You'd Better Watch Out

Colder weather moves hypothermia and slip-and-fall prevention to the top of many work sites' hazards list.

• By Fred Elliott
• Nov 01, 2004

OLD Man Winter brings to mind two safety concerns in particular: hypothermia and slip-and-fall injuries.

Hypothermia occurs when a person's body heat is lost to a cool or cold environment faster than it can be replaced. An internal body temperature of 95 F or below signals hypothermia; contrary to popular belief, ambient temperatures do not have to be below freezing for hypothermia to occur, especially in individuals whose risk of developing cold-related illnesses is elevated.

Contact with water--or immersion--can bring on hypothermia much faster because water cools body temperature 25 to 30 times faster than air. Keep in mind that a worker who is perspiring heavily or drenched with rain/snow will lose body heat faster than the same worker under dry conditions. Outdoor work continues in winter months in industries such as agriculture, trucking, logging, maritime, and commercial aviation, making it essential for those workers to be alert and well prepared.

The Oregon Occupational Safety and Health Division and other safety organizations note workers can be at higher risk of suffering cold-related health problems for various reasons. One risk factor is taking anti-depressants, sedatives, tranquilizers, or cardiovascular drugs--medications that prevent the user's body from regulating temperatures normally. Also exposed to higher risk are workers who are in poor physical condition or have a poor diet. Older workers are more vulnerable to hypothermia than younger ones.

Prolonged exposure to cold temperatures can result in serious health problems such as frostbite, trench foot, and hypothermia. Danger signs include uncontrolled shivering, slurred speech, clumsy movements, fatigue, and confused behavior. Call for emergency help if these are observed.

OSHA's Cold Stress Card provides recommendations in English and Spanish. Free to workers, it is available on OSHA's Web site, www.osha.gov.

A kindred agency, the Mine Safety and Health Administration, also wants its stakeholders to be wary of hypothermia and cold stress ailments. MSHA describes three stages of hypothermia in this fashion:

• Impending hypothermia: This occurs when the body's core temperature drops to 95 F (35 C). The skin may become pale, numb, and waxy. Muscles become tense. Fatigue and weakness begin to show. The treatment includes removing the victim from the cold environment, providing external heat (fire, blankets) and providing hot drink (no alcohol, tea, or coffee).
• Mild hypothermia: This occurs when the body's core temperature drops to 93.2 F (34 C). Uncontrolled shivering begins. The individual is still alert, but movement becomes less coordinated; some pain and discomfort exists. The treatment includes removal from the cold environment, keeping the head and neck covered to prevent further heat loss, and providing warm, sweetened drink (no alcohol, tea, or coffee) and high-energy food.
• Severe hypothermia: This occurs when the body's core temperature drops below 87.8 F (31 C). The skin becomes cold and may be bluish in color. The individual is weak and uncoordinated; speech is slurred; and the victim appears exhausted, denies the problem, and may resist help. Gradually there is a loss of consciousness with little or no breathing occurring. The individual may be rigid and appear dead. Treatment includes immediate external warming.

Apparel Recommendations
Both shielding the work area and having workers wear insulated, wind-resistant, water-repellent clothing are necessary if work must be performed at or below 39.2 degrees F, according to the "Physical and Biological Hazards of the Workplace" (2nd edition, 2001, John Wiley & Sons Inc., New York). That reference advises instructing workers in proper rewarming methods and first aid treatment; allowing new workers to get used to working in cold temperatures and wearing proper apparel also is recommended.

The basic principles of rewarming a hypothermia victim are to conserve the heat he has and replace the body fuel he is burning to generate that heat. Heat loss is reduced with additional layers of dry clothing, increased physical activity, and warm shelter. The victim should be adequately hydrated and fed carbohydrates, proteins, and hot liquids--and certainly should not consume anything containing alcohol, caffeine, or nicotine.

Addressing Slip-and-Fall Hazards
Wintry conditions can contribute to slip-and-fall incidents and injuries. Tripping and slipping hazards should be addressed promptly in any workplace, but snow and ice exponentially increase the challenge of doing this on loading docks and in areas of high exposure such as parking lots, sidewalks, entrances, outdoor stairways, and visitor reception areas.

Does your company maintain a documented review of employee-owned or provided footwear? Do you insist that foot protection be maintained according to the manufacturers' recommendations, and do you enforce compliance with your footwear policy by employing effective disciplinary action?

Employees should be instructed on the types of hazards that may cause foot injuries and on preventative measures. They should be made aware of a procedure for reporting transitory or permanent slip-and-fall hazards, for damaged footwear, for wet surfaces, for poor lighting, and certainly for near-misses.

Where the ground or walking surfaces are wet, employees should wear impervious boots, shoes, rubbers, or other appropriate shoes. Make sure you are providing waterproof footgear or dry places for standing.

OSHA reminds workers and employers to take necessary precautions during cold conditions. Workers in construction, commercial fishing, maritime, and agriculture are among those who need to take precautions, according to the agency. Here are tips from its Cold Stress Card:

• Recognize environmental and workplace conditions that can be dangerous.
• Learn the signs and symptoms of cold-induced illnesses/injuries and what to do to help workers.
• Train workers about cold-induced illnesses and injuries.
• Encourage workers to wear proper clothing for cold, wet, and windy conditions, including layers so they can adjust to changing conditions.
• Be sure that workers take frequent short breaks in warm, dry shelters to allow the body to warm up.
• Try to schedule work for the warmest part of the day.
• Avoid exhaustion or fatigue, because energy is needed to keep muscles warm.
• Use the buddy system--work in pairs so one worker can recognize danger signs.
• Drink warm, sweet beverages (sugar water, sports drinks). Avoid drinks with caffeine (coffee, tea, sodas, or hot chocolate) or alcohol.
• Eat warm, high-calorie foods, such as hot pasta dishes.
• Remember, workers face increased risks when they take certain medications, are in poor physical condition, or suffer from illnesses such as diabetes, hypertension, or cardiovascular disease.

This article originally appeared in the November 2004 issue of Occupational Health & Safety.