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#1 Posted : 05 July 2007 18:31:00(UTC)
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Posted By SAFE T
Trying to pick up a clear definition of Medical treatment, as this is seen as a factor which highlights an injury in my company as a recordable injury.
The reason for asking is that we have been sending people to hospital for x-rays, which our medical department class as medical treatment and as such a recordable injury. I have a hard time accepting this as I feel that x-rays are a diagnostic tool and not a treatment to aid recovery. I have looked at the OSHA The medical department have told me that they have adopted the definition of medical treatment from an OSHA description.
This I have checked: Recording and Reporting Occupational Injuries and Illness - Standard Number: 1904.7(b)(5), which clearly states it does not include diagnostic procedures.Any thoughts chaps ? I'm not looking to remove these injuries as there are clear learnings to be had, I want to ensure a consistent aproach to classification.
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#2 Posted : 05 July 2007 18:41:00(UTC)
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Posted By Chris Packham
A "treatment" is something to improve a recognised medical condition that has already been detected (possibly by the x-ray). Thus by definition an x-ray is not a treatment. An x-ray does not "treat" but merely indicates whether there is a medical condition that needs treatment.

An x-ray does not need to be reported as it is in the same category as audiometry, checking blood pressure, vision screening etc.

Chris
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#3 Posted : 05 July 2007 18:42:00(UTC)
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Posted By Ian G Hutchings
Hi

Having worked in a US company in the past, we used to consider a medical treatment case as one where the person had to go and see a medical professional, rather than site first aid.

This could be a grey area. I see your point that an injury is not actually being treated. I would tend to er on the side of caution and put it down as medical treatment, even though it probably slips in the middle somewhere.

If someone is having to go off site for this I would go for it as a MTC.

Merv?


Ian
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#4 Posted : 06 July 2007 09:29:00(UTC)
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Posted By Jim Masson
For my Accident / Incident records I treat any requirement to see a GP or hospital as being 'Medical Treatment', if it is treated on site then it is First Aid.
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#5 Posted : 06 July 2007 10:09:00(UTC)
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Posted By Sean Fraser
I take it the problem is one of classification and not whether or not to record an incident?

From what has been discussed I think it comes down to what you decide you want, as there is no definitive answer (now THERE'S a surprise!).

From the justification you gave the consensus is that going for a medical assessment is not a treatment, only exploratory. However, likelihood is that treatment will follow.

I suppose this also has an impact on what is classified as "loss time" - if you are waiting for an appointment, and are prevented working until a diagnosis has been provided, and this takes one or more days, how would you classify it? Now add the complication that the assessment gives you a positive statement in that no restrictions apply and you are fit for work.

Good sense applies.
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#6 Posted : 06 July 2007 10:15:00(UTC)
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Posted By LynneR
Any accident causing injury that cannot be treated on site by the first aider, or which the first aider believes to be and confirms as outside their scope or capabilities; is our classification of a medical aid accident.

This includes seeing doctor, dentist, optician, chiropracter, chiropodist, x-ray department, minor injuries department, A&E department or treated on site by a paramedic from the ambulance service. It also includes any 'follow up' appointments (physiotherapy etc) which do not result in the loss of days at work.
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#7 Posted : 06 July 2007 10:56:00(UTC)
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Posted By Heather Collins
If you are using the OSHA recordable illness/injury criteria to define medical treatment (which we do) then it is quite clear that "The conduct of diagnostic procedures, such as x-rays and blood tests" is NOT considered under the definition of medical treatment in the US.

The definition is very well set out in the US legislation - look on the OSHA site here http://www.osha.gov/pls/...able=STANDARDS&p_id=9638 under 1904.7(b)(5)
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#8 Posted : 06 July 2007 13:21:00(UTC)
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Posted By Robert K Lewis
On the other hand X rays are part of the actions carried out by doctors in the course of medical treatment and could thus be regarded as part of the treatment. Diagnosis is after all the first stage of treatment.

Bob
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#9 Posted : 06 July 2007 13:57:00(UTC)
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Posted By Chris Packham
Yes, Bob. But what is the position if the x-ray reveals that no treatment is needed?

Chris
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#10 Posted : 06 July 2007 14:22:00(UTC)
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Posted By Robert K Lewis
It reveals that No Further treatment is requiredother than the TLC of the doctor and nursing staff.

Bob
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#11 Posted : 06 July 2007 14:26:00(UTC)
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Posted By Booney
But Bob, surely that scenario means that no treatment has been administered?
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#12 Posted : 06 July 2007 15:31:00(UTC)
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Posted By Jay Joshi
I presume that your reference to "Medical Treatment" is in context of using OSHA Recodardables as a means of reactive performance measurement.

As stated previously, refer to the OSHA Recording Rule at:-

http://www.osha.gov/pls/...vel=1&p_part_number=1904

Interpretation can be complex, but the rule includes exceptions in the General Recording Criteria 1904.7 at

http://www.osha.gov/pls/...able=STANDARDS&p_id=9638

Then there is prescriptive definition of First Aid, for example, a tetanus immunisation is first aid, but even being given anti-biotics as a precautionary measure in A & E is medical treatment. First aid includes using a non-prescription medication at nonprescription strength.

For medications available in both prescription and non-prescription form, a recommendation by a physician or other licensed health care professional to use a non-prescription medication at prescription strength is considered medical treatment for recordkeeping purposes!


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#13 Posted : 06 July 2007 15:51:00(UTC)
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Posted By Robert K Lewis
The problem I think is that the doctor will use the X ray to decide if further treatment is required. Until that is done then no decision is possible - thus the x-ray is a fundamental measure in the initial treatment of a patient to achieve a diagnosis.

Bob
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#14 Posted : 06 July 2007 16:11:00(UTC)
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Posted By Jay Joshi
Bob,

This is in context of the prescriptive nature of OSHA recordable criteria and therefore, if implementing OSHA recordable criteria as a means of reactive monitoring, one has to carefully interpret the OSHA rule so as to have a transparent & consistent process-links in previous postings.

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#15 Posted : 06 July 2007 18:20:00(UTC)
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Posted By Chris Packham
The British Medical Association Illustrated Medical Dictionary:-

Examination:- The part of a medical consultation in which the doctor looks, feels, and listens to various parts of the patient's body to assess the patient's condition or to gather information to help make a diagnosis.

Treatment:- Any measure that is taken to prevent or cure a disease or disorder or to relieve symptoms.

An x-ray merely identifies the patient's conditon, i.e. is passive. There is no positive intervention to prevent or cure a disease.

If taking an x-ray is treatment, then by the same definition, so is taking blood pressure, testing eyesight and hearing.

Chris
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#16 Posted : 06 July 2007 21:45:00(UTC)
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Posted By Jay Joshi
SAFE T is not referring to a dictionary meaning, but about one of the "OSHA Recordable" criteria that is defined as "medical treatment".

Instead of taking the trouble to at least refer to some of the OSHA links, contributers appear to be confused, perhaps as SAFE T has put a question to "medical types" It is not a question of medical dictionary interpretation, but of the prescriptive OSHA rules

Many organisations, predominantly in the Oil & Gas/Petrochemical/chemical upstream & downstream use the OSHA Recordable criteria and calculate the TRIR( Total Recordable Incident Rate) and the LTIR (Lost Time Recordable Rate) based on the OSHA recording rule. (As many of them have US parent organisations!)


As there does not appear to be a copyright restriction on the OSHA website, I have taken the trouble of reproducing it to end this confusion:-

1904.7(b)(5)(i)
What is the definition of medical treatment? "Medical treatment" means the management and care of a patient to combat disease or disorder. For the purposes of Part 1904, medical treatment does not include:
1904.7(b)(5)(i)(A)
Visits to a physician or other licensed health care professional solely for observation or counseling;
1904.7(b)(5)(i)(B)
The conduct of diagnostic procedures, such as x-rays and blood tests, including the administration of prescription medications used solely for diagnostic purposes (e.g., eye drops to dilate pupils); or
1904.7(b)(5)(i)(C)
"First aid" as defined in paragraph (b)(5)(ii) of this section.
1904.7(b)(5)(ii)
What is "first aid"? For the purposes of Part 1904, "first aid" means the following:
1904.7(b)(5)(ii)(A)
Using a non-prescription medication at nonprescription strength (for medications available in both prescription and non-prescription form, a recommendation by a physician or other licensed health care professional to use a non-prescription medication at prescription strength is considered medical treatment for recordkeeping purposes);
1904.7(b)(5)(ii)(B)
Administering tetanus immunizations (other immunizations, such as Hepatitis B vaccine or rabies vaccine, are considered medical treatment);
1904.7(b)(5)(ii)(C)
Cleaning, flushing or soaking wounds on the surface of the skin;
1904.7(b)(5)(ii)(D)
Using wound coverings such as bandages, Band-Aids™, gauze pads, etc.; or using butterfly bandages or Steri-Strips™ (other wound closing devices such as sutures, staples, etc., are considered medical treatment);
1904.7(b)(5)(ii)(E)
Using hot or cold therapy;
1904.7(b)(5)(ii)(F)
Using any non-rigid means of support, such as elastic bandages, wraps, non-rigid back belts, etc. (devices with rigid stays or other systems designed to immobilize parts of the body are considered medical treatment for recordkeeping purposes);
1904.7(b)(5)(ii)(G)
Using temporary immobilization devices while transporting an accident victim (e.g., splints, slings, neck collars, back boards, etc.).
1904.7(b)(5)(ii)(H)
Drilling of a fingernail or toenail to relieve pressure, or draining fluid from a blister;
1904.7(b)(5)(ii)(I)
Using eye patches;
1904.7(b)(5)(ii)(J)
Removing foreign bodies from the eye using only irrigation or a cotton swab;
1904.7(b)(5)(ii)(K)
Removing splinters or foreign material from areas other than the eye by irrigation, tweezers, cotton swabs or other simple means;
1904.7(b)(5)(ii)(L)
Using finger guards;
1904.7(b)(5)(ii)(M)
Using massages (physical therapy or chiropractic treatment are considered medical treatment for recordkeeping purposes); or
1904.7(b)(5)(ii)(N)
Drinking fluids for relief of heat stress.
1904.7(b)(5)(iii)
Are any other procedures included in first aid? No, this is a complete list of all treatments considered first aid for Part 1904 purposes.
1904.7(b)(5)(iv)


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#17 Posted : 07 July 2007 00:09:00(UTC)
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Posted By SAFE T
I seem to have generated quite a healthy debate with this question, and thank you all for your replies. Agreed I am not looking for a medical dictionary interpretation, my frustration as mentioned is one of classification. A bit more detail: I do agree with the approach of our medical department when they send employees to hospital as a precautionary measure, however I am frustrated that we classify x-rays as medical treatment regardless of whether they are positive or negative and as such a recordable injury. An x-ray I firmly believe is a diagnostic tool and when no injury is detected we should not classify this as recordable.
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#18 Posted : 07 July 2007 08:11:00(UTC)
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Posted By John Murgatroyd
Given that exposing people to x-rays increases the chance/s of them developing cancer/s later in life, I think it should not only be considered medical treatment, but also as uneccessary treatment: since it is used mainly to confirm a diagnosis.
"routine" x-rays is another medieval medical treatment !
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#19 Posted : 09 July 2007 15:56:00(UTC)
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Posted By holmezy
Folks,

just by chance, I was reading the COSHH ACOP, and in Reg 5(2) it does say that "medical treatment" does include medical examination or treatment.

So I say a big yyeess

Holmezy
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#20 Posted : 09 July 2007 16:12:00(UTC)
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Posted By Sally
to reiterate jay Joshi's point what is being discussed here is not UK law rather USA law and that clearly says that for OSHA reporting purposes diagnostics aren't medical treatment.

Many companies with American parent companies use OSHA standards as a measure of incident stats and in this case these are the defenitions that must be used.
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#21 Posted : 09 July 2007 16:47:00(UTC)
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Posted By AHS
Medical in UK Safety terms normally means the involvement of a Doctor of Medicine registered with the HSE for a specific area ie Asbestos screening.

But that will not necessarily clarify your conundrum.
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