Design of the Poster
Using the Specific Medical Tests
and Other Parameters

DESIGN OF THE POSTER
USING THE SPECIFIC MEDICAL TESTS
AND OTHER PARAMETERS

As discussed in the Introduction on the Home page, my presentations at various Conferences were based on two specific Journal articles:

1. Occupational Sentinel Health Events (SHE[O]): An Up-Dated List for Physician Recognition and Public Health Surveillance in 1991. (284 references).

An Occupational Sentinel Health Event (SHE [O]) is an unnecessary Disease, an unnecessary Disability, or untimely Death which is occupationally related and whose occurrence may:

(a) provide the impetus for epidemiological or industrial hygiene studies ; or
(b) Serve as a warning signal that materials substitution, engineering control, personal protection, or medical care may be required.

Scientific information from the literature linked to the workplace from over 3,000 articles was collected and reviewed. A list of 64 disease or conditions of disease that was codable within the framework of the International Classification of Disease System (ICD-9) was compiled in 1991 along with a bibliography of literature citations. This list is useful for the practicing physician in occupational disease recognition, for occupational morbidity and mortality surveillance and as a periodically up-dated database of occupationally related diseases. For example, the Table in the article contains information on:

ICD #
Condition: whether the unnecessary Disease, unnecessary Disability, or untimely Death was preventable (P) or treatable (T)
Industry, Process or Occupation
The Agent(s) responsible for the unnecessary Disease, Disability or Death

To give you a flavor of the Table shown in the article, taking the example of ICD 162 which is Malignant Neoplasm of the Trachea, Bronchus and Lung: the disease, disability or untimely death were all preventable (P) for Underground Iron Ore Miners; the Agent was Radon daughters and there were 4 articles pertaining to this ICD 162.

Another example for ICD 162 is among Topside Coke Oven workers, the etiologic agent was Coke Oven Emissions, which also showed that the Disease, Disability or Death was preventable.

The third example is ICD 443.0: Raynaud’s phenomenon (secondary) (O) which is not a chemical per se but is a physical agent and is also a Sentinel Health Event for our purposes, whether it is occupational or used as a hobby. The parentheses (O) denote that only occupational studies were utilized for this article.

The Disease was preventable (P); the Industry/Occupations were Lumberjacks, Chain sawyers, Grinders, Choppers, Rock drillers, Stone cutters, Jackhammer operators, & Riveters. The agent was Whole Body or Segmental Vibration. There were 9 references.

The second article used for the Poster was the following:

2. Medical Screening and Biological Monitoring. A Guide to the Literature for Physicians published in 1995. (32 references)

The use of Medical Screening and Biological Monitoring has seen substantial changes in the past few decades specifically in the provision of occupational medical services. In the 1990 to 1991 survey, the Occupational Safety and Health Administration (OSHA) estimated that only 6.3% of US industries had a medical surveillance program at their industrial establishment.

I reviewed numerous CDC/NIOSH documents, OSHA’s Code of Federal Regulations and various textbooks and journal articles on Biological Monitoring and Medical Screening of workers by individual researchers and prepared a Poster entitled “Specific Medical Tests Published in the Literature for OSHA-Regulated Chemical Substances” in 1997 containing the following information:

1. Name of the Chemical

It is important to note that the name of a Chemical sometimes is also a synonym for another chemical since the manufacturer from another country may have produced this same chemical. In this Poster, the common name of the Chemical is provided.

2. CAS Number

The CAS Number is the Chemical Abstracts Service Registry Number for each chemical substance. In other words, every chemical that is manufactured is given a specific Registry Number by the Chemical Abstracts Service and it is called the CAS Number.

The Importance of the Use of the CAS Number

The manufacturing companies provide a specific name along with alternate names called synonyms. The commonly accepted name has been used in this Poster. The use of the CAS Number is extremely important as it denotes a specific number for each name.

In 1976, I was working on the Criteria Document on Dioxane which is a solvent for lacquers, paints and varnishes; many people including manufacturers were confusing Dioxane with Dioxin, also known as Agent Orange, which was found to be a contaminant of the Herbicide, 2,4,5-T, a defoliant that was sprayed during the Vietnam War.

I fielded numerous calls from manufacturers as well as users of Dioxane if it was the same as Dioxin or Agent Orange that was used in the Vietnam War. I mentioned to them that the two chemicals were very different: Dioxane is a solvent and Dioxin is a contaminant in the insecticide sprayed in the War zone to clear the heavy bushes for our service men and women to move north toward North Vietnam. The official name of Dioxin is 2,3,7,8-Tetrahydrodibenzo-p-dioxin.

The use of Dioxin was later banned by the US Food and Drug Administration (US FDA).

Therefore, if there is any doubt that your worker or patient has been exposed to a particular chemical, it is advisable to check the CAS Number of that chemical and continue to follow the procedure for its use.

3. Use of Specific Timings for the Specific Medical Tests to be Performed

Another important point to be made is the specific time as to when the blood, tissue or urine sample is to be taken from the worker; it is extremely important to note that each chemical goes through the body with a different half-life, some within 30 minutes, in which case, the sample is to be taken during exposure. Some chemicals stay in the body for a long time and so the sampling of the blood or tissue or urine can be taken at the end of the day or even at the end of the workweek following the end of exposure to the chemical. Some workers need to be sampled way beyond Termination of Employment because of the latency period of the chemical causing the disease, for example, Cancer of the Lung.

It is also important to know the effects of the chemical on workers from Acute exposure as well as from Chronic exposure. An example as to the importance of the sampling time of Trichloroethylene is provided below.

If we look at the various tests recommended for Trichloroethylene on the “Sample” Poster that has been attached to this website, each researcher has provided his own method for testing in Blood, Exhaled Air and Urine. Three researchers have recommended testing blood without any specific timing; two have recommended taking blood at the End of the Shift; One group has recommended taking the blood from the worker at the End of Shift at the End of the Workweek; in other words, the blood has to be taken just before the worker leaves for home while three other researchers have recommended at the End of the Workweek where blood could be taken perhaps in the last hour of the workweek. Similar recommendations have been given for the Exhaled Air and the Urine though they may differ slightly. One important point to mention is that it is a good idea to check the dates (i.e. year) that the recommendation is made. As research progresses, we learn more about the timings and it is a good idea to use only the later recommendations as perfection of the methods will have been achieved at the same time. Also, it is good to check if the author has personally conducted the research or quoting someone else’s work which may have been done a few years ago and may now be out-of-date.

4. Specific Medical Tests

Specific Medical Tests are recommended Tests by Governmental Agencies like OSHA and NIOSH and by various independent researchers around the world. These Specific Medical Tests have been placed in the Poster in abbreviated format. The complete name of the Tests is provided in the Glossary which is described below.

A point to note is the Medical Test that is provided in RED; it is a Regulated test by OSHA and has to be performed. If an OSHA official conducts a walk-through survey and finds that the company had not tested for that chemical if it is regulated, the company will be fined. Thus, all companies should adhere to the OSHA Regulations.

5. Glossary

Using the above parameters, I prepared a Glossary of Terms which provided the complete name of the Medical Test. As an example, “EOS” signifies: “End of Shift”. Another example is “PFT” which is “Pulmonary Function Tests”.

6. References

I also prepared a Reference Section which provides a complete Bibliography, and it is also provided in each individual File that I prepared for the 200+ chemical substances in 1997.

As mentioned in the Introduction, I received requests for over 20,000 copies of this Specific Medical Tests Poster from doctors, pharmacists, nurse professionals, researchers and even manufacturers, from around the world.

This Specific Medical Tests Poster was updated every time OSHA regulated a new chemical substance and the requests continued even following the final Poster published in 2005, when I retired.

Following retirement, I continued updating the Poster and also translated the information from the Poster into Spanish. As of March 2023, this new Specific Medical Tests Poster contains 257 chemicals in both English and Spanish languages as well as a Glossary of Terms used in the Specific Medical Tests, and 20 References.

7. Below the Poster

a. Left-hand side: when first printed; final revision

b. In the center is the information on COVID-SARS pandemic change in Spirometry Testing procedure published by NIOSH on May 25, 2021. This was done to protect both the coal worker & the industrial hygienist because they were in close proximity during the Spirometry Testing of the coal worker as soon as he came out of the coal mine.

c. Right-hand side: Name of Author with email and Name of Graphic Designer.

A ‘Sample” Poster is included below on this website for your view; it contains all the 257 chemicals, the CAS Numbers, the Specific Medical Tests, the Glossary and the Reference Section. Only the Medical Tests on a few chemicals are provided in the “Sample” Poster to show how the Tests are included in the Complete Poster. The Complete Poster with all the Medical Tests and other Tests recommended for the 257 chemicals needs to be purchased; this information is provided in the Membership and Data Access on Google Drive Section.