cold stress hazards and prevention
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Copyright ©2013 The Windsor Consulting Group, Inc.
Working in Cold Environments - How to Keep Workers Safe and Productive
When the Mercury Plunges
WARNING: This presentation contains photos that some viewers may find disturbing".
Overview
Workers who are exposed to extreme cold or work in cold environments may be at risk of cold stress.
Extreme cold weather is a dangerous situation for people without shelter, outdoor workers, and work areas poorly insulated or without heat.
Weather-related conditions may lead to serious health problems.
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Overview
What constitutes cold stress and its effects can vary across different areas of the country.
In regions unaccustomed to winter weather, near freezing temperatures are considered factors for "cold stress."
Whenever temperatures drop decidedly below normal and as wind speed increases, heat can more rapidly leave your body.
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Goals
Cold-related illnesses and injuries At-risk occupations and recreational activities Signs and symptoms of cold exposure Emergency response and first aid treatment Risk factors, evaluation of work environment,
prevention measures and protective clothing Case study and analysis Quiz
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Cold Workplaces
Roofs in cold weather Bridges near large
bodies of water High-rise buildings
exposed to wind Refrigerated rooms
or containers Commercial fishing areas Steel structures that retain cold Unheated warehouses in cold climates
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Cold Workplaces
Offshore oil/gas platforms Marine vessels Freezers/food warehouses Arctic exploration and
research projects Deep sea diving Logistics and transport Doormen and taxi drivers Longshoremen and stevedores Outside construction job sites
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Non-Work Cold Environments
Snowmobiling and tobogganing Downhill/cross-country skiing Ice skating and dog sledding Winter hunting and ice fishing Outdoor camping, hiking, boating Snowshoeing and snowboarding Rock and mountain climbing Holiday decorating home exterior Deicing, shoveling, and snow removal Riding motorcycles and off-road vehicles
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Risk Factors Related to Cold
A cold environment challenges the worker in three ways: by air temperature, air movement (wind speed), and humidity (wetness).
In order to work safely, challenges have to be counterbalanced by proper insulation (layered protective clothing), buddy system, physical activity, diet and nutrition, acclimatization, and by controlled exposure to cold (work/rest schedule).
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Risk Factors Related to Cold
Air Temperature: Air temperature is measured by an ordinary thermometer in degrees Celsius (°C) or degrees Fahrenheit (°F).
Wind Speed: Different types of anemometers are used to measure wind speed or air movement. Estimates of wind speed include: .
– 8 km/h (5 mph): light flag moves,
–16 km/h (10 mph): light flag fully extended,
–24 km/h (15 mph): raises newspaper sheet,
–32 km/h (20 mph): causes blowing and drifting snow.
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Risk Factors Related to Cold
Humidity (wetness): Water conducts heat away from the body 25 x faster then dry air.
Physical Activity: The production of body heat by physical activity (metabolic rate) is difficult to measure. Tables are used to show metabolic rates for a variety of activities. Metabolic heat production is measured in kilo calories (kcal) per hour. One kilocalorie is the amount of heat needed to raise the temperature of one kilogram of water by 1°C.
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Risk Factors Related to Cold
Work/rest schedule: This work schedule has been adopted by the American Conference of Governmental Industrial Hygienists (ACGIH) as Threshold Limit Values (TLVs) for cold stress.
Protective clothing: Adequate clothing is needed for work at or below 4°C. Clothing should be selected to suit the temperature, weather conditions (e.g., wind speed, rain), the level and duration of activity, and job design.
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Risk Factors Related to Cold
Other factors influencing cold injuries–Insulation materials and layering –Contact with metal or cryogenic liquids –Exposed skin –Vasodilation –Vasoconstriction –Previous cold injuries – frostbite and white finger syndrome
–Constricting garments
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Risk Factors Related to Cold
Factors influencing cold injuries–Local pressure –Cramped position –Body type –Dehydration –Women do better in cold than men (more body fat) –Higher caloric intake –Diabetes, some medications –Alcohol, caffeine, and tobacco/nicotine
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Body Reacts to Cold by:
Trying to maintain core temperature of 98.6ºF
Decreasing blood flow to extremities to prevent heat loss which– Keeps internal organs warm– Increases chance of frostbite
Shivering generates heat
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Heat Lost to Environment
Radiation – loss of heat due to temperature gradient below 98.6 oF
Conduction – heat transfer from sweating – water conducts heat from body 25 faster than air – Stay dry = Stay alive
Convection - wind chill is an example of heat transfer by air convection and water currents also transfers heat away from the core body
Evaporation – removal of heat by sweating mechanism or respiration
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Heat Lost to Environment
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Hypothermia
Body maintains a relatively stable temperature whereby heat production is balanced by heat loss (metabolism and blood circulation)
Core body temperature is 98.6 ºF or 37 ºC If outside environment gets too cold or the
body's heat production decreases, hypothermia occurs (hypo=less + thermia=temperature).
Hypothermia is a core body temperature less than 95 ºF or 35 ºC.
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Hypothermia
Progressive loss of body heat Accelerated when person is
wet or damp environment Most cases occur with air
temperatures between 30ºF and 50ºF
Can occur in air temperatures with high wind/rain as high as 65ºF
Occurs in water at 72ºF regardless of currents
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Risk Factors for Hypothermia
Age – cold affects the very old and young Physiology – decreased heat production,
increased heat loss, impaired thermoregulation Mental status – impaired judgment or mental
function like Alzheimer's disease Alcohol and certain drugs can dilate blood
vessels near the skin (vasodilation) and decrease capability to shiver to stay warm
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Risk Factors for Hypothermia
Medical conditions – hormonal abnormalities (thyroid, adrenal, pituitary glands), spinal cord injury patients may not be able to shiver, person’s who suffer stroke or brain tumors may have impairments to regulate temperature, person’s with overwhelming infection or sepsis may present lowered body temperature, and people with diabetes can appear very cold
Medications increase risk of hypothermia by limiting ability to shiver
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Risk Factors for Hypothermia
Occupational health – –Chemical skin irritants, allergens, sensitizers, corrosives, or solvents that defat or dry the skin
–Dermatitis from contact with poisonous plants –Physical agents such as ultraviolet (UV), infrared (IR) heat or electrical burns resulting in skin damage, and hand-arm segmental vibration causing Raynaud’s syndrome can increase risk
– Cryogenic liquid or gas hazards resulting in tissue damage
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Signs and Symptoms of Hypothermia
As body temp drops, a person feels cold and shivering occurs
Mental function is affected Danger increases affecting thinking and reasoning, which may go unnoticed
Initial hunger and nausea gives way to apathy Confusion, lethargy, slurred speech, so-called
“umbles”, loss of consciousness, and coma
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Condition Core Temperature Signs & Symptoms of Exposure
Mild Hypothermia
99º - 97ºF Normal, shivering can begin
97º - 95ºFCold sensation, goose bumps, unable to perform complex tasks with hands, shiver can be mild to severe, hands numb
Moderate Hypothermia
95º - 93ºF
Shivering, intense, muscle incoordination becomes apparent, movements slow and labored, stumbling pace, mild confusion, may appear alert. Use sobriety test, if unable to walk a 30 foot straight line, the person is hypothermic.
93º - 90ºF
Violent shivering persists, difficulty speaking, sluggish thinking, amnesia starts to appear, gross muscle movements sluggish, unable to use hands, stumbles frequently, difficulty speaking, signs of depression, withdrawn.
Severe Hypothermia
90º - 86ºFShivering stops, exposed skin blue of puffy, muscle coordination very poor, inability to walk, confusion, incoherent/irrational behavior, but may be able to maintain posture and appearance of awareness
86º - 82ºFMuscle rigidity, semiconscious, stupor, loss of awareness of others, pulse and respiration rate decrease, possible heart fibrillation
82º - 78ºFUnconscious, heart beat and respiration erractic, pulse may not be palpable
78º - 75ºFPulmonary edema, cardiac and respiratory failure,death. Death may occur before this temperature is reached.
Signs and Symptoms of Hypothermia
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Signs and Symptoms of Hypothermia
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Mild Hypothermia
Shivering and chattering teeth
Fatigue
Loss of coordination and slower to react
Confusion and disorientation
Lack of metal alertness increased risk of accidents and mistakes
Body temperature lowered to 90-95ºF
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Moderate Hypothermia
Increased mental impairment and confusion Disorientation and poor decision making Inability to take precautions from the cold Slower heart rate and breathing rate Slurred speech Body temperature
drops to 82-90ºF
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Severe Hypothermia
Resembles death Dilated pupils Irregular or hard-to-find pulse No shivering No detectable breathing Loss of consciousness Older workers at risk of heart attack Body temperature <82ºF
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Preventing Hypothermia
Keys to preventing hypothermia are:–Layering–Staying dry
Remember acronym COLD–Keep it Clean–Avoid Overheating–Wear it Loose and in Layers–Keep it Dry
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Field Management
Goals are to:–Rescue–Examine–Insulate–Rapidly transport
If untreated, hypothermia can become a true medical emergency
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Field Management
Monitor deep core body temperature with ear or temporal scanning thermometer or wireless skin sensor/monitor
Use basic principles of rewarming a hypothermic victim are to conserve the heat they have and replace the body fuel they are burning up to generate that heat.
If a person is shivering, they have the ability to rewarm themselves at a rate of 2 oC/hour.
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First Aid for Hypothermia
Alert their supervisor Move victim to shelter Remove wet clothing
and wrap victim in warm covers
Warm the center of their body first – chest, neck, head, and groin area using an electric blanket, if available or use skin-to-skin contact under loose, dry layers of blankets, clothing, towels, or sheets
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First Aid for Hypothermia
Give warm drinks and food to increase body temperature, if conscious
Avoid alcoholic or hot/cold caffeinated beverages
Monitor breathing and core body temperature
Keep victim dry and wrapped in warm blanket including head/neck
Administer CPR and get medical help
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First Aid for Mild Hypothermia
Reduce internal heat loss–Additional layers of clothes–Dry clothing and physical activity or shelter
Add caloric fuels and hot fluids–Carbohydrates 5 calories/gram quickly released–Proteins 5 calories/gram slowly released–Fats 9 calories/gram slowly released
Add external heat source–Fire or other external heat source–Body to body contact
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First Aid for Severe Hypothermia
Hypothermia wrap or multiple sleeping bags – to minimize sweating and protect against air temperature, wind and water.
Add caloric fluids fuels – gelatin mix
Absorb urine from diuresis
Add heat to major arteries with heat packs, hot water bottles, and towels
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First Aid for Severe Hypothermia
Paradoxical undressing occurs during moderate to severe hypothermia, as the person becomes increasingly disoriented, confused, and combative. Victim may begin discarding their clothing, which, in turn, increases the rate of heat loss and death.
One explanation for the effect induced malfunction of the hypothalamus, the part brain regulating body temperature
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First Aid for Severe Hypothermia
Sometimes a self-protective behavior known as terminal burrowing or “hide-and-die” syndrome occurs in the final stages before death due to hypothermia.
The afflicted will enter small, enclosed spaces, such as underneath beds or behind wardrobes.
It is associated with prior stage of paradoxical undressing
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Frostnip
Mildest form of a freezing cold injury Affects ear lobes, noses, cheeks, fingers, or toes
and the top layers of the skin freeze Affected area of the skin turns white and may
feel numb Top layer of skin feels hard
but the deeper tissue still feels normal (soft) and sometimes top layer of skin peels off
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Frostbite
Exposure to severe cold below 28-32ºF or contact with cold objects
Affects fingers, toes, cheeks, nose, face, and ears
Tissue freezes at 30ºF Injury may cause gangrene More susceptible to future frostbite Tissue death—amputation or loss of function
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Frostbite Symptoms
Sensations of coldness by reduced blood flow
Tingling, stinging, or aching sensation
Skin feels numb andcold to the touch
Skin is waxy and appears yellowish/white
Blistering, turning red, then black
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Field Management of Frostbite
Monitor air temperature and wind speed using wind chill index – freezing and hypothermia
Use contact gloves to handle all equipment, insulated and chemical resistant gloves, but never use bare hands
Avoid cotton clothing that holds perspiration Keep face and ears covered and dry Keep socks clean and dry Avoid light socks and boots
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First Aid for Frostbite
Get into warm room but avoid heating pad or other dry radiant heat sources – cause burns
Warm affected area slowly with body heat Do not rub or walk with frostbitten feet - may
result in more tissue damage Use warm-hot water between 98°F-104°F Apply sterile dressing to blisters Do not thaw if there is risk of re-freezing Get medical attention; and thaw at hospital
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Immersion – Non-Freezing Injury
Injury to feet that are not frozen but stay wet for many days or weeks
Occurs at temps up to 10°C/60°F Injury to nerve and muscle tissue Symptoms include tingling and
numbness; itching, pain, swelling of legs, feet, or hands; or blisters may develop
Skin may be red and turn to blue or purple In severe cases, gangrene may develop
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Immersion – Non-Freezing Injury
First phase: Hand or foot is cold and without pain.
Second phase: Affected limb feels burning hot and has shooting pains.
Third phase: Pale skin, bluish coloring around the nail beds and lips, weak pulse.
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Immersion – First Aid
Dry the affected part immediately. Remove wet clothing and replace with dry, warm
clothing. Rewarm affected area gradually in warm air. Do not rub or massage the affected hand/foot. Elevate the affected part to reduce swelling. Protect the casualty from additional injury. Evacuate medical treatment facility as soon as
practical
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Trench Foot/Hand – Non-Freezing Injury
Injury to feet/hand exposed <12 hours to wet and cold conditions
Wet feet lose heat 25 times faster than dry feet
Tissue affected below 60ºF Blood flow reduced to feet More susceptible to future frostbite Tissue death—amputation or loss of function Also known as “wet cold disease”
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Trench Foot/Hand Symptoms
Cold, numb hand/feet that may progress to hot with shooting pain
Reddening of the skin Leg cramps and swelling Tingling pain and sensitivity Blisters or ulcers Bleeding under skin may
lead to gangrene
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Trench Foot/Hand First Aid
Remove wet or constrictive clothing
Elevated affected limbs Cover with layers of loose,
warm, dry clothing Do not pop blisters, apply
lotions or cream, massage, or expose to extreme heat
Avoid walking and worsening the injury
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Chilblains – Non-Freezing Injury
Continuous skin exposure to air temperatures just above freezing to 50ºF
Damage to capillary beds (small blood vessels)
Repeated damage can be permanent Redness and itching returns with repeated exposure Redness on cheeks, ears, fingers, and toes
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Chilblains Symptoms
Redness Itching and burning
sensation Tender to touch Possible blisters Inflammation and
swelling Ulceration in severe
cases
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Chilblains First Aid
Apply local warming (put bare hands over the affected area on the face, put affected hands inside the uniform under the armpits, etc.)
Do not rub or massage the affected area Apply a field dressing to lesions (sores) Have person examined by medical personnel
when the opportunity presents itself
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Chilblains First Aid
Avoid scratching Slowly rewarm skin Use corticosteroid
cream to reduce itch Keep blisters and
ulcerated area clean, covered, and dry
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Other Cold Related Injuries
Freezing of cornea –Caused by forcing the eyes open during strong winds without goggles
–Treatment is very controlled, rapid rewarming e.g. placing a warm hand or compress over the closed eye.
–After rewarming the eyes must be completely covered with patches for 24 - 48 hours.
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Other Cold Related Injuries
Eyelashes freezing together–Put hand over eye until ice melts; open the eye
Snow blindness–Sunburn of the eyes from reflected sunlight–Wear sunglasses with side shields or tinted goggles–Eye protection from sun is the same as a cloudy or overcast day when on snow covered ground
–Snow blindness occurs during a snow storm if the cloud cover is thin
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Other Cold Related Injuries
Snow blindness–Symptoms occur 8-12 hours after exposure –Eyes feel dry and irritated, then feel as if they are full of sand, moving or blinking becomes extremely painful, exposure to light hurts the eyes, eyelids may swell, eye redness, and excessive tearing
–Treatment – use cold compresses and stay in dark environment
–Do not rub eyes
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Cold Stress Factors
Low temperature Cool, high winds Dampness Cold water immersion Prolonged or
repeated exposure Inadequate clothing
or protective gear No “buddy system”
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Other Risk Factors
Inadequate selection or wet clothing Prescription medications or alcohol Diseases like diabetes and thyroid conditions Severe trauma Nutrition and diet Elderly, infants, and children Persons who are mentally ill Physical condition
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Control Measures
Reduce exposure by applying engineering controls such as heated shelter or break areas
Apply administrative controls like work practices, standards and operating procedures including training, timing of work, policies and other rules to reduce exposure
Use personal protective equipment (PPE) Use combination of engineering/administrative
controls and personal protective equipment
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Engineering Controls
Use controls like enclosures and heating systems Air heaters, radiant heaters, or contact warm plates
may be used. (heaters that emit CO gas) Provide a heated shelter for workers to do their
work for and work/warm-up break Shield work areas from drafts or winds Use thermal insulating material on equipment
(when touching metal handles, or need to sit or kneel on concrete)
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Administrative Controls
Use a work/warm-up schedule. A warm shelter or vehicle should be available so workers can warm up
Allow a period of adjustment to the cold before assigning a full work schedule
Allow individuals to set their own pace and take extra work breaks when needed
Educate new or newly transferred workers on the hazards of working in a cold environment
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Administrative Controls
Avoid activities that lead to heavy sweating Do as many tasks as possible indoors and reduce
timeframe people must work outdoors Work outside during the warmer hours of the day
(mid-day/early afternoon) Minimize activities that reduce blood flow like
sitting or standing for long periods of time Use a buddy system and avoid working alone Look at co-workers for signs of cold stress
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Administrative Controls
If you see symptoms in a co-worker, take appropriate preventive steps
Work practices should prevent sitting or kneeling on cold, unprotected surfaces
Older workers, or those with certain medical problems, need careful about the effects of cold stress
Check with a doctor about special needs and precautions to prevent cold stress
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Administrative Controls
Avoid using alcohol or drugs that may impair judgment when working in cold environment.
Hypothermia commonly occurs in association with alcohol consumption. Besides its effect on judgment, alcohol increases heat loss by dilating blood vessels and prevent shivering
Keep energy level up and prevent dehydration by consuming plenty of warm, caffeine-free, non-alcoholic drinks and high calorie food
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Administrative Controls
Supervisors and workers should be trained to watch for signs of cold stress and allow workers to interrupt work when uncomfortable
Manage work schedules to allow rest periods Training should discuss engineering controls,
work practices, and protective equipment to reduce the risk of cold stress
Specialized cold training for arctic conditions Training/education included in the HASP
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Administrative Controls
ACGIH has adopted guidelines developed for working outdoors in cold weather conditions
Recommended exposure times based on the wind chill factor and assume workers wear dry clothing
Work-break schedule applies to any 4-hour period with moderate or heavy activity
Warm-up breaks are 10-min. in a warm area “Normal breaks" are taken once every 2 hours
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Administrative Controls
Work and Warm-up Schedule for 4-hour Shift
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Administrative Controls
Estimating Wind Speed
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Wind Speed (km/h) What to Look For
10 Wind felt on face; leaves rustle; wind vanes begin to move.
20Leaves and small twigs constantly moving; small flags extended.
30Dust, leaves, & loose paper lifted; large flags flap; small tree branches move.
40 Small trees begin to sway; large flags extend and flap.
50Larger tree branches moving; whistling heard in power lines; large flags extend and flap more wildly.
60Whole trees moving; resistance felt in walking against wind; large flags extend fully and flap only at the end
Source: The Weather Network “Glossary” http://www.theweathernetwork.com/glossary/windchill_formula
Wind Chill Temperatures
Combined effect of air temperature and air movement
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Wind Chill Temperatures
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Protective Clothing
Several layers of clothing Synthetic fibers next to
skin to whisk away sweat Water-repellent, wind-
resistant outer clothing Hats, hoods, or face covers Insulated, waterproof footgear Insulated, waterproof gloves Change clothing when wet
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Protective Clothing
Wear at least three (3) layers –Outer layer that is windproof but still allows some ventilation,
–Middle layer of wool, quilted fibers, or synthetic fleece to create an insulating layer,
–Inner layer of synthetic fabric or wool to provide ventilation and allow moisture to escape
The inner or base layer should not be cotton. Cotton stays wet and speeds heat loss
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Protective Clothing
Moisture evaporation and heat loss design for clothing layers
ISO 7720 and ASHRAE 55-2010 standards for the indoor environment based on air temp and relative humidity in air
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Protective Clothing
With the exception of the wicking layer do not wear tight clothing.
Loose clothing allows better ventilation of heat away from the body.
Do not underestimate the wetting effects of perspiration.
Wicking and venting of the body’s sweat and heat are more important than protecting from rain or snow.
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Protective Clothing
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Wear mittens rather than un-insulated gloves (mittens are warmer because your fingers stay together) or use thermal insulated gloves
Wear gloves when fine manual dexterity is not required
Nylon overmitts can be easily put on and taken off if gloved hands are necessary.
Be careful about wearing gloves/scarves getting caught in moving machinery parts
Protective Clothing
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Keep your head covered (up to 40 to 50% of body heat lost when the head is exposed)
Use an appropriate hardhat liner with your hard hat
Wear a facemask, gaiters, or balaclava when working in very cold conditions
Wear socks to protect your ankles and feet. Bring extra socks if moisture or sweat is likely and change socks when necessary
Protective Clothing
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Use footwear that protects against cold and dampness
Footwear should be insulated and fit comfortably when socks are layered
Boots with linings are preferred as they can be taken apart to dry more easily, or new linings can be used
Wet clothing causes body to lose heat quickly since evaporation takes up a lot of heat
Protective Clothing
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Wool and synthetic fabrics, on the other hand, do retain heat when wet
Dirty or greasy clothing has poor insulating properties
Clothing Type
Long underwear Wool, silk, synthetic fabric
Pants Wool, synthetic fabric
Shirts, sweaters, turtlenecks Wool, fleece, synthetic fabric
Head gear Wool, synthetic fabrics, wind barrier fabric if necessary
Gloves, mittens Loose fitting with wool or synthetic fabric liners, thermal insulated or pair of uninsulated gloves inside mittens plus windproof overmitts for very cold conditions
Socks Two pairs – light or medium inner and heavy wool or synthetic outer socks
Parka / Jacket Loose fitting, filled with down or insulating fiber, attached hood, outer layer of windproof fabric
Cold Weather Clothing
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Hand Protection
Use tools and machine controls designed for gloved hand operation
Limit bare hand work to 10-20 minutes when < 60ºF
Use warm air jets, radiant heaters, contact warm plates
Use metal handles covered by thermal insulating material
Prevent contact frostbite when near metal surfaces < 20ºF
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Other Protective Controls
Eat high calorie foods – carbohydrates/protein Consume warm, sweet drinks and soups Avoid coffee - a diuretic - causes water loss
increasing dehydration Avoid alcohol - a vasodilator - increases
peripheral heat loss Avoid smoking – nicotine - vasoconstrictor and
increases risk of frostbite Stay active in good physical condition
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Safe Work Practices
Avoid heavy perspiration Work in the warmest
hours of the day Minimize prolonged
sitting, standing Allow time to adjust to cold Do not work alone Watch for symptoms of cold-related illness
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Cold Case Study
Hazard assessment –On the ninth floor, the wind is blowing between 20 and 25 km/h (about 15 mph).
–Wind is blowing from a side that has support beams (but no walls).
–Carpenter needs to work without gloves. The work involves moderate physical activity.
–Crew has worked at this location at least 2 months.
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In Red Deer, a carpenter is working outside on a -20°C in February on a building
under construction on the 9th floor. The radio reports a general wind chill of –27.
Cold Case Study
Job hazard analysis and corrective action Workers use a work/warm-up schedule of 55
minutes of work, with 3 breaks, in a 4-hour shift Breaks taken in totally enclosed/heated room Measuring/layout on the 8th floor with walls Crew checks with “buddy” in every 30 minutes Everyone is dressed appropriately – three layers Warm drinks, soup provided in the break room
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Summary
Symptoms of hypothermia and frostbite First aid treatment Wind chill factor Engineering and administrative controls Protective clothing and staying dry
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Quiz
1. The body responds to cold stress by shivering and _____________________________________
2. Hypothermia can occur in air temperatures as high as 65ºF. True or False
3. Describe at least three symptoms of hypothermia.
4. Describe at least one form of environmental protection for workers in the field.
5. Other risk factors of cold-related illness include: certain medication, certain diseases, age, and physical condition. True or False
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Quiz (cont.)
6. Drinking coffee will help workers stay warm.True or False
7. Describe at least three symptoms of frostbite.
8. Warm up frostbitten areas by rubbing gently. True or False
9. Environmental cold stress factors include: temperature, wind, and __________________
10.Administrative controls, such as __________, can be used to protect workers from overexposure to cold conditions
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Quiz Answers
1. Decreasing blood flow to the extremities
2. True, when other contributing factors are present
3. Confusion, disorientation, slow heart rate and breathing, shivering, blue lips, poor coordination, slurred speech
4. Heated shelters, windscreens, heat sources, thermal insulated tools
5. True
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Quiz Answers (cont.)
6. False, coffee increases blood flow to the extremities
7. Cold sensation, tingling, aching, numbness, white skin, waxy skin
8. False, rubbing will contribute to the skin damage
9. Dampness
10. Limiting work time or taking additional breaks
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Working in Cold Environments - How to Keep Workers Safe and Productive
When the Mercury Plunges
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Thank you for your participation
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