I M P A I R M E N T T E S T

Benefits

Quick Test™ is a proven cognitive function assessment tool that is in use by professional sports teams and medical professionals around the world as a post head injury concussion assessment tool. Quick Test™ is now in use by Employers in North America to assess a Worker’s cognitive function status when impairment is suspected in the work area.

Quick Test™ from ImPACT Applications, Inc. is a medical device that is approved for use by the U.S. Food & Drug Administration (FDA), Health Canada, and the Australian Government Department of Health Therapeutic Goods Administration (TGA).

Quick Test™ functions “offline” without an internet connection to support remote use by the Employer with results being immediately displayed to the Supervisor.

When the iPad is “online” the results are uploaded to the Employer Administrator Dashboard that is compliant with the Country Specific Health Information Protection Legislation for the Licenced Territory including the U.S. requirements for the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the Canadian requirements for the Personal Information Protection and Electronic Documents Act (PIPEDA).

Quick Test™ requires minimal staff training for use in the workplace. Quick Test™ can be conducted in English, Español (Spanish), Français du Canada (Canadian French), Português do Brasil (Brazilian Portuguese), Italiano (Italian), Nederlands (Dutch), and Deutsch (German). Employer Authorized End Users that conduct a Quick Test™ assessment with the Worker are able to view the completed results for that assessment immediately but only the Employer Primary Administrator is able to access all of the other test results for that individual and other results for Workers at the Employer location.

Quick Test™ is not diagnostic, it provides percentile results for memory, attention, and motor speed that are determined from the age referenced normative data set. This allows non-medical Persons at the Employer location to complete the Quick Test™ assessment with the Worker and view the results.

Quick Test™ assesses the brain to determine the cognitive function status of a Worker related to all possible combinations of factors that could be causing cognitive function impairment. As an example, if a Worker used an over the counter cold medication prior to work, the Worker was up all night with their sick child, and the Worker is struggling with financial issues, these combined factors may be significantly impacting the Worker’s cognitive function status and the Worker should not be performing safety sensitive duties if they have a suboptimal cognitive function result in Quick Test™.

Supervisors understand that each Worker needs to work productively to fulfill both the Worker’s obligations and the Employer’s obligations. It is difficult at times for a Supervisor to subjectively remove a Worker from the work area for suspected Worker impairment due to the Supervisor’s empathy for a Worker’s unique situation, the Employer’s obligations for the continued delivery of products and/or services to their Clients, and the fear of Worker reprisal against the Supervisor if the Worker is not currently suffering from some form of cognitive function impairment in the work area.

Quick Test™ is an objective cognitive function assessment that is completed by the Worker. A Supervisor that suspects Worker impairment should remove the Worker from the work area, have a first aider quickly assess and treat the Worker for any life threatening conditions, if no life threatening conditions are present the Worker completes a Quick Test™ assessment to determine the Worker’s “in the moment” cognitive function status. If the Worker has a suboptimal cognitive function result in Quick Test™, this will objectively support the Supervisor’s decision to remove the Worker from the performance of safety-sensitive duties or other duties as required by the Employer’s policies.

The ability for the Employer to assess the Worker in the work area can potentially reduce lost production time that is normally required to transport a Worker to a facility for drug and/or alcohol testing or other assessment. An Employer Drug and Alcohol Policy could be updated to state that a sub-optimal cognitive function result in Quick Test™ is supporting evidence to initiate reasonable suspicion drug and/or alcohol testing.

Quick Test™ does not require a baseline assessment to be completed. Quick Test™ determines results from a scientifically validated age referenced normative data set. Quick Test™ is only performed on an iPad due to the high tolerances and consistencies of touch screen response and standardized screen sizes across all iPad devices. Quick Test™ is performed by the Worker in a seated position, or other comfortable position, and does not rely upon the accelerometer in the iPad to obtain results.

Other cognitive function assessment tools on the market that must have a Worker baseline assessment in place typically require the use of many different devices such as touch screen phones, touch screen tablets, different computer and mouse configurations, and other devices that may have inconsistent tolerances that can alter a Worker’s baseline results.

If a Health Professional must administer the baseline assessment with other systems, higher costs are typically involved for the Employer.

During baseline testing for other systems, a Worker may intentionally attempt to obtain a low baseline score in an effort to alter their scoring on future tests.

If a Worker’s health condition changes, a new baseline test for other systems should be administered which can increase the costs for the Employer.

Employer’s that obtain a Worker’s baseline cognitive function test results with other systems are at a very high risk of human rights discrimination if they alter a Worker’s employment status, especially if the Worker’s baseline cognitive function test results with other systems indicate an underlying cognitive function deficit related to a protected grounds medical condition.

The current Licence Agreement available from Impairment Test, a Division of HD Occupational Health Services Corporation, allows the Employer to complete an unlimited number of Quick Test™ assessments for a set fee structure in the Licence Agreement. This reduces and controls the Employer costs related to training and the use of Quick Test™ during the term of the Licence Agreement.

Cannabis

Cannabis / Marijuana is now a legal substance for purchase and use in Canada and many U.S. states which requires thousands of Employers to alter their existing Drug, Substance, Impairment, and Alcohol Policies.

These updated policies must address both the drug testing timelines for detection of Cannabis / Marijuana and/or Cannabis / Marijuana metabolites, and their correlation with timelines of prohibition from the use of Cannabis / Marijuana substances prior to work.

Quick Test™ can be included as a new bona fide occupational requirement in the Employer Drug, Substance, Alcohol, and Impairment Policies to address this correlation between the timeline from last use of a Cannabis / Marijuana substance and potential “in the moment” impairment.

Legislation in many U.S. states has changed to prohibit some Employers from conducting Cannabis / Marijuana drug testing in the workplace and other technologies are now required to assess for potential Worker impairment. Quick Test™ can assist Employers to assess a Worker in the work area when impairment is suspected.

When a Worker uses a Cannabis / Marijuana substance, such as Cannabis / Marijuana Flower, that contains Tetrahydrocannabinolic acid (THCA or 2-COOH-THC) which when heated causes a decarboxylation process to convert THCA to the psychoactive cannabinoid Tetrahydrocannabinol / (−)-trans-Δ⁹-tetrahydrocannabinol (THC), the Worker may suffer from THC related cognitive function impairment in their executive functions of basic motor speed, memory, and attention.

Assessment of “in the moment” motor speed, memory, and attention are the core components of a Quick Test™ assessment.

Motor Speed or Reaction Time is the lapse in time between the presentation of stimulus and a Worker’s response. For example, a Person is walking towards a forklift and the Worker operating the forklift safely stops the forklift.

Memory or Working Memory is the ability of a Worker to hold and manipulate information and then remember it following a short delay. For example, a Physician provides verbal or written instructions to a Registered Nurse and then the Registered Nurse is able to remember and act on those instructions in the work area.

Attention is the process of a Worker selectively attending to one aspect of the work environment while ignoring other stimuli. For example, a Worker is operating heavy equipment in the work area and is able to remain focused on the operation of their heavy equipment when other stimuli are present in the work area.

If a Worker has recently used a Cannabis / Marijuana substance containing THC, they may suffer from deficits in the aspects of planning and decision making with regard to response speed, accuracy, latency, and a decreased ability to apply higher order executive functions related to cognitive processing including the Worker’s inability to articulate that they are suffering from cognitive function impairment.

A Worker that has recently used a Cannabis / Marijuana substance containing THC may not be able to state that they are impaired however they may be able to describe their coping mechanisms related to cognitive function impairment. Examples of these coping mechanisms can include Worker statements such as,

“I leave more space between myself and other people when I am following them.”

(Impairment or latency of response in motor speed),

“I try to focus on one task at a time.”

(Impairment of working memory and latency in executive functions related to task completion),

and “I avoid busy areas and locations.”

(Impairment or latency of concentration and attention).

The timeline for detection of the main secondary metabolite of THC in urine drug testing, known as 11-Nor-9-carboxy-Δ9-tetrahydrocannabinol / 11-nor-9-carboxy-THC / THC-11-oic acid / (11-COOH-THC or THC-COOH or as defined by the US Department of Transportation(DOT) ∆-9-tetrahydrocannabinol-9-carboxylic acid (THCA)), above the Employer confirmatory test cut-off concentration can be as long as 6 weeks after the last use of a Cannabis / Marijuana substance containing THC.

If the Employer Drug and Alcohol Policies allow the Worker to use Cannabis / Marijuana substances containing THC within 6 weeks of working, urine laboratory drug testing for THC-COOH may result in a “Positive” test that may not directly correlate with recent Cannabis / Marijuana substance use.

Quick Test™ can assist the Employer with an “in the moment” assessment of a Worker’s cognitive function status to support urine laboratory testing results of non-compliance with the Employer’s Drug and Alcohol Policies.

The timeline for detection in oral fluid laboratory testing for the presence of Tetrahydrocannabinol / (−)-trans-Δ⁹-tetrahydrocannabinol (THC) above the Employer confirmatory test cut-off concentration can be from 15 minutes after last use to more than 5 days after the last use of a Cannabis / Marijuana substance containing THC.

THC that is stored in the adipose or fatty tissue of a Worker can be released into the blood stream for many days after the last use of a Cannabis / Marijuana substance containing THC potentially causing THC to become available for detection in oral fluid.

Persons with increased amounts of adipose tissue are at risk of having THC released for longer durations into their blood than Persons with very low amounts of adipose tissue leading to potential human rights discrimination concerns.

Quick Test™ can assist the Employer with an “in the moment” assessment of a Worker’s cognitive function status to support oral fluid laboratory testing results of non-compliance with the Employer’s Drug and Alcohol Policies.

When a Person consumes Cannabis / Marijuana edible substances, any available THC is rapidly oxidized to its active metabolite 11-Hydroxy-Δ9-tetrahydrocannabinol (11-OH-THC or 11-hydroxy-THC). 11-hydroxy-THC rapidly crosses the blood–brain barrier and can be up to 6 times more impairing than a similar dose of THC that was consumed by smoking or vaping.

11-hydroxy-THC has a later onset and longer duration of cognitive function impairment than THC that was consumed by smoking or vaping.

11-hydroxy-THC cognitive function impairment can last 5 or more hours depending on the dose, a Person’s metabolism, and other factors.

The only current accurate method of detecting 11-hydroxy-THC is in a blood drug test. Most Employers will not be implementing blood drug testing due to the invasive nature of the testing, substantial costs for testing, and the limitations of legal defense related to the blood drug testing process.

Quick Test™ can assist the Employer with an “in the moment” assessment of a Worker’s cognitive function status to support removal from safety sensitive duties decisions when drug testing is not available, or not defined in the Employers Drug and Alcohol Policies for substances like 11-hydroxy-THC.

Breath THC testing is in the testing phase with some data being collected by law enforcement agencies. No case law has been established to support Employer location breath THC testing. Breath THC testing can be difficult and potentially expensive due to the lipophilic nature of THC, unlike ethyl alcohol which is water soluble.

This is an oil soluble (cannabis) versus water soluble (alcohol) testing device type and measureable volume concern.

Almost all proposed breath THC testing devices measure the presence of THC in picograms, this is parts per trillionth of a gram (1/1,000,000,000,000). For reference, scientifically validated alcohol testing is measured in grams of alcohol for every 100 ml of blood.

Quick Test™ can assist the Employer with an “in the moment” assessment of a Worker’s cognitive function status to support removal from safety sensitive duties decisions when breath THC testing is available, or is not available, at the Employer location.

All cannabinoids and/or cannabinoid metabolites that enter the human body can interact with the human endocannabinoid system which are endogenous lipid-based retrograde neurotransmitters that bind to cannabinoid receptors, and cannabinoid receptor proteins, that are present throughout the vertebrate central nervous system, brain, and the peripheral nervous system.

There are more than 114 known cannabinoids and many other cannabinoid metabolites which can have a wide range of effects on a Person’s physiological and cognitive processes including a Person’s appetite, pain sensation, mood, memory, attention, motor speed, and other unknown interactions with over the counter medication use, prescribed medication use, and other substances use including alcohol.

For Employers that are not required to comply with US DOT legislation or other Legislation for total prohibition from exposure to all forms of Cannabis / Marijuana, please be aware that many new substances containing varying amounts of the 114+ different cannabinoids are now available for legal purchase in many areas of Canada and the U.S. including lip balms, hard candies, edible products, infused beverages, topical solutions, hair care products, skin care products, food products, oils, smoking and vaping products, and many other products.

These new Cannabis / Marijuana substances may impact the Employer’s ability to adequately enforce the Employer Drug and Alcohol Policy disciplinary components if you must address a situation where a Worker has used a Cannabis/Marijuana substance with no malicious intent to cause cognitive function impairment.

For example, a Worker that uses a THC and Cannabidiol (CBD) infused lip balm or moisturizer may have the presence of THC in the mouth, or the presence of THC-COOH in the urine. If the Worker’s THC levels are above the Employer confirmatory test cut-off concentration for laboratory oral fluid THC drug testing or if the Worker’s THC-COOH levels are above the Employer confirmatory test cut-off concentration for laboratory urine THC-COOH drug testing, this would confirm Worker non-compliance with the Employer prohibition from Cannabis / Marijuana substance use and/or exposure. Employer disciplinary actions in relation to a Worker’s use of a Cannabis / Marijuana infused lip balm or moisturizer that was used without malicious intent by the Worker to cause cognitive function impairment may lead to costly Employer legal actions in arbitration or other legal costs.

Quick Test™ can assist the Employer with an “in the moment” assessment of a Worker’s cognitive function status to support removal from safety sensitive duties decisions when drug testing is being completed or when drug testing is not being completed for other substances, cannabinoids, or cannabinoid metabolites that can alter brain functions and other physiological functions.

Any Worker, and especially a Worker that has a moderate to high THC tolerance, that uses any Cannabis / Marijuana substance is always at risk of being in violation of the blood drug levels, related to the operation of a motor vehicle or other conveyance, that are defined in Criminal Code and other Legislation as applicable for each geographical region.

At Employer locations where Workers are allowed to consume Cannabis / Marijuana on their off duty hours, some Workers may develop a THC tolerance as repeated activation of type 1 (CB1) receptors can cause desensitization. Workers that have a moderate to high THC tolerance may not present with as much THC related cognitive function impairment after use of a Cannabis / Marijuana substance containing THC as compared to a Worker with low THC tolerance after their use of a Cannabis / Marijuana substance containing THC.

A Worker with moderate to high THC tolerance from smoking and vaping Cannabis / Marijuana substances can still be impaired by their use of other Cannabis / Marijuana substances including edibles, CO2 oil extracts, distillates, dry sift, ice water hash, bubble hash, rosin, shatter, wax, pull and snap concentrates, or other Cannabis / Marijuana substances.

A Worker with moderate to high THC tolerance could also abstain from their exposure to THC for a few days and return to a low THC tolerance state which could result in immediate cognitive function impairment with the Worker’s next use of a substance containing THC.

A Worker with a moderate to high THC tolerance can have cognitive function impairment from other factors such as extreme heat exposure, extreme cold exposure, fatigue, mental health conditions, physical conditions, substance use, over the counter medication use, prescribed medication use, and the potential non-therapeutic side effects of an in use prescribed medication, or other substance, that is not metabolising at predicted rates due to competition with the in use cannabinoids for first-pass metabolism in the liver.

Quick Test™ can assist the Employer with an “in the moment” assessment of a Worker’s cognitive function status for all of the potential scenarios related to Workers that state that they have a high THC tolerance and for all of the other combined factors that can cause cognitive function impairment.

Employers that require a total prohibition from any form of Cannabis/Marijuana use as a bona fide occupational requirement (BFOR) must enforce this total prohibition. This includes Employers that must comply with the US Department of Transportation (DOT) legislation, many Oil and Gas Industries with Workers that are in a safety sensitive position, and when required by the Employer’s policies.

Quick Test™ can still be used by these Employers to support removal from work decisions related to other factors that can cause impairment including fatigue, extreme heat exposure, extreme cold exposure, substance use, mental health conditions, and other physical conditions.

Common Causes of Impairment

Activation of the hypothalamic-pituitary-adrenal (HPA) axis as a result of stress initiates a release of hormones and neurotransmitters in the brain that alters executive functions in the prefrontal cortex which can cause a decrease in working memory.

Quick Test™ can assist the Employer with an “in the moment” assessment of a Worker’s cognitive function status for all of the combined factors that can cause cognitive function impairment including deficits in working memory related to stress responses.

Most Workers and Supervisors have experienced some form of fatigue that alters their brain functions.

Fatigue and sleepiness can cause cognitive function impairment including decreased motor functions, impaired attention, decreased concentration, and decreased working memory functions.

For example, during an Oil and Gas Turnaround a Worker in a safety sensitive position just switched to nights and is 5 hours into their 3rd night of 12 hour shifts. A Supervisor observes that the Worker is yawning and has slurred speech.

Quick Test™ is an ideal tool to assist the Employer with an “in the moment” assessment of a Worker’s cognitive function status for all of the other combined factors that can cause cognitive function impairment including fatigue.

If the Worker obtains a suboptimal cognitive function result in Quick Test™, the Supervisor, as directed by the Employer’s Policies, may decide to place the Worker in a forced rest area for a few hours to allow the Worker to recover. Prior to the Worker returning to the work area, the Worker can complete a Quick Test™ assessment to confirm that the Worker’s “in the moment” cognitive function status is adequate to return to the performance of duties in a safety sensitive work environment.

Extreme heat events are becoming more frequent in all geographical areas.

Fires of all types are increasing in intensity and duration in many geographical areas.

All Workers that perform any type of safety sensitive duties are at now at some risk during the summer months of working in an extreme heat environment.

Stresses to the body can be further aggravated by the wearing of protective clothing without adequate ventilation, limited access to cool water and cooling breaks, air pollution found in some work areas and near forest fires, carrying protective equipment such as self-contained breathing apparatus (SCBA), performing medium or heavy physical tasks as a normal job duty or as required by extenuating circumstances, lack of access to shaded areas or air conditioning, and many other factors.Extreme heat exposure reduces the human body’s ability to perform thermoregulation which can alter the functions of the cardiovascular system, respiratory system, renal system, cerebrovascular system, and other systems. Extreme heat exposure causes cognitive function impairment including decreased working memory, decreased attention, and decreases in executive cognitive function decision making abilities. Dehydration, which is commonly related to extreme heat exposure, can significantly alter a Worker’s ability to perform simple motor tasks.

Quick Test™ can assist the Employer with an “in the moment” assessment of a heat exposed Worker’s cognitive function status for all of the combined factors that can cause cognitive function impairment. A suboptimal cognitive function result in Quick Test™ following Worker extreme heat exposure, can support the Employer decision to remove the Worker from the safety sensitive work area and support the Worker with a health assessment, rest, a cool environment, hydration, and other support measures.

Any Worker that is exposed to cold temperatures can suffer from cognitive function impairment in motor speed, working memory, reaction time, verbal speech communications, and other executive functions.

Cognitive function impairment can be worse with longer durations of cold exposure, colder temperature exposures, wind chill effects, high relative humidity, ineffective protective clothing, less than adequate Worker hydration, and many other factors.

Cognitive function impairment from cold exposure can persist into the recovery period after removal from the cold environment and during the rewarming phase.

For example, in a cold workplace such as a cold storage facility, oil and gas work in cold climates, some military environments, and search and rescue work, a Worker’s safety and performance could be dramatically altered when cognitive function impairment occurs both during the cold exposure and during the recovery period. Quick Test™ can assist the Employer with an “in the moment” assessment of a cold exposed Worker’s cognitive function status to determine if a suboptimal cognitive function result is present that would support removal of the Worker from the performance of safety sensitive duties and the completion of a health assessment with the Worker.

Supervisors are primarily responsible for ensuring that Workers are providing the products and/or services that are required by the Employer to meet the needs of the Client.Supervisors in many regions are now a named entity in Legislation for their work location with requirements for the Supervisor to protect the health and safety of all of the Workers that are assigned to the Supervisor.

Supervisors do not typically have extensive medical backgrounds that allow for their rapid assessment of a Worker’s health condition prior to the start of work and then during the working hours. Being able to rapidly assess a Worker for all combinations of symptoms related to impairment from substance use, over the counter medication use, prescribed medication use, mental health conditions, and other physical conditions is a skill set that can require years of training and hundreds of hours of practical experience.

If a Supervisor suspects Worker impairment for any reason, the Supervisor should remove the Worker from the work area and have the Worker assessed by a First Aider. If the Worker is suffering from a life threatening condition such as a heart attack, stroke, breathing difficulties, overdose, diabetic incident, or other condition, the First Aider can initiate transport by Emergency Medical Services (EMS), or by other Employer Policy defined actions, to get the Worker into the care of Medical Professionals as soon as possible. While the First Aider is assessing the Worker, the Supervisor should be able to quickly assign work duties to the rest of their team to ensure the delivery of products and/or services as required by the Employer. If no life threatening condition is present, either the First Aider or the Supervisor or the Human Resources Person can complete a Quick Test™ assessment with the worker.

This is an objective process for removal from work that best supports the Worker’s health, the Supervisor’s requirements to protect the health and safety of all Workers in their care, and the Employer’s requirements for the delivery of products and/or services. This process allows for a rapid assessment of the Worker’s current cognitive function status which allows the Employer to determine any possible accommodation requirements for the Worker on a case by case basis.