Page 14 - OHS, July/August 2024

OIL & GAS
in an environment with temperatures greater than 90°F,
■ six (67 percent) occurred in June and July,
■ five (56 percent) had positive post-mortem drug tests for
amphetamines and/or methamphetamines,
■ five (56 percent) had a body mass index (BMI) above 30.0
(obese), with one additional case having a BMI between 25.0 and 29.9 (overweight),
■ five (56 percent) showed evidence of lack of heat stress training,
■ five (56 percent) worked at the company for less than two weeks, with three (33 percent) dying on their first day of work, and
■ four (44 percent) had evidence of underlying hypertension
or arteriosclerotic cardiovascular disease.
Among cases in the OSHA Severe Injury Report Database, 50
workers were identified who were hospitalized with serious heat- related illness. Of these 50 cases,
More than 50 percent of the fatalities occurred among workers at their company for less than two weeks, highlighting the critical need for effective acclimatization and heat stress training.
■ 35 (70 percent) were well servicing workers (NAICS 213112),
■ 30 (60 percent) occurred in Texas,
■ 29 (56 percent) occurred in June and July,
■ 14 (28 percent) reported body aches/cramps/pain,
■ eight (16 percent) reported feeling ill or sick,
■ six (12 percent) reported nausea/vomiting, and
■ four (8 percent) reported lightheadedness or dizziness.
Implementing Prevention Measures
In reviewing these cases of heat-related fatalities and hospitalizations, several major risk factors were identified, including lack of appro- priate acclimatization and heat stress training implemented by the employers. More than 50 percent of the fatalities occurred among workers at their company for less than two weeks. One-third of the fatalities occurred to workers on the first day of work. Evidence sug- gests that the failure to recognize or appropriately respond to signs and symptoms of heat stress was a factor in more than 50 percent of the fatalities. While the absence of acclimatization and training pro- tocols for new workers have been previously identified as risk factors of heat-related illness resulting in deaths among workers, these data highlight the importance of such programs in this industry.
Substance use was associated with more than 50 percent of the fatalities identified. Amphetamines/methamphetamine use can induce or amplify hyperthermia4. However, it is unknown if the workers were using these substances illicitly or if the amphet- amines were prescribed by a medical practitioner as part of a treat- ment for a medical condition (e.g., attention-deficit/hyperactivity disorder [ADHD], narcolepsy).
Lastly, additional important risk factors identified were personal: the presence of obesity and underlying cardiovascular disease or hy- pertension among the worker fatalities. High environmental temper- atures can put increased burden and demand on the cardiovascular system. For OGE workers with pre-existing cardiovascular disease and obesity, such an additional burden can be especially dangerous.
Addressing these risk factors are key to preventing future heat- related illness, hospitalizations, and fatalities in this industry. While eliminating work in high temperature environments in the OGE in- dustry may be impossible, employers and health and safety profession- als can implement effective programs to address many of the risk fac- tors identified in the analysis. Adequate and comprehensive heat stress training and management programs are essential. Such programs can emphasize the importance of recognizing early signs and symptoms of heat-related illness and the proper response once identified (e.g., no-
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of first aid as needed, and seeking of immediate medical help).
Training can also include the importance of understanding and recognizing hydration status and the risk of substance use (includ- ing amphetamines prescribed by clinicians). Training and permit- ting workers to self-pace during work activities in which they are under high thermal stress can be a part of a holistic approach to managing heat exposures, although self-pacing alone may not be sufficient. Implementation of a buddy system to help identify early signs in one or more fellow workers and to provide first aid and emergency cooling can also be incorporated into a comprehensive heat stress training and management program.
NIOSH has developed recommendations5 for acclimatizing new and returning workers to work conditions in the heat. The high number of fatalities identified among workers new to their company (and likely not acclimatized to the work and/or environ- mental temperatures) indicates the need to implement a program that allows workers to appropriately develop heat tolerance. Be- cause of factors identified including substance use, obesity, and underlying cardiovascular disease, the utilization of a medical monitoring program is vital. Such a program can include an oc- cupational medical professional engaging with the worker to:
■ conduct a pre-placement medical evaluation that includes a comprehensive work and medical history, physical examination, and obesity assessment;
■ identify workers who may be more susceptible to heat stress due to medical illness such as high blood pressure, diabetes, or car- diovascular disease;
■ assess the workers’ health before and during physically de- manding work in a hot environment;
■ document medications6 workers take that may exacerbate thermal stress conditions (e.g., amphetamines) or that can exacerbate dehydration (e.g., diuretics) and advise them of the higher risk such medications may pose related to working in hot environments; and
■ if substances like amphetamines are being used by workers il- licitly, implementing a workplace supportive recovery program to prevent substance misuse and encourage recovery7 might also help prevent heat-related fatalities.
Heat exposure can result in physiological responses that con- tribute to increased workplace hazards, altered behavior, or reduced use or improper wearing of personal protective equipment (PPE)8.
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12 Occupational Health & Safety | JULY/AUGUST 2024
www.ohsonline.com