Heat Stroke

Shell Project No.: HP-3000-QAT

Contractor Project No.: 5887 Contractor name:

CHIYODA-HHI CONSORTIUMUnit:

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Contractor Contract No.: PI-096 Sheet: 1 of 23 PCWBS: NA

Contractor Doc No: NA (QPG Job No. 51505)

PEARL GTL PROJECTQATAR

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CHC Project Doc No: T-4.044.886 Rev.:B

T-4.044.886 Rev. B - Heat Stroke Prevention Procedure This document is confidential. Neither the whole nor any part of this document may be disclosed to any third party without the prior written consent of CHIYODA-HHI CONSORTIUM (CHC). Title in respect of this document is vested in Qatar Shell GTL Limited. Neither the whole nor any part of this document may be reproduced, stored in any retrieval system or transmitted in any form or by any means (electronic, mechanical, reprographic, recording or otherwise) without the prior consent of CHC.

HEAT STROKE PREVENTION PROCEDURE

Equipment description: NA

Tag/Item number(s): NA

B 23-Mar-07 S.S.J/A.H T.S/P.K.H/Z.S H.M RFC Released for Construction

A 6-Mar-07 S.S.J/A.H T.S/P.K.H/Z.S H.M RFC Released for Construction

O 24-Jan-07 S.S.J/A.H T.S/P.K.H/Z.S H.M ICC Issued for Company Comments

Rev. Date By Chkd Appr. Status Revision reason for issue description




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CONTENTS

1.0 PURPOSE…………………………………………………………………………………………………..3

2.0 SCOPE………………………………………………………………………………………………………3

3.0 RISKS………………………………………………………………………………………………………..3

4.0 IMPORTANT INFORMATION FOR SITE PERSONNEL.................................................................3

5.0 DEFINITIONS AND ABBREVIATIONS………………………………..………………………………..4

6.0 REFERENCES……………………………………………………………………………………………...5

7.0 ROLES AND RESPONSIBILITIES……………………………………………………………………….5

8.0 IMPLEMENTATION………………………………………………………………………………………..7

9.0 TRAINING AND MONOTORING…………………………………………………………………………7

10.0 HEAT AWARENESS CONDITIONS……………………………………………………………………..8

11.0 WORK PLACE , TASK EVALUATION AND RISK ASSESSMENT………..………………………..9

12.0 CONTROL OF HEAT STROKE…………………………………………….….……………………….10

13.0 HEAT ILLNESS AND HEALTH EFFECTS…………………………………..………………………..14

14.0 FACTORS AFFECTING HEAT TOLERANCE……………………….…….…………………………16

15.0 EFFECTIVE PROACTIVE MEAEURES………………………………………………………………..18

APPENDIX………………………………………………………………………………………………………...20 Attachment 1 : Flow chart for Evaluating Heat Stress & Strain..………………………………..…..….20 Attachment 2 : Heat Stress Prevention Check List (weekly)…………………………………..……..….21 Attachment 3 : Heat Stress General Guidelines & Heat Index Table.………………………...…..…....22 Attachment 4 : Dehydration Guide……………………………………..……………………..…………...…23




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1.0 PURPOSE

This procedure covers all peoples working on the project work site including camp, site performing work for the Pearl GTL project off site, to have an active Heat Stroke prevention Programme, operational and in accordance with these guidelines, prior to commencement of work.

2.0 SCOPE

CHC develop a Heat Stroke Prevention Program prior to project commencement.

3.0 RISK

Prevention of heat stroke is important for all contractors, subcontractors particularly during the summer months when temperatures are commonly above 40 degree with often humidity levels.

Failure to advise personnel of the dangers of heat stroke problems and to implement this procedure could lead to injury or death.

High body temperatures can cause death. Heat stroke is a medical emergency. Emergency medical treatment must be sought.

Fainting through heat exhaustion can be dangerous because the victims may be operating machinery, controlling and operation or working at height.

4.0 IMPORTANT INFORMATION FOR SITE PERSONNEL 4.1 Heat Related Health Systems

• Headache, dizziness • Nausea, Vomiting • Excessive sweating or dry skin • Fatigue, muscle cramps in lower limbs. • Visual disturbances or convulsions • Loss of consciousness

4.2 What to Do Until the Medic Arrives

• Transfer to shady area • Lying position, feet slightly raised. • Use fan, cover with cold packs or cold wet towel • Give fluid




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4.3 Prevention

• Take regular breaks • Make use of shady area • Take plenty of fluids even if not thirsty • Identify symptoms or signs of heat stress • Seek medical advice as soon as possible.

5.0 DEFINITIONS AND ABBREVIATIOS

5.1 Definitions

Item Description

Temporary Facility Contractor Contractors selected to install temporary facilities to support the project

Specialty Contractor Contractors that provide a service to the PMC such as overall security, overall transportation or any others specialty requirements

5.2 Abbreviations

Item Description

AT Apparent Temperature

CT Check Time

EPCM Engineering Procurement Construction Management

EPM E & P Middle East

GTL Gas to Liquid

HI Heat Index

HAC Heat Awareness Condition

HSSE/SD(HSES) Health, Safety, Security, Environmental and Sustainable Development

HSSE/SP Health, Safety, Security, Environmental and Social Performance

IC Implementation Contractor

ITB Invitation to Bid

MHR Maximum Heart Rate

NIOSH National Institute for Occupational Safety and Health




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PPE Personnel Protective Equipment

QP Qatar Petroleum

QS Qatar Shell

RCM Resident Construction Manager

RLC Ras Laffan City

TFC Temporary Facility Contractor

TSTI Total safety Training Instruction

6.0 REFERENCE

No. Title Reference No.

1 Qatar Labour Law 2004

2 Projection Specification Part IV Procedure and Requirements Chapter 9 – HSES Premises for the Implementation Phase –Appendix 1 Detailed HSES/SD Standards and Guidance

Section 1.4.2.6

3 QSGTL-PI-093 PMC ITB – Part II Technical Proposal, Section IV Construction /Commissioning

Section 19 Climatic Conditions

4 Health Aspects of Works in Extreme Climates within the E & P Industry :

The Hear : QGP Report no. 6.70/279.1998

5 ‘Yellow” Management Guide to Thermal Stress Shell HSE Committee. 1991

6 Heat Stroke Prevention Procedure 5877-ON-PR-HM-020

7.0 ROLES AND RESPONSIBILITIES

CHC is responsible for implementing procedure as per the attachment. CHC shall also ensure that all relevant sub-contractor produce and abide by an acceptable heat stroke prevention procedure.

The overall responsibility for the prevention of heat-related illness rest with the Construction Director(CD) and site safety personnel, however the daily monitoring of employee for signs and symptoms of heat-related disorders rests with the employees and their front-line supervisors.

NWS National Weather Service

OGP Oil and Gas Producers

PMC Project Management Contractor




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7.1 Construction Director Responsible for: • Assuring that these guidelines are implemented and administered onto the project. • Providing input when required to the heat stroke risk assessment process. • Reviewing the heat stroke risk assessment findings and recommendations. • Approve recommendations and implement • Communicate implementation process and initiatives to project work force.

7.2 HSSE Manager

Responsible for: • Provide technical support, guidance and advise as requested on heat stroke related problems. • Ensure approved employee training programs are available. • Provide support to and ensure assessment processes are being utilized. • Perform informal and formal inspections on site to check that the requirements of this

procedure are being implemented. 7.3 Area Supervisors

Responsible for: • A heat stroke risk assessment is completed for the tasks where hot working conditions could

be a problem. • All measures and recommendations resulting from heat stress assessments are undertaken. • People working with their control are made aware of any heat stress related risks. • The suitability of PPE provided. • Be aware of theirs employees’ work-related capabilities and limitations. And monitor on a

regular basis the condition of each employee assigned to them. • Ensure that temperature and humidity conditions are monitored daily. • Ensure that heat awareness colour coded flags are posted and reflect the current ambient

conditions. 7.4 Subcontractor

Responsible for: • The procedure is effectively implemented, observed and communicated to the workforce

through out the duration of their employment. • All activities requiring the workforce to be exposed to extreme temperature are properly

planned, coordinated and executed. • Suitable PPE is provided.




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• Suitable and adequate cool resting facilities and sufficient cool drinking water supplies are provided in the work area.

7.5 Employees

Every person tolerates heat differently. Since empirical measure can determine when an individual begins to sense, the primary responsibility for heat stress monitoring should be the appropriately trained employee’s determination of his/her condition.

8.0 IMPLEMENTATION 8.1 Facilities

In order to fulfil the requirements of this procedure the following facilities should be provided.

• Temperature and humidity monitoring equipment • A system of colour coded flags(Green, Yellow, Orange and Red) • Hygienic water supplies – to avoid the practice of many persons drinking from same cup etc. • Shaded rest areas. • 1 st Aid Equipment • Awareness training

9.0 TRAINING AND MONITORING

The HSSE Induction/Orientation training provided to all employees should explain the cause and symptoms of heat stress illness and injuries, minimum PPE requirements, the need to take regular breaks in cool shaded area and the need to take regular intakes of cool water. Specific Heat Stroke Prevention training will be provided to all Managers, Superintendents, supervisors and subcontractors.

9.1 Training

Heat Stroke awareness training should be provided at least once a year(preferably during the spring) to all project personnel. The training should include: • The hazards of hear stroke • Recognition of predisposing factors, warning signs, and symptoms • First-aid procedure for potential health effects of heat stroke and other heat disorders • Employee responsibilities in avoiding heat stroke • Dangers of the use of alcohol in hot work environments drugs, including prescription and over

the counter medicines • Proper use of engineering, administrative and work practice controls • Proper use of personnel protective equipment • Planning of strenuous physical activities and hot operations during cooler periods wherever

possible e.g early morning or evening or night. • Importance of taking regular breaks in cool shaded areas in accordance with Appendix 3 Heat

Stress Guide.




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• Measures employees can take to minimize the effects of heat stroke e.g hydration, work pace, helpful nutritional habits, etc.

• Importance of taking regular intakes of water in accordance with appendix 3 heat stress guide. In general personnel should be made aware of the need to drink at least 4 litres of water during an 8 hour shift or 6 litres during a 10 hour shift.

• Use of relief workers or rotations wherever possible. • What to do during a Heat Awareness Conditions.

9.2 Health Assessment/Monitoring

Only fit and healthy workers should be allowed to work in conditions where severe heat stress is possible. All employees expected to work in these conditions should undergo a medical examination prior to employment.

10.0 HEAT AWARENESS CONDITIONS 10.1 Flag System

A Heat Awareness Condition(HAC) should be declared when the conditions for heat stroke are significant. A scheme using colour coded flags shall be implemented to indicate the level of heat stress conditions on a given day. Flag corresponding to the colour code in Table 1 shall be installed at several prominent locations throughout the site to keep personnel of the heat stress conditions for that day. Heat Index Heat Stress Level(Flag Colour) Rest Period(Every Hour)

Below 38º C Green No requirement

38º C to 45º C Yellow 7 minutes

46º C to 54º C Orange 10 minutes

55º C to above Red 15 minutes When air temperature reached 50ºC or higher no work will be permitted and black flags posted.

Table 1 The Company shall assess the ambient working conditions at the bringing of each day, erect the corresponding colour coded flag and inform all site personnel. Ongoing monitoring of the conditions will continue throughout the day and changes communicated to all personnel. A HAC shall be assessed on the data taken from the daily weather forecast e.g the National Weather Service(NWS) or others competent forecast organizations. Use the Heat Stress General Guidelines & Heat Index Table in Appendix 3 to compute NWS values.




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Extremely hot weather is defined here as any of the following: (a) Ambient temperature in excess of 35ºC (b) NWS apparent temperature(AT), or heat index(HI) in excess of 32º C .

During a Heat Awareness Condition, the hazards and controls of heat are continuously emphasized with each employee and supervisor during TSTI. Workers should be instructed to interrupt heat exposure before they feel excessive discomfort or symptoms of any heat related disorder.

10.2 Key Points - Heat Awareness Condition

(1) Training for all site workers at induction and at least annually (2) Use Colour codes flag system to indicate Heat Awareness Condition. (3) Use TSTI to communicate task-specific heat stroke conditions. (4) Work Using buddy systems. (5) Implement engineering controls. (6) Implement heat stroke prevention working conditions. (7) Wear appreciate PPE (8) Continue monitoring work colleagues for signs of heat stress.

11.0 WORKPLACE, TASK EVALUATION AND RISK ASSESSMENT

A thorough evaluation of the workplace may be necessary to identify specific tasks and conditions that present a potential heat stroke hazard. This evaluation should include observations, discussions with workers and supervisors, and the review of any reported heat-related disorders. TSTI is the primary means for evaluating and communicating heat stroke conditions for a specific work task information that can help determine heat stroke potential and appropriate control measures includes the following: • Job Location

Analyse the specific locations of each task. Including proximity to others heat producing equipment.

• Work Duration and schedule

What is the frequency at which the task must be performed and how much time is required to perform the work? How much time is required for presentation, setup, actual task performance, and any normal breaks? Excessive overtime work, piece work, and machine-paced work are additional factors to considers. Each can cause fatique and increase heat stroke potential.

• Clothing

What workers wear can make a big difference in how much heat they build up. The use of semi-impermeable or impermeable protective clothing and respiratory protection will increase heat load and metabolic rate. However, clothing can shield a person from radiant heat. Cotton clothing generally retains less body heat. Next is polypropylene, then polyethylene. Workers should avoid excessive layering of clothing when heat stroke is a potential hazard.




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• Metabolism Working muscles produce metabolic heat. Heavy work can create body heat that is a major element in heat that is a major element in heat stroke because it can increase body core temperature and affect the brain’s thermo regulatory control(thermostat).

• Environmental Conditions

Air temperature, humidity, wind speed, and direct sunlight all effect heat stroke potential. If available, compare WBGT values to AGGIH exposure times guidelines that are based on the level of work activity. This may help to determine appropriate control measures.

• Existing Controls

What existing heat stroke controls are being used? Considerable work can be accomplished in very hot environments if appropriate control measures are taken. On the other hand, simply standing in direct sunlight, for example, can cause heat stroke if no controls are in place.

12.0 CONTROL OF HEAT STROKE

As with any hazard, feasible engineering controls should be the primary control measure, followed by administrative, work practice controls and PPE, in that order.

12.1 Engineering Controls 12.1.1 General Ventilation General ventilation can dilute hot air with cooler air generally brought in from the outside. This

technique work better in cooler climates than in hot ones. Large areas or entire buildings identified as high heat areas may require a permanently installed ventilation system to reduce temperature levels. In smaller areas, potable or local exhaust systems may be more effective or practical.

12.1.2 Local Ventilation

Reduce heat stress by increasing the air flow and velocity with fans and others moves in the work area, as long as the air temperature is less than the person’s skin temperature. If the air temperature is higher than about 38º to 40ºC, skin warming may offset any advantage gained by evaporative cooling. Because this method does not cool the air, the increased air flow must contact the worker directly to be effective. This control will have little, if any, positive effect on workers wearing vapour-barrier clothing.

12.1.3 Ait Treatment/Air Cooling

This control measure differs from ventilation because it cools the air by removing heat, and sometimes humidity. Air conditioning and air treatment devices may be expensive to install and operate. Nonetheless, mechanical refrigeration can be effective in specific area such as cool room used as recovery areas near hot jobs. Potable blowers are portability and minimal set-up time.




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12.1.4 Radiant Heat Reduction

Reflective heat shields and insulation will reduce radiant heat. With sources of radiation such as heating pipes, it is possible to use both insulation and surface modifications to achieve a substantial reduction in radiant heat. If shield are used, it is important to minimise their influence on the cooling effects of air flow.

12.1.5 Shade

Shade will reduce radiant solar heat and is a widely recognised control measure. Shading the work area, rest area, or equipment or enclosures can significantly decrease the heat load.

12.2 Administrative and Work Practice Controls. 12.2.1 Scheduling

If possible, perform potentially hot jobs when heat stroke conditions are at their minimum. Allow latent heat in equipment to dissipate before work begins. When practical, schedule work for the cooler part of the day, and schedule routine maintenance and repair work in hot area for the cooler seasons of the year.

12.2.2 Fluid Replacement

Place ample supplies of liquids in hygienic conditions close to the work area. Preferred drinks are low-sodium, non-carbonated, non-alcoholic, and non-caffeinated. They should be provided at 10º to 16º C. Because the normal thirst mechanism does not ensure sufficient fluid intake, encourage workers to drink small amounts on a frequent basis. The taste of commercial electrolyte replacement drinks may also encourage fluid intake. These products are perfectly acceptable when diluted 50% in water, although some commercial electrolyte replacement drinks contain salts, this is not necessary for acclimatised individuals who generally take sufficient salt in their diets. See appendix 4 Urine guide to indicate dehydration.

12.2.3 Acclimatisation

Most people get used to heat exposure to a point. This is called acclimatisation and it results in less cardiovascular demand for a given activity. The worker will sweat more efficiently(increasing evaporative cooling) and may lose less salt, thus will more easily maintain normal body temperature. Acclimatisation decrease the risk of heat-related illness and associated unsafe acts. Deliberate acclimatisation involves exposing employees to work in a hot environment for progressively longer periods. For worker with recent experience, within two weeks, in job where heat level may produce heat stroke, NIOSH recommends following regime:

Day Work Load

Day 1 50% of normal work load







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For new workers who will be similarly exposed, the regime should be 20% on day one, with a 20% increase in exposure each additional day.

12.2.4 Work/Rest Cycles

Prescribed periods of works and rest are based on the Heat Index Values and workload estimates given in Appendix 3. These prescribed levels are based on the assumption that the work is repetitive, controlled, and continuous over an eight-hour shift, and that the rest area is in an environment to that in which the exposure occurs.

12.2.5 Recovery Time

Recovery may be required for any heat stroke exposure. Recovery is complete when the person’s physiological state has returned to its pre-exposure condition. This means that excess stored body heat has been dissipated, lost fluid has been replaced, and electrolytes are in balance. To permit dissipation of stored body heat, the recommended recovery area should be cool.

12.2.6 Buddy System

Working in pairs or small teams allows appropriately trained workers to observe each other for signs of heat-related disorders. Employees may also share work activities to reduce metabolic heat production.

12.2.7 Persons Monitoring

An individual’s physiological response to heat stress can be monitored with a variety of instrument available on the markets. The instruments measure skin or ear canal temperature as a surrogate for core body temperature. Some instruments also measure heart and respiration rates. Most individuals can be trained to monitor their own heart rate. Healthy, acclimatised workers should avoid prolonged work/environment combinations that cause their heart rate to exceed the recommended maximum heart rate, MHR when taken during the first minute of rest. MHRs appear in the table below. The heart rate should drop to 110-120 beats per minute following the first of rest.

Age-Adjusted Maximum Heart Rate(MHR), in Beats per Minute. Age MHR Age MHR Age MHR Age MHR Age MHR 20 140 30 133 40 126 50 119 60 112 21 139 31 132 41 125 51 118 61 111 22 139 32 132 42 125 52 118 62 111 23 138 33 131 43 124 53 117 63 110 24 137 34 130 44 123 54 116 64 109 25 137 35 130 45 123 55 116 65 109 26 136 36 129 46 122 56 115 66 108 27 135 37 128 47 121 57 114 67 107 28 134 38 127 48 120 58 113 68 106 29 134 39 127 49 120 59 113 69 106 _________________________________________________________




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12.2.8 Self-determination Appropriately trained workers can help monitor their own heat conditions. Training should emphasize that heat stress can affect an individual’s ability to reason clearly. This may cause them to fail to recognise signs and symptoms of heat stroke. For this reason, self-determination needs to be augmented by the heat awareness program, worker training program, check time(CT) and buddy system controls described in these guidelines.

12.2.9 Check Times

A prescribed check time(CT) schedule can augment self-determination. Check times are intervals at which a heat stress-trained supervisor or observer, including a co-workers or “buddy”, must seek explicit confirmation from individual heat stress-trained workers that each can continue work. That is, the observer determines if there are obvious symptoms of heat disorders, or if there is any sense of diminished capacity. If so, the exposure is terminated and rest is required. Using CTs requires each work, at regular intervals, to explicitly asses his/her physiological state and ability to continue work, rather than waiting for symptoms to appear.

12.2.10 Other Administrative Controls

Reduce the physical demands of work such as excessive lifting or digging by using powered equipment, increase the number of workers assigned to a task, use relief workers, and limit worker occupancy in confined areas.

12.3 Personnel Protective Equipment

Depending on the recommendations of a given task risk assessment the following PPE solutions may be used if appropriate.

12.3.1 Circulating Air Systems

The most highly effective personal cooling system uses circulating air. Evaporative and corrective cooling is improved by directing compressed air around the body from a supplied air system. The greatest advantages occurs when circulating air is used with impermeable garments or double cotton overalls. One type used, when respiratory protection is required, forces exhaust air from a supplied-air hood(bubble hood) around the neck and down inside an impermeable suit. The air then escape through openings in the suit. Air can also be supplied directly to the suit without using a hood. Use only Grade D breathing air if the air vents into the worker’s breathing zone.

12.3.2 Circulating Liquid Systems

These systems attempt to supplant sweat evaporation as the principal mode of heat dissipation. Garments range from a hood, which cools only the head, to vests and “long johns” , which offer partial or complete body cooling. They are worn in close contact with the skin and the coolant, usually water, transfer heat from the skin to the heat sink, usually ice.

12.3.3 Wetted clothing

This is a simple, inexpensive personnel cooling technique that is effective when reflective or others impermeable protective clothing is worn. Wetted terry cloth coveralls or wetted two piece, whole-body cotton suits may be used.




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13.0 HEAT ILLNESS AND HEALTH EFFECTS

The following are the normal response to excess body heat. • Peripheral vasodilatation(reddened skin) – The skin becomes a radiator and the heart rate

increase to move blood more rapidly to the skin for cooling. • Body surface temperature increase slightly. • Sweating surface to provide evaporative cooling • Acclimatisation occurs over a few weeks. The symptoms and treatment for the more serious conditions of Heat Stroke, Heat Exhaustion, Heat cramps, Heat Rash and Fainting are given in the sections below.

13.1 Heat Stroke

Heat stroke is a life threatening emergency and serious health problem doe workers in hot environments. It occurs when the body’s system of temperature regulation fails and body temperature rises to critical levels. It is caused by a combination of highly variable factors that result in tolerable heat stress, and is often difficult to predict. Drug and/or alcohol abuse may increase the risk of hear stroke. Individuals who recover from true heat stroke may suffer from permanent physical damage including reduced heat tolerance. These individuals should be carefully evaluated by a competent physician before returning to a job with potential heat stroke. Special accommodations to control heat stress may be required for these individuals in order for them to work safely.

13.1.1 Symptoms The primary signs and symptoms of heat Stroke are:

• High body temperature(above 40.6 ºC) • No sweating • Hot dry skin • Vary rapid, weak pulse • Confused and irrational behaviour • Convulsions, seizures • Loss of consciousness, coma

13.1.2 Treatment

• Immediately call for emergency medical assistance • Place person in a cool shady area and do not leave him alone • Cool person rapidly with running water, cold compresses or rapid fanning • Remove the person’s outer clothing • Provide cool drinking water if he person is alert. Do not give caffeine or alcohol




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• Fluid should be replaced as soon as possible • Continue to cool body temperature until medical assistance arrives and worker can be taken

to a medical facility for further treatment

13.1.3 Prevention

• Take breaks during the day time to for rest • Make use of shady areas • Take plenty of water or fluids even if not thirsty • Identify the symptoms or signs of heat related problems • Seek medical advice as soon as possible

13.2 Heat Exhaustion

Heat exhaustion results when there is loss of salt and water through excessive sweating and failure to either drink sufficient fluids or take enough salt or both. Diarrhoea and vomiting both also contribute to dehydration. Heat exhaustion is similar to heat syncope in that strenuous exercise cause peripheral vasodilatation, which reduces blood flow to the brain. Do not dismiss heat exhaustion lightly. It is possible to confuse the symptoms of heat exhaustion with heat stroke which is a bona fide medical emergency. In addition, fainting can be dangerous if tie individual is operating machinery or controlling an operation that should not be left unattended. Moreover, fainting may injure the victim.

13.2.1 Symptoms

• Excessive sweating • Extreme weakness, fatigue • Pale, cold clammy skin • Dizziness • Headache • Nausea, Vomiting • Muscle cramps, usually abdominal • Fast shallow breathing • Normal or slightly increased body temperature • Loss of consciousness

13.2.2 Treatment

• Place person in a cool shady area and do not leave him alone • Cool person rapidly with running water, cold compresses or rapid fanning • Remove the person’s outer clothing • Provide cool drinking water if he person is alert. Do not give caffeine or alcohol • Rest for at least 12 hours




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13.3 Heat Cramps

Heat cramps are pain full spasms of the muscles that occur when workers drink large quantities of water but fail to replace their bodies electrolyte loss through sweating. They often occur when unacclimatised workers carry out strenuous physical activity. Cramps may also occur during or after working hours and may be relived by taking liquids by mouth, or saline solutions intravenous for quicker relief, if medical determined to be required.

13.3.1 Symptoms • Muscle spasms, usually in the lower extremities, abdomen or both. • Cool, moist skin • Rapid pulse • Remains alert • Normal body temperature

13.3.2 Treatment

• Stop work immediately and move the person to a cool shady resting place • Give enough cool drinking water, juice or oral rehydration solution • Let the patient rest for at least 8 hours

13.4 Heat Rash

Heat rash, also known as prickly heat, may our in hot and humid environments where sweat is not easily removed from the surface of the skin by evaporation. When extensive or complicated by inspection, heat rash can be uncomfortable that inhibits sleep and impedes a workers performance or even results in temporary disability. In most cases, heat rashes will disappear when the affected individual returns to a cooler climate.

13.5 Heat Syncope/Collapse(Fainting)

This condition is caused by prolonged standing, particularly in one spot, while under heat stress. Inactivity can result in excessive pooling of the blood in the extremities, thereby depriving the brains of sufficient oxygen. Consequently, the exposed individual loses consciousness of faints. For prevention, workers should become heat acclimatised and avoid prolonged standing in hot weather.

14.0 FACTORS AFFECTING HEAT TOLERANCE 14.1 Physiological Characteristics Physiological Characteristics are listed in no particular order.




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Acclimatisation State – Is the worker currently acclimatised? Heat acclimatisation may be reduced when an individual is removed from heat exposure for even a few days.

General Physical Fitness - For any work level, the upper limits of heat tolerance are reduced for the physically unfit.

Medical History - A history of heat intolerance. Non-acclimatisation, or incidence of heat stroke

may help predict susceptibility to future heat stroke conditions. Obesity – Fat is an excellent insulator. Obese individuals generally have a lower heat tolerance

than lean individuals. Hypertension – Some studies indicate even moderate hypertensive exhibit reduced heat

tolerance. Organic Heart(heart structure) and/or Vascular Disease – These problems may interfere heat

tolerance.

Respiratory Disease – Chronic obstructive pulmonary disease may limit heat tolerance as a function of the seriousness of the disease. Previous Thermal/Chemical Injury – Individual who have suffered thermal or chemical burns often have skin conditions that interfere with the body’s cooling process and adaptation to heat, thus increasing susceptibility to heat stroke. Skin Disease – Some skin diseases interfere with the sweating process and heat transfer. Infection – The body’s response to infection can include fever and fatique Pregnancy – Pregnancy puts additional stress on the individual. Dehydration – Since many heat-related conditions are due to dehydration, a pre-existing state of dehydration will obviously increase susceptibility to heat stress. See appendix 4 Urine guide. Diarrhoea – This condition can lead to dehydration, and may itself be a symptom of an underlying medical problems. Age - Heat tolerance may begin to decline in persons over 50 years of age, due to a sluggish sweat gland response. Nutrition – Individuals who are not maintaining a balanced diet may have a reduced capacity for performing work, and exhibit reduced heat tolerance. Poor nutrition may be the result of illness, stress, dieting to achieve weight loss, etc. Lack of Sleep – Fatique can reduce the body’s ability to respond to heat stress. Sex – The only difference appears to be the generally lower aerobic capacity of women and small men compared to average size men.




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Inadequate Mental Capacity – Be sure that all individuals are capable of understanding heat-related hazards and preventive measures. Inadequate Ability to Communicate – Be sure that all individuals are capable of describing the symptoms of heat-related illness to a co-worker or supervisor. Working Immediately After Eating – Having food in the stomach diverts some blood from the periphery to the body core.

14.2 External Agents Affecting Heat Tolerance

Alcohol – The ingestion of alcohol before or during work cause peripheral vasodilatation and increase heart rate, thereby reducing heat tolerance. Illegal Drug – Many of these substances alter behavioural functions, have serious effects on the central nervous and cardiovascular systems, and affect good judgement, all of which could increase the risk for a heat-related disorder to occur. Prescription and over-the-Counter Drugs – There are numerous legal drugs that may limit heat tolerance. Before taking any medicine, employees should consult with their physician regarding any potential effect on heat tolerance. Many of the following drugs can effect heat tolerance diuretics, vasodilators, central nervous system inhibitors, beta blocking agents, antihistamines, muscle relaxants, amphetamines, atropine, and tranquilizers. Others drugs not mentioned here may also affect certain individuals.

15.0 EFFECTIVE PROACTIVE MEASURES

Anticipate high heat days through weather forecast and initiate measures to communicate Heat Awareness Conditions using a colour coded flag system. The following are a few recommendations to aid in the prevention of heat related problems. • Begin drinking fluid nearly in the day. Waiting until the hottest portion of the day to replenish

fluids is too late. Avoid caffeine and alcohol the night before and during the day. • Dress for conditions. Lightweight, loose clothing is best. Avoid layering clothing underneath.

Fruits, vegetables, proteins, and starches work best. • A well balanced diet will help. Heavy, fatty foods do not support the body well in high heat

conditions. Fruits, vegetables, proteins, and starches work best. • Electrolyte solutions help to maintain energy levels. Do not drink more electrolyte solution

than water. Avoid taking salt tablets unless directed to do so by your physician. • Use sunscreen and cover your face and neck from the sun. • Provide shaded areas for mini-breaks and water stations. • Make sure drinking water stations are accessible so employees may take frequent breaks. • Strongly encourage SHORT (1-2 minutes) water breaks every 20-30 minutes during high heat

conditions. • Provide specially marked water barrels containing ice and water for soaking neck towels,

arms, sleeves, bandannas, and similar items. • Provide specific areas for employees to go to a regular basis and cool off when working in full

sun areas. See Appendix 3 for guidance on rest periods and water intake.




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• Using a Thermo-Scan type instrument, monitor personnel in their work areas to assure that there are not any consistently high core body temperature problems. Core body temperature should never exceed 38.3ºC. Pay particular attention to areas that have restricted air flow such as foundations, excavations, and vessels.

• Monitor work areas for ambient temperature. Use the Heat Index Chart, Appendix 3, to determine the apparent temperature. Areas with apparent temperature over 35º C should be monitored.

• MOST IMPORTANTLY, do not let schedule or productivity influence awareness or caution in high heat weather. Pressure from foreman or self-induced pressure is the most dangerous hazard.




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Appendix 1

Flow Chart for Evaluating Heat Stress & Strain

Yes

Flow Chart for Evaluating Heat Stress & Strain

Heat Index 38ºC or above

High Work Intensity?

Heat Acclimatisation?

Apply Work/Rest Period for specific Heat Index level Control Environment Monitoring of Personnel Heat Stress Training

Re-evaluate Exposure

Yes

Yes

No

Yes

Stop Work Is Air Temperature 50 º or above

Start Evaluation

Water Vapour Barrier Clothing or Encapsulated

Suit

Heat Strain Signs or Symptoms? Continue

Exposure




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Appendix 2

Heat Stress Prevention Check List(Weekly)

S/No Item Yes No If no, Indicate location and Mitigation Measure and Corrective action

1 Adequate ventilation provided in warehouse, workshop and similar building.

2 Hot surface effectively insulated where required? 3 Shields used to reduce radiant heat, where necessary 4 Offices/Accommodation/Camp building cooled by air-conditions, and

air-conditions working properly

5 Appropriate shade provided over work area where possible to shield workers from U/V rays and direct heat of the sun

6 Regular(hourly) rest breaks are being implemented in accordance with Section 6.5 of the Thermal Stress Prevention Procedures?

7 Adequate shaded areas and air-conditioned shads/building or vehicle are provided for workers to take rest

These areas are located within dose proximity to work areas to facilitate/encourage workers to take rest breaks?

8 Adequate supplies of cool drinking water and electrolyte solutions are provided in close proximity to all working areas?

9 Workers are drinking sufficient water and electrolyte solutions regularly(every 29 minutes)?

10 Workers are drinking at least 2 litre of water of water per 8 hour shift/ 5 litre per 10-hours?

11 Are workers taking salt tablets? 12 Workers are wearing appreciate clothing and PPE for the conditions in

which they are working?

13 First aids are properly trained in the recognition of Thermal stress symptoms and required treatments?

14 Workers understand the causes and symptoms of thermal stress(as explained in the HSE induction)?

15 Managers & Supervisors are aware of and have been trained in the requirements of the Thermal stress Prevention Procedures?

Name of inspector Date & Time of Inspection

Position/Role

Signature




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Appendix 3

Heat Stress General Guidelines & Heat Index Table




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Appendix 4

Dehydration Guide

Heat Stroke

Documents

rapid fanning

colour coded

hhi consortium

prior written

limit heat

na contractor

core body

qat contractor