SOP Bulletin No. 108

Decision Support Unit

8 — th Floor, 259 Queen St, Brisbane — 1 — st Floor Blackburn House, 199 Grenfell St, Adelaide

Intranet site:  http://intranet/service_delivery_support/compensa…

28 August 2006

THE FOLLOWING RMA SOPS ARE TO TAKE EFFECT ON 30 AUGUST, 2006

New SOPs	Shin splints Pulmonary barotrauma Dysbaric osteonecrosis
Revocations & Replacements	Acute myeloid leukaemia Myelodysplastic disorder Decompression sickness (revocation of Caisson disease) Rotator cuff syndrome External burn
Amendments	Nil

IMPORTANT OPERATIONAL FEATURES

Shin splints

New  – 49 & 50 of '06

• These are new SOPs.  The — se SOPs finalise the formal investigation into this previously non-SOP condition.  During the investigation, claims could not be determined for this condition.  Outstanding cases may now be finalised.
• Shin splints are defined as meaning medial tibial stress syndrome and chronic exertional compartment syndrome of the lower leg. These two terms are also defined in the SOP.
• Ther — e are causal f — actors for a sudden increase in exercise, and undertaking weight bearing exercise (with time requirements).
• For medial tibial stress synd — rome only, there is a causal factor for having an injury that has resulted in excess pronation of the affected limb before the clinical onset.

Decompression sickness

Revocation – 43 & 44 of '06 Replaces 147 and 148 of '95

• This is one of three SOPs dealing with the effects of decompression.  The others are pulmonary barotrauma and dysbaric osteonecrosis; see below.
• Decompression sickness is not the s — ame as decompression illness.  The combined effects of decompression may be referred to clinically as decompression illness (DCI), and could include decompression sickness, pulmonary barotrauma and dysbaric osteonecrosis.  For SOP purposes, each of the three conditions is dealt with separately.
• The name of this SOP is now decompression sickness, previously Caisson disease.
• The definition has been re-worded and expanded, without change in meaning.
• There is still o — nly one ca — us — al factor - experiencing an episode of decompression. The definition of this factor now describes the circumstances in which an episode of decompression may occur, but the meaning is unchanged.  The time requirements have been made easier.

Pulmonary barotrauma

New  – 45 & 46 of '06

Dysbaric osteonecrosis

New  – 47 & 48 of '06

• These are both new SOPs.  The — se SOPs finalise the formal investigation into pulmonary barotrauma.  During the investigation, claims could not be determined for th — is condition.  Outstanding cases may now be finalised.
• These are two of three SOPs dealing with the effects of decompression.
• Pulmonary barotrauma is an acute condition, also known as 'burst lung', and caused by rupture of the alveolar walls.  Th — is may present as pneumothorax, pneumomediastinum, subcutaneous emphysema or arterial gas embolism.
• For pulmonary barotrauma, t — here are causal factors for a change in ambient barometric pressure (which is defined), mechanical ventilation and a blast injury, all with time requirements.
• Dysbaric osteonecrosis may be an acute or a chronic condition.
• For dysbaric osteonecrosis, there are ca — u — sal and worsening factors for experiencing decompression after hyperbaric exposure (which is defined), with time requirements.

Acute myeloid leukaemia

Revocation – 35 & 36 of '06 Replaces 169 and 170 of '96

• The SOP definition of acute myeloid leukaemia has been re — worded and now also requires 20% or more myeloblasts in bone marrow or blood.  If there are fewer than 20% myeloblasts in bone marrow or blo — od, the diagnosis of myelodysp — l — astic disorder should be considered.
• Having myelodysp — l — astic disorder is now an onset factor in both RH and BOP.  A high proportion of acute myeloid leukaemia cases are preceded by myelodysplastic disorder (a 'pre-leukaemia'), and this is a 'linking factor' between the two SOPs.
• There are new onset factors in RH and BOP for thorium dioxide (Thorotrast) and in RH only for being obese, all with time requirements.
• The smoking f — actor remains in RH and BOP, and the dose in RH has been reduced from 15 to 10 pack years.
• The atomic radiation factor has the new wording, and is now in BOP as well as RH.
• The external ionising radiation factors have been removed.
• There is a new quantitative factor for benzene exposure, fo — r receiving greater than 20 ppm-years RH/40 ppm-years BOP, of cumulative exposure, with time requirements.
• The 'being exposed to benzene' factors remain, but ha — ve been re-worded, and the time requirements have been changed.
• The factors for AVGAS or petroleum products containing benzene greater than 5% by volume have been re-worded and the time requirements have been changed.  The factor — s for 1% by volume have been removed.

Myelodysplastic disorder

Revocation – 37 & 38 of '06 Replaces 15 and 16 of '00

• The SOP definition of myelodysplastic disorder requires fewer than 20% myeloblasts in bone marrow or blood.  Many cases of acute myeloid leukaemia are preceded by myelodysp — l — astic syndrome, a 'pre-leukaemia'.
• Many of the factors in these SOPs are identical to thos — e in the acute myeloid leukaemia SOPs.  The exceptions are noted below.
• There are no factors for AVGAS or petroleum products containing benzene, and no obesity factor.  Obviously, the 'linking' myelodysplastic syndrome factor does not appear either.
• The smoking factor here is in RH only with a dose of 15 pack years.
• The definition of 'a course of chemotherapy' is different with alkylating agents included in both SOPs, but topoisomerase II inhibitors included in acute myeloid leukaemia only.

Rotator cuff syndrome

Revocation – 39 & 40 of '06 Replaces 83 and 84 of '97

• The definition has been changed to include degenerative disorders of the musculotendinous cuff of the shoulder joint (previously inflammatory disorders only).  Adhesive capsulitis, previously referred to as frozen shoulder, is still excluded.
• There are new causal and worsening factors in both RH and BOP for having an infection of the subacromial bursa on the affected side, having rheumatoid arthritis involving the affected shoulder or associated bursa, and having gout involving the affected shoulder.
• The trauma factors have become injury factors, without change in meaning.
• The 'performing activities' factors have been changed to cover repetitive or sustained activities of t — he affected shoulder, which are described, and have time requirements.
• The haemodialysis treatment factor — s are replace — d by dialysis-related amyloi — dosis before the clinical onset.
• The worsening factors for upper limbs transfer and excess laxity of the shoulder joint in both RH and BOP now have the same time requirement as the causal factors i.e. at least the one year before the clinical onset (previously 30 days).

External burn

Revocation – 41 & 42 of '06 Replaces 37 and 38 of '94, as amended by 195 & 196 of '95

• The — se SOPs have been put into the new format.
• The SOP definition has been changed to mean a burn due to external application of an agent.  The new definition includes burns of the eye, and excludes 'windburn', frostbite, and burns of the respiratory tract, gastrointestinal tract and internal genitourinary tract.  The exclusions of the effect of solar radiation, and injuries caused by microwave, infrared, ultra-violet or laser energy radiation have been removed.  Sunburn is now covered by this definition.
• There are new causal factors in both RH and BOP for electric shock or lightning, radiofrequency or microwave radiation, infrared radiation, non-ionising radiation, ultraviolet radiation, and ultrasound.
• All factors now have the standard wording, have time requirements and require application of the agent 'to the affected area'.
• Ionising radiation now appears as a separate factor, with the standard wording.
• The chemicals factor does not now include the words “caustics” and “acid”, but as the term chemicals is not defined, this term would in — clude these agents.

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