Preventing Heat-Related Illnesses

1. August 2009 UCOP Safety Meeting Preventing Heat-Related Illnesses University of California Office of the President This month�s Safety Meeting topic is �Preventing Heat-Related Illnesses�.This month�s Safety Meeting topic is �Preventing Heat-Related Illnesses�.

2. University of California Office of the President August 2009 Safety Meeting Heat-Related Fatalities Centers for Disease Control (CDC) Between 1999 to 2003 � 3442 Heat-Related Fatalities in the U.S. Average Approximately 690 Deaths per Year Large Percentage of the Fatalities: Males Elderly According to the U.S. Centers for Disease Control (CDC), between 1999 to 2003, there were 3442 extreme heat-related fatalities in the United States, an average of approximately 690 deaths per year. This table shows the majority of these fatalities were males and large percentage of these fatalities were the elderly. Within the elderly category however, the fatalities were equally distributed between males and females.According to the U.S. Centers for Disease Control (CDC), between 1999 to 2003, there were 3442 extreme heat-related fatalities in the United States, an average of approximately 690 deaths per year. This table shows the majority of these fatalities were males and large percentage of these fatalities were the elderly. Within the elderly category however, the fatalities were equally distributed between males and females.

3. University of California Office of the President August 2009 Safety Meeting Production of Heat in Your Body Body Produces/Stores More Heat Than You Lose Metabolism/Exercise Heat Absorbed � Radiant Energy Sun, Heater Where does the heat come from? Through metabolism and exercise your body produces more heat than you are able to use. Your body can also absorb heat from radiant energy source such as the sun or a heater. Where does the heat come from? Through metabolism and exercise your body produces more heat than you are able to use. Your body can also absorb heat from radiant energy source such as the sun or a heater.

4. University of California Office of the President August 2009 Safety Meeting Body Cooling Mechanism The Body Attempts to Maintain an Internal Temperature of 98.6oF By: Increased Blood Circulation Which Results in More Blood to the Skin Increases Temperature of the Skin � Allows Body Rid Itself of the Excess Heat Sweating (Perspiration) Sweat Evaporates � Cooling of the Skin Body Cooling Mechanisms- The body attempts to maintain its core temperature at 98.6oF by: Increased Blood Flow - The body defends itself from heat by increasing the amount of blood flow to the skin, resulting in an increase in skin temperature. This allows the body to rid itself of excess heat to the environment. The increased blood flow results in an increase to the heart rate and therefore puts a strain on the heart. Sweating - The second method for cooling is through evaporation. When your body gets hot, you begin to sweat. When the sweat evaporates, heat from the surface of you skin is removed. Body Cooling Mechanisms- The body attempts to maintain its core temperature at 98.6oF by: Increased Blood Flow - The body defends itself from heat by increasing the amount of blood flow to the skin, resulting in an increase in skin temperature. This allows the body to rid itself of excess heat to the environment. The increased blood flow results in an increase to the heart rate and therefore puts a strain on the heart. Sweating - The second method for cooling is through evaporation. When your body gets hot, you begin to sweat. When the sweat evaporates, heat from the surface of you skin is removed.

5. University of California Office of the President August 2009 Safety Meeting Heat Illness Prevention � Drink Fluids Consume Plenty of Fluids 2 to 4 Glasses/Hour Thirst � Unreliable Indicator of Dehydration Avoid Alcohol, Caffeine, or High Sugar Beverages � Diuretics Consult Physician If On a Limited Fluid Regiment or If Taking Water Pills Heat Illness Prevention � Drink Fluids Staying well hydrated is one of the primary methods to prevent heat-related illnesses. Drink plenty of fluids. On hot days it is recommended that you consume 2 to 4 glasses of fluids per hour. You should not rely on your thirst mechanism. Thirst is an unreliable indicator of dehydration. Avoid alcohol, caffeine, or high sugar beverages. These are diuretics which cause you to lose more body fluids. If your physician limits the amount of fluids you drink or if you are on water pills, consult your physician on how much you should drink on hot days. Heat Illness Prevention � Drink Fluids Staying well hydrated is one of the primary methods to prevent heat-related illnesses. Drink plenty of fluids. On hot days it is recommended that you consume 2 to 4 glasses of fluids per hour. You should not rely on your thirst mechanism. Thirst is an unreliable indicator of dehydration. Avoid alcohol, caffeine, or high sugar beverages. These are diuretics which cause you to lose more body fluids. If your physician limits the amount of fluids you drink or if you are on water pills, consult your physician on how much you should drink on hot days.

6. University of California Office of the President August 2009 Safety Meeting Heat Illness Prevention Acclimation Slow Process for the Body to Condition Itself to Heat May Take Up to 10 Days Quickly Lost in a Matter of Days Conditioning/General Health Stay in Shape, Exercise Regularly Watch Your Weight What are methods to prevent heat illnesses? Acclimation - If you are continually are in a hot environment over several days, the body slowly conditions itself to the heat. This term is called �acclimation�. The acclimation process takes several days, up to 10 days for some persons. Once you are not in a hot environment, the body may lose the acclimation in a matter of days. Conditioning/General Health � Persons who are in good shape, regularly exercise, and are not overweight are better able to cope with extreme heat conditions.What are methods to prevent heat illnesses? Acclimation - If you are continually are in a hot environment over several days, the body slowly conditions itself to the heat. This term is called �acclimation�. The acclimation process takes several days, up to 10 days for some persons. Once you are not in a hot environment, the body may lose the acclimation in a matter of days. Conditioning/General Health � Persons who are in good shape, regularly exercise, and are not overweight are better able to cope with extreme heat conditions.

7. University of California Office of the President August 2009 Safety Meeting Heat Preventive Measures Stay Indoors in an Air Conditioned (A/C) Place If Home is Not A/C - Go to A/C Public Place Electric Fans - Effective Up to the Upper 90�s Cool Bath/Shower or Move to A/C Location Wear Light Weight, Light Colored, Loose Fitting Clothes Never Leave Anyone in Parked Closed Vehicles Temperatures Can Reach 120oF in 10 Minutes Since 1998, > 230 Child Fatalities What are some preventive measures we can take during extreme heat conditions? Air Conditioning (A/C) � Stay indoors in an A/C�ed place. If your home is not A/C�ed, go to a public place or a mall which is A/C�ed. Fans�Can help cool until temperatures reach the upper 90�s. When temperatures reach the upper 90s, take preventive measures such as taking a cool bath or shower, or moving to an A/C�ed location. Clothing � During extreme temperature conditions, wear light weight, light colored, loose fitting clothes. Vehicles � Never leave anyone or pets in a parked closed/locked vehicle during hot weather. During the summer months, a parked closed/locked car can become as hot as 120oF in just 10 minutes. Since 1998, there have been over 230 child fatalities in parked closed/locked cars.What are some preventive measures we can take during extreme heat conditions? Air Conditioning (A/C) � Stay indoors in an A/C�ed place. If your home is not A/C�ed, go to a public place or a mall which is A/C�ed. Fans�Can help cool until temperatures reach the upper 90�s. When temperatures reach the upper 90s, take preventive measures such as taking a cool bath or shower, or moving to an A/C�ed location. Clothing � During extreme temperature conditions, wear light weight, light colored, loose fitting clothes. Vehicles � Never leave anyone or pets in a parked closed/locked vehicle during hot weather. During the summer months, a parked closed/locked car can become as hot as 120oF in just 10 minutes. Since 1998, there have been over 230 child fatalities in parked closed/locked cars.

8. University of California Office of the President August 2009 Safety Meeting Preventive Measures If You Must Be Outdoors in the Heat Try to Limit the Activities to Morning or Evening Hours Do Not Engage in or Minimize Strenuous Activities Consume 2 to 4 Glasses of Water Per Hour Rest Often and Stay in Shady Areas Wear Wide Brim Hats What are preventive measures you can take if you must be outdoors in the heat? Try to limit your outdoor activities to the morning or evening hours when the temperature is a lot lower than mid-afternoon Do not engage in, or try to minimize strenuous activities Consume 2 to 4 glasses of cool, nonalcoholic beverages per hour. Avoid extremely cold liquids - they can cause cramps Rest often and stay in shady areas Wear a wide-brim hat to protect your head and neck from direct sunlightWhat are preventive measures you can take if you must be outdoors in the heat? Try to limit your outdoor activities to the morning or evening hours when the temperature is a lot lower than mid-afternoon Do not engage in, or try to minimize strenuous activities Consume 2 to 4 glasses of cool, nonalcoholic beverages per hour. Avoid extremely cold liquids - they can cause cramps Rest often and stay in shady areas Wear a wide-brim hat to protect your head and neck from direct sunlight

9. University of California Office of the President August 2009 Safety Meeting Persons Most Susceptible to Heat-Related Illnesses Infants and Young Children CDC Recommends Constant Monitoring The Elderly - Persons Who are 65 Years or Older CDC Recommends Checking On the Elderly Twice a Day During Hot Days Persons with Heart Disease or High Blood Pressure Persons Most Susceptible to Heat-Related Illnesses. Infants and Young Children � Their thermoregulatory mechanism in their body is not fully developed. Need to constantly monitor infants & young children during hot weather. Elderly (Persons 65 or Older ) � Cannot adjust to sudden changes in temperatures as well as young people. The elderly are more likely to have a chronic medical condition that upsets normal body responses to heat, They are more likely to take prescription medicines that impair the body�s ability to regulate its temperature or inhibit the ability to perspire. CDC recommends to check on the elderly at least twice a day in extreme temperature conditions. Persons with Heart Disease or High Blood Pressure � Extreme heat will result in added stress to the heart. Persons Most Susceptible to Heat-Related Illnesses. Infants and Young Children � Their thermoregulatory mechanism in their body is not fully developed. Need to constantly monitor infants & young children during hot weather. Elderly (Persons 65 or Older ) � Cannot adjust to sudden changes in temperatures as well as young people. The elderly are more likely to have a chronic medical condition that upsets normal body responses to heat, They are more likely to take prescription medicines that impair the body�s ability to regulate its temperature or inhibit the ability to perspire. CDC recommends to check on the elderly at least twice a day in extreme temperature conditions. Persons with Heart Disease or High Blood Pressure � Extreme heat will result in added stress to the heart.

10. University of California Office of the President August 2009 Safety Meeting California Heat-Related Occupational Fatalities 2004/2005 � 5 Fatalities Outdoor Occupations � Agriculture & Construction 2005 � Cal/OSHA Promulgated a Heat Illness Prevention Standard Title 8, California Code of Regulations, Section 3395 Applies Only to Outdoor Environments In the years 2004 and 2005 there were 5 heat-related occupational fatalities in California, all outdoor activities in the agriculture and construction industries. These fatalities resulted in California becoming the first state in the United States to adopt an occupational heat prevention standard, Title 8 California Code of Regulations, Section 3395. However, this standard only applies to outdoor environments.In the years 2004 and 2005 there were 5 heat-related occupational fatalities in California, all outdoor activities in the agriculture and construction industries. These fatalities resulted in California becoming the first state in the United States to adopt an occupational heat prevention standard, Title 8 California Code of Regulations, Section 3395. However, this standard only applies to outdoor environments.

11. University of California Office of the President August 2009 Safety Meeting Cal/OSHA Heat Illness Prevention Standard When Environmental Factors for Heat Illness are Present Major Components Access to Shade for Recovery Period Access to Drinking Water Written Program/Emergency Procedures Training � Employees & Supervisors The Cal/OSHA Heat Illness Prevention Standard - Applies when the environmental factors for heat illness are present. The major components of this regulation are: Access to Shade: Employees must have access to shade to rest and recover from the heat Access to Drinking Water: Employees must have access to 1 quart of drinking water per hour they are working outdoors in the heat. Written Program & Emergency Procedures: An employer must have a written Heat Illness Prevention Program and also must establish written emergency procedures to follow if an employee exhibits symptoms of heat-related illness. Training: Employees must be instructed on the employer�s heat prevention program and how to recognize when they are beginning to experience heat-related illness. Supervisors must also be training on emergency procedures and recognition of the onset of heat-related illnesses.The Cal/OSHA Heat Illness Prevention Standard - Applies when the environmental factors for heat illness are present. The major components of this regulation are: Access to Shade: Employees must have access to shade to rest and recover from the heat Access to Drinking Water: Employees must have access to 1 quart of drinking water per hour they are working outdoors in the heat. Written Program & Emergency Procedures: An employer must have a written Heat Illness Prevention Program and also must establish written emergency procedures to follow if an employee exhibits symptoms of heat-related illness. Training: Employees must be instructed on the employer�s heat prevention program and how to recognize when they are beginning to experience heat-related illness. Supervisors must also be training on emergency procedures and recognition of the onset of heat-related illnesses.

12. University of California Office of the President August 2009 Safety Meeting Heat Stroke Signs & Symptoms High Body Temperature Hot, Red (Gray) Dry Skin, Rapid Pulse Confusion, Loss of Consciousness Death is Imminent First Aid Call 9-1-1 ASAP & Request Ambulance Move to Cool Area Cool with Wet Cloth and Fan the Victim to Increase Cooling If Conscious, Slowly Give Cool Water Heat stroke - The most serious health problem for people in the extreme heat conditions. It is caused by the failure of the body to regulate its core temperature. Sweating stops and the body can not get rid of excess heat. Victims will die unless they receive proper treatment promptly. Signs and symptoms: - High body temperature of 106�F or higher - Hot, dry skin, usually red or gray color, rapid pulse - Confusion, delirium, fainting, or seizures - Death is imminent without treatment. What to do: - Call 9-1-1 immediately and request an ambulance - Move victim to a cool area - Cool with wet cloth and fan the victim to increase cooling - If conscious slowly give victim cool waterHeat stroke - The most serious health problem for people in the extreme heat conditions. It is caused by the failure of the body to regulate its core temperature. Sweating stops and the body can not get rid of excess heat. Victims will die unless they receive proper treatment promptly. Signs and symptoms: - High body temperature of 106�F or higher - Hot, dry skin, usually red or gray color, rapid pulse - Confusion, delirium, fainting, or seizures - Death is imminent without treatment. What to do: - Call 9-1-1 immediately and request an ambulance - Move victim to a cool area - Cool with wet cloth and fan the victim to increase cooling - If conscious slowly give victim cool water

13. University of California Office of the President August 2009 Safety Meeting Heat Illnesses Heat Cramps Painful Muscle Spasms �Electrolyte Imbalance Drink an Electrolyte Solution Fainting (Heat Syncope) Not Used to Hot Temperatures Brief Loss of Consciousness, Sweaty Skin, Normal Body Temperature & No Signs of Heat Stroke or Heat Exhaustion Lie Down in a Cool Place Heat Cramps: Painful muscle spasms. Signs & Symptoms: Cramping or spasms of muscles from electrolyte Imbalance What to Do: Drink an electrolyte solution (sports drink). Fainting (Heat Syncope): Usually happens to a person not used to the hot environment and simply stands around. Moving around, rather than standing still, will usually reduce the likelihood of fainting. Signs & Symptoms: Brief loss of consciousness; Sweaty skin, normal body temperature; No signs of heat stroke or heat exhaustion What to Do: Lie down in a cool place. Seek medical attention if not recovered after brief period of lying down Heat Cramps: Painful muscle spasms. Signs & Symptoms: Cramping or spasms of muscles from electrolyte Imbalance What to Do: Drink an electrolyte solution (sports drink). Fainting (Heat Syncope): Usually happens to a person not used to the hot environment and simply stands around. Moving around, rather than standing still, will usually reduce the likelihood of fainting. Signs & Symptoms: Brief loss of consciousness; Sweaty skin, normal body temperature; No signs of heat stroke or heat exhaustion What to Do: Lie down in a cool place. Seek medical attention if not recovered after brief period of lying down

14. University of California Office of the President August 2009 Safety Meeting Heat Illnesses Heat Rash Clogged/Irritated Sweat Glands Keep Skin Dry & Clean; Wear Loose Cotton Clothing Cool Baths; Lotions to Relieve the Pain/Irritation Heat Exhaustion Wet, Pale, & Weak Appearance Normal Heart Rate/Body Temperature Severe Cases � Vomiting & Fainting Rest in Cool Place & Drink Electrolyte Solution Heat Rash: Sweat cannot evaporate easily and sweat glands become clogged or irritated. Signs & Symptoms: Rash characterized by small pink or red bumps; irritation or prickly sensation; itching What to Do: Keep the skin clean & dry to prevent infection; wear loose cotton clothing; cool baths; over-the counter lotions may help ease pain and itching Heat exhaustion: Although not the most serious health problem, heat exhaustion is one the most common heat-related ailments Heat exhaustion happens when a person sweats a lot and does not drink enough fluids or take in enough electrolytes or both. The simple way to describe the person is wet, pale, and weak. Signs & Symptoms Sweaty (wet), pale, clammy skin (sometimes flushed) & weak Normal body temperature & heart rate Severe cases � Vomiting & fainting What to Do: Rest in a cool place Drink an electrolyte solutionHeat Rash: Sweat cannot evaporate easily and sweat glands become clogged or irritated. Signs & Symptoms: Rash characterized by small pink or red bumps; irritation or prickly sensation; itching What to Do: Keep the skin clean & dry to prevent infection; wear loose cotton clothing; cool baths; over-the counter lotions may help ease pain and itching Heat exhaustion: Although not the most serious health problem, heat exhaustion is one the most common heat-related ailments Heat exhaustion happens when a person sweats a lot and does not drink enough fluids or take in enough electrolytes or both. The simple way to describe the person is wet, pale, and weak. Signs & Symptoms Sweaty (wet), pale, clammy skin (sometimes flushed) & weak Normal body temperature & heart rate Severe cases � Vomiting & fainting What to Do: Rest in a cool place Drink an electrolyte solution

15. University of California Office of the President August 2009 Safety Meeting Heat Index Table: This is a heat index (HI) table. Heat index is the temperature the body feels when heat and humidity are combined. The turquoise column on the left is the ambient temperature. The green row on the top of the table is percent relative humidity. The numbers in the middle of the table are the heat index temperatures. - Tan colored heat index temperatures in the 80 to 90oF ranges may result in fatigue with prolonged exposure and physical activity. - Orange colored heat index temperatures in the 90 to 105oF range may result in possible sunstroke, heat cramps, or heat exhaustion. - Red colored 105 to 130oF heat index range, are likely to result in sunstroke, heat cramps, and heat exhaustion, along with a possibility of heat stroke. - Brown colored 130oF or great heat index range is highly likely to result in heat stroke with continued exposure. Heat Index Table: This is a heat index (HI) table. Heat index is the temperature the body feels when heat and humidity are combined. The turquoise column on the left is the ambient temperature. The green row on the top of the table is percent relative humidity. The numbers in the middle of the table are the heat index temperatures. - Tan colored heat index temperatures in the 80 to 90oF ranges may result in fatigue with prolonged exposure and physical activity. - Orange colored heat index temperatures in the 90 to 105oF range may result in possible sunstroke, heat cramps, or heat exhaustion. - Red colored 105 to 130oF heat index range, are likely to result in sunstroke, heat cramps, and heat exhaustion, along with a possibility of heat stroke. - Brown colored 130oF or great heat index range is highly likely to result in heat stroke with continued exposure.

16. University of California Office of the President August 2009 Safety Meeting In Summary To Prevent Heat Related Illnesses Stay Indoors or In the Shade If Possible Remain Indoors in the Heat of the Day Drink Plenty of Fluids Rest & Minimize Strenuous Activities The Young and Elder are the Most Susceptible to Heat-Related Illnesses Require Increased Monitoring During Extreme Heat Conditions In Summary: Measures to prevent heat-related illnesses during extreme temperatures: Stay indoors (preferably in an air conditioned building) or stay in the shade. If possible, remain indoors during the heat of the day (mid-afternoon). Drink plenty of fluids Rest and minimize strenuous activities The young and the elderly are the most susceptible to health-related illness and therefore they require increased monitoring during extreme heat conditionsIn Summary: Measures to prevent heat-related illnesses during extreme temperatures: Stay indoors (preferably in an air conditioned building) or stay in the shade. If possible, remain indoors during the heat of the day (mid-afternoon). Drink plenty of fluids Rest and minimize strenuous activities The young and the elderly are the most susceptible to health-related illness and therefore they require increased monitoring during extreme heat conditions