Advancing Workforce Health at the Department of Homeland Security Protecting Those Who Protect Us (2014) / Chapter Skim
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4 The Current State of Workforce Health Protection at DHS
4 The Current State of Workforce Health Protection at DHS
Pages 115-154
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From page 115... ...
ENSURING MEDICAL READINESS As described in Chapter 3, four interrelated occupational health functions support medical readiness: injury and illness prevention, readiness assessment, disability management, and health promotion. In the sections below, each of these functions is examined in turn -- first at the DHS 115
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From page 116... ...
, 1 The committee did not have an opportunity to speak with occupational health program staff at the Secret Service, despite repeated requests (it did hear from a representative on the agency's operational medicine program)
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The Chief Human Capital Officer declined a request to speak with the committee about DHS's safety and health program,5 so the committee was unable to ask about her ability to provide the program with the focus and resources befitting its importance. The department-level occupational safety and health program is staffed by two occupational safety and health managers (including the DHS Safety Manager)
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From page 118... ...
. Most have occupational safety and health manuals or handbooks containing both policies and procedures for, among other things, identification and control of safety hazards, program evaluations and inspections, mishap reporting and investigation, job safety analysis, training, medical surveillance, and infectious disease control (DHS, 2010a; FEMA, 2013; ICE, 2011; TSA, 2010; USCG, 2013)
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From page 119... ...
, rely heavily on collateral-duty safety officers for inspections, while others, such as TSA and CBP, have numerous safety professionals embedded in field sites across the United States, in addition to collateral-duty safety officers who inspect their assigned areas on a more regular basis. As with the safety and health committees, embedded safety and health professionals are familiar with operating conditions and know local management, providing opportunities for improved hazard identification and mitigation and risk communication.
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From page 120... ...
. Since then, TSA has been working aggressively to reduce injury and illness rates through a robust occupational safety and health program that works closely with TSA's workers' compensation program.
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With the exception of the Coast Guard, components generally outsource these functions to a private vendor or to Federal Occupational Health. Training and education Executive Order 12196 on federal occupational safety and health programs requires agencies to provide safety and health
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. DHS's occupational safety and health office also has developed a relative program rating based on the five-point scale used for assessments during annual occupational safety and health program reviews (Anderson, 2013)
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From page 123... ...
With the exception of the Coast Guard, clearly defined requirements for readiness generally are lacking at DHS, although, as discussed below, many components use fitness-for-duty evaluations to assess whether individuals can perform their essential job tasks. Headquarters Level The Delegation to the Assistant Secretary for Health Affairs and Chief Medical Officer assigns oversight responsibility for mission readiness functions, including preplacement evaluations, medical standards, fitness-forduty examinations, health screening and monitoring, deployment physicals, and medical exam protocols, to the CMO.
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From page 124... ...
Where appropriate, fitness-fordeployment processes also were reviewed. Medical and physical standards Although the committee was not given the opportunity to review them, several components -- including CBP, FAMS, the Secret Service, and the Coast Guard -- reported that they have implemented medical and/or physical ability standards for law enforcement and other security- and safety-sensitive positions (e.g., mechanics, firefighters)
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From page 125... ...
TSA, ICE, and FEMA all indicated that they are in the process of developing medical standards for safety- and security-sensitive positions. Medical standards for transportation security officers are required by the Aviation Transportation Security Act.12 Although not yet implemented, the standards have been developed based on the results of an outsourced job task analysis and are awaiting approval.
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From page 126... ...
Some agencies, such as the Coast Guard and FAMS, have sufficient numbers of physicians and occupational health nurses on staff to conduct some evaluations internally. FAMS has found that bringing this function in house can be cost-effective (FAMS, 2013a)
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From page 127... ...
The Coast Guard and Secret Service also use medical evaluation or medical review boards to determine whether an individual can perform essential job functions, with or without reasonable accommodation (Secret Service, 2012; USCG, 2011a)
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From page 128... ...
This information is then aggregated to determine the proportion of the Coast Guard workforce meeting each readiness requirement and all requirements. Workforce readiness information currently is tracked in the Coast Guard Medical Readiness Reporting System.
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between OHA and the occupational safety and health program office as a lead program area for OHA (see Appendix B)
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Although a hotline will be supplied for reporting purposes, it is unclear whether the first report-of-injury calls will be shared with component safety offices. Component Level The committee heard from only three components -- –CBP, TSA, and FAMS -- –regarding their disability management programs.
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From page 131... ...
. A key aspect of the program is that the in-house case managers, who also review fitness-for-duty evaluations, are intimately familiar with FAMS job requirements and medical standards, and therefore can also facilitate parallel medical clearance processes.
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Health Promotion During the past 5 years, there has been increased emphasis on resilience and health promotion programs at DHS. One of the primary goals of the current DHS strategic plan is to enhance the DHS workforce.
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Headquarters Level Responsibility for health promotion programs (sometimes called wellness programs) 19 at the headquarters level is divided between OHA and OCHCO, and the respective roles of each are not always clear, even to DHS staff (Hope, 2013b)
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In the Coast Guard, health promotion efforts are built into the mandatory annual periodic health assessment, whose 20 The IOM Committee on Department of Homeland Security Workforce Resilience was convened to examine this program. That committee identified a number of gaps and presented recommendations and the foundations for a 5-year strategic plan for building a more ready and resilient workforce at DHS.
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From page 135... ...
PROVIDING MEDICAL SUPPORT FOR OPERATIONS As discussed in Chapter 3, key functions for providing operational medical support include medical threat assessment, preventive medicine, ambulatory medical care, and emergency medical services. Because of the 23 The Coast Guard reported that it is waiting until its new Integrated Health Information System is implemented to establish goals and metrics and evaluate the effectiveness of health and wellness interventions.
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From page 136... ...
This is followed by a discussion of challenges identified by the committee to the development of a coordinated DHS operational medicine capability. Operational Medicine Programs at DHS Headquarters Level Among the CMO's delegated responsibilities is support for "component leadership to ensure that operations have appropriate medical support" (DHS, 2008a)
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From page 137... ...
Component Level Within DHS are nine components with EMS or operational medicine functions in support of their workforce: CBP, ICE, FEMA, NPPD, the Federal Law Enforcement Training Center (FLETC) , TSA, Science & Technology, the Secret Service, and the Coast Guard.
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From page 138... ...
provides armory services; training; guidance; and tactical and logistical support, including medical support for operations. NFTTU's National Emergency Medical Services Program employs 50 EMTs and 3 paramedics (Davis, 2013)
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The program provides medical support for national special security events and for protection details, both within and outside the United States. Medical direction and clinical training for practitioners are provided by the Johns Hopkins Center for Law Enforcement Medicine, which also provides referral services for occupational health issues (Stair, 2013)
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From page 140... ...
Challenges to a DHS Operational Medicine Capability Among the challenges to the development of a DHS-wide operational medicine capability are the need to maintain skills and proficiency and the difficulty of advocating for appropriate resource investments. Maintenance of Skills and Proficiency One of the greatest challenges faced by EMS and operational medicine programs at DHS is maintaining the clinical competency of the medical providers (Seifarth, 2013a)
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Other components have outsourced medical direction. ICE and the Secret Service both use contracted medical direction provided by the Johns Hopkins Center for Law Enforcement Medicine.
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This case study -- of the FAMS integrated medical program -- is presented at the end of this section. Integration Across DHS Headquarters Offices Because responsibility for workforce health protection programs currently is divided between OHA and OCHCO, mechanisms are needed to facilitate horizontal integration at the headquarters level.
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From page 143... ...
In fact, the committee learned that OHA does not provide oversight for medical surveillance; monitoring of such programs for OSHA compliance is being carried out by the safety and health program staff in OCHCO. Vertical Integration Between Headquarters and Components Vertical integration between headquarters and components for safety and health functions is facilitated by DHS-wide policy, such as the DHS Occupational Safety and Health Manual (2010a)
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From page 144... ...
Above all, they are advocates for workforce health protection. There are currently five SMAs involved with the program, hired to address different areas of health or medical concern within components (e.g., fitness for duty, operational medicine)
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Examples are presented below. In the Coast Guard, the Health Services, Safety and Environmental Health, and Work-Life offices are aligned organizationally into a single directorate, with one leader overseeing and accountable for all workforce health protection functions.
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From page 146... ...
As discussed in Chapter 3, the committee examined multiple public- and private-sector organizations, and from those evaluations, as well as current best practices available in the published literature, identified four elements essential to successful integration of workforce health programs: leadership commitment to workforce health, organizational alignment and coordination, functional alignment, and information management. During its review and assessment of the current occupational health and operational medicine infrastructure at DHS (discussed throughout this and earlier chapters)
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From page 147... ...
The gaps described throughout this chapter and summarized below indicate a need for DHS leadership to promote and resource workforce health programs, to communicate their essential role in mission readiness, and to ensure accountability across the department. Organizational Alignment and Coordination Organizations with integrated health systems examined by the committee took steps to ensure coordination among those with responsibility for key health protection functions, although approaches to this end varied.
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From page 148... ...
They provide round-the-clock coverage to fulfill this critical population safety mission and must be healthy both mentally and physically to discharge their responsibilities. Lost time due to injuries and other occupational health events can degrade the agency's capability to carry out its mission.
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This close and lasting relationship has contributed to increased communication, improved reporting, enhanced patient education and recovery planning, and more effective recovery from work-related health issues. Another exemplary feature of the program is the Employee Health and Fit ness Program, recently initiated through a partnership among the FAMS Medical Programs Section, the Field Operations Division, and TSA's Law Enforcement and Industry Training Division (FAMS, 2013c)
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From page 150... ...
Presentation to IOM Com mittee on DHS Occupational Health and Operational Medicine Infrastructure: Meeting 1, March 5, Washington, DC. Bowcutt, D
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From page 151... ...
Presentation to IOM Com mittee on DHS Occupational Health and Operational Medicine Infrastructure: Meeting 1, March 5, Washington, DC. Davis, D
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From page 152... ...
Presentation to IOM Committee on DHS Occupational Health and Operational Medicine Infrastructure: Meeting 2, June 10-11, Washington, DC. National Prevention Council.
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From page 153... ...
Presentation to IOM Com mittee on DHS Occupational Health and Operational Medicine Infrastructure: Meeting 2, June 10-11, Washington, DC. Secret Service.
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From page 154... ...
Presentation to IOM Committee on DHS Occupational Health and Operational Medicine Infrastructure: Meeting 2, June 10-11, Washington, DC. Wright, D
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