Heat-Related Illness in the Outdoor Environment

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Heat-Related Illness in the Outdoor Environment
WAC 296-62-095
Employee Training for WAC 296-62-095. Taken
largely from the Division of Occupational Safety
Health revision 6-6-07 from Washington State
Department of Labor and Industries
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• Presentation Outline
• Heat-related illness regulation
• Types of heat-related illness
• Signs and symptoms of heat-related illness
• Environmental factors that contribute to the risk
  of heat-related illness
• Personal factors that may increase susceptibility
  to heat-related illness
• How to prevent heat-related illness
• Emergency response procedures to heat-related
  illness
• Ultraviolet radiation

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Heat Illness RegulationsWAC 296-62-095

• Requires
• Employers with one or more employees performing
  work in an outdoor environment to implement
  workplace practices designed to reduce or
  eliminate risk of heat-related illness.
• Practices must be in writing, and must include
• Accessibility to drinking water in sufficient
  quantity to provide at least one quart per
  employee per hour
• Procedures to remove employees experiencing signs
  and symptoms of heat-related illness from duty,
  to provide sufficient means to reduce body
  temperature, and to determine if medical
  attention is needed
• Employee training must be provided initially and
  annually

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Heat-Related Illness
Why is it important to know about heat illness?

• Heat illness can effect anyone
• Heat illness is dangerous
• Heat illness can kill

• Heat illness is preventable

NASA
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Heat-Related Illness

• Heat illness is
• Overheating of the body, potentially resulting in
  the inability of the body to cool itself

• Risk of heat-related illness occurs in
• Any outdoor profession
• Temperatures greater than 75 or with a 10 spike
  in temperature
• High humidity (approaching 80 or greater)

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Types of Heat-Related Illnesses

• Types of heat-related illness
• Heat Rash-red rash appears, often under clothing
• Heat Cramps-painful spasms usually in arms or
  legs, results in abnormal posture or grasping of
  legs or arms
• Heat Fatigue-impaired sensorimotor and/or mental
  performance
• Heat Exhaustion (stress)-symptoms include
  fainting, nausea, profuse sweating, headache,
  disorientation, and irritability
• Heat Stroke-symptoms include convulsions, hot,
  dry skin, loss of consciousness, and can be fatal

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Heat Rash

• Heat Rash
• Red blister-like eruptions
• Itching or prickling

• Keep skin dry
• Monitor for infection
• Consult physician

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Heat CrampsMuscle Cramps

• A muscle cramp is an involuntarily and forcibly
  contracted muscle or fibers of a muscle that does
  not relax (i.e., a muscle spasm that doesnt
  relax is a muscle cramp)
• Muscle cramps can last a few seconds, a quarter
  of an hour, and occasionally longer
• Muscle cramps can recur multiple times
• Muscle spasms and cramps are painful
• Heat cramps usually occur in the arm, leg or
  stomach muscles

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Heat Fatigue

• Recognized when a person exhibits impaired
  sensorimotor or mental performance
• Person may faint
• Seek treatment ASAP before heat fatigue
  progresses to heat exhaustion

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Heat Exhaustion and Heat Stroke

• Take symptoms of both seriously
• Untreated heat exhaustion can progress to heat
  stroke heat stroke can kill!
• When the body cant cool itself, body temp can
  reach 106 in 10-15 minutes

Dehydration
Heat Exhaustion
Heat Stroke

• Heat exhaustion or stroke can develop rapidly or
  over a few days

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Heat Exhaustion Heat Stroke Learn to Recognize
the Signs Symptoms
HEAT EXHAUSTION
HEAT STROKE

• Dizziness or light-headed
• Weakness
• Extreme sweating
• Fatigue
• Red Face
• Mood changes, irritability or confusion
• High pulse rate
• Pale, clammy skin/ face
• Headache
• Nausea/Vomiting
• Normal to slightly elevated temperature
• Blurred vision
• Unsteady gait
• Fainting

• Disorientation
• Erratic behavior
• Hot, dry skin/face that is flushed, but not
  sweating
• Red face
• Mood changes, irritability, agitation, or
  confusion
• Rapid pulse
• Chills/Shivering
• Restlessness
• Nausea/Vomiting
• High temperature (gt104 F)
• Convulsions and/or seizures
• Loss of consciousness
• Coma
• May resemble a heart attack

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Heat Stroke or Heat Exhaustion Telling the
Difference!
Mental confusion/disorientation occurs in ALL
heat stroke victims

• Ask the person these 3 questions
• What is your name?
• What day is this?
• Where are we?

If the person cant answer these questions assume
it is heat stroke!
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How We-Stay Cool!

• Gland (hypothalamus) in the brain controls body
  heat
• Blood flows to skins surface to cool itself
• Body sweats

• Sweat evaporates off skin and has a cooling
  effect on the body

2.6 million sweat glands in the body
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MonitorHeat and Humidity

• It is important to monitor heat and humidity
  values each workday, all day, in hot and/or humid
  weather

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Environmental Risk Factors Humidity and Heat

• Humidity (moisture in the air) interferes with
  sweat evaporating from the skin thus interferes
  with the cooling of the body
• The more humid it is, the less sweat can
  evaporate, and the less body cooling occurs, and
  the more chance of heat-related illness
• Heat and humidity together greatly increase the
  potential for heat-related illness

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Heat Index WarningsHeat Humidity Heat Index
Heat Index General Effect of Heat Humidity with Prolonged Exposure Physical Activity
Caution 80-89 Fatigue possible
Extreme Caution 90-104 Heat stroke, heat cramps, and heat exhaustion possible
Danger 105-129 Heat stroke, heat cramps, and heat exhaustion likely, and heat stroke possible
Extreme Danger 130 or higher Heat stroke highly likely
May feel effects at 80
Implement controls at 90 or before
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Environmental Risk FactorsHeat Humidity Chart
Heat Index
Implement controls at 90 or before
May feel effects at 80
Source National Oceanic and Atmospheric
Administration
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Environmental Risk Factors
Direct Sun More direct sun the greater the
risk Radiant Heat From sun and other sources
transfers heat energy through the air Conductive
Heat Sources Transfers heat to worker by direct
contact with heat source (tools, machinery,
etc.) Limited Air Movement Low or no wind
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Radiant Conductive Heat Sources

• Hot equipment
• Engines add heat
• Reflected heat
• From ground or objects

Radiant heat may add 15 to Heat Index
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Risk FactorsPhysical Exertion

• Produces Internal Heat in the Body
• Consider
• What kind of work will be performed?
• How hard is the work?
• How long is the work task/period?

Photo credit http//www.sullys.com.au/LawnMowin
g.htm
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Risk FactorsClothing Type and Amount

• Clothing traps body heat and inhibits
  perspiration
• Especially
• Personal protective equipment (PPE)
• Heavy clothing
• Multiple clothing layers
• Dark-colored clothing which absorbs heat

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Personal Risk Factors

• Age, weight, and personal fitness
• Medical conditions
• Heart conditions
• Diabetes
• High blood pressure
• Etc.
• Certain medications

• Illness, fever or hangover

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Personal Risk Factors Medications

• Some medications can make a person more sensitive
  to the effects of heat (many contribute to body
  dehydration)
• Allergy medicines (antihistamines)
• Cough and cold medicines
• Blood pressure and heart medicines
• Irritable bladder or bowel medicines
• Laxatives
• Mental health medicines
• Seizure medicines
• Thyroid pills
• Water pills (diuretics)
• Consult health care provider or pharmacist for
  more information

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Personal Risk Factors

• Diet Matters
• No sugary drinks
• No heavy foods
• No alcohol
• No caffeinated drinks
• No Nicotine
• Constricts blood vessels

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Personal Risk Factors

• Ditch that Macho Attitude!
• Slow down, pace yourself, and take breaks,
  especially on hot days!

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Preventing Heat-Related IllnessAcclimatize

• Acclimatization is Extremely Important!
• People can collapse, become easily fatigued, make
  mistakes, get into accidents, or develop
  heat-related illnesses, if not properly
  acclimatized
• Many of us travel across the State, Nation, or
  over seas for our work
• Those who live in, and are used to, a cooler
  climate, should take special care when going to
  hot/humid climates
• Go Prepared!

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Preventing Heat-Related Illness Acclimatize

• Acclimate plan in extra time (several days) to
  adjust to hot working conditions
• Gradually build up exposure time, and adjust work
  routines, to increase heat tolerance

• Pay special attention to employees
• That are new
• Just returning from being sick
• Are absent for more than 2 weeks
• Just moved from a cooler climate
• During heat-wave events

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Preventing Heat-Related Illness Information for
Employees

• WSU strives to prevent heat-related illness by
• Monitoring the work day weather tracking heat
  index
• Scheduling tasks to minimize physical exertion on
  hot days
• Advising employees to pace themselves
• Encouraging frequent breaks on hot days
• Assigning workers a radio, pager, or cell phone
  to keep in contact with base and each other
• Providing annual heat-related illness awareness
  training
• Providing CPR and First Aid training

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Preventing Heat-Related Illness Information for
Employees
WSU strives to prevent heat-related illness by

• Providing
• Appropriate PPE
• Cooling vests and bandanas
• Hats, sunglasses, etc.
• UVA/UVB rated sun glasses
• Sun screen (SPF 15 or above and UVA/UVB
  effective)
• Easy access to water via water bottles, coolers,
  hydration packs, and/or transportation to base
  water supply

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Preventing Heat-Related IllnessWork Smart

• Schedule the hardest work for the cooler parts of
  the day
• Alternate heavy work with light work when
  possible
• Pace yourself
• Keep hydrated

• Increase breaks when
• Conditions are very hot
• Work requires high exertion levels
• Protective clothing limits evaporative cooling

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Preventing Heat-Related IllnessWork Smart
ESTABLISH A BUDDY SYSTEM!
Keep an on co-workers for symptoms of heat
illness such as crankiness and denial
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Preventing Heat-Related Illness Work Smart
Stay Cool!
Remove PPE and excess clothing during breaks
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Preventing Heat-Related IllnessWork Smart
Work in the shade or out of direct sun when
possible

• Wear proper clothing
• Light colored
• Light weight
• Natural fibers
• Hat with a brim
• Cooling vest or bandanas may be helpful in some
  cases

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Preventing Heat-Related IllnessStay Hydrated
Proper hydration is key to preventing heat illness

• It is important to drink water throughout the day
  or dehydration results
• When dehydrated the amount of sweat that can be
  produced decreases, and the body cant properly
  cool itself
• Do not wait for thirst before drinking water
• Water replaces body fluid lost by sweating

• One quart or more of water over the course of an
  hour may be necessary when the work environment
  is hot, and a person may be sweating more than
  usual as they work

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Preventing Heat-Related IllnessStay Hydrated

• A quart of water is suggested because the body
  can produce 1/2 gallon (2 quarts) of sweat per
  hour in hot environments
• It is also important to incorporate
  electrolyte-containing drinks in your daily fluid
  intake

1 cup every 15 minutes
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Preventing Heat-Related IllnessStay Hydrated

• Drinking water sources
• Be closeable have a tap
• Clearly marked
• Suitably cool
• Individual cups
• Bottled water
• Hydration packs called camelbacks-users sip water
  through a tube

Photo credit UC Davis
Hydration pack
Worker wearing hydration pack
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STOP

• All Activity if you become
• Light-headed
• Confused
• Weak
• Faint
• Or have a pounding heart or trouble breathing

• Notify Supervisor immediately, if you or a
  co-worker experience symptoms of heat-related
  illness

• Take a Break and Rest in a cool place
• Drink fluids
• Loosen or shed unnecessary clothing
• Lie Down

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What You Can Do For Others Treatment for Heat
Exhaustion Stroke

• Transport person to base, or to cooler, shaded
  area so person can rest and lay down
• Get help on the way call base and/or 911
• Do not leave person alone!
• Loosen and remove heavy clothing that restricts
  evaporation and cooling
• If person is alert and not nauseated, provide
  fluids such as cool water, juice, sports drinks,
  or non-caffeinated soft drinks ( cup every 15
  minutes).

• Fan the person, spray or mist with cool water,
  apply wet cloth to skin
• Do not further expose the person to heat this
  day. Have them rest and continue to drink cool
  water and electrolyte drinks

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Get Help on the Way!

• Call 911!
• When person does not feel better in about 15
  minutes, or sooner, if they show signs of heat
  stroke

SECONDS COUNT!
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If You Suspect Heat Stroke

• While waiting for medical help to arrive

• Cool the person using whatever methods available
• Do not give person fluids to drink
• If emergency 911 medical personnel are delayed
  call the hospital emergency room for further
  instruction

Cooling Methods

• Immerse the person in a tub of cool water
• Place the person in a cool shower
• Spray them with cool water from a hose
• Sponge the person with cool water
• If the humidity is low, wrap person in a cool wet
  sheet and fan them vigorously
• Apply ice packs under arms and to the groin area

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In Summary Work Smart!

• Stay hydrated! Drink water/fluids frequently!
• Know the signs and symptoms of heat related
  illnesses and take them seriously
• Consider sports drinks when sweating a lot
• Avoid alcohol, caffeinated drinks, and heavy
  meals before or during work
• Plan work tasks for heat relief
• Pace yourself
• Acclimatize
• Wear appropriate clothing
• Take regular breaks
• Keep an eye on your buddy!

Photo credit www.csao.org
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Questions?
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A Word AboutUltraviolet Radiation (UV)

• Ultraviolet radiation is energy from the sun
• Responsible for sunburn and skin cancers
• Three types of UV Rays come from the sun
• UVA passes through the ozone layer, not blocked
  by glass or most sunscreens, penetrate deep into
  the skin
• UVB only some absorbed in ozone layer thought to
  cause most sunburns, block by glass and some
  sunscreen
• UVC is absorbed by the ozone layer
• Can track UV intensity levels by monitoring the
  UV Index www.epa.gov/sunwise/uvindex.html
• Enter zip code for UV index of interest
• Sign up for UV email alerts for your area
• The Index was developed by the National Weather
  Service and the EPA

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UV Index
The UV Index provides a daily (next-day) forecast
by zip code of the expected risk of overexposure
to the sun. The index predicts UV intensity
levels on a scale of 1 to 11.
UV Index Exposure Level
0 to 2 Low
3 to 5 Moderate
6 to 7 High
8 to 10 Very High
11 Extreme
The UV index takes into account clouds and other
local conditions that affect the amount of UV
radiation reaching the ground
www.epa.gov/sunwise/uvindex.html
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Health Effects of UV Over-Exposure

• Sunburn is an inflammation of the skin that is
  caused by UV radiation from the sun or UV tanning
  lamps
• Frequent UV ray overexposure effects
• Skin Damage may cause scarring, freckling,
  drying out of, or premature wrinkling of the skin
  
• Skin Cancer is directly linked to skin cancer
• Eye Damage may burn the cornea, and increase the
  risk of developing macular degeneration (a
  leading cause of blindness), and cataracts
• Immune System Damage potential to cause immune
  system damage

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Skin Cancer

• Skin cancer is the most common form of human
  cancer ( 1 million new cases occur annually)
• Approximately, half of all Americans who live to
  age 65 will develop skin cancer at least once
• Skin cancer refers to three different conditions.
  From the least to the most dangerous, they are
• Basal cell carcinoma
• Squamous cell carcinoma
• Melanoma most serious as can metastasize and
  spread quickly throughout the body
• The most common warning signs of skin cancer is a
  change in the appearance of the skin, such as a
  new growth or a sore that will not heal

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Recognizing Skin Cancer

• A change in the size, shape, or color of an
  existing mole
• The appearance of a new, abnormal, or
  "ugly-looking" mole.
• The texture of an existing mole changes and
  becomes hard, lumpy, or scaly.
• A mole may feel different and itch, ooze, or
  bleed, but it usually is not painful

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The A-B-C-Ds of Recognizing Melanoma

• Watch moles for
• A Asymmetry -The shape of 1/2 doesnt match the
  other
• B Border -The edges are ragged, notched, or
  blurred
• C Color -The color is uneven Shades of black,
  brown, and tan, or areas of white, gray, red, or
  blue
• D Diameter - There is a change in size

Melanoma causes 75 of skin cancer deaths
annually
1 in 4 people that develop melanoma are under 40
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A B C D
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UV Protection Guidelines
Incorporate heat-related illness prevention
guidelines so not to develop a heat-related
illness while working in the sun, and in addition
for UV protection

• Minimize sun exposure at midday (10AM to 4PM)
• Use broad spectrum sunscreen SPF15 of higher
  (offers UVA UVB protection)
• Reapply sunscreen every 2 hours
• Wear a broad brimmed hat (at least 2 to 3 brim
  all around), and long sleeve shirts and pants
• Wear sunglasses that are labeled to block 99 to
  100 of UVA and UVB radiation.
• No UV Label-No Buy!

ANSI Z80.3 UV ANSI Z87.1 Safety
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Questions?