Document dYEKvOLxKO5r2p5B1dxOnvdNG

R. Fleming H. W. Smith April 5, 1974 Vinyl Chloride Health Screening Executive Safety - Trexlertovn, Panna CC: E. Blades T. Carey J. Novak M. Smith N. Spurlock H, Vatton Attached la tha National Inatttut# of Occupational Health statement of medical scraanlng to dataet I Ivor dltaasa and/ or hapatlc tumor which nay occur aftar exposure to vinyl chlorides. Evan though this statement Is a r>cn--ndatlon from NIMH to OSHA, It should became our minimum general nodical policy for our employees as wall as those employees engaged under contractual agreements. This program should ha put Into affect In vinyl chloride ect- Ivltlas until such time as additional Information la available and/or until Modifications are Indlcatad by qualified medical authority. Tha Corporate Safety Department Is currently preparing a simitar docwant for TOA exposure. Any changes must be approved by the Corporate Safety Department. Should you concur with this program for vinyl chloride, all attend ing physicians for tha chemical's group should ba notlflad. bis enclosure AP000I4014 MEDICAL SURVEILLANCE - VINYL CHLORIDES THE FOLLOWING MEDICAL SURVEILLANCE PROGRAM RECOMMENDED BY THE NA TIONAL INSTITUTE OF OCCUPATIONAL SAFETY AND HEALTH WAS ISSUED ON MARCH 22, 1974, THIS DOCUMENT WILL APPLY TO ALt PERSONS INVOLVED IN VINYL CHLORIDE MONOMER PRODUCTION AND POLYMERIZATION INCLUDING THOSE CLERKS AND MANAGEMENT PERSONNEL INVOLVED INDIRECTLY WITH THESE OPERATIONS. THIS WILL NATURALLY INCLUDE THOSE PERSONS EN GAGED IN RESERACH AND DEVELOPMENT WORK. THE MEDICAL SURVEILLANCE PROGRAM IS RECOMMENDED TO BE APPLIED BOTH AS A PRE-EMPLOYMENT REQUIREMENT AND AS PART OF PERIODIC HEALTH FOL LOW UPS. 1. AT TIME OF INITIAL EMPLOYMENT OR UPON INSTITUTION OF SCREEN ING, A PHYSICAL EXAMINATION SHALL BE PERFORMED WITH SPECIFIC ATTENTION TO DETECTING ENLARGEMENT OF LIVER OR SPLEEN BY AB DOMINAL PALPATION. 2. AT TIME OF INITIAL EMPLOYMENT OR UPON INSTITUTION OF SCREENING AND ANNUALLY THEREAFTER, A MEDICAL HISTORY CHECK-LIST SHALL BE COMPLETED BY THE EMPLOYEE. THIS LIST SHALL INCLUDE QUESTIONS CONCERNING: A. B. C. 1 D. E. ALCOHOL INTAKE PAST HISTORY OF HEPATITIS PAST EXPOSURE TO HEPATOTOXIC AGENTS, INCLUDING DRUGS AND CHEMICALS PAST HISTORY OF BLOOD TRANSFUSIONS PAST HISTORY OF HOSPITALIZATIONS COMPLETED MEDICAL CHECK-LISTS SHALL BE REVIEWED BY A PHYSICIAN AND SHOULD BE ACTED UPON AS MEDICALLY INDICATED FOR EACH EMPLOYEE. AP00014015 MEDICAL SURVEILLANCE - VINYL CHLORIDES ... Page 2 3. AT TIME OF INITIAL EMPLOYMENT OR UPON INSTITUTION OF SCREENING, A SERUM SPECIMEN SHALL BE OBTAINED FOR SCREENING WITH RESPECT TO THE FOLLOWING FIVE (5> BIO-CHEMICAL DETERMINATIONS OF LIVER FUNCTION: A. TOTAL BILIRUBIN B. ALKALINE PHOSPHATASE C. SERUM GLUTAMIC OXALACETIC TRANSAMINASE fSGOT) D. SERUM GLUTAMIC PYRUVIC TRANSAMINASE (SGPT) E. GAMMA GLUTAMYL TRANSPEPTIDASE (GGTP) ADDITIONAL TESTS THAT MAY OPTIONALLY BE CONSIDERED FOR USE IN SCREENING INCLUDE LACTIC DEHYDROGENASE (LDH), SERUM PRO TEIN DETERMINATIONS, SERUM PROTEIN ELECTROPHORESIS, AND PLATELET COUNT. LABORATORY ANALYSES SHALL BE PERFORMED IN LABORATORIES ACCREDITED BY THE COLLEGE OF AMERICAN PATHOLO GISTS OR LICENSED IN ACCORDANCE WITH THE PROVISIONS OF THE CLINICAL LABORATORIES IMPROVEMENT ACT OF 1967. 4. IF RESULTS OF LABORATORY SCREENING ARE NORMAL, SCREENING SHALL BE REPEATEO ON AN ANNUAL BASIS. IF THE PERSON BEING SCREENED HAS BEEN EMPLOYED DIRECTLY IN VINYL CHLORIDE MONOMER PRODUCTION OR POLYMERIZATION FOR TEN (10) YEARS OR LONGER, SCREENING SHALL BE REPEATED EVERY SIX (6) MONTHS. 5. IF ONE OR MORE LIVER FUNCTION TESTS ARE ABNORMAL, SERUM TESTING SHALL BE REPEATED AS SOON AS POSSIBLE, PREFERABLY WITHIN TWO C2) TO FOUR (4) WEEKS. IF NO ABNORMALITIES ARE PRESENT UPON RESCREEN ING, TESTING SHOULD BE REPEATED IN THREE (3) MONTHS. AP00014016 MEDICAL SURVEILLANCE - VINYL CHLORIDES ... Page 3 6. IF ABNORMALITIES PERSIST ON RESCREENING, THE EMPLOYEE SHALL BE REMOVED FROM CONTACT WITH VINYL CHLORIDE MONOMER OPERATIONS AND AN INDIVIDUALIZED MEDICAL WORKUP SHALL BE INSTITUTED. SUG GESTED AS INITIAL STEPS IN MEDICAL WORKUP ARE A COMPLETE PHYSICAL EXAMINATION AND VARIOUS SPECIAL PROCEDURES SUCH AS HEPATITIS "B" ANTIGEN DETERMINATION AND LIVER SCREENING. IF LIVER FUNCTION ABNORMALITIES ARE DETERMINED TO BE UNRELATED TO LIVER DISEASE (E.G., ELEVATED ALKALINE PHOSPHATAES IN A YOUNG, PHYSICALLY ACTIVE MAN OR ELEVATED BILIRUBIN IN GILBERT'S SYNDROME) OR TO BE TRANSIENT (E.G., DUE TO RECENT HEPATITIS OR RECENT ALCOHOL INTAKE), THE EMPLOYEE MAY BE PERMITTED TO RETURN TO VINYL CHLORIDE RELATED EMPLOYMENT, SUBJECT TO INDIVIDUAL MEDICAL EVALUATION. 7. IN VIEW OF THE PRELIMINARY RESULTS OF ANIMAL TOXICOLOGY STUDIES, IT IS RECOMMENDED THAT NO WOMAN WHO IS PREGNANT OR EXPECTS TO BE COME PREGNANT SHOULD BE EMPLOYED IN VINYL CHLORIDE MONOMER OPERA TIONS. NOTE I - AS VINYL CHLORIDE IS STILL UNDER INVESTIGATION BY NtOSH, IT IS ANTI CIPATED THAT THERE MAY BE CHANGES IN THE MEDICAL SURVEILLANCE PROGRAM. THIS DOCUMENT WILL BE UP GRADED AS THE NEED ARISES. NOTE 2 - THIS DOCUMENT STATES THE MINIMUM REQUIREMENTS. SHOULD ANY ATTENDING MEDICAL AUTHORITY DEEM THAT ADDITIONAL WORK MAY BE NECESSARY, THESE RECOMMENDATIONS WILL FORM THE BASE LINE EVALUATION. NOTE 3 - AS THESE RECOMMENDATIONS COULD APPLY TO ANY KNOWN OR SUSPECTED LIVER DISEASE OR HEPATIC TUMOR PRODUCING AGENT, THEY SHOULD NOT BE RESTRICTED TO VINYL CHLORIDES. NOTE 4 - ALL CHANGES TO THE RECOMMENDATIONS CONTAINED IN THIS DOCUMENT SHALL BE CLEARED THROUGH THE CORPORATE SAFETY DEPARTMENT. H. W. SMITH April 1974 APOOOt4017