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Heat Stress & Occupational Health

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Heat Stress & Occupational Health New Understandings in Heat Stress Emma Moynihan, MPH Doctoral Candidate – Johns Hopkins University Advisor: Gurumurthy Ramachandran, PhD Outline • Introduction • Heat Stress & Occupational Health • Measuring Heat Stress • Worker Protections for Heat Stress • Application of Remote Sensing to Determine Heat Stress • Conclusion 1 Introduction Sengupta, S & Frank, B.L (August 25, 2020). Heat Smoke and COVID are Battering the Workers who Feed America. The New York Times. Heat, Smoke and Covid Are Battering the Workers Who Feed America - The New York Times (nytimes.com) ©2015,© 2020,© Johns2014, Johns JohnsHopkins Hopkins Hopkins University. University. University. All All rights rights All reserved.rightsreserved. reserved. Heat Stress & Occupational Health • Nearly half (47%) of all jobs in the United States require working outside, where exposure to heat stress greatest, for some part of the workday.2 • Workers at particularly high risk to heat stress include: • Agricultural Workers • Emergency Responders • Firefighters • Construction & utility Workers • Healthcare workers • Transportation Workers3 Figure one: OSH Heat-Related Deaths and Extreme Heat Projections4 ©2015,© 2020,© Johns2014, Johns JohnsHopkins Hopkins Hopkins University. University. University. All All rights rights All reserved.rightsreserved. reserved. 3 What is Heat Stress? Universal Thermal Climate Index Heat Exhaustion Heat Stress Heat Stroke Wet Bulb Globe Temperature Heat Strain Heat Index ©2015,© 2020,© Johns2014, Johns JohnsHopkins Hopkins Hopkins University. University. University. All All rights rights All reserved.rightsreserved. reserved. Definition of Heat Stress The National Institute for Occupational Health and Safety (NIOSH) defines heat stress as:4 “The net head load to which a worker is exposed from the combined contributions of metabolic heat, environmental factors, and clothing worn which results in an increase in heat storage in the body “ • Heat Strain – Physiological reaction heat, where body tries to stabilize body temperature and maintain homeostasis • Heat Exhaustion – Illness where core body temperature rises above 38 C/100.4 F leading to altered function of 1+ organ systems, if not controlled can lead to… • Heat Stroke – Medical Emergency when body temperature rises over 41.1 C/106 F. Onset at central nervous system ©2015,© 2020,© Johns2014, Johns JohnsHopkins Hopkins Hopkins University. University. University. All All rights rights All reserved.rightsreserved. reserved. Definition of Selected Heat Stress Measurements Heat Index: 26A measure of what the temperature “feels” like to us – a combination of relative humidity and air temperature. Wet Bulb Globe Temperature: 30 Considered workplace gold standard for heat stress. Measurement of heat stress in sunlight. Universal Thermal Climate Index: 29 A relatively new metric that uses air temperature plus a number of “offsets” that are supposed to more accurately reflect humans physiological response to heat stress. ©2015,© 2020,© Johns2014, Johns JohnsHopkins Hopkins Hopkins University. University. University. All All rights rights All reserved.rightsreserved. reserved. Climate Change and Heat Stress Intergovernmental Panel on Climate Change (IPCC) declared the limited knowledge regarding the effects of climate change on workers is a research gap that needs to be prioritized.6 By the mid 21st century, the number of 38 C/100 F+ days are predicted to double or even triple compared to the period 1970-2000.7 Source: Schwingshackl et. al (2021)8 Heat Stress and Climate Change: A Public Health Burden Each year, 700+ deaths are attributed to heat exposure in the United States.5 Heat exposure causes more deaths than hurricanes, tornados, and floods.9 By end of 21st century thousands to tens of thousand more annual deaths are expected due to heat exposure.10 Chicago Heat Wave of 1995 – 739 deaths in period of a week ©2015,© 2020,© Johns2014, Johns JohnsHopkins Hopkins Hopkins University. University. University. All All rights rights All reserved.rightsreserved. reserved. Outline • Introduction • Heat Stress & Occupational Health • Measuring Heat Stress • Worker Protections for Heat Stress • Application of Remote Sensing to Determine Occupational Heat Stress • Conclusion 1 Heat Stress and Occupational Health • 79 worker fatalities between 2014-2016 directly due to environmental heat reported to OSHA.6 • The number of illnesses and injuries related to heat stress in the work-place is likely much higher. There is limited research on this topic. • Heat stress is not limited to workers outdoors. • NIOSH estimates 5-10 million workers are exposed to high temperatures at work that puts them at risk for serious medical Source: Los Angeles Times (2017) conditions.11 • Complicated by the fact other worker protections like PPE, can exacerbate heat stress.11 What happens to the body under heat stress? The human body works to maintain a temperature around 37 C/98.6 F through a process known as thermoregulation. A series of feedback loops through the body work to dissipate heat or stimulate heat- preserving mechanisms depending on need. There are limits to the human body’s ability to maintain homeostasis in the face of extremes, and this can be modified by age, overall health, climate acclimatation etc. ©2015,© 2020,© Johns2014, Johns JohnsHopkins Hopkins Hopkins University. University. University. All All rights rights All reserved.rightsreserved. reserved. Risk Factors for Occupational Heat Related Illness and Injury Source: NIOSH, 2016 The Importance of Worker Acclimization to Hot Environments • More than 50% of heat related fatalities on the job occur within the first few days of working in warm environments.12 • NIOSH recommends no more than 20% exposure to a hot environment in the first few days on the job, gradually increasing by 20%.13 Source: NIOSH, 2014 Three Examples of Occupational Illnesses and Injuries Associated with Heat Stress Fatalities due to direct heat exposure are among the most severe consequences of heat stress, but there are other insidious examples of heat stress negatively impacting worker health and well-being. Three Examples are: 1. Chronic Kidney Disease of Unknown Etiology/Origin (CKDu) among Agricultural Workers 2. Elevated stress hormones among foundry Workers 3. Increased risk of cardiovascular disease Chronic Kidney Disease of Unknown Origin (CKDu) • In the late 20th century, cases of advanced kidney disease began to appear in global agricultural worker populations without presence of the disease’s traditional risk factors: diabetes, hypertension, and older age. • While some risk factors for CKDu remain enigmatic, “What we do know for certain is that CKDu is related to heat exposure and dehydration.”14 Elevated Stress Hormones • Foundry plant workers exposed to higher wet bulb globe temperatures (WBGT) during their shift had elevated levels of cortisol, adrenaline, and noradrenaline compared to workers exposed to lower WBGTs.15 • Also found a decrease in cognitive performance among workers exposed to high WBGTs over course of shift.15 Heat Stress and Cardiovascular disease • Heat stress puts additional strain on the cardiovascular system, requiring increased blood flow in attempt to maintain homeostasis.16 • A large cohort study in Finland found an increased risk of cardiorespiratory ailments among certain occupations (agriculture compared to industry or office work) and among individuals exerting a greater physical load at work compared to a less physical load.17 ACGIH Source: ACGIH, 2019 Outline • Introduction • Heat Stress & Occupational Health • Measuring Heat Stress • Worker Protections for Heat Stress • Application of Remote Sensing to Determine Heat Stress • Conclusion 1 Measuring Heat Stress • There are many metrics available • Heat Stress can be measured: to measure heat stress including (but not limited to): Indirectly • Remote Sensing • Wet Bulb Globe Temperature (WBGT) – “Gold Standard” • Questionnaire/Surveys • Heat Index Directly • Which itself has multiple equations • Personal Monitoring • Apparent Temperature Instruments • Universal Thermal Climate • Area Monitoring Index • Biomarkers • Effective Temperature, among others Personal Monitoring • There are a number of wearable instruments to measure WBGT, heat index, temperature, relative humidity etc. Kestrell 5400 Heat Stress Tracker & Weather Meter. Can also be used for area monitoring Source: Negin Nazarian et al 2021 Environ. Res. Lett. 16 034031 More Examples of Personal Monitoring OSHA-NIOSH Heat Safety App • Measures Heat Index – modified for working conditions. • Works by plugging into phone’s locations services. • Option to edit variables (i.e. temperature, humidity, location) to predict heat index.23 Source: NIOSH, 2021 Biomarkers of Heat Stress What is a biomarker? “A biomarker is a biological characteristic that is objectively measured and evaluated as an indicator of normal biological or pathological processes, or a response to a therapeutic intervention. Examples include patterns of gene expression, levels of a particular protein in body fluids [i.e blood], or changes in electrical activity in the brain.”24 Source: Minnesota Dept of Health, 2020 Biomarkers of Heat Stress Examples of potential heat stress biomarkers Heat stress can also be measured indirectly. include: Proxy indicators for heat stress might include dehydration, which can be 1. “Heat shock proteins (HSPs) measured through urine specific gravity. 2. Innate immune markers, such as Acute Phase Proteins (APPs) 3. Oxidative stress markers
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