Heat Stress Expert Panel - May 11, 2022
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Heat Stress Expert Panel
May 11, 2022Agenda 1. Welcome & Opening Remarks 2. Panelist Presentations i. Colette Pichon Battle ii. Dr. Marc Schenker iii. Dr. Vivek Shandas iv. Arsenio Mataka 3. Q & A 4. Next Steps & Closing Remarks
Heat Stress Risks and Outcomes
Among Farmworkers
Marc Schenker, MD, MPH
Department of Public Health Sciences
University of California at DavisHeat-Related Illness
• Heat rash Mild
• Heat syncope (fainting)
• Heat cramps
• Heat exhaustion
• Heat stroke
– Core body temperature >104°F
– Multi-organ system dysfunction
– Medical emergency Severe
• Death“Classic” Heat-Related Illness
Risk Factors
• Age: Infants and elderly
• Lack of air conditioning
• Social isolation
• Pre-existing medical conditions
• Impaired mobility
• Low socio-economic status
• Housing characteristicsAugust 3, 2005
“This is a tragedy…and we will do everything it
takes to prevent this from happening again”
August 8, 2005
Emergency occupational regulations for heat illnessHeat Illness Fatalities in Agriculture, 2008
Maria Isabel Jimenez Ramiro Rodriguez
May 14, 2008 July 9, 2008
17 y.o. picking grapes 48 y.o. picking nectarines
Jose Hernandez Jorge Herrera
June 20, 2008 July 31, 2008
64 y.o. picking squash 37 y.o. loading grapes
Abdon Garcia Maria Alvarez
July 9, 2008 August 2, 2008
46 y.o. loading grapes 63 y.o. picking grapesCDC Analysis of Occupational
Heat Fatalities in Agriculture,
U.S. 1992 - 2006
• 423 deaths from occupational heat exposure
• Rate of agricultural worker deaths 20x all
industry rate
• 76% agriculture deaths in crop production
• Most (all?) agriculture deaths among immigrant
workers
MMWR 57 (24) : 649-
653, 2008Heat Stress Deaths by 5-year Periods,
U.S. 1992 - 2006
Source: Centers
for Disease
Control and
Prevention. (2008,
MMWR, Vol. 57,
No. 24.Personal Risk Factors
Lack of acclimatization
Dehydration
Lack of fitness
Obesity
Heavy clothing
Metabolic heat load
Precarious workerHeat exchange of worker performing
physical work in hot weather
Solar radiation
Wind
Evaporation
Air temperature (sweat and respiration)
Air humidity Convection
Radiation
Metabolic heat
Ground
thermal
Reflected solar
radiation
radiation“Exertional” Heat-Related Illness Military Athletes Workers
The Short and Preventable Death of Maria Isabel Vasquez Jimenez Meet Maria Isabel Vasquez Jimenez. On May 13, seventeen-year-old Maria was a farmworker, working the grape vineyard of West Coast Grape Farming in Stockton, California alongside her fiancee, Florentino Bautista. Three days later, Maria was dead -- killed after working nine straight hours in the Broiling heat of the California summer, without access to water or shade.
CHIPS Study Personal measurements: – hydration (weight, blood, observation) – work rate (HR and accelerometer) – clothing (IR photometry and visual assessment) – core body temp (pill) – questionnaire data
Questionnaire Results:
Experience of HRI in a Population-
Based Survey (n=587)
48% said they had ever experienced HRI symptoms in the
heat, mean = 5 times over career
– 59% of the sufferers were unacclimatized when they last
had HRI symptoms
– 42% said they just continued to work, regardless of
symptoms
– 54% said they now protect themselves by drinking and
resting more, working less intensely, or changing
clothing
13Thirst and HRI - Work Attitudes and Behaviors
Question n (%)
Intensity of thirst:
Not thirsty / only a little thirsty 78 (27.2)
Thirsty to extremely thirsty 209 (72.8)
Do you think you drink enough?
Yes 276 (96.8)
Do you slow down if you feel too thirsty?
Yes 188 (65.5)
Do you try to work faster to keep up?
Never / Rarely 101 (35.2)
Occasionally / Frequently 186 (64.8)
Level of concern about HRI at work?
Not at all 131 (45.8)
A little 122 (42.7)
Very concerned 33 (11.5)
14"We Just Have To Continue Working": Farmworker Self-care and Heat-related Illness by Michael D. Courville,8 * Gail Wadsworth,b and Marc Schenker c http:1/dx. doi.org/ 10. 5304/jaf scd .2016.062.014, pp. 143-164 Published online March 2, 2016
Elevated Core Body Temperature ≥ 38.50C
Multivariable Logistic Risk Factor Model. 25/499 workers with sufficient data,
recorded 3-minute max cT ≥ 38.50C
† Female
Adjusted OR and 95% CI
Dehydration
Age
BMI
WBGT
† Shift Length
Piece Rate
† High Work
Rate
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
† statistically significant 16Heat Related Illness: Increased
Susceptibility in Farmworkers
• Extended periods of working in direct sun with high
temperatures and humidity.
• Metabolic heat gain – motivations to work beyond
endurance, not take breaks, piece work pay, etc.
• Dehydration (restricted ability or failure to drink water,
rest in shade).
• Lack of knowledge of symptoms and response needed.
• Cultural beliefs (e.g. hot-cold syndrome).
• Poor nutritional habits, poverty, and stress.CA Heat Standard Revision – 2015
Subchp 7. Group 2. Article 10
• Access to shade
• High heat procedures
• Emergency response procedures
• Acclimatization
• Training
• Heat illness prevention plan
NIOSH Criteria for a
Recommended Standard
2016Summary • Heat-related illness (HRI) remains a risk of illness and death, especially for the most vulnerable outdoor workers. • Climate change factors will increase risks in the future. • Risk factors for HRI are multifactorial and require diverse approaches addressing heat gain and cooling. • Metabolic heat gain is a significant risk factor for HRI. • Approaches should include education, engineering and enforcement efforts, and address cultural beliefs and perceptions. • HRI is 100% preventable
California Heat Illness
Prevention Study (CHIPS)
Faculty and Staff
Marc Schenker Javier Castro
Debbie Bennett Teresa Andrews
Gail Wadsworth Melissa Franco
Dan Tancredi Jose Gutierrez
James Jones Carlos Piña
Diane Mitchell Alondra Vega
Sally MoyceSupported by: NIOSH Grants OH 007550 OH 010243
mbschenker@ucdavis.edu
22Centering marginalized places and voices in managing urban heat Vivek Shandas, Professor Portland State University
Travis Fox Ariel Photography
Source: Yale e360, NOAA
Community-Based Participatory Climate Science
Air Temperatures and Inequities Morning Afternoon Evening
Disproportionate Impacts of Heat on Communities
Impervious
Tree Canopy
Conscious and Deliberate Planning
1. Greater amount of asphalt and pavement
2. Highway projects and big box stores
3. Large-scale housing projects
4. Industrial facilities
D-A Difference: +2.6°C 5. Lack of parks and green spaces
Hoffman, Shandas, & Pendelton, 20201. AC installations are not random –
Access to Air largely predictable by level of income in
Conditioning an area
2. Higher levels of AC in the relatively
and
cooler parts of cities
Extreme Heat 3. Lower levels of AC presence and use in
historically marginalized areas of cities
Primary 4. Spatial analysis highlights inequities in
Takeaways access to cooling on a city-scale
5. Urban-scale resilient cooling strategies
are neededAdvancing Cooling Interventions • Social vulnerability: Which communities are exposed to higher or lower temperatures? • Mechanical interventions: With limited funds, how can we identify locations where HVAC upgrades will save lives during a heat wave? • Community Awareness: How might we ensure that those most vulnerable to climate-induced stressors, like extreme heat, are prepared? • Distribution of green assets: To what extent do green spaces as cooling interventions exacerbate displacement? • Transportation: How do we prioritize those climate-based interventions for public transit users and pedestrians? • Built environment: In what ways do our urban development patterns and designs interact with climate systems to amplify harms in specific areas? • Housing policy: Can increased housing density be achieved while keeping temperatures the same (or less) than today?
Pilot Projects Under Way
1. Engage residents in publicly
owned/managed properties
2. Installation of temperature
sensors – issues warnings
3. Develop policies for engaging
property mangers and emergency
management1. The same systems that created these inequities have not
changed since the inception of segregation policies.
2. Simply moving cooling interventions into disinvested
neighborhoods or households can further amplify existing
inequities (e.g. trust, economic insecurities, etc.).
3. Needed are community-based neighborhood scale
engagement campaigns that center on current needs and
sharing power.Heat Stress Arsenio Mataka Senior Advisor for Climate and Health Equity
OFFICE OF CLIMATE CHANGE AND HEALTH EQUITY Executive Order 14008 “Tackling the Climate Crisis” • Established the Office of Climate Change and Health Equity
PRIORITIES
PRIORITY 1 PRIORITY 2 PRIORITY 3
Climate and Health Climate Actions to Health Sector
Resilience for Most Reduce Health Resilience and
Vulnerable Disparities DecarbonizationEXTREME HEAT
Heat Related Illness by Region • Year - 2021 • Week - 6/27/21 - 7/03/21 • Rate of ED visits associated with heat-related illness per 100,000 ED visits by Region. • Colors show avg. max temp by county for same week. Source: National Syndromic Surveillance Program.
Heat Related
Illness
• Region- specific heat-sensitive
zones with heat alert criteria.
• Bottom line: Median heat alert
criteria often trails heat index
ranges where positively significant
peak health attributable health
risk/burden is observed.
Vaidyanathan A, Saha S,Vicedo-Cabrera AM, Gasparrini A, Abdurehman N, Jordan R, Hawkins M, Hess J, Elixhause A. “Assessment of extreme heat and hospitalizations to inform early warning
systemsexternal icon.” Proceedings of the National Academy of Sciences 2019; 116 (12): 5420-5427.• 203 counties or 31,877,388 people will experience 5 or more extreme heat days in May. • 66% of these counties have a high number of people without health insurance. • 68% of these counties have a high number of people living in areas without adequate tree cover.
Q&A
Next Steps/Resources
• Next Steps
• Join us next week on Thursday, May 19th from 2-3pm ET for the LIHEAP
Grant Recipient Heat Stress Panel Discussion
• Resources
• Heat Stress Landing Page
• Heat Stress Dashboard
• OCS Heat Stress Guidance
• OCS Guidance on the Use of Social Security Numbers (SSNs) and
Citizenship Status Verification
• DEA Contact Information
18Thank you for participating!
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