Safety critical work, ageing and cognitive decline

Fitness for work assessment is inherent to occupational medicine practice, whether at the pre-employment stage, or when a person is an established employee. Many occupational health practitioners are involved in the assessment of fitness of workers to undertake safety critical work, for example, driving a heavy goods vehicle or a train or working in health care. But, how do we define safety critical work and what constitutes a safety critical task? Furthermore, how do we assess fitness to carry out safety critical work? There is no generic definition of safety critical work within the literature that can be applied to all industries, although specific tasks or duties have been cited. In relation to the construction industry, the Health and Safety Executive (HSE) has stated that some safety critical jobs involve activities that can place safety-critical workers at risk, unless the workers have full, unimpaired control of their physical and mental capabilities [1]. The HSE guidance advises that safety critical jobs should be defined by analysing duties or tasks that are inherent to the job. Similarly, The Railways and Other Guided Transport Systems (safety) Regulations 2006 do not contain a definition for safety critical work and again concentrate on a task-based system (providing specified safety critical tasks within the regulations) by which to identify safety critical workers [2]. However, as industries evolve and as technology and techniques advance, tasks may change, and it is important to have a system to assess fitness to work that can account for this. In the aviation industry, there is an established and systematic approach for assessing an individual's fitness to work, which is used for air traffic control officers as well as commercial pilots. Each of these occupations contains tasks that are safety critical; therefore, workers are assessed according to established medical standards for risk of incapacitation due to medical causes in relation to carrying out these tasks. However, applying a task-driven approach to identifying safety critical workers may not identify all those who should be assessed for medical fitness. For instance, there are certain occupations, such as flight engineers who do not undergo medical assessment for possible causes of incapacitation. It could be argued that assessment of flight engineers is necessary because they too have the potential to cause a significant adverse outcome if errors or omissions are not recognized by quality assurance systems that are already in place. Therefore, employees such as flight …