6 pma salehuddin - advanced occuptaional health

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POST MODULE ASSIGNMENT (PMA)

ADVANCED OCCUPATIONAL HEALTH IN MY WORKPLACE

1.0 Introduction

1.1 Organisation Profile

The Malaysian Armed Forces is divided into 3 services; Army, Navy and Air Force. The

Malaysian Army organisation is generally divided into 4 big departments which consist of

Operational, Training, Administration and Logistics. Each of these department functions

interdependently with other departments. One of the important elements in the Training

Department for the Malaysian Army is the training unit Kolej Tentera Darat (KTD) situated

at Port Dickson.

KTD is responsible to produce Army officers from graduates from the various plethora of

tertiary education institutions. Several courses are run within a year to accommodate the

various categories of Army Officers for the Malaysian Army. The organisation structure is

shown in Figure 1.1. Basically, KTD itself is divided into 4 departments which is

Administration, Training, Logistic Support and Examination & Validation.

Figure 1.1 – KTD Organisation Structure

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1.2 OSH in KTD?

The OSH act states in section 1. (3), that it does not apply to the Armed Forces (OSH act

1994). Although the Armed Forces are not legally binded by the law in terms of OSH, KTD

acknowledges the benefit of OSH and promotes a safe and healthy working culture. The

effort is demonstrated by frequent activities of coincidentally integrating safety and health

with the overall security of the camp. There is no precise policy or committee for OSH as per

required by OSHA or OSHMS but the camp security plan and security committee has

elements of OSH embedded into it. I’m not permitted to disclose the full content of the

security plan and roles of the security committee but it is worth mentioning that elements of

OSH contained are:

a) Monitoring building condition and or structure damage.

b) Hygiene maintenance of drainage, kitchen, ration stores and dining hall.

c) Safety in military vehicle garage (tools and chemical storage, procedures and use of

PPE).

d) Military assets (ammunition, pyrotechnics and electronic warfare equipments) storing

procedures and handling in the armory and specialized stores.

e) Military Doctor report on occupational injuries and post mortem by investigating

accidents and deciding if the injuries can be prevented or genuinely unavoidable (due to the

nature of Army training).

2.0 Question

The questions provided by Dr. Rozhan Shariff Bin Radzi are:

a. List according to job title, the 4 most important or hazardous occupation that may be

found in your organisation/company. For each of these occupations, classify and discuss the

most common occupational healh hazards that can be encountered in these jobs.

b. Are you aware of any stress complaints at your workplace? How would you assess

whether stress is an issue among your workplace staff?

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3.0 Objective

The objective of this PMA is to perform the following:

a) Identify 4 hazardous occupations in the organisation.

b) Discuss occupational health hazards in these jobs.

c) Identify stress complaints in organisation.

d) Assessment of stress in workplace.

4.0 Methodology

Methodology is the manner, method, procedure, way or approach that will be used to attain,

achieve, and accomplish the objective of this PMA. The method used is application of

knowledge gained from the all the classes attended so far during EMOSHM in answering the

questions from the perspective of the organisation. No specific records or graph are recorded

or maintained by KTD, therefore assumptions and mental simulation are used to fill

informational gaps that are required to answer the questions.

5.0 Question 1

5.1 Hazardous Jobs

There are many jobs according to appointments positioned in different departments in the

previous Figure 1.1. Logically, those from the Training Department are more exposed to

occupational hazards when compared to the other 3 departments. This is due to the nature of

work for the Training Department which is usually training in the battlefield environment

when compared to the other 3 departments of mostly ‘office’ work. From the training

department, specific instructors focus on a specific skill to teach and train to the trainees

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called SME. Of course the trainees are only subject to possible acute exposure, but the SME

are subject to chronic exposure due to repetition of training for trainees from several different

courses that are run throughout the year. Of the many SME, the 4 most hazardous occupation

chosen for this PMA are:

a) Gunnery Instructor.

b) NBC Instructor.

c) Abseil and Rappel Instructor.

d) Jungle Warfare Instructor.

5.2 Gunnery Instructor

The Gunnery Instructor’s role and responsibility involves in training the theory and practical

application of using weapons, MBT gun (Figure 5.2A), artillery (Figure 5.2B), air defence

Figure (5.2C) and rocket launchers (5.2D) in combat. A simplified JHA is shown in Figure

5.2E.

Figure 5.2A – Pendekar PT-91M Pendekar MBT

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Figure 5.2B – FH-70 155mm Howitzer Artillery

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Figure 5.2C – Oerlikon 35mm Twin Cannon Air Defence

Figure 5.2D – ASTROS II Multiple Launch Rocket System (MLRS)

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JOB HAZARD ANALYSIS JOB TITLE: Gunnery Instructor DATE: 23/5/13

TITLE OF PERSON WHO DOES

JOB:

Instructor

SUPERVISOR:

Chief Instructor

ANALYSIS

PERFOMED BY:

Kapt Salehuddin

ORGANIZATION: KTD LOCATION:

Firing Range

DEPARTMENT:

Training

REVIEWED BY:

Safety and Health

Committee

SEQUENCE OF BASIC

JOB STEPS

POTENTIAL HAZARDS RECOMMENDED ACTION OR

PROCEDURE

Battle Procedure

• Explosive Ammunition – improper handling.

• Engineering Control - Ammunition containers can be made easier to hold and lift.

Loading of Ammunition

• Explosive Ammunition – improper handling.

• Mechanical – being caught between, struck by or against artillery mechanism during loading of ammunition.

• Noise – chronic exposure to hazardous noise levels.

• Environment – Mineral Dusts (firing range ground)

• Chemical – airborne chemical hazard generated from firing process producing lead dust.

• Engineering Control - Barriers to guard explosions from spectators. - Suppression of noise by inventing gun barrel silencer. - Dilution mechanism for lead dust.

• Administrative Control - Training and conditioning. - Safe Work Procedures. - Job Rotation. - Adequate breaks/rest.

• PPE - Ear plugs / ear muff. - Eye protector. - Breathing mask.

Register Target

Firing on Target

Confirmatory of Target

Hit

Reloading of

Ammunition and

Repeat Firing on Target

Process

• Ergonomic – MSD from repetitive action and awkward posture from loading heavy ammunition to gun.

• Administrative Control - Training and conditioning. - Safe Work Procedures. - Job Rotation. - Adequate breaks/rest.

Figure 5.2E – Simplified JSA for Gunnery Instructor

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Of the many practical hazards exposed to the Gunnery Intructor, chronic noise is the most

common work related occupational health hazard experienced. This is due to prolonged

repetitive exposure to high levels of the explosions of the guns firing. Noise is defined as all

adverse, unpleasant, irritating, annoying or harmful sound that reaches the hearing organ and

influences other senses and parts of the human body (Koradecka, 2010). The common

impulsive noise for gun fire is at an average 130 dB. When compared to dB values for

common noise sources (Figure 5.2 F), it is near the pain threshold of the hearing organ.

Prolonged exposure to noise above 85 dB itself may cause hearing impairment (Reese, 2009).

dB NOISE SOURCE 135 Pain Threshold 120 Jet Plane 100 Peneumatic Drill 80 Car 60 Office 40 Home 15 Birds Singing

Figure 5.3F – Common Noise Sources (Koradecka, 2010)

Considering the fact of the dangerous noise level experienced by the Gunnery Instructor, a

Hearing Conservation Program and application of hierarchy of control can be utilised for the

occupant. These interventions consist of:

a) Auditable written policy.

b) Comprehensive noise exposure assessment.

c) Noise hazard Education Training Program.

d) Audiometric Testing Program.

e) Medical evaluation and treatment.

f) Provision, training and utilization of suitable HPD.

g) Good record keeping of exposure monitoring, audiometric and clinical examination

results.

h) Applying work breaks and limiting working time (Koradecka, 2010).

i) Arranging soundproof resting rooms (Koradecka, 2010).

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5.3 NBC Instructor

The NBC Instructor’s role and responsibility involves in training the theory and practical

application of nuclear, biological and chemical warfare in the battlefield environment. This

involves of wearing the NBC suit as shown in Figure 5.3A, based on the MOPP level. The

training usually focuses on the several degrees of MOPP level as shown in Figure 5.3B.

Figure 5.3A – MOPP 4 & 5 NBC Suit

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Figure 5.3B – MOPP (Mission Oriented Protective Posture)

The training consists of provision, training, utilisation of the NBC suit and conditioning to

perform normal fieldcraft and battlecraft in a nuclear/biological/chemical hazard

environment. The NBC suit is designed to withstand hazardous chemical, biological and a

certain level or nuclear radiation exposure. The training involves wearing the NBC suit for

certain amounts of time while performing military exercises and the use of the gas mask

canisters. Therefore, the NBC instructor is chronically exposed to chemical hazard

throughout the year.

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Training for the exposure of airborne chemical and biological weapons are substituted with

tear gas within a timeframe focusing on the handling of the gas mask and replacing gas

canisters from the gas mask in an enclosed room/environment. A chemical hazard through

air contamination is defined as an occurrence of substances in the form of aerosol, gases or

vapours (Posniak and Skowron, 2010). The tear gas used in training is a form of airborne

chemical hazard. Although, the use of NBC suit protects the user from the substance, the

nature of work for the instructor which conducts training on a daily basis will increase the

likelihood risk of coming to contact and or inhaling the chemical hazard. Chronic exposure

to tear gas may cause eye scarring/glaucoma/cataract, skin irritant, suffocation, interference

with respiration, immediate lung irritation, airway constriction, and existing lung disease

aggravation.

Inhalation is the major route of entry for many hazardous chemicals in the work environment

involving those airborne contaminants that can be inhaled direct into the lungs and can be

physically classified as gases, vapors and particulate matter that includes dusts, fumes,

smokes and mist`s (Reese, 2010). Paying careful attention to prolonged exposure to tear gas

as a hazardous irritant which have a corrosive or irritating effect on the breathing organs is

particularly important because of the rapidity with which it can be absorbed in the lungs.

Several suggested measures that can be taken are:

a) Substitution of tear gas with a non hazardous gas to be used in training.

b) Develop a gas mask examination procedure of employees by a licensed party.

c) Qualitative or quantitative fit testing of gas mask.

d) Monitor replacement of gas mask canister with new canisters (sometimes old

canisters are still used).

e) Medical surveillance, lung function testing and eye examination.

5.4 Abseil and Rappel Instructor

The Abseil and Rappel Instructor’s role and responsibility involves in training the theory and

practical application of abseiling and rappelling from high locations and helicopters as shown

in Figure 5.4A and 5.4B. A simplified JHA is shown in Figure 5.4C.

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Figure 5.4A – Abseiling / Rappelling from a Tower

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Figure 5.4B – Abseiling / Rappelling from Nuri Sikorsky S-61A-4

JOB HAZARD ANALYSIS JOB TITLE: Abseil / Rappel Instructor DATE: 23/5/13

TITLE OF PERSON WHO DOES

JOB:

Instructor

SUPERVISOR:

Chief

Instructor

ANALYSIS

PERFOMED BY:

Kapt Salehuddin

ORGANIZATION: KTD LOCATION:

Abseil / Rappel Tower

DEPARTMENT:

Training

REVIEWED BY:

Safety and Health

Committee

SEQUENCE OF BASIC

JOB STEPS

POTENTIAL HAZARDS RECOMMENDED ACTION OR

PROCEDURE

Preliminary Procedure

– Set up and testing of

abseil/rappel black

marlow rope and

equipment on tower.

• Physical – falling from

height due to faulty equipment

during testing and

demonstration.

• Ergonomics – Awkward

posture during testing,

demonstration and secondary

instructor anchoring trainee as

load.

• Engineering Control

- Install foam or net at ground

level to avoid injury or death if

falling from height.

• Administrative Control

- Frequent technical testing of

equipment (special x-ray for snap

link and figure of eight)

- Monitor equipment expiration

date.

- Training.

- Safe Work Procedures.

- Job Rotation.

- Adequate breaks/rest.

• PPE

- Helmet

Demonstration of

abseil/rappel from

tower.

Checking of each

trainee’s harness,

snap link and

figure of eight.

Primary instructor

releases trainees

individually from

tower.

Secondary instructor

anchors and receives

trainees from below

tower.

Figure 5.4C – Simplified JHA for Abseil/Rappel Instructor

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Of the hazards exposed to the Abseil and Rappel Intructor, ergonomics is the most common

work related occupational health hazard experienced. This is due to prolonged specific

ergonomic risk factors including:

a) Repetitive actions.

b) Lack of recovery.

c) Forceful exertions.

d) Awkward posture.

e) Contact stress.

f) Excessive loading for anchor.

These ergonomic risk factors may cause one or more of the common categories of

muscoskeleteal disorder:

a) Back, lower and spine disorder.

b) Shoulder and upper limb disorder.

c) Cervico-brachial disorder.

d) Neurovascular disorder.

e) Tendon disorder.

f) Muscle disorder.

Besides the recommended action for procedures, other interventions that can be taken are

having medical surveillance and establishing an ergonomics team. The ergonomics team may

be required to conduct ergonomic assessments such as:

a) Symptom survey.

b) Detailed in depth JHA.

c) Work conditions measurement.

d) Review of existing equipments and controls.

e) NORDIC questionnaire.

f) Observational methods.

g) RULA.

h) QEC.

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5.5 Jungle Warfare Instructor

The Jungle Warfare Instructor’s role and responsibility involves in training the theory and

practical application of fieldcraft and battlecraft in the jungle environment (Figure 5.5A).

Due to the frequent exposure in the jungle environment, the most common occupational

health hazard that can be encountered for Jungle Warfare Instructors are natural biological

hazards sourcing from the jungle. Some examples of biological hazards in the jungle include:

a) Hazardous bacteria.

b) Hazardous viruses.

c) Hazardous parasites.

d) Hazardous molds, spores and fungi.

e) Animals and insects.

f) Poisonous plants.

g) Disease carried by vectors (mosquitoes and rodents).

Figure 5.5 – Fieldcraft in Jungle Environment

The many possible routes of infection are:

a) Accidental injury (skin contact, cuts, wounds, etc.).

b) Contamination of food and water.

c) Animal and insect bites.

d) Poor personal hygiene.

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The types of harm that can be caused are:

a) Infection.

b) Hypersensitivity / allergy.

c) Inflammatory / irritant effect.

d) Poisonous / toxic effect.

e) Bleeding.

f) Shock.

g) Respiratory arrest.

h) GIT disturbance (vomit, diarrhea, etc.).

i) Physical injury (bites, cuts, wounds, etc.).

The Jungle Warfare Instructors are trained for first aid and to enforce standard precautions

and Safe Work Procedures including frequent routine and culture of taking care of personal

hygiene. They are also trained to identify and avoid biological hazards in the jungle

environment. Nevertheless, incidents still happen such as a case where an instructor is

infected with Leptospirosis from drinking from water contaminated by jungle rodent urine.

Additional medical, technological and organizational solutions can also be applied to limit

the effects of exposure to harmful biological agents at work (Duckiewicz, 2010) such as:

a) Protective vaccinations.

b) Constant medical care and medical checkups.

c) Advanced health education regarding nature of job.

6.0 Question 2

6.1 Definition

Stress is the arousal of an organism as a result of a stimulus from the material or social

environment that is assessed as threatening to its physical or psychological balance to an

extent that exceeds its ability to cope with the problem (Konarska, 2010). Many occupational

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stress theories have been introduced; amongst the most popular ones are Stress performance

Curve (Figure 6.1A), Karasek Job Strain Model (Figure 6.1B), Siegrist Effort Reward

Imbalance Model (Figure 6.1C) and P-E Fit (Figure 6.1D).

Figure 6.1A – Stress Performance Curve

Figure 6.1B – Karasek Job Strain Model

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Figure 6.1C – Siegrist Effort Reward Imbalance Model

Figure 6.1D – Person-Environment Fit

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6.2 Stress Complaints and Findings

There are no official data in KTD that records stress complaints amongst the employees. But

as in any organisation, elements of stress are always present in any working environment.

What should be of concerned are stress elements that cause distress, anxiety and unhappiness.

Based from military doctor’s unofficial survey, personal experience and pass incidents in

KTD, it seems that the drivers from the Logistic Support department are the most distressed.

Among the military vehicles used is the focus-demanding Condor APC as shown in Figure

6.2A.

Figure 6.2A – Rheinmetall Condor 4x4 Armored Personnel Carrier

Among the many causes of driver’s stress, the unofficial main source of stress identified is

due to shift work. The shift work involves unfair rotating shifts, inadequate work-rest ratios,

unpredictable schedules and sleep deprivation due to the demanding nature of work to

provide transportation to the field exercises involved for all the running courses in KTD.

This may cause burnout to the drivers which are hazardous to the driver and others in the

organisation.

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Organisational contributory factors may also cause distress such as work overload, excessive

bureaucracy, poor communication/feedback, role conflict and dead-end jobs. Unrelieved

work stress of the drivers will cause emotional exhaustion, depersonalization and feelings of

reduced accomplishment. Further implications to the driver:

a) Disturb the circadian body rhythm.

b) Desynchronosis.

c) Gastrointestinal problems.

d) Cardiovascular problems.

e) The distressed driver himself as a work related hazard that may contribute accidents

in the workplace such as Figure 6.2B.

Figure 6.2B – Condor Road Accident

Some of the administrative controls that can be applied are:

a) Good management of rotating or variable shifts.

b) Increase the number of drivers.

c) Provide additional health education.

d) Provide counseling.

e) Limit shift work to essential tasks.

f) Encourage good eating habits.

g) Allow adequate meals and rest breaks.

h) Protecting the driver’s sleep periods.

i) Maintain physical fitness.

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j) Driver’s family and friends should be made aware of the potential harmful

consequences of shift work.

k) Driver’s adjust family and social life to maximize interaction.

l) Job enrichment for a better career development.

m) Fair rewards.

n) Empowerment.

o) Feedback and grievance channels.

p) Employee assistance program.

q) Health promotion programs.

r) Autogenic training (relaxation technique).

s) Nootropics (cognitive enhancement supplement).

t) Somatics (awareness practices to promote psycho-physical well being).

u) Religion and spiritual activities.

6.3 Assessment of Stress Issues

Stress issues in KTD are not only experienced by drivers but everyone. There may be other

appointments in KTD with similar or more stressful condition. In order to manage the stress

of the employees, an assessment may be done throughout the workers. There are two

possible approaches for assessing stress:

a) Hire a practitioner psychologist to assess the workers.

b) Use a Risk Assessment for Occupational Stress form to get to assess worker stress

such as in Appendix A (Macbeth, 2010).

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REFERENCE

1. Dr. Rozhan Shariff Bin Radzi. Lecture Notes. 2013

2. Occupational Safety And Health Act 1994 and Regulations. Laws of Malaysia.

3. MS 1722:2011 Occupational Safety and Health Management Systems – Requirements

(First Revision). Department of Standards Malaysia.

4. Guidelines on Occupational Safety and Health Management Systems. Department of

Occupational Safety and Health. Ministry of Human Resource.

5. Koradecka N. Handbook of Occupational Safety and Health. First edition. CRC Press.

2010.

6. Ausbury S. and Ashwell P. Health and Safety, Environment and Quality Audits. First

edition. Routledge. 2011.

7. Reese C. D. Occupational Health and Safety Management : A Practical Approach.

First edition. CRC Press. 2009.

8. Mohd Sadin Misnan, Abdul Hakim Mohammed dan Abdul Rahman Dalib.

Pembangunan Budaya Keselamatan di Tempat Kerja. Edisi pertama. UTM Press.

2011.

9. Yates W.D. Safety Professional’s Reference and Study Guide. First edition. CRC

Press. 2011.

10. Friend M. and Kohn J. Fundamentals of Occupational Safety and Health. Fifth

edition. GI. 2010.

11. Posniak M. and Skowron J. Handbook of Occupational Safety and Health: Chapter 6.

First edition. CRC Press. 2010.

12. Duckiewicz J. Handbook of Occupational Safety and Health: Chapter 19. First

edition. CRC Press. 2010.

13. Konarska M. Handbook of Occupational Safety and Health: Chapter 5. First

edition. CRC Press. 2010.

14. Macbeth E. Risk Assessment for Occupational Stress. University of Essex. 2010.