Consider pesticide exposure in their differential diagnosis. Focus groups conducted in Washington State found that many workers felt that their healthcare provider had not seriously considered the possibility that their symptoms were the result of pesticide exposure (Washington State Department of Health, National Institute for Occupational Safety and Health, 2004). Occupational health screening questions should be incorporated into patient encounters to insure this possibility is considered, as recommended by the Migrant Clinicians Network (Liebman and Rowland, 2009). (Also see the September-October 2009 Streamline.) Be familiar with the appropriate agency to report cases. There is no standard national protocol for reporting suspected pesticiderelated illness and injury; each state determines its own guidelines. Some states require that reports be sent to the local health department, whereas others mandate reporting directly to the state department of health. In a few cases, mandatory reporting can also be done through Poison Control Centers or other agencies. Report "suspected" cases. Many states with mandatory reporting require that the diagnosis of a pesticide-related illness be more likely than not. However, in some cases there may be insufficient toxicological information for providers to determine causality. In other cases, a patient may present with adverse health effects that are temporally related to a pesticide exposure, but have not been previously documented. In either case, documentation of such scenarios is critical because it can lead to improved safety laws and regulation of pesticide sale and use. Report suspected cases in a timely manner. Many states require immediate reporting of hospitalized, clustered or fatal cases. Other suspected cases are often notifiable within three to seven days. If reporting is timely, investigators are more likely to confirm exposure through collection of foliage or clothing samples, and workers may have better precision in recalling the time of symptom onset and exposure, exact location, and products involved. If reports are not timely, investigators may be unable to contact migrant workers. Healthcare providers have an important role in worker protection. Clinical reports of suspected and confirmed diagnoses are the principal source of information regarding the magnitude and nature of pesticide poisonings in the US. These reports trigger investigations of exposures and ultimately can help strengthen regulations and improve preventative measures to better protect workers.
Health-care; Health-care-personnel; Health-protection; Pesticides; Pesticides-and-agricultural-chemicals; Insecticides; Workers; Work-environment; Environmental-hazards; Environmental-exposure; Exposure-levels; Risk-factors; Education; Training; Medical-personnel; Medical-care; Injuries; Poison-control; Toxicology; Toxic-effects