Cold Stress Hazards and Prevention

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The winter season is almost upon us. Workers need to work in cold outdoor environments while other recreate in outdoor environments. Either way, people are exposed to the cold. This is a comprehensive view of the cold stress and how to prevent exposure and what to do if your are exposed to the cold, wind, and rain/snow.

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  • Speaker’s Notes:
    Working in cold conditions, whether exposed to cold and windy conditions outside or inside refrigerated environments, can result in cold-related illnesses and injuries such as hypothermia or frostbite.
    Cold-related illnesses and injuries can lead to permanent tissue damage and even death.
    Although our bodies have some natural heating systems, they are not designed to stay warm in extremely cold conditions. Protective clothing and work practices are required to keep workers protected in cold conditions.
    In this training session we will discuss signs and symptoms of cold-related illnesses and injuries, first aid measures, protective clothing, and safe work practices for cold conditions.
  • Background for the Trainer:
    Have employees discuss other jobs in which they have been exposed to cold conditions.
    Speaker's Notes:
    There are a number of workplaces and work environments where workers can be exposed to cold conditions.
    Construction workers are exposed to cold conditions in environments such as roof work in cold weather.
    Working on bridges near large bodies of water exposes workers to both the cold temperature and cold wind.
    Working outside of high rise buildings can expose workers to cold temperatures and cold winds.
    Refrigerated rooms, containers, or vessels expose workers to controlled cold environments. These environments will typically not have a wind chill factor.
    Commercial fishermen are exposed to cold weather, cold winds, and cold water.
    Steel structures retain cold temperatures and transfer the cold easily to the worker’s body.
    Warehouses in colder climates are usually not heated in the winter, so workers are exposed to cold temperatures.
  • Background for the Trainer:
    Have employees discuss other jobs in which they have been exposed to cold conditions.
    Speaker's Notes:
    What constitutes cold stress and its effects can vary across different areas of the country.
    In regions unaccustomed to winter weather, near freezing temperatures are considered factors for "cold stress."
    Whenever temperatures drop decidedly below normal and as wind speed increases, heat can more rapidly leave your body.
  • Speaker’s Notes:
    Cold-related illnesses and injuries
    At-risk occupations and recreational activities
    Signs and symptoms of cold exposure
    Emergency response and first aid treatment
    Risk factors, evaluation of work environment, prevention measures and protective clothing
    Brief case study and analysis
    We’ll wrap up this session with a short quiz.
  • Background for the Trainer:
    Have employees discuss other jobs in which they have been exposed to cold conditions.
    Speaker's Notes:
    Roofs in cold weather
    Bridges near large bodies of water
    High-rise buildings exposed to wind
    Refrigerated rooms or containers
    Commercial fishing areas
    Steel structures that retain cold
    Unheated warehouses in cold climates
  • Background for the Trainer:
    Have employees discuss other jobs in which they have been exposed to cold conditions.
    Speaker's Notes:
    Offshore oil/gas platforms
    Marine vessels
    Freezers/food warehouses
    Arctic exploration and research projects
    Deep sea diving
    Logistics and transport
    Doormen and taxi drivers
    Longshoremen and stevedores
    Outside construction job sites
  • Background for the Trainer:
    Have employees discuss other jobs in which they have been exposed to cold conditions.
    Speaker's Notes:
    Snowmobiling and tobogganing
    Downhill/cross-country skiing
    Ice skating and dog sledding
    Winter hunting and ice fishing
    Outdoor camping, hiking, boating
    Snowshoeing and snowboarding
    Rock and mountain climbing
    Holiday decorating home exterior
    Deicing, shoveling, and snow removal
    Riding motorcycles and off-road vehicles
  • Background for the Trainer:
    Have employees discuss other jobs in which they have been exposed to cold conditions.
    Speaker's Notes:
    A cold environment challenges the worker in three ways: by
    air temperature,
    air movement (wind speed), and
    humidity (wetness).
    In order to work safely, challenges have to be counterbalanced by
    proper insulation (layered protective clothing),
    buddy system,
    physical activity,
    diet and nutrition,
    acclimatization, and by
    controlled exposure to cold (work/rest schedule).
  • Background for the Trainer:
    Have employees discuss other jobs in which they have been exposed to cold conditions.
    Speaker's Notes:
    Air Temperature: Air temperature is measured by an ordinary thermometer in degrees Celsius (°C) or degrees Fahrenheit (°F).
    Wind Speed: Different types of anemometers are used to measure wind speed or air movement. Estimates of wind speed include:.
    8 km/h (5 mph): light flag moves,
    16 km/h (10 mph): light flag fully extended,
    24 km/h (15 mph): raises newspaper sheet,
    32 km/h (20 mph): causes blowing and drifting snow.
  • Background for the Trainer:
    Have employees discuss other jobs in which they have been exposed to cold conditions.
    Speaker's Notes:
    . Humidity (wetness): Water conducts heat away from the body 25 x faster then dry air.
    Physical Activity: The production of body heat by physical activity (metabolic rate) is difficult to measure.
    Tables are used to show metabolic rates for a variety of activities.
    Metabolic heat production is measured in kilo calories (kcal) per hour.
    One kilocalorie is the amount of heat needed to raise the temperature of one kilogram of water by 1°C.
  • Background for the Trainer:
    Have employees discuss other jobs in which they have been exposed to cold conditions.
    Speaker's Notes:
    Work/rest schedule: This work schedule has been adopted by the
    American Conference of Governmental Industrial Hygienists (ACGIH) as
    Threshold Limit Values (TLVs) for cold stress.
    Protective clothing: Adequate clothing is needed for work at or below 4°C.
    Clothing should be selected to suit the
    temperature,
    weather conditions (e.g., wind speed, rain),
    the level and duration of activity, and j
    ob design.
  • Background for the Trainer:
    Have employees discuss other jobs in which they have been exposed to cold conditions.
    Speaker's Notes:
    Other factors influencing cold injuries
    Insulation materials and layering
    Contact with metal or cryogenic liquids
    Exposed skin
    Vasodilation
    Vasoconstriction
    Previous cold injuries – frostbite and white finger syndrome
    Constricting garments
  • Background for the Trainer:
    Have employees discuss other jobs in which they have been exposed to cold conditions.
    Speaker's Notes:
    Cold-induced Vasodilation - When a hand or foot is cooled to 59 degrees F, maximal vasoconstriction and minimal blood flow occur. If cooling continues to 50 degrees, vasoconstriction is interrupted by periods of vasodilation with an increase in blood and heat flow. This "hunting" response recurs in 5-10 minute cycles to provide some protection from cold. Prolonged, repeated exposure increases this response and offers some degree of acclimatization. Ex. Eskimos have a strong response with short intervals in between.
    3. Pathophysiology of Tissue Freezing - As tissue begins to freeze, ice crystals are formed within the cells. As intracellular fluids freeze, extracellular fluid enters the cell and there is an increase in the levels of extracellular salts due to the water transfer. Cells may rupture due to the increased water and/or from tearing by the ice crystals. Do not rub tissue; it causes cell tearing from the ice crystals. As the ice melts there is an influx of salts into the tissue further damaging the cell membranes. Cell destruction results in tissue death and loss of tissue. Tissue can't freeze if the temperature is above 32 degrees F. It has to be below 28 degrees F because of the salt content in body fluids. Distal areas of the body and areas with a high surface to volume ratio are the most susceptible (e.g ears, nose, fingers and toes - this little rhyme should help remind you what to watch out for in yourself and others).
    Surface frostbite generally involves destruction of skin layers resulting in blistering and minor tissue loss. Blisters are formed from the cellular fluid released when cells rupture.
    Deep frostbite can involve muscle and bone
  • Speaker’s Notes:
    Cold-induced Vasodilation - When a hand or foot is cooled to 59 degrees F, maximal vasoconstriction and minimal blood flow occur. If cooling continues to 50 degrees, vasoconstriction is interrupted by periods of vasodilation with an increase in blood and heat flow. This "hunting" response recurs in 5-10 minute cycles to provide some protection from cold. Prolonged, repeated exposure increases this response and offers some degree of acclimatization. Ex. Eskimos have a strong response with short intervals in between.
    3. Pathophysiology of Tissue Freezing - As tissue begins to freeze, ice crystals are formed within the cells. As intracellular fluids freeze, extracellular fluid enters the cell and there is an increase in the levels of extracellular salts due to the water transfer. Cells may rupture due to the increased water and/or from tearing by the ice crystals. Do not rub tissue; it causes cell tearing from the ice crystals. As the ice melts there is an influx of salts into the tissue further damaging the cell membranes. Cell destruction results in tissue death and loss of tissue. Tissue can't freeze if the temperature is above 32 degrees F. It has to be below 28 degrees F because of the salt content in body fluids. Distal areas of the body and areas with a high surface to volume ratio are the most susceptible (e.g ears, nose, fingers and toes - this little rhyme should help remind you what to watch out for in yourself and others).
    Surface frostbite generally involves destruction of skin layers resulting in blistering and minor tissue loss. Blisters are formed from the cellular fluid released when cells rupture.
    Deep frostbite can involve muscle and bone
  • Speaker’s Notes:
    Radiation - loss of heat to the environment due to the temperature gradient (this occurs only as long as the ambient temperature is below 98.6). Factors important in radiant heat loss are the surface area and the temperature gradient.
    Conduction - through direct contact between objects, molecular transference of heat energy
    Water conducts heat away from the body 25 times faster than air because it has a greater density (therefore a greater heat capacity). Stay dry = stay alive!
    Steel conducts heat away faster than water
    Example: Generally conductive heat loss accounts for only about 2% of overall loss. However, with wet clothes the loss is increased 5x.
    Convection - is a process of conduction where one of the objects is in motion. Molecules against the surface are heated, move away, and are replaced by new molecules which are also heated. The rate of convective heat loss depends on the density of the moving substance (water convection occurs more quickly than air convection) and the velocity of the moving substance.
    Wind Chill - is an example of the effects of air convection, the wind chill table gives a reading of the amount of heat lost to the environment relative to a still air temperature.
    Evaporation - heat loss from converting water from a liquid to a gas
    Perspiration - evaporation of water to remove excess heat
    Sweating - body response to remove excess heat
    Respiration - air is heated as it enters the lungs and is exhaled with an extremely high moisture content
    It is important to recognize the strong connection between fluid levels, fluid loss, and heat loss. As body moisture is lost through the various evaporative processes the overall circulating volume is reduced which can lead to dehydration. This decrease in fluid level makes the body more susceptible to hypothermia and other cold injuries.
  • Radiation - loss of heat to the environment due to the temperature gradient (this occurs only as long as the ambient temperature is below 98.6). Factors important in radiant heat loss are the surface area and the temperature gradient.
    Conduction - through direct contact between objects, molecular transference of heat energy
    Water conducts heat away from the body 25 times faster than air because it has a greater density (therefore a greater heat capacity). Stay dry = stay alive!
    Steel conducts heat away faster than water
    Example: Generally conductive heat loss accounts for only about 2% of overall loss. However, with wet clothes the loss is increased 5x.
    Convection - is a process of conduction where one of the objects is in motion. Molecules against the surface are heated, move away, and are replaced by new molecules which are also heated. The rate of convective heat loss depends on the density of the moving substance (water convection occurs more quickly than air convection) and the velocity of the moving substance.
    Wind Chill - is an example of the effects of air convection, the wind chill table gives a reading of the amount of heat lost to the environment relative to a still air temperature.
    Evaporation - heat loss from converting water from a liquid to a gas
    Perspiration - evaporation of water to remove excess heat.
    Sweating - body response to remove excess heat
    Respiration - air is heated as it enters the lungs and is exhaled with an extremely high moisture content
    It is important to recognize the strong connection between fluid levels, fluid loss, and heat loss. As body moisture is lost through the various evaporative processes the overall circulating volume is reduced which can lead to dehydration. This decrease in fluid level makes the body more susceptible to hypothermia and other cold injuries.
  • Background for the Trainer:
    Discuss the physiological effects of hypothermia.
    Speaker’s Notes:
    Body temperature is controlled in the part of the brain called the hypothalamus, which is responsible for recognizing alterations in the body temperature and responding appropriately.
    The body produces heat through the metabolic processes in cells that support vital body functions. Most heat is lost at the skin surface by convection, conduction, radiation, and evaporation. If the environment gets colder, the body may need to generate more heat by shivering (increasing muscle activity that promotes heat formation).
    But if heat loss is greater than the body's ability to make more, then the body's core temperature will fall.
    As the temperature falls, the body shunts blood away from the skin and exposure to the elements.
    Blood flow is increased to the vital organs of the body including the heart, lungs, kidney, and brain.
    The heart and brain are most sensitive to cold, and the electrical activity in these organs slows in response to cold.
    If the body temperature continues to decrease, organs begin to fail, and eventually death will occur.
  • Background for the Trainer:
    Discuss any incidents of hypothermia that your workers may have experienced.
    Speaker’s Notes:
    Progressive loss of body heat. This can occur suddenly, such as during partial or total immersion in cold water, or over hours or days, such as during extended operations or survival situations.
    Hypothermia may occur at temperatures above freezing, especially when a person’s skin or clothing is wet.
    Most cases occur with air temperatures between 30ºF and 50ºF
    Can occur in air temperatures with high wind/rain as high as 65ºF
    Occurs in water at 72ºF regardless of currents
  • Background for the Trainer:
    Discuss any incidents of hypothermia that your workers may have experienced.
    Speaker’s Notes:
    Age: The very young and very old may be less able to generate heat. The elderly with underlying medical conditions such as hypothyroidism or Parkinson's disease that limit the ability of the body to regulate temperature are less able to generate heat. Infants don't generate heat as efficiently, and with their relatively large head size compared to the body, they are at risk for increased heat loss by radiation.
    Decreased heat production:
    Nutritional depletion: malnutrition, hypoglycemia, extremes of age (the very young and the very old)
    Endocrine disorders: hypopituitarism, hypoadrenalism, hypothyroidism
    Neuromuscular dysfunction: impaired shivering, immobility
    Increased heat loss:
    Environmental exposure: trauma, mental illness, disorientation, suicide, myocardial infarction
    Drug intoxication: alcohol, toxins, sedative/hypnotics, narcotics, barbiturates
    Skin disorders: burns
    Iatrogenic: prolonged cardiopulmonary resuscitation (CPR), postsurgical, therapeutic, cold intravenous fluids, overcooling of heat stroke patients
    Impaired thermoregulation:
    Central: spinal cord injury, cerebrovascular accident
    Peripheral: neuropathy, diabetes
    Metabolic/toxic: drugs (benzodiazepines, phenothiazines, tricyclic antidepressants, barbiturates, lithium, clonidine), anorexia, diabetic ketoacidosis, hepatic failure, uremia, lactic acidosis, hypoglycemia
    Miscellaneous:
    Sepsis - Gram-negative sepsis, meningitis
    Pancreatitis
    Uremia
    Vascular insufficiency
    Carcinomatosis
    Seizure disorder
    Peritonitis
    Serious causes
    Cerebrovascular accident
    Myocardial infarction
    Seizure disorder
    Diabetic ketoacidosis
    Sepsis
    Drug or alcohol intoxication
    Trauma
    Mental status: Impaired judgment and mental function can lead to cold exposure. Patients with Alzheimer's disease are prone to wander and become exposed to the elements
    Substance abuse: Alcohol and drug abuse increase the risk of hypothermia in two ways. First, impaired judgment can lead to cold exposure. Additionally, alcohol and similar drugs can dilate blood vessels near the skin (vasodilation) and decrease the efficiency of the shivering mechanism, both of which decrease the body's ability to compensate for cold exposure.
  • Background for the Trainer:
    Discuss any incidents of hypothermia that your workers may have experienced.
    Speaker’s Notes:
    Medical conditions: Underlying medical conditions can also lead to accidental hypothermia. Patients with hormonal abnormalities (thyroid, adrenal, pituitary), and those with peripheral neuropathy (due to diabetes or other conditions) or may be less able to feel the cold and generate a shivering response.
    Patients with spinal cord injuries, similarly, may not be able to adequately shiver.
    Patients who have suffered strokes or brain tumors may have impaired thermal regulation centers in the brain.
    Overwhelming infection and sepsis may both present with a lowered temperature instead of fever. People with diabetes who have very low blood sugar can appear unconscious and very cold
    Medications: Some medications can increase the risk of hypothermia by limiting the shivering mechanism including some psychiatric medications.
  • Background for the Trainer:
    Discuss any incidents of hypothermia that your workers may have experienced.
    Speaker’s Notes:
    Occupational health risks –
    Chemical skin irritants, allergens, sensitizers, corrosives, or solvents that defat or dry the skin
    Dermatitis from contact with poisonous plants
    Physical agents such as ultraviolet (UV), infrared (IR) heat or electrical burns resulting in skin damage, and hand-arm segmental vibration causing Raynaud’s syndrome can increase risk
    Cryogenic liquid or gas hazards resulting in tissue damage
  • Background for the Trainer:
    Discuss any incidents of hypothermia that your workers may have experienced.
    Speaker’s Notes:
    The body starts to slow as the temperature drops.
    Aside from the cold that is felt and the shivering that may occur, mental function is most affected initially.
    Diuresis may occur in early stages of cold stress.
    A particular danger of hypothermia is that it develops gradually, and since it affects thinking and reasoning, it may go unnoticed
    Initial hunger and nausea will give way to apathy as the core body temperature drops.
    This is followed by confusion, lethargy, slurred speech, so-called “umbles” – grumbles, mumbles, stumbles, fumbles, etc. - loss of consciousness, and coma.
    Often the affected person will lie down, fall asleep, and die. In some cases, the patient will paradoxically remove their clothes just before this occurs.
    The decrease in brain function occurs in direct relationship to the decrease in body temperature (the colder the body, the less the brain function). Brain function stops at a core temperature of 68 F (20 C).
    Often the affected person will lie down, fall asleep, and die..
  • Background for the Trainer:
    Discuss any incidents of severe hypothermia that may have occurred at your company.
    Speaker’s Notes:
    Severe hypothermia resembles death; however, patients must be treated as if they are alive.
    The victim may be unconscious.
    The heart rate has slowed down to the point where the pulse is either irregular or difficult to find.
    The victim is no longer shivering.
    There is no detectable breathing.
  • Background for the Trainer:
    Discuss any incidents of mild hypothermia that may have occurred at your company.
    Speaker’s Notes:
    It is important to know the early signs and symptoms of hypothermia. If mild hypothermia goes unnoticed and the person is not treated, more serious hypothermia may occur and result in more dangerous health concerns.
    Persistent shivering usually starts early, when core body temperature drops only a few degrees to 95F. The victim will shiver uncontrollably all over the body.
    The victim will have blue lips and fingers. This is a sign that the blood flow has been restricted to the extremities.
    Poor coordination can impact safety and increase risk from other workplace hazards.
  • Background for the Trainer:
    Discuss any incidents of moderate hypothermia that have occurred at your company.
    Speaker’s Notes:
    As hypothermia progresses from mild to moderate, victims lose the ability to understand that they are suffering symptoms from overexposure to the cold and should take corrective measures. When working alone, the chance of getting the necessary help is greatly decreased.
    Victims begin to suffer from mental impairment and confusion and may even think they are actually getting warmer.
    Victims may become disoriented and start to make poor decisions.
    They may not think anything is wrong and decide not to seek shelter and get warm or may become disoriented and unable to find shelter.
    Heart rate and breathing rate slow down, which decreases flow of blood and oxygen to internal organs, resulting in mental impairment. Victims become weaker and more lethargic.
    Another obvious sign is slurred speech. Victims begin to lose some basic motor control and speech is affected.
  • Background for the Trainer:
    Discuss any incidents of severe hypothermia that may have occurred at your company.
    Speaker’s Notes:
    Severe hypothermia resembles death; however, patients must be treated as if they are alive.
    The victim may be unconscious.
    The heart rate has slowed down to the point where the pulse is either irregular or difficult to find.
    The victim is no longer shivering.
    There is no detectable breathing.
  • Background for the Trainer:
    Discuss prevention of hypothermia.
    Speaker’s Notes:
    Keys to preventing hypothermia are:
    Layering
    Staying dry
    Remember acronym COLD
    Keep it Clean
    Avoid Overheating
    Wear it Loose and in Layers
    Keep it Dry
  • Speaker’s Notes:
    Monitor deep core body temperature with ear thermometer or skin sensor.
    Exogen thermometer measures temporal artery which is close to the skin and near the heart but not effective in measuring core body temperature in cold stress
    Rectal thermometer is the gold standard followed by gastrointestinal temperature but this may not be possible.
    Ear thermometer measures core body temperature from pulmonary artery which may be better than temporary artery by not as good as rectal thermometer.
    New skin sensors are being developed to compare skin temperature and core body temperature to accuracy.
    Use basic principles of rewarming a hypothermic victim are to conserve the heat they have and replace the body fuel they are burning up to generate that heat.
    If a person is shivering, they have the ability to rewarm themselves at a rate of 2 oC per hour.
  • Speaker’s Notes:
    Monitor deep core body temperature with ear thermometer or skin sensor.
    Exogen thermometer measures temporal artery which is close to the skin and near the heart but not effective in measuring core body temperature in cold stress
    Rectal thermometer is the gold standard followed by gastrointestinal temperature but this may not be possible.
    Ear thermometer measures core body temperature from pulmonary artery which may be better than temporary artery by not as good as rectal thermometer.
    New skin sensors are being developed to compare skin temperature and core body temperature to accuracy.
    Use basic principles of rewarming a hypothermic victim are to conserve the heat they have and replace the body fuel they are burning up to generate that heat.
    If a person is shivering, they have the ability to rewarm themselves at a rate of 2 oC per hour.
    Afflicted persons can generate their own heat by shivering or exercise, insulating against further heat loss, use of heat on the skin or direct delivery of heat to the core, which is done in a hospital.
    Use of heat on skin such as radiant heat, hot water bottles, electric blankets should only be applied when person has ceased shivering or traumatic vasodilation that increases heat loss
    Victims must be reassessed with burns
    For most cases, moving person to warmer location, replacing wet clothing, and movement/ligh exercise are sufficient to resture core temperature
  • Speaker’s Notes:
    First aid treatment for a victim of hypothermia involves stopping the cooling process and providing heat to begin re-warming the victim.
    Get the victim out of the cold environment and away from the cold. Move the victim to a warm shelter.
    Remove the victim’s wet and cold clothing and wrap the victim in warm, dry, and loose covers.
    Apply direct body heat to the victim. Do not place the victim in front of a hot fire or stove. Do not apply heated blankets or pads. The best method of re-warming is to provide direct body-to-body heat.
    Re-warm the internal organs first including the neck, chest, abdomen, and groin areas. Then re-warm the extremities.
    Keep the victim awake and provide warm, sweet drinks if conscious. Do not give alcohol or caffeine drinks.
    If the victim is unconscious, monitor the breathing and heart rate and administer CPR if needed.
    Get medical help for all cases of hypothermia.
  • Speaker’s Notes:
    First aid treatment for a victim of hypothermia involves stopping the cooling process and providing heat to begin re-warming the victim.
    Get the victim out of the cold environment and away from the cold. Move the victim to a warm shelter.
    Remove the victim’s wet and cold clothing and wrap the victim in warm, dry, and loose covers.
    Apply direct body heat to the victim. Do not place the victim in front of a hot fire or stove. Do not apply heated blankets or pads. The best method of re-warming is to provide direct body-to-body heat.
    Re-warm the internal organs first including the neck, chest, abdomen, and groin areas. Then re-warm the extremities.
    Keep the victim awake and provide warm, sweet drinks if conscious. Do not give alcohol or caffeine drinks.
    If the victim is unconscious, monitor the breathing and heart rate and administer CPR if needed.
    Get medical help for all cases of hypothermia.
  • 1. Reduce Heat Loss
    Additional layers of clothing
    Dry clothing
    Increased physical activity
    Shelter
    2. Add Fuel & Fluids
    It is essential to keep a hypothermic person adequately hydrated and fueled.
    a. Food types
    Carbohydrates - 5 calories/gram - quickly released into blood stream for sudden brief heat surge - these are the best to use for quick energy intake especially for mild cases of hypothermia
    Proteins - 5 calories/gram - slowly released - heat given off over a longer period
    Fats - 9 calories/gram - slowly released but are good because they release heat over a long period, however, it takes more energy to break fats down into glucose - also takes more water to break down fats leading to increased fluid loss
    b. Food intake
    Hot liquids - calories plus heat source
    Sugars (kindling)
    GORP - has both carbohydrates (sticks) and protiens/fats (logs)
    c. Things to avoid
    Alcohol - a vasodilator - increases peripheral heat loss
    Caffeine - a diuretic - causes water loss increasing dehydration
    Tobacco/nicotine - a vasoconstrictor, increases risk of frostbite
    3. Add Heat
    Fire or other external heat source
    Body to body contact. Get into a sleeping bag, in dry clothing with a normothermic person in lightweight dry clothing
  • Speaker’s Notes:
    1. Reduce Heat Loss
    Hypothermia Wrap: The idea is to provide a shell of total insulation for the patient. No matter how cold, patients can still internally rewarm themselves much more efficiently than any external rewarming. Make sure the patient is dry, and has a polypropylene layer to minimize sweating on the skin. The person must be protected from any moisture in the environment. Use multiple sleeping bags, wool blankets, wool clothing, Ensolite pads to create a minimum of 4" of insulation all the way around the patient, especially between the patient and the ground. Include an aluminum "space" blanket to help prevent radiant heat loss, and wrap the entire ensemble in plastic to protect from wind and water. If someone is truly hypothermic, don't put him/her naked in a sleeping bag with another person.
    2. Add Fuel & Fluids
    Warm Sugar Water - for people in severe hypothermia, the stomach has shut down and will not digest solid food but can absorb water and sugars. Give a dilute mixture of warm water with sugar every 15 minutes. Dilute Jello™ works best since it is part sugar and part protein. This will be absorbed directly into the blood stream providing the necessary calories to allow the person to rewarm themselves. One box of Jello = 500 Kilocalories of heat energy. Do not give full strength Jello even in liquid form, it is too concentrated and will not be absorbed.
    Urination - people will have to urinate from cold diuresis. Vasoconstriction creates greater volume pressure in the blood stream. The kidneys pull off excess fluid to reduce the pressure so the person will urinate. In order to reduce the potential heat lost from wet clothing fashion a 'diaper" for the person inside the hypothermia wrap and wrap that with a garbage bag. That will serve to allow them to urinate and prevent the wetness from leading to evaporative heat loss. You will need to keep them hydrated with the dilute Jello solution described above.
    3. Add Heat
    Heat can be applied to transfer heat to major arteries - at the neck for the carotid, at the armpits for the brachial, at the groin for the femoral, at the palms of the hands for the arterial arch.
    Chemical heat packs such as the Heat Wave™ provides 110 degrees F for 6-10 hours.
    Hot water bottles, warm rocks, towels, compresses
    For a severely hypothermic person, rescue breathing can increase oxygen and provide internal heat.
  • Speaker’s Notes:
    Paradoxical undressing occurs during moderate to severe hypothermia, as the person becomes increasingly disoriented, confused, and combative.Victim may begin discarding their clothing, which, in turn, increases the rate of heat loss.
    One explanation for the effect is a cold-induced malfunction of the hypothalamus, the part of the brain regulating body temperature.
    hypothalamus
  • Speaker’s Notes:
    Sometimes a self-protective behavior known as terminal burrowing or “hide-and-die” syndrome occurs in the final stages before death due to hypothermia.
    The afflicted will enter small, enclosed spaces, such as underneath beds or behind wardrobes.
    It is associated with prior stage of paradoxical undressing
  • Background for the Trainer:
    Discuss any incidents of frostnip that may have occurred at your company.
    Speaker’s Notes:
    Frostnip is the mildest form of a freezing cold injury. It occurs when ear lobes, noses, cheeks, fingers, or toes are exposed to the cold and the top layers of the skin freeze. The skin of the affected area turns white and it may feel numb. The top layer of skin feels hard but the deeper tissue still feels normal (soft). The top layer of skin sometimes peels off the affected area.
  • Background for the Trainer:
    Discuss any incidents of frostbite that may have occurred at your company.
    Speaker’s Notes:
    Frostbite is a common injury that is caused by exposure to severe cold or contact with extremely cold objects. Frostbite occurs suddenly more readily from touching cold metal objects than from exposure to cold air because heat is rapidly transferred from skin to metal.
    The body parts most commonly affected by frostbite are fingers, toes, cheeks, nose, face and ears.
    Can be caused by exposure to skin to metal, super cold fuel, and (POL – petroleum, oils, and lubricants), wind chill, and light clothing particularly boots.
    Persons riding in open terrain vehicles, exposure to propeller generated wind, running or skiing, and altitudes with little tree cover can contribute to wind chill.
    Frostbite occurs when skin tissue actually freezes—cells and blood vessels are damaged. The freezing point of skin is approximately 30ºF. Wind chill can be a significant factor in accelerating the process.
    The reduced blood flow from damaged blood vessels can cause gangrene.
    Body parts that have suffered frostbite damage are more susceptible to suffering frostbite in the future.
    Severe frostbite may result in tissue death, which often requires amputation or results in loss of function.
  • Speaker’s Notes:
    Frostbite symptoms vary and are not always painful. Sometimes victims may not even know they are suffering frostbite.
    Usually frostbite starts with uncomfortable sensations of coldness.
    Then the victim may feel tingling, stinging, or aching sensations in the areas affected by frostbite.
    The affected part of the body will feel numb and very cold to the touch.
    Initially, the skin will be waxy and appears yellowish almost white.
    In severe cases, this will be followed by heat, redness, swelling, blistering, and a color change to red and then black. Blistering usually takes about 10 days to subside.
    Significant pain after rewarming.
  • Speaker’s Notes:
    Monitor air temperature and wind speed using wind chill index.
    If peripheral freezing is suspected, victim also may be hypothermic
    Use contact gloves to handle all equipment, insulated and chemical resistant gloves, but never use bare hands
    Avoid cotton clothing that holds perspiration
    Keep face and ears covered and dry
    Keep socks clean and dry
    Avoid light socks and boots
  • Speaker’s Notes:
    Warm frostbitten areas gradually with body heat. Do not put affected body part near a stove or other source of heat. Do not pour hot water onto the area.
    Do not use dry heat to rewarm. Temperature cannot be effectively maintained and can cause burns further damaging the tissues.
    Do not rub the frostbitten area because this can lead to greater tissue damage.
    Water between 98ºF and 104ºF can be used to warm up the affected area.
    Once a body part has been rewarmed it cannot be used for anything.
    Apply sterile dressing to blistered areas. Keep the blisters clean and dry and do not break.
    Do not thaw frozen tissue that has suffered severe frostbite unless you are far from medical aid and there is no risk of re-freezing.
    Get medical attention for more severe cases and let hospital personnel thaw the frozen tissue, especially if the affected tissue involves the hands or feet.
    Remember, it is more important to prevent hypothermia than to rewarm frostbite rapidly.
  • Background for the Trainer:
    Discuss any incidents of immersion foot that may have occurred at your company.
    Speaker’s Notes:
    Immersion foot occurs in individuals whose feet have been wet, but not freezing cold, for days or weeks.
    It can occur at temperatures up to 10°C.
    The primary injury is to nerve and muscle tissue.
    Symptoms include tingling and numbness; itching, pain, swelling of the legs, feet, or hands; or blisters may develop.
    The skin may be red initially and turn to blue or purple as the injury progresses.
    In severe cases, gangrene may develop.
  • Background for the Trainer:
    Discuss any incidents of immersion foot that may have occurred at your company.
    Speaker’s Notes:
    First phase: Hand or foot is cold and without pain.
    Second phase: Affected limb feels burning hot and has shooting pains.
    Third phase: Pale skin, bluish coloring around the nail beds and lips, weak pulse.
  • Background for the Trainer:
    Discuss first aid for immersion foot that may have occurred at your company.
    Speaker’s Notes:
    Dry the affected part immediately.
    Remove wet clothing and replace with dry, warm clothing.
    Rewarm affected area gradually in warm air.
    Do not rub or massage the affected hand/foot.
    Elevate the affected part to reduce swelling.
    Protect the casualty from additional injury.
    Evacuate medical treatment facility as soon as practical
  • Background for the Trainer:
    Discuss any incidents of immersion or trench foot/hand that may have occurred at your company.
    Speaker’s Notes:
    Trench foot/hand is a process similar to chilblains. It is caused by prolonged exposure (< 12 hours) of the feet to cool, wet conditions.
    Inactivity and damp socks and boots (or tightly laced boots that impair circulation) speed onset and severity.
    This can occur at temperatures as high as 60 degrees F if the feet are constantly wet.
    This can happen with wet feet in winter conditions or wet feet in much warmed conditions (ex. sea kayaking).
    The mechanism of injury is as follows: wet feet lose heat 25x faster than dry, therefore the body uses vasoconstriction to shut down peripheral circulation in the foot to prevent heat loss. Skin tissue begins to die because of lack of oxygen and nutrients and due to buildup of toxic products.
    The skin is initially reddened with numbness, tingling pain, and itching then becomes pale and mottled and finally dark purple, grey or blue.
    The effected tissue generally dies and sluffs off. In severe cases trench foot can involve the toes, heels, or the entire foot. If circulation is impaired for > 6 hours there will be permanent damage to tissue.
    If circulation is impaired for > 24 hours the victim may lose the entire foot. Trench Foot cuases permanent damage to the circulatory system making the person more prone to cold related injuries in that area.
    A similar phenomenon can occur when hands are kept wet for long periods of time such as kayaking with wet gloves or pogies.
    The damage to the circulatory system is known as Reynaud's Phenomenon
  • Background for the Trainer:
    Discuss any incidents of trench foot/hand that may have occurred at your company.
    Speaker’s Notes:
    Cold, numb feet that may progress to hot with shooting pains.
    Swelling, redness, and bleeding may become pale and blue.
    Accompanied by aches, increased pain sensitivity and infection.
    Reddening of the skin
    Leg cramps
    Tingling pain
    Blisters or ulcers
    Bleeding under skin
    Gangrene
  • Background for the Trainer:
    Discuss any first aid steps for trench foot/hand that may have occurred at your company.
    Speaker’s Notes:
    Keep feet clean and dry; change wet or damp socks as soon as possible.
    Wipe dry the inside of Vapor Barrier boots dry at least once per day, or more often as feet sweat.
    Dry leather boots by stuffing with paper towels.
    Remove shoes and boots
    Remove wet socks
    In severe cases, avoid walking to prevent tissue damage
    Get medical attention
    Remove wet or constrictive clothing, gentle wash and dry affected extremities.
    Elevate affected limbs and cover with layers of loose, warm, dry clothing.
    Do not pop blisters, apply lotions or creams, massage, expose to extreme heat or permit
    Walking can increase tissue damage and worsen the injury.
    Evacuate for medical treatment.
  • Background for the Trainer:
    Discuss any incidents of chilblains that may have occurred at your company.
    Speaker’s Notes:
    Chilblains is one of the most common non-freezing injury
    Continuous or repeated skin exposure to air temperatures just above freezing to 60ºF for more that 1 to 5 hours.
    Damage to capillary beds (small blood vessels)
    Repeated damage can become permanent
    Redness and itching returns with repeated exposure
    Redness on cheeks, ears, fingers, and toes
  • Background for the Trainer:
    Discuss any incidents of frostbite that may have occurred at your company.
    Speaker’s Notes:
    Chilblains Symptoms
    Redness
    Itching
    Tender to the touch
    Possible blisters
    Inflammation and swelling
    Ulceration in severe cases
    With re-warming, the skin becomes swollen, red (or darkening of the skin in dark-skinned soldiers) and hot to the touch.
    An itching or burning sensation may continue for several hours after exposure.
    Early diagnosis of chilblains becomes evident when symptoms do not resolve with re-warming.
  • Background for the Trainer:
    Discuss treatment of chilblains
    Speaker’s Notes:
    Apply local warming (put bare hands over the affected area on the face, put affected hands inside the uniform under the armpits, etc.).
    Do not rub or massage the affected area.
    Apply a field dressing to lesions (sores).
    Have the casualty examined by medical personnel when the opportunity presents itself.
  • Background for the Trainer:
    Discuss treatment of chilblains
    Speaker’s Notes:
    Avoid scratching
    Slowly rewarm skin
    Use corticosteroid cream to reduce itch
    Keep blisters and ulcerated area clean, covered, and dry
  • Background for the Trainer:
    Discuss any other cold related incidents that may have occurred at your company.
    Speaker’s Notes:
    Freezing of cornea
    Caused by forcing the eyes open during strong winds without goggles
    Treatment is very controlled, rapid rewarming e.g. placing a warm hand or compress over the closed eye.
    After rewarming the eyes must be completely covered with patches for 24 - 48 hours.
  • Background for the Trainer:
    Discuss any cold related incidents that may have occurred at your company.
    Speaker’s Notes:
    Eyelashes freezing together
    Put hand over eye until ice melts; open the eye
    Snow blindness
    Sunburn of the eyes from reflected sunlight
    Wear sunglasses with side shields or tinted goggles
    Eye protection from sun is the same as a cloudy or overcast day when on snow covered ground
    Snow blindness occurs during a snow storm if the cloud cover is thin
  • Background for the Trainer:
    Discuss any cold related incidents that may have occurred at your company.
    Speaker’s Notes:
    Snow blindness
    Symptoms occur 8-12 hours after exposure
    Eyes feel dry and irritated, then feel as if they are full of sand, moving or blinking becomes extremely painful, exposure to light hurts the eyes, eyelids may swell, eye redness, and excessive tearing
    Treatment – use cold compresses and stay in dark environment
    Do not rub eyes
  • Speaker's Notes:
    Obviously, temperature plays a key role in determining the amount of stress that a worker faces in a cold work environment. The colder the temperature, the greater the cold-related stress—which means a higher risk for cold-related disorders.
    Cool winds also contribute to cold stress. Wind chill may often contribute to cold-related illnesses and injuries without workers knowing what hit them.
    Working in damp conditions, or working and sweating in cold conditions, will also contribute to cold-related disorders. It is important to always stay dry.
    Cold water may result in hypothermia much quicker than the cold air.
  • Background for the Trainer:
    Your company may require employees to meet certain physical conditions before they can work in cold environments. If so, describe them.
    Speaker's Notes:
    In addition to cold temperatures and windy conditions, there are other risk factors that can contribute to cold-related illnesses and injuries.
    Inadequate or wet clothing increases the risk because the actual effects of cold on the body depend on how well the skin is insulated from cold temperatures and cold wind. Wet or damp clothing does not provide sufficient insulation from cold temperatures.
    Drug use or certain medications can inhibit the body’s response to the cold or even impair judgment such that the victim does not realize he or she is suffering symptoms of a cold-related disorder. Avoid drugs, alcohol, caffeine, and cigarettes when working in cold conditions.
    Certain diseases or medical conditions such as a cold, heart disease, asthma, bronchitis, diabetes, atherosclerosis, hypothyroidism, and even poor blood circulation may increase risk of suffering a cold-related illness or injury. Be sure to have a physical evaluation by a medical doctor prior to doing work in cold conditions.
    Male death rates in cold conditions are greater than female death rates. Some suspected reasons include inherent risk-taking activities, body fat composition, or other physiological differences.
    Workers become more susceptible to cold-related illnesses and injuries as they age.
    Exertion in cold can constrict blood vessels in the heart. This means older workers or workers with coronary disease have an increased risk of heart attack when working in cold conditions.
    People who are overweight, have had inadequate rest, or are just physically unfit are more susceptible to cold-related illness.
  • Background for the Trainer:
    Discuss the specific administrative controls utilized by your company.
    Speaker's Notes:
    The ACGIH has adopted guidelines developed by Saskatchewan Labour for working outdoors in cold weather conditions.
    The recommended exposure times are based on the wind chill factor and assume workers are wearing dry clothing.
    The work-break schedule applies to any 4-hour period with moderate or heavy activity.
    The warm-up break periods are 10-minutes long in a warm location.
    The schedule assumes that "normal breaks" are taken once every two hours.
    At the end of a 4-hour period, an extended break (e.g. lunch break) in a warm location is recommended.
    More information is available in the ACGIH publications "2013 TLVs® and BEIs®" and on the Saskatchewan Labour web page "Cold Conditions Guidelines for Outside Workers" (http://www.lrws.gov.sk.ca/cold-condition-guidelines-working-outside).
  • Background for the Trainer:
    Discuss the specific engineering controls utilized by your company.
    Speaker's Notes:
    Use controls such as enclosures and heating systems where practical and possible.
    Protect the hands, face, and feet from frostbite with an on-site source of heat. Air heaters, radiant heaters, or contact warm plates may be used.
    (Heaters that emit carbon monoxide should be used with caution.)
    Provide a heated shelter for workers to do their work in, where possible, but at minimum as a shelter for a work/warm-up break.
    Shield work areas from drafts or winds as much as possible.
    Use thermal insulating material on equipment (such as when touching metal handles, or when you have to sit or kneel on concrete).
  • Background for the Trainer:
    Discuss the specific administrative controls utilized by your company.
    Speaker's Notes:
    Use a work/warm-up schedule. A warm shelter or vehicle should be available so workers can warm up
    Allow a period of adjustment to the cold before assigning a full work schedule
    Allow individuals to set their own pace and take extra work breaks when needed
    Educate new or newly transferred workers on the hazards of working in a cold environment
  • Background for the Trainer:
    Discuss the specific administrative controls utilized by your company.
    Speaker's Notes:
    Avoid activities that lead to heavy sweating
    Do as many tasks as possible indoors and reduce timeframe people must work outdoors
    Work outside during the warmer hours of the day (mid-day/early afternoon)
    Minimize activities that reduce blood flow like sitting or standing for long periods of time.
    Use a buddy system and avoid working alone
    Look for signs and symptoms of cold stress in fellow co-workers
  • Background for the Trainer:
    Discuss the specific administrative controls utilized by your company.
    Speaker's Notes:
    If you see symptoms in a co-worker, take appropriate preventive steps
    Work practices should include:
    Do not sit or kneel on cold, unprotected surfaces
    Older workers, or those with certain medical problems, need careful about the effects of cold stress
    Check with a doctor about special needs and precautions
  • Background for the Trainer:
    Discuss the specific administrative controls utilized by your company.
    Speaker's Notes:
    Avoid using alcohol or drugs that may impair judgment while working in a cold environment.
    Hypothermia commonly occurs in association with alcohol abuse. In addition to its effects on judgment, alcohol increases heat loss by dilating the blood vessels and it may prevent a person from shivering (a warming mechanism).
    • Keep energy levels up and prevent dehydration by consuming warm, sweet, caffeine-free, non-alcoholic drinks and soup.
  • Background for the Trainer:
    Discuss the specific training utilized by your company.
    Speaker's Notes:
    Supervisors and workers should be trained to watch for signs of cold stress and allow workers to interrupt work when uncomfortable
    Supervisors and workers should manage work schedules to allow appropriate rest periods
    Training should discuss engineering controls, work practices, and protective equipment to reduce the risk of cold stress
    Specialized training is needed to for work exposure in arctic conditions. Three levels of courses based on job tasks.
    Control measures should be part of the written health and safety plan (HASP)
  • Background for the Trainer:
    Discuss the specific administrative controls utilized by your company.
    Speaker's Notes:
    The ACGIH has adopted guidelines developed by Saskatchewan Labour for working outdoors in cold weather conditions.
    The recommended exposure times are based on the wind chill factor and assume workers are wearing dry clothing.
    The work-break schedule applies to any 4-hour period with moderate or heavy activity.
    The warm-up break periods are 10-minutes long in a warm location.
    The schedule assumes that "normal breaks" are taken once every two hours.
    At the end of a 4-hour period, an extended break (e.g. lunch break) in a warm location is recommended.
    More information is available in the ACGIH publications "2013 TLVs® and BEIs®" and on the Saskatchewan Labour web page "Cold Conditions Guidelines for Outside Workers" (http://www.lrws.gov.sk.ca/cold-condition-guidelines-working-outside).
  • Background for the Trainer:
    Discuss the specific administrative controls utilized by your company.
    Speaker's Notes:
    Administrative controls for cold conditions include limiting worker exposure to the cold conditions by providing additional breaks or by rotating workers through the cold conditions.
    Use this table to determine maximum working periods and the number of breaks workers should have for each 4-hour work period. Between the 4-hour shifts, workers should be given an extended lunch period in a warm location.
    This schedule applies to workers doing moderate to heavy work. Workers doing light to moderate work should be given one additional break during the 4-hour shift.
    Workers should be given 10-minute breaks in a warm location.
    This work schedule applies to workers in dry clothing. When clothing gets wet, workers should immediately retreat to the warm shelter and change clothing.
  • Background for the Trainer:
    Discuss the specific wind speed conditions related to cold stress.
    Speaker's Notes:
    The Saskatchewan Department of Labour has produced the following useful guide to help estimate the wind speed.
    8 kilometres per hour (kph) (5 mph)—moves a light flag;
    16 kph (10 mph)—fully extends a light flag;
    24 kph (15 mph)—raises a newspaper sheet;
    32 kph (20 mph)—blowing and drifting snow.
  • Background for the Trainer:
    The information for this chart was taken from the new wind chill chart developed by the National Weather Service.
    Speaker's Notes:
    Wind chill is the combined effect of air temperature and air movement.
    A dangerous situation of rapid heat loss may arise for any workers exposed to a combination of high winds and cold temperatures.
    In this chart, we can see how the “wind chill temperature” drops as the speed of the wind picks up. The National Weather Service also determined when the combination of temperature, wind speed, and exposure time will produce frostbite on humans.
    The teal numbers indicate that a person’s skin can be exposed for 30 minutes before frostbite develops.
    The blue numbers indicate that a person’s skin can be exposed for 10 minutes before frostbite develops.
    The purple numbers indicate that a person’s skin can be exposed for 5 minutes before frostbite develops.
    When in the field, it may be difficult to gauge wind speed. Some ways to estimate speed in the field include:
    5 mph – light flag just moves
    10 mph – light flag is fully extended by wind
    15 mph – newspaper sheet is raised off the ground
    20 mph – wind capable of blowing snow
  • Background for the Trainer:
    Bring samples or pictures of, or describe, the protective clothing that your company provides workers exposed to cold conditions.
    Speaker's Notes:
    Wear several layers of clothing rather than one thick layer. Air captured between the layers acts as an insulator.
    As the material gets thinner, the type of fabric and any coatings or membranes used become more important, especially to vapour resistance.
    If conditions are wet or windy, wear appropriate outer clothing that protects from the wetness and the wind, but still allows some ventilation.
    Gortex or nylon materials are often used.
    Workers should wear hats, hoods, or face covers to prevent heat loss from the head and to protect ears from the cold.
    Up to 40 percent of body heat can be lost when the head is exposed.
    Wear insulated footgear that protects against the cold and dampness.
    Footgear should not be too tight because it will restrict blood flow and contribute to the potential for frostbite. Footgear should be large enough to allow wearing either one thick sock or two thin pairs of socks.
    Wearing too many socks can tighten the fit and do more harm than good.
    Wear insulated gloves that protect against the cold and dampness.
    Gloves should not be so tight that they restrict movement and blood flow in the hands.
    Fingers and hands lose their dexterity at temperatures below 59F.
    If dexterity is required to do the job so that gloves cannot be worn, then appropriate engineering controls must be used.
    Keep an extra change of clothing available in case work clothing becomes wet.
    When working in temperatures 35F or below, workers should immediately change clothes and be treated for hypothermia if their clothing gets wet.
  • Background for the Trainer:
    Bring samples or pictures of, or describe, the protective clothing that your company provides workers exposed to cold conditions.
    Speaker's Notes:
    Wear several layers of clothing rather than one thick layer. Air captured between the layers acts as an insulator.
    Wear at least three layers.
    an outer layer that is windproof but still allows some ventilation,
    a middle layer of wool, quilted fibres, or synthetic fleece to create an insulating layer, and
    an inner layer of synthetic fabric or wool to provide ventilation and allow moisture to escape. The inner or base layer should not be cotton. Cotton stays wet and speeds heat loss.
    NOTE: The type of fiber used is less important as long as the garment is thick enough.
    As the material gets thinner, the type of fabric and any coatings or membranes used become more important, especially to vapour resistance.
    If conditions are wet or windy, wear appropriate outer clothing that protects from the wetness and the wind, but still allows some ventilation.
    Gortex or nylon materials are often used.
    Workers should wear hats, hoods, or face covers to prevent heat loss from the head and to protect ears from the cold.
    Up to 40 percent of body heat can be lost when the head is exposed.
    Wear insulated footgear that protects against the cold and dampness.
    Footgear should not be too tight because it will restrict blood flow and contribute to the potential for frostbite. Footgear should be large enough to allow wearing either one thick sock or two thin pairs of socks.
    Wearing too many socks can tighten the fit and do more harm than good.
    Wear insulated gloves that protect against the cold and dampness.
    Gloves should not be so tight that they restrict movement and blood flow in the hands.
    Fingers and hands lose their dexterity at temperatures below 59F.
    If dexterity is required to do the job so that gloves cannot be worn, then appropriate engineering controls must be used.
    Keep an extra change of clothing available in case work clothing becomes wet.
    When working in temperatures 35F or below, workers should immediately change clothes and be treated for hypothermia if their clothing gets wet.
  • Background for the Trainer:
    Bring samples or pictures of, or describe, the protective clothing that your company provides workers exposed to cold conditions.
    Speaker's Notes:
    Wear several layers of clothing rather than one thick layer. Air captured between the layers acts as an insulator.
    Wear at least three layers.
    an outer layer that is windproof but still allows some ventilation,
    a middle layer of wool, quilted fibres, or synthetic fleece to create an insulating layer, and
    an inner layer of synthetic fabric or wool to provide ventilation and allow moisture to escape. The inner or base layer should not be cotton. Cotton stays wet and speeds heat loss.
    NOTE: The type of fiber used is less important as long as the garment is thick enough.
    As the material gets thinner, the type of fabric and any coatings or membranes used become more important, especially to vapour resistance.
    If conditions are wet or windy, wear appropriate outer clothing that protects from the wetness and the wind, but still allows some ventilation.
    Gortex or nylon materials are often used.
    Workers should wear hats, hoods, or face covers to prevent heat loss from the head and to protect ears from the cold.
    Up to 40 percent of body heat can be lost when the head is exposed.
    Wear insulated footgear that protects against the cold and dampness.
    Footgear should not be too tight because it will restrict blood flow and contribute to the potential for frostbite. Footgear should be large enough to allow wearing either one thick sock or two thin pairs of socks.
    Wearing too many socks can tighten the fit and do more harm than good.
    Wear insulated gloves that protect against the cold and dampness.
    Gloves should not be so tight that they restrict movement and blood flow in the hands.
    Fingers and hands lose their dexterity at temperatures below 59F.
    If dexterity is required to do the job so that gloves cannot be worn, then appropriate engineering controls must be used.
    Keep an extra change of clothing available in case work clothing becomes wet.
    When working in temperatures 35F or below, workers should immediately change clothes and be treated for hypothermia if their clothing gets wet.
  • Background for the Trainer:
    Bring samples or pictures of, or describe, the protective clothing that your company provides workers exposed to cold conditions.
    Speaker's Notes:
    Wear several layers of clothing rather than one thick layer. Air captured between the layers acts as an insulator.
    Wear at least three layers.
    an outer layer that is windproof but still allows some ventilation,
    a middle layer of wool, quilted fibres, or synthetic fleece to create an insulating layer, and
    an inner layer of synthetic fabric or wool to provide ventilation and allow moisture to escape. The inner or base layer should not be cotton. Cotton stays wet and speeds heat loss.
    NOTE: The type of fiber used is less important as long as the garment is thick enough.
    As the material gets thinner, the type of fabric and any coatings or membranes used become more important, especially to vapour resistance.
    If conditions are wet or windy, wear appropriate outer clothing that protects from the wetness and the wind, but still allows some ventilation.
    Gortex or nylon materials are often used.
    Workers should wear hats, hoods, or face covers to prevent heat loss from the head and to protect ears from the cold.
    Up to 40 percent of body heat can be lost when the head is exposed.
    Wear insulated footgear that protects against the cold and dampness.
    Footgear should not be too tight because it will restrict blood flow and contribute to the potential for frostbite. Footgear should be large enough to allow wearing either one thick sock or two thin pairs of socks.
    Wearing too many socks can tighten the fit and do more harm than good.
    Wear insulated gloves that protect against the cold and dampness.
    Gloves should not be so tight that they restrict movement and blood flow in the hands.
    Fingers and hands lose their dexterity at temperatures below 59F.
    If dexterity is required to do the job so that gloves cannot be worn, then appropriate engineering controls must be used.
    Keep an extra change of clothing available in case work clothing becomes wet.
    When working in temperatures 35F or below, workers should immediately change clothes and be treated for hypothermia if their clothing gets wet.
  • Background for the Trainer:
    Bring samples or pictures of, or describe, the protective clothing that your company provides workers exposed to cold conditions.
    Speaker's Notes:
    Protect your feet, hands, head, and face.
    Wear mittens when possible rather than gloves (mittens are warmer because your fingers stay together).
    Nylon overmitts can be easily put on and taken off if gloved hands are necessary.
    Use thermal insulated gloves otherwise use mittens to reduce heat loss.
    Fingers and hands lose their dexterity at colder temperatures.
    However, be careful about wearing gloves or scarves that can get caught in moving parts of machinery.
  • Background for the Trainer:
    Bring samples or pictures of, or describe, the protective clothing that your company provides workers exposed to cold conditions.
    Speaker's Notes:
    Keep your head covered (up to 40 to 50% of your body heat can be lost when the head is exposed)
    Use an appropriate hardhat liner with your hard hat
    Wear a facemask or balaclava when working in very cold conditions
    Wear socks to protect your ankles and feet.
    Bring extra socks if moisture or sweat is likely and change when necessary.
    Wear gloves when fine manual dexterity is not required
  • Background for the Trainer:
    Bring samples or pictures of, or describe, the protective clothing that your company provides workers exposed to cold conditions.
    Speaker's Notes:
    Use footwear that protects against cold and dampness.
    Footwear should be insulated and fit comfortably when socks are layered.
    Boots with linings are preferred as they can be taken apart to dry more easily, or new linings can be used.
  • Background for the Trainer:
    Bring samples or pictures of, or describe, the protective clothing that your company provides workers exposed to cold conditions.
    Speaker's Notes:
    Wet clothing causes the body to lose heat quickly, because evaporating water takes up a lot of heat.
    Cotton especially is not recommended.
    It tends to get damp or wet quickly, stays this way, and loses its insulating abilities.
    Wool and synthetic fabrics, on the other hand, do retain heat when wet.
    Have a change of clothes available in case your clothes get wet.
    Dirty or greasy clothing has poor insulating properties.
    Do not underestimate the wetting effects of perspiration.
    Oftentimes wicking and venting of the body’s sweat and heat are more important than protecting from rain or snow.
    Hats:  Insulated headbands for active exercise and warmer/sunnier days.  Stocking caps for colder weather and stationary or light exercise.  Balaclavas/ski masks for the coldest and windiest days–bring a couple, since they get wet and lose their effectiveness over time from your breath.
    Goggles:  Important protection from wind, which can make eyes tear up and lashes freeze.  Dark lenses may also be needed if there’s lots of snow and sun.
    Scarves:  Vital wind protection.  Always have one tucked under the shell layer.
    Parkas:  Big, insulated outer layers that reach down to the knees or lower.  The most intense of outer layers.  Bulky but very effective.  Almost always include a hood for extra warmth.
    Ski Jackets:  Waist-length insulated jackets with a waterproofed or water-resistant exterior.  Thinner and lighter than parkas, making them a little more versatile.
    Weatherproof Shells:  Soft garments made of treated fabric that stop wind and water but have little or no insulation of their own.  Useful lightweight protection to pair with thick insulation layers.
    Sweaters:  A standard insulation layer.  Wool is the best–thick, natural wool with the lanolin still in it is extremely durable and water-resistant, while lighter cashmere wool makes very lightweight garments that still provide good insulation.
    Performance Fleece:  Excellent for cold weather exercise.  Very breathable, but not windproof at all, and tends to be bulky.
    Snow Pants:  Big, insulated pants (usually overall-style) with a waterproof or water resistant outer layer.  Bulky but extremely warm.  Made to fit over regular trousers.
    Wool Trousers:  Useful as both dress clothes and cold weather gear.  Thicker wools add more warmth and can handle more wetness.
    Flannel-lined Pants:  Common in blue jeans and other work clothes.  Adds a layer of insulation to regular, functional pants.  Basically worthless when wet, however.
    Snow Boots:  Soft-sided boots with flexible soles and insulation on the insides.  Usually waterproof.
    Wool Socks:  Vital layer for the feet.  Can come quite thin in wool/synthetic blends, but the extra padding of thick wool socks helps trap more air for warmth.
    Liner Socks:  Synthetic socks meant to be worn under warmer socks.  Useful for wicking moisture away from the feet.
    Long Underwear:  Wool or synthetic (or a blend of both).  Makes a huge difference in keeping the legs warm.
    Under Armor (and similiar type garments):  Athletic-style moisture-wicking undershirts.  Vastly preferable to plain cotton undershirts, which trap moisture and stay clammy.
    Wool Gloves:  Thin sock-style gloves used as an extra layer below thick gloves or mittens.
    Ski Gloves:  Or basic winter gloves; fingered gloves with padded insulation and weatherproof exteriors.
    Mittens:  Big, fingerless gloves.  Can be made from insulation and a synthetic liner similar to ski gloves, or from natural sheepskin with the wool still attached and the leather side out.
  • Long underwear - Wool, silk, synthetic fabric
    Pants - Wool, synthetic fabric
    Shirts, sweaters, turtlenecks - Wool, fleece, synthetic fabric
    Head gear - Wool, synthetic fabrics, wind barrier fabric if necessary
    Gloves, mittens - Loose fitting with wool or synthetic fabric liners, thermal insulated or pair of uninsulated gloves inside mittens plus windproof overmitts for very cold conditions
    Socks - Two pairs – light or medium inner and heavy wool or synthetic outer socks
    Parka / Jacket - Loose fitting, filled with down or insulating fiber, attached hood, outer layer of windproof fabric
  • Speaker's Notes:
    When fine manual dexterity is not required, wear gloves. When doing sedentary work, put on gloves in temperatures <60F. When the work is light, put on gloves in temperatures <40F. When the work is moderate, put on gloves in temperatures <20F.
    Tools and machine controls for use in cold conditions should be designed for use by bulky gloved hand operation.
    If working in temperatures <60F, limit bare hand work to 10-20 minutes. Prolonged work will result in a loss of hand dexterity and control.
    To continue doing bare hand work in cold conditions, use special measures such as warm air jets, radiant heaters, or contact warm plates.
    Metal handles of tools or machine controls that are used in cold conditions should be covered by a thermal insulating material.
    Prevent contact frostbite when working near metal surfaces that are <20F by wearing insulated gloves and warning workers to avoid skin contact with the cold surfaces.
  • Speaker’s Notes:
    Workers should be medically fit to work in extremely cold conditions, especially workers that have a tendency to the risk factors already mentioned, such as heart conditions, diabetes, etc. Employers should consider implementing a medical surveillance program.
    Workers should eat high calorie foods when working in cold conditions.
    Workers should consume warm, sweet drinks and soups while at the worksite to maintain calorie intake and fluid volume.
    Avoid coffee because it increases water loss and blood flow to extremities.
    Stay in good physical condition through regular exercise, plenty of sleep, and a balanced diet.
  • Background for the Trainer:
    Discuss any other safe work practices utilized by your company.
    Speaker’s Notes:
    Avoid activities, whenever possible, that can lead to heavy perspiration.
    When possible, schedule work for the warmest period of the day.
    Minimize activities that reduce circulation, such as sitting or standing in cold environments for prolonged periods of time.
    Allow a period of adjustment to the cold before starting on a full work schedule.
    Never work alone in very cold weather—use the buddy system.
    Watch for symptoms of cold-related illness—seek shelter and first aid immediately.
  • Background for the Trainer:
    Discuss any case studies and other safe work practices utilized by your company.
    Speaker’s Notes:
    . a carpenter is working outside on a -20°C in February on a building under construction on the 9th floor.
    The radio reports a general wind chill of –27.
    How do you protect the workers?
  • Background for the Trainer:
    Discuss any other safe work practices utilized by your company.
    Speaker’s Notes:
    The wind speed on the 9th floor may be more than the wind chill value reported on the radio so workers decide to use a work/warm-up schedule matching the air temperature at –26 to –28 at a wind speed of 20-25 km/h (15 mph) which equals 55 minutes of work maximum, with 3 breaks, in a 4-hour shift.
    Breaks will be taken on the first floor, which is completely enclosed and heated, in the area currently being used as a meeting area.
    Since the meeting room is needed in the afternoon, later breaks will be taken in the crew vans.
    The carpenter will do as much measuring and layout as possible on the 8th floor, which has more walls that provide a better wind break than the structure on the 9th floor.
    The crew reviews the health effects and signs/symptoms of cold exposure. Since many of the crew work in isolation, they agree to check in every 30 minutes with their assigned “buddy”.
    They confirm that everyone is dressed appropriately – three layers including an inner layer to wick away sweat, a middle layer to retain heat, and a third outer layer to break the wind. The two outer layers are to be removed when in the break room. Hats and extra socks are also important. Workers are encouraged to wear their mittens or gloves whenever possible. A change of clothes is necessary if excess sweating occurs.
    Warm drinks, soup and extra water are provided in the break room.
  • Summary:
    Symptoms of hypothermia and frostbite
    First aid treatment
    Wind chill factor
    Engineering and administrative controls
    Protective clothing and staying dry
  • Cold Stress Hazards and Prevention

    1. 1. Working in Cold Environments How to Keep Workers Safe and Productive When the Mercury Plunges WARNING: This presentation contains photos that some viewers may find disturbing Copyright ©2013 The Windsor Consulting Group, Inc. ".
    2. 2. Overview  Workers who are exposed to extreme cold or work in cold environments may be at risk of cold stress.  Extreme cold weather is a dangerous situation for people without shelter, outdoor workers, and work areas poorly insulated or without heat.  Weather-related conditions may lead to Copyright ©2013 The Windsor Consulting Group, Inc.
    3. 3. Overview  What constitutes cold stress and its effects can vary across different areas of the country.  In regions unaccustomed to winter weather, near freezing temperatures are considered factors for "cold stress."  Whenever temperatures drop decidedly below normal and as wind speed increases, heat can more rapidly leave your body. Copyright ©2013 The Windsor Consulting Group, Inc.
    4. 4. Goals  Cold-related illnesses and injuries  At-risk occupations and recreational activities  Signs and symptoms of cold exposure  Emergency response and first aid treatment  Risk factors, evaluation of work environment, prevention measures and protective clothing  Case study and analysis  Quiz Copyright ©2013 The Windsor Consulting Group, Inc.
    5. 5. Cold Workplaces  Roofs in cold weather  Bridges near large bodies of water  High-rise buildings exposed to wind  Refrigerated rooms or containers  Commercial fishing areas  Steel structures that retain cold  Unheated warehouses in cold climates Copyright ©2013 The Windsor Consulting Group, Inc.
    6. 6. Cold Workplaces          Offshore oil/gas platforms Marine vessels Freezers/food warehouses Arctic exploration and research projects Deep sea diving Logistics and transport Doormen and taxi drivers Longshoremen and stevedores Outside construction job sites Copyright ©2013 The Windsor Consulting Group, Inc.
    7. 7. Non-Work Cold Environments           Snowmobiling and tobogganing Downhill/cross-country skiing Ice skating and dog sledding Winter hunting and ice fishing Outdoor camping, hiking, boating Snowshoeing and snowboarding Rock and mountain climbing Holiday decorating home exterior Deicing, shoveling, and snow removal Riding motorcycles and off-road vehicles Copyright ©2013 The Windsor Consulting Group, Inc.
    8. 8. Risk Factors Related to Cold  A cold environment challenges the worker in three ways: by air temperature, air movement (wind speed), and humidity (wetness).  In order to work safely, challenges have to be counterbalanced by proper insulation (layered protective clothing), buddy system, physical activity, diet and nutrition, acclimatization, and by controlled exposure to cold (work/rest schedule). Copyright ©2013 The Windsor Consulting Group, Inc.
    9. 9. Risk Factors Related to Cold  Air Temperature: Air temperature is measured by an ordinary thermometer in degrees Celsius (°C) or degrees Fahrenheit (°F).  Wind Speed: Different types of anemometers are used to measure wind speed or air movement. Estimates of wind speed include: . 8 km/h (5 mph): light flag moves, – 16 km/h (10 mph): light flag fully extended, – 24 km/h (15 mph): raises newspaper sheet, – 32 km/h (20 mph): causes blowing and drifting snow. – Copyright ©2013 The Windsor Consulting Group, Inc.
    10. 10. Risk Factors Related to Cold  Humidity (wetness): Water conducts heat away from the body 25 x faster then dry air.  Physical Activity: The production of body heat by physical activity (metabolic rate) is difficult to measure. Tables are used to show metabolic rates for a variety of activities. Metabolic heat production is measured in kilo calories (kcal) per hour. One kilocalorie is the amount of heat needed to raise the temperature of one kilogram of water by 1°C. Copyright ©2013 The Windsor Consulting Group, Inc.
    11. 11. Risk Factors Related to Cold  Work/rest schedule: This work schedule has been adopted by the American Conference of Governmental Industrial Hygienists (ACGIH) as Threshold Limit Values (TLVs) for cold stress.  Protective clothing: Adequate clothing is needed for work at or below 4°C. Clothing should be selected to suit the temperature, weather conditions (e.g., wind speed, rain), the level and duration of activity, and job design. Copyright ©2013 The Windsor Consulting Group, Inc.
    12. 12. Risk Factors Related to Cold  Other factors influencing cold injuries –Insulation materials and layering –Contact with metal or cryogenic liquids –Exposed skin –Vasodilation –Vasoconstriction –Previous cold injuries – frostbite and white finger syndrome –Constricting garments Copyright ©2013 The Windsor Consulting Group, Inc.
    13. 13. Risk Factors Related to Cold  Factors influencing cold injuries –Local pressure –Cramped position –Body type –Dehydration –Women do better in cold than men (more body fat) –Higher caloric intake –Diabetes, some medications –Alcohol, caffeine, and tobacco/nicotine Copyright ©2013 The Windsor Consulting Group, Inc.
    14. 14. Body Reacts to Cold by:  Trying to maintain core temperature of 98.6ºF  Decreasing blood flow to extremities to prevent heat loss which – Keeps internal organs warm – Increases chance of frostbite  Shivering generates heat Copyright ©2013 The Windsor Consulting Group, Inc.
    15. 15. Heat Lost to Environment  Radiation – loss of heat due to temperature gradient below 98.6 oF  Conduction – heat transfer from sweating – water conducts heat from body 25 faster than air – Stay dry = Stay alive  Convection - wind chill is an example of heat transfer by air convection and water currents also transfers heat away from the core body  Evaporation – removal of heat by sweating mechanism or respiration Copyright ©2013 The Windsor Consulting Group, Inc.
    16. 16. Heat Lost to Environment Copyright ©2013 The Windsor Consulting Group, Inc.
    17. 17. Hypothermia  Body maintains a relatively stable temperature whereby heat production is balanced by heat loss (metabolism and blood circulation)  Core body temperature is 98.6 ºF or 37 ºC  If outside environment gets too cold or the body's heat production decreases, hypothermia occurs (hypo=less + thermia=temperature).  Hypothermia is a core body temperature less than 95 ºF or 35 ºC. Copyright ©2013 The Windsor Consulting Group, Inc.
    18. 18. Hypothermia  Progressive loss of body heat  Accelerated when person is wet or damp environment  Most cases occur with air temperatures between 30ºF and 50ºF  Can occur in air temperatures with high wind/rain as high as 65ºF  Occurs in water at 72ºF regardless of currents Copyright ©2013 The Windsor Consulting Group, Inc.
    19. 19. Risk Factors for Hypothermia  Age – cold affects the very old and young  Physiology – decreased heat production, increased heat loss, impaired thermoregulation  Mental status – impaired judgment or mental function like Alzheimer's disease  Alcohol and certain drugs can dilate blood vessels near the skin (vasodilation) and decrease capability to shiver to stay warm Copyright ©2013 The Windsor Consulting Group, Inc.
    20. 20. Risk Factors for Hypothermia  Medical conditions – hormonal abnormalities (thyroid, adrenal, pituitary glands), spinal cord injury patients may not be able to shiver, person’s who suffer stroke or brain tumors may have impairments to regulate temperature, person’s with overwhelming infection or sepsis may present lowered body temperature, and people with diabetes can appear very cold  Medications increase risk of hypothermia by limiting ability to shiver Copyright ©2013 The Windsor Consulting Group, Inc.
    21. 21. Risk Factors for Hypothermia  Occupational health – –Chemical skin irritants, allergens, sensitizers, corrosives, or solvents that defat or dry the skin –Dermatitis from contact with poisonous plants –Physical agents such as ultraviolet (UV), infrared (IR) heat or electrical burns resulting in skin damage, and hand-arm segmental vibration causing Raynaud’s syndrome can increase risk – Cryogenic liquid or gas hazards resulting in tissue damage Copyright ©2013 The Windsor Consulting Group, Inc.
    22. 22. Signs and Symptoms of Hypothermia  As body temp drops, a person feels cold and shivering occurs  Mental function is affected Danger increases affecting thinking and reasoning, which may go unnoticed  Initial hunger and nausea gives way to apathy  Confusion, lethargy, slurred speech, so-called “umbles”, loss of consciousness, and coma Copyright ©2013 The Windsor Consulting Group, Inc.
    23. 23. Signs and Symptoms of Hypothermia Condition Core Temperature Signs & Symptoms of Exposure 99º - 97ºF Normal, shivering can begin 97º - 95ºF Cold sensation, goose bumps, unable to perform complex tasks with hands, shiver can be mild to severe, hands numb 95º - 93ºF Shivering, intense, muscle incoordination becomes apparent, movements slow and labored, stumbling pace, mild confusion, may appear alert. Use sobriety test, if unable to walk a 30 foot straight line, the person is hypothermic. 93º - 90ºF Violent shivering persists, difficulty speaking, sluggish thinking, amnesia starts to appear, gross muscle movements sluggish, unable to use hands, stumbles frequently, difficulty speaking, signs of depression, withdrawn. 90º - 86ºF Mild Hypothermia Shivering stops, exposed skin blue of puffy, muscle coordination very poor, inability to walk, confusion, incoherent/irrational behavior, but may be able to maintain posture and appearance of awareness Moderate Hypothermia Severe Hypothermia 86º - 82ºF 82º - 78ºF 78º - 75ºF Muscle rigidity, semiconscious, stupor, loss of awareness of others, pulse and respiration rate decrease, possible heart fibrillation Unconscious, heart beat and respiration erractic, pulse may not be palpable Pulmonary edema, cardiac and respiratory failure,death. Death may occur before this temperature is reached. Copyright ©2013 The Windsor Consulting Group, Inc.
    24. 24. Signs and Symptoms of Hypothermia Copyright ©2013 The Windsor Consulting Group, Inc.
    25. 25. Mild Hypothermia  Shivering and chattering teeth  Fatigue  Loss of coordination and slower to react  Confusion and disorientation  Lack of metal alertness increased risk of accidents and mistakes  Body temperature lowered to 90-95ºF Copyright ©2013 The Windsor Consulting Group, Inc.
    26. 26. Moderate Hypothermia       Increased mental impairment and confusion Disorientation and poor decision making Inability to take precautions from the cold Slower heart rate and breathing rate Slurred speech Body temperature drops to 82-90ºF Copyright ©2013 The Windsor Consulting Group, Inc.
    27. 27. Severe Hypothermia         Resembles death Dilated pupils Irregular or hard-to-find pulse No shivering No detectable breathing Loss of consciousness Older workers at risk of heart attack Body temperature <82ºF Copyright ©2013 The Windsor Consulting Group, Inc.
    28. 28. Preventing Hypothermia  Keys to preventing hypothermia are: –Layering –Staying dry  Remember acronym COLD –Keep it Clean –Avoid Overheating –Wear it Loose and in Layers –Keep it Dry Copyright ©2013 The Windsor Consulting Group, Inc.
    29. 29. Field Management  Goals are to: –Rescue –Examine –Insulate –Rapidly transport  If untreated, hypothermia can become a true medical emergency Copyright ©2013 The Windsor Consulting Group, Inc.
    30. 30. Field Management  Monitor deep core body temperature with ear or temporal scanning thermometer or wireless skin sensor/monitor  Use basic principles of rewarming a hypothermic victim are to conserve the heat they have and replace the body fuel they are burning up to generate that heat.  If a person is shivering, they have the ability to rewarm themselves at a rate of 2 oC/hour. Copyright ©2013 The Windsor Consulting Group, Inc.
    31. 31. First Aid for Hypothermia  Alert their supervisor  Move victim to shelter  Remove wet clothing and wrap victim in warm covers  Warm the center of their body first – chest, neck, head, and groin area using an electric blanket, if available or use skin-to-skin contact under loose, dry layers of blankets, clothing, towels, or sheets Copyright ©2013 The Windsor Consulting Group, Inc.
    32. 32. First Aid for Hypothermia  Give warm drinks and food to increase body temperature, if conscious  Avoid alcoholic or hot/cold caffeinated beverages  Monitor breathing and core body temperature  Keep victim dry and wrapped in warm blanket including head/neck  Administer CPR and get medical help Copyright ©2013 The Windsor Consulting Group, Inc.
    33. 33. First Aid for Mild Hypothermia  Reduce internal heat loss –Additional layers of clothes –Dry clothing and physical activity or shelter  Add caloric fuels and hot fluids –Carbohydrates 5 calories/gram quickly released –Proteins 5 calories/gram slowly released –Fats 9 calories/gram slowly released  Add external heat source –Fire or other external heat source –Body to body contact Copyright ©2013 The Windsor Consulting Group, Inc.
    34. 34. First Aid for Severe Hypothermia  Hypothermia wrap or multiple sleeping bags – to minimize sweating and protect against air temperature, wind and water.  Add caloric fluids fuels – gelatin mix  Absorb urine from diuresis  Add heat to major arteries with heat packs, hot water bottles, and towels Copyright ©2013 The Windsor Consulting Group, Inc.
    35. 35. First Aid for Severe Hypothermia  Paradoxical undressing occurs during moderate to severe hypothermia, as the person becomes increasingly disoriented, confused, and combative. Victim may begin discarding their clothing, which, in turn, increases the rate of heat loss and death.  One explanation for the effect induced malfunction of the hypothalamus, the part brain regulating body temperature Copyright ©2013 The Windsor Consulting Group, Inc.
    36. 36. First Aid for Severe Hypothermia  Sometimes a self-protective behavior known as terminal burrowing or “hide-and-die” syndrome occurs in the final stages before death due to hypothermia.  The afflicted will enter small, enclosed spaces, such as underneath beds or behind wardrobes.  It is associated with prior stage of paradoxical undressing Copyright ©2013 The Windsor Consulting Group, Inc.
    37. 37. Frostnip  Mildest form of a freezing cold injury  Affects ear lobes, noses, cheeks, fingers, or toes and the top layers of the skin freeze  Affected area of the skin turns white and may feel numb  Top layer of skin feels hard but the deeper tissue still feels normal (soft) and sometimes top layer of skin peels off Copyright ©2013 The Windsor Consulting Group, Inc.
    38. 38. Frostbite  Exposure to severe cold below 28-32ºF or contact with cold objects  Affects fingers, toes, cheeks, nose, face, and ears  Tissue freezes at 30ºF  Injury may cause gangrene  More susceptible to future frostbite  Tissue death—amputation or loss of function Copyright ©2013 The Windsor Consulting Group, Inc.
    39. 39. Frostbite Symptoms  Sensations of coldness by reduced blood flow  Tingling, stinging, or aching sensation  Skin feels numb and cold to the touch  Skin is waxy and appears yellowish/white  Blistering, turning red, then black Copyright ©2013 The Windsor Consulting Group, Inc.
    40. 40. Field Management of Frostbite  Monitor air temperature and wind speed using wind chill index – freezing and hypothermia  Use contact gloves to handle all equipment, insulated and chemical resistant gloves, but never use bare hands  Avoid cotton clothing that holds perspiration  Keep face and ears covered and dry  Keep socks clean and dry  Avoid light socks and boots Copyright ©2013 The Windsor Consulting Group, Inc.
    41. 41. First Aid for Frostbite  Get into warm room but avoid heating pad or other dry radiant heat sources – cause burns  Warm affected area slowly with body heat  Do not rub or walk with frostbitten feet - may result in more tissue damage  Use warm-hot water between 98°F-104°F  Apply sterile dressing to blisters  Do not thaw if there is risk of re-freezing  Get medical attention; and thaw at hospital Copyright ©2013 The Windsor Consulting Group, Inc.
    42. 42. Immersion – Non-Freezing Injury  Injury to feet that are not frozen but stay wet for many days or weeks  Occurs at temps up to 10°C/60°F  Injury to nerve and muscle tissue  Symptoms include tingling and numbness; itching, pain, swelling of legs, feet, or hands; or blisters may develop  Skin may be red and turn to blue or purple  In severe cases, gangrene may develop Copyright ©2013 The Windsor Consulting Group, Inc.
    43. 43. Immersion – Non-Freezing Injury  First phase: Hand or foot is cold and without pain.  Second phase: Affected limb feels burning hot and has shooting pains.  Third phase: Pale skin, bluish coloring around the nail beds and lips, weak pulse. Copyright ©2013 The Windsor Consulting Group, Inc.
    44. 44. Immersion – First Aid  Dry the affected part immediately.  Remove wet clothing and replace with dry, warm clothing.  Rewarm affected area gradually in warm air.  Do not rub or massage the affected hand/foot.  Elevate the affected part to reduce swelling.  Protect the casualty from additional injury.  Evacuate medical treatment facility as soon as practical Copyright ©2013 The Windsor Consulting Group, Inc.
    45. 45. Trench Foot/Hand – Non-Freezing Injury  Injury to feet/hand exposed <12 hours to wet and cold conditions  Wet feet lose heat 25 times faster than dry feet  Tissue affected below 60ºF  Blood flow reduced to feet  More susceptible to future frostbite  Tissue death—amputation or loss of function  Also known as “wet cold disease” Copyright ©2013 The Windsor Consulting Group, Inc.
    46. 46. Trench Foot/Hand Symptoms  Cold, numb hand/feet that may progress to hot with shooting pain  Reddening of the skin  Leg cramps and swelling  Tingling pain and sensitivity  Blisters or ulcers  Bleeding under skin may lead to gangrene Copyright ©2013 The Windsor Consulting Group, Inc.
    47. 47. Trench Foot/Hand First Aid  Remove wet or constrictive clothing  Elevated affected limbs  Cover with layers of loose, warm, dry clothing  Do not pop blisters, apply lotions or cream, massage, or expose to extreme heat  Avoid walking and worsening the injury Copyright ©2013 The Windsor Consulting Group, Inc.
    48. 48. Chilblains – Non-Freezing Injury  Continuous skin exposure to air temperatures just above freezing to 50ºF  Damage to capillary beds (small blood vessels)  Repeated damage can be permanent  Redness and itching returns with repeated exposure  Redness on cheeks, ears, fingers, and toes Copyright ©2013 The Windsor Consulting Group, Inc.
    49. 49. Chilblains Symptoms  Redness  Itching and burning sensation  Tender to touch  Possible blisters  Inflammation and swelling  Ulceration in severe cases Copyright ©2013 The Windsor Consulting Group, Inc.
    50. 50. Chilblains First Aid  Apply local warming (put bare hands over the affected area on the face, put affected hands inside the uniform under the armpits, etc.)  Do not rub or massage the affected area  Apply a field dressing to lesions (sores)  Have person examined by medical personnel when the opportunity presents itself Copyright ©2013 The Windsor Consulting Group, Inc.
    51. 51. Chilblains First Aid  Avoid scratching  Slowly rewarm skin  Use corticosteroid cream to reduce itch  Keep blisters and ulcerated area clean, covered, and dry Copyright ©2013 The Windsor Consulting Group, Inc.
    52. 52. Other Cold Related Injuries  Freezing of cornea –Caused by forcing the eyes open during strong winds without goggles –Treatment is very controlled, rapid rewarming e.g. placing a warm hand or compress over the closed eye. –After rewarming the eyes must be completely covered with patches for 24 - 48 hours. Copyright ©2013 The Windsor Consulting Group, Inc.
    53. 53. Other Cold Related Injuries  Eyelashes freezing together –Put hand over eye until ice melts; open the eye  Snow blindness –Sunburn of the eyes from reflected sunlight –Wear sunglasses with side shields or tinted goggles –Eye protection from sun is the same as a cloudy or overcast day when on snow covered ground –Snow blindness occurs during a snow storm if the cloud cover is thin Copyright ©2013 The Windsor Consulting Group, Inc.
    54. 54. Other Cold Related Injuries  Snow blindness –Symptoms occur 8-12 hours after exposure –Eyes feel dry and irritated, then feel as if they are full of sand, moving or blinking becomes extremely painful, exposure to light hurts the eyes, eyelids may swell, eye redness, and excessive tearing –Treatment – use cold compresses and stay in dark environment –Do not rub eyes Copyright ©2013 The Windsor Consulting Group, Inc.
    55. 55. Cold Stress Factors      Low temperature Cool, high winds Dampness Cold water immersion Prolonged or repeated exposure  Inadequate clothing or protective gear  No “buddy system” Copyright ©2013 The Windsor Consulting Group, Inc.
    56. 56. Other Risk Factors         Inadequate selection or wet clothing Prescription medications or alcohol Diseases like diabetes and thyroid conditions Severe trauma Nutrition and diet Elderly, infants, and children Persons who are mentally ill Physical condition Copyright ©2013 The Windsor Consulting Group, Inc.
    57. 57. Control Measures  Reduce exposure by applying engineering controls such as heated shelter or break areas  Apply administrative controls like work practices, standards and operating procedures including training, timing of work, policies and other rules to reduce exposure  Use personal protective equipment (PPE)  Use combination of engineering/administrative controls and personal protective equipment Copyright ©2013 The Windsor Consulting Group, Inc.
    58. 58. Engineering Controls  Use controls like enclosures and heating systems  Air heaters, radiant heaters, or contact warm plates may be used. (heaters that emit CO gas)  Provide a heated shelter for workers to do their work for and work/warm-up break  Shield work areas from drafts or winds  Use thermal insulating material on equipment (when touching metal handles, or need to sit or kneel on concrete) Copyright ©2013 The Windsor Consulting Group, Inc.
    59. 59. Administrative Controls  Use a work/warm-up schedule. A warm shelter or vehicle should be available so workers can warm up  Allow a period of adjustment to the cold before assigning a full work schedule  Allow individuals to set their own pace and take extra work breaks when needed  Educate new or newly transferred workers on the hazards of working in a cold environment Copyright ©2013 The Windsor Consulting Group, Inc.
    60. 60. Administrative Controls  Avoid activities that lead to heavy sweating  Do as many tasks as possible indoors and reduce timeframe people must work outdoors  Work outside during the warmer hours of the day (mid-day/early afternoon)  Minimize activities that reduce blood flow like sitting or standing for long periods of time  Use a buddy system and avoid working alone  Look at co-workers for signs of cold stress Copyright ©2013 The Windsor Consulting Group, Inc.
    61. 61. Administrative Controls  If you see symptoms in a co-worker, take appropriate preventive steps  Work practices should prevent sitting or kneeling on cold, unprotected surfaces  Older workers, or those with certain medical problems, need careful about the effects of cold stress  Check with a doctor about special needs and precautions to prevent cold stress Copyright ©2013 The Windsor Consulting Group, Inc.
    62. 62. Administrative Controls  Avoid using alcohol or drugs that may impair judgment when working in cold environment.  Hypothermia commonly occurs in association with alcohol consumption. Besides its effect on judgment, alcohol increases heat loss by dilating blood vessels and prevent shivering  Keep energy level up and prevent dehydration by consuming plenty of warm, caffeine-free, non-alcoholic drinks and high calorie food Copyright ©2013 The Windsor Consulting Group, Inc.
    63. 63. Administrative Controls  Supervisors and workers should be trained to watch for signs of cold stress and allow workers to interrupt work when uncomfortable  Manage work schedules to allow rest periods  Training should discuss engineering controls, work practices, and protective equipment to reduce the risk of cold stress  Specialized cold training for arctic conditions  Training/education included in the HASP Copyright ©2013 The Windsor Consulting Group, Inc.
    64. 64. Administrative Controls  ACGIH has adopted guidelines developed for working outdoors in cold weather conditions  Recommended exposure times based on the wind chill factor and assume workers wear dry clothing  Work-break schedule applies to any 4-hour period with moderate or heavy activity  Warm-up breaks are 10-min. in a warm area  “Normal breaks" are taken once every 2 hours Copyright ©2013 The Windsor Consulting Group, Inc.
    65. 65. Administrative Controls  Work and Warm-up Schedule for 4-hour Shift Copyright ©2013 The Windsor Consulting Group, Inc.
    66. 66. Administrative Controls  Estimating Wind Speed Wind Speed (km/h) What to Look For 10 Wind felt on face; leaves rustle; wind vanes begin to move. 20 Leaves and small twigs constantly moving; small flags extended. 30 Dust, leaves, & loose paper lifted; large flags flap; small tree branches move. 40 Small trees begin to sway; large flags extend and flap. 50 Larger tree branches moving; whistling heard in power lines; large flags extend and flap more wildly. 60 Whole trees moving; resistance felt in walking against wind; large flags extend fully and flap only at the end Source: The Weather Network “Glossary” http://www.theweathernetwork.com/glossary/windchill_formula Copyright ©2013 The Windsor Consulting Group, Inc.
    67. 67. Wind Chill Temperatures  Combined effect of air temperature and air movement Copyright ©2013 The Windsor Consulting Group, Inc.
    68. 68. Wind Chill Temperatures Copyright ©2013 The Windsor Consulting Group, Inc.
    69. 69. Protective Clothing  Several layers of clothing  Synthetic fibers next to skin to whisk away sweat  Water-repellent, windresistant outer clothing  Hats, hoods, or face covers  Insulated, waterproof footgear  Insulated, waterproof gloves  Change clothing when wet Copyright ©2013 The Windsor Consulting Group, Inc.
    70. 70. Protective Clothing  Wear at least three (3) layers –Outer layer that is windproof but still allows some ventilation, –Middle layer of wool, quilted fibers, or synthetic fleece to create an insulating layer, –Inner layer of synthetic fabric or wool to provide ventilation and allow moisture to escape  The inner or base layer should not be cotton. Cotton stays wet and speeds heat loss Copyright ©2013 The Windsor Consulting Group, Inc.
    71. 71. Protective Clothing  Moisture evaporation and heat loss design for clothing layers  ISO 7720 and ASHRAE 55-2010 standards for the indoor environment based on air temp and relative humidity in air Copyright ©2013 The Windsor Consulting Group, Inc.
    72. 72. Protective Clothing  With the exception of the wicking layer do not wear tight clothing.  Loose clothing allows better ventilation of heat away from the body.  Do not underestimate the wetting effects of perspiration.  Wicking and venting of the body’s sweat and heat are more important than protecting from rain or snow. Copyright ©2013 The Windsor Consulting Group, Inc.
    73. 73. Protective Clothing  Wear mittens rather than un-insulated gloves (mittens are warmer because your fingers stay together) or use thermal insulated gloves  Wear gloves when fine manual dexterity is not required  Nylon overmitts can be easily put on and taken off if gloved hands are necessary.  Be careful about wearing gloves/scarves getting caught in moving machinery parts Copyright ©2013 The Windsor Consulting Group, Inc.
    74. 74. Protective Clothing  Keep your head covered (up to 40 to 50% of body heat lost when the head is exposed)  Use an appropriate hardhat liner with your hard hat  Wear a facemask, gaiters, or balaclava when working in very cold conditions  Wear socks to protect your ankles and feet. Bring extra socks if moisture or sweat is likely and change socks when necessary Copyright ©2013 The Windsor Consulting Group, Inc.
    75. 75. Protective Clothing  Use footwear that protects against cold and dampness  Footwear should be insulated and fit comfortably when socks are layered  Boots with linings are preferred as they can be taken apart to dry more easily, or new linings can be used  Wet clothing causes body to lose heat quickly since evaporation takes up a lot of heat Copyright ©2013 The Windsor Consulting Group, Inc.
    76. 76. Protective Clothing  Wool and synthetic fabrics, on the other hand, do retain heat when wet  Dirty or greasy clothing has poor insulating properties Copyright ©2013 The Windsor Consulting Group, Inc.
    77. 77. Cold Weather Clothing Clothing Type Long underwear Wool, silk, synthetic fabric Pants Wool, synthetic fabric Shirts, sweaters, turtlenecks Wool, fleece, synthetic fabric Head gear Wool, synthetic fabrics, wind barrier fabric if necessary Gloves, mittens Loose fitting with wool or synthetic fabric liners, thermal insulated or pair of uninsulated gloves inside mittens plus windproof overmitts for very cold conditions Socks Two pairs – light or medium inner and heavy wool or synthetic outer socks Parka / Jacket Loose fitting, filled with down or insulating fiber, attached hood, outer layer of windproof fabric Copyright ©2013 The Windsor Consulting Group, Inc.
    78. 78. Hand Protection  Use tools and machine controls designed for gloved hand operation  Limit bare hand work to 10-20 minutes when < 60ºF  Use warm air jets, radiant heaters, contact warm plates  Use metal handles covered by thermal insulating material  Prevent contact frostbite when near metal surfaces < 20ºF Copyright ©2013 The Windsor Consulting Group, Inc.
    79. 79. Other Protective Controls  Eat high calorie foods – carbohydrates/protein  Consume warm, sweet drinks and soups  Avoid coffee - a diuretic - causes water loss increasing dehydration  Avoid alcohol - a vasodilator - increases peripheral heat loss  Avoid smoking – nicotine - vasoconstrictor and increases risk of frostbite  Stay active in good physical condition Copyright ©2013 The Windsor Consulting Group, Inc.
    80. 80. Safe Work Practices  Avoid heavy perspiration  Work in the warmest hours of the day  Minimize prolonged sitting, standing  Allow time to adjust to cold  Do not work alone  Watch for symptoms of cold-related illness Copyright ©2013 The Windsor Consulting Group, Inc.
    81. 81. Cold Case Study In Red Deer, a carpenter is working outside on a -20°C in February on a building under construction on the 9th floor. The radio reports a general wind chill of – 27.  Hazard assessment –On the ninth floor, the wind is blowing between 20 and 25 km/h (about 15 mph). –Wind is blowing from a side that has support beams (but no walls). –Carpenter needs to work without gloves. The work involves moderate physical activity. –Crew has worked at this location at least 2 months. Copyright ©2013 The Windsor Consulting Group, Inc.
    82. 82. Cold Case Study  Job hazard analysis and corrective action  Workers use a work/warm-up schedule of 55 minutes of work, with 3 breaks, in a 4-hour shift  Breaks taken in totally enclosed/heated room  Measuring/layout on the 8th floor with walls  Crew checks with “buddy” in every 30 minutes  Everyone is dressed appropriately – three layers  Warm drinks, soup provided in the break room Copyright ©2013 The Windsor Consulting Group, Inc.
    83. 83. Summary  Symptoms of hypothermia and frostbite  First aid treatment  Wind chill factor  Engineering and administrative controls  Protective clothing and staying dry Copyright ©2013 The Windsor Consulting Group, Inc.
    84. 84. Quiz 1. The body responds to cold stress by shivering and _____________________________________ 2. Hypothermia can occur in air temperatures as high as 65ºF. True or False 3. Describe at least three symptoms of hypothermia. 4. Describe at least one form of environmental protection for workers in the field. 5. Other risk factors of cold-related illness include: certain medication, certain diseases, age, and physical condition. True or False Copyright ©2013 The Windsor Consulting Group, Inc.
    85. 85. Quiz (cont.) 6. Drinking coffee will help workers stay warm. True or False 7. Describe at least three symptoms of frostbite. 8. Warm up frostbitten areas by rubbing gently. True or False 9. Environmental cold stress factors include: temperature, wind, and __________________ 10.Administrative controls, such as __________, can be used to protect workers from overexposure to cold conditions Copyright ©2013 The Windsor Consulting Group, Inc.
    86. 86. Quiz Answers 1. Decreasing blood flow to the extremities 2. True, when other contributing factors are present 3. Confusion, disorientation, slow heart rate and breathing, shivering, blue lips, poor coordination, slurred speech 4. Heated shelters, windscreens, heat sources, thermal insulated tools 5. True Copyright ©2013 The Windsor Consulting Group, Inc.
    87. 87. Quiz Answers (cont.) 6. False, coffee increases blood flow to the extremities 7. Cold sensation, tingling, aching, numbness, white skin, waxy skin 8. False, rubbing will contribute to the skin damage 9. Dampness 10. Limiting work time or taking additional breaks Copyright ©2013 The Windsor Consulting Group, Inc.
    88. 88. Working in Cold Environments How to Keep Workers Safe and Productive When the Mercury Plunges Thank you for your participation Any questions? Copyright ©2013 The Windsor Consulting Group, Inc.

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