Will the machinist be healthy?
About what was said and unsaid at the network school in Povorino depot
A recent meeting of locomotive industry specialists at the Povorino depot, discussing the most important production issues related to train safety, was for me, a specialist at the Department of Public Health MPS was of great interest. We assess our participation in the work of such schools as one of the most important elements of interaction between medical institutions and railway transport enterprises in solving joint tasks. In Povorin, it was supposed to bring to the attention of the participants of the representative meeting the opinion of healthcare industry experts on some problems and ways to solve them.
The meeting schedule did not allow discussing all the urgent issues, however, the lack of time allotted for the speech was later partially compensated by their discussion at the section of locomotive workers of the Central Committee of the branch trade union.
I was pleasantly surprised by the genuine interest of many production specialists, trade union leaders and other participants of the network school in the issues of medical train safety and railway workers' health protection. This was evident in numerous conversations with the locomotive engineers.
LET'S AGREE ON THE TERMS
First, let's focus on some of the most characteristic points. First of all, briefly about the quality of paperwork for referral to the Medical Expert Commission (IEC) and differentiated approaches to medical examination of locomotive crew members.
A personnel management specialist, taking into account the current departmental regulations, must specify in detail all the specifics of the work of a machinist or assistant. The registration form AKU—22 of the Ministry of Internal Affairs "Compulsory Medical examination Card" (approved by Appendix 5 to the Ministry of Internal Affairs Instruction No. L-2257u dated October 8, 1999) depends on how the referral is made.:
- frequency of medical examination — paragraphs 10.1 — 10.4 of the Ministry of Internal Affairs Order No. 6C dated March 29, 1999;
- volumes of medical research — Appendix 4 to instruction no. L-2257u;
- medical contraindications — "A list of medical contraindications to work directly related to train movement." It is important to know that the specific medical contraindications (25 articles listed in tables 1-6 of the specified "List") in the group "machinists, drivers and their assistants" differ significantly for the individual subgroups.:
- most of the machinists and assistants (including machinists who work as one person on shunting work with the right to exit onto station tracks);
- machinists engaged in one-person train work and locomotive crews of high-speed trains;
- machinists engaged in shunting work at the depot.
Differentiated private medical contraindications have been developed not only for the above three, but also for 18 subgroups providing train service. Of course, these differentiated approaches do not exhaust all the features of the work of locomotive crews.
At the school, proposals were made to develop separate contraindications for those involved in passenger, cargo (including transfer, export) and economic movements. However, this is practically impossible. Nevertheless, it is recommended that VEC specialists take into account a number of labor features that are not taken into account by the regulatory act when issuing a medical opinion on suitability for the profession.
Here are excerpts from a letter from the Ministry of Internal Affairs of the Ministry of Internal Affairs dated May 22, 2000. "First of all, about medical contraindications to the work of persons directly involved in the movement of trains. The articles of medical contraindications are clearly formulated and for the first time take into account the international classification of diseases of the so-called tenth revision. However, the approved medical contraindications are not dogma, since it is impossible to absolutely specify either the full clinical manifestations of diseases or all the features of each employee's working conditions.
The principle of individual approach to the patient has always been and remains one of the main principles in medicine. The conclusion of the HEC depends on a large number of individual clinical features: the severity of painful manifestations, the course of the disease, the presence and severity of complications and concomitant diseases, the degree of functional disorders, the effectiveness of treatment and other factors, the assessment of which is largely subjective.
Special attention is paid to the protection of workers' health. their health is primarily affected by the quality of their rest - visiting beauty salons (for more information, see
here), wellness treatments - massages, trips to resorts, etc.
In comparison with the medical contraindications approved by the Ministry of Health for all industries, contraindications to work directly related to train movement are traditionally much more specific. However, the possibilities of their specification are limited: no regulatory legal acts can take into account all the individual characteristics of each person being examined..."
The approved medical contraindications are based on the most stringent selection criteria, which do not take into account the individual characteristics of the health status and working conditions of specific employees. The task of the commissions is to assess the totality of the characteristics of each employee unconventionally and make a qualified conclusion, softening the selection criteria if necessary. The commission's decision must be justified in writing in a personal medical record.
As mentioned above, in addition to medical contraindications, differentiated approaches are also used to determine the frequency of the examination and the scope of the examination. In particular, many medical studies are regulated as mandatory only for machinists working in one person. In connection with the above, it is required to list the following information in the "Compulsory medical examination Card":
- does the train driver work with or without an assistant;
- is he engaged in train or shunting work;
- does the shunting driver have the right to travel to the station tracks or is he only employed at the depot;
- what harmful and dangerous factors of production are associated with a person?
This information should be available for every worker who has passed the sanitary and epidemiological certification. They are also indicated in the "Professional route" of the registration form AKU-22. The frequency, volume of examinations and medical contraindications to the work depend on this, the lists of which were approved by the Ministry of Health and Medical Industry on March 14, 1996.
Other features of the driver's work were not always accurately indicated in the referral for an examination of a single-person driver. There were facts of erroneous application of stricter medical examination criteria to drivers on maneuvers employed at the depot, or those who have the right to enter the station tracks. In this regard, the Ministry of Internal Affairs recommended that health authorities and institutions conduct explanatory conversations at locomotive enterprises.
At the same time, it is impossible to agree with the opinion of the representative of the West Siberian Railway who spoke at the school that the internists of the shop medical sections should instruct the personnel officers of the locomotive enterprises. These are not their responsibilities, but the employer's! In addition, not all shop doctors participate in the work of the VEC and have the necessary knowledge.
One more thing. There are many complaints about the allegedly excessively strict criteria for the examination of the professional suitability of employees of locomotive crews, which is groundless. Official medical statistics data for 2001 indicate that the average level of professional competence of machinists and assistants is 1.98%. In addition, their structure has now changed significantly. Previously, "old-timers" (with 3 years or more of experience) and "people who applied for jobs" were examined. Since 2000, the category of "employees" has been adopted instead of "old-timers" (regardless of seniority).
The VEC has improved its equipment with modern medical equipment, strict examination regulations have been approved, and single-person train driving has been introduced and expanded.
As a result, the detection of diseases and the quality of professional aptitude examination have significantly improved. For example, equipping the VEC with audiometers made it possible to diagnose such occupational diseases as sensorineural hearing loss at the preclinical stage. That is, timely removal of a person from the source of increased noise allows the employer to avoid payments on compulsory social insurance in connection with an occupational disease.
Prior to the introduction of audiometry, significant hearing function was assessed using whisper acumetry, which allowed the disease to be detected only at the clinical stage, which implied these payments. However, due to timely diagnosis, the number of railway workers who were recognized as unfit for medical contraindications has increased significantly.
According to official data from the medical and sanitary services, 978 drivers working in one person, aged from 26 to 63 years, were examined on nine roads. Of these, 515 people (52.7%) were recognized as unfit for professional work.
As explained above, the examination regulations for machinists working in one person have been expanded, and the selection criteria have been tightened, which is justified both by their high responsibility and purely medical reasons.
Usually, experienced train drivers aged 40 and over are assigned to train work in one person. But at the same time, the risk of sudden death increases by 6 times, since most of them already have a number of chronic diseases, many of which are related to their profession. Neuroticism of varying severity is detected in 12% of cases among railway transport workers, and in 30% of cases there is a high level of anxiety.
11.12.2022, 19:40
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