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Thermal Stress
Thermal stress is defined as the physical and physiological reactions of the worker to temperatures that fall outside of the workers normal comfort zone.
Comfort Zones
-Accepted method of determining comfort zones is through the use of an ASHRAE chart. -ASHRAE American Society of Refrigeration, Heating, and Air-Conditioning Engineers. -ASHRAE standard 55-1981 outlines human comfort zones based on temperature and humidity.
Measuring temperature
Accurate temperature measurement is crucial for determining thermal stress. WBGT (Wet Bulb Globe Temperature) is the accepted method for determining true temperature
Accounts for air currents, relative humidity, solar load
WBGT Formulae:
For indoor or shaded environments:
Tnwb = natural wet-bulb temperature Tg = globe temperature For direct sunlight exposure:
WGBT Example
Using the reading from the thermostat on the west wall, convert that temperature to WBGT using the following info:
-WB = 64.1 F -GT = Temperature reading from thermostat
TLVs
TLVs, contd
Notice the ACGIH Heat Stress/Strain TLVs take into account the workload as well as the work/rest cycle.
Also to note that the TLVs make a few assumptions regarding acclimatization, clothing, water and salt intake, as well as the ability of most workers to work continuously at 38C.
light
29.5 27.5 30.5 29.0 31.5 30.0 32.5 31.0
moderate
27.5 25.0 28.5 26.5 29.5 28.0 31.0 29.0
heavy
26.0 22.5 27.5 24.5 28.5 26.5 30.0 28.0
very heavy
not allowed not allowed 27.5 25.0 29.5 26.5
Unacclimatized
Acclimatization
-The process whereby the body adapts to the temperature variations of the area. Acclimatization requires up to 3 weeks to be fully established and is noticeably decreased after 4 days (for TLV purposes: use 5 of last 7 days) Having lost 1.5% of your body weight due to dehydration eliminates any benefit of being acclimatized
Acclimatization, contd
Body Changes due to Acclimatization:
Ability to get rid of excess heat improves sweating becomes more efficient (1500 mL/h vs. 700 mL/h non-acclimatized) Decreased loss of electrolytes (less salt in sweat) Blood flow to skin is reduced; more blood is available to muscles Heart rate more stable, heart stoke volume increases and blood volume increases Decreased stress response(s)
Screening Measurements:
Heat Stress/Strain measurements (WBGT) should be taken prior to work being performed, to allow for measures to be taken to protect exposed individuals. Anticipated workload, work/rest cycle, clothing should be taken into account in determination. If work/rest cycle is not constant, time-weighted average should be used in determination.
Temperature Regulation
The hypothalamus is a small organelle within the brain which adjusts bodily functions through hormones which: -Increase heart rate -Begin the sweating mechanism -Increase blood flow to the skin surface
10 8 6 4 2 0 cool hot
Convection
Convection is the transfer of heat by movements of air masses.
Air cooling
Radiation
Radiation is the outward flow of energy from a source to the surrounding environment.
Evaporation
Evaporation is the process of a liquid changing state into a gas. For our discussion, it is the process where large sweat droplets are reduced in size and become vapor suspended in air.
Sweat vapor
Sweat droplet
Conduction
Conduction is the process where energy is transferred between objects through direct contact.
Hot Cold
Heat Sources
It must be remembered that there are two sources of exposure to heat (external and internal)
70-80% of muscle expended activity in the body is changed into heat (rather inefficient) called metabolic heat
Heat Injuries
Heat Rash (prickly heat):
Cause: Heat buildup in the skin due to clogged pores and sweat ducts. Prolonged skin wetness from sweating. Symptoms: Area becomes reddened and may itch or hurt. Skin eruptions. First Aid: Practice good personal hygiene; keep the skin clean and the pores unclogged, allow skin to dry, wear loose clothing, see doctor if rash persists. Seriousness: Relatively minor.
Heat Injuries
Radiation Burns (Sunburn)
Cause: UV radiation is absorbed by the skin. Symptoms: Water molecules within skin are disrupted, leading to drying-out of tissues. Extreme cases involve blisters, ruptures, and deep-tissue damage. First Aid: Covering of exposed skin. Use of protective creams (sunscreen). Bandaging of serious burns. Seriousness: Minor to relatively serious.
Cause: Depressed condition of the circulatory system due for the most part to a lack of adequate fluid replacement (dehydration). Blood vessels dilate and blood flow is seriously reduced (clinical condition of shock has occurred). A victim may be able to take actions that will alleviate the condition, if the symptoms are recognized early enough. Symptoms: Nausea, dizziness, weakness, headache, blurred vision, profuse sweating, cold/wet (clammy) grayish skin, unconsciousness, coma and death.
First Aid: Place victim in a face down position in a cool location, administer fluids if the victim is conscious. If unconscious, seek medical care or transport to a medical emergency room.
Seriousness: Shock is a serious medical condition regardless of the cause of its onset. Victims may require several days or even weeks to recover. Even longer periods may be necessary before the victim can resume working in heat stress conditions.
Cause: The bodys temperature regulation mechanism, located in the hypothalamus, fails and sweating stops. Core body temperature rises dramatically and the victims condition becomes a serious medical emergency. The victim is unlikely to be able to reverse the condition without assistance or medical intervention.
Symptoms: Chills, restlessness, irritability, euphoria, red face and skin, disorientation, hot/dry skin (not always), collapse, unconsciousness, convulsions and death.
First Aid: Immediate, aggressive cooling of the victims body using wet cloths, immersion into cool water or using alcohol wipes. Transport to emergency medical facility.
Seriousness: Heat Stroke is a MEDICAL EMERGENCY. Without outside intervention, the victim will die. By the time the victim realizes s/he is in trouble, it is usually too late to employ effective self-intervention procedures that can reverse the thermo-regulatory failure and reduce core temperatures. Recovery times from heat stroke are generally the longest of any heat-related disorder.
Decrease thirst:
Haldol
Decrease sweating:
antihistamines anticholinergics phenothiazines Benztropine
Control methods
Engineering controls Administrative controls
Use machinery instead of people where applicable Take steps to cool building or worksite Use thermal barriers (mylar reflective surfaces) More?
Personal Safeguards
How Much Water is Enough? More than you want just to satisfy your thirst Sources of water are:
1. Fluids - 1 cup or 8 oz = 240 mL every 20 min 2. Foods - fruit & veggies are 90% water
Why 10-15C? to maximize the amount you drink (not too cold, not luke warm)
unnoticed (at 1.5% weight loss you are considered dehydrated) loss of endurance, start to feel thirsty, feel hot, uncomfortable loss of strength, loss of energy, moderate discomfort cramps, headaches, extreme discomfort heat exhaustion, nausea, faint heat stroke, collapse, unconsciousness
Protective/Corrective measures
Take readings: Select a representative spot to place your thermometer(s) and/or hygrometer Designate someone to take readings on an hourly basis (on the hour) and record them
If activities are altered in response to the heat (slow down, more breaks, water distribution) record the details including the time and the degree
If heat stress health conditions appear record time and describe symptoms and situation
Protective/Corrective measures
Things you can check:
Look for typical heat strain symptoms; feeling overheated, fatigue, headache, nausea, weakness, dark concentrated urine, etc. Sweat that drips off your body no longer allows for cooling by evaporation; thus, unless theres another medical reason for it, this is a sign that your body is heating up
Check your pulse; heat stress is unlikely if your pulse rate is under 100 beats per minute after 1 minute rest. MAKE SURE YOURE DRINKING ENOUGH!!!
Cold Stress
Just as high temperatures have far-reaching effects on the body, cold temperatures present their own challenges to the thermal regulation of the human body.
Lets examine what the effects of cold temperatures are, what health effects cold temperatures present, and methods for treatment of cold-related injuries.
Hypothermic environment
As we see, the four causes of heat loss in a hypothermic environment are convection, radiation, evaporation, and conduction.
The large difference is that in hypothermic environments, you are trying to retain heat, instead of releasing it to the environment.
Heat Retention:
-
Size/shape (Eskimo vs. Masai) Insulation (Clothing type/# of layers) Fat (Used as insulation) Shell (Blood in core of body)
These are positive factors. Increase of any or all of these factors decreases risk of injury.
Heat Production
-
Cold Factors:
-
The total of these represents the challenge to the thermo-regulation of the human body. If Retention + Production < Cold Factors, Hypothermic condition could develop.
Hypothermia
a decrease in the core body temperature to a level at which normal muscular and neurological functions are impaired Medicine for Mountaineers
Hypothermia is possible at any temperature under 98.6 degrees, if the right conditions exist (lack of insulation, increased heat loss, etc.)
Hypothermia - signs
Umbles Stumbles, Mumbles, Fumbles, and Grumbles
Shows decreased physical and mental capacity.
Hypothermia - mild
Mild Hypothermia: - core temperature 98.6 96 F - non-voluntary shivering -complex motor functions impossible -vasoconstriction to periphery
Hypothermia - moderate
Moderate Hypothermia: - core temperature 95 93 F - loss of fine motor coordination - slurred speech - violent shivering - paradoxical undressing - apathetic attitude
Hypothermia - severe
Severe Hypothermia: - core temperature 92 86 F or below - shivering in waves (violent then pause) - person curled in fetal position to conserve heat - muscle rigidity develops - pale skin/dilated pupils - reduced pulse
Cold Injuries
Although hypothermia is well known, there are other cold injuries. -Frostnip -Frostbite -Immersion foot (trench foot)
Frostnip
Frostnip is the freezing of upper layers of the skin. Characterized by: - white, waxy skin. - general numbness Frostnip is generally reversible and does no major tissue damage.
Frostnip - treatment
Gently warm area by blowing warm air on it or by placing it near a warm body part. DO NOT rub the area! Rubbing can rupture frozen cells, causing extensive damage.
Frostbite
Frostbite is a freezing of the surface and deep layers of tissue. Characterized by: - white, and feels woody - numbness, possible anesthesia - deep frostbite can affect bone and muscle - purple/black color is from ruptured blood vessels
Frostbite a view
Frostbite - treatment
Immerse affected area in 105 110 degree F water until thawing is complete. - part will be extremely painful Wrap affected part in sterile gauze Affected part should not be used for anything - keep part from refreezing
Chart
Careful washing and drying of feet. Keep feet dry as much as possible. Keep off feet as much as possible until healed.
References
Curtis, Rick. Outdoor Action Program. Princeton University. 1995 Occupational Safety and Health Administration 3154 Occupational Safety and Health Administration 3156 Occupational Health Clinics for Ontario Workers. Heat Stress Training. 2001 Plog, Barbara A. et al. Fundamentals of Industrial Hygiene. 1996 USAF. Heat Stress Fact Sheet. 1998 www.firstworldwar.com/atoz/trenchfoot.html