HEAT ILLNESSES ERWIN DYAH N

Introduction Heat can be one of the most serious hazards in construction Too much heat can cause workers to feel tired, lessen overall work performance, and increase the possibility of work injuries

Heat Can Be Deadly! Based on the 13,511 OSHA recordable fatalities between 1990-2007, 40 were heat related in nature. Heat Stress - 17 cases Heat Exhaustion – 5 cases Heat Stroke – 28 cases Source: OSHA Fatality Statistics, 1990-2007

Typical Scenarios Employee, was an unacclimated but healthy 21-year old carpenter's apprentice, on his seventh day of employment. Temperature and humidity were extremely high, and there was little wind. Water and first aid were not provided by the employer. Employee was found comatose with a body temperature of 108 deg. F. There was a 30 minute delay before arrival at the hospital. Employee experienced severe kidney and liver failure and brain damage. Employee never regained consciousness and died 12 days later from heat stroke. The employee was working outside. After the work shift was finished the employee complained of heat stroke and vomited. The employee was offered aid by co-workers and refused. The employee was found dead approximately two hours following the work shift. Source: OSHA Fatality Statistics, 1990-2007

OSHA Fatality Statistics Source: OSHA Fatality Statistics, 1990-2007

Common Fatality Factors Employee Not Acclimated to Heat, First Day/New to Job Lack of Employee Heat Safety Training Improper Treatment by Employer Refusal of Treatment by Employee

Even with emergency treatment, it is sometimes too late Even with emergency treatment, it is sometimes too late. Many have died in the hospital, days after receiving medical treatment!

Efek suhu panas terhadap tubuh Ta & RH > zona nyaman ( the optimal ranges for comfort) (>27 C; >60) masalah Efek pertama  tergantung apa yang dirasakan Paparan dengan heat stress > masalah fisik  mengganggu efisiensi pekerja  gangguan kesehatan (Short-term exposure / Long-term exposure).

AS TEMPERATURE INCREASE… Mental Problems TEMPERATURE RANGE EFFECTS 20-27 C Comfort Zone Maximum Efficiency AS TEMPERATURE INCREASE… Discomfort: Increased irritability Loss of concentration Loss of efficiency in mental tasks Mental Problems Increase of errors: Loss of efficiency in skilled tasks More incidents Pyscho-physiological problems Loss of performance of heavy work: Disturbed water and electrolyte balance Heavy load on heart and circulation Fatigue and threat of exhaustion Physiological problems 35 - 40°C Limit of high temperature tolerance

Kondisi panas sedang  tubuh masih bisa mengendalikan panas tubuh dengan : Meningkatnya denyut nadi darah dipompa ke tepi (kulit)  panas lepas , berkeringat. Akibat aliran darah ke kulit dan keringat meningkat  kemampuan kerja fisik dan mental berkurang Kerja manual  peningkatnya panas metabolisme  menambah beban panas tubuh Saat suhu lingkungan > 30°C mengganggu kinerja pekerjaan mental (performance of mental tasks)

Thermoregulatory system Perifer Suhu panas  merangsang syaraf sympatis Heart Beat Sweat Gland Aliran Darah >>  Penguapan Keringat >> Gejala lain : Tekanan darah Emosi

Melalui Circulatory System Upaya pengaturan suhu tubuh di : LINGKUNGAN PANAS Peningkatan aliran darah ke kulit (vasodilatasi) Peningkatan produksi keringat LINGKUNGAN DINGIN - upaya meningkatkan suhu tubuh  menggigil - upaya mencegah hilangnya panas lebih lanjut  vasokonstriksi di aliran darah kulit

Melalui System Hormonal ADH (Anti Diuretik Hormon) Lingk. Panas Penguapan Keringat Osmosis darah meningkatdarah >pekat Merangsang kelj.Post.Pituitary ADH Reabsorbsi air ir tubuli renalis (air dikembalikan ke tubuh)

Melalui System Hormonal Aldosteron Lingk.Panas  Keringat >> (+ garam Na) Hyponatremia merangsang Kelj.Cortex (Gld supra Renalis) produksi Aldosteron REtensi Garam ( Na) Pertahankan Cairan Tubuh dengan Water Retensi

LINGKUNGAN KERJA EKSTRIM LINGKUNGAN KERJA EKSTRIM (TERLALU PANAS / DINGIN)  MELAMPAUI KEMAMPUAN TUBUH UNTUK MEMPERTAHANKAN KESEIMBANGAN PANAS  GANGGUAN KESEHATAN (HEAT / COLD ILLNESS)

HEAT STRESS Terjadi jika suhu tubuh meningkat Efek dikelompokkan menjadi 6 (berdasarkan perbedaan gejala, prognosis, dan terapi): Heat stroke Heat exhaustion Heat cramps Heat rash Heat syncope Heat fatigue

Heat Stroke Nama lain =hyperthermia suhu tubuh >40 C (104 F) Kondisi yang “life threatening” Tanda dan gejala : Kulit kering dan panas Mental confusion Convulsion unconciousness

Sering berahir dengan kematian / kerusakan organ yang irreversible Fatality : 50% Suhu tubuh >42 C (108 F) selama > beberapa jam  biasanya fatal (tergantung dari status kesehatan)

Heat stroke and hyperpyrexia (elevated body temperature)  paling parah Akibat paparan jangka panjang Tanda : kulit panas dan kering (karena tidak berkeringat) , suhu tubuh sering > 41C, kehilangan kesadaran (penuh atau sebagian) Heat Hyperpyrexia Tanda Heat hyperpyrexia = heat stroke kecuali kulit yang tetap lembab

Penanganan medis yang lambat kerusakan otak, jantung dan ginjal Heat stroke dan heat hyperpyrexia  perlu P3K dan perhatian medis segera Penanganan medis yang lambat kerusakan otak, jantung dan ginjal Terapi meliputi : Lepas baju korban  semprot dengan air dingin Kipas angin  agar berkeringat Rendam dalam air dingin  lebih efisien untuk pendinginan  bahaya kedinginan  dpt mengganggu fungsi vital otak  hanya boleh dilakukan dengan pengawasan medis

Emergency Treatment

Emergency Treatment Move the victim into the shade Call for medical help Remove or loosen boots & clothing Pour water & ice on the victim Fan the victim Elevate the victim’s legs Massage the victim’s arms & legs If victim is conscious, give the victim lightly salted water or electrolyte beverage Stay until medical help arrives Source: OSHA Quick Card. “Protect Yourself from Heat Stress”.

Prognosis Heat Stroke Early recognition & treatment menurunkan risiko kematian dan kerusakan organ (otak, liver, ginjal,dll)

Treatment Heat stroke merupakan kondisi emergency  harus segera diberi pertolongan medis Pertolongan awal  menurunkan suhu tubuh segera pindah penderita ke tempat yang sejuk, lepas baju , basahi kulit dengan air kipas angin Prosedur tsb akan memaksimalkan upaya pendinginan dg evaporasi dan mencegah peninngkatan suhu tubuh lebih lanjut  sambil dibawa ke RS Jangan beri makanan atau minuman (kecuali ika penderita sadar) Suhu tubuh harus tetap diawasi  mencegah agar suhu tubuh tak turun terlalu rendah

Heat exhaustion Penyebab: kekurangan cairan/ volume darah Terjadi bila jumlah cairan yang hilang melalui keringat lebih banyak dari jumlah air yang diminum

Tanda dan gejala utama Heat Exhaustion Lelah (fatigue) Sangat Lemah (extreme weakness) Mual (nausea), muntah, diare Sakit kepala (headache) Pingsan (faintness) Kulit dingin, pucat dan basah Suhu tubuh normal atau sedikit meningkat keringat berlebihan pusing, mata kabur, haus sekali nafas pendek berdebar, kesemutan, tangan da kaki terasa baal

Heat exhaustion-> akibat kehilangan air dan garam melalui keringat yang berlebihan Pemulihan  setelah istirahat di lingkungan sejuk dan minum air garam dingin

Terapi Pindahkan ke tempat sejuk Istirahatkan Beri air minum dingin (jika sadar) , jika tidak sadar  infus Pemulihan biasanya dalam waktu < 12 jam PROGNOSIS : Tidak ada efek permanen

Major Heat Injuries Heat exhaustion and heat stroke victims must be given immediate medical attention!

Heat Cramps Sangat nyeri Kram pada kaki, tangan, otot perut Terjadi karena penderita kehilangan garam dalam jumlah yang berlebihan bersama keringat (karena kerja fisik berat dan terpapar panas tinggi) Terjadi selama / setelah bekerja Dapat sembuh spontan

Heat cramps  kramnyeri otot dpt mrpk satu2nya gejala atau bersamaan dengan gangguan panas lain. Penyebab  gangguan keseimbangan elektrolit  >> ok minum air terlalu banyak tanpa penggantian elektrolit

Terapi Heat cramps Istirahat & tenangkan Minum air + elektrolit Peregangan & pemijatan Hub dokter jika gx tak membaik

Pencegahan Orang yang belum beraklimatisasi terhadap panas perlu tambahan garam Garam dalam diet normal sdh cukup untuk mencegah heat cramps

Heat Rash Nama lain : prickly heat Terjadi pada lingkungan yang panas dan lembab keringat tak dapat menguap Mengenai bagian tertentu saja pada tubuh Jika kulit yang terkena luas gangguan produksi keringat kemampuan mengatur suhu tubuh secara evaporasi menurun menurunnya kapasitas kerja di tempat panas

Heat rashes / biang keringat/ milliaria/ prickly heat bintil2 merah dan gatal di kulit  ok. Inflamasi saluran keringat tersumbat

Pencegahan Jaga agar kulit tetap kering minimal 12 jam sehari mencegah heat rash yang parah Pakai pakaian yg longgar

Prognosis Walau sudah sembuh, perlu 4-6 minggu agar produksi keringat embali normal

Terapi Mengurangi waktu terpapar panas dan lembab Mencegah infeksi

Heat syncope Merupakan “alarm”  gangguan tak terlalu parah Tanda : Pusing (dizziness) Pingsan Biasanya karena berdiri lama di tempat panas pooling down aliran darah ke tepi aliran darah ke otak kurang

Risk Factors Tidak aklimatisasi

Terapi dan Prognosis Pindah ke tempat yang sejuk istirahatkan Prognosis  segera pulih

Sunburn Stops the body from efficient heat regulation Sunburn Prevention: Apply sunscreen both before and during work in the sun Work in the shade whenever possible If already sunburned, stay out of the sun as much as possible Source: Center to Protect Workers’ Rights. “Heat Stress in Construction”. December 2005.

Heat Fatigue respon behavioral terhadap paparan panas akut/kronis Discomfort gangguan Psychological strain kinerja (senso- Psychological stress ry motor tasks,cognitif Perubahan hormonal , alertness

Heat edema  muncul pada orang yg belum aklimatisasi  biasanya jelas di pergelangan kaki  pulih 1 – 2 hari (di lingkungan sejuk)

People at risk Miners (underground deeper than about 1200 meters) Foundry workers Steel workers Rubber workers Kitchen workers & bakers etc

Penyebab Penyerapan panas > pengeluaran panas suhu tubuh meningkat Kerja fisik berat di tempat yang panas dan lembab+ pakaian yang berat atau chemical protective clothing Panas bisa berasal dari radiasi atau konduksi dan konveksi (jika suhu lingungan sangat panas (>36 C)

Pencegahan secara umum Mengurangi produksi panas (panas metabolisme ) dengan mengurangi beban kerja Mengurangi panas yang diserap (panas lingkungan) shielding, isolasi Mempermudah pemindahan panas ke lingkungan menigkatkan jumlah keringat  cukup air minum

Gangguan Kesehatan akibat paparan panas Risiko PAK akibat paparan panas  bervariasi antar orang Risiko tinggi tua , obesitas, underweight, dehidrasi, alocoholic, IKJ rendah

Factors related to individual susceptibility to heat Tidak aklimatisasi Kesegaran jasmani rendah Diare –dehidrasi / demam  rawan heat stroke dan hyperpyrexia. tua , obesitas, underweight, alocoholic, Obat2an : tranquilizers, diuretics  meningkatkan kerentanan sebelumnya pernah mengalami Heat stroke/ heat stress

Aklimatisasi , kapan? Jika sba = 25-28 ºC sk = 33-35 ºC

Personal Protective Equipment (PPE) No specific forms of personal protective equipment are required to be worn by workers Work clothes that are light colored and lightweight can mitigate the safety hazards of heat

Products Cooling Vests & Clothing Hard Hat Cool Pack Reflective Clothing Wetted Clothing

coverall Coverall yg dialiri udara dingin atau air  vortex

Management Commitment Implement Training Program Schedule Work/Rest Cycles Alternate Light and Heavy Work Schedule Heaviest Work for Cooler Times of the Day Rotate Work among Work Teams Implement Worker Monitoring Programs

PAK karena paparan jangka panjang (Kronis) Certain kidney, liver, heart, digestive system, central nervous system and skin illnesses are thought by some researchers to be linked to long-term heat exposure. However, the evidence supporting these associations is not conclusive. Chronic heat exhaustion, sleep disturbances and susceptibility to minor injuries and sicknesses have all been attributed to the possible effects of prolonged exposure to heat.

ILLNESSES caused by long-term (chronic) heat exposure The lens of the eye is particularly vulnerable to radiation produced by red-hot metallic objects (infrared radiation) because it has no heat sensors and lacks blood vessels to carry heat away. Glass blowers and furnace-men have developed cataracts after many years of exposure to radiation from hot objects. Foundry workers, blacksmiths and oven operators are also exposed to possibly eye-damaging infrared radiation.

ILLNESSES caused by long-term (chronic) heat exposure A possible link between heat exposure and reproductive problems has been suggested. Data from laboratory experiments on animals have shown that heat stress may adversely affect the reproductive function of males and females. Exposure of males resulted in reduced rate of conception. Exposure of females caused disruption of the reproductive cycle until they became acclimatized to heat. When animals are simultaneously exposed to heat and toxic chemicals, the influence of heat exposure seems to accelerate the chemical reactivity.

In men, repeatedly raising testicular temperature 3 to 5C decreases sperm counts. There is no conclusive evidence of reduced fertility among heat-exposed women. There are no adequate data from which conclusions can be drawn regarding the reproductive effects of occupational heat exposure at currently accepted exposure limits.

Laboratory study of warm-blooded animals has shown that exposure of the pregnant females to hyperthermia may result in a high incidence of embryo deaths and malformations of the head and the central nervous system (CNS). There is no conclusive evidence of teratogenic effects of hyperthermia in humans. The NIOSH criteria document (1986) recommends that a pregnant worker's body temperature should not exceed 39-39.5C during the first trimester of pregnancy. (Reference: Occupational exposure to hot environments. Revised Criteria. Cincinnati, Ohio: National Institute for Occupational Safety and Health, 1986)

Conclusions Heat Stress Illnesses and Injuries Can Be Prevented Workers Should Be Properly Trained and Acclimated to High Heat Work Environments Management Commitment to Heat Safety is a Must

Think Safety Work Safely

What are some of the terms used in this document (Glossary of Terms)? Acclimatization - Physiological changes which occur in response to several days of heat exposure and make the body accustomed to a hot environment. Convection - Process of heat exchange between the body and the surrounding air or fluid as a result of bulk flow of that air or fluid. Dehydration - Loss or deficiency of water in body tissues caused by sweating, vomiting or diarrhea. Symptoms include excessive thirst, nausea, and exhaustion. Heat cramps - Painful and often incapacitating cramps in muscles. Heat cramps are caused by depletion of salt in the body as a result of heavy sweating, and ingestion of water without replacing salt. Heat exhaustion - Weakness, lassitude, dizziness, visual disturbance, feeling of intense thirst and heat, nausea, vomiting, palpitations, tingling and numbness of extremities after exposure to a hot environment.

Heat hyperpyrexia - Rise in body temperature with moist skin and mental dysfunction, caused by exposure to an extremely hot environment. Heat rash (prickly heat or milliaria) - An itchy rash of small raised red spots on the face, neck, back, chest and thighs caused by a hot and moist environment. Heat strain - Physiological and behavioural responses of the body as a result of heat exposure. Heat stroke - Acute illness caused by overexposure to heat. Symptoms are dry, hot skin, high body temperature (usually over 105F) and mental dysfunction. Heat syncope - Temporary loss of consciousness induced by insufficient flow of blood to the brain. Recovery is normally prompt and without any long-term ill effects.

Metabolic rate - Rate of energy (heat) production of the body which varies with the level of activity. Natural Wet Bulb Temperature - Air temperature measured using a thermometer in which the bulb is covered with wet cotton wick and cooled by the natural movement of air. Nausea - The feeling that one is about to vomit as experienced in seasickness. Prickly heat - See Heat rash. Radiation (heat) - Transfer of heat between hot and cold bodies without contact between them. Relative humidity - The ratio of the water vapour content of air to the maximum possible water vapour content of air at the same temperature and air pressure. Document last updated on September 18, 2001 Copyright ©1997-2006 Canadian Centre for Occupational Health & Safety