Heat Illness Prevention Planning

1. Heat Illness Prevention Planning Georgia On-Site Consultation Program Georgia Tech Research Institute 2013

2. 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. Water B. Shade C. Rest D. All Three are Important • The 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?

3. Why Is This Topic Important? • Heat illness can be a matter of life and death. Every death is preventable. • When heat stroke doesn’t 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. .

4. Heat Fatalities Map 2009-2012 http://www.osha.gov/SLTC/heatillness/map.html

5. August 2012 • MARK 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.

6. June 2013 • Waste Management of NJ • Temp worker fatality • OSHA cited company for excessive heat conditions; lacking rule on fluid consumption

7. A Lucky One Thank You to Brasfield & Gorrie, LLC for sharing this important video

8. OSHA Enforcement: July 2012 • The 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); or • The employer’s industry has issued guidance or information about heat hazards.

9. OSHA Enforcement: July 2012 3. The hazard was causing or was likely to cause death or serious physical harm: • Heat exhaustion; • Heat stroke; or • Fatality 4. 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; or • Providing a climate – controlled area to cool down.

10. OSHA Enforcement: July 2012 • If 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.

11. Factors That Affect Body’s Ability to Cool Down • Age • Weight • Physical Fitness • Adjusting to the hot environment • Other Health Conditions • Use of Alcohol/Drugs/Caffeine • Medications • Clothing/PPE Diuretics Blood-pressure medications Antihistamines Anti-cholinergics (for COPD) Psychiatric conditions

12. What 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.

13. Types of Heat Stress Disorders • Heat Rash (Prickly Heat) • Heat Cramps • Heat Exhaustion • Heat Stroke • Transient Heat Fatigue • Fainting (heat syncope)

14. Behavioral Clues of Heat Stroke • Hand/limb shaking • Decreasing productivity through shift • Increased absenteeism • Awkward postures (to compensate for fatigue) • Person takes frequent short breaks

15. First Aid: Heat Stroke • Call 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 clothing • Spraying, sponging, or showering them with water while fanning their body • Apply ice packs to armpits, groin, neck

16. Control & prevention strategies

17. Acclimatization: Gradually Increase Exposure to Hot Environments • Workers new to outdoor jobs are generally most at risk for heat-related illnesses • Cal/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.

18. Acclimatization Physiological Response • Sweat Response: • Less salt in sweat • Lower core temperature • Lower heart rate • Sweating occurs at lower skin temperatures and total production increases • = body is better adapted to working in heat and is less at risk

19. General Guideline • > Work intensity = > Rest periods • Rest does not mean complete cessation • Objective is to reduce energy expenditure

20. Employer Provided Training Workers need to be trained to know what to do when a worker has signs of heat exhaustion: • Call supervisor • Stay with worker until help arrives • Move 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!

21. The Risk of Heat Stress • Your 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 103°F, orally) • red, hot, and dry skin (no sweating) • rapid, strong pulse • throbbing headache • dizziness, nausea • disorientation, confusion • unconsciousness • If you see any of these signs, you may be dealing • with a LIFE-THREATENING emergency. Call 911

22. Environment Measures: Heat Index http://www.osha.gov/SLTC/heatillness/index.html

26. Heat Index Additional Risk Factors • Work 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 15°F.Also, strong winds, particularly with very hot, dry air, can be extremely hazardous.

27. RESPONSIBILITY

28. Fatality Assessment and Control Evaluation Program (FACE)Case Study(s)

29. FACE REPORT Fatality Assessment and Control Evaluation Program FACE REPORT #1 After reporting he felt ill, his foreman instructed him to lie in the shade beneath a tree He remained in the shade for 10 minutes, returned to work and was observed staggering, speaking incoherently, and stumbling through freshly poured concrete FACTS: • 31-year-old male concrete construction laborer dies of heat stroke at end of work day • Temperature was 88 degrees

30. FACE REPORT(Fatality Assessment and Control Evaluation Program) FACE REPORT #2 FACTS: • 41-year-old male laborer died from heat stroke at end of work day • Temperature was 90 degrees; dew point humidity 69 degrees (relative humidity 50%) • Employee (a welder), had spent the day cutting 2x4’s to varying lengths to fabricate forms for concrete footers • His internal temperature was 108 degrees F.

31. FACE Fatality Assessment and Control Evaluation Program FACE REPORT #3 FACTS • 30-year-old male landscape mowing assistant dies from heat stroke at end of work day • He was part of a 2-person crew • He had reported feeling light-headed and short-of-breath to his partner in the mid-afternoon • Outdoor temperature was 81 degrees • Victim’s internal temperature was 107.6 degrees at the hospital