II. History: Occupational

  1. Job History
    1. Employers (include part-time work)
    2. Job titles and responsibilities
      1. Construction workers, nursing aids and custodians are highest risk
    3. Accidents and injuries at each location
      1. Most common fatal injuries are due to MVA, strikes by equipment, falls, Violence, and harmful substance exposures
      2. Personal history of symptoms and injuries at each work site
    4. Military service
  2. Exposures
    1. Specific exposures (with frequency and quantity of exposure and safety data sheets)
      1. Biological exposures (communicable disease, animals)
      2. Chemical exposures (solvents, fumes, dust)
      3. Physical exposures (noise, radiation, vibration and repetitive motion, heavy lifting)
      4. Stressors (work relationships, workload and overtime)
    2. Personal Protective Equipment
    3. Assistive Devices
    4. Monitoring data (e.g. lead, radiation badge)
  3. Symptoms attributed to workplace exposure
    1. Similar symptoms in coworkers
    2. Symptom onset after new job or work responsibilities, new work process or materials
    3. Symptoms worse during or immediately after work
    4. Symptoms improve when on vacation from work
  4. Pscyhosocial factors
    1. Stress at work
    2. Job satisfaction
    3. Job variation versus monotony
    4. Relationship with coworkers or supervisors
    5. Fear avoidance behavior (limited activities imposed by patient due to fear of injury)

III. History: Non-occupational

  1. Habits
    1. Tobacco use
    2. Alcohol use
    3. Illicit substance use (e.g. Marijuana)
  2. Household contact history
    1. Others in same household with similar illnesses or symptoms
    2. Others in same household who work with hazardous materials (e.g heavy metals, lead)
  3. Home environment
    1. Heating and cooling (central air, wood stove, Carbon Monoxide detectors)
    2. Age of home and renovation history
    3. Pets in home
    4. Nearby industrial plant or toxic waste site
    5. Drinking water source
    6. Home projects (yard work, home remodeling)
    7. Hobbies (hunting, carpentry, painting)
  4. Psychosocial factors
    1. Excessive stress
    2. Family members or friends on Disability insurance
  5. Exercise
    1. Flexibility
    2. Weight lifting (e.g. dumbbell or kettlebell)

IV. Associated Conditions: Common Workplace Attributed Illnesses and Injuries

V. Precautions

  1. Early return to work is preferred with the best longterm outcomes
    1. Apply restrictions to prevent further injury or worsening
    2. Patient should expect some level of discomfort with return but the workday effects should significantly exacerbate the condition
    3. Of those off work due to restriction for >3 months, only 50% return to regular employment
  2. Avoid early Opioid use if possible
    1. Encourage the use of Non-Opioid Analgesics (e.g. NSAIDs) and non-pharmacologic therapy (e.g. physical therapy, massage)
    2. Low Back Pain treated early with Opioids is associated with prolonged use of Opioids, longer recovery period and higher surgery rate
    3. Webster (2007) Spine 32(19): 2127-32 [PubMed]

VI. Management

  1. Medical Documentation: Four Ws (from ACOEM)
    1. Where
      1. Work site where the injury occurred
    2. When
      1. Time and date of injury
    3. Who
      1. Who witnessed the injury?
      2. Who else was injured?
    4. What
      1. Mechanism of injury (and circumstances)
      2. List possible injuries and pain sources
  2. Specific evaluations
    1. Independent medical examination (frequently requested by employer)
    2. Functional Capacity Evaluation
    3. Impairment Rating
    4. Neuropsychological Exam

VII. Management: Return to Work (Workability Letter)

  1. Capabilities
    1. What activities can a patient safely perform
  2. Restrictions
    1. What activities is a patient unable to perform (without risk to self or others)
  3. Limitations
    1. What activities is a patient physically incapable or performing
  4. Schedule changes
    1. Recommendations for modified work schedule
  5. Duration
    1. Length of time for which restrictions are in place

VIII. Resources

  1. Agency for Toxic Substances and Disease Registry (ATSDR)
    1. http://www.atsdr.cdc.gov/
  2. National Institute for Occupational Safety and Health (NIOSH)
    1. http://www.cdc.gov/niosh/
  3. Occupational Safety and Health Administration (OSHA)
    1. http://www.osha.gov/

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Ontology: Occupational Diseases (C0028797)

Definition (MSH) Diseases caused by factors involved in one's employment.
Definition (CSP) an illness caused by factors arising from one's employment.
Concepts Disease or Syndrome (T047)
MSH D009784
SnomedCT 115966001
English Disease, Occupational, Diseases, Occupational, Occupational Disease, Occupational Diseases, occupational disease, DIS OCCUP, OCCUP DIS, Occupational Diseases [Disease/Finding], occupational diseases, diseases occupational, disorders occupational, occupational disease/disorder, occupational disorder, Illnesses, Occupational, Illnesse, Occupational, Occupational Illnesses, Occupational Illnesse, Occupational diseases, Occupational disorder (disorder), Occupational disorder
Portuguese Doenças Profissionais, Doenças do Trabalho, Doenças Ocupacionais
Spanish Enfermedades Profesionales, Enfermedades Ocupacionales, Enfermedades Laborales, enfermedad ocupacional (trastorno), enfermedad ocupacional, patología ocupacional, trastorno ocupacional
Swedish Yrkessjukdomar
Czech nemoci z povolání
Finnish Ammattitaudit
Italian Malattie occupazionali, Malattie professionali
Russian PROFESSIONAL'NYE BOLEZNI, ПРОФЕССИОНАЛЬНЫЕ БОЛЕЗНИ
Croatian PROFESIONALNE BOLESTI
Polish Choroby zawodowe
Japanese 産業病, 職業病, 職業性疾患
Norwegian Yrkessykdommer
French Pathologies professionnelles, Maladie du travail, Maladies professionnelles
German Berufskrankheiten
Dutch Beroepsziekte, Beroepsziekten, Ziekte, beroeps-, Ziekten, beroeps-

Ontology: Occupational Injuries (C0521168)

Definition (MSH) Injuries sustained from incidents in the course of work-related activities.
Concepts Injury or Poisoning (T037)
MSH D060051
SnomedCT 70962001, 371128008
English occupational injury, injuries occupational, Occupational Injuries, Injury, Occupational, Occupational Injury, Injuries, Occupational, Occupational Injuries [Disease/Finding], Occupational injury (morphologic abnormality), Occupational injury (diagnosis), Occupational injury (disorder), Occupational injury, Occupational injury, NOS
French Blessures professionnelles, Lésions professionnelles, Lésions au travail, Lésions sur le lieu de travail, Blessures au travail, Lésions en milieu professionnel, Blessures sur le lieu de travail, Blessures en milieu professionnel
Portuguese Traumatismos Ocupacionais, Lesões Ocupacionais
Russian ПРОФЕССИОНАЛЬНЫЕ ПОВРЕЖДЕНИЯ, PROFESSIONAL'NYE POVREZHDENIIA, PROIZVODSTVENNYE TRAVMY, ПРОИЗВОДСТВЕННЫЕ ТРАВМЫ
Spanish Traumatismos Ocupacionales, lesión traumática ocupacional, lesión traumática laboral, lesión traumática laboral (anomalía morfológica), injuria laboral, lesión ocupacional (trastorno), lesión ocupacional
Czech pracovní úrazy, úraz v zaměstnání, úrazy pracovní
Polish Uraz zawodowy, Urazy zawodowe
Italian Lesioni sul lavoro
German Arbeitsunfälle, Arbeitsunfaelle
Norwegian Yrkesskader, Skader, arbeidsrelaterte, Arbeidsrelaterte skader, Skader ved arbeidsulykker