Principles of occupational medicine: an educational case study of hazards and risks for Dr “Indiana” Jones

Abstract

Background

Understanding the nature and consequences of hazards and risks in the workplace is critical to protecting people from harm.

Educational case study

We review the fictional example of “Indiana” Jones as an educational vector to illustrate principles of occupational medicine in real-world scenarios.

Conclusion

After reviewing the Jones saga regarding potential hazards (physical – biological – chemical – psychosocial), we provide a practical outlook on the workplace health for readers with a non-occupational medicine background.

Introduction

Understanding the nature and consequences of hazards and risks in the workplace requires knowledge of occupational medicine. Thus, educating and training physicians in key principles of occupational medicine is important [1]. Educating readers who are employers or employees with non-occupational medicine backgrounds is also important.

Herein, we aim to inform about occupational safety, procedures, preventive measures, and key questions such as “what are hazards and risks at work?”, “how do we recognize work accidents and occupational diseases?”, and “how do we use risk assessments as a key to prevention?”. To this end, we review the exposures to the fictional archaeologist Dr “Indiana” Jones – protagonist of the Indiana Jones film series – to illustrate hazards and to provide reference and context for discussion of principles of occupational medicine.

We expect that the extreme conditions for the movie character can foster informed thinking among readers with non-occupational medicine backgrounds. This is especially important in terms of the size of this population and the reach of such informed thinking. Taking the UK as an example, there are nearly 32 million employees, approximately half of a general practitioner’s patients are part of the general workforce, and the burden and cost of work-related illness challenges health care and the economy [2]. Hopefully, this article – with Indiana Jones as an educational vector – will contribute to understanding principles of occupational medicine that can benefit individuals and populations in workplace settings [3].

Methods

Three authors (PL & CD & JW) independently reviewed and extracted data from all five films about the adventures of Dr Henry Walton “Indiana” Jones, Jr.: “Raiders of the Lost Ark” (1981; Film 1), “Indiana Jones and the Temple of Doom” (1984; Film 2), “Indiana Jones and the Last Crusade” (1989; Film 3), “Indiana Jones and the Kingdom of the Crystal Skull” (2008; Film 4) and “Indiana Jones and the Dial of Destiny” (2023; Film 5). The extracted data concerned potential occupational hazards (grouped into physical, biological, chemical, and psychosocial hazards).

We use the examples from the Indiana Jones films for context and illustration of elements of occupational risk assessments that are broadly applicable. Of course, knowledge of hazards and risks increase over time; we apply our knowledge basis in 2024 to all films rather than what was known at the time of filming or at the supposed time in which the fictional adventures took place.

Specifically, we focussed on expedition scenes leading to and including Dr Jones retrieving artefacts from “archaeological” sites or bringing/returning artefacts to their final destination. We exclude parts of expeditions that involve attempting to steal artefacts or rescue a person from another interested party and we exclude excessive travel scenes that include transport such as via planes, trains, larger boats, and a zeppelin. We do this for three reasons; namely to narrow the focus of review, because these scenes are either extremely short or involve violence, and such travel is also commonplace outside the scope of occupational medicine. That is not to say, of course, that such travel is not important in terms of occupational medicine; it is. Furthermore, supernatural exposures (such as the Ark and its power in Film 1 or the Grail with an immortal knight in Film 3) and hypothetical exposures (Film 5 with time travel, time-space-related wormhole theory [4]) were also excluded because they have no occupational medicine relevance. An overview of the findings is presented in tabulated form and in an in-text synthesis.

In the Discussion section, we ask and answer a series of questions that allow clarification as to how the risk assessments for Indiana Jones’ scenarios translate in generalisable principles for real-world occupational-settings, for both readers with and without occupational medicine backgrounds.

Results

We identify and report on nine workplaces in eight countries in five films released over 42 years between 1981 and 2023. An overview of corresponding locations, tasks, and hazards is presented in Table 1. We note that Dr Jones is not necessarily working as an archaeologist; thus, the tabulated overview must be considered lightly on the one hand but illustrative on the other.

Table 1 Potential hazard examples from selected scenes across 5 Films*¹

More relevant potential hazards to the “everyday” workplaces that are observed in the films include the use of tools, the height of shelf/ground upon which an object is placed, strain from reading text (placement of computer monitor [or hieroglyphics] and size of font), tripping hazards, polluted air, and the prevailing climate and weather. Conspicuously prevalent across all films are the hazards and risks of impact and strain injuries and different climates and weathers associated with the different locations. Moreover, the possibility of fire-related injury was a common theme across the films as were potential hazards from the non-ergonomic wearing of a backpack or satchel.

Discussion

After the synthesis of potential hazard examples using scenes from the Indiana Jones films (Table 1), we now elaborate on elements of occupational risk assessments by discussing: (i) What is the extreme nature of Dr Jones’ exposures and how does this compare to real-life? (ii) What if Dr Jones – or real-life workers at archaeological sites – would make a statutory insurance claim? (iii) How must employers protect their employees, and others, from harm? (iv) How may what Dr Jones does contribute to his health? (v) Given the hazards identified in Table 1, what were the risks of working on the film set? Our discussion closes with (vi) what are principles of occupational medicine identified in our article and (vii) what do we conclude for readers with a non-occupational medicine background?

What is the extreme nature of Dr Jones’ exposures and how does this compare to real-life?

Dr Jones contends with extreme events that go far beyond those encountered on a typical archaeological mission. This is made clear, for example, by Dr Jones’ words to Dr Schneider: “Since I’ve met you I’ve nearly been incinerated, drowned, shot at and chopped into fish bait […]” (Film 3). His extreme exposures include, but are not limited to, plane crashes/explosions, car chases/accidents, being dragged along a bumpy road from a car or hanging from the roof of a car, bar fights, sliding down the Himalayas in a life raft, kidnapping, mind control, torture, nuclear bomb explosions, and supernatural events.

In real life, exposure to drowning hazards and being shot at may be more likely in emergency services and military professions. Factual examples for hazards and risks for archaeological field work include Lyme disease, rabies, hantavirus, the plague or exposures to arsenic, lead, or radiation [5]. That incidents occur despite occupational risk assessments – see below – is shown by repeated cases of coccidioidomycosis. This fungus caused an outbreak of C. immitis infection in 1970 among archaeology students in an area of northern California [6, 7]. Three decades later, coccidioidomycosis struck again with acute respiratory disease at an archaeological site at Dinosaur National Monument in Utah [8].

Dr Jones’ exposures to different climates and weathers associated with the different locations highlight that various hazards and risks may not be the same even if the occupation is the same. Indeed, location and time play an important role. Also based on this, we might expect climate change to affect or change the nature of hazards and risks for a given job in a given location in the future (arguably it is already being observed [9]). The role of climate change and emerging risks must be emphasized. As one possible consequence, the precautionary criteria (such as the so-called ArbMedVV and DGUV recommendations in Germany) for employees in the tropics and subtropics (latitudes 40°N to 40°S) as well as other work settings with special climatic stresses will probably have to be extended [10, 11].

What if Dr Jones – or real-life workers at archaeological sites – would make a statutory insurance claim?

What about possible recognition of work accidents – let alone occupational diseases – for Dr Jones? Whether the statutory insurances would have covered Dr Jones’ risk taking is open. What exactly constitutes Dr Jones’ various workplaces could also be disputed. Whether he would report accidents or injuries is another question [12]. Formally, countless incidents summarized in Table 1 would qualify for injuries or accidents as they occurred after “exposures” within one presumed work-shift. With regard to years or decades of exposure as a prerequisite for the recognition of one of the 82 currently recognized occupational diseases in Germany, UV radiation is listed in the Table as a candidate for causing skin cancer.

Post-traumatic stress disorder (PTSD) may soon be recognized as an occupational disease – at least in Germany. While not yet listed in the Occupational Diseases Ordinance, such possibility for a paramedic was decided in 2023 by a Federal Social Court in Germany [13]. However, while Dr Jones had lots of stress over decades, a “typical” archaeologist will differ from emergency service providers, soldiers, or peacekeepers who can be traumatized chronically by devastating accidents, shootings, suicides, and other life-challenging incidents [14, 15].

As personal protective equipment (PPE), Dr Jones’ fedora protects his face and neck from UV radiation that can cause skin cancer. As mentioned above, this can be recognized as an occupational disease (“BK5103”) [16]. In 2021, a systematic literature review as part of the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury concluded that employees working outdoors are at increased risk of both melanoma and non-melanoma skin cancer [17]. Further PPE is Dr Jones’ iconic leather jacket: It protects him from impact injury such as when he is dragged across rough ground in the 1981 movie (Film 1).

For individual countries, differences in “what” is considered an occupational disease and “how” it can be compensated may exist and national regulations for occupational diseases should be consulted. In many countries, statutory compensation for an occupational disease requires a clear “yes” to the question: “Has the presumed causal link been proven beyond doubt?” In 2007, a group of experts convened by the International Agency for Research on Cancer (IARC) classified “shift work with circadian disruption” as a “probable” human carcinogen [18, 19]. This Group 2A classification allowed women with breast cancer in Denmark who had worked night shifts for at least 20 years to receive compensation from their employer’s insurance schemes [20], but not in countries such as Germany. Some international orientation is provided by the “List of Occupational Diseases recommended by the ILO” [21].

How must employers protect their employees and others from harm?

Workplace risk assessments are a legal requirement [22]. For occupational risk assessments, the UK’s Management of Health and Safety at Work Regulations 1999 requires the following: “Identify what could cause injury or illness in your business (hazards)”, “decide how likely it is that someone could be harmed and how seriously (the risk)”, and “take action to eliminate the hazard, or if this isn’t possible, control the risk” [23]. Ultimately, for any workplace-specific occupational risk assessment, the following questions need answers [24]: “What are the hazards?”, “Who might be harmed and how?”, “What are you already doing to control the risks?”, “What further action do you need to take to control the risks?”, “Who needs to carry out the action?”, “When is the action needed by?”.

Noting some practical details of a possible risk assessment for Dr Jones, hazard of fire may be prioritised over tripping for Dr Jones when exploring the catacombs in Film 3 given the presence of an accelerant (Table 1). In terms of risk and severity, characteristics of Dr Jones must be considered. For instance, not being a pregnant woman, he may better tolerate many exposures compared to a developing foetus. Age and health status are noted by Dr Jones in Film 5 as he discusses his own “mileage” and how exposures have affected his physical health in previous films while scaling a wall in a cave. In terms of control or preventative measures, examples from the films include Dr Jones throwing a stone into an area of suspected booby-traps (Film 1), throwing pebbles over a path that is otherwise invisible (Film 3), using information provided by his father to avoid booby traps in Film 3, and using his hat to protect against sun exposure in all films as PPE. In terms of communicating hazards, Dr Jones repeatedly warns colleagues about potential hazards.

In any case, regardless of where you live and which workplace you are interested in, it is always worth looking for existing risk assessment information as exemplified by “Occupational safety and health protection on archaeological excavations” in Germany [25].

How may what Dr Jones does contribute to his health?

While work comes with risks, it comes with health too [26]. Twenty years ago, it was concluded that “There is a strong evidence base showing that work is generally good for physical and mental health and well-being” [27]: Work is key to identity, social role, and status; job loss is linked to poor health; reemployment contributes to higher self-esteem and better health and can reverse the effects of the job and employment loss; work can have a therapeutic value for the sick and disabled, leading to better recovery, rehabilitation and health, and less poverty.

Hypothetically, Dr Jones’ work contributed to his work-life-balance. With a view to salutogenic work [28], Dr Jones will have benefited from his appreciated role in academia and beyond. He experienced job loss (he loses his professorship at the university because the US government suspects him of being a Russian double agent in Film 4) but will have avoided poverty. Furthermore, some effects of his work may have contributed to Dr Jones’ mental acuity and physical fitness, even until old(er) age (Film 5).

Given the hazards identified in Table 1, what were the risks of working on the film set?

Of course, details from filming – for instance, the “well of the souls” scenes (Film 1) – go beyond preventative measures for typical archaeological excavation sites. Around 10,000 snakes were deployed, antivenom was imported from India when local supplies were exhausted, and quick access to a waiting ambulance was provided! Scattered poisonous snakes at some “real” – rather than fictitious – archaeological sites, while having the potential to be a biological hazard through snakebites [29], would – more generally – pose a much smaller risk or probability of damage to life and health than the risk stemming from the diverse and many snakes at the filming location of the 1981 movie (Film 1), in particular. But again, not all accidents may be reported [12].

What principles of occupational medicine does our article cover?

Illustrated in the content above are principles of occupational medicine in the UK, Germany, and elsewhere: (a) Prevention = occupational medicine’s primary target – to identify and remove possible sources of hazards and risks and associated accidents and occupational diseases – actually practiced by Dr Jones himself when it comes to his colleagues (i.e., he goes first or he keeps them out of harm’s way). (b) Risk assessment – to manage and prevent risk illustrated by our potential hazard examples for Dr Jones (Table 1) and the presented elements of risk assessments using Dr Jones for added context. (c) Causal inference when it comes to cases and claims – exemplified by regulations and compensation practice regarding links between shift-work and cancer in Denmark and possible recognition of PTSD as an occupational disease in Germany. (d) Salutogenic work effects – illustrated by positive effects associated with work, including Dr Jones work keeping him fit. Of course, this list is not exhaustive.

What do we conclude for readers with a non-occupational medicine background?

Occupational health and safety laws require all employers to assess and prevent risks to employees in the workplace [23, 24]. When employers do not ‘get this right’, the costs to individuals, the workforce as a whole, and the public are significant [2].

As a consequence, every doctor should have workplace health on their agenda. A promising tool is to ask your patients the following questions: “What do you do in your job every day? What are you exposed to at work – but also outside of work? Have risk assessments and training been carried out?” [2].

With the reader’s own risks in mind (or even a doctor’s concern for their patient), this paper explains how occupational risk assessment is used to predict and prevent harmful effects of exposures for every job, activity, and occupation. Even if your work doesn’t involve fighting a tank on a horse or hunting for artefacts around the world like Dr Jones, why not request the risk assessment for yourself and contribute if you see room or needs for improvement?