need help--new to occ med

Sharon · Nov 25, 1998

Hey Sasha,

You are beginning to make the transition to an Occupational Health Nurse with the question: "Please elaborate, what are some examples of pre and post exposure prophylaxis???"

Typically when you hear pre and post exposure prophylaxis today what is being referred to is a HIV and HVB exposure. The new guidelines from the CDC at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00042200.htm. When there is a high risk occupational exposure to body fluids then a client will need to be evaluated to begin anti viral treatment within 120 minutes. These guidelines were developed for health care workers but I am using them more often with law enforcement, overseas workers, and any worker whose responsibility it is to remove debris from an abandon site.

In occupational health pre and post exposure prophylaxis may need to be evaluated for either a biological, chemical, energy, or physical exposure. For instance, a non-insulin dependent fireman working in extreme cold to extract a person from a wreck, may experience a severe Raynaud's phenomenon. The firefighter may need to be placed on medication to relieve the symptoms and return the individual to work. Initially, if possible, to a work station with less cold exposure.

BTW, one short course that has helped me in emergency care, disaster and occupational health has been the 40 hour haz mat training required of all potential volunteer and paid first responders. This course was were in a hazardous materials emergency I learned how to act. Specifically when to stop and help and when to run and duck. I also learned who and how to contact each official resource for identification of the contaminate. I received my training with the local fire department and rescue squad. When I took it in the mid 80's it was free because the state was trying to become compliant with the SARA re-authorization act. The course was open to hospital but I know no one from an ED let alone a hospital worker took it the first three years unless they were also involved with EMS. After that I relocated out of the state.

Try with your local EMS office or possibly the American Red Cross Disaster Services.

By the way if you do not subscribe on-line to the MMWR I would suggest you do. It is a great resource for monitoring health care issues especially occupational. If you aren't a regular reader I think you will be surprised at the occupational health information.

sasha · Nov 26, 1998

Sharon,

You are a veritable wealth of good knowledge. You make me want to ask soo many questions. I have heard of Haz Mat through my truck driver spouse. Never knew they gave courses though, will definitely look into this. Who, what or where is MMWR? Oh Boy, I am beginning to doubt that I know anything about nursing, there is so much that I don't know. This field evidently is much more different than I initially thought...I am getting excited...I start to work Tuesday. Thank you again for remembering me and I will investigate HazMat for sure.

Happy Thanksgiving to everyone!!!

Sasha

Sharon · Nov 30, 1998

Sasha,

I hope you had a nice Thanksgiving.

The MMWR is the CDC's Morbidity and Mortality Weekly Report and is located on line at www.cdc.gov.

sasha · Nov 30, 1998

Thanks for your response about MMWR. Yes, I had a wonderful Thanksgiving, did you? I have had luck in locating Emergency Care in the Streets by Caroline and I have it on order. What text do I need to look in for DOT regs? I understand that a lot of this I will get at work as OJT...but, I just feel better if I know what they are talking about when I hear them refer to something that I never have heard of before. For example, I heard them refer to BATs being done...I can only assume that this is breath analyzer tests...more than likely I am wrong...a friend of mine believes it is a series of blood tests (battery). I will find out tomorrow, I actually start work tomorrow! I am getting just slightly anxious:}

Sharon · Nov 30, 1998

Sasha,

Thanksgiving was fine. BTW I am on line at work which is why there was a gap in responding.

The best source for government regs are to go directly to the source. Luckily the federal government regs are on line. A good federal on line source that summarizes the medical requirements for commercial motor carriers is: http://www.fhwa.dot.gov/omc/pihs/pihs391.pdf.

The other source is to go to the GPO (government printing office) on line Code of Federal Regs and look up Title 49 319.41 for the specific wording. The url is: http://www.access.gpo.gov/nara/cfr/index.html. I do not recommend a text because they can change annually.

I agree with you I believe that BAT either stands for blood alcohol testing or breath analyzer test. Usually blood panels are not referred to as "bats" unless it is a local colloquialism.

Have a good time tomorrow and try to relax tonight.

Sharon

sasha · Dec 6, 1998

Sharon,

Well, it is time for me to report. I made it through my first week...I think that I am going to like it. I have to go out of town in a couple of weeks to do surveillance exams for a company that contracts with us. Our clinic is busy, especially on certain days when there are several docs seeing several pts. On my second day JACHO walked in behind me looking for employee health records...what a day. I like getting to know the employees at our facility as well as other people from other companies. It is totally different from anything that I have done before...but then when someone injures themselves it seems a little like ER. Thanks again for all of your help, it made me feel more comfortable on my first day and allowed me to ask a bit more intelligent questions.

I am sure you haven't heard the last from me.

Sharon · Dec 10, 1998

Sasha,

I am glad to hear things went pretty well. If you can say that about JACHO. I would like to hear how things are going especially your first trip. It sounds like you have landed in an occupational health position that will give you a lot of variety. Happy Holidays! Sharon

Patricia Paone · Jan 22, 1999

Sasha - for a wonderful guide you may want to get Bonnie Roger's books on occupational health nursing. One deals with the concepts of Occ health and the other one is for medical problems that come through the door for instance, foregin body in th eye or muscle strain. I have found them helpful. Bonnie also has many articles published.

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sasha · Jan 22, 1999

Hi, Patricia:

Thanks for the info about the books...I am finally beginning to feel comfortable with my job. I learn many new things each day. Now, I want to know all about worker's comp for Texas. Does anyone have any feedback about where to look for the rules and regs? It seems very complicated. I will look into these books and see if I can find them. Sharon, The offsite trip went just fine, one of us did hearing conservation, and one did vital signs and education. Had fun in the evenings and made some new friends during the day. It is nice having healthy patients who are very interested in their well-being...since they are exposed to many hazards in their work. We have another scheduled for Spring, may just volunteer to go. Gotta hit the sack now...lids are drooping. "I'll be baaack!"