Preemployment medical examination

The periodic medical examination should ideally be conducted annually for full-time operatives (e.g., in pesticide manufacture) or at midseason and the end of the work season for part-time employees (e.g., field workers). However, in determining the periodieity of medical examinations and special studies for individual cases, the advising physician should take into account factors that include age, gender, frequency and duration of exposures, and potential exposure dosages. Additionally, employees should be advised, ideally at the preemployment medical examination, that if they believe that they are developing pesticide exposure-... 

Genetic factors The presence of an atypical ChE leading to a reduced pla.sma BChE is relatively rare but should be screened for at the preemployment medical examination of potential employees. 

Workers who work with items possibly contaminated with diseases communicable to humans, including tissue, fluids, fecal materials, and equipment which has come into contact with any of these, should be offered appropriate immunizations, if safe effective vaccines are available. Tetanus shots are recommended for all who work with animals, while those who work with wild animals should be ofleied rabies vaccinations. A preemployment medical examination is mandatory and should include medical and work histories. Periodic examinations may be desirable and should be considered. Any worker who may come into contact with human or primate tissue, blood, and fluids must receive training to meet the standards of the OSHA bloodbome pathogen standard and be offered shots for Hepatitis-B. 

De Kort WL, Fransman LG, van Dijk FJ (1991) Preemployment medical examinations in a large occupational health service. Scand J Work Environ Health 17 392-397... 

Workers exposed to butter yellow should wear personal protective equipment and their work should be carried out only in restricted areas. Technical measures should prevent any contact with the skin and mucous membranes. After use, clothing and equipment should be placed in an impervious container for decontamination or disposal. Preemployment and periodic medical examination should focus on liver function. 

During loading and application of pesticide, there should be supervision of employees by experienced people. The employees should be carefully instructed, before the working day starts, about the intended applications and where pesticide handling and exposure may occur. As a reminder, there. should be posters and notices drawing attention to, and clearly defining the health ha7,ards and risks from, overexposure to anti-ChE.s. Pn/vision should be made for preemployment medicals for new workers and for regular periodic medical examinations for established workers. 

The Multidisciplinary Approach. At one time, the company physician and occupational health nurse bore the primary responsibility for the health and safety of workers in their workplace. Although that physician-nurse team has expanded to include other disciplines, clinical services are stiU an important part of occupational health and safety programs. Some of the services provided by health care professionals include preemployment physicals, health assessments, and health surveillance through intermittent medical examinations and basic laboratory testing. Health education and counsehng usually falls to occupational health professionals, as do treatment, rehabilitation, and referral. 

Medical surveillance of exposed workers is also a necessary tool for protection against toxic exposures. Preemployment and periodic medical examinations can reveal the presence of toxic effects at an early stage, when a cure is often possible. Medical examinations should include specific organ functions to detect changes relative to the specific contaminants to which the worker is exposed. 

In-Plant Surveillance. A good medical surveillance program will include preemployment examinations of all employees and periodic checkups. Those whose duties are most likely to expose them to mercury should be tested at least annually. Medical surveillance should be supplemented by analyses of plant products, emissions, and effluents and by an environmental monitoring program. Employee monitoring may be on a personal basis or by way of atmospheric measurements. 

Pre-Employment Examination In addition to the standard preemployment examination protocol, special attention should be given to the cardiopulmonary system. Work at high altitudes places greater demands on the circulatory and respiratory systems. For example, medical conditions such as early chronic obstructive pulmonary disease and asthma are more disabling at altitude. Workers with blood disorders (such as sickle ceU anemia, anemia, or polycythemia) wiU find working at high altitudes much more difficult. Medical professionals should be consulted to establish the appropriate medical protocols for the preemployment examinations. 

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