Occupational Medicine considerations during medical assessments for fitness to dive and for compressed air work.

Most medical examinations performed on divers and compressed air workers to assess their fitness to work focus on the risks associated with exposure to increased and changing environmental pressure. However, these employees are also exposed to numerous other hazards in their workplace that may have long- and short-term health impacts. The potential adverse impact must be assessed and risk managed by companies working with a Contract Medical Advisor (CMA) assigned to the works via a Hazard Identification and Risk Assessment (HIRA) process. The appointed CMA should visit the work site to be in a position to provide adequate input into a workplace health and safety plan by directly participating in that HIRA process. A detailed analysis follows to determine whether medical surveillance would be required for hazards that are considered potential health risks. This process is reviewed with practical examples from the literature. This review does not intend to comprehensively cover all workplace hazards and risks to health associated with diving and hyperbaric operations. It aims to introduce aspects of occupational medicine and HIRA processes to Diving Medical Examiners who have not yet considered occupational hazards beyond those related to pressure. We strongly urge those doctors to work closer with the employers of divers and compressed air workers and to consider further formal study in occupational medicine. In many countries, diving medicine doctors involved with occupational divers must also have a formal occupational medicine qualification.