Download Newsletter 2nd Quarter 2015

2nd qtr 2015
SCAAOHN News
Special Interest
Articles:
• NIOSH Hearing
Loss Study
• NUAC update
Angela Day
• New recordable
medical
treatment
NIOSH Hearing Loss Study
NIOSH Study Spans over Thirty Years of Hearing Loss Trends
March 4, 2015
NIOSH Update:
A new study from the National Institute for Occupational Safety and Health (NIOSH)
examines thirty years of hearing loss trends experienced by workers exposed to noise
while on the job, across various industries. The study, published by the American Journal
of Industrial Medicine, found that while progress has been made in reducing the risk of
hearing loss within most industry sectors, additional efforts are needed within the
Mining, Construction, and Healthcare and Social Assistance sectors.
Approximately 22 million U.S. workers are exposed to hazardous noise at work. Longterm exposure to hazardous noise, a single instantaneous high noise exposure, or
exposure to chemicals that damage hearing (ototoxic chemicals) can cause occupational
hearing loss – a job-related illness that is permanent and potentially debilitating, but
entirely preventable. This study is the first to look at thirty years of hearing loss trends by
industry sector and give a birds-eye view of how workers are affected by hazardous noise
environments.
“Looking at hearing loss trends across all industries over a long period of time can
provide a better understanding of what still needs to be done for the protection of
workers,” said NIOSH Director John Howard, M.D. “Noise control in the workplace is
directly linked to the prevention of hearing loss among workers in all industries and can
positively impact workers on the job and at home.”
The study, Trends in Worker Hearing Loss by Industry Sector, 1981–2010, can be found at:
http://onlinelibrary.wiley.com/doi/10.1002/ajim.22429/abstract
SCSAOHN News
Page 2 of 6
NUAC report – Angela Day
SCWCC Narcotics Use Advisory Committee
Meeting November 20, 2014
This was the third meeting of the NUAC, but the first one that I attended as representative of
SCSAOHN. I greatly appreciate the honor of representing our association on this committee.
Governors Prescription
Drug Abuse Prevention
Plan
http://www.wcc.sc.gov/
Documents/Narc%20Us
e%20Adv%20Comm/Pr
esscription%20Drug%2
0Abuse%20Prevention
%20Council%20(PDAC
P)%20Final%20Decem
ber%202014.pdf
A quote from the
document
“Astonishingly,
enough
prescription
painkillers were
prescribed in the
United States in
2010 to medicate
every American
adult every four
hours for one
month”
The committee is made up of a broad spectrum of various disciplines including physician
specialists (pain management, anesthesiologists), one WC Commissioner, Claim managers,
adjusters, attorneys, pharmacists, Risk managers, case managers, Injured worker advocates,
civil justice coalition, manufacturer alliance, DHEC, Chambers, municipal associates, hospitals
and dept of alcohol and drug use.
One of the main items on our agenda was the presentation of a report from the Governor’s
Prescription Drug Abuse Presentation Council. The committee was formed on order of Gov.
Haley and charged with studying the controlled substance issue in SC and making
recommendations for solutions. The report was not complete and was due to be given to
Gov. Haley in less than two weeks. (It was presented on December 11). The report is 150
pages and contains over 50 recommendations. Some of the highlights are:
1. Only 21% of controlled substance prescribers are enrolled in the SCRIPTS
program. (Electronic statewide database that prescribers can access to review a patient’s
controlled substance history in SC).
2. In 2013 physicians were required to have two hours of continuing education
related to approval, procedure of prescribing and monitoring controlled substances. It was
committee’s recommendation that this be extended to include dentists, PA and APRN’s.
3. The committee worked with stakeholders to revise Pain Management Guidelines
and those new guidelines are published in appendix B of the report.
4. Recommendation to REQUIRE the registration and use of SCRIPTS be mandatory.
(Many pharmacies report prescriptions issued already).
5. SCRIPTS system be used to monitor prescribing practices and have guidelines in
place for appropriate prescribing practices as well as educational or judicial intervention
when prescribers are outside of the guidelines.
6. Have governor ask NC and GA to share their controlled substance information
with SC. (17 states currently participate in sharing of information but these two states
currently do not).
7. Expand the statewide take back drug program
8. Insurers to offer insurance coverage for substance abuse treatment
For more information on this report, go to www.wcc.sc.gov and access the Narcotics Use
Advisory committee on the left sidebar. Click on resources and it will show up near the top
of the resources.
It was important that we know the work of this committee so we don’t duplicate efforts and
work to complement their recommendations.
Third party payers were asked to submit information in a certain format to assist the
committee in the fact gathering phase. To date of meeting, only 3 companies had submitted
their information and only one of these was in the format requested.
We briefly discussed review of other states work in worker’s compensation controlled
substances in IN, CT, TN and CA. We were asked to review these states work in depth.
There were several other states as well. It is a hot topic in the nation currently.
Page 3 of 6
NUAC cont’d
It seems that it is likely that our committee will definitely be recommending an educational
piece both for providers, other health care professionals, and patients. It may also to extend
to carriers and others, but it is too soon to tell.
There was discussion from the pain management specialists about how front line prescribers
were:
a. over prescribing,
b. not really qualified to manage chronic pain,
c. over prescribed for acute pain.
They went on to state how it would greatly benefit everyone concerned if they saw these
workers much earlier. They expressed concern about how far along the case was before
they first saw these workers. They discussed how their practices (in middle and lower part
of state) monitor their patients and do not continue to prescribe unless pain is being
controlled and there is a corresponding increase in function. They also discussed how they
use complimentary therapies and not center on narcotic pain medications. No one was
disagreeing with them. I finally had to speak up….I told the group that I apologized if my
remarks were going to be upsetting, but here in the upstate the last place we wanted to see
our workers go was to a pain management specialist because it was a black hole - lots of
money, no real gains, and no release unless they were discharged from the practice for noncompliance. Once I voiced those concerns, the insurance representatives agreed and
discussion followed that helped the pain management specialists to understand our
concerns.
We were asked to continue to review information for other states and were asked to submit
any suggestions we have to the Chairman.
It is anticipated that our next meeting will be sometime in February.
After I returned home and contemplated the discussion at the meeting, I realized that there
were no “front line” prescribers on the NUAC. I felt very strongly that if we were possibly
going to make prescribing recommendations then at least one primary care physician should
be included in the discussion to represent their concerns (since they may have to live with it
should it eventually be adopted). I contacted the chairman and made a recommendation
that ACOEM be contacted and asked to send a representative from SC who is a member in
active practice (MPH) to sit on the committee. I also told him that ACOEM had done work
on this matter already and did presentation to congress and that we needed this member in
order to access ACOEM’s materials. He did not disagree. However, when he contacted the
decision makers they disagreed and I believe it will not move forward. I was told that there
was already an entity seat that represented physician concerns (with an occupational slant)
and it may be offensive to that member to add someone else. It’s politics. I think it is
unfortunate decision. I made my argument twice, so I will have to accept the decision and
do my best to keep our occupational physician’s and APRN’s concerns in mind as we move
forward. I apologize that it took so long to publish this report, but I was trying to wait until I
received a decision on my recommendation.
I welcome any input that our members have to add to the discussion. You may contact me
at: [email protected] or my work number is: 864-487-2448. If you would like
additional information, please go to the SCWCC website and click on the NUAC on the left
sidebar. You can look up members, agendas and the resource page is rich with articles and
reports.
Respectfully submitted,
Angela R. Day
Website for NUAC
resources
http://www.wcc.sc.gov/P
ages/NUACResource.a
spx
SCSAOHN News
Page 4 of 6
OSHA Recordability
A "New Recordable Medical Treatment" from OSHA
From OSHA in a Letter of Interpretation to Ms. Linda Ballas [12/10/14]:
"Thank you for your recent letter to the Occupational Safety and Health Administration
Kinesiology Taping
https://www.osha.gov/pls/os
haweb/owadisp.show_docu
ment?p_table=INTERPRETATI
ONS&p_id=29288
(OSHA) regarding the recordkeeping requirements contained in 29 CFR Part 1904 Recording and Reporting Occupational Injuries and Illnesses. You ask if kinesiology tape
is considered medical treatment for OSHA recordkeeping purposes.
We consulted with physicians in OSHA's Office of Occupational Medicine, and they
inform us that kinesiology taping is designed to relieve pain through physical and
neurological mechanisms. The lifting action of the tape purportedly relieves pressure on
pain receptors directly under the skin, allowing for relief from acute injuries. The use of
kinesiology tape is akin to physical therapy and is considered medical treatment beyond
first aid for OSHA recordkeeping purposes." (See section
1904.7(b)(5)(ii)(M)).
Clarification of new Reporting requirements OSHA
Dear Ms. Ballas:
Thank you for your recent letter to the Occupational Safety and Health Administration (OSHA) regarding the recordkeeping
regulation contained in 29 CFR Part 1904 – Recording and Reporting Occupational Injuries and Illnesses. You ask for specific
classification of the new reporting requirements contained under section 1904.39.
Question 1: Please provide the definition of an amputation.
Response: An amputation, for OSHA reporting purposes, is defined under section 1904.39(b)(11). "An amputation is the traumatic
loss of a limb or other external body part. Amputations include a part, such as a limb or appendage,that has been severed, cut off,
amputated (either completely or partially); fingertip amputations with or without bone loss; medical amputations resulting from
irreparable damage; amputations of body parts that have since been reattached. Amputations do not include avulsions,
enucleations, deglovings, scalpings, severed ears, or broken or chipped teeth."
Question 2: How do you distinguish between an amputation and an avulsion?
Response: If and when there is a health care professional's diagnosis available, the employer should rely on that diagnosis. If the
diagnosis is avulsion, the event does not need to be reported. If the diagnosis is amputation, the event must be reported. If there
is no available diagnosis by a health care professional, the employer should rely on the definition and examples of amputation
included in the regulatory text of Section 1904.39(b)(11). Examples of avulsion that do not need to be reported include deglovings,
scalpings, fingernail and toenail removal, eyelid removal, loss of a tooth, and severed ears. Remember, employers are required to
report amputations to OSHA when they learn that the reportable event occurred. The employer must report the event when he or
she has information that the injury is a work-related amputation. See, Section 1904.39(b)(8).
Question 3: If an employee loses the very tip of his finger, would this have to be reported to OSHA within 24 hours of the workrelated event? What if the employee loses any part of the finger above the first joint?
Response: If the tip of the finger is amputated, the work-related event must be reported. An amputation does not require loss of
bone.
https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=INTERPRETATIONS&p_id=29291
Page 5 of 6
Medical Office Telephone Evaluation of Patients with Possible
Influenza
The flowchart below is designed to be used when influenza is circulating in the
community. This tool may help medical office staff triage calls from patients with flu-like
symptoms and identify when it might be appropriate to initiate antiviral treatment before an
office visit. Patient triage or prescribing of prescription medicines should be done under
the direction of a licensed physician or other licensed health care provider.
.
CDC website with more
info
http://www.cdc.gov/flu/p
rofessionals/antivirals/of
fice-evaluation.htm
SCSAOHN News
Telephone evaluation of flu symptoms cont
**High-risk patients include:

Children younger than 2 years (although all children younger than 5 years are considered at
higher risk for complications from influenza, the highest risk is for those younger than 2 years);

Adults aged 65 years and older;

Persons with chronic pulmonary (including asthma), cardiovascular (except hypertension
alone), renal, hepatic, hematological (including sickle cell disease), and metabolic disorders
(including diabetes mellitus), or neurologic and neurodevelopment conditions (including
disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy
[seizure disorders], stroke, intellectual disability [mental retardation], moderate to severe
developmental delay, muscular dystrophy, or spinal cord injury);
.

Persons with immunosuppression, including that caused by medications or by HIV infection;

Women who are pregnant or postpartum (within 2 weeks after delivery);

Persons aged younger than 19 years who are receiving long-term aspirin therapy;

American Indians/Alaska Natives;

Persons who are morbidly obese (i.e., body-mass index is equal to or greater than 40); and

Residents of nursing homes and other chronic-care facilities.
Page 6 of 6