Dr. Michael Picio, DO, Retired Navy Physician, Medical Director of Taylor Made Diagnos
Employees who work outside are vulnerable to cold weather injuries. Having employees prepared for winter is critical.
Four factors contribute to cold stress: cold temperatures, high or cold wind, dampness and cold water. Cold forces the body to work harder to maintain core temperature. When in cold environments, the body's energy is used to keep its internal temperature warm. The body shifts blood from the extremities to the core (chest & abdomen). When the body can’t maintain temperature, it shivers to increase heat production. Severe shivering develops when body temperature falls to 95°F. Hypothermia then becomes an issue.
Some workers claim constant exposure to cold enables them to withstand cold temperatures better. In reality, workers learn to survive - rather than adapt - to cold weather. Getting used to cold weather (or habituation to cold) dulls awareness of being cold and increases risk of hypothermia. Long hair and beards provide little insulation; in fact, they can build-up ice and mask frostbite. Older employees aren’t able to generate heat quickly. Medications (anti-depressants, amphetamines, diabetes and some heart medications) may prevent generating body heat normally.
In Mild Hypothermia, move the victim to a warm area, keep them active, remove wet clothes, replace with dry clothes or blankets, cover the head, and have the victim drink warm (NOT Hot) sugary drinks (such as hot chocolate or soups). In Moderate Hypothermia, call 911, cover the victim’s extremities, and place hot packs or hot water bottles on the victim's head, neck, chest and groin. In case of an unconscious victim of Severe Hypothermia, do not attempt re-warming. Call 911 and handle the victim carefully - sudden movement or rough handling can send victims into cardiac arrest.
Frostbite occurs when skin freezes and ice crystals form in the tissues. Frostbite occurs readily from touching cold metal, because heat rapidly transfers from skin to metal. Frostbite develops within 3 seconds when touching metal below 5°F.
Frostbite symptoms include skin that looks waxy and feels numb. Once damaged, tissues are always susceptible to frostbite. Effects from frostbite may persist for several years. Cold, tingling, stinging, or aching feelings in frostbitten areas are followed by numbness. The victim’s skin turns red, then white or very pale, and is cold to the touch. Blistering occurs in severe cases.
In cases of frostbite, call 911. Do NOT rub the affected area with ice or snow; this causes further freezing! Do not warm affected skin if there is the chance of refreezing.
So, how can you assist employees to prevent cold weather stress?
Understand the impact of alcohol, caffeine and smoking. Alcohol impairs judgment and causes expansion of blood vessels in the skin, impairing the body's regulation of temperature. Caffeine increases urine production and blood flow to the skin’s surface, leading to decreased body heat and dehydration. Smoking decreases blood flow and increases cold injury risk.
Consider Exhaustion and Fatigue. Employees should not sit or kneel on cold, unprotected surfaces. Schedule work during warmer parts of the day, and take breaks out of the cold. Have employees work in pairs and keep an eye on each other as hypothermia victims may not recognize symptoms.
Wear the right clothing to avoid cold stress. Cotton loses insulation when wet. Denim is loosely woven, allowing water to penetrate and cool winds to blow away body heat. Duck or goose down stops wind, but becomes waterlogged. Plastic or woven nylon provides little insulation. Wool retains good insulation qualities - even when wet. Wear at least three layers of clothing, a hat extending to the neck, and insulated boots. Be cautious of tight-fitting footwear or wearing too many socks that will restricts blood flow Be sure to wear insulated gloves.
Although weather in Hampton Roads is usually mild, prepare for winter - even if it’s a short season. Ensure that your employees are aware of dangers in cold conditions.
About the Author
Dr. Michael Picio, DO, retired Navy Physician, is serving as Medical Director of Taylor Made Diagnostics, an occupational medicine and workers compensation clinic, located in in Chesapeake, VA. Dr. Picio is recognized for his medical leadership as an osteopathic medicine diagnostician and expertise in occupational medicine. Dr. Picio has received several awards and recognition for his achievements. Taylor Made Diagnostics has been an active member and supporter of VSRA for 10+ years.
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