IntroductionHealth risk assessments are carried out to determine the risk of adverse health events occurring in the population being assessed. These are commonly carried out in populations though can also be carried out at the individual level.

Individual health risk (IHR) assessments set out to evaluate the individual’s risk of an adverse health event occurring rather than using general population statistics. The probability of occurrence is being determined for the individual alone and requires specific data collection to make a reasoned determination.

If a risk estimate takes into account information on the number of individuals exposed, it is termed a 'population risk' and is in units of expected increased cases per a time period. If the risk estimate does not take into account the number of individuals exposed, it is termed an 'individual risk' and is in units of incidence rate per a time period. Population risks are of more use for cost/benefit analysis; individual risks are of more use for evaluating whether risks to individuals are 'acceptable' in terms that the decision on fitness for duty being made could result in a potential threat to the health of the individual, and/or the risks could be reduced by employee specific planned mitigation measures.

The outcome of this IHR assessment would be expected to influence and guide employment decisions so it is important that all relevant data is collected and used in the evaluation process.

Conducting an individual health risk assessment:

1. Data Collection and ResponsibilitiesThis assessment process involves looking at the factors that affect the individual with regard to their active health risk factors, current diagnoses, intervention results, treatment response, current and future medication requirements, and living and working environment.

Because this guidance is specifically workplace-related it is recommended that the final assessment be made by a qualified occupational physician. If a general physician or clinician conducts the initial assessment an occupational physician should be available to assist in the final fitness for duty assessment and recommendation process.

Health technical information sheet 1:

Individual health risk assessments

www.energyinst.orgEI Health Technical Committee - July 2009Copyright © 2009 by the Energy Institute a professional membership body incorporated by Royal Charter 2003 Registered charity number 1097899.

• Currentdiagnosesasidentifiedbyhistoryand/orclinical examination.

• Natureofthediagnoseswithregardtoprogressionor regression in that individual.

• Severityofanyhealthconditionssuchastheyaffectthe individual with regard to:

i) decrease in capability ii) symptoms iii) expected increased mortality.• Potentialinteractionofmultiplehealthconditions.• Stabilityofconditionoverhistoryofdiagnosesand

in more recent context.• ResultsofexistingIndividualHealthRisk

Assessments such as a Cardiac Risk Assessment (CRA).

• Responsetointerventionmeasures.• Responsetocurrenttreatment.• Historyofcompliancewithappointmentsfor

clinical review and for medical surveillance recommendations.

Other factors that should be used for the secondary determination for fitness for duty for specific locations:

• Requirementforaccesstospecialisedcare/followup.

• Resourceavailability.• Risktoothersposedbyemployeeifcondition

were to deteriorate in the workplace.• Workenvironmentincludingpresenceofany

factors which may adversely affect underlying diagnoses.

• Communicationrequirementsoutwithnormalexpectations.

• Exceptionaltransportrequirementsforseeablycreated by the existing or potential escalation of the medical conditions evaluated such as the need to access higher specialised care at short notice.

3. Assessment ProcessThe examining physician or clinician should perform a comprehensive assessment of the individual health status of the employee to determine the extent and likely progression of existing and potential health conditions, with a resulting recommendation that would be ultimately supported by peer review.

Identification of a named medical condition alone is therefore not appropriate. The health status must be assessed for each individual in the following manner:

i) Taking all information gathered as indicated above: the Individuals health risk is determined by the identification and assessment of the nature of any medical condition(s) for that individual–specifically looking at the current severity of each diagnosis and how it is expressed with regard to symptoms and capability, mitigated by the ’individual’s specific response to their current treatment.

ii) The history of the stability of the condition, likely progression and future disability along with any restricted availability of treatment options due to limitations of location should be also be considered and documented.

2. Factors to be included in assessment process

Data sources

To make a valid qualitative assessment the clinician should collect pertinent data from every available source. These may include:• Clinicalhistoryasknowntoemployeeanddeclaredtoclinician.• Medication–prescribedandover-the-counterasdeclaredbytheemployee.• PreviousHealthRiskAssessmentresults–historicalandcontemporaneous.• Clinicalexamination.• Laboratoryinvestigations.• FunctionalCapacityEvaluation(s).• Specialistreports–historicalandcontemporaneous.• Otherspecialisedinvestigations.

www.energyinst.orgEI Health Technical Committee - July 2009Copyright © 2009 by the Energy Institute a professional membership body incorporated by Royal Charter 2003 Registered charity number 1097899.

4. ResultsFollowingtheassessmenttheclinicianshouldbeabletobandtheemployeeintooneofthreeriskcategories:

www.energyinst.orgEI Health Technical Committee - July 2009Copyright © 2009 by the Energy Institute a professional membership body incorporated by Royal Charter 2003 Registered charity number 1097899.

Low – the risk of a significant health event is minimal and probably equivalent to the general population. Allowing for the well-worker effect this would normally encompass the majority of the workforce.

Medium/Moderate – the risk of a significant health event is evident although the probability of occurrenceisunlikely.Forconditionswhereresearchhasresultedindocumentedriskfactorsthiswouldbequantifiedatlessthan5%peryear.ForthisgroupLife-styleormitigatingmedical intervention may be available and appropriate to reduce risk.

High – the risk of a significant health event is evident and might be an expected outcome if the individualwerenottoseekinterventionandorlife-stylechanges.Foravailableriskfactorstheprobability would be greater than 5 % – or associated mortality of 1 % per year or more.

5. Fitness for Job PositionTheassessmentwillresultineachindividualbeingevaluatedasLow,ModerateorHighriskcategory,asdefinedabove. This category should then be evaluated by an occupational physician with regard to the specific safety aspects of the individuals profession and workplace environment, and the potential consequences related to the occurrence of a foreseeable health event occurring, whilst also carefully considering any potential difficulties related to emergency medical evacuation, limitations of on site medical care and any other health-related factors that may be identified as pertinent to that individuals employment.

Low risk would normally result in a recommendation that the individual is fit to work in most locations.

Moderate risk may be fit – occasionally requiring some workplace accommodation – and very often will require increased medical surveillance and periodicity of review. These individuals may not be fit to work in some highly safety sensitive positions where failure of capability may compromise the health or safety of others.

High risk categorisation will more often result in a recommendation that the individual is unfit. This may be temporary if medical intervention is planned and likely to effect a reduction in risk.

High risk individuals may be considered fit for low-risk occupations where the essential job functions do not increase the risk of a health related event – and the health and safety of others is not foreseeably compromised.

The assessment results should always be fully discussed with the employee before being shared with the employer so that any mitigating options including workplace accommodations can be fully explored in light of the potential employment implications.

ForfurtherinformationontheEnergyInstitute’sHealthTechnicalCommitteeandtechnicalworkinthisareapleasecontactDrJennyLyn(jlyn@energyinst.org).

Details of EI health publications are available at www.energyinstpubs.org.uk

The information contained in the health technical information sheet is provided as guidance only and while every reasonable care has been taken to ensure the accuracy of its contents, the Energy Institute cannot accept any responsibility for any action taken, or not taken, on the basis of this information. The EI shall not be liable to any person for any loss or damage which may arise from the use of any of its publications.

EI Health Technical Committee - July 2009The information contained in the health technical information sheet is provided as guidance only and while every reasonable care has been taken to ensure the accuracy of its contents, the Energy Institute cannot accept any responsibility for any action taken, or not taken, on the basis of this information. The EI shall not be liable to any person for any loss or damage which may arise from the use of any of its publications. Copyright © 2009 by the Energy Institute a professional membership body incorporated by Royal Charter 2003 Registered charity number 1097899.

Increasing numbers of workers in the oil and gas sector can be expected to take prescribed and over the counter medications as the average age of the working population increases.

The use of medication will not inevitably adversely affect a person’s ability to work. However medications can impair one’s ability to work safely or expose a worker to additional hazards in the workplace.

In assessing the suitability of a person to perform his or her duties, a risk assessment should be carried out. Factors to consider would be the nature and frequency of adverse effects and the likely consequences of these effects in the working environment. Some medications may increase the worker’s vulnerability to environmental hazards.

Following a risk assessment, risk reduction measures should be considered such as worker education or redeployment.

Health technical information sheet 2:

Medication and work

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The following adverse medication effects should be considered:

• Sedation,drowsiness,dizziness.Impairedperformanceofskilledtasksortasksrequiringvigilanceandsoundjudgement

• Neuropsychiatriceffectsorstimulation

• Visualproblemssuchasblurredvision,impairednightvision

• Thermoregulatorydisturbanceordiuresiscausingdifficultyacclimatisingtoheat

• Cardiovasculareffectsresultinginposturalhypotension,limitationofexercisetoleranceorRaynaud’sphenomenon

• Immunosuppression

• Bleedingtendency

• Convulsionsandtremor

• Bronchospasm

• Disturbanceofsleep,nightmares;increasedarousal

• Ototoxicity

Other factors to be considered:

• Difficultyinresupplyortransportofmedicationsto remote locations or across international borders

• Consequencesofsuddencessationofmedicationincluding withdrawal

• Lackofmedicalexpertiseorequipmenttorecognise and manage a medicine’s side-effects

• Theextenttowhichtheunderlyingconditioniscontrolled

• Theneedtomonitordruglevelsorside-effects

• Shiftwork,travelacrosstimezonesanddoseadjustment

• Occupationalfactorsthatcouldalteramedicine’spharmacodynamics or potentiate its side-effects

• Interactionofdrugscausingeffectsnotexperienced with either alone

For further information on the Energy Institute’s Health Technical Committee and technical work in this area pleasecontactDrJennyLyn(jlyn@energyinst.org)

Further sources of information:- Company Medical Adviser-Localmedicalresourcesormedicalevacuation

agencies- National formularies-PatientInformationLeaflet- Fitness for Work, The Medical Aspects, 4th

Edition, Edited by Palmer, Cox and Brown, Faculty of Occupational Medicine, Oxford University Press 2007 Chapter 25, Medicines.

Large numbers of workers in the oil and gas industry can be expected to be taking prescribed and over the counter medications, for a variety of reasons. Some of the reasons for taking medication will be ‘trivial’ symptoms of day-to-day minor illness, but others will be for more significant medical problems. In either case however, the use of medication may impair an individual’s ability to work safely, or expose them to additional hazards in the workplace.

Health technical information sheet 3:

Medication and work - A brief guide for Managers

For further information on the Energy Institute’s Health Technical Committee and technical work in this area please contact Dr Jenny Lyn (jlyn@energyinst.org)

www.energyinst.org

EI Health Technical Committee - July 2009The information contained in the health technical information sheet is provided as guidance only and while every reasonable care has been taken to ensure the accuracy of its contents, the Energy Institute cannot accept any responsibility for any action taken, or not taken, on the basis of this information. The EI shall not be liable to any person for any loss or damage which may arise from the use of any of its publications. Copyright © 2009 by the Energy Institute a professional membership body incorporated by Royal Charter 2003 Registered charity number 1097899.

From a supervisory perspective, the above factors mean that the effects (or potential effects) of medication being taken by personnel require consideration when planning work tasks, personnel deployment etc. Supervisors cannot expect to have or obtain a full knowledge of the medication being taken by personnel, but can remind personnel of the need to seek appropriate advice if taking medication. Advice may usefully be obtained from Company Medical Advisors, or local resources such as installation medics or medical evacuation agencies.

• Sedation(whichmayleadtoimpairedperformanceofskilledtasksortasksrequiringvigilanceandsoundjudgement).

• Visualproblems(suchasblurredvisionorimpairednightvision).

• Difficultyinacclimatisingtoheat.• Effectsontheheartandbloodvessels

(resultinginaliabilitytofaints,orreducedabilitytoexercise).

• Reducedimmunitytoinfection.• Increasedtendencytobleeding.• Thepotentialforoccurrenceofserious

medicalsymptoms(suchasconvulsionsorasthma)unrelatedtotheconditionbeingtreated.

Additionally, some medications: • Requirethatthepatienthasperiodicteststo

check that blood levels of the medicine are correct and the dose is correct.

• Shouldnotbestoppedsuddenly(whichmayhappen if there is difficulty in resupply or transport of medications to remote locations or across international borders).

• Maybelesseffective,orhaveincreasedsideeffects due to occupational factors (such as shift work or travel across time zones).

Medicationsmayresultinthefollowingside-effects: