加拿大職業(yè)病管理概況課件

加拿大職業(yè)病管理概況Overview概況OVERVIEWOFCANADA加拿大概況REGULATORYENVIRONMENT立法環(huán)境DEFINITION定義COMPENSATION賠償TREATMENT治療PREVENTION預(yù)防TheLand

國土10millionsquarekilometers-secondlargestnationonEarth,afterRussia

1000萬平方公里—世界上第二大國僅次于俄羅斯Northtosouth4,800km-morethantwothirdsofitsresidentslivewithin300kmofitssouthernborderwith12statesoftheUnitedStates南北跨度4800公里--三分之二多的人口居住在和美國12個(gè)州接壤的南部300公里以內(nèi)的邊界地帶。ThePeople

國民ThePopulation人口加拿大人口統(tǒng)計(jì)Thousands單位千persons(thousands)20022003200420052006Canada31,372.6031,676.1031,989.5032,299.5032,623.50NewfoundlandandLabrador紐芬蘭省519.4518.4517.2514509.7PrinceEdwardIsland愛德華王子島省136.9137.3137.9138.2138.5NovaScotia新斯科舍省934.5936.5938936.1934.4NewBrunswick新布拉威克省750.3751.2752.1751.5749.2Quebec魁北克省7,445.707,494.707,548.607,597.807,651.50Ontario安大略省12,102.0012,262.6012,416.7012,558.7012,687.00Manitoba曼尼托巴省1,155.601,161.901,170.501,174.101,177.80Saskatchewan薩斯喀徹溫省995.9994.7994.9990985.4Alberta艾爾伯塔3,116.303,161.403,207.003,277.603,375.80BritishColumbia卑詩省4,115.404,155.404,203.304,257.804,310.50YukonTerritory育空地區(qū)30.130.630.931.131.2NorthwestTerritories西北地區(qū)41.542.242.842.641.9Nunavut魯拉烏特地區(qū)28.729.229.63030.8Note:PopulationasofJuly1.2006ThePeople

國民Canada’sPopulationisover31.6millionpeople.人口超過3160萬1.17millionpeople(4%)areAboriginalPeoples:FirstNations(60%),Métis(33%),Inuit(4%)andOther(3%)

117萬（4%）為土著居民：-原住民（60%），米提人（法裔土著混血33%），因紐特人（4%）6.2millionpeople(20%)areImmigrants.

620萬（占人口20%）移民Canada’spopulationgrowth(1997-2005)isattributableto:加拿大的人口增長（1997-2005）主要來自于：3millionbirths,2milliondeathsandover2millionnewimmigrants.

出生人數(shù)300萬，死亡人數(shù)200萬，超過200萬的新移民MostCanadiansliveinurbansettings-over80%resideintownsandcities.大部分加拿大人居住在城市環(huán)境-80%的人居住在城鎮(zhèn)和城市中8TheCanadianConstitution加拿大憲法Canadaisafederationwiththreelevelsofgovernment:federal,provincialandmunicipal加拿大是由三級政府組成的聯(lián)邦體制：聯(lián)邦、省、市UndertheCanadianConstitution,powersaredividedbetweenthefederalandprovincialgovernments

根據(jù)加拿大憲法，聯(lián)邦和省級政府分權(quán)MunicipalitiesarenotrecognizedintheConstitutionexcepttotheextentthattheyaretheresponsibilityofprovinces憲法中對市級政府的管理范圍沒有明確，只提到該級政府由省級政府負(fù)責(zé)Thereareabout4,000municipalgovernmentsinCanada加拿大大約有4000個(gè)市政府9TheCanadianConstitution加拿大憲法Thefederalgovernmentmaintainsthe“peace,orderandgoodgovernment”ofthewholecountrybymakinglawswithrespecttoimmigration,unemploymentinsurance,tradeandcommerce,nationaldefence,nativeaffairs,andcriminallaw.聯(lián)邦政府通過制定關(guān)于移民、失業(yè)保險(xiǎn)、商貿(mào)、國防、少數(shù)民族事務(wù)和刑法等法律，來維持整個(gè)國家的“和平、秩序和良政”。Provincialgovernmentsareempoweredtocontrolregionalandlocalaffairsincludingeducation,health,socialservices,propertyrights,administrationofjustice,localpublicworks,andmunicipalinstitutions.省級政府被授權(quán)管理地區(qū)和地方事務(wù)，包括：教育、衛(wèi)生、社會(huì)服務(wù)、財(cái)產(chǎn)權(quán)、司法管理、地方公共設(shè)施和市級機(jī)構(gòu)。Someresponsibilitiesaresharedbetweenthefederalandprovincialgovernmentssuchasimmigration,agriculture,andpensions.

在有些領(lǐng)域中，聯(lián)邦和省政府共同承擔(dān)責(zé)任，如移民、農(nóng)業(yè)和養(yǎng)老金。Municipalgovernments-strictlylocalmatters市政府-僅限于管理當(dāng)?shù)厥聞?wù)Economy

加拿大的經(jīng)濟(jì)theeight-largesttradingnation

世界第八大貿(mào)易國high-techindustrialsociety,CanadatodaycloselyresemblestheUS

當(dāng)今的加拿大是高新技術(shù)工業(yè)社會(huì)，和美國十分相似advantages-naturalresources,skilledlaborforce,andmoderncapitalplant經(jīng)濟(jì)優(yōu)勢：自然資源、高技能的勞工隊(duì)伍和現(xiàn)代化的工廠NaturalResources:IronOreNickelZincCopperGoldLeadPotashSilverFishTimberWildlifeCoalPetroleumNaturalGasHydropowerEconomy

經(jīng)濟(jì)Theworkforce勞動(dòng)力結(jié)構(gòu)Industry行業(yè)Number人數(shù)GoodsProducing商品生產(chǎn)3,708,300Agriculture農(nóng)業(yè)321,900NaturalResources自然資源310,700Utilities基礎(chǔ)設(shè)施149,900Construction建筑1,178,000Manufacturing制造業(yè)1,756,800Theworkforce勞動(dòng)力結(jié)構(gòu)Industry行業(yè)Number人數(shù)Industry行業(yè)Number

人數(shù)Services服務(wù)業(yè)13,086,400Trade貿(mào)易2,632,100Accommodation/Food酒店/食品1,034,500Transportationandwarehousing交通和倉儲(chǔ)819,900Other其他785,500Finance,insurance,realestate金融、保險(xiǎn)和房地產(chǎn)1,118,000PublicAdmin公共管理923,800Professional專業(yè)技術(shù)人員1,196,900Businessservices商業(yè)服務(wù)639,000Education教育1,196,500HealthCareSocialServices公共衛(wèi)生服務(wù)1,955,100OccupationalInjuries/diseases

職業(yè)傷害/職業(yè)病rNumberofWorkersCovered(000s)(1)涉及到工人TotalClaimsReported統(tǒng)計(jì)的申報(bào)數(shù)字AcceptedTime-LossInjuriesFatalitiesTotal受理的誤工工傷%Time-LossInjuries誤工工傷比率Total死亡數(shù)%Fatalities死亡率1996

10

758.6947

776377

88539.97030.071997

10

986.7962

134379

85139.58330.091998

11259.497022437536038.77980.081999

11548.499661737945038.18350.082000

11781.8105022639250237.48820.082001

11983.9102152437321636.59190.092002

12148.899769135917436.09340.092003

12729.098043634871535.69630.102004

12708.297711834050234.89280.092005

13052.299488633793034.01

0970.11Average

11895.798986336645937.08890.09

TheAccidentPyramid

事故金字塔結(jié)構(gòu)Foreveryoneworkplacedeaththereare 34injuriesresultinginlosttime,900minorinjuries,1,500nearmisses,and20,000unsafeactions.作業(yè)點(diǎn)每死亡1人的同時(shí)大約有34人受傷誤工

900人受輕傷

1500人僥幸脫險(xiǎn)和20,000人次違法安全規(guī)定操作Causeofworkplacefatality

作業(yè)點(diǎn)死亡原因統(tǒng)計(jì)(2005)Exposuretoharmfulsubstancesorenvironments–512deaths(asbestosisthesingleleadingcause)接觸有害物質(zhì)或環(huán)境-512人（石棉是最主要的原因）Transportationaccidents–229deaths交通事故-229人Contactwithobjectsandequipment–142deaths接觸物體及操作設(shè)備致死-142人Falls–77deaths高墜或摔倒-77人Bodilyreactionandexertion–30deaths身體反應(yīng)及用力不當(dāng)-30人Fireorexplosion–19deaths火災(zāi)或爆炸-19人Assaultsandviolentacts–21deaths施暴和其它攻擊性暴力行為-21人Other(eventsorexposures,unknownorsimplynotspecified)–67deaths其他（事故或接觸，情況不明或不具體）-67人死亡RegulatoryEnvironment立法環(huán)境HEALTHCARE醫(yī)療衛(wèi)生Canadahas1Federaland13provincialandterritorialgovernments加拿大有1個(gè)聯(lián)邦政府和13個(gè)省級和特區(qū)政府Constitutionsaysthat[a]healthcareisaprovincial/territorialresponsibilityandthat[b]allCanadianshaveaccesstothesamelevelofhealthcarenomatterwheretheylive憲法規(guī)定，醫(yī)療衛(wèi)生由省級或特區(qū)政府管理，無論居住在哪個(gè)地方，所有加拿大人都享有同樣水平的醫(yī)療衛(wèi)生服務(wù)RoleoftheFederalgovernmentistoprovidefunding,ensureequalityandensurecompliancewiththeCanadaHealthCareAct聯(lián)邦政府的職責(zé)是提供資金，確保平等并且加拿大醫(yī)療保?。ㄐl(wèi)生）法得到執(zhí)行RegulatoryEnvironment立法環(huán)境OccupationalHealthandSafety職業(yè)衛(wèi)生與安全Regulatedmostlyattheprovinciallevel(over80%ofworkers)主要由省政府立法（涵蓋超過80%的工人）Workersinsomeindustries(e.g.,banking,inter-provincialtransportation)arefederallyregulated有些行業(yè)（如銀行、省際交通）則屬于聯(lián)邦立法范圍Greatdealofcollaborationbetweenprovincialandfederalagencies–soregulationsareverysimilar(butnotexactlythesame)acrossjurisdictions省級和聯(lián)邦機(jī)構(gòu)之間進(jìn)行了大量協(xié)作-所以各個(gè)管轄區(qū)的法規(guī)非常相似（但是并不完全相同）DefinitionofOccupationalDisease職業(yè)病的定義Twomainelementsarepresentinthedefinitionofanoccupationaldisease:職業(yè)病的定義包括兩個(gè)要素thecausalrelationshipbetweenexposureinaspecificworkingenvironmentorworkactivityandaspecificdisease;and某一疾病與接觸某一工作環(huán)境或從事某一工作存在的因果關(guān)系thefactthatthediseaseoccursamongagroupofexposedpersonswithafrequencyabovetheaveragemorbidityoftherestofthepopulation.接觸特定環(huán)境工作的人群患某一疾病頻率高于其他人群ClassesofOccupationalDisease(ILO)職業(yè)病的分類1.Diseasescausedbyagents由不同因素導(dǎo)致的職業(yè)病 1.1Diseasescausedbychemicalagents化學(xué)因素導(dǎo)致的職業(yè)病 1.2Diseasescausedbyphysicalagents物理因素導(dǎo)致的職業(yè)病 1.3Diseasescausedbybiologicalagents生物因素導(dǎo)致的職業(yè)病2.Diseasesbytargetorgan特定器官疾病 2.1Occupationalrespiratorydiseases職業(yè)呼吸道疾病 2.2Occupationalskindiseases職業(yè)皮膚病 2.3Occupationalmusculoskeletaldiseases職業(yè)骨骼疾病3.Occupationalcancer職業(yè)性癌癥4.Others其它多種

如果肺炎的診斷成立，評價(jià)病情的嚴(yán)重程度、肺部炎癥的播散和全身炎癥反應(yīng)程度。除此之外患者如有下列危險(xiǎn)因素會(huì)增加肺炎的嚴(yán)重程度和死亡危險(xiǎn)：（一）病史年齡>65歲；存在基礎(chǔ)疾病或相關(guān)因素，如慢性阻塞性肺疾?。–OPD）、糖尿病、慢性心、腎功能不全、慢性肝病、一年內(nèi)住過院、疑有誤吸、神志異常、脾切除術(shù)后狀態(tài)、長期嗜酒或營養(yǎng)不良。（二）體佂呼吸頻率>30次/分；脈搏≥120次/分；血壓<90/60mmHg;體溫≥40℃或≤35℃；意識(shí)障礙；存在肺外感染病灶如腦膜炎，甚至敗血癥（感染中毒癥）。（三）實(shí)驗(yàn)室和影像學(xué)異常血白細(xì)胞計(jì)數(shù)>20X109/L；呼吸空氣時(shí)動(dòng)脈血氧分壓（PaCO2）>50mmHg;血肌酐>106umol/L或血尿素氮>7.1mmol/L；血紅蛋白<90g/L或血紅細(xì)胞比容<0.30；血漿白蛋白25g/L；感染中毒癥或彌散性血管內(nèi)凝血的證據(jù)，如血培養(yǎng)陽性、代謝性酸中毒、凝血酶原時(shí)間和部分激活的凝血活酶時(shí)間延長、血小板減少；X線胸片病變累及一個(gè)肺葉以上、出現(xiàn)空洞、病灶迅速擴(kuò)散或出現(xiàn)胸腔積液。重癥肺炎目前還沒有普遍認(rèn)同的標(biāo)準(zhǔn)，如果肺炎患者需要呼吸支持(急性呼吸衰竭、氣體交換惡化伴高碳酸血癥或持續(xù)低氧血癥)、循環(huán)支持(血流動(dòng)力學(xué)障礙、外周低灌注)和需要加強(qiáng)監(jiān)護(hù)和治療(肺炎引起的感染中毒癥或基礎(chǔ)疾病所致的其他器官功能障礙)可認(rèn)為重癥肺炎。目前許多國家制定了重癥肺炎的診斷標(biāo)準(zhǔn)，雖然有所不同，但均注重肺部病變的范圍、器官灌注和氧合狀態(tài)。我國制定的重癥肺炎標(biāo)精品PPT課件瀏覽免費(fèi)下載后可以編輯修改。/jnejclxh/see161///打造最權(quán)威的專業(yè)課件醫(yī)學(xué)精品課件本文檔免費(fèi)瀏覽閱讀，下載后可以編輯修改。Someproblematiccharacteristics存在的一些問題Resultsfromcumulative(chronic)ratherthanacuteexposure結(jié)果來自長期積累（慢性）而非急性接觸Delayedonsetconditions推遲了發(fā)作因素Notuniquetooccupationalexposures有些職業(yè)病不僅限于職業(yè)接觸引起Compensation賠償Appliedfor(typically)afterdiagnosis診斷后申請Applicationlikelytobesuccessfulif[a]employedinaknownhighriskoccupationforspecificcondition;[b]documentedexposuretohazard;and[c]clinicaldiagnosis/impairment如具備以下條件申請可能成功：1.受雇于高危行業(yè)；2.有接觸致危因素的條件；3.醫(yī)療診斷/損傷MostWCBsrecognizepresumptivecases(firefightersandsomecancers,coalminersandsilicosis,constructionworkersandHAVS)大多數(shù)工傷賠償局接受以下推理的情況為職業(yè)病（消防員與一些癌癥，煤礦工人與矽肺病，建筑工人與手臂振動(dòng)綜合癥Canextendintoretirement賠償可以延續(xù)到退休以后Treatment治療Occursintheregularhealthcaresystem在正規(guī)醫(yī)療衛(wèi)生系統(tǒng)進(jìn)行Nottiedtocompensationbutifpensionable,thenawardmayincludemedicalcosts(e.g.,drugs)notnormallypaidforinhealthcaresystem與賠償無關(guān)，如果可以領(lǐng)養(yǎng)老金，賠償則會(huì)包括醫(yī)療衛(wèi)生系統(tǒng)通常不會(huì)支付的醫(yī)療費(fèi)用（如某些藥品）Somespecificoccupationalclinicsinlargercentres(e.g.,occupationalmedicine,HAVSetc),byreferral,additionalcostspaidforbyinsurer大中心的一些特定職業(yè)診所（如職業(yè)藥物、手臂振動(dòng)綜合癥等）的轉(zhuǎn)診病人，額外費(fèi)用由保險(xiǎn)公司支付Somespecializedclinics(e.g.,painclinics)–byreferral,additionalcostspaidbyinsurer一些特定門診（如疼痛門診）的轉(zhuǎn)診病人，額外費(fèi)用由保險(xiǎn)公司支付Insurermayinstituteactivereturntoworkpoliciesincludingtreatment,jobaccomodation,ergonomicredesignetc保險(xiǎn)公司會(huì)遵守相關(guān)規(guī)定，包括治療、重新安排工作、根據(jù)人體工學(xué)重新設(shè)計(jì)等。Prevention預(yù)防DealtwithundertheOHSlegislation–nodistinctionmadebetweenoccupationalaccidentsandoccupationaldisease針對職業(yè)衛(wèi)生與安全立法-沒有將職業(yè)事故和職業(yè)病加以區(qū)別Sincealloccupationaldiseaseresultsfromexposuretoahazard,preventionfocusesoncontrollingtheexposure:因所有職業(yè)病都由接觸致危因素導(dǎo)致，預(yù)防的重點(diǎn)主要為控制接觸Atthesource–elimination,engineeringandadministrativecontrols源頭上-消除、工程和管理控制Alongthepath–elimination,engineeringandadministrativecontrols過程中-消除、工程和管理控制Attheworker–personalprotectiveequipment(PPE)工人-個(gè)人防護(hù)用品Typesofcontrol控制類型EngineeringControls工程控制-MOSTEFFECTIVE最有效 Processcontrol–changehowjobisdone過程控制-改變工作方式 Isolation/enclosureofemissionsource隔離/關(guān)閉排放源 Ventilation通風(fēng)AdministrativeControls管理控制–CANBEUNRELIABLE可能靠不住 Scheduling/jobrotation/restperiods日程安排/工作輪換/休息時(shí)間 WorkPractices工作實(shí)踐 Emergencypreparedness應(yīng)急準(zhǔn)備 PersonalHygiene個(gè)人衛(wèi)生PersonalProtectiveEquipment(PPE)-CANFAIL

WITHOUT WARNING個(gè)人防護(hù)用品-如果無警告可能無效

PublicHealthinCanada加拿大的公共衛(wèi)生

TheroleofthePublic