Heat Stress Management

Management of Heat DisordersManagement of Heat Disorders

Heat disordersHeat disorders are mild to serious reactions to high environment are mild to serious reactions to high environment temperature due to inadequate or inappropriate responses of heat-temperature due to inadequate or inappropriate responses of heat-regulating mechanisms. Exposure to high ambient temperature without regulating mechanisms. Exposure to high ambient temperature without efficient heat loss may lead to heat cramps, heatstroke, or heat efficient heat loss may lead to heat cramps, heatstroke, or heat exhaustion.exhaustion.

Acute or prolonged exposure to heat with excessive sweating Acute or prolonged exposure to heat with excessive sweating uncompensated by fluid intake leads to dehydration, sodium and uncompensated by fluid intake leads to dehydration, sodium and potassium depletion, and hypovolemia. Associated vomiting and potassium depletion, and hypovolemia. Associated vomiting and diarrhea contribute to fluid loss.diarrhea contribute to fluid loss.

Heatstroke and heat exhaustion both occur in hot, humid Heatstroke and heat exhaustion both occur in hot, humid environments, but they are markedly different disorders.environments, but they are markedly different disorders.

Resources required:Resources required: the recommended shelters, cloths, meals, fluids the recommended shelters, cloths, meals, fluids and medicines should be provided to the personnel. A campaign and medicines should be provided to the personnel. A campaign information should be in place, including posters, and documentation. information should be in place, including posters, and documentation. Training, physical conditioning and acclimatization programs should be Training, physical conditioning and acclimatization programs should be in place.in place.

Factors influencing the body’s heat-regulating mechanismsFactors influencing the body’s heat-regulating mechanisms

Environmental as well as physiological factors influence the body’s Environmental as well as physiological factors influence the body’s heat-regulating mechanisms.heat-regulating mechanisms.

Environmental Factors:Environmental Factors:

Ambient air temperature:Ambient air temperature: Ambient air temperature dictates the direction of heat flow from or to Ambient air temperature dictates the direction of heat flow from or to the body. When air temperatures are high, the direction of heat flow is the body. When air temperatures are high, the direction of heat flow is to the body, and heat can only be dissipated by sweating where the to the body, and heat can only be dissipated by sweating where the heat is carried away by sweat evaporation at the skin surface.heat is carried away by sweat evaporation at the skin surface.

Wind velocity:Wind velocity: Air currents carry body heat away. The higher the velocity of these Air currents carry body heat away. The higher the velocity of these currents, the faster the heat loss.currents, the faster the heat loss.

Humidity:Humidity:

Evaporation, the most important source of heat loss, depends on Evaporation, the most important source of heat loss, depends on relative humidity: The higher the humidity, the less efficient the heat relative humidity: The higher the humidity, the less efficient the heat loss. Therefore, high ambient humidity (which decreases the cooling loss. Therefore, high ambient humidity (which decreases the cooling effect of sweating) and prolonged strenuous exertion (which increases effect of sweating) and prolonged strenuous exertion (which increases heat production by muscle) increase the risk of developing heat heat production by muscle) increase the risk of developing heat disorders.disorders.

Radiant heat:Radiant heat:

Radiant heat is the heat produced by the reflective energy of the sun Radiant heat is the heat produced by the reflective energy of the sun or equipment in close proximity to a human body. The radiated heat is or equipment in close proximity to a human body. The radiated heat is absorbed into the surrounding air or directly into the body. In either absorbed into the surrounding air or directly into the body. In either case the body’s ability to cool itself is hampered.case the body’s ability to cool itself is hampered.

Physiological Factors:Physiological Factors:

Predisposing factors that may increase susceptibility to heat disorders Predisposing factors that may increase susceptibility to heat disorders are:are:

* Previous history of heat illness (exhaustion, stroke or cramps).* Previous history of heat illness (exhaustion, stroke or cramps).

* Personnel suffering from or recovering from an acute or chronic * Personnel suffering from or recovering from an acute or chronic disease or debility.disease or debility.

* Old age personnel are more susceptible to heat disorders.* Old age personnel are more susceptible to heat disorders.

* Poor physical conditioning.* Poor physical conditioning.

* Obesity interferes with the heat regulatory mechanism and causes * Obesity interferes with the heat regulatory mechanism and causes the individual to expend more energy to accomplish a given amount of the individual to expend more energy to accomplish a given amount of work.work.

* Fatigue, physical and mental weariness can cause a lot of concern * Fatigue, physical and mental weariness can cause a lot of concern and result in a failure to take proper precautions against heat injuries.and result in a failure to take proper precautions against heat injuries.

* Dehydration due to vomiting, diarrhea or insufficient water intake predisposes * Dehydration due to vomiting, diarrhea or insufficient water intake predisposes to heat disorders, as individual’s fluid output is greater than fluid intake. to heat disorders, as individual’s fluid output is greater than fluid intake.

* Personnel suffering from skin trauma due to sunburn, heat rash or other * Personnel suffering from skin trauma due to sunburn, heat rash or other dermatological malady. The body’s heat regulatory mechanism is hampered at dermatological malady. The body’s heat regulatory mechanism is hampered at the skin surface.the skin surface.

* Chronic alcoholism, alcohol should not be consumed for 24 hours prior to heat * Chronic alcoholism, alcohol should not be consumed for 24 hours prior to heat stress.stress.

* Certain drugs (e.g., anticholinergics, antihistamines, phenothiazines, * Certain drugs (e.g., anticholinergics, antihistamines, phenothiazines, decongestants, numerous psychoactive drugs, immunizing agents, alcohol, decongestants, numerous psychoactive drugs, immunizing agents, alcohol, cocaine…)interfere with the body’s heat regulatory mechanism.cocaine…)interfere with the body’s heat regulatory mechanism.

* Sickling of blood cells impairs circulation and increases risk of injury. Persons * Sickling of blood cells impairs circulation and increases risk of injury. Persons with sickle cell trait should be advised of their risk and preventive measures.with sickle cell trait should be advised of their risk and preventive measures.

PreventionPrevention

The successful prevention of heat injuries depends largely The successful prevention of heat injuries depends largely on education of personnel, especially supervisory on education of personnel, especially supervisory personnel.personnel.

Equally important is the development of procedures to alert Equally important is the development of procedures to alert individuals to the existence of dangerous heat stress levels individuals to the existence of dangerous heat stress levels once temperatures exceed 40 C.once temperatures exceed 40 C.

““Always remember that prevention is better than cure.”Always remember that prevention is better than cure.”

RESPONSIBILITIESRESPONSIBILITIES

A. Responsibilities of Project/Site ManagementA. Responsibilities of Project/Site Management

Project /Site Management is in charge of ensuring that this Project /Site Management is in charge of ensuring that this Management of Heat Stress has been applied and respected by all Management of Heat Stress has been applied and respected by all personnel and mainly those working in extreme heat climates where personnel and mainly those working in extreme heat climates where the temperatures can exceed 40 C.the temperatures can exceed 40 C.

B. Responsibilities of HSE RepresentativeB. Responsibilities of HSE Representative

HSE Representative is in charge of insuring that this approach has HSE Representative is in charge of insuring that this approach has been explained and well understood by all the personnel and mainly been explained and well understood by all the personnel and mainly those working in extreme heat climates where the temperatures can those working in extreme heat climates where the temperatures can exceed 40 C. And also that this approach has been applied and exceed 40 C. And also that this approach has been applied and respected by all the personnel and mainly those working in extreme respected by all the personnel and mainly those working in extreme heat climates where the temperatures can exceed 40 C.heat climates where the temperatures can exceed 40 C.

C. Responsibilities of Medical Doctor/NurseC. Responsibilities of Medical Doctor/Nurse

The Medical Doctor/Nurse is in charge of application of this Heat The Medical Doctor/Nurse is in charge of application of this Heat Stress Management.Stress Management.

The application of measures to reduce both the severity and duration The application of measures to reduce both the severity and duration of exposure and adoption of techniques to increase the resistance of of exposure and adoption of techniques to increase the resistance of exposed persons. These techniques are:exposed persons. These techniques are:

Using common sense is best.Using common sense is best.

Selection of personnel:Selection of personnel: * Employ personnel physically fit to work in such hot environment.* Employ personnel physically fit to work in such hot environment.

Avoid direct sunlight:Avoid direct sunlight: * Stay in the shade when you can.* Stay in the shade when you can. * Shelter under shades, draperies, awnings, or louvers.* Shelter under shades, draperies, awnings, or louvers. * During periods of extreme heat, stay indoors as much as possible * During periods of extreme heat, stay indoors as much as possible out of out of the sunshine.the sunshine.

Meals and water:Meals and water: * Eat well-balanced, light meals before, during and after any * Eat well-balanced, light meals before, during and after any outdoors outdoors strenous activity.strenous activity. * Drink plenty of water regularly before, during and after any * Drink plenty of water regularly before, during and after any outdoors outdoors strenous activity. Persons who have epilepsy or heart, strenous activity. Persons who have epilepsy or heart, kidney, or liver kidney, or liver disease; are on fluid-restrictive diets; or have a disease; are on fluid-restrictive diets; or have a problem with fluid problem with fluid retention should consult a doctor before retention should consult a doctor before increasing liquid intake.increasing liquid intake.

Alcohol and caffeine:Alcohol and caffeine: * Limit intake of alcohol beverages and caffeine. Although beer and * Limit intake of alcohol beverages and caffeine. Although beer and alcohol alcohol beverages appear to satisfy thirst, they actually cause further beverages appear to satisfy thirst, they actually cause further body body dehydration.dehydration.

Cloths:Cloths: * In a very hot environment or in an inadequately ventilated space * In a very hot environment or in an inadequately ventilated space heavy heavy insulating clothing should not be worn. Wear light-colored, insulating clothing should not be worn. Wear light-colored, loose-loose- fitting, open-weaved clothes that cover as much skin as fitting, open-weaved clothes that cover as much skin as possible and possible and that reflects heat and sunlight and helps maintain that reflects heat and sunlight and helps maintain normal body normal body temperature. Clothing should be loose fitting, temperature. Clothing should be loose fitting, especially at the neck, especially at the neck, arms, waist and lower legs, to permit arms, waist and lower legs, to permit circulation of air.circulation of air. * Protect face and head by wearing a wide-brimmed hat.* Protect face and head by wearing a wide-brimmed hat. * In extreme heat, avoid activities that require you to wear a * In extreme heat, avoid activities that require you to wear a helmet.helmet.

Acclimatization:Acclimatization: * Allow your body to get acclimated to hot temperatures for at least * Allow your body to get acclimated to hot temperatures for at least 2 or 3 2 or 3 days.days. * Increase the amount of time you spend outdoors and your activity * Increase the amount of time you spend outdoors and your activity

everyday little by little. everyday little by little.

Avoid sunburn:Avoid sunburn: * Sunburn slows the skin’s ability to cool itself, use a sunscreen * Sunburn slows the skin’s ability to cool itself, use a sunscreen lotion with lotion with high SPF (sun protection factor) rating.high SPF (sun protection factor) rating.

Avoid extreme temperature changes:Avoid extreme temperature changes: * A cool shower immediately after coming in from hot temperatures * A cool shower immediately after coming in from hot temperatures can can result in hypothermia, particularly for elderly and very young result in hypothermia, particularly for elderly and very young people.people.

Work schedules:Work schedules: * Strenuous exertion in a very hot environment or in an * Strenuous exertion in a very hot environment or in an inadequately inadequately ventilated space should be avoided.ventilated space should be avoided. * Try to schedule strenuous activities during the cooler hours of the * Try to schedule strenuous activities during the cooler hours of the day, day, early in the morning or late in the evening, avoid heavy early in the morning or late in the evening, avoid heavy outdoor outdoor activity between 10 AM and 6 PM, when sun is the activity between 10 AM and 6 PM, when sun is the hottest.hottest.

If exertion a hot environment is unavoidable:If exertion a hot environment is unavoidable: * Fluid and electrolytes should be replaced by frequently drinking * Fluid and electrolytes should be replaced by frequently drinking fluids fluids slightly salty to taste.slightly salty to taste. * Wearing open mesh clothing or using fans should facilitate * Wearing open mesh clothing or using fans should facilitate evaporation, evaporation, which helps the skin cool.which helps the skin cool. * Individuals should be instructed to note the color of their urine, * Individuals should be instructed to note the color of their urine, the color the color

should be straw to clear, dark colored, concentrated urine should be straw to clear, dark colored, concentrated urine suggest suggest dehydration.dehydration.

Heat-related injuries fall into three Heat-related injuries fall into three major categories:major categories:

Heat cramps Heat cramps

Heat exhaustion Heat exhaustion

HeatstrokeHeatstroke

Heat crampsHeat cramps are are muscular pains and muscular pains and spasms that occur spasms that occur when the body loses when the body loses electrolytes during electrolytes during profuse sweating or profuse sweating or when inadequate when inadequate electrolytes are taken electrolytes are taken into the body. They into the body. They usually begin in the usually begin in the arms, legs or arms, legs or abdomen, and often abdomen, and often precede heat precede heat

exhaustion.exhaustion.

Treatment for heat Treatment for heat crampscramps is to rest in the is to rest in the shade, get near a fan, shade, get near a fan, spray the person with spray the person with water and massage the water and massage the cramp. cramp.

Heat exhaustionHeat exhaustion is is a medical emergency. a medical emergency. When a person is When a person is suffering from heat suffering from heat exhaustion, they will exhaustion, they will perspire profusely and perspire profusely and most likely will be pale. most likely will be pale. It is best treated by It is best treated by taking the patient to a taking the patient to a cool place, applying cool cool place, applying cool compresses, elevating compresses, elevating the feet and giving the the feet and giving the patient fluids.patient fluids.

Signs & symptoms of Heat ExhaustionSigns & symptoms of Heat Exhaustion

Normal, low, or only slightly elevated body Normal, low, or only slightly elevated body temperature. temperature. Cool, clammy, pale skin. Sweating. Cool, clammy, pale skin. Sweating. Dry mouth. Thirst. Dry mouth. Thirst. Fatigue. Weakness. Feeling dizzy. Fatigue. Weakness. Feeling dizzy. Headache. Headache. Nausea. Vomiting can occur. Nausea. Vomiting can occur. Muscle cramps. Muscle cramps. Weak or rapid pulse. Weak or rapid pulse.

Heat strokeHeat stroke is the is the worst heat-related worst heat-related injury. The brain has lost injury. The brain has lost its ability to regulate its ability to regulate body temperature. The body temperature. The patient will be hot, patient will be hot, reddish and warm to the reddish and warm to the touch. Their touch. Their temperature will be temperature will be markedly high and there markedly high and there will be no perspiration.will be no perspiration.

Signs & symptoms of Heat StrokeSigns & symptoms of Heat Stroke

These signs and symptoms can occur suddenly with little warning:

Very high temperature (104ºF or higher). Hot, dry, red skin. No sweating. Deep breathing and fast pulse. Then shallow breathing and weak pulse. Confusion. Hallucinations. Convulsions. Loss of consciousness.

Do not attempt to treat a case of heat stroke at home, but you can help while waiting for medical assistance to arrive.

Here’s what to do:Here’s what to do:

The emergency care of heatstroke is The emergency care of heatstroke is to cool the body as to cool the body as quickly as possible.quickly as possible. One of the best methods for cooling the One of the best methods for cooling the body during a heat emergency is to body during a heat emergency is to wrap the patient in wrap the patient in cool, wet sheets.cool, wet sheets. Move the person to a cooler environment, or place him or Move the person to a cooler environment, or place him or her in a cool bath of water (as long as he or she her in a cool bath of water (as long as he or she is conscious and can be attended continuously). is conscious and can be attended continuously).

Alternatively, moisten the skin with lukewarm water and use Alternatively, moisten the skin with lukewarm water and use a fan to blow cool air across the skin. a fan to blow cool air across the skin.

Give cool beverages by Give cool beverages by mouthmouth only only if the person has a if the person has a normal mental state and can tolerate it.normal mental state and can tolerate it.

Saipem corporate procedure of the Heat stroke Saipem corporate procedure of the Heat stroke prophylaxis, treatment depends from medic on site (kind of prophylaxis, treatment depends from medic on site (kind of medicine and dose). medicine and dose).

Approved treatment: Approved treatment:

POLASE tablets  / Potassio+Magnesio raceaspartatoPOLASE tablets  / Potassio+Magnesio raceaspartatooror-the HYDRALYTE (electrolyte replacement drink) Or-the HYDRALYTE (electrolyte replacement drink) Or- DEXTORSE mineral salts tab.- DEXTORSE mineral salts tab.Or you can buy any kind of mineral salts tab.Or you can buy any kind of mineral salts tab.The dose of medicine depends on the degree and time of The dose of medicine depends on the degree and time of heat exposure: and of course from condition of employee.heat exposure: and of course from condition of employee.Please note: it is not for health if it is over dose!  Please note: it is not for health if it is over dose!  The kidney stones could be made by a lots of mineral salts The kidney stones could be made by a lots of mineral salts in human blood (as for example).in human blood (as for example).

Prepared by:Joseph ConsularMedical DepartmentSaipem Spa, Sharjah BranchTel. No. +97165284140, Exr. 266Mobile No. +971502703856Email: [email protected]

Summer is the perfect time to get outdoors and enjoy the sunshine! But the summer sun and heat can take a major toll on your health, so don’t let a heat-related illness ruin your day. Learn how you can protect yourself from the sun so you can have a happy, healthy and safe summer.