Who We Are:
The Building Trades National Medical Screening Program (BTMed) is administered by CPWR – The Center for Construction Research and Training, the health and safety research center of North America’s Building Trades Unions, in partnership with Stoneturn Consultants, Duke University Medical Center, University of Maryland Medical Center, and Zenith-American Solutions. BTMed is funded by a cooperative agreement from the Department of Energy.
What we do:
For nearly 26 years, the Building Trades National Medical Screening Program (BTMed) has provided free, ongoing medical screening exams to construction workers previously employed at thirty-five (35) DOE nuclear weapons sites (see Figure 1). These workers may have been exposed to toxic substances and hazardous conditions, increasing their risk for occupational illnesses. The exams help identify work-related health conditions at an early, more treatable stage and contribute to these workers’ overall health and well-being. Since its inception, BTMed has provided over 41,500 medical screening exams and 7,500 CT scans to former DOE workers. BTMed participants are very satisfied with the services provided to them and in this year recorded a perfect 100% satisfaction rating.
BTMed COVID-19 Response:
The spread of COVID-19 initially shut down the work of BTMed, but BTMed’s medical team developed safety protocols that allowed our network of health providers to resume the vital screenings they provide. We are currently addressing the waiting list that developed during the shutdown. This ongoing work has included over 23,000 wellness calls to update participants; communicating with health clinics, local outreach coordinators, and state and local Building Trades Council; enrolling and interviewing participants; and continuing outreach through telephone calls, mailings, and virtual events. For those participants that aren’t comfortable going to a clinic, BTMed offers a Remote Health Assessment, that’s an alternative to in-clinic exams, with participants interviewed virtually to identify conditions that may be referred for medical follow-up or compensation. BTMed outreach staff are busy engaging workers and enrolling new participants. BTMed has a new online video that gives an overview of BTMed and features interviews from BTMed staff and participants. Visit www.btmed.org/cms/bThe spread of COVID-19 initially shut down the work of BTMed, but BTMed’s medical team developed safety protocols that allowed our network of health providers to resume the vital screenings they provide. We are currently addressing the waiting list that developed during the shutdown. This ongoing work has included over 23,000 wellness calls to update participants; communicating with health clinics, local outreach coordinators, and state and local Building Trades Council; enrolling and interviewing participants; and continuing outreach through telephone calls, mailings, and virtual events. For those participants that aren’t comfortable going to a clinic, BTMed offers a Remote Health Assessment, that’s an alternative to in-clinic exams, with participants interviewed virtually to identify conditions that may be referred for medical follow-up or compensation. BTMed outreach staff are busy engaging workers and enrolling new participants. BTMed has a new online video that gives an overview of BTMed and features interviews from BTMed staff and participants. Visit www.btmed.org/cms/btmed-informational-video/ to watch the video.
BTMed launched a redesigned and expanded website that is easier to navigate, provides more information on program benefits, features testimonials from BTMed participants, and has a responsive design that works across all devices. Visit BTMed at www.btmed.org.
BTMed Covered Sites
What we have found:
Important Occupational Health Findings
a. Conventional Medical Screening Exams
- Chest x-rays (N = 23,250 participants receiving at least one CXR): 19.2 percent demonstrated findings consistent with work-related lung disease.
- Pulmonary function tests (N = 22,882 participants receiving at least one PFT): 22.5 percent demonstrated findings consistent with obstructive disease.
- Beryllium Lymphocyte Proliferation Tests (BeLPT) (N = 22,024 participants receiving at least one BeLPT): 2.2 percent had at least one abnormal BeLPT.
- Audiometry (N = 21,373 participants receiving at least one audiogram): 65.1 percent demonstrated hearing loss for normal speech tones.
b. Early Lung Cancer Detection Program Exams
Former DOE construction workers at high risk for lung cancer may be eligible for BTMed’s Early Lung Cancer Detection (ELCD) Program. BTMed uses low-dose helical computed tomography (CT) scans to detect lung cancer at an earlier, more treatable stage. We offer scans in 10 locations (Augusta, GA, Cincinnati, OH, Columbia, SC, Denver, CO, Seattle, WA, Hanford, WA, Kansas City, MO, Oak Ridge, TN, Paducah, KY and Portsmouth, OH).
- Lung cancer was detected in 45 of 1,725 participants receiving low-dose CT scans.
- 34 of the 45 (75.6 percent) individuals whose lung cancers have been staged to date had an early stage lung cancer (carcinoma in situ, Stage I or Stage II non-small cell cancer or limited small cell cancer) at the time of diagnosis.
BTMed and Research:
BTMed’s commitment to research to improve screenings for construction workers was highlighted this year in a study of chronic obstruction pulmonary disease (COPD). A 2010 BTMed study of former DOE construction workers found increased risk of COPD. The current study of a larger worker cohort allowed for a more detailed analysis of COPD risk, including for employment beginning after the mid-1990s, when additional occupational safety and health programs and controls were implemented. The primary study objectives were to better define overall COPD risk and risk by severity according to trade while considering other factors which can cause COPD such as risk by longevity of construction trade work and DOE site employment. BTMed researchers examined COPD prevalence by demographic and smoking information, respiratory history, and employment history among 17,941 BTMed participants. The results found that compared to non-construction workers, construction trade workers were at significantly increased risk for all COPD and even more so for severe COPD. Findings support the prevention of both smoking and occupational exposures to reduce these risks. The study was published in the American Journal of Industrial Medicine in March 2021. Visit www.btmed.org/cms/publications/published-medical-findings/ to read the full paper. BTMed has completed and published 17 studies in the scientific literature.
BTMed Medical Team:
Knut Ringen, DrPH, MHA, MPH
Principal Investigator, BTMed
With more than 45 years of experience in public health administration, Dr. Knut Ringen is considered one of the founders of the field of occupational high-risk management. Due to his intensive studies of issues within one of the most high-risk industries in the world, he is an expert in construction safety and health. In 1996, he used this experience to establish the first medical screening program for former DOE construction workers, which evolved into the Building Trades National Medical Screening Program (www.BTMed.org). BTMed serves construction workers from 35 DOE sites across the country and has delivered in excess of 42,000 screenings to date. In 2013, BTMed added a special focus of early lung cancer detection for a subset of BTMed participants who have a significantly higher risk of lung cancer. Dr. Ringen is the principal investigator for BTMed.
In 1979, Dr. Ringen launched three projects to demonstrate that medical screenings among workers known to have been exposed to work-related health hazards could identify occupational illnesses and could help these workers secure their rights and prevent a premature death. When growing evidence from scientific studies and concerns expressed by workers suggested that DOE working conditions were hazardous, Dr. Ringen advocated for a special focus on construction workers, as these workers were usually employed by subcontractors and were more likely to be assigned to the most hazardous duties. Using the data collected from these medical screenings, Dr. Ringen and others showed how effective this model of medical screening and assistance was and why it should be applied to construction workers on DOE sites. This scientific analysis helped encourage Congress to enact legislation in 1993 that forms the basis for DOE’s Former Worker Medical Screening Program.
BTMed has saved lives, helped workers and their families with compensation, and demonstrated to DOE that construction workers need better safety and health protections. The program is well appreciated by the participants.
BTMed is administered by CPWR – The Center for Construction Research and Training (cpwr.com), a 501(c)(3) non-profit research institution, which serves as the research arm of North America’s Building Trades Unions (nabtu.org). Dr. Ringen was the first executive director of CPWR and currently is its senior science advisor. He has directed other non-profit health organizations and has worked at the National Academy of Sciences and the National Cancer Institute. Among many honors, he is a fellow of the European Academy of Sciences and the Collegium Ramazzini, the international society of scholars in environmental and occupational health. He has a Master in Hospital Administration from the Medical College of Virginia (now a part of Virginia Commonwealth University) and a Doctor of Public Health from Johns Hopkins University.
Marianne Cloeren, MD, MPH
Dr. Marianne Cloeren has decades of experience managing teams of clinicians, serving as Medical Director for a variety of private and government programs. Her work experience includes interacting with remote nurse case managers, managing quality assurance and audits, and delivering effective and well-reasoned case reviews in a Federal program; she has written and overseen the production of tens of thousands of such reviews. Dr. Cloeren serves as co-medical director for BTMed.
Stella Hines, MD, MSPH
Dr. Stella Hines is board-certified in Occupational Medicine, Pulmonary Medicine, Critical Care Medicine, and Internal Medicine. Her research and work experience include respiratory protection, pulmonary function testing, and surveillance for exposure to beryllium, asbestos, and other pulmonary toxins. Dr. Hines serves as co-medical director for BTMed.
Melissa McDiarmid, MD, MPH
Dr. Melissa McDiarmid is a clinical toxicologist who is board-certified in Internal Medicine and Occupational Medicine; she heads the University of Maryland Division of Occupational and Environmental Medicine. A seasoned clinician and researcher, she is an expert in medical surveillance programs and cancer related to occupational exposures. Dr. McDiarmid serves as a medical advisor for BTMed.