Protecting Yourself from Cold Stress Illness

Workers who are exposed to extreme cold or work in cold environments may be at risk of Cold Stress. Extremely cold or wet weather is a dangerous situation that can cause occupational illness and injuries such as hypothermia, frostbite, and trench foot.

Trench Foot

Any injury to the feet resulting from prolonged exposure to wet and cold conditions that can occur at temperatures from 60 degrees or below, when the feet are constantly wet due to sweat or immersion in water.

Symptoms: Reddening of the skin, numbness, leg cramps, swelling, tingling pain, blisters and ulcers, bleeding under the skin, gangrene (foot turning grey, dark purple, or blue).

First Aid: Remove shoes/boots and wet socks; Dry feet thoroughly; Avoid walking on feet (may cause tissue damage) for 3-10 days as per doctor’s recommendations.

Frostbite

Any injury to the body that is caused by freezing, which most often affects the nose, cheeks, chin, ears, fingers, and toes.

Symptoms: Reduced blood flow to extremities (mentioned above), numbness, aching, tingling/stinging pain, bluish or pale waxy skin.

First Aid: Get into a warm area out of the weather ASAP; Unless necessary do not walk on frostbitten feet/toes; Immerse the affected area in warm (not hot) water, or warm the affected area with body heat. Do not use radiating heat from hot pad, furnace, electric heater, or fireplace for warming; Do not rub or massage the frostbitten area (may cause tissue damage).

Hypothermia

A condition in which the body uses up its stored energy and can no longer produce heat. Often occurs after prolonged exposure to cold temperatures.

Early Symptoms: Shivering, fatigue, loss of coordination, confusion/disorientation.

Late Symptoms: No shivering, blue skin, dilated pupils, slow pulse and breathing, loss of consciousness.

First Aid: Seek immediate medical attention; Move victim into a warm room/shelter; Remove wet restrictive clothing; Warm the center of the body first (chest, neck, head, groin) using blankets or skin to skin contact under loose dry layers of blankets, towels, clothing; If the victim is conscious and lucid give them warm (not hot) non-alcoholic drinks; Once body temperature has increased, keep them dry and warm in blankets including head and neck; If no pulse, begin CPR.

Preventative Protection

Watch or listen to weather forecasts and prepare for the day:

• Monitor your physical condition and that of your co-workers

• Wear appropriate clothing for the conditions (Keep warm and dry)

• Be aware that some clothing may restrict movement putting you at greater risk due to loss of circulation; Wear loose fitting layered clothing

• Protect ears, face, hands, and feet in extremely cold, wet, windy conditions

• Take breaks in warm locations (but not overheated); Limit the amount of time outside

• Carry extra socks, gloves, hats, jacket, blankets, and a thermos of warm liquid

• Include chemical hot packs in your first-aid kit

• Avoid touching cold hard objects with bare skin

Trenching and Excavation Safety: Planning is Paramount

In an instant and without notice, an unsupported trench can give way and a worker can be buried alive. “Even though small amounts of dirt may not seem treacherous, a single cubic yard of dirt can weigh more than 3,000 pounds, which can fatally crush or suffocate workers,” NIOSH states. OSHA notes that excavation and trenching are among the most hazardous construction operations, with cave-ins being perhaps the most feared trenching hazard. Other hazards in this line of operation include: falls, hazardous atmospheres, and falling loads.

How can employers help keep workers safe? NIOSH recommends that employers do the following before beginning a trenching or excavation project:

·       Designate a trained “competent person” to check that all safety precautions are in place. In relation to trenching, OSHA defines a competent person as “an individual who is capable of identifying existing and predictable hazards or working conditions that are hazardous, unsanitary, or dangerous to workers, soil types and protective systems required, and who is authorized to take prompt corrective measures to eliminate these hazards and conditions.”

·       Call 8-1-1 to ensure no utility lines are in the job area and to mark any existing lines.

·       Locate safe places away from the trench to place spoil piles and heavy equipment paths.

·       Ask the competent person to determine what kinds of protective systems will be needed for the job and have the systems in place before workers are allowed in the trench or excavation.

·       Enforce the rule that workers who are younger than 18 are not allowed in the trench or excavation.

·       Assign workers to the job only if they have been trained about hazards and work practices in a language and at a literacy level they understand.

·       Have a written emergency action plan in place that details the steps to take in the event of a trench incident and do hands-on training of that emergency action plan.

·       Make sure all workers know to never enter an unprotected trench.

·       Teach workers to immediately exit a trench and call for the competent person if they find any evidence of problems with the protective system.

Trench Rescue Awareness for Emergency Services Personnel

A dispatch call for a trench emergency rescue is not common for EMS and fire departments. But when a call like this comes, is your department prepared to respond to a trench rescue incident? Are your providers trained in what to do? This article provides some awareness-level information for responding to a technical rescue in a trench.

While trench rescues may not be common, trenches in municipal public works are. Often at construction sites, trenches are dug for workers to install or repair underground utilities, including water pipes, sewer pipes, and electric lines. These types of trenches are often narrow and deep, descending anywhere from four to 20- plus feet. These excavations differ from other trenches that are wide and deep, often used for repairs of streets, gas lines, or water main repairs. At times workers operating in excavations will be using a protective trench box or shoring.

If an emergency occurs in a trench, it could be a cave-in or a non-cave-in situation. Cave-ins are generally due to changing weather conditions, machinery, or vibrations that cause the walls to collapse, or removed dirt from the spoil pile falling back into the trench. A non-cave-in situation may be a medical emergency in the trench, entrapment of a worker under a pipe or machinery, flooding, or equipment failure.

It is crucial that first-arriving emergency units establish command, contain the incident, and request the appropriate resources. To establish command, follow your written “incident command guidelines.”

·       Notify dispatch

·       Size up the situation and determine if it is a cave-in or non-cave-in

·       Determine the number and types of victims

·       Determine the nature of the emergency

·       Determine the hazards on the scene (utilities, weather, water, hazmat, machinery)

·       Determine the approximate depth of the trench

·       Determine if it is a rescue or recovery operation

·       Establish “hot, warm, and cold” zones (hot= only trained rescuers, warm= trained support staff, and cold = non-trained personnel are not allowed within a 10-foot radius around the trench)

·       Make sure no first responders endanger themselves by urging them not to play hero and enter the “hot” zone without the proper training and technical equipment

·       Establish a staging area for equipment and personnel coming to the scene

A trench rescue incident requires a technical rescue team. A minimum of 20-30 rescue technicians are needed for the operation. Since most municipalities don’t have the personnel or the training to perform a trench rescue, it is much more feasible to thoroughly and effectively plan out your trenching jobs and use the appropriate techniques to protect your workers prior to sending them into a trenching situation.

Specialized equipment will need to be brought in by rescue teams, such as airbags, struts, shoring, hand tools, buckets, ladders, ground pads or plywood to stabilize the area around the trench, ropes and rigging, generators, and lighting. For extended incidents consider additional resources such as food, water, and warming equipment for rescuers. Rescues are not generally done in a few minutes. Often they take hours and many times result in a recovery rather than a rescue.

Two feet of soil covering a victim can be the equivalent of 600-1000 pounds on their body. Clearly, crushing and airway compromises are strong possibilities. Once an EMS can assess a victim, the following should be treatment priorities:

·       Airway access and control

·       Oxygenation

·       Maintain body temperature

·       Intravenous access before removal of victim

·       Head, eye, and ear protection

·       Pain management

·       Fracture management and immobilization

It is highly recommended that all responders take a trench rescue awareness and operation course that meets NFPA standards. While trench rescues are rare, they are technical operations requiring a great deal of personnel, resources, and logistics. The best way to prevent a trench rescue situation is to follow strict safety procedures in setting up your municipal trenching and excavation situations before you put workers at risk in the trenches!