Origins, Personalities and Roles of Navy Occupational Health in Peace and War Sam Forman, MD, MPH, M

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Origins, Personalities and Roles of Navy
Occupational Health in Peace and WarSam
Forman, MD, MPH, MSOH, MBAPresident, Oak and
Ivy Health Systems, Inc.18 March 2008Hampton,
VA
47th U.S. Navy Occupational
and Environmental
Health Conference
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Learning Objectives

• Participants will be able to...
• Name 3 key individuals founding and shaping the
  Navy OH communities
• Describe the strategic role of the professions in
  the Navy
• Define the circumstances at the creation
  of NAVOSH and its early challenges
• List 3 key contributions of the OH-related
  professions critical to both historical, current
  and likely future military contingency roles

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Background

• Navy 1973 - 1986
• On orders for the task of
  rediscovering history of occupational health
  within Navy Medicine.
• implications for current contingency
  roles and morale.
• Basis for annual NEHC Workshop recognition awards
  beginning 1986

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Background

• Physician and
  historian
• Practiced at sea, industrial facilities and NEHC
• Published on a variety of clinical,
  toxicological, military medical, admin and
  business issues
• Caveats

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Individuals Documenting Navy OH Origins

• George Lock Johnson
• Sam Forman
• Paul Gillooly and Carol Pickerel
• Tom Germain
• Larry Betts

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Beginnings Age of Sail

• Construction and repair organized around
  traditional trades
  Woodworking, sail loft, copper shop,
  foundry, etc.

Ship Construction in Philadelphia
Shipwright
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Beginnings Rumblings of Change

• Iron hulls
• Steam propulsion

HMS Great Eastern under construction - 1855
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Civil War Era

• Mechanized Navy
• Leading edge industrial processes steam,
  metals, ordnance, thermal insulation

USS Monitor - 1862
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Civil War Era

• Mechanized Navy
• Changed industrial base to build and repair

Naval Blacksmiths at Work on a Monitor
USS Modoc - Construction in San Francisco 1865
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Age of Empire

• Mahan expounds on role of sea power
• Vital role for maritime industries
• Overseas bases for fueling and repair

USS Olympia in Drydock
Navy Gun Factory
Shipyard Foundry
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Age of Empire and WW I

• Enlarged Fleet
• Yards and Docks, Ordnance, Arsenals
• Federal Workers Compensation

USS Connecticut Great White Fleet 1907
Shipyard Activity in WW I
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Formal Organization 1920s 30s

• BUMED
• CDR Jones
• Linkage to prev med
• Advanced training
• LT Linwood Smith to Harvard
• Naval district billets

CDR Jones
Alice Hamilton Harvard
Shipyards
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Navy Industrial Hygiene 1920s 1930s

• Industrial Hygiene and Occupational Medicine
  billets at Naval Districts
• Supported by advanced out-service training
• Naval Medical Bulletin 1922 Comprehensive
  listing of hazards and control strategies

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Navy Industrial Hygiene 1920s 1930s

• Respiratory physiology respirator selection and
  use
• Submarine environmental issues
• Lead poisoning at Philadelphia Naval Shipyard

Construction of Early Submarines
Removal of Lead Paint
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Developments in the Civilian Community

• Professional Organizations
• ACGIH 1938 - SSA
• AIHA 1939
• Workers Compensation enacted and extended to
  occupational diseases
• Safety First
• Lead poisoning
• Asbestos Morro Castle shipboard fire
• Silicosis Gauley Bridge, WV

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CAPT E.W. Brown

• Mission of OH program in national defense
• Organization, functions and staffing for Navy
  industrial health program
• Program content
• Injury care
• Pre-employment pre-placement
• Health hazard control

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WW II

• RADM Stephensons leadership
• Captain E.W. Browns vision

A State of National Emergency
Charles Stephenson
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Charles S. Stephenson

• Deep Knowledge of Navy workplace health hazards
  and controls at the highest levels
• Inspections
• Training
• Staffing
• Consultants

Otto Burton
H. Karl Sessions
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World War II

• Maritime Commission Prof. Philip Drinker
• Training IH courses for officers
• Requirements and inspections of shipyards

T.J. Carter
Philip Drinker
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Minimum Requirements 1942-1943

• Signed by SECNAV and Maritime
  Commission
• Navy leads in enumerated expectations for IH and
  Safety in Navy and contract industrial
  facilities as well as providing people,
  training and inspections to get it done

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OM and IHO Out-Service Training
First IHO graduating class, 10 Aug 1942, Columbia
University, NYC.
Top row left to right Walstaff, Dilustro,
Farnsworth, Kamela, Levinson, Levesy, Munton,
Norton

Bottom row
Bessmer, Kerkian, Kardong, Bjorklund, Byrd,
Gillard, Ruben, Rosati (not pictured)
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IHO Plank Owners
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Navy Occupational Health Nursing

• Staffed locally at industrial clinics 1940s or
  prior
• Focus on injury care and components of preventive
  programs
• Navy OHN history has not yet been written

WWII Era Poster
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Workplace Prevention 1940s

• Respirator use is a key part of asbestos dust
  control strategy

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Navy Leads in Professional Training

• 111 Physicians and IHOs educated at Harvard and
  Columbia
• 1941 2 Regular Navy medical officers, MPH
• 1942 25 medical Regular Navy medical officers
  certificate program
• 1942 41 more Navy Reservist medical officers
  certificate program
• 29 IHOs 13 already trained

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Navy and Maritime Commission OH in WWII

• Decreased lost time from illness and injury
• Decreased compensation costs
• Increased production and efficiency
• Promoted morale
• Superior practitioners broke new ground for IH as
  a distinct health related profession

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Medical Service Corps

• Medical Service Corps 1947
• Early IHers were H(V)-S
• Army-Navy Medical Service Corps Act of 1947,
  PL80-377
• 252 MSC commissioned officers, 4 IHO plank owners
• Pharmacy, Supply and Admin
• Optometry
• Allied Sciences, including IH

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1950s

• Drs. Otto Burton and H. Karl Sessions
• IHOs Sidney Goren and George Lock Johnson
• 1955 BUMEDINST on TLVs
• 1959 IH to division status at shipyards 1959
• Rad Health issues added at Mare Island and
  Portsmouth NH
• Occupational Health Hazards 1954-1972 quarterly

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Navy Hearing Conservation

• Navy Audiology history has not yet been written
• BT and GM deafness
• Aviation community 1950s
• Audiology billets and staffing
• Needs
• Fitness for duty
• Measurability
• WC and Disability
• MOHCATs

Gunnery Practice USS Vestal
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1960s

• BUMED CAPT Rosenwinkel, MC
• CDR Charles J. Joe Jordan, MSC
• OSHA PL91-596 1970, Section 19
• Executive Order 11612 of 1971
• Executive Order 11807 of 1974

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Asbestos Health Concerns

• Asbestos required by Navy in numerous
  Mil Specs many favorable
  performance
  characteristics
• Navy health knowledge paralleled and
  at times led state of the
  art
• Issue focused on thermal insulation and
  asbestosis potential in
  full-time insulators and laggers into 1960s
• Cancer case reports complicating asbestosis from
  1930s
• New knowledge of cancer outcomes in insulation
  end-users
• Dr. Irving Selikoff mid-1960s
• Controversies spur creation of OSHA, NAVOSH,
  NOSHIP and increased OH staffing

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Asbestos Health Concerns
1957

• US Naval Medical Bulletin 1922
• Handbook of the Hospital Corps, U.S. Navy 1939
• E.W. Brown in War Medicine - 1940
• C.S. Stephenson to ADM McIntyre 1941
• Minimum Requirements for Contract Shipyard
  
  Health and Safety 1943
• A Health Survey of Pipe Covering Operations
  Fleischer,
  Drinker et al paper 1946
• Awareness and accommodation of asbestosis as
  a
  low-incidence disease handled via workers
  compensation
• BUMEDINST on TLVs 1955
• Pipe and Copper Shop Master Mechanics Conference
  1957
• Navy Safety Review Asbestosis 1962
• LT Marr - 1964

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Asbestos Health Concerns cont.

• Issues raised by the experience
• Latency
• Benchmarking to silicosis
• Surveillance tools targeted to known outcomes
• Unexpected outcomes
• Military contingencies versus controlling
  long-term risks
• In hindsight missed opportunities to control
  exposures

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Late 1960s, 1970s

• CAPT Lawton, MC
• LCDR Samuel H. Barboo, MSC
• IH staff to bring Navy into compliance with new
  Federal requirements
• LCDR Douglas Rector, LT Joe Drozd, ENS Leigh
  Doptis
• Navy Environmental Health Center, Norfolk

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1970s

• Regionalization early 1970s starting at
  Portsmouth, VA
• 1976 GAO and Defense Audit Agency cited Navy for
  workplace deficiencies
• 1977 NAVMAT actions

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Navy and Marine Corps Public Health Center

• NAVORD Environmental Health Center 1967, Crane,
  IN
• Workshops initiated
• Naval Ordinance Environmental Health Center
  (NOEHC), Cincinnati, OH 1970
• Naval Industrial Environmental Health Center
  (NIEHS) 1971, transferred to BUMED.
• CAPT George Lawton OIC, ADDU while still at BUMED
• Navy Environmental Health Center, (NEHC) 1974
• CO Tom Markham, MC
• First female IHO LTJG Noreen Considine, MSC at
  NEHC 1975
• NEHC moved to Norfolk, VA 1978-79
• EPMUs under NEHC 1981

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NOSHIP

• CAPT Barboo 1978
• Concern that DOL and OSHA inspectors would come
  into Navy
• CNO approached NAVMAT. Went to BUMED
• Under IG, administratively attached to BUMED

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Early 1980s

• OP45
• Comply with OSHA by 1986
• EO 12196, 26 Feb 1980 Except for military
  personnel and uniquely military environments and
  operations
• Defense Audit Agency (DAS) 81-112, 09 Oct 1981
  
  IH unsat

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Early 1980s cont.

• Lack of staffing standards and IH laboratories
• Deputy Sec Def memo 11 August 11 1982 Program
  Decision Memorandum
  increase civilian end strength
  181 in FY84, 362 in FY85, 547 in FY86
• Congressional hearings were held in Sep 1983
  regarding Navy non-compliance with OSHA
• JRB Associates study by OP-45 doubling of
  civilian and military IH billets

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Named Awards

• Navy and Marine Corps Public Health Center
• VADM Richard Nelson, MC, USN
• Award established 2001
• Naval service 1967-2001
• 33rd Navy Surgeon General
• Sustained OH, PM or Health Promotion excellence
  and contributions
• HMCM Stephen W. Brown
• Award established 1989
• Served 1952-1989
• For PMT
• Radiation Health Technician of the Year

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Named Awards - cont.

• Navy and Marine Corps Public Health Center
• RADM Charles S. Stephenson, MC, USN
• Award established 1986
• Navy OH, PM or Health Promotion
• CAPT Earnest E.W. Brown, MC, USN
• Award established 1986
• Navy OH, PM or Health Promotion

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Conclusions

• Navy and government occupational health
  paralleled, and at times led, development of U.S.
  IH and Occ Med during the last century
• Origins arose from the safety and hygiene aspects
  of military naval industries
• Program enhanced by notable leaders and
  personalities
• Communities feature unique skills in toxicology,
  measuring and controlling environmental toxins

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Opinions

• Apply and adapt core skills in clinical
  toxicology, environmental contaminant detection
  and control
• Era of asymmetric warfare
• Smaller, higher tech industrial base
• Achieve balance of military and civilian
  expectations
• Exploit synergies versus differences in Corps and
  professional affinities

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Learning Objectives - Revisited

• Participants will be able to...
• Name 3 key individuals founding and shaping the
  Navy OH communities
• Describe the strategic role of the professions in
  the Navy
• Define the circumstances at the creation
  of NAVOSH and its early challenges
• List 3 key contributions of the OH-related
  professions critical to both historical, current
  and likely future military contingency roles