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Occupational Health and Safety Act, 1993 (Act No. 85 of 1993)

Code of Practice

Diving Regulations, 2009

Code of Practice for Inshore Diving

9. Medical

9.2 Occupational Health Personnel

 

Not all health practitioners are able to render occupational health care. Additional training and registration is required to perform these functions. Certain regulations under the Act require that specific work-related medical functions be performed by practitioners who have undergone such training and who are appropriately registered. The legal definition of these practitioners is contained in the Occupational Health and Safety Act.

 

9.2.1        Occupational Health Practitioners

 

Practitioners registered as nurses, doctors or specialists can undergo training in occupational health that enables them to register as "occupational health practitioners ". This is thus a general term that includes all these practitioners. All such practitioners are registered either as occupational health nursing practitioners or as occupational medicine practitioners or as occupational medicine specialists. Certain medical functions may be performed by occupational health practitioners (these are then usually performed by nursing practitioners), Certain functions are however legally required to be performed by occupational medicine practitioners (doctors).

 

9.2.2        Occupational Medicine Practitioners

 

Occupational Medicine Practitioners are General Medical Practitioners (GPs) and Medical Specialists who have undergone additional training in occupational health and are registered as occupational medicine practitioners.

 

9.2.3        Occupational Medicine Specialists

 

These are occupational medicine practitioners who have undergone specialist training in occupational medicine. They are registered as occupational medicine specialists and have advanced knowledge on occupational medicine matters.

 

9.2.4        Occupational Health Advice and Support

 

Not all occupational health practitioners are able to provide occupational health support for diving projects. Occupational Health Practitioners that do not have appropriate knowledge and experience in providing such support in the hyperbaric environment should consult with a level 2 designated medical practitioner or a colleague experienced in hyperbaric work. The following considerations are worth mentioning:

• The Occupational Exposure Limits (as contained in the Regulations for Hazardous Chemical Substances) need significant adjustment and cannot be applied "as is".
• The increase in environmental pressure acts as an additional risk factor, which necessitates it being considered as part of 'mixed exposures". The effect is in some cases additive and in others synergistic.
• Significant physiological changes in the cardiovascular, respiratory and other systems of the body significantly changes a number of toxicological principles, which should be taken into account. The absorption. distribution, metabolism and elimination of almost all substances are changed.
• Some exposures are extremely difficult (if not impossible) to model (e.g. noise exposure: sound conduction is different in different fluids that divers are diving in; increase in pressure has an effect on sound conduction; the middle ear space may be filled with compressed gas or with gas other than air; the external ear canal may be filled with fluid - thus splinting the tympanic membrane, etc.)
• Specific diving injuries and diseases are listed as occupational diseases. A thorough knowledge of these is needed.

 

The diving contractor should only use occupational health practitioners that are competent to provide such services in the diving environment. The ideal is a designated medical practitioner who is also registered as an occupational medicine practitioner or occupational medicine specialist.