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The U.S. environmental protection agency's pesticide worker safety program--implementation of The National Strategies for Health Care Providers: Pesticides Initiative.

Farmworkers face a disproportionately high risk of exposure to pesticides due to their hand-labor work in agriculture. Farmworker families can be exposed to pesticides through drift or secondary exposure when a worker brings pesticide residues home on clothing and transfers these residues to family members. The Pesticide Worker Safety Program in the U.S. EPA Office of Pesticide Programs uses regulation, training programs, and outreach initiatives to protect farmworkers from harmful exposure to pesticides. Pesticide poisonings often go undiagnosed, untreated, and unreported. This is due in part from inadequate training for health care providers in environmental health. U.S. EPA is addressing these training deficiencies through a national initiative to improve the health care of farmworkers and their families.

U.S. EPA, in partnership with other federal agencies and organizations, leads the National Strategies for Health Care Provider: Pesticides Initiative. The initiative is aimed at improving the training and practice of health care providers in the recognition, diagnosis, treatment, and prevention of pesticide poisonings. The initiative's goal is to create institutional change in the management of pesticide poisonings through education, professional training, and the development of new resources and tools for use with pesticide-related health conditions.

In the first phase, the initiative developed core competencies and practice skills for primary care providers in the education and training settings (see Figure 1). These skills provide guidance for medical and nursing students and practicing clinicians to advance their ability to manage pesticide-related illnesses. The strategies, guidelines, and resources developed under this initiative are applicable to pesticide-related scenarios beyond the agricultural and occupational settings, and can serve as health care training models in the broader context of environmental and occupational health.

In the second phase of the initiative, the focus is on developing and testing models of integration of the key competencies and practice skills into the educational and practice settings. To achieve these goals, U.S. EPA established cooperative agreements with the University of Washington Pacific Northwest Agricultural Safety and Health Center (PNASH) and the Migrant Clinicians Network (MCN).

The PNASH project goal is to incorporate skills for the effective diagnosis and treatment of patients with pesticide-related illnesses into the educational curricula of future health care providers. The project aims to insert the "core competencies" for managing pesticide poisonings into the training content of medical and nursing schools at several universities in the Pacific Northwest. Core competencies include determining if pesticide exposure was a potential cause through taking an environmental history, clinical management of pesticide exposure, and prevention education for patients. The successful integration of pesticide content into existing medical and nursing school curricula relies upon the dedication of key student and faculty members recruited to serve as "champions" for the addition of pesticide content. This pesticide exposure assessment module is being evaluated for effectiveness as it may become a national model for the insertion of pesticide content and other environmental health information into medical and nursing school curricula.


MCN is the largest clinical network for the mobile underserved, providing a unique position from which to promote change across a wide range of practice settings. MCN's project works directly with the health care community to improve pesticide education and awareness and to train frontline health care providers to recognize and treat pesticide-related health conditions.

MCN partners with a variety of migrant and community health centers to facilitate the integration of environmental medicine into primary care by tailoring the approach to each clinic based on each center's needs and design. Methods include the addition of screening questions to capture environmental occupational exposures, the incorporation of environmental occupational education and outreach, on-site training of clinicians, distribution of resources, linkages to occupational and environmental medicine specialists, and ongoing technical assistance. The strength of the program is demonstrated by its ability to fit successfully into different types and sizes of practice settings.

The availability of resources to guide health care providers in managing pesticide poisonings is a critical aspect of the initiative. The fifth edition of U.S. EPA's Recognition and Management of Pesticide Poisonings manual is an internationally used resource to aid clinicians in identifying and properly treating patients with suspected pesticide-related illnesses. The manual provides detailed information on the toxicology of commonly used pesticides by pesticide class, and provides recommendations for treatment based on a consensus of experts on the best clinical management. Since the last publication in 1999, new pesticide types have become available to consumers. This, along with trends in pesticide poisonings, warranted an update to the manual's content, including the consensus treatment strategies. U.S. EPA has entered into a cooperative agreement with the Medical University of South Carolina to develop and publish a new edition of the manual. The new manual will include a new chapter dedicated to pyrethroids, and will include more discussion of chronic health effects associated with long-term exposure to pesticides.

As the second phase of the National Strategies for Health Care Providers: Pesticides Initiative draws to a close in 2010, U.S. EPA is preparing for the third phase of the project, which will build on the foundations of current activities. For more information, visit the U.S. EPA Health Care Initiative Web page and resource link at healthcare/healthcare.htm.

Editor's note: This article is part of our series of bimonthly columns sponsored by the U.S. Environmental Protection Agency's (U.S. EPA's) Community Action for a Renewed Environment (CARE) program. The CARE program brings columns to the Journal that reflect the U.S. EPA programs, tools, or approaches to help local communities address a wide variety of environmental health issues. We think this column is of interest to a broad range of environmental health professionals. The agency will report here on the activities and lessons learned from communities across the nation and describe the range of U.S. EPA resources and programs available to support local environmental health initiatives. This column will also help keep readers up-to-date on U.S. EPA's progress in building partnerships that span federal, state, and local environmental and environmental health agencies. We believe that this column is an indication of U.S. EPA's commitment to joining with environmental health professionals to better meet the needs of communities, and we are pleased to make it available to our readers.

Carolyn Schroeder is an environmental protection specialist with the U.S. EPA's Office of Pesticide Programs. Her work in the Certification and Worker Protection Branch includes regulatory implementation of the national pesticide worker safety program. She manages grants and agreements promoting pesticide worker safety through resource development, outreach, and training. Elizabeth Evans is also an environmental protection specialist with the U.S. EPA's Office of Pesticide Programs in the Certification and Worker Protection Branch. Her focus is on protecting the workforce that is occupationally exposed to pesticides. Her work includes the development of outreach initiatives aimed at educating farmworkers to protect themselves and their families from pesticide exposure.
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Title Annotation:Direct from U.S. EPA: Community Action for a Renewed Environment Program
Author:Schroeder, Carolyn; Evans, Elizabeth
Publication:Journal of Environmental Health
Geographic Code:1USA
Date:Jul 1, 2009
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