OCCUPATIONAL MEDICINE FORUM

The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney.

What is Risk Assessment in Occupational Health? Answered by Tee L. Guidotti, MD, MPH, DABT. Dr Guidotti is an international consultant in health, environment, and sustainability with medical advisory services, Rockville, MD, www.mas.md. E-mail: [email protected]. Dr Guidotti is a former President of ACOEM. “Risk assessment” has different meanings in different fields, such as regulatory policy (where it usually applies to evaluation with the intent to regulate a hazard1 ), insurance (where it applies to assessing exposure to a claim), loss prevention (where it refers to the probability of costs or loss of assets). Confusingly, our colleagues in clinical preventive medicine also use the term as a synonym for health risk appraisal, to ascertain personal risk for an individual. In occupational health and safety, this concept of risk assessment is simply applied to a workplace to determine what hazards are most likely to result in harm or loss. Similarly, risk assessment can be applied to the enterprise as a whole. It is therefore useful to qualify “workplace-level risk assessment” or “enterprise-level risk assessment.”2 These concepts and meanings are all related, of course.3 A hazard is something that has the capacity to cause harm, whether it is a chemical or a condition in the workplace. A risk is the probability of something bad happening, such as an injury or health effect. A consequence is the result, the occurrence of that bad outcome. Risk assessment, at the workplace or enterprise level, is the process by which a hazard is identified, evaluated, and prioritized, when a decision is made as to whether it is a big risk requiring high priority or a medium or small risk that can be prioritized among other business priorities and wait its turn for management attention. The term “risk assessment” in the context of the workplace or the enterprise is more often used in industrial hygiene than in medicine and is especially common in Europe because it is a linchpin of the regulatory structure of the European Union and c 2014 by American College of OccupaCopyright  tional and Environmental Medicine DOI: 10.1097/JOM.0b013e3181e5a37b

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the UK Health and Safety Executive. The simplified approach they have taken, which is rapidly gaining ground worldwide, puts workplace-risk assessment within the grasp of workers and managers without special training. The objective is to reduce dependency on complicated and expensive exposure assessment by going directly to an assessment of risk. Workplace-level risk assessment feeds into a similarly simplified approach to risk management, including that which is called “control banding.” The objective is not to solve every problem without help: it is to deal with 80% of the problems which are easy and to identify the 20% that require professional attention. The five general categories of hazard found in the workplace are

r physical (noise, radiation, temperature, r r r r

pressure) mechanical (including ergonomic) chemical biological (including biological allergens) psychogenic (including stress)

Many experts count physical and mechanical hazards together, because they are really both hazardous forms of kinetic energy. In the oil and gas industry, it is common to see “Travel,” “Location” or “Geography” listed as a distinct category of hazard because many hazards are not specific to a particular occupation and instead are associated with a job assignment to a particular place.4 Examples are bad roads and motor vehicle injury, malaria, and HIV/AIDS. “Hazard identification” is the step in which a hazard comes to the attention of management or is recognized as a threat to health from research studies or the diffusion of information on health risks. Once a hazard is recognized in a workplace or in the enterprise, there is an obligation to manage it! Hazard identification initiates the process. After the hazard has been identified, it has to be evaluated. This is the analytical risk assessment step. In occupational health and safety, this is done by determining how serious a risk it poses to employees, contractors or other people who are likely to be exposed. Hygienists, of course, are the experts in evaluating chemical hazards and often do so with sophisticated measurements. How-

ever, the simple quantity of a chemical hazard that is present is a useful indicator of the potential for causing problems, if the toxicity or safety profile is known. There are three pieces of information that are most important in workplace-level risk assessment. Exposure opportunity: how likely is it that people will come into contact with the hazard (most often by inhaling it) at levels that could be harmful? (We will call this level “over-exposure” for simplicity, because exposure at low levels is not our concern here.) Quantity: how much is used or is present in the workplace (grams, kilograms, tonnes)?

Level of hazard: how dangerous is the hazard? The level of hazard is usually determined by comparing the occupational exposure level or other standard, by consulting standard references, or by referring to the manufacturer’s information on the material safety data sheet. Some risks are complicated and involve multiple ways in which things can go wrong. For example, an upset in a refinery is much more complicated than a welding accident. These complicated risk profiles can be modeled using conventional methods derived from engineering: Fault tree analysis is an evaluation based on a flow charts showing how an adverse event (such as a fire or a blowout or a spill) could happen. Fault trees work backward to determine what failure could cause the event and then what factors could cause the failure and so forth, until a clear picture emerges of what would have to go wrong to result in a serious event. In many cases, more than one failure is required for an adverse outcome. Hazard and operability (HAZOP) studies are used to predict what could go wrong when a part or a process fails. They emphasize consequences and are particularly useful for complicated situations where there may be unanticipated consequences. These advanced methods are not required for most risk assessment activities in the workplace. For most, simple methods such as checklists, grids, and physical inspection are enough but even these can become JOEM r Volume 56, Number 6, June 2014

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TABLE 1. Simple Table for the Prioritization of Risks Magnitude of Consequence Probability of Occurrence Low Medium High High Medium Low

Medium High Priority Priority Low Medium Priority Priority No Low Priority Priority

Highest Priority High Priority Medium to high Priority

complicated.4 One rather simplistic table for prioritization is given in Table 1. Hazards that are unlikely to occur and that result in little risk of harm are not important and are given no priority. Hazards that cause little harm are given lesser priority but if a hazard has the potential to cause serious harm it must be attended to even if the likelihood of harm is low. Hazards that result in risks that are both common and severe were usually dealt with a long time ago. If a hazard in this category is not an unavoidable part of operations, then the manager must ask the question of why it was allowed to occur in the first place. Higher and middle priority hazards need to be reduced and controlled before they hurt someone or damage company assets. This generally means making a special effort and not waiting until the next maintenance or replacement cycle. For example, if a relief valve is malfunctioning, it should be fixed without waiting for a plant shutdown. Beware of risks that are relatively unlikely but can cause serious harm or damage—they are usually underestimated. That is why they

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Occupational Medicine Forum

may be given a high instead of a middle priority, specifically if the consequences could cause serious injury or death or can stop production. Managers should not be complacent about any risk that can cause serious harm. Hazards resulting in risks that do not result in significant loss are not a priority, especially if they happen rarely, but still should be managed as part of regular operations. There will still be efficiencies to be gained by correcting these hazards and so it is worth paying attention to them. Low priority hazards may be inconvenient but only cause minor and tolerable risk and therefore can usually wait until the next maintenance or replacement cycle. When workers are grappling with a stiff stapler or a pair of scissors that are uncomfortable, to use a fairly trivial example, they are expending unnecessary energy and concern over something that is easily fixed. That energy could be used more productively and an unnecessary source of annoyance would be removed. Some hazards are contained and should be left alone until there is scheduled maintenance. For example, asbestos lagging (insulation) can be left in place as long as it is intact and not disintegrating, to prevent inadvertent release of fibers. Asbestos should only be removed when it is possible to seal off the area and use protective measures. This is usually best done during a plant overhaul or renovation, when the area would be disrupted anyway. (By now, asbestos has been removed from most industrial sites in North America.) Hazards resulting in risks that do not result in significant loss are not a priority, especially if they happen rarely, but should be managed as part of regular operations. For example, asbestos lagging (insulation)

can be left in place as long as it is intact and not disintegrating, to prevent inadvertent release of fibers. Asbestos should only be removed when it is possible to seal off the area and use protective measures. This is usually best done during a plant overhaul or renovation, when the area would be disrupted anyway. This is a general approach. The technical details will obviously be different for each problem.5 The occupational physician usually does not get involved at this level of detail. Enterprise- or workplace-level risk assessment is usually done by occupational hygienists and safety professionals. For that reason, the literature on risk assessment in occupational health is mostly to be found in industrial hygiene and safety.

REFERENCES 1. Smith CM, Christiani DC, Kelsey KT. Chemical Risk Assessment and Occupational Health: Current Applications, Limitations, and Future Prospects. Santa Barbara, CA: Greenwood; 1994. 2. Sadhra S, Rampal K. Occupational Health Risk Assessment and Management. Hoboken, NJ: Wiley-Blackwell; 1999. 3. Guidotti TL. The Praeger Handbook of Occupational and Environmental Medicine. Santa Barbara, CA: Praeger; 2010:379–458. 4. OGP. Managing Health for Field Operations in Oil and Gas Activities. Report No. 343. London: International Association of Oil and Gas Producers; May 2003. 5. Donoghue AM. The design of hazard risk assessment matrices for ranking occupational health risks and their applications in mining and mineral processing. Occup Med. 2001;51:118–123.

2014 American College of Occupational and Environmental Medicine Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

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What is risk assessment in occupational health?

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