Company health care management strategies and policies and health care providers can be an important part of the overall ergonomics program.

In general, health care management emphasizes the prevention of impairment and disability through early detection, prompt treatment, and timely recovery [Hales and Bertsche 1992; Parker and Imbus 1992; American National Standards Institute 1996]. Medical management responsibilities fall on employers, employees, and health care providers.

Employer Responsibilities

The employer can create an environment that encourages early evaluation by a health care provider by taking the following steps:

• Providing education and training to employees regarding the recognition of the symptoms and signs of WMSDs (see Step 3, Training Building In-House Expertise) and the employers procedures for reporting WMSDs
  
  
• Encouraging employees early reporting of symptoms and prompt evaluation by an appropriate health care provider
  
  
• Giving health care providers the opportunity to become familiar with jobs and job tasks
  
  
• Modifying jobs or accommodating employees who have functional limitations secondary to WMSDs as determined by a health care provider
  
  
• Ensuring, to the extent permitted by law, employee privacy and confidentiality regarding medical conditions identified during an assessment

Employee Responsibilities

Employees should participate in the health care management process by

• following applicable workplace safety and health rules,
  
  
• following work practice procedures related to their jobs, and
  
  
• reporting early signs and symptoms of WMSDs.

Employees may be faced with conflicting job demands or requirements. Safe work practices or rules may conflict with pressures or incentives to be more productive.

Health Care Provider Responsibilities

The health care provider should do the following:

• Acquire experience and training in the evaluation and treatment of WMSDs.
  
  
• Seek information and review materials regarding employee job activities.
  
  
• Ensure employee privacy and confidentiality to the fullest extent permitted by law.
  
  
• Evaluate symptomatic employees including:
  
  
• medical histories with a complete description of symptoms,
  
  
• descriptions of work activities as reported by the employees,
  
  
• physical examinations appropriate to the presenting symptoms and histories,
  
  
• initial assessments or diagnoses, opinions as to whether occupational risk factors caused, contributed to, or exacerbated the conditions, and
  
  
• examinations to follow up symptomatic employees and document symptom improvements or resolutions.

Issues

Job Familiarity and Job Placement Evaluations

Health care providers who evaluate employees, determine employees functional capabilities, and prepare opinions regarding work relatedness should be familiar with employee jobs and job tasks. With specific knowledge of the physical demands involved in various jobs and the physical capabilities or limitations of employees, the health care provider can match the employees capabilities with appropriate jobs. Being familiar with employee jobs not only assists the health care provider in making informed case management decisions but also assists with the identification of ergonomic hazards and alternative job tasks.

One of the best ways for a health care provider to become familiar with jobs and job tasks is by periodic plant walk-throughs. Once familiar with plant operations and job tasks, the health care provider should periodically revisit the facility to remain knowledgeable about changing working conditions. Other approaches that may help the health care provider to become familiar with jobs and job tasks include reviewing job analysis reports, detailed job descriptions, job safety analyses, and photographs or videotapes that are accompanied by narrative or written descriptions of the jobs.

Early Reporting and Access to Health Care Providers

Employees reporting symptoms or signs of potential WMSDs should have the opportunity for prompt evaluation by a health care provider. In general, the earlier that symptoms are identified and treatment is initiated, the less likely a more serious disorder will develop. Employers should not establish policies that discourage employees from reporting symptoms. For example, programs that link a manager s earnings to the number of employees reporting symptoms may discourage supervisors from allowing symptomatic employees to be evaluated by the health care provider. Employees should not fear discipline or discrimination on the basis of such reporting.

Treatment

• Health care providers are responsible for determining the physical capabilities and work restrictions of the affected workers.
  
  
• The employer is responsible for giving an employee a task consistent with these restrictions.
  
  
• Until effective controls are installed, employee exposure to ergonomic stressors can be reduced through restricted duty and/or temporary job transfer.
  
  
• Complete removal from the work environment should be avoided unless the employer is unable to accommodate the prescribed work restrictions.
  
  
• Immobilization devices, such as splints or supports, can provide relief to the symptomatic area in some cases. These devices are especially effective off-the-job, particularly during sleep. They should not be used as prophylactic PPE to prevent the development of WMSDs. Therefore, these devices should be dispensed to individuals with WMSDs only by health care providers who have knowledge of the benefits and possible negatives of these devices. Wrist splints, typically worn by patients with possible carpal tunnel syndrome, should not be worn at work unless the health care provider determines that the employee s job tasks do not require wrist bending. Employees who struggle to perform a task requiring wrist bending with a splint designed to prevent wrist bending can exacerbate symptoms in the wrist because of the increased force needed to overcome the splint. Splinting may also cause other joint areas (elbows or shoulders) to become symptomatic as work techniques are altered. Recommended periods of immobilization vary from several weeks to months depending on the nature and severity of the disorder. Any immobilization should be monitored carefully to prevent complications (e.g., muscle atrophy caused by nonuse).
  
  
• The health care provider should advise affected employees about the potential risk of continuing hobbies, recreational activities, or other personal habits that may adversely affect their condition as well as the risk of continuing work without job modifications.
  
  
• Oral medications such as aspirin or other nonsteroidal anti-inflammatory agents (NSAIA) are useful to reduce the severity of symptoms. However, their gastrointestinal and kidney side effects make their use among employees who have no symptoms inappropriate and may limit their usefulness among employees with chronic symptoms. In short, NSAIA should not be used preventively.

NIOSH activities in health care management of work-related health problems have included efforts to assess the implementation of such programs. One case is illustrated in Exhibit 20.