1. Control of vibration at work Dr Peter Noone, Consultant Occupational Physician,

7. Alice Hamilton, the year she graduated from medical school, 1893 The Schlesinger Library, Radcliffe Institute, Harvard University

8. Bedford, Indiana, 1918: ". . .the trouble seems to be caused by the vibrations of the tool, and cold. If these features can be eliminated the trouble can be decidedly lessened.". Alice Hamilton, MD . 1978 repeat of the Alice Hamilton study in Bedford, prevalence of HAVS=80%= same as 1918 result, nothing changed.

9. Alice Hamilton at her home, 1957, The Schlesinger Library, Radcliffe Institute, Harvard University, Scope Weekly

13. Who’s at risk

14. Mechanisms contributing to Raynaud’s phenomenon

15. Wigley F. Raynaud’s Phenomenon. N Engl J Med 2002;347(13):1001-8

28. Hand-Arm Vibration Syndrome: Pathophysiology Stoyneva et al. Current pathophysiological views on vibration-induced Raynaud’s phenomenon. Cardiovascular Research. 2003. 57, 615-624

31. Test TOS

32. Other tests

35. Cook RA. Hypothenar Hammer syndrome: a discrete syndrome to be distinguished from hand-arm vibration syndrome. Occupational Medicine 2003;53:320-324

38. ISO 5349-1:2001 for HAV and ISO 2631-1:1997 for WBV.

56. www.hse.gov.uk/vibration

57. Points 100 points Action value- 400 points -Limit value-

59. Simple ‘exposure points’ system to estimate the daily exposure.

61. Average latent periods for vibration-induced diseases in different occupations Vibration effects on the hand and arm in industry. Edited by A.J. Brammer et al. New York : John Wiley and Sons, 1982. 13.7 Blanching Grinder 4 Numbness Chain saw operator 9.1 12.0 16.8 Tingling Numbness Blanching Shipyard worker 1.8 2.2 2.0. Tingling Numbness Blanching Foundry worker Latency (years) Stage of VWF Occupation

64. Demolition without vibration Use hydraulic crushers instead of demolition hammers

65. Elimination by design Eliminating the need for fettling Pile cropping C(DM)

66. Piling operations

67. Old: Pneumatic pick Slow process with exposure to noise, vibration, dust, heat

85. Staging for Hand-arm Vibration Syndrome (Taylor-Pelmear System)

86. Stockholm (Revised) Hand-arm Vibration Syndrome Classification

89. SWS Sensorineural modification Persistent = > 2 hours, Constant= all the time >6<9+ Intermittent numbness and/or tingling 2SN early >9<16+ late persistent numbness and/or tingling reduced sensory perception 2SN >19+ Constant numbness and/or tingling reduced sensory perception+ manipulative dexterity reduced in warmth 3SN >3<6 Intermittent numbness and/or tingling 1SN >3<6 Nil 0SN Sn Scores Symptoms Stage

90. SWS Vascular modification 18+ Frequent attacks all fingers most, digits all year 3 Occasional 3 or < /wk, Frequent > 3/wk Trophic changes 4 10-16 Frequent distal and, middle phalanges 2 V late 5-92 Occasional distal and, middle phalanges 2 V early 1-4 Fingertips only 1V 0 None 0 Griffin Score Vasospastic attacks Stage

93. Whole Body Vibration