Heat Illness Prevention Presented by: Don Dressler, July 9 2013
What We Will Cover: Heat Illness- the focus of Federal OSHA, Cal/OSHA and other states and Canada Major prevention points about heat illness What is heat illness When is it hot enough to worry about heat illness? What works: Water; Shade; Training; Supervisor monitoring employees
The California campaign to protect outdoor workers from HEAT ILLNESS
Graphic, easy-to-read and available in Spanish, Hmong, Punjabi and English.
http://www.99calor.org
Heat Illness is not just a work related problem! 123 high school football players died of heatrelated illnesses between 1960 and 2009. In 2010, exertional heat stroke is the second leading cause of death among athletes, followed only by sudden cardiac death.
The Heat Illness Story: Most people typically are not acclimated when temperatures climb above 90 degrees especially when combined with direct sunlight, high humidity and physical exertion. As the body attempts to cool itself through sweating, it loses fluid and salt the body s engine coolant. When those fuels are not replenished, symptoms like muscle cramps, light-headedness, nausea and headaches can result. To stay hydrated, drink 24 ounces of water or an electrolyte sports drink before beginning a shift and then consume at least eight ounces of water an hour while working. Oregon OSHA recommends drinking one small cup of water every 15 to 20 minutes. The heat index the combination of heat and humidity that can really pump up the ability of the environment to cause trouble.
Important! Everyone Needs to Know: Stop all activity if you become: Lightheaded Confused Weak Faint Or have a pounding heart or trouble breathing Tell your supervisor if you or one of your co-workers experience symptoms of heatrelated illness.
Major Points About Heat Illness #1 Acclimatization is a key to keeping safe #2 Water needs to be consumed frequently-must be fit to drink. #3 - Shade is needed to provide somewhere to cool off #4 Train employees and supervisors (or coaches and athletes) in signs of heat illness and emergency procedures. #5 Be able to summon Emergency Responders
Dangerous Days Why Acclimatization is Critical The first days on the job (or on the sports field) are the highest danger! Almost 50% of reported heat illnesses occur on the 1 st day of work. 80% of illnesses within 1 st 4 days of work. Percent 60 40 20 0 Number of Days on the Job 0-1 1-4 5-14 > 14 Days California - 2005
Acclimatization What is it? Anyone working for the first time under heat stress will develop signs of strain: high body temp, pounding heart On each succeeding day, work ability increases Our body adjusts physiologically: Increased, more dilute sweat more evaporation Increased core-skin temp gradient more convection Increased maximal cardiac output less heat generation Decreased peak heart rate less heat generation
Heat Waves Even if an employee has been working- sudden increase in heat has an impact! Direct Relationship Between Temp and Number of Reported Cases-84% of the Cases Occurred During the July 2006 Heat Wave Historical Temp from UC IPM CIMIS Temp. Kern Co. 115 110 105 100 95 90 85 7/16/2006 7/17/2006 7/18/2006 7/19/2006 7/20/2006 7/21/2006 7/22/2006 7/23/2006 7/24/2006 Date 7/25/2006 7/26/2006 7/27/2006 7/28/2006 9 8 7 6 5 4 3 2 1 0 # Reported
Other 1 st Day Factors The Psychological Factors: Being new want to show that I am a good worker Don t stop to drink water, take breaks Don t know how to dress appropriately for evaporative cooling Other factors: dehydration due to caffeine, alcohol, etc.
What is Thermoregulation? The ability to keep the body temperature within certain limits even when surrounding temperature is very different. The body is able to regulate temperature by balancing heat produced and heat lost. Core temp. is maintained within 98.2 F +/-3 degrees. The skin temperature can vary. Food you eat generates energy which is used to contract muscles. The more you move, the more heat is generated.
Heat Exchange or Loss Heat is lost from our body in the following ways: 1. Evaporation: sweat changes from liquid to gas causing heat to be lost to atmosphere 2. Convection: the skin is cooler than the core 3. Radiation: transfer of electromagnetic waves from the sun to our body. This can result in heat gain when air temperature is above 95 F 4. Conduction: the body loses heat by direct contact with a cooler object e.g. wet cloth
Heat Illness-What is it? Heat Illness is a continuum of illnesses related to the body s inability to cope with heat. It includes: Heat Rash Heat Cramps Fainting or heat syncope Heat Exhaustion Heat Stoke Human oral temperature is maintained at 98.2F. Core temperature is.5f higher. Death occurs when core temperature approaches 106-109F
Types of Heat Illnesses There are five main kinds of heat illness: 1. Heat rash often under clothing 2. Heat cramps in arms or legs with physical labor. Can be caused by the loss of electrolytes from sweating. 3. Fainting can occur when person not used to heat 4. Heat exhaustion more serious effect 5. Heat stroke can be fatal
Heat-related illness: Signs, symptoms, Illness Heat rash Signs and Symptoms Red blister-like eruptions/bumps Itching (prickly sensation) and response Response Rest in a cool place. Allow the skin to dry. Monitor for infection. Heat Cramps Painful spasms Abnormal body posture Grasping the affected area Rest in a cool place. Drink water or a heavily diluted sports beverage (such as Gatorade). Or ¼ - ½ teaspoon salt to 1 qt. water. Seek medical attention if cramping is severe or does not go away.
Heat Rash Heat Rash: caused by blocked sweat glands. Sweat contains salt which irritates the skin leading to inflammation and itching around the pores. In response: rest in a cool place avoid polyester and nylon clothing wash with gentle soap and rinse wash area several time a a day if possible.
Heat Cramps & Heat Fainting Heat cramps are painful, involuntary muscle contractions that occur after exercise or working in a hot environment. Usually due to electrolyte imbalance (Sodium, Potassium, Calcium and Magnesium) Heat Fainting or Syncope: caused by decreased blood flow to the brain due to blood collecting in the legs and skin. Could also be due to lack of acclimatization. Symptoms include nausea, weakness, sensation of blacking out and dizziness.
Heat exhaustion: Signs and Symptoms Illness Signs and Symptoms Heat exhaustion Headaches, Dizziness, light-headedness, or fainting Weakness, Mood changes, irritability or confusion Feeling sick to your stomach and/or vomiting Extreme sweating Decreased and dark-colored urine Pale clammy skin Pulse is usually rapid
Heat Exhaustion Heat exhaustion is usually caused by salt deficiency (sodium lost in sweat). This leads to decreased fluid and blood volume. Body temperature may be 100 F or greater, and blood pressure likely to be low.
Heat Exhaustion: Response Move the person to a cool, shaded area. Don t leave the person alone. If the person is dizzy or light-headed, lay him on back and raise his legs about 6-8 inches. If the person is sick to his stomach, lay him on his side. Loosen and remove heavy clothing. Have the person drink some cool water (a small cup every 15 minutes) if he is not feeling sick to his stomach. Try to cool the person by fanning him. Cool the skin with a cool spray mist of water or wet cloth. If the person does not feel better in a few minutes call for emergency help. Avoid strenuous activity for the rest of the day.
Heat stroke: Signs and Symptoms Illness Signs and Symptoms Heat Stroke Dry, pale skin, sweating likely to be absent Constricted pupils, low blood pressure Nausea and vomiting Hot, red skin (looks like sunburn) Irritability, confusion, and not making any sense Seizures or fits Collapse (will not respond) High temperature (104 F or higher)
Heat Stroke: Response A Medical Emergency Call for emergency help (ambulance or 911) Move the person to a cool, shaded area. Don t leave the person alone. If the person is sick to his stomach, lay him on his side. Remove heavy and outer clothing. Have the person drink small amounts of cool water if he is alert enough to drink anything and not feeling sick to his stomach. Try to cool the person by fanning. Cool the skin with a cool spray mist of water, wet cloth. If ice is available, place ice packs in armpits and groin area.
Heat Exhaustion or Heat Stroke? How do you tell the difference?? The telling difference is mental confusion/disorientation in ALL heat stroke victims. You can ask these 3 questions. 1. "What is your name?" 2. "What day is this?" 3. "Where are we?" If a worker can t answer these questions, assume it is heat stroke.
So when is it hot enough to worry about heat illness? Cal/OSHA Serious Hazard - 85 F Cal/OSHA High Heat Procedures -95 F NIOSH When temperature is 95 F or more, the body gains heat by radiation unless other cooling mechanisms are present. Humidity is also a factor affects evaporation. Individuals have died from heat illness in temperatures in the 70 s
Humidity and the Heat Index Evaporation is one of the key methods of cooling for the body, the higher the humidity, the harder it is for sweat to evaporate. The Heat Index illustrated: Relative Humidity of 40% at 80 F = Heat Index of 80 Relative Humidity of 20% at 90 F = Heat Index of 86 Relative Humidity of 60% at 90 F = Heat Index of 100
California OSHA Rules Re: Heat Illness
Water- the most essential Sufficient amounts of cool water available at all times w/at least one quart per employee per hour for the entire shift Easy access to clean and cool water encourages frequent drinking As close as practicable given the working conditions and layout of the worksite. Keep the water replenished
Kevin Mercer, a carpenter with Walsh Construction, always keeps a bottle of water in his tool belt. A Portland,OR physician recommends that laborers drink 24 ounces of water or an electrolyte sports drunk before tackling work. (File photo/djc)
Shade The Second Key Preventative Recovery Period (PRP) is necessary if an employee is suffering from heat illness or believes that a rest break is needed to recover from the heat Employees must have access to an area with shade that is either open to the air or provided with ventilation or cooling for a period of no less than 5 minutes When they request it at any time.
California Shade Rules Shade Up if expected to be 85 F, or upon employee request Shade must block sunlight. Enough space to accommodate any employee who seeks it. Enough room to accommodate 25% of employees at one time without touching each other. Reachable within 2 ½ minute walk.
Shade The employees must be allowed and encouraged to take a break in the shade for at least five minutes, when they feel the need to do so to protect themselves from overheating. (Cal/OSHA rule)
High Heat Procedures In CA: Ag, Construction, Landscaping, Oil and Gas, and heavy transport- When temp. is 95 F or more- Observe employees for signs of heat illness Give more frequent reminders to drink water Closely supervise new employees (first 14 days) Ensure communications with employees
Topics for Employee Training (Cal/OSHA) The environmental and personal risk factors for heat illness-the added burden of heat load on the body caused by exertion, clothing, Importance of frequent consumptions of small quantities of water-up to four cups per hour Importance of acclimatization Different types of heat illness, common signs and symptoms
Additional Employee Training Topics (Cal/OSHA) Importance of immediately reporting signs/symptoms of heat illness to supervisor-of heat illness in themselves, or in coworkers. Employer s Procedures for responding to possible heat illness -including how emergency medical services will be provided should they become necessary. Procedures for contacting and directing emergency medical services to the worksite
Additional Employee Training Topics (Cal/OSHA) The employer s procedures, if necessary, for transporting employees to a point where they can be reached by an emergency medical service provider. The employer s procedures for ensuring that, in the event of an emergency, clear and precise directions to the work site can and will be provided as needed to emergency responders. The employer must designate someone to be available to invoke the emergency procedures when necessary.
Supervisor Training (Cal/OSHA) Same information required under employee training PLUS How to implement the Cal/OSHA heat illness standard Procedures to follow when an employee exhibits symptoms of heat illness, including emergency response How to monitor weather reports and how to respond to hot weather advisories
US DOL's OSHA Releases Mobile App To Help Protect Workers From Heat-Related Illnesses HEAT SAFETY TOOL [en Español] By U.S. Department of Labor (DOL), Occupational Safety and Health Administration (OSHA)
Learn how to access National Weather Service
National Weather Service Weather Forecast Office Excessive Heat Outlooks: are issued when the potential exists for an excessive heat event in the next 3-7 days. Excessive Heat Watches: are issued when conditions are favorable for an excessive heat event in the next 12 to 48 hours. Excessive Heat Warnings/Advisories: are issued when an excessive heat event is expected in the next 36 hours.
To Make Training Effective Managers/Owners should quiz supervisors to ensure they are well versed in company policies. When training ask questions rather than just giving out information. ask about personal experiences. describe actual cases to make it real. don t ever make fun of anyone. follow-up to make sure the employees understood the information.
Know how to direct emergency responders to work site in emergency
Drink Water Every 15 minutes
Have Shade Available
Training BEFORE Exposure to Heat Conditions
Cal/OSHA Requires Written Plan Detail in writing how your company will: Provide access to water & shade Monitor the weather Institute high heat procedures and address lack of acclimatization Train all employees and supervisors Respond to heat illnesses without delay, provide first aid and emergency services. Provide clear and precise directions to the worksite.
Written Procedures As long as they are effective, your Heat Illness Procedures can be integrated into the IIPP. Maintain the procedures on site or close to the site, so that it can be made available to representatives of Cal/OSHA upon request.
Emergency Response Procedures To ensure that emergency assistance is provided without delay, plan in advance how you will: Immediately respond to symptoms of possible heat illness (who is responsible?) Contact emergency medical service providers Provide clear and precise directions to the worksite Ensure that emergency procedures are invoked when appropriate
What are the most serious heat illnesses? Heat exhaustion and Heat stroke Dehydration Heat Exhaustion Heat Stroke Untreated heat exhaustion may progress to heat stroke. Symptoms of either should always be taken seriously
Workers Responsibilities Carrying out instructions and training for controlling heat stress Being alert for symptoms in themselves and others Drinking enough water Getting adequate rest and sleep Avoiding alcohol, illegal drug use, and excessive caffeine
Supervisor s Responsibilities 1. Overseeing acclimatization and heat stress training of new workers 2. Always make sure water and shade are available 3. Conducting periodic safety meetings during hot weather 4. Observing worker drinking enough water? rested? showing any signs of heat illness? 5. Deal immediately with heat illness problems 6. Monitoring environmental conditions 7. Adjust work assignments as necessary
Business Owner s Responsibilities 1. Make sure Company has written plan and procedures in place to assure adequate water, shade, training and ability to respond to emergencies. 2. Ensure supervisors are trained and know their responsibilities. 3. Make sure every new employee is both trained about heat illness and monitored during first days on the job. 4. Enforce your heat illness plan. 5. Discipline any employee or supervisor who violates heat illness plan. 6. Continue to monitor compliance with safety plans. If the owner does not care the employees and supervisors will not care!
Some ideas: To prevent heat-induced illness, Workers use the buddy system; Perform the heaviest, most labor-intensive work during the coolest part of the day; Wear light, loose-fitting and breathable clothing; Take frequent, shaded breaks; Avoid eating large meals; and Avoid drinking caffeinated or alcoholic beverages, which dehydrate the body.
For Heat Illness Materials, Visit: WWW.99calor.org
Resources: UC Division of Agriculture and Natural Resources. http://ucanr.org/news/heat/ Centers for Disease Control and Prevention (CDC), Extreme Heat. http://www.bt.cdc.gov/disasters/extremeheat/index.asp NIOSH Publication No. 86-112: Working in Hot Environments. http://www.cdc.gov/niosh/hotenvt.html TRABAJANDO EN AMBIENTES MUY CALUROSOS. http://www.cdc.gov/spanish/niosh/docs/86-112sp.html http://www.wsib.on.ca/files/content/preventionhsguide/he atstressguide.pdf -Heat Stress Awareness Guide from the Occupational Health and Safety Council of Ontario
Additional Resources Korey Stringer Institute, http://ksi.uconn.edu/ Cal/OSHA 2013 training materials - http://www.dir.ca.gov/dosh/heatillnessinfo. html Cal/OSHA Consultation e-tools: http://www.dir.ca.gov/dosh/etools/08-006/index.htm
Feel free to send questions To DonDressler1@hotmail.com