Heat Illness: How to Keep Your Workers Safe and Productive When the Mercury Rises Presented by:

Don Dressler Don Dressler Consulting

Gil Molina California Association of Agricultural Labor

Sheilaja Mittal MD, WorkWell Medical Group

Wednesday, May 15, 2013 1:30 p.m. to 3:00 p.m. Eastern 12:30 p.m. to 2:00 p.m. Central 11:30 a.m. to 1:00 p.m. Mountain 10:30 a.m. to 12:00 p.m. Pacific

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Heat Illness: How to Keep Your Workers Safe and Productive When the Mercury Rises Presented by:

Don Dressler Gil Molina Sheilaja Mittal May 15, 2013

What We Will Cover: • Heat Illness- the focus of Federal OSHA, Cal/OSHA and other states • Major prevention points about heat illness • What is heat illness • When is it hot enough to worry about heat illness? • What works: Water; Shade; Training; Supervisor monitoring employees Don Dressler Consulting www.DonDressler.com

The California campaign to protect outdoor workers from HEAT ILLNESS

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In 2012 Cal/OSHA issued 1,379 citations for violation of the Heat Illness Prevention Standard, #3395

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Graphic, easy-to-read and available in Spanish, Hmong, Punjabi and English.

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http://www.99calor.org

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Heat Illness is not just a work related problem!

123 high school football players died of heatrelated illnesses between 1960 and 2009. In 2010, “exertional heat stroke is the second leading cause of death among athletes, followed only by sudden cardiac death.”

Important! Everyone Needs to Know: Stop all activity if you become: 9 Lightheaded 9 Confused 9 Weak 9 Faint 9 Or have a pounding heart or trouble breathing

Tell your supervisor if you or one of your co-workers experience symptoms of heatrelated illness. Don Dressler Consulting www.DonDressler.com

Major Points About Heat Illness #1 – Acclimatization is a key to keeping safe #2 – Water needs to be consumed frequently-must be fit to drink. #3 - Shade is needed to provide somewhere to cool off #4 – Train employees and supervisors (or coaches and athletes) in signs of heat illness and emergency procedures. #5 – Be able to summon Emergency Responders

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Dangerous Days Why Acclimatization is Critical The first days on the job…(or on the sports field) are the highest danger! Almost 50% of reported heat illnesses occur on the 1st day of work. 80% of illnesses within 1st 4 days of work. Don Dressler Consulting www.DonDressler.com

California - 2005

What is Thermoregulation? • The ability to keep the body temperature within certain limits even when surrounding temperature is very different. • The body is able to regulate temperature by balancing heat produced and heat lost. • Core temp. is maintained within 98.2 F +/-3 degrees. • The skin temperature can vary. • Food you eat generates energy which is used to contract muscles. • The more you move, the more heat is generated.

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Acclimatization • What is it? Anyone working for the first time under heat stress will develop signs of strain: high body temp, pounding heart • On each succeeding day, work ability increases • Our body adjusts physiologically: – – – –

Increased, more dilute sweat – more evaporation Increased core-skin temp gradient – more convection Increased maximal cardiac output – less heat generation Decreased peak heart rate – less heat generation

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Heat Waves Even if an employee has been working- sudden increase in heat has an impact! Direct Relationship Between Temp and Number of Reported Cases-84% of the Cases Occurred During the July 2006 Heat Wave

Other 1st Day Factors • The Psychological Factors: – Being new – want to show that I am a good worker – Don’t stop to drink water, take breaks – Don’t know how to dress appropriately for evaporative cooling – Other factors: dehydration due to caffeine, alcohol, etc. Don Dressler Consulting www.DonDressler.com

Heat Exchange or Loss Heat is lost from our body in the following ways: 1. Evaporation: sweat changes from liquid to gas causing heat to be lost to atmosphere 2. Convection: the skin is cooler than the core 3. Radiation: transfer of electromagnetic waves from the sun to our body. This can result in heat gain when air temperature is above 95 F 4. Conduction: the body loses heat by direct contact with a cooler object e.g. wet cloth

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Heat Illness-What is it? Heat Illness is a continuum of illnesses related to the body’s inability to cope with heat. It includes: •Heat Rash •Heat Cramps •Fainting or heat syncope •Heat Exhaustion •Heat Stoke Human oral temperature is maintained at 98.2F. Core temperature is .5F higher. Death occurs when core temperature approaches 106-109F Don Dressler Consulting www.DonDressler.com

Types of Heat Illnesses There are five main kinds of heat illness: 1. Heat rash – often under clothing 2. Heat cramps – in arms or legs with physical labor. Can be caused by the loss of electrolytes from sweating.

3. Fainting – can occur when person not used to heat

4. Heat exhaustion – more serious effect 5. Heat stroke – can be fatal Don Dressler Consulting www.DonDressler.com

Heat-related illness: Signs, symptoms, and response Illness

Signs and Symptoms

Response

Heat rash

•Red blister-like eruptions/bumps •Itching (prickly sensation)

•Rest in a cool place. •Allow the skin to dry. •Monitor for infection.

Heat Cramps

•Painful spasms •Abnormal body posture •Grasping the affected area

•Rest in a cool place. •Drink water or a heavily diluted sports beverage (such as Gatorade). •Or ¼ - ½ teaspoon salt to 1 qt. water. •Seek medical attention if cramping is severe or does not go away.

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Heat Rash Heat Rash: caused by blocked sweat glands. Sweat contains salt which irritates the skin leading to inflammation and itching around the pores. In response: • rest in a cool place • avoid polyester and nylon clothing • wash with gentle soap and rinse • wash area several time a a day if possible. Don Dressler Consulting www.DonDressler.com

Heat Cramps & Heat Fainting Heat cramps are painful, involuntary muscle contractions that occur after exercise or working in a hot environment. Usually due to electrolyte imbalance (Sodium, Potassium, Calcium and Magnesium) Heat Fainting or Syncope: caused by decreased blood flow to the brain due to blood collecting in the legs and skin. Could also be due to lack of acclimatization. Symptoms include nausea, weakness, sensation of “blacking out” and dizziness. Don Dressler Consulting www.DonDressler.com

Heat exhaustion: Signs and Symptoms Illness

Signs and Symptoms

Heat •Headaches, exhaustion •Dizziness, light-headedness, or fainting •Weakness, •Mood changes, irritability or confusion •Feeling sick to your stomach and/or vomiting •Extreme sweating •Decreased and dark-colored urine •Pale clammy skin •Pulse is usually rapid

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Heat Exhaustion Heat exhaustion is usually caused by salt deficiency (sodium lost in sweat). This leads to decreased fluid and blood volume. Body temperature may be 100 F or greater, and blood pressure likely to be low.

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Heat Exhaustion: Response • Move the person to a cool, shaded area. •Don’t leave the person alone. •If the person is dizzy or light-headed, lay him on back and raise his legs about 6-8 inches. If the person is sick to his stomach, lay him on his side. • Loosen and remove heavy clothing. • Have the person drink some cool water (a small cup every 15 minutes) if he is not feeling sick to his stomach. • Try to cool the person by fanning him. Cool the skin with a cool spray mist of water or wet cloth. • If the person does not feel better in a few minutes call for emergency help. • Avoid strenuous activity for the rest of the day.

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Heat stroke: Signs and Symptoms Illness

Signs and Symptoms

Heat Stroke

•Dry, pale skin, sweating likely to be absent •Constricted pupils, low blood pressure •Nausea and vomiting •Hot, red skin (looks like sunburn) •Irritability, confusion, and not making any sense •Seizures or fits •Collapse (will not respond) •High temperature (104° F or higher)

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Heat Stroke: Response – A Medical Emergency •Call for emergency help (ambulance or 911) •Move the person to a cool, shaded area. Don’t leave the person alone. If the person is sick to his stomach, lay him on his side. •Remove heavy and outer clothing. •Have the person drink small amounts of cool water if he is alert enough to drink anything and not feeling sick to his stomach. •Try to cool the person by fanning. Cool the skin with a cool spray mist of water, wet cloth. •If ice is available, place ice packs in armpits and groin area. Don Dressler Consulting www.DonDressler.com

Heat Exhaustion or Heat Stroke? How do you tell the difference?? The telling difference is mental confusion/disorientation in ALL heat stroke victims. You can ask these 3 questions. 1. "What is your name?" 2. "What day is this?" 3. "Where are we?" If a worker can’t answer these questions, assume it is heat stroke.

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So when is it hot enough to worry about heat illness? • Cal/OSHA – Serious Hazard - 85 F • Cal/OSHA – High Heat Procedures -95 F • NIOSH – When temperature is 95 F or more, the body gains heat by radiation unless other cooling mechanisms are present. • Humidity is also a factor – affects evaporation. Don Dressler Consulting www.DonDressler.com

Humidity and the Heat Index • Evaporation is one of the key methods of cooling for the body, the higher the humidity, the harder it is for sweat to evaporate. • The Heat Index illustrated: – Relative Humidity of 40% at 80 F = Heat Index of 80 – Relative Humidity of 20% at 90 F = Heat Index of 86 – Relative Humidity of 60% at 90 F = Heat Index of 100

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California OSHA Rules Re: Heat Illness

Water-the California Standard ™Sufficient amounts of cool water available at all times w/at least one quart per employee per hour for the entire shift ™Easy access to clean and cool water encourages frequent drinking ™ As close as practicable given the working conditions and layout of the worksite.

™Keep the water replenished Don Dressler Consulting www.DonDressler.com

Shade – The California Standard ™Preventative Recovery Period (PRP) is necessary if an employee is suffering from heat illness or believes that a rest break is needed to recover from the heat ™ Employees must have access to an area with shade that is either open to the air or provided with ventilation or cooling for a period of no less than 5 minutes ™ When they request it – at any time.

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California Shade Rules • Shade Up if expected to be 85 F, or upon employee request • Shade must block sunlight. • Enough space to accommodate any employee who seeks it. • Enough room to accommodate 25% of employees at one time without touching each other. • Reachable within 2 ½ minute walk. Don Dressler Consulting www.DonDressler.com

Shade The employees must be allowed and encouraged to take a break in the shade for at least five minutes, when they feel the need to do so to protect themselves from overheating. (Cal/OSHA rule)

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High Heat Procedures • In CA: Ag, Construction, Landscaping, Oil and Gas, and heavy transport• When temp. is 95 F or more– Observe employees for signs of heat illness – Give more frequent reminders to drink water – Closely supervise new employees (first 14 days) – Ensure communications with employees

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Topics for Employee Training (Cal/OSHA) ™ The environmental and personal risk factors for heat illness-the added burden of heat load on the body caused by exertion, clothing, ™ Importance of frequent consumptions of small quantities of water-up to four cups per hour ™ Importance of acclimatization ™ Different types of heat illness, common signs and symptoms Don Dressler Consulting www.DonDressler.com

Additional Employee Training Topics (Cal/OSHA) ™ Importance of immediately reporting signs/symptoms of heat illness to supervisor-of heat illness in themselves, or in coworkers. ™ Employer’s Procedures for responding to possible heat illness -including how emergency medical services will be provided should they become necessary. ™ Procedures for contacting and directing emergency medical services to the worksite Don Dressler Consulting www.DonDressler.com

Additional Employee Training Topics (Cal/OSHA) ™ The employer’s procedures, if necessary, for transporting employees to a point where they can be reached by an emergency medical service provider. ™ The employer’s procedures for ensuring that, in the event of an emergency, clear and precise directions to the work site can and will be provided as needed to emergency responders. ™ The employer must designate someone to be available to invoke the emergency procedures when necessary.

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Supervisor Training (Cal/OSHA) ™ Same information required under employee training PLUS ™ How to implement the Cal/OSHA heat illness standard ™ Procedures to follow when an employee exhibits symptoms of heat illness, including emergency response ™ How to monitor weather reports and how to respond to hot weather advisories Don Dressler Consulting www.DonDressler.com

US DOL's OSHA Releases Mobile App To Help Protect Workers From Heat-Related Illnesses

HEAT SAFETY TOOL [en Español] By U.S. Department of Labor (DOL), Occupational Safety and Health Administration (OSHA)

Learn how to access National Weather Service

National Weather Service Weather Forecast Office • Excessive Heat Outlooks: are issued when the potential exists for an excessive heat event in the next 37 days. • Excessive Heat Watches: are issued when conditions are favorable for an excessive heat event in the next 12 to 48 hours. • Excessive Heat Warnings/Advisories: are issued when an excessive heat event is expected in the next 36 hours.

To Make Training Effective • Managers/Owners should quiz supervisors to ensure they are well versed in company policies. • When training – – ask questions rather than just giving out information. – ask about personal experiences. – describe actual cases to make it real. – don’t ever make fun of anyone. – follow-up to make sure the employees understood the information. Don Dressler Consulting www.DonDressler.com

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Know how to direct emergency responders to work site in emergency

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Drink Water Every 15 minutes

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Have Shade Available

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Training –BEFORE Exposure to Heat Conditions

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Cal/OSHA Requires Written Plan Detail in writing how your company will: • Provide access to water & shade • Monitor the weather • Institute high heat procedures and address lack of acclimatization • Train all employees and supervisors • Respond to heat illnesses without delay, provide first aid and emergency services. • Provide clear and precise directions to the worksite.

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Written Procedures ™

™

As long as they are effective, your Heat Illness Procedures can be integrated into the IIPP. Maintain the procedures on site or close to the site, so that it can be made available to representatives of Cal/OSHA upon request.

Emergency Response Procedures To ensure that emergency assistance is provided without delay, plan in advance how you will: – Immediately respond to symptoms of possible heat illness (who is responsible?) – Contact emergency medical service providers – Provide clear and precise directions to the worksite – Ensure that emergency procedures are invoked when appropriate Don Dressler Consulting www.DonDressler.com

What are the most serious heat illnesses? Heat exhaustion and Heat stroke Dehydration

Heat Exhaustion

Heat Stroke

Untreated heat exhaustion may progress to heat stroke. Symptoms of either should always be taken seriously

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Workers’ Responsibilities • Carrying out instructions and training for controlling heat stress • Being alert for symptoms in themselves and others • Drinking enough water • Getting adequate rest and sleep • Avoiding alcohol, illegal drug use, and excessive caffeine

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Supervisor’s Responsibilities 1. Overseeing acclimatization and heat stress training of new workers

2. Always make sure water and shade are available 3. Conducting periodic safety meetings during hot weather 4. Observing worker • drinking enough water? • rested? • showing any signs of heat illness? 5. Deal immediately with heat illness problems 6. Monitoring environmental conditions 7. Adjust work assignments as necessary Don Dressler Consulting www.DonDressler.com

Business Owner’s Responsibilities 1. Make sure Company has written plan and procedures in place to assure adequate water, shade, training and ability to respond to emergencies. 2. Ensure supervisors are trained and know their responsibilities. 3. Make sure every new employee is both trained about heat illness and monitored during first days on the job. 4. Enforce your heat illness plan. 5. Discipline any employee or supervisor who violates heat illness plan. 6. Continue to monitor compliance with safety plans. If the owner does not care – the employees and supervisors will not care! Don Dressler Consulting www.DonDressler.com

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For Heat Illness Materials, Visit: WWW.99calor.org

Resources: • UC Division of Agriculture and Natural Resources. http://ucanr.org/News/Heat/ • Centers for Disease Control and Prevention (CDC), “Extreme Heat”. http://www.bt.cdc.gov/disasters/extremeheat/index.asp • NIOSH Publication No. 86-112: Working in Hot Environments. http://www.cdc.gov/niosh/hotenvt.html • “TRABAJANDO EN AMBIENTES MUY CALUROSOS”. http://www.cdc.gov/spanish/niosh/docs/86-112sp.html • Don Dressler Consulting www.DonDressler.com

Additional Resources • Korey Stringer Institute, http://ksi.uconn.edu/ • Cal/OSHA 2013 training materials http://www.dir.ca.gov/dosh/heatillnessinfo. html • Cal/OSHA Consultation e-tools: http://www.dir.ca.gov/dosh/etools/08006/index.htm Don Dressler Consulting www.DonDressler.com

Feel free to send questions To [email protected]

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Disclaimers *This webinar is designed to provide accurate and authoritative information about the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional services. *This webinar provides general information only and does not constitute legal advice. No attorney-client relationship has been created. If legal advice or other expert assistance is required, the services of a competent professional should be sought. We recommend that you consult with qualified local counsel familiar with your specific situation before taking any action.

Speaker Biography

Don Dressler Don Dressler of Don Dressler Consulting of Irvine, California has been working with safety recordkeeping for over 15 years as the head of an agricultural trade association's safety and loss control staff and since 2003 as a safety and human resources consultant and attorney. Dressler focuses on safety, employment and human resources issues, accident investigations, OSHA compliance and workers' compensation. He serves as Risk and Safety Consultant to the California Association of Nurseries and Garden Centers, Group Safety Manager for the 3,500 members of the Attorneys and Accountants Association safety group sponsored by the American Association of Attorney/Certified Public Accountants and also legal advisor to the California Association of Agricultural Labor, an association of California farm labor contractors.

Gil Molina Gil Molina is CEO of the California Association of Agricultural Labor, one of the most active farm labor contractor associations in California. Molina is a former U.S. Department of Labor wage and hour investigator. His has expertise in dealing with compliance issues in agricultural employment matters. He is fluent in Spanish and frequently conducts safety and supervisory training, Cal-OSHA compliance training, and heat illness training for supervisors and employees.

Sheilaja Mittal Sheilaja Mittal, MD, QME, MRO, is the medical director for WorkWell Medical Group and has an extensive medical perspective for identifying signs of heat illness and how to respond when the first signs of heat stress begin.