Exxon Mobil Student Electives Award- Nisha Tailor · Elective Report OHAssist Glasgow 1 Exxon Mobil Student Electives Award- Nisha Tailor I would like to thank the Faculty of Occupational

Elective Report OHAssist Glasgow

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Exxon Mobil Student Electives Award- Nisha Tailor

I would like to thank the Faculty of Occupational Medicine for awarding me the Exxon Mobil

Student Electives Award, which has helped me to fund a placement in Occupational Medicine. I

would also like to thank Dr Andrew Colvin, Consultant Occupational Physician and my location

supervisor, for helping me to organise such a varied and valuable elective.

Introduction:

I am currently a fourth year medical student, and prior to this elective placement, my only

exposure to Occupational Medicine has been a day of introductory lectures into the speciality.

However, I have been surprised by how often, when taking a history, patients talk about how their

illnesses have affected their work, or how work has contributed towards their illness, in addition to

asking when they can return to work. These experiences have contributed towards my interest in

exploring this speciality further.

Aims and objectives:

My primary aim was to learn about opportunities within the speciality of Occupational Medicine,

through my experiences and by talking to members of the multidisciplinary team, to consider

whether this is a speciality which I would like to pursue a career. Additionally, I wanted to learn from

my experiences on placement to encourage me to think about the effect of work on health, and

health on work, across all different medical specialities. I am particularly interested in

musculoskeletal conditions, therefore during my placement I focused especially on the management

of low back pain, one of the most prevalent occupational illnesses, and how this compared to

management in the primary and secondary care settings.

Placement Overview:

I completed a four week placement based at OHAssist Glasgow Office under the clinical supervision

of Dr Andrew Colvin. OHAssist is one of the largest outsourced OH providers in the UK, employing

nearly 300 occupational health practitioners, and offering a range of services including: absence

management, fitness for work assessments, health surveillance, vocational rehabilitation,

diagnostics and treatments. 1

The elective programme was planned to cover all branches of OH, including seeing the role of

occupational physicians, occupational health advisors, occupational therapists, occupational

hygienists, health and safety managers, ergonomists and vocational rehabilitation therapists. The

placement also included some external attachments at the Institute of Occupational Medicine

(Edinburgh), Scottish Power and Rehab Works, and various work site visits to Longannet Power

Station, Whitelee Wind Farm and Royal Mail Delivery Centre.

Elective project- What is the role of occupational health (OH) in the management of low back pain

(LBP) and how does this compare to management in the primary and secondary care setting?

Literature Review and Background:


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Non specific LBP can be defined as tension, soreness and/or stiffness in the lower back region not

attributable to any identifiable specific cause. 2It is a common condition with up to 84% of people

experiencing it at some point in their lives 3. The majority of these cases (90%) resolve in

approximately 6 weeks, whilst the remaining 10% go on to develop chronic LBP which may result in

disability. 4 Around 20% of individuals (approximately 2.6 million people) suffering from LBP consult

their GP for it in the UK.2,5 LBP, therefore, is a great source of burden both economically and

socially. Direct health care costs for the management of LBP include: GP consultations, referrals to

secondary care, pharmacological treatments. 5 In addition to this, LBP incurs many indirect costs, e.g.

costs due to lost productivity at work from sick leave, employee retraining, administrative expenses.

An estimated £11 billion was accounted for by LBP in the UK in 2000. 6

There are many implicated risk factors for LBP. Patient personal factors are very important, for

example, the patient’s health beliefs and expectations regarding the nature of their LBP and its

treatment, and previous episodes of LBP.17 Occupational risk factors can be split into physical and

psychological factors.7Several systematic reviews published in Spine Journal have looked at the

causative association between various occupational activities and LBP.8-15 The occupational duties

examined included: standing/walking, sitting, pulling/pushing, manual handling, lifting/carrying,

bending/twisting, awkward occupational postures. Whilst they did not identify an independently

causative relationship, a cumulative effect of these activities combined with other known risk factors

cannot be excluded. Implicated occupational risk factors for LBP can be summarized in figure 1.

There are, broadly speaking, two strands for management of LBP: 1) in primary/secondary care 2) in

the workplace (occupational health). In May 2009, NICE produced the guidance “Early management

of persistent non-specific low back pain.” 2These guidelines split the management of LBP into patient

education, physical exercise, non pharmacological therapy, pharmacological therapy and surgery.

The Faculty of Occupational Medicine has also produced the document “Occupational Health

Guidelines for the management of low back pain at work (2000)” which identifies key OH areas

which are considered for LBP: background, pre-placement assessment, prevention, assessment and

Occupational Risk Factors for LBP

Physical Factors8-16

standing/walking

sitting

pushing/pulling

manual handling

lifting/ carrying

bending/twisting

awkward occupational postures

Psychosocial Factors7

low job esteem

high workload

monotonous job

working under pressure

Figure 1. Implicated Occupational Risk Factors for LBP


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Patient Education

1 Physical Exercise

2

Non Pharmac-ological Therapy

3 Pharma-cological Therapy

4 Surgery 5

Reduction of Workplace

Risks/Health Promotion and

Surveillance

1

Assessment of Illness and

its Occupational

Impact

2

Vocational Rehabiliation and Return

to Work Advice

3 4 4

Description

-what happened?

Feelings

- what were you thinking and feeling?

Evaluation

-what was good and bad

about the experience? Analysis

- what sense can you

make of the situation?

Conclusion

-what else could you have done?

Action Plan

-if it arose again what would you

do?

management of the worker presenting with back pain, and management of the worker having

difficulty returning to normal occupational duties at approximately 4-12weeks. 17

In my clinical experiences in the NHS, the management of LBP has closely followed the pathway

outlined in the NICE guidance, which is summarized in figure 2. My experiences during my elective

have shown me that OH management of LBP can be summarized according to the categories

outlined in figure 3.

Figure 2. Pathway for management of LBP- primary and secondary care

Figure 3. Pathway for management of LBP- occupational health

Reflective Analysis:

In my reflection, I will apply the first five stages of the Gibbs’ Reflective Cycle18 (Figure 4) to

experiences from my placement, comparing them to my primary and secondary care experiences in

the analysis sections. I will create an action plan based on my collective experiences.

Figure 4. Gibb’s Reflective Cycle


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Reduction of Workplace risks for Occupational Illness/ Health Promotion and Surveillance in the

Workplace

This is an area not routinely covered in the management of LBP in primary/ secondary care in the

NHS; therefore reflection of these elective experiences in OH will not be directly comparable to my

clinical experiences to date. It should be noted however, that all clinicians are responsible for health

promotion when seeing individual patients.

I will reflect on my time at the Institute of Occupational Medicine (IOM), during which, I had

opportunity to talk to an ergonomist. I discussed with him the sort of workplace design adjustments

and recommendations that could be made in order to prevent the onset of LBP. These might

include: use of height adjustable tables, specific chair types such as sit stand chairs, saddle chairs,

and balance chairs. Normal seats should also support the lumbar spine with people sitting at an

angle of around 110 degrees.

Prior to this, I had thought that ergonomics was solely the adaptation of workplace design to

maximise health, and I hadn’t fully appreciated that it involves the interaction of the environment

with the human body. I also hadn’t realised that ergonomists work in such a wide range of industries

and environments, both in design (primary prevention) of working environment and individual

workstation assessment for employees already presenting with musculoskeletal conditions

(secondary prevention). I also learnt that ergonomists have a large role in research too. This

experience was therefore great in helping me to understand the role of the ergonomist. I learnt a lot

about the different types of adaptations and equipment that might be used to help improve working

environment design for employees.

I think it would have also been useful to actually see an ergonomist’s assessment in the workplace in

action, however unfortunately I was unable to do this during my placement at IOM, due to time and

logistical constraints. I did, however, do other relevant site visits where I was able to see ergonomic

principles in practice.

A site visit to the Royal Mail Delivery Centre in Glasgow allowed me to reflect on workplace risks for

LBP, as well as to talk to health and safety managers to look at the measures in place to prevent

onset of LBP. Additionally, this visit allowed me to see some ergonomic principles in practice.

At a Royal Mail Centre, the route a letter takes from postage to delivery involves numerous tasks

which have potential risks for LBP. Mail is collected and arrives at the delivery centre via lorry. On

arrival, 90% of mail is sorted automatically by machines- sorted by parcel size, then 1st and 2nd class

post and finally by postcode. Larger parcels after being sorted manually are loaded into

ergonomically designed containers. These are designed to maintain the device at optimum height

for loading, to avoid injury i.e. waist height, to avoid bending. As the load of the container increases,

the bottom of the device will sink down, so the employee can continue to load the container at waist

height. These devices are being used more frequently than parcel bags which were previously used,

which did require employees to bend to load them, and were known to be related to

musculoskeletal strain.

Those letters which are addressed further away, once sorted, are manually loaded into storage to be

flown to mail centres closer to the location. This loading requires bending, lifting and twisting


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actions, all of which can contribute to LBP. However, the workplace have accounted for this, by

rotating the workers doing these duties every 2-3 hours. Additionally, the pushing of these storage

containers is facilitated as they are on top of specially designed and installed rollers, which requires

only minimal pushing or pulling forces to move even when fully loaded (when they weigh several

tonnes).

I felt grateful to have been allowed on a site visit here, which enabled me to consolidate some of the

ergonomic principles I had learnt about at the IOM. I hadn’t realised how complex the postal sorting

process is, and was surprised to discover how much manual handling is involved, despite a large

amount of the sorting being automated.

This experience was useful in allowing me to put into perspective how a specific working

environment could contribute to pathogenesis of LBP. In addition to seeing the risks, it also allowed

me to see the measures in place to successfully control, eliminate or minimise them, through the use

of employee work rotation, ergonomic design of equipment. The site visit was also important

because it allowed me to see some health promotion strategies in action. For example, in addition to

provision of information, and training about manual handling, RMG also had an onsite gym for their

employees. The exercise facilities help maintain the employees’ general fitness, as well as minimising

the risks of musculoskeletal injury at work, through its use for physical conditioning after illness.

In hindsight, this experience would have been even more beneficial, had I spoken to some of the

employees, to see how they felt about their work duties, and if they had suffered from

musculoskeletal injury. It would have given me their perspective of the efficacy of workplace health

and safety measures to avoid occupational illness.

Assessment of Occupational illness

During the elective, I realised that after triage, many OH assessments were successfully conducted

via telephone by occupational health advisors (OHA), with a minority of complex cases (30%) being

referred onto the occupational physician or other appropriate professional. The first case I will

reflect on was a telephone consultation assessment of LBP undertaken by an OHA (nurse). The

pathway followed by an OH case is summarized in Figure 5.

Mrs X was a longstanding part time employee at a bank, and her work involved helping customers

whilst standing for long periods of time. This was exacerbating her LBP, to the extent that her

symptoms were now severely impacting on her quality of life and she was struggling to walk. Her

assessment concluded that she would no longer be able to work, and she should apply for long term

disability allowance.

I found the telephone consultation to be a new experience, as all the consultations I have

experienced so far in primary and secondary care have been face to face. I did not feel confident

that the same level of rapport could be established by telephone; however I was proved otherwise

during this consultation.

I realised that telephone consultations require special skill, but they can be an appropriate method

of clinical assessment of patients with a variety of different conditions. This method of consulting did

have some advantages, for example, it allows the health care professional to help patients anywhere


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Referral

•Company Referral e.g. manager

•Self Referral (uncommon)

Assessment

•OH nurse assessment-history, further medical evidence requirements, occupational history

Opinion / Recomend-

ations

•health condition and prognosis

• work capability

•return to work

•disability advice

Outcome

•Return to Work

•Ill Health Retirement

•Long term disability allowence

in the country. The disadvantage of not been able to see the patient, was that we could not interpret

the patient’s body language and other non verbal cues as to how they were feeling about their

condition and the recommendations being made. Additionally, we could not be certain that the

employee was in a suitably private environment to be able to talk about their medical condition,

although this is asked at the beginning of the conversation.

Figure 5. Pathway followed by an OH case on referral to OH provider

I will now compare this telephone consultation to a primary care consultation I saw during my

medical school clinical experience. A 24 year old male, Mr A, presented to the GP with LBP which

was a constant dull ache with “muscle spasms”. He was not experiencing any red flag symptoms, and

he said that it had been triggered by his work, lifting in a warehouse. He had experienced back pain

in the past, and it had been relieved by a short course of diazepam. He was also referred to

physiotherapy at this point but he did not attend because the pain had resolved by the time the

appointment came around. On examination, flexion and lateral rotation of the spine were painful,

reflexes were normal. The patient was advised to take up his physiotherapy appointment and

prescribed co-codamol. He was also advised on how to lift safely with his back straight.

This face to face consultation in primary care did have some benefits, for example, it allowed

thorough objective examination of the patient. However, it was clear that the OH telephone

consultation elicited a far more detailed occupational history covering not only what the job was,

but duties that it entailed, the length of employment, if applicable, how much they had been lifting/

how long they were standing for, the patient’s expectations and beliefs regarding the job.

Additionally, the OH consultation was three times as long as the average ten minute GP

OHA triage to decide if a telephone/face

to face consultation is needed or other

referral


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consultation. The outcomes of both consultations were different: the OH consultation resulted in a

recommendation about the patient’s work capability and return to work, whilst the primary care

consultation was more focused on symptom control.

I felt that there was a lot of information to be gathered in the allocated telephone time slot, and the

employee would have had more opportunity to voice any issues, had there been more time

available; however, I realise that this is restricted by the constraints of the OH provider. Outsourced

OH assessments appear to be similar to primary care in that they both are limited by time

constraints. There didn’t appear to be any major omissions caused by the lack of physical contact, in

the telephone assessment.

A second case I will reflect on is an assessment of LBP for eligibility into a functional restoration

programme (FRP) which I attended at Rehab Works. Miss Y, aged 41 years, was referred to OH by

her manager, due to difficulties continuing her work duties as a post office customer service advisor

due to intermittent LBP she had been experiencing for 9years. This role involved standing for long

periods of time as well as walking, lifting especially overhead and some duties at the counter. She

had been in this role for 16years, and had previously used NHS services such as physiotherapy which

had been unsuccessful in restoring function. The rehabilitation assessment lasted for three hours

and included a structured subjective interview, use of evidence based psychosocial questionnaires,

clinical assessment, measurement of strength/ flexibility, work specific functional assessment, and

goal setting.

I was surprised that the assessment lasted for such a long length of time and that the nature of the

questioning was so heavily focused on psychosocial aspects of the condition. For example, the

patient’s understanding of their illness and how effective they feel treatment has been so far, their

coping mechanisms and “blue flags” i.e. employees concerns about work and perceptions of work

and health, and how motivated the patient is to return to work. Important non medical factors, such

as having to pay a mortgage also may influence whether the patient wants to return to work. Miss Y

became quite emotional during the assessment, and I feel that this was partly due the frustration

she was experiencing of having a chronic condition, which was not improving. I felt quite empathetic

towards the patient, because I could see how distressing the condition was for her and how it was

impacting on her work and general quality of life.

The good thing about this assessment was that it was extremely thorough, with a large focus on

psychosocial aspects of the problem. I think that this made the patient feel more involved and that

the health professional was listening to her concerns. The objective functional assessments were

specifically tailored to the tasks that might need to be carried out in the patient’s job, which was

extremely useful in trying to establish a feasible return to work plan. A simple clear target was set at

the end of the assessment e.g. being able to walk around the park comfortably, and I believe that

this had a big impact on the patient, as it gave her something to aim for.

I will compare this consultation to an example I saw in secondary care back pain clinic (Royal

Orthopaedic Hospital). A 53 year old female, Mrs B, had been having LBP for 11 years; she had been

referred due to complex intractable nature of her symptoms, which didn’t seem to fit any pattern.

She was a hospital porter/driver and her work often involved pushing beds etc, which she had begun

to find increasingly difficult. She was also struggling with activities of daily living. Mrs B was referred


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for hydrotherapy (low impact exercises) then physiotherapy to rehabilitate her, and a possible pain

clinic referral.

The nature of these assessments had some overlap, for example, both the assessment of Mrs B and

Miss Y were physiotherapy led and played a large role in addressing patient education and

expectations. However, the OH assessment had a greater focus on patient subjective assessment

through the use of questionnaires such as Tampa Scale of Kinesiophobia, Orebro Musculoskeletal

Pain Screening Questionnaire, Patient Health Questionnaire 9 and Fear Avoidance Belief

Questionnaire, to name a few. The OH assessment seemed to focus on restoration of function

specifically in the context of return to work, whilst the secondary care clinic appeared to be more

focused on symptoms with another secondary care option for treatment being referral to the pain

clinic where other options for the management of pain, in addition to pharmacology are explored,

such as acupuncture and TENS. The secondary care rehabilitation was more aimed to restore

function for home life rather than specifically return to work.

Overall, the assessment for FRP was extremely thorough. I did feel that there were a lot of

questionnaires used in the assessment, which were useful; however, they might be a little

overwhelming for the patient. Additionally, some of these were American questionnaires, which

might have been confusing for the patient. It might have been better to be more selective in those

that the patients were asked to fill out.

Rehabilitation

I will reflect on a functional restoration programme (FRP) class for rehabilitation of MSK illness,

which I attended. Unfortunately the cases I saw were not LBP, so I will use the rehabilitation of a

postman post hip surgery, Mr Z, as an example. The same principles used in this case many also be

applied for LBP.

Patients go through a 6 week course of FRP, attending for a full day each week, which is run in

conjunction with a return to work plan. At the beginning of each session, the patients identified

personal, work and exercise goals that they would like to achieve. The morning involved an

educational session- the one I attended was called “work and lifestyle”. It focused very much on how

to maintain a healthy lifestyle and how this could benefit and facilitate an easier return to work.

There was also a graded exercise programme including: 20 minute aerobic warm up, condition

specific functional circuit, and 10 minute aerobic cool down. The afternoon consisted of a psycho-

social based discussion, and a repeat of the mornings exercises. The patients were also given

exercises to do at home using resistance bands, to create some overlap between home and class

rehabilitation.

The only aspects of the day which would have differed for LBP were the condition specific functional

circuits. A discussion with the specialist physiotherapists informed me that for LBP, exercises would

focus especially on stretching (flexibility) and core strength using a lot of floor work such as a plank,

bridge, single extension hold, swiss ball sit ups, squats. It would also involve work with weights such

as narrow row and lat pulldown.

I was impressed by how tailored the exercise programme was for specific vocation, as many

prescribed exercises tried to mimic work duties. For example, Mr Z was a postman, and his duties


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consist of: sorting mail and parcels, loading vans, and delivery rounds. Mr Z was taught the correct

way in which to carry the bag, to distribute weight equally across the body. He was then given step

up exercises whilst carrying the 11kg postman bag, mimicking climbing steps on a delivery round.

Prior to the class, I had not realised how draining and intensive the day would be for the patient, not

only due to the physical exercises but also by participation in the education sessions.

I think that the education sessions worked well and had a great impact on Mr Z, as he had seen a lot

of specialists, whom had given him different information regarding his condition, which he found

confusing. These sessions helped to clarify his understanding. The afternoon psychosocial

discussions over the 6 weeks covered: coming to terms with my condition, improving function, stress

and pain, treatment for pain, what do I think about my condition, worries and concerns. This was

useful in helping address issues such as fear avoidance. Mr Z told me that previously he had been

worried to do certain activities with his hip, for fear of injuring it further, however these sessions had

helped to build his confidence, and lessen his concerns regarding how to exercise safely. I found the

best part of this programme was that it runs alongside a phased return to work programme. Mr Z

had noticed an improved in his function over the programme, and had been glad of the phased

return, as he felt he would not have been able to go straight into full duties. One pitfall was that the

patients identified for this programme must be assessed properly, because it only works if the

patient engages in it. For example, if the patient doesn’t have the motivation to continue their

exercises at home, then they will not get the maximum benefit out of the programme.

To analyse this case further I will compare it to my experiences of rehabilitation for LBP at the Royal

Orthopaedic Hospital (ROH). Rehabilitation in the NHS and in OH does have similarities. For example,

many patients in primary and secondary care are offered physiotherapy sessions of around 30

minutes per week. These sessions cover some of the same exercises covered in the FRP class,

however not the vocation specific activities. Additionally, at the ROH, they do run FRP classes similar

to the one I attended, also run by specialist physiotherapists. However, I think that these are

reserved for extremely complicated cases not helped by ordinary physiotherapy sessions, and

additionally, they are not matched against a return to work programme.

Overall, I feel that although some rehabilitation is offered in primary and secondary care, it is less

intensive than that which I experienced in OH, with the primary aim being return home, as opposed

to return to work. Additionally, there was a greater focus on education in the FRP compared to

physiotherapy. It is also clear to me that the employee’s line manager/company can exert a positive

influence of patient’s behaviour with regard to return to work, therefore encouraging engagement

with the FRP course, especially if there is a threat to employment if there is no further improvement

in the patient’s condition or illness.

Sickness Absence, Return to Work, Ill Health Retirement/Long Term Disability Benefit

I will reflect on an assessment for IHR which I went through with a pension’s doctor. Mr C was a

50year old full time dentist. He had made an application for IHR due to his continuing LBP which had

been exacerbated by the nature of the awkward postures having to be adopted by his occupation.

There was continued functional decline with increasing sickness absences despite working hour

adjustments. The application is divided into three sections: 1) to be completed by the employer

about the applicant’s job role and sickness absence history 2) to be completed by the applicant 3)


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medical review- IHR can only be successful is all reasonable and appropriate available treatment and

management options for the employee’s medical condition have been exhausted.

In this case, the assessment didn’t involve a face to face consultation with the employee, as the

medical consultation had been carried out by an independent physician. So the application form and

all the medical evidence had to be reviewed to make an objective assessment. The application is

based on a tier system. Tier 1-the employee is unfit to carry out their current job role. Tier 2- the

employee is unfit to carry out any role. The pensions doctor felt that the patient fit the criteria for a

tier 2 IHR.

The impact of an IHR assessment on a patient is large, as the doctor is making decisions which could

have financial implications for them, and I learned that the doctor needs to be very thorough in

making the objective assessment. The good thing about the assessment was that I was able to apply

what I had learned in some OH assessments I observed, to this experience, to follow a case through.

I think that I should have improved my experience by sitting in some more face to face assessments

for IHR as well.

Assessment for IHR is not routine in primary and secondary care, however, a lot of the medical

information is based on assessments by GPs and hospital physicians. Additionally, both GPs and

hospital physicians play an important role in assessing fitness for work and completing “fit notes”

(previously called “sick notes”) for patients after 7 days of sickness absence. Fit notes may give

advice such as: phased return to work, altered work duties and workplace adaptations. 19The

occupational physician is often involved in fitness to work assessments, and may give advice similar

to those that can be written on a fit note. However, the occupational physician appears to be better

placed to understand the exact nature of the employment that the employee is returning to.

Overall, both primary care/hospital doctors and occupational physicians are involved in assessing a

patient’s fitness for work. However, the occupational physician has a duty to provide support and

advice to employers as well as the patient (employee) regarding their sickness absence. IHR is dealt

with specifically in OH for many organisations/industries.

Action Plan (from my collective reflective experiences)

As a doctor, in whichever speciality I eventually choose, I will now have more of an awareness of the

importance of work in a patient’s life. I will, where appropriate, take a good occupational history,

taking care to establish not only what their job title is, but actually what their duties involve, because

I have learnt throughout the duration of this placement that the same job title might mean different

things to different people. This will enable me to consider any work related factors contributing to

the causation of illness. I will listen to the patient’s concerns and expectations in order to

understand the impact their condition and its management have had on their work capability and

quality of life, and therefore tailor management appropriately to enable them to return to work as

soon as possible.

Site Visits and External Attachments:

I found the site visits to be very interesting because they enable you to see medical and health

principles in a completely different setting to the hospital.


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Longannet Power Station

Longannet Power Station is the second largest coal fired power station in the UK, located in the

north shore of Firth of Forth. There are around 250 employees working there distributed

approximately as follows: 50 management, 70 production staff mainly working in the boiler house

and turbine hall (on rotating shifts), 70 maintenance and 60 administrative.

Coal is delivered to Longannet by rail or on the Clyde coast. Coal chunks are pulverized to fine

powder in the mills. The fine powder is burned at very high temperature in the furnaces; this boils

water in the boiler to steam. The force of the steam turns the turbines and the turning of the coils of

the generator creates electricity. Steam is condensed back to water and is pumped into the Forth of

Firth.20

I am very fortunate to have been granted a site visit to Longannet Power Station, especially as coal

fired power stations might be replaced with more renewable energy in the future. It proved to be an

invaluable experience for me, as understanding the working environment is essential in being able to

provide successful occupational health care. I was surprised by the working environment, especially

how many hazards there were, including dusts, steam, heat and noise to name a few. I was very

impressed by how the risks to health and safety were successfully controlled by careful planning and

good multidisciplinary teamwork and management efforts to ensure a safer working environment. It

was interesting to see the protective and preventative measures in place, such as the use of personal

protective equipment (PPE). During my visit, I had to wear safety boots, protective overalls, hard

helmet, safety goggles, ear plugs and gloves.

The power station was built in the 1960’s using the latest technology of the time, and had a planned

life of 25 years, which has now been extended. At this time, asbestos containing materials were

often used in construction. We are now aware that asbestos is a risk to health, in dust form, with

potential long term complications including lung carcinoma and mesothelioma. I found that at

Longannet, the health culture in the workplace was excellent. The employees were all very aware of

the risks of asbestos, and work stops immediately if there was an incident thought to be related to

asbestos. Additionally, there was a member of the IOM on site, to deal with any potential incidents

by doing air monitoring and taking samples for examination in the laboratory.

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Whitelee Wind Farm

Whitelee Windfarm is situated in Eaglesham Moor. It is the largest onshore windfarm in the UK, with

215 turbines each standing at 110 metres tall, and capable of generating 2.3 megawatts of

electricity. Prior to construction, careful wind analysis studies were carried out, so that the turbines

could be positioned optimally to produce the most energy. The blades of the turbine of made out of

special fibreglass. They rotate in the wind and are connected to a generator which creates the

electricity. The electricity is transported via underground cables to the substation, before it is

connected to the national grid.

There are approximately 60 employees on site- around 30 maintenance and 30 administrative. The

role of the maintenance staff involves climbing up the wind turbines by ladders bolted into the

inside of the turbines, to solve any issues with them; therefore the biggest risk is from the height at

the top of the turbines. It is important for the these employees to undergo fitness to work medicals

especially to assess any illness which might increase the risk of a fall such as epilepsy or diabetes,

and their general physical health, as the climbing is a physically demanding requirement of the job.

Additionally, when these employees are climbing the turbines, they have to wear protective gear

such as gloves, overalls, harnesses.

Whilst on this site visit, I also had opportunity to have a tour around the control rooms. I was

particularly impressed with the design of the rooms as they employed good principles to minimise

workplace ill health. For example, they used ergonomic design such as sit stand tables and an

optimum number of screens per table, large windows to maximise natural light entry, quiet

environment with minimum clutter.

Royal Mail Delivery Centre Glasgow

The Royal Mail Group Glasgow employed around 600 workers- including workers in the delivery

centre, and those driving royal mail vehicles. Earlier, I reflected on my experiences at the Delivery

Centre Glasgow from the perspective of LBP prevention and management; however I was also given

the opportunity to talk to the health and safety managers there, who gave be a good insight into

how they managed their sickness absence, and at what stage they referred employees to

occupational health. I was surprised that referrals were made so early, in some cases, after just 7

days. I thought that this was really useful, because it allowed employees to get help earlier, and if

appropriate be referred to rehabilitation services, so that it optimised and facilitated an easier

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return to work. Overall, this visit was useful in helping to highlight some key OH principles which I

have learnt about throughout the duration of my elective.

Institute of Occupational Medicine

The Institute of Occupational Medicine is an internationally recognised leader in occupational health

research and consultancy e.g. providing services such as occupational hygiene and ergonomics to

different industries, to do workplace assessment and make recommendations. It was established in

the 1969. 22

During my time there, I was able to spend some time with their occupational hygienists and

ergonomists. Earlier, I discussed my time with an ergonomist. From this experience, I also learnt a lot

about what occupational hygiene involves- including the methods that can be used in the evaluation

of workplace hazard and risks, and some of the recommendations that they could make. A tour of

the IOM laboratory, allowed me to see some of the equipment that could be used in sampling of

hazards in the workplace e.g. measuring of air quality using different filters. I also learnt about the

methods employed to analyse samples, such as mass spectrometry and chromatography to name a

few.

Personal protective equipment has to undergo testing, usually for one of three reasons 1) for

accreditation prior to implementation 2) quality assurance 3) if an aspect of the clothing wanted to

be changed. I was able to learn about this process by seeing it in action- the testing of chemical

protective clothing. Prior to this experience, I hadn’t appreciated how rigorous the testing process

for PPE is. The chemical protective clothing had to be worn, and it was tested by firing dyes at it (as a

substitute for chemicals which would have been used in the actual workplace) in controlled

conditions. I also learnt that the protective clothing should protect the employee whilst in use, but

also on removing the clothing i.e. none of the dye should drip onto the person on removal of the

clothing. On this occasion, the IOM were specifically testing the protective clothing against

chemicals. However, protective clothing can also be tested against other conditions such as

abrasion, puncture, tear, flammability.

In addition to this, I was able to discuss the IOM’s upcoming research projects in occupational health

with their scientists, particularly with regard to their research into the health effects of

nanomaterials from the workplace. Nanomaterials can be found in a diverse range of industries e.g.

electrical, manufacturing, and construction. They are a relative new advance, and as such there is a

lot of uncertainty about their properties. There is concern that some nanomaterials might have

similar toxicology to that of asbestos. Nanomaterials are currently regulated under the same

regulations as other chemicals- Control of Substances Hazardous to Health (COSHH).

My time at the IOM allowed me the opportunity to see a completely different branch of

occupational health. It was extremely useful in helping me to understand just how diverse this

speciality is.

Conclusion:

By reflecting on my experiences, I have learnt a lot about the main principles of OH. The use of LBP

as an example has enabled me to learn about the role of the full MDT in management of work-


14

related conditions, and has helped me to meet my original educational objectives for this elective.

Following this placement, I am going to continue considering and researching Occupational Medicine

as a speciality I would potentially consider pursuing as a career.

Abbreviations:

FRP-functional restoration programme

FOM-Faculty of Occupational Medicine

GP-general practitioner

IHR- ill health retirement

IOM- Institute of Occupational Medicine

LBP- low back pain

MSK-musculoskeletal

NHS-National Health Service

NICE- National Institute for Health and Care Excellence

OH-occupational health

OHA-occupational health advisor (occupational health nurse)

PPE- personal protective equipment

RTW- return to work

RMG- Royal Mail Group

ROH- Royal Orthopaedic Hospital

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http://www.fom.ac.uk/publications-policy-guidance-and-consultations/publications/faculty-publications

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http://www.iom-world.org/about-us/

http://www.iom-world.org/about-us/

Exxon Mobil Student Electives Award- Nisha Tailor · Elective Report OHAssist Glasgow 1 Exxon Mobil Student Electives Award- Nisha Tailor I would like to thank the Faculty of Occupational

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