Health Surveillance Protocol Triggering

The following causes can trigger a health surveillance protocol, whereby an AND logic operation has the effect that a protocol is proposed only if all triggering causes for a person apply simultaneously.

If one triggering cause is sufficient, the Link Triggering Causes with AND indicator must not be set.

Age

You specify the age interval in which a health surveillance protocol is proposed by using the Age From and Age To fields.

Gender

Task

Agent

To trigger a health surveillance protocol, the system accesses a rating of the amount and frequency of exposure that occurs. The absolute reference value for the agent is not used. This means that the actual exposure ratings must be entered in infotypes 1403 (Long-Term Average) and 1404 (Task-Related Exposure) . The trigger levels for health surveillance protocols must also be entered. This allows the system to compare the actual exposure measurements or ratings with the trigger levels at which a certain protocol is proposed.

The system does not trigger a protocol automatically. Instead, it assigns the relevant persons to the protocol in question and displays them in a proposal list so that the physician can decide whether the protocol should actually be performed or not.

Triggering Criteria

If you have entered the actual exposure values as well as the relevant trigger levels for health surveillance protocols, you can start a fine-tuning process to determine the protocols required (see Assignment of Health Surveillance Protocols to Persons ).

This graphic is explained in the accompanying text.

The system uses predefined periods to assign periodic and past exposure examinations automatically to the relevant persons (see Stipulated Time Periods for Health Surveillance Protocols ).

The system compares the data available and proposes a protocol for the relevant person if the following criteria are met:

Trigger Level		Exposure Value	Value
Long-term average OR Frequency reference values exceeded OR Frequency trigger levels exceeded	<= >= >=	Long-term average Frequency reference values exceeded Frequency trigger levels exceeded	A to E 1 to 4 1 to 4
OR
Short-time exposure rating AND Exposure frequency AND Additional trigger level: long-term average	<= >= <=	Rating for short-time exposure limit Short-time exposure frequency Long-term average	A to E 1 to 4 A to E
OR
Skin absorption OR Skin exposure OR Ingestion	>= >= >=	Skin absorption Skin exposure Ingestion	1 to 4 1 to 4 1 to 4

This table shows how the system checks the individual trigger levels and proposes a health surveillance protocol if the criteria are met. There are OR and AND links:

In the case of an OR link, the system uses the value at which an exposure value is exceeded. The system then proposes the protocol for the persons in question.

In the case of an AND link, all given values must trigger a protocol.

Accordingly, the following applies to short-time exposure: If the Short-time exposure rating triggers a protocol, the system checks whether the Exposure frequency also meets the criteria.

If not, no protocol is triggered – eventhough the short-time exposure rating meets the criteria.

If it does, a protocol is triggered since both trigger levels meet the criteria.

The same is true of the Additional trigger level: long-term average (provided that an entry exists for it). If the entry value meets the criteria, a protocol is triggered; if the value fails to meet the criteria, no protocol is triggered, even though the two other values would trigger a protocol.

The values specified for the trigger levels can be based on statutory or in-company regulations. You do not need to complete all the entries.

This graphic is explained in the accompanying text.

If no values are entered, the system cannot trigger any protocols.

The Triggering Process

When health surveillance protocols are triggered, the system works through the trigger levels one by one and checks which value meets the criteria. (In the case of an AND link, it checks all the values.) If at least one criterion is met, the system proposes a protocol for the person in question. Whether other values also meet the criteria is then irrelevant.

If several agents are assigned to a protocol, the protocol is triggered by the agent whose values exceed the specified trigger levels.

Agents can also be assigned to several objects, each of which is linked to the same person and can thus have different exposure values. In such cases, the system always uses the higher exposure value for trigger levels with an OR link to trigger the protocol.

This graphic is explained in the accompanying text.

One person can be assigned to the exposure group Shop 1 and, at the same time, to the position Welder . The agent Welding fumes is assigned to both objects (exposure group and position), but the exposure values are different. It is always the higher value entered for Welding fumes that is relevant for triggering a health surveillance protocol.

In the case of trigger levels with AND links, where a combination of exposure rating and exposure frequency is compared, the system follows a special procedure:

The system first of all takes the highest rating for each object and cumulates these in a new matrix from A to E. This cumulation procedure also takes the frequency entered for the previous rating into consideration for the subsequent rating. For the comparison with the protocol trigger levels, the system uses the exposure value with the highest rating (for example, A1 instead of D4).

This graphic is explained in the accompanying text.

The system has determined the following exposure values for welding fumes on the basis of the highest values for the individual objects:

Exposure group Shop 1 D4

Position Welder A1

Task Welding B2

There is no frequency entered for ratings C and E.

The total rating for the short-time exposure limit is cumulated from A to E:

A= 1

B= 2 + 1(from A) = 3

C= 0 +3(from B) = 3

D= 4 + 3(from C) = 4 (4 is the highest value)

E= 0 + 4(from D) = 4

When comparing these values with the protocol trigger levels, the system uses the value with the highest rating.

You should also remember that links and measured values both have specific validities. In the process that triggers a protocol, the system compares the values that are valid at the time of this comparison. In the proposal list, the system displays whether anything has changed during the assignment of protocols to a person. However, only the last change is listed. If several changes have taken place in the period for which the comparison is being run (for example, if the person has changed positions twice), the system can only take the last change into account (see also Assignment of Health Surveillance Protocols to Persons ).