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WORK-RELATED HEAT STRESS Mustafa Khogali Dec.2006. INTRODUCTION. Is our climatic environment a threat to our physiological adaptation? Animals are better suited! Humans attained sophisticated control But? Both are suited to risk of HEAT ILLNESS?. Evolution of Thermo.Reg.Sys.

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Work related heat stress mustafa khogali dec 2006

WORK-RELATED HEAT STRESSMustafa KhogaliDec.2006


INTRODUCTION

  • Is our climatic environment a threat to our physiological adaptation?

  • Animals are better suited!

  • Humans attained sophisticated control But?

  • Both are suited to risk of HEAT ILLNESS?


Evolution of thermo reg sys
Evolution of Thermo.Reg.Sys

  • ↑ H. Elimination V H. Conservation

  • Survival► Maintenance of B.T 37˚C


B t equilibrium
B.T. EQUILIBRIUM

  • Two Physiologic Mechanisms:

  • Cardiopulmonary

  • Sweating

    Evaporation ↑SKBF


1 factors influencing h s climate env conditions demands of work clothing personal characteristics

1. Factors Influencing H. S.

Climate / Env. Conditions.

Demands of work.

Clothing.

Personal characteristics.


Factors modifying heat tolerance
FACTORS MODIFYING HEAT TOLERANCE

  • Physiological or pathological changes that alters body’s heat production or heat loss capacity modify tolerance of hot environment:

  • 1. Physical Fitness (Exercise) 2. State of Hydration

  • 3. State of Acclimation 4. Endotoxins

  • 5. Age 6. Drugs

  • 7. Others


Heat stress
HEAT STRESS

  • Are there safe limits??

  • Wide variability in Human TL.

  • Complexity of H.Exchange.


H s indices
H.S.INDICES

  • Rational: S=M±C±R-E

  • EMPIRICAL : Subjective/Objective.

    ET

    WBGT 

    P4SR


WBGT

  • OUTDOOR =

    WBGT = 0.7 WB + 0.2 GT + 0.DB

  • INDOOR =

    WBGT = 0.7 WB + 0.3 GT


Permissible heat exposure threshold limit values wbgt c
PERMISSIBLE HEAT EXPOSURE THRESHOLD LIMIT VALUES (WBGT °C)

ADAPTED FROM ACGIH: THRESHOLD LIMIT VALUES FOR CHEMICAL AND PHYSICAL AGENTS AND BIOLOGICAL EXPOSURE INDICES, 1992-1993, CINCINNATI, 1992, THE CONFERENCE.

* LIGHT = 200 Kcal/hr or less; Moderate = 201-300 Kcal/hr; Heavy = above 300 Kcal/hr


Heat stress principal systemic responses
HEAT STRESS: PRINCIPAL SYSTEMIC RESPONSES

  • 1.Sweating4.CNS

  • 2.Cardiovascular Status5.Hematology

  • 3.Metabolic status6.Hormone


Measurement of body t
MEASUREMENT OF BODY T

  • ORAL To

  • RECTAL Tr

  • TYMPANIC Tt

  • ESOPHAGEAL Te

  • Skin Ts


1. HEAT DISORDERS

H.Syncopy

H.Cramps

H.Exhaustion

H.Stroke

2. H.Induced Illnesses


T67 effects of heat and light
T67 EFFECTS OF HEAT AND LIGHT

  • T67.0HEAT STROKE AND SUN STROKE

  • T67.1 HEAT SYNCOPE

  • T67.2 HEAT CRAMP

  • T67.3 HEAT EXHAUSTION, ANHYDROTIC

  • T67.4 HEAT EXHAUSTION DUE TO SALT DEPLETION

  • T67.5 HEAT EXHAUSTION, UNSPECIFIED

  • T67.6 HEAT FATIGUE, TRANSIENT

  • T67.7 HEAT OEDEMA

  • T67.8 OTHER EFFECTS OF HEAT AND LIGHT

  • T67.9 EFFECTS OF HEAT AND LIGHT, UNSPECIFIED


DEFINITION: ( CLASSIC TRIAD )

  • Heat stroke is a state of thermoregulatory failure characterised by:

  • (A) CNS Dysfunction:

  • (Poor limb coordination, delerium, convulsions,grand mal seizures and coma).

  • (B) Generalised Anhidrosis:

  • (C) A Rectal Temperature Above 40.6 °C


Interacting mechanism and outcome in heat stroke patients
INTERACTING MECHANISM AND OUTCOME IN HEAT STROKE PATIENTS

AGE, DRUGS

CHRONIC DISEASES

ENVIRONMENT

METABOLISM

V

V

HEAT AGAIN

V

V

V

SWEATING T

VASODILATION

CESSATION OF

SWEATING

FLUID LOSS

V

V

V

V

V

ACIDOSIS HYPOXIA

SHOCK

RISE IN BODY CORE TEMPRATURE

RHABDO-MYOLSIS

V

V

V

MYOCARDIAL ACUTE RENAL DIC CIRCULATORY CNS

DYSFUNCTION FAILURE FAILURE


Host factors reported to increase risk of heat stroke
HOST FACTORS REPORTED TO INCREASE RISK OF HEAT STROKE

  • Lack of acclimitization

  • Obesity

  • Lack of physical fitness

  • Fatigue

  • Lack of sleep

  • Dehydration

  • Febrile Illness

  • Acute and convalescent infections

  • Fever following immunization

  • Conditions affecting sweating

  • Skin diseases

  • Acute or chronic alcoholism

  • Chronic diseases; e.g. diabetes, cardiovascular disease

  • Lesions of hypothalamus, brainstem, and cervical part of the spinal cord

  • Potassium deficiency

  • Sustained output of muscular metabolic heat

  • Increased susceptibility due to biological variability


Management of heat stroke
MANAGEMENT OF HEAT STROKE

  • CRITICAL MANAGEMENT STRATEGIES

  • Recognition of Hyperthermia

  • Rapid Effective Cooling

  • Supportive Care

  • Observation of H.R. Complications of Tissue Injury


Cooling modalities
COOLING MODALITIES

  • 1. Ice water immersion

  • 2. Evaporation cooling (FANS)

  • 3. Ice packs

  • 4. Lavage: peritoneal, rectal, gastric

  • 5. Alcohol sponge bath

  • 6. Cardiopulmonary by pass


Objectionsto ice water immersion
OBJECTIONSTO ICE WATER IMMERSION

  • 1. Intense peripheral vaso constriction

  • 2. Induction of shivering

  • 3. Extreme discomfort of patient

  • 4. Discomfort of medical attendance

  • 5. Difficulty: Cardiopulmonary resuscitation

  • 6. Difficulty: Monitoring vital signs

  • 7. Unpleasant and unhygienic conditions


Alternative method
ALTERNATIVE METHOD

  • Evaporative cooling from warm skin

  • M.B.C.U.


Groups at risk
Groups at Risk

  • WORKERS : In hot industries.

    : Outdoor occupations.

    : Who wear protective clothing

  • ELDERLY : Those with chr.diseases.

  • EXERCISING CHILD

  • MAKKAH PILGRIMS (In hot season)


Occup h exposure
Occup.H.Exposure

  • OUTDOOR: Agric./Farming;construction

    Cane sugar cutting

    Oil and gas drilling

    Fire fighting etc.


Occ h exposure 2
OCC.H.EXPOSURE--2

  • INDOOR: Bakeries

    Forging/Foundries

    Engine room

    Steel/Iron/Glass manufacture

    Laundries etc.


Thermal problems in sport
Thermal Problems in Sport

  • Outdoor sport activities

  • Mass Participation (Marathons)

    (Aerobic Capacity imp)



H illness alert prog hiap
H.Illness alert prog. (HIAP)

Strategies based on triad of Prev.

  • Primary

  • Secondary

  • Tertiary


Prim prev
PRIM.PREV.

  • Adequate/Eff.Eng.Design

  • Comfortable cooling

  • Good ventilation

  • ↓Workload

  • Education/Awareness


Second prev
SECOND.PREV.

  • Preselection/Acclimation

  • PE Med Ex.►Employees

  • Preplac.Med Ex.► Sport

  • Appropriate Adm.Management

    (Work-rest cycle + Fluids)


Information to physician
Information to Physician

  • Detailed Job Description:-

    * Length/Duration of work

    * Shift system

    * Freq./duration of rest

    * Env.T


Pre placement exam
Pre.Placement Exam

a) Medical History

  • Occupational History

  • Past History of H.R.I

  • Behav.habits

    b) Physical Exam


Tert prev
Tert.Prev.

  • Diag.H.I. Syndromes

  • Facilities

  • Training Diff.Categories

  • Protocol of Management


Work practice
WORK PRACTICE

  • ENV.ASSESSMENT.

  • PROG.OF ACCLIMATIZATION.

  • ADEQUATE WATER SUPPLY.

  • FIRST AID TRAINING.

  • GENERAL TRAINING FOR HEALTH SAFETY.

  • ADAPTIVE WORK SCHEDULE.

  • WORK-REST REGIMEN

  • PREPLACEMENT/PERIODICAL MED.EXAM.

  • OBSERVATION/MONITORING BY TRAINED PERSON.


Alert programs
Alert Programs

Alert Danger

I. Permissible Heat 0 0

Exposure TLV

II. Thermal Limit

1- Oral temperature Increase ˚c 1.5 2.5

2- Skin temperature Increase ˚c 3.0 4.0



H. S. Training

  • Rev. of H. S. Disorders.

  • Risk factors of HRD.

  • Recognition of signs or symptoms.

  • Prev. measures to be used.

  • Fluid replacement options.

  • Expectations.


Conclusions
Conclusions

a. Prevention of Heat illness in both

occupational and sport is crucial since they potentially lethal.

  • Appreciation of Heat illness: Physician/Administrator/ Param industrial & military/Organizers.

  • Principles of Prev and Management

    - All members of community


Conclusions1
Conclusions

d. Success achieved through:

  • Awareness and education.

  • Acclimatization (Matching Activity α T+H).

  • Liberal Water Replacement.

  • Use of Proper clothing.

  • Appropriate history of medical exam.

  • Adoption of Heat Alert Prog.


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