L ow Dust L e ve ls from Mine sa mpling doe s not re pla c e - - PowerPoint PPT Presentation

L

• w Dust L

e ve ls from Mine sa mpling doe s not re pla c e the ne e d for Me dic a l Surve illa nc e :

T he ro le o f He a lth Sc re e ning a nd Se c o nda ry Pre ve ntio n

Global Cut the Dust Confe r e nc e Goal Coast, Que e nsland, F e b 2020

Ro be r t Co he n, MD, F CCP

Ho no r ar y Pr

• fe sso r

Unive r sity

• f Que e nsland, SMI

Clinic a l Pro fe sso r - E OHS, Unive rsity o f I llino is Sc ho o l o f Pub lic He a lth Chic a g o , I llino is Pro fe sso r o f Me dic ine No rthwe ste rn Unive rsity F e inb e rg Sc ho o l o f Me dic ine Se nio r Co nsulta nt NI OSH Re spira to ry He a lth Divisio n

Disc lo sure o f F ina nc ia l Suppo rt

F

unde d b y the Alpha F

• unda tio n fo r the

I mpro ve me nt o f Mine Sa fe ty a nd He a lth, I nc .

F

unde d b y HHS/ HRSA/ ORHP/ BL CP & BL CE

Se nio r Co nsulta nt NI

OSH/ RHD

F

unde d b y USDOL / OWCP & MSHA

F

unde d b y Que e nsla nd Go ve rnme nt, Austra lia

Ob je c tive s

 De sc rib e the ro le o f pre ve ntive me a sure s in pub lic

he a lth fo r Bla c k L ung

 I

mpo rta nc e o f Se c o nda ry Pre ve ntio n

 I

nte r-re la tio n b e twe e n prima ry a nd se c o nda ry pre ve ntio n

 Ne e d fo r me dic a l sc re e ning / surve illa nc e e ve n a fte r

e xpo sure c e a se s – fo rme r mine rs

Prima ry Pre ve ntio n

Re g ula tio ns a nd Sta nda rds fo r E

xpo sure

US PE

L

• 2014-pre se nt 1.5 mg / m3 - Qua rtz

0.075/ m3

Que e nsla nd PE

L – 2.5 mg / m3 – Silic a 0.1 mg / m3

Re c o mme nde d e xpo sure limit – 1 mg / m3 1995

• NI

OSH

Mo nito ring a nd E

nfo rc e me nt

US - MSHA I

nspe c to rs, Ope ra to r Sa mple s

DNRME

inspe c to rs, Priva te I H Co mpa nie s, SI MT ARS

Se c o nda ry Pre ve ntio n – Me dic a l Sc re e ning / Surve illa nc e

De te c t e a rly dise a se

Re mo ve fro m e xpo sure – wo rke r e nte rs

c o mpe nsa tio n syste m

Mitig a te E

xpo sure – re turn to wo rk

I

de ntify fa ilure o f prima ry pre ve ntio n

Unde rsta nd the na tura l histo ry o f dise a se I

nfo rm re g ula to ry a g e nc ie s

Ho w Do e s Dise a se Go Unde te c te d?

Ofte n no initia l sympto ms L

• ss o f sig nific a nt lung func tio n b e fo re

a ffe c ting a c tivity

Attrib ute sympto ms to o the r c a use s, i.e .

a g ing

Se c o nda ry Pre ve ntio n

Co a l Wo rke r’ s He a lth Surve illa nc e Pro g ra m – MSHA/ NI OSH Co a l Mine Wo rke rs He a lth Sc he me - DNRME USA

 Ma nda te d b y MSHA  Vo lunta ry Pro g ra m  F

irst e xa m o n hire , the n fo llo we d e ve ry 5 ye a rs

 Ope ra to r Org a nize d Surve illa nc e

 Only 1/ 3 o f mine rs pa rtic ipa te  Che st Ra d io g ra phy

 Re a d c e ntra lly b y dua l b -re a de rs

 L

ung F unc tio n T e sting

 NIOSH Mo b ile Va n

Austr alia

 Ma nda te d b y DNRME  Ma nda to ry Pro g ra m  F

irst e xa m o n hire , the n fo llo we d e ve ry 5 ye a rs

 Ope ra to r Org a nize d Surve illa nc e

 AMAs a nd E

MOs

 Che st Ra d io g ra phy – re a d c e ntra lly

b y d ua l B-re a d e rs

 L

ung F unc tio n T e sting

 F

ull Me dic a l E xa m

 Que e nsla nd Mo b ile Va n

Lung function

Dust mo nito ring in the US

 T

wo prima ry me tric s a re me a sure d in US

 T

• ta l ma ss c o nc e ntra tio n o f re spira b le dust (mg / m3)

 Ma ss fra c tio n o f q ua rtz (%) - c o mmo nly re fe rre d to a s “silic a ”

 “Ne w dust rule ” (2014) did no t c ha ng e me tric s, ra the r it

 Re duc e d the PE

L fo r mo st mine rs fro m 2.0 to 1.5 mg / m3

 Ma nda te d use o f the CPDM fo r o pe ra to r sa mple s  Ma inta ine d a 5% ma ss limit fo r silic a  Cha ng e d sa mpling rule s

Sa mpling e q uipme nt in US mine s

ze fo n.c o m

Air pump + c yc lo ne fo r tra ditio na l g ra vime tric sa mple s

CDC/ NI OSH

Co ntinuo us Pe rso na l Dust Mo nito r (CPDM)

Mo nito ring in US mine s

 We re ly prima rily o n pe rso na l dust sa mple s, using a syste m de sig ne d

to mo nito r the individua ls e xpe c te d to ha ve ma ximum e xpo sure s

 Mo nito re d individua ls a re tho se wo rking in the “de sig na te d

• c c upa tio n” o r “DO” – mo st o fte n the se a re CM o r L

W o pe ra to rs, o r ro o f b o lte rs

 We fo c us mo nito ring e ffo rts during typic a l pro duc tio n, a nd thus no t

during o the r de ve lo pme nt wo rk

 Sa mple s a re c o lle c te d b o th b y the mine o pe ra to r a nd b y MSHA

Re spira b le dust in c o a l mining : 1982–2003 Ge o me tric me a n e xpo sure s – MSHA inspe c to r a nd mine o pe ra to r sa mple s NI OSH Wo RL D Re po rt 2007, F ig ure 2-6.

Re spira b le silic a in c o a l mining : 1982–2003 Ge o me tric me a n e xpo sure s MSHA inspe c to r a nd mine o pe ra to r sa mple s NI OSH Wo RL D Re po rt 2007, F ig ure 3-5a .

OSHA PEL NIOSH REL

Pe rc e nt of mine rs with Coal Worke rs’ Pne umoc oniosis (CWP) by te nure in mining, 1970-2006

1970-1974 1975-1979 1980-1984 1985-1989 1990-1994 1995-1999 2000-2004 2005-2006* Percentage 5 10 15 20 25 30 35

0-9 years 10-14 years 15-19 years 20-24 years 25+ years Tenure in Mining

SOURCE: NIOSH Coal Workers’ X-ray Surveillance Program (CWXSP) as cited in NIOSH 2007 WoRLD Report, Figure 2-4.

Dust sa mpling c e ntra l Appa la c hia

L e e a nd Wise c o untie s, VA

1997 – Category 3/3 – Stage O 37 years old – 16 years underground 2000 – Category 3/3 – Stage B 40 years old – 19 years underground Upshur County, West Virginia Started mining in 1981 at 21 years of age Roof bolter

Tazewell County, VA Started mining in 1980 at 20 years old 2002 – Category 3/3 Stage C 42 years old with 22 years underground Roof Bolter/ Shuttle Car Operator/ Scoop Operator

Ca se s o f PMF in the K y, Va , WVA

Pro po rtio n o f PMF Cla ims in DOL BL BP – 1970-2016

CMDL D Pro g re ssio n

Ra dio g ra phic CMDL

D No dula r CWP Dust-re la te d diffuse fib ro sis

L

ung func tio n de c line COPD

Re sults: F irst a nd F ina l CXRs

Large Opacity Score at First CXR Large Opacity Score at Final CXR Miners (n)

O O 1,825 A A 1 O A 48 O B 17 O C 6

T able 1. Co mpa riso n o f I

nte rna tio na l L a b o ur Offic e (I L O) inte rpre ta tio ns o f la rg e o pa c itie s fro m CXRs o f fo rme r U.S. c o a l mine rs a pplying fo r b e ne fits fro m the De pa rtme nt o f L a b o r Bla c k L ung Be ne fits Pro g ra m, 2000 – 2013.1

F E V1 De c line , Pre - a nd Po st-Re tire me nt

Dimic h-Wa rd a nd Ba te s, 1994

Me dic a l surve illa nc e : L e sso ns le a rne d

 Surve illa nc e is e sse ntia l to mo nito r dise a se tre nds – e spe c ia lly with c ha ng e s

in pro duc tio n a nd industria l pro c e sse s.

 Me dic a l surve illa nc e is impo rta nt to a sse ss e ffic a c y o f prima ry pre ve ntive

stra te g ie s.

 Vo lunta ry pro g ra ms suc h a s tho se in the US like ly unde re stima te the

pro b le m.

 Re tire d/ fo rme r wo rke rs a nd sub c o ntra c to r mine rs sho uld b e inc lude d in

surve illa nc e o f dise a se s with la te nc y.

 Pro g ra ms sho uld b e sta ffe d b y tra ine d e xpe rts (i.e , I

L O B re a de rs, c e rtifie d spiro me try te c hnic ia ns).

 Pro g ra ms must sta y true to missio n/ purpo se : ta rg e te d to de te c t a nd

pre ve nt o c c upa tio na l dust dise a se s, no t fitne ss fo r duty e xa ms.

Ac kno wle dg e me nts - Co lla b o ra to rs

MinE R Ce nte r at UIC

K irste n Almb e rg , PhD L e o na rd Go , MD K a thle e n K e nne dy, PhD L e e F rie dma n, PhD

National Je wish He alth

Ce c ile Ro se , MD, MPH

Unive r sity of Ne w South Wale s

De b o ra h Ya te s, MD Guy Ma rks, MD T re vo r Wa ite , PhD

Unive r sity of Que e nsland

Da vid Cliff