ThermaPure® Overview of Heat Illness Prevention Programs[i]
Heat Illness Prevention
The application of high temperature to a structure is currently being applied by a variety of different contractors, including restoration, pest control, environmental remediation and IAQ. These are industries that use process(es) to significantly increase the temperature in a target area. These contractors need to be concerned over the well being of their workers and workers need to be concerned with their health. Indoor heat is a potential worker hazard. It is important that these businesses have a Heat Illness Prevention program is in place.
Indoor Heat – A Potential Worker Hazard
Humidity increases the risk to worker health and safety. When performing pest treatments or while killing microbes if the substrates are dry the relative humidity in the work area will be low. But as you begin to dry a wet building the relative humidity will increase in the work area and potentially cause a more dangerous environment for the workers.
In 2005 the California Department of Industrial Relations, Division of Occupational Safety and Health investigated[ii] twenty-five cases of heat related illnesses that occurred between May and November of that year. The cases investigated involved only men employed in various industries including agriculture, construction, transportation, service and public safety. Over two-thirds of the individuals spoke Spanish as their primary language. Most of the incidences occurred outdoors, although one involved indoor-only work. The work performed was described as moderate in regard to degree of strain required to complete the tasks. These 25 incidences resulted in 13 deaths and 9 hospitalizations greater than 24 hours, some for significantly longer times.
Heat Illness Prevention Standard – CA Title 8 §3395.
As a result of their investigation, on June 15, 2005 the State of California enacted a Standard[iii] proposed and developed by the Division of Occupational Safety and Health (Cal/OSHA) for Heat Illness Prevention. This Standard was developed with a conviction that the best defense against heat-related illnesses and fatalities is through prevention. The Standard was developed primarily out of response to heat related injuries in outdoor work settings.
Revisions to CA Standard– 2015
On May 14, 2015 Title 8 §3395, Heat Illness Prevention Standard was revised with new and additional information and procedural requirements. In the revised standard Heat Illness is defined as: a serious medical condition resulting from the body’s inability to cope with a particular heat load, and includes heat cramps, heat exhaustion, heat syncope, and heat stroke.
California Standard Includes “Indoor Heat”
A November 2, 2015 News Release[iv] from the CA Department of Industrial Relations announced that “Cal/OSHA Wins Unprecedented Decision in Case Protecting Workers from Indoor Heat. In this decision, the ruling affirmed that California’s Injury and Illness Prevention Program (IIPP) can be used “to address hazards that the standard does not specifically identify, including indoor heat.”
ThermaPure® Encourages Adopting a Heat Illness Prevention Program
Companies that deploy high temperatures in or to a structure should familiarize themselves with the requirements of the California Standard. ThermaPure® encourages this. If not, the OSHA “General Duty Clause” and Injury and Illness Prevention Programs and any other appropriate guidelines should be followed. OSHA does not have a specific guidelines section for heat illness, but does have a webpage addressing the issue.[v]However, the Cal/OSHA Standard is reflective of a higher standard of care for Heat Illness Prevention and ThermaPure® recommends that it be considered as a best practice. For California licensees it is necessary that a Heat Illness Prevention Program is included as a part of the Illness and Injury Prevention Program. For licensees outside of California, this is the only specific heat illness prevention program available.
Heat Illness Prevention – Cal-OSHA – 2016
The following sections are taken verbatim from the Heat Illness Prevention e-tool from the California Department of Industrial Relations Cal-OSHA website.[vi] Some of the copied sections have comments added by ThermaPure for clarification primarily regarding the ThermaPure process:
- Heat Illness – “More to the Story”,
- Types of Heat Illness and Common Signs/Symptoms,
- What Causes Heat Illness,
- Loss of Heat Balance, and
- Preventing and Responding to Heat Illness
Heat Illness – “More to the Story”
What Happens to the Body
Human beings need to maintain their internal body temperature within a very narrow range of a few degrees above or below 98.6 °F. People suffer from heat illness when their bodies are not able to get rid of excess heat and properly cool. The body losses it’s “heat balance” because it cannot shed heat at a fast enough rate.
When the body starts to overheat the blood vessels get bigger and the heart beats faster and harder. More blood flows to the outer layers of the skin from the internal “core” so that the heat can be released into the cooler outside environment. If this process does not cool the body fast enough, or the outside air is warmer than the skin, the brain triggers sweating to cool the body. Sweat glands in the skin draw water from the bloodstream making sweat. The sweat evaporates and releases the heat from the body. During an hour of heavy work in hot weather, the body can easily sweat out one quart of water.
Shifting blood to outer body layers (the “shell”) causes less blood to go to the brain, muscles, and other organs (the “core”). Prolonged sweating can deplete the body of water and salt causing dehydration. Because the body looses water and the salts that are needed for the muscles to work, muscle cramping may occur. The physiological strain on the body from heat illness may cause the person to become dehydrated, weak, tired, and confused.
As dehydration gets worse the body can no longer keep its temperature within the normal range, sweating stops and severe heat illness occurs. In heatstroke, the person’s body temperature rises rapidly damaging the brain, muscles and vital organs causing death.
Heat illness can develop very rapidly and is not always obvious before it becomes life-threatening. During high heat, heat illness can develop faster and even employees who have been doing their job for sometime are a risk.
|Variability in Symptom Recognition and Reporting
The symptoms of heat illness may vary between individuals. Also, employees may not accurately recognize and report the symptoms. As a result victims may be placed at a greater health risk. A person certified to provide first aid should be available at the work site to initially evaluate potential heat illness victims. See Emergency Response Procedures
Victims of heat illness may not report the full range of symptoms they are feeling because they:
· Choose not to for fear of negative consequences
· Deny that the symptoms may be serious
· Have not been trained to identify the symptoms of heat illness
· Are not physically able to report (e.g., they may have fainted)
· Are not fully aware of what is happening to their bodies (e.g., they may be delirious or mentally confused)
Types of Heat Illness and Common Signs/Symptoms
Heat illness affects the body, causing employees with mild symptoms to experience weakness, tiredness, and mental confusion, or even exhibit irritable or erratic behavior. Heat illness can also affect employees work performance and increase their risk of having accidents.
|Employees should be encouraged never to discount any discomfort or symptoms they are experiencing when working in heat, after work or before the next workday. Heat illness symptoms can occur even after work has stopped. They should immediately report any problems they are experiencing to a supervisor and coworker, or a family member to seek prompt medical attention. Employees and supervisors must be fully trained on the prevention of heat illness before they are assigned to work in locations where they are at risk for heat illness.|
Heat illness can be one or more of the following medical conditions including: heat rash, heat cramps, fainting, heat exhaustion, and heatstroke. The following symptoms are commonly associated with the different heat illness medical conditions. Given the variability in recognition and reporting of heat illness symptoms, the information listed below should be used only as a general guideline to train employees and supervisors.
Heat Rash (Prickly Heat) – Heat rash is a skin irritation caused by excessive sweating and clogged pores during hot, humid weather.
- Can cover large parts of the body
- Looks like a red cluster of pimples or small blisters
- Often occurs on the neck, chest, groin, under the breasts, or in elbow creases
- Uncomfortable so it can disrupt sleep and work performance
- Complicated by infections
Heat Cramps – Heat cramps affect people who sweat a lot during strenuous work activity. Sweating makes the body loose salts and fluids and minerals. If only the fluids are replaced and not the salts and minerals painful muscles cramps may result.
- Painful muscle spasms in the stomach, arms, legs, and other body parts may occur after work or at night
Fainting (Heat Syncope) – Employees who stand for long periods or suddenly get up from a sitting or lying position when working in the heat may experience sudden dizziness and fainting. In both cases, the fainting is caused by a lack of adequate blood supply to the brain. Dehydration and lack of acclimatization to work in warm or hot environments can increase the susceptibility to fainting. Victims normally recover consciousness rapidly after they faint.
- Sudden dizziness
Heat Exhaustion – Heat exhaustion is the body’s response to an excessive loss of the water and the salt contained in sweat.
|Cool skin temperature is not a valid indicator of a normal body temperature. Although the skin feels cool the internal body temperature may be dangerously high and a serious medical condition may exist.|
- Heavy sweating
- Painful muscle cramps
- Extreme weakness and/or fatigue
- Nausea and/or vomiting
- Dizziness and/or headache
- Body temperature normal or slightly high
- Pulse fast and weak
- Breathing fast and shallow
- Clammy, pale, cool, and/or moist skin
|Heatstroke is usually fatal unless emergency medical treatment is provided promptly.|
- No sweating because the body cannot release heat or cool down
- Mental confusion, delirium, convulsions, dizziness
- Hot and dry skin (e.g., red, bluish, or mottled)
- Muscles may twitch uncontrollably
- Pulse can be rapid and weak
- Throbbing headache, shallow breathing, seizures and/or fits
- Unconsciousness and coma
- Body temperature may range from 102 – 104 °F or higher within 10-15 minutes
If the muscles begin to twitch uncontrollably, keep the person from self-injury. Do not place any objects in the mouth.
Monitor body temperature and continue cooling efforts until emergency medical treatment is provided to the victim.
What causes Heat Illness?
The following is taken from the Cal/OSHA website:
T8CCR 3395 (b) Definitions states the following:
“Environmental risk factors for heat illness” means working conditions that create the possibility that heat illness could occur, including:
- Air temperature
- Relative humidity
- Radiant heat from the sun and other sources
- Conductive heat sources such as the ground
- Air movement
- Workload severity and duration
- Protective clothing and personal protective equipment worn by employees
“Personal risk factors for heat illness” means factors such as:
- Water consumption
- Alcohol consumption
- Degree of acclimatization
- Caffeine consumption
- Use of prescription medications that affect the body’s water retention or other physiological responses to heat.
- An individual’s age
More on what causes Heat Illness:
Loss of Heat Balance
Heat illness results when the body is out of heat balance. Heat balance means that the heat the body produces equals the heat it looses. When the body is out of Heat balance it produces and retains more heat than it looses causing heat illness.
Sources of Body Heat
Heat building-up inside the body from moving muscles during physical work activities is the major source of heat build-up in the body. About 75% of the stored energy the body uses to do physical work is converted into heat. Only about 25% of the energy is converted into the movements required to perform work. The more strenuous the physical activity, the more internal heat the body produces. Performing physical work activities when risk factors for heat illness are present increases the internal heat the body produces.
Added to this internal heat is the external heat load on the body which comes from working where environmental risk factors (e.g., hot air, direct sunlight or lack of effective shading) are present. A major danger from warm and hot weather, high relative humidity and lack of air movement is that these factors greatly slow the body’s natural processes of releasing heat to the surrounding environment. All of these and other risk factors can increase the risk of heat illness.
Body Heat – Losses and Gains
The body looses and gains heat in various ways. These include:
- Evaporation– the loss of heat through sweating. This is a major way the body loses heat. High relative humidity reduces this heat loss and thus reduces the body’s main cooling mechanism. Therefore, during periods of high relative humidity (such as in a water restoration application) there is a greater risk of developing Heat Illness. An indication of how relative humidity affects the risk of developing Heat Illness is called a Heat Index Value. Heat Index Values or Apparent Temperatures, are given in degrees Fahrenheit and measure how hot it really feels when relative humidity and air temperatures are both considered.
- Radiation– the transfer of heat through space. The body loses or radiates heat to surrounding surfaces if the body is hotter than these surfaces. The body can gain heat from these surfaces if they are hotter than the body.
- Convection– the transfer of heat in a moving fluid like air. Air flowing past the body can cool the body if the air temperature is cooler than about 95 °F. The body can gain heat through convection if the air is hotter than about 95 °F.
- Conduction– the transfer of heat between surfaces touching each other. The body can loose heat directly through the skin if surfaces it touches (e.g., clothes, chairs, floors) are cooler than the skin. The body can gain heat through conduction if the surfaces it touches are hotter than the skin.
- Inhalation/Exhalation– the loss of heat from warming and wetting of the air by breathing in and out. Accounts for about 10% of the body’s heat loss.
- Heat Storage– some heat is lost through storage in the body.
- Excretion– excretion of urine and feces accounts for about 3% of the body’s heat loss.
Heat build-up inside the body from physical work activities is the major source of heat load. In combination with this, working where the environmental and personal risk factors listed above are present, creates an even greater possibility that heat illness could occur.
|Cal/OSHA investigations (Study 2) showed that in 2006 heat illness cases occurred in temperatures as low as 80 °F.|
Environmental risk factors can increase the external heat load on the body. Personal risk factors may increase an individual’s susceptibility to developing heat illness. For example, not drinking enough water or drinking alcohol can both cause dehydration. Other personal risk factors which may increase the risk of heat illness include previous heat illness, excessive weight of the person, and poor levels of fitness. They can also affect an individual’s ability to acclimatize or adapt to working in hot or warm conditions.
More on Environmental Risk Factors
Heat build-up inside the body from physical work activities is the major source of heat load on the body. During a high heat period, the external heat load on the body from working in extremely hot temperatures is much greater. Also, if it does not cool down at night the heat load in the body continues to build up and the body never has a chance to cool down. This is especially true for employees who do not have access to air conditioned environments or other ways to cool down and rest in the evening. In addition, if there is humidity sweat does not readily evaporate off the skin. This greatly slows the body’s natural processes of releasing heat to the surrounding environment causing the body to quickly overheat. These cumulative effects of high heat can occur over one or more days causing employees to return to work with increased risks of developing heat illness.
Personal Protective Equipment (PPE) – The more the body is covered with materials which limit cooling, the greater the potential risk for heat illness. Wearing PPE which covers the body or face, limits air movement and the cooling effects of sweating. This results in the greatly reduced release of heat from the body to the surrounding environment and an increased heat load on the body. These factors make work tasks harder.
The type and level of PPE worn and the nature and duration of the work tasks, are the main factors which determine employee’s additional risk of heat illness from PPE. The types of PPE employees are required to wear can vary widely depending on their work tasks and exposures. PPE worn can range from hard hats, gloves or boots all the way up to a fully encapsulating chemical protective suit and a self-contained breathing apparatus (SCBA).
Inappropriate Work Clothing – In warm or hot work environments, or where other environmental risk factors are present, wearing inappropriate work clothing (e.g., dark colored or tight fitting clothing), can increase the risk of heat illness. Under these conditions wearing appropriate work clothing can protect against the sun and other risk factors.
More on Personal Risk Factors
Not Drinking Enough Water – In warm or hot conditions, drinking enough water (one quart per hour during the entire work shift) to stay healthy is vital for maintaining a normal body temperature. When working in these conditions the body looses a lot of water through sweating. Sweating helps lower the internal body heat but as the body continues to loose water it needs to be replaced to prevent dehydration and heat illness. Dehydration results in less perspiration so the body cannot get rid of heat fast enough causing increased heat load. Without sufficient water the body overheats.
Remind employees not to wait until they are thirsty to drink water. Being thirsty is not a good signal of the body’s need for water. By the time a person is thirsty they may have already lost too much water and their work performance has already declined. Employees should be encouraged to drink water frequently before and after work. Common symptoms of moderate to severe dehydration to make employees aware of and to have them check for include:
· Dark yellow or brown urine
· Reduced output of urine
· Rapid heart rate, muscle fatigue
· Loss of strength and dexterity
· Lightheadedness, dizziness
· Headache, blurred vision
Note: Drinking sufficient amounts of water allows for light or “straw” colored urine
It is important to avoid drinking alcohol altogether. This is because alcohol increases dehydration and the body’s requirements for water. Sweating can cause the body to loose large amount of water. As the body becomes dehydrated more water is required to replace bodily fluids. Dehydration increases a person’s susceptibility to heat illness and deteriorates their work performance. Therefore, it is important for employees working in warm or hot environments to drink sufficient amounts of water and avoid drinking any alcohol beverages.
Lack of Acclimatization – In general, individuals are more susceptible to heat illness until their bodies have had time to adjust. Adjusting to working in the heat is called acclimatization.
Acclimatization is important for all employees working in warm or hot temperatures or where other risk factors for heat illness are present. However, in any large group of workers, remember that there are wide differences in the ability of individuals to adapt to the heat. These differences in individuals cannot be accurately predicted prior to exposure to warm or hot conditions. For these reasons even some acclimatized individuals may still develop heat illness given the temperatures and other risk factors present at a particular worksite at a given time.
|Changes in work activities, locations or conditions
Even employees who were previously fully acclimatized may still be susceptible to heat illness and need further acclimatization when workplace conditions change. Such changes include:
· More physically demanding work tasks
· Working with required respiratory or personal protective equipment which reduce heat loss from the body
· Work locations with hotter temperatures
· High heat
Caffeine, Carbonated Sodas, Sports Drinks and Other Beverages – Sodas and drinks containing caffeine and sugar may increase dehydration. Therefore it is important to encourage employees to choose water over these types of drinks. Also, if employees choose these other drinks they may drink less water.
Note: The cautious use of sports drinks may be appropriate in the treatment of certain heat illnesses (e.g., heat cramps) but employees need to consult with their health care provider first.
Medications and Drugs – Certain “over-the-counter” medicines, prescription medicines, and other drugs may increase the risk for heat illness and other serious medical conditions. These substances may alter the body’s ability to deal with heat and reduce the individual’s awareness of the symptoms of heat illness. Because of this it is important:
- For employees to consult with their health care provider and inform them that they will be working in warm or hot conditions, before taking any prescription, “over-the-counter” medications or other drugs
- To only take these medications or other drugs under the advice of their doctor
Preventing and Responding to Heat Illness
Preventing heat illness protects your workers and is good business. Health and safety problems and other health problems like heart attacks and falls, may result from heat illness at the workplace. Heat illness may increase the costs of doing business by:
- Reducing employee productivity and efficiency
- Increasing your medical and emergency services costs
- Taking up supervisory and administrative time
- Increasing workers’ compensation premiums
Effective communication and the 10 elements listed below are keys to an effective program for preventing and responding to Heat Illness in your workplace.
California employers are required to take these four steps to prevent heat illness:
- Train all employees and supervisors about heat illness prevention.
- Provide enough fresh water so that each employee can drink at least 1 quart per hour, or four 8 ounce glasses, of water per hour, andencourage them to do so.
- Provide access to shade and encourage employees to take a cool-down rest in the shade for at least 5 minutes.They should not wait until they feel sick to cool down. (ThermaPure note: Because a ThermaPureHeat project is indoors, a cool-down location is analogous to “shade”).
- Develop and implement written procedures for complying with the Cal/OSHAHeat Illness Prevention Standard.
Cal/OSHA investigations showed that in 80% of the cases in which suspected heat illness occurred, the employer did not have a heat illness prevention program. Not having such a program caused harms including fatalities, serious injuries etc. The Cal/OSHA Heat Illness Prevention regulation requires employer’s procedures to be in writing, and to be made available to employees and representatives of the Division of Occupational Safety and Health (DOSH) upon request.
These written procedures must include:
- Complying with the requirements of the standardT8 CCR 3395(f)(1)(B)
- Responding to symptoms of possible heat illness, including how emergency medical services will be provided should they become necessaryT8 CCR 3395(f)(1)(G)
- Contacting emergency medical services, and if necessary, for transporting employees to a point where they can be reached by an emergency medical service providerT8 CCR 3395(f)(1)(H)
- Ensuring that, in the event of an emergency, clear and precise directions to the work site can and will be provided as needed to emergency responders. These procedures shall include designating a person to be available to ensure that emergency procedures are invoked when appropriate.T8 CCR 3395(f)(1)(I)
As a general rule ThermaPure recommends that no one stay in a treated building during the heating process for more than 20 minutes. Even if you do go inside be sure the other person onsite knows where in the structure you are going and if possible always have a “buddy” as you enter buildings that are being heated. This recommendation applies to workers, property owners, tenants and the like who might be participating, in some form or another, in a ThermaPureHeat® treatment.
The Buddy System
As was previously mentioned, the “Buddy System” is recommended. When your technician team is performing a ThermaPureHeat® treatment and a worker goes into the treatment area make sure that the technician is either with somebody, or has contact via a mobile radio or cell phone with another person who is outside the treatment area. At the very least, make sure that the person entering the treatment informs a co-worker what he/she is doing and where he/she is going to be working inside the project. Think of what happened to the worker who was immobilized by cramping. If he were in the treatment area by himself and had fainted, he probably would not have been discovered until 30 minutes later when workers were going back inside to check the temperatures and the moisture levels.
Cal/OSHA Employer Sample Procedures for Heat Illness Prevention, Title 8 §3395
As a major component of Title 8 CCR §3395, Heat Illness Prevention Standard, Cal/OSHA stresses prevention as the primary tool to fight heat illness. The Standard specifically states that California employers with any outdoor places of employment must comply with Title 8 CCR §3395, the Heat Illness Prevention Standard. To assist employers in the development of a program to implement the Standard, Cal/OSHA developed a sample procedure[vii] as a tool.
In this sample procedure Cal/OSHA states that the procedure provides minimal steps for application in most outdoor work settings. They further state that “in working environments with a higher risk for heat illness (e.g., during a heat wave, or other severe working or environmental conditions), it is the employer’s duty to exercise greater caution and additional protective measures beyond what is listed in this document, as needed to protect their employers.” ThermaPure® has interpreted this statement to encompass California workers employed by E-Therm and TPE licensees to deploy the ThermaPureHeat® process. This interpretation has been confirmed in California by a 2015 court ruling in which Cal/OSHA won an unprecedented decision in a case protecting workers from Indoor Heat. In this press release, Juliann Sum, Chief of Cal/OSHA stated: “California is the only state with an outdoor Heat Illness Prevention standard. Now all workers, including those who work indoors like warehouse workers, are protected from the hazard of heat.”
It is important to understand that Cal/OSHA does not intend for these procedures to supersede or replace the application of any other Title 8 regulation, particularly Title 8 CCR §3203, Injury and Illness Prevention Program (IIPP). The Heat Illness Prevention Program may be incorporated into the Employer’s Injury and Illness Prevention Program. Although this standard is specific to California employers, E-Therm and TPE recommend all licensees develop a similar program for incorporation into their Illness and Injury Prevention Program or Safety and Health Program.
Applicable Regulations or Standards
- 29 CFR 1910 – General Industry Standards
- 29 CFR 1926 – Construction Industry Standards
- OSHA Technical Manual (OTM) TED 1-0.15A, Chapter 4 – Heat Stress
- Title 8 CCR §3395 – Heat Illness Prevention Standard
- Title 8 CCR §3203 – Injury and Illness Prevention Program (IIPP)
[i] ThermaPure® Heat Technician Training Manual, 2016.
[ii] “Cal-OSHA Investigation of Heat Related Illnesses”, State of California Memorandum, February 17, 2006, https://www.dir.ca.gov/dosh/heatillnessinvestigations-2005.pdf.
[iii] California Code of Regulations, Title 8, Subchapter 7, General Industry Safety Orders Group 2, Safe Practices and Personal Protection, Article 10. Personal Safety Devices and Safeguards §3395. Heat Illness Prevention.
[iv] “Cal/OSHA Wins Unprecedented Decision in Case Protecting Workers from Indoor Heat” Department of Industrial Relations, State of California, News Release No.: 2015-101, November 2, 2015.
[v] “Water. Rest. Shade. The Work Can’t Get Done Without Them”, July 27, 2016, United States Department of Labor, OSHA, https://www.osha.gov/SLTC/heatillness/index.html?utm_source=Twitter.
[vi] “Heat Illness Prevention etool”, California Department of Industrial Relations, Cal-OSHA division, Jul 27, 2016, http://www.dir.ca.gov/dosh/etools/08-006/index.htm.
[vii] “Employer Sample Procedures for Heat Illness Prevention,” California Department of Industrial Relations, Cal/OSHA, May 2015.