Ma.

Gia Baquiran- Sison, MD MOH DPCOM

Diplomate, Philippine College of Occupational Medicine
Consultant, World Health Organization, Western Pacific Region
Medical Director, Meralco Corporate Wellness Center
Consultant, Makati Medical Center
Masters in Occupational Health, University of the Philippines Manila
Masters in Occupational Medicine, University of Illinois Chicago

Outline of Presentation

Definition of the practice of Occupational

Medical
The Role of Emergency Medicine in
Occupational Medicine
Global trends and Conditions that affect
Occupational Medical Practice
Local trends in Occupational Medicine in the
Philippines
Emerging health trends in the workplace
Conclusion and Recommendations

What is the practice of

Occupational Medicine?

Occupational Medicine is a medical

discipline that emphasizes prevention and
deals clinically and administratively with
the health needs of both individuals and
groups with respect to their working
environment and includes recognition,
evaluation, control, management and
rehabilitation of occupationally-related
diseases and injuries.

Role of ER Medicine in
Occupational Medicine

1985: ACEP established the

Occupational Medicine Committee to
evaluate and develop the role of the ER
physician in Occupational Medicine.
1986: ACEP defined 6 areas of
Emergency Medicine which is inclusive
of an area in Occupational Medicine

Role of ER Medicine in
Occupational Medicine

ACEP statement: The ER physician

with additional qualifications and/or
special competencies may engage in
the provision of initial care and
continuing Occupational Medicine
services including illness and injury
prevention, case management and
patient rehabilitation.

Initial Management of Patients at

the ER presenting with a Workrelated
Injury
or
Illness

Established policy of ACEP last 1998

Delineates ER physicians
responsibilities in the following areas:
Provision of emergency evaluation and

treatment
Determination of medical causation
Establishment of physical limitations
Communication with the employer
Arrangement of appropriate follow-up care

Global Trends and Conditions

Affecting Occupational Medical
Practice

Migration of Industry to developing countries

Migration of workers OFWs, seamen
Increase in the Business process outsourcing ( BPO)
business
Demographic changes in nearby countries
Emerging new diseases and conditions
Increased Travel

Top Outsourced
Industries in the
Philippines
Manufacturing Industry microchips, cars,

telecommunication equipment
Agricultural Industry pineapple, vegetable oil,
biofuels
Service Industry BPO (call centers), medical
transcription and coding, accounting/billing
Health Services medical tourism
Retirement Industry

Local Trends in
Occupational Medicine in
the
Philippines

Increase in BPO companies (call centers) SHIFT WORK

problems
Computer chip industry relocations
Heavy industries (shipbuilding, oil refineries) to Export
processing zones
Outsourcing of health services by companies
Growth of HMOs and health plans
Enforcement of Occupational Health Laws as mandated
by the Department of Labor and Employment

Philippine Labor Standards

in the Occupational Health
Based on Rule 1960 of the DOLE-BWC Standards in
Practice

Occupational Health and Safety and the Philippine

Labor Code
In all workplaces where there is more than 1 work shift
in a day, the employer shall in addition to the
requirements of the rule, provide the services of a
fulltime first-aider for each work shift.
Workers 10-50: first aider
50-200: full time registered nurse
201-300: full time RN, parttime MD, parttime dentist
301 above: full time RN, full time MD, full time dentist

General Features

Work as one of the causes.

Both workers and non-workers are affected.
Increase in the NCDs (diabetes,
hypertension, coronary artery disease in the
young)
Has impact in health cost utilization
Emphasis must always be towards the
preventive side and fitness to work should
be highly considered.

Top Occupational Health

Issues in the Workplace

Infectious diseases
Bronchial asthma
Skin diseases
Cardiovascular diseases
Gastrointestinal-related diseases
Cataract, deafness
Acute poisoning

Based on the Philippine National OSH Profile, Sept. 20

Occupational Health Issues

in the Business Process
Outsourcing
Increasing number in NCDs (diabetes, hypertension in the
young)
Shift work related health issues
Ergonomic-related health issues such as Repetitive Strain
Injuries (RSI)
Psychosocial factors (job satisfaction, personality traits,
perception of intensified workload, job control)

Sample Shift Schedules

in the BPO Industry

8 hour shift/ 37.3 hours per week/ 6

days on, 3 days off
10 hour shift/ 40 hours per week/ 6 days
on, 1 day off
24 hours shift/ 56 hours on the average
per week/ 7 days on but rotated every 9
days

Re-Emerging Health
Issues in the Workplace

Increase in HIV-AIDS
Increase in Respiratory diseases, UTI,
Gastrointestinal-related diseases,
Cardiovascular diseases
Persistence of Obesity as number one in
annual physical examinations
Resurgence of PTB
Substance abuse

Demographics:
Population

Demographics: Gender

Demographics: Marital
Status

Demographics: Age

Demographics: Body
Mass Index (BMI)

Demographics: BMI by
Gender

Demographics: BMI by
Age

Smoking History

Smoking History by Age

Drinking History

Drinking History by
Gender

Drinking History by Age

Prevalent Illnesses
based on Annual
Physical Examination

Medical Conditions by
Gender

Medical Conditions by
Age

Medical Conditions by
Drinking History

Medical Conditions
based on Smoking
History

Top Illnesses based on

Doctors Diagnosis

Acute Tonsillopharyngitis
Upper Respiratory Illness
Gastrointestinal-related Disorders
Tension Headache/ Migraine
UTI
Hypertension
Conjunctivitis
Musculoskeletal strain
Systemic Viral Illness
OB-related

Top Reasons for ER

Conduction

Gastrointestinal-related disorders
Cardiovascular-related disorders
Respiratory-related
Pregnancy-related
Asthma
Accidents
Anaphylaxis

Top Reasons for Sent

Home Cases

Conjunctivitis
ATP
GI-related Disorders
URTI
Tension Headache/ Migraine
Systemic Viral Illness
Hypertension
Musculoskeletal disorders
Dental-related disorders
UTI

Occupational-related
Contributing Factors

Repetitive activities
Shiftwork-related
Forceful exertion
Awkward/static posture
Temperature extremes
Localized mechanical stress
Lifestyle-related factors such as eating
habits, smoking and drinking

New Trends in Occupational

Health

To predict individual susceptibility to a

substance/ certain disorders
To estimate internal exposure or early
biological effects by molecular biomarkers or biological monitoring
Monitor exposure especially for
carcinogens like toluene and pesticides

New Trends in Occupational

Health

Introduction of Medical Case Management

Fitness for Work specialty
Enforcement of health and wellness
programs in the workplace

References in
Occupational and
Medline via PubMed:
Environmental
Health
www.ncbi.nlm.nih.gov/entrez/query.fcgi

TOXLINE and Hazardous Substances

Data Bank:
http://toxnet.nlm.nih.gov/index.html
IRIS (Integrated Risk Information
System): toxic doses of substances in
the environment
NIOSHTIC-2: www.2a.cdc.gov/nioshtic-2

CONCLUSION

Knowledgeable in global trends and their

effects on Occupational Medical Practice
Recent trends and developments in
Occupational and Environmental health
Managed care and its tools to ensure
quality of care and cost-effectiveness
Medical professionals should be
advocates of change in the workplace and
be of GOOD influence to patients/workers