MEDICAL EVALUATION FOR RESPIRATOR USE- UPDATED APPROACHES.

OBJECTIVE: Respirator medical evaluations are an important component of occupational health practice. Concepts and practices were established 25-50 years ago.METHODWe suggest analysis and discussion of three areas warranting update.

RESULTS: a) Shifting from disease-based decisions to evaluating 12 specific domains- cardiopulmonary, sudden change in condition, thermal, work interference, exacerbating existing condition, donning/doffing, dermatologic, proper utilization, fit testing interference, cultural/religious, arms/legs, subjective responses. Two distinct evaluation processes are advised-"algorithmic" for the frequent straightforward evaluations and "specialist" for the more complex. b) Acknowledging the importance of subjective responses and clarifying the underlying causes - external stimulus, sensation, perception, interpretation, acceptability, and emotional response. c) Optimizing the organizational structures by explicitly defining the scope of evaluations, modifying the sequencing of assessment, and specifying qualifications of clinicians performing assessments.

CONCLUSIONS: Reassessing respirator medical evaluation methods is needed.