Heat Illness Prevention Worker Training

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1. Slide 1

   Heat-Illness Prevention

   • This material was produced under grant number SH-05032- SH8 from the Occupational Safety and Health Administration, U.S. Department of Labor. It does not necessarily reflect the views or policies of the U.S. Department of Labor, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
2. Slide 2

   Photo Sources

   • Bureau of Labor Statistics (BLS)
   • California Occupational Safety and Health Administration (Cal OSHA)
   • Centers for Disease Control and Prevention (CDC)
   • Department of Defense (DOD)
   • National Institute for Occupational Safety and Health (NIOSH)
   • Occupational Safety and Health Administration (OSHA)
   • Public Health Information Library (PHIL)
   • Source: Cal OSHA
3. Slide 3

   Take Pre-Test

   • The pre-test is compared to a post-test (at the end of the training) and helps us determine if we did a good job or need to make improvements.
   • It will also help you know what we will be covering in the training
   • Test (Clipart)
4. Slide 4

   Learning Objectives

   • 1. Discuss why heat-illness prevention is important
   • 2. Know cause, prevention and first aid for heat illnesses
   • 3. Understand the approach for heat-illness prevention
   • Train workers and supervisors on prevention strategies and to recognize signs and symptoms of heat-related illnesses
   • Monitor weather and workplace conditions
   • Assess heat-related hazards
   • Implement appropriate prevention strategies and controls
   • Plan for heat-related medical emergencies
   • 4. Understand how physiological monitoring can be used to help prevent heat-related illnesses
5. Slide 5

   Section 1:

   • Why is heat-illness prevention important?
6. Slide 6

   Class Discussion: Why is heat-illness prevention important?

   • Question mark clip art
7. Slide 7

   Heat-Illness Statistics

   • OSHA reported heat-related fatalities among outdoor workers (not all workers) 2008 to 2014
   • Source: OSHA
8. Slide 8

   Statistics for Texas

   • Temperature-Related Deaths Texas, 2003-2008
   • Temperature-related Deaths
   • 439 heat-related deaths reported among Texas residents
   • Harris County 41
   • Fort Bend 3
   • Liberty 3
   • Montgomery 3
   • Brazoria 2
   • Galveston 2
   • Source: Texas Health and Human Services (Temperature-related Deaths)
9. Slide 9

   Houston Area Statistics

   • Houston Heat related data, 2013- 2016
   • Houston Epidemiology Report
   • Source: Houston Health Department
10. Slide 10

    #1: The number one reason why we all need to look after each other on the job

    • We all deserve to go home safe to our family and friends
    • Children
    • Source: Centers for Disease Prevention and Control (CDC)
11. Slide 11

    OSHA Video on Heat Stress

    • OSHA Heat Illness Prevention Campaign OSHA Video on Heat Stress
12. Slide 12

    Section 2:

    • Heat-Illness Prevention Plan
13. Slide 13

    Elements Heat-Illness Prevention Plan

    • 1. Training
    • 2. Monitoring weather
    • 3. Assess Heat-related hazards
    • 4. Heat-Illness Prevention Strategies
    • 5. Emergency Preparedness
    • Plan (Clipart)
14. Slide 14

    Purpose and Scope

    • Purpose
    • This heat-illness prevention plan was developed to provide supervisors and workers with the training and tools to help protect them from heat-related exposures and illnesses.
    • Scope
    • Each work site and job task can be unique and contain a number of heat stress hazards that must be addressed prior to the beginning work and during work activities. Supervisors and workers are responsible for assessing these hazards and taking necessary corrective actions to reduce heat-related illnesses.
15. Slide 15

    Employee Training and Responsibilities

    • Each employee trained on procedures and will strictly adhere to them except when doing so would expose them to a greater hazard
    • Employees are to notify their supervisor of a concern and have the concern addressed before proceeding
    • Source: Cal OSHA
16. Slide 16

    Section 3: Training on Heat- Illness Prevention

17. Slide 17

    Risk Factors for Heat

    • Stress
    • Environmental risk factors
    • 1. Temperature
    • 2. Humidity
    • 3. Air movement
    • 4. Radiant heat
    • (e.g., sun exposure)
    • Risk Factors (Source: NIOSH)
18. Slide 18

    Risk Factors for Heat Stress

    • Work-related risk factors
    • 1. Age
    • 2. Physical fitness
    • 3. Acclimatization
    • 4. Medical conditions
    • 5. Medications
    • 6. Alcohol and/or drug use
    • 7. Caffeine
    • Risk Factors (Source: NIOSH)
19. Slide 19

    How the Body Handles Heat

    • Increased heart rate
    • Increased blood circulation to skin
    • Evaporative cooling from sweating
    • Thermogram (Stock Photo)
20. Slide 20

    The importance of acclimatization

    • Reduces risks of dehydration and salt loss
    • Sweating and evaporative cooling becomes more efficient
    • Salt loss becomes more efficient (less loss)
    • Core body temperature maintained more efficiently
    • Reduces strain on heart
    • Blood circulation to skin becomes more efficient
    • Recovery heart rate improves
    • More efficient sweating, blood flow to skin and heart rate recovery (CDC & Stock Photo)
21. Slide 21

    Human body needs to acclimate to hot environments, typically 10-14 days

    • Gradually increase exposure to hot environment over 7-14 days
    • Avoid prolonged exertion during hottest times of day
    • Schedule heavy exertion for cooler parts of day
    • Calendar (Clipart)
22. Slide 22

    When acclimated workers take an extended break they need to re-acclimate

    • Acclimatized workers will need 2-3 days of re-acclimatization if they stop working under heat stress conditions more than a week
    • Calendar 2 to 3 days (Clipart)
23. Slide 23

    The importance of consuming water throughout the work shift

    • One cup (8 oz.) of cool water or an electrolyte replacement fluid every 15-20 minutes; four cups of water every hour.
    • Increased water intake may be needed to account for increased physical exertion and/or sweating.
    • Source: Cal OSHA
24. Slide 24

    Too much water intake can be dangerous

    • Too much water intake can lead to headache, nausea, vomiting and/or mental confusion
    • Water bottle (Stock Photo)
25. Slide 25

    Physiological monitoring for dehydration may be necessary under extreme conditions

    • If sweat is not trapped within clothing, then we can monitor body weight, which should not drop below 1.5% of starting body weight.
    • Urine color is another indicator of potential dehydration. Normal urine should be a pale yellow.
    • Sweat trapped by encapsulating suit
    • (Source: PHIL)
26. Slide 26

    Monitoring Body Weight

    • Use a scale capable of accurately reading within ± 0.25 lbs.
    • Measure your weight at breaks, at least every hour if you are sweating a lot
    • Your body weight should not drop by more than 1.5%
    • If 150 lbs., then not more than 2 lbs.
    • If 200 lbs., then not more than 3 lbs.
    • Body Scale (Clipart)
27. Slide 27

    Monitoring Urine Color

    • Urine Color Chart
    • Normal urine should be pale yellow
    • Darker urine can indicate dehydration
    • Some diets, medications and illnesses may affect results
    • Source: NIOSH
28. Slide 28

    Importance of frequent rest breaks and shade

    • Prolonged physical exertion and muscle activity increases the body’s core temperature and reduces the body’s ability to cool itself.
    • Breaks allow blood to flow to the skin to be cooled.
    • Rest breaks slow down the buildup of heat in the body from prolonged muscle activity.
    • Rest breaks are important for the heart and allow your heart rate to recover from sustained heat stress and physical exertion.
    • Rest breaks in the shade help will cooling, especially if there is air movement with cool air.
    • Shade (Source Cal OSHA)
29. Slide 29

    NIOSH Investigation: Construction Laborer

    • KY FACE #03KY053
    • What factors contributed to his heat stress?
    • 41-year-old male sawing boards to make concrete forms
    • Clothing
    • Heavy blue jeans
    • Long-sleeved heavy shirt
    • Outside in sun during summer
    • Temperature 90 °F
    • Humidity 69%
    • Concrete pad (Source: NIOSH)
30. Slide 30

    He suffered from heat stroke

    • He collapsed towards the end of the day
    • A co-worker found him at 5 PM
    • Emergency services removed clothing, provided first aid and water
    • After being transported to the hospital, his body temperature was 108 °F
    • He died of heat stroke
    • Ambulance (Source: Cal OSHA)
31. Slide 31

    NIOSH Recommendations

    • 1. Supervisors and their employees should be trained to understand heat exhaustion/stroke symptoms when there is high heat and humidity.
    • 2. Breaks should be provided frequently to reduce dehydration and heat stroke/ exhaustion.
    • 3. Adjust amount of hours working outside for high humidity and heat conditions
    • Drink water (Source: CDC
32. Slide 32

    Heat-Related Illnesses

    • Major Heat-Related Illnesses
    • Heat Rash
    • Heat Cramps
    • Heat Syncope
    • Heat Exhaustion
    • Heat Stroke
    • Rhabdomyolysis
    • What You Need to Know
    • Cause
    • Preventative measures
    • Signs & symptoms
    • First aid treatment
    • When to report
33. Slide 33

    Progression of Heat-Related Illnesses (Source: NIOSH)

    • Less Severe Heat Rash
    • Heat Cramps
    • Heat Exhaustion
    • Heat Syncope
    • More Severe
    • Heat Stroke
    • Rhabdomyolysis
34. Slide 34

    Heat Rash: Cause and Prevention

    • Cause
    • Irritation of skin due to excessive sweating
    • Preventative Measures
    • Wear loose fitting clothing that allows sweat to dissipate
    • Wear freshly laundered clothing each day
    • Avoid working in sweat soaked clothing for prolonged periods (e.g., change at breaks as needed)
    • Wash sweat-soaked areas with mild soap and water and dry thoroughly at breaks and after your shift ends
35. Slide 35

    Heat Rash: Signs & Symptoms

    • Itchy and painful clusters of red blisters
    • Common to the neck, chest, groin, armpits and creases of the elbows and knees
    • Heat rash (Source DOD)
36. Slide 36

    Heat Rash: First Aid Treatment

    • Move person to a cool location
    • Have person take a cool shower
    • Thoroughly dry the skin following shower
    • Continue to ensure skin is cleaned and dried frequently, especially before and after shifts
    • Seek medical treatment if rash persists for more than two days or if rash become infected
    • Shower (Clipart)
37. Slide 37

    Heat Rash: Reporting

    • Report to supervisor or safety manager
    • Seek medical treatment if rash persists for more than two days or if rash becomes infected
    • Report to Supervisor (Stock Photo)
38. Slide 38

    Heat Cramps: Cause and Prevention

    • Cause
    • Preventative Measures
    • Acclimatization to heat helps reduce salt and water loss
    • Drink adequate amounts of water throughout the day This is a precursor to more
    • serious heat exhaustion
    • Salt your foods to taste
    • Depletion of salt and water in body due to excessive sweating.
    • and/or heat stroke.
39. Slide 39

    Heat Cramps: Signs & Symptoms

    • Muscle cramps, spasms and/or pain
    • Common to major muscles used for work
    • Arm muscles
    • Leg muscles
    • Abdominal muscles
    • Back muscles
    • Heat cramps (Source OSHA)
40. Slide 40

    Heat Cramps: First Aid Treatment

    • Move person to a cool location
    • Provide person with an electrolyte replacement fluid to replace lost salt and water
    • Seek medical treatment if cramps persist or other heat-illness symptoms develop
    • Sports Drink (Stock Photo)
41. Slide 41

    Heat Cramps: Reporting

    • Report to supervisor or safety manager
    • Seek medical treatment if cramps persist or other heat-illness symptoms develop
    • Elevated body temperature
    • Elevated heart rate
    • Headache
    • Dizziness, etc .
    • Check Temperature and heart rate (Stock Photo)
42. Slide 42

    Heat Syncope: Cause and Prevention

    • Cause
    • Prolonged standing or sudden rising from a sitting or resting (supine) position
    • Dehydration can be a contributing factor
    • Preventative Measures
    • Acclimatization to heat helps reduce dehydration
    • Drink adequate amounts of water throughout the day
    • Break up long periods of standing with small rest breaks
    • Rise slowly from sitting or resting positions
43. Slide 43

    Heat Syncope: Signs & Symptoms

    • Light-headedness or dizziness
    • Fainting
    • Worker fainted on job (Source: Cal OSHA)
44. Slide 44

    Heat Syncope: First Aid Treatment

    • If person fainted, then secure the area, elevate their feet above heart level and request immediate first aid and/or medical attention; do not allow them to get up quickly or walk
    • If person is only slightly dizzy and able to move
    • Have two people assist and carefully move to a cool location and have them lay down on back with feet elevated above heart level
    • Provide small amounts of water
    • If the dizziness persists, request immediate first aid and/or medical attention
    • Provide water and rest (Source: OSHA)
45. Slide 45

    Heat Syncope: Reporting

    • Report to supervisor or safety manager
    • If they fainted or dizziness persists, request immediate first aid and/or medical attention
    • Provide water, rest and monitor (Source: OSHA)
46. Slide 46

    Heat Exhaustion: Cause and Prevention

    • Cause
    • Inability of body to cool itself, often due to a combination of several factors (e.g., high temperatures, humidity, physical exertion, dehydration, clothing that blocks sweat evaporation or alcohol use).
    • This is a serious condition that can lead to a life-threatening heat stroke.
    • Preventative Measures
    • Acclimatization to heat helps reduce dehydration
    • Drink adequate amounts of water throughout the day
    • Take small rest breaks in shade to allow body to recover from heavy physical exertion and heat exposure
    • Protect skin against sunburn, which reduces body’s ability to cool itself
    • If possible, perform heavier physical labor towards cooler part of the day (e.g., early morning or evening)
47. Slide 47

    Heat Exhaustion: Signs & Symptoms

    • Elevated core body temperature of 100.4 to 102.2 °F; oral temperature 99.6 to 101.4 °F
    • Weak, but rapid pulse (elevated heart rate)
    • Cool, moist skin
    • May appear pale with clammy skin
    • Excessive sweating
    • Headache and possible irritability
    • Fatigue or weakness
    • Dizziness and/or feeling faint
    • Nausea and/or vomiting
    • Decreased urine output
    • Heat exhaustion (Source Cal OSHA)
48. Slide 48

    Heat Exhaustion: First Aid Treatment

    • Seek immediate medical care
    • Immediately help the person cool off
    • Move to a cool location
    • Remove or loosen unnecessary clothing
    • Have them drink small amounts of cool water
    • Spray skin with cool water and fan rapidly to increase evaporation and cooling
    • Monitor body temperature and continue cooling efforts until body temperature returns to a normal temperature below 99 °F (37 °C).
    • Implement additional heat stroke treatments if body temperature does not decrease below 100
    • F (37.8 °C) after 30 minutes or increases above 102 °F (38.9 °C).
    • Heat exhaustion (Source: OSHA)
49. Slide 49

    Heat Exhaustion: Reporting

    • Seek immediate medical care, especially if worker does not recover in first hour
    • Report to supervisor or safety manager
    • First aid (Clipart)
50. Slide 50

    Heat Stroke: Cause and Prevention

    • Cause
    • Preventative Measures
    • Body is unable to cool itself and regulate core body temperature.
    • Same as for Heat Exhaustion
    • Acclimatization
    • Drink adequate amounts of water throughout the day
    • Take small rest breaks in shade
    • Protect skin against sunburn
    • If possible, perform heavier physical labor towards cooler part of the day
    • This is a serious and life-threatening condition that requires immediate medical attention
    • (call 911).
51. Slide 51

    Heat Stroke: Signs & Symptoms

    • Elevated core body temperature above 104 °F
    • Oral temperature above 103.2 °F
    • Hot, dry skin or heavy sweating
    • Fainting or a loss of consciousness
    • Seizures or convulsions
    • Mental confusion, agitation
    • Irrational behavior
    • Clumsiness
    • Slurred speech
    • Heat stroke (Source Cal OSHA)
52. Slide 52

    Heat Stroke: First Aid Treatment

    • Seek immediate medical care (call 911)
    • Provide immediate and aggressive cooling to their body
    • Call 911 (OSHA)
    • Elevate feet above heart level
    • Remove or loosen unnecessary clothing
    • Pack ice in groin and armpit areas
    • Soak skin with cool water and fan vigorously to increase cooling of skin
    • As an alternative, immerse them in a tub of cool water or spray body with large amounts of cool water
    • Do not give person fluids to drink if unconscious or vomiting
    • Monitor body temperature and continue cooling efforts until body temperature returns to a normal temperature below 99 °F (37 °C).
    • Administer CPR as needed, if blood circulation or breathing stops, until emergency medical services arrive
53. Slide 53

    First Aid Treatment for Heat Stroke

    • Pack Ice along arm pit and groin areas (Source: DOD)
    • Remove clothing, spray skin with water and fan vigorously (Source: CDC)
54. Slide 54

    Heat Stroke: Reporting

    • Seek immediate medical care (call 911)
    • Report to supervisor or safety manager
    • Hospital (Clipart)
55. Slide 55

    NIOSH Investigation: Landscaping

    • FACE #02-MI-75-01
    • What factors contributed to his heat stress?
    • 30-year-old male performing lawn work
    • Two layers of clothing
    • Outside in sun during summer
    • Temperature 81 °F
    • Humidity likely > 60% (not reported)
    • Taking an antidepressant and antipsychotic
    • Antipsychotic had warning on heat exposures and heavy physical exertion
    • Landscaping (Source: NIOSH)
56. Slide 56

    He suffered and died from heat stroke due to a multiple drug intoxication

    • He complained of being light headed and short of breath at 3 PM
    • Co-worker brought him water and offered to get him help, but he refused help
    • Worked 30 more minutes at another location and then collapsed
    • After being transported to the hospital, his body temperature was 107.6 °F
    • Ambulance (Source: Cal OSHA)
57. Slide 57

    NIOSH Investigation Recommendations

    • 1. When hot outside, supervisors should consistently check on their employees for heat stress.
    • 2. Have medical staff help workers who take medications understand what may happen to them when outside in high heat conditions.
    • 3. Train staff on heat related illnesses before summer starts.
    • 4. Train staff on heat-related illness signs and symptoms.
    • 5. Give reminders throughout the day on drinking fluids.
58. Slide 58

    Rhabdomyolysis: Cause and Prevention

    • Cause
    • Sometimes caused by a combination of heat stress and prolonged physical exertion Muscle starts to break down and die, releasing proteins and electrolytes into the bloodstream.
    • This is a potentially life-threatening condition affecting the kidneys that requires immediate medical attention.
    • Preventative Measures
    • Same as for heat exhaustion and heat stroke
    • Avoid overexertion, such as lifting objects heavier than you can comfortably lift or straining muscles to a point where they can no longer function properly.
    • Those with diabetes, thyroid conditions or muscular dystrophy are at greater risk.
    • Those with a viral infection, such as flu, HIV or herpes, are at greater risk.
    • Use of alcohol & illegal drugs, such as heroin, cocaine & amphetamines can increase the risk.
    • Some medications, such as such as antipsychotics or statins, can increase the risk.
59. Slide 59

    Rhabdomyolysis: Signs & Symptoms

    • Muscle cramps, pain and/or loss of range
    • Joint pain and/or stiffness
    • Swelling of muscles
    • Weakness and a decreased ability to perform physical exertion for even a small amount of time
    • Dark urine (similar to tea or cola in color)
    • If kidney damage and/or failure occurs the following life-threatening indicators may be observed:
    • Shortness of breath
    • Irregular heart beat
    • Swelling in the legs and feet
    • Seizures
    • Coma
    • Rhabdomyolysis urine
    • (Creative Commons: James
    • Heilman, MD)
60. Slide 60

    Rhabdomyolysis : First Aid Treatment

    • Seek immediate medical care (call 911)
    • IV fluids and treatments to combat toxic proteins in blood are needed to prevent kidney failure
    • Hospital (Clipart)
61. Slide 61

    Rhabdomyolysis: Reporting

    • Seek immediate medical care (call 911)
    • Report to supervisor or safety manager
    • Hospital (Clipart)
62. Slide 62

    Section 4: Heat-illness prevention strategies

63. Slide 63

    Heat-illness prevention strategies

    • When Risk Level is High Incorporate Physiological Monitoring
    • Hierarchy of controls
    • Engineering controls
    • Administrative controls
    • Protective clothing & equipment
64. Slide 64

    When Risk Level is High Incorporate Physiological Monitoring

    • Oral temperature
    • Heart rate recovery
    • Additional measures to help reduce dehydration
    • Body weight
    • Urine color
    • Oral temperature monitoring (US ARMY DOD)
65. Slide 65

    Oral temperature

    • It is important to make sure the thermometer is stored in a cool environment and not exposure to temperatures above 95 °F.
    • Readings should not be taken be taken within 15-minutes of consuming hot or cool liquids and foods or if breathing heavy (mouth breathing).
    • Oral temperatures should not exceed 99.5 °F.
    • As a precautionary measure, when the oral temperature is elevated above 99.1 °F, adjust the work-rest schedule to increase the frequency and duration of rest breaks or take other preventative measures.
    • Oral thermometer
    • (Stock Photo)
66. Slide 66

    Oral Body Temperature

    • Guidelines
    • Oral temperature should not exceed 99.5 °F
    • When the oral temperature is elevated above 99.1 °F:
    • Adjust the work-rest schedule to increase the frequency and duration of rest breaks or take other preventative measures
    • Oral thermometer (Stock
    • Photo)
67. Slide 67

    Oral Body Temperature Measurement

    • Use a reliable and accurate clinical thermometer according to the manufacturer’s instructions.
    • Disposable oral thermometers; readings will take longer (e.g., 3-4 min).
    • Digital oral thermometers can deliver an accurate reading in as little as 30 seconds.
    • Make sure the thermometer is stored in a cool environment below 95 °F.
    • Do not take readings within 15-minutes of consuming hot or cool liquids and foods or if the worker is breathing heavy by mouth.
    • Oral Thermometer (Source: PHIL)
68. Slide 68
    • Oral Temperature Warning Levels
69. Slide 69

    Table 13. Collection and Interpretation of Oral Temperatures

    • STEP
    • Instructions
    • Schedule times for collection During the hottest times of the workday, collect oral temperatures at least every hour. Under severe conditions, the cycle should be at least every 30 minutes.
    • Collect oral temperature
    • If worker is not breathing heavily by mouth, then collect oral temperature at a scheduled rest breaks, before consumption of fluids. If worker is breathing heavily, then first drink fluids and collect temperature at end of rest break,
    • 15-minutes after drinking fluids.
    • Reading less than 99.1 °F
    • If thermometer reading is less than 99.1 °F, then resume normal work activities and work-rest schedule.
    • Reading 99.2 to 99.5 °F
    • If thermometer reading is 99.2 to 99.5 °F, then take precautionary measures to reduce heat stress (e.g., adjust work-rest schedule or implement additional controls)
    • Reading above 99.5 °F
    • If thermometer reading is above 99.5 °F, then suspend work and physical exertion within the hot environment and take immediate actions to cool body temperature (e.g., relocate to a cool environment with air movement and provide cool fluids). Monitor body temperature and continue cooling efforts until body temperature returns to a normal temperature below 99 °F. Seek medical attention if worker exhibits additional signs of heat exhaustion or temperature does not drop or continues to elevate at rest.
    • Reading above 101.2 °F
    • If thermometer reading is above 101.2 °F, then seek immediate medical attention and take immediate actions to cool his/her body temperature assuming potential heat stroke conditions (e.g., relocate to a cool location with air movement, remove excess clothing, spray body with cool water and fan vigorously, and pack ice in armpits and groin area).
70. Slide 70

    Methods for Collecting Pulse Rate

    • Heart rate pulse (Clipart)
    • The pulse rate can be collected manually
    • A reliable and accurate clinical pulse rate device for the finger, wrist or chest is recommended.
    • Use the guidelines provided by the device manufacture when collecting pulse rates.
    • Collect pulse rate at start of rest break
    • As the pulse rate will change with time, it is important to collect the pulse rate within a consistent and short interval (e.g., 5 to 10 seconds).
71. Slide 71

    Manually Counting Pulse Rate

    • Count the pulses at the inner wrist just below the palm on the thumb or neck to the side of the windpipe over a 30 second timed interval (e.g., using a stopwatch).
    • Use the index and middle fingers to detect a pulse and do not start counting until a reliable pulse can be detected. A slight amount of pressure may be necessary.
    • The number of pulses is then multiplied by 2 to give the pulse rate in bpm.
    • Check pulse (Clipart)
72. Slide 72

    Heart Rate Recovery

    • Take pulse rate readings at the beginning of a scheduled rest break.
    • With the worker sitting and resting, collect an initial pulse rate reading (P1) and if it is above 110 bpm, then take readings at a two-minute (P2) and four-minute (P3) interval.
    • If pulse rate does not drop to below 110 bpm, then this indicates heat stress conditions are above an acceptable level. The resting heart rate is too high, which indicates the work rate is too high for the individual.
    • With P1 above 110 bpm, if the difference between two-minute intervals is less than 10 bpm, then this also indicates heat stress conditions are above an acceptable level. The heart rate is not effectively recovering at rest, which also indicates the work rate is too high for the individual. It could also indicate dehydration.
73. Slide 73

    General Guidelines for Heart Rate Recovery

    • Within the first few minutes of rest
    • Your heart rate should drop to below 110 bpm
    • If it does not, then measure again at 2-minute intervals
    • Your heart rate should drop by more than 10 bpm every 2-minutes
74. Slide 74

    Table 14. Collection and Interpretation of Pulse Rates

    • STEP
    • Schedule times for collection
    • Instructions
    • During the hottest times of the workday, collect pulse rates at least every hour. Under severe conditions, the cycle should be at least every 30 minutes. Collect at the start of the rest break, within the first few minutes.
    • Collect initial pulse rate (P1)
    • Have the work sit on a stool or chair and rest. Collect the initial pulse rate within a few minutes after the worker has stopped working, at the start of the rest break.
    • If P1 is below 110 bpm
    • If the pulse rate is below 110 bpm, then resume normal work activities and work-rest schedule.
    • If P1 is above 110 bpm
    • If the pulse rate is above 110 bpm, then evaluate heart rate recovery by collecting two additional pulse rate measurements at two-minute intervals.
    • If differences between 2-
    • If differences between 2-minute intervals is greater than 10 bpm and the pulse rate drops below 110 bpm, then
    • minute intervals is greater
    • resume normal work activities and work-rest schedule.
    • than 10 bpm and the pulse rate drops below 110 bpm
    • If differences between 2-minute intervals is less than 10 bpm, then suspend work and physical exertion within the hot
    • minute intervals is less than
    • environment and take immediate actions to cool his/her body temperature (e.g., move to a cool location with air
    • 10 bpm
    • movement and provide cool fluids). Monitor pulse rate and/or body temperature and continue cooling efforts until
    • pulse rate drops below 90 bpm or body temperature returns to normal below 99 °F. Seek medical attention if worker exhibits additional signs of heat exhaustion or pulse rate and/or temperature do not drop or continue to elevate at rest.
75. Slide 75

    Caution: Heart Rate Recovery

    • There can be variation among individuals and some may exhibit much lower or higher resting pulse rates. A qualified medical provider should examine individuals with pre-work pulse rates above 100 bpm when at normal rest. High resting pulse rates could be indicative of an underlying medical condition.
    • Medical symbol
    • (Clipart)
76. Slide 76

    Class Exercise #1 Body Temperature and Heart Rate Recovery

    • Worker #1
    • Worker #2
    • Oral temperature 98.9 °F
    • Heart rate
    • Oral temperature 99.4 °F
    • Heart rate
    • P1: 140 bpm
    • P2: 115 bpm
    • P3: 95 bpm
    • P1: 125 bpm
    • P2: 120 bpm
    • P3: 118 bpm
77. Slide 77

    Class Exercise #1

    • What is your assessment for each worker? Can they return to normal duties?
    • Worker #1
    • Worker #2
78. Slide 78

    Hierarchy of Controls – a combination of several is always recommended

    • Engineering
    • Administrative
    • Reduce heat stress factors
    • Reduce WBGT
    • Acclimate workers
    • Use tools & equipment to Adjust work schedule reduce physical exertion
    • Rest, water & shade
    • Training
    • Clothing & Equipment
    • Adjust clothing layers
    • Light colored or reflective clothing
    • Cooling vests and clothing
79. Slide 79

    Engineering Controls

    • 1. Reduce physical exertion and physical demands of work through use of powered tools and equipment, especially for tasks involving heavy lifting.
    • 2. Reduce radiant heat loading from the sun or other sources of radiant heat (e.g., furnaces, combustion engines and compressors, hot surfaces, heated transfer lines, windows receiving intense sun, etc.). Place line-of-sight, reflective barriers between the heat source and workers. Insulate hot surfaces, such as furnaces.
    • 3. If air temperatures are below 95 °F, then increase air speed across skin using fans or air movers, to increase evaporative cooling from skin.
    • 4. If air temperatures are above 95 °F, then reduce air speed across skin, to reduce convective heat transfer from air to skin.
    • 5. If humidity is below 50%, then evaporative coolers and portable fans with water mist systems can be used to effectively cool the air by about 10 to 20 °F.
    • 6. Decrease humidity to below 50% to increase evaporative cooling from sweating.
80. Slide 80

    Examples of Engineering Controls

    • Misting fan (Wikimedia Creative
    • Commons by Tdorante10)
    • Forklift (Clipart)
81. Slide 81

    Administrative Controls 1 - 5

    • 1. Adjust work schedule to acclimate workers to heat.
    • 2. Schedule work or work requiring heavy physical exertion during the coolest parts of the day.
    • 3. Modify the work-rest schedule to shorten heat exposure periods by including frequent rest breaks. Shorter, more frequent breaks are more effective than longer, less frequent rest breaks.
    • 4. Encourage adequate water intake at frequent intervals to prevent dehydration (e.g., one 8-ounce cup of cool water or an electrolyte replacement fluid every 15-20 minutes).
    • 5. Use a shaded and cool space nearby for rest and water breaks.
82. Slide 82

    Water for Remote Job Sites

    • Water quantities need to be sufficient and at least 1 quart per worker per hour for the entire shift
    • Locate water containers as close as possible
    • Frequently drink water and not wait until thirsty – at least 1 cup every 15-20 minutes
    • Water cooler (Source: Cal OSHA)
83. Slide 83

    Review: Water for Remote Job Sites

    • Sanitation
    • Ensure water containers are clean and sanitary
    • Ensure water containers are filled at a sanitary location
    • Use disposable cups
    • Do not share cups and dispose properly
    • Do not open the cooler top to fill cups - Instead use the provided spigot
    • Use only pure and cool potable water
    • Do not use water from irrigation, sprinklers or fire systems
    • Do not use water from a garden hose (may contain contaminants and/or microbes)
    • Unacceptable water (Source: Cal OSHA)
84. Slide 84

    Examples of Administrative Controls

    • Adjust work schedule to have heavy physical exertion at cooler times of day (Clipart)
    • Rest in shade (OSHA)
85. Slide 85

    Administrative Controls 6 - 11

    • 6. Give training on the recognition of the signs and symptoms of heat-induced illness and on heat-illness prevention strategies.
    • 7. Provide alerts for extreme heat events or heat stress conditions and review of the heat-illness prevention strategies for the day.
    • 8. Work in pairs (buddy system) and monitor each other for signs and symptoms of heat stress or illness.
    • 9. Avoid caffeine and alcohol before and during work in heat. 10.Report illnesses or medical conditions that may put you at risk of heat stress (e.g., diarrhea, fever, infection, etc.)
    • 11.Get medically screened for work in hot environments.
86. Slide 86

    Protective Clothing and Equipment Controls

    • 1. Wear clothing designed to keep the body cool, such as air, cooled fluid or ice-cooled conditioned clothing.
    • 2. Wear reflective clothing to reduce radiant heat loading from the sun or hot surfaces radiating heat.
    • 3. If air temperatures are below 95 °F and you are protected from radiant heat, then decrease clothing coverage or layers (when feasible) to increase evaporative cooling from skin.
    • Caution: Do not remove clothing designed to protect you from chemical, mechanical or other hazards without a proper evaluation to address those hazards.
    • 4. If air temperatures are above 95 °F, then increase clothing coverage to reduce air speed across skin, which can help reduce convective heat transfer from air to skin.
87. Slide 87

    Examples of Protective Clothing Controls

    • Ice vest (DOD)
    • Light colored clothing (OSHA)
88. Slide 88

    CalOSHA Video on Heat Stress

    • Water. Rest. Shade.
89. Slide 89

    Section 5:

    • Preparing for medical emergencies
90. Slide 90

    Preparing for Medical Emergencies

    • When workers are exposed to heat stress conditions, it is critical to ensure adequate supervision, first aid and medical services are readily available in the event a worker suffers from a heat illness.
    • This includes ensuring adequate first aid supplies are available and supervisors and workers are trained on what to do if a co-worker suffers from a heat-related illness.
    • Preparation
    • Supervision
    • Training
    • First aid supplies
    • First aid providers
    • Nearby medical services
91. Slide 91

    First Aid Supplies: Have On Hand

    • 1. Reliable oral thermometer for checking body temperature.
    • 2. Reliable instrument or timer for checking heart rate.
    • 3. Cool water or electrolyte replacement fluids.
    • 4. Cold packs or ice packs for treatment of heat stroke.
    • 5. Spray bottles with water or an available water source for treating heat stroke.
    • First aid (Clipart)
92. Slide 92

    First Aid Providers

    • Each work site should have at least one person trained to administer first aid, with two or more preferred.
    • The location, physical address and phone number of the nearest hospital or emergency medical services must be obtained prior to the beginning of work activities under hot conditions.
    • First aid (Clipart)
93. Slide 93

    Emergency Response Information

    • The following emergency response information must be obtained prior to the beginning of work activities.
    • 1. Names, locations and phone numbers of all first aid trained supervisors or key personnel on site.
    • 2. Phone numbers for on-site or local medical emergency services.
    • 3. Address, phone number and directions from site to closest emergency medical services (e.g., hospital).
    • 4. Physical address and detailed directions for emergency medical services. If the site is a remote location, then check with emergency medical services to ensure they can find the location. Some providers may require GPS coordinates.
    • Map (Source Cal OSHA)
94. Slide 94

    Near the end… Anything to add?

    • Light bulb clip art
95. Slide 95

    Review of Learning Objectives

    • 1. Discuss why heat-illness prevention is important
    • 2. Know cause, prevention and first aid for heat illnesses
    • 3. Understand the approach for heat-illness prevention
    • Train workers and supervisors on prevention strategies and to recognize signs and symptoms of heat-related illnesses
    • Monitor weather and workplace conditions
    • Assess heat-related hazards
    • Implement appropriate prevention strategies and controls
    • Plan for heat-related medical emergencies
    • 4. Understand how physiological monitoring can be used to help prevent heat-related illnesses
96. Slide 96

    Take Post-Test and Complete Survey

    • The post-test and survey helps us determine if we did a good job or need to make improvements in certain areas.
    • THANK YOU!
    • BE SAFE!
    • Test (Clipart)