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Using Humidex to Prevent Heat Stress John Oudyk MSc CIH ROH Occupational Hygienist May 26, 2009 Occupational Health Clinics for Ontario Workers Inc. JH&SC.

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Presentation on theme: "Using Humidex to Prevent Heat Stress John Oudyk MSc CIH ROH Occupational Hygienist May 26, 2009 Occupational Health Clinics for Ontario Workers Inc. JH&SC."— Presentation transcript:

1 Using Humidex to Prevent Heat Stress John Oudyk MSc CIH ROH Occupational Hygienist May 26, 2009 Occupational Health Clinics for Ontario Workers Inc. JH&SC information session

2 Monthly average daily high temperatures (YYZ )

3 S S Cooling evaporation of sweat Heat Balance H H Internal Heat sources muscle activity H External Heat sources hot weather radiant heat sources

4 Symptoms: General feeling of tiredness or fatigue. First Aid: Fluid replacement and rest. Transient Heat Fatigue:

5 First Aid: Practice good personal hygiene; keep the skin clean and the pores unclogged, allow skin to dry, wear loose clothing, see doctor if rash persists. Heat Rash (prickly heat) Symptoms: Skin becomes reddened and may itch, feel prickly or hurt.

6 Symptoms: Syncope means “fainting.” First signs are dizziness, feeling light-headed and perhaps nauseous, then the person may faint. Usually occurs in the beginning of heat stress season before the circulation system is adapted. First Aid: Lay victim in a cool location horizontally with feet elevated. If conscious, give fluids. Treatment the same as shock. Heat Syncope (fainting)

7 Symptoms: Cramping of either active muscles (arms, legs) or involuntary (usually abdominal) muscles (or both). First Aid: Replenish electrolytes through drinking of fluids such as Gator-Ade, Squincher, PowerAde, etc-Ade. Rest in a cool environment. Heat Cramps:

8 Symptoms: Nausea, dizziness, weakness headache, blurred vision, profuse sweating, cold/wet (clammy) grayish skin, unconsciousness, coma and death. First Aid: Place victim in a prone position in a cool location, administer fluids if the victim is conscious. If unconscious, seek medical care or transport to a medical emergency room. Heat Exhaustion:

9 Symptoms: Chills, restlessness, irritability, euphoria, red face and skin, disorientation, hot/dry skin (not always), collapse, unconsciousness, convulsions and death. First Aid: Immediate, aggressive cooling of the victim’s body using wet cloths, immersion into cold water or alcohol wipes. Transport to emergency medical facility ASAP! Heat Stroke:

10 Watch out for each other! A worker heading into a heat stroke will no longer realize what’s happening to him/her It is vital that co-workers be able to recognize what’s happening and intervene Without quick attention, the co-worker may die!

11 Indirect Health Effects: Reduced Work Performance: tired, fatigued workers perform with reduced accuracy, efficiency Increased Accidents: tired, fatigued workers are more susceptible to accident and injury Reproductive Problems: heat has been shown to reduce both male and female fertility and can be a problem for the fetus Heart/Lung Strain: if you already have heart, lung, kidney or circulatory problems; heat stress is an added strain on your body which in severe situation may precipitate serious episodes of acute problems

12 Predisposing Factors:  very small body size  overweight  over 40 years old (the older the more sensitive)  previous heat illness  heart disease  high blood pressure  diabetes  inactivity  physical activity  …sooner or later we’re all vulnerable …

13 … with all these vulnerabilities who typically gets heat stroke? young physically fit males and sick older people

14 What’s the Law? General Duty Clause: –25(2)(h) “… an employer shall, … take every precaution reasonable in the circumstances for the protection of a worker;” taken from: OH&S Act MOL Heath and Safety Guidelines: Heat Stress: –“The MOL uses the TLVs ® for Heat Stress published by the ACGIH”. taken from:

15 1. clothing OK/adjustment? 2/3a. WBGT screening/ detailed action limit 2/3b. WBGT screening/ detailed TLV ® 5. job-specific controlsNO 4. heat strain evaluation - heart rate - core temperature YES above below above or no data excessive OK below 2007 ACGIH Heat Stress/ Strain TLV ® keep monitoring general controls

16 clothing adjustment changes clothing adjustment work clothes 0.0 cloth coveralls (with only underwear) 0.0 double layer cloth +3.0 SMS coveralls +0.5 polyolefin coveralls +1.0 limited-use vapour barrier coveralls +11.0

17 What is a WBGT? 1.normal thermometer (dry-bulb) 2.wet-bulb thermometer humidity 3.globe temperature radiant heat WBGT Wet Bulb Globe Temp.

18 WBGT Formulas: For indoor or shaded environments For indoor or shaded environments: WBGT = 70% T nwb + 30% T g T nwb = natural wet-bulb temperature (70%) T g = globe temperature (30%) For direct sunlight exposure: WBGT = 70% T nwb + 20% T g + 10% T db T db = dry-bulb temperature

19 Screening WBGT (in °C ): work demands: lightmoderateheavyvery heavy 100% work; (breaks incl.) not allowed 75% work; 25% rest not allowed 50% work; 50% rest % work; 75% rest Action Level TLV ®

20 Can we simply use the outside temperature to estimate WBGT? 4+ºC WBGT 30ºC

21 Outside vs Inside (WBGT): temperature lag (4ºC WBGT) in heating up temperature lag (3ºC WBGT) in cooling down

22 1. clothing OK/adjustment? 2/3a. WBGT screening/ detailed action limit 2/3b. WBGT screening/ detailed TLV ® 5. job-specific controlsNO 4. heat strain evaluation - heart rate - core temperature YES above below above or no data excessive OK below 2007 ACGIH Heat Stress/ Strain TLV ® keep monitoring general controls

23 Action limit vs. TLV ® Action limit triggers general controls for unacclimatized workers, general controls include: –providing annual heat stress training, –encouraging adequate fluid replacement, –permitting self-limitation of exposure, –encouraging watching out for symptoms in co- workers, and –adjusting expectations for workers coming back to work after an absence

24 Action limit vs. TLV ® The TLV ® applies to healthy, acclimatized, well hydrated workers not on medication and triggers job-specific controls (in addition to general controls) which include: –engineering controls to reduce physical job demands, shielding of radiant heat, increased air movement, reduction of heat and moisture emissions at the source, –adjusting exposure times to allow sufficient recovery, and –personal protective equipment that provides for body cooling – in addition to general controls)

25 Body Changes due to Acclimatization: Gradually build up your ability to handle heat (increase exposure time by an hour/day) When your body gets used to the heat (acclimatized) your sweating becomes more “efficient” (more sweat, quicker but with less salt in sweat) blood flow to skin is reduced; more blood is available to muscles heart rate more stable, heart stoke volume increases and blood volume increases

26 When are you acclimatized? acclimatization requires up to 3 weeks to be fully established and is noticeably decreased after 4 days: the 2007 TLV ® suggests as a criteria: exposed for 5 of last 7 days or 10 of the last 14 days “Hot spells in Ontario seldom last long enough to allow acclimatization.” (taken from Ontario Ministry of Labour Heat Stress Guideline: )

27 Pearson Airport (Jun-Sept/05)

28 See your doctor If you are having trouble getting used to the heat or If you have questions about how heat may affect a medical condition you have … see your doctor!

29 Workload Descriptions (TLV Table 3): Light: Sitting with light manual work with hands or hands and arms, and driving. Standing with some light arm work and occasional walking. Moderate: Sustained moderate hand and arm work, moderate arm and leg work, moderate arm and trunk work, or light pushing and pulling. Normal walking. Heavy: Intense arm and trunk work, carrying, shoveling, manual sawing; pushing and pulling heavy loads; and walking at a fast pace. Very Heavy: Very intense activity at fast to maximum pace.

30 Adjusting for Weight: Sample calculation: standing = 42 watts*(55 min/60min)= 38.5 watts walking = 174 watts*(5 min/60min)= 14.5 watts light work, two arms = 105 watts basal metabolism = 70 watts total metabolic rate = 228 watts (light) … but this applies to a 154 lb person, for an 200 lbs person we need a correction factor: 228 watts * (200/154)= 296 watts (moderate) … for an 245 lb person we need a correction factor: 228 watts * (245/154)= 362 watts (heavy) … and, what if the worker is female, or dehydrated, or etc.? …

31 1. clothing OK/adjustment? 2/3a. WBGT screening/ detailed action limit 2/3b. WBGT screening/ detailed TLV ® 5. job-specific controlsNO 4. heat strain evaluation - heart rate - core temperature YES above below above or no data excessive OK below 2007 ACGIH Heat Stress/ Strain TLV ® keep monitoring general controls

32 Physiological Monitoring? check heart rate check body temperature is this medical monitoring? (MOL opinions split) should data collected be treated as medical information? (i.e. confidential) who is qualified to collect info, store it, interpret? what happens if exceed limits? personal vital signs monitoring equipment (e.g. swallow monitoring pill, ear temperature monitor, heart rate monitor) – who sets alarms on machines? issues need to be addressed before it happens

33 Heat stress death Inquest Findings: Brian Freeman, arts student, on the second day on a summer job as a garbage collector experienced a heat stroke; died 17 days later No training to recognize symptoms WBGT too difficult to apply and doesn’t take into account vulnerabilities Rather than relying on the TLV, train workers to enable them to self-regulate (recognize symptoms and know how to reduce heat stress with breaks and fluid intake) issues around malignant hyperthermia, a genetic condition (1 in 200) which makes people more susceptible to heat strain

34 Response to a Heat Stroke Death the hazard of heat stress was tragically illustrated by a fatal incident in Barrie in 2001 soon after the incident, the CAW approached OHCOW to find a simpler way of evaluating heat stress (e.g. Humidex), than the WBGT (wet bulb globe temperature) the Oshawa GM assembly plant was used for the pilot study & GM management had input into the development

35 WBGT-Humidex correlation a mid-sized manufacturing firm (350 workers) with some heated presses (400 °F) during summer of 2002 three students hired to take WBGT/Humidex measurements continuously on 3 shifts (>7000 measurements taken) based on 3773 measurements (all measurements above 22°C WBGT) resulting regression equation: Humidex = *WBGT

36 WBGT table converted to Humidex by correlation lightmoderateheavyvery heavy % work not allowed 50-75% work not allowed 25-50% work % work Action Level TLV ®

37 2007 Humidex Response Plan: Humidex action alert & information & water warning, education & double water restrict activity 25% & actively monitor for signs of heat strain 40-41* restrict activity 50% & actively monitor for signs of heat strain 42*-44 restrict activity 75% & actively monitor for signs of heat strain 45+ stop work

38 WBGT/Humidex Category Assignment Comparison: jobagreementHumidex earlier WBGT earlier Job1 (n=612) 89.5%7.5%2.9% Job2 (n=629) 92.2%6.5%1.3% Job3 (n=638) 92.9%5.2%1.9% Job4 (n=677) 89.8%8.3%1.9% Job5 (n=631) 89.6%4.9%5.8%

39 acclimatized version: Humidex1 Response Humidex supply water to workers on an “as needed” basis post Heat Stress Alert notice; encourage workers to drink extra water; start recording hourly temperature and relative humidity post Heat Stress Warning notice; notify workers that they need to drink extra water; ensure workers are trained to recognize symptoms Work with 15 minutes relief per hour can continue; provide adequate cool (10-15  C ) water; at least 1 cup (240 mL) of water every 20 minutes worker with symptoms should seek medical attention Work with 30 minutes relief per hour can continute in addition to the provisions listed previously; 45-46* if feasible, work with 45 minutes relief per hour can continuein addition to the provisions listed above * 45 or over only medically supervised work can continue *at Humidex exposures above 45, heat stress should be managed as per the ACGIH TLV ® 50* or over

40 1.Find a representative place 2.Find temperature and humidity on chart and read Humidex 3.Take into account radiant heat (add 2-3° to Humidex for full sun) 4.Need to take clothing into account (add 5° for overalls on top of clothes) 5.Measurements should be when the ambient temperature is above 26°C and then be taken hourly 6.Compare to chart How to measure heat stress using temperature & humidity

41 CAVEAT (warning)! never ignore symptoms even if measurements meet standards!

42 Outside vs Inside (Humidex): temperature lag (5ºC Humidex) in heating up temperature lag (6ºC Humidex) in cooling down

43 Where do breaks fit in? General controls (action limit triggered) do not specifically mention breaks although the categories are ordered by % work Specific controls (TLV triggered) specifically mention adjusting work/rest schedules (administrative controls) However, general controls do specify permitting “self-limitation of exposures” – what if this cannot be done (line work) … situation is ambiguous …

44 Calculators: Humidex calculator ( ) WBGT estimate calculator (under development) ( )

45 Adjustments for Radiant Heat : Outside measurements taken over 2002 show the radiant heat load (globe temperature - T g ) between 10 am- 3 pm was 0-16°C above dry bulb temperature (T db ) with an average 7.5°C The difference this makes to the WBGT (using the formula WBGT = 0.7 x T nwb x T g x T db ) is 0-3.2°C WBGT (average 1.5°C which is equivalent to 2-3°C Humidex on average)

46

47 Adjustments for Air Velocity: For the issue of the difference air velocity makes, the difference between natural wet bulb and psychrometric wet bulb is 1°C Thus the maximum WBGT difference between dead air and high velocity air would be (using the formula WBGT = 0.7 x T nwb x T g ) about 1°C or 1.5-2°C Humidex

48 General Controls (1) Humidex 1 Provide accurate verbal and written instructions, frequent training programs, and other information about heat stress and strain Encourage drinking small volumes (approximately 1 cup) of cool, palatable water (or other acceptable fluid replacement drink) about every 20 minutes Permit self-limitation of exposures and encourage co- worker observation to detect signs and symptoms of heat strain in others Adjust expectations of those returning to work after absence from hot exposure situations Monitor heat stress conditions and reports of heat- related disorders

49 General Controls (2) Humidex 1 Counsel and monitor those who take medications that may compromise normal cardiovascular, blood pressure, body temperature regulation, renal, or sweat gland functions; and those who abuse or are recovering from the abuse of alcohol or other intoxicants Encourage consumption of salty foods (with approval of physician if on a salt-restricted diet) Consider pre-placement medical screening to identify those susceptible to systemic heat injury

50 External heat source controls At the source –Replace/isolate heat producing processes –Block radiant heat with barriers (shade) Along the path –Isolate worker from heat –Air condition workplace (booth) –Capture hot air with exhaust ventilation External Heat sources hot weather radiant heat sources H

51 Internal source controls: At the source –Reduce workload improve ergonomics, provide assistance, increase relief time slow down –Provide adequate water –Actively cool body –Gradually acclimatize –Ensure good nutrition and rest Internal Heat sources muscle activity H H

52 Cooler Fans Purpose of a cooling fan is primarily to increase the rate of sweat evaporation but it also cools by convection if the air is cooler than the skin Fan coolers may interfere with local exhaust ventilation for contaminant control, therefore be careful in where they are placed and how they are pointed

53 Cooler Fans (limitations) If the relative humidity is over 75-80% the fan will no longer increase evaporation of sweat The closer the air temperature is to skin temperature (35- 36°C) the less effective the cooling –if the air temperature exceeds skin temperature then the fan may even heat up the body (like a convection oven)!

54 Promoting Cooling Wear loose clothes that allow sweat to evaporate easily (cotton) Take internal heat sources into account when using any personal protective clothing that prevents sweat from evaporating Wash clothes regularly and maintain good personal hygiene S S Cooling evaporation of sweat

55 Drink Water Acclimatization does not decrease your body’s need for water. Drink plenty of water!

56 What to drink: Electrolyte drinks (e.g. Gatorade) are usually not needed for typical North American diet (can be used for first aid for cramps). Stay away from caffeinated carbonated, diet drinks and alcohol as they take water out of your body. Water is the best; juices and/or noncaffeine sport drinks are also good (juices contain energy restoring glucose).

57 Dehydration To prevent dehydration, take advantage of scheduled water breaks!

58 How Much Water is Enough? More than you want just to satisfy your thirst Sources of water are: 1. Fluids - 1 cup or 8 oz = 240 mL every 20 min 2. Foods - fruit & veggies are 90% water Why 10-15°C? … to maximize the amount you drink (not too cold, not luke warm) Does it need to be delivered to the work station? … depends on workplace logistics …

59 Dehydration fluid losstime*effect & symptoms (* timing may vary based on intensity of work and heat/humidity) 0.75 L1 hr unnoticed (at 1.5% weight loss you are considered dehydrated) 1.5 L2-3 hrs loss of endurance, start to feel thirsty, feel hot, uncomfortable 2.25 L3-4 hrs loss of strength, loss of energy, moderate discomfort 3 L4-5 hrs cramps, headaches, extreme discomfort L5-6 hrs heat exhaustion, nausea, faint 5+ L7+ hrs heat stroke, collapse, unconsciousness taken from: OH&S Canada Volume 69, Number 5, page 52, May 2000

60 You can and should replace essential elements lost during sweating; Eat a balanced diet rather than taking salt tablets or drinking expensive sports drinks. Eat Healthy

61 Personal Protective Equipment Special cooling vests or ice vests have been developed to wear under chemical–resistant suits (use on a case by case basis – they may not work for everyone)

62 Job Specific Controls Humidex 2 Consider engineering controls that reduce the metabolic rate, provide general air movement, reduce process heat and water-vapor release, and shield radiant heat sources, among others Consider administrative controls that set acceptable exposure times, allow sufficient recovery, and limit physiological strain Consider personal protection that is demonstrated effective for the specific work practices and conditions at the location In addition to general controls

63 OHSCO Package: the poster

64 OHSCO Package: the heat stress awareness tool (wheel)

65 OHSCO Package: the Awareness Guide

66 Resources: Workers Health & Safety Centre Video PowerPoint presentations Humidex handout sheets online calculators OHSCO wheel pocket/wall WBGT/Humidex estimator (thermal hygrometer)? (opportunity for an entrepreneur?)

67 WH&SC video 13 minute video summarizing heat stress hazards and how to respond to them target audience is workers downloadable from the internet (60 Mbytes)

68 other jurisdictions … BC H&S Guideline G7.29-4: Heat stress assessment using a Humidex index onNumber:G onNumber:G Alberta has incorporated the Humidex plan in a 17 page bulletin for workplaces

69 other jurisdictions …

70 Acknowledgements: I’d like to acknowledge those who helped shape the ideas presented here: George Botic Paul Goggan Dan BoonePaul Piels Tom HarrisLejla Krdzalic

71 … any questions? …


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