Electronically Signing Occupational First Aid Patient Assessment Made Easy

Electronically signing occupational first aid patient assessment

Jessica | COEH CE: Ready to get Jessica | COEH CE: On behalf of the Center for Occupational Environmental Health, I would like to welcome you to the webinar heat stress exposure hazards health effects and measurement protocol presented by Michael strange CR CH. Jessica | COEH CE: Michael strange began his career as an analytical chemist at fireman's fund environmental lab laboratory Jessica | COEH CE: Then he worked as a field industrial hygiene is under the direction of Certified industrial hygiene is for the SPE group. Jessica | COEH CE: Before coming becoming a CH himself in 1990 he evaluates airborne chemical hazards noise radiation vibration and heat stress exposures to workers. Jessica | COEH CE: As well as indoor air quality in office environments manufacturing facilities chemical farm pharmaceutical and medical facilities agriculture hospitality construction office buildings and other environments. Jessica | COEH CE: Currently, he is the principal consultant for chub global risk advisors assigned to the Pacific Northwest. However, he regularly practices internationally with experienced in Australia Europe, North Africa, Canada and Mexico. Jessica | COEH CE: Thank you so much for joining us, Michael. Jessica | COEH CE: Are you ready, are you ready to go. Michael Strange: Yes, I am. Can you hear me okay Jessica | COEH CE: Yes, I can't thank you so much. Michael Strange: Excellent. And thank you all for attending. I apologize about the technical difficulties getting started a little late. Michael Strange: You know, I've attended several of the CH webinars and they've all been excellent presentation and very fine speakers. Michael Strange: So it's both my honor and somewhat humbling to have this opportunity to make this presentation to you. Michael Strange: I hope you'll find it useful August is good timing for a discussion on heat stress hazards to workers and as the summers get hotter as the current climate change models indicate workers indoors and outdoors will probably become more susceptible to heat related illness as we go on. Michael Strange: I promise you this is the most wordy and difficult to read. Slide that I'll show you. It's our attorneys disclaimer and you're welcome to read that at your leisure. I do want to add that Michael Strange: Extra disclose that I am an employee of global risk advisors and I've no relevant financial relationships to disclose. There was no financial in kind commercial support for this activity. Michael Strange: And I'd like to take this opportunity to give thanks to my colleague Tony DiMaggio in Chicago. Michael Strange: He developed the core of this presentation for his local section of the American desta Hygiene Association. I've made modifications to fit with this diverse audience today, but it was great. Start with good working model. So, so thank you, Tony. Michael Strange: Today we're going to define he stress heat strain and heat related illness and then we'll go into an overview of a heat stress and strain program includes these four parts. The where it's applicable, the heat stress assessment or measurements heat stress controls and awareness training. Michael Strange: Heat stress is the net heat load to which workers exposed and all these factors contribute to the heat stress both the physical exertion environmental factors and the type of clothing that's worn Michael Strange: And heat strain is the body's physiological response to heat stress of such as sweating or primary method. Michael Strange: The body uses evaporation to prevent its core temperature from rising to unhealthy levels. Michael Strange: evaporation of water is an endo thermite reaction, because the liquid water must absorb heat from its surroundings to change from its liquid state to vapor Michael Strange: And that's why we sweat to cool the body by evaporation. We also have an increase in heart rate so that more heat can be transferred from the core to the skin where the blood is cooled. Michael Strange: And when this pumping action and evaporation can't pull the body core fast enough. The result is a heat related illness or even death. And here are the types of illnesses that can manifest and we'll go through each one of these Michael Strange: The most serious Michael Strange: Illness is a heat stroke and it's the most life threatening and the symptoms include a hot dry skin or profuse sweating and they tend to have flushed skin. Michael Strange: Nausea and vomiting throbbing headache high body temperature, there can be an altered states mental stage or behavior. And of course, rapid breathing and racing heart rate. Michael Strange: So in terms of heatstroke, what can you do if you think someone's experience it. You need to get immediate medical attention call 911 or your local emergency services number Michael Strange: And then you need to take a while you're waiting for the ambulance, you need to take immediate action to cool the overheated person. Michael Strange: And those would include getting the person to shade or indoors. Remove excess clothing pool, the person with whatever means you have available, you can use a cold tub of water or cool shower. You see a person on a stretcher here with ice and Michael Strange: You can cool with fanning and missing with water, even a garden hose on a mild setting anything to get them cool Michael Strange: So here are the symptoms of heat exhaustion and I'm going to bring back the symptoms of heat stroke, so you can compare and contrast because Michael Strange: heat exhaustion can slip very easily into heat stroke and you'll notice some of these symptoms are very similar and may just vary by severity Michael Strange: With heat exhaustion. You may see cool my skin with Goosebumps contrasting heatstroke with hot dry skin or profuse sweating. Michael Strange: With heatstroke the skin may be dry because the body's given up on evaporation as a means of cooling. So the core temperature continues to rise, and there's the danger. Michael Strange: Flush skin is another sign of heatstroke that's not typical of heat exhaustion. The faintness dizziness and fatigue might be hard to distinguish from altered mental state as well as the pulse nausea and headache. So when in doubt, it's best to err on the side of caution and call an ambulance. Michael Strange: So with heat exhaustion. Michael Strange: You must stop all activities and rest moved to a cooler place and drink cool water or a sports drink. Michael Strange: One person should stay with you and watch for symptoms that could suggest. You're slipping into heatstroke, such as unable to drink becoming confused or agitated losing consciousness or running a high fever, and if you're showing these actions, go back to the actions I described for heatstroke Michael Strange: Don't worry about remembering these details because later in the presentation, I'll show you an excellent free phone app. So this resource can always be with you. Michael Strange: A heat cramps are painful involuntary muscle spasms, that usually occur during heavy exercise and hot environment. They may be more intense and prolong than the typical nighttime like cramps and fluid and electrolyte loss often contribute to the Centrum Michael Strange: So what you can do is rest briefly and cool down. Drink it clear, choose or an electrolyte containing sports drink practice gentle range of motion stretching and temperament gentle massage the affected muscle groups. Michael Strange: And don't assume strenuous activity for several hours or longer after the heat cramps go away. And if they don't go away within an hour. So that's when you should see your doctor. Michael Strange: So, Michael Strange: Talk about sink heat sink copay and exercise related collapse. Michael Strange: It syncopated is a feeling of lightheadedness or fainting caused by high temperatures and it often occurs after standing for a long period of time or standing quickly after sitting for too long a period of time. Michael Strange: Exercise associated collapse is feeling light headed and fainting immediate or fainting media Lee after exercising, especially if you immediately stopped running and stand after Michael Strange: Race or a long run Michael Strange: For heat rash. It's also known as prickly heat or Millie area and it felt that effects adults as well as babies, especially during hot humid weather. Michael Strange: heat rash develops when the block pores are sweat ducks trap perspiration onto your skin. So it tends to develop and skin folds, where the clothing causes friction Michael Strange: Symptoms range from superficial blisters too deep red lumps and some forms of heat rash field prickly are intensely itchy heat rash usually clears on its own severe forms of the condition may need medical care. But the best way to relieve symptoms is to pull your skin and prevent sweating. Michael Strange: The types of Millie ARIA are classified according to how deeply the sweat ducks are blocked and the signs and symptoms for each type very Michael Strange: Male the ARIA Kristalina is the mildest form and it's marked by clear fluid filled blisters and pumps bumps or pap fuels that break easily Michael Strange: Millie ru ru bro occurs in Michael Strange: Deeper in the skin and the signs and symptoms include red bumps and itching or prickling in the effective area. Michael Strange: Occasionally the fluid filled containing sacks the festivals of milling ARIA Rupert become inflamed and plus filled and this form is called Millie Oreo cookies too low. So Michael Strange: And the last one is less common. It's really profound where sweat leaks out of the sweat glands, but still retained in the skin and it causes firm flesh colored leads and Lisa. Lisa things that resemble goosebumps. Michael Strange: heat rash usually heels by cooling the skin and avoiding further exposure to heat the cost it Michael Strange: Then you should see your doctor if you were a child have symptoms that last longer than a few days. Michael Strange: If the heat rash seems to be getting worse, or if you notice signs of infection, such as increased pain, swelling, redness or warmth around the affected area plus training from the lesions swollen lymph nodes and the armpit Matt or growing Michael Strange: Or fever, chills, Michael Strange: There are many factors that contribute to the risk for heat stress related illness and I like to go over these obviously high temperature and humidity are factors as well as direct sunlight. Michael Strange: If you have indoor radiant heat sources like furnaces and if there's limited air movement indoors or outdoors. Michael Strange: If you're not in taking enough fluid that's an increased risk of heat related illness, a physical exertion personal protective equipment and clothing. Michael Strange: And it's also based on your physical conditions or any pre existing health problems, your medications can affect make you more susceptible to heat stress. Michael Strange: Pregnancy a lack of recent exposure. If you're not an a climate eyes worker. You're a greater risk for heat related illness advanced age or if you've previously had heat related illness. Michael Strange: I think related illness prevention program is most effective when management commits to identifying and reducing exposure to the hazards. The program should establish how to determine if workers are exposed to a heat hazard based on these environmental conditions. Michael Strange: And we've established tools for doing that. The program should also include procedures to control and hopefully minimize the heat hazards. Michael Strange: So the four key aspects of Michael Strange: The heat illness heat related illness prevention program I mentioned earlier, it's where it applies applicability heat stress assessment measurement Michael Strange: What you do to control the heat stress issues and awareness training, very important. And we'll go through each of these Michael Strange: It's the program is applicable where the temperatures may exceed the action level federal OSHA has a heat stress guideline, but not a regulation. Michael Strange: They can do site under the general duty clause, but it needs to be a clear and an imminent hazard and we've seen earlier how the consequences of a heat stress exposure could be very severe Michael Strange: In California, we do have a heat stress regulation and title eight and Minnesota and Washington State have also adopted standards. Michael Strange: In California, Cal Osha requires employers to provide shade at an ambient level of Fort sorry 80 degrees Fahrenheit. When temperatures reach 95 degrees or above, Cal Osha requires the employer to ensure that employee takes minimum 10 minute cooldown rest periods every two hours. Michael Strange: On the actual limit does not apply to infrequently performed light to moderate work tasks of short duration like 15 minutes or less. I'm contractors also have to have their own heat stress prevention program and implement that program for their work activities. Michael Strange: When the action levels exceeded he assessment needs to be done. And if control measures are implemented a reassessment as needed to make sure that they've been effective. Michael Strange: And here are three methods that you can use the best method is a direct reading instrument to measure the wet all blog temperature Michael Strange: There are units you can purchase, but I usually rent lawn for about $65 a day. That way we don't have to get them calibrated annually for an instrument, I may only use a few times a year. Michael Strange: The rental company does the calibrations and they can give you a certificate and we compare these results to the AC GH T LV an actual limit and I'll show you an example of that, too. Michael Strange: You can also estimate heat floats using your local weather forecast will give you the dry ball temperature and humidity. Michael Strange: This is only applicable if the outdoor weather conditions are representative of those in the workplace. Usually they're not. Michael Strange: If you have interior heat sources such as furnaces, or a lot of machinery, you really need to get into our measurements and I'll also show you a heat stress cocktail calculator screening tool. Michael Strange: A wet ball globe temperature Michael Strange: Is a heat measurement used by a CGI. Ah, and NIOSH NIOSH is the National Institutes for Occupational Safety and Health, the research on OSHA Michael Strange: So based on the it's based on the Dr. Bob temperature the wet bulb temperature and the globe temperature the web bulb is the center prob with the wick with his older model. Michael Strange: You have to, you put distilled water in the reservoir to keep the week wet the newer models use internal probes. So the ambient temperature that Dr. Bob is the far right probe and the radiant heat or globe temperature is measured in the black probe. Michael Strange: And here's what that relationship looks like mathematically here the formulas for the calculation for what bulb globe temperature Michael Strange: Now I just provide these to demonstrate the mathematical relationship. I haven't need to calculate these numbers, since I took the CH exam. Michael Strange: And then instruments give you the light bulb globe temperature value. Exactly. You just need to know whether it's with direct sunlight to exposure to sunlight, which is the out measurement or without direct exposure to the sun, called the end Michael Strange: This is table from the TV book live under the category of heat stress it lists the clothing clothing adjustment factors that you add to your wet bulb globe temperature measurement. There's no adjustment for standard work clothes or cloth coveralls three four double layer woven clothing. Michael Strange: You add half a half a degree for Michael Strange: SMS propylene propylene propylene coveralls the SMS is a special type of material that provides a combination of Readability is somewhat porous. Michael Strange: At the same time, it provides protection from the paints or liquid sprays or powders or whatever you're protecting from as compared to the poly olyphant coveralls that are less permeable to air. Michael Strange: There are also limited use vapor barrier coveralls with a protective factor of 11 Michael Strange: Now, note that none of these none. There's no value for level a fully encapsulated students. It's not assigned to value. Michael Strange: And that doesn't mean it's not zero. In fact, it's quite the contrary, they will inflate the body heat. Oftentimes, this is mediated with Michael Strange: Cooling from supplied air respirators or scb A's and we'll show you later. Some of the other ways to cool the person inside these barriers. Now, all of these values. Assume that only modesty clothing is worn underneath. No street clothes that would make the factor higher Michael Strange: So you add your clothing factors zero 11 to your web bulb globe temperature measurement and you then compare it to the appropriate to the value of table to Michael Strange: The horizontal component demonstrates the percentage of time spent at work, compared to the amount of time at rest and cool environments. Michael Strange: The vertical value is the level of exertion required for the work and that contributes to the metabolic heat load. Michael Strange: So if you have like work at a 75 to 100% work rest ratio work to rest ratio, the TV is 31 degrees centigrade and the action level is 28 degrees centigrade. Michael Strange: And you can see as you go higher in the what ball globe temperature your time working needs to become less and the rest periods need to become longer Michael Strange: Heavy and very heavy work involved physiological strain and the crime and there are no criteria developed provided for continuous work very heavy work is also excluded for the 50 to 75% range. Michael Strange: So as the work demand increases, as I said, so does the metabolic rate. And here are some of those values. Michael Strange: Consequently, these values on the table decrease Michael Strange: The criteria values in the table decrease to make sure that most workers will have will not have a body core temperature greater than 38 degrees centigrade and table three estimates that metabolic rate in watts and we'll use that later in the Michael Strange: Next, Michael Strange: At this table is from as well as by this worksheet was by Thomas Bernard of the University of South Florida college and public health. Michael Strange: And it is available on his website and I'll bring it up here too I put in some numbers as an example here are wet ball globe temperature measurements over various tasks throughout the day and I Michael Strange: Assumed and increasing temperature and the last column is all the rest breaks have put together. And I'm assuming a break room at 20 degrees centigrade and an hour a day would be to 15 minute breaks and a half hour lunch period. So this is the most 75 to 85 I mean 75 200 Michelle | COEH CE: I go to interrupt you for just a moment. It looks like we're actually not seeing the Excel window. I'm Michelle | COEH CE: Just sharing PowerPoint and Excel. Just wanted to let you know. Michael Strange: Yeah so appreciate that, um, Michael Strange: I could stop share and then bring up the worksheet, try to do that. Michelle | COEH CE: Go ahead, that that way people can see what you're you're looking at there. Michael Strange: I just hope it doesn't knock again. Michelle | COEH CE: And then if this time. If you want to share the full window that should help. Michelle | COEH CE: Perfect. Now we can see it. Thank you, Michael. Michael Strange: Okay. Thank you for pointing that out. So anyway, I will be healed back to the beginning because you didn't see those numbers in the PowerPoint. Right. Michael Strange: What we were pointing to actually know because you didn't see my my cursor move. So I've assumed Michael Strange: That bulb cold temperatures over five different tasks of the day. And this last column is the rest period and a 20 degree centigrade room, assuming to 15 minute breaks and a half hour lunch period. Michael Strange: So each of these where I've assumed a metabolic rate it's assigned that metabolic rate in watts. Michael Strange: And then we have the standard work clothing and what happens at the top, the effective wet bulb globe temperature for the for the day is Michael Strange: Just above the TV by about a 10th of a percent. Michael Strange: You want to be not only below the TV, but you want to be down at or below the action level or preferably below the action level. So there's some things that you can do to moderate this Michael Strange: Let's say that you put under the heavy work. Work task. Why don't you put a second person in there, put the time in half and then add that time over to the rest break Michael Strange: And that brings you even further down below the TL V still doesn't count as quite down to actual level, but as you can see you can you can work with those numbers. You can also a better solution would be to Michael Strange: Try to reduce that temperature in some way more cooling, so forth. But you can see how the tool works. So let me get back to the presentation, since we Michael Strange: started a little bit late here. Michael Strange: It didn't go back Michael Strange: To that one. Oops. Michael Strange: There it is. Okay. Michael Strange: Okay, are you seeing the presentation again. Michelle | COEH CE: Yes, we are. Michael Strange: Okay. Yes. Okay, good. Um, so let's look at a real world example here in late June 2018 I went to a chemical dispensing facility in in Arizona, where they package it in organic acids such as hydrogen fluoride also alkali and peroxide and so forth. Michael Strange: It's in an air conditioned building. So you might expect that the ambient heat levels are likely to stay below action level. Michael Strange: But Michael Strange: And and that's pretty much is the case in terms of just the standard reading with no clothing adjustment. But let's say that you had to put on one of those have full vapor barrier suits for heights and fluoride. Michael Strange: That would have to add a clothing factor of 11 and and almost all these cases, both indoors and outdoors, that puts us over the action level, if not over the to V. Now this is a gross overestimation of the exposure, because they don't package hydrogen fluoride all day. Michael Strange: For a whole shift day, but the work load does fluctuate depending on what supply orders. They're getting so we assume the worst case. Michael Strange: And also we're assuming the Michael Strange: 75 to 100% work site rest cycle. I like to call your attention to graphs. Oops, the back Michael Strange: To the graphs, a three and a four here and you'll see that in the in the basic dispensing room with nothing happening. Michael Strange: You got the very low temperatures. If you had the clothing adjustment of 11 you get this on a for I had asked the worker to wear the heat stress monitor Michael Strange: On what he was wearing street clothes under his coveralls and he put the monitor in on his belt in between the street clothes and the vapor barrier coveralls. He was a good sport. Michael Strange: Um, and he worked in there for about an hour and look what happens with the results, the low end of the measurement is pretty much what we predicted for the empty room. Michael Strange: But look at the high end measurement is more than 11 degrees hotter and there could be a couple of reasons. That one is the fact that he's wearing street clothes and it doesn't apply. Michael Strange: And the other is, he was working very fast. And so he might have slipped from moderate work too heavy work. So you kind of have to go back and forth with your definitions, based on what you see in the field and what the numbers show you Michael Strange: Two of my recommendations for this site was that they Michael Strange: Change out of street clothes before donning the vapor barrier cover roles and Michael Strange: Increase the well decrease the work versus rest time to 50 to 75% Michael Strange: Now for the peroxide. The analyzing the other chemicals, the P P is really not a problem because it's either a cloth cover all or it's our paper cover or it's a Michael Strange: Protective aprons. I wanna call your attention also to the outdoor mix platform. Here are the measurements. Michael Strange: Early in the morning and the shift STANDARD SHIFT is five to 130 and that lets them get out before the heat of the day in the summer and winter time, it goes back to a different kind of ours. Michael Strange: And if you notice at the last measurement. You can see that even the ambient temperature out on that mix platform was above the action level and you add clothing to that and substantially higher Michael Strange: So I wanted to show you all those dispensing results graphically in the top graph is Michael Strange: The data logging readout of the heat stress meter in the dispensing room with no work going on. And you can see the temperature ranges from 14 to 21 degrees. See the lower scale down here. Michael Strange: Goes from 24 to 16 and this is the monitor, when it was inside the workers coveralls and you can see that, first of all, the humidity is really high, he was he was Michael Strange: Really his clothes are really drenched when he got out of there. And you can see it. The heat index went incredibly high. The temperature, plus the humidity. Michael Strange: So that was again and it demonstrates the effect of the heat and the clothing. Michael Strange: So the goal of the TV's to keep the body core temperature below 38 degrees. And so what do we do with these wet ball blown temperature readings. Michael Strange: If you go down the chart if you anticipate heat stress, the first thing you look as a clothing. Does it allow air movement. And then the next step down. Do you have screening criteria. Michael Strange: Is the screening criteria table to exceed it, in other words you above the action level. And if it's yes you go down into Michael Strange: The is the data for Dale detailed analysis. Michael Strange: That indicates heat stress and if Michael Strange: I'm sorry, it's a data available. Michael Strange: And if there's yes then you go down to excessive heat stress based on detailed analysis. If not, I mean, so you perform the heat strain physiological monitoring. Michael Strange: And if you find that there's excessive heat strain based on the monitoring you implement job controls and then go back and go through the reassessment again. Again, this is right out of the TV booklet. Michael Strange: You're welcome forecast allows you time to prepare for forecasted heat waves, but keep in mind too that the outdoor conditions might not represent indoor Michael Strange: For example, if you have a large metal fabrication shop with open windows and rolled up doors, but no air conditioning. Michael Strange: All I can really help you do is anticipate Potter overall conditions in your region. Weather Underground. Same thing, give you a historical data for any city and also daily forecasts. Michael Strange: I NIOSH and OSHA have developed the screening tool app which takes the local weather conditions. The Dr. Bob and relative humidity and it determines a combined hate heat index the heat index is higher. When that occurs. Michael Strange: With temperatures occur high temperatures occur with high humidity and lower when they occur with lower humidity. Michael Strange: And the heat index is based on studies of skin cooling caused by evaporation sweat. Michael Strange: The heat index is a number that represents the effect of temperature and humidity on humans by combining the two variables into an apparent temperature like 90 feels like 112 Michael Strange: It also has a handy tabs at the bottom here that site. The symptoms of different illnesses that I described beginning and it has a tab for first aid instructions for each heat illness. Michael Strange: When you're in that stressful situation, trying to observe someone symptoms. This is a very handy tool to have right at your fingertips. The knowledge can help keep us calm and baseball. That's the ball, it's, it's a free app. Michael Strange: But the ocean is app destined to, again, it's give you the heat index value and the work itself. Michael Strange: Just, you know, such as the large metal fabrication shop or outdoors for the agricultural workers are working in the fields. Michael Strange: I would like to show you another screening tool that's based on these or agencies listed here. Michael Strange: The tool is based on heat index and also considers worker climates ization clothing, p, p workload and solar low but before we get there, let's talk about issues of climate face on climate ization and other factors. Michael Strange: In terms of quick and easy heat stress measurement tool. Um, there's a slinky micrometer. Michael Strange: Which Michael Strange: Is good manual tool. It has to thermometers a wet bulb and a Dr. Paul that you spend in the air while you're holding the handle. Michael Strange: And then you take the let dry bulb readings together and it gives you the relative humidity and percent Michael Strange: Are there also electronic versions of this, but they should be calibrated annually by the manufacturer Michael Strange: And if there's a phone app for this. I wouldn't trust them. I was once with a customer who bought a sound level meter app. And when we did side by side measurements against my calibrated sound level meter. Michael Strange: His result was just as much as as much as 10% off in some cases, and that's huge of a logarithmic scale. So, you know, if it's not calibrated. It's just not. It's not a calibrated instrument. It's not a real reading Michael Strange: So when we measure the temperature and relative humidity, then we need to know if the workforce is the climate eyes to the hot environment. Michael Strange: And the climate ization program when it's properly designed and applied it to increases substantially the risk of heat related illnesses among employees and it involves exposing employees to work in the hot environment for progressively longer periods. Michael Strange: If you have workers have had previous experience in jobs where the heat levels are high enough to produce heat stress. Michael Strange: The regimen should be 50% exposure on day 160 percent on day 280 percent on day three 100% on day four. And it's also important to add that previous experience needs to be recent because you can lose the climate, the station. Michael Strange: For new workers. It's no more than 20% on day one, no more than 20 with a daily increase of no more than 20% per day for five days. And also, as I said, Michael Strange: The loss of a account climate ization can occur when you no longer exposed usually becomes noticeable after four days and may be completely lost after three to four weeks and then you need to start from the beginning again. Michael Strange: And so, next, just like with the TLC comparison we equate the impact of clothing flame retardant clothing and personal protective equipment. Michael Strange: And we also Michael Strange: Evaluate the level of the physical workload, just like he did in the other example. Michael Strange: And what we come up with when we place all these factors into the tool we wind up with a number that gives us the relative risk level from no adverse impact expected, you know, all the way up to high risk where heatstroke could be likely without controls. Michael Strange: And Michael Strange: Good back Michael Strange: Okay. Michael Strange: Here's the other example that I showed you have a heat stress tool and that will use this heat index formula. So let's take for example you have an ambient Michael Strange: outdoor temperature or a rookery temperature, excuse me up 90 degrees. Michael Strange: And let's say it's 50% humidity. Michael Strange: Assuming we have a privatized workforce with light or no thick garments normal exertion and note direct exposure to sunlight. We have a heat index of 96 which puts us in a low risk category where the heat stress heat exhaustion or cramps are possible. Michael Strange: If just to see how the numbers go let's say you have a non a climate eyes worker. Well, you add a factor of 10 Michael Strange: And it raises you up to 106 which puts you into that medium category where those heat cramps and exhaustion are likely and heatstroke possible Michael Strange: And so let's just let's just add some more and see what that does to our heat. Heat stress settings fully protect full body chemical protective suit adds another 10 Michael Strange: If you have strenuous work heavy work. It's a huge adjustment five and let's say there's direct sunlight takes you up to 15 and that Michael Strange: brings you down to 136 which puts you in a very high risk category. And so there have to be some cooling effects measures taken and I'll show you what some of those are Michael Strange: Okay, yeah, there's a tool. Michael Strange: Okay, next. Michael Strange: If the heat stress Calculator Tool gives you very borderline results, then you should probably do more detailed analysis of the direct reading Michael Strange: Wet bulk low temperature measurements and even then you have to consider the TV and action levels are estimates that are reasonably expected to protect most workers. Michael Strange: And there is also the option of doing physiological monitoring directly to see if a work with having response to heat stress. Michael Strange: You can measure it right on the person. I'll tell you right now, there's not a very easy. Michael Strange: Workable Michael Strange: Technological tool for that we had been experimenting with a number of them. Michael Strange: Here are some of the physiological monitoring parameters that we can look for. And if you're below these numbers, then it indicates and acceptable management of your heat stress exposures. Again, you want to consider extremes and less tolerant workers. Michael Strange: Basically they should be discontinued at the heart rate is over 180 beats per minute, minus the individual agent years if the core temperature for Michael Strange: Climate eyes are on the climate eyes worker is excessive or the recovery heart rate at one minute after a peak work effort is greater than 120 or if there are those symptoms of sudden and severe fatigue, nausea, dizziness, Michael Strange: On now at that same mom chemical packaging facility in Arizona, where I did the area wet ball monitoring. Michael Strange: I also asked workers to wear probes that would monitor their body temperature all day long. The probe is designed as an earplug that's wired to a data logging device that a worker wears on the belt. Michael Strange: The probe measures the temperature inside the ear and compares it to the temperature inside the mold. Michael Strange: A temperature differential and more than 10 degrees centigrade means that the earplug fit is compromised and there in lies the problem. Michael Strange: Unfortunately, the ear pro plug pro the year plug is so big that only people with very large ear canals can keep them in Michael Strange: And in fact this instrument has been discontinued by the manufacturer, although most of the rental companies still have them and you can get them. As you can see, the temperature ranges that are shown here, you know, we're not really very helpful. And it was full of caveats because of the Michael Strange: The earplugs getting loose or losing their, their good fit. And at the end of day all the employee employees complained of sore ears. But just to show you a couple of graphs. Michael Strange: Here's one. The blue line represents the air temperature by the probe and then the dark green line. Michael Strange: Means the temperature inside the mold and you see the first worker on top here had a really hard time getting any kind of seal. Michael Strange: jam it in here and only go up a couple of degrees. And it was kind of get looser again and he kept working with it, working with it. And finally, for about the last Michael Strange: Half the morning we had reasonably usable data. But yes, you can see, you know, the temperature we're reasonably confident that, at least during this period. Michael Strange: He didn't have an excessive core temperature. And the same thing is true of this worker, but he had more at the bottom, but he had more success in terms of keeping the earplug inside his year Michael Strange: So I'm hoping that somebody will come out with a model that is a better fit. Michael Strange: Because this is this is a good way to measure, monitor temperatures through the day. The other thing is the probe issues a small alarm. If your body temperature rises above core Michael Strange: Unfortunately, it also issues, the same alarm. If the earplugs fit. It's loose so it's it's it's just not very reliable. Michael Strange: Which, you know. We've also been experimenting with exercise monitors to check pulse rates, but I myself had disappointing results with it. I actually with the model. I tried. I actually got better use Michael Strange: Results with my Fitbit in terms of measuring pulse rates. So for now I the best system. I see for physiological monitoring is the buddy system and watching for signs and symptoms of heat stress on a person might be at greater risk if you see them. Michael Strange: profuse sweating it sustained over a number of hours weight loss can also make one more susceptible and you can also do a your analysis for sodium Michael Strange: So again, that makes it even more critical that supervisors and workers are trained to recognize the symptoms of heat related illnesses and what to do about it. Michael Strange: So let's talk about the here. Here are key of controls in industrial hygiene. The hierarchy is the best local control is elimination of the hazards chemical or the heat or what have you, when you can't do that. You go to engineering controls. Michael Strange: And next is administrative controls and finally his personal protective equipment. So with elimination controls you can modify the hot process or operation to a lower temperature. Michael Strange: With engineering controls. If you have a high surface temperature, you can reduce that surface temperature or shields worker from it using some type of insulating or reflective material with convective heat you can modify air temperature and or the air movement. Michael Strange: With evaporate of heat. You can decrease ambient humidity minimize excess moisture sources, where possible, and increase the air movement. Michael Strange: In terms of administrative controls you can train and educate workers and supervisors on risk factors and early warning signs of heat stress and this you need to do. Michael Strange: If you have a heat, heat related illness program prevention program. Anyway, you need to train and educate the workers and if you can schedule very hot day jobs on cooler part of the day, like in my example where they started the shift early in during the summer. Michael Strange: You can schedule routine maintenance and repair work and hot areas during cooler seasons where the risk of heat stress would not be so severe. Michael Strange: You can shorten the duration of exposure reduce the time workday time increase rest breaks and restrict over time. If you can create shorter, but more frequent work rest cycles that provides the greatest benefit to the employee. Michael Strange: And where possible, the brakes should be taken in an area that's cooler than the work environment such as an air conditioned break room or in the shade and the rest area should be close to the work area. Michael Strange: We need to allow on a climate eyes workers to break in slowly. Michael Strange: And rotate workers or task where, well, where you can Michael Strange: And the use of the buddy system where employees work with another employee or a small team and they can serve and serve each other for early signs of heat stress. Michael Strange: Other administrative controls you can require workers have Michael Strange: Freedom to interrupt their work when they feel extreme heat and discomfort. Michael Strange: You can reduce metabolic demands of activity by mechanical methods specialized tools or equipment or increase the number of employees doing the task. Michael Strange: And this is very important. You need to ensure that there's adequate fluid replacement, there should be at least five to eight ounces of cool water every 20 or 30 minutes, whether the person is thirsty or not, that should or should not be the trigger. Michael Strange: And of course, individual drinking cups must be provided, especially in today's coven but that was true before coda to Michael Strange: Use of electrolyte replacement fluids and is good, but the use of salt tablets is prohibited. Michael Strange: So what can you do for personal protective equipment. Well, there are cool fluid or ice cooled clothing or air cooled garments that are available, especially if you're under heavy protective gear or fully encapsulating suits. Michael Strange: You can wear absorptive or if operative cooling clothing wedded cloths over garments, such as terry cloth or cotton when you have impermeable clothing. Michael Strange: You can use reflective clothing or aprons to reflect the heat, it's Michael Strange: Don't know why the chat came up Michael Strange: And you can were brought him brimmed hats and lightweight clothing to reduce direct exposure to sun. Michael Strange: And again, the heat stress awareness training should include training to all effective employees on assignment and annually after that. Michael Strange: They need to be trained on heat stress and its potential effects on their life and health and factors that contribute to heat stress. It's a lot of material, the importance of early recognition of heat stress and the signs of symptoms of heat related illnesses. Michael Strange: You want to teach them about emergency response to heat stress first aid measures on treatment as early as possible. Michael Strange: You need to teach them about predisposing factors that increase an individual susceptibility to developing heat stress and take extra precautions for that person and generally precautions for working in heat stress areas, including a climate ization Michael Strange: How to properly use and take care of heat protective clothing and equipment. If you're using that Michael Strange: And these are the references that we use to put together this Michael Strange: This program and I actually forgot to include the Mayo Clinic on that. I'll have to go back and replace that Michael Strange: So, do we have time for questions. Jessica | COEH CE: Yes. Hi. This is Jessica and I went ahead and let everybody know that will try to answer a few questions. Michael, if you want, we can go a little bit past one o'clock. If you have time, but we can answer what we can Jessica | COEH CE: So, Jessica | COEH CE: I'll go ahead Michael Strange: I said it's alright with me to go a little over time. Okay, great. Jessica | COEH CE: So I'm just going to go through some of the questions, if it is something that some of these are from earlier in the presentation. So if you've already answered it, you can feel free to Jessica | COEH CE: Let me know. We'll move on to the next one. If anybody has any questions, if you can put them in the Q AMP a box and I will try to get to them. Jessica | COEH CE: So one of the first questions during the presentation was what are the ramifications of the rejection of the use by OSHA of the NWS heat index. Michael Strange: Um, Michael Strange: I wasn't aware of the oceans rejecting Michael Strange: Rejecting the heat index program. Michael Strange: I think I don't think I got quite quite the question. Michael Strange: Yes. Jessica | COEH CE: If the person who wrote the question would like Paul, if you can maybe write a little bit more about that. I'll come back to that in just a second. Jessica | COEH CE: The second question, do any insurance companies provide services to assess and prevent heat related illness and productivity loss and indoor workplaces. Jessica | COEH CE: That you know Michael Strange: Oh, yes, yes, we are one that does it, our parent company is CHOP, CHOP insurance. We are division called CHOP, CHOP global risk advisors and other ah consulting firms do it as well. Jessica | COEH CE: Great, thank you. And also in the chat. I just want to let you know that one of the participants said that a judge actually overruled OSHA on using the heat index and a very recent decision. Okay. Jessica | COEH CE: So on to another question. Jessica | COEH CE: To the Department of does the Department of Defense. He illness prevention policies meet Cal Osha requirements and. On a side note, Jessica | COEH CE: This person heard that the Navy personnel working outdoors in the Middle East were required to take cooling and hydration breaks to cool down. They went indoors and laid on concrete floors for 15 minutes or more Michael Strange: Wow. Um, it's, I don't be too quick to answer this, but it's it's been my understanding that Michael Strange: Of Cal Osha doesn't state OSHA programs don't have Michael Strange: Jurisdiction over the military, I may be wrong. That may be federal OSHA does, but I would like to get a list of these questions. And I'd like to research that one before. Before I commit to an answer on it. Jessica | COEH CE: Great. And I can give you a copy of these later on for you to go ahead and look into. Jessica | COEH CE: Another question is, what is your evidence based research on giving sports drinks that would like to know what about victims who may have medical conditions such as diabetes or other issues. Jessica | COEH CE: The individual thought that the recommendation was to give water and not drinks that contain sugars or substances that may cause the sentence to the increase Michael Strange: Was certainly in a diabetic situation. Yes, and Michael Strange: I believe that diabetes would be symptom. I mean, a condition that could predispose you to hire heat stress hazard. Michael Strange: Um, in terms of the sports drinks that recommendation was through the the Mayo Clinic and I would have, I would have to do further research to see what the evidence base on those recommendations are Jessica | COEH CE: Great, thank you again another update in the chat box, one of our viewers said that you are correct. The military falls under federal show Michael Strange: Thank you. Michael Strange: Gotta have a fact checker. Jessica | COEH CE: Yes, everybody's helping we have so much and so much expertise, even among our audience. Michael Strange: Oh, this is a fantastic group. I love attending these webinars. Jessica | COEH CE: Thank you. I'm so glad. Okay, so the next question is, are many employers and employees and your perspective, from your perspective, are they using the NIOSH heat app that forecast hourly heat index indices Michael Strange: You know I'm, I'm really not sure I've demonstrated it to a number of clients who weren't aware of it before so Michael Strange: You know this this site DHS people, you know, they, they are all over the board in terms of experience and Michael Strange: And and and knowledge. Michael Strange: So I would say probably. Some are and some aren't. Jessica | COEH CE: Great, thank you. Jessica | COEH CE: In the chat box. For the record, I just added the comment from one of our viewers that says the information for the Federal OSHA USPS case regarding the NWS he index. The link is now in the chat if anybody needs that Michael Strange: Oh, good. Thank you. Jessica | COEH CE: Okay, so let's see. The next question. Um, Jessica | COEH CE: Let's see. Jessica | COEH CE: Do you have are sorry have the heat stress TV has changed over the past 30 years back, then the TL, these were judged. Jessica | COEH CE: It's just judge by my organization to be in feasible for the maintenance workforce, the oil refinery that the viewer was working at in the tropics, because they permitted almost no work to be done during the summer. What are your thoughts about that. And if there's been changed there. Michael Strange: Well, um, the, the, to have these are guidelines. Michael Strange: You know, and Michael Strange: There's so many different chemicals and everything has changed over the years that that's another one I would need to research how long this particular set has been Michael Strange: You know, Michael Strange: At these at these levels. Michael Strange: I don't recall a recent change but I my memory doesn't go back 30 years. I'm sorry. Jessica | COEH CE: Okay. And I do have a couple of questions that are maybe a little smaller questions for you, but I'll go ahead and just ask all three. Jessica | COEH CE: One user wanted to know if there's any relation between heat stress and dehydration. Another two questions about the clothing. One was asking how many degrees that you would add for FR rated clothing and maybe what an explanation of double layer woven clothing is Very Michael Strange: Good to the first one. Jessica | COEH CE: Yes. So is there any release relation between heat stress and dehydration. Michael Strange: I'd say it would be the other way around. I would say the dehydration would make you more prone to heat stress because your body's just not Michael Strange: You know, produce producing enough perspiration. Michael Strange: And then the second was about the clothing or so. Jessica | COEH CE: So how many degrees. Jessica | COEH CE: Would you add for FR rated clothing and then just exactly what is double layer woven clothing for a viewer, just wanted to know, okay. Michael Strange: I'm just glancing and see if it's in the to be booklet here. Michael Strange: And I may need to go back to the documentation on the TV. Michael Strange: Okay. Jessica | COEH CE: And I can also let if that falls into resources, then I'm sure that they attended could maybe look that look that up in the future. Michael Strange: You know, you were talking about the work in the tropics in oil refineries, you know, again, this is it's going to get worse as the temperature of global temperatures continue to rise, both in the cop tropics and in the desert and up here. Michael Strange: So that's, that's, that's an issue. They're not going to raise the to VCs to accommodate that. Michael Strange: I on my, my advice would be to to go with the Michael Strange: Go with the controls you know cool of down with ice vests and Michael Strange: More frequent rest breaks in a cool area, but it's all I can suggest Thank you. Jessica | COEH CE: Go ahead and move on to the next question. And then we're pushing time but I'll probably try to answer two or three more questions, or have you answer. Jessica | COEH CE: Okay, so one of the users is asking if you've seen many heat stress problems with firefighters. Jessica | COEH CE: This user heard from a Northern California volunteer fireman that they have had several young male volunteers need heart defibrillation due to consumption and Red Bull working hard in full gear and hot weather and experience tachycardia. Jessica | COEH CE: What are your thoughts on that. Michael Strange: That does not surprise me at all. I have not done any work directly with firefighters. Michael Strange: But I can certainly imagine that situation on. First of all, you have the the heat of the flame and then also the fire is happening during the summer season when the ambient temperature so hot, too. So Michael Strange: I can see that being a real problem. And they really need to have a robust Michael Strange: Not only heat avoidance system. But, you know, emergency rescue system. Jessica | COEH CE: Okay, thank you. And again, another update from the audience with regard to the tropical climates, one of our CH CH is wrote that wind speed and tropical climates can also reduce the risk slightly in those tropical areas. Michael Strange: Even even the movement of hot moist air. Hmm. Jessica | COEH CE: We'll see. Jessica | COEH CE: Okay, so we have another question I think is a good one. But there are several types of common medications and medical conditions that increase sensitivity to heat stress. Do you know if any of the calculators are other methods can help adjust for these factors. Michael Strange: Not off the top of my head, but I can do some research on that. Okay, great. Michael Strange: In fact, I'll research all the questions, even the ones that you haven't been able to read out Jessica | COEH CE: Absolutely. And I'll go ahead and send those to you after so Jessica | COEH CE: I'm just looking at some of these questions that we have in here. Jessica | COEH CE: Okay, so I'll just ask one final question, and it's how would you objectively assess workers prior Jessica | COEH CE: Excellent, excellent. I can't say that word. Michael Strange: Monetization Jessica | COEH CE: Thank you, accurate, that word before subjecting them to different regiments, as pointed in presentation for those with prior and those without Michael Strange: You know, I think, I think it really comes down to, you know, the interview and ask them, you know, about their experience working in hot environments for how long, um, in terms of physiological measurements. That's something I can research as well. Jessica | COEH CE: Great. Thank you so much, and I really appreciate you taking the extra time out to answer some of these questions. They were so many I'm sorry if we didn't get to yours. Jessica | COEH CE: That said, we will make sure that there are resources and the recording will be available. Jessica | COEH CE: I just wanted to thank you Michael for this great presentation. And it's so relevant right now. And thank you to everyone who Jessica | COEH CE: Joined us for today's webinar. Be sure to check out our website for more information@ch.berkeley.edu backslash about see Jessica | COEH CE: As a reminder, in email will be sent out tomorrow afternoon with the webinar recording and evaluation link for all of those who logged in with their registration emails today. Jessica | COEH CE: Thank you so much for all these wonderful questions and your participation and I hope everybody enjoys the rest of their day. Thank you. Michael Strange: And I will certainly and I will add that all of your questions will be rad and and addressed one way or another. Jessica | COEH CE: Yes. And thank you guys so much for all for all of your input.