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Responses of occupational physicians and laboratory staff to reports of high blood lead levels.

We evaluated the responses of physicians specializing in occupational health and of laboratory personnel engaged in occupational lead monitoring when periodic blood lead analysis results exceeded the Biological Exposure Index (BEI). Legally, Israeli workers must be removed from the site of occupational lead exposure after a repeat test shows "value above BEI" (VABEI). The maximum legal period between a report of VABEI and the repeat test is 14 days. Physicians have the discretion to remove workers after the first VABEI test if deemed necessary. In 1987-88, 242 of 3,776 analyses had a VABEI, 167 of which were periodic tests. The average laboratory response time between receipt of the sample and VABEI reports to occupational physicians was 13 days (SE = 0.4). Medical records of 100 workers who had 134 tests with a VABEI were available. In 35 (26.1%) of these events the physicians recommended removing the workers from the exposure source, in 55 (41.0%) events the physicians required repeat tests, and in 44 (32.9%) they neither recommended removal nor repeated the tests. The minimum time lapse between the first and repeat test was 20 days. The second test yielded 24 VABEI. Physicians recommended removing workers from the source only in 13 (54.2%) of these cases. This study suggests that the system must be improved in order to ensure the proper response to VABEI results.