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APPENDIX
STATE AND LOCAL ENVIRONMENTAL AND OCCUPATIONAL
HEALTH INFORMATION PROGRAMS
A brief description of state and local programs for
O-E information is given for New Jersey, Iowa, and San
Francisco, California.
New~lersey's Environmental and Occupational Health
Information Program (EOHIP)
The State of New Jersey ranks high in population
density and chemical production. In recognition of the
serious threats to its water and air resources from any
possible indiscriminate use and disposal of hazardous
substances, the EOHIP program was developed to
educate the public about O-E health risks in the Office of
Consumer Health EcJucation, Department of Environmental
and Community Medicine, University of Medicine and
Dentistry of New Jersey - Robert Wood Johnson Medical
School.
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The EOHIP is under the oversight of an Advisory
Committee composed of leaders that represent private
industry, state, local, and federal government; major health
organizations; voluntary environmental groups; and labor.
It has six primary approaches:
· continuing education in O-E health for physicians;
.
resource Center for dissemination of O-E health
information;
· O-E health articles for distribution through major
New~Jersey employers;
.
.
.
O-E health information services for focal
governmental and voluntary environmental
organizations; and
O-E health information programs in New~Jersey
schools;
O-E health services to small industries.
The goal of the EOHIP is to provide the public and
professionals with current information about the prevention
and control of O-E health risks from a reliable and
accessible source. Both technical assistance and
information are disseminated through responses to
telephone and mad! inquiries. Printed information and
INFOsheets - each authored by a prominent scientist - are
available to address a various topics of concern. Each is
written in a straightforward question and answer format.
INFOline is an 800 telephone number available in New
Jersey only that responds to questions for information
about environmental or job-related health topics. It is not
for specific medical problems.
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UWorksafe Iowan Program
The University of Iowa Institute of Agricultural Medicine
and Occupational Health, through a W.K. Kellogg
Foundation grant, has designed and implemented a state-
wide occupational safety and health outreach program
Worksafe Iowa. This program was developed to provide
O-E medical information, education and consultation to
agriculture, industry and health care providers in Iowa and
the region. lt is built around an O-E medical resource
center which includes-occupational medicine physicians,
toxicologists, industrial hygienists, epidemiologists,
environmental health specialists, and O-E health educators
and information specialists. Specific components of the
program include a consultation unit in occupational
medicine and industrial hygiene, an O-E medical education
unit, and the Worksafe Iowa Information Network (WIIN).
Specific programs and staff expertise are available for the
three target groups - agriculture, industry and health care
providers - and all programs and staff overlap and
interact.
For health care providers two interrelated programs
have been designed. The first is the Worksafe Iowa
Occupational Medicine Associates Network which now
consists of five community hospital-based occupational
medicine clinics. This Network is expanding to 10-12
hospitals throughout the state in the summer of ~ 990.
These clinics provide occupational medicine and education
programs to their respective communities and affiliated
smaller hospitals and clinics. Worksafe Iowa provides
technical support to these hospitals in the areas of O-E
medicine, industrial hygiene, and educational and
information systems in exchange for an annual
membership fee which covers less than half of the
program costs (the remainder is covered by the Kellogg
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grant). Each clinic is networked to the Center and each
other via WIIN which operates a personal computer-based
electronic bulletin board to facilitate information
dissemination and in the future will provide an operational
data-base for occupational illness and injury surveillance
data.
The second program for health care providers, which
is not ye! implemented, is an 800 O-E information access
number for all physicians in Iowa. This service will provide
access by phone, or by computer through WIIN. It will
provide access to the appropriate expert on the Worksafe
Iowa staff, or transfer to the University Poison Control
Center, the University Cancer Hotline, or for referral to the
University of Iowa Hospitals and Clinics Occupational
Medicine Clinic or other relevant specially clinics. Foflow-
up will provide information by mail, facsimile or WIIN
electronic bulletin board on a fee-for-service basis.
Inquiries will be loggec' upon receipt into a data-base that
will provide surveillance information for the several
hospitals on the network, for the University of Iowa
Hospitals and Clinics, for the Iowa Department of Public
Health (that conducts occupational medicine surveillance
on selected occupational illnesses and injuries), and for
Worksafe Iowa.
Both of these components of a primary health care
provider O-E medical information program for education,
consultation and surveillance are currently being
implemented and evaluated as a state and regional model.
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SAN FRANCISCO BAY AREA REGIONAL
POSION CONTROL CENTER (SFBARPCC)
AND ITS
TOXIC INFORMATION CENTER (TIC)
San Francisco's Toxic Information Center Operation
The San Francisco Bay Area Regional Poison Control
Center (SFBARPCC) is a 24 hour a day toll-free
informational hotline serving the San Francisco Bay Area
and the northern coast of California (population over 4
million). Certified as a Regional Poison Center by the
State of California and the American Association of Poison
Control Centers, the SFBARPCC provides immediate
information and treatment advice to callers regarding the
toxicity of drugs, poisons, and environmental chemicals.
In-depth advice is provided to calling physicians and other
health care professionals managing complicated
poisonings or drug overdoses. The Poison Center also
provides referrals to local, state and federal agencies
when appropriate.
Located adjacent to the Emergency Department at
San Francisco General Hospital, the SFBARPCC began
operating in 1979, and has grown steadily from a staff of
5 handling 12,000 calls to a staff of 10 managing over
70,000 calls per year, utilizing the most up-to-date
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computerized information systems. The telephone hotline
staff are all doctorate-level clinical pharmacists (PharmDs)
with extensive experience in managing poisoning anc! drug
overdose. They are assisted by a back-up pane' of 5
amending physicians, all board-certified in Medical
Toxicology, with specialties including emergency medicine,
internal medicine,-occupational medicine, and laboratory
medicine. In addition, the Center maintains a list of
volunteer experts in industrial hygiene, environmental
health, botany, mycology, and medical subspecialties.
The SFBARPCC is actively involved in the education
of health professionals. Each year more than 50
pharmacy and medical students and residents rotate
through an intensive 4-6 week training program.
Postgraduate fellows in Clinical Toxicology receive
comprehensive training towards board certification in
Medical Toxicology. Each year the Center sponsors a
2-day continuing education symposium, amended by over
200 participants, providing lectures and discussion
sessions on a variety of topics, including diagnosis and
treatment of acute drug overdoses as well as occupational
and environmental emergencies. The SFBARPCC staff is
also in the final phase of completing a handbook for
treatment of poisoning, to be privately in 1990.
In 1983, under a contract with the California State
Department of Health Services Community Toxicology Unit,
the SFBARPCC created the Toxic Information Center (TIC)
to serve the entire State of California with information
about the toxic effects of environmental chemicals and
hazardous materials. The TIC receives approximately
5,000 calls each year, on topics such as asbestos,
solvents, pesticide use, house-ho hazardous waste,
carcinogens, and is staffed by specially trained
environmental toxicologists. The TIC assists in the
management of over 100 acute hazardous materials
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incidents each year, providing information to on-scene and
hospital personnel about the acute toxic hazards of the
materials involved, specific treatments including antidotes,
and recommendations or protective gear and
decontamination, as well as referral to appropriate local
and state agencies. The TIC also provides information
about the health effects of the involved chemicals to
calling public and media. The TIC maintains an extensive
reprint file and a large library of books, journals, and
computerized information sources to provide the
specialized information requested by calling health
professionals, citizens, and government agencies. The TIC
is physically located within the SFBARPCC hotline area,
providing for direct referral of callers with acute toxic
exposures to on-duty Poison Control Center staff, and
allowing for after business hours coverage. The TIC also
makes referrals to its affiliated telephone information
service for occupational hazards, the Hazard Evaluation
System and Information Service (HESIS), and to the
Occupational and Environmental Health Clinic at San
Francisco General Hospital. The TIC is actively involved in
research related to environmental and occupational
medicine, and has published studies supporting the use of
poison control centers as sources for reporting of
occupational illness.
The TIC also contributes articles on common
household and environmental poisons to the
SFBARRPCC's bimonthly newsletter, Community Newswire.
The TIC has developed special training programs in
environmental toxicology and meclical management of
hazardous materials emergencies. As a member of the
State Emergency Medical Services Authority's Hazardous
Materials Advisory Committee, its Medical Director has
participated in the development of practical protocols for
on-scene and hospital treatment of victims of acute
hazardous materials exposure. These protocols are being
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adopted statewide. In addition, the TIC has developed, in
association with the EMS Authority and UC Davis
Extension, a course on medical management of hazardous
material emergency to train physicians, other health
professionals, emergency and disaster planners, and
firefighters to recognize and manage acute hazardous
chemical exposure.
The TIC has responded to emerging needs of
California's health professionals and citizens, and now
provides information regarding health effects and focal and
state regulations regarding health effects and local and
state regulations relating to household hazardous waste
disposal, Proposition 65 chemicals, and air toxics
emissions reported under the EPA Toxics Release
Inventory. Recognizing the need for a reliable source of
peer-reviewed, summarized information on acute and
chronic toxic effects of environmental and occupational
chemicals, the SFBARPCC and TIC are actively working
with the American Association of Poison Control Centers.
the Agency for Toxic Substances and Disease Registry,
the National Academy of Sciences, and the Chemical
Manufacturers Association.
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Table A-1. A Hypothetical Cost Projection for An O-E Infonnation Center
Expense TypeStartup YearSubsequent Years.Subsequent Years.
PERSONNEL 1
MD toxicologist$ 90,000$ 95,000$ 100,000
MPH CIH Level60,00063,00066,000
. .
specialist
Health educator45,00047,00050,000
Administrative30,00031,00031,000
Telephone infonna-60,000(1.5 FTE)125,000 (3.0 FTE)220,000 (5.0 FEE)
don Specialists
EQUIPMENT:
Computers60,00020,00010,000
Software and40,00020,0005,000
software development
Piles and furniture5,00000
SUPPLIES:
Books and journals5,0002,0001,000
Computer programs5,0001,0001,000
Online services30,00015,00015,000
and CD ROMs
Miscellaneous30,00040,00050,000
TELEPHONES:
Equipment10,00000
line charges10,00020,00040,000
$480,000$479,000
Source: The subcommittee projected these costs from the members' estimates
of salaries, and costs of equipment, supplies, and telephones.
$589,000
1Costs for personnel must be increased depending on the numbers of professionals on a 24 hour
cycle. Also, in some locations the telephone information specialist might best include industrial
. .
hygienists.
35
Representative terms from entire chapter:
worksafe iowa
