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

L ow 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 Ro be r t Co he n, MD, F CCP Global Cut the Dust Confe r e nc e Ho no r ar y Pr o fe sso r Unive r sity Goal Coast, Que e nsland, F e b 2020 o 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 o 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 o 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 Austr alia  Ma nda te d b y MSHA  Ma nda te d b y DNRME  Vo lunta ry Pro g ra m  Ma nda to ry Pro g ra m  F irst e xa m o n hire , the n fo llo we d  F irst e xa m o n hire , the n fo llo we d e ve ry 5 ye a rs e ve ry 5 ye a rs  Ope ra to r Org a nize d Surve illa nc e  Ope ra to r Org a nize d Surve illa nc e  Only 1/ 3 o f mine rs pa rtic ipa te  AMAs a nd E MOs  Che st Ra d io g ra phy  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  Re a d c e ntra lly b y dua l b -re a de rs  L  L ung F unc tio n T e sting ung F unc tio n T e sting  F  NIOSH Mo b ile Va n 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 o 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 Air pump + c yc lo ne fo r tra ditio na l g ra vime tric sa mple s Co ntinuo us Pe rso na l Dust Mo nito r (CPDM) ze fo n.c o m CDC/ NI OSH

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 o 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 35 Tenure in Mining 30 0-9 years 10-14 years 25 15-19 years 20-24 years Percentage 25+ years 20 15 10 5 0 1970-1974 1975-1979 1980-1984 1985-1989 1990-1994 1995-1999 2000-2004 2005-2006* 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 2000 – Category 3/3 – Stage B 37 years old – 16 years underground 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 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 T 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 Large Opacity Score at Large Opacity Score at First CXR Final CXR Miners (n) O O 1,825 A A 1 O A 48 O B 17 O C 6

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 Unive r sity of Ne w South Wale s K irste n Almb e rg , PhD De b o ra h Ya te s, MD L e o na rd Go , MD Guy Ma rks, MD K a thle e n K e nne dy, PhD T re vo r Wa ite , PhD L e e F rie dma n, PhD Unive r sity of Que e nsland National Je wish He alth Da vid Cliff Ce c ile Ro se , MD, MPH