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.