1. 1 Heat-Related Illness in the Outdoor Environment

2. 2 Quick Quiz – True or False 1.Cola drinks are the best way to hydrate when you are working outside. 2.Light colored clothing is better than dark when working in the sun. 3.Your medicine may make you more vulnerable to heat-related illness. 4.It is important to drink your water all at once.

3. 3 Training for Employees Information

4. 4 This employee training will cover: Environmental factors that contribute to the risk of heat-related illness Personal factors that may increase susceptibility to heat illness Your employer’s procedures for identifying, evaluating, and controlling exposure The importance of removing personal protective equipment during all breaks The importance of frequent consumption of small quantities of water The importance of acclimatization

5. 5 This employee training will also cover: The different types of heat-related illness Signs and symptoms of heat-related illness The importance of reporting possible heat illness in yourself or co-workers to your employer and/or supervisor. Your employer’s procedures for responding to symptoms of possible heat-related illness, including how emergency medical services will be provided should they become necessary The purpose and requirements of this standard

6. 6 Heat illness is:  Overheating of the body  Inability of the body to cool itself NASA Why is it important to know about and address heat illness?  Heat illness is dangerous  Heat illness can kill  Heat illness is preventable

7. 7 Where does heat illness happen?  Heat illness can affect anyone.  It can happen in logging, construction projects, landscaping, agriculture, field work, transportation, etc.

8. 8 Environmental factors that contribute to the risk of heat-related illness

9. 9 Environmental Factors Direct sun, heat and humidity  More direct sun the greater the risk  See temperature/ humidity chart (next slide) Limited air movement  Low or no wind

10. 10 Heat and Humidity Chart Source: National Oceanic and Atmospheric Administration

11. 11 Evaluation of environmental factors – air temperature and humidity Heat IndexGeneral Effect of Heat Index on People in Higher Risk Groups 80-89 Caution Fatigue possible with prolonged exposure and physical activity. 90-104 Extreme Caution Sunstroke, heat cramps, and heat exhaustion possible. 105-129 Danger Sunstroke, heat cramps, and heat exhaustion likely, and heat stroke possible. 130 or higher Extreme Danger Heat stroke highly likely with continued exposure. Link: The full heat index charts are available through the National Climate Data Center at http://www.crh.noaa.gov/dvn/tools/heatindex.pdfhttp://www.crh.noaa.gov/dvn/tools/heatindex.pdf

12. 12 Environmental Factors Hot equipment  Engines add more heat Heat reflected from ground or objects  Watch out for reflected heat

13. 13 Environmental factors Physical exertion  What kind of work are you doing?  How hard are you working?

14. 14 Workload Activity CategoriesExample Activities RestingSitting quietly Sitting with moderate arm movement LightSitting with moderate arm and leg movements Standing with light work at machine or bench while using mostly arms Using a table saw Standing with light or moderate work at machine or bench and some walking about

15. 15 Workload Activity CategoriesExample Activities ModerateScrubbing in a standing position Walking about with moderate lifting or pushing Walking on level at about 4 miles/hr while carrying 6-7 pound weight load HeavyCarpenter sawing by hand Shoveling dry sand Heavy assembly work on a non-continuous basis Intermittent heavy lifting with pushing or pulling (e.g. pick-and-shovel work) Very HeavyShoveling wet sand

16. 16 Environmental factors Clothing  Personal protective equipment (PPE)  Heavy clothing  Multiple layers  Dark colored clothing

17. 17 Personal factors that may make you more susceptible to heat-related illness

18. 18 Personal risk factors Dehydration –You need to drink more water when it’s hot Loss of electrolytes –When you sweat you lose electrolytes –Electrolytes are needed for your body to function Illness/fever

19. 19 Personal risk factors Age, weight, and personal fitness Medical conditions –Heart conditions –Diabetes –Etc. Certain medications –See next slide

20. 20 Some medications can make you more sensitive to the effects of heat. Allergy medicines (antihistamines) Cough and cold medicines Blood pressure and heart medicines Irritable bladder or bowel medicines Laxatives Mental health medicines Seizure medicines Thyroid pills Water pills (diuretics) A health care provider or pharmacist can tell you for sure.

21. 21 Personal risk factors Diet –Sugar added drinks –Heavy foods –Alcohol –Hangover Nicotine use

22. 22 “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” “I’m new here ~ I need to prove myself” Don’t fall for these beliefs – we want you healthy! Personal risk factors

23. 23 Preventing heat illness – Work Smart Schedule the hardest work for the cooler parts of the day Alternate heavy work with light work when possible. Increase breaks if: Conditions are very hot; or High exertion levels; or Protective clothing limits evaporative cooling Establish a “Buddy System” to keep an eye on co-workers for symptoms of heat illness such as crankiness and denial.

24. 24 Preventing heat illness - Other important precautions Wear proper clothing –Light colored –Light weight –Natural fibers –Hat with a brim –Cooling vest may be helpful in some cases. Work in the shade or out of direct sun when possible

25. 25 Remove PPE and excess clothing during breaks This is important to help you stay cool

26. 26 Water It is important to drink small quantities of water throughout the day. One quart or more over the course of an hour may be necessary when the work environment is hot and you may be sweating more than usual as you work.

27. 27 Proper hydration is key to preventing heat illness DO Drink plenty of water (about a cup every 15 minutes) Start work well hydrated Consider sports drinks DO NOT Drink pop and other sugary drinks Drink lots of coffee and tea Drink alcohol Wait for thirst before drinking water

28. 28 Sources of water Drinking water sources: Closeable & have tap Clearly marked Suitably cool Individual cups Other options: Bottled water Hydration packs- ( “camelbacks”) Lightweight bags carried on the back. Users sip water through a tube. Photo credit: UC Davis Worker wearing hydration pack Hydration pack

29. 29 Acclimatization is important Not being used to the heat –People need to adjust (acclimate) to hot working conditions over a few days. In severe heat, gradually build up exposure time especially if work is strenuous. Adjust work routines as needed so employees are able to adjust and increase their tolerance. Pay special attention to: New employees People just back from being sick Anyone absent for more than 2 weeks People who have just moved from a cooler climate Everyone during heat wave events

30. 30 Types of Heat Illnesses There are five main kinds of heat illness: Heat rash – often under clothing Heat cramps – in arms or legs with physical labor Fainting – can occur when person not used to heat Heat exhaustion – more serious effect Heat stroke – can be fatal

31. 31 Procedures for responding to signs or symptoms of possible heat-related illness IllnessSigns and Symptoms Treatment Heat rashRed blister-like eruptions Itching (prickly sensation) Rest in a cool place. Allow the skin to dry. Monitor for infection. Heat Cramps Painful spasms Abnormal body posture Grasping the affected area Rest in a cool place. Drink water or a heavily diluted sports beverage (such as Gatorade). Seek medical attention if cramping is severe or does not go away.

32. 32 Dehydration Heat Exhaustion Heat Stroke What are the most serious heat illnesses? Untreated heat exhaustion may progress to heat stroke. Symptoms of either should always be taken seriously Note: Heat exhaustion or heat stroke may develop over a few days. Heat exhaustion and Heat stroke

33. 33 What are the symptoms of heat exhaustion? Photo credit: www.africaninspace.com Weakness Headache Fatigue Nausea Vomiting Blurred vision Dizziness High pulse rate Extreme sweating Pale face Red face Unsteady gait Clammy and moist skin Normal to slightly elevated temperature

34. 34 What are the symptoms of heat stroke? Rapid pulse Chills Restlessness Nausea Vomiting Irritability Red face Hot dry skin (25% - 50% of cases) Disorientation High temperature (104° F or higher) Erratic behavior Shivering Collapse Convulsions Fainting Heat Stroke may resemble a heart attack

35. 35 Heat Stroke or Heat Exhaustion? The telling difference is mental confusion/disorientation in ALL heat stroke victims. You can ask these 3 questions. 1."What is your name?" 2."What day is this?" 3."Where are we?" If a worker can’t answer these questions, assume it is heat stroke. How do you tell the difference??

36. 36 What do you do if someone is suffering from heat exhaustion? Move person to cooler/shaded area to rest and if possible, lay the worker down. Contact your first aid trained person. Do not leave him or her alone. Loosen and remove heavy clothing that restricts evaporation and cooling. If worker is alert and not nauseated, provide fluids such as cool water, juice, sports drinks, or non-caffeinated soft drinks. (About a cup every 15 minutes)

37. 37 What do you do if someone is suffering from heat exhaustion? Fan the person, spray/mist with cool water, or apply a wet cloth to his or her skin but if the worker begins to shiver, stop cooling. Call 911 if person does not feel better in about 15 minutes. Do not further expose the person to heat that day. Have them rest and continue to drink cool water and electrolyte drinks.

38. 38 What do you do if someone is suffering from heat stroke? Seconds count! While waiting for medical help to arrive: Move the victim to a cool shaded area Remove clothing that restricts cooling. Cool the person using whatever methods you can Get medical help immediately by calling 911.

39. 39 Heat Stroke – Possible cooling methods For example: Immerse the person in a tub of cool water; Place the person in a cool shower; Spray them with cool water from a garden hose; Sponge the person with cool water; If the humidity is low, wrap person in a cool wet sheet and fan him or her vigorously; Apply ice packs under arms and to the groin area.

40. 40 What do you do if someone is suffering from heat stroke? Have the person drink sips of cool water if he is alert enough to drink anything and not feeling sick to his stomach. If emergency medical personnel are delayed after calling 911, call the hospital emergency room for further instruction. Photo credit: www.dcfd.com

41. 41 Important! Stop all activity if you become: Lightheaded Confused Weak Faint Or have a pounding heart or trouble breathing Take a break and rest in a cool area or shade. Tell your supervisor if you or one of your co-workers experience symptoms of heat-related illness.

42. 42 Procedures for responding to symptoms of possible heat-related illness: Make sure person is in an area of safety Call 911 Explain to 911 the situation you have 911 may have instructions for you to do with the patient (If you haven’t done already.) If you are in an area that is difficult for 911 responders to find you, place someone in an area to flag where you and the patient can be found

43. 43 This standard applies to all employers with one or more employees performing work in an outdoor environment. Employers must implement workplace practices designed to reduce or eliminate the risks of heat- related illness resulting from outdoor exposure to temperature, humidity, and other environmental factors, or any combination of these Prevention- The employer must establish, implement, and maintain effective written procedures to prevent the occurrence of heat- related illness. The purpose and requirements of this standard

44. 44 The purpose and requirements of this standard Water - When heat-related illness hazards are present, drinking water must be provided and made readily accessible in sufficient quantity to provide at least one quart per employee per hour. Employees showing signs or demonstrating symptoms of heat-related illness must be relieved from duty and provided with a sufficient means to reduce body temperature. Some examples include: –shaded rest areas, –misting stations, or –temperature controlled environments (for example, air conditioned trailers).

45. 45 The purpose and requirements of this standard Employees showing signs or demonstrating symptoms of heat-related illness must be carefully evaluated to determine whether it is appropriate to return to work or if medical attention is necessary. Training must be provided prior to outdoor work assignments presenting heat-related illness hazards, and at least annually thereafter.

46. 46 Remember – to prevent heat illness: Drink water frequently !! Know the signs and symptoms of heat related illnesses and take them seriously Consider sports drinks when sweating a lot Avoid alcohol, caffeinated drinks, and heavy meals before or during work Work smart Acclimate Wear appropriate clothing Take regular breaks Keep an eye on your buddy! Photo credit: www.csao.org

47. 47 Questions?