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OHG Medical Staff Tours Kohler Company
On May 5, 2004 staff members from Occupational Health Group, The Orthopaedic Center and Huntsville Hospital Physical Therapy were invited to tour the Kohler plant in Huntsville, Alabama. This opportunity allowed Dr. James Gauthier (shown center of photo below), OHG’s Assistant Medical Director, to view the employees performing their actual job tasks. He was able to meet employees and ask questions about their equipment, ergonomics, and their safety program.

Kohler has made great strides in reducing their injury rate through close communication with their occupational health medical providers and automation. Many of the job processes have been upgraded and are either automated, to some degree, or have robotics performing the heavy lifting tasks. Though Kohler has shifted some of the job tasks from manual labor to automation, they continue to grow and currently employee over 450 employees.

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Wellness Services Attends Health Fair at Boeing
OHG Wellness Services participated in the 2004 Annual Boeing Health Fair on June 1st. Fern Thompson (left), a Wellness Specialist with OHG, counsels a Boeing employee following his cholesterol and blood pressure screening.

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Employer - Based Research Study: Wellness in the Workplace Crucial to Business Success
The American Association of Occupational Health Nurses (AAOHN) has released its employer research findings that uncover employer perceptions of and attitudes toward employee health. The research, released at the AAOHN 2005 Symposium & Expo in Minneapolis during May, was conducted to better gauge executive management.s thoughts on issues surrounding their employee.s health and wellness. Read Full Story

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Keeping Employees Well and Health Care Costs Down
(February 8, 2005) -- Health care costs have skyrocketed. While the medical community, insurance companies, and politicians address the issue, each group jockeying for the position that best serves their interests, employers are having to make serious decisions about whether they can continue to provide employee health care plans~Wthe most valued employee benefit~Wwithout breaking the bank. Exploring all possible ways to keep plan costs down for both the employer and the employee is an arduous, critical task. Read Full Story

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Back Education Luncheon
OHG, in association with PESCA (Public Employee~Rs Safety Council of Alabama), recently hosted a luncheon on Back Education. The program entitled "Back to Backs", was held Wednesday, February 9, 2005 at Mr. Prime's Restaurant. Patrick Swinea, a Physical Therapist and Clinic Coordinator with RehabAccess Physical and Occupational Therapy, in Decatur, Alabama was the presenter. There were approximately 85 attendees.

Topics and Objectives:
  • Anatomy of the back
  • Forces Involved in Back Injuries
  • Common Causes of Back Injuries
  • Prevention
  • Medical Treatment
  • Educating Employees
OHG would like to thank the following:
If you are interested in being notified of future seminars presented or co-presented by OHG, you may do so my contacting the OHG marketing representative in your area (see "Contact Us").

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Wellness Programs Cost Effective for Employers
Wellness programs are cost-effective for employers, Barela said, usually amounting to 1 percent to 3 percent of the company’s annual health care costs, and the benefits can be impressive.

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Just Released: "2004 State Report Cards for Workers' Comp"
based on newly available
OSHA data Work Loss Data Institute - 07/01/04

San Diego, CA - A new study based on data from OSHA Form 300's and 200's, covering all OSHA recordable injuries and illnesses, provides the basis for rating state-by-state workers' compensation performance. The study, called 2004 State Report Cards for Workers' Comp, was prepared by Work Loss Data Institute (WLDI) to help employers, insurers, TPA's, state governments, and consultants answer the questions, "Who is doing well and why?" Read more about the 2004 State Report Cards study

Click here for full story on Wellness Programs.

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OHG Announces New Medical Director
Dr. James Gauthier has been promoted to the position of Medical Director for Occupational Health Group (OHG) a division of Health Group of Alabama.

Dr. Gauthier has been a staff physician with OHG since 1994 and served as Associate Medical Director of Huntsville since 2001. He received his Bachelor of Science in Biology from Mercer University, his medical degree from the University of Alabama School of Medicine and completed residencies in Occupational/Preventive Medicine and Family Practice. He earned an MPH in Occupational Medicine from the Medical College of Wisconsin and is Board Certified in both Occupational Medicine and Family Practice. He is a Clinical Assistant Professor, voluntary faculty for UAB, serves as a volunteer physician at the Community Free Clinic of Decatur and is member of the Knights of Columbus.

Dr. Gauthier’s focus with OHG will be to continue practicing occupational medicine as well as advancing the practice to service the unique working community of North Alabama.

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Siemens VDO Partners with OHG to Provide Occ Health Services
On July 1st, OHG and Siemens VDO Automotive formalized an agreement to provide occupational health services to Siemens employees. OHG is excited to welcome Siemens VDO Automotive to our list of valued clients. We look forward to assisting them with all of their occupational health care needs.
On April 1, 2004, Siemens VDO Automotive officially completed the acquisition of Chrysler Group’s Huntsville Electronics operations, advancing Siemens VDO Automotive to a top-three spot in the global automotive supplier industry.

This transition of ownership enables the manufacture of innovative electronics to remain in the Huntsville community. The company plans to make the Huntsville location one of its global electronics manufacturing and engineering centers of expertise. In addition, Siemens VDO Automotive has worked closely with the local UAW to plan a careful transition of ownership.

As a subsidiary of Siemens VDO Automotive, the Huntsville plants have access to a broader range of business opportunities within the rapidly growing global $125-billion automotive electronics market.

With the completion of the acquisition, Siemens VDO Automotive has complete access to Huntsville Electronics, including two facilities comprising 1.1 million sq. ft. of space and approximately 2,000 employees. Huntsville Electronics generated approximately $1 billion in annual sales last year. The manufacturing capabilities, product portfolio, technical expertise and highly skilled workforce at Huntsville Electronics complement Siemens VDO Automotive’s core competencies of innovative electronics and electrical systems.

Siemens VDO Automotive is a tier-one supplier of automotive electronic/electrical systems and components with applications covering gasoline and diesel powertrain technologies, safety and chassis systems, body electronics, plus interior products including infotainment systems. Worldwide sales reflecting fiscal year 2002/2003 totaled $9.589 billion (€8.375 billion).

Click here to read the complete article

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OHG In the Community
On November 10, at the request of the local Alabama Department of Human Resources, OHG’s Decatur Marketing Representative, Dayton Gowen, presented the CHOICES program to a group of individuals currently participating in Alabama’s Welfare to Work Program. Dayton has presented the program to the Department of Human Resources in the past, as well as in the local school systems through a joint venture of Calhoun Community College and the Decatur-Morgan County Chamber of Commerce.

CHOICES is a two-hour interactive classroom seminar, facilitated by volunteer presenters from the business community, designed to help participants increase their future career and life options based on the level of education they decide to achieve, as well as, the impact their choices will have on others and the world around them. CHOICES also acts as a powerful tool for building and sustaining effective school and business partnerships in local communities.

Programs such as CHOICES have assisted Alabama in reducing those enrolled in the Temporary Assistance for Needy Families (TANF) program by more than 50 percent since the passage of the 1996 welfare reform law. Alabama is also one of 37 states and the District of Columbia receiving a share of $200 million in TANF High Performance Bonuses.

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OHG-Decatur Partners with Comp1One, SportsMed Orthopedics, the National Safety Council, and The Orthopaedic Center to Present Seminar
OHG-Decatur, in partnership with Comp1One, SportsMed Orthopedics, the National Safety Council, and The Orthopaedic Center, presented a 2-hour seminar at the Decatur Utilities auditorium entitled "Time is Money in Workers' Comp" on Tuesday, November 9, 2004. The Porgram was presented by Russell Ellis, M.D., with Decatur Orthopedics, and Dana Sellers, with Comp1One.

Topics and Objectives:

MMI, PPI, and IME's, By Russell Ellis, M.D.
  • Maximum Medical Improvement (MMI): What is it? When does it Occur?
  • Permanent Partial Improvement (PPI): What is it? How is it decided?
  • Independent Medical Evaluation (IME): What is it? How and when is it useful?
Case Management: Getting the Injured Worker Back to Work by Dana Sellers, Comp1One
  • Components of an effective program
  • Red Flag Indicators for Case Management
  • Closing the "loopholes"
  • Ways to lower your premium
  • Risk Management for Workplace Injuries
  • How to fight fraud
  • Work Comp Common Sense
OHG would like to thank Dr. Russell Ellis,with Decatur Orthopedics, and Dana Sellers, with Comp1One, for the time taken to prepare and present the programs, Decatur Utilites for the hospitality shown in using their auditorium, RehabAccess Physical and Occupational Therapy for providing the refreshments, and Decatur General-West for providing a door prize.

If you are interested in being notified of future seminars presented or co-presented by OHG, you may do so my contacting the local OHG marketing representative in your area (see "Contact us") or by email to leslieh@hgala.org.

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Drugfree Workplace Program Could Warrant WC Discounts
The Alabama Legislature passed and Governor Fob james signed a bill calling for a five percent (5%) workers' compensation insurance premium discount for those employers who establish a drug-free workplace on the job. Click here for full story about the Drugfree Workplace Program

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Workplace could be Optimum Setting for Battling the Bulge
ATLANTA (July 16, 2004) -- While obesity remains a serious health condition affecting millions of Americans and costing U.S. businesses $13 billion annually in health care costs and productivity (1), a recent study commissioned by the American Association of Occupational Health Nurses Inc. (AAOHN) sheds new light on ways businesses can help employees shed pounds.

According to the survey, workplace weight-management programs play a tremendous role in helping employees achieve weight loss. In fact, nearly half of all respondents who claimed to participate in workplace weight-management programs reported success in reaching and maintaining their long-term goals.

Read more about workplace weight-management programs

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OHG Medical Director Announces Retirement
After leading our clinical team for the past 14 years, Dr. William Walley, announced his retirement from his position as Occupational Health Group Medical Director, effective July 3, 2004.

Dr. Walley has been an integral part of Occupational Medicine in North Alabama. After many years in the private and corporate practice of Occupational Medicine, Dr. Walley joined Huntsville Hospital System in 1990 as Medical Director of Occupational Health Services. Under his leadership, OHS grew to provide occupational clinical services to more than 4000 clients in North Alabama. Since 1999, when OHS joined HealthGroup of Alabama to become Occupational Health Group, Dr. Walley has continued to serve as Medical Director.

Dr. Walley is Board certified in Occupational and Environmental Medicine. He is a member of the Madison County Medical Society, Medical Association of Alabama, American Medical Association, and the American College of Occupational and Environmental Medicine. He has served in progressive positions of leadership within the Alabama Occupational Medicine Association, including Vice President, President, and member of the Board of Directors.

Dr. Walley has been instrumental in the development of occupational medicine service programs in North Alabama. Under his leadership, Occupational Health Group has become a recognized leader in occupational medicine services on a state and regional basis.

Dr. Walley will certainly be missed by those who had the pleasure of working with him over the years. We wish him good health and prosperity as he enters this new phase of his life.

In the interim, Dr. James F. Gauthier, Associate Medical Director, will serve as the acting Medical Director. An announcement will be made when a new Medical Director is formally appointed.

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Flu Vaccination Reduces Work Absenteeism Among Adults
Influenza vaccination is the primary method for preventing influenza and its severe complications. Vaccination is associated with reductions in influenza-related respiratory illness and physician visits among all age groups, hospitalization and death among persons at high risk, otitis media among children, and work absenteeism among adults.* *Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP) (May 28, 2004)
  • Studies have shown employers can save up to $47.00 for each person vaccinated by reducing medical care and sick leave.
  • Flu vaccine has been linked to a 43% drop in work absences, 44% fewer doctor visits and 25% drop in upper respiratory infections
For over 16 years, OHG's Wellness Services has been bringing flu vaccinations directly to companies in North Alabama, at a very reasonable cost. Our licensed nurses can come on-site and administer the vaccine to your employes during their usual shift. Employees stay healthy, minimizing time off the job.

Read more about OHG’s Flu Shots and fee schedule

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The Need is Real - Donate Blood!
You've heard the pleas for blood from the local media. But often we don't see the faces behind the need. They are our friends, family and neighbors. Every day, more than 100 people in North Alabama hospitals require blood. Huntsville Hospital is the region's trauma referral center and uses the bulk of blood in North Alabama. For example, each year, Huntsville Hospital uses over 15,000 units of blood for surgeries, traumas, cancer patients, premature babies, accident victims and others.

LifeSouth Community Blood Centers, the nonprofit organization supplying blood to area hospitals, has public blood donor centers conveniently located in Huntsville, Albertville, Decatur and Florence that are open daily. Bloodmobiles are also available for blood drives, so consider planning and scheduling one in the near future. Every unit you donate will help save the life of a neighbor. Now is the time to join in the effort to help your friends and neighbors. There is no substitute for human blood . Please donate.
Click here to read more about LifeSouth.

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OHG Educates Decatur Employers OHG Educates Decatur Employers
OHG hosted a free 2-hour seminar at the Decatur Utilities auditorium entitled “D.O.T. & Non-D.O.T. Drug and Alcohol Education Program” on Tuesday, March 30, 2004. The program was presented by Larry Cantor, PhD who is a Licensed Professional Counselor, D.O.T. Certified Substance Abuse Professional, and the Clinical Services Director & Employee Assistance Professional for Decatur General West's Behavioral Medicine Center.

The goals of the program were to:
  • Meet the need for the Department of Transportation's regulation 49CFR 382.603 requirement
  • Meet the need for the required annual 2-hour supervisory training for those employers who participate in the "Alabama Drug Free Workplace" program, AND
  • Provide a general overview to local employers on how to best handle all aspects of a situation when an employee tests positive for drugs

Dr. Cantor speaks on D.O.T. & Non-D.O.T. Drug and Alcohol Education Programs
The 70 attendees, made up of HR personnel, safety personnel, Occupational Health Nurses, and supervisors, heard Dr. Cantor speak on topics such as:
  • “The Role of the Substance Abuse Professional”
  • “Patterns of Job Deterioration”
  • “Constructive Confrontations”
  • and the “Five Step Assistance Formula Summary”
Based on the results of the post-seminar survey, when asked -
“How applicable is the content to your daily professional activities?”
Many of the attendees responded “very applicable”.
Other comments noted on the survey by attendees were:
  • “Very helpful/useful tool”
  • “Aid in understanding of signs & symptoms”
  • "Good Information”

Each attendee received a certificate of attendance for proof of compliancy for the D.O.T.'s regulation 49CFR 382.603 requirement and the annual 2-hour supervisory training for the Alabama Drug Free Workplace.

OHG would like to thank Decatur Utilities for the hospitality shown in using their auditorium, Decatur General-West and Dr. Larry Cantor for the time taken to prepare and present the program, and Rehab Access Physical and Occupational Therapy for providing the refreshments.

If you are interested in being notified of future seminars presented or co-presented by OHG, you may do so by contacting the local OHG marketing representative in your area (see “Contact Us”). Or by email to leslieh@hgala.org.

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Living Large in America
Obesity is a disease that affects nearly 1/3 of the American adult population (60 million Americans). The number of overweight and obese Americans has continued to increase since 1960, a trend that is not slowing down. Today, 64.5% of American adults (about 127 million) are considered overweight or obese. How are “overweight” and “obese” defined?

Body Mass Index (BMI) is a mathematical calculation used to determine whether someone is overweight or obese. BMI is calculated by dividing a person's weight in kilograms by their height in meters squared. (This number can be misleading, however, for very muscular people, or for pregnant or lactating women).

Being obese and being overweight are not the same thing. A BMI of 30 or more is considered obese and a BMI between 25 and 29.9 is considered overweight. (Please visit the National Heart, Lung, and Blood Institute to calculate your Body Mass Index)

Obesity is considered just as significant a health risk as smoking and problem drinking. But this growing epidemic doesn't get the attention it deserves. Actually obesity is the 2 nd leading cause of preventable deaths (following closely behind smoking). And it directly affects a company's bottom line. Research reveals that obesity-related health conditions cost our nation $100 billion each year. Even more, obesity causes 58 million lost workdays and $5.66 billion in lost productivity annually.

Still not convinced? Check out the following statistics:
  • Approximately 127 million American adults are overweight. 60 million American adults are obese. 9 million American adults are severely obese.
  • In 1985, the National Institutes of Health recognized obesity as a disease.
  • In 1997, the World Health Organization declared obesity to be the biggest, global, chronic health problem among adults.
  • The average health care cost for individuals with a BMI above 27 is $2,274. The average for those with a BMI below 27 is $1,499.
  • Obesity is associated with more than 30 medical conditions, including Type 2 diabetes, hypertension, cancer, sleep apnea, infertility and osteoarthritis.
  1. American Obesity Association
  2. American Heart Association
  3. Centers for Disease Control and Prevention
Where do we go from here?
Weight loss of about only 10% is proven to benefit health by reducing many obesity-related risk factors. Most successful weight loss interventions focus on dietary changes, physical activity and other behavior modification strategies. OHG Wellness Services offers many valuable classes on healthy nutrition and weight

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Blood Pressure Update

****************************************************** Test YOUR Blood Pressure I.Q.
Please take ten minutes of your time and take this interactive quiz to test your knowledge about high blood pressure. Don't let this "silent killer" creep up on you.

For thirty years the National Heart, Lung and Blood Institute (NHLBI) has tracked research results from around the world regarding high blood pressure. About every five years NHLBI issues updated guidelines and advisories on blood pressure issues.

The Seventh Report (JNC-7) of the Joint National Committee on prevention, detection, elevation and treatment of high blood pressure was recently issued. In a nutshell, the study indicates inadequate treatment is being offered for hypertensive patients in a large percent of patients and the cardiovascular risks have not been fully appreciated.

Normal blood pressure is defined as less than 120 systolic and less than 80 diastolic. Pressures in the range of 120 to 139 systolic and 80 – 90 diastolic are considered to be prehypertension and should be aggressively managed by lifestyle modifications (weight control, tobacco cessation, more exercise, reduced salt intake, less cholesterol and saturated fat intake, moderation of alcohol use, and increased intake of fruits, vegetables and low fat dairy products).

In patients older than 50 years, systolic (upper number) blood pressure is much more important as a cardiovascular risk factor than the diastolic (lower number) blood pressure – contrary to previous opinions. The risk of adverse cardiovascular disease or events doubles with each 20/10 mm Hg increment above 115/75 mm Hg. The drug of choice for initial therapy is hydrochlorothiazide (“fluid pill”) – the drug of choice 35 – 40 years ago. For good blood pressure control, a second or even a third medication may be necessary.

High blood pressure afflicts 50 million American adults. It leads to an increase of 50% in congestive heart failure, 40% in strokes, 30% in heart attack, and elevated risks of serious kidney and eye disorders.

If you have questions, you may contact an OHG physician, practice manager, or the wellness division. We may be able to assist you in reducing hypertension and its serious consequences – including premature death in your employee population. Click here for additional information on the NHLBI Report.

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Cold Weather Health Risks
Cold weather can bring its own variety of health risks for workers. Factors of temperature, dampness, wind, and the individual's age and fitness level can combine to result in serious difficulties in the face of excessive cold.

The hands, feet, and the face (especially the nose and ears) are the body areas most susceptible to local damage. Cold exposure leads to tissue blanching , then hardness from loss of pliancy and, taken to the extreme, tissue destruction. Severe cold can also lead to general effects. Internal temperature drops and the body attempts to increase its inner heat by shivering. Behavioral effects can ensue such as slurred speech, clumsy movements, fatigue, and confused behavior. If the cold exposure is not abated, organ failure and, ultimately, death may follow.

Workers can be protected from cold weather health risks through better understanding of the risks and by work practices conducive to limiting those risks. Recognizing the physical and behavioral effects, dressing properly, and scheduling work to avoid sustained exposure to the cold can all help.

OSHA offers a free Cold Stress Card which workers can carry with them and refer to. The card gives further details on protection from the cold and is available in both English and Spanish. Free copies of the card can be obtained by going to OSHA's website at www.osha.gov or by calling 1(800) 321-OSHA.

OSHA's tips on how to protect workers include:

  • Recognize the environmental and workplace conditions that may be dangerous.
  • Learn the signs and symptoms of cold-induced illnesses and injuries and what to do to help workers.
  • Train workers about cold-induced illnesses and injuries.
  • Encourage workers to wear proper clothing for cold, wet and windy conditions, including layers that can be adjusted to changing conditions.
  • Be sure workers in extreme conditions take a frequent short break in warm dry shelters to allow their bodies to warp up.
  • Try to schedule work for the warmest part of the day.
  • Avoid exhaustion or fatigue because energy is needed to keep muscles warm.
  • Use the buddy system – work in pairs so that one worker can recognize danger signs.
  • Drink warm, sweet beverages (sugar water, sports-type drinks) and avoid drinks with caffeine (coffee, tea, sodas or hot chocolate) or alcohol.
  • Eat warm, high-calorie foods such as hot pasta dishes.
  • Remember, workers face increased risks when they take certain medications, are in poor physical condition or suffer from illnesses such as diabetes, hypertension or cardiovascular disease.
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OSHA 300 Recordkeeping
The revised OSHA Form 300, Log of Work-Related Injuries and Illnesses, must be used effective January 1, 2004. The newly revised form provides a column for hearing loss. A few other minor self-explanatory changes have been made.

Remember posting of the Summary, OSHA Form 300A, has been extended to cover the period February 1 until April 30th. OSHA requires the Summary to be signed by a company executive before posting.

A copy of all revised forms can be found on the OSHA website.

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New DOT Guidelines for Cardiovascular Diseases in Drivers
The OHG Standard, July 2003, has an article on this same topic; however, that article was generic. This article presents a brief technical review of pertinent requirements of the Guidelines. Please access the July 2003 OHG Standard at www.ohgonline.org and also reference the full 154 pages of guidelines at the FMCSA site at www.dot.gov.

The new DOT Examination form has not been released yet. Implementation of the new guidelines will become effective on release of the new form according to unofficial information from DOT. However, they also point out that the new guidelines on cardiovascular diseases may be utilized now since they more specifically address issues and decisions faced each day by DOT medical examiners.

Some of the changes to be aware of include:
  1. Certification and recertification physical qualifications differ in some respects;
  2. Drivers with implantable cardiac defibrillators are not qualified for certification;
  3. Routine resting EKGs are no longer recommended;
  4. Determination of the drivers’ risk factors for coronary heart disease (using the Framingham risk factor assessment) may be indicated;
  5. Those drivers age 40 years and greater with a Framingham CHD risk for non-fatal heart attack or coronary heart death of 20% or greater for 10 years shall be evaluated the same as those drivers with known heart disease. Similar evaluations apply to drivers 40 years of age or greater with diabetes or peripheral vascular disease (i.e.: poor circulation in the feet and legs);
  6. Drivers age over 45 must be recertified annually if they have multiple (2 or more) risk factors (e.g.: high cholesterol and smoker);
  7. Requirements for utilization and interpretation of stress EKGs have been tightened up and are required in more circumstances than previously.
  8. Drivers who have heart attacks must have an ejection fraction (percent of blood contained in the main pumping chamber of the heart ejected/pumped out per beat) performed and not be less than 40%. An exercise EKG must also be done before return to work and preferably at least 4-6 weeks after the heart attack;
  9. Heart attack patients will need annual certification with an evaluation by a cardiologist including an exercise EKG at least every 2 years;
  10. Drivers with angina pectoris (chest pain or other symptoms due to poor circulation to the heart) must wait three months after onset before returning to work if the symptoms are stable and no symptoms occur at rest; recertification is required annually and an exercise EKG is required every two years;
  11. A driver with stable angina pectoris (chest pain) who has an angioplasty without complications may return to driving after one week with exam and approval of the treating cardiologist. These drives should have an exercise EKG 3-6 months later and repeat test every 2 years. They must have annual recertification.
  12. Drivers who have bypass surgery may not drive the first three months after surgery. The driver must be cleared by a cardiologist. A resting echocardiogram is recommended before the first qualifying DOT exam. Recertification must be annually. After 5 years exercise EKG must also be done annually;
  13. Hypertrophic or restrictive cardiomyopathy is automatically disqualifying. Borderline cardiomyopathies may be qualified but not for greater than one year at a time;
  14. Congestive heart failure will be evaluated on the basis of the ejection fraction of 40% or more. Drivers with heart failure who are certified must be evaluated annually with echocardiogram and Holter monitoring (24 hour EKG);
  15. Drivers with pacemaker implant shall not be certified sooner than 1 month after insertion - provided the underlying cardiac disease is not disqualifying. Annual recertifications are required;
  16. Generally implanted defibrillators will be disqualifying;
  17. Drivers at least one-year post heart transplant may be considered for certification. Cardiologist evaluation and recertification will be required every six months;
  18. Abdominal aortic aneurysms 5 cm or greater are disqualifying. If the driver has any symptoms with a lesion 4 cm or more and/or surgery is planned, driver is disqualified; otherwise, drive may be qualified and recertified annually while monitoring the size of the lesion by ultrasound annually; chest aneurysm over 3.5 cm in size is disqualifying;
  19. Drivers with intermittent claudication (leg pain due to poor circulation) at rest do not qualify under DOT. Those without clardication at rest may be qualified but require re-certifications annually. A minimum of 3 months wait after surgery or angioplasty is required.
  20. Blood clots of legs are disqualifying until treatment has been achieved. If on blood thinner at least one month of adequate control of blood status must be achieved.
  21. Blood clot to the lung(s) is disqualifying for minimum of 3 months.
  22. Regulation of blood thinning must be achieved for 1 month before qualification – not merely on blood thinner for one month.
  23. Hypertension – The Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNCVI) is used as the reference document for blood pressure requirements for CDL holders. Because of the high prevalence of hypertension in the adult population and the poor record of blood pressure control in the U.S., these guidelines will have a significant impact on the certification process.

New guidelines consider 140mmHg the upper limit for certification – not the old 160mmHg. For the diastolic (lower) pressure, 90mmHg is recommended. If the Blood pressure is less than 150/90 and no treatment is being taken, recertification is every two years. If the Blood Pressure is less than 140/90 and treatment is being taken, re-certifications will be required every 6 or 12 months depending on the original untreated blood pressure level.

If blood pressure is 150-159/90-99 initially and medication controls it to 140/90 or less, recertification will be annually. If the recertification exam finds the blood pressure greater than 140/90, but less than 160/90, certification can be granted one time only for a 3 month period.

If initial blood pressure is 160-179/100-109, driver may be certified for one 3-month period while treatment is being started. Once the driver has been successfully treated, certification can be for 12 months from initial exam. Annual re-certifications are required and blood pressure on subsequent exams should be 140/90 or less.

If blood pressure is greater than 180 systolic (upper number) and/or greater than 110 diastolic (lower number) the driver must be disqualified immediately. When treatment is well tolerated with blood pressure of 140/90 or less certification can be for only 6 months. Re-certification exam blood pressures must be 140/90 or less.

Contact any OHG medical provider for additional information or questions.

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ACOEM Guideline Automated External Defibrillation
On November 13, 2000, President Clinton signed into law H.R. 2498, the Cardiac Arrest Survival Act (CASA), designed to expand the availability of automated external defibrillators (AEDs) in public settings. The new legislation requires the Secretary of the Department of Health and Human Services (HHS) to establish guidelines for the placement of AEDs in buildings owned or leased by the federal government.

The American College of Occupational and Environmental Medicine (ACOEM), while applauding this legislation urges the consideration of AEDs in selected workplaces, beyond the scope of federal buildings. The College has thus developed this guideline to increase the awareness of the value of AEDs and has presented recommendations to encourage and provide guidance on their use in the workplace.

This guideline reviews the following topics:

  1. Epidemiology, morbidity, and mortality of cardiovascular diseases in the workplace;
  2. The “chain of survival” paradigm;
  3. History and descriptions of AEDs;
  4. Standard-of-care interventions and guidelines;
  5. Public-access defibrillation and federal initiatives;
  6. Recommendations for establishing and managing a workplace AED program
To read more from ACOEM's AED Guidelines, click here.

The following is a list of commercially available devices approved by the U.S. Food and Drug Administration:

AED Model Manufacturer Wave Form Energy Levels Website/Link:
First Save Survivalink Corp (Minnetonka, MN) Biphasic truncated, monophasic truncated Biphasic, variable escalating, 140-360; monophasic, 200-360 www.cardiacscience.com
Heartstream ForeRunner Agilent Technologies (Seattle, WA) Impedance-compensating biphasic Nonscalating 150, 150, 150 www.medical.philips.com/cms
LIFEPAK 500 Medtronic Physio-Control (Redmond, WA) Impedance-and voltage-compensating biphasic, monophasic Biphasic, adjustable, 200-350; monophasic, 200-360 www.stopheartattack.com
LifeQuest Medical Research Laboratories, Inc. (Buffalo Grove, IL) Biphasic, monophasic Biphasic, 2-360; monophasic, 200-360
Zoll M Series ZOLL Medical Corp, Inc. (Burlington, MA) Rectilinear biphasic, monophasic Biphasic, 120, 150, 200; monophasic, 1-360

Another excellent source of information on AED's is the AED Superstore, www.aedsuperstore.com.

You can get trained in the use of an AED by contacting your local American Red Cross for a listing of training classes. The Red Cross offers half-day courses that include CPR and AED skills and comprehensive, daylong sessions that also include first aid. Click here for more information on Red Cross Courses.

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Heat Stress
by Joseph L. Rea, M.D., M.P.H.
Summer for outdoor workers means increased seasonal risk for heat stress and its resultant medical problems. Avoidance of these problems comes from awareness and by taking some simple preventive steps.

The body’s response to heat

The body is remarkably adaptable to increased external heat, such as from the summer sun. The body naturally tries to maintain a constant core temperature. However, a hot external environment can cause increased body temperature. The body will respond by increasing blood flow to the skin. Heat can then dissipate from warmed blood to the external environment at the skin surface. If heat loss from this increased blood flow is not sufficient, then the body will activate its sweat glands. Large amounts of sweat carrying heat will pour over the skin and evaporation will carry away the excess heat.

Individual risks
People have varying susceptibility to heat stress. Increased age, deconditioning, alcoholism, obesity, and problems like hypertension, heart disease, or skin disease can all increase the risk.

Types of heat stress illnesses
What are these heat illness problems?
If the body cannot respond adequately to internal heat buildup, medical problems can occur in the form of a heat stress illness. There are three main types. The first and most common form is heat exhaustion. Because more blood is moved to the skin, there is less blood going to muscles and important internal organs like the brain. And, because of sweat loss, there is dehydration. This decreased blood flow and loss of fluid volume can lead to weakness and mental fatigue. There may be dizziness, headache, and nausea. Heat exhaustion can be reversed by cooling off and drinking water.

The second type of heat illness is heat cramps. In this, salt loss from sweat leads to painful muscle cramps. Like heat exhaustion, heat cramps can be helped by resting, cooling off, and taking fluids.

The third and last form of heat stress illness is heat stroke, and it can be very serious. In this condition, the body fails to respond to increased internal heat buildup. Sometimes sweating stops completely and internal heat rises to extremely high levels. Individuals may lose consciousness, have seizures, lapse into coma, and die. Mortality is high if there is no effort to quickly cool the heat stroke victim. This needs to be done in the emergency room using cooling water, fans, or even ice baths.

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National Alcohol and Drug Addiction Recovery Month
September 2003 is the 14th Annual National Alcohol and Drug Addiction Month celebration, and businesses are encouraged to participate. Substance abuse places a major burden on all segments of American society, including the workplace. Substances abused include alcohol, illicit drugs, non medical use of prescription drugs, over-the-counter drugs & legitimately prescribed drugs. The good news, however, is that experience demonstrates that employers have enormous potential to protect their businesses from the negative impact of substance abuse by educating employees about its dangers and encouraging individuals with substance abuse problems to seek help.

Alcohol and Drug Abuse in America Today….

  • An estimated 22 million Americans are current substance abusers.
  • Of the 22 million adult current drug users, 15.3 million (79 percent) work.
  • Alcohol is the most widely abused drug among working adults. An estimated 6.2 percent of adults working full time are heavy drinkers.
  • More than 60 percent of adults know someone who has reported to work under the influence of alcohol or other drugs.

Substance abusers do not have to indulge on the job to have a negative impact on the workplace. Compared to their non-abusing coworkers, they are:

  • 10 times more likely to miss work,
  • 3.6 times more likely to be involved in on-the-job accidents
  • 5 times more likely to injure themselves or another in the process
  • 5 times more likely to file a worker’s compensation claim,
  • 33% less productive, and
  • responsible for health care costs that are 3 times as high.

Everyone involved in running a business, both employers and employees, suffers when there is workplace substance abuse. Some costs are obvious, such as those stated above; others such as low morale and high illness rates are equally harmful.

How can it be prevented? A comprehensive drug-free workplace program may be the best means of preventing, detecting, and dealing with substance abusers. Such a program generally includes the following elements:

  • A written policy that is supported by top management, understood by all employees, consistently enforced, and perfectly clear about what is expected of employees and the consequences of policy violations.
  • A substance abuse prevention program with an employee drug education component that focuses not only on the dangers of drug and alcohol use, but also on the availability of counseling and treatment.
  • Training of managers, front-line supervisors, human resource personnel and others in identifying and dealing with substance abusers.
  • An appropriate drug and alcohol testing component, designed to prevent the hiring of workers who use illegal drugs and, as part of a comprehensive program, provide early identification and referral to treatment for employees with substance abuse problems.
  • An Employee Assistance Program (EAP)

Now is the time to think about your drug-free workplace program and review your current policies and update them to better serve your company and your employees. Occupational Health Group works with employers to implement drug screen program by providing drug and alcohol testing, on-site drug and alcohol testing, random select services following your random protocol and supervisor training. For further information on our Substance Abuse programs, please visit us at www.ohgonline.org or contact us at (256) 922-6675.

The month long Recovery campaign highlights the significant strides made in substance abuse treatment and educates that addiction to alcohol and other drugs is a treatable, public health problem which impacts all segments of society and the workplace. To access further information on Recovery Month, you can visit www.recoverymonth.gov.

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West Nile Virus
Mosquitoes Can Carry Serious Illness

If you recall the events of August 1793, in the city of Philadelphia. The summer had been hot, dry, and mosquitoes and other insects filled the air. Several people experienced a strange disease whose symptoms included a severe fever and nausea, followed by black vomit, deep lethargy, a rapid, feeble pulse, incontinence and yellow coloring of the skin. These symptoms led to an almost certain death. As doctors frantically searched for a cure to this mysterious ailment, thousands of residents fled from Philadelphia. The Yellow Fever Epidemic of 1793 was the worst in the history of the city. Now it is known that mosquitoes transmitted the disease and involved a virus later identified as Yellow Fever Flavivirus.

Today, in the 21st century, a different virus and disease is being recognized in America. This virus also is carried by mosquitoes but causes different serious symptoms. It is called West Nile virus and is a member of the Flavivirus family just like the Yellow Fever virus.

What is West Nile encephalitis?
"Encephalitis" means an inflammation of the brain which can be caused by viruses and bacteria, including viruses transmitted by mosquitoes. West Nile Encephalitis is an infection of the brain caused by West Nile virus, a Flavivirus commonly found in Africa, West Asia, and the Middle East. It is closely related to St. Louis Encephalitis virus also found in the United States.

Historically, where has West Nile Encephalitis occurred worldwide?
West Nile (WN) virus has emerged in recent years in temperate regions of Europe and North America, presenting a threat to public, equine, and animal health. The most serious manifestation of WN virus infection is fatal encephalitis (inflammation of the brain) in humans and horses, as well as mortality in certain domestic and wild birds. According to the Centers for Disease control, they state West Nile virus was first isolated from a febrile adult woman in the West Nile District of Uganda in 1937. The virus became recognized as a cause of severe human meningoencephalitis (inflammation of the spinal cord and brain) in elderly patients during an outbreak in Israel in 1957. Equine disease was first noted in Egypt and France in the early 1960s.

Geographic Distribution:
West Nile virus has been described in Africa, Europe, the Middle East, west and central Asia, and most recently, North America. Recent outbreaks of WN virus encephalitis in humans have occurred in Algeria in 1994, Romania in 1996-1997, the Czech Republic in 1997, the Democratic Republic of the Congo in 1998, Russia in 1999, the United States in 1999-2002, and Israel in 2000.

What are the symptoms of West Nile Encephalitis?
Most infections are mild, and symptoms include fever, headache, and body aches, occasionally with skin rash and swollen lymph glands, very similar to the "flu". More severe infection may be marked by headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, paralysis, and, rarely, death. Historically, the virus is spread by the bite of an infected mosquito, and can infect people, horses, many types of birds, and some other animals. Most people who become infected with West Nile virus will have either no symptoms or only mild ones. On rare occasions, infection can result in a severe and sometimes fatal illness known as West Nile Encephalitis. Until recently, there is no evidence to suggest that West Nile virus can be spread from person to person or from animal to person. Now, the Centers for Disease Control has just begun evaluating the possibility of transmission during blood transfusions and organ transplantation. Currently, there are 854 laboratory confirmed human cases and 43 deaths from West Nile Virus illness in the U.S. reported to the CDC. In Alabama, the CDC reports 14 laboratory positive West Nile Virus infections in humans between January 1, 2002 and September 6, 2002.

Protect yourself from mosquito bites
Human illness from West Nile virus is rare, even in areas where the virus has been reported. The chance that any one person is going to become ill from a mosquito bite is low. To avoid mosquito bites, you can limit the number of places available for mosquitos to lay their eggs by eliminating standing water sources from around your home. Check to see if there is an organized mosquito control program in your area. If no program exists, work with your local government officials to establish a program.

Q. What can I do to reduce my risk of becoming infected with West Nile virus?


  1. Stay indoors at dawn, dusk, and in the early evening.
  2. Wear long-sleeved shirts and long pants whenever you are outdoors.
  3. Spray clothing with repellents containing permethrin or DEET since mosquitoes may bite through thin clothing. Avoid applying repellent to children less than 2 years old.
  4. Apply insect repellent sparingly to exposed skin. An effective repellent will contain 35% DEET (N,N-diethyl-meta-toluamide). DEET in high concentrations (greater than 35%) provides no additional protection.
  5. Repellents may irritate the eyes and mouth, so avoid applying repellent to the hands of children.
  6. Install or repair window and door screens so that mosquitoes cannot get indoors.
  7. Note: Vitamin B and "ultrasonic" devices are NOT effective in preventing mosquito bites.

For more information and reference for this review, visit the Centers for Disease Control website at http://www.cdc.gov/ncidod/dvbid/westnile/q&a.htm

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Can Arthritis EVER be a Workers' Compensation Injury?
As the nation observed with President Clinton's testimony during his impeachment hearings, he wanted to know the definition of the word "is". Of course, many of us found this laughable. However, when dealing with workers' compensation issues, we have a similar challenge in that everyone, inclusive of physicians, lawyers, judges and other involved parties, must have a clear definition of what an "aggravation, recurrence and infirmity" are before proceeding forward with a work comp issue.

An example of this definition problem exists in a prior case involving Martin Industries vs. Netti Ruth Dement in Civ. 3520 at the Alabama Supreme Court (82-718 records). This particular case involved a plaintiff who struck her ankle on the corner of an empty pallet, which resulted in her ankle swelling and turning blue. She reported the injury to her employer. The treating physician diagnosed her with rheumatoid arthritis in her right foot. Depositions of the three physicians who treated Ms. Dement were printed in the hearing records stating: "the medical cause of rheumatoid arthritis is unknown. Testimony was presented that physical trauma to a joint could aggravate, accelerate, or trigger rheumatoid arthritis. Furthermore, the physicians testified that lifting heavy objects, standing for long periods of time, and bending or stooping can have an aggravating or accelerating effect on the symptoms of rheumatoid arthritis."

The employee stated the injury to her ankle caused her to have arthritis and the injury arose from an "accident." (An accident is defined an unexpected or unforeseen event, happening suddenly and violently, with or without human fault, and producing at the time injury to the physical structure of the body…Kane v. South Central Bell Telephone.) The court held that the plaintiff's "accident is consistent with an injury that could trigger rheumatoid arthritis." The court determined the plaintiff was entitled to a sixty percent permanent partial disability award.

So, from this example, we have learned some critical definititions:

  1. An "accident" must be suffered by the employee and legally caused by the performance of their duties and a causal relationship of a medical nature must exist between the injury and job (City of Tuscaloosa v. Howard).

  2. An "aggravation" of an injury is when a second work-related injury contributed independently to the final disability.
  3. An "infirmity" which is relating to a preexisting condition and is simply a "condition affecting an employee's ability to work as a normal man, both prior to and at the time of the job-related accident." Remember, according to Blue Bell v. Nichols, when a job-related injury combines with a preexisting condition to produce employee disability, the preexisting condition does not affect the compensation award. Furthermore, regardless of the existence of preexisting condition or disease, if the employee was able to perform his duties prior to the injury, no preexisting condition is present for compensation purposes. Ability to earn must be influenced by the infirmity. If ability is affected, then apportionment (amount of liability) of the injury may exist.
  4. A "recurrence" exists when the subsequent injury does not contribute, even slightly, to causation of disability then no aggravation has occurred and the complaint is like a "flair up" of a non-work related disease.

Physicians who treat your injured employees, the attorneys who represent both the employer and employee, and the judge who hears the case should all have the same definitions in mind. Otherwise, all complaints may have to be covered under a company's workers' compensation insurance policy. Thus, the word "is" has a definition just like legalese in workers' compensation cases. | Back to List of News Articles |

Supreme Court Decides Important ADA Case
June 10, 2002

The U.S. Supreme Court ruled 9-0 that the Americans with Disabilities Act (ADA) permits an employer to refuse to hire a person on the grounds that his or her perfomance of the job would endanger his or her own health. Click here to read more...

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Did you know…
A recent decision in the Alabama Court of Civil Appeals makes the idea of pre-placement evaluations a good idea. The case involved a claimant who settled in 1997 a workers' compensation claim against General Motors Corp for $48,000 relative to injuries sustained in 1993 to both arms. In a subsequent action involving the same extremities, the trial court entered a judgment finding the plaintiff permanently and totally disabled; the court relied on the testimony of two medical doctors who said the plaintiff was totally disabled. The Alabama Court of Civil Appeals reversed and remanded citing evidence that the plaintiff had not fully recovered from her earlier injuries and accordingly the trial court erred in failing to apply 25-5-57 and 25-5-58 relating to pre-existing injuries. If a worker has not fully recovered from prior injuries, these sections would limit the company's liability to only the increased disability suffered by the employee caused by the current injury.

Thus, pre-placement evaluations by a doctor familiar with worker's compensation can document the current health status of the applicant which may be important if a worker sustains an injury to a previously injured body part. At the same time, the doctor can document prior workers' compensation injuries, provide an opportunity for health prevention screening, and approve the right job for the worker in order to decrease future injuries.

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Success Story...
OHG co-hosted its 4th Annual Occupational Health, Safety and Workers' Compensation Seminar on April 17th, 2002 at the Von Braun Center. The seminar was a tremendous success with over 450 people in attendance and 37 sponsors exhibiting. Attendees from as far away as Texas and several from Georgia, Mississippi and Tennessee took advantage of this informative seminar featuring 25 speakers and Col. Leon C. Schenck, Deputy Chief, Huntsville Police Department as guest luncheon speaker. The seminar offered the latest information on human resources, occupational medicine, safety, workers' compensation and regulatory issues. With the State of Alabama Department of Industrial Relations/Workers' Compensation Division and the Alabama Board of Nursing's endorsement, professionals were able to earn invaluable CEU credits. Other co-hosts included American Society of Safety Engineers, Alabama Chapter National Safety Council, Comp1One, and The Orthopaedic Center. | Back to List of News Articles |

OSHA to Issue Final Rule on Recording Hearing Loss
Agency Will Seek Comments on Delaying MSD Provisions

The Occupational Safety and Health Administration plans to issue a final rule on July 1, 2002, that revises the criteria for recording work-related hearing loss. The agency will also seek comments on a proposal involving the recording of MSDs on OSHA's injury and illness logs.

Beginning Jan. 1, 2003, employers will be required to record work-related hearing loss cases when an employee's hearing test shows a marked decrease in overall hearing. Employers can make adjustments for hearing loss caused by aging, seek the advice of a physician or licensed health care professional to determine if the loss is work-related, and perform additional hearing tests to verify the persistence of the hearing loss.

"Hearing loss can result in a serious disability and put employees at risk of being injured on the job," said OSHA Administrator John Henshaw. "This approach will help employers better protect their workers and help all of us improve our national injury and illness statistics and prevent future hearing loss among our nation's workers."

Under the new rule, the criteria will record 10-decibel shifts from the employee's initial hearing test when they also result in an overall hearing level of 25 decibels. The old criteria recorded 25-decibel shifts.

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Hepatitis B (HB) Immunizations
Employees at risk of exposure to blood or other potentially infectious materials should be provided HB immunizations. A three shot series is recommended. The first shot is followed in one month by a second and 6 months by the "booster". The CDC is now recommending a blood test 4 - 8 weeks after the booster to determine if the recipient has developed immunity (hepatitis B antibody titer). If the test shows no immunity or less than 10 units, a second series identical to the first is recommended (at time 0, 1 month, 6 months). Blood testing is performed at 4 - 8 weeks after the conclusion of the series and if no immunity or less than 10 units is detected, the individual remains at risk for infection. Additional vaccinations are unlikely to generate an immune response. The older the recipient, the less likely immunity will be developed.

OHG is recommending post immunization titers for all vaccinees and a repeat series if the titer is less than 10 units. Contact your OHG clinic/physician if you have any questions or wish to discuss in more detail.

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New OSHA Occupational Injury and Illness Recording Rule
OSHA's new Occupational Injury and Ilness Recording rule becomes effective January 1, 2001. Details are available at www.osha.gov. Recording of MSDs (musculoskeletal disorders), and changes in the recording of hearing loss has been deferred for one year. The OSHA forms have been revised to eliminate these categories for the time being. The Alabama Workers' Comp First Report of Injury does not include all of the contents required by the new rule for the OSHA 301 form. Either both forms will need to be completed or the First Report of Injury Form will need to have an appendage or space developed to meet the 301 content.

OHG conducted training sessions in December. If you missed the classes and have questions, feel free to contact your local OHG clinic/physician or refer to the site mentioned above.

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Carpal Tunnel Syndrome (CTS) Testing
OHG has an NC-Stat, electronic testing device for assessing the function of the median (CTS) nerve. The test is done at the Huntsville Clinic (only) and requires about 5 - 6 minutes. The test can be used to "rule out" or to diagnose CTS. It may also be used as a post-offer test in new hires who may be going to work in jobs with highly repetitive hand/finger/wrist work, or for jobs where employers have had excessive numbers of CTS claims. Nerve conduction tests are considered to be the gold standard diagnostic test for CTS.

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ANTHRAX - What to do if There is a Possible Exposure
by Shanon D. Smith, M.D., Occupational Health Group, Huntsville

  1. Immediately secure the area. If small object, cover with a trash can or cloth.
  2. Do not touch or continue to touch the object.
  3. Leave the area.
  4. Shut down the ventilation system to the area, if feasible.
  5. Immediately wash your hands with soap and water.
  6. Call the Huntsville Police Department's non-emergency number and report the incident at (256) 722-7100. Note: HPD will contact the FBI if they deem it a credible threat.
  7. Make a list of everyone in the area. Get a phone number or numbers where they can be reached 24 hours a day (home, work, and cell) for the next week to check for symptoms.
  8. If someone begins to show flu-like symptoms after hours and weekends, they should call the company's contact person immediately and then report to the Huntsville Hospital Emergency Room. If someone begins to show flu-like symptoms during working hours, they should go immediately to their family physician and explain their possible anthrax exposure.
  9. Call the Madison County Health Environmental Department at (256) 539-8101 if an employee tests positive for anthrax.
  10. Locally, Mid-South Testing in Decatur has qualified staff to test for anthrax on-site. They can be reached at (256) 351-7900. This is not an endorsement of services, simply a guide for information.
  11. We recommend you look to the CDC for information. You may visit them at www.cdc.gov. Additionally, the United States Postal Service is a good reference for further information. You may visit their website by clicking here:
  12. www.usps.gov .
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Updated U.S. Public Health Service Guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for Postexposure Phophylasis.

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1615 Kathy Lane
Decatur, AL 35603
(256) 353-4325
(256) 353-9639 fax
1963 Memorial Pkwy, #24
Huntsville, AL 35801
Phone: (256) 265-7000
(256) 265-7007 fax
9238 Madison Blvd, #200
Madison, AL 35758
(256) 774-7300
(256) 774-5300 fax
6767 Old Madison Pike, #400
Huntsville, AL 35806
(256) 922-6699
(256) 922-6660 fax