Compressed air tunnel work and occupational health care, from the past to the future

This thesis is on occupational health care, particularly on diving medicine in tunnel work and in the treatment of decompression illness. The health and safety risks and related control measures associated with the use of various breathing gases and the deployment of saturation diving are presented. When using trimix, less effort was required for breathing and work efficiency was considerably better as the available working time was longer relative to decompression time. No decompression sickness incidents were observed while using trimix. In a field study the microbiological load for saturation divers was evaluated. This health surveillance program has demonstrated the potential value of an early warning system. Body fat is examined as a predisposing factor for venous gas emboli (VGE) and decompression sickness (DCS). For divers in their midlife (and older), the analyses indicate that neither body fat nor BMI stimulate bubble formation, since correlations were nonsignificant. In contrast age and especially VO2max appeared to determine VGE. A scoping review of occupational health surveillance in compressed air work aimed to provide insight into adverse health effects, health surveillance measures related to tunnel construction. A positive trend can be observed showing a substantial reduction in adverse health effects. Several new health risks are mentioned such as silica, bentonite, and shotcrete. Information on long-term health effects is scarce. To promote health and safety at work we recommend mandatory registration of well-defined key information. Registration in a well-accessible international respository can form a base for international research needed to support practice with evidence.