hazard(s)• Control(s)

– Process 2» Hazard(s)

• Control(s)

Similar Exposure Group (SEG)

• SEG: A collection of people

SEG– Airman 1– Airman 2– Airman 3

How does a shop link to a SEG? Through a process

• A process gets linked to a SEG

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.

Example 1: Multiple SEGs for 1 ShopShop Processes SEG

Structural Maintenance

Painting Structural Maintenance Painters

Sanding Structural Maintenance Sanders

Machining Structural Maintenance Machiners

Unlikely Scenario

Example 2: Multiple Shops for 1 SEGShop Processes SEG

Vehicle Maintenance

Painting Painters

AGE

Corrosion Control

Unlikely Scenario

Example 3: 1 SEG for 1 Shop

Shop Processes SEG

Structural Maintenance

Painting Structural Maintenance

Sanding

Machining

Common Scenario

Example 4: 2 SEGs for 1 ShopShop Processes SEG

Structural Maintenance

Painting Full time equivalentsDSGs

Sanding

Full time equivalents

Machining

DSGs

Common Scenario

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.

“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.

Trick Question

• Does an OEHED apply to a SEG or a shop?

Trick Question

• Does an OEHED apply to a SEG or a shop?

Questions

Part 2: Air Force Mold Policy

Maj Mark PaineNGB/SGPB

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-2014-0017 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 http://www.dtic.mil/dtic/tr/fulltext/u2/a607657.pdf

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

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.”

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)

Remediation Examples(Mold Policy Attachment 4)

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

Part 3: Flight Surgeon Shop Visits(AFI 48-149, Flight and Operational Medicine Program (FOMP))

Maj Mark PaineNGB/SGPB

Requirement 1 (not for ARC)

• 3.2.2.2. 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)

Requirement 2

• 3.6.6. 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.”

Requirement Summary

• Perform shop visits– Interact with Line personnel– Advise line commanders– Better understand and support the

occupational/operational stressors

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

Which shops to visit

• CATM • Corrosion Control/Structural Maintenance• Cat I shops • Cat II shops• Any shop you are concerned about

Prepare for a Shop Visit

• ESOH Service Center Website– https://hpws.afrl.af.mil/dhp/OE/ESOHSC/– Google

• Print a copy of the OEHED• If you don’t have time to prep– Go anyway– Ask the Airmen how they are doing

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

Checklist-style Questions

Reference: “ABC of Occupational and Environmental Medicine” (Snashall & Patel, 2003)

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

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

Noise Surveys• Noise source surveys– 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

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

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

When Pilots get hit with Lasers

• Follow steps in Section 2.0 of AFRL-SA-WP-SR-2012-0005, USAFSAM Laser Injury Guidebook, available on the ESOH Service Center website: https://hpws.afrl.af.mil/dhp/OE/ESOHSC/pages/index.cfm?id=717– 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

When Pilots get hit with Lasers

• BEE or Flight Doc needs to fill out a form on the ESOH Service Center website: https://hpws.afrl.af.mil/dhp/OE/ESOHSC/laserinjury/

Note: A blank form is on the next slide

Summary

• Follow the procedures in the Laser Injury Guidebook

• Fill out the incident form online

Exam Question #1/4

How should Occupational and Environmental Health Exposure Data sheets (OEHEDs) be generated? A. Microsoft WordB. Microsoft ExcelC. They are not an Air Force RequirementD. Defense Occupational and Environmental

Health Readiness System (DOEHRS)

Exam Question #2/4

What is the investigation technique specified for mold in the Air Force mold policy?A. Air samplingB. Visual inspectionC. Surface sampling D. Radiofrequency sampling

Exam Question #3/4

The most effective thing to bring on an occupational shop visit is:A. StethoscopeB. FlashlightC. Copy of the shop’s OEHEDD. NIOSH Pocket Guide

Exam Question #4/4

What do you do when a pilot has been hit with a laser? A. Fill out an incident form on the ESOH Service

Center websiteB. Perform medical procedures in the USAFSAM

Laser Injury Guidebook C. Both A and BD. Neither A nor B

Answers

• 1-D• 2-B• 3-C• 4-C