008 - Big 4 Factors for Eliminating Heat Stress Illness & Fatalities


Maggie (00:00):
And the big thing to know about or recognize about that is in how important it is. Is that about approximately 70% of heat related illnesses occur within the first couple days. So it's really important for, for you to utilize a heat acclimatization protocol.

Al (00:25):
Welcome everybody to Radio Free Tenacity, the voice of worker safety. I'm your host Al Buczkowski and we will be joined here in a minute by our worksite safety specialist, Allie Thunstrom, who had a chance to sit down with Maggie Morrissey, President of the National Heat Safety Coalition and Director of Occupational and Military Safety for the University of Connecticut's Korey Stringer Institute. Named in honor of the Pro Bowl Minnesota Vikings offensive lineman who passed away from heat stroke in 2001, the Korey Stringer Institute's mission is to provide research, education, advocacy, and consultation to maximize performance, optimize safety, and prevent sudden death for the athlete or fighter and laborer. One of the leading heat safety advocates in the world, Maggie was kind enough to sit down with Allie to unpack a lot of really important info, including the four big factors for eliminating heat stress illness and fatalities on the job. She also gives her thoughts on the odds of a federal heat stress standard becoming a reality in the near future, a topic that's been picking up a lot of momentum in recent years. So let's get right into it, shall we? Without any further ceremony here's Allie and her convo with Maggie Morrissey.

Allie (01:47):
Welcome back everyone to Radio Free Tenacity. Co-Host Allie here. And today I am joined with Maggie Morrissey the Director of the Korey Stringer Institute, Labor Division. So just for a background for those of you that may not be familiar, the Korey Stringer Institute kind of was formed after Minnesota Vikings lineman Korey Stringer passed away from heat stroke in the summer of 2001. And so KSI has, you know, really come to the table and done a lot of research. They have an entire testing lab to really get to the bottom of why these type of heat stroke injuries happen and what we can do both in the athletic world and in the occupational world to prevent them. So welcome to the podcast today, Maggie.

Maggie (02:31):
Thank you so much. Thanks for having me. I'm super excited to talk to you about occupational heat safety.

Allie (02:37):
Perfect. So can you give us a little bit of a background on how did you get to your current position in your profession and what really attracted you to the business of protecting others?

Maggie (02:47):
Yeah. so everything really started for me back in 2016. I was working as a research assistant with Dr. Denise Smith who's at Skidmore College and she was running a big Department of Defense grant that was looking at cardiovascular effects of firefighting. And I remember looking at the, so essentially we were measuring physiological responses to firefighting. So the firefighters would go in live burn. So that essentially means that the, they would light the building on fire and they go in and test their response. And I was watching the computer that shows all of their physiological responses. And the second the door opened where the live burn was, so the burning building, their physiological responses were off the charts. Just high heart rates, high blood pressure. And I was so, so incredibly amazed about, you know, how vulnerable this group is. So I recognizing that, I knew that I wanted to go into the field of occupational health, specifically protecting workers from the dangers of heat. And so it's always just been a passion of mine and I, and I hope to continue on that.

Allie (04:04):
That's really awesome. And, and I can only imagine what that would look like, the physiological effects of firefighting. I mean, not only is there that fight or flight response, but then, you know, the heat that they're dealing with and everything else, it, that had to be just phenomenal to look at.

Maggie (04:19):
Oh yeah, it was incredible. I, I couldn't, you know, fathom how quickly all the responses occurred, which was really, really opening to like my mind.

Allie (04:32):
Absolutely. So scholars like yourself have really, you know, studied heat related illnesses and their impact on athletes of all ages and levels. So what would you say the findings and how can the findings be applied to the industrial setting to aid safety professionals in preventing them in the workplace?

Maggie (04:49):
Yeah. so for prevention strategies, it's really like overall across athlete, athletics, military and occupational setting it's really similar. So it's hydration, heat acclimitization body cooling. However, the logistics of how they're implemented as well as the risk profile of each group is different. So for example laborers, maybe a little bit more vulnerable than athletes because they're working for prolonged hours, many might be considered socially vulnerable. So they might be migrant workers who aren't don't, aren't don't feel as protected. So they're also there's individuals who have cardiovascular risk factors, so are in the workforce as well as an aging workforce. So a lot of those risk factors are associated with heat intolerance. And so it's, that's not typically found in the athletic setting. So it definitely has a unique profile for occupational workers. So it, and there isn't a lot of research really being done in that area, which is exciting for me to, you know, kind of move that field forward.

Allie (06:09):
Absolutely. And, you know, I think one thing that we've kind of referred occupational workers are occupational athletes, you know, kind of looking at it from that scope, which is, which is, you know, a lot of it comes from the KSI Institute and looking at it from that perspective of a lot of these challenges that you see in athletes. And you have, you know, the sudden death that is occurring and people like Korey Stringer can also equate to, you know, our occupational athletes. And, you know, KSI really identified four big ticket items that would, if these items are followed, would almost certainly eliminate eliminate HRI's and fatalities. So if we could, I'd like to dive into those a little bit and kind of unpack what these items look like in practice. So, you know, simple, practical steps that work crews can take to incorporate these into their day to day business.

Maggie (07:03):
So do you want me to just go ahead and start with, with one of them?

Allie (07:06):
Yeah. So let's start with hydration.

Maggie (07:08):
Sure. Okay. So hydration I think when people think of hydration, it's one of the most obvious prevention strategies. It's very logistically different, especially in the occupational space. So safety managers should really consider the unique barriers that they have to consuming fluids or their workers do because a lot of occupational workers have to wear heavy PPE. So the opportunities to drink a may be much lower. They needs to be able to provide potable, cool water. So they need to have fluid delivery and accessibility. So a lot of occupational workers who are in remote settings might not be able to get to water as easily as like an athlete would. So these need to be considerations. They also need to be able to encourage their workers to drink, but also have their workers be able to recognize when they're dehydrated. So a really good method for that is to look at your urine color. So if you have a light colored urine that's associated with hydration, so you're in a good spot if you have light colored urine. And if it's darker, on the darker side, you are likely dehydrated. So you know, pay attention to your body. And if you have this thirst sensation, it means you're already dehydrated. So if you feel thirsty, make sure you're drinking because it means you're dehydrated.

Allie (08:39):
Absolutely. And how do electrolyte solutions kind of play into that? Cause I think you hear, in some instances, that drinking something like a Gatorade, or in the industrial world Sqwincher, or any electrolyte solution that it can change the color of your urine. Do you see that a lot or is that something to also also be cognitive of?

Maggie (08:55):
Yeah. So electrolyte beverages are, are really good idea if you're working for prolonged hours in the heat. So the only thing that you'd have to be careful with is ones that are carbohydrate electrolyte because there might be some workers who have diabetes or, you know, and have to be careful with providing carbohydrate drinks. Or, you know, with the obesity epidemic, make sure that you're providing beverages that are just electrolyte water solutions. But typically like the phrase is that water follows salt. So salt, which is electrolytes, helps retain water. So it does help you stay better hydrated. So it is a good option for workers, definitely.

Allie (09:41):
Really awesome. So the next one on the big ticket four items is heat acclimatization. So do you wanna walk us through that one?

Maggie (09:48):
Yeah, definitely. And I think this topic is the least well known of all of them. Is sometimes people have a hard time even saying acclimitization. But what it is is it's repeated and progressive exposure to heat and it results in a series of adaptations that are beneficial. So what this would look like would be increased sweat rate. So you're cooling your body better. It reduced body temperature reduced heart rate, things like that. So what safety managers can do is they need to make sure that their new workers, as well as workers who are returning from an injury, so it's like a prolonged absence or a prolonged vacation is undergoing a heat acclimitization protocol. And what that basically entails is about five to seven days of progressively exposing them to heat. So instead of just having a new worker come and do like what they would be expected to do on the first day, you're kind of just slowly exposing them to the heat so that they have better tolerance. And the big thing to know about or recognize about that is and how important it is, is that about approximately 70% of heat related illnesses occur within the first couple days. So it's really important for, for you to you utilize a heat acclimitization protocol. And we're actually creating a document at the Korey Stringer Institute. We're starting a new branch of KSI and we're creating a document that focuses on occupational heat safety recommendations, particularly heat acclimitization is one of the topics that you'll be able to use once it's published to create a protocol that's unique to your setting. So it's, we're really excited about that.

Allie (11:46):
That's super awesome. And I think of, you know, we're in Minnesota and so we have you never really know what season it is it turns out. You know, last week we had three days at 80 degrees and then the next day it's 39. So how do climates like that, where you don't really get that constant five to seven day period of 80 degrees, or maybe you do and then all of a sudden it's back down to 39. Each time there's that, you know, fluctuation do they still kind of need to implement that protocol again, as it gets hotter for the second time? Or how does that kind of work?

Maggie (12:17):
Yeah, so it depends on like when, especially when a new worker or like the season, I guess. So if workers are they're going into the summer months with summer months are typically you associated with higher exposures to heat. It would be much better to have people slowly progress, but in, in workers who are already like fully like capable of doing the job, they don't need to be introduced to the work, that's where work to rest ratios really comes into play. So what essentially that would be is creating like when they should work and when they should rest. So time points based on what the environmental conditions are. So if it, you know, the condition is really, really hot then say the worker and the workers are working at like a pretty heavy pace, then they might have a work to rest ratio that's, you know, 15 minutes on and then 15 minutes off. And they continuously do that to make sure that their body temperature doesn't increase too much. And then they're, you know, susceptible to exertional heat illness.

Allie (13:29):
Yeah, that makes a ton of sense. So for listeners, the third one was work to rest ratio. So that was a, a really nice segue into that, which leads us to the fourth one of body cooling throughout the session. So can you kind of talk us through that piece of the puzzle?

Maggie (13:42):
Yeah, definitely. So body cooling is, I think by far, one of the most underutilized strategies especially because I think if we think of it from an athletic standpoint there's time points such as like before you exercise, where you can throw on like a, a cooling, cooling gear or something like that, or after. Whereas safety managers really can't dictate what their workers are doing before they come in and versus, and also like when they leave. So it's important to, for safety managers to be able to utilize body cooling devices and shade is also a really good option. It's really simple, you know, just get a tent and your workers can, can sit under there during rest periods. But you know, what I typically tell most safety managers who are asking what type of body cooling device that they should utilize in their specific setting. I tell them to think of the acronym left. So L being location E being efficacy, F being feasibility and then T being timing. So what essentially that would mean is okay, location. So are you in a remote setting, do you have access to power? There's a lot of, you know, body cooling gear that needs to be like refrigerated every once in a while. So that wouldn't be feasible if you're in a remote setting and so efficacy, is it evidence based? Is it feasible? Like can they actually utilize that particular device? And timing of course is, is just really making sure that they're utilizing it during their rest breaks, but if they're wearing like a cooling vest they can, you know, utilize that during work. But also safety managers should educate their workers in terms of, of the benefits of pre and post cooling as well, although they can't dictate, you know, that they do that. It's, it's great to have that educational piece.

Allie (15:48):
Absolutely. So what do you think about, you know, as far as in our world, and you mentioned a few of 'em. When we look at cooling PPE, a lot of what you see in the market are cooling towels. You know, you mentioned cooling vests and phase change in particular is the one that would need to be refrigerated. But do you see those as being a very integral part of a prevention plan and having access to those for the workers? Is that something that you typically say is a good idea?

Maggie (16:15):
Yeah, absolutely. And I think it's a really good idea, especially for the workers who are wearing that really heavy PPE and, and don't have a lot of opportunity to drink fluids. They if they have some sort of body cooling such as the vests they can wear like under their gear or something like that, that is gonna be huge to be able to help them, you know, tolerate the heat a little bit better. So I definitely think it's a great strategy.

Allie (16:43):
Awesome. Yeah, that's, that's definitely a huge piece of the puzzle and something that's super simple to implement on a job site and usually not very cost prohibitive. So ideally that's something that safety managers will start to incorporate more and more into their heat stress prevention plans. As far as, as far as athletics go, you see a lot of heat related illnesses in the preseason among, you know, newer athletes. And you see that also in, we mentioned it before, newer workers in the industrial setting. So in both of those populations, athlete and occupational, we often see or talk about fighting the notion of "I don't need a break" is kind of a challenge. You know, a newer worker, a newer athlete wants to prove their worth on the job site or on the field. And I think sometimes that psychologically can come into play that, you know, they wanna show their boss or show their coach that they're tough and can work through it. What kind of, what can safety leaders do to really decouple that attitude when it comes to heat stress? Because as we know, we're all susceptible to it.

Maggie (17:47):
Absolutely. Yeah. That's a great question. So I think there's a couple different things that they can do both on a small scale and a large scale. First would really be implementing a heat acclimitization protocol because it really forces the workers to have to progressively, you know, be exposed to work and the environment. So you're not, you know, having a worker who's very, very motivated come in and try and do as much as they can because they won't be really allowed to, because you're gonna, they're gonna be performing the heat acclimitization protocol. Other things I think, and I, and I don't think this is unique to the occupational heat space, but is really changing the, the safety culture. I think especially with occupational heat safety, it's not, you know, the first thing that comes to mind for a lot of workers. So I think being able to educate workers on that, it's an issue. And, you know, with our changing climate things are just gonna get, you know, worse for us. So it's important to implement these things now and for workers I think revising the pay structure. So avoiding the, the piece pay system. I know that doesn't, you know, it doesn't occur across a lot of businesses, but so do where workers are getting paid based on the items they produce. And that really is detrimental and increases susceptibility to heat related illnesses because they just wanna, you know, if it's a farmer, they wanna pick as much as they can because they wanna get paid more. So I think that definitely is dangerous pay structure, so.

Allie (19:33):
Absolutely that's a huge, huge point to make. And it, it makes sense, you know, if it's money to feed your family versus taking a break, you, you can understand why that would occur. So I think that's a, a really good point. So as far as like heat stress standards go, right now they currently exist on more of a state by state basis. And are more handled federally by OSHA's general duty clause. You know, the state of California has probably the most robust heat stress plan, but do you see a federal heat stress standard as inevitable?

Maggie (20:05):
Yeah, so I, I do I'm very optimistic, especially because there are currently some legislative efforts to get a heat safety standard in place. So there's a there's a heat illness fatality protection act that was introduced to Congress. If anyone's interested in seeing what that is, it's a Public Citizen has a website where they've shared information about that. So it essentially would just direct OSHA to issue a standard for outdoor and indoor workers. So I think we're on the, the path for it. The only thing to recognize is that, you know, implementing a standard takes a really long time. So, you know, safety managers need to be able to implement these practices in the meantime, right? And really, I think we can still create recommendations and standards even if they're not mandated. So I think we just need to continuously share the importance of, of, you know, heat safety,

Allie (21:10):
Absolutely bringing that awareness piece is so huge. And we we've talked about a few times in this conversation, but educating the workers, educating the safety site managers that, you know, it's not always the first thing that's top of mind, and we're also used to enjoying the summer heat, but there is actually a detrimental side to this and, and just to continue to make people aware. So as you kind of look at the future of heat stress prevention, what developments are you really excited about if any are on the horizon?

Maggie (21:38):
Yeah. So as I said before, I feel like this field is very untapped which is exciting for me because I'm just so passionate about it. But there's a lot of different things. I will share that which we had mentioned at the beginning, that Korey Stringer Institute is forming a organization that will be a branch of, of KSI that is a hundred percent dedicated to protecting workers from the dangers of heat. It's called the National Heat Safety Coalition. We're actually launching June 1st, so everyone listening can tune in to our website once it launches. But I think that platform will really allow more research initiatives, educational initiatives. And our plan for this organization is to really partner with businesses and, and go in there, do onsite visits or review their procedures and make sure that they're implementing these best practices and, and ones that are actually gonna be feasible within their work setting. Because, you know, you know, occupational workers that term in job general is so, so vague. And there's so many different workers that you need to address specifically. And, and I think so I'm very super, you know, excited about that. I'm gonna be directing that organization. So I'm very excited. But I think also future developments is really in the physiological monitoring world. So I think many of you may be aware of all the wearable technologies that are coming out and they're very popular in athletics. I think having, you know, physiological monitoring to monitor core temperature, heart rate would be great for safety and health of the workers. And I we're really starting to, to go into that space, which is exciting. I also think, as we mentioned before the importance of heat acclimatization. So there really aren't any specific heat acclimatization protocols for the work setting. And so being able to tailor it specifically to each unique work site would be fantastic. So I think those are a couple things of, of many that I'm really excited about.

Allie (24:00):
One thing I did kind of steal the thunder on at the beginning is explaining how the Korey Stringer Institute really came to be. So if you wanna just give a quick overview of, you know, how it came to be and how, you know, maybe what you guys are doing now could have prevented what happened years ago.

Maggie (24:19):
Yeah, absolutely. So I think a lot of people have heard the name Korey Stringer. So Korey was a Minnesota Viking offensive lineman and in 2001 he passed away from exertional heat stroke. And what happened was it was during preseason. It was the second day of, of training camp and he collapsed on a field. There was no body cooling administered. So for those of you who don't know whole body, cold water immersion is the gold standard for treating exertional heat stroke. And so he didn't have any body cooling administered. So it ended up resulting in his death, which is very unfortunate. So in effort to prevent additional exertional heat deaths Korey Stringer's widow, Kelsey, joined forces with Dr. Douglas Casa, he's the CEO of Korey Stringer Institute, and they launched the Korey Stringer Institute in 2010. And so since then, so it's been 11 years. KSI's mission has been to provide research, education consultation to really maximize performance and safety to prevent sudden death in athletes, military as well as laborers. So it's been a really great, you know, 11 years. And so we continue to, to build this organization. So it's really exciting.

Allie (25:49):
That's super awesome. I know when KSI participated with us on a heat stress panel, one of the main things that we discovered, and that was shared with, you know, the groups that we presented to was, if you can reduce that core body temperature within a half hour, I think it was from 104 down to even just 102, you will almost always save the life. And I think that it's like you mentioned, he didn't have access to those body cooling, a tub or whatever it might be, but something that simple to just get that two degrees within 30 minutes can save a life.

Maggie (26:22):
Yeah, definitely. And I think that's also an important point for safety managers as well. If you have a worker who you think may be, you know, suffering from an exertional heat stroke, whole body, cold water immersion is really important to have. So if you have a plastic tub, tub like available with, from water and ice, like just for the really, really hot days, that's really, really a good idea to prevent that from happening. Or if you have a tarp and you can throw the water in the ice in there and cool them until medical professionals can come on site, that would be critically important to saving their life.

Allie (27:00):
Awesome. Thank you again so much for your time Maggie and your expertise.

Maggie (27:04):
Great. Yeah. Thank you so much. I loved being on this and I look forward to listening to future, future podcasts.

Al (27:14):
Okay, thanks Allie. And extra special thanks to Maggie Morrissey for sharing her time with us and for her continued heat safety advocacy.Think she really left safety managers with some simple, actionable items here for preventing heat illness and tragedy on the job site. For more strategies, solutions, and resources to fold into your heat safety program, head over to ergo.zone/heat. And you can also find more on the Korey Stringer Institute and its mission at ksi.uconn.edu. Thanks again to Maggie and to you, dear listener, for doing your part in Making the Workplace a Betterplace. Until next time, stay safe out there people.