Remote operations are typical for various industries around the world. Personal communications indicate that interest in remote industrial hygiene is growing among occupational hygienists, who are contributing to scientific discussions about occupational health and safety at remote sites and designing practical solutions. Remote industrial hygiene approaches and solutions are suitable for a significant number of workers involved in oil and gas operations, mining facilities, crews for ships and planes, scientific expeditions and explorers, among others. For these activities, as a rule, the workforce should be supplied with specific healthcare options, including evacuation potential and telemedicine.  FIELD WORK IN REMOTE AREAS In 2004, the Consortium for Risk Evaluation with Stakeholder Participation, or CRESP, conducted a research expedition for the Department of Energy in remote areas of the western Aleutian Islands to study possible radiological contamination of the marine environment from the underground nuclear tests conducted on Amchitka Island from 1965 through 1971. CRESP researcher Michael Gochfeld and co-authors published a landmark paper in the Journal of Occupational and Environmental Hygiene in 2006 that described approaches to developing a health and safety plan for this interesting study. The paper emphasized that the remoteness of the expedition and the diversity of activities imposed some unusual challenges.  The specific health hazards encountered during the Amchitka Island project included unusual factors, like cold water diving, extreme weather, elevated exposure levels for chemicals and physical factors (such as radiation “hot spots”), and others. These hazards are much less predictable than those typically encountered in manufacturing workplaces, for example. The project team stressed the need to count on local resources and expertise in resolving health and safety issues. Despite the comprehensive preparation phase, several injuries occurred during the course of the  project, though none were severe. The JOEH paper concluded that operations in remote areas were a growing challenge facing the industrial hygiene profession.  SYNERGISM WITH REMOTE HEALTHCARE The term “remote healthcare” was reportedly coined by Dr. Max House when he was the only neurologist responsible for the vast remote areas of Newfoundland and Labrador in the mid-1970s. Later, Dr. Nelson Norman from Aberdeen University formulated five priorities of effective remote healthcare systems devised for workers at risk so they could care for themselves to cover the “vital time interval” in emergency situations. Those priorities are:
  • first aid training
  • a sophisticated system of communication (“telemedicine”)
  • a medical coordinating system
  • appropriate evacuation systems
  • auditing and research
For many reasons, industrial hygiene risk assessment and activities should be added to this widely accepted list of priorities. Industrial hygiene plays a critical role in combination with healthcare systems. Instead of reacting to emergencies, industrial hygiene allows for the anticipation, recognition, evaluation, and control of various hazards, and proactive prevention of adverse emergency events that would require immediate medical interventions or evacuations. Therefore, occupational risk assessment for remote locations should be performed before and during operational activities, and the results of the assessment should be communicated to the facilities and medical professionals.  Remote industrial hygiene, in turn, can be associated with the following priorities:
  • risk assessment as a basis for effective preventive and health-improving programs
  • use of advanced communication systems to observe and evaluate the situation
  • remote occupational hygiene and safety training
  • remote monitoring of workplace conditions
  • remote auditing of health and safety management systems
Some of the resources developed for remote healthcare can be used for the purposes of remote industrial hygiene. For example, “telemedicine” involves satellite communication and modern computer servers to establish connections between hospitals and remote sites. The same technology can be used to help industrial hygienists stay in continuous communication with locations that would be difficult to visit on a regular basis.  RUSSIA: WHERE EVERYTHING IS REMOTE It is useful to evaluate how the international community is dealing with new initiatives in the areas of remote healthcare and remote industrial hygiene. The Russian Federation is a good example because of its vast territory. The population density in the Asian part of Russia is 1.9 people per square kilometer, far lower than in the United States (35 per km2) and the European Union (119 per km2). More than 800,000 workers in Russia are employed in the natural resources sector, a significant number of them in remote areas.  The first independent organization dealing with healthcare at remote sites, the Center of Corporate Medicine, or CCM, was created in 2006 in the Russian city of Tomsk, situated 2,266 miles from Moscow. In 2016, with the active support of the Institute of Remote Health Care (Aberdeen, Scotland), the Remote Healthcare Association was founded in Russia. These initiatives provided remote sites with effective healthcare services, including a 24/7 call center, evacuation resources, and training for professionals.  Comparing the reasons for medical evacuations from a representative set of facilities in Russia with those in other countries can help illustrate industrial hygiene priorities for remote sites. Table 1 presents the number of evacuations by illness type for the offshore oil and gas industry from three sources: published data for Shell International (130 cases of medical evacuation for 2008‒2012), Medevac data for Aberdeen, Scotland operations (99 cases for 2008‒2012), and data for CCM clients in Russia (704 cases for 2018‒2019). As shown in Table 1, a high percentage of evacuations from Russian remote sites were due to cardiac diagnoses (more than four times higher than for Shell workers, according to published information). This disproportion can be evidence of the lack of efficiency in preventive medical evaluations for Russian workers. These evaluations are mandatory in Russia but are often disconnected from monitoring of workplace conditions. 
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Table 1. Comparison of Top Five Diagnostic Groups for Medical Evacuation (Percentage of All Cases)* 
Annals of Occupational Hygiene: “Unmanned Aerial Systems in Occupational Hygiene—Learning from Allied Disciplines” (October 2015). Canadian Medical Association Journal: “Telecommunications in Health and Education” (March 1981). Journal of the Institute of Remote Health Care: “Development of Competent, Remote Healthcare Practitioners” (July 2016).  Journal of Occupational and Environmental Hygiene: “Developing a Health and Safety Plan for Hazardous Field Work in Remote Areas” (December 2006). Journal of Travel Medicine: “Medical Evacuations in the Oil and Gas Industry: A Retrospective Review with Implications for Future Evacuation and Preventative Strategies” (May 2017). Oman Medical Journal: “Shift Work and the Risk of Cardiovascular Diseases and Metabolic Syndrome among Jordanian Employees” (May 2018). Provectus: “Worker Safety in Construction.” Sociedad Colombiana de Higienistas Ocupacionales: “Advances in the Collection and Analysis of Data on Injury Risks: Bio-Ergo Technology,” Sixth National Occupational Hygiene Day (presentation by Anthony N. Harris, September 2019).
The factors that contribute to cardiac emergencies in Russian workers at remote sites should be addressed by both occupational physicians and industrial hygienists. Psychological stress is one of the contributing hazards, and shift work—typical for remote operations—is a risk factor for cardiovascular disease. (A study of Jordanian workers published in the Oman Medical Journal in 2018 found that the duration of night shifts and the number of night shifts per month significantly increased workers’ Framingham 30-year risk score, one of the predictors of cardiovascular disease.) Risk assessment is needed to quantify various contributing factors and determine the most effective measures to prevent the need for medical evacuations at remote locations.  ASSESSING RISKS AT REMOTE SITES Though risk assessment theory and practice have been in development for many decades already, understanding of this methodology is still not uniform among experts and practitioners. However, more facilities internationally are using risk assessment to deal with complex and emerging occupational health problems. Remote sites seem to be an important area where the most current health risk assessment techniques could be tested because of the numerous challenges at these locations that can be resolved only by collaboration between industrial hygienists and occupational physicians.  Especially important is to view risk assessment as a process, not just an isolated study with narrow targets. For companies whose workers are situated at remote locations, we recommend implementing an annual risk assessment cycle covering diverse hazards, including workplace agents along with personal exposome, lifestyle, and behavioral parameters. The risk assessment procedure should cover the usual steps, including hazard identification, exposure assessment, dose-response assessment, and risk characterization. It is important, however, to transition from qualitative and semi-quantitative ways of evaluating risks to more consistent quantitative approaches.  Consider a worker at a remote site who would be exposed to crystalline silica at the level of 0.05 mg/m3 (95th percentile of exposure distribution) for five years (the average employment duration) during the shifts that accounted for 30 percent of her total annual work time. Her excess risk of lung cancer can reach 40 cases per 10,000 per lifetime (an average of various dose-response models selected by OSHA). We can interpret this value in many ways. For example, we might recommend additional workplace air quality control measures for risk exceeding 1 x 10-3 and development of an individual health improvement and preventive program for risk exceeding 1 x 10-4. If this person, however, smoked one pack of cigarettes per day for 15 years, her excess risk of lung cancer from smoking, based on various estimations, would be around 400 cases per 10,000 per lifetime. By quitting smoking for five years, she would reduce her risk approximately by a factor of 2.  This information is useful for preparation of individual risk assessments and recommendations for workers and should inform the pre-deployment health evaluation for the remote workforce. For example, regular checklists can be recommended for workers who have specific risk factors and risk levels to facilitate regular assessment of early symptoms of unwanted health conditions. Industrial hygienists and occupational physicians can be involved in telecommunication with the sites, and they should have access to the risk assessment information so they can fully understand the workers’ health challenges.  THE FUTURE OF REMOTE INDUSTRIAL HYGIENE Remote industrial hygiene should significantly benefit from future technological developments. For example, wearable devices and “smart clothing” can provide ergonomics assessments and send information about the risk of musculoskeletal injuries to central servers in real time. Unmanned aerial systems could help with the collection of information about environmental and occupational hazards at remote locations. Also, artificial intelligence can be an effective tool in the remote recognition and interpretation of hazardous behavior and potentially dangerous health and safety situations. In particular, the remote monitoring of workers to ensure that they’re wearing personal protective equipment can be performed through computer vision- and image analysis-driven systems. Development of analytical real-time monitors for detecting hazardous substances—one of AIHA’s content priorities—also will bring additional opportunities to control the occupational environment at remote sites and to reduce health risks for workers. These developments suggest that as remote healthcare continues to progress, remote industrial hygiene won’t be left behind.   ANDREY KORCHEVSKIY, PhD, DABT, CIH, is director of Research & Development at Chemistry and Industrial Hygiene, Inc., in Wheat Ridge, Colo. SERGEY ANTIPOV, MD, PhD, is general director of the Center of Corporate Medicine in Tomsk, Russian Federation.  ANDREY KARPOV, MD, PhD, is president of the Remote Healthcare Association in Tomsk, Russian Federation. DARYA ANTIPOVA, MBChB, MSc, PhD, is a researcher at the University of Aberdeen and specialty doctor at the National Health Service in Highland, United Kingdom. Send feedback to The Synergist.

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Protecting Workers in Locations with Difficult Access
Remote Industrial Hygiene: Emerging Challenges, Promising Solutions
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Disadvantages of being unacclimatized:
  • Readily show signs of heat stress when exposed to hot environments.
  • Difficulty replacing all of the water lost in sweat.
  • Failure to replace the water lost will slow or prevent acclimatization.
Benefits of acclimatization:
  • Increased sweating efficiency (earlier onset of sweating, greater sweat production, and reduced electrolyte loss in sweat).
  • Stabilization of the circulation.
  • Work is performed with lower core temperature and heart rate.
  • Increased skin blood flow at a given core temperature.
Acclimatization plan:
  • Gradually increase exposure time in hot environmental conditions over a period of 7 to 14 days.
  • For new workers, the schedule should be no more than 20% of the usual duration of work in the hot environment on day 1 and a no more than 20% increase on each additional day.
  • For workers who have had previous experience with the job, the acclimatization regimen should be no more than 50% of the usual duration of work in the hot environment on day 1, 60% on day 2, 80% on day 3, and 100% on day 4.
  • The time required for non–physically fit individuals to develop acclimatization is about 50% greater than for the physically fit.
Level of acclimatization:
  • Relative to the initial level of physical fitness and the total heat stress experienced by the individual.
Maintaining acclimatization:
  • Can be maintained for a few days of non-heat exposure.
  • Absence from work in the heat for a week or more results in a significant loss in the beneficial adaptations leading to an increase likelihood of acute dehydration, illness, or fatigue.
  • Can be regained in 2 to 3 days upon return to a hot job.
  • Appears to be better maintained by those who are physically fit.
  • Seasonal shifts in temperatures may result in difficulties.
  • Working in hot, humid environments provides adaptive benefits that also apply in hot, desert environments, and vice versa.
  • Air conditioning will not affect acclimatization.
Acclimatization in Workers