Petroleum-based fuels and lubricants are sold directly to consumers at full-service and self-service (with or without repair bays) service stations, car washes, automotive service centres, motor vehicle agencies, truck stops, repair garages, automotive parts stores and convenience stores. Service station attendants, mechanics and other employees who fuel, lubricate and service motor vehicles should be aware of the physical and chemical hazards of the petroleum fuels, lubricants, additives and waste products they come into contact with and follow appropriate safe work procedures and personal protection measures. The same physical and chemical hazards and exposures are present at commercial facilities, such as those operated by motor truck fleets, automobile rental agencies and bus companies for fuelling and servicing their own vehicles.

Because they are the facilities where motor fuels are delivered direct to the user’s vehicle, service stations, particularly those where drivers fuel their own vehicles, are where employees and the general public are most likely to come into direct contact with hazardous petroleum products. Other than those drivers who change their own oil and lubricate their own vehicles, the likelihood of contact with lubricants or used oil by motorists, except for incidental contact when checking fluid levels, is very small.

Service Station Operations

Fuel island area and dispensing system

Employees should be aware of the potential fire, safety and health hazards of gasoline, kerosene, diesel and other fuels dispensed at service stations. They should also be aware of suitable precautions. These include: safe dispensing of fuels into vehicles and containers, clean-up and disposal of spills, fighting incipient fires and draining fuels safely. Service stations should provide fuel-dispenser pumps which operate only when the fuel-hose nozzles are removed from the dispensers’ brackets and the switches are manually or automatically activated. Fuel-dispensing devices should be mounted on islands or protected against collision damage by barriers or curbs. Dispensing equipment, hoses and nozzles should be inspected regularly for leaks, damage and malfunctions. Safety features may be installed on fuel dispensers such as emergency breakaway devices on hoses, which retain liquid on each side of the break point, and impact valves with fusible links at the base of dispensers, which close automatically in event of severe impact or fire.

Government regulations and company policies may require that signs be posted in dispensing areas similar to the following signs, which are required in the United States:

• “No Smoking—Shut off engine”

• “WARNING: It is unlawful and dangerous to dispense gasoline into unapproved containers”

• “Federal Law prohibits the introduction of any gasoline containing lead or phosphorus into any motor vehicle labelled UNLEADED GASOLINE ONLY”

• “UNLEADED GASOLINE”, posted at unleaded gasoline dispensers and “CONTAINS LEAD ANTIKNOCK COMPOUNDS”, posted at leaded gasoline dispensers.

Fuelling vehicles

Service station employees should know where the fuel dispenser pump emergency shut-off switches are located and how to activate them, and should be aware of potential hazards and procedures for safely dispensing fuel into vehicles, such as the following:

• Vehicle engines should be shut off and smoking prohibited while fuelling to reduce the hazards of accidental vehicle movement, spills and fuel vapour ignition.

• When fuel is dispensed, the nozzle should be inserted into the vehicle’s fill pipe and contact between the nozzle and the fill pipe maintained to provide for an electric bond until the delivery has been completed. Nozzles should not be blocked open with fuel caps or other objects. Where allowed, approved latches should be used to hold open automatic nozzles.

• Vehicles such as cement mixers and recreation vehicles with auxiliary internal combustion engines should not be fuelled until both the vehicle’s engines and auxiliary engines are shut off. Care should be taken when fuelling recreational or other vehicles equipped with gas-fired stoves, refrigerators and water heaters to ensure that fuel vapours are not ignited by pilot lights. Employees should not fuel trucks while standing on the side rail, truck bed or fuel tank.

• Fuel tanks on motorcycles, motor bicycles, fork-lift trucks and similar vehicles should not be filled while the engine is running or when anyone is seated on the vehicle. The tanks should be filled at a slow rate to prevent fuel spills that could run onto hot engines and start fires.

• After fuelling, hose nozzles should be promptly replaced on the dispensers, pumps turned off and caps replaced on fill pipes or containers.

Filling portable fuel containers

Service stations should establish procedures such as the following for safely dispensing fuel into portable containers:

• Where required by government regulation or company policies, fuel should be dispensed only into approved, properly identified and labelled portable containers, with or without dispensing spouts, nozzles or hoses and equipped with vents and screw tops or self-closing gravity, spring action or combination fusible link covers designed to provide pressure relief.

• Containers should be placed on the ground and filled slowly to avoid splash filling and overfills and to provide for grounding (earthing). Containers should not be filled while in a vehicle or in the bed of a truck, particularly one with a plastic liner, as proper grounding cannot be achieved. Bonding wires and clamps should be provided and used, or contact should be maintained between dispenser nozzles and containers to provide a bond while filling, and between container spouts or funnels and tanks during refuelling from containers.

• When pouring fuel from containers which do not have built-in spouts, funnels should be used to minimize spillage and avoid splash filling.

• Portable containers which contain fuel or vapours should be properly stored in approved storage cabinets or rooms away from sources of heat and ignition.

Storage tanks, fill pipes, fill caps and vents

Service station underground and aboveground storage-tank gauge and fill-caps should be kept closed except when filling and gauging to minimize release of fuel vapours. When tank-gauge openings are located inside buildings, spring-loaded check valves or similar devices should be provided to protect each of the openings against fluid overflow and possible vapour release. Storage-tank vents should be located in accordance with government regulations and company policy. Where venting to open air is permitted, vent-pipe openings from both underground and aboveground storage tanks should be located at a high level so that flammable vapours are directed away from potential sources of ignition and will not enter windows or air intakes or doors or become trapped under eaves or overhangs.

Improper mixing of different products during deliveries may be caused by lack of identification or improper colour coding or markings on storage tanks. Storage-tank covers, fill pipes, caps and fill-box rims or pads should be properly identified as to products and grades so as to reduce the potential of a delivery into the wrong tank. Identification symbols and colour coding should conform to government regulations, company policies or industry standards, such as the American Petroleum Institute’s (API) Recommended Practice 1637, Using the API Color Symbol System to Mark Equipment and Vehicles for Product Identification at Service Stations and Distribution Terminals. A chart indicating the symbols or colour codes in use should be available at the service station during deliveries.

Delivery of fuel to service stations

Service stations should establish and implement procedures such as the following, for the safe delivery of fuel into aboveground and underground service station storage tanks:

Prior to delivery

• Vehicles and other objects should be moved from the area where the delivery tank truck and delivery hoses will be located.

• Delivery tank trucks should be positioned away from traffic areas, and vehicles should be restricted from driving near the unloading area or over hoses by the use of traffic cones or barriers.

• Receiving storage tanks should be gauged prior to delivery to determine if there is sufficient capacity, and checked to see if any water is in the tank.

• Drivers should assure that fuel is delivered into the correct tanks, that gauge caps are replaced before starting delivery and that all tank openings not being used for delivery are covered.

• Where required by company policies or government regulation, the tank truck vapour recovery system should be connected to the receiving storage tank prior to starting delivery.

During delivery

• Drivers should monitor the area near the receiving tank’s vents for potential ignition sources and check that the vents operate properly during delivery.

• Drivers should remain where they can observe the delivery and be able to stop delivery or take other appropriate action in event of an emergency, such as ejection of liquid from vents or if an overfill device or tank vent alarm activates.

After delivery

• Storage tanks may be gauged after delivery to verify that specific tanks have received the correct products and the proper amount of products as indicated on the delivery ticket or record. Samples may be taken from the tanks after delivery for quality-control purposes.

• After delivery, spill containment devices should be drained if necessary and the correct fill and gauge caps and storage tank covers replaced on the proper tanks.

Other Service Station Functions

Storage of flammable and combustible liquids

Government regulations and company policies may control the storage, handling and dispensing of flammable and combustible liquids and automotive chemicals such as paints, starter fluids, antifreeze, battery acids, window washer fluids, solvents and lubricants in service stations. Service stations should store aerosols and flammable liquids in closed containers in approved, well-ventilated areas, away from sources of heat or ignition, in appropriate flammable liquid rooms, lockers or cabinets, or in separate, outside buildings.

Electrical safety and lighting

Service station employees should be familiar with electrical safety fundamentals applicable to service stations, such as the following:

• Lighting and electrical installations, equipment and fixtures of the proper electrical classification should be provided and maintained in accordance with codes and regulations and should not be replaced by equipment of lesser classification.

• Electric tools, water coolers, ice machines, refrigerators and similar electrical equipment should be properly grounded (earthed). Portable lights should be protected against breakage to minimize the chance that a spark might ignite flammable vapours in case bulbs break.

Adequate illumination should be provided at appropriate locations in service stations to reduce the potential for accidents and injuries. Government regulations, company policies or voluntary standards may be used to determine appropriate illumination levels. See table 1.

Table 1. Illumination levels for service station areas.

Source: ANSI 1967.

Lockout/tagout

Service stations should establish and implement lockout/tagout procedures to prevent the release of potentially hazardous energy while performing maintenance, repair and service work on electrical, mechanical, hydraulic and pneumatic powered tools, equipment, machinery and systems such as lifts, hoists and jacks, lubrication equipment, fuel-dispenser pumps and compressors. Safe work procedures to prevent the accidental start-up of vehicle engines during servicing or repair should include disconnecting the battery or removing the key from the ignition.

Service station fluids

Fluid and coolant levels

Before working under a hood (bonnet), employees should assure that it will stay open by testing the tension or using a rod or brace. Employees should exercise caution when checking vehicle engine fluids to avoid burns from exhaust manifolds and to prevent contact between dipsticks and electrical terminals or wires; care is also necessary when checking transmission fluid levels (since the engine must be running). Employees should follow safe work procedures when opening radiators, such as allowing pressurized radiators to cool and covering radiator caps with a heavy cloth when opening, using PPE and standing with face turned away from radiators so as to not inhale any escaping steam or vapours.

Antifreeze and window washer fluids

Employees servicing vehicles should be aware of the hazards of both glycol and alcohol antifreezes and window washer fluid concentrates and how to safely handle them. This includes precautions such as storing alcohol-based products in tightly closed drums or packaged containers, in separate rooms or lockers, away from all heating equipment, and providing containment to prevent contamination of drains and ground in the event of a spill or leak of glycol-type antifreeze. Antifreeze or washer fluid should be dispensed from upright drums by using tightly connected hand pumps equipped with drip returns, rather than by using faucets or valves on horizontal drums, which may leak or be knocked open or broken off, causing spills. Air pressure should not be used to pump antifreeze or washer fluid concentrates from drums. Empty portable antifreeze and washer fluid concentrate containers should be completely drained prior to disposal, and applicable regulations governing the disposal of glycol antifreeze solutions should be followed.

Lubrication

Service stations should ensure that employees are aware of the characteristics and uses of the different fuels, oils, lubricants, greases, automotive fluids and chemicals available in the facility and their correct selection and application. The proper tools should be used to remove crankcase, transmission and differential drains, test plugs and oil filters so as to not damage vehicles or equipment. Pipe wrenches, extenders and chisels should be used only by employees who know how to safely remove frozen or rusted plugs. Because of the potential hazards involved, high-pressure lubricating equipment should not be started until the nozzles are set firmly against grease fittings. If testing is to be done prior to use, the nozzle should be aimed into an empty drum or similar receptacle, and not into a hand-held rag or cloth.

Lift operations

Employees working in and around vehicle service areas should be aware of unsafe conditions and follow safe work practices such as not standing in front of vehicles while they are being driven into service bays, over lubrification pits or onto lifts, or when vehicles are being lifted.

• Vehicles should be properly aligned on two-rail, free-wheel or frame-contact lifts, since an off-centre position may cause a vehicle to fall.

• Lifts should not be raised until occupants have left the vehicles and a check of overhead clearance has been made.

• Once the vehicle is in position, the emergency stop device should be set so the lift will not fall in the event of a pressure drop. If a lift is in a position where the emergency stop device cannot be engaged, blocks or safety stands should be placed under the lift or vehicle.

• A hydraulic lift may be equipped with a low-oil control valve, which prevents operation if the oil in the supply tank falls below a minimum level, since the lift can drop accidentally under those conditions.

When wheel-bearing lubrication, brake repair, tyre changing or other services are performed on free-wheel or frame-contact lifts, vehicles should be raised slightly above the floor to allow employees to work from a squatting position, to reduce the possibility of back strain. After vehicles are raised, the wheels should be blocked to prevent rolling, and safety stands should be placed underneath for support in case of jack or lift failure. When removing wheels from vehicles on drive-on lifts, the vehicles should be blocked securely to prevent rolling. If jacks or stands are used to lift and support vehicles, they should be of the proper capacity, placed at appropriate lift points on the vehicles and checked for stability.

Servicing tyres

Employees should be aware of how to safely check pressures and inflate tyres; tyres should be inspected for excessive wear, maximum tyre pressures should not be exceeded, and the worker should stand or kneel to the side and turn the face when inflating tyres. Employees should be aware of hazards and follow safe work practices when servicing wheels with multi-piece and single-piece rims and lock-ring-rim wheels on trucks and trailers. When repairing tyres with flammable or toxic patching compounds or liquids, precautions such as controlling ignition sources, using PPE and providing adequate ventilation, should be observed.

Parts cleaning

Service station employees should be aware of the fire and health hazards of using gasoline or low-flashpoint solvents to clean parts and should follow safe practices such as using approved solvents with a flashpoint above 60ºC. Parts washers should have a protective cover that is kept closed when the washer is not in use; when the washer is open, there should be a hold-open device such as fusible links, which allows the cover to close automatically in case of fire.

Employees should take precautions so that gasoline or other flammable liquids do not contaminate the cleaning solvent and lower its flashpoint to create a fire hazard. Contaminated cleaning solvent should be removed and placed in approved containers for proper disposal or recycling. Employees who clean parts and equipment using cleaning solvents should avoid skin and eye contact and use appropriate PPE. Solvents should not be used for hand-washing and other personal hygiene.

Compressed air

Safe work practices should be established by service stations for the operation of air compressors and the use of compressed air. The air hoses should be used only for inflating tyres and for lubrication, maintenance and auxiliary services. Employees should be aware of the hazards of pressurizing fuel tanks, air horns, water tanks and other non-air pressure containers. Compressed air should not be used for cleaning or to blow residue from vehicle brake systems, since many brake linings, especially on older model vehicles, contain asbestos. Safer methods such as cleaning with vacuums or liquid solutions should be used.

Storage battery service and handling

Service stations should establish procedures to ensure that storage, handling and disposal of batteries and battery electrolyte fluids follow government regulations and company policies. Employees should be aware of the hazards of electrical short circuits when charging, removing, installing or handling batteries; disconnect the ground (negative) cable first before removing batteries; and reconnect the ground (negative) cable last when installing batteries. When removing and replacing batteries, a carrier may be used to facilitate lifting and to avoid touching the battery.

Employees should be aware of safe practices such as the following for handling battery solution:

• Containers of electrolyte solution should be stored at temperature ranges between 16 and
  32ºC in safe areas where they cannot overturn. Any electrolyte solution spilled on the batteries or in the filling area should be flushed with water. Baking soda (sodium bicarbonate) may be used on spills, since it is an effective neutralizer for battery electrolyte solution.

• New batteries should be placed on the floor or work table when being filled with electrolyte solution, and the caps should be replaced prior to installation. New batteries should not be filled when they are inside vehicles.

• Face shields and chemical goggles, aprons and gloves may be used to minimize exposure to battery solution. Battery solution should be handled and dispensed where a supply of potable water or eye wash fluid is available, in case the battery solution spills or contacts an employee’s skin or eyes. Do not use neutralizing solutions on skin or eyes.

• When servicing batteries, corrosive particles which accumulate around the terminals should be brushed away, washed with clean water, neutralized with baking soda or other similar agents and prevented from contacting eyes or clothing.

Employees should check fluid levels in batteries prior to charging and periodically check them during charging to determine whether batteries are overheating. Chargers should be turned off before disconnecting cables from batteries, to avoid creating sparks which may ignite hydrogen gas generated during the charge. When “quick charging” batteries are installed in vehicles, the vehicles should be moved away from the fuel-dispensing islands, and the battery ground (negative) cables should be disconnected before connecting the charger units. If the batteries are located within passenger compartments or under vehicle floorboards, they should be removed before charging.

Employees should be familiar with the hazards and safe procedures to “jump start” vehicles that have dead batteries, in order to avoid electrical system damage or injury from exploding batteries if the jumper cables are hooked up incorrectly. Employees should never jump start or charge frozen batteries.

Driving vehicles and towing

Employees should be trained, qualified and have proper motor vehicle operator’s licences to drive customer or company vehicles, service trucks or towing equipment either on or off the premises. All vehicles should be operated in compliance with government regulations and company policies. Operators should check the vehicle’s brakes immediately, and vehicles with faulty brakes should not be driven. Employees operating tow trucks should be familiar with safe operating procedures, such as operating the hoist, checking the transmission and frame of the vehicle to be towed and not exceeding the tow truck’s maximum lifting capacity.

Confined spaces in service stations

Service station employees should be aware of the hazards associated with entry into confined spaces such as aboveground and underground tanks, sumps, pump pits, waste containment tanks, septic tanks and environmental collection wells. Unauthorized entry should not be allowed, and confined-space entry permit procedures should be established that apply to both employee and contractor entrants.

Emergency procedures

Service stations should develop emergency procedures, and employees should know how to sound the alarms, how to notify authorities of emergencies when and how to evacuate and what appropriate response actions should be taken (such as shutting off emergency switches in the event of spills or fires in the dispensing pump areas). Service stations may establish security programmes to familiarize employees with robbery and violence prevention, depending on the service station’s location, hours of operation and potential threats.

Service Station Health and Safety

Fire protection

Gasoline vapours are heavier than air and may travel long distances to reach sources of ignition when released during fuel filling, spills, overflows or repairs. Proper ventilation should be provided in enclosed areas to allow for dissipation of gasoline vapours. Fires may occur from spills and overflows when fuelling or servicing vehicles or delivering product into service station tanks, particularly if smoking is not restricted or if vehicle engines remain running during fuelling. To avoid fires, vehicles should be pushed away from spill areas or the spilled gasoline should be cleaned from under or around vehicles before starting their engines. Vehicles should not be permitted to enter or drive through spills.

Employees should be aware of other causes of fires in service stations, such as improper handling, transfer and storage of flammable and combustible liquids, accidental releases during fuel system repairs, electrostatic discharge when changing filters on gasoline dispensers and the use of improper or unprotected work lights. Draining gasoline from vehicle fuel tanks could be very hazardous due to the potential for release of fuel and vapours, especially in enclosed service areas when sources of ignition may be present.

Hot-work permits should be issued when work other than vehicle repair and servicing is performed which introduces sources of ignition in areas where flammable vapours may be present. Employees should be aware that carburettor priming should not be attempted while vehicle engines are running or being turned over with their starters, since flashbacks could ignite the fuel vapours. Employees should follow safe procedures, such as using starter fluid and not gasoline for priming carburettors and using clamps to hold the chokes open while attempting to start the engine.

Although government regulations or company policies may require the installation of fixed fire-protection systems, fire extinguishers are usually the primary means of fire protection in service stations. Service stations should provide fire extinguishers of the proper classification for the expected hazards. Fire extinguishers and fixed fire protection systems should be regularly inspected, maintained and serviced, and employees should know when, where and how to use the fire extinguishers and how to activate the fixed systems.

Service stations should install fuel-dispenser emergency shut-down controls at clearly identified and accessible locations and ensure that employees know the purpose, location and operation of these controls. To prevent spontaneous combustion, oily rags should be kept in covered metal containers until they are recycled or discarded.

Safety

Employee injuries at service stations may result from improper use of tools, equipment and ladders; not wearing PPE; falling or tripping; working in awkward positions; and lifting or carrying cases of materials incorrectly. Injuries and accidents may also occur from not following safe practices when working on hot radiators, transmissions, engines and exhaust systems, servicing tyres and batteries, and working with lifts, jacks, electrical equipment and machinery; from robbery and assault; and from improper use of or exposure to automotive cleaners, solvents and chemicals.

Service stations should develop and implement programmes to prevent accidents and incidents which can be attributed to problems associated with service station physical conditions, such as poor maintenance, storage and housekeeping practices. Other factors contributing toward accidents in service stations include employees’ lack of attention, training or skills, which may result in the improper use of equipment, tools, automotive parts, supplies and maintenance materials. Figure 1 provides a safety checklist.

Figure 1. Service station safety and health checklist.

Robberies are a major safety hazard in service stations. Appropriate precautions and training are discussed in the accompanying box and elsewhere in this Encyclopaedia.

Health

Employees should be aware of health hazards associated with working in service stations, such as the following:

Carbon monoxide. Internal combustion engine exhaust gases contain carbon monoxide, a highly toxic, odourless and colourless gas. Employees should be aware of the dangers of exposure to carbon monoxide, particularly when vehicles are inside service bays, garages or car washes with their engines running. Vehicle exhaust gases should be piped outside through flexible hoses, and ventilation should be provided to assure an adequate supply of fresh air. Fuel oil appliances and heaters should be checked to assure that carbon monoxide is not vented to inside areas.

Toxicity of petroleum fuels. Employees who come in contact with gasoline, diesel fuel, heating oil or kerosene should be aware of the potential hazards of exposure and know how to handle these fuels safely. Inhaling sufficient concentrations of petroleum fuel vapours for extended periods of time may result in mild intoxication, anaesthesia or more serious conditions. Short exposure to high concentrations will cause dizziness, headaches and nausea, and irritate the eyes, nose and throat. Gasoline, solvents or fuel oils should never be siphoned from containers or tanks by mouth, since the toxicity of low viscosity liquid hydrocarbons aspired directly into the lungs is 200 times greater than if they are ingested. Aspiration into the lungs may cause pneumonia with extensive pulmonary oedema and haemorrhage, leading to serious injury or death. Vomiting should not be induced. Immediate medical assistance should be sought.

Benzene. Service station employees should be aware of the potential hazards of benzene, which is found in gasoline, and avoid inhaling gasoline vapours. Although gasoline contains benzene, low-level exposure to gasoline vapours is unlikely to cause cancer. Numerous scientific studies have shown that service station employees are not exposed to excessive levels of benzene during the course of their normal work activities; however, there is always the possibility that overexposure could occur.

Dermatitis hazards. Employees who handle and come into contact with petroleum products as part of their jobs should be aware of the hazards of dermatitis and other skin disorders and the personal hygiene and personal protective measures needed to control exposure. If eye contact with gasoline, lubricants or antifreeze occurs, the eyes should be flushed with clean, lukewarm potable water, and medical assistance should be provided.

Lubricants, used motor oil and automotive chemicals. Employees who change oil and other motor vehicle fluids, including antifreeze, should be aware of the hazards and know how to minimize exposure to products such as gasoline in used motor oil, glycol in antifreeze and other contaminants in transmission fluids and gear lubricants by the use of PPE and good hygiene practices. If high-pressure lubricating guns are discharged against an employee’s body, the affected area should be examined immediately to see if petroleum products have penetrated the skin. These injuries cause little pain or bleeding, but involve almost instant separation of the skin tissues and possible deeper damage, which should receive immediate medical attention. The attending physician should be informed of the cause and the product involved in the injury.

Welding. Welding, besides being a fire hazard, can involve exposure to lead pigments from welding on car exteriors, as well as metal fumes and welding gases. Local exhaust ventilation or respiratory protection is needed.

Spray painting and auto body fillers. Spray painting can involve exposure to solvent vapours and pigment particulates (e.g., lead chromate). Auto body fillers often are epoxy or polyester resins and can involve skin and respiratory hazards. Drive-in spray booths for spray painting, local exhaust ventilation and skin and eye protection are recommended while using auto body fillers.

Storage batteries. Batteries contain corrosive electrolyte solutions of sulphuric acid that can cause burns and other injuries to the eyes or skin. Exposure to battery solution should be minimized by the use of PPE, including rubber gloves and eye protection. Employees should immediately flush electrolyte solution from the eyes or skin with clean potable water or eye wash fluid for at least 15 minutes and seek immediate medical attention. Employees should thoroughly wash their hands after servicing batteries and keep their hands away from the face and eyes. Employees should be aware that overcharging batteries can create explosive and toxic quantities of hydrogen gas. Because of the potential harmful effects of exposure to lead, used storage batteries should be properly disposed of or recycled in accordance with government regulations or company policies.

Asbestos. Employees who check and service brakes should be aware of the hazards of asbestos, know how to recognize whether brake shoes contain asbestos and take appropriate protective measures to reduce exposure and contain waste for proper disposal (see figure 2).

Figure 2. Portable enclosure for preventing exposure to asbestos dust from brake drums It is equipped with an enclosed compressed-air gun with a cotton sleeve and is connected to a HEPA vacuum cleaner.

Courtesy of Nilfisk of America, Inc.

Personal protective equipment (PPE)

Injuries to employees may occur from contact with automotive fuels, solvents and chemicals or from chemical burns caused by exposure to battery acids or caustic solutions. Service station employees should be familiar with the need to use and wear PPE such as the following:

• Work shoes with oil- and slip-resistant soles should be worn for general work in service stations, and approved protective-toe safety shoes with oil/slip-resistant soles should be worn where there is a danger of foot injuries due to rolling or falling objects or equipment.

• Safety goggles and respiratory protection should be used for protection against exposures to chemicals, dust or steam, such as when painting or working around batteries and radiators. Industrial safety glasses or face shields with goggles should be worn when the potential exists for exposure to impact materials, such as working with grinders or wire buffers, repairing or mounting tyres, or replacing exhaust systems. Welding glasses should be worn when cutting or welding to prevent flash burns and injuries from particles.

• Impervious gloves, aprons, footwear, face shields and chemical goggles should be worn when handling automotive chemicals and solvents, battery acid and caustic solutions and when cleaning up chemical or fuel spills. Leather work gloves should be worn when handling sharp objects such as broken glass, motor vehicle parts or tyre rims and while emptying trash cans.

• Head protection may be needed when working beneath vehicles in pits or changing overhead signage or lights and in other areas where a potential exists for injury to the head.

• Employees working on vehicles should not wear rings, wristwatches, bracelets or long chains, since the jewellery may contact the vehicle’s moving parts or electrical system and cause injury.

To prevent fires, dermatitis or chemical burns to the skin, clothing that is soaked with gasoline, antifreeze or oil should be immediately removed in an area or room with good ventilation and where no sources of ignition, such as electric heaters, engines, cigarettes, lighters or electric hand dryers, are present. The affected areas of the skin should then be thoroughly washed with soap and warm water to remove all traces of contamination. Clothing should be air dried outside or in well-ventilated areas away from sources of ignition before laundering to minimize contamination of wastewater systems.

Service Station Environmental Issues

Storage tank inventory control

Service stations should maintain and reconcile accurate inventory records on all gasoline and fuel oil storage tanks on a regular basis to control losses. Manual stick gauging may be used to provide a check of the integrity of underground storage tanks and connecting pipes. Where automatic gauging or leak detection equipment is installed, its accuracy should be verified regularly by manual stick gauging. Any storage tank or system suspected of leaking should be investigated, and if leakage is detected, the tank should be made safe or emptied and repaired, removed or replaced. Service station employees should be aware that leaking gasoline can travel long distances underground, contaminate water supplies, enter sewer and drainage systems and cause fires and explosions.

Handling and disposal of waste materials

Waste lubricants and automotive chemicals, used motor oil and solvents, spilled gasoline and fuel oil and glycol-type antifreeze solutions should be drained into approved, properly labelled tanks or containers and stored until disposed of or recycled in accordance with government regulations and company policies.

Because engines with worn cylinders or other defects may allow small amounts of gasoline to enter their crankcases, precautions are needed to prevent vapours which could be released from tanks and containers with crankcase drainings from reaching sources of ignition.

Used oil filters and transmission fluid filters should be drained of oil prior to disposal. Used fuel filters which have been removed from vehicles or fuel dispenser pumps should be drained into approved containers and stored in well-ventilated locations away from sources of ignition until dry before disposal.

Used battery-electrolyte containers should be thoroughly rinsed with water before discarding or recycling. Used batteries contain lead and should be properly disposed of or recycled.

Cleaning large spills may require special training and PPE. Recovered spilled fuel may be returned to the terminal or bulk plant or otherwise disposed of according to government regulations or company policy. Lubricants, used oil, grease, antifreeze, spilled fuel and other materials should not be swept, washed or flushed into floor drains, sinks, toilets, sewers, sumps or other drains or the street. Accumulated grease and oil should be removed from floor drains and sumps to prevent these materials from flowing into sewers. Asbestos dust and used asbestos brake linings should be handled and disposed of according to government regulations and company policies. Employees should be aware of the environmental impact and potential health, safety and fire hazards of these wastes.

Back

Law enforcement is difficult, stressful, demanding work. There is evidence that much of the work is sedentary, but the small part of the work which is not sedentary is physically demanding. This is also the part of the work which is often the most critical. In this respect, police work has been likened to the work of a lifeguard at a swimming pool. Most of the time, the lifeguard is watching from the water’s edge, but when it is necessary to intervene the emotional and physical demands are extreme and there is usually no warning. Unlike the lifeguard, the police officer may be exposed to attack with a knife or a gun, and may be exposed to intentional violence from some members of the public. Routine activities include patrolling streets, subways, country roads, parks and many other areas. Patrols may be carried out on foot, in vehicles (such as automobiles, helicopters or snowmobiles) and sometimes on horseback. There is a need for constant vigilance and, in many parts of the world, there is the constant threat of violence. Police officers may be called upon to provide assistance to the public in cases of robbery, riot, assault or domestic disputes. They may be involved in crowd control, search and rescue, or assistance to the public in the event of natural disaster. There is an episodic need to chase criminals on foot or in a vehicle, to grapple with, tackle and control criminals and, occasionally, to resort to the use of a lethal weapon. Routine activities can escalate to life-threatening violence with little or no warning. Some police officers work undercover, sometimes for prolonged periods. Others, particularly forensic specialists, are exposed to toxic chemicals. Almost all are exposed to biohazard risk from blood and body fluids. Police officers usually work shifts. Often their shifts are extended by administrative work or court appearances. The actual physical demands of police work and the physical tasks of policing have been extensively studied and are remarkably similar in different police forces and different geographical locations. The question of whether any specific medical condition may be attributable to the occupation of policing is controversial.

Violence

Violence is, unfortunately, a reality of police work. In the United States the homicide rate for police is more than double that for the general population. Work-related violent assault is common among police officers. The particular activities that are likely to result in violent conflict have been the subject of much recent research. The notion that domestic dispute calls were particularly dangerous has been seriously questioned (Violanti, Vena and Marshall 1986). More recently, the activities most likely to result in the assault of a police officer were ranked as follows: First, arresting/controlling suspects; second, robbery in progress; and third, domestic dispute.

The type of violence to which police officers are exposed varies from one country to another. Firearms are more common in the United States than Britain or Western Europe. Countries where political unrest is recent may see police officers exposed to attack from large-calibre or automatic-fire weaponry of a military type. Knife wounds are encountered everywhere, but large-blade knives, particularly machetes, seem more common in tropical countries.

Police officers must maintain a high level of physical fitness. Police training must include training in the physical control of suspects where necessary, as well as training in the use of firearms and other types of tools such as CS gas, pepper spray or hand-held batons. Personal protective equipment such as the “bullet proof” vest is necessary in some communities. Similarly, a communication system that allows the police officer to summon assistance is often important. The most important training, however, must be in the prevention of violence. Current police theory underscores the idea of community policing, with the police officer an integral part of the community. It is to be hoped that as this approach replaces the philosophy of armed military incursion into the community, the need for weaponry and for armour will be reduced.

The sequelae of violence need not be physical. Violent encounters are exceedingly stressful. This stress is particularly likely if the incident has resulted in serious injury, bloodshed or death. Particularly important is the assessment for post-traumatic stress disorder (PTSD) after such incidents.

Emotional and Psychological Stress

It is apparent that police work is stressful. For many police officers the excess of paperwork, as opposed to active law enforcement, is seen as a major stressor. The combination of shiftwork and the uncertainty about what may happen during the shift provides a powerfully stressful situation. In times of fiscal restraint, these stressors are often dramatically amplified by inadequate staffing and inadequate equipment. Situations where there is a potential for violence are stressful in themselves; the stress is dramatically increased where staffing is such that there is inadequate back-up, or when the police officer is seriously overworked.

In addition, the high stress levels which may result from police work have been blamed for marital difficulties, alcohol abuse and suicides among police officers. Much of the data supporting such associations are variable from one geographic region to another. Nevertheless, these problems may well result from the occupation of police work in some cases.

The need for constant vigilance for evidence of stress-related problems or post-traumatic stress disorder cannot be overemphasized. Stress-related disease may manifest as behavioural problems, marital or family problems or, sometimes, as alcohol or substance abuse.

Atherosclerotic Heart Disease

There have been numerous studies suggesting that atherosclerotic disease is more common among police officers (Vena et al. 1986; Sparrow, Thomas and Weiss 1983); there are also studies suggesting that this is not the case. It has been suggested that the increase in the prevalence of heart disease among police officers was almost entirely due to the increased risk of acute myocardial infarction.

This is intuitively satisfying since it is well known that sudden exertion, in the face of underlying heart disease, is an important risk factor for sudden death. The functional job analysis for a general-duty constable clearly indicates that a police officer may be expected, in the course of duty, to go from the sedentary state to maximal exertion with little or no warning and with no preparation. Indeed, much police work is sedentary, but, when required, the police officer is expected to run and chase, to grapple and tackle, and to forcibly subdue a suspect. It is therefore not unexpected that even if the rate of underlying coronary disease is not much different among police officers than the rest of the population, the risk of suffering an acute myocardial infarction, because of the nature of the work, may well be higher (Franke and Anderson 1994).

The demographics of the police population must be considered when assessing the risks for heart disease. Heart disease is most commonly found among middle-aged men, and this group makes up a very large proportion of police officers. Women, who have a significantly lower rate of heart disease during their premenopausal years, are significantly under-represented in the demographics of most police forces.

If one is to effectively reduce the risk of cardiac disease in police officers, the regular assessment of the police officer, by a physician knowledgeable about police work and the potential cardiac risks that are associated with police work, is essential (Brown and Trottier 1995). The periodic health assessment must include health education and counselling about cardiac risk factors. There is good evidence that work-based health promotion programmes have a salutary effect on employee health and that the modification of cardiac risk factors reduces the risks of cardiac death. Smoking cessation programmes, nutritional advice, hypertension awareness and cholesterol monitoring and modification are all appropriate activities that will help modify risk factors for cardiac disease among police officers. Regular exercise may be particularly important in police work. The generation of a work environment that educates the worker about positive nutritional and lifestyle choices and that encourages such choices is likely to be beneficial.

Lung Disease in Police Work

The evidence suggests that the prevalence of lung disease in police work is lower than in the general population. There is, however, evidence of an increased rate of cancer of the respiratory system. The majority of police officers are not routinely exposed to inhaled toxins at a rate any greater than other residents of the communities they police. There are exceptions to this general rule, however, the most notable exception being police officers working in forensic identification. There is good evidence that these individuals may suffer from an increased prevalence of respiratory symptoms and, possibly, occupational asthma (Souter, van Netten and Brands 1992; Trottier, Brown and Wells 1994). Cyanoacrylate, used in uncovering latent fingerprints, is a known respiratory sensitizer. In addition to this, there are a large number of chemical carcinogens routinely used in this type of work. For these reasons it is recommended that police officers who work in forensic identification, particularly those who do fingerprint work, should undergo annual chest x ray and spirometry. Similarly, periodic health assessment of these officers must include a careful assessment of the respiratory system.

Even though the practice of smoking cigarettes is becoming less common, a significant number of police officers continue to smoke. This may be the reason why some studies have shown an increased risk of lung and laryngeal cancers among police officers. Smoking is, of course, a major risk factor for cardiac disease. It is also the leading cause of lung cancer. When a police officer gets lung cancer the question frequently asked is whether the cancer is due to occupational exposure, in particular to the carcinogens known to be present in fingerprint powders. If the police officer smokes, it will be impossible to confidently assign blame to any occupational exposure. In summary, respiratory disease is not normally an occupational hazard of police work except for forensic identification workers.

Cancer

There is some evidence that police officers suffer a somewhat higher risk of cancer than expected in the general population. In particular, the risk of digestive tract cancers such as cancer of the oesophagus, cancer of the stomach and cancer of the large bowel is reported to be elevated among police officers. There may be an increased risk of cancer of the lung and larynx. The risk of cancer among police officers working in forensic identification and forensic laboratory work has been briefly discussed above. The controversial issue of testicular cancer associated with the use of police “radar” to detect speeders must also be addressed.

The data suggesting an increase in the risk of cancer of the digestive tract among police officers is scant, but it is a question that must be seriously examined. In the case of lung and oesophageal cancer, it is difficult to see how the activities of police work would be expected to increase the risk. Smoking, of course, is known to increase the risk of both lung and oesophageal cancer, and significant numbers of police officers are known to continue to smoke cigarettes. Another substance known to increase the risk of oesophageal cancer is alcohol, particularly whisky. Police work is known to be exceedingly stressful, and there have been some studies that suggest police officers may sometimes use alcohol to relieve the tension and stress of their work.

The same research that demonstrated an increased risk of cancers of the digestive tract also demonstrated a peculiar increase in the incidence of cancers of the lymphatic and haemopoietic systems in some police officers. The increased risk was restricted to one group and the overall risk was not elevated. Given this very peculiar distribution, and the small numbers, this finding may well turn out to be a statistical aberration.

The risk of cancer among police officers involved in forensic identification work and forensic laboratory work has been discussed. The expected toxicities of chronic low-level exposure to various chemicals are determined by the level of exposure and the use of personal protective equipment. Based on these exposures a periodic health examination has been developed, performed annually and tailored to risks specific for these exposures.

Recent work has suggested a possible increase in the risk of skin cancer, including melanoma, among police officers. Whether this is due to the amount of sun exposure experienced by some police officers who work out of doors is purely speculative.

The question of cancer resulting from exposure to microwaves from “police radar” units has created much controversy. There is certainly some evidence that there may be clustering of certain kinds of cancers among police officers exposed (Davis and Mostofi 1993). The particular concern is about exposure from hand-held units. Alternatively, recent work with large populations refutes any risk of carcinogenicity from exposure to these units. Testicular cancer, in particular, has been reported to be associated with such exposure. The circumstance said to pose the greatest risk is that where the hand-held unit is turned on and resting on the lap of the police officer. This could result in considerable cumulative exposure of the testes over the long term. Whether such exposure causes cancer remains unproven. In the meantime it is recommended that police radar units be mounted outside the police car, be directed away from the police officer, not be used inside the car, be turned off when not in use and be tested regularly for microwave leakage. In addition the periodic examination of police officers should include careful palpation of the testes.

Back Pain

Low-back pain is a major cause of absenteeism throughout the Western world. It is a condition most common among middle-aged males. The factors which predispose to chronic low-back pain are multiple and some, such as the correlation to smoking, seem intuitively difficult to comprehend.

With respect to the occupation of driving, there is ample evidence that individuals who drive for a living are at a dramatically increased risk of low-back pain. This observation includes police officers for whom driving plays a significant part in their daily work. The majority of police cars continue to be equipped with the seats that were installed at the time of their manufacture. Various back supports and prosthetic devices are available which may improve the support of the lumbar spine, but the problem remains.

There is evidence that physical confrontation may play a role in the development of back pain. Motor vehicle accidents, particularly in police vehicles, may play a part. Some police equipment, such as thick leather belts festooned with heavy equipment, may also play a role.

It is important to remember that stress may precipitate or exacerbate back pain and that back pain, as a reason for sick-leave, may be perceived by some police officers as more acceptable than the need to recover from emotional trauma.

There is no doubt that specific exercises designed to maintain flexibility and strengthen the muscles of the back can significantly improve function and symptoms. Numerous classification systems of back pain have been promulgated. These different patterns of pain have distinct approaches of active intervention through specific muscle strengthening programmes. It is important that specific symptom patterns be sought out among police officers and that appropriate intervention and treatment be initiated. This requires periodic assessment by physicians knowledgeable in this clinical syndrome and capable of early effective intervention. It is equally important that a good level of overall fitness be maintained in order to avoid disability from this common chronic, costly syndrome.

Biohazard Risks

There are reports of police officers said to have contracted AIDS from their work. In May 1993 the US Federal Bureau of Investigations reported that there had been seven cases of police officers contacting AIDS through their work over 10 years (Bigbee 1993). Let us begin by noting that this is a surprisingly small number of cases over a 10-year period in the entire United States. Let us next observe that there was some controversy about whether these cases were all to be considered job-related. Nevertheless, it is clearly possible to become infected with HIV as a result of police work.

Since there is no cure for AIDS, and no vaccine that prevents the disease, the best defence a police officer has against this infection is prevention. Latex gloves should be worn, whenever possible, any time that contact with blood or blood-contaminated evidence is foreseen. This is especially important if there are any skin breaks on the hands.

Any open sores or cuts that a police officer has sustained must be kept covered with an occlusive dressing while on duty. Needles should be handled with extreme care, and needles or syringes must be transported in a sharps container that can effectively prevent the needle from penetrating through the container. Sharp edges must be avoided and sharp exhibits handled with extreme care, particularly when contaminated with fresh blood. Where possible, such exhibits should be picked up with instruments rather than by hand.

Latex gloves and a barrier mask should be used if resuscitation attempts are undertaken, and latex gloves must always be worn when rendering first aid. It is important to bear in mind, however, that the risk of becoming infected with HIV from resuscitation procedures is very remote.

There are also some traditional techniques in policing that must be avoided. “Pat down” searches are dangerous to the police officer. There are numerous cases of police officers suffering needle stick injuries from this type of procedure. Also dangerous is searching containers, bags or even pockets by rummaging through them. All containers must be emptied into a flat surface and their contents examined in plain view. Similarly sweep searches under car seats and between seats and backs of couches and chairs must not be performed. It is preferable to dismantle furniture rather than have police officers putting their hands blindly in places where needles and syringes may be hidden. Latex gloves do not protect from needlestick injury.

Eye protection and face masks may be appropriate in circumstances where spatter of body fluid such as saliva or blood can reasonably be foreseen. There must be a system in place for the safe disposal of personal protective equipment. There must be a facility for police officers to wash their hands. Given the fact that few patrol cars have running water and sinks, prepackaged washing solutions for cleaning skin should be provided. Lastly, the question of what should be done for a police officer who, in spite of all the best precautions, suffers a percutaneous exposure to HIV should be asked. After appropriate wound care the first step is to try to determine whether the source of the exposure is truly HIV positive. This is not always possible. Secondly, it is imperative that the police officer be educated about the true risks of infection. Many non-medical personnel assume that the risk is much higher than it really is. Thirdly, the police officer must be informed of the need to retest for at least six months and possibly nine months in order to ensure that the officer has not been infected. Steps must be taken to prevent potential infection of the officer’s sexual partner(s) for at least six months. Lastly, the question of post-exposure prophylaxis must be discussed. There is increasing evidence that prophylaxis with antiviral drugs may be helpful in reducing the risk of seroconversion after percutaneous exposure. These are discussed elsewhere in the Encyclopaedia. In addition, the area of prophylaxis is under intense research scrutiny so that current references must be consulted to assure the most appropriate approach.

There are numerous case reports of occupationally acquired hepatitis among law enforcement personnel. The quantitative risk is not dramatically high when compared to other occupations. Nevertheless it is a real risk and must be seen as a possible occupational disease. The preventive approach to HIV infection that was outlined above applies equally well to the blood-borne disease hepatitis B. Given the fact that hepatitis B is so much more contagious than AIDS, and more likely to cause disease or death in the short term, this disease ought to be an even more compelling reason for following universal precautions.

There is an effective vaccine against hepatitis B. All police officers regardless of whether they are involved in forensics or general-duty policing, should be vaccinated against hepatitis B. Other conditions, including hepatitis C, tuberculosis and airborne pathogens, may also be encountered by police officers.

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The term singer applies to any person whose career, avocation or livelihood relies heavily on the use of his or her voice in a musical context rather than ordinary speech. Unlike percussionists, pianists or violinists, the singer is the instrument. Hence, the well-being of a singer depends not only on the health of his or her larynx (where the sound originates) or vocal tract (where the sound is modified), but also on proper functioning and maximal coordination of most mind and body systems.

Of the many styles of singing documented throughout the world, some reflect a unique liturgical, cultural, linguistic, ethnic or geo-political heritage, while others are more universal in nature. Among the common styles of singing in the United States and Western world are: traditional classical (including oratorio, opera, art songs and so on), barbershop, jazz, musical theatre (Broadway), choral, gospel, folk, country (and western), popular, rhythm and blues, rock ’n’ roll (including heavy metal, alternative rock and so on) and others. Each style of delivery has its typical settings, patterns, habits and associated risk factors.

Vocal Problems

Unlike non-singers, who may not be significantly hindered by vocal problems, for the classical singer, the effect of subtle vocal impairment can be devastating. Even within that category of trained singers, vocal impairment is much more debilitating for the higher voice classifications (sopranos and tenors) than for lower classifications (mezzo sopranos, altos, baritones and basses). On the other hand, some vocal performers (pop, gospel or rock, for example) go to great lengths to achieve a unique trademark and enhance their marketability by inducing vocal pathologies which often yield a breathy, husky, muffled diplophonic (simultaneous multiple pitches) quality. Owing, in part, to their impairment, they tend to sing with great effort, struggling particularly to produce the high notes. To many listeners, this struggle adds a dramatic effect, as if the singer is sacrificing his or her self while engaging in the artistic process.

The prevalence of occupation-related injuries in general, and voice disorders in particular, among singers is not well documented in the literature. This author estimates that on the average, between 10 and 20% of singers in the United States sustain some form of chronic voice disorder. However, the incidence of vocal injury varies significantly with many factors. Because many singers must adhere to specific artistic/aesthetic criteria, performance practices, popular (consumer) demands, financial constraints and social pressures, they often stretch their vocal capabilities and endurance to the limits. Furthermore, singers generally tend to deny, trivialize or ignore warning signs and even diagnoses of vocal injury (Bastian, Keidar and Verdolini-Marston 1990).

The most common problems among singers are benign mucosal disorders. The mucosa is the outer layer, or cover, of the vocal folds (commonly called vocal cords) (Zeitels 1995). Acute problems can include laryngitis and transient vocal fold swelling (oedema). Chronic mucosal lesions include vocal fold swellings, nodules (“calluses”), polyps, cysts, sub-mucosal haemorrhage (bleeding), capillary ectasia (widening), chronic laryngitis, leukoplakia (white spots or patches), mucosal tears and glottic sulci (deep furrows in the tissue). Although these disorders can be exacerbated by smoking and excessive alcohol consumption, it is important to note that these benign mucosal lesions are typically related to the amount and manner of voice use, and are the product of vibratory trauma (Bastian 1993).

Causes of Vocal Problems

In looking at the causes of vocal problems in singers, one should distinguish between intrinsic and extrinsic factors. Intrinsic factors are those related to personality, vocal behaviour (including speaking) on and off stage, vocal technique, and intake habits (primarily if substance abuse, improper medication, malnutrition and/or dehydration is involved). Extrinsic factors are related to environmental pollutants, allergies and so on. Based on clinical experience, intrinsic factors tend to be most important.

Vocal injury is usually a cumulative process of misuse and/or overuse during the singer’s productive (performance-related) and/or non-productive (domestic, social) activities. It is difficult to ascertain how much of the damage is attributable directly to the former versus the latter. Performance risk factors can include unreasonably long dress rehearsals requiring full-voice singing, performing with an upper-respiratory infection in the absence of a replacement and excessive singing. Most vocalists are advised not to sing for more than about 1.5 hours (net) per day. Unfortunately, many singers do not respect the limitations of their apparatus. Some tend to get caught up in the exploratory excitement of new technical skills, new means of artistic expression, new repertoire and so on, and practice 4, 5 or 6 hours daily. Even worse is the beating of the voice into shape when distress signals of injury (such as loss of high notes, inability to sing softly, breathy delay in sound initiation, unstable vibrato and increased phonatory effort) are manifested. The culpability of vocal overtaxing is shared with other taskmasters such as the booking agent who squeezes multiple performances into an impossible time frame, and the recording agent who leases the studio for 12 consecutive hours during which the singer is expected to record a complete CD sound track from start to finish.

Although every singer may encounter acute episodes of voice problems at some point in his or her career, it is generally believed that those singers who are musically literate and can adjust the musical score to their voice limitations, and those who have had proper voice training, are less likely to encounter severe problems of a chronic nature than their untrained peers, who often learn their repertoire by rote, repeatedly imitating or singing along with demo tapes or recordings of other performers. In doing so, they frequently sing in a key, range or style unsuitable for their voices. Singers who lend themselves to periodic tutelage and maintenance by proficient voice experts are less likely to resort to faulty compensatory vocal manoeuvres if confronted by physical impairment, and are more inclined to establish a reasonable balance between artistic demands and vocal longevity. A good teacher is aware of the normal (expected) capabilities of each instrument, can usually distinguish between technical and physical limitations, and often is the first to detect warning signs of vocal impairment.

Sound amplification can also create problems for singers. Many rock groups, for example, amplify not only the singer, but the entire band. When the noise level interferes with auditory feedback, the singer is often unaware that he or she is singing too loudly and using faulty technique. This may contribute significantly to the development and exacerbation of vocal pathology.

Non-performance factors can also be important. Singers must realize that they do not have separate laryngeal mechanisms for singing and speaking. Although most professional singers spend much more time talking than singing, speaking technique is commonly discarded or rejected, which can adversely affect their singing.

Many of today’s singers must travel regularly from one performance venue to another, on trains, tour buses or airplanes. Ongoing touring requires not only psychological adaptation, but also physical adjustments on many levels. In order for singers to function optimally, they must receive adequate quality and quantity of sleep. Radical rapid changes in time zones causes jet lag, which forces singers to remain awake and alert when their internal clock is cueing various body systems to shut down for sleep, and conversely, to sleep when their brain systems are aroused to plan and execute normal daytime activities. Such interruption may result in a host of debilitating symptoms, including chronic insomnia, headaches, sluggishness, dizziness, irritability and forgetfulness (Monk 1994). Aberrant sleep patterns are also a common problem among those singers who perform late at night. These abnormal sleep patterns are all too often mismanaged with alcohol or recreational, prescription or over-the-counter (OTC) drugs (most of which adversely affect the voice). Frequent and/or prolonged confinement to a closed cabin of a motor vehicle, train or aircraft may create additional problems. Inhalation of poorly filtered (often recycled), contaminated, dehumidified (dry) air (Feder 1984), according to many singers, can cause respiratory discomfort, tracheitis, bronchitis or laryngitis that may linger on for hours or even days following a trip.

Owing to environmental instability and hectic scheduling, many singers develop erratic, unhealthful eating habits. In addition to reliance on restaurant food and unpredictable changes in meal times, many singers eat the main meal of the day after their performance, usually late at night. Particularly for the overweight singer, and especially if spicy, greasy or acidic foods, alcohol or coffee were consumed, lying down soon after having filled the stomach is likely to result in gastroesophageal reflux. Reflux is the retrograde flow of acids from the stomach up the oesophagus and into the throat and larynx. The resulting symptoms can be devastating to the singer. Eating disorders are quite common among singers. In the operatic and classical realm, overeating and obesity are quite common. In the musical theatre and pop domain, particularly among young females, reportedly one-fifth of all singers have encountered some form of eating disorder, such as anorexia or bulimia. The latter involves various purging methods, of which vomiting is thought to be particularly hazardous to the voice.

A detrimental factor to voice production is exposure to pollutants, such as formaldehyde, solvents, paints and dusts, and allergens, such as tree, grass or weed pollens, dust, mould spores, animal danders and perfumes (Sataloff 1996). Such exposure may occur on and off stage. In their work milieu, singers can be exposed to these and other pollutants associated with vocal symptoms, including cigarette smoke and theatrical smoke and fog effects. Singers use a greater percentage of their vital capacity than ordinary speakers. Furthermore, during intense aerobic activity (such as dancing), the number of breathing cycles per minute increases, and mouth breathing prevails. This results in the inhalation of larger amounts of cigarette smoke and fogs during performances.

Treatment of Vocal Problems

Two major issues in the treatment of vocal problems of singers are self-medication and improper treatment by physicians who are not knowledgeable about the voice and its problems. Sataloff (1991, 1995) surveyed the potential side effects associated with medications commonly used by singers. Whether recreational, prescription, over the counter or food supplements, most drugs are likely to have some effect on phonatory function. In an attempt to control “allergies”, “phlegm” or “sinus congestion”, the self-medicating singer will ultimately ingest something that will damage the vocal system. Likewise, the physician who keeps prescribing steroids to reduce chronic inflammation caused by abusive vocal habits and ignores the underlying causes will eventually hurt the singer. Vocal dysfunction resulting from poorly indicated or ill-performed phonosurgery has been documented (Bastian 1996). To avoid injuries secondary to treatment, singers are advised to know their instruments, and consult only with health care professionals who understand and have experience and expertise managing the vocal problems of singers, and who possess the patience to educate and empower singers.

Back

Most episodes of acute back pain respond promptly to several days of rest followed by the gradual resumption of activities within the limits of pain. Non-narcotic analgesics and non-steroidal anti-inflammatory drugs may be helpful in relieving pain but do not shorten the course. (Since some of these drugs affect alertness and reaction time, they should be used with caution by individuals who drive vehicles or have assignments where momentary lapses may result in harm to patients.) A variety of forms of physiotherapy (e.g., local applications of heat or cold, diathermy, massage, manipulation, etc.) often provide short periods of transient relief; they are particularly useful as a prelude to graded exercises that will promote the restoration of muscle strength and relaxation as well as flexibility. Prolonged bed rest, traction and the use of lumbar corsets tend to delay recovery and often lengthen the period of disability (Blow and Jayson 1988).

Chronic, recurrent back pain is best treated by a secondary prevention regimen. Getting enough rest, sleeping on a firm mattress, sitting in straight chairs, wearing comfortable, well-fitted shoes, maintaining good posture and avoiding long periods of standing in one position are important adjuncts. Excessive or prolonged use of medications increase the risk of side effects and should be avoided. Some cases are helped by the injection of “trigger points”, localized tender nodules in muscles and ligaments, as originally advocated in the seminal report by Lange (1931).

Exercise of key postural muscles (upper and lower abdominal, back, gluteal and thigh muscles) is the mainstay of both chronic care and prevention of back pain. Kraus (1970) has formulated a regimen that features strengthening exercises to correct muscle weakness, relaxing exercises to relief tension, spasticity and rigidity, stretching exercises to minimize contractures and exercises to improve balance and coordination. These exercises, he cautions, should be individualized on the basis of examination of the patient and functional tests of muscle strength, holding power and elasticity (e.g., the Kraus-Weber tests (Kraus 1970)). To avoid adverse effects of exercise, each session should include warm-up and cool-down exercises as well as limbering and relaxing exercises, and the number, duration and intensity of the exercises should be increased gradually as conditioning improves. Simply giving the patient a printed exercise sheet or booklet is not enough; initially, he or she should be given individual instruction and observed to be sure that the exercises are being done correctly.

In 1974, the YMCA in New York introduced the “Y’s Way to a Healthy Back Program”, a low-cost course of exercise training based on the Kraus exercises; in 1976 it became a national programme in the US and, later, it was established in Australia and in several European countries (Melleby 1988). The twice-a-week, six week programme is given by specially-trained YMCA exercise instructors and volunteers, mainly in urban YMCAs (arrangements for courses at the worksite have been made by a number of employers), and it emphasizes the indefinite continuation of the exercises at home. Approximately 80% of the thousands of individuals with chronic or recurrent back pain who have participated in this program have reported elimination or improvement in their pain.

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