Document nkMXLLe6NnzmN7gzrzKKJJy4X

i, j k 1 C(. A comprehensive program in asbestos hazarG i .jluJtlOn .7;. i Dept, of HV. surveillance and education , PfNCER FELTON. M.D. , Kfoiessor of Community Medicine. University of Southern California School of i .> Lc s Angeles. California; Chief. Occupational Health Service. Naval Regional! .ii Center Long Beach. Long Beach. Californ.a 90822 " plaintiffs' exhibit MON-298 t-nnefit from the sights of their it me end of their .prions almost or me executives cues and a fresh v-nisan important nee. Five days of acquainting the and problems : ves sit in on 'ormal meetings Agency Heads, Jress Corps and :ay Internationa; Paris, Bonn and "`"t with senior "'ts and discuss aiong with trade .'ort'cipantshave ' ** interchange ~sors with new other sector. * the Program of promising t-" called upon J sory posts and ns Cassidy, 'change Year '"'erested in ""Presidents " J'i. 1900"E" '4l5. Phone H-iaiy. 1?'9 vugh asbestos has had ncariv a century of .porary industrial use. Its presence and ...tcristics were known for hundreds of . More recently added to the body of :.;ic knowledge, though, have been the . itie effects on both workers and persons in .>.;j contact with this valuable material. ..if and others have brought to light the .. -T.iologic base, descriptive of the family of . .tos-related diseases, the close ties to . .cnant change, and the role of smoking as a v.ircirvogen. v in the acceptance of these findings, greater ;;:mn was given to the need for clinical . ,;!ance of asbestos workers and to the iopment of work practices that would .lude. or minimize within the area of . ".curing possibility, contact of the craftsman his work substance, so as to prevent his irring asbestosis or the later-to-come ..noma of the lung or other organs, or uac or peritoneal mesothelioma. institution which has been designed to detect levels of specific morbidity and to educate managers and workers in all the elements of medical superintendence, the significance of the findings, and the subsequent indicated actions. background The United States Navy supports a number of shipyards and other facilities on the East and West Coasts and abroad for the maintenance of the vessels of its fleets. The Long Beach Naval Shipyard is the most recently established of the yards, becoming operational in 1943 to meet the needs of World War II. The mission consists of the overhaul, repair, and modification of ships of the Pacific Fleet. Each craft is assigned to the shipyard at regular intervals for reworking, as determined by its particular schedule of recycling during periods of availability. To plan for such work, which will include drydocking and outfitting, a ship-check team is sent abroad for purposes of diagnosis. On its return, pians ' 'though the studied observations of 'Min. Sargent, and others, the awareness 'heightened regarding the early, subtle me.1' detectable in chest roentgenograms, so 'lowly, the community of radiologists and f.otury disease specialists is becoming Pledgeable in this particular field of .T.t'O.S. are drawn, supplies are ordered, and manpower needs are determined so that on the arrival of the ship in port, everything will be ready. Time is of particular importance for the vessel must be turned around for deployment in the shortest period compatible with the work needs. A further function of the facility is the supervision of subcontracted repair in adjacent civilian H.itaer than reviewing what has been replete yards. ".e literature concerning the clinical and All ships require insulation of the sources of aaologic aspects of asbestosis. this writing heat and of the extensive piping systems which 'its to describe a program at a specific transport steam under pressure. It has beer, traditional to use asbestos for this purpose in one M tsiertion* contained in t*>f roort #r tn ** *' wiltf *nd Sf not construoo 3i Of s * of tfi Navy Oeonm#n| ot Njvji *rv*c or more of its fabricated forms, such as pre-cut block, padding, board, flexible gaskets, and the like. With the demonstration, however, of its Copyright 1979, American Industrial Hygiana Association I'm 'if Asvjojfon JOURNAL |J0| 1 '9 11 6113 18182 P.0023,30 serious toxic properties, substitutes have been sought, and in recent years, fibrous glass has been uv.-d in its place in nearly all of its applica tions. Because asbestos was used in new con struction. it is still found in ships and when piping must be renewed, the surrounding and covering insulation is removed, the process of demolition being known as "rip-out." The former haphazard removal of the insulating material would produce clouds of high-asbestoscontent dust in the ship's spaces, leading to inhalation of free fiber and the coating of work clothing. Simultaneous with the coding of rigid work practices was the creation of a medical oversight program, fully in parallel with the asbestos standard promulgated by the Department of Labor, and in compliance with directives from Navy authority. Medical care has been regionalized in the Navy, and each region is designated as a Naval Regional Medical Center (NRMC), with the administrative headquarters based at a core hospital. Personnel, equipment, supplies, etc., are provided to Branch Clinics throughout the jurisdictional area of the Region, which cifer services to the particular activities where they are located. A Branch Clinic on Terminal Island furnishes preventive and therapeutic health services to the civilian and military personnel of the Long Beach Naval Shipyard. medical surveillance Initially, certain crafts were considered at risk, specifically the insulators and pipefitters. But as closer scrutiny of the chest radiographs of the personnel in allied trades was begun, it was realized that many more employee groups outside of these two were, or had been, exposed to asbestos as a work material. Another factor arose in the determination of groups at risk, a factor possibly unique to the obtainment and nurturing of marine craftsmen. A great number of tradesmen are trained within the shipyard through the mechanismPof a four-year apprentice program. After serving as journeymen, many move up through the foremen levels, eventually to become executives. Because of this kind of occupational mobility, the lop w hue-collar persons have had the same kind of work-substance exposure as those craftsmen currently in the shops and on waterfront and. for purposes of surveillance considered equally at risk. With the , exposure-torclinical-signs lag period, concept of risk has to be altered to inc. personnel who were in contact years ago. > practical purposes, certain shipyard wr. other than insulators are considered at risk. t. is anticipated that asbestos will be encounuin ships for years to come. An interesting example of the need continuous clinical observation is that owoman now 68 years old. who was emph with asbestos padding for one year, in 1943.. who recently became known to us. When rayed, her chest film showed typical bilatc pleural thickening characteristic of asbesu fibrosis of the parietal pleura. The dose was c known, and the course of lesion developm. not measurable: but 35 years later, the signs u. present. The program of clinical observation con>. of the following entities: clinical examination -- pre-placement Each new employee accepting a position as insulator or whose work involves contact vs asbestos, receives a complete prepiacen:. medical examination prior to actuai w. assignment, consisting of medical and occe: tional histories, standard organ system tunc: inventories, a visual acuity evaluation thruuse of the Ortho-Rater, audiometry i: through 6.000 Hz), complete urinalysis, i chest X-ray (14" X 17"), and a screen, pulmonary function evaluation consisting VC. FVC* FEV,. FEV9c, and FEF. If sugge-. positive findings are encountered, and it : radiographic definition is not adequate ' diagnosis of such entities as pleural thiekenin. interstitial disease, additional views (right left anterior obliques) are obtained. Medrecord jackets are appropriately mar* "ASBESTOS WORKER," and Radiograr Report Forms are comparably imprinted " "ASBESTOS WORKER." clinical examination -- periodic At a yearly interval, each exposed empl* returns for a repeat of the evaluative procea 12 Am lad Hyg Assoc J (40) Jjitji't 6H3 18183----------------------------------------------------------------- ------------------------------------------------------------------------------ --------------- ---- ------------------------------------------ p 1 ps and or, : m rvcillancc. .1: , \\ ith the !t>. period. 1 tied to inch..: .I.: >ears ago. 1, Miipwird work:-: .-..tcred at risk, for., will be encounters k- of the need fo-..ition is that of ,, who was employe; ne year, in 1943. an; .wi to us. When \ .ed typical biiaterc .eiibtic of asbcstoti. ::a. The dose was un lesion developmer..-viatcr. the signs we:: observation consist- pre-placement |:.g a position as a: olves contact wit: I'iete preplacemen: r to actual wefi alical and occupacun system functioevaluation throuc judiometry (50 -e urinalysis. P' and a screenir. uion consisting c 1 f F:F. Ifsuggeste. i'.tered. and if th. not adequate fo ' -:ral thickening o 1 \u ws (right an. ' obtained. Medica ;tlately marke. r.J Radiograph: imprinted wit r* riodic ':'..ved employe e procedu: ..ited above. Again, to maintain a minimal .are to ionizing radiation, a PA film only is -, ned unless there are indications for >nal views. If a worker demonstrates more disease radiographically, or if it is the .-.ition of the radiologist or the pulmonary consultant that he be followed because of . rated development of malignant change. . interval of examination wiil be shortened to . % months or even less. When indicated, -.ography may be conducted. During the .-.heal examination, special attention is given -.he presence of clubbing of the terminal digits. io symptoms arising from the respiratory', .`-..-.vascular, or gastrointestinal systems. On occasion, a recheck of the patient's smoking .;ory is carried out. clinical examination -- termination \t tne time of separation from employment, . i.h worker exposed to asbestos has a repeat of :i:c procedures outlined previously. The examination may be conducted as part of a -ability retirement evaluation or may arise as hi of a worker's compensation disability claim. .' a icrminee has moved from Long Beach, a iw-up letter will be sent to him with a copy of - :.nal X-ray findings -- if significant -- so that may seek medical consultation w here he has `a'd as a resident. He is also invited to call the cal Director by telephone if additional tails are needed. In a rare instance, mcements have been made for the extremely r.t retiree to have additional X-rays taken at adjacent Naval facility. Copies of the m xpondence or the content of the telcons are >-le part of the Out-patient Treatment Record. clinical examinations -- asbestos worker '"'lister ' `fecial register has been maintained of all -'"nnel manifesting changes on chest - s l.ography indicative of asbestos-related - >'c at one stage or another. Included also are ..i.iiors or pipefitters who may not have " i".:levied asbestotic changes. This register ' constant information as to the status of ;---.<rd personnel who have been or currently '--.'sed toasbestos products! Inaddition.in Mid segment of the register, a list is maintained of all personnel demonstrating normal chest X-rays. Further, as part of the register, the Medical Director retains copies of death certificates, insofar as he has been able to acquire them, of Shipyard employees who died from asbestosis or an asbestos-related disease, such as carcinoma of the lung. Copies of forwarded reports on selected patients from the University consultant are maintained with the register. clinical examination -- special consultation Nearly two years ago. a special arrangement was made with the Office of Workers' Compensation Programs (OWCP), U.S. Department of Labor, in San Francisco, whereby the Medicai Director at Long Beach Naval Shipyard was granted authority to refer certain asbestos workers for extensive clinical evaluation. The primary examiner selected, among others, is Professor of Medicine and Chief of the Pulmonary Disease Service, School of Medicine, University of Southern California, Los Angeles. He is an internationally recognized authority in pulmonary disease, and has one of the most outstanding laboratories in the western states. After preliminary examination, the Medical Director will refer the patient and will receive a five- or six-page detailed report of his findings, subsequent to interpretation of a clinical history', medicai examination, chest radiography, and multiple pulmonary function studies. The report along with appropriate other documents will be sent to the OWCP. which will accept the report, and consider the study definitive and the statement of cause and work relationship as clinically and administratively sound. The workers who are referred for this special kind of evaluation are those persons who are disabled, or who art considering retirement, or who have an admixture of work-generated and non-occupationaliy caused pulmonary findings, wherein a separation must be made cf the effects of each causative agent. An example of the latter would be a patient with extensive pulmonary emphysema who shows, in addition, pleural or interstitial asbestosis. On receipt of the report from the consultant, the patient is called imo the office of the Medical Director and a full interpretation of every aspect Jinut'y. u Htitr.e Aiiocuiion JOURNAL (43) l/>9 6113 18184 BQC~832 13 of the study is carried out. The employee is given a copy of the report and it is on these occasions where the worker's wife may accompany the individual. At these sessions, also, if the patient is sufficiently disabled, full explanation of the retirement options is given. At the time of the inception of this special evaluative procedure, a clarifying meeting was held with representatives of the Metal Trades Council (MTC), and their complete support has been obtained at all times. If, in the consultant's opinion, the asbestos worker is in need of treatment, a copy of the report will be forwarded to the physician he selects for this purpose. At the time of this visit, the names of Boardcertified pulmonary disease specialists close to the patient's residence are given for his choice. To date, approximately 66 workers have been studied at the University ofSouthern California, and elsewhere, and appointmentrare pending at a rate of one per week through the next three months. The referral form used for such employees involves the completion of a history, physical examination, and report of laboratory findings. A copy of the completed referral form is maintained in the Outpatient Treatment Record. Frequent telephone conversations with the consultants are held for clarification of specific clinical findings or details needed for interpretation to the patients once seen and who are still working in the Shipyard. clinical examination -- special consultation by mail and telephone At the request of certain asbestos workers, chest films will be forwarded to Irving J. Selikoff. M.D., Department of Community Medicine, Mount Sinai School of Medicine. New York City, who is a recognized authority on the medical effects of asbestos. These workers wish authoritative review of their films and frequently may not be satisfied with interpretations given locally. Only in a rare instance, in the past, has there been disagreement between Dr. Selikoff and the radiologist who reviewed the films. There is never any hesitancy in forwarding the films for. were this to take place, the credibility of the medical facility would be suspect of parochialism. Frequent telephone conversations are held with Dr. Selikotf in w hich new issues are presented for discussion and guidam. obtained relative to problems in placet: interpretation, records, and the like. clinical examination -- special survey In June 1977, a special chest X-ray surve> conducted of 500 persons who comprised percent representative sample of the 5 persons involved in production at the 1. Beach Naval Shipyard. Of the numbers stud 316 were normal (63. i'Tc), 153 (30.5 demonstrated positive findings related dire, to changes secondary to the inhalation asbestos fibers, and 32 (6.4<Tc) showed line;* unrelated to asbestos but demonstrative of otpathologic changes in the lungs or in the hc^ such as diaphragmatic hernia, pulmon. emphysema, and the like. A few subjects show combinations of pulmonary change occupational and nonoccupational in one Correlations have been carried out of ; diagnosis with the variables of age, sex, length Shipyard service, and work location. In r survey, one employee with previouundetected cancer of the lung was found, a one person demonstrated a rare bone disc, currently undergoing diagnostic scrutiny. Of: 18 women surveyed, two showed finds: indicative cf asbestos changes. As a result of: survey, the Shipyard Commander directec comparable review of all other persons in : Shipyard, a total of approximately 6.( workers who had not had X-rays during 19* clinical examination -- total survey Beginning 31 October 1977, all* remain:personnel of the Shipyard who have not h. chest X-rays completed in the calendar year i-* were scheduled for chest radiography, consis' solely of a single PA view. If findings w; questionable or were in need of grea: definition, additional views were obtained, the time of writing, approximatley 5.1' individuals have been seen, at an average slightly more than 100 per day. This sun should be completed shortly. Correlations <* be made on completion of the survey as fol!.positive findings as related to age. sex. w> location, smoking history, and length of set' The findings from the study will be ottered > H 4m ftxt Hyt 4jjec J !*0) hnui'r wbC-333 6113 18185 guidance . in placemen: like. , .*cial survey \.ray survey wa- . .< comprised a 1* -c- of the 5.00* \.>n at the Lon: : numbers studied i. 153 (30.5^ _> related direct!} :ne inhalation o: . .howed finding. -n>trative of other cs or in the heart ,-rnia. pulmonarv :cw subjects showed .'nary changes, rational in origin umed out of the age; sex. length o: K location. In the with previous!} e was found, ane ^e bone disease ^Rcrutiny. Of the showed findinc- As a result of the -under directed i persons in th: -roximately 6.00' wavs during 197T stal survey all remaining 'ho have not hae calendar year 197' -raphv. consisting * If findings were need of greater 1 were obtained. A: "ximatley 5.00' at an average o day. This sumCorrelations vu survey as follow- age. sex. wor 1 length of s-ervice he offered in - .f.itc report. The survey is characterized by unusual cooperation of the Metal Trades . :r.cil. AFL-CIO. the Shipyard^ and the s.i'MC. Long Beach. It is only through such a :;nuing cooperative effort among these !:vidual bodies that a medical surveillance --..cram of this type can succeed. worker education a ade it is necessary to know the health status of .. ukers at special risk, the effort becomes ..Hectual if the results are maintained laterally. It is essential that the members of work force under clinical study Be informed the findings and be apprised of tBe nature of ::c risk attendant upon their job assignments. Mthough it is mandated by the Occupational vitety and Health Act of 1970 that employees be ,-.!.;cated in the health aspects of their work .. ntacts. activities in such training can be rv.ended as to alleviate much of the anxiety -.imfested by those persons who fearasbestosis. Much rumor is rampant. Some workers equate . ~:-.totic change with cancer, while others i. .<id chest radiography in fear of what might be covered. To a great number, notification that ural fibrosis is present is interpreted as valent to an orher that they immediately i'i retire and move to Arizona. It is this kind of misinformation and i.'neous belief systems that must be altered, : Mich change can only be effected by a warm, - i-.^crc, dedicated information exchange 'rtween the clinical monitors and the Tutored. The program in education takes my configurations. worker education -- individual 1 "on individual asbestos workers have their 'animation findings reviewed by the Medical I' rector so that interpretation and counseling m he offered to those at particular risk of .'genic lung disease. At these sessions, both mal landmarks and pathologic findings, as n in the chest films, are demonstrated to the "`'}ec. the pulmonary function findings are " '!.ucd into understandable terms, and he is "led as to his work status, e.g., remain at - ar work in the Shipyard, seek modified or ::-`tivc employment, consider a special consultative examination if symptoms or length of service warrant, consider disability retirement under U.S. Civil Service Commission regulations, or consider compensable disability retirement under the U.S. Federal Employees' Compensation Act. Infrequently, an employee will bring with him his spouse, and occasionally his child, so that there will be family understanding of the interpretation of his health status. The family session is ideal, for it is our experience that the employee's wife usually asks more significant or penetrating questions than does the worker himself. On the conclusion of these sessions, the employee is given a copy of his chest film interpretation and a duplicate of the reported results of his pulmonary function evaluation. work history As part of the individual review with the exposed asbestos worker, a complete work history is obtained if his chest X-rays for the first time disclose findings indicative of one form or another of asbestos-related disease. It is of interest that in the past few months, the Metal Trades Council has been in the process of developing a medical history form, and several lengthy medical histories have been obtained by officers of the Council in an effort to aid their members in documenting their Shipyard work exposure. worker education -- special employee groups In keeping with a Navy requirement, at a sixmonth frequency the insulators along with their foremen, attend a training program in divided groups. In sessions lasting 1-1/2 to 2 hours, either slides or a film on asbestos use are shown; updated knowledge of asbestos and asbestos diseases is offered, and questions which are submitted in advance arc answered by members of a panel which may include one or more or ail of the following: the Shop Superintendent, the General Foreman, the Safety Director, the Industrial Hygienist, and the Medical Director. A question-and-answer period allows interchange of information. Of significance to these workers is not only the potential hazard of asbestos, but also the potential toxicity of Jjnujfy, IS ` *' - ii Aisocutpon JOURNAL (40) 1/79 1$ BQG~3Q4 6ii3 18186 adhesives and other materials used in lagging. The content is varied from a review of the disease potential, to X-ray findings, t<fa description of sample collection and fiber counting, to a history of the use ot asbestos. to a review of the total surveillance program. An effort has been made to vary the content of each presentation so as to maintain interest for both old and new shop members. At a recent session, the workers were given a complete demonstration of the variety of X-ray findings. Further, the Industrial Hygienist explained the procedures involved in sample collection and fiber counting. The Safety Department representative reviewed the Shipyard's new Asbestos Control Manual which calls for stringent work practices regarding the removal of asbestos. At the same session, the results of the; special chest survey were delineated. Because of the increasing number of positive X-rays returned on Shipyard personnel, a system has been instituted, in keeping with the meetings with employee groups, on coding of the significant findings. Those employees with comparable levels of findings are met with in groups of approximately 40-60 persons for a presentation of the X-rays and other findings applicable to that group. Each worker attending is given a copy of his report, the terms encountered are defined for his and his physician's use. and he is given printed material on asbestos. The sessions provide opportunity for questions and answers relative to asbestos and the clinical conditions resulting from working with that material. This format will continue to be used in the future for the relaying of information and for the opportunity of the workers to meet directly with the Medical Director. During the survey of the entire shipyard, these meetings have been held weekly. worker education -- executive management Periodically, the Medical Director appears before one of the daily meetingrof the Group and Shop Superintendents, the top civilian executive group of the Shipyard. In addition, several of the military heads are in attendance. In these meetings, the problem of, asbestos is discussed and at one session, examples of all of the pertinent chest X-ray finding demonstrated to the group. The v.u pathologic changes was presented. u:..; particular meeting led to a voluntary re.; . chest films by about 50 percent superintendents; eventually all superintendents participated. At the week;-, meeting conducted by the Shipyard Conn er, information is provided relating t, medical surveillance of asbestos workers v, both civilian arid military managerial per-, can be kept current as to the significance i,: studies. worker education -- first-line supervu. In the past 3-1/2 years, subsequent tn initiation of the new shipyard effor: occupational health, the Medical Director been regularly scheduled for inclusion in supervisors' training program, a week-lor..hour-a-day series of sessions held for lore: and general foremen. Included inpresentation is information about asbofindings of clinical surveillance, the need managerial enforcement of protective rr.eas:. and emphasis on the importance ot ' supervisor's knowledge in disease prevent These presentations led to some 60 percer.: each group attending (average number :: session is 25) requesting voluntary current e: radiography, prior to the survey. * supervisors are intensely interested in material because most of them, as indic. previously, have had long periods of seme, this, or other, shipyards. worker education -- new employ orientation Within the past few months, an oriental program for new employees - those indiuu hired during the previous 30 days -- ha* instituted and both occupational health nit; and industrial hygiene representatives tr. presentations to the group. The significant medical surveillance is emphasized, as is the for continuing chest radiography durtne period of employment. Questions present.-*: the new employees are responded to so iha much clarification of an issue can be otteii possible. 1C Am Ind Hrt Asac J (40) Jjnjj-i 6ii3 18187 BQC~335 findings wcIhc varictv M-nted, and u .. .,,:ttur> request t. mi percent of tr. Muailv all of tk ..! At the weekly star vapvard Commane . .led relating to tk. -.'Ms workers so th^ . .-,.:n.ieerial personn-. :`:e significance of ou- first-line supervision subsequent to tk. - shipyard effort ir Medical Director ha' * tor inclusion in the . ram. a week-long, i- :is held for foremen . Included in the iT.on about asbestos, mce. the need for : rrotective measures, importance of the ui'ease preventioi some 60 percent c -'rage number in -ntary current che: the survey. The mterested in the them, as indicated periods of service at new employees an orientation those individual' **' days - has been rial health nursing 'ntatives make 11 - significance ot 'd. as is the need ifhy during the presented h> :-'d to so that a> 'un he offered a .. departmental communication ;er that all occupational safety and health rmei in the Region be familiarized with the ..il surveillance program, a review of the oos and asbestos-related disease situation ::ered by the Medical Director at each ihly Occupational Safety and Health i-.g. These meetings, held at different illations within the region, are attended by ..clans, nurses, industrial hygienists, safety ,-ctors. union representatives, and 'Oppressive personnel from both civilian and ..ury components. After the mid-morning cak. which follows a special guest speaker, . material, or the progress being made with ,:in aspects of the surveillance program, is . .-.-nted to the group. For example, just .cmly. the writer was apprised ofthedeath ofa mer asbestos worker from the Long Beach vc.al Shipyard, who at the time of death, had cause of death recorded as congestive heart : are. Autopsy showed carcinoma of the lung : ii metastases to bone, the liver, and ail nodes. . lungs were complete with asbestos bodies, pleura was remarkably thickened, and tumor - present at the site of that thickening. These :;ng$ were reviewed at a subsequent meeting .1 procedure typical of the method of updating '<>r.nel as to the asbestos situation. Monthly staff meetings are held for Branch :c personnel, and professional staff meetings :;eld with the same periodicity. At each of -e meetings, personnel are informed of events He asbestos surveillance program. At a recent :hly meeting, a presentation was made ' - 'riptive of the asbestos removal project at a "fe facility of the Navy. The planning and the ' "' .unions used were extraordinarily in parallel - i the measures used aboard ship in the -m.nai of insulation. interdepartmental communication 1 'me 1975, an Occupational Health Advisory mitiec was appointed at the Long Beach '! Shipyard, the Committee members 'ent the Enployee Relations Division of the -irial Relations Office, Safety Office, ' personnel, management, and employee ' \t the monthly meetings of this ' mce. the representatives are informed of the progress being made in medical surveillance, in patient progress (anonymously), and with any new surveillance activity relating to this type of work exposure. Trade union representatives convey the gist of these reports to their constituents, and by means of minutes, the Shipyard Commander and others are kept apprised of developments. extramural communication The Medical Director remains in touch with personnel involved in special studies, such as those conducted at the other Naval shipyards, gaining information either through the Medical Directors or representatives of the trade unions. Representative samples of workers have been studied at other activities and the Medical Director attempts to remain current in his knowledge of the results of such studies. For example, data are on hand of a recent study at a west coast shipyard and at a northeast facility in the private sector, which will serve as a good basis for comparison with the results of the total Long Beach study. environmental surveillance Industrial hygiene control measures are executed at the Long Beach Naval Shipyard in the form of environmental measurements, consisting of sample collection and fiber counting of such samples. The method of measurement consists of the use ofa membrane filter, 400 to 450 magnification, with phase contrast illumination, and with the sample mounted in a high viscosity solution of the membrane filter material. Sampling is undertaken in those work compartments aboard ship where rip-out is being undergone. Records of such monitoring are maintained in the Industrial Hygiene Laboratory and in the office of the Medical Director. Hundreds of such reports are of file, dating from iate 1975. Measurements are made on request from management, the Metal Trades Council or. in some instances, from individual workers. The reports of findings are forwarded to the originator of the request, the Metal Trades Council or othgr employee groups if indicated, the Safety Office, the NRMC. Long Beach, and to other managerial personnel who should be Jiftuiry, * :. Ji Mijifif Aiioculion JOURNJtr (SO) (.79 17 R0CSS36 6113 18188 I iI ! i t : i ii X t i i i f t i *i i i t apprised of the findings: recommendations are made for control measures when necessary. The Industrial hygienist and Industrial hygiene Chemist have sought knowledge of compliance with recommendations, and notes regarding compliance or noncompliance are entered into subsequent inspection reports when the environmental caseload permits re-investi gation. During the past few weeks through the cooperation of the Production Officer, personnel from one of the shops have been trained to collect air samples for fiber counting in the Industrial Hygiene Laboratory. In addition, certain of the group have been trained in actual counting itself. Through this kind of paraprofessional extension, more samples will be obtained which will permit greater compliance with environmental testing requirements. This personnel wili continue to be trained by the Industrial Hygienist and the monitoring which they will conduct will be under the supervision of the Hygienist. manual on policies and procedures The Manual for the Branch Clinic, which has been prepared in part, will include procedures relative to the entire asbestos surveillance program. The details of the examination process will be entered, and all of the administrative steps will be described. participation in control program The Director and other members of the Branch Clinic staff participate in control programs with Production and Safety personnel. Recommendations have been made regarding respiratory protection, wet-process sanding and cutting, laundry of work clothing, substitution of alternative safe materials, and posting of caution signs. The issue of environmental pay has been left entirely to the Industrial Relations Office, as this is a matter of negotiation, and not scientific rationalization. When opinions are sought regarding any aspect of asbestos toxicity, the issue is reviewed with the Department seeking aid. literature file Annotated files of the professional Iiterat-..asbestos are maintained and currently nu:many hundreds of articles relating to thee!;industrial hygiene, analytic, epidemt.i; engineering control, and personal In. aspects of work with free asbestos Included in the collection are those textbooks devoted to the subject of fibro. lung disease. Nearly all of the public.-: emanating from H.M. Dockyards are at h. the future extension to the fleet A meeting has been held with the med department representatives from the v currently in port at which a presentation made on asbestos and asbestos-related disca This kind Of session represents an oriental, program of fleet personnel to the environme.and medical surveillance needs in work u asbestos. research projects Plans are being made currently for : preparation of a research protocol for a nr. year research project to be carried out at: Long Beach Naval Shipyard with both Xav\. extramural funding. Efforts will be made define the problem in light of all : epidemiologic variables, and an exten> program in worker education will be develop, executed, and evaluated. Special audio-vi* aids will be made so that the education prog: will be extended to employees in crafts or than that of insulator. The aids will be upcu: as indicated, and at the present time var: organizations are being solicited for materia!' be used in this aspect of the program. Furtr plans are being made for the utilization of c. processing in the establishment of a call-in fi roster of employees by asbestosis status, and' maintenance of records relating to both recer. retired and present employees. Coi appropriate to this project are in preparaiu" discussion A program of this dimension attains se*f objectives. It provides display of the hestatus of the asbestos workers at risk, it bn- IS Am. Irxt Hyt Aisoe. J (AO) Jinui't 6113 18189 BQG2337 -vsionai literature mtk currently nun^Br.itingtothcc!in. .tie. epidemioli-. ..! personal hyg.. ::ee asbestos fib-.,non are those ic : subject of fibrogc: . ,>f the publican. dockyards are at har.. . . loimation. personal and general, to . . singularly involved, and through it ,;-ts to limit as much as possible the .. :.:.h has been developed by injudicious j press statements. The truth is >nrring of the emotions without the ..( inllammatory editorial comments. proxiMon of all available information to ..>Ued employee is an apprehension- act in itself, for he is assured that no material re his health is held back. His :> arc open to him, and he is free to take ports to his own physician. Surveillance, education, and conjoint mcdical-managcmeht-labor efforts in disease control can spell the eventual ridding of a potentially disabling occupational disease. summary The surveillance program of asbestos workers at the Long Beach Naval Shipyard consists of a variety of clinical examinations and consultations; educational efforts targeted toward individual patients and groups; environmental measurement; maintenance of pertinent monographic and periodic literature; and records and report maintenance. Aec*p<*d July 2*. 1978 .`.rid with the medic. .':vc$ from the shir .h a presentation u. ->.'tos-related disease presents an orientatin' .1 to the environment. e needs in work uit- new industrial hygiene consultant s specialty codes added . . . le currently for th . r: protocol for a mu!: he carried out at th Jttkvith both Navy ar.. Kise of a growing demand, two new .illy code designations will be available : June, 1979 and future published will be made : ;s of industrial hygiene consultants, m light of all th 'ulustrial hygiene chemistry, coded 5A, and an extensi: : respiratory protection, coded 10A, are will be developed ...... ... specialties. The "A" designations ' Special audio-visu. been assigned to avoid disturbing long the education progra- : ..shed relationships of present code "loyees in crafts othe : its to particular specialties. l "e aids will be update. *.e presently listed as consultants who ' present time varioi to add either or both new specialty hvited for materials: ' to their present listings Should write to the program. Furthr ijiior, American Industrial Hygiene ' the utilbation of dat. i.iiion JOURNAL, 475 Wolf Ledges ' "lent of a call-in File. . Akron, OH 44311 NO LATER THAN status, and th 'Mil i, 1973, the deadline for additions or uingto both recent, ;>`S m the listings to be published in the employees. Code 1979 issue. New listings MUST be t arc in preparation v*d by the same date. Billing for June and December, 1979 listings will be mailed in January, 1979. in fairness to individuals placing listings up to five lines deep, carrying name, street address, city/state/zip, phone number and one line of code designations, billing will be based on the five-line basic standard. Deeper listings (six or more lines) will be billed for the five-line base charge, plus 20% additional for each added line. Billing for a nine-line listing will be the base charge X 180%. Payment MUST BE RECEIVED by the April 1 deadline to assure June publication. All additions, changes or new listing requests MUST be in writing. Telephone instructions CANNOT be accepted. Only national or organizational members of AIHA, in good standing, are eligible to be listed as consultants in the JOURNAL'S semi-annual (June and December) listings. *"Mnn attains seven play of the heal: r*cf' at risk, it briin * Jtnuinr. !' "* Msacut.on JOURNAL (40)1/79 19 BGC2838 6113 18190