1. Heat-Related Illness in the Outdoor Environment
WSU EH&S Statewide 10/07

2. Why is it important to know about heat illness?
Heat-Related Illness
Why is it important to know about heat illness?
Heat illness can effect anyone
Heat illness is dangerous
Heat illness can kill
Heat illness is preventable

3. Presentation Outline What is a heat-related illness
Types of heat-related illness
Signs & symptoms
Contributing risk-factors
Prevention
Emergency response procedures

4. Heat-Related Illness
Heat stress is the buildup in the body of heat generated by the muscles during work, plus heat coming from warm and hot environments.
When the body becomes overheated, less blood goes to the active muscles, the brain and other internal organs. Workers get weaker, become tired sooner, may be less alert, and less able to use good judgment.
As the stress from heat becomes more severe, there can be a rapid rise in body temperature and heart rate.
Heat exhaustion and heat stroke result when the body is subjected to more heat than it can cope with, causing decreased mental performance, organ damage, convulsions, and death.
During hot weather, heat-illness can be the underlying cause of other injuries, such as heart attacks on-the-job, falls, and equipment accidents arising from poor judgment.

5. Types of Heat-Related Illnesses
Heat Rash
Heat Cramps
Heat Fatigue
Heat Exhaustion
Heat Stroke
No comments

6. Heat Rash What to look for: Red blister-like eruptions
Itching or prickling
What to do:
Get out of the sun to somewhere cool
Keep skin dry
Monitor for infection
Consult physician

7. Heat Cramps
A heat cramp is an involuntarily and forcibly contracted muscle or fibers of a muscle that don’t relax (i.e., a muscle spasm that doesn’t relax).
Heat cramps usually occur in the arm, leg or stomach muscles, and are very painful.
Heat cramps can last a few seconds, 15 minutes, or more, and can occur multiple times, and without warning.

8. Heat Cramps are Painful!
Pain from heat cramps distract a worker, and may create serious consequences.
A person’s automatic reaction is to bend over in pain, fall down in pain, or reach for area in pain without thought of the result of moving quickly.
This can be dangerous, if a person is operating machinery, driving, on a roof, etc. when a heat cramp occurs; a serious accident may result.

9. Treatment of Heat Cramps
Get out of the heat to a cool place.
Rest!
Drink electrolyte-containing fluids.
Gently stretch the cramped muscle and hold the stretch for ~ 20 seconds, then gently massage the muscle. Repeat if necessary.
Don’t return to work in the heat this day.

10. Heat Fatigue
Heat Fatigue signals a person is in trouble, and potentially headed towards heat exhaustion.
What to look for:
Impaired mental or sensorimotor performance
Fainting
What to do:
ASAP: Stop work, get out of the heat, drink fluids, and seek medical aid before heat fatigue progresses to heat exhaustion.

11. Heat Exhaustion Beware!
Heat exhaustion is a more serious and advanced stage of heat-related illness than heat fatigue.
Beware!
Untreated heat exhaustion can quickly progress to heat stroke.

12. Heat Stroke Can Be Fatal!
Danger!
Heat Fatigue
& Dehydration
Heat
Exhaustion
Stroke
Heat Stroke Can Be Fatal!

13. Heat Stroke IS A MEDICAL EMERGENCY
The body becomes so stressed that it can no longer regulate its on own temperature & it over-heats.
Potentially, when the body can’t cool itself, body temp can reach 106° in minutes.
The body literally cooks itself.

14. Prevent Heat-Related Illness
To prevent injury, learn to recognize the signs and symptoms of heat exhaustion and heat stroke.

15. Signs & Symptoms Heat Exhaustion & Heat Stroke
Both heat exhaustion and stroke may exhibit:
Red Face
Mood changes, irritability, agitation, or confusion
Nausea/Vomiting
Unsteady gait
Fainting
Erratic behavior
Rapid pulse
Fatigue and weakness
Dizzy or light-headed

16. Knowing the Difference
Can Save a Life!
HEAT EXHAUSTION
HEAT STROKE
Hot, dry skin/face that is flushed, but not sweating
High temperature
(>104° F)
Only in Heat Stroke
Chills/Shivering
Convulsions and/or seizures
Loss of consciousness
Coma
May resemble a heart attack
Extreme sweating or pale, clammy skin
Normal to slightly elevated temperature

17. Heat Exhaustion and Heat Stroke
Stop work, get out of the heat, drink electrolyte-containing fluids, and seek medical aid

18. How The Body Stays Cool!
The body’s thermostat is the Hypothalamus gland, which is located in the brain, and controls body heat.
The hypothalamus signals blood to flow to surface of the skin to cool itself.
The body sweats.
Sweat evaporates off skin and has a cooling effect on the blood and thus the body.
Many things can interfere with the body’s cooling processes or contribute to body heat production.

19. Contributing Factors to Heat-Related Illness
Heat + Humidity + Other (Internal & External) Factors =
Total Heat Burden on the Body

20. Humidity and Heat Inhibit Body Cooling
Humidity (moisture in the air) interferes with sweat evaporating from the skin thus interferes with the cooling of the body.
The more humid it is, the less sweat can evaporate, and the less body cooling occurs, and the more chance of heat-related illness
The hotter the temperature, the harder the body has to work to produce enough sweat to stay cool.
Heat and humidity together greatly increase the potential for heat-related illness.
No comments

21. Monitor Heat and Humidity
To help keep the body’s cooling mechanisms working properly, it is important to monitor heat and humidity values throughout each workday in hot and/or humid weather, and adjust tasks accordingly.
No comments

22. Heat Index Used to Monitor Heat + Humidity
Heat + humidity values = Heat Index
The higher the temperature and humidity the higher the Heat Index.
The Heat Index gives an “Apparent” Temperature.
The Apparent Temperature is a higher value than temperature alone as it factors in humidity.
Monitor the Heat Index on-line and/or by using a Heat Index Chart (see next slide).

23. Heat Index Chart Heat + Humidity = Heat Index
Implement controls at 90° or before
No comments
May feel effects at 80°
Source: National Oceanic and Atmospheric Administration

24. Heat Index Warnings Heat + Humidity = Heat Index
General Effect of Heat + Humidity with Prolonged Exposure & Physical Activity
Extreme Danger
130 or higher
Heat stroke highly likely
Danger
Heat stroke, heat cramps, and heat exhaustion likely, and heat stroke possible
Extreme Caution
90-104
Heat stroke, heat cramps, and heat exhaustion possible
Caution
80-89
Fatigue possible
Implement controls at 90° or before
May feel effects at 80°

25. Other Risk Factors Heat + Humidity + Other Factors = Total Heat Burden
Learn to recognize risk factors and how to mitigate them to avoid heat-related illness.

26. Risk Factors: Direct Sun
The more direct sun, the hotter the environment.
Shield yourself or stay out of the direct sun as much as possible.
Sunlight is at its peak between 10AM-2PM daily; a good time to stay out of the sun.

27. Risk Factors: Radiant Heat Radiant heat can add 15° to Heat Index
Radiant heat is the transfer of heat energy through the air from sun and other sources such as, asphalt, engines, and dark surfaces.
Radiant heat can add 15° to Heat Index

28. Risk Factors: Conductive Heat
Conductive heat transfers heat to worker by direct contact with heat sources such as tools, equipment, and machinery.

29. Risk Factors: Limited Air Movement
Limited air movement, such when there is little or no wind, creates a hotter environment as the less the air moves, the less cooling of the body can occur.
For example, there is limited air movement while working in a trench, a partially enclosed area, vehicle cab, or on the leeward side of a structure.

30. Risk Factors: Physical Exertion
The harder and longer you work, the hotter you become.
Physical exertion increases the chance of dehydration.

31. Risk Factors: Protective Clothing
Wearing PPE such as non-breathable spray suits, gloves, boots, rain gear or respirators can hold heat to the body and inhibit cooling.

32. Risk Factors: Personal
Age: the young and over-50 are more susceptible to heat-related illness
Poor fitness: use more physical exertion and energy to do a job
Over-weight: the body holds heat more easily and is stressed by extra weight

33. Risk Factors: Certain Medications
Some medications can make a person more sensitive to the effects of heat and many contribute to body dehydration; examples are:
Allergy medicines (antihistamines)
Cough/cold medicines
Blood pressure/heart medicines
Irritable bladder/bowel medicines
Laxatives
Mental health medicines
Seizure medicines
Thyroid pills
Water pills (diuretics)
Consult health care provider or pharmacist for information

34. Risk Factors: Medical Conditions or Illnesses
Heart conditions, diabetes, high blood pressure, etc.
Illness or fever
Hangover

35. Risk Factors: DIET MATTERS!
Before working in the heat:
No heavy foods
Harder to digest & increases metabolic heat
No alcohol or sugary drinks
Dehydrate the body
No caffeinated drinks
Diuretic
No carbonated drinks
Gas bubbles limit fluid intake
No nicotine
Constricts blood vessels

36. Risk Factors: Attitude
Ditch that “Macho” Attitude!
Slow down, pace yourself, and take breaks, especially on hot days!

37. Risk Factors: Attitude
Type-A’s: Slow the Pace to Keep from Over-Heating!
Slow down, pace yourself, and take breaks on hot days!

38. Risk Factors: Attitude
Don’t Be a Super-Hero!
These actions lead to dehydration and heat stress:
“I’m tough ~ I don’t need a water break”
“I’m not thirsty ~ I don’t need to drink”
“I’ll lose pay, if I take a water break”
“I’ll be letting my team down, if I take a break”
“I’m new here ~ I need to prove myself”

39. Heat Illness Regulations
An average of 500 people die each year in the United States by effects from heat (EPA)
In 2007, the State of Washington put in place regulations to address heat related illness:
WAC

40. Heat Illness Regulations WAC 296-62-095
Requires:
Employers with one or more employees performing work in an outdoor environment to implement workplace practices designed to reduce or eliminate risk of heat-related illness.
Practices must be in writing, and must include:
Accessibility to drinking water in sufficient quantity to provide at least one quart per employee per hour
Procedures to remove employees experiencing signs and symptoms of heat-related illness from duty, to provide sufficient means to reduce body temperature, and to determine if medical attention is needed
Employee training must be provided initially and annually.

41. Preventing Heat-Related Illness
Supervisors prevent heat-related illness by:
Monitoring the work-day weather & heat index
Scheduling tasks to minimize physical exertion
Advising employees to pace themselves
Encouraging frequent breaks on hot days
Providing radio, pager, or cell phone to keep in contact with base and each other
Rotating job tasks

42. Preventing Heat-Related Illness
Supervisors prevent heat-related illness :
By providing annual heat-related illness awareness training
By providing CPR and First Aid training
By providing easy access to water via water bottles, coolers, hydration packs, and transportation to base water supply

43. Preventing Heat-Related Illness
Supervisors prevent heat-related illness by:
Providing appropriate PPE
Cooling vests & bandanas
Hats
UVA/UVB rated sun glasses
Providing sun screen (SPF 15 or greater & UVA/UVB effective)

44. Work Smart Learn how to Keep Cool!

45. Preventing Heat-Related Illness
Work Smart
Clothing traps body heat and inhibits perspiration
Especially:
Personal protective equipment (PPE)
Heavy clothing
Multiple clothing layers
Dark-colored clothing absorbs heat
Stay Cool!
Remove PPE & excess clothing during breaks

46. Preventing Heat-Related Illness Work Smart
Wear appropriate clothing:
Light-colored
Light-weight
Natural fibers
Hat with a brim
Cooling vest or bandanas may be helpful in some cases
Apply appropriate sunscreen to exposed skin

47. Preventing Heat-Related Illness Work Smart: Acclimatize
Acclimatization is Extremely Important!
People can collapse, become easily fatigued, make mistakes, get into accidents, or develop heat-related illnesses, if not properly acclimatized
Many of us travel across the state, nation, or over seas for our work
Take special care, if you are used to a cooler climate and are going to a hot/humid climate
Go Prepared!

48. Preventing Heat-Related Illness Work Smart: Acclimatize
Plan in extra time (several days) to adjust to hot working conditions
Gradually build up exposure time, and adjust work routines, to increase heat tolerance

49. Preventing Heat-Related Illness Work Smart: Acclimatize
Supervisors and co-workers pay special attention to employees that are:
New
Just returning from work from being sick
Are absent for more than 2 weeks
Just moved from a cooler climate
During heat-wave events

50. Preventing Heat-Related Illness Work Smart: Physical Exertion
Produces Internal Heat in the Body
Consider:
What kind of work will be performed?
How hard is the work?
How long is the work task/period?
No comments
Photo credit:

51. Preventing Heat-Related Illness Work Smart
Alternate heavy work with light work
Schedule the hardest work for cooler parts of the day
Pace yourself
Work in the shade or out of direct sun
1.) Insert slides # 28 and 27 before this slide in that order.
Increase frequency of breaks when:
Conditions are very hot
Work requires high exertion levels
Protective clothing limits evaporative cooling

52. Preventing Heat-Related Illness Work Smart: Stay Hydrated
Proper hydration is key to preventing heat illness
When dehydrated the amount of sweat that can be produced decreases, and the body can’t cool itself
Drink water throughout the day to replace body fluid lost by sweating
Do not wait for thirst before drinking water
It is also important to incorporate electrolyte-containing drinks in your daily fluid intake
Drink 8-16 ounces of water before work to pre-hydrate

53. Preventing Heat-Related Illness Work Smart: Stay Hydrated
Drink 1 quart or more of water over the course of an hour when the work environment is hot, and a person sweats more than usual
This is to replace the 2 quarts of sweat per hour the body can produce in hot environments
~1 cup every 15 minutes
Persons who are on restricted fluids, or with medical conditions that heat or bright light effect consult a physician before working in the heat

54. Preventing Heat-Related Illness Work Smart: Stay Hydrated
Drinking water sources:
Be closeable & have a tap
Clearly marked
Suitably cool
Individual cups provided
Bottled water
Hydration packs called camelbacks
-users sip water through a tube
Photo credit: UC Davis
Hydration pack
Worker wearing hydration pack

55. Preventing Heat-Related Illness Work Smart
ESTABLISH A BUDDY SYSTEM!
Keep an on co-workers for symptoms of heat illness such as crankiness and denial

56. Having Trouble in the Heat?
All Activity
If you become:
Light-headed
Weak
Have a pounding heart
Confused
Faint
Trouble breathing
Notify Supervisor
Take a Break and Rest
In a cool place
Drink fluids
Loosen or shed unnecessary clothing
Lie down

57. If a Co-Worker Is Having Trouble in the Heat
Transport the person to base, or to a cooler, shaded area so the person can rest and lay down.
Get help on the way: call 911, or have base call 911, and then alert the supervisor.
Do not leave person alone!
Loosen and remove heavy clothing that restricts evaporation and cooling.
If person is alert and not nauseated, provide fluids such as cool water, juice, sports drinks, or non-caffeinated soft drinks.
Fan the person, spray or mist with cool water, apply wet cloth to skin.
Do not further expose the person to heat any more that day.

58. Get Help on the Way!
Call 911!
Call when a person does not feel better in about 15 minutes. Call sooner if they show any signs of heat stroke!
SECONDS COUNT!

59. If You Suspect Heat Stroke
WHILE WAITING FOR MEDICAL HELP TO ARRIVE
Cool the person using whatever methods available
Apply ice packs under arms & to the groin area
Place the person in a cool shower
Spray them with cool water from a hose
Sponge the person with cool water
If the humidity is low, wrap person in a cool wet sheet and fan them vigorously
Immerse the person in a tub of cool water
Do not try to give unconscious persons fluids to drink.

60. If You Suspect Heat Stroke
If emergency 911 medical personnel are delayed, call the hospital emergency room for further instruction

61. In Summary: Work Smart!
Know the signs and symptoms of heat related illnesses and take them seriously
Stay hydrated - Drink water/fluids frequently
Consider sports drinks when sweating a lot
Monitor Heat Index
Avoid alcohol, caffeinated drinks, and heavy meals before or during work
Photo credit:

62. In Summary: Work Smart! Plan work tasks for heat relief Pace yourself
Acclimatize
Wear appropriate clothing
Keep an eye on your buddy
Take breaks

63. Stay Cool!
Proceed to quiz