Heat Illness Prevention Research Articles

Analyzing and Assessing the Current Status of Heat-Related Illnesses in the South Korean Military.

The population of the Republic of Korea often experiences heat-related illnesses during summer that are exacerbated by significant variations. With rising temperatures attributed to global warming and other environmental changes within the military, combined with the military medical services' mission to uphold combat capabilities and promote health, it has become crucial to accurately understand the status of heat-related illnesses and integrate more comprehensive and systematic preventive measures. This study aimed to analyze data on heat-related illnesses between 2018 and 2022 to assess and reflect on the said diseases in the South Korean Military. We performed a secondary analysis using data provided by the Defense Medical Statistic Information System. This single-institution retrospective, cross-sectional study was approved by the Institutional Review Board of the Armed Forces Medical Command (approval number: AFMC-2023-11-001). Over the past 5 years, the annual number of soldiers treated for heat-related illnesses, whether as outpatients or inpatients, at division medical facilities and military hospitals ranged from 846 to 1,250 cases per year. The proportion of severe cases fluctuates annually between 1.1% and 1.8%. Notably, 94 to 96% of all heat-related illnesses were recorded between May and September, with peak rates in July and August. The army reported the highest number of heat-related illnesses among military branches, with soldiers comprising the majority of cases. This highlights the urgent need for enhanced heat illness prevention measures within army ranks. Notably, the incidence of these illnesses peaked during July and August, underlining the critical periods for intensified preventive efforts.

Social interactions and heat stress mitigation among elderly people in a healthy city

BackgroundIncreased frequencies and duration of extreme heat events have caused severe heat stress, especially among elderly people. Despite its obvious cause and universally known preventive measures, heat stress preventive measures have not been implemented effectively at community levels. This study examined heat coping practices among elderly people and their associations with living conditions, social interactions, and community involvement. MethodsA self-administered questionnaire was done to assess heat-coping practices to mitigate heat stress, living conditions, and interactions with family, friends, and neighbours. Participants were 3000 randomly selected elderly people aged 65 years and older living in Owariasahi, Japan, a city that applies the 2004 Healthy City Approach. A generalised linear regression model was applied with binominal distribution to examine the association between social interactions and application of heat-coping practices. Sex and ages were adjusted in the model. FindingsAmong the 2127 elderly people who completed the survey, 745 (35·0%) had heat stress during the summer of the survey year. The presence of heat stress was higher in male participants living alone and having less interaction with friends and neighbours; only interaction with friends and relatives showed difference in the occurrence of the heat-related illness in female participants. The use of ice packs, air conditioners, and the opening of windows or doors were associated with the presence of heat stress. The odds of not applying relevant preventive practices were higher in participants disconnected from relatives and friends (odds ratio 1·52 [95% CI 1·12–2·04]). Participants living alone and disconnected from their neighbours showed similar trends to the connection with relatives and friends but not significantly. InterpretationThe findings of the study indicated that heat stress mitigative measures were underused in elderly people who are socially disconnected. Heat illness prevention programmes need to focus on outreach to the disadvantaged population. FundingJapan Society for the Promotion of Science.

Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update.

The Wilderness Medical Society (WMS) convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. The current panel retained 5 original members and welcomed 2 new members, all of whom collaborated remotely to provide an updated review of the classifications, pathophysiology, evidence-based guidelines for planning and preventive measures, and recommendations for field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality. This is an updated version of the WMS clinical practice guidelines for the prevention and treatment of heat illness published in Wilderness & Environmental Medicine. 2019;30(4):S33-S46.

Outcomes for a Heat Illness Prevention Program in Outdoor Workers: A 9-Year Overview.

To describe the outcomes effect of removing the medical surveillance component from a heat illness prevention program (HIPP) for outdoor workers from a Central Texas municipality. Heat-related illness (HRI) frequency and workers' compensation (WC) cost were assessed retrospectively in a cohort of 329 workers from 2011-2019. During 2011-2017, the HIPP included training, acclimatization, and medical surveillance. In 2018-2019, a modified (mHIPP) was implemented that included training and acclimatization, but without medical surveillance. The HRI rate during HIPP averaged 19.5 per 1000 workers during the first 4 years, dropped to 1.01 per 1,000 workers over the next 3 years, (2015-2017), and increased during mHIPP, to 7.6 per 1,000 workers. Although the case increase during the mHIPP was small, medical surveillance may be an important component in lowering workforce HRI.

Exertional Heat Illness Prevention

Exertional Heat Illness Prevention

Heat-related Physical Activity Loss Estimation And Sport Guidelines For Exertional Heat Illness Prevention In China

Heat-related Physical Activity Loss Estimation And Sport Guidelines For Exertional Heat Illness Prevention In China

How Does Environmental Temperature Affect Farmworkers' Work Rates in the California Heat Illness Prevention Study?

Estimate the association between environmental temperature (wet bulb globe temperature [WBGT]) and work rate over the course of a workday. Repeated-measures regression was used to identify characteristics impacting work rate in a cross-sectional study of Latino farmworkers. Minute-by-minute work rate (measured by accelerometer) and WBGT were averaged over 15-minute intervals. Work rate decreased by 4.34 (95% confidence interval [CI], -7.09 to -1.59) counts per minute per degree Celsius WBGT in the previous 15-minute interval. Cumulative quarter hours worked (2.13; 95% CI, 0.82 to 3.45), age (-3.64; 95% CI, -4.50 to -2.79), and dehydration at the end of workday (51.37; 95% CI, 19.24 to 83.50) were associated with counts per minute as were gender, pay type (piece rate vs hourly) and body mass index ≥25 kg/m 2 . The effects of pay type and body mass index were modified by gender. Increased temperature was associated with a decrease in work rate.

U.S. High School Coaches’ Knowledge, Perception, and Current Practices Regarding Exertional Heat Illness

Exertional heat illness (EHI) is a dangerous, but preventable and treatable condition that affects approximately 9,000 athletes each year in the United States. Unfortunately, less than 30% of schools in the United States have access to an athletic trainer, making coaches responsible for the safety of the athletes during practices and games. The purpose of this study was to evaluate the knowledge, perception, and procedures of high school coaches in the United States regarding heat illness recognition, prevention, and treatment. An online survey including Likert items and open-ended questions was completed by 1,676 coaches from 16 states and compared between age, coaching experience, gender, education level, experience handling EHI, state, and the completion of either a general coaching certification or a heat safety certification. Average knowledge score among coaches was 74%. Coaches with experience handling or witnessing EHI, more years of coaching experience, older age, and the completion of a coaching certification had significantly higher level of knowledge than others. Results revealed that evidence-based strategies and state mandates aimed at preventing EHI are not being implemented. More training in prevention, recognition, and treatment of EHI is necessary for all individuals involved with high school athletes to prevent avoidable deaths.

Trends in ambulance dispatches related to heat illness from 2010 to 2019: An ecological study.

Heatstroke is a serious heat-related illness that can even cause death. Heat alert systems play an important role in reducing the number of patients experiencing heat illness, as they encourage preventive actions such as the use of air conditioning, hydration, or other strategies. However, to date, the Japanese hazard classification has not considered seasonal and regional variations, despite clear differences in meteorological conditions across different regions in Japan. Moreover, several studies have reported a difference in thermoregulation between older and younger adults, implying that the hazard classification should also consider age differences. This study examined the relationship between the number of ambulance dispatches related to heat illness (ADRHI) and the Japanese heat hazard classification from 2010 to 2019, focusing on monthly and regional differences. Data from 47 prefectures during the 10-year period were collected and analyzed. ADRHI and wet bulb globe temperature (WBGT) data were collected from Japan's Ministry of Internal Affairs and Communications and the Ministry of the Environment Heat Illness Prevention Information website, respectively. The findings showed a significant relationship between ADRHI and WBGTmax (p < 0.05, r = 0.74). ADRHI per 100,000 people showed significant differences across months. The post hoc test detected the first steep increase in ADRHI at a WBGTmax of 23°C than at 22°C in June, and at a WBGTmax of 26°C, 27°C, and 25°C in July, August, and September, respectively. Moreover, the first significant increase in ADRHI per 100,000 people at WBGTmax differed across each region, at a WBGTmax of 24°C in Hokkaido-Tohoku, 25°C in Kanto, Kansai, and Chugoku, 26°C in Chubu, 27°C in Shikoku, and 28°C in Kyushu-Okinawa. Further, Poisson regression analysis revealed that the relative risks differed across each region and month. These results imply that the hazard classification should be adjusted according to region and month in Japan.

Prevention of exertional heat illness among high school baseball athletes and coaches : knowledge, attitude, practice, facilitators, and barriers

Prevention of exertional heat illness among high school baseball athletes and coaches : knowledge, attitude, practice, facilitators, and barriers

Associations between Heat Index and Child Emergency and Hospital Visits in New York City

BACKGROUND AND AIM: Emerging literature has documented heat-related impacts on child health, yet few studies have evaluated the effects of heat among children of different age groups or compared emergency department (ED) with hospitalization risks, which may serve to indicate morbidity severity. We examine the differing associations between maximum heat index (a metric that combines maximum temperature and relative humidity) and risk of ED visits and hospitalizations among children by age group. METHODS: We used New York Statewide Planning and Research Cooperative System (SPARCS) data on children aged 0-18 years admitted to EDs (n = 2,252,550) and hospitals (n = 228,006) during the warm months (May-September) from 2005 to 2011. Using a time-stratified, case-crossover design, we estimated the risk of ED visits and hospitalizations associated with daily heat index for children of all ages and by age group. Heat index was modeled using distributed lag functions accumulated over lag 0 to 5 days using a linear term for ED visits and a piecewise linear term above the threshold of 90F for hospitalization. RESULTS:The average maximum heat index over the study period was 84.4F (range 48F-135F). Heat index conferred an increased risk of ED visits for children of all age groups, with the strongest effect observed among children 0-4, followed by those 13-18 and 5-12 years. For hospitalizations, an elevated risk was observed when heat index exceeded a threshold of 90F, and the effect was found only among adolescents 13-18 years. CONCLUSIONS:Heat impacts on child morbidity differ between ED visits and hospitalizations and by age groups. Young children, as well as older children and adolescents, are sensitive to heat effects. Our findings underscore the importance of focusing on children and adolescents in targeting heat illness prevention and emergency response activities, especially as global temperatures continue to rise. KEYWORDS: Temperature, Children and adolescents, Emergency department, Hospitalization, New York City

High ambient temperature and child emergency and hospital visits in New York City.

BackgroundEmerging literature has documented heat‐related impacts on child health, yet few studies have evaluated the effects of heat among children of different age groups and comparing emergency department (ED) and hospitalisation risks.ObjectivesTo examine the differing associations between high ambient temperatures and risk of ED visits and hospitalisations among children by age group in New York City (NYC).MethodsWe used New York Statewide Planning and Research Cooperative System (SPARCS) data on children aged 0–18 years admitted to NYC EDs (n = 2,252,550) and hospitals (n = 228,006) during the warm months (May‐September) between 2005 and 2011. Using a time‐stratified, case‐crossover design, we estimated the risk of ED visits and hospitalisations associated with daily maximum temperature (Tmax) for children of all ages and by age group.ResultsThe average Tmax over the study period was 80.3°F (range 50°, 104°F). Tmax conferred the greatest risk of ED visits for children aged 0–4, with a 6‐day cumulative excess risk of 2.4% (95% confidence interval [CI] 1.7, 3.0) per 13°F (ie interquartile range) increase in temperature. Children and adolescents 5–12 years (0.8%, 95% CI 0.1, 1.6) and 13–18 years (1.4%, 95% CI 0.6, 2.3) are also sensitive to heat. For hospitalisations, only adolescents 13–18 years had increased heat‐related risk, with a cumulative excess risk of 7.9% (95% CI 2.0, 14.2) per 13°F increase in Tmax over 85°F.ConclusionsThis urban study in NYC reinforces that young children are particularly vulnerable to effects of heat, but also demonstrates the sensitivity of older children and adolescents as well. These findings underscore the importance of focussing on children and adolescents in targeting heat illness prevention and emergency response activities, especially as global temperatures continue to rise.

Heat Illness Prevention in the Outdoor Workplace

In the construction industry a large amount of work is completed outdoors where the sun may expose or heat up rooms that can affect employees while working. This research will recognize how companies combat with heat illness and heat prevention methods to keep employees healthy and safe while working in high temperatures. Each year in the United States thousands of employees fall ill to heat related illnesses, stem from heat rash to heat stroke, which can be fatal, if not treated properly. Research will examine what standards are required by the Occupational Safety & Health Administration (OSHA) and how many participants companies currently abide by those standards. Every day that employees who work outdoors or in high temperature facilities go without proper training and education about heat stress, the number of cases will rise and more will become ill to heat related complications. This study will give prevention methods to help keep American workers safe.

Thermal Comfort Assessment and Heat-Related Illnesses among Sellers in Periodic Local Markets: A Case Study in Hot and Dry Climate of Iran

Background:This study aims to evaluate the thermal conditions of periodic local markets and determine the thermal comfort and sensation of sellers, as well as the prevalence of heat-related diseases in the hot and dry climate of Iran.
 Methods:In this study, thermal comfort and sensation of 330 sellers from periodic markets in Qom city, a dry and hot climate in Iran, were evaluated. Measurements were performed for 15 days, from July 16 to August 1. To assess environmental thermal condition, wet bulb globe temperature (WBGT) index and discomfort index (DI) were determined, and participants' tympanic temperature was determined to consistency assessment with thermal indices. Finally, the effects of environmental, personal, and working conditions on the prevalence of heat-related diseases among sellers were determined.
 Results:The environmental indices, including DI and WBGT index, had the most association with heat-related illnesses and tympanic temperature (P<0.05). The sellers perceived the environmental conditions as warm to hot after 1:00 pm. Besides, they expressed an uncomfortable or very uncomfortable situation after 12:00 pm. The findings showed that environmental parameters play a more important role in the prevalence of heat-related diseases and heat strain than individual and occupational factors.
 Conclusion:The sellers may be at risk of heat stress in outdoor markets in nearly half of the workday in the summer months. Therefore, it is very important that these people receive the necessary training in the prevention of heat illness in order to take appropriate protective measures in accordance with local conditions.

Association Between Work-Related Hyperthermia Emergency Department Visits and Ambient Heat in Five Southeastern States, 2010-2012-A Case-Crossover Study.

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.

Heat Illness Prevention at the Tokyo 2020 Olympic and Paralympic Games

Heat Illness Prevention at the Tokyo 2020 Olympic and Paralympic Games

Exertional Heat Illness Prevention lead by Athletic Trainer in Japanese High School: A Case Study

Exertional Heat Illness Prevention lead by Athletic Trainer in Japanese High School: A Case Study

Knowledge and Practices to Avoid Heat-Related Illness among Hispanic Farmworkers along the Florida-Georgia Line

ABSTRACTObjectives: Farmworkers who harvest and weed field crops are at increased risk for heat exposure and heat-related illness (HRI). The study objectives were to: (1) train crew leaders to use the Occupational Safety and Health Administration (OSHA) heat safety tool app and evaluate the utility of the app from a crew leader perspective; and (2) characterize heat safety knowledge, preventive practices, and perceptions of HRI risk among Hispanic farmworkers.Methods: Before harvest season, six crew leaders completed a 2-hour OSHA heat illness prevention training, including evaluation of a heat safety mobile app. Between August and October 2018, 101 Hispanic farmworkers participated in cross-sectional surveys about heat safety. Survey participants responded to questions about HRI prevention, HRI knowledge, and sociodemographics.Results: Crew leaders using the heat safety app rated the app very highly on relevance, functionality, value and privacy. Farmworkers did not report being overly concerned about HRI based on their survey responses. Nevertheless, 19% of farmworkers had experienced nonspecific symptoms from working in the heat, such as headache, dizziness, and nausea. In the multivariate linear regression model, farmworkers had lower heat safety knowledge scores if they were H-2A visa holders, female, and only “a little bit concerned,” compared to others who were “very concerned” about working in the heat.Conclusion: The results of this study indicate the need for continued heat safety training for both crew leaders and farmworkers to reduce the risk of HRI, especially among less experienced farmworkers.

Diagnosed and Undiagnosed Diabetes among Agricultural Workers in California.

Latino agricultural workers in California are a vulnerable population at risk for many undiagnosed health concerns. Principal among them is diabetes, and the prevalence of diagnosed and undiagnosed diabetes is difficult to estimate. In a convenience sample of 579 agricultural workers recruited through the California Heat Illness Prevention Study (CHIPS), we found HbA1c levels consistent with diabetes in 54 participants, of whom 33 (61.1%) were aware of their status. We found HbA1c levels consistent with pre-diabetes in 59 participants, of whom none was aware. Results indicate a health disparity between agricultural workers and other populations in the U.S. Many are unaware of having a chronic illness and lack resources or have other barriers to manage it. Nurses, midlevel providers, and health fairs are often the first or only point of health care contact for agricultural workers and can provide valuable information, screening, and support for this vulnerable population.

Physical activity and common tasks of California farm workers: California Heat Illness Prevention Study (CHIPS)

Farm workers are at risk of heat related illness (HRI), but their work rates that contribute to HRI have not been objectively assessed. The CHIPS study collected accelerometer data and characterized the physical activity of major farm tasks. Demographic information, work characteristics, and accelerometer data were collected from 575 farm workers in California. Each participating worker contributed measurements over one work shift. An Actical accelerometer was attached securely to a belt worn at the hip. Data were collected at one-minute intervals throughout the work shift. A total of 13 major work-task categories were defined. The mean physical activity counts per minute (cpm) and percentage of the shift spent at moderate and/or vigorous levels of activity were described for each task. Multiple linear regression models were constructed to determine the worker and environmental characteristics contributing to the physical activity level. Mean levels of physical activity ranged from 700 cpm (workers who carry produce) to a low of 150 cpm “ground pruners” who tend low-level plants, with an overall mean of 345 cpm or “light” activity (2 to ≤3 metabolic equivalents). The environmental temperature was the major factor associated with physical activity. A 10°C increase in the median temperature reduced the mean cpm by 135 (95% CI = 87, 193). Age and the tasks of sorting, ground pruning, and harvesting low-level crops were also negatively and independently associated with mean cpm. Incentivized (piece rate) pay, multi-task work, and irrigator work were positively associated with cpm. An interaction was found between piece rate and sex. Men’s activity significantly increased (p < 0.001) by a mean of 95 cpm, (95% CI = 38.3, 150.7) if they were paid by the piece, but there was a non-significant association with women’s activity level. Workers conducting multiple tasks, irrigators, men, and those earning incentivized (piece rate) pay had higher adjusted mean physical activity levels and are likely at increased risk of heat-related illness on hot days.