Best Practices Re: Medical Surveillance for Miners
“The first priority and concern of all in the coal or mining industry must be the health and safety of our most precious resource, the miner.”
~Federal Coal Mine Health and Safety Act of 1969, amended 1977
Early detection of any disease is critical for successful treatment, and even more so for the coal miner exposed to the hazardous coal dust. Starting in 1970, the coal workers’ health surveillance program (CWHSP), established by the Coal Mine Health and Safety Act of 1969, has offered chest x-rays, or radiographs, for underground coal miners for the purpose of early detection and treatment of occupational pneumoconiosis (OP) to slow its progression. “If black lung is caught early, steps can be taken to help prevent it from progressing to the most serious forms of the disease,” said National Institute of Occupational Safety and Health (NIOSH) Director John Howard, M.D. In 2014, the Mine Safety and Health Administration (MSHA) expanded testing by directing the NIOSH to add periodic lung function testing (spirometry) and respiratory health assessment questionnaires, and extend testing to include surface coal miners.
The goal of medical surveillance and monitoring is to protect the mines most precious resource: the miner via the miner’s health. When adverse health effects are detected early, they can be reversed, prevented from progressing or limited. When the surveillance plan and mine exposure are coordinated, the miner’s health is further optimized. There are two components of medical monitoring, the miner and the operator; each have unique responsibilities.
The miner will be his/her own best advocate and must be diligent in participation of the medical monitoring process. The miner should expect an interview about work history, and a physical (medical) examination. In addition, testing may include blood work, x-rays, and lung function tests. Other tests may also include an audiogram for hearing or a urinalysis for liver, kidney, urinary tract health. Medical examinations and testing should be repeated regularly, at least annually. There is no cost to the miner for the monitoring. Since 2014, testing for miners is mandatory within the first 30 days of employment, with follow up within 3 years of initial testing and follow up within two years if there is evidence of OP or reduced lung function at the three year evaluation. One element of the operator’s responsibility is to post NIOSH testing availability on the mine bulletin board.
The NIOSH screenings include a work history questionnaire, a chest radiograph, a respiratory assessment questionnaire, spirometry testing, and blood pressure screening. The screenings typically take about 30 minutes and each individual miner is provided with their results. By law, each miner’s results are confidential. Participation in this program gives the coal miner and easy way of checking their health; confidential reporting regarding whether or not they have radiographic evidence of CWP; and a confidential report about their lung function.
In submitting to regulation screenings, the miner also has the responsibility for getting maximum benefit from the exam. Notably, the miner must be completely honest when responding to questions about his health and health history. The worker should follow all guidelines and work practices as directed by the operator, which may include wearing personal protective equipment such as a respirator and/or earplugs, getting tested regularly, using new work practices or procedures. Finally, if the miner observes conditions which raise health (or safety) concerns, this should be reported to the mine operator.
The mine operator is also involved in the medical surveillance and screening process to target early detection and prevention. Baseline interviews and work histories are obtained from miners should be used by operators to initiate the analysis. This information supplements hazard recognition, evaluation and controls, such as engineering controls, work practice and PPE, and miner education. Because not all miners are exposed to the same hazards, operators can target high occurrence areas of the mine for improvement with information obtained from the surveillance and screening.
When health changes are detected in the miner, it is the operator’s responsibility to evaluate protective measures. For example, performance controls should be compared to recommended standards. Additional air sampling should also be considered. It is also important that the operator has policies which promote PPE and ensure that PPE such as respirators. Equally important, proper task-related training and use of PPE should be regularly conducted. It is also the responsibility of the operator to ensure that engineering controls are performing as intended and miners are complying with policies. The operator should have a plan to mitigate hazards that may affect miner health. Medical results should be communicated to the miner in a confidential and timely manner. Finally, when changes have been made to mitigate health hazards, medical surveillance for miners at risk should continue to determine if the new plan is effective.
Any miner who, in the judgment of NIOSH, has evidence of the development of pneumoconiosis, must be afforded the option of transferring from his or her position to another position in an area of the mine where the concentration of respirable dust in the mine atmosphere is in compliance with the MSHA requirements in 30 CFR part 90.