effectively managing the “underexposed” robert emery, drph, chp, cih, csp, rbp, chmm, cpp, arm...
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Effectively Managing the “Underexposed”
Robert Emery, DrPH, CHP, CIH, CSP, RBP, CHMM, CPP, ARMVice President for Safety, Health, Environment & Risk Management
The University of Texas Health Science Center at Houston
Associate Professor of Occupational Health
The University of Texas School of Public Health
Consider This Paradox Of all the personnel monitoring you have
performed in your career, for whatever potential hazard or insult ….. Chemicals Radiation Mold Particulates
How many results were at or above the established limit?
Are We Overlooking the Majority?
The recurrent answer from multitudes of practicing safety professionals is 1 to 5%
Much of our collective academic and professional preparation is focused towards the protection of this 1 to 5%
What about the other 95 to 99%?
The “Underexposed” Persons exhibiting monitoring results below any
required or recommended limit
“Underexposed” is actually a misnomer, as these persons are likely exposed, but just to a lower or even trivial level
But these persons can still hold concerns or apprehensions about their exposures, and can consume vast amounts of program energy and resources if mismanaged
Management of the Underexposed Ironically, once assessed or monitored, the
underexposed population of workers is either ignored or, if problematic, managed through a series of unwritten techniques
These management techniques are developed over years of experience, and many battle scars, but are rarely documented
General Classes of the “Underexposed”
1. The unconcerned 2. The curious 3. The inquisitive 4. The concerned 5. The upset 6. The upset with symptoms 7. The outraged,
and not shy about making it known
Identifying Who is Who? Sometimes it’s hard to tell
But using a methodical approach, self selection can occur
The trick is the subsequent and appropriate management of these individuals as the different classes of individuals become apparent
Beyond Risk Communications Certainly the well articulated precepts of
risk communication are applicable, but its more that merely talking
Processes and actions must match and mesh with the messages being sent
Empathy and respect is crucial
1. The Unconcerned The easiest to handle May not have known or cared if they were
being exposed Mere education that the exposure may exist,
but is being monitored and controlled is sufficient
They then turn their attentions elsewhere Likely best left alone at this point
2. The Curious
May be aware of exposures and have heard about them from somewhere else
Once educated, can be re-assured by providing monitoring results and follow up care
3. The Inquisitive Likely aware of exposures and have talked
about them Along with education, displays of monitoring
results in context must be provided Means for communications of any
subsequent concerns a must! The installation of an environment of trust –
follow up actions are crucial
Barriers to Trust Disagreement
amongst experts Lack of
communication, coordination amongst risk management organizations
Inadequate risk communication skills, actions
Lack of exposed person participation
Apparent mismanagement or neglect
History of distortion, secrecy
Functioning Without Trust Applying a lesson from business
In contract negotiations, accountability, not trust, is the dominant value
Accept the obligation to prove contentions to critics, using methods such as third party sampling, analysis, oversight or audits
By relying more on accountability and less on trust, organizations become more trustworthy
Data in Context: Post-Flood Relative Humidity
Percent Relative Humidity in the Non-Flooded Areas (Floors 1-7) of the Medical School Building & John Freeman Building Pre and Post Flood 06/09/01
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
-2.0 8.0 18.0 28.0 38.0 48.0 58.0 68.0
Days past flood event
Perc
ent R
elat
ive
Hum
idity
Measured Humidity Levels ASHRAE Guideline Reoccupation Occurs
4. The Concerned All previous steps required, along with
proactive and frequent follow up
Even if calls have not come in, dropping by and checking on things (better if with a sampling device) can serve to re-assure
Third party analysis of samples always helpful to maintain trust
5. The Upset Allowing persons to vent is critical!
Seek to organize a forum where venting can occur with managers, supervisors or other key folks who have likely been cc’ed on multiple e-mails present.
Typically have hunted up information on the web (usually the wrong information) but important to let them have their say
Respond calmly and rationally
When describing options, always emphasize that the final decision rests with the employee!
The Options When exposures are demonstrated to be below
the accepted standard, the ultimate decision rests with the employee: Continue to work Work in PPE Arrange some sort of trade out of work
tasks/locations? Request annual leave/vacation Seek doctor’s note and access sick leave Apply for a transfer? ?
The Options When exposures are demonstrated to be below
the accepted standard, the ultimate decision rests with the employee: Continue to work Work in PPE Arrange some sort of trade out of work
tasks/locations? Request annual leave/vacation Seek doctor’s note and access sick leave Apply for a transfer? Resign? (exercise caution here!)
6. The Upset with Symptoms Never discount the symptoms being
described!
Articulate that the symptoms are real –its just the root cause of the responses that may be in question
Understand the emerging field of psychoneuroimmunology
• Illness
• Loss of Productivity
• Worker discontent
• Protracted WCI/Legal Issues
Physiological
Response
toxin or infection
Allergen or Irritant
Pathways for Indoor Air Quality-related Physiological Responses
Cues
Pavlovian Conditioning Immune conditioning demonstrated in animals Can produce many physiological responses May also increase anxiety, fear, anger, etc.
(“buttons”) Conditioning stimulus can be any sense
• Illness
• Loss of Productivity
• Worker discontent
• Protracted WCI/Legal Issues
Physiological
Response
toxin or infection
Allergen or Irritant
Pathways for Indoor Air Quality-related Physiological Responses
• Illness
• Loss of Productivity
• Worker discontent
• Protracted WCI/Legal Issues
Physiological
Response
Other cue- v
isual,
odor, etc.
toxin or infection
Allergen or Irritant
Pathways for Indoor Air Quality-related Physiological Responses
Psychogenic Model Produced or caused by psychic or mental factors rather
than organic Of psychological rather than physiological origin When the mind induces the body to create or exacerbate
poor health Somatoform disorders
Compilation of illnesses unexplained by physiological symptoms
“Somatization”
Source: American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th edition
Synonyms Sick building syndrome Building related illness Multiple chemical
sensitivity Chronic fatigue
syndrome Environmental
somatization syndrome Total allergy syndrome Cacosmia Functional somatic
syndrome
Occupational neurosis Mass psychogenic illness Psychogenic idiopathic
environmental intolerance
20th century disease Cerebral allergy Chemically induced
immune dysregulation Idiopathic building
intolerance Toxic agoraphobia
Stress Reported Associations Allergy/Asthma Autoimmune diseases Cardiovascular diseases Infectious diseases Malignant diseases Metabolic diseases
Psychogenic Illnesses Physiologic responses are REAL Extremely difficult to treat
Patient denial Employer disdain/impatience Limited response to traditional therapies
Approach to problem is multilevel Patient/doctor/employer education Early/consistent involvement of environmental
safety Deconditioning strategies
Treatment Acknowledge the symptoms as real Actively investigate Explore options for removal from environment Make actions noticeable Provocative challenge? Cognitive-behavioral therapy
Resistance to psychological treatment Explanation of stress playing a role in symptoms Regardless of monitoring results, office
cleaning, control over ventilation, and increased outside air
7. The Outraged Employ all approaches described so far
Learn to know when to create “Pearl Harbor File” as litigation likely
Documentation that reflects actions taken, dates, times, and third party results
Review your case in this manner: “have we done everything we could reasonably do?”
“How will our actions be perceived on the front page of the paper or the evening news?”
Important Point to Remember “If we have not gotten our message
across, then we ought to assume that the fault is not with our receivers”
Baruch Fischhoff, Dept of Engineering and Public Policy, Carnegie Mellon University 1995
Case Study Despite best planning and controls, odors from a
roofing project from a building adjacent to an existing, occupied building
Odors are strong, but measured to be below recommended exposure limits
Large population of workers (n > 100) exposed to odors, producing a wide variety of responses
What steps should be taken to address this issue?
Lessons We Learned Advanced warning of project via multiple communication
pathways (requires active Facilities involvement and awareness)
Include explanations about options explored, and reasons for not being implemented
Include information about substances to be encountered, and associated exposure limits, effects
Include reminders for supervisors about available options for management of employees
Active surveillance of worksite and exposures
Mechanism for occupants to express concerns, and active follow up
Summary The general professional consensus is that
most of the persons we monitor are “underexposed”
Although underexposed, these individuals can consume vast program resources and energy if mismanaged
Academic and professional preparation in this area is generally lacking
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