01-MEDEVAC Protocols Procedures

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H,S&EP Document/26003/Issue 3/March 2010

Medical Protocols,

Procedures

&

Standards

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CONTENTS 1

Introduction to Occupational Health Procedure & Standards

2 Definitions and other Relevant Information

3 The Health Professionals

4 Suitability of Individuals for Work

5 Pre-placement Questionnaires

6 A Health Screening Programme

7 The Medical Protocol

8 Procedure and Standards

9 Body Mass Index (BMI)

10 Vision

11 Hearing

12 Lung Function

13 Blood Pressure

14 Urinalysis

15 Venapuncture

16 Musculoskeletal Assessment

17 Skin Assessment

18 Assessment of Hand Arm Vibration Syndrome (HAVS)

19 Drug Alcohol Testing

20 Cholesterol Testing

21 Health Promotion

22

Job Types & Health Surveillance Needs

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UK Contractors Group

OCCUPATIONAL HEALTH PROCEDURE & STANDARDS

1. INTRODUCTION

UK Contractors Group Companies are, generally, the larger contractors who already have

in place an Occupational Health infrastructure. This can be made up of an internal in

company facility or an external service provider. In both cases doctors, occupational

health managers and nurses will already be undertaking the activities referred to in this

document. It should be noted that whilst this document deals with many technical issues,

its over-arching aim is to ensure the wellbeing of the workforce by monitoring the effect of

work on the individual and the likely impact of the individual on the work process

Whilst the UK Contractors Group (through the now defunct Major Contractors Group)

contributed to the drafting of the Constructing Better Health document, it was felt that

because MCG Companies already had structures in place, associated with this subject,

that a simplified document was required for UKCG Companies use. This is not intended to

undermine CBH but rather that parallel arrangements, relating to the larger contractors

existing occupational health arrangements, are produced. It is recognised that continuity

between the two approaches to this subject is important, as many of the contractors

supply chain partners, in time, will be likely to use CBH as their occupational health

provider.

The general objectives of this document are therefore clarity, simplicity and a defining of

standards for medical protocols and reporting procedures. It should be noted that these

are minimum standards and companies are free to do more and set higher standards than

this document requires. It is also the intention of the writers that this document be used in

a sensible manner and therefore logical, appropriate, balanced, effective and proportional

are all watchwords that should be applied. In other words simply using this document in a

painting by numbers manner is not an option. For example, a plant operator using a

remotely controlled roller on a green field site may not require the same level of health

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surveillance as a tower crane driver working in a difference environment: it is for the

management to decide what is appropriate in the circumstances.

One of the reasons for the UKCGs past successes in health & safety is its ability to

encourage contractors to act together. This document attempts to build on this platform in

terms of medical practice, equipment used and reporting format. However, it should be

noted that UK Contractors are strongest when they work together and the sentence above

concerning minimum standards is not intended to be a licence to enable everyone to do

their own thing.

Reporting is often seen as the poor relation in this respect, but by standardising the

method of reporting/types & units of measurement, UK Contractors Group Companies may

be able to share information in the future, where this is appropriate. The focus for health

surveillance should, in our view, be safety critical workers. (This term is defined in the

next section). However, this should not prevent the health screening of other workers

taking place where the organisation concerned thinks that it is appropriate

Where contractors attempt to transfer occupational health information from one to another,

it is essential that this has the approval of the person(s) concerned and that it takes the

form of a simple, fit for work declaration. This must relate of course to the work that the

person is expected to do and therefore can be qualified in this respect.

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2. DEFINITIONS

Occupational Health

Occupational Health is a multidisciplinary subject. It encompasses medicine, nursing,

occupational hygiene, ergonomics, toxicology.

Occupational health can be conveniently divided into two main components:-

The effects of work on health (e.g., the effects of dusts on the lungs, irritants on the

skin).

The effects of health on work (fitness to work, e.g. good vision for drivers, how to

accommodate the diabetic or epileptic if they work at heights or in isolation).

Relevant Legislation

There is a wealth of current health and safety legislation, which directs and drives good

Occupational Health Practice, usually in conjunction with Safety Management. The Health

and Safety at Work Act requires employers to take account of the needs of their

employees in terms of health, safety and welfare. It places duties on the employer and

employees to set and achieve acceptable and reasonable standards of practice, so far as

is reasonably practicable.

Additional Legislation

Additional legislation such as the Control of Substances Hazardous to Health and the

Management of Health and Safety at Work Regulations require health surveillance to be

carried out where the health of employees could be at risk from the work they do which

may include exposure to substances hazardous to health.

This situation is mirrored in the very specific Control of Lead at Work Regulations, the

Control of Asbestos at Work Regulations and the Ionising Radiations Regulations.

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Health and Safety speaks in terms of Hazard, Risk and Control Measures. In the

occupational health world these terms could mean:

Hazard

Is the possible adverse effect on health, following exposure to a substance or activity, e.g.

exposure to dust containing silica may result in silicosis, exposure to wet concrete may

result in dermatitis, and poor ergonomics at a VDU workstation may result in

musculoskeletal problems.

Risk and Control Measures

Risk is a means of measuring the potential for a substance or activity to cause harm and

varies according to the nature of the hazard and the number of persons likely to be

involved. There are various risk measurement techniques although this is not a precise

science and High medium and low are perfectly satisfactory. All these measures do is

flag up the amount of effort (control measures) required to bring the level of possible harm

down to zero or low. Whilst it is easier to assess the hazard before any control measures

are taken the degree to which it is already controlled, e.g., dust exposure may be

controlled at source, i.e. removed by appropriate ventilation should be taken into account.

Personal protective equipment such as respirators and goggles may provide immediate

protection to the individual from the working environment, although this is not as desirable

as control at source. The need to design out the problem rather than simply providing

PPE is much higher up the Principles of Prevention which are themselves a legal

requirement under the Management of Health and Safety at Work Regulations. Again, the

aim is to take suitable and sufficient measures to reduce the risk to zero or low starting

with the need to reduce the risk in the first place and only providing PPE as a solution

when all other avenues have been exhausted.

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In many situations within the workplace, control measures cannot be regarded as absolute

and there may be a need for health surveillance, the purpose of which is to:

Identify early health problems before they cause significant morbidity

To check the control measure are working adequately

Health surveillance takes various forms depending upon the nature of the hazard and the

techniques available, e.g., exposure to noise may result in noise-induced deafness.

Audiometry tests hearing and gives an indication of whether or not an employee is

beginning to suffer from early signs or even later more significant signs of noise-related

deafness.

Safety Critical Workers

These are individuals whose ill health, mental or physical condition, may in the course of

their work, compromise or pose a significant risk to the health and safety of either

themselves or others. Plant operators would be an example of persons in this group,

where the nature of their occupation and their ability to place others at risk places them in

the safety critical section.

Similarly, a workers specific working environment could place them in the high risk group.

Persons who work in confined spaces, compressed air, on the railways or in motorway

traffic management could also be deemed to be safety critical.

3. THE HEALTH PROFESSIONALS

The Management of Health and Safety at Work Regulations (MHSW) state that, where

risk assessment identifies circumstances where health surveillance is required employees

must have access to an appropriately qualified practitioner for advice on surveillance.

Therefore employers who appoint doctors, nurses or other health professionals to advise

them of the effects of work on employee health, or to carry out certain procedures, for

example, health surveillance, should first check that the providers can offer evidence of

sufficient level of expertise or training in occupational health.

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This is reinforced by the Health Surveillance at Work Guidance (HSG 61, HSE Books)

which states that it is the duty of the employer to provide health surveillance for those

employees considered at risk and that it is essential that the people who carry out health

surveillance are competent to do so. The level of competence required will depend on the

tasks performed and specific standards can be found within guidance associated with

regulations.

When appointing either an occupational doctor or an occupational health nurse, their

registration/personal identification number (PIN) should be obtained and confirmed with

the appropriate governing body.

For doctors, the General Medical Council (GMC) website (www.gmc-org.uk) will provide

information relating to the individuals registration and fitness to practice and the Faculty of

Occupational Medicine (FOM), (www.facoccmed.ac.uk) will be able to confirm their

occupational health qualification. For nurses, the Nursing and Midwifery Council (NMC)

website, (www.nmc-uk.org), will allow you to confirm the individuals registration and

qualification details.

Occupational Health Doctors

Occupational Health Doctors are required by law to possess skills and expertise including

an understanding of the health hazards which can arise at work, the ability to assess risks

relating to the health of individuals and groups, knowledge of the law relating to workplace

issues and awareness and understanding of the way business operates.

There are currently three levels of qualification in Occupational Medicine for Doctors:

The Diploma in Occupational Medicine (D.Occ.Med.)

The Associateship of the Faculty of Occupational Medicine (AFOM)

Membership of the Faculty (MFOM).

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In addition, the Fellowship of the Faculty (FFOM) is awarded to those occupational

physicians with MFOM who have made a distinguished contribution to the specialty and

who demonstrate a greater depth of experience and expertise in occupational medicine.

Doctors without these qualifications who rely solely on experience gained in the workplace

may not meet the requirements for competence that are demanded by health and safety

legislation. Therefore, it is recommended that the Diploma in Occupational Medicine be

used as the minimum standard for the construction industry.

However, individuals should work within the limits of their competence and be cognisant of

the need to access specialist occupational physician advice as needed. The level of

occupational health expertise will need to be commensurate with the level of health risk

identified for the project e.g. for a complex construction project such as the building of a

nuclear power station for example. it would be usual for the Occupational Health Provision

to be led by a Consultant Occupational Health Physician. The Faculty of Occupational

Medicine (www.facoccmed.ac.uk) can confirm the qualifications and specialist status of a

member. The Employment Medical Advisory Service of the Health and Safety Executive

(HSE) can also advise on both Occupational Health needs and services available locally.

Revalidation is the mechanism whereby doctors will demonstrate, at regular intervals, that

they remain up to date and fit to practice. In the near future, doctors who wish to practice

medicine in the UK will need to hold a licence to practice. To retain this licence, Doctors

will need to revalidate, normally every five years.

Occupational Health Nurses

Nurses carrying out occupational health surveillance should hold current registration with

the Nursing and Midwifery Council (NMC), as a minimum. They may also hold an

occupational health qualification at Certificate, Diploma or Degree level. If they do not

have an occupational health qualification then they should be working under the

supervision of an appropriately qualified clinician (Doctor or Nurse).

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Nurses will need to renew their registration every year with the NMC. For a Nurse led

Occupational Health Service, the lead Nurse should also be registered as a Specialist

Community Public Health Nurse (Occupational Health) with the NMC and have access to

specialist Occupational Physician advice as needed.

Occupational Health Technicians

The Occupational Health Technician is a developing role. With the expert supervision of

OH qualified Nurses and Doctors and the correct training, they may be able to carry out

aspects of health surveillance required within an OH programme. This in turn will free-up

the OH clinicians for other, more appropriate tasks. Currently there are no minimum

standards available to follow although there are academic organisations currently looking

to develop a training programme for technicians.

In addition to the fulfilment of the necessary legal requirements of employment of clinical

staff, it is recommended that the construction industry apply the following minimum levels

of competence:

Doctors: should hold the D.Occ.Med qualifications as minimum

Nurses: should be registered as a specialist nurse practitioner in public health

(Occupational Health)

Occupational Health Technicians: should be trained in the specific elements of the

service they deliver and must be clinically supervised.

Some aspects of health surveillance also require additional competences to be

demonstrated e.g.

Hand, arm vibration: a Faculty of Occupational Medicine approved training course

in HAVS or an equivalent level of competency

Noise induced hearing loss: a British Society for Audiology approved course for

industrial audiometricians or an equivalent level of competency.

Respiratory: Association for Respiratory Technology and Physiology (ARTP)

diploma or an equivalent level of competency.

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4. SUITABILITY OF THE INDIVIDUAL FOR WORK

The aim of a pre-placement assessment is to ensure that people are placed in suitable

work and that any reasonable adjustments on the grounds of disability are able to be

made. For certain specific activities, there are legal duties to carry out pre-placement

assessments of an individuals fitness for work for example, under the Asbestos at Work

Regulations, the Control of Lead at Work Regulations (CLAW) and The Work in

Compressed Air Regulations). However, prudent employers should ensure that pre-

placement assessments are undertaken for all safety critical workers.

Baseline health surveillance assessments are also recommended (subject to a suitable

risk assessment) for individuals exposed to a number of hazards including hand-

transmitted vibration, noise, and silica. For low risk workers the provision of a health

questionnaire is considered suitable and sufficient. For medium and high risk (Safety

Critical Workers) a completed health questionnaire will be required in addition to an

assessment (medical check).

It should be noted that the use of medical selection to narrow the choice of job applicants

is wasteful of clinical resources. More importantly, it may lead to discrimination on the

grounds of disability, which may be difficult for an employer to defend legally. Therefore

pre-placement health screening is preferred after conditional offer (subject to occupational

health assessment) and acceptance of the job.

5. PRE-PLACEMENT HEALTH QUESTIONNAIRES

Assessments are often conducted using self-administered questionnaires which are then

processed by either the human resources departments or occupational health staff.

However, there are a number of ethical and legal issues, which arise over the handling of

such questionnaires, which need to be considered.

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Applicants should not be expected to reveal clinical details to non-clinical staff (who are

not bound by medical confidentiality) as non-clinical staff are not qualified to interpret

medical data and should not do so. Only when questionnaires are returned directly to

qualified medical or nursing staff can there be any assurance that clinical details will be

handled in medical confidence. As information on the health of an individual is sensitive

personal data, its processing, which includes obtaining it, is subject to strict controls under

the Data Protection Act.

Health questionnaires should be reviewed by a competent person, such as a qualified

occupational health professional, to allow appropriate decisions on the management of

fitness for work issues and compliance with the Disability Discrimination Act to be made.

All the employer needs to know is whether the applicant is fit for the intended work and

any suggested adjustments that may be required. This can be a very difficult area, as the

individuals permission must be obtained before personal details are discussed with a

Manager, for example; even if the personal details could have implications for safety at

work.

6. A HEALTH SCREENING PROGRAMME

Elements from a typical programme are in the following section.

7. MEDICAL PROTOCOL

The employee will be asked to complete a general health questionnaire; perhaps with the

assistance of a nurse. The questionnaire will also contain questions about the individuals

health history and any health problems which relate to the work that they do to ascertain

whether or not their health is being affected by their work, and vice versa. Much of the

information about the employee is obtained in this way.

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Depending on the extent of the protocol the nurse will also ask the employee to undergo a

number of assessments to provide detailed information on the following:

1. Height, weight and Body Mass Index (BMI): Height and weight will be taken and

the Nurse will provide the employee with the BMI. The BMI is a useful and quick

method for measuring whether the employee is underweight, overweight or obese.

2. Blood pressure: The Nurse will take the employees blood pressure.

3. Urine analysis: The employee will be asked to provide a sample of urine, which will

be dip-stick, tested to see if there is any protein, blood or sugar in their urine (these

test for kidney disease and diabetes).

4. Review of noise exposure, past and present hearing problems and hearing test

(Audiogram). The test is conducted in a sound proof hearing booth and will last

approximately 15/20 minutes.

5. Vision questionnaire and vision screen: The vision screen consists of looking

into a machine to recognise shapes/letters/colours and a colour vision test, which

consists of looking at a book and distinguishing the numbers from the patterns. This

is very important for trades such as electricians where colour blindness could make

the identification of coloured wires a problem.

6. Respiratory questionnaire and lung function test: The lung function test is undertaken

using a Vitalograph machine. All employees will be required to blow into this

machine these results show how healthy their lungs are.

7. Skin review: Employees will be required to complete a questionnaire about skin

problems. The Nurse will also look at the employees skin to check for rashes etc.

8. Musculo-skeletal review, particularly for upper limb, spine and vibration related (i.e.

white finger) disorders. This is undertaken via a questionnaire with the assistance of

a Nurse.

The length of time a full health assessment should take is approx 45 minutes to 1hour

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8. PROCEDURE AND STANDARDS

9. HEIGHT, WEIGHT AND BODY MASS INDEX (BMI)

HEIGHT

Equipment: Standard metric/imperial measure

Procedure: Individual removes shoes. The measure should be set up so

as to accurately read the height. The horizontal indicator must

rest level on the crown of the skull. Measure the height on the

scale. Record centimetres/inches.

WEIGHT

Equipment: Scales (which have been checked for accuracy and the

calibration recorded)

Procedure: Individual removes heavy items of clothing/personal belongings

(e.g. shoes, keys). Stands on scales. Weight is read from

scales and recorded in kgs/lbs.

BODY MASS INDEX (BMI)

Equipment: Calculator

Procedure: Calculate at time of assessment:

BMI = Weight (Kg)

Height (m) Compare with standards

The BMI is not necessarily an accurate assessment of correct proportion of fat to

muscle v height, particularly in the obese, or body builders. This should be taken into

account when assessing fitness.

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10. VISION INTRODUCTORY NOTES

Class II = Large (previously called heavy) Goods Vehicle (refer to DVLA Standard

Guidelines)

Class I = Ordinary cars, small vans (

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PROCEDURE

Check the VS11 is in proper working and that the lenses are clean and dust-free (clean

using soap and water dampened cloth when necessary).

The test should be performed in a quiet well lit environment. If more than one person is to

be tested they should be admitted to the test area one at a time.

Both examiner and subject should be seated comfortably throughout the test.

Using results sheet, complete employee details ensuring he/she has corrective lenses

where required.

Position subject so that they are able to sit with their back and head erect and shoulders

level. His/her head should be resting comfortably against the instruments headrest and

instructed to look through the top half of the lens to being the test.

Do not allow the subject to pull away from the instrument between individual tests.

Caution him/her against tilting the head to the side at any time.

The test should now commence following the manufacturers instructions. Corrective

lenses should be worn at the appropriate point during testing (i.e. glasses for distance only

for FAR and glasses for reading / VDU work for NEAR)

If the subject wears bifocals, examiner must ensure that he/she is looking through the

appropriate lens segment for each of the two test distances. Where corrective lenses are

used a note must be made on the results sheets.

On completion of distance/far vision test the subject should be instructed to adjust their

position until they are looking through the bottom half of the lens to complete the test.

On completion of the test, the examiner should interpret the results using the information

contained in the manufacturers instructions and follow the guidelines for pass / fail /

referral (see Vision Standards).

Those subjects failing to meet the standards for distance vision should be tested

using a Snellen chart (see separate instructions).

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PROCEDURE FOR TESTING VISION USING A SNELLEN CHART

EQUIPMENT REQUIRED

Snellen chart (6 metre / 3 metre)

Card suitable for eye occlusion

PROCEDURE

The test should be performed in an area with adequate lighting and the examiner should

ensure that the subject is the correct distance from the type of Snellen chart being used

(i.e., 6 metres or 3 metres).

The subject should now be asked to being reading the letters on the chart starting from the

top line and continue until he / she can no longer see the letters clearly.

The examiner should then record the last line on which the subject read all the letters

correctly on the keystone results chart already in use.

The examiner should now proceed to test the other eye in the same way and record the

results.

All subjects should be referred to the optician if they still fail to meet the standards.

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STANDARDS

Distant Acuity Drivers Class II, Mobile Plant, Forklift Truck Drivers - Class I

Normally the 6/9 or 6/12 rule applies (unless advised otherwise) Lazy eye PASS if normal visual fields For true monocular vision and other defects of visual field, etc, refer to OHP for advice Class I drivers should NOT be restricted unless there are serious concerns regarding visual fields.

Fail: Refer to Optician Inform Manager that they should not drive until vision has been checked and management are satisfied that they are wearing a correction if it is necessary OHP will advise Company of outcome.

Near Acuity No Standard, but ensure employee can read instructions/equipment, including keyboards, dials, Leds, screens, etc., accurately.

If unacceptable, refer to Optician. Do not restrict. (Only restrict if serious concerns re safety [of employee, others or equipment])

Intermediate Vision No specific Standard If unacceptable, refer to Optician. Do not restrict. Advise employee to enquire about Company DSE Policy.

Colour Vision Normal colour vision is required in certain occupations e.g. Electricians NB: DO NOT INDICIATE A RESTRICTION UNLESS THE EXACT RESTRICTION IS SPECIFIED

For all non-railway employees, check any suspected defect with Ishihara. Discuss with OHP before taking further action

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Visual Fields Good visual fields are

desirable, particularly in Drivers, Plant Operators

If defective discuss with Occupational Health Physician

Fusion May be abnormal (unacceptable) particularly if phoria is also abnormal

If failed fusion alone, no further action, but encourage to see Optician at usual interval. If fails, and phoria/steropsis abnormal, refer to Optician. Discuss need for restriction with Occupational health Physician

Fail Phoria If acuity//fields normal If acuity and/or fields fail/abnormal

Refer to Optician Do not restrict Refer to Optician. Restrict according to standard

Fail Stereopsis (usually associated with abnormality of visual acuity)

If fails stereopsis and acuity If fails stereopsis but not acuity

Refer to Optician. May require restriction if acuity failed (see standard) Particularly Drivers of Plant etc. Advise to see Optician at usual interval Do not restrict

Employees should be encouraged to attend the Optician on the day of their assessment

and re-assessed on that day for a review of their (corrected) vision.

Ishihara Colour Vision Test

Pre-employment A deficiency in colour vision defect may have implications for certain

occupations (e.g. Electricians, Signallers). If a defect is identified, the result should be

discussed with the OHP who will advise on fitness.

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APPENDIX I

COLOUR VISION

TESTING PROTOCOL USING ISHIHARA

16 CHOSEN PLATES (See Guidance overleaf)

1 PRACTICLE PLATE

a. Test in normal daylight or colour corrected day lamp.

b. If the tested person requires correction he/she should be tested with their

Glasses/lenses.

Only clear glasses/lenses are appropriate for testing

c. Place the book at arms length.

d. The examiner should turn the pages

e. Allow approximately 2 seconds per page

f. Always start from plate 1 (you do not need to follow the numerical order afterwards) and stop at plate no. 17.

g. Record the answers on response sheet as you go along

h. Check the answers given against the table enclosed

i. Circle misreading or errors (misreading should be circled in black, errors in

red).

j. Interpret the result and record it on notes.

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ISHIHARA TESTING

Plate Normal

Person Person with Red-Green Deficiencies

Person with

Total Colour

Blindness

1 12 12 12

2 8 3 X

3 29 70 X

4 5 2 X

6 15 17 X

7 74 21 X

8 6 X X

9 45 X X

10 5 X X

11 7 X X

12 16 X X

13 73 X X

14 X 5 X

15 X 45 X

Red Green

Strong Mild Strong Mild

16 26 6 (2) 6 2 2 (6)

17 42 2 (4) 2 4 4 (2)

The mark X shows that the plate cannot be read. Blank spaces denote that the reading is indefinite. The numerals in parenthesis show that they can be read but they are comparatively unclear.

Name: Date:

Result: Please Tick Box

Normal

Strong Red/Green Deficit

Mild Red/Green Deficit

Total Colour Blindness

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11. HEARING

EQUIPMENT REQUIRED

Audiometer AMPLIVOX SERIES II / III (CA850)

Compatible keyboard and lead

Sound-proof hearing booth (The department of health recommend a minimum size of

1.2m by 1m and a height of 2m a comfortable seat and a window. Suitable booths

are available from several sources including INDUSTRIAL ACCOUSTICS COMPANY

LTD, ENGLAND.

It is not always possible to carry out hearing tests on site using a booth. Therefore,

as specified in ISO6189, a quiet environment is required and a background noise

reading should be taken using a simple sound level meter. Ideally the subject should

be sitting and have ambient noise levels continuously below 30 dB(A), although this

is rarely achieved without a sound booth.

If a booth is not available and background noise is of a reasonable level, audiocups

of MX41/AR cushions, which exclude more noise then the standard TDH39

headphone, should be used.

NB: Once headphones are calibrated to the audiometer, they cannot be changed

without re-calibration.

If the subject is having his/her audiogram for pre-employment screening to highlight

any pre-existing condition, it is recommended that a sound booth be used. Whilst

repeat audiometric tests without the use of a booth can be carried out, all the

employees previous and present test results should be scrutinised for abnormalities

and referred to a specialist for further investigations.

Appropriate printer paper (printers are supplied with Amplivox ll x lll)

Paperwork for recording history and results (example provided with this procedure

document).

Auroscope and disposable ear pieces

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PROCEDURE FOR AUDIOMETRIC TESTING

Ensure all equipment is working

Testing should take place in a quiet location away from loud / sudden noise

Where more than one subject is to be tested, they should be brought into the testing

area one at a time

Ideally the subject should not be tested immediately after exposure to loud noise

A full audiological history should be taken and documented (recurrent ear disease,

tinnitus, perforated ear drum, previous diagnosis of noise induced hearing loss)

The subjects ears should now be examined and findings documented

(wax/abnormalities)

The examiner should begin by giving the subject an explanation of the test

procedure.

Proceed to commence test following manufactures instructions which are supplied with

the equipment (copies attached for your information)

NOTE- the BECKESEY test is usually used but the computerised method should be used:-

At the point where the examiner has entered the subjects details, the subject should be

asked to enter the booth, sit down and make themselves comfortable.

The examiner should now give the subject CLEAR, SIMPLE and CONSISTENT

instructions.

Continue to run the test following manufactures instructions.

When the test is complete, invite the subject to leave the hearing booth and print out the

results.

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Calculate the low and high frequency results (add together the results of (0.5, 1 & 2

kHz) for low frequencies and (3 4 & % kHz) for high frequencies).

Categorise using health and Safety Executive (HSE) guidelines.

Advise subject of the results and refer to the standards provided with this procedure

document in order to assess the effects of these results on their competency to carry out

their jobs safely.

Advise management when necessary.

Refer to physician/GP for clinical opinion if warranted.

Calibration checks should be performed annually by a qualified technician.

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Highway Workers Lone working in traffic

Low Frequency Follow standard for PTS (with exception to individuals wearing good quality hearing aids)

Fail: If possible due to wax, advise removal at GP surgery and retreat If no wax, advise fail and inform employer/employee and record in notes Advise employee to discuss result with own GP as appropriate

Drivers Class I Drivers Class II Mobile Plant Fork Lift Drivers Heights Confined Spaces Noisy Areas

High Frequency Assess ability to hear warnings, (spoken, electronic etc). A whisper test may be helpful, but take account of beneficial effects of hearing aids where they are allowed.

With the exception of Rail workers, employees will be allowed to continue working normally if they use an effective hearing aid. (Please not, Rail workers cannot work un-accompanied even with hearing aids unless they pass the hearing test standard.

Restriction for Highway Workers/Lone Workers:

Accompanying on/near highways at all times. Not to take responsibility for safety on highway

Non-Railway Workers Low/High Frequency Loss No Standard, but HSE

Category should be referred to and the employee counselled with the resulting categories.

Significant high or low frequency hearing loss i.e. with a significant effect on awareness/concentration and / or ability to communicate may need to be brought to the attention of employer. All such cases should be documented and discussed with the OHP.

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12. LUNG FUNCTION

EQUIPMENT REQUIRED

Vitalograph Alpha II Portable Office Spirometer with integral screen and thermal printer

Precision syringe for checking accuracy (available from Vitalograph)

Disposable cardboard mouthpieces

Accurate free-standing measure to measure height of subject in centimetres

Appropriate container for disposal of used mouthpieces

Mains electricity supply

Room thermometer

PROCEDURE

Plug vitalograph in and switch the unit on. Check that there is an adequate amount of

printer paper in place.

Perform accuracy check and update calibration as required.

Using the keyboard and following the written instructions on the vitalograph screen.

Enter:-

The ambient temperature of the room (CHECK BEFORE EACH TEST), and the correct

date. The menu will now appear select NEW SUBJECT and proceed to enter the:-

Age

Height

Sex

Ethnic origin of current subject

The printer will now start automatically which confirms the subject has been entered as the

current subject

From the menu now select VC TEST and insert unused mouthpiece into flow head.

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The subject should now be instructed as follows:-

1) Stand or sit upright in front of the unit 2) Take hold of flow head unit, keeping it in a vertical position and away from the mouth.

(Ensure the device is not jerked whilst handing it to the subject) 3) Inhale as deeply as possible and then insert the mouthpiece into your mouth, clamping

it between your teeth 4) Close your lips around the mouthpiece 5) Exhale normally for as long as possible Now press ENTER to return to main menu From the menu now select FVC TEST and repeat instructions 1 4 above The instructions for step 5 should now be given as follows:- Exhale as quickly as possible and try to keep exhaling for at least 6 seconds Remove used disposable mouthpiece Now press the ENTER button to return to main menu From main menu now select PRINT

The results of the VC test and the BEST FVC test will now be printed along with the

predicted results for this subject

From the menu now select NEW PATIENT. The screen will now show ALL RESULTS

WILL BE CLEARED (Y) OR (NO) select (Y). The Vitalograph is now ready fro the next

subject

The results should now be interpreted using the guidelines provided (see Appendix 1). For

further information on operating, cleaning, calibrating and maintaining the Vitalograph Alph

II, please refer to the separate internal guidance and the manufacturers instruction manual

which is supplied with the unit.

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NB: If the employee becomes distressed or breathless then the test should be

suspended and this should be documented. The test may need to be repeated at a

later date. The nurse should follow the guidelines laid out in the treatment of

anaphylaxis, ensuring the employees safety and call the emergency number

provided at the site, if required.

GUIDELINES FOR INTERPRETING RESULTS OF LUNG FUNCTION TESTS

The results of the following measurements are recorded automatically on completion of

lung function tests following the procedure provided:

VC

FEV1

FVC

PEFR

FEV1%

FEF (25-75)

(vital capacity)

(forced respiratory volume in 1 second)

(forced vital capacity)

(peak expiratory flow rate)

(FEV1% to FVC ratio)

(forced expiratory flow rate)

Both FEV1, FVC and PEFR should fall within the expected range for age, gender and

height. The ACTUAL result should be checked against the PREDICTED.

The FEV1% should be greater than 75%. An FEV1% of less than 75% indicates possible

obstruction (narrowing of the airways i.e. asthma, bronchitis) which may warrant referral to

the subjects own doctor for further assessment. This would not be necessary in the

absence of a clinical history and/or symptoms.

An FVC% (predicted/actual x 100) of less than 80% may indicate significant disease of the

lung tissue (e.g. fibrosis) and may warrant referral to the subjects own doctor in the

presence of clinical history.

The FEF (22-75) should be greater than 55% or obstruction particularly due to small

airways disease is indicated and referral to the subjects own doctor is required. A result

of over 55% but less than 75% may indicate a defect but due to the normal variability of

this parameter it should not be used in isolation.

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Changes of 5% or more between current and previous results (where available) should be

deemed as significant and they should be taken into account in future health assessments.

STANDARD

TASK

RESULT

WITH

SYMPTOMS

WITHOUT

SYMPTOMS

All occupations, in

particular those with

a significant manual

handling component.

FEV1

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IF THE ERROR MESSAGE IS LESS THAN 3% THEN THE DEVICE IS ACCURATE.

PRESS (N) AS THERE IS NO NEED TO UPDATE THE CALIBRATION.

IF THE ERROR MESSAGE IS GREATER THAN 3% RECHECK THE ACCURACY BY

PRESSING (N) TO UPDATE CALIBRATION FOLLOWED BY (Y) TO RETEST.

IF THE ERROR MESSAGE IS STILL GREATER THAN 3% PRESS (Y) TO UPDATE

CALIBRATION (WHEN CALIBRATION HAS BEEN ADJUSTED ACCURACY SHOULD

AGAIN BE CHECKED).

A calibration CHECK will now be printed if no update was required.

A calibration REPORT if an update was required.

CLEANING VITALOGRAPH ALPHA II

All parts of the unit should be cleaned regularly.

The flow head assembly (i.e. the CONE and the ELEMENT) should be cleaned and

disinfected on a weekly basis.

The FLOW CONDITIONING MESHES should be replaced regularly (at least monthly or

every 100 subjects i.e. 500 blows) in the event of damage or if visibly contaminated.

The FLOWHEAD COMPLETE and FLOWHEAD CONNECTION TUBE should be replaced

annually.

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13. BLOOD PRESSURE

EQUIPMENT

Standard sphygmomanometer / Stethoscope / Cuff preferably adjustable, otherwise

standard and large.

PROCEDURE

The blood pressure should be measured using a standard sphygmomanometer and cuff.

The cuff should be at least half as wide as half the arms circumference. The new

generation of automatically adjustable cuffs should be used in preference to the older

wrap round type.

Readings should be taken as follows:

1) Systolic when the initial softer sounds become harsher and more tapping) in

quality

2) Diastolic when the sounds cease altogether

Blood pressure will vary accordingly to the state of the patient. Employees will naturally be

anxious and this may influence the readings. Normal blood pressure should be no more

than 120 systolic and/or 80 diastolic. However, the systolic pressure increases with

advancing age.

Confirmed Hypertension

If the blood pressure exceeds 160 systolic and/or 100 diastolic consistently over a 6 month

period (British Hypertension Society), and these results are based on at least 3 readings,

each a week apart, the employee would be regarded as having an abnormal blood

pressure. It is obviously not possible to record employees blood pressure at weekly

intervals, nor is moderately raised blood pressure necessarily a bar to safety, unless it is

likely to impair health or there is evidence of and/or pathology (e.g. myocardial infarction,

stroke, renal impairment, visual impairment).

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Borderline Hypertension:

If the systolic exceeds 140 and/or the diastolic exceeds 90 respectively (but not both).

Probable Hypertension:

If the systolic is greater than 140 and the diastolic is great than 90.

Note that the systolic pressure increases with advancing age.

STANDARD

Drivers (Class II, Mobile Plant including Fork Lift Truck) (DVLA) bans driving of Class II vehicles if BP exceeds 180/100 until controlled without side effects from medication)

Borderline (i.e. systolic > 140 or diastolic > 90)

If systolic >140 and >90 but 180 and/or diastolic >100

Repeat if possible. Advise employee and refer to GP ___________________ Repeat later in the day if possible. If still raised, refer to GP

Inform OHA/OHP who will advise re restriction if necessary

Safety Critical Workers Crane Operatives

A restriction may be necessary if BP exceeds systolic of 180 and/or diastolic of 100, particularly if there are symptoms associated with hypertension. In on medication, ascertain if there are any side effects which may affect safety e.g. dizziness, visual disturbance.

Inform OHA/OHP who will advise re restriction if necessary.

Class I Drivers If systolic >140 and/or diastolic >90 but

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14. URINALYSIS

EQUIPMENT REQUIRED

Specimen Pots, Labstix, Accutrend / Glucotrend Machines

PROCEDURE

Test urine (preferably but not essentially a fresh specimen) with Labstix. Dispose of waste

hygienically.

Standard

All Occupations Drivers, Class I and Class 2

Whether know diabetic or not Refer to GP using appropriate form. Obtain consent as appropriate. Known diabetics, poorly controlled:- restrict if Class 2 driver, driver of mobile plant, or safety critical. Other drivers need to see their GP but will not require a restriction unless they are on medication which may require adjustment and may cause hypoglycaemia/side effects. Potential new diabetics:- Normally restrict as for Class 2 drivers or safety critical until investigated and fit, with or without medication PLEASE REFER TO DVLA GUIDELINES FOR DETAIL REGARDING NEW/EXISTING DRIVERS, CLASS 1 AND 2

Glycosuria (trace, 1, 2 or 3+) repeat on fresh specimen. If positive, try to obtain blood sugar on finger prick sample (preferably also offer test on venepuncture) If blood sugar high (>9) advise, refer to GP and inform OHP. If blood sugar normal (3-9) advise, refer to GP. May require restriction until fit. Consult OHA/OHP

Railway Workers (Trackman, O/H Linesman, etc)

Will usually be temporarily restricted pending further investigations. Inform OHP and discuss

Proteinuria, Haematuria, Other

Retest on fresh sample. Inform employee and refer to GP. Do not restrict unless OHA/OHP advises.

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15. VENEPUNCTURE

Equipment:

Monovette/Vacutainer

Needles

Tourniquet

Plasters

Sharps Box

Gloves

Cotton wool buds

Procedures:

Needle stick injury

Disposal of clinical waste

PROCEDURE

1) Seat the patient or lie them down if they are needle phobic or faint easily.

2) Explain procedure. Check for any special risks of bleeding, clotting deficiency,

Warfarin therapy do not proceed but D/W OHP.

3) There is no need to clean or sterilise the skin unless it is obviously dirty.

4) Apply tourniquet, select a vein, insert needle at 30 and withdraw blood.

5) Place a gauze/cotton wool swab over the puncture site as the needle is removed.

Get the patient to press firmly on the swab with the arm straight for two minutes.

6) Discard (do not re-sheath) the needle immediately to a sharps bin, which should be

located within comfortable reach of you (but not that of children).

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RISKS ASSOCIATED WITH VENEPUNCTURE

1. CONTAMINATION

There is no risk of contamination of the sample as health care workers always use the

vacutainer system to obtain the sample. The collection of the blood sample is carried

out in a clean environment using single use gloves. This method prevents cross

contamination.

2. NEEDLE PHOBIA

The employee is asked if they have a needle phobia prior to carrying out the

procedure. If they have a needle phobia, they are invited to lie flat on the floor with

their legs elevated on a chair or if there is access to a first aid room, then they should

be advised to lie on the couch during the procedure. Following the procedure, they are

monitored for 10 minutes to ensure they have recovered enough to resume their usual

activities.

Policy and Procedure in the event of needle stick injury

1. Needle stick injuries occur most frequently when needles are re-sheathed.

Therefore needles should not at any time be re-sheathed but should be disposed of

directly into the appropriate container for use.

2. In the event of a needle stick injury, the wound should be encouraged to bleed as

profusely as possible and run under clean, running water for at least five minutes.

There is a risk of transmission of Hepatitis B and/or HIV, but this clearly depends on

the status of (a) the donor and (b) the recipient.

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The following steps should always be followed in the event of a needle stick injury:

1. The wound should be attended to as above and a clean dressing applied

eventually.

2. The following details should be obtained from the donor:

Name

Address

Date of Birth

Medical History past history of infection with Hepatitis B and/or HIV

If possible, a sample of blood from the donor should be obtained with their consent to be

tested for Hepatitis B and/or HIV.

3. If the donor admits to past infection from Hepatitis B and the recipient has not been

immunised against Hepatitis B, then a blood sample should be obtained from the

Recipient and arrangements should be made for it to be tested for Hepatitis B

status.

4. If the donor admits to a past history of Hepatitis B and the recipient has been

successfully immunised against Hepatitis B within the last 5 years, no further action

need be taken but the needle stick injury should be entered in the accident book

and a note made in the doctors file for future reference.

5. If the donor admits to being HIV positive and the recipient is HIV positive, no

further action need be taken.

6. If the donor admits to being HIV positive and the recipient is not HIV positive, the

recipient should seek advice from an appropriate medical authority as to whether or

not HIV testing should be carried out. It should be borne in mind that it can take

several weeks for the recipient to convert to HIV positive.

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Please be assured by the fact that infection through needle stick injury amongst health

workers for both Hepatitis B and HIV is relatively rare. The incidence is still as far as we

are aware around 0.1% transmission amongst health workers for HIV alone.

If the needle stick injury occurs before a vein has been punctured, then there is less

likelihood of transfer of significant blood products. If the needle stick injury involves

contamination with blood which has been within the needle for more than four to six hours,

then whilst the risk of Hepatitis B infection presents, the risk of HIV infection will be very

low as the virus does not survive readily outside the body tissue.

General points:-

1. All needle stick injuries should be reported to their Manager and an opportunity is

afforded to discuss the matter with an Occupational Physician. If they are more

distant then they can make their own arrangements, either via the local Accident

and Emergency Department or their own General Practitioner.

SAFE USE AND DISPOSAL OF SHARPS

A sharp is any item that is capable of penetrating the skin, i.e. needles, glass slides,

ampoules, Stitch cutters.

ALL STAFF MUST DISPOSE OF SHARPS CORRECTLY:-

The person using the sharp is responsible for the safe disposal of it in a sharps

container. The sharps container should be situated in an area where the sharps are to

be used. NEVER carry sharps in hands or pockets.

Used needles must NEVER be RE-SHEATHED, CUT or BENT.

The syringe should NEVER be DISCONNECTED from the needle; it should be

disposed of as a single unit. Wherever possible the operator should wear disposable

gloves if he or she has any cuts, abrasions or broken skin on the hands when a blood

sample is being taken.

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Sharps containers should comply with the British Standards Institutes regulations (DoH

1989) and be marked accordingly. They should be coloured yellow and white/blue and

clearly marked sharps. The date and the name of the assemble should be clearly

marked at the time of assembly. No other container should be used.

Sharps containers should be kept out of reach of children and others.

The container should not be more than two thirds full or above the fill line.

Appropriate sized sharps containers should be used. Large objects should not be

forced into small containers.

The date and name of the person responsible for sealing the sharps container should

be clearly written on the side of the container, enabling the waste to be traced back to

its point of origin.

THE DISPOSAL OF CLINICAL WASTE

The Environment Protection Act (1990) requires that:-

1. Waste is stored correctly until collected.

2. A written description of the waste is provided

3. The waste is transferred to a registered carrier

SEGREGATION OF CLINICAL WASTE

Clinical items, i.e. dressings and other soft waste contaminated with blood or body

fluids must be placed in yellow bags. These bags should not be more than full.

Blades and sharp items must be disposed of in a sharps container which meets the

British Standard BS7320.

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The person responsible for sealing the clinical waste bag should make sure that the

bag is no more than two thirds full. The bag should be sealed with a tag and the

bag clearly labelled with the date and name of the person sealing the bag.

GENERAL WASTE (NON-CLINICAL)

General waste, including paper should be placed in black bags and disposed of with other

household waste.

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16. MUSCULOSKELETAL ASSESSMENT

1. The purpose of the assessment is to ascertain whether or not the individual is

suffering from recognisable musculoskeletal problems and identify.

a) Whether or not they are likely to be related to, or made worse by work,

and/or

b) Whether or not they are likely to affect the individuals fitness for work.

2. The clinical questionnaire should be completed with the employee.

3. A general assessment of mobility and agility should be carried out by completion of

the supplementary questionnaire (attached). The individual should be asked to

complete the tasks listed on the questionnaire and a judgement made as to whether

or not they were able to complete the tasks satisfactorily.

4. A decision should be made as to whether or not:

a) There is a work-related problem

b) Its implications for on going work in terms of fitness or likelihood of

exacerbation

c) There is sufficient mobility and agility for the individual to be able to carry out

their given duties safely, effectively and without detriment to their welfare.

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Medical Standard

1. The individual who is experiencing on-going i.e. musculoskeletal problems which they

feel is caused by work and/or affects their ability to work, then a more detailed

medical assessment should be carried out with an Occupational Physician and an

opinion be obtained as to:

a) Whether or not the individual is fit to continue working in their given capacity,

b) Whether any adjustments or restrictions are necessary,

c) Whether any further investigations are necessary in order to provide more

detailed advice regarding future management at work.

2. In some cases an individual may be experiencing significant problems because of

Musculoskeletal problem which necessitate adjustment/restriction or even removal

from one or more tasks, in which case advice should be given to management so that

a risk assessment can be carried out and appropriate action taken.

3. There will be a number of individuals who state that they have a work-related

musculoskeletal problem or indeed one which is not work-related but which has been

present for some time and is well controlled. In such cases, the individual may not be

experiencing any problems at work, but it may be appropriate for

management to be informed that they should review the risk assessments relating in

particular to manual handling activities to ensure that the individual does not

experience problems in future.

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17. SKIN ASSESSMENT

1. The purpose of this assessment is to ascertain whether or not an employee is

suffering from a skin problem that might be caused or made worse by work and/or

may affect their fitness for work

2. The clinical questionnaire should be completed by the employee.

3. An elementary inspection of skin should be carried out looking particularly at

exposed areas, i.e. those areas such as the hands/face, which may come into

contact with substances during the course of work activities. If there is evidence of a

skin problem particularly dermatitis, on the exposed areas then the employee should

be asked if there are similar problems affecting other parts of the body.

4. Appropriate note should be taken and entered on to the questionnaire.

5. In particular, the examiner should look for evidence of rashes which may indicate

Dermatitis and also any other skin conditions such as psoriasis, eczema, fungal or

bacterial infections that might become contaminated by substances at work and/or

making cleaning of the skin more difficult.

Medical Standard

1. Any individual who is suspected of suffering from a work-related skin problem such

as Dermatitis should be referred for a full medical assessment and advice given to

the company regarding further protection from exposure to substances that may

have caused the dermatitis whilst further investigations are carried out. If there is a

likelihood of sensitization, then arrangements will have to be made for the individual

to undergo patch testing with a Dermatologist.

2. If a work-related skin problem is suspected, the company should undertake a risk

assessment and take appropriate action.

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3. If the individual is suspected of having a skin problem which is not necessarily work-

related but may impinge on their ability to work safely and effectively, account

should be taken of this and the company informed so that a risk assessment can be

carried out and appropriate protective measures can be instigated to protect the

employees skin from further harm.

4. There may be circumstances in which the skin problem is so severe that the

individual needs to be restricted from certain work activities. Management should

be informed of this opinion and take appropriate action.

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18. ASSESSMENT FOR HAND ARM VIBRATION SYNDROME (HAVS)

1. Hand Arm Vibration syndrome (HAVS) comprises 3 main elements:-

a) Vascular white finger (blanching)

b) Sensorineural numbness and/or tingling

c) Musculo-skeletal a variety of symptoms and signs including aching in the

fingers, hands, wrists or forearms, loss of grip/cramps and other sensations

in the upper limbs.

NB Numbness and/or tingling may occur in association with white finger whilst

blanching is present.

2. White Finger

White finger occurs in reaction to cold temperatures but not to vibration itself.

Numbness and tingling may occur during and after the use of a vibrating tool

therefore it is important to ascertain if this is the case and if so how long the

symptoms last after they stop using the tool. It is also important to ascertain

whether or not any numbness or tingling occurs at other times i.e. when tools are

not being used.

3. Document as accurately and clearly as possible any sins and symptoms which may

indicate HAVS. The purpose of this screening is to act as an initial filter so that

potential cases can be more closely evaluated by means of the details HAVS

questionnaire and if required, subsequent assessment by an OHA/OHP. Based on

the responses in this further questionnaire, the physician will stage the condition

and recommend further action e.g.

~ confirm via OHA assessment

~ confirm via OHP assessment

~ refer for Standardised Testing

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APPENDIX II

Supplementary Clinical Guidelines

Clinical

Component Main Features Circumstances

Vascular

Blanching (white finger) Clear demarcation, variable phalanges/digits affected. White Purple Red Blanching may cause numbness, recovery may produce tingling.

White finger occurs in response to cold i.e. low temperatures not exposure to vibration.

Sensorineural Numbness (loss of normal sensation) which may or may not be associated with tingling (pins and needles/parasthesiae). May occur during use of vibrating tools and persist for some time after. Important to ascertain if symptoms appear to be more persistent i.e. occurring at other times, particularly when relaxing e.g. at night, on walking.

May occur whilst using tools and persists for variable periods after, but may also occur in more severe cases at other times. NB Symptoms may be associated with peripheral nerve damage e.g. ulnar/median nerve problems.

Musculoskeletal Various symptoms/signs most commonly cramps/aches/pains in fingers, wrists, forearms, Many employees will have arthritic changes as a result of manual handling. These may be aggravated by the use of Jack Hammers etc. Other conditions e.g. Carpal Tunnel Syndrome, Dupytrens Contracture may be associated but cause/effect with vibration not demonstrated scientifically.

Symptoms appear to be most commonly related to the prolonged use of Jack Hammers with the exception of Carpal Tunnel Syndrome and Dupytrens Contracture. Soft tissue/musculo-skeletal signs and symptoms are exacerbated by exposure to vibration rather than directly caused by it.

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THE STOCKHOLM WORKSHOP SCALES

Vascular Component Stage Grade Description 0 No attacks

1V Mild Occasional attacks affecting only the tips of one or

more fingers

2V Moderate Occasional attacks affecting distal and middle (rarely also proximal) phalanges of one or more fingers

3V Severe Frequent attacks affecting all phalanges of most fingers

4V Very Severe As in Stage 3 with trophic changes in their fingers

Sensorineural Component Stage Description 0SN

Vibration exposed but no symptoms

1SN Intermittent numbness with or without tingling

2SN Intermittent or persistent numbness reduced sensory perception

3SN Intermittent or persistent numbness reduced tactile discrimination and/or manipulative dexterity.

Note:

The staging is made separately for each hand. The grade of disorder is indicated by stage

and number of affected fingers on both hands, e.g. stage/handling/number of digits. It is

customary to report the overall grade according to the most severe Stage documented:

E.g. Result: Vascular Sensorineural

Right 3 2 (late)

Left 2 (early) 1

Overall Stage is 3

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19. DRUG AND ALCOHOL

ESSENTIAL REQUIREMENTS

Urine Samples

Private facilities and space for completion of paperwork

Toilet cubicle allocated for the use of collection officer only

Site preparation checklists

Sign to alert others that tests are in progress e.g. MEDICAL IN PROGRESS

Sign to remind Donor not to flush the toilet e.g. DO NOT FLUSH

Means of colouring the water in the cistern e.g. Blu-Loos or similar

Tamper proof tape for sealing the cistern and/or taps

Adequate supplies of specimen collection kits (at least six for each Donor)

Collection Agencys Donor Guidelines

Chain of custody forms

Current medication questions

Collection Agencys Specimen Collection Procedures as a source of reference

Envelopes in which to place Donors possessions

Refusal to provide and Unable to provide sample forms

Labstix

PROCEDURE

On arrival at the site identify the toilet facilities allocated to you.

Ensure that the facilities are suitable in accordance with Collection Agencys collection

procedures.

Welcome the Donor and give the Donor an explanation of the test procedure.

Explain in particular the following:-

1) The importance of disclosure of all medication taken in the 10 days preceding date of

collection, including injections received in the previous 14 days, prescribed medicines

and proprietary medicines.

2) The significance of the second sample.

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Ensure that the donor has the appropriate photographic identification required as

documented in the CANDIDATE IDENTIFICATION FOR THE PURPOSES OF A DRUG

AND ALCOHOL TEST guidelines. Where are these? In all cases this should be done

before asking them to read the consent form.

Ensure that the Donor reads and fully understands the information on the consent form

and then ask them to sign if they are happy to do so (please ensure that the DO/DO NOT

is deleted as appropriate). If the Donor is unable to read the form, read it to them or ask

for a translator. Document your actions on the COC form and in the notes.

Commence the collection using Collection Agencys Collection Procedure Guidelines (NB

if routine analysis of the urine using a lab stick is required; this should be performed on

any urine remaining after you have transferred an adequate amount into the two

containers to avoid the risk of contamination).

Upon reaching step four on the guidelines, complete the INFORMATION REQUIRED BY

COMPANY section ensuring you use the correct code and the name of the company

requesting the test on the top line (refer to separate form).

Upon reaching step five on the guidelines complete THE DONOR DETAILS using the

appropriate photographic identification (Refer to candidate identification for the purposes

of a drug and alcohol test guidelines).

Upon reaching step six on the guidelines, invite the Donor to place his/her possessions

into an envelope, observed by the Donor, seal the envelope. Donor and collection officer

must then sign across the seal. Place the envelope in a lockable drawer and keep the key

with you at all times. Upon leaving the unit to obtain the sample lock the door. Reassure

the Donor that no one will have access in your absence. Upon reaching step twenty three

on the list, return the sealed envelope to the Donor ensuring the seal is not damaged.

When the collection is complete ask the Donor if he/she has any further questions.

The Donor may now leave.

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Ensure you have all the relevant completed paperwork

Send the sample to the testing laboratory in a padded envelope using address label

provided.

When a Donor is unable to refuses to provide a sample or refuses to sign the consent

to test, terminate the collection and complete the appropriate forms (i.e. unable or

refusal declaration). Ensure the Donor understands the implications as outlined on the

relevant forms.

NB: - For a Donor to be deemed unable to provide a sample he/she must have been

allowed to consume a maximum of 1 litre of water given in amounts of 250mls at 20

minute intervals. They should be allowed a maximum wait of 2hrs. Document the amount

of water given in the comments box on the Chain of Custody Form.

If you have any concerns with regards to the appearance of the sample, follow the

collection agencys guidelines and document your concerns both on the chain of custody

form and in the notes in the case of a full medical.

On completion of all collections, remove all signs and tape from toilet facilities and inform

your contact that they are now free for normal use.

NB: If several collections are to be carried out, the Collection Officer MUST re-

check the facilities for signs of tampering prior to each collection.

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ORAL FLUID (MOUTH SWAB) SAMPLING The advantage of mouth swaps over a urine sample is that it is more difficult to adulterate, more hygienic and less intrusive for the donor. Essential requirements Private facilities and space for paper work Adequate supplies of specimen collection kits (at least six per donor) Collection Agency Donor Guidelines Chain of Custody forms Current Medication Questionnaire Collection Agency specimen procedures, as a source of reference Refusal to Provide Sample forms Procedure Welcome the donor then give the an explanation of the test procedure which should include that the donor has the appropriate photographic evidence to corroborate he/she is the correct donor

1. The importance of disclosure of all medication taken in the last ten days, including injections received in the last fourteen days.

2. The significance of the second sample 3. Ensure the donor reads and fully understands the information on the consent form,

then ask them to sign the consent form, if they are happy to do so 4. Complete the information required by company section ensuring you use the correct

code and the name of the company requesting the test on the top line If the first oral fluid specimen is positive and as it has been proven that oral fluids have a much shorter shelf life than urine, a urine specimen may be taken as an alternative for a chain of custody, The urine collection protocol should then be followed. When the collection is complete ask the donor if he / she has any questions The Donor may then leave.

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SITE PREPARATION CHECKLIST FOR URINE COLLECTIONS FOR LEGALLY DEFENSIBLE DRUG AND ALCOHOL TESTS

DATE

LOCATION

COMPANY

NAME OF COLLECTION OFFICER

STEP REQUIRED ADEQUATELY

PERFORMED RECHECKED

At the start of collection session (one cubical only to be used)

YES NOT YES NOT

Placing of Medical in Progress sign?

Placing of Do not flush sign?

Blu Loo placed in cistern?

Cistern sealed with tamper evident tape?

Any ground floor windows are locked?

Potential hiding places are clear and all cleaning products or potential contaminants are removed?

Before each collection Signs are still in place and visible?

Tamper evident tape is in place and not damaged?

Any ground floor windows remain locked?

Potential hiding places remain clear and all cleaning products or potential contaminants are removed?

All taps that are within the cubicle are sealed with tamper evident tape?

No third party present during the collection?

SPECIMEN COLLECTORS INSTRUCTION UNABLE TO PROVIDE A SPECIMEN FOR DRUG AND ALCOHOL TESTING

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I .. (full name of donor) Confirm that I was unable to provide a urine specimen, which was satisfactory for the purposes of a drug and alcohol test, after 2 hours, having been provided with 250mls of drinking water every 20 minutes up to a maximum of 1,000 mls.

The company who have requested the test is . I understand that the company will be informed that I was unable to provide a suitable specimen and that I may be required to re-attend for a drug and alcohol test in the future. I am aware that failure to do so will be treated in accordance with the companys policies and may lead to rejection of a job offer/disciplinary action against me. * Signature of donor:

Date: Time: I, (full name of Collection Officer) Certify that the above named individual was unable to provide a suitable urine specimen as stated above. * Signature of Collection Office: Date:

Time:

* Delete as appropriate

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SPECIMEN COLLECTORS INSTRUCTION UNABLE TO PROVIDE A SPECIMEN /REFUSAL TO GIVE CONSENT FOR DRUG AND ALCOHOL TESTING

I .. (full name of donor) Have been asked to provide a urine specimen for the purpose of a drug and alcohol test. The company who have requested the test is .

I understand that the company will be informed of my refusal and that this will be treated in accordance with the companys policies. I also understand that my refusal may lead to rejection of a job offer/disciplinary action against me. * Signature of donor: Date: Time: I, (full name of Collection Officer) Certify that the above named individual has refused to provide a urine specimen for the purpose of a drug and alcohol test/has failed to give their consent for the specimen to be used for such a test. *

Signature of Collection Office: Date: Time:

* Delete as appropriate

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20. CHOLESTEROL TESTING

Introduction

A raised level of cholesterol in blood is known as hypercholesterolemia. This is a known

risk factor for Coronary Heart Disease but is just one of several risk factors. Other known

non-modifiable factors increasing the risk are male gender, a family history, diabetes and

certain races. Lifestyle factors that are modifiable include cigarette smoking, high blood

pressure, alcohol consumption (excessive and very low), inactivity and obesity.

Coronary heart disease and stroke remain the most common cause of death in the UK.

One in 12 men dies from CHD before the age of 65. The combined effect of all risk factors

on risk is cumulative. It is very important to consider other risk factors for heart disease.

For example, even if cholesterol is only 4.5mmol/L if overweight, have high blood

pressure, smoke and take little exercise there remains a relatively high risk of heart

disease.

Health Surveillance

There are no requirements to undertake testing for raised cholesterol for non-safety critical

workers, but can be used as part of a general health / lifestyle programme, or for those in

safety critical / increased risk roles as part of the fitness for work assessment.

Frequency

3 yearly if used as part of the cardiovascular health re-assessment for Fitness for Work.

The National Institute for Health and Clinical Excellence (NICE) and Department of Health

cholesterol guidelines, which is the policy doctors follow, are:

total cholesterol: less than 5.0mmol/l

LDL cholesterol: less than 3.0mmol/l give description of anagram

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However, the Joint British Societies (a group of the main UK expert societies involved in

cardiovascular disease) recommend different cholesterol limits for people who have, or are

at risk of, coronary heart disease:

total cholesterol: less than 4.0mmol/l

LDL cholesterol: less than 2.0mmol/l

HDL cholesterol: more than 1.15mmol/l give description of anagram

triglycerides: less than 1.5 mmol/l

These guidelines match the more stringent recommendations used in Europe.

NICE is currently reviewing its national policy guidelines.

21. HEALTH PROMOTION

Health surveillance provides a unique opportunity to promote not only work related health,

but also general health and well being. Employers are increasingly recognising the value

of including health promotion in their health surveillance programmes. Issues such as

smoking, weight loss, healthy eating and exercise, alcohol, mental, cardiovascular and

sexual health can be incorporated. Investigations such as blood tests (for cholesterol and

lipids, liver and kidney disease, diabetes, and prostate function) and electrocardiographs

can be undertaken with minimum discomfort and disruption.

Employees feel valued as a result, and appreciate the opportunity to discuss issues which

they might not otherwise have the time to raise with their GP; they are less likely to feel

that the health surveillance is just for the employers benefit, and more likely to participate

willingly in the programme.

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22. MEDICAL PROTOCALS, PROCEDURE & STANDARDS Job types and health surveillance needs

These charts are provided to show what screening is required by the different trades and occupations. However, in practical terms it would be more appropriate if a general screen was undertaken for all workers with add-ons being provided where there was a particular work related need identified and linked to an individual.

Job Title Clinical Examination Required Duration of

Clinical Exam Administrator (site) Mid Range Acuity DSE users)

20 minutes With Screening Technician / OHA

Asbestos Licensed Worker

Pre-placement Health Questionnaire Safety Critical Workers Fitness for Task Assessment Statutory Medicals (Appointed Doctor) Musculoskeletal Questionnaire / Assessment Skin Health Assessment Respiratory Surveillance Audiometry & Questionnaire HAVs Assessment Blood Pressure Urinalysis

1 hour 30 min With Screening Technician / OHA

Bricklayer

Pre-placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Respiratory Surveillance Audiometry & Questionnaire HAVs Assessment Work at Height Assessment (balance)


Bricklayers Labourer

Pre-placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Respiratory Surveillance Audiometry & Questionnaire HAVs Assessment Work at Height Assessment (balance)


Carpenter / Joiner / Shopfitter

Pre-placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Respiratory Surveillance Audiometry & Questionnaire HAVs Assessment Blood Pressure Urinalysis


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Job Title Clinical Examination Required Duration of Clinical Exam

Construction Site Operative Specialist



Demolition Operative Pre-placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Respiratory Surveillance Audiometry & Questionnaire HAVs Assessment Blood Pressure Urinalysis


Electrician Fitter / Engineer

Pre-placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Respiratory Surveillance Audiometry & Questionnaire HAVs Assessment Colour Vision Blood Pressure Urinalysis


Form Worker

Pre-placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Respiratory Surveillance Audiometry & Questionnaire HAVs Assessment Tiers Blood Pressure Urinalysis


Glazing / Glass Fitter / Window Installer



Grounds Person Pre-placement Health Questionnaire Audiometry & Questionnaire HAVs Surveillance Skin Health Assessment Mobility Check Respiratory Surveillance Blood Pressure Urinalysis


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Handyman Pre-placement Health Questionnaire Audiometry & Questionnaire HAVs Screening Skin Check Mobility Check Respiratory Surveillance Blood Pressure Urinalysis


Laminator Audiometry & Questionnaire Respiratory Surveillance HAVs Screening Skin Health Assessment Mobility Check Blood Pressure Urinalysis


LGV / HGC Driver

Pre-Placement Health assessment Assessment Musculoskeletal Questionnaire / Assessment Audiometry & Questionnaire Blood Pressure Urinalysis Visual Acuity & Fields Drug & Alcohol Testing

2 hours With Screening Technician / OHA

Painter / Decorator Pre-Placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Respiratory Surveillance HAVs Assessment Blood Pressure Urinalysis


Piling Operative Pre-Placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Audiometry & Questionnaire HAVs Assessment Blood Pressure Urinalysis Drug & Alcohol Testing


Pipefitter Pre-Placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Respiratory Surveillance HAVs Assessment Blood Pressure Urinalysis


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Plant Operator - General Pre-Placement Health Assessment Musculoskeletal Questionnaire / Assessment Skin Health Assessment Audiometry and Questionnaire Blood Pressure Urinalysis Visual Acuity & Fields Drug & Alcohol Testing


Plant Operative Crane Driver

Pre-Placement Health Assessment Musculoskeletal Questionnaire / Assessment Skin Health Assessment Blood Pressure Urinalysis Visual Acuity & Fields Drug & Alcohol Testing

2 hours With Screening Technician / OHA With OHA

Plant Operative Mobile Machine Driver

Pre-Placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Audiometry and Questionnaire Blood Pressure Urinalysis Visual Acuity & Fields Drug & Alcohol Testing


Plasterer / Dry Liner Pre-Placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Respiratory Surveillance HAVs Assessment Blood Pressure Urinalysis

1 hour With Screening Technician / OHA

Plumber / Gas / Heating / Ventilation Engineer

Pre-Placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Respiratory Surveillance HAVs Assessment Blood Pressure Urinalysis

1 hour With Screening Technician / OHA

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Rail Trackside Pre-Placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Respiratory Surveillance Audiometry and Questionnaire HAVs Assessment Blood Pressure Urinalysis Visual Acuity & Fields Drug & Alcohol Testing


Road Construction Asphalter / Paver

Pre-Placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Respiratory Surveillance Audiometry and Questionnaire HAVs Assessment Blood Pressure Urinalysis Visual Acuity & Fields


Roadside (high speed)

Pre-Placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Respiratory Surveillance Audiometry and Questionnaire HAVs Assessment Tiers Blood Pressure Urinalysis Visual Acuity & Fields


Roofer Slater / Thatcher Pre-Placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Respiratory Surveillance HAVs Assessment Blood Pressure Urinalysis Visual Acuity & Fields Drug & Alcohol Testing Work at Height Assessment (balance)


Scaffolder / Rigger Pre-Placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Blood Pressure Urinalysis Respiratory Surveillance Visual Acuity & Fields Drug & Alcohol Testing HAVs Assessment Work at Height Assessment (balance)


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Site Foreman / Supervisor Pre-Placement Health Questionnaire Musculoskeletal Questionnaire / Assessment Skin Health Assessment Respiratory Surveillance Audiometry and Questionnaire HAVs Assessment Tiers Blood Pressure Urinalysis Visual Acuity & Fields


01-MEDEVAC Protocols Procedures

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