MEDICAL SURVEILLANCE PROCEDURES MANUAL AND …

1 Navy and Marine Corps Public Health Center Technical MANUAL NMCPHC-TM OM 6260 AUGUST 2015. (Revised 10/6/2021). MEDICAL SURVEILLANCE . PROCEDURES MANUAL . AND. MEDICAL MATRIX. (EDITION 12). NAVY AND MARINE CORPS PUBLIC HEALTH CENTER. BUREAU OF MEDICINE AND SURGERY. MEDICAL SURVEILLANCE PROCEDURES MANUAL AND MEDICAL MATRIX. Published By NAVY AND MARINE CORPS PUBLIC HEALTH CENTER. OCCUPATIONAL AND ENVIRONMENTAL MEDICINE (OEM) DIRECTORATE. 620 JOHN PAUL JONES CIRCLE, SUITE 1100. PORTMOUTH, VIRGINIA 23708-2103. August 2015. PREFACE. This 12th Edition of the MEDICAL SURVEILLANCE PROCEDURES MANUAL and OEM MEDICAL Matrix is the result of collaborative efforts and work by a group of subject matter experts from across the Department of Defense. It is a dynamic document that has been built on the efforts of Occupational and Environmental Medicine professionals for almost 25 years.

2 NMCPHC OEM would like to thank everyone who contributed thoughts and recommendations to the update of the Matrix Program. The NMCPHC Staff responsible for this update of the MEDICAL Matrix MANUAL and MEDICAL Matrix Online (formerly PC Matrix) include: Alan Philippi, CAPT, MC James R Pate, CDR, MC Paul Seeman, CDR(Ret), MC. John Muller, MD Lori O'Berry, RN Robert C. Edwards, CIH. Joshua Newell, BSCS. For changes from the 11th edition of the Matrix, see C8. Revisions and Improvement of the Matrix. This document will be regularly updated. The latest version may be found on the Navy and Marine Corps Public Health Center, Occupational and Environmental Medicine Department website at the following URL: medicine/oemd/ Reviewed and approved _____. Alan Philippi, MC, USN. By Direction NMCPHC-TM OM 6260. TABLE OF CONTENTS. Chapter 1 - Matrix Development History C1.

3 Matrix Development 1. MEDICAL Matrix 1. Further Development of the 1. Explanation of 1. Limitations of Matrix 2. Chapter 2 - Occupational MEDICAL SURVEILLANCE C2. Occupational MEDICAL 3. General Duty 3. OMS and Disease 3. Risk Based 3. MEDICAL Certification 4. Components of 4. 4. Chapter 3 - Sources of Guidance in Determining Matrix Programs and Elements C3. Sources of Guidance in Determining Matrix Programs and 5. Hierarchy of Authoritative 5. Safety 5. Chapter 4 - Types of Occupational MEDICAL Examinations C4. Types of Occupational MEDICAL 6. Baseline Examination (Pre-Placement or Pre-Assignment).. 6. Periodic 6. Termination 6. Situational 6. Standard 6. Chapter 5 - Placement of Workers in MEDICAL SURVEILLANCE Programs C5. Placement of Workers in MEDICAL SURVEILLANCE 7. Special 7. Exception to Risk Based 7. Using the SF-600 7. Chapter 6 - Certification Exams of Special Interest C6.

4 Certification Exams of Special 8. Vehicle 8. Police and Security 8. 9. Screening for Tuberculosis (TB) for Firefighters (707), Healthcare Workers (719), Childcare Workers (703), and Silica Workers (187).. 9. Chapter 7 - Disqualification of Workers and Candidates C7. Disqualification of Workers and 11. Description of Job 11. MEDICAL and Physical 11. i NMCPHC-TM OM 6260. Definitive and Presumptive Evidence of Qualification or 11. MEDICAL Qualification Determinations: Guidance for Occupational Health 12. Determining MEDICAL 12. Additional Tests and 12. Requesting Additional MEDICAL 12. Reviewing 13. Fitness for Duty 13. Chapter 8 - Revisions and Improvement of the Matrix C8. Revisions and Improvement of the 14. Revisions from MEDICAL Matrix 14. Improvement of the 14. Chapter 9 - References C9. 16. Chapter 10 - Chemical Stressors C10. Chemical 18.

5 18. 2-ACETYLAMINOFLUORENE 19. ACRYLAMIDE 21. ACRYLONITRILE (VINYL CYANIDE) 22. ALLYL CHLORIDE 24. ALPHA-NAPHTHYLAMINE 26. 4-AMINODIPHENYL 28. ANTIMONY 30. ARSENIC 32. ASBESTOS CURRENT WORKER 34. ASBESTOS PAST WORKER 37. BENZENE 39. BENZIDINE 41. BERYLLIUM 43. BETA CHLOROPRENE 50. BETA-NAPHTHYLAMINE 52. BETA-PROPIOLACTONE 54. BIS-CHLOROMETHYL ETHER 56. BORON TRIFLUORIDE 58. 1,3-BUTADIENE 60. CADMIUM (CURRENT EXPOSURE) 62. CADMIUM (PAST EXPOSURE) 66. CARBON BLACK 70. CARBON DISULFIDE 72. CARBON MONOXIDE 74. CARBON TETRACHLORIDE 76. CHLOROFORM 78. ii NMCPHC-TM OM 6260. CHROMIC ACID/CHROMIUM (VI) 80. COAL TAR PITCH VOLATILES/POLYCYCLIC AROMATIC. HYDROCARBONS 82. COBALT 84. CRESOL 86. 1,2 DIBROMO-3-CHLOROPROPANE (DBCP) 88. 3,3'-DICHLOROBENZIDINE 90. 4-DIMETHYLAMINOAZOBENZENE 92. DINITRO-ORTHO-CRESOL 94. DIOXANE 96. EPICHLOROHYDRIN 98. ETHOXY AND METHOXY ETHANOL 100.

6 ETHYLENE DIBROMIDE 102. ETHYLENE DICHLORIDE 104. ETHYLENEIMINE 107. ETHYLENE OXIDE 109. FLUORIDES (INORGANIC) 112. FORMALDEHYDE 114. FREON (HALOALKANE) WORKERS 117. GLYCIDYL ETHERS 119. HYDRAZINES 121. HYDROGEN CYANIDE/CYANIDE SALTS 124. HYDROGEN SULFIDE 126. HYDROQUINONE (DIHYDROXY BENZENE) 128. ISOCYANATES 130. LATEX 132. LEAD (INORGANIC) 134. MANGANESE OXIDE FUMES 137. MERCURY 139. METHYL BROMIDE 142. METHYL CHLOROMETHYL ETHER 144. 4,4'-METHYLENE BIS (2-CHLOROANILINE) (MOCA) (ALSO MBOCA). 146. METHYLENE CHLORIDE (DICHLOROMETHANE) 148. 4,4'-METHYLENEDIANILINE (MDA) 151. NICKEL CARBONYL 153. NICKEL (INORGANIC) 155. 4-NITROBIPHENYL 157. NITROGEN OXIDES 159. NITROGLYCERINE 161. 2-NITROPROPANE 163. N-NITROSODIMETHYLAMINE 165. ORGANOTIN COMPOUNDS 167. ORTHO-TOLIDINE 170. iii NMCPHC-TM OM 6260. ORTHO-TOLUIDINE 172. OTTO FUEL II AND OTHER ALKYL NITRATE PROPELLANTS AND.

7 EXPLOSIVES 174. POLYCHLORINATED BIPHENYLS (PCB) 177. SILICA (CRYSTALLINE) 179. STYRENE 184. SULFUR DIOXIDE 186. 1,1,2,2 TETRACHLOROETHANE 188. TETRACHLOROETHYLENE (PERCHLOROETHYLENE) 190. TETRYL 192. TOLUENE 194. 1,1,1 TRICHLOROETHANE (METHYL CHLOROFORM) 196. TRICHLOROETHYLENE 198. VINYL CHLORIDE ANY EXPOSURE (CHLOROETHENE) 200. VINYL CHLORIDE 10+ YEARS EXPOSURE (CHLOROETHENE) 202. XYLENE 204. Chapter 11 - Physical Stressors C11. Physical 206. Introduction and 206. Physical 206. Significant 206. 206. COLD 207. HEAT 209. NOISE 211. NOISE - FOLLOW UP OF STS (#1 AND/OR #2) 213. RADIATION - IONIZING 215. RADIATION - LASER (CLASS 3B & 4) 216. VIBRATION, HAND-ARM 219. WHOLE BODY VIBRATION 222. Chapter 12 - Mixed Exposures C12. Mixed 224. Introduction and 224. Mixed 224. Significant 224. 224. ACID/ALKALI (PH< > ) 225. ANESTHETIC GASES 227.

8 ANIMAL ASSOCIATED DISEASE 229. HAZARDOUS DRUGS 233. HERBICIDES 236. MANMADE MINERAL FIBERS 238. METAL FUMES 240. METALWORKING FLUIDS 242. iv NMCPHC-TM OM 6260. MIXED SOLVENTS (VOLATILE ORGANIC COMPOUNDS) 244. ORGANOPHOSPHATE/CARBAMATE COMPOUNDS. (ACETYLCHOLINESTERASE INHIBITORS) 246. WOOD DUST 248. Chapter 13 - Specialty Examinations C13. Specialty 250. Introduction and 250. Specialty 250. 250. AVIATION 251. BARBER AND BEAUTY SHOP EMPLOYEES 252. BLOOD AND/OR BODY FLUIDS 254. CHILDCARE WORKER 257. DIVER/HYPERBARIC WORKER 261. EXPLOSIVES HANDLER and EXPLOSIVES MATERIAL HANDLING. EQUIPMENT OPERATOR 263. EXPLOSIVES VEHICLE OPERATORS 266. FIREFIGHTER (COMPREHENSIVE) 268. FORKLIFT OPERATOR / MATERIAL HANDLING EQUIPMENT 274. HAZARDOUS WASTE WORKERS AND EMERGENCY RESPONDERS. 278. HEALTH CARE WORKERS (HCWS) 282. MOTOR VEHICLE OPERATOR (OTHER THAN DOT) 285.

9 MOTOR VEHICLE OPERATORS (DOT) 288. NAVAL CRIMINAL INVESTIGATIVE SERVICE 290. OCONUS DEPLOYMENT GREATER THAN 30 DAYS 293. POLICE/SECURITY WORKER 295. RESPIRATOR USER CERTIFICATION 300. RESPIRATORY SENSITIZERS (COAST GUARD) 303. SUBMARINE DUTY 306. WASTEWATER/SEWAGE WORKER 308. WEIGHT HANDLING EQUIPMENT (MANAGEMENT OF) 309. WELDERS/BRAZIERS/NON-DESTRUCTIVE INSPECTION TECHS. 312. Chapter 14 - Physician Opinion Letters C14. Physician Opinion 314. v NMCPHC-TM OM 6260. Chapter 1: C1. Matrix Development History MEDICAL Matrix Committee The MEDICAL Matrix Validation Committee was formed in March 1988. Its tasking was to review existing OMS and design a program that would define hazard-based MEDICAL SURVEILLANCE . The goal of the Committee was to develop standard examination protocols for MEDICAL SURVEILLANCE programs that could be presented in a useable format.

10 The original Matrix was published as a Navy and Marine Corps Public Health Center (NMCPHC, previously the Navy Environmental Health Center) Technical MANUAL in January 1989. The MEDICAL Matrix Committee continues to review existing programs and to evaluate the need for and write new programs for those stressors that have adverse health effects. Further Development of the Matrix Previous editions of the Matrix were in two parts: a document called the MEDICAL Matrix and a software program called PC Matrix. PC Matrix was used to produce a single MEDICAL record entry (an SF-600 overprint) that included all the pertinent elements from one or many MEDICAL SURVEILLANCE programs applicable to each patient. The Matrix Committee determined the contents of the MEDICAL Matrix, and the PC Matrix was programmed to include the MEDICAL Matrix information.