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Regional Medical Inspector
GUIDELINES TO COMPREHENSIVE OCC. HEALTH
MANAGEMENT IN THE MINING INDUSTRY
5-6 SEPTEMBER 2014
OUTLINE
• Introduction
• Fitness Guideline
• Roles And Responsibilities
• Tb Guidance Note
• Risk Based Emergency Care
• Incapacity Due To Injury And Ill Health
• Risk Based Fatigue Management
• Conclusion & Recommendation
INTRODUCTION1. Process for the development and promulgation of guidelines
MOHAC considers the need for development of guidelinesDecision taken and Task Team established to carry out the mandate. Draft document considered and approved by MOHAC then Council.Document send to LDC and MRAC for consideration.
2. The list of Guidelines approved by MOHAC awaiting promulgation.Fitness to work in the mines and worksRoles and responsibilitiesIncapacityTB Guidance Note
3. The Chief Inspectors Instruction on the TB/HIV Reporting Template
Fitness to Work Guideline
Issues: Stakeholder disagreements on the following:
•Inclusion of Physical and Functional Work Capacity Assessments.
•Principles for addressing HIV, Pregnancy and Alcohol and
substance abuse during fitness assessments.
Solutions:
•Acknowledged employee exposure to strenuous work as a risk..
•Defined “Strenuous Work” means physically and demanding tasks
combined with extended hours of work where the work rate exceeds
160 M/W2.
•Categorisation and minimum standards for strenuous work
CATEGORISATION AND MINIMUM STANDARDS FOR STRENUOUS WORKProduction / Non Production Related:
Work tasks are imposed by a processes (directly linked to production).
Heavy:
•Manual Material Handling: Consists of 34-66% of the work shift (daily
exposure).
•Work Environment: Manual material handling takes place in
unrestricted work environments.
•Heat Exposure: Daily exposure to high environmental heat loads for
more than 34% of the work shift.
•Production / Non Production Related: Work tasks are imposed by a
process (directly or indirectly linked to production).
CATEGORISATION AND MINIMUM STANDARDS FOR STRENUOUS WORKModerate
•Manual Material Handling:•Load handling consists of less than 34% of the work shift on a daily basis or more than 34% of the work shift on an occasional basis.
Light•Manual Material Handling: •Load handling consists of less than 34% of the work shift - occasional load handling.
Sedentary•Manual Material Handling: •Load handling limited to loads of up to 10kg, occasional exposure only.
Roaming•Manual Material Handling: •None. No external workloads required other than wearing PPE.
GUIDELINES FOR OMPs IN TERMS OF DIFFERENT BODILY SYSTEMS
CARDIOVASCULAR SYSTEM•The cardiovascular system should be free from acute or chronic disease, which may impair ability to undertake the required physical exertion for a particular category of work. Persons with cardiovascular disease, particularly ischaemic heart disease or uncontrolled hypertension, are not suitable for employment as drivers of passenger or dangerous goods conveyances. A Physical Work Capacity screening (PWC) may be recommended by the OMP as an objective assessment of the cardiovascular system.•With reference to hypertension, controlled blood pressure should be below 140 mm Hg (systolic) and 90 mm Hg (diastolic).MUSCULO SKELETAL SYSTEM•There should be sufficient musculo-skeletal integrity to undertake the required physical exertion for a particular category of work. PWC or FWC may be recommended by the OMP to assess fitness to perform work of a strenuous nature
GUIDELINES FOR OMPs Cont. ALCOHOL OR SUBSTANCE ABUSE/DEPENDENCY
• To be guided by the Alcohol and Substance Abuse Policy, as directed by the Health and Safety Committee at the mine.
PREGNANT WOMEN• Women should be protected against health risks during pregnancy, after birth and while breast feeding.• Department of Labour has provided a Code of Practice in terms of Section 87 (1) (b) of the Basic Conditions of Employment Act (75 of 1997). Occupational Medicine Practitioners should refer to this code to guide them on the management of this category of employees (Ref: No 19453 Government Gazette, 13 November 1998; No R.1441 13 November 1998)
HIV: Company policy applies and excluded from the document.
DEPARTMENT OF MINERAL RESOURCESMINE HEALTH & SAFETY INSPECTORATE
GUIDELINE FOR COMPILATION OF A MANDATORY CODE OF PRACTICE ON THE ROLES AND RESPONSIBILITIES OF
OCCUPATIONAL HEALTH PRACTITIONERS IN A SYSTEM OF MEDICAL SURVEILLANCEAT A MINE
Chief Inspector of Mines
DATE: REVISION DATE:
KEY ASPECTS OF THE GUIDELINE
1.FOREWORD
This guideline is intended to assist the Employer to meaningfully
engage services of the occupational medical practitioner (OMP)
and also to optimally benefit from services of other role players in
Ooccupational health practice, providing them with clear roles and
responsibilities and allowing them the appropriate level of
accountability in areas of their professional and legal responsibility.
2. LEGAL STATUS OF GUIDELINES AND CODES OF PRACTICE
Failure by the employer to prepare or implement a COP in
compliance with this guideline is a breach of the MHSA.
KEY ASPECTS OF THE GUIDELINE
3. KEY ROLE PLAYERS IN MEDICAL SURVEILLANCE
• The medical surveillance system activities are managed in an
integrated manner, including linking of occupational hygiene
measurement results and the medical surveillance outcomes of
employees by the ooccupational medical team;
• Mine management understand the role and outcomes of the
occupational Health Programmes at their mines.
• The recommendations of the occupational health practitioner with
regard to the potential impact on health status of employees are
implemented in a manner that promotes and improves the health
of employees at the mine;
ROLES AND RESPONSIBILITIES OF OCCUPATIONAL HEALTH PRACTITIONERS IN OCCUPATIONAL HYGIENE
AND MEDICINE PROGRAMMES.
•Screening tests and physical examination of employees
While the OMP is charged with the responsibility to ensure that the
employer implements and maintains an effective medical surveillance
system, it is sometimes not possible for the OMP to conduct all screening
tests and physically examine all employees.
• In order to prevent any malpractice in conducting screening tests and
physical examinations for employees,
(a)A competent OHNP may conduct workplace screening tests as an
independent function within their professional scope of practice, and
would therefore be accountable for their own acts and omissions in
this regard:
ROLES AND RESPONSIBILITIES OF OCCUPATIONAL HEALTH PRACTITIONERS IN
OCCUPATIONAL HYGIENE AND MEDICINE PROGRAMMES.
(b) The OMP can through standard working procedure (protocol) delegate certain duties; intended to fulfil the responsibilities they are charged with; provided this is done within the scope of practice of the occupational nursing practitioner concerned and with clear understanding that it does not remove the OMP’s liability over the delegated duties.
CONT,
(c)Where duties of the OMP is legally and ethically responsible for have been delegated two the OHNP, the medical records must clearly indicate the areas professionally accounted for by the OHNP; and co-signed by the OMP where occupational diseases have been detected;
(d) Where the Employer is using a contracted ooccupational health service provider, not under their direct management, all reports submitted to the Employer should clearly indicate the accountable practitioner’s contact information and HPSCA registration number for reference purposes;
(e) The employer must ensure that their service provider in terms of Medical Surveillance is accessible when the Inspector requires any information related to performance of their duties
These certificates are issued based on the findings from occupational medical examinations conducted on employees, after determining whether an employee has or does not have any medical condition which would prevent him/her to work under certain conditions at the mine or when leaving such a mine in case of the Exit Medical Certificate. While regulation 11.3.gives provision for the OHNP completing the exit certificate to sign on behalf of the OMP responsible for producing the certificate , it is the OMP’s responsibility to:(1) Satisfy himself or herself before delegating such a responsibility to the OHNP, that the OHNP is competent to conduct such functions as the delegation does not relieve him/her of the accountability;(2) Include delegation of such responsibilities in the standard working procedure referred to in 8.2.3. (3) in the document ;
CERTIFICATE OF FITNESS TO PERFORM WORK AT A MINE AND EXIT MEDICAL CERTIFICATE
(3) The standard working procedure on delegated responsibilities is
accessible to the Occupational Medicine Inspector when required;
and
(4) Where an occupational disease has been diagnosed, the
certificate must be signed by both the responsible OHNP and the
OMP, including those issued for contract workers.
CERTIFICATE OF FITNESS TO PERFORM WORK AT A MINE AND EXIT MEDICAL CERTIFICATE
ROLES AND RESPONSIBILITIES OF OTHER HEALTH CARE PRACTITIONERS AND SPECIALISTSONCLUSION
•Effective and efficient occupational health service provision requires
close cooperation and collaboration with all related experts. In order
to achieve such
•The Occupational Health Practitioners will need to communicate and
collaborate with other team members who may include but not limited
to technical experts in screening procedures, Ergonomists, Safety
Practitioners , Environmental Practitioners, Occupational and
Physiotherapists, Pharmacists, Chemists, Toxicologists and Public
Health specialists.
•Private and public partnerships and collaboration between relevant
interest groups and sectors, in the formulation and implementation of
strategies to manage outcomes of medical surveillance are
encouraged.
TB GUIDANCE NOTE
•To assist employers:
• In the management of TB in SAMI.
•In preparing a comprehensive TB control programme.
•To set out good practice.
•To Minimize the burden of disease due to TB through
proper management
•The management of TB on mines requires extra
measures to those in the NTBMG due to:
-Occupational risk of silica dust,
- The high TB incidence rates,
- Tuberculosis and silico-tuberculosis are
compensable diseases
- Dangerous working conditions
-Migrant labour force.
•TB control is primarily the responsibility of the DOH, but
•National problem- SAMI purported to be an exporter of TB
•More active role to address the national problem
•Supplement to the National TB Management Guideline (NTBMG) issued by DOH.
TB GUIDANCE NOTE cont’
•Several TB specialists invited to a workshop
•Inputs made to the guidance note
•The document referred to MOHAC
•Stakeholders reviewed document separately
•Document then approved at MOHAC
•Referred to the MHSC Board for approval
•TB GUIDANCE NOTE cont’
•For all suspected cases, additional investigation:
•Nuclear Amplification Test( e.g. Gene Expert)
•An algorithm talking to NAT included in the guideline
•G:\ALGORITHM BY DOH.docx
•The time frame for restart of treatment different in
SAMI
•TB GUIDANCE NOTE cont’
•Instead of 1 month, 2 weeks has been recommended
during intensive phase.
•Internal review should be conducted by each mine
annually using the Mine Health and Safety Council TB
Review Tool
•External reviews to be conducted every 5years.
GOOD PRACTICE
All mines should provide easy access to a good
quality, client-orientated, diagnostic and treatment
service for tuberculosis and all other occupational and
non occupational diseases, and where possible
integrated TB and HIV treatment services.
TB is to be reported by all mines, irrelevant of the
commodity mined
GOOD PRACTICE
•Reporting should be made in terms of the Mine
Health and Safety legislation, which has a different
requirements from Occupational Diseases in Mines
and Works Act (ODMWA)
•No period of service is linked to reporting of TB in
terms of MHSA
GOOD PRACTICE
•Evaluation of fitness to return to work should be
individualized.
•Individuals should be clinically well from any injury or
disease and be smear negative if were suffering from TB.
•The assessment for fitness to perform work at any
mine, should be conducted by the OMP.
The world has made defeating AIDS a top priority…. But TB remains ignored. Today we are calling on the world to recognize that we can’t fight AIDS unless we do much more to fight TB as well.
-Nelson Mandela Bangkok, July 15, 2004
THE RISK – BASED EMERGENCY CARE GUIDELINE
•Developed to assist employers in achieving the
objectives of ensuring the provision of appropriate
emergency care at any working site, determined in
accordance with the relevant risks at the working site.
•Outline the competencies required to render risk based
emergency care at a working site;
- Minimize any complications that may result from
any, accident or incident that adversely affects the
health or safety of any person at the mine; ,
•Ensure that any injured persons are stabilised,
transferred, transported and received as soon as
practicable by appropriately trained, qualified and skilled
personnel, from first aiders to the most advanced
emergency care personnel.
THE RISK – BASED EMERGENCY CARE GUIDELINE
•RISK MANAGEMENT
•Section 11 of the MHSA requires the employer to identify
hazards, assess the health and safety risks to which employees
may be exposed while they are at work,
•record the significant hazards identified and risk assessed.
•The COP must address how the significant risks identified in the
risk assessment process must be dealt with.
•Requirements of sections 11(2) and (3), as far as reasonably
practicable, attempts should first be made
- to eliminate the risk, thereafter to control the risk at
source,.
RISK MANAGEMENT
• Insofar as the risk remains, to provide personal protective
equipment and to institute a program to monitor the risk.
• To assist the employer with the hazard identification and risk
assessment all possible relevant information such as accident
statistics, locality of mine and emergency services, ergonomic
studies, research reports, manufacturers’ specification, approvals,
design criteria and performance figures for all relevant equipment
should be obtained and/or considered.
RISK MANAGEMENT
• In addition to the periodic review required by section 11(4) of the
MHSA, the COP should be reviewed and updated after every serious
emergency, or if significant changes are introduced to procedures,
mining and ventilation layouts, mining methods, plant or equipment
and material.
•Insofar as the risk remains, to provide personal protective equipment
and to institute a program to monitor the risk.
RISK MANAGEMENT
•To assist the employer with the hazard identification and
risk assessment all possible relevant information such as
accident statistics, locality of mine and emergency
services, ergonomic studies, research reports,
manufacturers’ specification, approvals, design criteria
and performance figures for all relevant equipment should
be obtained and/or considered.
.
DETERMINING EMERGENCY CARE REQUIREMENTS FOR EACH WORKING SITE
Risk rating of the work site
Calculating the response time and classifying the work
sites
Step 1: Determine the EMS response time to the
operation site
Step 2: Determine the time to the side of the patient
Step 3: Response time to the emergency = EMS
response time to the operation site plus the time to the
side of the patient.
.
DETERMINING EMERGENCY CARE REQUIREMENTS FOR EACH WORKING SITE
Step 4: Classify work sites in terms of response time.
•Close Work Site = Time to site < 30 minutes
•Distant Work Site =Time to site 30-60 minutes
•Isolated Work Site = Time to site > 60 minutes
NIHL
Its is a misnomer to use Percentage Loss of Hearing for
prevention of developing disability related to NIHLS.
The use of a permanent hearing threshold shift is most
appropriate and this can be monitored
The Noise Guideline has been reviewed and discussed with
the stakeholders .
NCD
• Non communicable diseases are to be controlled before an
employee is sent back to assume work. (Medical Fitness
Guideline)
• An individual should either be fit to perform their previous
work, or referred for vocational assessments and possible
retraining for alternative job placement.
DISABILITY AND APPEALS
•Disability management programmes should be followed and
income secured during temporary and permanent
disablements.
• The OMP has an obligation to inform an employee about the
process of appeal, in the event that he /she declares an
employee permanently unfit for work.
CONCLUSION•The Occupational Health Practitioners professional independence is observed in decision making, ethical requirements and reporting requirements in terms of statutory provisions. 8.1.5. Appropriate and effective referral systems for further clinical management are in place as contemplated in MHSA. Act
•Employees diagnosed with occupational health diseases have access to the compensation systems.
• Contractors have performed risk assessments, employees have undergone medical surveillance and where occupational diseases have been diagnosed, and their employees should have access to the compensation systems.
• The principle must be observed that no distinction is made between
permanent contractor and subcontractor employees in occupational health management.