Pre-Exposure Medical Screening of Workers Deployed for Hurricane Disaster Work
The primary goal for pre-deployment (or comparable pre-exposure) medical
screening programs is to evaluate a worker's fitness to perform potentially
hazardous or stressful work safely. Additionally, pre-deployment medical
screening can be used to assess minimal physical and emotional requirements to
perform work activities, the ability to use personal protective equipment
(PPE), and the worker's immunization status. Pre-deployment medical screening
also documents the workers' health status for use as a baseline when
interpreting the results of any subsequent evaluations. Screening can also be
used to identify risk factors that should be mitigated before or during
disaster work. Finally, while not a primary purpose in this context, screening
may help detect subclinical or unrecognized disease for early intervention.
Pre-deployment screening is particularly important for work in areas affected
by natural disasters because the potential for exposure to hazardous conditions
or agents may not be easily predicted, adequately characterized, or effectively
controlled. When exposure information is lacking, medical screening programs
may be one of the few recourses for assessing occupational health effects
related to disaster work; valid interpretation of post-work health effects
requires baseline information for comparison.
At a minimum, workers should be screened for fitness, and baseline information
should be obtained for all hurricane disaster workers before the start of
response work. The level or extent of screening appropriate for a given work
activity will depend on multiple factors, in particular the type of work
activity anticipated and the extent to which hazardous conditions can be
predicted.
This document provides interim guidance on medical screening for workers before
beginning disaster response activities and is based on information available as
of October 27, 2005; it will be updated or revised as appropriate, as
additional information becomes available. This guidance does not address issues
related to the post-deployment period, which are addressed separately (
http://www.cdc.gov/niosh/topics/flood/MedScreenWork.html).
It is intended for occupational health professionals and other clinicians who
are responsible for medical oversight of workers who will be deployed.
Reasons for Screening
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Document baseline health parameters
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Identify individuals with health concerns that need to be addressed
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Identify individuals with specific susceptibilities whose activities may need
to be restricted or modified
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Identify individuals not suitable because of health reasons for anticipated
tasks
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Identify medications being taken and side effects of such medications that may
affect or be affected by deployment
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Identify immunization needs
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Identify training needs
Who Needs to Be Screened
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All workers who will be deployed or will move from usual activities to response
activities
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Workers who are not in existing medical screening programs should be screened
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Workers who are currently in medical screening programs for their work should
be re-screened if it is feasible, but may not need additional screening if
circumstances require immediate deployment or re-assignment
What type of screening should be done?
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Screening approaches will vary depending upon the anticipated activities,
working conditions, and potential exposures
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Pre-deployment (or pre-exposure) biological monitoring for exposure to
hazardous chemicals is not generally recommended. Such monitoring is not
practical for unanticipated exposures to hazardous chemicals. When exposures to
specific chemical agents are predictable, workers should be adequately
protected. However, there may be some instances in which obtaining baseline
specimens prior to deployment for work in environments with predictable
exposures may be helpful in subsequently assessing whether the protections used
during this work are adequate and performing as intended.
When to screen?
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Because the primary reason for pre-deployment medical screening is to evaluate
workers' fitness to perform potentially hazardous or stressful tasks safely,
screening immediately before deployment is optimal.
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Workers who will be performing their usual work and are currently in
work-related medical screening programs may not require repeat pre-deployment
screening; however, such screening may have benefits, and attempts should be
made, prior to or as soon after the deployment date as practicable, to evaluate
changes in health status that may have occurred in these individuals since
their last screening.
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For those already deployed and not in any existing work-related medical
screening program, screening should be done as soon as practicable.
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Further screening may be necessary during deployment, depending on results
obtained during pre-deployment screening.
Minimum Screening Information
The specific types of information elicited may be modified based on anticipated
work characteristics and deployment location; however, the following data
elements should be obtained for all individuals:
Personal information
Identifying and Contact Information
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Name, address, appropriate telephone number(s), e-mail addresses (work,
personal)
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Age, date of birth, birthplace, sex, social security number
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Contact information for someone who will know where the worker is 6 months
after leaving response work
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Response organization:
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Employer vs. volunteer organization (indicate which)
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Name and address
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Contact person's name and telephone number
Usual Work
Industry, occupation, job tasks, number of years
Special Needs
Primary language
Health status
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Pre-existing medical and mental health conditions
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Symptoms currently experienced
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Medications and side effects
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Other specific risk factors (will depend on job, e.g., use of personal
protective equipment, exposures)
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Immunization status: routine adult and any special risk (e.g., health care
worker)
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Pregnancy status (female workers)
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Assure worker has enough prescription medications to last the expected duration
of deployment (with a comfortable safety margin in case of delayed return to
home)
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Include question(s) to elicit whether workers have physical or mental health
concerns that they would like to be addressed
Response-Related Information
Response Work
This information should be provided by the worker's agency, organization, or
employer.
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Expected deployment location (as specific as possible)
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Anticipated tasks and circumstances under which tasks will be performed.
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Anticipated date of deployment.
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Anticipated duration of deployment
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Anticipated need for, use, and type of PPE
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Adequacy of training for tasks
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Characteristics of expected work locations and relationship to known or
suspected hazardous agents or conditions
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Anticipated shift schedules: hours per day, days per week, rotation schedules
Additional Screening Information Needs
Some workers with significant pre-existing medical or mental health conditions
may need more extensive screening. Other workers may need additional screening
because of the likelihood of working in hazardous conditions. Additional
screening may include a more comprehensive medical history and review of
systems, a physical examination, or, in some instances, laboratory testing, as
indicated by clinical judgment and good occupational medical practice. The
specific content should be determined by the following factors:
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Report of or concern about pre-existing illness, symptoms, physical impairment,
or emotional sensitivities that may be adversely affected during deployment
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Use of certain PPE such as respirators
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Anticipated tasks, working conditions, locations, or exposures that are known
to be hazardous or have specific exposures that may warrant medical monitoring
Follow-Up to Screening/Outcomes
Possible determinations from the initial basic screening are:
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Cleared for deployment with no restrictions
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Cleared for deployment with specified restrictions on types of
activities/exposures
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Recommended for training prior to clearance
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Recommended for further medical screening
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Not cleared for deployment
Other Considerations
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Simple and concise screening instrument(s)
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Designated custodian for the information collected
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Policies in place to assure confidentiality of information collected
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Appointed program administrator
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Clear identification of those with access to data results
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Data collection locations convenient to workers (e.g., central location where
workers report)
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Private area for conducting screening to maintain privacy
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Secure space to maintain records containing confidential information