Our Occupational Health Services Program is headed by Dr. David Hewitt, who is a board certified physician in occupational medicine and general preventative medicine with experience in toxicology and environmental epidemiology. As an occupational medicine physician he has experience in treating work-related injuries and illnesses, providing case management for facilitation of early return to work of injured workers, and providing Independent Medical Examinations (IME’s) regarding alleged health effects secondary to chemical exposures. He has completed a Master of Public Health (MPH) in epidemiology and has designed, coordinated, and published environmental epidemiology studies regarding chemical exposures and biomonitoring. As a medical officer with the Agency for Toxic Substances and Disease Registry (ATSDR), he provided consultation to both medical providers and the general public regarding chemical exposures.

Additionally, we have three registered nurses who are also members of the Association of Legal Nurse Consultants. This combination of credentials is only held by two others in the State of Arkansas. Dr. Hewitt, with our three registered nurses, coordinates all occupational health programs and provides litigation medical support services. CTEH^®'s Senior Medical Specialist has over 18 years experience managing occupational health programs within the railroad industry both in the field and at the corporate level. CTEH^® understands the regulatory requirements of industry and can assist clients in meeting those requirements.

Members of CTEH^®'s nursing staff maintains specialized licenses including: Licensed Social Worker, Certified Case Manager, and Certified Occupational Health Nurse Specialist and Legal Nurse Consultant. The CTEH^® nursing staff participates in on-going continuing education seminars to keep abreast of the current trends in occupational health and litigation support services.

In an attempt to address the increasing demands of work-related health issues, CTEH^® has developed several occupational health programs. A short overview of these programs is presented below.

Mobile Occupational Respiratory Evaluation

A New and Innovative Approach to Pulmonary Function Testing In the Workplace

CTEH^® has teamed with Union Pacific Railroad to provide on-site pulmonary function testing (PFT). The Mobile Occupational Respiratory Evaluation (MORE) Program attempts to address the increasing demands of work-related health issues. The PFT is performed to evaluate work-related respiratory complaints, such as asthma and Reactive Airway Dysfunction Syndrome (RADS). In circumstances where the precipitating agent(s) is known or suspected, real-time and laboratory air monitoring can be performed to correlate with PFT results. Observations of on-going work activities potentially associated with respiratory complaints and PFT changes can also be provided by a CTEH^® industrial hygienist.

MORE utilizes cutting-edge technology and the services of experienced health professionals to provide our clients with effective testing in the workplace, thereby reducing the amount of time an employee is away from the job, alleviating inconvenience, and ensuring a more accurate evaluation. In addition, an occupational medicine physician is available for workplace evaluation and consultation.

Acute work-related changes in respiratory function are typically evaluated through the use of portable peak-flow meters that can be used any time during the workday. In a typical case scenario, the patient is instructed in the use of the peak-flow meter and carries it to the workplace. While performing regular work activities, the worker takes several readings during the work shift and records them in a diary. The information is later evaluated by a health care provider who analyses the data to determine if there are any consistent changes associated with work activities.

Unfortunately, obtaining successful and accurate results is difficult as peak-flow meters are highly effort-dependent and provide limited data. In addition, there is no way to monitor the user to ensure that testing was performed correctly and with maximum effort.

The ideal method to evaluate respiratory function during the workday would be a series of PFTs administered before, during, and after the work shift. Information on work activities and workplace air concentrations obtained concurrently with PFTs can also provide valuable information for workplace associations. However, onsite PFTs and real-time air testing are generally not available through local providers, and to transport an individual to and from a local clinic for multiple PFTs during a work shift would most likely present logistical problems.

The solution to a more accurate method for evaluating respiratory function is the MORE Program. Although PFT testing requires equipment and a qualified individual to administer the test, results obtained using the PFT method are more accurate and reliable, thus providing valuable information for data interpretation. Advantages in using the MORE Program include:

• NIOSH-trained nurses directly on-site
• Multiple PFTs taken during various job functions
• More objective data collected
• More accurate results
• Data can be reviewed by CTEH^®'s occupational medicine physician
• Real-time air monitoring and work activities observations can be conducted at the time of PFTs by an industrial hygienist
• More reliable conclusions regarding whether or not problems are work place-related
• One fee covers multiple tests

Worker Exposure Response Program (WERP)

Because of increasing client requests, CTEH^® developed the Worker Exposure Response Program (WERP) designed to offer immediate response from a toxicology professional when their employees report a chemical exposure at their work place. CTEH^®'s program is designed to provide our clients with access to a full complement of toxicological resources to address these employee complaints and to ensure that medical care providers, company supervisors, and employees have the necessary information concerning the chemical in question. WERP offers our clients a unique and proactive method of addressing employee chemical exposure incidents/injury claims. CTEH^® toxicologists, in consultation with CTEH^® occupational health services staff, can tailor a program to suit the specific needs of the client.

The services CTEH^® provides for clients include the following:

• 24-hours per day, 7 days per week support by two of our ten Ph.D.-level toxicologists, occupational medicine physician, and occupational health nurses. Clients contact CTEH^® through our 24-hour Help Desk at 1-866-869-2834 who then places the client in direct contact with the on call toxicology/medical professional.
• The CTEH^® toxicologist will provide consultation and support to the affected employee, his/her supervisor, and/or medical personnel involved in the employee's care, which may include verbal and/or published information regarding the chemical(s) involved in the exposure incident.
• As outlined in the program, CTEH^® will provide follow up contact by a registered nurse with the involved worker(s).
• CTEH^® will provide follow-up information to the client contact person initiating the call to CTEH^®.
• On a quarterly basis, CTEH^® will provide a program summary to the client's designated representative, summarizing the worker exposure response calls taken during that quarter.
• CTEH^® will interact with and provide information to any appropriate client individual (e.g., someone from the medical and/or industrial hygiene groups) as needed.

Occupational Health Services

CTEH^® offers clients a full range of occupational health services. CTEH^® believes that leaders in industry now and in the future will be those that have a strong commitment to maintaining employee health and safety both on and off the job. A healthy workforce increases employee productivity, decreases lost time from work due to illness, and decreases the risk of many on the job injuries. CTEH^®'s occupational health service staff includes registered nurses with experience in industrial health and safety programs and can provide rapid response to industrial client issues.

CTEH^® has a proven reputation in occupational health service delivery and environmental safety as well as extensive knowledge and experience working in and consulting with all types of industries, tailoring programs to meet individual client needs.

Potential occupational health services offered by CTEH^® include:

• Independent Medical Evaluations
• Worker bio-monitoring services to include consultation, on-site collection, coordination of laboratory services, and professional review and analysis of results
• Needs assessment and data analysis
• Medical provider recruitment, training, and on-going supervision of services in the client's locale and tailored to the client's medical program requirements
• Training in employee health and wellness
• Employee health services including the coordination of:

• Pre-employment physical examination
• Drug screening services
• Respirator fit testing
• Other occupational health services tailored to suit the specialized needs of the client

• Registered nurse case management for injured or ill workers
• Development and management of industrial medical surveillance programs as required by certain OSHA or FRA standards

Legal Nurse Consulting Services:

CTEH^® has a team of experienced legal nurse consultants with diverse medical training backgrounds including knowledge and experience in case management, litigation, and case process from both the legal and medical aspects. Legal nurse consultant services are provided to both the litigation teams and expert witnesses and offer a critical analysis of health care facts and issues pertinent to the litigation. CTEH^® nurses provide clients with the highest quality of products that are delivered on time, are versatile, easy to use, and most importantly, accurate.

Legal Nurse Consultant Services include:

• Medical records document management, including state of the art document scanning and data management technology
• Preparation of detailed medical record abstracts/chronologies
• Preparation of medical case summaries/litigant profiles
• Individual case review for merit