Medical appraisal during health hazard evaluations involving workers exposed to lead

To evaluate the medical aspects of the Health Hazard Evaluation (HHE) program of the National Institute for Occupational Safety and Health (NIOSH), 170 lead-related HHE reports published through 1984 were examined. The percentages of HHEs conducting basic medical examination procedures justified by elevated environmental exposure to lead at worksites were as follows: blood or urine lead level testing, 57%; medical history taking, 55%; physical examinations, 23%; CBCs, 18%; and urinalysis, 7%. The HHE program has primarily focused on whether or not environmental worksite hazards are present at the time of the evaluation and not on ascertaining whether there is evidence of adverse health effects attributable to past worksite exposures. The program has not focused on minimizing adverse health effects when they exist or on providing a series of building blocks for health effects research. More clearly defined HHE program goals and a logic for deciding when and how medical examinations should be performed during HHEs need to be developed.