Preventing needlesticks in emergency medical system workers.

Emergency medical system (EMS) workers frequently use sharp devices in injury-prone circumstances that involve limited visibility, confined spaces, rapidly moving vehicles, and uncooperative victims. This study examined the efficacy of an automatic self-retracting lancet in reducing needlestick injuries and related direct and indirect costs. Subjects were 477 active-duty EMS workers. Counseling, laboratory testing (hepatitis B and C, hepatic function enzymes, and human immunodeficiency virus), antiviral prophylaxis, and immunizations were provided according to US Public Health Service guidelines. Baseline and biennial laboratory testing for hepatitis B and C and liver function enzymes were conducted. After the introduction of a spring-loaded automatic-retracting type glucometer lancet device, needlestick injuries decreased from 16 per 954 EMS worker-years to 2 per 477 EMS worker-years. The annualized cost of treatment declined from $8276 to $2068. The change to a self-retracting device decreased the number of needlestick injuries and was cost-effective with a minimal increase in device cost (annualized $366 per year).

Fitness self-perception and Vo2max in firefighters.

Firefighters work at maximal levels of exertion. Fitness for such duty requires adequate aerobic capacity (maximum oxygen consumption [Vo2max]). Aerobic fitness can both improve a worker's ability to perform and offer resistance to cardiopulmonary conditions. Inactive firefighters have a 90% greater risk of myocardial infarction than those who are aerobically fit. Participants (101 firefighters) completed a questionnaire that asked them to rank their fitness level from 0 to 7; e.g., Level 0 was low fitness: "I avoid walking or exertion, e.g., always use elevator, drive whenever possible." The level of activity rating increased to Level 7: "I run over 10 miles per week or spend 3 hours per week in comparable physical activity." Each participant then completed two measures of Vo2max: a 5-minute step test and a submaximal treadmill test. There was no association between the firefighters' self-perception of their level of fitness and their aerobic capacity as measured by either step test or submaximal treadmill. Because of the critical job demands of firefighting and the negative consequences of inadequate fitness and aerobic capacity, periodic aerobic capacity testing with individualized exercise prescriptions and work--community support may be advisable for all active-duty firefighters.

Occupational and environmental medicine in preventionist residency training programs.

In the United States today, there remains a need to train physicians with expertise in occupational medicine and its corollary, environmental medicine. To determine whether preventive medicine residency training programs provide trainees with skills and knowledge in occupational and environmental medicine, we conducted a survey among directors of general preventive medicine and combined general preventive medicine/public health programs in the United States that listed such emphases in the Directory of Preventive Medicine Residency Programs in the United States and Canada. Of the programs surveyed, over 50% included occupational and environmental medicine training opportunities. Individuals who have trained in these settings have obtained employment in positions related to this training, and some have obtained certification. Our findings suggest that preventive medicine training programs may provide an avenue for training and certification in occupational and environmental medicine.

Occupational musculoskeletal disorders.

Musculoskeletal disorders of the workplace include the acute, cumulative and chronic injuries or illnesses of the soft tissues which are caused by mechanical stress, strain, sprain, vibration, inflammation, or irritation. The successful management of occupational musculoskeletal disorders must account for workplace conditions (ergonomics and work practices), psychosocial factors, diagnostic uncertainties, and the need for active modalities (exercises and a progressive increase in activities of daily living), rather than passive (bed rest and traction). Although most occupational musculoskeletal disorders respond to conservative measures such as ice or heat, protective devices such as, neutral splints for carpal tunnel syndrome, nonsteroidal anti-inflammatory drugs, and progressive strengthening, resolution may take months. Prevention is often more important than treatment, and may entail workplace revisions and special worker training. Worker selection programs--strength testing, pre-placement radiographs, and inquiries about prior low back pain--have poor predictive value.

Comprehensive care of travelers.

Travel, especially if it is international, often means major changes for the family. Family physicians should assess the epidemiologic risk and psychosocial significance of travel or relocation in light of the family's life-cycle stage and antecedent health. Using core references, which are kept current in partnership with public health agencies, family physicians are able to provide comprehensive immunization, medications, and patient education for all travel risks. Families are given medical record summaries and recommended sources of care at their destination. Eight weeks after their return patients are reassessed for newly acquired illness and helped to integrate the perspectives gained during the travel into the family's future dynamics. Taking advantage of growing travel medicine opportunities, family medicine educators should base the care of travelers and teaching of residents on defined competence priorities. Travelers' health provides a mutually rewarding model of shared care with public health consultants in the community medicine curriculum.

Work-related eye injuries and illnesses.

More than 65,000 work-related eye injuries and illnesses, causing significant morbidity and disability, are reported in the United States annually. A well-equipped eye tray includes fluorescein dye, materials for irrigation and foreign body removal, a short-acting mydriatic agent, and topical anesthetics and antibiotics. The tray should be prepared in advance in case of an eye injury. Eye patching does not improve cornea reepithelialization or discomfort from corneal abrasions. Blunt trauma to the eye from a heavy object can cause a blow-out fracture. Sudden eye pain after working with a chisel, hammer, grinding wheel, or saw suggests a penetrating globe injury. Chemical eye burns require immediate copious irrigation. Nontraumatic causes of ocular illness are underreported; work-related allergic conjunctivitis increasingly has been recognized among food handlers and agriculture workers who are exposed to common spices, fruits, and vegetables. The patient's history of eye injury guides the diagnosis. Primary prevention and patient counseling on proper eye protection is essential because over 90 percent of injuries can be avoided with the use of eye protection. As laser use increases in industry and medical settings, adequate personal protection is needed to prevent cataracts. Outdoor workers exposed to significant ultraviolet rays need sun protection and safety counseling to prevent age-related macular degeneration. Contact lenses do not provide eye protection, and physicians should be familiar with guidelines for the use of contacts in the workplace.

Core strength: a new model for injury prediction and prevention.

OBJECTIVE: Many work in injury prone awkward positions that require adequate flexibility and strength in trunk stabilizer muscle groups. Performance on a functional movement screen (FMS) that assessed those factors was conducted and an intervention was designed. METHODS: A battery of FMS tests were performed on 433 firefighters. We analyzed the correlation between FMS performance and injuries and other selected parameters. An intervention to improve flexibility and strength in trunk stabilizer or core muscle groups through a training program was evaluated. RESULTS: The intervention reduced lost time due to injuries by 62% and the number of injuries by 42% over a twelve month period as compared to a historical control group. CONCLUSION: These findings suggest that core strength and functional movement enhancement programs to prevent injuries in workers whose work involves awkward positions is warranted.

Outpatient management of burns.

Most of the 2.5 million Americans who seek medical attention for burns each year can be successfully managed as outpatients. Mainstays of treatment are proper wound cleaning, unroofing and debriding of most blisters, and topical chemoprophylaxis for all second- and third-degree burns. Early surgical evaluation for possible excision and grafting is necessary for third-degree burns, deep second-degree burns and infected burns. Systemic antibiotic therapy alone is insufficient for infected burns. Hospitalization is mandated for most fire-related inhalation injuries.

Health precautions for travelers to Mexico.

After Canada, Mexico is the most popular destination for Americans traveling outside the United States. As a developing country, Mexico presents numerous health hazards to American visitors, including the prevalent travelers' diarrhea (turista), from which 40% will suffer, and the less common typhoid, dengue, rabies, malaria, taeniasis, cysticercosis, and trichinosis. Environmental hazards, including sun, heat, high altitude, motion sickness, and accidents, also threaten the unwary traveler. In the event of illness or injury, Americans may find medical facilities unfamiliar and less well equipped than those in the United States. Utilizing both an individualized risk assessment for each traveler and readily available references, physicians, in partnership with local public health agencies, can develop comprehensive preventive health plans for their patients traveling to Mexico.