Good afternoon, everyone. And I promise you, if you were in this room before lunch, you will see less of me. So I'm going to be very quick, more moderating than anything else. So this afternoon's session is on addressing workplace impairment, solutions spanning fatigue to opioids. So that gives you a hint that we're not looking at just one single issue, but impairment really is a broad spectrum of conditions. Problem is, I think we know that, we think about it, but unfortunately, a lot of times those supervisors, the managers, just say, he's got, he's doing something wrong, he's got to be impaired, and you all know it goes right to his mind. This is primarily a National Safety Council presentation, I'm, they invited me to help moderate, so that was my role here. And Katie Muller, Katie is the Senior Program Manager for the Impairment Practice at the National Safety Council, prior to the National Safety Council, she spent 15 years in public safety policy and prevention. So in general, just going to start out with a case scenario, you know, clinical specialty, we should do that occasionally. Talk about what is impairment and what does impairment do. We kind of think we know what employers think, but there's some good studies that show what employers really do think and what they want to do about impairment. And then some technology and training that's available for us to be using, either in our clinics or in the workplace. And then of course, questions and answers. I am going to ask those of you who are watching remotely, just to let you know, we'll be monitoring the questions and we'll be taking the questions at the end of the session and announcing them live so everyone can participate. So the National Safety Council's mission, just to start off, save lives from the workplace to any place, whether it's workplace, whether it's roadway, and this practice is really focused on impairment. I think the impairment practice is about a year, a year and a half old. There were a lot of siloed groups and it really was a recognition that impairment is not a one-size-fits-all and it really does need to be dealt with as an overall issue. So impact of impairment, when you think of workplace impairment, what do you think comes to mind? Again, if you were in this room earlier, you heard about sleep apnea. If you were in this room yesterday, you heard about drugs and medications and all the different things from the National Transportation Safety Board, I'm sorry. So there's lots of other things. If you were here, I think, the day before, we talked to her a little bit about marijuana and cannabis. So lots of different things can cause impairment, but let's think about a scenario. You have a 40-year-old forklift operator who's been working in the same plant for quite some time. He's been loading and moving these pallets to the waiting tractor trailer during discussion. Then you notice he just seems to be not all there. He seems to be having problems operating his forklift. He bumped into a pole a couple of weeks ago, but of course he says he's absolutely fine. So, what do we think? Yeah, the supervisor does. Five panel drug test. Drug test not surprisingly is negative. So what happens? He gets put right back to work because there's nothing wrong with the drug test, therefore he's not impaired. There's no problem. Let's go on from there. But what's wrong with the story that we needed to be thinking about? Well, Benadryl, again, we talked about Benadryl and its impact on safety just a couple of days ago. Benadryl is a newborn at home, so obviously he is not sleeping very well. He has some family stressors, but his brother recently diagnosed with cancer, and of course we talked about the Benadryl, which is probably one of the big concerns that we and many of our employees tend to forget about. So what I'm going to do right now, as I said, I'm going to turn this over to Katie. We'll watch the questions and we'll do a little bit more discussion at the end. Thank you, Dr. Hartenbaum. All right. As the doctor said, I'm Katie Mueller, and I'm the Senior Program Manager for Impairment at the National Safety Council, and I'm going to talk to you a little bit today about how we at the National Safety Council view impairment and kind of some solutions that we're bringing to the table for the workplace and for employers. A couple of years ago, the National Safety Council really examined impairment and its impact for employers and really decided to expand our definition, and for that to include things like chemical substances that we traditionally think of impairment, but also things like physical factors, fatigue, mental distress, and social factors. So really coming to the table with hopefully some innovative approaches for employers to use to address this broad definition. All right, so most of you know and understand that impairment is a fitness for duty concern, and we at the National Safety Council really aim to talk to employers about what this can do to affect their business, not just in safety-sensitive positions. Oh, sure. Higher, I guess. Is that okay? Is that better? Having a little problem hearing me? There's an echo. There is an echo. Oh, you want me to hold it? I don't have my pants to do that. Let me put it real high. Thank you. Okay. All right, is that better for everyone? Great. Okay. Thank you for that. All right, so we talk about impairment traditionally as a fit for duty concern, but we really want to take a look at those psychological factors that can impact a person's ability to come to work or drive to work and be ready to work. A couple of years ago, the National Safety Council, we did an environmental scan of what was really available and on the market as far as solutions for employers to address this broader scope of impairment. We'll talk a little bit about that. Looking at chemical factors, obviously we know that substance use disorders are a huge issue, and 70% of people with substance abuse disorders are in the workforce. So, we also know that we're in the middle of an opioid epidemic, and the odds of dying from an opioid overdose now have surpassed car crashes. I don't know if those of you who monitor requests, DTI, but they just recently released some new data from there, and I apologize. That is not in this presentation. I didn't have time to update it. It'll be in a presentation tomorrow afternoon, so look for that. But we do know that drug positivity has increased to its highest level in two decades, and so we look at those data really closely at the National Safety Council, really to inform what we're doing as an organization. We also found that National Safety Council, like I said, we did a survey last year, and one-third of employees say that they have observed regular cannabis use at work. So, I'm going to take this opportunity to plug my presentation for tomorrow. I am doing a cannabis presentation tomorrow, so if you're interested in that and interested in survey-related data from employers on that, please come to my session. All right, and like I said, workplace overdose is definitely on the rise. Increase of 24% in 2019. Of course, that's unintentional, and for comparison, there was about 91,000 overdoses in 2020, and that number surpassed 100,000 this year. All right, and this is a video, if I could get them to play it in the back. All right. All right. All right. All right. So, like I said, National Safety Council really focused on bringing attention to these issues and developing solutions to help employers and employees address what's going on. In the pandemic, we saw what we have referred to as the perfect storm, you know, an increase in the issues that exacerbate substance misuse and problems with mental health and really impacting safety both outside and inside the workplace as, you know, families are struggling with their general day-to-day activities. We really are looking at the multisubstance use impairment issues in a way like we never have before. And obviously, the physical factors that we're all very used to. Dr. Hartman was just talking in the previous session about sleep disorders and what happens with just in sleep problems in general. Our focus at National Safety Council, the efforts are really on fatigue and keeping in mind temperature changes and things like that, heart conditions that can exacerbate those things. In 2014, we looked and found that 13% of work injuries could be attributed to sleep problems, those fatigue symptoms, and a person who loses two hours of sleep similarly performs to someone who obviously has drank alcohol, as you may be familiar. Obviously, shift workers are very much attuned to having these injuries or having these factors. One impact of COVID has been that we've seen an increase in some of these fatigue symptoms. The social factors, again, broadening that definition of what we traditionally think about when we talk about impairment. The social factors that we deal with on a day-to-day basis. Almost certainly a part of life for all of us, right? But that stress can have those impairing side effects. We've all driven in a car, I would assume, we've all driven and thought, how did I get here? You kind of have that lapse in that mental time. That could be an impairing situation if you are in a safety-sensitive situation like driving. As employers look to address these things, we think it's important for people to recognize their own stress and how that can change their ability to do the job and the tasks that they're being asked to perform. I talked a little bit about this, but obviously stress and mental distress can be interrelated. It's important to have, not having a mental health disorder is not necessarily impairing, but when we talk about those related distressors, it can be a very real safety issue. Importantly, there can be a link between mental health distress and those increased safety risks. One of the things that we often ask employers to look at is the cost of these things. Unfortunately, those of us who are not in the medical field, sometimes public health is not the first priority, unfortunately. We ask employers to really think about how these safety impacts impact their bottom line. We've developed some cost calculators, that's what we call them, to help employers understand the individual workplace costs. I'll have some links at the end of the presentation if you're interested in these. We really have worked alongside a lot of research to develop these tools so that employers can calculate their annual costs and really understand the importance of investing in prevention and investing in solutions to help their employees before they get to the costly workers' compensation claim or need for treatment or hospitalization, injury, or even death. Let's talk a little bit about, this is how we approach it with employers when we're talking about the cost. How much does it cost to treat a substance use disorder or how much does it cost for that person versus how much that person costs in recovery? We have done a lot of research with the University of Chicago on these costs and looking at things like health care costs, turnover, workers' compensation and disability claims, prescription costs, and things like that. We also have the substance abuse cost calculator and then we have the mental health cost calculator, which I think is a really great tool for employers to understand the investment in mental health. We recently did a study on COVID's impact on employers utilizing their EAPs. The data that we're getting from that study is really interesting about how much employers valued or not the EAP utilization of their own employees. That is some data that is really hard to get at. If anybody has any ideas about how to get at employee utilization of EAPs, I would love to talk to you about this. What we're finding is most employers buy a package for their EAP and then sometimes that data is not readily available to the employer. We are searching for that information to measure the impact of EAP utilization over this time in the pandemic. We know it's expensive. We know that these costs are expensive for employers, but we also want them to understand what a return on this investment it can be. Again, another cost factor, fatigue. We talked a little bit about this before, but costing $136 billion a year in productivity. That's hard to measure, right? We can measure those hard costs a lot easier than we can measure the soft costs like productivity and absenteeism, presenteeism, those types of things, but certainly an area that we can show value to employers when they invest in those prevention tools or the treatment options. Worker well-being is another area that I think is emerging as a topic that employers should take a look at and be invested in. That true culture of safety that includes treating the whole person or accommodating the whole person at work or whatever that person's needs or risks may be. The total worker health initiative or model, really integrating those protections into the daily work and culture of that organization. At National Safety Council, we really value those models and we provide frameworks for employers to adopt these more broad definitions of solutions than just your traditional physical worker well-being types of programs. I talked a little bit about the impact of COVID on well-being and I think that that is going to continue to be studied, right? I have to tell you, my former life, I worked with pediatricians and trauma docs on pediatric injury prevention. And so, docs are definitely getting to be some of my new best friends as I'm learning from you guys all the time and you're doing the work that we need to do in the areas that need to be researched and understood more. Impacts of COVID on well-being and re-entry into the workforce certainly being one of those. But we know that there has been an impact and we're going to continue to kind of elevate employers and asking them to address these risk factors that are happening to their employees as a result of the pandemic. So, at the National Safety Council, we have a broad strategy that includes safety at the workplace to any place. And like I said, even though opioid overdoses have surpassed crashes as a leading cause of death, we still want to address crashes and its impact on safety and really get employers to understand the risks that when you are driving, you are in a safety-sensitive position, right? And not just when you're driving for work, but when you're driving to work or from work, and it costs employers, even when employees are injured off the job in crashes, right? Because they are taking the brunt of the cost of that insurance. So, the National Road Safety Strategy is really important to what we do at National Safety Council because crashes continue to be a leading cause of death for many Americans. And we know that research into these behavioral issues that cause crashes need to continue, but you have kind of seen, if any of you follow the DOT, kind of the emphasis on needing that integrated approach with infrastructure and behavior modification, right? So, we're going to continue to be invested in that strategy and look for ways for National Safety Council to kind of lead and be part of that discussion. All right. So, I'm going to talk next about a few surveys that we did on what do employers think about when they think about impairment, right? Because you guys are the experts and you know the signs and symptoms and all of that, but do our frontline supervisors know? Do they know how to recognize and respond to impairment? So, we asked about 1,000 employers, what do you think about impairment? When you think about impairment, what do you think about? And we received a lot of different responses but they do know that impairment is an issue and it's something that's causing decreased safety in their workplace. Some of them even even attributing those the impairment to injuries. I have a lot of questions about you know our ability to articulate injury cause specific specifically in the workplace because we are able to get to that data right if OSHA records something like a fall do we know whether or not that person was impaired or not currently we don't have access to a lot of that data so we're really interested in that but what we do know is that 77% of the respondents from our survey view impairment as important to their organization when ensuring that someone is fit to work right and they say that they say that they're just as concerned about those mental health issues and you know our substance use disorders as they are the physical things but I don't know about that but I think one really really important thing is that employees less than half of employees felt like they could go to their next line supervisor if they were impaired and so how do we get to a place where we are comfortable talking about that right and that's one of the places that National Safety Council is really looking to build is how do we have a positive workplace culture where that we can talk about mental health and substance use and its risks so I know this is thought is a little bit hard to read but if you go to NSC org slash impairment we have a lot of infographics and things that can be used in presentations these are free to use you know you can snip some of them if you see something on there that you'd like more information about give me a call or send me an email and I can get you you know graphics or anything that you need along those lines we have a suite of things that are available on our website for that so some important feedback that we got from those employers was that again one-third say that they have observed cannabis use in the workplace and employers believe that employees feel comfortable coming to them and talking about their issues but remember I said less than half of employees feel that way right so again these are not surprising learnings from our survey right I know that you guys probably know all of this but again areas that we at National Safety Council want to continue to bring in attention to so I'm going to talk a little bit about some of the solutions that we are starting to build to address some of these issues so policy is the top and the one of the top areas of prevention right we really work with our member organizations to develop strong policy and enforceable policy not just about drug testing but about all kinds of different things that can impact a person's ability to work safely and really get information to the leaders who can make decisions I think that when it comes to organizational culture and organizations being able to make changes it's important that everyone have a lot of information but it's important that the decision makers be at the table because if they're not at the table then they cannot make they can't elevate the priority that's needed for safety in their organization training training training you'll hear the National Safety Council talk about training all the time because we are a hundred and twenty year old organization and we have really great evidence-based training for employers and employees on all kinds of topics and issues so another thing that we're looking at this year is impairment detection technology and really looking at those technologies that can detect multiple forms of impairment not just your traditional drug and alcohol impairment so that's been really interesting and we will be sharing the results of that research study in June of this year so that's next month because today is it's now May somehow when I flew from Oklahoma to here I lost like two days I swear so yeah and it's cold here it was like 90 degrees at home I did not bring the right clothes so but anyway so we're really looking at those detection technologies and I'll get I'll give you some more information about that in a little bit but that data collection and reporting and communication I think that that's one of the areas that you'll see us pushing towards policy and looking at in the coming years because we know that there is room for improvement when it comes to reporting and data collection and we are dedicated to kind of delving into that in the next couple of years so how can employers make an impact we have the opportunity at National Safety Council to get in front of a lot of employers and like I said we have over 50,000 member companies but we this is really how we talk to them about it we talk first about prevention obviously and then treatment and recovery and return to work and there's a lot of things that fall underneath this umbrella of impairment and we really encourage companies to acknowledge that impairment isn't treated like a lot of other injuries or issues in the workplace and really form that culture of inclusion and understanding where the needs of their employees are all right so again this is just a little bit about the some of the tools that we have at National Safety Council to help employers prioritize prevention really we and we understand that when employees feel supported and encouraged that they might be more willing to reach out and say that they have a substance use disorder a sleep disorder or experiencing mental distress that can impact their ability to work and really encouraging support from managers and supervisors when employees experience stress I think we've all experienced this over the last couple of years and how in different organizations have responded to their employees needs during the pandemic have been really interesting to me education obviously is something that we strive to be a resource for at National Safety Council those policies need to be a priority and they need to be enforceable and then understanding the benefits and health care options that are available or could be available to employees and employers treatment is obviously the next step there and employers can dramatically increase the accessibility of treatment and to ensuring that their health plans cover treatment and employer initiated treatment and EAPs like I talked about like I talked about before really making sure that those important tools are accessible to all employees when care is needed and really for those workers who might be struggling and make sure that those resources are communicated to employers into employees frequently because life changes right and we could have something going on a stressor in the family going on that may there may be an EAP benefit that that would greatly help that person but they may never thought of something they may never thought of the EAP as something that they would utilize recovery and return to work is something and that we are you know invested in at National Safety Council we understand that there are American workers working and in recovery and we really encourage those recovery friendly workplaces employers play a really important role in this and a supportive environment can really do a lot for a person to help sustain that healthy lifestyle as they go through their work I talked a little bit about this before but having that positive culture and employee engagement is something that really benefits employers we talk to employers all the time about developing and boards and advisory councils of employees themselves who are helping to build and shape those policies and programs so that they have a voice in what's happening but also have having a really good sample of the different of the diverse diversity of the workforce in those in those groups because we know that the needs of the new the new employee or the early career employee can be much different than the later career employees who may need just as much support at work so these are some of the examples of workplace policies that we advocate for at National Safety Council and we have a number of policy positions on our website if you're interested in looking at those a little bit more in depth we usually don't provide like sample or template policies because we feel that organizations should really do things like identifying who is their safety sensitive employees themselves right because if we call them out we may miss something that is important to that organization but certainly having these workplace policies that address things like fatigue and return to work flexible scheduling if possible leave policies that accommodate things like mental health visits and things like that again having the ability for employees to reach out to the employer and get the resources that they need define definition of that safety sensitive position is is something that is a really hot topic right now right and we partner with ACOEM all the time and really use that as a model for what employers should be saying is their safety sensitive position I think we'll continue to see more discussion on that as you know all kinds of things evolve I in my primary job is working on cannabis initiatives at National Safety Council so I'm really in tune to how employers and employees and states are defining safety sensitive as we see cannabis legalization across the country so really looking at the need to expand what employers are offering beyond traditional alcohol and drug programs and if impairment is really viewed as a safety concern policies need to be in place to just to address that and I think that that multifaceted approach looking at it broadly and looking at things like fatigue and mental distress as a possible factor of impairment is really asking employers to take a new look at their policies and how they can address it so again here are a few of our resources you'll see all different kinds of vanity URLs on our website for these things but please take a look at them and reach out to us if you have questions we have some specific resources and recommendations about cannabis that I'll be presenting tomorrow and we have new materials coming out next year like I talked about our impairment detection technology and one of the projects that I'm working on is a database of cannabis legalization laws and regulations throughout the state or throughout the states so if you're familiar about regulation state regulation what's happening with cannabis is because it's still schedule one and it's still federally illegal states are legalizing and creating their own regulation framework which is a huge patchwork of you know broad definitions and we are really advocating at National Safety Council for there to be a more aligned approach and I'll talk a little bit about that tomorrow but we also have an opiate opioids at work employer a toolkit this toolkit can be used but it's free and available on NSC org it include it includes educational materials resources for different audiences so we have some for supervisors we have some for HR professionals and employees as well as just introductory tree information about the topic if the issue is something that an employer isn't used to looking or talking about we have things like safety talks and policy guides information on naloxone of course and information on health care benefits this was a really great resource that we developed a few years ago and continue to get we continue to update it so if you have haven't looked at it in a few years please take a look at it and we'll continue to add as we can I'm gonna grab my drink really quick I'm okay see you again I'll get my plug later okay great all right so here's just a couple of mental health resources that we have available we have a webinar series we have a group at National Safety Council that's called safer and it's safe actions for employee returns which is focused on returning to work after kovat and really broad topics discussed there from vaccines to policy to you know all kinds of things and we have a free mental health webinar series June is National Safety Month so during that month we will have a webinar pretty much every week in different topics the second week of June is the impairment week so you'll hear about this presentation plus one on the kovat impact of EAP utilization that project and then one on cannabis specific things as well I talked a little bit earlier about fatigue in our fatigue cost calculator we receive or we released four reports in 2018 on fatigue and its impact in the workplace and these can be found on our website we're continuing to update things like the new shift work guidelines that have recently came out into this program we also have a program at National Safety Council that's called work to zero and that's really focused on technology and how we can utilize that in the workplace and if you're interested in looking at their website they have some great information on technology but also what employers are doing utilizing that technology similar to the opioid toolkit we have a fatigue toolkit and again it's a free resource available at nse.org fatigue at work and we have fillable policy templates some you know for high-risk industries like construction and manufacturing example incident reports like how how do we provide a tool for us to gather the information that we need right and then really understanding that it's a shared responsibility that we need to address the issue of fatigue all right so I'm going to talk a little bit about the training and technology that we have at NSE and again we really strive to have these address that broad spectrum of issues not just your traditional drug and alcohol so we conducted an environmental scan in 2020 really to inform all of our work in the impairment practice area like dr. Hartman said we're relatively new practice at NSE and really because as an organization we understood that impairment is an issue that deserves its own research and attention and team we are a small but mighty team there are seven of us and really we wanted to understand how employers are looking at impairment and what research and trainings are out there to address it so we did a lit review here and an expert advisory panel was convened and I'll talk about the survey a little bit more but we're still working on the technology component of this but we do have a new training that I'll be telling you about in a second but really important finding here was that 87% of the respondents indicated that they needed new supervisor impairment training so we know that it's a need and we are excited to offer it at National Safety Council we just launched this training in October and it's really essentially a reasonable suspicion course but different from others because it's focused on all forms of impairment instead of just drug and alcohol we are focused on well mental health and well-being as well addressing gaps in what we found in the environmental scan research was a bit readily available on the market it's relevant to supervisors safety professionals and others I will say that it's not currently DOT compliant but we are working on a DOT compliant piece and then also a standalone cannabis module so that will be coming in this year in 2022 and this is really a well-rounded training and I think that we're starting to receive feedback from employers who have taken the training and looking forward to providing it to a broader audience after the summer. So we understand that employers are, or supervisors, I'm sorry, are essential in getting this information to their employer, to their employees, but also recognizing and responding and protecting the health and safety of their employees. Research shows that the supervisors are the ones that have a lot of influence on their employees safety attitudes, knowledge, and their behavior on the work site. So just a little bit about the training, if you're interested in the contents and how we develop this. It's focused on scenarios and it's really interactive and skills-based. It includes quizzes and post tests. Also, again, really focusing on broad impairment very broadly. We focus on actionable signs and symptoms of impairment, which we have heard from employers that supervisors, we need to hone those skills, right? They need to practice this. So I know that this is not an inclusive list, but this is one of the most common, some of the most common signs and symptoms, and we use this approach instead of overwhelming supervisors with each kind of impairment. Really, we just need them to recognize that the impairment is there, right? It matters less why in the beginning or what the cause is. So we don't expect our employers, you know, to be drug recognition experts or something like that, unless you're in a state that's going that way, but we really want them to be able to notice when that behavior is abnormal. And not to jump to conclusions why that might be, but getting the employee the necessary information that they need to take action or to change their behavior if needed. We found that employees are more likely to come forward when they know that they have support of their supervisors. So the most critical component of this training is knowing how to respond when supervisors realize that impairment might be present. Keeping company policies at the center and the focus, we want, we provide specific steps for employers to lean on so that they have confidence in knowing what to do. Most of the scenarios are skill-based, like I said, and it really drives home this process. So we ask them to identify, is this a safety-sensitive position? Is the situation unsafe at this moment and when to act? Documentation, we cover the concrete facts and understanding how to document conversations with their employees about this impairment. We talk about preparation, reviewing the information gathered and company policies, get them to understand what their own organization says about impairment. And the action part is working with HR and their safety team to have their conversation and identify what the next steps should be. Making sure that the employee has a voice here and that it is in a very conversational experience. And then, of course, following up. If action was taken, what is it, what is, what does the supervisor do next? What does the employee do next? How do we follow up and monitor their progress of this employee? Whether or not they needed an intervention or not, sometimes we just need that follow-up, right? And supervisors can do this. It doesn't have to be in a clinical way. It can be, you know, in a more peer-based interaction. I'm gonna skip that one because the video isn't working. All right, so we, in our pilot, some of this, this is some of the feedback that we received on the training. And after three months, we saw almost half of the supervisors who took the training found that there was something that they could implement immediately. So, we hope that our, our six-step training is something that employers can continue to use and agree is worthwhile. We really heard feedback that the focus on impairment holistically was important, that there were actionable things that the supervisors could do right away, and that there was, this was an evaluated program. So, we are going to continue to evaluate it. I know that this evidence-based program is very, very important for the field, and we're going to continue to work to refine it. So, just a little bit about our impairment detection technology. This is a research study that we're doing in conjunction with Work to Zero, and it's a resource that really expands dealing with impairment, just one cause. We really wanted to identify technology that was available on the market that has the ability to detect multiple forms of impairment. And we understand that this some of this type of technology has been in use for over a decade, but its effectiveness really has not been well published, and so we're looking forward to helping disseminate some of that information. We're launching this research project in June, so you can look for more information from NSE at that point. And we also have a psychomotor vigilance testing project that we're working on, and the results of that will probably be towards the end of this summer. So, looking at what's happening in the impairment detection technology world right now, this is just a snapshot of the survey that we did, and what technology was in use, and what types of types of impairment did it detect. So, as this technology is emerging, there are few workplaces that are currently implementing any type of technology, but we really want to increase the adoption of these technologies that we know are evidence-based and useful to help prevent injuries. So, one of the things that we asked employers is, what are the barriers to adopting this type of technology? And these were their responses. Really, cost, not surprisingly, is the top barrier, but also employer distrust or fear. So, at the National Safety Council, that's one of the things that we think we can have a positive influence on, is that adoption and that confidence in adoption of technology that's evidence-based, that we know and understand, can help prevent those incidents. Obviously, we're going to continue to monitor piloting of new and emerging technologies with our partners at Work to Zero, and continue to understand what's happening in this space. So, I'm going to close here, so we can have some time for questions, but as the National Safety Council, we really understand that leadership is needed in this area, and we are ready to lead employers in the direction that points to prioritizing safety. Addressing impairment holistically is something that we're dedicated to, and we are going to continue to develop evidence-based solutions and strategies to do that. So, we will look for opportunities to do this, and when we talk to employers, these are kind of the things that we tell them about. You know, we have data and information on why addressing impairment is important, utilizing those cost calculators if, you know, we need to reach the pocketbook, and then helping have that conversation about recognizing impairment, about adopting helpful technology, and just about understanding holistically what's happening to the people, right? The people who are in our workplaces every day. So, this is my contact information. If you're interested in, I think my slides may not be on there, so if you want them, I can send them to you directly, but we are going to upload them, right? We're going to upload them after this session's over. Okay, all right. All right, well, we have a few questions and a few comments. Well, first comment was going to be, we will be uploading slides after the session's over, so it should be there later on today. We have one question about the role of prescription medications that may cause dizziness, drowsiness, fatigue, other similar symptoms, but are not controlled substances and are not tested for routinely in drug test panels. Would you like to answer that? I will defer to the physician. You know, I think that's really one of the things that I'm most concerned about, is I routinely see employers say, go for the drug test, they order a five panel. If they're really thinking about it, they may order a ten panel or another expanded panel. What they really need to do is have a healthcare provider evaluate that individual and start from the very beginning of what happened, why do you think it happened, what are your underlying medical conditions, what are you taking prescription, what are you taking over-the-counter, hint-hint Benadryl, and what are you taking supplements, CBD, Delta ATHC, you know, all those different things can also cause impairment as well. So, we really need somebody who understands, and then on top of that, it's the, what's happening in your life, are you getting enough sleep, how many jobs are you working, do you have any family issues, do you have a newborn at home, and you can get the idea that you can have a whole long list of questions. So, I think it's really short-sighted for employers to often just think about prescription drugs and ending it there. Pop to that table and then we'll go to another question online. Hi, I'm Michael Caldwell from Meharry Medical College, Nashville, Tennessee, and we are going to be launching Dry January USA, so it's take a month off of alcohol, and some people may have heard of it, but it's gonna really have a presence. We are so grateful for the National Safety Council for all you do, and you're leaning into that education and being proactive with the employees to try to get them to think about their own relationship with alcohol. A lot of my impression of how we look at alcohol and work is alcohol on work as opposed to alcohol off work, and that can really, what we may just see is somebody being tired during the day. So, please visit poster 542, we have our poster up online, we'd like to share it, and we'd love more partners, other companies trying to lean into this with us. Thank you. Thank you very much. Thank you. Again, poster 542, alcohol is an issue not just in the workplace, but outside the workplace, and to this doctor more about it. So, second thing I want to go back and forth is, keep an eye open, I'm going to be inviting Katie to join us again, probably in July or August, to present. I know we're all looking for the impairment technologies and what we can maybe use in the workplace. So, another question online, seeing an increase in worker fatigue and injury due to long hours, 12 to 16 hours, 5 to 7 days in a row, due to staffing shortages, employer needing to keep 24-7 production going, basically, with COVID, people are just fatigued, overwhelmed, burnt out, stressed, etc, etc. Any thoughts or comments on that, besides telling the employer, I knew you were going to do that. Yeah, I think part of the problem is really balancing the, you know, yes, the operations have to continue, I know there was a presentation talking about meatpacking plants, you can't close them down and we won't be able to eat, you have to have the grocery workers there, we're not going to have food, you have to have the railroad employees moving the trains, because otherwise we're not going to have anything. So, it's really trying to get that employer to understand that, yes, we have to have operations going, we have to have the businesses open, but if we overwork our employees, we're not going to have them anymore. And that's a really hard message because they hear, we need to get the business done, we need to get the business done. So, your role could also be, how can we provide you with tools of what to do when you're off work, i.e. don't go home and have a few drinks and then you'll fall asleep and then you'll wake up and you'll have all other kinds of problems. Look at the medications that you're taking, talk to your health care provider, utilize the EAPs that are out there, there's a lot of really good and certainly NSC has a great, safer program, I use it a lot during COVID. You know, what can we do to help you get through all these really horrible work conditions, because we will come out, hopefully, at some point on the other end. Hi, you talked about a stigma-free workplace, especially for folks in recovery. Can you talk a little bit more about how you balance that with things like known relapse rates and safety concerns with having those folks in a work environment that a lot of us work in, where we've got folks doing very dangerous things, and maybe some direction on another place we can go to to get some additional information. I could imagine that could be hours of conversation. Yeah, absolutely, thank you for that. So, we partner with an organization called Heritage Health Solutions, and they are an organization that is focused on supporting employees in recovery, and I think that that's a really important conversation to address and have that open communication and understanding what that person needs. You know, understanding if that person can or cannot do the tasks that are required by that job first, you know, and then having a supervisor that's willing to work with that person, or having an organization that can put, you know, can understand the needs of the person in a way that they can be successful, both at work and for the organization. We also have a great partnership with Shatterproof, which is an organization that's dedicated to reducing the stigma, and having them involved in our advisory boards and things that those of us who aren't in recovery cannot understand. I think having employees on, again, involved in the decision-making and the policymaking that are in those situations will go a great deal to help them. And it's having that support both inside and outside the workplace, because they have a place to turn in either location. And while Dr. Mignone is coming to this, can you talk about the advisory panel very quickly? Sure. You mentioned it a couple times. Yeah, absolutely. So at National Safety Council, we have a couple of advisory panels, and the impairment practice area has one that is very broad. Dr. Hartenbaum is on it, but we are looking to establish a foothold for NSC to understand all those different types of impairment and how we can build solutions to understand them. So we've asked experts from sleep, we've asked experts from transportation, experts from the pharmaceutical industry to join us to understand the issues that are going on, and how we can build those evidence-based solutions that can address all of the issues. And the point being they're getting input from everyone, and it was a really interesting call. Great. Great. A quick question. For the organizations you deal with that don't have an internal medical department, as you expand the reasonable suspicion assessment beyond a five-panel drug test, what do you do with the inevitable flow of PHI and PII? Good question, doctor. The question is how do you, when you have a company that does not have a medical director or in-house medical department, how do you handle that PHII when you're having somebody kind of get that information, and then what do you tell the employer after the employee tells somebody what's going on? It's really important, and I'm a big proponent of whether you have an in-house medical department, whether you have a contracted medical department, when you have a consulting medical department, that you have someone that you can turn to. And ideally not just a go to the, and I'm not, hopefully nobody works for a mental clinic because I'm not putting them down, but go to the mental clinic down the street and get a drug test, which is what we often see happening. You want someone who understands how do you evaluate impairment, how do you begin, how do you talk to the employee, how do you talk to the treating provider, and by the way you can't access the PDMP in your state physician drug monitoring program if you are not the treating provider, even the people think that you can. So how do you work with the treating providers who can access that, who maybe can give you some insight, but you've got to get the information from the employer first. One of my biggest pet peeves is something's wrong with John Smith, can you evaluate him? Would you please tell me what's wrong with, he's just not acting right, give me specifics. So that's what I want from my employer, and then from the employee you've got to make sure that you only tell the employer what they need to know. They're safe, they're not safe, they need a reasonable accommodation. That's it. Did I answer your question? And that is, and you have to frequently say if they mention, because I try to put it back on the supervisor first, have you spoken to your employee and told them what you've observed? But if they say the word medical, they give you a diagnosis, they need a medication, say stop, I don't need to know that. Yeah, that may be one of the challenges for those of us who are looking for data and information on utilization of EAPs, because that information is protected and rightly so. So I'm a huge proponent of data linkage and how do we get that data so that we can continue to study these solutions that are working. Now for those of you who want to go on break, you do have a break scheduled now, if you want to keep asking a few more questions. I think it is right, doesn't it? But you can keep on asking questions if you want to. Hi, thank you. The statistic about opioid use rising in the 25 to 34 year olds is super alarming to me. First time I've seen the data visualization like that. But I was wondering, is there a breakdown for that demographic of people, just like industry, job title, race, socioeconomic status, income level, anything like that? Like in other words, is there a more nuanced... Can you just break down for what by demographic? Like the 25 to 34 year old rise in opioid use? Yeah, I've seen it. I don't know if it's CDC or not. There probably is something out there. Email me and I'll see if I can think of a couple places to look for it. Okay, I have one more question. So the impairment detection technology that you'll be presenting in June, you talk about fatigue, specifically for impairment. It makes me think about healthcare workers, right? Having a... Oh, okay, we've got to stop. There's another lecture right after this. It's not a break. I'm sorry. We can talk. We can have a conversation. Thank you.

Katie Mueller

Impairment

National Safety Council

workplace impairment

fatigue

mental health

supervisors

managers

policy development

positive workplace culture