Image courtesy: Coastal Mag
Summer is upon us, a time of year many folks look forward to after a New England winter. The days are longer and warmer. It seems as if the heat arrives earlier each year; hot days increasingly populate the calendar in May and June. Certainly by July we are in the midst of the so-called dog days of summer. All that beautiful sunshine is not without risk and one such risk is heat stroke. What exactly is heat stroke? How do we prevent, recognize, and treat it in the field?
Heat Illness Types, Diagnosis and First Aid
Long hours in the sun, limited shade opportunities, strenuous activity, various individual health conditions coupled with limited resources aboard a boat and certain weather conditions increase the risk for heat-related illnesses. These illnesses range from heat stress and heat strain to the most serious illness, heat stroke.
Heat stroke is a life-threatening diagnosis that requires immediate interventions and medical attention. It is present when the body’s core temperature reaches in excess of 104oF. Don’t worry, no one expects you to take someone’s temperature at sea. Instead you can rely on the signs and symptoms to make an informed assessment. According to the National Institute for Occupational Safety and Health (NIOSH), key indicators of heat stroke include: - Confusion, altered mental status, slurred speech - Loss of consciousness (coma) - Hot, dry skin or profuse sweating - Seizures
Given that heat stroke can be fatal if treatment is delayed, if you see any of the above indicators it is an emergency. Notify the U.S. Coast Guard and nearby vessels and return to port immediately. The Coast Guard will assist as needed and alert Emergency Medical Services (EMS) ahead of your arrival in port. While on the vessel, rapid cooling is the single most important action to improve the person’s outcome. NIOSH also recommends: - Move to a shaded, cool area on the boat and remove outer clothing and equipment - Cool the individual quickly with a cold water or ice bath if possible; wet the skin, place cold, wet cloths on the skin, or soak clothing with cool water. - Circulate air around the person to speed cooling. - Place cold, wet cloths or ice on the head, neck, armpits, and groin; or soak the clothing with cool water.
Given the seriousness of heat stroke, captains and crew should monitor themselves and each other for the milder symptoms that can lead to heat stroke. Heat exhaustion often precedes heat stroke and should be taken seriously. Symptoms include excessive weakness, dehydration, light-headedness, heavy sweating, headache, nausea, vomiting, abdominal discomfort, and paleness. Any lobsterman or fisherman experiencing any of these symptoms needs to stop all activity. As above, move him/her to a shaded cool area, take off excess clothing, and physically cool with (ice) water. Rehydrate with cold water; a sports drink can be used if nausea/vomiting is not present. Continue to observe and support the individual as you head back to port. If the symptoms do not decrease, professional medical care is advised upon arrival in port.
Heat cramps and heat syncope (fainting) are more narrowly-focused symptoms often noticed early in the progression to heat stroke. Muscle cramping is, as you might expect, more common when dehydration and electrolyte imbalances (i.e., salt imbalances) are present. Syncope and/or near-fainting often occurs when a person in hot conditions stands up too quickly or has been on his/her feet for a prolonged period of time without moving. When fainting happens as the result of a sudden change of position or prolonged standing, the condition is described as syncope, not heat stroke; cooling interventions should be started to avoid progression to heat stroke. As with any loss of consciousness, be on the lookout for secondary injuries related to the fall such as head or other bodily trauma.
Keep in mind the onset of heat illness can occur rapidly and symptoms are not necessarily sequential.
Prevention
Now that we have a basic background on heat stroke/illnesses, we can talk about prevention. Prevention is too often only addressed after an incident occurs or at the end of an article like this one when it should be the first thing on our minds.
Before the hot season, adapt or acclimatize to hotter conditions safely. Typically, this process takes about 1-2 weeks of heat exposure. Increase work duration/intensity in a phased approach to allow the body to adapt to increasing heat. In the Northeast, hot days can be randomly peppered in during mid- to late spring. The sudden arrival of hot days poses a high risk to lobstermen and other fishermen because the environmental stressor (heat) has sharply increased before physiologic adaptation has had a chance to occur. These acute conditions require shorter work duration and decreased work intensity along with more frequent breaks.
Hydrate long before departing the harbor, while at sea, and upon return. This means ensuring you have enough chilled water on board before you leave for the day. Drink water and include a sports drink to replace electrolytes during prolonged sweating. Avoid caffeine and alcohol as both lead to dehydration.
While fishing, take breaks to rest, cool off and hydrate. Weather has always been a critical factor to fishermen, and its implications for heat illness at sea are also important. Take note not only of the temperature but also the humidity. This combination gives the heat index, aka “feels like” temperature, and more accurately reflects the increased thermal strain on the body. Consider downloading the OSHA (Occupational Safety and Health Administration)-NIOSH Heat Safety Tool application on your phone. It uses your location-specific heat index to help guide decision making. The app also provides condition-specific recommendations, signs/symptoms of heat illness and first aid guidance. A third factor in the mix is the amount of sunshine. Full sun adds 13oF while partly cloudy adds 7oF. A sample work/rest schedule can be found at www.cdc.gov/niosh/mining/UserFiles/works/pdfs/2017-127.pdf.
Provide annual heat stress education for your crew. Preferably this training would be conducted in the spring before hot weather takes hold. Training material is available from the NIOSH and OSHA websites. Beyond what has already been discussed above, remind the crew that individual factors and baseline fitness levels influence heat tolerance. Those with obesity, certain medications/dietary supplements and acute or chronic illness, such as diabetes, are more susceptible. Establish and review emergency action plans with an emphasis on responding to heat stroke. Keep a few extra electrolyte/sports drinks on board in case of a heat-related illness on your vessel, or to provide to another crew during a Good Samaritan response. Whether you’re a crew of one or a captain of many, these precautions should keep you safe out at sea or potentially save a life if a “hot” medical issue arises.
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