Environmental Engineering Reference
In-Depth Information
At JACADS and TOCDF, committee members met
with members of the occupational and environmental
health teams, including the clinic medical directors,
nurses, and industrial hygienists. Each person described
his or her role in the program and answered the
committee's questions. The committee observed nor-
mal operations of the clinic and reviewed relevant
Army and contractor documents, including generic and
site-specific forms and regularly used medical and in-
dustrial hygiene forms. One anonymous medical file
was later reviewed by a committee member.
Three Army documents, Generic Medical Support
Plan (U.S. Army, 1998a), Generic Medical Implemen-
tation Plan (U.S. Army, 1999b), and Generic Medical
Continuing Quality Improvement Plan (U.S. Army,
1998b), provide detailed descriptions of the medical
support functions at all CSDP sites. They also specify
the policies, operational concepts, personnel require-
ments, and program elements necessary for the provi-
sion of medical support. The contractor medical direc-
tor at each site is expected to use these documents as a
guide to the development of site-specific medical
implementation plans responsive to local policies and
procedures.
These documents cover the following areas, which
are governed in turn by numerous referenced OSHA
and Army standards and regulations, as well as other
federal and state regulations:
Emergency treatment of nonoccupational injuries
and illnesses is also provided, although it is not specifi-
cally referred to in these documents.
The Generic Medical Implementation Plan also
specifies that the systems contractor's quality assur-
ance unit must conduct regular audits of the systems
contractor's occupational health program and that an
annual audit of the program must be conducted by
PMCD-designated health care professionals. Reports
of all audits are forwarded to the clinic medical director
and the medical administrator for prompt action. Non-
conformance requires a written plan for corrective action.
Similar site-specific documents reviewed at
JACADS included Occupational Health and Hygiene
Plan and Medical Surveillance Program (U.S. Army,
1997c, 2000c). Both documents cover essentially the
same areas as the Army's generic plan but include
modifications to meet site-specific needs. Site-specific
documents for medical procedures were also reviewed
at TOCDF. These included Medical Surveillance for
Potential Agent Exposure and Cholinesterase Monitor-
ing Program (U.S. Army, 1996b, 1999d). These docu-
ments are specific to the medical surveillance program
for chemical agents. Several other documents relative
to the heat-stress prevention program at JACADS and
TOCDF were reviewed, as well as the quality improve-
ment plan (U.S. Army 1998c, 1999b).
The Army's CSDP includes all of the essential com-
ponents recommended by ACOEM for an occupational
and environmental health program except for partici-
pation in the development of government health and
safety regulations. The lack of Army involvement in
this area is appropriate because this is an industry regu-
latory activity. Several of the nonessential program
components recommended by ACOEM, such as pallia-
tive treatment of disorders to enable a worker to com-
plete a work shift and to obtain health education and
counseling, are included in the Army's program.
The Army also provides in-depth training for all per-
sonnel involved in the occupational and environmental
health program. One committee member attended the
Toxic Chemical Training Course for Medical Support
Personnel given at Edgewood, Maryland, in April
2000. The course lasted one week and covered all as-
pects of the Army's occupational and environmental
health program. An exam was given at the end of the
course, which was approved for continuing education
credit. The quality of the presentations and the instruc-
tional materials was excellent.
Based on the committee's review of the Army's
staffing and training
medical surveillance, including medical surveil-
lance exams
medical surveillance for chemical agent
monitoring for heat stress
keeping, releasing, and retaining medical records
support for the alcohol and drug abuse program
support for hazardous waste operations
support for the chemical PRP
medical response to chemical accidents/incidents
hearing conservation program
support for the respiratory protection program
support for the occupational vision program
health education/communication about hazards,
including reproductive and carcinogenic hazards
treatment of on-the-job illnesses and injuries
epidemiological investigations
health care administration, including establish-
ment of a quality improvement plan
industrial hygiene services
protection of patients' rights and responsibilities
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