Hyperbaric Medical Considerations for Occupational Exposure to Compressed Gas Environments

Compressed air work encompasses various occupations, including caisson workers, tunnel workers, commercial divers, and inside observers in multiplace hyperbaric chambers. These roles all involvie working in environments with increased atmospheric pressure. For the sake of simplicity, this article collectively refers to individuals in these roles as compressed air workers. In tunneling projects, compressed air workers utilize compressed air to prevent flooding by groundwater and the infiltration of toxic substances such as methane gas. Over time, the compressed air work industry has evolved significantly since its establishment in the 1800s, when tunnels and caissons were primarily excavated by hand, exposing workers to the challenges of increased atmospheric pressure. This period saw a notable prevalence of decompression sickness among caisson workers, commonly known as the bends, due to the physical strain on their bodies caused by decompression sickness-induced pain in the hips and spine. However, the advent of pile driving has largely supplanted the need for compressed air caisson work. Skilled commercial divers now perform underwater compressed air tasks, with their risk of decompression sickness and air gas embolism mitigated through comprehensive academic diving education programs and continually updated decompression tables and modeling. Job sites may require onsite hyperbaric chambers and medical teams depending on the specific conditions and depth of the work. Regulatory guidelines for compressed air work are on the Occupational Safety and Health Administration (OSHA) website under standard number 1926.803-Compressed Air. Despite efforts to mitigate risks, tunnel compressed air workers may still experience symptoms of decompression sickness and other hazards associated with construction work.