Occupational Heat-Related Illness in California

1. Occupational Heat-Related Illness in California Kathleen Fitzsimmons, MPH California Department of Public Health CDC/CSTE Applied Epidemiology Fellowship Kathleen.Fitzsimmons@cdph.ca.gov

2. Heat-Related Illness Mild • Heat rash • Heat syncope (fainting) • Heat cramps • Heat exhaustion • Heat stroke • Core body temperature >104°F • Multi-organ system dysfunction • Medical emergency • Death Severe

3. “Classic” Heat-Related IllnessRisk Factors • Age: Infants and Elderly • Lack of air conditioning • Social isolation • Pre-existing medical condition • Impaired mobility • Low socio-economic status • Housing characteristics

4. “Exertional” Heat-Related Illness Military Recruits Athletes Workers

5. Heat exchange of worker performing physical work in hot weather Solar radiation Wind Evaporation (sweat and respiration) Air temperature Air humidity Convection Radiation Metabolic heat Ground thermal radiation Reflected solar radiation Conduction

6. Lack of Acclimatization Dehydration Lack of Fitness Obesity Heavy Clothing Personal Risk Factors

7. Environmental Risk Assessment Link: The full heat index charts are available through the National Weather Service at http://www.crh.noaa.gov/jkl/?n=heat_index_calculator

8. Prevention • Education • Emergency response • Fluids accessible anddrinking encouraged • Cool area for rest breaks • Work/rest schedules • Acclimatization protocols

9. Occupational Heat-Related Illness • Mining • Construction • Agriculture • Forestry • Landscaping • Hazardous waste management • Fire fighting • Aluminum production and other hot industries

10. California Agriculture 5 heat-related deaths within 12 months • July 28, 2004 – Asuncion Valdivia picking grapes • July 13, 2005 – Salud Rodriguez in bell pepper field • July 14, 2005 – Ramon Hernandez in melon field • July 20, 2005 – Agustine Gudino in tomato field • July 31, 2005 – Constantino Cruz in tomato field “United Farm Workers calls on governor and lawmakers for emergency action”

11. August 3, 2005 “This is a tragedy…and we will do everything it takes to prevent this from happening again” August 22, 2005 Emergency regulation for heat illness

12. Public Health Action July 27, 2006

13. Heat Illness Prevention Regulation • Water • Training for supervisors and employees • Written procedures for compliance • Shade

14. Cal/OSHA Heat-Related Investigations2006 Employer Compliance with Regulation • Water Present Drinking encouraged? • Shade Available during rest breaks Allowed breaks as needed • Training Acclimatization importance Supervisor Training Written Heat Illness Prevention Prog. Written Emergency Response Plan Source: Prudhomme J, Neidhardt A. State of California Report. 10/18/07.

15. Millican R, Baker RC, Cook GT. Controlling heat stress: administrative versus physical control. Am Ind Hyg Assoc J. 1981; 42:411-6. Dinman BD, Horvath SM. Heat disorders in industry: a reevaluation of diagnostic criteria. J Occ Med. 1984;26(7):489-95. Donaghue AM. Heat illness in the U.S. mining industry. Am J Ind Med. 2004;45:351-6. Bonauto D, Anderson R, Rauser E, Burke B. Occupational heat illness in Washington State, 1995-2005. Am J Ind Med. 2007;00:1-11. Occupational HRI Incidence ?

16. Surveillance ProjectOccupational Health Branch, CDPH • Statewide, multisource surveillance to: • Detect cases of occupational HRI • Characterize disease and exposures • Calculate incidence • Identify areas for targeting prevention

17. Surveillance Case Definition(s) • Include all HRI cases (heat rash heat stroke) • Exclude burns and skin cancers • Probable and Possible

18. Data Sources • Healthcare Provider Treatment : Doctor’s First Reports of Occupational Injury or Illness (DFR) • 2007 data • WC Claims : Workers’ Compensation Information System (WCIS) • 2000-2007 data

19. N = 155 (2007) Ongoing, passive surveillance Mandated, statewide reporting Essentially a medical record High Positive Predictive Value DFR

20. Data Sources • Healthcare Provider Treatment : Doctor’s First Reports of Occupational Injury or Illness (DFR) • 2007 data • WC Claims : Workers’ Compensation Information System (WCIS) • 2000-2007 data

21. CA WCIS Heat-Related ClaimsBy Year of Injury2000-2007 (N=5,140) No. Claims Year

22. CA WCIS Heat-Related ClaimsBy Month of Injury2000-2007 (N=5,140) No. Claims Month

23. CA WCIS Heat-Related ClaimsBy Month of Injury2000-2007 (N=5,140) No. Claims Month

24. CA WCIS Heat-Related Claim Distribution By Month (April-Sept) and Year of Injury (2000-2007) 2006 2005 No. Claims Month 2000-2007

25. Next Steps • Continue data preparation and analysis • Data collection • Coding • Analysis • Evaluate surveillance system • Assess data usefulness • Evaluate system attributes

26. Conclusion “Changes in climate have implications for occupational health and safety. Heat stress due to high temperature and humidity is an occupational hazard…” -IPCC Fourth Assessment Report Climate Change 2007: Climate Change Impacts, Adaptation and Vulnerability, Ch.8, p.405

27. CDPH-OHB Bob Harrison Jennifer Flattery Carolina Espineli Matt Frederick Eleana Martysh Christine Hannigan Thomas Kim Janice Prudhomme Amalia Neidhardt (DIR) Gail Bateson John Beckman Dan Smith (CDPH-EHIB) Acknowledgements

28. Photo credit: www.csao.org Thank you