AMSP AND BREADERS

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AMSP AND B-READERS
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References

• OPNAVINST 5100.23 Series, Chapter 17 Asbestos
  Control
• NEHC 6260 TM 96-2, Asbestos Medical Surveillance,
  Feb 2004
• SECNAV Instruction 5212.10B "Mandatory Retention
  of Insulation/Asbestos Related Records" 6 Jun 96
• NEHC Memo, 6260 Ser 321mt/04043 "Request for
  Technical Guidance for Implementing The Asbestos
  Medical Surveillance Program (AMSP)" 5 Apr 90
• Memo, Head, Occupational Medicine, NAS JAX, Dept
  6260/0701 29 Jan 92, " Asbestos Medical
  Surveillance Programs (AMSP)
• Memo, FS Environmental, MCLB, Albany GA 5090.6A
  Code 505, Mar 96 " Annual Notification of
  Asbestos Containing Material in Areas of
  Responsibility
• Memo, 6260 Ser OMLLL/08764, CO Navy
  Environmental Health Center, "Asbestos Medical
  Surveillance Program
• 29 CFR 1915.1001
• 29 CFR 1926.1101
• 29 CFR 1910.1001
• PC Matrix Manual---AMSP SF 600 guidelines and
  overprints

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Forms

• Patient Education Handout, AMSP
• DD2493-1, Asbestos Exposure Initial Medical
  Questionnaire
• DD2493-2, Asbestos Exposure Periodic Medical
  Questionnaire
• NAVMED 6260/5, Periodic Health Evaluation, Navy
  AMSP History and Physical Examination
• NAVMED 6260/5 History and Physical Examination
  Instructions
• NAVMED 6260/7, Periodic Health Evaluation, Navy
  AMSP Roentgenographic Interpretation For
  Pneumoconiosis (B-Reader Form)
• NAVMED 6260/7, Periodic Health Evaluation
  Instructions
• Physician's Written Opinion Asbestos Medical
  Surveillance Program
• Asbestos Medical Surveillance Program Follow-Up
  Letter
• SF 600 Current Worker (Baseline, Periodic, and
  Termination)
• SF 600 Past Worker-last exposure gt10 years
  (Baseline, Periodic, and Termination)
• SF 600 Past Worker last exposure 0-10 years
  (Baseline, Periodic, and Termination)

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What is the AMSP?

• BUMED has tasked the Navy Environmental Health
  Center (NEHC) with centrally managing the Navy
  Asbestos Medical Surveillance Program (AMSP)
  ashore and afloat. These responsibilities include
  the following
• 1. Providing professional and technical
  consultation on the medical aspects of
  occupational exposure to asbestos.
• 2. Maintaining and analyzing the central registry
  database containing information on personnel
  enrolled in the AMSP. This contains data from
  NAVMED 6260/5 (history and physical evaluation)
  and NAVMED 6260/7 (roentgenographic
  interpretation for pneumoconiosis).
• 3. Certifying equipment and technique of x-ray
  facilities to take AMSP chest films, and
  facilitating the forwarding of films for
  B-readings to NIOSH-certified B-readers.

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Per OPNAVINST 5100.23 CHAPTER 17

• The AMSP is designed to identify signs and
  symptoms of asbestos related medical conditions
  as early as possible through periodic medical
  evaluations. The program also provides for
  identification of medical conditions which may
  increase the employees risk of impairment from
  asbestos exposure and for counseling of workers
  on medical conditions related to asbestos
  exposure.
• 1. Criteria for Inclusion of Personnel in the
  AMSP. Include personnel who meet the exposure
  criteria defined in CFR references. These
  persons must remain in the program for the
  duration of current exposure. Civil service
  employees may be required to complete medical
  examinations related to asbestos exposure per
  reference OPNAVINST.

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What are B-readers?

• NEHC contracts with NIOSH-certified B-readers to
  read all AMSP films using the ILO classification
  for pneumoconioses. All films must be read by the
  local radiologist before they are mailed for
  B-readings.
• The B-reading is designed for epidemiological
  purposes, not For clinical evaluation.

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Can we take B-reader films with digital equipment?

• Not for Current workers, but we can for those
  personnel on the past worker programs.

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And the formal reason why?

• In light of the recent technological advances in
  radiology, particularly in the area of digital
  radiology, many B Readers have inquired about the
  use of digital radiography (DR) in the
  classification of pneumoconioses. Questions have
  focused on the use of either 'soft copy' images
  that can be read on a monitor or 'hard copy'
  digital images that can be printed on film like
  traditional film-screen radiography (FSR). To
  comply with regulatory requirements under 42CFR
  Part 37, B Readers must continue to use standard
  film screen radiographs when classifying chest
  x-ray films for the Coal Workers' X-Ray
  Surveillance Program. The regulation specifies
  the use of film no less than 14 by 17 inches, and
  the use of a diagnostic X-ray machine having a
  rotating anode tube with a maximum of a 2 mm.
  source.
• In addition, the guidelines for use of the ILO
  International Classification of Radiographs of
  Pneumoconioses prescribe side-by-side viewing of
  subject and standard radiographs, and state that
  the standard films take precedence in defining
  profusion categories. Thus, until provisions for
  use of digital images have been specified,
  readers using the ILO Classification for all
  purposes should continue to use traditional film
  screen radiographs and standards.

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Well..

• AMSP evaluations will be completed by a
  Occupational Medicine Physician.
• AMSP procedures and forms vary depending upon
  the patient's age, present or past exposure and
  time elapsed since the first exposure.
• Enrollment in the AMSP is based on information
  in References (a), (b), (c), (e), and (h).
  History of Asbestos exposure is documented on
  OPNAV 5100/15, Medical Surveillance
  Questionnaire/Part I, Occupational History.
• Current Asbestos workers require a Physicians
  Written Opinion.
•  Findings of severe respiratory impairment
  (FEV/FVC lt 45 or FVC lt 70 of predicted) or
  documented actual or probably asbestosis will be
  disqualifying of initial assignment to asbestos
  related duties, per reference (a).
• AMSP evaluation is a screening examination. A
  definitive diagnosis of asbestos related diseases
  cannot be made without further evaluation or
  consultation as per references (a) and (b).

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Who is considered a CURRENT WORKER?

• Identified by Industrial Hygiene as Certified
  to work with Asbestos removal and be listed to
  call up for this task.
• The criteria for enrollment are contained in the
  OPNAVINST 5100.23 series.
• a. Military and civilian personnel who meet the
  exposure criteria defined in OPNAVINST 5100.23
  series must be included in the AMSP and must
  remain in the program for "asbestos current
  worker" as long as the exposure criteria are met.
• b. An individual enrolled in the "asbestos
  current worker program must be removed from that
  program if he/she no longer meets the exposure
  criteria defined in OPNAVINST 5100.23 series. If
  he/she would like medical evaluation continued,
  he/she may be enrolled in the "asbestos past
  worker" program.

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Who is considered a PAST WORKER?

• Through questionnaire and IH determination that
  any previous asbestos exposure or surveillance
  participation existed.
• This program is NOT required by OSHA or other
  regulatory bodies only by the United States Navy

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So what is the English translation of all of this?
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Industrial Hygiene Survey Completed
Current Exposure
Previous Exposure
Pre-placement Baseline
Initial Baseline
Termination
Periodic
Annual
Termination
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Current ExposurePre-Placement/Baseline

• (1)     DD2493.1 Initial Medical Questionnaire
• (2)     NAVMED 6260/5 Periodic Health
  Evaluation
• (3)     NEHC 6260/7 B Reader X- ray Form
• (4)     SF 600 AMSP Medical Matrix Exam
  (Computer generated)
• (5)     DD Form 2766 (indicate date of program
  placement, program frequency and next due
  date).
• (6)     Spirometry (FVC, FEVs, FEV1/FVC)
• (7)     Physician's Written Opinion
• (8) OPNAV 5100/15

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Current WorkerAnnual Examination

• (1) DD2493-2 Periodic Medical Questionnaire
• (2) NAVMED 6260/5 Periodic Health Evaluation
• (3) NEHC 6260/7 B-reader X-ray (See x-ray
  frequency dates next slides)
• (4) SF 600 AMSP Medical Matrix Exam
• (5) Spirometry (FVC, FEV1, FEV1-FVC)
• (6) Physician's Written Opinion
• (7) OPNAV 5100/15
• (8) NAVMED 6150/20 Problem Summary Sheet
  (change due date)

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Current WorkerTermination

• (1)     Requirements are the same as for the
  annual examination.
• (2)     A termination examination is not
  required if the patient has received an asbestos
  evaluation within the past 12 months.
• (3) An employee being terminated from the
  program as a current worker is automatically
  enrolled in the
  past worker program.

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X Ray FrequencyX Rays are NOT automatically
performed with each AMSP. Frequency is
determined by age and time elapsed since first
exposure.
First Exposure lt 10 Years ago
First Exposure gt 10 Years ago
X Ray Every 5 years
X Ray AGE DEPENDENT
35-44 YEARS Every 2 years
lt35 YEARS Every 5 years
gt44 YEARS Annually
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Past WorkerInitial/Baseline

• (a) NAVMED 6260/5 Periodic Health Evaluation
• (b) NEHC 6260/7 B-reader X-ray Form
• (c) SF 600 AMSP Medical Matrix Exam
• (d) NAVMED 6150/20 Problem Summary Sheet
• (e) Spirometry (FVC, FEV1, FEV1/FVC)
• (f) OPNAV 5100/15

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Past WorkerPeriodic ExaminationsBased on age
and time elapsed since first exposure(See
additional slide)

• (a) NAVMED 6260/5 Periodic Health Evaluation
• (b) NEHC 6260/7 B-reader X-ray
• (c) SF 600 AMSP Medical Matrix Exam
• (d) OPNAV 5100/15
• (e) NAVMED 6150/20 Summary of Care (Change due
  date)

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Past Worker Termination Exam

• Performed on exit from Federal Civil Service.
  Same as Periodic.
• Not required if exam has been done in preceding
  12 months.

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Exam FrequencyFrequency is determined by age and
time elapsed since first exposure.
First Exposure lt 10 Years ago
First Exposure gt 10 Years ago
X Ray Every 5 years
AGE DEPENDENT
35-44 YEARS Every 2 years
lt35 YEARS Every 5 years
gt44 YEARS Annually
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Additional Medical Record Info

• 1. Health Records and X-ray jackets must be
  prominently labeled with "ASBESTOS".
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• 2. All forms, x-rays, correspondence,
  Industrial Hygiene reports, etc., which are
  related to the AMSP shall become a permanent part
  of the health record.
•  
• 3. AMSP forms and documents are filed under
  Part III of the four-part record

ASBESTOS
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So..What do I do with the B-reader forms?
Check your local OM SOP policy and procedure
manual
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Does it matter how the forms are filled out?

• YES
• WHY YOU ASK.
• Forms received from the medical treatment
  facilities are reviewed and critically evaluated
  for legibility and accuracy.
• Forms are scanned into the NEHC database and must
  be legible.
• Any illegible or inaccurate data must be returned
  and corrected by the medical treatment facility.
• Quality assurance of forms is crucial in ensuring
  NEHCs health physician has  accurate and valid
  data for performing a scientific data analysis on
  the records received.

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Instructions for sending forms to NEHC

• Copies of both the NAVMED 6260/5 and NAVMED
  6260/7 are mailed to NEHC.
• The address
• Commanding Officer
• Navy Environmental Health Center
• 620 John Paul Jones Circle
• Suite 1100
• Portsmouth, VA 23708-2103
• Attention AMSP Professional Support
  Division

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THINK YOU GOT IT?
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It is A LOT of Informationto learn
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And it take A LOT of practice!!!
But you will get there!!!!