Occupational Heat-Related Occupational Heat-Related Illness in CaliforniaIllness in California

Kathleen Fitzsimmons, MPHKathleen Fitzsimmons, MPHCalifornia Department of Public Health California Department of Public Health

CDC/CSTE Applied Epidemiology CDC/CSTE Applied Epidemiology FellowshipFellowship

Kathleen.Fitzsimmons@cdph.ca.govKathleen.Fitzsimmons@cdph.ca.gov

Heat-Related IllnessHeat-Related Illness

• Heat rashHeat rash• Heat syncope (fainting)Heat syncope (fainting)• Heat crampsHeat cramps• Heat exhaustionHeat exhaustion• Heat strokeHeat stroke

– Core body temperature >104Core body temperature >104°F°F– Multi-organ system dysfunctionMulti-organ system dysfunction– Medical emergencyMedical emergency

• DeathDeath

MildMild

SevereSevere

““Classic” Heat-Related IllnessClassic” Heat-Related IllnessRisk FactorsRisk Factors

• Age: Infants and ElderlyAge: Infants and Elderly• Lack of air conditioning Lack of air conditioning • Social isolationSocial isolation• Pre-existing medical condition Pre-existing medical condition • Impaired mobilityImpaired mobility• Low socio-economic statusLow socio-economic status• Housing characteristicsHousing characteristics

Military RecruitsMilitary Recruits AthletesAthletes WorkersWorkers

““Exertional” Heat-Related IllnessExertional” Heat-Related Illness

Heat exchange of worker performing Heat exchange of worker performing physical work in hot weatherphysical work in hot weather

Air temperature

Air humidity

Solar radiation

Reflected solar radiation

Evaporation (sweat and respiration)

Convection

Wind

Ground thermal

radiation

Conduction

Radiation

Metabolic heat

Personal Risk FactorsPersonal Risk Factors

Lack of AcclimatizationLack of Acclimatization

DehydrationDehydration

Lack of FitnessLack of Fitness

ObesityObesity

Heavy ClothingHeavy Clothing

Environmental Risk AssessmentEnvironmental Risk Assessment

Heat IndexHeat Index General Effect of Heat Index on People in General Effect of Heat Index on People in Higher Risk GroupsHigher Risk Groups

80-89 80-89

CautionCaution

Fatigue possible with prolonged exposure and Fatigue possible with prolonged exposure and physical activity. physical activity.

90-104 90-104

Extreme CautionExtreme Caution

Sunstroke, heat cramps, and heat exhaustion Sunstroke, heat cramps, and heat exhaustion possible. possible.

105-129 105-129

DangerDanger

Sunstroke, heat cramps, and heat exhaustion Sunstroke, heat cramps, and heat exhaustion likely, and heat stroke possible. likely, and heat stroke possible.

130 or higher 130 or higher

Extreme DangerExtreme Danger

Heat stroke highly likely with continued exposure.Heat stroke highly likely with continued exposure.

Link: The full heat index charts are available through the National Weather Service at http://www.crh.noaa.gov/jkl/?n=heat_index_calculator

PreventionPrevention

• Education Education • Emergency responseEmergency response• Fluids accessible andFluids accessible and drinking encourageddrinking encouraged• Cool area for rest breaksCool area for rest breaks• Work/rest schedulesWork/rest schedules• Acclimatization protocolsAcclimatization protocols

Occupational Heat-Related Occupational Heat-Related IllnessIllness

• Mining Mining • ConstructionConstruction• AgricultureAgriculture• ForestryForestry• LandscapingLandscaping• Hazardous waste managementHazardous waste management• Fire fightingFire fighting• Aluminum production and other hot industriesAluminum production and other hot industries

• July 28, 2004 – Asuncion Valdivia picking grapesJuly 28, 2004 – Asuncion Valdivia picking grapes

• July 13, 2005 – Salud Rodriguez in bell pepper fieldJuly 13, 2005 – Salud Rodriguez in bell pepper field

• July 14, 2005 – Ramon Hernandez in melon fieldJuly 14, 2005 – Ramon Hernandez in melon field

• July 20, 2005 – Agustine Gudino in tomato fieldJuly 20, 2005 – Agustine Gudino in tomato field

• July 31, 2005 – Constantino Cruz in tomato fieldJuly 31, 2005 – Constantino Cruz in tomato field

California AgricultureCalifornia Agriculture

““United Farm Workers calls on United Farm Workers calls on governor and lawmakers for governor and lawmakers for

emergency action”emergency action”

5 heat-related deaths within 12 months5 heat-related deaths within 12 months

August 3, 2005August 3, 2005

““This is a tragedy…and we will do everything it takes This is a tragedy…and we will do everything it takes to prevent this from happening again”to prevent this from happening again”

August 22, 2005August 22, 2005Emergency regulation for heat illnessEmergency regulation for heat illness

Public Health ActionPublic Health ActionJuly 27, 2006July 27, 2006

Heat Illness Prevention Heat Illness Prevention RegulationRegulation

• Training for supervisors Training for supervisors and employeesand employees

• Written procedures for Written procedures for compliancecompliance

• WaterWater

• ShadeShade

• WaterWater PresentPresent

Drinking encouraged? Drinking encouraged?

• ShadeShade Available during rest breaksAvailable during rest breaks

Allowed breaks as neededAllowed breaks as needed

• TrainingTraining Acclimatization importanceAcclimatization importance

Supervisor TrainingSupervisor Training

Written Heat Illness Prevention Written Heat Illness Prevention Prog. Prog.

Written Emergency Response PlanWritten Emergency Response PlanSource: Prudhomme J, Neidhardt A. State of California Report. 10/18/07.

Employer Compliance with RegulationEmployer Compliance with Regulation

Cal/OSHA Heat-Related Cal/OSHA Heat-Related InvestigationsInvestigations

20062006

?• Millican R, Baker RC, Cook GTMillican R, Baker RC, Cook GT. .

Controlling heat stress: Controlling heat stress: administrative versus physical administrative versus physical control. Am Ind Hyg Assoc J. control. Am Ind Hyg Assoc J. 1981; 42:411-6.1981; 42:411-6.

• Dinman BD, Horvath SM.Dinman BD, Horvath SM. Heat Heat disorders in industry: a disorders in industry: a reevaluation of diagnostic reevaluation of diagnostic criteria. J Occ Med. criteria. J Occ Med. 1984;26(7):489-95.1984;26(7):489-95.

• Donaghue AM.Donaghue AM. Heat illness in Heat illness in the U.S. mining industry. Am J the U.S. mining industry. Am J Ind Med. 2004;45:351-6.Ind Med. 2004;45:351-6.

• Bonauto D, Anderson R, Bonauto D, Anderson R, Rauser E, Burke B.Rauser E, Burke B. Occupational heat illness in Occupational heat illness in Washington State, 1995-2005. Washington State, 1995-2005. Am J Ind Med. 2007;00:1-11. Am J Ind Med. 2007;00:1-11.

Occupational HRI Occupational HRI IncidenceIncidence

Surveillance ProjectSurveillance Project Occupational Health Branch, CDPH Occupational Health Branch, CDPH

• Statewide, multisource surveillance to:Statewide, multisource surveillance to:– Detect cases of occupational HRIDetect cases of occupational HRI– Characterize disease and exposuresCharacterize disease and exposures– Calculate incidenceCalculate incidence– Identify areas for targeting preventionIdentify areas for targeting prevention

Surveillance Case Definition(s)Surveillance Case Definition(s)

• Include all HRI cases (heat rash heat stroke)Include all HRI cases (heat rash heat stroke)• Exclude burns and skin cancersExclude burns and skin cancers• Probable and PossibleProbable and Possible

Data SourcesData Sources

• Healthcare Provider Treatment : Doctor’s First Healthcare Provider Treatment : Doctor’s First Reports of Occupational Injury or Illness (DFR)Reports of Occupational Injury or Illness (DFR)– 2007 data2007 data

• WC Claims : Workers’ Compensation Information System (WCIS)– 2000-2007 data

DFR DFR

• N = 155 (2007)N = 155 (2007)• Ongoing, passive Ongoing, passive

surveillancesurveillance• Mandated, Mandated,

statewide reportingstatewide reporting• Essentially a Essentially a

medical recordmedical record• High Positive High Positive

Predictive ValuePredictive Value

Data SourcesData Sources

• Healthcare Provider Treatment : Doctor’s First Reports of Occupational Injury or Illness (DFR)– 2007 data

• WC Claims : Workers’ Compensation WC Claims : Workers’ Compensation Information System (WCIS)Information System (WCIS)– 2000-2007 data2000-2007 data

CA WCIS Heat-Related ClaimsCA WCIS Heat-Related Claims By Year of By Year of InjuryInjury

2000-2007 (N=5,140)2000-2007 (N=5,140)

0

200

400

600

800

1000

1200

2000 2001 2002 2003 2004 2005 2006 2007

Year

No

. Cla

ims

CA WCIS Heat-Related ClaimsCA WCIS Heat-Related Claims By Month of By Month of InjuryInjury

2000-2007 (N=5,140)2000-2007 (N=5,140)

0

200

400

600

800

1000

1200

1400

1600

1800

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov DecMonth

No

. Cla

ims

CA WCIS Heat-Related ClaimsCA WCIS Heat-Related Claims By Month of By Month of InjuryInjury

2000-2007 (N=5,140)2000-2007 (N=5,140)

0

200

400

600

800

1000

1200

1400

1600

1800

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov DecMonth

No

. Cla

ims

CA WCIS Heat-Related Claim Distribution By CA WCIS Heat-Related Claim Distribution By Month (April-Sept) and Year of Injury (2000-Month (April-Sept) and Year of Injury (2000-

2007)2007)

0

100

200

300

400

500

600

700

Apr May Jun Jul Aug Sep

No

. Cla

ims

Month 2000-2007

2006

2005

Next StepsNext Steps

• Continue data preparation and analysisContinue data preparation and analysis– Data collectionData collection– CodingCoding– AnalysisAnalysis

• Evaluate surveillance system Evaluate surveillance system – Assess data usefulnessAssess data usefulness– Evaluate system attributesEvaluate system attributes

ConclusionConclusion

““Changes in climate have implications Changes in climate have implications for occupational health and safety. for occupational health and safety. Heat stress due to high temperature Heat stress due to high temperature and humidity is an occupational and humidity is an occupational hazard…”hazard…”

--IPCC Fourth Assessment Report Climate IPCC Fourth Assessment Report Climate Change 2007: Climate Change Impacts, Change 2007: Climate Change Impacts, Adaptation and Vulnerability, Ch.8, p.405Adaptation and Vulnerability, Ch.8, p.405

CDPH-OHBCDPH-OHB• Bob Harrison Bob Harrison • Jennifer FlatteryJennifer Flattery• Carolina EspineliCarolina Espineli• Matt FrederickMatt Frederick• Eleana MartyshEleana Martysh• Christine HanniganChristine Hannigan

• Thomas KimThomas Kim• Janice PrudhommeJanice Prudhomme• Amalia Neidhardt Amalia Neidhardt (DIR)(DIR)• Gail BatesonGail Bateson• John BeckmanJohn Beckman• Dan Smith Dan Smith (CDPH-EHIB)(CDPH-EHIB)

AcknowledgementsAcknowledgements

Thank youThank youPhoto credit: www.csao.org