AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 42:443–454 (2002) Development of a Medical Examination Program for Former Workers at a Department of Energy National Laboratory Patrick N. Breysse, 1 Virginia Weaver, 1 Maureen Cadorette, 1 Laurie Wiggs, 2 Barbara Curbow, 3 Aleksandr Stefaniak, 1 Jim Melius, 4 Lee Newman, 5 Hugh Smith, 2 and Brian Schwartz 1 Background As a part of the U.S. Department of Energy (DOE) Former Workers’ Medical Surveillance Program, a Needs Assessment was conducted at Los Alamos National Laboratory (LANL). The objective was to identify former LANL employees who may be at significant risk for occupational disease and determine whether a medical examination program could reduce morbidity or mortality. We describe the needs assessment approach used at LANL. Methods An algorithm was developed to make needs determinations. Information on factors including exposure, health impacts, size of exposed populations, and LANL worker concerns and recommendations were obtained. Each of these factors was scored from 1 to 3. The resulting factor sum was then multiplied by a binary (1 or 0) intervention suitability factor which was 1 if both of the following were available: (1) a screening test with acceptable sensitivity and specificity for the health outcome of concern; and (2) an inter- vention that decreases morbidity or mortality. This resulted in an Intervention Needs Score that was used to set priorities for the medical examination program for the estimated 35,000 former LANL workers. Results Analysis of the algorithm output suggested that six exposure categories be recommended for consideration in a medical examination program. Beryllium, asbestos, and noise clearly warranted inclusion. Lead and ionizing radiation required careful consideration regarding availability of screening tests. Solvents were problematic due to the lack of screening tests and suitable intervention in formerly exposed workers. Conclusions The algorithm approach to the needs assessment at LANL documented that six chemical and physical agents should be considered as candidates for inclusion in a medical examination program for former workers. Am. J. Ind. Med. 42:443 – 454, 2002. ß 2002 Wiley-Liss, Inc. KEY WORDS: medical screening; surveillance; DOE ß 2002 Wiley-Liss, Inc. 5 Division of Environmental and Occupational Health Sciences, National Jewish Medical and Research Center, Denver, Colorado Contract grant sponsor: Los Alamos; Contract grant number: LA-01-5623. *Correspondence to: Patrick N. Breysse, Johns Hopkins Bloomberg School of Public Health, 615 N.Wolfe Street, Baltimore, MD 21205. E-mail: pbreysse@jhsph.edu Accepted12 August 2002 DOI 10.1002/ajim.10136. Published online in Wiley InterScience (www.interscience.wiley.com) 1 Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 2 Occupational Medicine Group, Los Alamos National Laboratory, Los Alamos, New Mexico 3 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 4 Laborer’s Health and Safety Fund of North America, New York Health and Safety Fund, Albany, New York