Risk assessments: good and bad.

The spectrum of respiratory disease associated with exposure to metal working fluids. Robertson AS, Burge PS. Fifteen-year trends in occupational asthma: data from the Shield surveillance scheme. cross-reactivity between nickel and chromium salts in electroplating-induced asthma. Many years ago, I had the responsibility once a month of doing a tuberculosis clinic in deepest West Virginia. The small town that I drove to was the site of the State penitentiary—it was said the citizens had been polled on whether they wished to have this or the State university and had opted for the gaol in the belief it would provide more jobs. On one occasion, a small and inof-fensive-looking patient was led in, handcuffed on both wrists to burly warders. I ensured that he was taking his drugs and making satisfactory progress and arranged to see him again the next month. After he left, curious to know why the security had been so apparently excessive, I asked the nurse, a local woman, what he was in for. She told me that he had been done for armed robbery. The story was that he had lived in the town all his life and was known to most in the community. One day he had walked in to his local bank, pulled out a pistol and demanded of the cashier that he hand over all the money. The cashier , recognizing that death from acute lead poisoning was an occupational hazard of bank employees, wisely complied but took the sensible step of calling the police when the robber left, giving them his name and address which, as he was also a customer, was known to the bank. The police went round to his house where he was found counting the money on his kitchen table. He received a severe sentence, an occupational hazard of robbers. Hazards, foreseeable adverse consequences of an activity, are quantified as risks in our Control of Substances Hazardous to Health (COSHH) assessments. The risk of being a victim of an armed robbery is low for any individual, even in Appalachia, but the outcome may be fatal and is always traumatic. The cashier clearly made a snap-risk assessment and decided on a wise course of action. The risk of being apprehended after performing an armed robbery on one's own bank in one's own community must be high, even in Appalachia. My poor patient must have been unfamiliar with the practical …