Medical surveillance for respirator users

The Occupational Safety and Health Administration has changed the content and frequency of medical assessments required by the Respiratory Protection Standard. The revised Standard contains a mandatory questionnaire to be used for preplacement evaluation of all users. The requirement for periodic reevaluations has been replaced by a requirement to reevaluate users when they experience difficulty with respirator use, or when their workplace changes in such a way as to significantly impact the physiologic stresses of the job. The experience of medical surveillance programs for respirator users suggests that routine surveillance is not necessary. The frequency of disease sufficiently debilitating to preclude respirator use found through medical surveillance is low; adverse outcomes experienced by respirator users, although potentially tragic, are not outcomes for which medical surveillance plays a preventive role. In an effort to better use resources once spent on repetitive examination of asymptomatic respirator users without compromising their health, this article proposes an approach for addressing symptomatic respirator users in which the respirator components are evaluated before the user is subjected to medical investigations.