Sunday, May 14, 2006

Avoiding Heat Related Illness

Hello everyone.

Since summer has set in on the Gulf, but spring has barely arrived up North, I figured I’d write a small missive about Heat Exhaustion, Heat Stroke and Dehydration. These are all things you will have to watch your volunteers for as they work. I am also attaching a poster you can place where the volunteers will see it.

My medical background includes having been a paramedic and in emergency medical services for 15 years as well as having a degree in Health Science and Exercise Physiology. I have also lived in Louisville, KY and Dallas, TX so am very familiar with working in very hot, humid conditions.

Most of your volunteers are what would be called unconditioned. They aren't athletes in any sense of the word, so their ability to deal with heat under physical stress is diminished. That's one strike. The next strike is if they have any underlying medical conditions, which I would guess about half have. If they have high blood pressure or heart conditions, they should do as little hard manual labor as possible. Any medications they are on are likely to diminish their ability to deal with heat even further.

So, since you're only working with one strike left, you've got to make the most of it.

Strongly urge that no caffeine be taken to the work sites. Caffeine in the AM and after work is finished is tolerable, but not during work.
Carbonated beverages are tolerable, but not optimal during work.
Take breaks every 15 minutes to drink. Suggest they take their pulse.
Seriously consider stopping work at 2PM.
Urge the volunteers to alternate water with their favorite beverage.

Caffeine increases body temperature, pulse, constricts blood vessels and draws water out of the body. None of these things are good in hot conditions. Hence, no caffeine at work sites.

Carbonated beverages don't offer much more than sugar with a little water, so aren't of high value, but are certainly better than drinking nothing at all. Sports drinks are OK as well, as is Gatorade or Tang.

By taking breaks every 15 minutes to drink, this will help better assure hydration and will also keep Heat Exhaustion/Stroke at bay. Having them take their pulse during these breaks will also give a very quick evaluation of their status. If their heart rates are over 100 5 minutes into the break, they need to rest further. Heat Exhaustion is beginning.

The hottest part of the day actually begins after 2PM – generally around 3PM and continues well into the evening. In Dallas, temperatures would remain into the 90’s well after midnight. If you must, begin work early – say 630AM. This is generally the coolest time of the day.

Knowing that water can be very tedious, urge the volunteers to alternate their beverages with water. As I stated before, just about anything is acceptable, as long as water is included. The best test for full hydration is the color of the urine. Clear and almost colorless is perfect. If it's cloudy and dark, the person is NOT drinking enough. This will be included in the poster. Gatorade is good. Tang might be better. It is higher in potassium, which is more important than the sodium in Gatorade. Plus, people might drink more of it due to better taste. And it can be mixed to individual strengths.

No alcohol. Heat Exhaustion/Stroke can set in well after the work is complete. Alcohol has the best potential to throw a person's body into one of these long after the hot work is done.

Think about having things such as dill pickles and green olives available. After work in Dallas, I would eat at least a half dozen olives and then drink another gallon of water during the evening. Even with this, I would be dehydrated by the end of the week. 2 gallons of fluids each day is not unreasonable and very much favored. Expect the volunteers to be dehydrated by week's end and not be performing as well as they should. Accidents will be far more likely the last day of work due to the brain not working quite right without its water.

Signs of Heat Exhaustion:
The signs of heat exhaustion include paleness, dizziness, nausea, vomiting, fainting, and a moderately increased temperature (101-102 degrees F). They will also have excessive sweating. This means they will look like they've been hit with a fire hose of water. You'll know it if you see it.

If a person shows these signs, get them to a cool shady place that has a fan or breeze. Make them lie down and drink fluids as much as possible. If they are vomiting, they may need to seek emergency medical assistance as this can lead to Heat Stroke. They will NOT be able to work for the duration of their visit. Heat Exhaustion does not end in a day. It takes several days to weeks to fully recover.

Signs of Heat Stroke
Heat stroke is the most severe form of heat illness. It can occur even in people who are not exercising, if the weather is hot enough. These people have warm, flushed (red) skin, and do not sweat. Whether exercise-related or not, though, a person with heat stroke usually has a very high temperature (106 degrees F or higher), and may be delirious, unconscious, or having seizures. These people need to have their temperature reduced quickly, often with ice packs, and must also be given IV fluids for rehydration; they must be taken to the hospital as quickly as possible and may have to stay in the hospital for observation since many different body organs can fail in heat stroke.

Anyone suffering from Heat Stroke must not work in this type environment again for about a year and may never be able to again. Heat Stroke alters the body's ability to tolerate hot environments. Also – if anyone in the team does suffer Heat Stroke, assume all are suffering from Heat Exhaustion and stop all work.

I know it sounds serious. And it is. But with proper hydration listed at the beginning, there will be no problems. I just want you aware of what could happen so that you can take care of yourself and your volunteers.

If you are a long-term volunteer, seriously consider eating yogurt every day, significantly reducing your sugar intake, and even taking acidophyllus pills. These actions will significantly reduce your chances at athlete's foot, jock itch, yeast infection - which are all basically the same thing, just different areas of the body. Change all underclothing (socks too) twice a day in order to minimize your risk for these problems. This is knowledge gained from personal experience!

The Following is a poster I made for you to put where your volunteers will be able to read it and educate themselves:

Avoid Heat Related Illness!

No Caffeine While Working
Drink Fluids Every 15 Minutes While Working
Rest 5 Minutes Every 15 Minutes
Take Your Pulse Before Starting Work Again.

Your pulse is over 100, REST until it’s below 90.
You feel nauseous, STOP working.
You stop sweating, STOP working.
You feel dizzy, STOP working.

Find the coolest spot possible, lie down, and drink copious amounts of fluids. If, after 30 minutes you continue to feel ill or worse, seek medical attention NOW and alert your team leader. No work for the rest of the day.

After work, continue drinking every 15 minutes until your urine is clear and pale yellow. Dark and/or cloudy means you’re dehydrated. It’ll only get worse tomorrow if you don’t keep drinking.

If you don’t like water, alternate it with another fluid. NO ALCOHOL


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