台灣地區異常氣壓作業意外事故之調查研究

A Survey of Occupational Diving Accidents in Taiwan

牛柯琪(Ko-Cli Niu) ； 陳秋蓉(Chiou-Zong Cheng) ； 劉紹興(Saou-Shing Liou) ； 林文(Wen Lin) ； 何俊傑(Jiune-Jye Ho) ； 李惠傑(Hui-Chieh Lee) ； 陳興漢(Shing-Han Cheng) ； 顧天倫(Ten-Lung Kou) ； 張陸澎(Lu-Peng Chang) ； 林燈賦(Teng-Fu Lin) ； 黃崑崙(Kun-Lung Huang) ； 賴朝英(Chao-Yinz Lai) ； 林瑞雄(Ruey-Shiung Lin) ； 林玉鐘(Yu-Cheng Lin)

《中華民國航空醫學會刊》 10卷2期 (1996/12) Pp. 93-104

https://doi.org/10.7011/TAMAROC.199612.0093

摘要

The purpose of this series of studies for the following three years is to initiate a demographic and epidermiologic survey of compressed-air workers in Republic of China. The survey is composed of diving area, natural of work, work and training history, diving related health problems and record of health care. The subjects suffered from disasters during the dive including decompression sickness (DCS) were studied. The objective of the first year created the preliminary data of compressed-air workers who are commercial compressed-air workers salvage, underwater sewer constructors, ship hull scrubber and subway workers. The results of the analysis explored the possible related factors leading to the high incidence of diving accidents in Taiwan.
First year, 231 of the total 450 listed compressed-air divers were interviewed. The results of the analysis have shown that the incidence of diving accidents from 1994 March to 1995 April was 32.5% C 75/231 cases ) and two thirds of those (19.9%, 46/231 cases) were diagnosed as decompression sickness (DCS). Comparing to the accepted incidence of DCS below 02% for the professional divers in western countries, the incidence of diving accidents in Taiwan is extremely high. The possible risk factors relating to the high incidence of DCS, using logistic regression analysis are (1) knowing step decompression concept; (2) following the decompression table; (3) performing the annual physical examination; (4) number of divers for each shift; (5) bottom times; (6) full-time or part-time work; and (7) age. Of these, whether divers knowing the step decompression concept should be most concerned.
From the point of view of occupational safety and health, we have found that only 40.7% divers received classical training and the necessary on-job education has not yet began routinely. More than half the divers (54.1%) did not have correct decompression concept and less than one fifth (22.5%) divers strictly followed the decompression tables. This indicates that the majority of divers often violate the dive regulations.
Although only 4.8% divers got class Ⅱ certification, as high as 27.7% divers, without necessary equipment and technique, dove deeper than 50 meters that is the limit for Class Ⅲ divers. Moreover, 29.6% of these 27.7% divers (19/64 divers) went down deeper than 70 meters. With regard to the required planing, only 10% divers recorded the operation in detail for each dive. Summarizing, inadequate training, incorrect step decompression concept resulting in repetitive dives, no planing, insufficient facility and exceeding depth are the common problems in occupational divers in Taiwan.
We make the following suggestions regarding to the occupational safety and health : (1) to provide the training course and diving safety education; (2) to execute diving-safety checking strictly; (3) to further strengthen the system of certification for professional divers; (4) to perform annual physical examination; (5) to establish the diving safety Network; (6) to organize a diving labor union; (7) to reinforce the diver's labor insurance; and (8) to amend the regulations for diving operation.
From the point of view of diving medical care and preventive medicine, we have concluded that disorders occurred during the dive including DCS is one of the most serious occupational diseases. The reviewing of past illness history has shown that the incidence of unhealthy condition (cardiovascular problems, diabetes mellitus, gout, and neuropsychological problems) in DCS cases is significantly higher than non-DCS cases (153% versus 105%, p＜0.02). The divers, with joint pain, were often delayed for the recompression treatment in hyperbaric chamber are due to unrecognizing the syndromes of DCS, diving at the remote islands, or DCS unfamiliar to general practicing doctors.
We, therefore, make the following suggestions with regard to diving medical care and preventive medicine (1) Department of public health of Executive Yuan provides the education course of diving disorders and prevention to the divers; (2) Department of public health of Executive Yuan provides the medical training course of diving disorders to doctors and the personnel of public health and diving safety; (3) The incharged agency puts an effort to increase the number of hyperbaric chamber and the personnel of diving medicine in remote areas; (4) The incharged agency puts an effort to create an Diving Alert Network (DNA); (5) The incharged agency consigns diving-research centers to lanuch a series of studies in the epidermiologic survey, pathophysiology and therapeutic method of diving disorders.

關鍵字

第一型減壓症 ； 第二型減壓症 ； 異常氣壓工作人員

並列摘要

The purpose of this series of studies for the following three years is to initiate a demographic and epidermiologic survey of compressed-air workers in Republic of China. The survey is composed of diving area, natural of work, work and training history, diving related health problems and record of health care. The subjects suffered from disasters during the dive including decompression sickness (DCS) were studied. The objective of the first year created the preliminary data of compressed-air workers who are commercial compressed-air workers salvage, underwater sewer constructors, ship hull scrubber and subway workers. The results of the analysis explored the possible related factors leading to the high incidence of diving accidents in Taiwan.
First year, 231 of the total 450 listed compressed-air divers were interviewed. The results of the analysis have shown that the incidence of diving accidents from 1994 March to 1995 April was 32.5% C 75/231 cases ) and two thirds of those (19.9%, 46/231 cases) were diagnosed as decompression sickness (DCS). Comparing to the accepted incidence of DCS below 02% for the professional divers in western countries, the incidence of diving accidents in Taiwan is extremely high. The possible risk factors relating to the high incidence of DCS, using logistic regression analysis are (1) knowing step decompression concept; (2) following the decompression table; (3) performing the annual physical examination; (4) number of divers for each shift; (5) bottom times; (6) full-time or part-time work; and (7) age. Of these, whether divers knowing the step decompression concept should be most concerned.
From the point of view of occupational safety and health, we have found that only 40.7% divers received classical training and the necessary on-job education has not yet began routinely. More than half the divers (54.1%) did not have correct decompression concept and less than one fifth (22.5%) divers strictly followed the decompression tables. This indicates that the majority of divers often violate the dive regulations.
Although only 4.8% divers got class Ⅱ certification, as high as 27.7% divers, without necessary equipment and technique, dove deeper than 50 meters that is the limit for Class Ⅲ divers. Moreover, 29.6% of these 27.7% divers (19/64 divers) went down deeper than 70 meters. With regard to the required planing, only 10% divers recorded the operation in detail for each dive. Summarizing, inadequate training, incorrect step decompression concept resulting in repetitive dives, no planing, insufficient facility and exceeding depth are the common problems in occupational divers in Taiwan.
We make the following suggestions regarding to the occupational safety and health : (1) to provide the training course and diving safety education; (2) to execute diving-safety checking strictly; (3) to further strengthen the system of certification for professional divers; (4) to perform annual physical examination; (5) to establish the diving safety Network; (6) to organize a diving labor union; (7) to reinforce the diver's labor insurance; and (8) to amend the regulations for diving operation.
From the point of view of diving medical care and preventive medicine, we have concluded that disorders occurred during the dive including DCS is one of the most serious occupational diseases. The reviewing of past illness history has shown that the incidence of unhealthy condition (cardiovascular problems, diabetes mellitus, gout, and neuropsychological problems) in DCS cases is significantly higher than non-DCS cases (153% versus 105%, p＜0.02). The divers, with joint pain, were often delayed for the recompression treatment in hyperbaric chamber are due to unrecognizing the syndromes of DCS, diving at the remote islands, or DCS unfamiliar to general practicing doctors.
We, therefore, make the following suggestions with regard to diving medical care and preventive medicine (1) Department of public health of Executive Yuan provides the education course of diving disorders and prevention to the divers; (2) Department of public health of Executive Yuan provides the medical training course of diving disorders to doctors and the personnel of public health and diving safety; (3) The incharged agency puts an effort to increase the number of hyperbaric chamber and the personnel of diving medicine in remote areas; (4) The incharged agency puts an effort to create an Diving Alert Network (DNA); (5) The incharged agency consigns diving-research centers to lanuch a series of studies in the epidermiologic survey, pathophysiology and therapeutic method of diving disorders.

並列關鍵字

decompression sickness ； compressed air workers