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14. First Aid and Emergency Medical Services

14. First Aid and Emergency Medical Services (2)

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14. First Aid and Emergency Medical Services

Chapter Editor:  Antonio J. Dajer


Table of Contents


First Aid
Antonio J. Dajer

Traumatic Head Injuries
Fengsheng He


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1. Traumatic head injuries
2. Glasgow Coma Scale

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15. Health Protection and Promotion

15. Health Protection and Promotion (25)

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15. Health Protection and Promotion

Chapter Editors: Jacqueline Messite and Leon J. Warshaw

Table of Contents

Figures and Tables

Health Protection and Promotion in the Workplace: An Overview
Leon J. Warshaw and Jacqueline Messite

Worksite Health Promotion
Jonathan E. Fielding

Health Promotion in the Workplace: England
Leon Kreitzman

Health Promotion in Small Organizations: The US experience
Sonia Muchnick-Baku and Leon J. Warshaw

Role of the Employee Health Service in Preventive Programmes
John W.F. Cowell

Health Improvement Programmes at Maclaren Industries, Inc.: A Case Study
Ian M.F. Arnold and Louis Damphousse

Role of the Employee Health Service in Prevention Programmes: A Case Study
Wayne N. Burton

Worksite Health Promotion in Japan
Toshiteru Okubo

Health Risk Appraisal
Leon J. Warshaw

Physical Training and Fitness Programmes: An Organizational Asset
James Corry

Worksite Nutrition Programmes
Penny M. Kris-Etherton and John W. Farquhar

Smoking Control in the Workplace
Jon Rudnick

Smoking Control Programmes at Merrill Lynch and Company, Inc.: A Case Study
Kristan D. Goldfein

Cancer Prevention and Control
Peter Greenwald and Leon J. Warshaw

Women’s Health
Patricia A. Last

Mammography Programme at Marks and Spencer: A Case Study
Jillian Haslehurst    

Worksite Strategies to Improve Maternal and Infant Health: Experiences of US Employers

Maureen P. Corry and Ellen Cutler

HIV/AIDS Education
B.J. Stiles

Health Protection and Promotion: Infectious Diseases
William J. Schneider

Protecting the Health of the Traveller
Craig Karpilow

Stress Management Programmes
Leon J. Warshaw

Alcohol and Drug Abuse
Sheila B. Blume

Employee Assistance Programmes
Sheila H. Akabas

Health in the Third Age: Pre-retirement Programmes
H. Beric Wright

Saul G. Gruner and Leon J. Warshaw


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1. Health-related activities by workforce size
2. Breast & cervical cancer screening rates
3. Themes of “World No-Tobacco Days”
4. Screening for neoplastic diseases
5. Health insurance benefits
6. Services provided by the employer
7. Substances capable of producing dependence


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16. Occupational Health Services

16. Occupational Health Services (16)

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16. Occupational Health Services

Chapter Editors:  Igor A. Fedotov, Marianne Saux and Jorma Rantanen


Table of Contents

Figures and Tables

Standards, Principles and Approaches in Occupational Health Services
Jorma Rantanen and Igor A. Fedotov

Occupational Health Services and Practice
Georges H. Coppée

Medical Inspection of Workplaces and Workers in France
Marianne Saux

Occupational Health Services in Small-Scale Enterprises
Jorma Rantanen and Leon J. Warshaw

Accident Insurance and Occupational Health Services in Germany
Wilfried Coenen and Edith Perlebach

Occupational Health Services in the United States: Introduction
Sharon L. Morris and Peter Orris

Governmental Occupational Health Agencies in the United States
Sharon L. Morris and Linda Rosenstock

Corporate Occupational Health Services in the United States: Services Provided Internally
William B. Bunn and Robert J. McCunney

Contract Occupational Health Services in the United States
Penny Higgins

Labour Union-Based Activities in the United States
Lamont Byrd

Academic-Based Occupational Health Services in the United States
Dean B. Baker

Occupational Health Services in Japan
Ken Takahashi

Labour Protection in the Russian Federation: Law and Practice
Nikolai F. Izmerov and Igor A. Fedotov

The Practice of Occupational Health Service in the People’s Republic of China
Zhi Su

Occupational Safety and Health in the Czech Republic
Vladimír Bencko and Daniela Pelclová

Practising Occupational Health in India
T. K. Joshi


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1.  Principles for occupational health practice
2.  Doctors with specialist knowledge in occ. medicine
3.  Care by external occupational medical services
4.  US unionized workforce
5.  Minimum requirements, in-plant health
6.  Periodic examinations of dust exposures   
7.  Physical examinations of occupational hazards
8.  Results of environmental monitoring
9.  Silicosis & exposure, Yiao Gang Xian Tungsten Mine
10. Silicosis in Ansham Steel company


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Friday, 11 February 2011 20:58

Practising Occupational Health in India

Workers’ health has been of interest to physicians in India for almost half a century. The Indian Association of Occupational Health was founded in the 1940s in the city of Jamshedpur, which has the country’s best known and oldest steel plant. However, multidisciplinary occupational health practice evolved in the 1970s and 1980s when the ILO sent a team which helped create a model occupational health centre in India. The industry and workplaces traditionally provided health care under the banner of First Aid Stations/Plant Medical Services. These outfits managed minor health problems and injuries at the worksite. Some companies have recently set up occupational health services, and, hopefully more should follow suit. However, the university hospitals have so far ignored the specialty.

Occupational safety and health practice started off with injuries and accident reporting and prevention. There is a belief, not without reason, that injuries and accidents remain under-reported. The 1990–91 incidence rates of injuries are higher in electricity (0.47 per 1,000 workers employed), basic metal (0.45), chemical (0.32) and non-metallic industries (0.27), and somewhat lower in wood and wood pulp industries (0.08) and machinery and equipment (0.09). The textile industry, employing more workers (1.2 million in 1991) had an incidence rate of 0.11 per 1,000 workers. With regard to fatal injuries, the incidence rates in 1989 were 0.32 per 1,000 workers in coal mines and 0.23 in non-coal mines. In 1992, a total of 20 fatal and 753 non-fatal accidents occurred in ports.

Figures are unavailable for occupational hazards as well as for the number of workers exposed to specific hazards. The statistics published by the Labour Bureau do not show these. The system of occupational health surveillance is yet to develop. The number of occupational diseases reported is abysmal. The number of diseases reported in 1978 was just 19, which climbed to 84 in 1982. There is no pattern or trend visible in the reported diseases. Benzene poisoning, halogen poisoning, silicosis and pneumoconiosis, byssinosis, chrome ulceration, lead poisoning, hearing loss and toxic jaundice are the conditions reported most frequently.

There is no comprehensive occupational health and safety legislation. The three principal acts are: the Factories Act, 1948; the Mines Act, 1952; and the Dock Workers Safety, Health and Welfare Act, 1986. A bill for construction workers’ safety is planned. The Factories Act, first adopted in 1881, even today covers workers only in the registered factories. Thus a large number of blue- as well as white-collar workers do not qualify for occupational safety and health benefits under any law. The inadequacy of law and poor enforcement are responsible for a not very satisfactory state of occupational health in the country.

Most occupational health services in industry are managed by either doctors or nurses, and there are few with multidisciplinary disposition. The latter are confined to large industry. The private industry and large public sector plants located in remote areas have their own townships and hospitals. Occupational medicine and occasionally industrial hygiene are the two common disciplines in most occupational health services. Some services have also started hiring an ergonomist. Exposure monitoring and biological monitoring have not received the desired attention. The academic base of occupational medicine and industrial hygiene is not yet well developed. Advanced courses in industrial hygiene and postgraduate degree courses in occupational health practice in the country are not widely available.

When Delhi became a state in 1993, the Health Ministry came to be headed by a health professional who reaffirmed his commitment to improving public and preventive health care. A committee set up to study the issue of occupational and environmental health recommended setting up an occupational and environmental medicine clinic in a prestigious teaching hospital in the city.

Dealing with the complex health problems arising out of environmental pollution and occupational hazards requires more aggressive involvement of the medical community. The teaching university hospital receives hundreds of patients a day, many of whom have exposure to hazardous materials at work and to the unhealthy urban environment. Detection of occupationally and environmentally induced health disorders requires inputs from many clinical specialists, imaging services, laboratories and so on. Owing to the advanced nature of disease, some supportive treatment and medical care becomes essential. Such a clinic enjoys the sophistication of a teaching hospital, and following detection of the health disorder, treatment or rehabilitation of the victim as well as the suggested intervention to protect others can be more effective as teaching hospitals enjoy more authority and command more respect.

The clinic has expertise in the area of occupational medicine. It intends to collaborate with the labour department, which has an industrial hygiene laboratory developed with liberal assistance under an ILO scheme to strengthen occupational safety and health in India. This will make the task of hazard identification and hazard evaluation easier. Medical practitioners will be advised about health assessment of the exposed groups at the point of entry and periodically, and regarding record keeping. The clinic will help sort out the complicated cases and ascertain work-relatedness. The clinic will offer expertise to industry and workers on health education and safe practices with regard to the use and handling of hazardous materials in the workplace. This should make primary prevention more easily achievable and will strengthen occupational health surveillance as envisaged under the ILO Convention on Occupational Health Services (No. 161) (ILO 1985a).

The clinic is being developed in two phases. The first phase is focusing on identifying hazards and creating a database. This phase will also emphasize the creation of awareness and developing outreach strategies with regard to hazardous working environments. The second phase will focus on strengthening exposure monitoring, medical toxicological evaluation and ergonomic inputs. The clinic plans to popularize occupational health teaching for undergraduate medical students. The postgraduate students working on dissertations are being encouraged to choose topics from the field of occupational and environmental medicine. A postgraduate student has recently completed a successful project on acquired blood-borne infections among health care workers in the hospitals.

The clinic also intends to take up environmental concerns, namely the adverse effects of noise and rising pollution, as well as the adverse effects of environmental lead exposure on children. In the long run education of primary health care providers and community groups is also planned through the clinic. The other goal is to create registers of prevalent occupational diseases. The involvement of several clinical specialists in occupational and environmental medicine is also going to create an academic nucleus for the future, when a higher postgraduate qualification hitherto unavailable in the country can be undertaken.

The clinic was able to draw the attention of enforcement and regulatory agencies towards the serious health risks to fire fighters when they fought a major polyvinyl chloride fire in the city. The media and environmentalists were only talking of risks to the community. It is hoped that such clinics will in the future be set up in all major city hospitals; they are the only way to involve senior medical specialists in occupational and environmental medicine practice.


There is an urgent need in India to introduce a Comprehensive Occupational Health and Safety Act in line with many indus-trialized countries. This should be associated with the creation of an appropriate authority to supervise its implementation and enforcement. This will enormously help ensure a uniform standard of occupational health care in all states. At present there is no linkage between the various occupational health care centres. Providing quality training in industrial hygiene, medical toxico-logy and occupational epidemiology are other priorities. Good analytical laboratories are required, which should be certified to ensure quality. India is a very rapidly industrializing country, and this pace will continue into the next century. Failing to address these issues will lead to incalculable morbidity and absenteeism as a consequence of work-related health problems. This will undermine the productivity and competitiveness of industry, and gravely affect the country’s resolve to eliminate poverty.



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