Welcome to the WOEMA WINDOW, our e-newsletter sent to members by email on a monthly basis. The newsletter links to this page. Below are the items that appeared in the July 2018 issue.
- Western Occupational Health Conference 2018
- FREE CME Webinar: Maintaining Board Certification in Occupational Medicine
- OEM in a Changing Climate: Practical Advice for Clinicians
- Now Available: MTUS & Drug Formulary Webinar
- Topical News
- Your Picture Here
Western Occupational Health Conference 2018
Worksite Tours & Post- Graduate Sessions
Thursday, September 13
8:00 AM – 11:00 AM
Power Ortho: What Not to Miss in Back, Shoulder, and Foot Injuries (PG-1)
Kevin Burnham, MD; Brandee Waite, MD; Steven Y. Wang, MD; James Van den Bogaerde, MD
This session will focus on common musculoskeletal pathology in the occupational setting. Participants will have the opportunity to hone their orthopedic physical examination skills in a small group format. In addition to discussing diagnosis and advanced imaging, we will also discuss the latest evidence on new and common treatment modalities as well as red flags/what not to miss.
1:30 PM – 4:30PM
Power Pharma: Take a Deep Dive into the Science and Use of Non-Steroidal Anti-Inflammatory Drugs (PG-2)
Lori Reisner, PharmD, FCSHP; Gurkirpal Singh, MD
Do you know all that you should about NSAIDs? These are the most commonly used drugs in OEM practice; this three-hour seminar will explore them in depth from the perspectives of a pharmacologist and a rheumatologist. This course covers relevant topics including: basic science pharmacology (molecular structure, mechanism of action, absorption rate, excretion, etc.), applied clinical science (visceral changes, side effects, drug interactions, efficacy for various conditions, idiosyncratic sensitivities), regulatory realities (formulary) and market issues.
1:30 PM – 4:30 PM
The Provider’s Guide to Public Safety Medicine: Understanding and Using the Available Guidelines and Standards (PG-3)
Fabrice Czarnecki, MD, MA, MPH, FACOEM; Dan Samo, MD, FACOEM
This session offers state of the art training in applying the currently used guidelines and standards (most notably ACOEM’s Guidance for the Medical Evaluation of Law Enforcement Officers and NFPA 1582) when conducting post-offer, return to work, disability or annual examinations of Law Enforcement Officers and Fire Fighters. Our faculty is drawn from the American College of Occupational and Environmental Medicine’s (ACOEM) Public Safety Medicine Section. In addition to authoring the ACOEM Guidance for the Medical Evaluation of law enforcement officers, the faculty co-authors NFPA 1582, the standard for the medical evaluation of fire fighters.
7:30 AM – 11:30 AM
Live Fire Burn at the San Francisco Fire Department’s Training Facility (WST-1)
Tour the Treasure Island Training Facility of the San Francisco Fire Department and observe fire suppression activities during a live fire burn. Participants will learn about safety precautions during fire suppression activities, personal protective equipment for fire suppression, and standard procedures employed during fire suppression of a structural fire. Space limited to 30 participants.
1:00 PM – 4:30 PM
Worksite Tour: Golden Gate Bridge (WST-2)
This tour offers participants a unique, behind-the-scenes look at occupational health and safety exposures of the Golden Gate Bridge. This tour will cover in detail the occupational health programs that have been developed to mitigate exposures. The tour will include a visit of the grounds and short walk on the bridge.
FREE CME: WOEMA Webinar Series
Thursday, August 30, 12:00 PM PDT
Topic: Maintaining Board Certification in Occupational Medicine
Speaker: Eric Wood, MD, MPH
This webinar is designed to assist physicians in meeting requirements of Maintenance of Certification (MOC) for the American Board of Preventive Medicine. The lecture will provide an overview of the origins and evolving nature of MOC. It will address the four required parts of MOC: Part 1- Professional Standing; Part 2– Lifelong Learning and Self-Assessment (LLSA); Part 3– Assessment of Cognitive Expertise; and Part 4– Assessment of Practice Performance. The timeline for completion of these parts will be presented. Finally, the learner will be directed to resources and tools that are available to achieve these goals.
Learning Objectives – after this webinar participants will be able to:
- Review the origins and evolving nature of Maintenance of Certification
- Review Pathways to Board Certification
- Describe and define the Four Parts of Continuous Certification
- Identify timelines to meet MOC requirements
- Provide resources for achieving MOC requirements
Dr. Eric Wood is Director of Occupational Medicine at the Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), University of Utah. He also serves as the Director of the Occupational and Environmental Medicine Residency program at the University of Utah. He completed residency training in Family Medicine and Occupational Medicine and is Board-Certified in both disciplines. He has broad training and experience in occupational health, having begun his career as an Industrial Hygienist working for both OSHA and private consulting to address and mitigate a wide spectrum of occupational health risks among workers. His current academic responsibilities include education and training of occupational medicine residents, graduate students, medical students, and other health professionals; research with a focus on Occupational Health and Wellness among Commercial Truck Drivers, and Work-Related Musculoskeletal Disorders; and consultation and clinical practice of occupational medicine. He is Co-Chair of the NIOSH NORA Transportation, Warehousing and Utility (TWU) Sector Council. Dr. Wood is a Director of the American Board of Preventive Medicine (ABPM), and he serves as Vice Chair of Occupational Medicine for the ABPM.
OEM in a Changing Climate: Practical Advice for Clinicians
By Gina Solomon, MD, MPH
Clinical Professor, Division of Occupational and Environmental Medicine, U.C. San Francisco
Climate change in recent years has become a political issue, with politicians staking out positions on whether they ‘believe’ in it or not. Fundamentally, however, this is not a matter of belief, but of science. The scientific evidence is very strong that the earth’s climate is changing, with significant increases in air and water temperatures over the past decades. Increases in atmospheric heat lead directly to more extreme temperatures, and increases in atmospheric energy bring more extreme weather events such as droughts, severe storms, and floods. Resulting direct and indirect health effects will include a fairly predictable cascade of injuries and illnesses. As OEM physicians, our role requires us to be knowledgeable about how a changing climate can affect the workers and communities we serve, and what we can do to prevent morbidity and mortality from climate-related events.
Climate change can be viewed as a threat-multiplier, in that it will exacerbate already existing vulnerabilities. For example, populations most vulnerable to heat-related illness are those with other underlying morbidities (e.g., cardiovascular disease, diabetes), the very young and the elderly, pregnant women, and outdoor workers. The death of a 17-year-old pregnant farmworker in California in 2008 after working for 9 hours in 100o F heat pruning a vineyard with no shade or rest breaks was the impetus for new workplace regulations in the state. The California OSHA regulations now require that employers provide adequate shade, water, rest breaks, and take additional measures to protect outdoor workers from heat-related illness.
OEM physicians can take four actions in the near term to address the health effects of climate change:
- Educate patients and employers about heat-related illness prevention. All physicians should familiarize themselves with the signs and symptoms and the treatment of the trio of heat-related illnesses: heat cramps, heat exhaustion, and heat stroke. They should be aware of factors that increase the risk of these heat-related illnesses, and should also know and communicate the actions that can help prevent morbidity and mortality from heat. OEM physicians should also be familiar with regulations such as the Cal/OSHA rules on heat illness prevention, which are also useful outside California as guidelines.
- Identify vulnerabilities to extreme weather events in your practice and your community. Physicians should assess potential vulnerability to flood, severe storms and fire in their own clinical setting, community, and the workplaces they serve. Severe firestorms, such as those seen in Sonoma County in 2017, can engulf medical infrastructure, workplaces and communities within minutes. Riverine and coastal flooding and mudslides have also recently affected communities throughout the United States, and hurricanes crippled infrastructure in Puerto Rico, Southern and Eastern coastal States. All OEM clinics should update their disaster plans to minimize loss of life in disasters and to minimize disruption to patient services. Many states, including Arizona and Florida, provide resources to clinics to assist with disaster preparedness.
- Stay alert and report potential emerging illnesses. Climate change will result in changing patterns of infectious disease, including waterborne and foodborne illnesses. Returning travelers may contract vector-borne diseases, while outdoor workers may be at greater risk of zoonoses and tick-borne illnesses. Harmful algal blooms can affect fishermen and other workers who come into contact with affected waters. Recent outbreaks of Zika virus suggest that we can anticipate ongoing changes in disease patterns. OEM physicians may be among the first to see these diseases because they may be treating returning business travelers or workers in affected industries. Prompt reporting of any unusual diseases to local public health authorities could help dramatically with early identification and response. Similarly, patterns of pesticide use may change in response to shifting agricultural pest pressures. New chemical use patterns could result in increased risk of illness, and therefore require alert clinicians to detect and report these new hazards.
- Take practical steps to reduce greenhouse gases. In a clinic setting, energy efficiency can range from installation of more efficient lighting to simple steps such as turning off lights and powering down computers at the end of the day. Reduction of waste by reducing paper and plastic use where possible, or recycling, will also conserve energy. Water takes large amounts of energy to pump, transport, and treat, so water conservation translates to energy conservation, while also preserving our water supplies. Dietary changes that we often recommend to our patients as health-promoting are also climate friendly. For example, reducing consumption of red meat, fatty dairy products, and processed foods, while increasing consumption of vegetables and whole grains, is a win-win for health and our environment. The most difficult step for many of us is reducing our solo vehicle-miles traveled. Many physicians commute to work by car, and find it impractical to bicycle or take public transit. To the extent that newer hybrid and electric vehicle technologies are rapidly emerging, this may be an increasingly cost-effective alternative that could work for many people. Ultimately, as health professionals we have a responsibility to be leaders in protecting our patients and communities, educating the employers with whom we work, and demonstrating the power of prevention.
Dr. Solomon will be giving a presentation on climate change and health at the Western Occupational Health Conference in San Francisco on September 13-15, 2018.
- Patz J. A., Frumkin, H., Holloway, T., et al. 2014. Climate change: challenges and opportunities for global health. JAMA, 312(15): 1565–80.
- Basu, R., Pearson, D., Malig, B., et al. 2012. The effect of high ambient temperature on emergency room visits. Epidemiology, 23(6): 813–20.
- Watts, N., Adger, W. N., Agnolucci, P., et al. 2015. Health and climate change: policy responses to protect public health. Lancet: pii.
- California Code of Regulations Subchapter 7, Group 2, Article 10, §3395. Heat Illness Prevention. Available at: https://www.dir.ca.gov/title8/3395.html.
- Millán R, Thomas-Paulose D, Egan DJ. 2018. Recognizing and managing emerging infectious diseases in the emergency department. Emerg Med Pract: 20:1-20.
- Banwell N, Rutherford S, Mackey B, Chu C. 2018. Towards Improved Linkage of Disaster Risk Reduction and Climate Change Adaptation in Health: A Review. Int J Environ Res Public Health: 15(4). pii: E793.
Now Available: MTUS & Drug Formulary Webinar
On July 10, Dr. Steven Feinberg presented on The MTUS & Drug Formulary: Report Writing to Avoid Denials of Treatment Requests in one of WOEMA’s best attended webinars! If you missed this informative presentation, you can view the slides and a recording of the webinar on the WOEMA website. Be sure to browse the other past webinars available for viewing!
Topical News for the OEM Practitioner
- To reduce opioids, Colorado hospitals take part in innovative pain management pilot program.
- CBD oil: all the rage, but is it safe & effective?
- Does CBD oil work for chronic pain management?
- Opioid use after discharge in postoperative patients: Over the past 2 decades, there has been an increase in opioids use and deaths. The amount of opioids prescribed to surgical patients has also increased. This study suggests that surgical patients are using substantially less opioid than prescribed.
- Opioids after surgery can, paradoxically, prolong pain.
- California Medical Board provides legitimacy to physician directed use of cannabinoids.
Your Picture Here
The WOEMA Window is a member driven newsletter. It needs you to thrive. Do you have a story or opinion piece you’d like to write? Who do you know in the medical community that has a unique practice or is doing interesting work in the OEM field? Help us to share that in the Window.
Don’t be shy – writing is fun and satisfying. Give us an occasional piece or be a regular contributor. Contact the WOEMA staff with your ideas.
Troy Ross, MD, WOEMA Window Editor