Abstract
The objective of this study is to assess ambient temperatures' and extreme heat events' contribution to work‐related emergency department (ED) visits for hyperthermia in the southeastern United States to inform prevention. Through a collaborative network and established data framework, work‐related ED hyperthermia visits in five participating southeastern U.S. states were analyzed using a time stratified case‐crossover design. For exposure metrics, day‐ and location‐specific measures of ambient temperatures and county‐specific identification of extreme heat events were used. From 2010 to 2012, 5,017 work‐related hyperthermia ED visits were seen; 2,298 (~46%) of these visits occurred on days when the daily maximum heat index was at temperatures the Occupational Safety and Health Administration designates as having “lower” or “moderate” heat risk. A 14% increase in risk of ED visit was seen for a 1°F increase in average daily mean temperature, modeled as linear predictor across all temperatures. A 54% increase in risk was seen for work‐related hyperthermia ED visits during extreme heat events (two or more consecutive days of unusually high temperatures) when controlling for average daily mean temperature. Despite ambient heat being a well‐known risk to workers' health, this study's findings indicate ambient heat contributed to work‐related ED hyperthermia visits in these five states. Used alone, existing OSHA heat‐risk levels for ambient temperatures did not appear to successfully communicate workers' risk for hyperthermia in this study. Findings should inform future heat‐alert communications and policies, heat prevention efforts, and heat‐illness prevention research for workers in the southeastern United States.
Highlights
To begin to characterize and better understand the specific risk factors for exposure of workers to heat in the southeastern United States, this study examines emergency department (ED) visits for work‐related hyperthermia in Florida, Georgia, Kentucky, Louisiana, and Tennessee between 2010 and 2012
Sixty‐nine percent of the ED visits for work‐related hyperthermia were for the non‐Hispanic ethnicity group; only 6% were Hispanic workers— the ethnicity was unavailable in 25% of the ED visits for hyperthermia
Forty‐six percent of the hyperthermia ED visits occurred on days when the daily maximum heat index (HI) was less than 103°F—which includes the temperatures the Occupational Safety and Health Administration (OSHA) designates as having “lower” (HI < 91°F) or “moderate” heat risk (91°F
Summary
Identified risk factors for work‐related hyperthermia include high temperature and humidity in the work setting, environmental (ambient) heat, physical exertion, heavy or protective clothing, exposure to direct sunlight, limited air movement, fluid loss, excessive perspiration, and a lack of heat acclimatization, work breaks, cooling areas, and adequate hydration (Jacklitsch et al, 2016; NIOSH, 1972, 1986a, 1986b). Workplace‐specific heat sources (e.g., furnaces, ovens, and structure/wildland fires) have been identified as risk factors (Jacklitsch et al, 2016; NIOSH, 1972, 1986a). Critical information is needed to successfully target prevention strategies for workers and track the effectiveness of existing or future prevention efforts. This need is especially great in the SHIRE ET AL
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