Document pmZx6YYZgDRQj0M64NjLd7qBB

Table 1 Air Products Survey 251 initial surveys 48 routine 6 months rechecks - no abnormalities 16 with single laboratory abnormalities 3 with x-ray abnormalities of hands 1 clubbing (Roberson, K.) 1 marginal tuft clefts (Clay, W.) 1 acro-osteolysis (Clyatt, Tom) 1 with x-ray abnormality of chest interstitial fibrosis, unchanged since 1972 (Berrlsford, Bert) 8 with more than 1 laboratory abnormality t' AP00027042 1 m Vo Table 2 Single Abnormalities Barnes, H. Lambert, M. T. Mize, R. F. Diamond, R. Reuschel, Stanfield, T. James, W. L. Randall, B. Childs Jenson, B. Olsey, W. Spurlock, John Williamson, Berrlsford, B. Lowery, W. A. Roberson, K. CEA 6.0 CEA 5.2 CEA 6.0 LAP 240 u. LAP 250 u. LAP 230 u. Aik. phos. Aik. phos. 5.6 B.TJ. 6.1 SGPT SGPT SGPT SGPT SGPT SGPT 36 40 41 31 31 36 LDH 670 Alb. 4.6 - 3.4 - 3.7 gmX Glob. 3.2 '- 3.5 - 3.3 gaX (Clubbing of fingers) (N: < 5.0) (Ns 75 - 210 u (Ns 1.5 (Ns 5 - 30) . (N: 200 - 500) (Ns 3.5 - 5.0) (Ns 2.0 - 4.0) t- 'f AP00027043 frfrOZZOOOdV MORE THAN ONE LABORATORY ABNORMALITY NAME Glvatt Danlev Jones Kimmons G riffin 'O Connor Pangbum Scott TOTAL X X X X S' XW CM CM 1o XX XX X m co X X X X X X vO XH /Aik. |a Phos. g B il. SGOT GGTP SGPT 1LAP AFP CEA Scan Total Remarks CO <uCuC>ooa0oH1OO 55 4(<Oi3AxD , 'O J zC) X XX *<Nu XX zwof; z tc sa XX "Hepatitis"as an infant ! 10 beers a dav r 4-6 beers a day M01 S5 s4s> X 00 ' Cl CO cn m cn CM m fO n cm OCCUPATIONAL SAFETY AND HEALTH Attached are the vinyl chloride medical surveillance recommendations which were transmitted to DOL on March 21. U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE I f, if i* * / i AP00027045 h. Medical Surveillance \ ~w~------------------ :-- 'rhe fallowing recommendations are directed primarily at medical screening to detect liver disease and/or hepatic tumor. They siiould be considered in the context of routine health screening for any general employee health problems, including nan-hepatic health conditions potentially related to vinyl chloride monomer exposure. Routine health screening should include at time of initial employment the recording of past medical history and the performance both of a general physical examination and certain basic laboratory procedures (e.g., complete blood count, urinalysis, chest x-ray); provisions should also be made for routine periodic health followup examinations. Employees covered by the following specific recommendations shall encompass all persons engaged in vinyl chloride monomer production and polymerization, including personnel peripherally involved such as in clerical and management assignments. The recommendations shall be applied both as a pre-employment requirement and as part of periodic health followup. Screening priority should be given to current employees with prolonged and close potential . exposure to vinyl chloride monomer, whether in present or past work settings. .v Ci) At time of initial employment, or upon institution of screening, a physical examination shall be performed with specific attention to detecting enlargement of liver or spleen by abdominal palpation. (ii) 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) alcohol intake; (b) past history of hepatitis; (c) past exposure to potential hepatotoxic agents, including drugs and chemicals; Cd) past history of blood transfusions; and (e) past history of hospitalizations. Completed medical check-lists shall be reviewed by a physician and should be acted upon as medically indicated for each individual employee. BjT(iii) At time of initial employment, or upon institution of sc1^6&Pj a serum specimen shall be obtained for screening with respect to Hwt; following five bio-chemical determinations of liver function: (a) total bilirubin; (b) alkaline phosphatase; (c) serum glutamic oxalacetic transaminase (SGOT); (d) serum glutamic pyruvic transaminase (SGPT); and (e) gamma glutamyl transpeptidase (GGTP). AP00027046 Additional tests that nay optionally ho considered for use in screening include lactic dehydrogenase (LDI1), serum protein determinations, serum protein electrophoresis, and platelet count. Laboratory analyses shall be performed in laboratories accredited by the College of American Pathologists or licensed in accordance with the provisions of the Clinical Laboratories Improvement Act of 1967. (iv) If results of laboratory screening are normal, screening shall be repeated on an annual basis. If the person-being screened has been employed directly in vinyl chloride monomer production or polymer ization for 10 years or longer, screening shall be repeated every six (6) months. (v) If one or more liver function tests are abnormal, serum testing shall be repeated as soon as possible, preferably within two (2) to four (4) weeks. If no abnormalities are present upon rescreening, testing should be repeated in three (3) months. (vi) 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. Suggested as initial steps in medical workup are a complete physical examination and various special procedures such as hepatitis B antigen determination and liver scanning. 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), tho employee may be permitted to return to vinyl chloride-related employment, subject to individual medical evaluation. (vii) In view of the preliminary results of animal toxicology studies, it is recommended that no woman who is pregnant or who expects to become pregnant should be employed directly in vinyl chloride monomer operations. AP00027047