Overview of Occupational and Environmental Medicine

When a worker is injured or becomes ill, OEM doctors try to determine whether the injury or illness is work-related or related to something in the environment. So doctors ask the worker questions designed to determine what led to the problem, such as:

• Where the injury or possible exposure occurred

• What the worker was doing when injured or became ill

Doctors may suspect a work-related cause, for example, if a person suddenly develops an unexpected illness that has no other clear non–work-related cause. Doctors may also suspect a work-related cause if a group of workers develop similar problems. In that case, doctors also ask managers whether other workers have similar symptoms. For example, if several workers from the same building report headache, nausea, and vomiting, they may have been exposed to carbon monoxide. Doctors may ask workers who have similar symptoms or who do not have symptoms but work in the same area as the worker being evaluated and may ask members of the community about any symptoms they have. This information can help doctors determine what chemicals or other exposures are causing symptoms among workers and others that have or may have had similar exposures. This information can help doctors determine whether the illness is work-related or not.

If the injury or illness is work-related, OEM doctors evaluate the conditions that led to the injury or illness. They evaluate workplace safety and ergonomics. They can then recommend ways to prevent future injury or illness.

Doctors check for one or more of these types of hazards:

• Air contaminants (such as dusts and fumes)

• Chemical hazards (such as asbestos, emissions from diesel or gasoline engines, formaldehyde, and lead)

• Biologic hazards (such as bacteria or viruses)

• Physical hazards (such as radiation, temperature extremes, noise, and vibration)

• Ergonomic hazards (such as lifting, reaching, and repetitive movements)

Doctors then talk to the employer about ways to reduce potential risks for workers. The most effective way to reduce risk is to remove the hazard from the workplace entirely. If removal is not possible, the hazard may be replaced with a less dangerous substitute. For example, a newer machine with additional safeguards may be substituted. Other less effective strategies are isolating a process or machine from the worker and changing the way workers interact with the hazard, either by improving training and procedures or by limiting the total time a worker is exposed to the hazard. Use of personal protective equipment (PPE) is the least effective way to reduce risk, partly because it requires that PPE fit or seal tightly and that workers use it consistently.

OEM doctors are frequently asked to assess disability in a worker. In the United States, various organizations (such as the Social Security Disability System, Civil Service Retirement, state worker's compensation programs, and state and Railroad Retirement Board) have regulations that establish whether a worker is disabled and whether the disabled worker should receive disability benefits.

During these assessments, OEM doctors determine

• Which organs are impaired

• How severe and long-lasting the impairment is

• Whether function in a body part has been lost

• Whether the worker is disabled (unable to do activities, including activities necessary for employment) because of an impairment

If the injury may have resulted from exposure to a substance in the workplace, tests are done to measure how much of the substance workers are exposed to regularly and/or after an incident (such as an unintended release of a substance). Workers may be tested to determine whether an exposure in the workplace has damaged an organ (such as the lungs).

Governmental agencies (such as the Occupational Safety and Health Administration [OSHA] or the National Institute for Occupational Safety & Health [NIOSH]) may inspect the workplace when workers report dangerous conditions or injuries or illnesses.

Testing may also be done to determine how much of a substance people in the community are exposed to after an unintended release of that substance.

Treatment for illnesses and injuries that occurred at the workplace is the same as that outside the workplace.

An important goal of OEM doctors is to return workers to the workplace as soon as it is safe. An early return to work can reduce the number of missed work days and the extent of disability over the long term. When workers with an injury or illness cannot return to their typical work routine, they may be assigned transitional duty (sometimes called light or modified duty). For example, OEM doctors may recommend limitations on pushing, pulling, lifting, sitting, and standing.

OEM doctors screen job applicants to determine whether they can safely fulfill the duties of the position they are applying for. OEM doctors evaluate such factors as an applicant's preexisting chronic illnesses or conditions, use of drugs that may cause impairment, and substance abuse (often with drug tests) and the results of a physical examination.

OEM doctors provide medical screening and surveillance of workers in workplaces with potential exposures to hazardous substances. In the United States, the Occupational Safety and Health Administration (OSHA) issues standards for such screening and surveillance.

Medical screening is a one-time evaluation, typically before the worker is hired. Screening is done to detect illness or dysfunction before a person seeks medical care. For example, doctors may screen people who may be at high risk of certain conditions.

Medical surveillance involves periodic evaluations of one or more workers over time to monitor their risks when they are exposed to potential workplace hazards that require specific preventive measures.

Depending on the substance involved, screening, surveillance, or both may be done.

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

1. An Employee's Guide on Reporting a Work-Related Injury or Disease: Provides detailed information about reporting a work-related injury or illness, including links to the forms needed.

2. Occupational Health and Safety Administration: Sets and enforces standards to ensure safe and healthful working conditions for workers; also provides information about workers' rights, hazard recognition, COVID-19, fall prevention, suicide prevention, personal protective equipment, and documentation requirements.

3. Pediatric Environmental Health Specialty Units: Provides information about how environmental factors (such as hurricanes, floods, lead, and wildfires) affect the health of children and adults of reproductive age; also provides contact information to experts in various areas of the United States.

4. National Institute for Occupational Safety and Health (NIOSH): Seeks new information about occupational safety and health, based on its own scientific research, and provides guidance and authoritative recommendations for improving safety and health in the workplace; also provides information about such topics as nail gun safety and about the health implications and applications of nanotechnology (eg, nanotechnology laboratory safety).