Changes in world, workplace mean changes in scope of occupational health

Occupational, environmental health has key role in disaster preparedness

The scope of the occupational health practice began expanding almost from its beginnings in 1888, when Betty Moulder, a nurse in Pennsylvania, began caring for coal miners and their families. Today's occupational and environmental health nurses have one foot in the clinical world and one in the business world, with frequent steps into the policy and public health arenas.

Issues such as cost of prevention vs. cost of treatment, wellness and public health, and workers' compensation and insurance have been as much a part of occupational health nursing as tending to sick and injured employees at the work site for some time. More recent events have caused the scope of practice to expand to include environmental health, disaster and pandemic preparedness and response, and the role of occupational health in the broader field of public health in times of crisis.

"Some of the things I see happening [indicate] that occupational and environmental health nurses have much broader responsibilities than they have had in the past," says Susan Randolph, MSN, RN, COHN-S, FAAOHN, American Association of Occupational Health Nurses (AAOHN) president.

The U.S. Department of Labor's Bureau of Labor Statistics (BLS) projects that employment in the occupational health field will grow at a rate of 9% to 17%, and cites the Sept. 11, 2001, terrorist attacks as one reason.

"Emergency preparedness has become a greater focus for the public and private sectors, and for occupational health and safety specialists and technicians," the BLS states (see www.bls.gov/oco/ocos017.htm).

Disaster preparedness big OH focus

Occupational and environmental health professionals in all areas of the discipline have taken a greater role and and been more active in disaster preparedness in the nearly five years since the Sept. 11 attacks and the subsequent anthrax, avian flu, and SARS scares.

"We are focusing on being prepared if an event were to happen or an exposure situation occurred," Randolph says.

AAOHN is one of several collaborators on a project that brings occupational and environmental medicine together to address that specialty's role in the event of a mass casualty disaster. The Occupational Health Disaster Expert Network (OHDEN) sprang from the American College of Occupational and Environmental Medicine (ACOEM) and an emergency response panel — and later a multidisciplinary team — created to respond to the 9/11 disaster and to directives from the president and the Office of Homeland Security. The mission of OHDEN and its founding entity, the Occupational Health Advisory Committee (OH-AC), is to serve as an official Department of Health and Human Services/Homeland Security working group concerned with health care infrastructure in the event of a large-scale disaster or pandemic.

Is this concern about occupational health and medicine's role in the event of a large-scale health crisis new?

"Yes and no," replies Robert K. McLellan, MD, MPH, chief of occupational and environmental medicine at Dartmouth-Hitchcock Medical Center in Lebanon, NH, and a co-chairman of OH-AC. "Emergency preparedness has been part of occupational medicine since its beginning, particularly in industrial medicine when the workplace was not such a safe place. Early occupational medicine was very much a part of emergency planning — as in, what do you do when your plant blows up?"

What is new, McLellan says, is the extent to which occupational health and medicine is being drawn upon to deal not only with what happens at individual workplaces, but in the community at large.

OH network creates 'parallel public health'

"Particularly since 9/11, occupational and environmental medicine is being seen as forming a parallel public health system, parallel to the community public health system," he says.

Randolph says the greater reliance on occupational health providers beyond the doorway of the workplace is due in part to the realization that an employee's performance and health does not rely only on what happens when he or she is at work.

"You can't just look at the person at work; that's only one part of that person," she explains. "What else is going on with that person at work, and what is going on with that person at home?"

Networking with other health providers in the community is important, Randolph continues, because if a pandemic, disaster or attack were to occur, "all the health care partners in a community, including occupational health, would work together as a team, and it would be hard to [create alliances] as the disaster is happening or after a disaster occurs."

McLellan says that the OHDEN web site (www.ohden.sph.unc.edu) is a central location for occupational and environmental health providers to turn to for information on disasters, pandemics, and emergencies. A sub-page, OHDEN pandemic (www.ohden.sph.unc.edu/pandemic/index.htm) is both an active tool and an example of what OH-AC hopes OHDEN will provide for an assortment of situations.

At the pandemic site users find links to instructional materials and reference sites on H5N1 avian influenza and the concepts of pandemic influenza; information on care and prevention pertaining to workers and pandemics; organization needs regarding public health or population concerns, including contingency management, plans for major absenteeism, and illness; and plans and programs created by other professionals responsible for occupational and environmental health issues.

"OHDEN is a prototype for some of the functionalities," McLellan explains. "The aim of OHDEN is to provide a place where [occupational health providers] can go in the midst of an event and reach out to people who might not be in the thick of battle who have the time or expertise on what's going on to provide appropriate information."

The public health aspect of occupational medicine will put occupational health providers in the thick of the fray in the case of mass disaster or disease, McLellan says.

"The public health infrastructure has been allowed to deteriorate, and now there is an effort under way to restore that," he says. "But occupational and environmental medicine now provides public health services to their own employees, and are increasingly asked to respond to issues outside their own plants. This is very true of medical center occupational health [providers], who have been very involved in mass campaigns such as smallpox and responding to threats of pandemic flu."

Furthermore, he adds, corporate health care providers are closely involved in advising management "on everything from when to close down a plant to when to close down travel abroad to when to reopen and reoccupy an area that has been potentially contaminated."

Occupational health clinics could find themselves designated as central distributors for medications or mass immunizations or for treating the "worried well" during a crisis, McLellan says, which makes logistical sense but presents new problems that have to be planned for.

"There are many issues that need to be thought of," he says. "For example, who would pay for it? There are businesses that would need to recover [costs], but they present an opportunity for an organized network that could complement the community-based network during a crisis."

[For more information, contact:

Susan A. Randolph, MSN, RN, COHN-S, FAAOHN, president, American Association of Occupational Health Nurses; clinical instructor, public health nursing, University of North Carolina at Chapel Hill, school of public health. Phone: (919) 966-0979.

Robert K. McLellan, MD, MPH, chief, section of occupational and environmental medicine; associate professor of medicine and community and family medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756. E-mail: Robert.K.McLellan@Hitchcock.org.

Occupational Health Disaster Expert Network, web site: www.ohden.sph.unc.edu.]