Management of Heat Disorders

Heat disorders are mild to serious reactions to high environment

temperature due to inadequate or inappropriate responses of heat-
regulating mechanisms. Exposure to high ambient temperature without
efficient heat loss may lead to heat cramps, heatstroke, or heat
exhaustion.

Acute or prolonged exposure to heat with excessive sweating

uncompensated by fluid intake leads to dehydration, sodium and
potassium depletion, and hypovolemia. Associated vomiting and
diarrhea contribute to fluid loss.

Heatstroke and heat exhaustion both occur in hot, humid

environments, but they are markedly different disorders.

Resources required: the recommended shelters, cloths, meals, fluids

and medicines should be provided to the personnel. A campaign
information should be in place, including posters, and documentation.
Training, physical conditioning and acclimatization programs should be
in place.
Factors influencing the body’s heat-regulating mechanisms

Environmental as well as physiological factors influence the body’s

heat-regulating mechanisms.

Environmental Factors:

Ambient air temperature:

Ambient air temperature dictates the direction of heat flow from or to

the body. When air temperatures are high, the direction of heat flow is
to the body, and heat can only be dissipated by sweating where the
heat is carried away by sweat evaporation at the skin surface.

Wind velocity:

Air currents carry body heat away. The higher the velocity of these
currents, the faster the heat loss.
Humidity:

Evaporation, the most important source of heat loss, depends on

relative humidity: The higher the humidity, the less efficient the heat
loss. Therefore, high ambient humidity (which decreases the cooling
effect of sweating) and prolonged strenuous exertion (which increases
heat production by muscle) increase the risk of developing heat
disorders.

Radiant heat:

Radiant heat is the heat produced by the reflective energy of the sun
or equipment in close proximity to a human body. The radiated heat is
absorbed into the surrounding air or directly into the body. In either
case the body’s ability to cool itself is hampered.
Physiological Factors:

Predisposing factors that may increase susceptibility to heat disorders

are:

* Previous history of heat illness (exhaustion, stroke or cramps).

* Personnel suffering from or recovering from an acute or chronic

disease or debility.

* Old age personnel are more susceptible to heat disorders.

* Poor physical conditioning.

* Obesity interferes with the heat regulatory mechanism and causes

the individual to expend more energy to accomplish a given amount of
work.

* Fatigue, physical and mental weariness can cause a lot of concern

and result in a failure to take proper precautions against heat injuries.
 * Dehydration due to vomiting, diarrhea or insufficient water intake
predisposes to heat disorders, as individual’s fluid output is greater than fluid
intake.

* Personnel suffering from skin trauma due to sunburn, heat rash or other
dermatological malady. The body’s heat regulatory mechanism is hampered at
the skin surface.

* Chronic alcoholism, alcohol should not be consumed for 24 hours prior to

heat stress.

* Certain drugs (e.g., anticholinergics, antihistamines, phenothiazines,

decongestants, numerous psychoactive drugs, immunizing agents, alcohol,
cocaine…)interfere with the body’s heat regulatory mechanism.

* Sickling of blood cells impairs circulation and increases risk of injury. Persons
with sickle cell trait should be advised of their risk and preventive measures.
Prevention

The successful prevention of heat injuries depends largely

on education of personnel, especially supervisory
personnel.

Equally important is the development of procedures to alert

individuals to the existence of dangerous heat stress levels
once temperatures exceed 40 C.

“Always remember that prevention is better than cure.”

RESPONSIBILITIES

A. Responsibilities of Project/Site Management

Project /Site Management is in charge of ensuring that this

Management of Heat Stress has been applied and respected by all
personnel and mainly those working in extreme heat climates where
the temperatures can exceed 40 C.

B. Responsibilities of HSE Representative

HSE Representative is in charge of insuring that this approach has

been explained and well understood by all the personnel and mainly
those working in extreme heat climates where the temperatures can
exceed 40 C. And also that this approach has been applied and
respected by all the personnel and mainly those working in extreme
heat climates where the temperatures can exceed 40 C.

C. Responsibilities of Medical Doctor/Nurse

The Medical Doctor/Nurse is in charge of application of this Heat

Stress Management.
The application of measures to reduce both the severity and duration
of exposure and adoption of techniques to increase the resistance of
exposed persons. These techniques are:

Using common sense is best.

Selection of personnel:
* Employ personnel physically fit to work in such hot environment.

Avoid direct sunlight:

* Stay in the shade when you can.
* Shelter under shades, draperies, awnings, or louvers.
* During periods of extreme heat, stay indoors as much as possible
out of the sunshine.

Meals and water:

* Eat well-balanced, light meals before, during and after any
outdoors strenous activity.
* Drink plenty of water regularly before, during and after any
outdoors strenous activity. Persons who have epilepsy or heart,
kidney, or liver disease; are on fluid-restrictive diets; or have a
problem with fluid retention should consult a doctor before
increasing liquid intake.
Alcohol and caffeine:
* Limit intake of alcohol beverages and caffeine. Although beer and
alcohol beverages appear to satisfy thirst, they actually cause further
body dehydration.

Cloths:
* In a very hot environment or in an inadequately ventilated space
heavy insulating clothing should not be worn. Wear light-colored,
loose- fitting, open-weaved clothes that cover as much skin as
possible and that reflects heat and sunlight and helps maintain
normal body temperature. Clothing should be loose fitting,
especially at the neck, arms, waist and lower legs, to permit
circulation of air.
* Protect face and head by wearing a wide-brimmed hat.
* In extreme heat, avoid activities that require you to wear a
helmet.

Acclimatization:
* Allow your body to get acclimated to hot temperatures for at least
2 or 3 days.
* Increase the amount of time you spend outdoors and your activity
everyday little by little.
Avoid sunburn:
* Sunburn slows the skin’s ability to cool itself, use a sunscreen
lotion with high SPF (sun protection factor) rating.

Avoid extreme temperature changes:

* A cool shower immediately after coming in from hot temperatures
can result in hypothermia, particularly for elderly and very young
people.

Work schedules:
* Strenuous exertion in a very hot environment or in an
inadequately ventilated space should be avoided.
* Try to schedule strenuous activities during the cooler hours of the
day, early in the morning or late in the evening, avoid heavy
outdoor activity between 10 AM and 6 PM, when sun is the
hottest.

If exertion a hot environment is unavoidable:

* Fluid and electrolytes should be replaced by frequently drinking
fluids slightly salty to taste.
* Wearing open mesh clothing or using fans should facilitate
evaporation, which helps the skin cool.
* Individuals should be instructed to note the color of their urine,
Heat-related injuries fall into three
major categories:

Heat cramps

Heat exhaustion

Heatstroke
Heat cramps are Treatment for heat
muscular pains and cramps is to rest in the
spasms that occur shade, get near a fan,
when the body loses spray the person with
electrolytes during water and massage the
profuse sweating or cramp.
when inadequate
electrolytes are taken
into the body. They
usually begin in the
arms, legs or
abdomen, and often
precede heat
exhaustion.
Heat exhaustion is
a medical emergency.
When a person is
suffering from heat
exhaustion, they will
perspire profusely and
most likely will be pale.
It is best treated by
taking the patient to a
cool place, applying cool
compresses, elevating
the feet and giving the
patient fluids.
Signs & symptoms of Heat Exhaustion

Normal, low, or only slightly elevated body

temperature.
Cool, clammy, pale skin. Sweating.
Dry mouth. Thirst.
Fatigue. Weakness. Feeling dizzy.
Headache.
Nausea. Vomiting can occur.
Muscle cramps.
Weak or rapid pulse.
Heat stroke is the
worst heat-related
injury. The brain has lost
its ability to regulate
body temperature. The
patient will be hot,
reddish and warm to the
touch. Their
temperature will be
markedly high and there
will be no perspiration.
 Signs & symptoms of Heat Stroke
These signs and symptoms can occur suddenly with little
warning:

Very high temperature (104ºF or higher).

Hot, dry, red skin. No sweating.
Deep breathing and fast pulse.
Then shallow breathing and weak pulse.
Confusion. Hallucinations.
Convulsions.
Loss of consciousness.

Do not attempt to treat a case of heat stroke at home, but

you can help while waiting for medical assistance to arrive.
Here’s what to do:

The emergency care of heatstroke is to cool the body as

quickly as possible. One of the best methods for cooling
the body during a heat emergency is to wrap the patient in
cool, wet sheets.
Move the person to a cooler environment, or place him or
her in a cool bath of water (as long as he or she
is conscious and can be attended continuously).

Alternatively, moisten the skin with lukewarm water and use

a fan to blow cool air across the skin.

Give cool beverages by mouth only if the person has a

normal mental state and can tolerate it.
Saipem corporate procedure of the Heat stroke
prophylaxis, treatment depends from medic on site (kind of
medicine and dose).

Approved treatment:

POLASE tablets / Potassio+Magnesio raceaspartato

or
-the HYDRALYTE (electrolyte replacement drink) Or
- DEXTORSE mineral salts tab.
Or you can buy any kind of mineral salts tab.
The dose of medicine depends on the degree and time of
heat exposure: and of course from condition of employee.
Please note: it is not for health if it is over dose!
The kidney stones could be made by a lots of mineral salts
in human blood (as for example).
Summer is the perfect time to get outdoors and enjoy
the sunshine! But the summer sun and heat can take
a major toll on your health, so don’t let a heat-related
illness ruin your day. Learn how you can protect
yourself from the sun so you can have a happy,
healthy and safe summer.

Prepared by:
Joseph Consular
Medical Department
Saipem Spa, Sharjah Branch
Tel. No. +97165284140, Exr. 266
Mobile No. +971502703856
Email: Sharjah.Medic@saipem.eni.it