Heat Illness & Prevention

Transcription

1 Heat Illness & Prevention Introduction Summer means two things to most of us: sunshine and outdoor fun! But while you enjoy both of those, especially with your clients, please be aware of the health hazards posed by high temperatures, high humidity, and that bright summer sun. Coupled with the physical activities we love to enjoy in the summer time, hot weather can prove deadly. Physical exertion builds up heat in the body, and hot/humid weather, prevents it from being released. Without the proper preventative measures, like weather appropriate clothing, heat illness can occur in temperatures as low as 80 F! Please be aware of the steps you can take to prevent heat illness. Prevention is part of your job as a Respite Care Provider and it is of utmost importance when dealing with dangers like heat exhaustion or heat stroke! However, when prevention is not enough, it is imperative that you are able to recognize the signs and symptoms of heat illness (for your clients and for yourself), as it will be your responsibility to render first aid. This in-service training will provide you with the necessary information for preventing, recognizing, and dealing with mild, moderate, and severe heat illnesses. Definition & Cause Heat illness is the result of an imbalance between the heat produced by a person s body and the heat released from a person s body. This means a person retains more heat than he/she loses, causing a spike in body temperature and eventual heat illness. In other words, the mechanism by which the human body regulates its average temperature of around 98.6 F is disrupted. Heat illness is caused by a combination of internal and external (environmental) factors. Internally, muscle movement from physical activity causes heat to build up inside of the body. In fact, 75% of the stored energy the body uses during physical activity is converted into heat; only 25% of that energy is actually required for physical work or activity. Normally, the body can release this heat in a variety of ways: Evaporation the body can release heat by sweating Radiation Transfer of heat through space. Heat can be transferred to surrounding surfaces (if the surfaces are cooler than the body). Convection Transfer of heat through moving air (if the air temperature is cooler than 95 F). A cool breeze is a very effective cooling mechanism. 1

2 Conduction Transfer of heat by contact. The body can lose heat through the skin if it touches something cooler than itself like clothes, furniture, or the floor. Inhalation/Exhalation Heat can be lost by the wetting of the air as someone breaths in and out. This accounts for about 10% of the body s heat loss. Heat Storage A small percentage of heat is lost as the body stores it. Excretion 3% of the body s heat loss is the result of the expulsion of urine/feces. 2

3 Externally, certain environmental factors make it harder for the body to release that built-up heat through the normal means mentioned above. These environmental factors include: High temperature/hot air Affects the body s ability to radiate and conduct heat. Heat transfer by radiation only works if surrounding surfaces are cooler than the body. When ambient temperatures are high, and surrounding surfaces are hotter than the body, a person can actually absorb heat from these surfaces. This is also true of conduction. High relative humidity Makes it harder to sweat (evaporation), reducing one of the body s main cooling mechanisms Lack of air movement When temperatures are less than 95 F, breezes are one of the most effective ways to cool down (convection). When the air is still, it is harder for the body to release built-up heat. Direct Sunlight/Lack of shade Affects the body s ability to radiate and conduct heat by warming surrounding surfaces. Areas of shade provide cooler temperatures and keep surrounding surfaces cooler as well. Direct sunlight can also increase the body s loss of fluid. This imbalance caused by internal and external forces does not always cause heat illness. People who often work in hot, humid conditions can become adapted to the environmental factors after a certain period of time. Acclimatization is the process by which the body becomes adapted to hot and humid weather. Fitness, health, and other factors also play a role in whether or not a person is susceptible to heat illness. 3

4 Risk Factors for Heat Illness -Dehydration is one of the main risk factors for heat illness. It can be caused by a variety of things, most notably: not drinking enough water. Drinking water helps maintain normal body temperature by allowing the natural process of evaporation (sweating) to take place. The body loses water when it sweats, and this water needs to be replenished in order to continue to do so! Without perspiration/evaporation, the body cannot release heat fast enough and the heat begins to build up, this can lead to overheating and heat illness. PLEASE NOTE: The consumption of alcohol, soda, and other caffeinated & sugary beverages can increase dehydration and the body s need for water. A person who consumes these beverages may also choose to use them as a substitute for water, a very dangerous decision! One exception is the use of sports drinks/commercial hydrating drinks, which have salt in them, and can be effective for re-hydration. The symptoms of dehydration are: Dark yellow or brown urine (urine should be lightly straw colored), reduced urination, rapid heart rate, muscle fatigue, loss of strength/dexterity, lightheadedness and dizziness, headache, blurred vision. -Certain medications, both prescription and over-the-counter can alter the body s natural heat-release mechanisms. They can also reduce awareness (as can alcohol) of the body, and any serious symptoms indicating heat illness. If you are on any medications, please remember to check with your doctor when you plan on being outside in the heat with your clients on a regular basis. -Lack of acclimatization is also a serious risk factor for heat illness. The body can overheat if it does not get the proper adjustment period to hot/warm conditions, especially when performing any strenuous labor or activity. Different people need different acclimatization periods depending on age, weight, fitness level, and health problems. -Previous heat illness usually means a person is especially susceptible to heatrelated problems. Other health issues can also attribute to this problem, including high-blood pressure. -Advanced age, poor levels of fitness, or excessive weight can affect the way the body releases heat. They can reduce a person s ability to acclimatize, and increase their chances of heat illness. (A physically fit person acclimatizes 50% faster than a physically unfit person). People who are overweight tend to retain more body heat, and are therefore more prone to developing heat illness. -Sunburn & sun poisoning increase the body s loss of fluid, and make it harder for the body to cool itself. They can be very serious. 4

5 Types of Heat Illness, Symptoms, and First Aid There are five main types of heat illness. They range from mild to deadly. 1. Heat Rash 2. Heat Cramps 3. Heat Syncope 4. Heat Exhaustion 5. Heat Stroke 6. Sunburn & sun poisoning are not considered heat illnesses, but they will be addressed in this section, as they cause a serious risk of heat illness. 1-Heat Rash is a skin irritation caused by sweating in hot and humid weather. It appears as a red, inflamed group of pimples or blisters usually on the neck, upper chest, in the elbow creases, or under the breasts. The best form of treatment is: To stay dry and keep from sweating, hopefully by staying out of the heat. This is not always possible, so dusting powders, like baby powder, can help keep these areas dry. 2-Heat Cramps are muscle pains and/or spasms in the abdomen, arms, or legs. They are the result of low salt levels in the muscles (caused by dehydration), and they usually occur when a person is working strenuously in a hot environment. Heat cramps can also be a sign of a more serious heat illness, like heat exhaustion, so first aid procedures, should be implemented immediately. To treat heat cramps in you or in another person: Sit down and rest in cool, shady area (preferably air conditioned) Drink cool juice, a commercial hydrating drink (like Gatorade), or water Do not return to any strenuous activities or work Seek medical attention if: victim has heart problems, if victim is on a low-sodium diet, if the cramps do not subside after one hour. 3-Heat Syncope is fainting, light-headedness, or dizziness that normally occurs during physical exertion in excessive heat. It occurs when the body attempts to cool itself down by dilating its blood vessels, reducing blood flow to the brain. It is often grouped together with heat stroke as this loss of consciousness is usually the result of a very high body temperature. I distinguish it here because it can present much more mildly than full-blown heat stroke. First aid should include: Sitting or lying down in a cool shady area (preferably air conditioned) Elevating the feet to promote blood flow to the head Hydrating using juice, water, or a commercial hydrating beverage 4-Heat exhaustion is the body s response to dehydration, usually from excessive sweating; it can lead to heat stroke if not properly treated. Symptoms vary and can include: headache, heavy sweating, extreme fatigue/weakness, 5

6 dizziness, confusion, nausea, clammy skin, pale or flushed complexion, muscle cramps, slightly elevated temperature, fast and shallow breathing. First aid should include: Sitting or lying down in a cool shady area (preferably air conditioned) Removing any excess clothing Elevating the feet to promote blood flow to the head Hydrating using juice, water, or a commercial hydrating beverage Cool shower, bath, or sponge bath (in order to lower body temperature) 5-Heat stroke occurs when the body stops sweating and can no longer regulate its temperature. Usually the body reaches 105 F or higher (usually within a short period of time, between 10 & 15 minutes). It can be fatal or lead to permanent disability without prompt treatment. Symptoms include having hot, dry skin OR heavy sweating. However at this point, sweating has usually ceased. Chills, hallucinations, severe headache, confusion, dizziness, slurred speech, and very high body temperature are also common. First aid should be administered rapidly and should include: Calling or your local emergency number Removing any excess clothing from the victim Cooling the victim as best and as fast as possible by any means available, including: Moving the victim to a cool, shady, or air-conditioned area, fanning them Soaking in an ice bath, spraying, sponging, showering victim in cool water Applying cold compresses or ice packs to the armpits, neck, and groin 6- Sunburn & sun poisoning occur from prolonged exposure to the sun, usually because the skin is unprotected by clothing or sunscreen. Certain medications make the skin more vulnerable and sensitive to sunlight; please check with your doctor if you are on any medications. In mild cases, symptoms include tingling and red, irritated skin with some pain, often followed by blistering and peeling, dead, skin. In severe cases, sun-poisoning can cause severe pain, chills, fever, nausea, and other flu-like symptoms. The burn will be much more serious, almost always including blisters and high risk of infection. It can lead to shock (and death) if not treated promptly. It is usually accompanied by severe dehydration and electrolyte imbalance. First aid should be prompt and should include: Cooling the burned/affected area using a cool shower or a cold, damp cloth Once the burn has been properly cooled, use Aloe Vera lotion to moisturize and relieve irritation (do not apply lotion directly after the burn occurs, as this can trap in heat and cause further damage) Drink extra fluids for a few days Do not go outside again without thoroughly covering the affected area If necessary take aspirin or ibuprofen to control pain, it can also help reduce swelling and the extent of the burn 6

7 Seek medical attention if the burn is very severe and if it is accompanied by nausea or vomiting, chills, fever, facial swelling, faintness, confusion, or headache. Prevention There are a variety of precautions you can take to prevent heat illness in yourself or your clients. First and foremost, if you believe that the conditions outside are too hot and/or humid for an excursion, stay indoors and wait for a cooler day! Heat illness is not worth the risk of a few hours outside. However, if you will be taking your clients outside in hot weather please take the following protective measures into account. STAY HYDRATED! Bring enough water along so that you and your client(s) can each drink four 8-oz. glasses of water (about 1 quart) per hour. (Gatorade or other commercial hydrating sports drinks also work well). Adding ice or keeping the water in a cooler is also a good idea. Hydration is the best way to prevent heat illness (it will keep your body sweating, the main mechanism it has for cooling itself). Attempt to drink small amounts of water frequently, as opposed to a large amount all at once. If you are physically exerting yourself, drinking a large amount of water can make you ill. Do not drink alcohol or anything with caffeine (like soda or coffee)! PLEASE NOTE: drinking only when you are thirsty is an ineffective way to stay hydrated. In severe heat and humidity, thirst is a sign of advancing dehydration. DRESS PROPERLY! Wear (and have your clients wear) lightweight and loose fitting clothes. Clothing should be made of breathable fabric (not leather, for instance) so as to allow the body to cool itself through airflow/air movement (convection). Clothes should also be light-colored, since darker colors absorb more heat. If possible, wear long sleeves to protect your arms from sunburn. Hats with wide brims are recommended, they will also help protect the face, neck, and eyes from the sun. USE SUNSCREEN! It helps prevent sunburn and sun poisoning. Thoroughly apply to yourself and your client(s) about minutes before going outside. Sunscreen should be at least SPF 30, and should protect against both UVA and UVB rays. Remember to reapply every two hours, more if you are swimming and getting wet. 7

8 STAY IN THE SHADE! Staying out of the sun greatly reduces the risk of heat illness. It increases the body s heat loss through radiation and conduction and it prevents sunburn. Shade makes it easier for the body to cool itself. TAKE BREAKS! Frequent rest periods are important if you will be moving around outside for long periods of time, especially if you (or the victim) are suffering from a headache. Make sure your clients take the time to rest in the shade with you, and give them lots to drink while they do! This will help bring and keep the body temperature at safe levels. ACCLIMATIZE! Take your clients out for short excursions at the beginning of the summer, and slowly increase the time you spend outside. The more accustomed you become to the heat, the less likely you are to get heat illness. According to Cal- OSHA, most instances of heat illness at work occur during heat waves, that is, when temperatures are abnormally high and workers are not properly acclimatized! PACE YOURSELF! In very hot weather, please make sure to keep from doing anything too strenuous. Physical exertion is the easiest way to build up body heat. Hiking, running around, and climbing all day may not be safe if it is too hot and humid outside. PLAY IT SAFE! It is always important that you plan activities that are appropriate for the weather and temperature outside (always run them by your client families first). In hot, sunny, and humid weather take shady walks, picnic in the park under some trees, go to the pool, play in the sprinkler, play with water guns, water balloons etc. CHECK THE WEATHER! If there are abnormally high temperatures or humid conditions, it is best to stay inside out of the sun, with a fan or air conditioner. Heat waves are dangerous, and going outdoors should be avoided until they pass. WATCH THE CLOCK! Never stay outside for too long in serious heat, humidity, and sun, especially in heat waves and on Spare the Air days. If you can t stand to stay inside, try to schedule outdoor time during the cooler parts of the day (morning/evening). 8

9 Conclusion As Respite Care Providers, it is your responsibility to prevent, recognize, and treat heat illnesses. Some of your clients may not be able to express their discomfort in harsh weather, and others may not be aware enough of their bodies to notice that they are experiencing symptoms of heat illness. Remember to assess any personal risks your clients may have (medicines, medical conditions, previous heat illness, low fitness levels) before you decide to take them out in the heat. Also, evaluate the conditions outside for temperature and humidity. Even if a client s family wants you to take them out, make sure conditions are such that you are comfortable doing so. Help your clients dress properly and remember to take frequent breaks. You can also encourage them to play in the shade, and help them acclimatize before spending a lot of time outside (please make sure to do so yourself as well). When in doubt, stay inside or do cool outdoor activities like swimming. Whether or not you decide to stay in or go out, if there are hot conditions please do not forget to bring and drink plenty of water! Hydration is the most effective way to cool off and stay cool. Heat illnesses are easily preventable, and if necessary, easily treatable. Survival rates for heat stroke are about 90%, as it is usually fairly easy to bring body temperature down quickly. Heat stroke is also easily prevented if bystanders can recognize a victim of heat exhaustion, before it develops into full blown heat stroke. So please stay cool, be careful, be observant, and be ready to take action if necessary! References: 1) ASHI First Aid Training Manual 2) California Code of Regulations, Title 8, Section 3395 Heat Illness Prevention 3) Maya Clinic Online 4) US Center for Disease Control NIOSH Workplace Safety & Health Topics 5) Web MD 9