Laurence V. Hicks and Xavier Ramirez
Laurence V. Hicks, D.C., D.O., M.D. • 1443 Anny Drive East • Twin Falls, ID 83301 Xavier Ramirez, D.C., M.D. • 5995 W State St. Suite B Garden City ID, 83703
Address Correspondence to: Laurence V. Hicks, D.C., D.O., M.D. • 236 Martin Street • Twin Falls, ID 83301 • Phone: 1-208-733-4444 • Email: firstname.lastname@example.org
Cite As: Hicks, LV and Ramirex,X, “Occupational Medicine Specialty
And the Trucking Industry”, Blue Marble University Medical School, Posted July 12, 2021. https://bluemarbleuniversitymedicalschool.com/2021/07/12/occupational-medical-specialty-and-the-trucking-industry/ Accessed [Insert your date accessed]
Key Words: Occupational Medicine, workplace hazards, Occupational Health, Certified Medical Examiner, and DOT Physicals.
This paper presents an overview discussion of the doctoral-level healthcare specialty of Occupation Medicine (OM), aka Occupational Health. Additional to defining the parameters of this discipline, we consider its utility as a benefit to professional truck drivers and we discuss the need for significant proactive interventions to be made on the part of individual drivers and the trucking industry to diminish occupational health risks.
What is an Occupational Medicine Physician?
An occupational medicine doctor is specialized in preventing, diagnosing and treating injuries, illnesses and harmful exposures occurring on the job. OM specialists promote wellness among workers and seek to manage occupational disability. An OM doctor may function as a clinician working with patients, as a researcher or educator or support a combination of roles in an effort to secure a safe work environment and a healthy workforce. It also plays a critical role in corporate medical compliance with local, state and federal authorities like DOT, FMCSA, NIOSH, and OSHA.
An OM physician encourages a healthy workforce through preventive medicine, clinical care, disability management, research and education. Here, an OM practitioner typically:
- Offers preventive medicine evaluations, exams, and interventions.
- Performs mandate workplace test like body index measurements, audiometry, pulmonary function tests, and many other work related assessments.
- Encourages employees to comply with health and safety regulations to minimize workplace hazards.
- Conducts ergonomic assessments among workers to prevent injury and disability.
- Develops wellness programs for the workplace focused on prevention and reduction of recordable data.
- Administers epidemiological and statistical research to assess health trends among a workforce.
An OM practitioner may also be known by the following names: occupational and environmental medicine physician, company doctor, occupational health provider, and industrial medicine doctor, etc.
OM providers endeavor to make sure the safest work environment exists for employees, reducing or eliminating risk factors at work, but also reducing the economic impact of work-related injuries. An occupational health doctor will reinforce best work and safety practices in a variety of different industries to improve the healthiness of the work environment.
Occupational Medicine Training and Certifications
A practitioner may work in OM without becoming board certified in the specialty; but education, training, experience and certification will be fundamental elements to ensure a provider’s basic level of competence. A Department of Transportation (DOT) Federal Motor Carrier Safety Administration (FMCSA) Certified Medical Examiner (CME) national regulation is a gateway for entering this medical career path for those without a formal specialty. Additionally, multiple other certifications like Audiometry, Pulmonary Function Testing (PFT), DOT drug testing and collection, and OSHA based training completes the initial set for performing most of the standardized evaluations. Having formal training in ergonomics is also a crucial part of the grounding because understanding workplace ergonomics and assessing the work environment plays a crucial role in injury prevention. Finally, board certification confirms that a doctor has completed post-graduate training in OM will confirm that a doctor has completed post-graduate training in OM and has passed competency examinations.
A board-certified OM specialist has earned certification in OM either by the American Board of Preventive Medicine, the American Osteopathic Board of Preventive Medicine or the American Chiropractic Board on Occupational Health.
A board-certified OM practitioner will also have:
- Graduated from an allopathic medical school, a college of osteopathic medicine or Chiropractic College, earning an MD, a DO or a DC degree, respectively.
- Obtained specialized residency training in OM, a clinical pathway or a postgraduate educational program.
- Generally, will have completed a Master of Public Health (MPH) or equivalent degree.
While we have referred to this specialty as OM, it should be made clear that the chiropractic profession, like the nursing profession, prefers to designate the forte as “Occupational Health (OH).” Both professions consider themselves to hold a holistic orientation and aim to focus on health promotion rather limit themselves to disease management.
Depending on the state law, some jurisdictions will permit workers to choose a preferred OM doctor; otherwise workers may be required to see their employer’s designated provider. Injured workers should always check with the employer’s human resources department or the state’s worker’s compensation statutes prior to selecting just any OM physician. Failure to follow the state’s guidelines may mean an injured employee becomes responsible for their own medical expenses.
When reading a worker’s medical history and understanding the working environment and job-related conditions; then, by amalgamating these factors, the OM physician is able to better diagnose and manage occupational illnesses or injuries that have resulted from the working conditions. When an injured worker must be removed from their job for any period of time, the OM specialist will treat the patient and later determine whether they are sufficiently fit to RTW. An experience OM/OH doctor will have the field experience and specialized knowledge of the specific workplace conditions affecting its clients.
The OM Prevention-Intervention-Mitigation Cycle
As an overview, OM doctors perform physicals and may visit the patient’s workplace to assess any possible contributing factors or hazards that may be negatively impact the patient. It is preferable that this survey happens when the physician is contracted by the company. This specific survey plays a key role in understanding the employees and the company’s individual needs for health and safety. This will also reduce the possibility of future accidents and will prevent or reduce deaths, injury, and recordable data from OSHA and other regulatory agencies. Thereafter, the OM specialist makes a diagnosis and begins treatment. The management plan will be specific to the needs and set of circumstances for each worker, and will be highly personalized. If an injury resulted from workplace hazard, the OM doctor will offer suggestions designed to better mitigate future injuries resulting from that specific hazard. Then, a mitigation plan will be put into place to prevent future injuries from the same source from recurring. Finally, these new preventive measures will be put into place to reduce risk and improve performance
Reasons for Businesses or Corporations to seek Assistance from OM Specialists
Businesses consult with OM specialists for a variety of reasons including compliance with regulatory bodies, injury prevention, reduction in recordable data, loss prevention, worker’s satisfaction and productivity, and improved health-conscious working environment conditions. On occasion, workers may individually seek out care from an OM provider when they become injured, exposed to a work hazard or illness and when they believe they may be at risk of a work-related health condition.
While OM practitioners treat a variety of illnesses and injuries, the top three leading causes of work-related injuries – overexertion and bodily reaction, slips, trips and falls, and injuries resulting from contact with objects and equipment – account for more than 84% of all nonfatal injuries involving days away from work. OM doctors refer to other specialists when appropriate.
Medical Tests, lab work, and Specialized Exams Ordered or performed by OM doctors
OM doctors can order or perform a wide variety of diagnostic screenings and lab tests including:
- Exams following a work-related injury, either acute of by repetitive stress.
- Exams after exposure to a chemical, radiation, or other hazardous material on the job.
- Exams after acquiring health problems in association with work assignments.
- Exams to be fitted for specialized safety equipment such as a respirator of ear protection.
- Respiratory and cardiovascular assessments and monitoring like PFTs and electrocardiograms (EKG).
- Pre-employment, monitoring, and post-employment hearing assessments.
- Physical examination before employment, as a part of on-going employment, or to RTW.
- Preventive health services or wellness programs like blood pressure (BP) management or diabetes monitoring.
- Blood tests such as a complete blood count (CBC), blood sugar, cholesterol panels, liver and kidney function tests, and testing for infectious diseases, e.g., COVID-19.
- Drug and alcohol testing by urine, saliva, and blood sampling.
- General health tests like vision and hearing tests, urinalysis, BP and vital sign screening, PFTs, colon cancer screening, EKGs, and tuberculosis blood and skin testing.
- Imaging studies to include X-rays and computed tomography (CT) scans, as well as, physical abilities testing including grip strength, static push and pull strength, lifting at specified heights and frequencies, and ability to carry.
To tally, OM practitioners order or perform various procedures and treatments to prevent or manage work-related health conditions. If an illness or injury is overly severe or requires specialized care, an OM doctor may refer the employee to a different medical specialty. Common procedures and treatments even include chronic disease management and surveillance.
Which Medical Conditions Would an Occupational Medicine Specialist Manage?
An OM practitioner treats job-related injuries, illnesses and exposures including:
- Allergies including eczema and allergic or contact dermatitis.
- Breathing and pulmonary problems including occupational respiratory disease, asthma and emphysema.
- Harmful chemical and hazardous substance exposure including asbestos, pesticides, solvents as well as heavy metals.
- Infectious disease exposures including exposure to avian influenza (bird flu), tuberculosis (TB), human immunodeficiency virus (HIV/AIDS), hepatitis B and C, and SARS Co 2, etc.
- Non-life-threatening injuries or trauma that will not endanger a limb including cuts, burns, eye injuries, sprains, strains, and fractures. Emergency physicians treat life-threatening injuries and injuries that could involve loss of an arm or leg.
- Some neurologic conditions including neuropathy, encephalopathy, and chronic pain due to work or career related.
- Repetitive motion and cumulative trauma disorders including carpal tunnel syndrome, tendinitis, bursitis, and trigger finger.
- Sensory problems including hearing and vision loss.
- Stress including overexertion; chronic fatigue; and sleep disorders, such as shift work sleep disorder.
- Nutritional prescriptions, advice, and interventions to reduce co-morbidity in hypertension, diabetes, obesity, depression, etc.
Occupational Healthcare Prevention and Interventions Associated with the Trucking Industry, a Primary Function of the OM Doctor
The occupational physician may provide quality medical services in a myriad of different industries; however, the scope of this paper will be to home in on the conditions and management services that OM physicians provide to workers, e.g., in the trucking industry. OM doctors, according to an FMCSA survey in 1917, are the only contact with a healthcare provider that many truck drivers have in the period of their certification; and many erroneously think that this visit substitutes for a primary care medicine visit.
The trucking industry is one of the most heavily regulated industries in the United States (US). The reason being is that motor vehicle collisions (MVCs) are still the third cause of death in the US. From that statistic, most involved trucks, e.g., a total of 4,119 people died in large truck crashes in 2019. Sixteen percent of these deaths were truck occupants, 67% were occupants of cars and other passenger vehicles, and 15% were pedestrians, bicyclists, or motorcyclists.
Most of these accidents are related to health issues, alcohol consumption, and/or drug abuse. Therefore, the DOT – FMCSA mandates exceedingly high health standards for truckers.
Each trucker is subjected to mandatory periodic examinations, drug, and alcohol testing to help reduce occupational risk, morbidity and mortality. OM doctors are trained on risk factors associated with this group of workers and must be nationally certified to conduct commercial driver’s exams (CDL) in order to provide certification. The doctor undergoes a rigorous training process that includes taking specialized courses and sitting for a national board to be able to conduct these exams.
Long hours experienced by professional drivers may lead to deterioration in health, and increase the incidence of developing serious illness, including the risk for cardiac and metabolic problems, and may give rise to a situation that can result in an MCV, causing bodily harm, death, and/or monetary losses to those involved.
Prolonged sitting, sleep deprivation, and substandard eating habits are common to “long-haulers,” affecting health adversely. But many health problems can be prevented before becoming serious, if the “trucker” is aware of developing symptoms, s/he may thwart future adverse outcomes. Also driver certification time is directly correlated to the health of the individual, thus better health, longer certification, and less interruption of workdays
The more Common Issues Drivers are dealing with in the Trucking Industry
Some of the most common health issues drivers are facing in the trucking industry include:
- Obesity and excessive stress, which can lead to high BP and diabetes.
- Poorly designed truck cabs can contribute to neck and back pain.
- Most musculoskeletal injuries, among all American workers, are associated with loading and unloading cargo from the vehicle.
- Exposures to hazardous chemicals.
- Chronic exposure to diesel fumes may lead to chronic lung disease, or even carbon monoxide intoxication and death.
- Tobacco smoking, vaping and chewing are common and known to cause cancer and chronic lung problems.
- Countless fatal motor vehicle injuries, two out of three MVCs are related to a commercially operated heavy vehicle.
- An overwhelming degree of fatigue results in 34% of trucker accidents caused by falling asleep while driving.
- Dependence on stimulants like coffee, soft drinks or energy beverages, to maintain wakefulness, contribute to anxiety and cardiovascular problems.
- Depression and loneliness arises out of job isolation or a lack of social interaction
- Sleep apnea is related to several different poor health habits and can be assessed with the “STOP BANG” pneumonic. The STOP–BANG acronym stands for: Snoring history, Tired during the day, Observed stop breathing while sleep, High blood pressure, BMI more than 35 kg/m2, Age more than 50 years, Neck circumference more than 40 cm and male Gender. The higher the number of risks factors, the greater the likelihood of sleep apnea. Apnea leads to increased risk for MVCs and is a major contributor to falling asleep behind the wheel.
Bad Habits Leading to Poor Health Outcomes
Bad habits, e.g., below par personal hygiene, insufficient exercise, smoking, wrong food choices, including skipping meals altogether, are behaviors to be aware of and try to change. Distress affects individuals in different ways, and may be severe. Stressors affecting drivers include financial pressures, health issues including death in the family, unstable relationships, and self-isolation.
OM Interventional Recommendations to Motor Vehicle Drivers
Here are some ways to OM specialists will advise drivers to deal with distress that can be effective and include:
- Mild to moderate forms of exercise can occur while waiting for your truck to be loaded may include walking, stretching, Tai Chi, yoga or any other activity in the vicinity of the truck help keep one active.
- Eat only healthy snacks, even prepare them beforehand to bring along
- Having fun, seeking recreation, or while resting, make time when home to socialize with friends and family to counteract the times when being alone on the road. Also develop a social network by phone and online that can be accessed anywhere the driver goes.
- When symptoms of stress become overwhelming, get help from a trusted physician or mental health professional. Remember, the DOT exam is not a personal physical evaluation from a primary care physician. The driver should also consider the benefits to be obtained from a doctor of chiropractic, a naturopathic physician or by just being proactive in regards to personal health advancement.
Truck drivers should know that when stress occurs in association with a high workload, talking with a supervisor at the trucking company may be helpful. Many companies want to work-assist their drivers when possible. It may be possible for drivers to decrease their job schedule and the load amounts that they are carrying or select a different route if that is part of the problem. Partnering up with a non-forced dispatch company can also help reduce the stress of locating or turning down a particular load. Also, top truck companies are implementing driver wellness programs, directed by OM physicians, to diminish the occupational risks associated with the load-hauling profession, increasing driver’s health, holistic health, and work performance
OM specialists are aware that extended hours on the road easily interfere with long-haulers getting appropriate healthcare. It is well known that drivers frequently ignore common signs or symptoms resulting in a worsening of their health. Additional to all the bad things the COVID 19 pandemic brought to us, it also allowed better access for medical attention in non-conventional settings.
Drivers can now access primary physicians while on the road since many of the restrictions for interstate telemedicine have been put on hold over the past year. Some states have been working to make these changes permanent, while many medical offices offer telehealth services across state borders making it easier for a driver to obtain affordable, immediate, and stable care while on the road.
Despite this innovation becoming available, other drivers still struggle with unattended medical problems and poor adherence to care, interfering with the successful execution of their career. For example, a driver with good health can be given two year driving authorization from a practitioner with National Registry of Certified Medical Examiners (NRCME) credentials. In contrast a hypertensive or diabetic driver, even with good control, is only afforded 12 months or the period is cut in half, providing the health condition meets guidelines on the day of the visit. There is a direct correlation between driver health, work performance and career length. This issue also reflects on transport company activity, their schedules, efficiency and costs millions of dollars due to the extra exams required to monitor their health conditions more closely.
The Most Common Health Problems Affecting Truck Drivers
Many health-related issues can be directly associated with the transport and delivery industry. Unfortunately, interstate truck drivers’ exhibit increased risk factors and usually, there is an association with one of more of the following Conditions:
Sedentary lifestyle and poor dietary choices will promote the risk of diabetes. Since 1970, diabetics have faced government promulgated driving restrictions. While some exceptions have recently allowed latitude for insulin users; many other limitations cause various difficulties and act as stressors to certain drivers. Many healthcare professionals will even argue that an A1c value of 10 mg%, a remarkably high number, is still unable to be achieved by many drivers on a yearly exam. Uncontrolled diabetes is a major problem affecting the driver population, reducing career years and leading to early retirement. The Standard American (western) Diet and being sedentary are the primary contributing factors propelling the epidemic within the truck driver cohort. Despite general guidelines being available and the common cliché of truck stop food, drivers continue to struggle getting adequate exercise and maintaining healthy diets.
Depression is also a dangerous and significant factor affecting this target population. Major depression is a consequential disorder and is exacerbated by being alone on the highway, apart from family and friends, and is aggravated due to developing stable companion relationships. Further, military veterans who drive may suffer with Post Traumatic Stress Disorder (PTSD), additional to their new daily stressors. High turnover rates are important concerns facing the trucking company’s management daily, and may relate to family members and their mental health issues.
Being diagnosed with a major depressive disorder may preclude a driver from obtaining getting driving certification. Also, some common medications used to manage depression are banned from use by commercial drivers. The impact from losing one’s means of income may further aggravate the clinical depression cycle making it sometimes impossible to RTW. In the best-case scenario, when having been diagnosed with depression, the commercial driver will receive a limited certification up to a maximum of a year, half of the two-year standard for a healthy individual; and only after 6 months to a year of follow up and treatment under a mental health specialist waiver. It is a big deal for commercial drivers, early detection, and non-pharmacological management may play a significant role in the drivers’ career.
Hypertension is one of the most common pathologies affecting commercial drivers. A driver’s nightmare, to confront the impartial judge called a sphygmomanometer. A blood pressure reading over 140/90 is restrictive to full driving certification. Stage 2 or 3 hypertension is even more restrictive, sometimes even stopping the trucker from driving his vehicle out of the office parking lot. It is a profoundly serious issue affecting the industry since it predisposes drivers to cardiovascular events like a fulminant stroke or myocardial infarction. It also cost millions of dollars to the motor carriers on days lost from work due to late deliveries, absenteeism, and incapacitation secondary to unhealthy blood pressure levels. Blood pressure medication takes time to achieve therapeutic effects, so individuals needing treatment may require a couple of weeks off work while hypertension is stabilized. Motor driver companies must implement programs that aim to prevent and reduce hypertension among their drivers. But, while they are keeping their drivers healthy they are sustaining revenue loss secondary to their drivers’ work restriction, not being DOT FMCSA certified.
Stress is also quite common in the transportation industry. OM providers are aware that a major stressor affecting drivers is finding suitable accommodations to sleep. Many rest stops have been shut down to reduce costs or secondary to COVID 19 related government restrictions. Many truckers are forced to park on the side of the interstate to catch a few hours of restless shuteye. OM physicians suggest it is important for drivers to plan their routes out ahead of time so they can be safe and get the rest they need, to reduce stress. Also, stress-reducing activities like exercise, recreation, a healthy diet, and proper supplementation will help reduce the impact of this co-morbidity on other diver-related problems.
Owner-operators who are employed by transportation logistics providers and freight dispatching companies are encouraged to visit their doctor regularly for check-ups allowing early detection of any potential health problems before they become serious.
To conclude, we have engaged in an overview discussion of the healthcare specialty of OM aka Occupational Health and have seen how this specialty can contribute to a better working environment, and improvement of a companies’ productivity. We evaluated factors that defined the occupational requirements of the OM specialty, certifications, knowledge, and various conditions surrounding its operation. We discussed how it might offer benefits to the general industry, but especially to professional truck drivers, directly correlated to the driver’s ability to participate in work activity.
After a careful review of this topic, occupational health practitioners suggest motor carrier companies should implement preventive, interventional, mitigation, and wellness measures, aimed to reduce or prevent hypertension, diabetes, sleep problems, stress, and depression among commercial drivers. OM doctors can play a significant role in developing these preventive interventions so that drivers can meet the federal and state standards when being tested for their routine mandated physicals. Further, there are remote monitoring medical options and telehealth advancements that may be employed so the drivers can achieve better health quality.
We believe it is imperative that the trucking industry make significant proactive interventions to lower the risk of their employees’ previously discussed health factors. Not only will this reduce morbidity and mortality, but it may significantly reduce lost work time, may decrease insurance prices, may also directly cut the cost associated with the loss of the driver’s certification, and health-related motor vehicle collisions. We are proposing that wellness conscious companies may see commercial benefits from having a more healthy and productive workforce.
Further analysis and specific studies should be performed to establish direct correlations between the aforementioned mentioned conditions, and how they may impact the trucking industry. Direct interventions may be needed to address this problem at the local, state, and federal levels, to promote permanent access for drivers to obtain pressing care from across state lines. Motor carriers should enjoy direct benefits as they invest in the health and wellbeing of their drivers that go far beyond increasing revenue and reducing risk.
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