Preventing Cold Weather Injuries

I know it is not cold here in North America yet, but during the winter months in North America, winter hazards abound. Now is the time to learn how to control or eliminate those hazards. People usually work during these periods keeping the roads open, fixing frozen and broken pipes, and completing a variety of other tasks. This exposure puts them at risk of cold weather injuries. Individuals must know the warning signs of cold weather injuries and heed them. The best way to prevent or reduce the occurrence of cold weather injuries is to know what cold weather injuries are, how they occur, how serious they are, first-aid treatment, and what can be done to prevent them. This blog post will highlight just that information and help people prepare for cold weather.

Before discussing the prevention of cold weather injuries, it is important to understand the concept of wind chill. This is important because the human body is continually producing and losing heat. When the wind blows across the body, it removes heat making the body susceptible to cold weather injuries. The combined effect of wind and temperature is expressed as an equivalent temperature, see figure 1 next page. Locate the ambient temperature across the top of the figure and run a finger down to the wind speed that is the temperature that the body is feeling. For example, if it is 15° Fahrenheit (F) and the wind is blowing 30 miles per hour the body is experiencing a temperature of   -5° F, which is much more dangerous to the body than 15° F.

Cold weather injuries come in various shapes and sizes, so to speak. Hypothermia, Frostbite, and Trench Foot are the most common. There are often extenuating factors that increase ones’ risk of experiencing a cold weather injury or perhaps making an injury worse, these include:

  • Acclimation to cold weather
  • Length of exposure
  • Previous cold injuries
  • Use of prescriptions drugs
  • Consumption of alcoholic beverages

The next few paragraphs will highlight the different types of cold weather injuries and provide useful information for prevention. It is important to remember that it is always easier to prevent a cold weather injury than to treat one after it occurs.

Hypothermia

Hypothermia is a lowering of the body temperature caused by exposure to the cold. It is aggravated by moisture and the wind. Hypothermia occurs when the body is unable to produce heat as quickly as it is being lost. Most hypothermia cases develop in air temperatures between 30 and 50° F. It is important to note that a person will die if the internal body temperature drops below 78.6° F, making this a deadly injury. The moment one begins to lose heat faster than the body can replace it, they experience exposure. This is followed by the body taking drastic measures to conserve its energy and maintain the temperature of internal organs. As the body’s core temperature drops the symptoms develop.

The treatment of hypothermia consists of stopping or at least reducing the heat loss from the victim’s body. This is followed by adding heat to the victim’s body. This is best done by:

  • Getting the victim to a sheltered area even if it is a warm vehicle.
  • If the victim is wet, replacing the victim’s wet clothes with dry ones.
  • Giving the victim warm, non-alcoholic drinks.
  • Getting the victim to a hospital or medical clinic as soon as possible.

The prevention of hypothermia consists of:

  • Dressing properly in layers (wear a hat and gloves or mittens).
  • In the rain, choosing rain gear that works against wind-driven rain.
  • Using the buddy system or working in pairs so help is nearby if needed.
  • Knowing the weather and taking precautions based on the forecast.

Frostbite

Frostbite is the freezing of the skin and tissue of a body part exposed to temperatures of 32° F or below. The first symptom is an uncomfortable aching sensation, tingling, or stinging. If the condition is allowed to continue, numbness sets in. The skin initially turns red, later becoming pale gray or waxy white. In extreme cases, Frostbite can be very serious and result in the loss of or permanent damage to a body part. People have lost fingers and toes from Frostbite.

Frostbite occurs superficially and deep. Treatment depends on the degree of frostbite injury. The longer a body part has been without feeling, the more severe the frostbite. If the time is very short, the frostbite is probably superficial. Otherwise, you should assume the injury is deep and therefore, serious. In the case of deep frostbite seek emergency medical treatment immediately. While waiting for emergency medical care, protect the frozen part of the body from further injury by heeding these do’s and don’ts:

  • Do keep the parts of the body not frozen warm.
  • Don’t thaw frozen body parts by rubbing, bending, or massaging.
  • Don’t soak the frozen area in either cold or warm water.
  • Don’t rub the frozen body part with snow.
  • Don’t expose the frozen body part to hot air, engine exhaust, or open fires.
  • Don’t use ointments or salves.

The prevention of Frostbite consists of:

  • Dressing properly in layers to keep the body warm.
  • Always wearing a hat and gloves or mittens.
  • Avoid wearing clothing that interferes with circulation. Tight-fitting shoes, socks, and gloves are especially dangerous.
  • In rain choosing rain gear that works against wind-driven rain.
  • Using the buddy system or working in pairs so there is help nearby if needed.
  • Knowing the weather and taking precautions based on the forecast.
  • Exercising your face, fingers, and toes to keep them warm.

Trench Foot

Trench foot is caused by prolonged standing in water or by having wet feet for hours while exposed to a temperature just above freezing. The stages of trench foot are:

  • Early stages-feet and toes are pale, numb, and stiff while walking becomes difficult.
  • Later stages-feet and toes become red, swollen, and warm, which can include flesh dying.

There are several reasons the feet are susceptible to Trench Foot that include:

  • The feet are far from the heart causing the heart to pump blood longer distance to warm feet.
  • When standing for long periods, blood circulation can slow.
  • It is easy for the feet, even in waterproof boots, to get wet.
  • Tight socks or tight-fitting boots can restrict circulation.

The best prevention for Trench Foot is a good pair of shoes or boots and socks that fit properly. Here are a few dos and don’ts:

  • Do dry, wet feet as soon as possible and put on dry socks.
  • Do dry the inside of boots and shoes.
  • Do seek medical attention as soon as foot problems occur.
  • Do exercise the feet by stamping, stepping back and forth while flexing and wiggling the toes when working out in the cold.
  • Do handle feet gently.
  • Do wash feet carefully using mild soap and water.
  • Do dry and elevate the feet leaving them uncovered and at room temperature.
  • Don’t rub or massage them.
  • Don’t restrict blood circulation by wearing tight socks or lacing shoes too tightly.

With people out and working in the hazardous winter weather, it is important to know what cold weather injuries are, how they occur, how serious they are, first-aid treatment, and what can be done to prevent them. One last point the author would like to highlight is a mnemonic used by the U.S. Army. COLD is a good memory device for the use and care of cold weather clothing and footwear that can be used as the first line of defense against exposure to cold weather.

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Winter Weather Driving Guidelines

If this year is anything like years past there will be more opportunities for employees to be plowing snow, clearing sidewalks, and perhaps, more importantly, providing fire and ambulance services to their communities in inclement weather. The public expects essential services even under extreme weather conditions. This can put a strain on employees and contractors hired to do the work. There are even many locations that depend on volunteer fire and ambulance services. The hazards of driving in extreme weather can be identified and intelligent decisions made as to who will drive under what conditions. This blog post will highlight a rating scheme that includes a risk management matrix in an effort to help protect public employees driving in winter weather.

Road conditions can be rated on a continuum from green or normal driving conditions to black or dangerous. For discussion purposes, it is best to start with a description of the types of road conditions. GREEN road conditions include dry road surfaces, with no ice or snow, visibility greater than 150 feet and a temperature greater than 35° Fahrenheit (F). Most people would describe these driving conditions as normal. These conditions normally won’t cause or contribute to a motor vehicle accident. These conditions normally call for unrestricted vehicle dispatches; however, drivers should be reminded to observe normal precautions and speed limits. Decisions to dispatch vehicles should come from a first line supervisor.

As weather conditions start to impact driving they are usually identified as AMBER. At this point, normal road conditions, temperature, and visibility do not exist. The road surface is wet from rain; or the road surface contains packed snow or slush, usually less than four inches; or the road surface has patches of ice or black ice, or visibility is reduced to between 60 and 150 feet, and the temperature is between 30-35° F. At this point drivers must:

  • Increase driving times
  • Drive 10 miles per hour (MPH) below the posted speed limit to maintain  traction
  • Increase following distances to allow for safe stopping

Driver experience should be considered when determining whether or not to dispatch vehicles under Amber conditions. The decision to dispatch should be made by the second level supervisor.

As the weather creates worse road conditions the description of RED is more appropriate. At this point water is flooding or snow is drifting across the road surface, or there is sheet ice, or the snow depth is greater than four inches. Visibility is less than 60 feet and the temperature is below 30° F. At this point only mission-essential and emergency-essential vehicle dispatches should be authorized. Driving above 10-15 MPH could cause vehicles to lose traction and safe stopping distances are significantly increased. A risk assessment should be completed before dispatch to determine if the risks of the vehicle trip are worth taking. The decision to dispatch should now be made by a third level supervisor.

If weather conditions continue to get worse and impact the road surfaces the term BLACK is applied. The road surfaces are now heavily flooded or heavy drifting of snow is occurring. There are extremely large areas of sheet ice and the snow might be greater than six inches deep. The visibility is now down to 45 feet and the temperature is below 10° F. At this point the dispatch of vehicles is limited to emergency-essential vehicles (police; fire; ambulance; snow and ice removal (SNAIR) vehicles, and emergency engineering services). Chiefs of appropriate offices (police, fire, medical activity, and public works) should authorize dispatch of vehicles. A risk assessment should be completed before dispatch to identify control measures to reduce risks.

As winters go weather seems to be getting more severe. Now is the time to prepare for this winter’s weather. One area of preparation is identifying who will be allowed to drive vehicles when and under what conditions. The more severe the weather the fewer people should actually be able to drive vehicles. There will always be exceptions for SNAIR, police, fire, and medical services. The public expects essential services even under extreme winter weather conditions and it is up to employees and contractors to get the job done in spite of the strain it places on them. As we look at the road hazards of winter we should not forget about the volunteer fire and ambulance services. This blog post has identified the hazards of driving under extreme winter weather.

Recommendations were also included to help supervisors make informed and intelligent decisions about who will drive under what conditions. This blog post also highlighted a rating scheme that included a risk management matrix in an effort to help protect employees.

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Hunter Safety a Must

Each year hunters head for the woods during the fall turkey and deer hunting seasons. Unfortunately, what is intended to be a time of fun and recreation all too often ends in tragedy. Because of hunting accidents, some hunters never return home, and others are seriously injured. Most accidents are preventable, by diligently following simple safety rules.

A dozen recommendations to prevent hunting accidents:

  • Attend a good hunter safety course.
  • Be physically fit, dress warm and comfortable, and wear a significant amount of hunter orange clothing so other hunters can see you.
  • Make sure you are familiar with the weapon you will be using and any safety instructions for it.
  • Do not hunt if you are distracted, overly tired or hurried. Beware of hunting companions who are careless, excited, or overeager.

Wear clothing appropriate for the weather. Protect against frostbite, hypothermia, and other cold-weather injuries. During cold weather, wear several layers of loose-fitting clothing.

  • Never mix drinking and hunting and do not hunt with anyone who has been drinking.
  • Treat every gun as loaded. Always point the muzzle in a safe direction.
  • Be sure of your target. Never shoot at unidentified noises. Wait until the entire deer, turkey, or other animal is visible, before shooting. Never shoot in the direction of people.
  • Carry your gun properly, using both hands. Make sure the safety is on, the finger is outside the trigger guard, and the muzzle is pointed in a safe direction and under control.
  • Do not load the weapon until ready to fire. Unload the weapon before crossing a fence or climbing into or out of a tree stand. Never run with a loaded gun. Unload it before putting it into a vehicle.
  • Never hunt alone or without telling someone where you will be and when you will return.
  • Make sure tree stands are stable and will support your weight. Wear your safety belt. Do not sleep while in the stand. Be careful when firing from a tree stand. Use care when climbing into or out of the stand.

Follow these rules and live to hunt another day.

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It is time for Halloween Safety

As the big spooky day approaches and you gather your costumes and treats, don’t forget to complete a Halloween safety check.  Start your trick-or-treating tradition off on the right track with these tips, and the worst danger you face will be a stomachache from eating too much candy!

  • Accompany your child while trick-or-treating to significantly reduce the risk of possible danger.
  • Well-lit streets in neighborhoods that you know provide the best trick-or-treat route.
  • Choose a costume with reflective or fluorescent colors to make your child more visible.
  • Use light-colored trick-or-treat bags to make children more visible in the dark.
  • Give your child a flashlight to play with so she can see and be seen.
  • Check all candy and throw away suspicious ones.
  • Buy only flame-resistant costumes, masks, and other Halloween gear.
  • Don’t use oversized clothing; it is not safe.
  • Purchase a mask that allows your child to see clearly with it in place before.
  • Tell your kids not to:
  • accept rides from strangers
    • accept treats from persons in a car
    • take shortcuts through alleys, parks, or backyards
    • never go into a stranger’s home

Following these simple tips can help you have a safe and enjoyable Halloween.

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Recognize October as Fire Prevention Month

October has long been fire prevention month to me. The reason I like to use October to raise the awareness of fire prevention primarily in the home. If awareness is raised at the same time each year people learn the habit of preventing fires. I emphasize fire prevention because fires kill people. The Federal Emergency Management Association reports that 1592 civilian home fire fatalities reported by U.S. news media between January 1, 2017, and October 10, 2017 (Home, 2017). The actual cause of these fires can be found by entering information at https://apps.usfa.fema.gov/civilian-fatalities/incident/reportMap. I also like to use the local Fire Department to help provide information for the employees of the organization I am working for. Furthermore, I use the U.S. Fire Administration site at https://www.usfa.fema.gov/prevention/.

The primary tool to prevent deaths from fire is for every home to have smoke detectors installed. I always push for installing smoke detectors in homes that don’t have them. Put it simply working smoke detectors save lives in the event of a fire.  Three out of five home fire deaths resulted from fires in properties with no or no working smoke alarms (Ahrens, 2017). The National Fire Protection Association has a program titled Planning & Implementing a Successful Smoke Alarm Installation Program that you can download from              file:///C:/Users/frede/Downloads/Smoke%20Alarm%20Installation%20Guide.pdf. I encourage you to download this program and try to get a program working in your community.

When smoke detectors are installed they won’t help if they don’t work. I emphasize installing new batteries and testing in October. This again gets people in the habit of installing new batteries. There is normally a button on the detector that tests its operation. If the detector with charged batteries doesn’t sound an alarm when this button is pushed the detector must be replaced.

Another element I like to emphasize during October is developing and practicing an escape plan from the home. The National Fire Protection Association provides information to help with this task that can be accessed at http://www.nfpa.org/Public-Education/By-topic/Safety-in-the-home/Escape-planning/Basic-fire-escape-planning. It essential for everyone living in a home to understand how to get out of the home and where to meet nearby to ensure everyone is safe. This can be more difficult for families living in multi-family buildings. It is however just as important. Once a fire escape plan is developed it must be tested to ensure it works. Afterwards, families should practice there escape plan twice a year.

The loss of life is always terrible, but it can be worse in a situation where that loss of life could have been prevented. The loss of life in many fires can be prevented by installing and maintaining smoke detectors as well as developing and practicing a fire escape. Each October take the time to emphasize fire safety knowing that lives can be saved by the effort.

Bibliography

Home Fire Fatalities in the News retrieved on October 19, 2017, from  https://apps.usfa.fema.gov/civilian-fatalities/incident/reportMap.

Ahrens, Mary, Smoke Alarms in U.S. Home Fires September 2015 retrieved on October 10, 2017, from http://www.mysmokealarmla.org/wordpress/wp-content/uploads/2016/08/ossmokealarms.pdf

 

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Prepare to Evacuate Nursing Homes

A rehabilitation and nursing home were forced to evacuate over 100 patients because of a gas leak. Then there were those pictures on the news of elderly people waist-deep water from Hurricane Harvey as water flooded into their nursing home. Finally, there were the 35 patients that died from flooding in their nursing home from Hurricane Katrina

These stories are real and remind us all that elderly people living in facilities need to have emergency plans to remove them from the danger. Most if not all these people cannot rescue themselves and depend on the caregivers of the facility to help them. Too many times these caregivers fail. When that happens, people face severe danger, and some even die.

What can be done? The owners of these type of facilities need to develop viable Continuity of Operations (COOP) capabilities to ensure these residents or patients are safe. COOP planning must is done in advance of the emergency. Contract for

  • Space and facilities to relocate patients and residents too.
  • Travel and transportation services to get patients and residents to an alternate
  • Employees to stay and provide their services in the event of an emergency even at a different location.
  • Meals and medical services at an alternate location.
  • Travel and transportation services to get patients and residents back to the original site after resolving the emergency.

This plan should allow staff to move patients or residents to an alternate location before or just as the emergency strikes. It will provide for any treatment as well as meals and care while at an alternate site. Lastly, it will bring everyone back to the original facility. It is also important to notify the relatives or guardians of the patients or residents that they have relocated. Here are some things that I think are helpful:

  • Delegate full authority for the person in charge of the facility to act.
  • Train employees about their roles in the event of an emergency.
  • Maintain vital records and databases in electronic format an alternate site.

Since there will likely be medical records on site, it is important to ensure that information is available at the alternate site. Do this with information technology equipment and transmissions.

It is essential that a risk assessment is conducted for the alternate site to identify risks. Act on those risks and reduce as many as possible.

This blog post touched on a grave weakness with nursing and rehabilitation facilities not fully prepared for emergencies such as hurricanes. Without this planning, it will be very difficult if not impossible to respond. Moreover, if the response is weak patients or residents can die.

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What Is Measured Gets Done

Things that are measured and tracked by management are the things that usually get done in an organization. I have found that including safety in performance appraisals gets hazards fixed, poor behavior corrected, and accidents prevented. Does your organization use performance appraisals to enhance the safe performance of employees? If not, I recommend they begin using them this way the very next performance cycle and in this blog post I will explain how.

Performance cycle usually last 12 months, which gives the employee ample time to demonstrate performance. To be effective supervisors must develop performance standards prior to the rating period. These standards are satisfied by the employee in the performance of the most important duties. Here are some actual examples of safety performance standards:

  • Report unsafe acts and working conditions within one-hour of occurrence to a supervisor.
  • Report accidents within one hour of occurrence to a supervisor.
  • Complete accident reports within seven days of the accident.
  • Perform before operational checks of equipment.
  • Wear safety clothing and equipment for tasks identified as requiring them.
  • Provide lockout and tagout procedures prior to equipment maintenance.

For each of the safety performance standards, you should describe five levels of performance (Wolfe, 2015). The levels will form to a bell curve and show the middle range of fully successful. This means that a 5 is the best score while 1 is the worst score. Barry Wolfe (2015) describes the five levels as 5 = Outstanding, 4=Exceeds Expectations, 3=Fully Successful, 2- Does Not Meet Expectations, and finally 1-Immediate Improvement Required.

Let’s look at one example: “Perform before operational checks of equipment.” The five levels would look something like:

  • Level 1-Does not perform before operational checks of equipment daily.
  • Level 2-Performs before operational checks of equipment three of five days.
  • Level 3-Performs before operational checks of equipment every day.
  • Level 4-Performs before operational checks of equipment every day and makes minor repairs to
  • Level 5-Performs before operational checks of equipment every day and trains other equipment operators to perform daily before operational equipment checks.

The five levels must be described for each safety performance standard. With safety performance standards like these in place, the safety performance can now be measured. In contrast to the measures listed earlier, there is one that is not efficient or effective but is often used. Do not use “Reduce accidents by X%” as a performance standard. The primary reason is that most employees have little control over the actual accident. What they have controlled over are following procedures, reporting and correcting unsafe conditions, and behavior. The performance standards must be written down and agreed to by supervisor and employee. Minor changes may have to be made to get both the supervisor and employee to agree.

To be effective employees must be counseled on their performance periodically during the rating period. The results of employee counseling are collated and become the end of year review. This is a meeting with the employee to go over their performance during the entire one-year rating period. It is too late for improvements now. The rating is assigned based on the actual performance of the employee. The end of year appraisal is discussed with the employee and both the supervisor and employee must sign. If the employee refuses to sign a note signed by a third party indicated that the meeting took place and the employee refused to sign. I think ratings work best when they are tied to pay increases or performance bonuses.

It is also important to mention in the annual performance report any safety milestones the employee might have reached. An example could be “During this rating period Henry reached the 1 million miles driving milestone and received an award and salary increase.” This keeps the ratings on the up and up. I also find it helpful to mention in the annual performance report when employees did something exceptional. An example would be that “During the rating period Peter found a broken gear in the machine during his pre-operational checks. This replacement saved the machine from severe damage saving the factory time and money.”

If your organization uses performance appraisals, it is important for those performance standards to enhance the safe performance of employees. In this blog post, I explained how to use safety performance standards. If your organization begins to use safety performance standards I believe they will find accident rates and the associated costs going down.

Bibliography

Klinger, Donald and John Nalbandian (2003).  Public Personnel Management: Contexts and Strategies, 5th ed., New Jersey, Prentice Hall.

Wolfe, Barry (2015). Performance Appraisals: To Appraise or Not to Appraise, Pittsburg, The Express Press.

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