Work Related Heat Illness Indicator. SouthON Regional Collaboration Annual SouthOn Meeting October 22 23, 2013

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1 Work Related Heat Illness Indicator SouthON Regional Collaboration Annual SouthOn Meeting October 22 23, 2013

2 Recognized Occupational Hazard Rash Heat Cramps Heat Syncope Heat Exhaustion Heat Stroke

3 Agriculture Construction Firefighters Bakery workers Miners Boiler room workers Factory workers Workers at Risk Workers at greater risk of heat stress include those who are 65 years of age or older, are overweight, have heart disease or high blood pressure, or take medications that may be affected by extreme heat. Source:

4 Outdoor Workers: forms of heat stress Internal metabolic, body heat + Moderate to high temps, high humidity, direct sun exposure, heavy clothing, lack of fluids, rest and shade Source: NIOSH Preventing Heat Related Illness or Death of Outdoor Workers Pub #

5 Other Risk Factors for Heat Related Illness Chronic health problems Mental illness Age Some medications Physically active Inadequate sleep Poor nutrition Alcohol and drug use

6 Occupational Heat Mortality in US Heat Related Deaths Among Crop Workers United States, (all industries) died due to heat 102 (24%) occurred in agriculture Of 102, 68 were involved in crop production Ave annual fatality rate for crop production workers was.39/100,000 crop workers vs..02/100,000 workers

7 44 year old Hispanic migrant farm worker dies from heat stroke while working in a tobacco field on a farm. Migrant Farm Worker Dies From Heat Stroke While Working on a Tobacco Farm North Carolina NIOSH In house FACE Report Arrived on the farm from Mexico on July 21, 2006, started work July 24 On August 1, 2006, he started work at 7 a.m.; break at 9 am & 12 pm. The weather was hot and humid with a heat index between 100 and 110. There were no breaks scheduled for the afternoon At 3 p.m. he complained to the crew leader that he was not feeling well, drank some water and was driven back to the workers' housing and left alone to rest. At approximately 3:45 p.m. found unconscious on the steps of the house. At hospital core body temperature 108º F and he was pronounced dead.

8 Department of Commerce, National Oceanic & Atmospheric Administration, US National Weather Service. [ Date accessed: 10/17/13.

9 Acclimatization 5 to 7 days 14 days for complete acclimatization Migrant workers still require this if new and hotter/more humid conditions or there is change in work load, temps or humidity EPA publication A Guide to Heat Stress in Agriculture, EPA 750 b & NIOSH Heat

10 Agricultural Production Dairy poultry tobacco Cotton, rice sugarcane, soybeans citrus

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12 Construction More construction workers in South compared with US (7.2 % vs. 6.4%) (BLS 2010) Non employer establishments as a percentage of all construction establishments, by state, 2007 The Con Chart Book, 2013 The Construction Chart Book 2013: CPWR, 2013

13 Manufacturing Manufacturing workers in South compared with US (9.1 % vs. 10.0%) (BLS 2010) Common industries include: Mining, quarrying, oil and gas extraction Chemicals Transportation and warehousing Food processing Machinery & transportation equipment Telecommunications

14 Source: National Climate Assessement 2013 Draft publicreviewdraft chap17 southeast.pdf

15 Source: National Climate Assessement 2013 Draft publicreviewdraft chap17 southeast.pdf

16 Work Related Heat Illness Indicator Rationale Provide a means to track occupational heatrelated illness Using ED an HD data Modeled after Environmental Public Health Tracking Baseline to understand the magnitude of the disease burden in the population

17 Methods Demographic Group: NUMERATOR Denominator: Measures of Frequency: Time Period: Employed persons Emergency department (ED) visits with primary payer coded as workers compensation or a work related Ecode Employed persons age 16 years or older for the same calendar year Annual number of ED visits for persons age 16 years or older (numerator) Annual crude rate of ED visits per 100,000 employed persons age 16 years or older Calendar year

18 Data Resources: Other available data: Emergency department visits data (numerator) BLS Current Population Survey Data (denominator) Age, gender, race/ethnicity, diagnosis, residence zip code

19 Methods 1. Identify all heat cases in data set (ED/HD) Inpatient visits with a primary or contributing diagnosis of ICD 9 CM code (Effects of heat and light) or ICD 9 CM Ecode of E900.0, (excessive heat due to weather conditions) or E900.1 (excessive heat of man made origin), or E900.9 (excessive heat of unknown origin)

20 Methods 2. Filter for work related cases Use only cases defined as work related Define work related as primary payer = Worker s Compensation or, the presence of a work related E code (see table)

21 Work Related E Codes ICD-9-CM Definition E000.0 Civilian activity done for income or pay E000.1 Military activity E800-E807 E830-E838 E840-E845 Railway accident among railway employee (4th digit = 0) Water transport accident among crew, Dockers and stevedores (4th digit = 2 or 6) Air and space transport accidents among crew and ground crew (4th digit = 2 or 8) Accidents involving powered vehicles used E846 solely within the buildings and premises of industrial or commercial establishment E849.1 Place of occurrence: farm building/land under cultivation E849.2 Place of occurrence: mine or quarry E849.3 Place of occurrence: industrial place and premises

22 Technical Notes E codes selected appear directly related to work Don t know how representative they are, if all hospitals contribute, some newer Limited published studies Need validation Show promise in expanding data collection A standardized list would be potentially useful for other conditions

23 Preliminary Data Emergency Department

24 Preliminary Data Hospital Discharge