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OCCUPATIONAL RESPIRATORY DISEASE SURVEILLANCE

Coal Miner Health Surveillance

In accordance with the Mine Safety and Health Administration's (MHSA's) recently-published final rule on respirable coal mine dust exposure, the National Institute for Occupational Safety and Health (NIOSH) is expanding its national program of health surveillance for coal miners. The NIOSH Coal Workers’ Health Surveillance Program (CWHSP) was originally established by the Federal Coal Mine Health and Safety Act of 1969 and has been in operation since 1970. In the past, medical testing including periodic chest radiographs and occupational history questionnaires were only required for underground coal miners. The expanded program will also provide periodic lung function testing (called spirometry) and respiratory health assessment questionnaires and will extend health surveillance to workers at surface coal mines. On this page you will find information on the new requirements for Coal Miner Health Surveillance and detailed information for operators, facilities, and miners.

New Requirements for Coal Miner Health Surveillance

The new requirements are defined in an updated NIOSH rule.

Coal Mine Operators Including Contractors

Operators of underground coal mines are currently required to post a NIOSH-approved health examination plan providing health surveillance to their underground miners every five years. The Coal Mine Operator's Plan Form is already available for submitting these Mine Plans.

During this interim period, as NIOSH prepares to establish the expanded national surveillance program, operators of new underground mines and operators of surface mines must use the existing form to file their Mine Plans. Contractors that employ workers at coal mines who are eligible for health surveillance should use the Coal Contractor Plan Form to file their Mine Plans. Eligible employees are those who require MSHA Part 48 miner training. 

The operator must promptly display in a visible location on the bulletin board at the mine its proposed Plan or proposed change in Plan when it is submitted to NIOSH.  The proposed Plan or change in Plan must remain posted in a visible location on the bulletin board until NIOSH either grants or denies approval of it at which time the approved Plan or denial of approval must be permanently posted.  In the case of an operator who does not have a bulletin board, such as an operator that is a contractor, the operator must otherwise notify its employees of the examination arrangements.  Upon request, the contractor must show NIOSH written evidence that its employees have been notified. 

Contractors do not need to indicate at which mines they are operating, and should indicate the number of miles by road from the location of the contractor to the X-Ray Facility(ies).

Surface operators and contractors should leave the x-ray begin-and-end dates blank. NIOSH will assign these dates for all new plans as part of the Mine Plan approval process.

The currently posted mine plan form only provides for x-rays and occupational history questionnaires. MSHA will be notifying operators and contractors that filed plans using the current mine plan form when they need to add periodic spirometry and respiratory health assessment questionnaires to their plans.

Health Providers of Periodic Chest Radiographs for Coal Miners

All facilities that perform the periodic chest x-rays required for the CWHSP must be approved by NIOSH. Current NIOSH-approved facilities are not required to submit a new application and should continue to submit x-rays and supporting documents in their usual manner. Facilities applying for approval to provide chest x-rays to the expanded CWHSP (underground and surface coal miners) should consult the regulations outlined in 42 CFR, Part 37 [42CFR37 Specifications of Medical Examinations of Underground Coal Miners]:

  • 37.41 Chest roentgenogram specifications,
  • 37.42 Approval of roentgenographic facilities, and
  • 37.43 Protection against radiation emitted by roentgenographic equipment.

Facilities interested in NIOSH approval should contact the CWHSP for an approval packet which details the requirements. Facilities may be approved for x-ray only, spirometry only, or both x-ray and spirometry.

Health Providers of Periodic Spirometry for Coal Miners

Facilities must be approved by NIOSH before they can provide spirometry tests and administer respiratory assessment questionnaires for the Coal Workers’ Health Surveillance Program (CWHSP). Current NIOSH-approved x-ray facilities must seek separate approval to provide spirometry testing and the respiratory assessment. Facilities seeking approval to administer spirometry tests and the respiratory assessment under the expanded CWHSP (underground and surface coal miners) must comply with the regulations as outlined in 42 CFR, Part 37 [42CFR37 Specifications for Medical Examinations of Coal Miners]:

  • 37.93 Approval of spirometry facilities,
  • 37.94 Respiratory assessment form,
  • 37.95 Specifications for performing spirometry examinations, and
  • 37.96 Spirometry interpretations, reports, and notification.

A brief outline of some requirements for spirometry facilities is as follows:

Approval of facilities:

To request to become a NIOSH-Approved Spirometry Facility, facilities must submit an application form entitled Spirometry Facility Certification Document and all the supporting documents listed below to NIOSH. Use the Spirometry Facility Certification Form to apply for approval.

  1. Copies of staff training certificates and licenses
  2. Spirometer validation letter (see Spirometry Testing section below)
  3. Sample test report for interpreter (see 42CFR37.96)

NIOSH will review the request upon receipt of all of the above documentation. If the facility is acceptable, NIOSH will assign a Spirometry Facility Certification Number and notify the facility that they are NIOSH-Approved.

Staff training:
  1. Each person administering spirometry examinations must successfully complete a NIOSH-Approved Spirometry Training Course and maintain a valid certificate by periodically completing NIOSH-Approved Spirometry Refresher Training Courses. A copy of the certificate of completion from a NIOSH-Approved Spirometry Training or Refresher Course, with validation dates printed on the document, must be submitted with the Spirometry Facility Certification Form. View information about the .
  2. Spirometry tests must be interpreted by physicians or other qualified health care professionals with expertise in spirometry who have all required licensure and privileges to provide this service in their State or Territory. A copy of the health professional’s license and documentation of spirometry training must be submitted with the Spirometry Facility Certification Document.
Spirometry Testing:

Spirometry testing equipment must meet the 2005 ATS/ERS Standardization of Spirometry specifications for spirometer accuracy and precision (Table 6, page 332) and real-time display size and content. It is the facility’s responsibility to ensure that the equipment meets the requirements for testing; the facility cannot rely on a manufacturer’s claim that the equipment meets the recommendations of the ATS/ERS, NIOSH, or any other professional or government entity.

  1. Written verification from a third-party testing laboratory (not the manufacturer or distributor) that a prototype of the model of spirometer being used has successfully passed its validation checks as required by the ATS Standardization of Spirometry 1994 Update protocol is required. Facilities may request a copy of the independent laboratory report from spirometer manufacturers.
  2. The spirometry system must have a calibration check routine consistent with the 2005 ATS/ERS Standardization of Spirometry.
  3. Graphical displays must provide real-time volume-time and flow-volume curves during the test. These displays must meet or exceed a minimum size. A sample of the minimum curve sizes can be found on page 7 of the OSHA 2013 Spirometry Testing in Occupational Health Programs: Best Practices for Healthcare Professionals.
  4. The spirometer software must automatically perform quality assurance checks on expiratory maneuvers during each spirometry testing session.
  5. The spirometry software must have the capacity to save and recall curves and results preferably from all maneuvers, but at a minimum for 3 acceptable maneuvers.
  6. The spirometry data file must retain a record of the parameters defined in the 2005 ATS/ERS Standardization of Spirometry (Table 8, page 335).
  7. Spirometers that provide electronic transfer of spirometry data results files must use the format, content, and data structure specified by the 2005 ATS/ERS Standardization of Spirometry, p. 335, or a procedure for data transfer that is approved by NIOSH.
Spirometry Interpretation:

Interpretations must be carried out using procedures and criteria consistent with recommendations in the 2014 ATS Technical Standards: Spirometry in the Occupational Setting, pp. 987-990, and the 2005 ATS/ERS Interpretative Strategies for Lung Function Tests, p. 950, p. 956 including Table 5, and p. 957 including Table 6.

Facilities interested in NIOSH approval should contact the CWHSP for an approval packet which details the requirements. Facilities may be approved for x-ray only, spirometry only, or both x-ray and spirometry.

Coal Miners

The new NIOSH rule provides all U.S. coal miners with the opportunity to have respiratory health testing. The testing is provided under the NIOSH Coal Workers’ Health Surveillance Program (CWHSP). The primary purpose of this testing is to prevent severe coal mining-related respiratory disease by detecting it early so miners can take steps to keep it from getting worse. This information also helps NIOSH to know if miners are being adequately protected from respiratory diseases including coal workers’ pneumoconiosis (black lung), silicosis, COPD and other mining-related respiratory diseases.

Under the new rule, coal miners have the right to receive periodic chest x-rays and lung function tests at no cost to themselves. Operators must inform the miners when they are eligible and where they can go to receive these screening tests. All new miners must be provided this testing within the first 30 days of work once a Mine Plan is approved by NIOSH. Miners receive the results of their tests from NIOSH with clear interpretations of the findings and additional instructions if follow up is recommended. Miners with evidence of black lung on their chest x-rays are informed as to how to pursue their right to work with reduced dust exposure through the Mine Safety and Health Administration (MSHA). NIOSH will not share a miner’s individually identifiable test results without the permission of the miner or their legal representative.

To participate in the testing, coal miners should watch for the required notices about when and where the checkups will be available.

 
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  • Page last reviewed: August 4, 2014
  • Page last updated: October 21, 2014
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