Heat Stress 1 18 March 2021
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Heat Illness Response Guideline Presented in order of decreasing urgency. One or more indicators in a category indicate a positive determination for that category. Observations Determination and Action Severe Fatigue or Vomiting – Heat Stroke Watch for other signs of heat stroke Emergency Response while starting treatment for severe Begin aggressive cooling (cover in ice or place in cold/ice heat exhaustion. water bath). If ice is not available, other methods of cooling are flushing water over person from hose or shower; or Erratic / Irritable Behavior keep the skin wet and fanning. Confusion / Disorientation Garbled / Gibberish Speech Call emergency services and advise them that it is a heat Hysteria / Delirium / Apathy stroke case. Collapse Shivering Convulsions Unconscious Wobbly Walking Severe Heat Exhaustion Slow Reaction Times Move to air-conditioned space, encourage water/electrolyte Severe Fatigue drink if able, and allow to lay down. Severe Muscle Cramps Vomiting or Collapse without Any Optional: Cover head and shoulders with a towel soaked in Signs of Heat Stroke ice water. Person may say they have Watch for signs of heat stroke. Severe Fatigue Loss of Appetite If recovery is not progressing in 15 min, arrange for medical Nausea treatment and continue to watch for possible heat stroke. Headache Blurred Vision Person may say they feel Mild Heat Exhaustion Tired / Fatigued Inform supervisor Thirsty Recovery in cool area Weak Drink water and/or electrolyte drink Dizzy Lightheaded If symptoms persist after 15 min, treat as severe heat Muscle cramps exhaustion 16 March 2021 Occupational Heat Stress 1 18 March 2021 Alternate Titles Occupational Heat Stress More than you could ever want to know Somethings Old about heat stress Somethings New or Bernard – A one trick pony Thomas E Bernard | 18 March 2021 1 2 Special Thanks Fla AIHA Those with whom I have worked • USF and sponsors of my work Heat-Related Illness Are Real • CDC/NIOSH and Sunshine Education and Research Center • ACGIH® and ISO Committees to which I contribute • Faculty, staff, students and the many study participants • Candi D. Ashley and Ximena P. Garzón Notice: All opinions are mine 3 4 NIOSH Case for Heat Stress Management Rate of Heat-Related Illness CDC (2008) Occupation Incidence per 100,000 FTE • 423 deaths from 1992 through 2006 (28/y) Full Year Summer • Rate 20x higher for crop workers than all others Letter Carriers 81.3 176.5 Outdoors Fire Protection 80.8 158.8 BLS (2011) Roofers 59.0 161.2 • 4,190 lost time heat stress cases in 2010 Highway Construction 44.8 105.6 Increases with • Most fatalities among outdoor workers Underground Mining – Hard Rock 33.7 Hot Weather • Cases likely to be underreported Surface Mining – Stone 12.9 20 OSHA Citations in 2012 and 2013 Landscaping 11.6 25.6 Construction 6.8 21.3 • Most were deficient programs Surface Miners – Coal 5.3 • For fatalities: Usually no provisions for acclimatization All Other Industries 1.7 4.7 5 6 © 2021 Thomas E Bernard Occupational Heat Stress 2 18 March 2021 Exertional Heat Illness Carry-Over Effect Probability of exertional heat illness increases with environmental Previous Day heat and humidity • US Marine Training • Outdoor (mostly agriculture): 75% of heat disorders above 28°C- • Gulf Clean-up WBGT • Meta-analysis: Warm/Hot Work v Neutral: RR = 4) • Aluminum smelting (ORModHS = 20 and ORHighHS = 80) Multiple Day • Sports (OR = 7 between below and above 23 °C-WBGT) • Emergency Department Cases from Five States (3- to 4-day influence) • Outdoor work (Gulf Cleanup: OR = 1.4/°C-WBGT for >20°C) • Military training (OR = 4 between below and above 23 °C-WBGT) • Aluminum plants in Middle East (3-day weighted average) That is, there is an exposure-response relationship 7 8 200 Increased Accidents 150 Loss of Productivity Moderate Work Increase in Unsafe Behaviors Increase 100 1.8 50 1.7 Percent Light Work 1.6 0 Acute injuries in Aluminum Smelter 23 25 27 29 31 33 WBGT (ºC) 1.5 Speed (m/s) See also analysis of published papers 1.4 by June Spector, et al. (2019) that 1.3 demonstrates relationship between 0.1 1 10 100 1000 10000 ambient heat stress and frequency of Air Permeability severe injury 9 10 Synthesis of Key Elements Heat Stress Management NIOSH Criteria Document ACGIH® TLV® for Heat stress and strain documentation Bernard Vision of Prof. Jacques Malchaire, Belgium Key Heat Stress Management Elements My personal experience and practice A blend of old and new wine in new bottles 11 12 © 2021 Thomas E Bernard Occupational Heat Stress 3 18 March 2021 Topics for Today Written Policies Basics of Heat Stress Written Policies Heat Stress Exposure Assessment Interventions 13 14 Written Policies Program Context Fundamental principle of occupational health and safety Part of your continuous improvement program programs In the context of heat stress • Policies Specific to Heat Stress Management Program • Individual Discretion over Exposure • Discussed under heat stress hygiene practice • Part of administrative controls (See Tier 2 Interventions) • Acclimatization • Discussed under heat stress hygiene practices 15 16 Heat Exchange Biophysics of heat stress and job risk factors The Basics 17 18 © 2021 Thomas E Bernard Occupational Heat Stress 4 18 March 2021 Heat Flow Heat Balance Equation S = (M-W) + R + C + K – E S Heat storage rate (M-W) Net rate of metabolic heat generation R Net rate of radiant heat exchange C Net rate of convective heat exchange K Net rate of conductive heat exchange E Rate of evaporative heat loss 19 20 Metabolic Rate -- M Convection -- C Work demands are met by W Depends on converting chemical energy • Air to Skin Temperature Gradient (M) to mechanical energy (W) • Air Motion with a great deal of internal • Clothing heat generated in the process. M 0.6 C = hc vair (Tdb – Tsk) M >> W Clothing Effect, hc • Insulation (Inversely) H = M-W • Effective Porosity 21 22 Radiant Heat -- R Maximum Evaporative Cooling Depends on Depends on • Mean Radiant Temperature • Water Vapor Pressure (Humidity) Gradient • Clothing • Air Motion • Clothing Emax can be also limited by R = hr (Tr – Tsk) 0.6 Emax = vair (Psk – Pa) / Re sweating capacity Clothing Effect, hr Clothing Effect, Re • Insulation (Inversely) • Water Vapor Permeability of Fabric (Inversely) • Effective Porosity (Inversely) 23 24 © 2021 Thomas E Bernard Occupational Heat Stress 5 18 March 2021 Heat Balance Equation So, what makes the environment hot? S = (M-W) + R + C + K - E High If S = 0, W=0, and K=0, then Humidity High Air Ereq = M + R + C where Ereq < Emax Temperature Belding & Hatch Heat Stress Index: and Speed HSI = (Ereq/Emax)x100 Hot Surfaces S = Emax - Ereq (Increased Rate of Radiant Heat) 25 26 Clothing Effects Job Risk Factors for Heat Stress Fabric Water Vapor Environment Permeability • Humidity (Water Vapor Pressure) Convective Fabric Permissibility Work (Metabolic) Demands Insulation • Fabric • Construction Clothing Requirements Thermal • Evaporative Resistance Characteristics of Clothing 27 28 Measurement of Heat Stress Temperatures Psychrometric Natural Dry Bulb Wet Bulb Wet Bulb Globe Environment Tdb Tpwb Tnwb Tg Metabolic Rate Clothing 29 30 © 2021 Thomas E Bernard Occupational Heat Stress 6 18 March 2021 Wet Bulb Globe Temperature Estimations from Weather Data WBGT = 0.7 Tnwb + 0.3 Tg There are methods to estimate Tpwb, Tnwb and Tg from weather data. Except in direct sunlight, WBGT = 0.7 Tnwb + 0.2 Tg + 0.1 Tdb WBGT Index reflects effects of air temperature, humidity, hot surfaces and air motion. That is, C+R and Emax. 31 32 Metabolic Rate Table Values Tables Type of Work Metabolic Rate • Need to apply to the job of interest [Watts] • Most job descriptions and content are not current and thus the estimates are poor Passing the buck 125 Categories Dragging your heels 150 • Judgment about demands relative to descriptors Bending over backwards 200 Component Analysis Beating around the bush 250 Predictive Equations Jumping to conclusions 300 Heart Rate Running around in circles 350 Oxygen Consumption (called indirect calorimetry) 33 34 Metabolic Rate Categories ISO Estimation Method Light (Reference Rate: 180 W) Components of Metabolic Rate • < 235 W • Basal (Base) Metabolism (B) • sitting, standing, light hand/arm work Most Common • Posture (P) Moderate (Reference Rate: 300 W) • 235 - 350 W Approach • Type of Work (W) • walking, moderate lifting • Walking (D) Heavy (Reference Rate: 415 W) • Climbing (C) • 350 - 470 W • heavy materials handling Very Heavy (Reference Rate: 520 W) Potential Error • 470 - 800 W • Broad Range Total Metabolic Rate (M) = B + P + W + D + C • pick and shovel work • Over-Estimation 35 36 © 2021 Thomas E Bernard Occupational Heat Stress 7 18 March 2021 Predictive Equations and Others Early Thought on Clothing Effects Published equations that relate activity (or external work) to What WBGT metabolic rate. makes the heat stress Relationship between heart rate and metabolic demands the same? • Requires some care and no heat stress 28 °C-WBGT ?? °C-WBGT Assessment of oxygen consumption Moderate Work Moderate Work • Requires expertise and specialized equipment Work Clothes Protective Clothing 37 38 Tc v WBGT and Clothing Clothing Adjustment Values CAV Clothing Ensemble [°C-WBGT] Work Clothes 0 Cloth Coveralls 0 Double Layer Cloth Clothing 3 Shorts and Short-Sleeved Shirt -1 SMS Coveralls 0.5 Polyolefin Coveralls 1 Limited-Use Vapor-Barrier Coveralls 11 Note: Respirator Face Masks Have No Effect 39 40 Effective WBGT Time-Weighted Average WBGTeff1 x t1 + ••• + WBGTeffn x tn WBGTmeasured/estimated