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Heat Stress 2009

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  • Although rarely recognized, heat is by far the number one killer of all weather events. Over the last ten years, heat has averaged nearly 200 fatalities a year, with flash flooding being second to heat with 90 fatalities a year. In 1995 alone, there were over 1021 heat related fatalities. Extreme heat affects all, but the elderly, poor, infants and those who work outside during the summer are the most likely to succumb to the heat.
  • A new, unacclimatized, 55 year old laborer collapsed due to high heat while working outdoors hand excavating footings on a hot and smoky day. The laborer was transported to a Medical Center, found to have a temperature of 107*F, diagnosed with heat stroke, admitted, but progressed into multisystem organ failure. The laborer died nine days later on 20 Jul 08. The employer was cited General for failure to include all required procedures in the written heat illness prevention procedures and Serious, Accident Related, for failure to train a new, unacclimatized employee on the employer's heat illness prevention procedures.
  • The sandbags are used to support the installation of a 36" diameter natural gas pipeline. The ambient temperature at the time of the incident was approximately 110 degrees. The crew started work at 0700 and were to quit at 1700. The crew had water and ice to drink and shade was provided by their shuttle bus at the worksite. The worker went down at approximately 1530 and was non-responsive to verbal instructions and physical stimuli and displayed signs of heat stress and/or possible heart attack. The worker was air-evacuated to a Medical Center and passed away the following morning at approximately 0930.
  • Victim was one of two fire instructors conducting class in fire fighting techniques for a community college. Afternoon portion of class included donning turnout gear and SCBA for various demonstrations and practical application. Outside temperature high of 97 F. At the end of class, both instructors were refilling tanker truck with water from a hydrant. Victim collapsed. Other instructor started CPR and contacted 911. EMS responded and victim was transported to hospital, where he was pronounced dead due to heat exhaustion.
  • Section 5(a)(1) of the Occupational Safety and Health Act of 1970: The employer did not furnish employment and a place of employment which were free from recognized hazards that were causing or likely to cause death or serious physical harm to employees in that: Employees were exposed to excessive environmental heat while performing framing work on a single family residential construction site. Employees were exposed to a heat index of approximately 102 degrees Fahrenheit, as reported on 08/03/2006, by the National Oceanic and Atmospheric Administration weather station in Melbourne Florida. Such exposures may lead to the development of serious heat induced illness such as heat exhaustion and/or heat stroke. a) For employees performing framing and other related construction activities where the heat index is approximately 102 degree Fahrenheit, the employer failed to asheat-load to which they may be exposed and failed to develop and implement a heat stress program designed to protect employees from that exposure. The estimated work-load for these employees puts them in the moderate workload category as correlated with the guidelines established by the American Conference of Governmental Industrial Hygienist (ACGIH) and the National Institute for Occupational Safety and Health (NIOSH). Means of feasible abatement include but may not be limited to: 1. Develop and implement a written heat stress program which includes, at a minimum, the following items: a) Establish provisions for a work/rest regimen to reduce the work exposure time to excessive environmental heat. b) A training program informing employees about the effects, signs and symptomsand prevention of heat induced illness and to include specific instructions and warnings concerning the effects of heat stress. c) An acclimation policy for new employees to adjust to the working conditions. d) Develop and implement a pre-employment medical questionnaire designed to determine employees' fitness to work in hot environments. e) Provide protective covers or personal protective clothing to protect employees from the heat. f) Provide ample supplies of cool drinking water.
  • Employers may begin the shift with smaller quantities of water if they have effective procedures for replenishment during the shift as needed to allow employees to drink one quart or more per hour. The frequent drinking of water, as described in (e), shall be encouraged.
  • Except for employers in the agricultural industry, cooling measures other than shade (e.g., use of misting machines) may be provided in lieu of shade if the employer can demonstrate that these measures are at least as effective as shade in allowing employees to cool.
  • Employee training. Training in the following topics shall be provided to all supervisory and non-supervisory employees. (A) The environmental and personal risk factors for heat illness; (B) The employer's procedures for complying with the requirements of this standard; (C) The importance of frequent consumption of small quantities of water, up to 4 cups per hour, when the work environment is hot and employees are likely to be sweating more than usual in the performance of their duties; (D) The importance of acclimatization; (E) The different types of heat illness and the common signs and symptoms of heat illness; (F) The importance to employees of immediately reporting to the employer, directly or through the employee's supervisor, symptoms or signs of heat illness in themselves, or in co-workers; (G) The employer's procedures for responding to symptoms of possible heat illness, including how emergency medical services will be provided should they become necessary; (H) The employer's procedures for contacting emergency medical services, and if necessary, for transporting employees to a point where they can be reached by an emergency medical service provider; (I) 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. (2) Supervisor training. Prior to assignment to supervision of employees working in the heat, training on the following topics shall be provided: (A) The information required to be provided by section (e)(1) above. (B) The procedures the supervisor is to follow to implement the applicable provisions in this section. (C) The procedures the supervisor is to follow when an employee exhibits symptoms consistent with possible heat illness, including emergency response procedures. (3) The employer's procedures required by subsections (e)(1)(B), (G), (H), and (I) shall be in writing and shall be made available to employees and to representatives of the Division upon request.
  • Heat stress factors include ambient air temperature, relative humidity, heat radiation (from sun, earth, machinery and from your body), air movement and surface temperatures. The “Heat Index” was implemented in 1984 to combine the ambient air temperature with relative humidity to determine an apparent temperature of what the air actually feels like. Don’t judge conditions by temperature alone: relative humidity plays a big part in heat stress. In conditions of high humidity, evaporation of sweat, a cooling process, is inhibited.
  • Heat Exhaustion starts with the accumulation of large quantities of blood in the skin in the body’s attempt to increase it’s cooling efficiency. This is normally due to temperature conditions the individual is not used to. There is a loss of circulating blood volume in the body which decreases the blood supply to the brain, increasing the likelihood of fainting.
  • The underlying cause of heat stroke is connected to the sudden inability to dissipate body heat through perspiration. This accounts for the excessive rise in body temperature and it’s the high fever which can cause permanent damage to internal organs, and can lead to death. When someone passes out from heat stroke, his or her brain is being cooked just as the colorless part of an egg turns white when it hits the griddle. Any cold liquid should be used to cool the victim. Once revived, the victim should be watched for more than an hour as his temperature can start to rise to high levels again.
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  • Transcript

    • 1. Heat Stress John Newquist June 2009
    • 2. Severe Weather Fatalities “… heat is by far the number one killer of all weather events…” Courtesy National Weather Service Forecast Office
    • 3. News
      • CAL-OSHA labor officials said Thursday, May 19, 2009 they have shut down five more farm labor contractors whose crews were found laboring in triple-digit heat with no shade, not enough water and no training in safety and emergency response.
    • 4. Fatalities
      • 7/10/08
      • A new, unacclimatized, 55 year old laborer collapsed while working outdoors hand excavating footings on a hot and smoky day.
      • Found to have a temperature of 107*F, diagnosed with heat stroke, admitted, but progressed into multisystem organ failure.
      • The laborer died nine days later on 20 Jul 08.
    • 5. Fatalities
      • On 7/10/08
      • 37 year old male that was loading boxes of grapes
      • He was taken by ambulance to Community Hospital and was treated for Heat Stroke with a core body temperature of 108 degrees.
      • He died on 07/31/08 at 3:25 p.m. from heat stroke.
    • 6. Fatalities
      • 7/15/08
      • A mechanic for the employer suffered fatal injuries from heat stroke while working in the service bay area of the truck maintenance shop.
    • 7. Fatalities
      • 06/30/2008
      • One worker unloading 40 pound sandbags to support the installation of a 36" diameter natural gas pipeline.
      • Temperature was approximately 110 degrees.
      • The worker went down in the late afternoon and was non-responsive.
      • The worker was air-evacuated to a Medical Center and passed away the following morning at approximately 0930.
    • 8. Fatalities
      • 6/6/08
      • Instructors conducting class in fire fighting techniques. Afternoon portion of class included donning turnout gear and SCBA for various demonstrations and practical application.
      • Outside temperature high of 97 F.
      • Victim collapsed during truck water filling and was transported to hospital, where he was pronounced dead due to heat exhaustion.
    • 9. Risk Factors
      • Age
      • Weight
      • Fitness
      • Acclimatization
      • Use of alcohol and drugs
      • Hypertension
      • Clothing worn
    • 10. Guidance
      • OSHA has no specific heat illness guidance. They would use the General Duty Clause of the OSHA Act. (See next)
      • NIOSH has guidance
      • Cal-Osha has regulations that cover this issue
    • 11. Sample General Duty Clause Violation
      • Section 5(a)(1) of the Occupational Safety and Health Act of 1970: The employer did not furnish employment and a place of employment which were free from recognized hazards that were causing or likely to cause death or serious physical harm to employees in that: Employees were exposed to excessive environmental heat while performing framing work on a single family residential construction site. Employees were exposed to a heat index of approximately 102 degrees Fahrenheit, as reported on 08/03/2006, by the National Oceanic and Atmospheric Administration weather station in Melbourne Florida. Such exposures may lead to the development of serious heat induced illness such as heat exhaustion and/or heat stroke. a) For employees performing framing and other related construction activities where the heat index is approximately 102 degree Fahrenheit, the employer failed to asheat-load to which they may be exposed and failed to develop and implement a heat stress program designed to protect employees from that exposure. The estimated work-load for these employees puts them in the moderate workload category as correlated with the guidelines established by the American Conference of Governmental Industrial Hygienist (ACGIH) and the National Institute for Occupational Safety and Health (NIOSH). Means of feasible abatement include but may not be limited to: 1. Develop and implement a written heat stress program which includes, at a minimum, the following items: a) Establish provisions for a work/rest regimen to reduce the work exposure time to excessive environmental heat. b) A training program informing employees about the effects, signs and symptoms and prevention of heat induced illness and to include specific instructions and warnings concerning the effects of heat stress. c) An acclimation policy for new employees to adjust to the working conditions. d) Develop and implement a pre-employment medical questionnaire designed to determine employees' fitness to work in hot environments. e) Provide protective covers or personal protective clothing to protect employees from the heat. f) Provide ample supplies of cool drinking water.
    • 12. Cal OSHA rules
      • Provision of water.
      • Employees shall have access to potable drinking water.
      • Where it is not plumbed or otherwise continuously supplied, it shall be provided in sufficient quantity at the beginning of the work shift to provide one quart per employee per hour for drinking for the entire shift.
    • 13. CAL-OSHA rules
      • Access to shade.
      • Employees suffering from heat illness or believing a preventative recovery period is needed, shall be provided 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 five minutes.
      • Such access to shade shall be permitted at all times.
    • 14. CAL-OSHA Rules
      • Employee training. Training in the following topics shall be provided to all supervisory and non-supervisory employees.
      • The environmental and personal risk factors for heat illness;
      • The employer's procedures for complying with the requirements of this standard;
      • The importance of frequent consumption of small quantities of water, up to 4 cups per hour, when the work environment is hot and employees are likely to be sweating more than usual in the performance of their duties;
      • The importance of acclimatization;
      • The different types of heat illness and the common signs and symptoms of heat illness;
      • The importance to employees of immediately reporting to the employer, directly or through the employee's supervisor, symptoms or signs of heat illness in themselves, or in co-workers;
    • 15. CAL-OSHA Rules
      • Employee training continued
      • The employer's procedures for responding to symptoms of possible heat illness, including how emergency medical services will be provided should they become necessary;
      • The employer's procedures for contacting emergency medical services, and 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.
    • 16. CAL-OSHA rules
      • Supervisor training.
      • Prior to assignment to supervision of employees working in the heat, training on the following topics shall be provided:
      • The heat information required to be provided to employees
      • The procedures the supervisor is to follow to implement the applicable provisions in this section.
      • The procedures the supervisor is to follow when an employee exhibits symptoms consistent with possible heat illness, including emergency response procedures.
      • The employer's procedures shall be in writing and shall be made available to employees and to representatives of Cal-Osha upon request.
    • 17. NIOSH Recommendations
      • Schedule maintenance and repair jobs in hot areas for cooler months.
      • Schedule hot jobs for the cooler part of the day.
      • Acclimatize workers by exposing them for progressively longer periods to hot work environments.
      • Reduce the physical demands of workers.
      • Use relief workers or assign extra workers for physically demanding jobs.
    • 18. NIOSH Recommendations
      • Provide cool water or liquids to workers.
      • Avoid drinks with caffeine, alcohol, or large amounts of sugar.
      • Provide rest periods with water breaks.
      • Provide cool areas for use during break periods.
      • Monitor workers who are at risk of heat stress.
      • Provide heat stress training that includes information about:
      • Worker risk
      • Prevention
      • Symptoms
      • The importance of monitoring yourself and coworkers for symptoms
      • Treatment
      • Personal protective equipment
    • 19. NIOSH to Employees
      • Wear light-colored, loose-fitting, breathable clothing such as cotton.
      • Avoid non-breathing synthetic clothing.
      • Gradually build up to heavy work.
      • Schedule heavy work during the coolest parts of day.
      • Take more breaks in extreme heat and humidity.
      • Take breaks in the shade or a cool area when possible.
      • Drink water frequently. Drink enough water that you never become thirsty.
      • Avoid drinks with caffeine, alcohol, and large amounts of sugar.
      • Be aware that protective clothing or personal protective equipment may increase the risk of heat stress.
      • Monitor your physical condition and that of your coworkers.
    • 20. Water Loss
      • Normally, with light activity, your body loses 2 to 3 quarts of water daily.
      • In a hot weather environment, you loose 6 to 8 quarts of sweat which is critical to your bodies cooling.
      • Your thirst mechanism is not sensitive enough to be an accurate indicator of your body’s needs.
      • Encourage workers to drink water-about a cup of water every 15 to 20 minutes, even if they are not thirsty. Avoid alcohol, caffeine and soft drinks.
    • 21. WBGTI Heat related illness includes: heat rash, cramps, exhaustion and stroke.  These illnesses are a real danger to people not accustomed to the stress of hot weather exercise. The Wet-Bulb Globe Temperature Index (WBGTI) takes into account four variables: air temperature, humidity, radiant heat and air movement.  This reading gives a more accurate measurement of heat stress than any one reading alone.
    • 22. Heat Stress Flag Colors Black - Wet Bulb Globe Thermometer (WBGT) index of 90 o or Above . Physical training and strenuous exercise must be suspended for all personnel. (excludes operational commitment not for training purposes) . A “20-minute work/ 10- minute rest” cycle may be utilized, as well as employee rotation. Above 89 88 – 89.9 85 - 87.9 82-84.9 Red - WBGT index of 88 – 89.9 0 . St renuous exercise must be curtailed for all personnel with less than 12 weeks training in hot weather. Yellow - WBGT index of 85 – 87.9 o . Strenuous exercise and activity must be curtailed for new and unacclimatized personnel during the first 3 weeks of heat exposure. Outdoor classes in the sun must be avoided. Green - WBGT index of 82 – 84.9 o . Discretion is required in planning heavy exercise for unacclimatized personnel. This is a marginal heat stress limit for all personnel. (numbers are Wet Bulb Globe Temperature Index- not temperature ) Wearing body armor or NBC protective uniforms adds approximately 10 points to measured WBGT. Limits of exposure should be adjusted accordingly.
    • 23. Heat Stress Illnesses Heat Rash Causes- Heat rash normally happens most often in hot, humid conditions, particularly wearing heavy clothing and with excessive sweating. Fair skinned individuals are more prone to develop heat rash. Symptoms : Interferes with sleep and results in decreased deficiency and cumulative fatigue. Treatment: Treated by keeping skin dry, use of cooled sleeping quarters, calamine lotion .
    • 24. Heat Stress Illnesses Heat Cramps Causes It occurs when large volumes of water are consumed without adequate salt replacement. Symptoms : Severe pain and cramps in legs and abdomen, fainting or dizziness, weakness, profuse sweating and headaches. Treatment: Increase fluid intake, increase salt intake, rest and move to a cool place. Usually resolves after an electrolyte beverage.
    • 25. Heat Stress Illnesses Heat Exhaustion Causes Occurs when the heart and vascular system do not respond properly to high temperatures, and the mechanisms our body uses to cool itself fails Symptoms : Headache, nausea, fatigue, dizziness, skin is cool and pale, pupils become dilated. Victim is usually conscious but may faint, has a core temperature of over 102. Treatment: Get to the shade, cool off, increase fluids, cold wet towels or ice, fan, elevate legs above heart, loosen clothing, don’t give any liquids containing alcohol or caffeine, may need IV. If condition worsens seek medical attention immediately. If left untreated Heat Exhaustion can lead to HEATSTROKE.
    • 26. Heat Stress Illnesses Heat Stroke Causes- Heat stroke is a medical emergency and a life threatening condition. It is caused by the failure of the heat-regulating mechanisms of the body, due to high heat and humidity. Symptoms : Headache, nausea, dizziness, skin is red, dry and very hot (sweating has ceased). Pulse is strong and rapid, small pupils, high fever 105. May be disorientated, lose consciousness, possible convulsions.
      • Treatment: Remove to cooler location, loosen clothing, immerse in cool water, wrap in wet sheets, cold compresses to the head, neck and groin. Place ice pack behind neck - under arms
      • SEEK MEDICAL ATTENTION IMMEDIATELY. DO NOT give medication to lower fever, DO NOT use an alcohol rub.
    • 27.
      • Underestimate the seriousness of heat illness
      • Give the victim medications to reduce fever
      • Give the victim liquids that contain alcohol or caffeine
      • Give anything by mouth if HEAT STROKE is suspected
    • 28. Heat Basics
      • If muscles are being used for physical labor, less blood is available to flow to the skin and release heat
      • If body can’t dispose of excess heat, it will store it. When this happens the body’s core temperature rises and the heart rate increases.
    • 29. Heat Basic
      • Don’t use the feeling of thirst as an indicator that you need water.
      • You can deplete as much as 30% of your body’s water before you feel thirsty. Drink plenty of water before, during and after time spent in the heat.
      • Individuals vary in their tolerance to heat stress conditions
    • 30. Prevention
      • Spending time in air-conditioned environments
      • Increase nonalcoholic/
      • Non-caffeinated fluid intake
      • Monitor urine output
    • 31. More
      • Persons working either indoors or outdoors in high temperatures should take special precautions including allowing 10 -14 days to acclimate to high temperatures
      • Salt tablets are not recommended and may be hazardous to many people
    • 32. Summary
      • Develop a heat illness program
      • Provide cooling or shaded area
      • Plenty of water
      • Training
      • Treatment of heat illnesses
      • Acclimatize workers
    • 33. Questions?