Preventing Heat Illness: Water, Rest, Shade

With summer comes hot, humid weather and a greater chance of heat-related illness for outdoor workers. How to prevent heat illness? Three words: water, rest and shade, according to the Occupational Safety and Health Administration (OSHA).

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Heat illness is not to be taken lightly—in 2014, 2,630 workers suffered from heat illness and 18 died from heat stroke and other heat-related conditions on the job. Workers most at risk are those exposed to hot and humid conditions, especially those whose jobs require heavy lifting or heavy work tasks and who wear dense or bulky clothing and equipment.

Industries most affected by heat-related illness are construction, trade, transportation and utilities, agriculture, grounds maintenance, landscaping services and support activities for oil and gas operations, OSHA said. Workers who have not built up a tolerance to heat, including new workers, temporary workers, or those returning to work after a week or more off are all at greater risk, and all workers are at risk during a heat wave.

The body normally cools itself by perspiring. During hot weather, however, especially in high humidity conditions, sweating isn’t enough to keep the body cool. To keep body temperature from rising to dangerous levels, OSHA suggests drinking water and resting in the shade to prevent heat exhaustion or heat stroke.

If a worker becomes ill, OSHA recommends:

  • Call a supervisor for help. If a supervisor is not available, call 911.
  • Have someone stay with the worker until help arrives.

According to the Mayo Clinic, heatstroke symptoms include:

  • High body temperature. A body temperature of 104⁰ F or higher is the main sign of heatstroke.
  • Altered mental state or behavior. Confusion, agitation, slurred speech, irritability, delirium, seizures and coma can all result from heatstroke.
  • Alteration in sweating. In heatstroke brought on by hot weather, your skin will feel hot and dry to the touch. However, in heatstroke brought on by strenuous exercise, your skin may feel moist.
  • Nausea and vomiting. You may feel sick to your stomach or vomit.
  • Flushed skin. Your skin may turn red as your body temperature increases.
  • Rapid breathing. Your breathing may become rapid and shallow.
  • Racing heart rate. Your pulse may significantly increase because heat stress places a tremendous burden on your heart to help cool your body.
  • Headache. Your head may throb.

The Mayo Clinic urges immediate action to cool the overheated person while waiting for emergency treatment, including:

  • Get the person into shade or indoors.
  • Remove excess clothing.
  • Cool the person with whatever means available—put in a cool tub of water or a cool shower, spray with a garden hose, sponge with cool water, fan while misting with cool water, or place ice packs or cold, wet towels on the person’s head, neck, armpits and groin.

Workforce Drug Positivity Rate Highest Since 2004

Workforce use of illicit drugs across the board—including cocaine, marijuana and methamphetamine—has climbed to the highest rate in 12 years, a study by Quest Diagnostics found.

Overall positivity in urine drug testing among the combined U.S. workforce in 2016 was 4.2%, a 5% relative increase over last year’s rate of 4%—the highest annual positivity rate since 2004 (4.5%), according to an analysis of more than 10 million workforce drug test results.

“This year’s findings are remarkable because they show increased rates of drug positivity for the most common illicit drugs across virtually all drug test specimen types and in all testing populations,” Barry Sample, senior director of science and technology at Quest Diagnostics Employer Solutions, said in a statement. “Our analysis suggests that employers committed to creating a safe, drug-free work environment should be alert to the potential for drug use among their workforce.”

The positivity rate in urine testing for cocaine increased for the fourth consecutive year in the general U.S. workforce and for the second consecutive year in the federally-mandated, safety-sensitive workforce. Cocaine positivity increased 12% in 2016, reaching a seven-year high of 0.28%, compared to 0.25% in 2015 in the general U.S. workforce, and 7% among federally-mandated, safety-sensitive workers to 0.28% from 0.26% in 2015.

Marijuana positivity continued to climb in both the federally-mandated, safety-sensitive and general U.S. workforces. In oral fluid testing, which detects recent drug use, marijuana positivity increased nearly 75%, from 5.1% in 2013 to 8.9% in 2016 in the general U.S. workforce. Marijuana positivity also increased in both urine testing (2.4% in 2015 versus 2.5% in 2016) and hair testing (7.0% in 2015 versus 7.3% in 2016) in the same population. Among the federally-mandated, safety-sensitive workforce, which only uses urine testing, marijuana positivity increased nearly 10% (0.71% in 2015 versus 0.78% in 2016), the largest year-over-year increase in five years.

In Colorado and Washington, the first states in which recreational marijuana use was legalized, the overall urine positivity rate for marijuana outpaced the national average in 2016 for the first time since the statutes took effect. The national positivity rate for marijuana in the general U.S. workforce in urine testing increased 4% (2.4% in 2015 compared to 2.5% in 2016).

Positivity for amphetamines (which includes amphetamine and methamphetamine) continued a year-over-year upward trend, increasing more than 8% in urine testing in both the general U.S. and federally-mandated, safety-sensitive workforces compared to 2015. According to Quest, this rise over the past decade has been driven primarily by amphetamine use, including certain prescription drugs such as Adderall.

After four straight years of increases, in 2016, urine testing positivity for heroin held steady in the general U.S. workforce and declined slightly among federally-mandated, safety-sensitive workers.

Positivity for prescription opiates—including hydrocodone, hydromorphone and oxycodones—declined in urine testing among the general U.S. workforce. Oxycodones have seen four consecutive years of declines, dropping 28% from 0.96% in 2012 to 0.69% in 2016. Hydrocodone and hydromorphone both showed double-digit declines in both 2015 and 2016 (0.92% in 2015 to 0.81% in 2016) and (0.67% in 2015 to 0.59% in 2016), respectively.

This decline may be due to the fact that state and federal authorities have made efforts in the past few years to place tighter controls on opiate prescribing in order to address the opioid crisis.

Weighing In on Stand-Up Workstations and Exercise Balls

Stand-up workstations and exercise balls used for sitting in place of an office chair are gaining popularity. This has been fueled by reports of workers at Google, Facebook and other companies trading in their chairs to stand, or bounce, while working. They cite studies of the harm that hours of sitting can do.

Even here at the RIMS office several employees prefer sitting (or bouncing) on exercise balls to the familiar rolling desk chair, or working at a stand-up desk. Risk professionals have long been discussing the merits and downsides of these two popular choices.

But are these alternative ergonomic preferences really that beneficial?

Recently in an online discussion, some members of the RIMS Opis community said they were not in favor of exercise balls as ergonomic solutions. A risk manager in Oregon stated it bluntly: “Exercise balls should be limited to fitness programs. Your [workers comp] will own the injury if an employee slips off the ball and hits [his or her] head or has a soft tissue injury from the fall.” Several other commenters agreed that the balls are unstable and their use is discouraged or officially prohibited.

A CEO said: “While great for encouraging engagement of your core muscles during exercise, [balls] are not good for sitting at a workstation and in fact, research shows, increase your risk of ergonomic injury.”

In fact, some research has found their benefits negligible. A study of 28 subjects found that exercise or chair balls offer no advantages over a traditional workplace chair. According to a study by BioMed Central:

Results:

The results showed no significant difference with regard to spinal curvature between seating types. Initial sitting curvature was found to increase significantly over 30 minutes in both the desk chair and stability ball. In addition the results of the usability questionnaire showed a significant difference in three of the eight questions, in favor of the desk chair.

Conclusion:

No benefits were found through sitting on a stability ball over that of a desk chair in prolonged sitting as both seating types were found to replicate a poor sitting position through a kyphosed [outwardly curved spine] and slumped posture. The clinical implications of this study serve to benefit any healthcare professional considering use of the stability ball as a replacement desk chair.

In another online comment, a Missouri risk manager suggested a compromise, elaborating that while his organization allows their use, “They cannot be free-standing balls… they must be part of a chair ball with wheels and a seat backing.”

Stand-up desks received more positive feedback. Several risk professionals cited research equating excessive sitting and sedentary lifestyles with serious chronic health problems. A number of commenters shared anecdotes about how stand-up workstations have helped employee health issues. Several users noted that in their newly renovated, or soon-to-be-renovated, offices, stand-up workstations are de rigueur.

Who pays for these workstations? Most who commented said, or implied, that their companies foot the bill for stand-up desks if an employee requests them. Most seem willing to make the investment based on reports that providing ergonomic options can reduce workers comp claims.

Not all are sold on the benefits, however. A commenter from Chicago said, “As odd as it sounds, stand-up desks may not be wholly safe…. People get tired and fall down using them. And there is no confirmation standing is less stressful than sitting. Folks very quickly started to complain of sore hips, knees, feet and spines.”

A Virginia risk manager shared the wisdom of moderation and the middle ground, saying, “While sitting is bad—and the motive for getting a standing desk—standing all day can cause myriad lower back, leg and feet issues. It would be similar to what risk managers at grocery stores have to deal with their cashiers on their feet all day. Interspersing standing with sitting is key.”

Some researchers agree with this conclusion. A New York Times article reported that 15 minutes per hour at a standing workstation is recommended over standing all day.

Fed Program Initiates Life-Saving Training for Shootings, Terror Attacks

The length of time victims wounded in school shootings and terror attacks must wait for help from an EMT could be minutes or hours—during which time they could bleed to death. This has happened in a number of cases, including a shooting at an Orlando nightclub in June, when a woman bled to death while waiting for help to arrive.

These incidents have prompted the Department of Homeland Security’s Stop the Bleed campaign, a nationwide initiative to empower individuals to act quickly and save lives in emergency situations. Bystanders are asked to take simple steps to keep an injured person alive until medical care is available. Security guards, custodians, teachers and administrators are being trained at schools and other places to administer first aid until help arrives.

stop-the-bleed

Stony Brook University Hospital’s trauma center is spearheading training for school districts and colleges across the country. According to the Associated Press:

At a recent training session, paramedics and doctors brought in fake body parts—blood spurting from the wounds—to show staffers of a Long Island school district how to tie tourniquets and pack open wounds with whatever they have.

“Seconds matter. It really can be minutes when you can lose your life,” said Dr. James Vosswinkel, the chief of trauma and emergency surgery at Stony Brook University Hospital, who led the training.

Doctors emphasized that in the critical seconds after an attack it’s important for teachers and other school staff to stay calm and begin assessing injuries. Teachers learned to apply tourniquets in case a student is shot in the arms or legs—using T-shirts or belts, if necessary—and to stick anything they can to pack wounds in the torso.

Stony Brook doctors have reached out to local schools to offer the training, but are looking to expand the program as part of a federal Department of Homeland Security initiative to other schools, colleges and police departments across the country.

“Nobody should die from preventable hemorrhage,” Vosswinkel said.