A pocket card developed by the Atlanta-based Centers for Disease Control and Prevention’s Agency for Toxic Substances and Disease Registry (ATSDR) employs a mnemonic device to help occupational health physicians and nurses remember the key steps to a thorough exposure history. The steps spell out the words "I PREPARE" in a vertical design. They stand for the following key issues and groups of questions you should ask your workers:
• I — Investigate Potential Exposures: Have you ever felt sick after coming in contact with a chemical, pesticide, or other substance? Do you have any symptoms that improve when you are away from your home or work?
• P — Present Work: Are you exposed to solvents, dusts, fumes, radiation, loud noise, pesticides or other chemicals? Do you know where to find Material Data Safety Sheets on chemicals that you work with? Do you wear personal protective equipment? Are work clothes worn home? Do co-workers have similar problems?
• R — Residence: When was your residence built? What type of heating do you have? Have you recently remodeled your home? What chemicals are stored on your property? Where does your drinking water come from?
• E — Environmental Concerns: Are there environmental concerns in your neighborhood (i.e., air, water, soil?) What types of industries or farms are near your home? Do you live near a hazardous waste site or landfill?
• P — Past Work: What are your past work experiences? What is the longest job held? Have you ever been in the military, worked on a farm, or done seasonal work?
• A — Activities: What activities and hobbies do you and your family engage in? Do you burn, solder, or melt any products? Do you garden, fish, or hunt? Do you eat what you catch or grow? Do you use pesticides? Do you engage in any alternative healing or cultural practices?
• R — Referrals and Resources: Use these key referrals and resources: Agency for Toxic Substances & Disease Registry (www.atsdr.cdc.gov); Association for Occupational & Environmental Clinics (www.aoec.org); Environmental Protection Agency (www.epa.gov); Material Safety Data Sheets (www.hazard.com/msds); Occupational Safety & Health Administration (www.osha.gov); local health department, environmental agency, poison control center.
• E — Educate: Are materials available to educate the patient? Are alternatives available to minimize the risk of exposure? Have prevention strategies been discussed? What is the plan for follow-up?
Source: Paranzino GK, Butterfield P, Becker J, et al. PREPARE: Environmental Exposure History Mnemonic. Atlanta: Agency for Toxic Substances and Disease Registry; 2000.
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