Heat Illness Prevention Planning

Heat Illness Prevention Planning

Georgia On-Site Consultation ProgramGeorgia Tech Research Institute2013

Heat Illness Prevention [Presentation for CAS] May 20111Talking points and additional information are found in the Notes section of this presentation.

OSHAs nationwide outreach campaign about the hazards of working outdoors in extreme heat and the steps that employers and workers can take to prevent heat illnesses this summer. The campaign is intended to raise awareness of these hazards among workers who must work outdoors and their employers. The campaign will also highlight common sense steps that can be taken to minimize these hazards.The campaigns focus is outreach and guidance and OSHA will be using media (public service announcements, outdoor advertising), social marketing, and training to reach workers, employers and community organizations.This presentation will assist employers communicate OSHAs Campaign to Prevent Heat Illness in Outdoor Workers. Some of the heat illness prevention content used was adapted from OSHA, and from materials developed by The Division of Occupational Safety and Health, better known as Cal/OSHA and Labor Occupational Health Program (LOHP).Do you know the facts?Heat stress may result from the buildup of muscle generated heat in the body. True or False?The time to drink water is when you are thirsty?True or False?What are the three most important things you should know about preventing heat stress?A. WaterB. Shade C. RestD. All Three are ImportantThe evaporation of sweat is the most important way our bodies get rid of heat?True or False?Over 70% of those who suffer a heat stroke die if not treated promptly. True or False?Answers:TrueFalseDTrueTrue: Morbidity and mortality from heatstroke are related to the duration of the temperature elevation. When therapy is delayed, the mortality rate may be as high as 80%; however, with early diagnosis and immediate cooling, the mortality rate can be reduced to 10%. Mortality is highest among the elderly population, patients with preexisting disease, those confined to a bed, and those who are socially isolated.

2Why Is This Topic Important?Heat illness can be a matter of life and death. Every death is preventable.When heat stroke doesnt kill immediately, it can shut down major body organs causing acute heart, liver, kidney and muscle damage, nervous system problems, and blood disorders.Workers suffering from heat exhaustion are at greater risk for accidents, since they are less alert and can be confused.

New workers are at increased risk of injuries. Temporary workers often new to a jobsite several times a year.3.Heat Illness Prevention [Presentation for CAS] May 20113Heat Fatalities Map 2009-20124

http://www.osha.gov/SLTC/heatillness/map.htmlThis map shows locations of outdoor worker, heat-related fatalities between 2009 and 2012. It is not an exhaustive list of all worker fatalities from heat exposure during this time period. It includes only those fatalities that involve workers who are covered by either the Federal Occupational Safety and Health Administration (Federal OSHA) or a State OSHA plan. Some fatalities reported to the Bureau of Labor Statistics (BLS) are outside Federal and State plan OSHA jurisdiction and are not included. In addition, reporting and update timeframes for the Federal OSHA information systems used to generate this map vary from BLS and are based on the circumstances of the case, which may result in inconsistencies.

http://www.osha.gov/SLTC/heatillness/map_text.html- Text version of map plus inspection no. and event summary

Heat Illness Prevention [Presentation for CAS] May 20114August 2012MARK RAINEY, a 60-year-old temporary worker at an Ohio roofing company, was working in the hot summer sun on top of a roof, throwing roofing material down into a dump truck. He started to become lethargic and confused, then lost consciousness, and died of heat stroke. He left behind two daughters, three grandchildren and a large extended family of aunts, uncles, and cousins. 5

The Bureau of Labor Statistics found that thirty-one percent of all heat-related fatalities in 2011 were in construction.

5June 2013Waste Management of NJTemp worker fatalityOSHA cited company for excessive heat conditions; lacking rule on fluid consumption6

A Lucky One7Thank You to Brasfield & Gorrie, LLC for sharing this important video

Brasfield and Gorrie Heat Illness Case Study video; you will need speakers (or a microphone near your computer speakers).Heat Illness Prevention [Presentation for CAS] May 20117OSHA Enforcement: July 2012The employer failed to keep the workplace free of a hazard to which its employees were exposed:Workers were exposed to a HI at or above the Danger zone (see Hi chart); or Workers were working outside for most of the day or during the heat of the day when there was a NOAA Heat advisory.2.The hazard was recognized:NOAA issued heat advisory because of a HI at or above Danger zone (see HI chart) and employer was or should have been aware of the advisory;Employees made complaints regarding heat;Employees showed signs or symptoms of heat exposure;Employer indicated that it was aware of the heat hazard (e.g., by providing water but not rest and shade); orThe employers industry has issued guidance or information about heat hazards.Source: July 19, 2012: Richard Fairfax Memo to Regional Administrators Expedite heat related inspection and issuance of citationsThere are no specific standards for Heat Stress. The general duty clause (PL Section 5a1) is used when problems are identified as described below. Only the Hazwoper standard (29 CFR 1910.120) addresses heat stress

A violation of the general duty clause may exist if workers are working outside and the employer is aware of heat-related dangers but has not taken protective action to provide at minimum : water, rest, and shade.

THE 4 POINTS in the slide are examples only, and there could be other observations as evidence that would satisfy OSHAs burden of proof.

Discuss the OSHA Inspection ProceduresHeat Illness Prevention [Presentation for CAS] May 20118OSHA Enforcement: July 20123. The hazard was causing or was likely to cause death or serious physical harm:Heat exhaustion;Heat stroke; orFatality4.There was a feasible and useful method to correct the hazard:Providing workers with immediate access to water, rest, and shade, and allowing them to use that relief;Implementing an acclimatization program for new employees and for those returning from extended time away (e.g., vacation)Implementing a work/rest schedule; orProviding a climate controlled area to cool down.

9OSHA Enforcement: July 2012If all four factors for a general duty clause are not present, a Hazard Alert Letter (HAL) shall be issued to the employer as soon as possible. The HAL shall recommend specific steps the employer can take to protect workers from the heat hazard.Source: July 19, 2012 Richard Fairfax MemoHeat Illness Prevention [Presentation for CAS] May 201110Factors That Affect Bodys Ability to Cool DownAge WeightPhysical FitnessAdjusting to the hot environmentOther Health ConditionsUse of Alcohol/Drugs/CaffeineMedicationsClothing/PPE

DiureticsBlood-pressure medicationsAntihistaminesAnti-cholinergics (for COPD)Psychiatric conditionsBe sure and discuss Dark versus Light colored clothing and PPEAdjusting to the hot environment is called acclimatization . Your body needs time to get used working in these conditions.Certain medications can increase risk for heat stress: diuretics (water pills), anti-hypertensives (blood pressure medication), anti-cholinergics (for COPD pulmonary disorders), antihistamines (allergy medications), anti-depressants and anti-psychotics.Drink plenty of liquids, especially if your urine is dark yellow, to replace the fluids you lose from sweating as much as one quart per hour may be necessary. Water and/or sports drinks are recommended. Since caffeine is a diuretic (makes you urinate more), beverage such as cola, iced tea and coffee should be avoided. Thirst is not a reliable sign that your body needs fluids. When doing heavy work, it is better to sip rather than gulp the liquids (Source: princeton.edu)

Heat Illness Prevention [Presentation for CAS] May 201111What is Heat Stress? Build of Heat in the body that can not be removed by natural mechanisms. It is a result of internal heat generated by the body (Metabolic Load) and the external heat load from the work environment.

Ask Crew if they know of a co-worker who suffered from a heat disorder. What happened and what was done to prevent it in the future. If there is no work-related anecdotal information offered by the Crew, ask if any of them have heard of things in the news, etc.Heat Illness Prevention [Presentation for CAS] May 201112Types of Heat Stress DisordersHeat Rash (Prickly Heat)Heat CrampsHeat ExhaustionHeat Stroke

Transient Heat FatigueFainting (heat syncope)

Ask participants if they know any one who has developed a heat related illness. [Transient Heat Fatigue: temporary physical discomfort or mental/psychological strain; results in decline in work performance, coordination, alertness][Fainting: as a result of standing up too quickly, etc. Fainting is the outcome, not progressive to exhaustion or stroke]

Review that least dangerous is heat rash ---- moving to heat stroke as most da.ngerousHeat Illness Prevention [Presentation for CAS] May 201113Behavioral Clues of Heat StrokeHand/limb shakingDecreasing productivity through shiftIncreased absenteeismAwkward postures (to compensate for fatigue)Person takes frequent short breaks14Ask workers what else would they look for and what do they think will put a person at greater risk.

From OSHA Heat Illness Prevention Training Guide Page 10

You arent used to working in heat or doing heavy work.You are new to working outdoors.You are not physically fit or are overweight.You drink alcohol or take drugs (illegal drugs or prescription medicine).You wear heavy, dark, or tight clothing, or use personal protective equipment.You had some early heat-related symptoms the day before.First Aid: Heat StrokeCall 911 and notify their supervisor. Move the sick worker to a cool shaded area. Cool the worker using methods such as: Soaking their clothes with water Remove or open unnecessary clothingSpraying, sponging, or showering them with water while fanning their bodyApply ice packs to armpits, groin, neck

15If emergency services are delayed, transport individual to hospital. Delay in seeking medical attention can be fatal.

Unconsciousness: Unless the person has fallen from height and you are unsure of neck/spinal injury, you MUST move the individual to a cool location.Heat Illness Prevention [Presentation for CAS] May 201115Control & prevention strategies16Acclimatization: Gradually Increase Exposure to Hot EnvironmentsWorkers new to outdoor jobs are generally most at risk for heat-related illnessesCal/OSHA investigated 25 incidents of heat-related illness in 2005. In almost half of the cases, the worker involved was on their first day of work and in 80% of the cases the worker involved had only been on the job for four or fewer days.17Heat Illness Prevention [Presentation for CAS] May 201117Acclimatization Physiological ResponseSweat Response: Less salt in sweatLower core temperatureLower heart rateSweating occurs at lower skin temperatures and total production increases= body is better adapted to working in heat and is less at risk18

Becoming acclimated or gaining short-term acclimatization to the heat typically requires physiological changes in the body that take place over several days to weeks (depending on the heat load).

The body alters its ability to sweat (basically improves how the body sweats lower volume of sweat and less salt being lost = lower temperature and lower heart rate).Heat Illness Prevention [Presentation for CAS] May 201118General Guideline> Work intensity = > Rest periodsRest does not mean complete cessationObjective is to reduce energy expenditure1920Employer Provided TrainingWorkers need to be trained to know what to do when a worker has signs of heat exhaustion:Call supervisorStay with worker until help arrivesMove worker to cooler/shaded area Fan and mist the worker with water Provide cool drinking water If the worker feels confused, vomits, or faints, this may indicate heat stroke Call 911 immediately!

Heat Illness Prevention [Presentation for CAS] May 201120For example Training Session #2 (How to Respond to Symptoms) in the Heat Illness Prevention Training Guide: A Lesson Plan for Employers helps employers walk workers through what to do if someone on the crew exhibits signs of heat exhaustion.

[TRAINER: YOU WILL WANT TO INPUT YOUR OWN COMPANY AND/OR JOBSITE SPECIFIC INFORMATION HERE FOR DISCUSSION AND REVIEW. ENSURE THAT YOU COVER DIRECTIONS, PHONE NUMBERS, CONTACT INFORMATION, ETC.]Know your company's emergency action plan. Procedures to ensure that clear and precise directions to the work site will be provided to emergency medical services.

Remember that:Workers and supervisors should be trained to recognize and prevent heat illness before they start working outsideWorkers should be trained to report symptoms earlyWorkers need to know what to do in an emergency

21The Risk of Heat StressYour risk of heat stress depends on many factors.

These include: Your physical condition The weather (temperature, humidity) How much clothing you have on How fast you must move or How much weight you must lift If you are near a fan or there is a breeze If you are in the sun.Heat emergencies

Warning signs of Heat Stroke vary but may include: an extremely high body temperature (above 103F, orally) red, hot, and dry skin (no sweating) rapid, strong pulse throbbing headache dizziness, nausea disorientation, confusion unconsciousnessIf you see any of these signs, you may be dealing with a LIFE-THREATENING emergency. Call 911The foreman/supervisor has a responsibility to review the risk factors and interpret them for his crew.Heat Illness Prevention [Presentation for CAS] May 201121Environment Measures: Heat Index22

http://www.osha.gov/SLTC/heatillness/index.htmlThe Heat Index is a measure of how hot it really feels when relative humidity is factored with the actual air temperature.

This is a screen shot of OSHAs Heat Index App that is available for smart phones.Heat Illness Prevention [Presentation for CAS] May 20112223

http://www.nws.noaa.gov/om/heat/images/heatindex.png

Based on what heat index category the humidity and temperature are at, the recommendations on the following slide are a guide to use for determining what workplace precautions should be taken.Heat Illness Prevention [Presentation for CAS] May 20112324

Heat Illness Prevention [Presentation for CAS] May 20112425

Heat Illness Prevention [Presentation for CAS] May 201125Heat Index Additional Risk FactorsWork in direct sunlight Perform prolonged or strenuous work Wear heavy protective clothing or impermeable suits These must be taken into consideration even when the heat index is lower.

Since heat index values were devised for shady, light wind conditions, exposure to full sunshine can increase heat index values by up to 15F. Also, strong winds, particularly with very hot, dry air, can be extremely hazardous.26http://www.nws.noaa.gov/om/heat/index.shtml Heat Illness Prevention [Presentation for CAS] May 201126RESPONSIBILITY27Fatality Assessment and Control Evaluation Program (FACE)Case Study(s) 28Work in groups or alone. These are an optional part of this lecture. Use as time allows.Heat Illness Prevention [Presentation for CAS] May 201128FACE REPORT Fatality Assessment and Control Evaluation ProgramFACE REPORT #1FACTS:31-year-old male concrete construction laborer dies of heat stroke at end of work dayTemperature was 88 degrees

After reporting he felt ill, his foreman instructed him to lie in the shade beneath a treeHe remained in the shade for 10 minutes, returned to work and was observed staggering, speaking incoherently, and stumbling through freshly poured concrete

29#1 Construction Concrete Worker Dies From Heat StrokeFACTS:31-year-old male concrete construction laborer dies of heat stroke at end of work dayTemperature was 88 degreesAfter reporting he felt ill, his foreman instructed him to lie in the shade beneath a treeHe remained in the shade for 10 minutes, returned to work and was observed staggering, speaking incoherently, and stumbling through freshly poured concreteWhat Questions Do You Have/Might You Want to Ask?What was the task he was performing?Pouring concrete sidewalks and curbs: setting forms, shoveling gravel, pouring and shoveling concreteHow long had he been performing the task that day?10.5 hoursHow long had he been employed by the company?8 daysHow long had he been working at the site?2 daysWas 88 degrees the average temperature?No; 6 degrees higher than normalWas shade available?A treeWas water provided to the crew?Water was availableWas water required to be consumed?NoWere rest breaks required?Rest breaks took place as time permittedWas there an emergency action plan established by the company?Unknown. A police officer driving by was flagged down and EMS summoned; response time 5 minutesDid the employee use any medication?Unknown, but not reported as such

Recommendations?Workers should be acclimatized to working in hot environmental conditions, especially if they will need to perform heavy physical labor. It generally takes 5 days of working at least 1.5 hours/day in a particular environment before the body is prepared physically to respond to hot conditions.Scheduled rest periods should be provided and required for employees performing tasks in hot environments. The goal is to not raise the core temperature beyond 100.4 degrees F. Work/rest schedules can be calculated using the ACGIH TLV standards however, these standards are written assuming that the affected individuals are healthy, non-medicated, acclimatized, and in normal clothing/attire. Additional precautions should be taken if these assumptions are not met.

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FACE REPORT(Fatality Assessment and Control Evaluation Program)FACTS:41-year-old male laborer died from heat stroke at end of work dayTemperature was 90 degrees; dew point humidity 69 degrees (relative humidity 50%)Employee (a welder), had spent the day cutting 2x4s to varying lengths to fabricate forms for concrete footersHis internal temperature was 108 degrees F.

FACE REPORT #2FACTS:41-year-old male laborer died from heat stroke at end of work dayTemperature was 90 degrees; dew point humidity 69 degrees (relative humidity 50%)Employee (a welder), had spent the day cutting 2x4s to varying lengths to fabricate forms for concrete footersHis internal temperature was 108 degrees F.What Questions Do You Have/Might You Want to Ask?What was the task he was performing?Sawing boards to varying lengths. Used hard hat, tool belt, hammer, sledge hammer and saw.How long had he been performing the task that day?10 hours (lunch of 30 minutes)How long had he been employed by the company?1 dayHow long had he been working at the site?1 dayWas 90 degrees the average temperature?unknownWas shade available?Yes, an air-conditioned construction trailer was used for all breaks, and if they felt over-heated during workWas water provided to the crew?YesWas water required to be consumed?UnknownWere rest breaks required?Yes (morning, lunch, afternoon)Where did rest breaks occur?In air-conditioned trailerWas there an emergency action plan established by the company?Unknown; victim was found in parking lot of facility where the construction expansion was taking placeDid any co-workers notice any symptoms?Co-workers noted that the victim did not eat lunch, but did drink water. The job foreman drove the victim to his car 15-30 minutes before he was found collapsed in the parking lot.Did the employee use any type of medication?Unknown, but not indicated in coroners report.Recommendations?Employers should train supervisors and employees to recognize symptoms of heat exhaustion/stroke when working in hot and/or humid conditions. The victim collapsed within 15-30 minutes after leaving the foreman; no one noticed any symptoms.Employees should be given mandated breaks and fluids to drink. Attempt to match fluid intake with fluid lost.Work hours should be adjusted to accommodate dangerous environmental work conditions. If high temperatures are predicted, if possible, change work hours to cooler times of the day.

30FACE Fatality Assessment and Control Evaluation ProgramFACTS30-year-old male landscape mowing assistant dies from heat stroke at end of work dayHe was part of a 2-person crewHe had reported feeling light-headed and short-of-breath to his partner in the mid-afternoonOutdoor temperature was 81 degreesVictims internal temperature was 107.6 degrees at the hospital31

FACE REPORT #3FACTS30-year-old male landscape mowing assistant dies from heat stroke at end of work dayHe was part of a 2-person crewHe had reported feeling light-headed and short-of-breath to his partner in the mid-afternoonOutdoor temperature was 81 degreesVictims internal temperature was 107.6 degrees at the hospitalWhat Questions Do You Have/Might You Want to Ask?What was the task he was performing?Lawn-mowing with a walk-behind mower, push mower, edging, and back-pack blowerHow long had he been performing the task that day?Full-day; multiple job locationsHow long had he been employed by the company?unknownHow long had he been working at the site?unknownWas 81 degrees the average temperature?Unknown. It was May in MichiganWas shade available?yesWas water provided to the crew?unknownWas water required to be consumed?unknownWere rest breaks required?Unknown, although rest breaks occurred in the work trucks while driving to the next jobsiteWhere did rest breaks occur?Truck. The trucks were air conditioned but it is unknown if the a/c was usedWas there an emergency action plan established by the company?Unknown, although the team-mate did call for EMS immediatelyDid any co-workers notice any symptoms?The victim had reported feeling light-headed and short-of-breath 2 hours prior to his collapse. The victim had also been observed in the past to eat his lunch, but vomit afterwards. Did the employee use any type of medication?Yes, 2 prescription medications (fluoxetine (i.e. Prozac) and quetiapin (i.e. an antipsychotic medication). This class of medication has been associated with problems in body temperature regulation. The manufacturer of quetiapine warns Appropriate care is advised when prescribing quetiapine for patients who will be experiencing conditions which may contribute to an elevation in core body temperature (exercising strenuously, exposure to extreme heat, receiving other medications, or being subject to dehydration). The partner was aware that the victim was on medication, but not what type.Recommendations?Employers should ensure that supervisors/managers regularly monitor workers during periods of high heat stress/work volume. Monitoring could include observing employees at the beginning, during, and end of the day, and ensuring they are consuming adequate fluids.Have medical care providers identify workers who take medications or have medical conditions that would pre-dispose them to heat-related illnessTrain supervisors and employees on heat-related illness in early spring. Train on the spectrum of heat-related illness (heat rash, heat cramps, heat exhaustion, heat stroke) and that one illness can rapidly progress to another more severe form if intervention is not completed. Train workers to recognize symptoms in themselves and others, and not discount the ill feelings as weakness.

31Sheet1ExternalData_1: Failed ...Plan ElementHeat Index Risk LevelLowerModerateHighVery High/Extreme(Caution)Heat IndexRisk LevelProtective MeasuresSupplies (ensuring adequate water, provisions for rest areas, and other supplies)Less than 91FLower (Caution)Basic heat safety and planningEmergency planning and response (preparing supervisors and crews for emergencies)91F to 103FModerateImplement precautions and heighten awarenessWorker acclimatization (gradually increasing workloads; allowing more frequent breaks as workers adapt to the heat)103F to 115FHighAdditional precautions to protect workersModified work schedules (establishing systems to enable adjustments to work schedules)Greater than 115FVery High to ExtremeTriggers even more aggressive protective measuresTraining (preparing workers to recognize heat-related illness and preventive measures)Physiological, visual, and verbal monitoring (using direct observation and physiological monitoring to check for signs of heat-related illness)

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Sheet1ExternalData_1: Failed ...Plan ElementHeat Index Risk LevelLowerModerateHighVery High/Extreme(Caution)Supplies (ensuring adequate water, provisions for rest areas, and other supplies)Emergency planning and response (preparing supervisors and crews for emergencies)Worker acclimatization (gradually increasing workloads; allowing more frequent breaks as workers adapt to the heat)Modified work schedules (establishing systems to enable adjustments to work schedules)Training (preparing workers to recognize heat-related illness and preventive measures)Physiological, visual, and verbal monitoring (using direct observation and physiological monitoring to check for signs of heat-related illness)

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