Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 16
COMMENTS
The growing need for information by health care
providers about O-E medicine cannot be met by a single
database, computer program, or compilation of printed
materials. Much of the O-E health data in this field are
"soft," frequently based on inferences from, or
extrapolations of, toxicity information from animal mode'
systems often acquires' by methods of varying reliability
and questionable usefulness.
The answers to many of the questions asked by
health care providers often call for professional judgement.
Although a number of computerized information sources
exist that contain technical data, the synthesis of these
data into a patient-specific assessment of risk or a
recommendation for patient management will remain the
province, for the foreseeable future, of human experts able
to make professional judgements. And, as noted above,
knowlecige of focal industry, geography, patterns of illness
and legal requirements may critically influence the
information needed in a given case. Thus, it is clear that
communication links must be established broadly with
existing database information resources. These links
should be made with agencies at the state and federal
level to encompass the breadth of knowledge needed to
respond to questions of O-E relatecl illnesses, reporting
requirements, and compliance with local laws pertaining to
illnesses auribulable to hazardous substances.
RECOMMENDATIONS
Based on the findings of the subcommittee, the
committee recommends that Congress authorize and
16
OCR for page 17
appropriate funds within a governmental agency to
establish a two-component national O-E medical
information system described in this report.
The subcommittee believes that the best mode! for an
O-E medical information "system" would be nationally co-
ordinated, regional multi-disciplinary centers that would
provide a widely publicized telephone-based information
service for professional inquiries. The importance of local
industrial' transportation, and geographic factors in
assessing O-E hazardous exposures persuades the
subcommittee that no single center could reasonably
serve national needs, and that a network of regional
centers is needed.
11
It is equally clear that a fully decentralized system of
nformation centers would be inefficient and duplicative.
Similarly, the need for national summary statistics on the
incidence and prevalence of illnesses and injuries caused
by O-E hazardous exposures would not be met solely by
a network of regional centers. Therefore, a national center
is envisioned that would be complementary to the regional
units.
The national center would:
1) Develop Requests For Proposal (RFPs) for the
competitive award of regional center contracts or
grants. Regions would be identified by needs,
resources, population base and types of industry.
Full national coverage would be an important
program goat.
2) Administer contracts or grants Five year funding
cycle) to run regional centers.
17
OCR for page 18
3) Build shared information resources (such as new
specialized databases) in collaboration with other
public organizations such as the National Library
of Medicine and provide efficient communication
linkages among the regional and national centers
(such as electronic bulletin boards and electronic
mad! facilities).
4) Establish standards for data dissemination to, and
data collection from, regional centers.
5) Collect, monitor, and analyze data from regional
centers to identify clusters and detect sentinel
events (widespread but subtle toxic exposures
recognized only by diagnosis of clusters of
patients in a local area), define the needs for
relevant national statistics, conduct
epidemiological studies, identify opportunities for
applied research, and issue periodic reports.
These periodic reports should be made to state
health agencies, NIOSH, OSHA, and perhaps
other agencies depending on the circumstance of
the sentinel evenness.
6) Provide a forum for regional centers to share their
experiences and their expertise.
7) Conduct an ongoing program for assurance of
performance, creditability, and quality.
8) Collaborate with national trade associations,
industries, and state governments where
appropriate, in sharing costs and cleveloping non-
cluplicative services and information.
9) Work with professional organizations (such as The
American College of Physicians, American
18
OCR for page 19
Academy of Family Physicians, American College
of Occupational Medicine), to make sure that the
system is wiclely known and used by physicians.
Informal advisory groups composed of representatives
from these related organizations should help guide the
programs and services of the regional centers.
Regional centers would:
1. Provide a 24-hour toxics information 800-number.
Disseminate information of printed publications by
either facsimile or electronic mail.
3. Develop region-specific information about
procedures, laws, and policy.
Provide referrals for additional information and
assistance.
5. Collect clinical case data about local and regional
exposure patterns.
6. Establish linkages with state public health
agencies; state and local hazardous materials
teams; National Institute for Occupational Safety
and Health (NIOSH), Occupational Safety and
Health Administration (OSHA), Centers for
Disease Control (CDC), National Institute of
Environmental Health Sciences (NIEHS), Agency
for Toxic Substances and Disease Registry
(ATSDR), and the Environmental Protection
Agency (EPA) regional offices; industries; and
health-related private organizations and
associations. Also, establish informal advisory
groups composed of representatives from these
19
OCR for page 20
related organizations that would help guide the
programs and services of the regional centers.
7. Maintain a core, full-time staff to respond to
telephone inquiries (Note: 24 hr. coverage would
require 4-6 persons, however, the cost projections
in Table A-1 show only 1.5 FTE for start-up year).
B. Insure access to consultant expertise in O-E
medicine, industrial hygiene, toxicology,
epidemiology, risk assessment, and education.
9. Serve as an integral component of a first-alert
system in the identification and characterization of
acute toxic episodes, the toxicants, and relevant
resource information and experts knowledgeable
about the involved toxicants.
Funding for regional centers would be awarded on a
competitive basis to organizations possessing the relevant
expertise. Some centers might be existing organizations
(e.g., a- poison control center or occupational health clinic)-,
while others might be brought together specifically to
respond to a request for proposals. Once established,
the regional centers should be actively promoted within
the medical community.
20
Representative terms from entire chapter:
health agencies
