Q&A With The Experts

Respiratory Protection

Written by Joel Blanchard, MD, executive medical director

Q. What is the purpose of the Occupational Safety and Health Administration (OSHA) Respiratory Protection Program?

A. The primary objective is to protect employees from exposure to air with insufficient oxygen or hazardous contaminants, including dust, fog, smoke, mist, fumes, gases, vapor or sprays. OSHA requires employers to provide respiratory protection to prevent lung disease and potential death.  

Q. How is a respiratory protection program developed?

A. The employer designates an administrator who is responsible for the company’s program and assesses the worksite for potential risks. Safety engineering is used to prevent unnecessary exposure. If risk still cannot be avoided, a full program must be started.

Q. What constitutes an effective respiratory protection program?

A. An effective program comprises: 

  • Using National Institute for Occupational Safety and Health (NIOSH)-approved respirators
  • Medical evaluations
  • Ongoing maintenance
  • Respirator fit testing
  • Training
  • Written procedures
  • Work surveillance 
Learn more at www.osha.gov.

For additional information, read this article on seven respiratory hazards: https://ohsonline.com/articles/2018/07/01/seven-respiratory-hazards.aspx?admgarea=news.

Winter Slips and Falls

Written by Clayton Van Balen, Employee Health Director

Q: How can I protect myself from winter’s slips and falls? 

A: This time of the year can bring an increase in injuries caused by slips and falls.

According to the 2015 Bureau of Labor Statistics, a total of 2,905,900 injuries were reported, with 238,610 of those involving falls, slips and trips. These specific injuries can lead to concussions, sprains and strains, as well as fractures of ankles, hips, pelvis, spine and wrists. 

To help prevent these injuries, be aware of hazards that increase the risk of slips such as liquid on the floor. Other common areas where falls occur are sidewalks and parking ramps. I encourage the use of proper footwear and apply sand and salt to areas as needed. I also recommend using appropriate passageways. One of the most significant ankle fractures I have seen occurred when an individual cut across the grass, rather than use the side walk. 

An action that may only take a minute to perform may save months of recovery. 

Designated Provider

Written by Joel Blanchard, MD, executive medical director at Sanford Health Bismarck

Q: What is a designated medical provider (DMP)?

A DMP is a medical provider, facility or health care system selected by an employer to treat employees’ work-related injuries. The DMP and the employer partner to establish a relationship focused on improving injury care for the worker. This relationship is better if established prior to an injury to ensure the injury care philosophy of the DMP and employer match.

Q: Why choose a DMP?

Injuries are expensive for employers. Lost time from work and restrictions are costly and make it more likely for the injured worker to become disabled long term. The DMP helps decrease unnecessary medical expenses and prevent long-term disability by:

  • Providing prompt, appropriate care to the injured worker
  • Using a strong stay-at-work philosophy incorporating the job into the recovery process
  • Actively communicating with the employer
  • Ensuring the worker can safely perform duties
  • Focusing on the injured worker’s abilities versus disabilities

Job Descriptions

Written by Grant Judah, senior physical therapist at Sanford Health Occupational Medicine Clinic Bismarck.

Q: What is the purpose of an accurate job description?

A: An accurate job description is a crucial resource for employees and employers alike. A well-defined job description, or job function description, needs to be a credible document that objectively defines work expectations for a specific position. An outline of work expectations is especially important for physically demanding jobs, as injuries are more likely to occur during strenuous tasks.

A job function analysis can be used to determine the essential physical demands of a job, which can then be explained in a detailed job function description. The ability to identify and document the essential functions of a job can be an employer’s most effective tool for the prevention of work-related injuries, but a job description can also be helpful if an injury does occur. During the injury management process, the job description can act as a definitive reference document for the employer, injured worker, physician and worker’s compensation insurance provider involved in the case.

Employers with well-defined job function descriptions also have the opportunity to administer post-offer employment testing, allowing the company to become more active in managing future workplace injuries.

A job description is the foundation for establishing standardized job function tests. A job function test physically replicates the requirements of a job for new hires, transfer employees and employees returning to work post-injury or after an extended leave of absence.

Accurate job descriptions are a great way to invest in solid injury management policies that support the safety of employees and the success of a company.

Injuries at Work

Written by David Saxon, MD, occupational medicine.

Q: What do I do if my employee is injured at work?

A: First, make sure your employee is in no further immediate danger. Their supervisor should ensure that the employee is safe and conscious. If the injury is not life threatening, then your employee should make an appointment to see your preferred health care provider as soon as possible. After a work-related injury occurs, you and your employee should work together to file a First Report of Injury (FROI) with North Dakota Workforce Safety & Insurance (WSI) within 24 hours. You can do this after medical treatment is received. WSI requires you, as the employer, to file a FROI form no later than seven days after receiving notice of an injury.

A health care provider with occupational medicine experience will know the worker’s compensation requirements and OSHA standards you’ll need to consider. With the best interests of your employee and the company in mind, your health care provider will determine the best treatment plan. Conservative treatment with over-the-counter medications, ice, heat, home stretching and exercises can resolve many injuries. Physical therapy and chiropractic care are other treatment options that your provider might recommend. You can help support your employee’s recovery by staying informed about their healing progress.

Injuries are part of work, but with good injury management and communication they should only be a temporary inconvenience.

Post-Off Employment Testing

Q: How do I begin a post-offer employment testing program and what are its benefits?

A: Companies use post-offer employment testing (POET) to verify employees can meet the essential functions of a job as a conditional offer of employment. The test includes the physical job demands that an employee must meet to perform the job safely.

One of POET’s major benefits is injury prevention. Fitting the right person to the right job can decrease workers’ compensation claims and lost work time. A POET program can also help the employer determine if reasonable accommodations can be made for workers who are unable to complete all essential functions of the job. Employers may have other positions available and may offer another job with more appropriate physical demands.

If an employee does sustain a workers’ compensation injury, a POET program can assist in accurately identifying which portions of the job an employee can safely perform under restricted conditions. Additional lost work days are avoided if this earlier return to work is possible.

A first step to establishing a program is to consult with an occupational medicine provider who is able to measure the job through Job Analysis. Upon completion of a Job Analysis, the provider will be able to produce an accurate Functional Job Description with corresponding post-offer employment testing for each measured job. Post-offer testing can be performed at facilities able to carry out the testing. In addition, most occupational medicine providers who perform Job Analysis will also be able to carry out post-offer testing.

Reduce Worker's Compensation and Health Care Costs

Written by Stephanie Murdock, MBA, MSN, COHM

Q: How can we reduce workers’ compensation and health care costs?

A: The short answer is to align those efforts as one strategy.

In most cases, injury and health care claims data will reveal the value of working on injury prevention and wellness programs together rather than as separate interventions. Protection of a worker’s health as it relates to occupational injury and exposure remains the primary goal of safety programs. Health protection programs become significantly improved when including a focus on health promotion in workers. Health and safety together are key drivers of productivity and safety. The behaviors in the home environment translate to the work environment as well as the reverse. The company culture can play a central role in advancing prevention, promoting the company’s bottom line and improving the overall health of the community.

To get started:

  • Assess both work related and non-work related data for trends.
  • Establish a baseline health report of the workforce.
  • Identify top risks or opportunities across all data sets and develop priorities. For example, strengthen programs when data indicates an increased risk of incidents.
  • Ensure alignment of safety and benefits programs across the company.
  • Strongly recommended: develop a strong partner with your company’s occupational medicine provider; the physician should be willing to review all the data with you and assist in identifying priorities, areas to focus and ways to decrease injury and cost.

Influenza Protection

Written by Joel Blanchard, MD

Q: What is influenza and how can I protect myself?

A: Influenza is an acute respiratory infection caused by influenza A or B viruses. It occurs every year, mainly in the winter season. Symptoms include fever, headache, muscle ache and weakness.

Among healthy individuals, influenza is usually uncomplicated. However, in high-risk populations (elderly and infants) influenza may lead to disability and death. Also certain variant strains of influenza such as H1N1, H3N2 and H7N9 cause increased chance of disability and death.

Influenza is spread through secretions of the respiratory tract by coughing and sneezing. Children get influenza more often than adults and are a major factor in spreading the disease.

Influenza viruses change their genetic information frequently. These changes can lead to pandemics such as the H1N1 pandemic of 2009. That is why, each year the influenza vaccine must be changed to provide protection from the current strain of influenza.

The most effective way to prevent getting sick from influenza is to obtain the flu vaccine every year. Although, the vaccine does not provide total protection, it gives you the best line of defense. If you do get influenza, the vaccine may also reduce how sick you get.

Early prevention is essential as flu season can begin as soon as October, and runs all the way through May. The only vaccine recommended is the flu shot. The nasal spray (Flumist) is no longer recommended as it has been shown to provide significantly less protection compared to the flu shot.

FMCSA-Mandated Changes to the DOT Exam

Written by Joel Blanchard, MD

Q: How will my company and my employees be affected by the FMCSA-mandated changes to the DOT exam?

 A: Effective April 20, 2016, the FMSCA will implement changes to the existing DOT form. Starting on this date, medical examiners (ME) are required to use the revised Medical Examiner’s Report (MER) Form MCSA-5875, new Medical Examiner’s Certificate (MEC) Form MCSA-5876 and CMV Driver Medical Examination Results Form MCSA-5850*.

What this means for your employees:

  1. The ME must give qualified drivers a paper copy of the MCSA-5876 form to provide to their employers and government enforcement officials. 
  2. A new status has been added to the exam: Determination pending. This status allows the ME up to 45 days to obtain more information to determine qualification. Drivers with this status may continue to operate a CMV if they have a valid MEC.
  3. The ME or staff must record what type of government-issued photo ID was used to verify the driver’s identity (e.g. CDL, driver’s license, passport).
  4. Drivers are required to have a new examination when their MEC expires, regardless of the length of the MEC.


What this means for your company:

  1. A full DOT examination and charge is required once your driver’s MEC expires, even for short-term certificates.
  2. A driver with determination pending status can only drive if the previous MEC is still valid. If it is expired, the individual is ineligible to drive.

*The new forms are available on the FMCSA website.