Mary K. Salazar, Timothy Takaro, Kathy Ertell, Scott Barnhart
University of Washington
Seattle, Washington

Michael Gochfeld
Rutgers University
Piscataway, New Jersey

Assuring the health and safety of workers at United States Department of Energy (DOE) sites is a major DOE goal. While occupational health and safety services are integral to operations at most of these sites, the structure and function of service delivery varies widely among the sites. Because of this, it is difficult to assess and compare the occupational health and safety of site workers. Other challenges to health and safety include the changing DOE mission from production to clean up, a new generation of workers at many sites, and extensive use of subcontractors. Much remains to be learned in order to achieve DOE's goal of worker health and safety. The purpose of this study was to evaluate the structure and function of occupational health and safety services at ten major DOE sites. The structure consists of the service unit, the personnel who work in health and safety, health and safety programs, and policies and procedures related to health and safety services. The function consists of activities and processes aimed at protecting workers' health and safety. These include exposure assessment and other hazard surveillance activities, data collection, provision of health services, and the interaction between the various professionals involved in service provision. The specific aims were to describe and compare 1) the primary hazards associated with the site activities; 2) the occupational safety and health structure including service providers; and 3) the occupational health and safety function including occupational health and medical surveillance, safety training, exposure monitoring, employee assistance activities and protective equipment utilization. The study described in this paper is the first part of a two phased project. This first phase consisted of written surveys which were intended to provide a broad description of each of the study sites; the second phase will consist of telephone interviews which will build on information from the surveys. In addition to structure and function, the second phase will also describe the financing of occupational health and safety services. Thus, the ultimate goal of this project is to develop a comprehensive description of existing DOE occupational health and safety programs in terms of structure, function, and financing, to identify the primary barriers and facilitators to efficient and cost effective services, and to make recommendations based on these findings. It is anticipated that the findings from this study will provide valuable information that can be used to guide and direct the continued development and refinement of comprehensive programs at DOE sites.

The original DOE mission which was in place for more than 40 years was the production of weapon-grade materials to be used in nuclear bombs. The 'new' DOE mission is to clean up the debris that has resulted from these 40 years of production. The DOE owns and operates about 4,000 facilities at 40 major contractor sites and numerous other small sites across the nation. Sites range in size from one square mile to 560 square miles; the sites have from 3 to 600 buildings on their premises.¹ Many of these buildings and structures, which were used in the course of bomb production, are outmoded and in poor condition. ^1,2 A plan is underway to safely decontaminate and decommission (D&D) the sites as quickly as possible. The process is being undertaken by DOE's Environmental Restoration and Waste Management Program, keeping in mind and abiding by various environmental regulations and 'good practice' requirements.

It is estimated that there are approximately 850,000 employees (200,000 contractors and 650,000 subcontractors) working at these sites. The population of workers at the individual sites varies from 75 to 25,000 workers. ¹ These workers participate in a wide variety of activities that can result in their exposure to diverse and ill-defined hazards. The change of focus from production to clean up has resulted in new operating practices that have been implemented in very short time frames. Because of the culture of these weapons complexes, the workforce has not been empowered to report potential exposures or related health problems; in fact, whistleblowers within these systems have traditionally been punished. There is an urgent need to be sure that these workers are protected from real and potential exposures to chemical, biological, and physical hazards as the clean up plans are implemented.

In September 1993, as part of an agreement with the Soviet Union, President William Clinton described the development of a framework, which was to guide the United States' efforts to prevent the proliferation of nuclear weapons. A goal of this framework was to eliminate the accumulation of stockpiles of weapon-grade materials and to ensure the safety and security of materials that exist³. The President's announcement was immediately followed by a number of comprehensive reports and recommendations related to the control and disposition of fissile materials. These reports described a full range of considerations that needed to be addressed including concerns related to the safe disposition of these materials and the assurance of environmental health and safety.

Also in 1993, the U.S. General Accounting Office conducted a hearing on DOE's efforts to protect the health and safety of DOE workers. The assurance of workers' health and safety was described as a major challenge for DOE^4,5. As a direct result of the Defense Authorization Act of 1994, the Department of Energy and the National Institute for Occupational Safety and Health (NIOSH) convened a meeting with the intent of developing a plan to assure the health and safety of DOE workers. The emphasis of the plan was the development of a prevention-oriented program, which would place a heavy emphasis on worker participation. The principles underlying the plan were as follows¹:

1. The public health model for prevention should be incorporated into the operating practices at all levels within the superstructure;
2. The DOE Surveillance Plan should be directed towards prevention;
3. Emphasis should be placed on exposure assessment and hazard surveillance;
4. DOE has to be ready for all phases of their D&D and HAZWOPER (Hazardous Waste Operations and Emergency Response) activities; and
5. DOE needs to evaluate its own specific research and design programs based on data collected from the Surveillance Plan.

While the general DOE mission of weapons production applied to all of the DOE sites, each site operated independently from the others (thus sometimes being termed 'semi-autonomous fiefdoms'). This is largely a result of the utmost secrecy which characterized the operations of the sites for so many years and the need to secure information and data at each site. Historically, the processes and modes of operation have varied widely from site to site; each having unique systems of operations, differing facilities, and various methods of recordkeeping. Likewise, the occupational health and safety hazards at each site are variable in terms of the type of hazards that characterize each site and the degree of risk and likelihood of exposure among the workers.

Clearly, well-developed and comprehensive occupational health and safety programs are key to assuring the health and safety of DOE workers. The primary goal of any occupational health and safety program is to promote, protect, and restore workers' health, within the context of a safe and healthful work environment. The occupational health system serves as a barrier between the worker and the many hazards to which they are exposed on a day to day basis (See Figure 1). Examples of strategies which are designed to protect worker health and safety are health surveillance, radiation protection, and, hearing conservation programs. The DOE sites are characterized by all of the hazards that are found in a typical industry such as noise, stress, and various physical hazards; but they also have the added hazards related to the development of nuclear weapons, particularly radiation hazards. The effectiveness of a program depends on many variables, including the supporting structures within an organization, the processes that characterize the organization, and mechanisms that are in place to finance the program.

Figure 1. Occupational health system as barrier between DOE workers and hazards.

Much remains to be known about the occupational health and safety services at the DOE sites. Because of the diversity of structure and operations as well as the variety of data collection methods used, it is virtually impossible to compare the health and safety of workers from one site to another. The primary source of morbidity data is the return to work clearance forms which must be completed by all DOE workers when an occupational injury or illness occurs and when a worker is absent for more than 5 consecutive days. Most studies at DOE sites have focused on the association between radiation exposure and mortality.

Most of the sites have occupational health and safety services in one form or another. The majority have physicians who serve as medical directors at the site. In some of the smaller sites, the actual work that is normally performed by a site occupational health program is performed by local physicians who may or may not have expertise in occupational medicine. Other providers might include industrial hygienists, occupational health nurses, health educators, health physicists, and safety professionals.

The purpose of this study is to evaluate and compare the philosophies, structures and operations of the occupational health and safety services at nuclear weapons complexes owned and operated by the U.S. Department of Energy. The structure consists of the service unit, the personnel who work in health and safety, health and safety programs, and policies and procedures related to health and safety. The functioning consists of activities and processes aimed at protecting the workers' health and safety. These include exposure assessment and other hazard surveillance activities, data collection, provision of health services, and the interaction between the various principles involved in health and safety. The specific aims of this study were to describe and compare:

1. the primary hazards associated with site activities
2. the occupational health and safety structure including the service providers and the programs in place; and
3. the occupational health and safety functions including occupational health and medical surveillance, safety training, exposure monitoring, and employee assistance programs.

There are approximately 40 major DOE sites scattered across the nation. The following ten sites were selected for this study (Figure 2): Fernald (Ohio), Mound (Ohio), Savannah River (South Carolina), Los Alamos National Laboratory (new Mexico), Hanford (Washington), INEEL (Idaho), Pantex (Texas), Rocky Flats (Colorado), Paducah (Kentucky), and Oak Ridge (Tennessee). These sites were selected because they are among the largest of the DOE sites. Additionally, they represent a broad geographic distribution of sites scattered across the nation.

Two phases of data collection were used to gather information for this project: written surveys and telephone interviews. This paper will describe the findings from Phase 1, the written surveys. The first step in this process of conducting the survey was to identify a primary contact at each site. Whenever possible, this was someone who had a major role in the provision of occupational health and safety services, for example, a medical director or the occupational health and safety manager. The contact was called and provided with a brief description of the study. Permission was then obtained to send a three paged written survey. The survey provided a general overview of the site, including the number of employees (contractors and subcontractors), a brief description of the occupational health and safety service unit, the hazards and health and safety problems at the site, the availability of data systems targeting health and safety activities, and an itemization of some of the health and safety functions at the site.

The data analyses for the written surveys consisted of both quantitative and qualitative techniques. In keeping with the aims of this study, the following areas were identified through these surveys:

• Known and potential hazards at the site;
• The occupational safety and health service unit at each site;
• The types of personnel who provide services;
• The health and safety programs;
• Mechanisms used for data collection; and
• The activities and processes aimed at protecting workers' safety and health (i.e., health surveillance, safety training, exposure monitoring, and protective equipment utilization).

All data from the written surveys were entered into a statistical software program, EpiInfo, for the analyses. These data provide a summary of objective information about the sites, including the safety and health hazards, the types of programs in place, and the types of personnel that provide services at the sites.

Subjects were asked to identify the five most common hazards at their site and to rank them according to the degree of risk and the likelihood of exposure on a scale of 1 (least) to 5 (greatest). This was an open-ended question which resulted in multiple responses and a fair amount of overlap among responses. Ultimately, all responses were grouped into the following seven categories: radiological agents; explosives; chemical agents; ergonomic hazards; gases, solvents, and acids; physical agents; and asbestos. (Respondents separated asbestos from other agents, thus it was included as a separate category). As an example of the diversity of responses, physical agents included such things as slips and falls, cuts/abrasions, inadequate walkways, and traffic. Responses falling in the category of chemical agents ranged from specific chemicals such as 'chlorine' or 'fluorine,' to broad descriptors, such as 'chemical hazards.'

The most commonly mentioned of the seven categories of hazards were radiological (N=8), chemical (N=7), and physical agents (N=14). Based on reported degree of risk (Table I), radiological hazards and explosives rated the highest (3.7 each). Physical agents and asbestos were at the bottom of the list. Respondents were also asked to rate on the 1 to 5 scale the likelihood of exposure, that is, how likely did the respondent feel that the worker would be exposed to this identified risk. In contrast to the rating for the level of risk, the highest rating for likelihood of exposure was for physical agents followed by ergonomic risks (Table II). The hazards that were rated as the lowest in terms of likelihood of exposure were radiological and explosives (2.2 and 1.8, respectively).

Subjects were asked to identify the three most common safety problems at their site. Once again, there was an array of responses based on subjects' interpretation of the question. Some responses related directly to injury occurrences (i.e., crushing, back injury); some identified conditions leading to injury (i.e., weather, poor walking surfaces, radiological contamination, inattention to detail); and others described activities which resulted in the injury (i.e., falls, lifting, poor work planning). These were grouped into the following six categories: sprains/strains including back, worker attributes, traffic-related, falls problems, environmental conditions, and other. The most commonly identified category was strains/sprains including back (N=7). There were a number of responses (N=6) which suggested that there were worker attributes that contributed to safety problems. These included things like 'at risk behavior,' employee apathy, inattention to details, lack of safety empowerment. One respondent suggested that worker involvement and trust building were needed if injuries were to be prevented. Several respondents also described the general condition of sites as a safety problem. The category 'other' included items that were mentioned only once and were not included in the previously identified categories. Examples are crushing injuries and electrocution.

Subjects were asked to identify the one most common health problem at their sites. This, too, was an open-ended question which generated an array of responses. It was clear that some respondents answered in terms of general health; others focused on occupational health problems. Some respondents had two responses, one to represent non-occupational and a second to represent occupational health concerns. The categories identified were as follows:

• Ergonomic-related conditions (CTDs, strains/sprains) (N=6)
• Hypertension (N=3)
• Coronary artery disease (N=2)
• Upper respiratory illness
• Stress
• Dermatitis
• Chronic beryllium
• Diabetes

The DOE sites that participated in the written surveys vary widely with regard to the size of their employee population. The range is from 890 employees (Mound) to 14,238 employees (Savannah River Site) (Table III). More than 60,000 employees are represented by the ten sites. These preliminary results seem to suggest that there are approximately ten times the number of contracted as subcontracted employees; however, in general, respondents had difficulty providing the precise number of subcontractors, partly because data were not available and partly because there are such wide swings in the numbers of these employees on a day to day basis.

Respondents were provided with a list of the various types of health and safety professionals that are likely to provide services at these sites (Table IV). They were asked to indicate how many of these professionals provided services at their particular site. On average, of all the health and safety professionals identified, more than half fell in the category 'health physicists' (52.25%). The next most frequently occurring professional was industrial hygienist (17.01%) followed closely by safety personnel (16.85%). Overall, physicians represented just over 3 percent of professionals providing health and safety services; and nurses represented more than 7 percent.

Several other types of professionals who contribute to health and safety were identified in separate categories by several respondents. These included radiation control technicians, clinical psychologists, fitness/wellness coordinators, nuclear explosion safety professionals, emergency preparedness personnel, fire protection personnel, safety and management supervisors, and transportation safety personnel. Several of these could have been assigned to the categories included in the original list; for example, some respondents may have included fire protection and transportation safety personnel under the category 'safety personnel.' Thus, the apportionment may have been weighted slightly differently if the responses had been standardized across sites. It could be expected that the greatest difference would be in the category 'safety personnel,' with probably a slightly larger number of professionals falling in this broad category.

All subjects reported that they had a safety committee; most met once per month or more often. All subjects reported that they had a medical and a health surveillance program. Likewise, all subjects reported that they had some type of data system in place to monitor and evaluate health and safety activities. The types of data that respondents reported collecting at sites included return to work, occupational and non-occupational injury and illness, OSHA required data, chemical, noise, and radiological monitoring data, medical/physical data, visits to the occupational health clinic, accident rates, and reasons and length of non-occupational absences.

Subjects were asked to identify who is responsible for safety and health programs. The responses were as follows:

• Contractor
• VP, Safety Systems and Engineering
• Maintained by Safety and Health Manager; implemented by Line Manager
• Safety and Health Manager
• VP, Environmental Health and Safety
• Everyone at the plant

Two questions related to occupational health and safety functions. The first was an open-ended question which asked how data were used at the site. The second asked the respondent to describe the types of occupational health and safety services and programs available at their sites. A broad array of uses for the collected data was described. These included benchmarking, tracking of injury and illness occurrences, analyzing trends, evaluating what lessons were learned when an event occurred, development of targeted prevention programs, notifying employees who were at risk of exposure or whose monitoring indicated a problem and certifying readiness for work.

In order to identify the type of service provision, respondents were provided a check list which included the following: industrial hygiene, nuclear safety, industrial safety, fire protection, physical examinations, radiological monitoring, biologic monitoring, radiation protection, direct care services, and employee assistance programs. All respondents indicated that all of these services were offered at their sites. They were also asked to indicate any additional programs or services. Programs that were identified by at least one respondent were radiological monitoring, emergency preparedness, functional capacity testing, and nuclear explosive safety.

The remediation and cleanup activities at Department of Energy sites are accompanied by an enormous potential for occupational exposure to complex and varied chemical, radiological, and physical hazards. There is an urgent need to assure that workplace exposures are controlled and that occupational health and safety programs are adequately protecting workers at these sites. The goal of this project is to describe existing programs in terms of structure, function, and financing and to identify the primary barriers and facilitators to efficient and cost effective services.

The second phase of the study will expand and clarify information obtained from the written surveys. Phase II consists of semi-structured telephone interviews, which were conducted with three individuals at each site. These individuals included the medical director or a representative, an industrial hygienist or a representative, and an occupational health and safety manager. The interviews were intended to clarify and expand upon information obtained from the written surveys. The interview guide included a series of questions specific to the structure, function, and financing of occupational health and safety services. The following describes the criteria for the interviews:

• Each interview was scheduled for a one hour period.
• The interview guide was tailored for each of the participants. While there was overlap in content, each interview focused on the unique attributes of the site and the ability of the individuals to respond to questions. For example, the Program Director may be in a better position to respond to questions about financing; the industrial hygienist, to questions about hazards at various locations on the site.
• The proposed questions served as a guide only. The interviews were semi-structured, that is, information about specific topics was collected; however, there was plenty of leeway for elaboration and probing.
• The interviews built upon one another. In other words, if discoveries were made with any single interview, the information obtained was used to expand the interview guide so that information could be added on subsequent interviews.
• All interviews were tape recorded and transcribed in their entirety.

The analyses of the interviews are currently in progress. A qualitative research program, NUD*IST, is being used to conduct this qualitative analyses. Data are being organized into themes and the words of the subjects are being used to expand the description of the themes. The data from the interviews will provide more in-depth information about topics examined in the written surveys. They will also provide subjective information about participants' perceptions of the structure, function, and financing of occupational health and safety services. It is anticipated that the findings from this study will provide valuable information that can be used to inform and guide the continued development and refinement of comprehensive programs throughout all of the DOE sites.

1. National Institute for Occupational Safety and Health & U.S. Department of Energy. Prevention-oriented surveillance plan for workers at DOE defense nuclear facilities: Draft report. Washington, DC. (June 16-17, 1994).
2. U.S. General Accounting Office. Safety and health: Worker safety and health oversight issues facing DOE. GAO/T-RCED-94-54. Statement of Victor S. Rezendes, Resources, Community, and Economic Development Division: Washington, DC. (October, 1993).
3. U.S. Department of Energy. Statement of Charles B. Curtis Under Secretary of Energy, before the committee on armed services military application of nuclear energy panel on the fissile material control and disposition. (April, 1994).
4. U.S. General Accounting Office. Health and safety: DOE's implementation of a comprehensive health surveillance program is slow. GAO/RCED-94-47: Report to the Chairman , Committee on Governmental Affairs, US Senate: Washington, DC. (1993).
5. U.S. General Accounting Office. Oversight program needs strengthening. GAO/RCED-93-85: Washington, DC. (1993).

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