A systematic approach to health surveillance in the workplace.

This paper reviews the range of health surveillance activities which can be utilized in the workplace by occupational health professionals for assessing fitness for work and contributing to the prevention of occupational illness and promotion of good health. The systematic approach described categorizes health surveillance procedures into occupational or non-occupational, risk-based or unfocused, and as primary, secondary or tertiary preventive measures. All categories of health surveillance are currently being practised to some extent, but the type of surveillance may not match the needs of the workplace in some situation. In order to aid health professionals in deciding which procedures should be implemented, recommendations based on an assessment of health risks are made. The key proposal is to establish a minimum level of periodic health surveillance for all workers based on a targeted lifestyle health risk assessment and a structured health questionnaire. Additional procedures can then be added sequentially as appropriate to manage any health risks in the workplace. The role of the unfocused periodic general medical examination is discussed in the context of the systematic approach and allows occupational professionals to critically appraise its usefulness.

Management of a complex diving accident.

After the accidental ascent of a diving bell from 80 m, one diver died from pulmonary barotrauma and the other-though grossly ill-survived. After recompression therapy, this diver was tetraplegic with evidence of patchy microcirculatory damage of brain, cord, liver, kidneys, and gut. All systems eventually returned to normal, except the spinal cord, mainly because of the post-recompression phase of management, in which pharmacological doses of steroids, hyperbaric oxygen, and dextran were used. Although function returned in the upper limbs, the diver remained paraplegic.