So I think we'll go ahead and get started. Thank you. Thank you for your attendance at our session, which is entitled, When You're Hot, You're Hot, When You're Not, You're Not, Practical Measures for Dealing with Heat Stress. My name is Dr. Doug Martin, Dr. Bob Bourgeois. To my left, both immediate past presidents, you may ask yourself the question, why did we elect to do this session? And the reason is, is because this is a hot topic. Okay, that's the last joke, I promise. Okay, so we're going to go through some practical aspects of dealing with heat stress as it relates to some of the workforces that we take care of. You might say, well, what does Louisiana and Iowa have in common? Not much. However, we both deal with heat stress in different ways. Bob's is more external environment, outdoor type of thing. Mine, interestingly enough, is more inside, internal type of thing. So we'll have a little brief conversation about those things. Bob has got a lot more experience in dealing with this than I do, and he's got a lot more interesting stories to tell you than I do. But I thought that I would start off and just kind of give you my perspective on things. We have nothing to disclose. We don't own heat, so I guess that's good. So those of you who know me well know that I take care of meatpacking workers primarily because of the fact that in my neck of the woods, which is Sioux City, Iowa, we have large meatpacking facilities, both beef and pork primarily. There's some surrounding communities that also do chicken, turkeys, and some other interesting animals, including ostrich, by the way. So that's kind of fun. But there are lots of different heat mitigation strategies that are involved in the meatpacking industry. Now meatpacking facilities can be from entry until out the door in a final processing situation. And in the meatpacking world, we oftentimes refer to that as the kill side versus the chill side. And let me explain what I mean by that. So the kill side has to do with regards to obviously the killing of the animal, right, whether that's cattle, hogs, whatever, and the initial processing of that animal, right? So there's a hiding process. There's a process that's involved in getting rid of all the internal organs and so forth. And then that also includes, by the way, decontamination and inspection and all those types of things. So those types of jobs that are on the kill side are the ones that are subjected to the heat stress, right? Not talking about the chill side, which is the processing, that's where the various different cuts of meat occur, because those environments obviously are colder, right? So just want to make sure that everybody understands the differences here. So the problem with these types of facilities is that it's a very warm environment on the initial kill side of the facility. And there's reasons for that, one of which is, as I said, the decontamination process, which usually uses heat or steam in order to decontaminate the animal's hide. So it's a process to try to eliminate bacteria, grime, dirt, all those types of things. And it becomes not only hot, but also very humid. And that's difficult. So some of the mitigation strategies that are used in that scenario include line supervisors who actually now are focused only on making sure that the individual's health is okay. So one of the things that the line supervisor does now, say compared to maybe 20 years ago, is that they're really paying attention to how the worker is doing in that type of environment. And if there's any sense that the person's having difficulty with the heat or the humidity, then they're spelled out. One of the great things about the meatpacking industry is that they use a training philosophy. And obviously in a meatpacking facility, you have various different jobs that are available. But they employ what are frequently referred to as utility workers. In the lingo in the industry is yellow hats. And what they mean by that is that yellow is the color of the hard hat that they typically wear. But these people are cross-trained in many different areas. So you have the availability of a yellow hat to spell out somebody that's on the kill side of the equation if they run into a problem, they have to take a break, they have to get more water, they have to cool down, and those types of things. So it becomes a very useful type of process from a planning standpoint. There are some other things that have been introduced in the meatpacking world, and that's utilization of cooling vests and camelbacks just for water access instantaneously. Those of you who are campers, hikers, and so forth understand what a camelback is. It's something that can be worn that's like a canteen water source that's easily accessible. There are various different commercially available camelbacks nowadays that keep the water cool. And then you also have cooling vests that are available. And there's a variety of these things that we'll kind of show you some pictures of here that are intended to try to help with monitoring the core temperature of the individual. And just about every meatpacking facility that I know of nowadays has a rotational spell out type process. So it's not like the old, old days where somebody was working an eight-hour shift and they were sort of in the same place for that entire period of time. There are rotations here that are intentionally done so that, for example, somebody may be working 40 minutes in the environment on the line, on the kill side, sacrificing the animal or what have you, and then they have a 20-minute spell out time that's part of the routine. Those things have come a long way as well. What are some interesting things about the slaughter process? Well, it does require a lot of water. And if you've ever been inside of a meatpacking facility on the kill side, you know that the humidity here is very, very high. And the reason is because in most situations in animal processing for food products, there's a requirement to either have a fire blast or a heat flash method to decontaminate either the cattle or the hogs that are coming through the facility. And in that particular location, despite the fact that you can have circulating fans, lots of air exchange and that sort of thing that's part of the process, it still leads to some fairly high temperatures and high humidity work environments. So this is probably not a great picture to look at, but this is an example of what one of these facilities will look like. I have no idea if we can get the video here to actually work. But one of the things that I want you to pay attention to is if you look at the middle of that picture towards the top, you'll see how hazy it is. Probably that doesn't give you, you know, do justice with regards to how this actually looks when you're in this environment. But that's the steam that's generated through this process. So if you want to think of it, there's like a tumbler mechanism and you can see the hog that is exiting through the tumbler mechanism. Inside of that tumbler mechanism is where the heat is generated and that decontaminates the hog surface itself. And it doesn't look like I'm going to be able to get that to start, so sorry about that. So as I said, in large meatpacking facilities, line supervisors have multiple job tasks and one of those includes periodically checking the workers for heat-related illness. The spell out of the workers, again, we talked about the yellow hats and the utility workers that are cross-trained to kind of give them some breaks if that's necessary. It's a very effective way of making sure that you're not paying attention to individual workers' safety and needs, but also just from an efficiency standpoint, it doesn't decrease the processing, right? So the line continues to move along as it's supposed to move without any interruption or delay, which of course is very important in these facilities. These are just some examples of what camelbacks look like. I'm not a salesperson for the camelback company, but there are a variety of different styles of these that are available commercially. And again, water sources that can be used as something that you wear over the shoulders that's on the back, or there's a belt, kind of a fanny pack type of look to it, if you want to think of it that way. Both of these things are available. And then similarly, there's a variety of different cooling vests that are available. Some of the ones that are used in the meatpacking facilities are examples of what the, on the left-hand side, where there's actual replenishing type of thing. I think most people are familiar with the post-op cooling systems, like after a total knee or ankle surgery and that sort of thing that has a continuous type of thing where you get cooled water that goes through the reservoir. And this is the same type of thing. So these cooling vests can be very useful, especially in high-stress environments. On the right-hand side, that's not a meatpacking worker. That's something else that's more external. But that's intended to show you that there are more advanced cooling devices that are out there, some of which are complete encapsulation type of processes as well. So if you have a really significant heat environment, those things can be beneficial. And as I said, job rotation has come a long way in the meatpacking industry. It's probably the most efficient and simplistic integration strategy. And for whatever reason, it seems as though that it took a long time in this industry for people just to finally figure that out. But most facilities nowadays have gone to one-hour rotations in the summer months, meaning that there's a continuous spell out or change in job activity at one-hour increments. And again, that has been developed over time to make sure that that does not negatively affect any particular individual. So again, a very, very important process. So some of the things to think about are listed on this slide. And at this point, I will turn it over to my colleague, Dr. Bourgeois. All right. So Louisiana is an interesting place for heat because when we look at the heat stress tables, you really can't work in Louisiana for a 12-hour day. During the day from about April to October, you can't work 12 hours at night from about May to September. So when you start looking at the tables, you figure out what do I do to fix this? And this got to be really evident for us back when in 2010 with the Deepwater Horizon response. We had 49,000 folks working on beaches. A whole bunch of them were people that came down from up north in the late spring, had never been into the furnace that we call South Louisiana. And so we had all these folks who were trying to put to work and work them safely in the heat. And so anyway, we looked at a bunch of things. And so today, we'll talk about some of those. So some of the things we look at are obviously heat and humidity. But which jobs are hotter than others? Look at heat load generated by that job or by whatever other external forces. Drugs that increase heat risk. There are a whole ton of drugs that make a difference in heat. Energy drinks. Nowadays, everybody's doing some kind of energy drink somewhere. A bunch of them are all vaping now. So there's all these different stimulants and other things they're putting in their bodies. We'll talk about acclimatization, hydration, heat load mitigation. Heat load mitigation, like with the cooling vest and brakes and rotations, makes a huge difference. And then the heat stress monitors, which we used. And basically, it's a buddy system. So OSHA, with the new heat stress standard that's coming out, AECOM commented on a bunch of different things. And look in JOEM, we have a bunch of articles from AECOM members on heat and heat stress. And so some of the things we talked about were if you just use just the tables, there's no way we're going to get work done. And all these companies are freaking out. All the employees are freaking out, thinking I'm going to lose my job because I'm not going to be able to work in the heat. So how do we go about making this palatable? And what do we do to make everybody understand how it works? Let them work safely, but take care of our folks. And one of the things that we did way back when is heat stress monitors. And one of the great things OSHA looked at and said, man, this is super because this is actually supervisors taking care of their people, which is what you're supposed to do. So a lot of the things that we gave in some of the talks with OSHA about the heat stress and our comments were practical measures that will work. And I think it looks like some of that may be part of the package, which would be great. So a lot of things come out in the heat in Louisiana, and that's one of them. And he's really not that big. It's only about eight feet. So if you ever want to see a big one, come in my backyard. So with us, it's heat and humidity and trying to do those long stretches because, you know, offshore and a bunch of these places that never shut down, you know, remote areas where you're doing either maritime work on a vessel or you're working on an oil platform or a drill ship. Those are all 12 hour shifts. And then there's a difference in the workers in Louisiana between straight work or working hitches. Some of the folks that work offshore, they'll work seven and seven, seven days on, seven off, 14 and seven, 14, 14, 28 and seven. You know, so when you go home, if you go home and just sit in air conditioning, drink beer all week, you've got to get used to the heat again when you come back. So all those things we look at. And so if you're working on land and you're working five to seven days a week, you know, you do OK because you're kind of used to it. But when you go home for 28 days and then come back for 28, you have to kind of get used to that heat again. And so that's when we watch these folks and a lot of them, you know, they make a lot of the mariners from Maine, from Massachusetts, from Vermont, you know, so they trained up on the East Coast. They still live up there and they come back in that heat, you know, every hitch. And then PPE, because there's so many things we do that require PPE. And just like with some of the fire retardant clothing, that makes it pretty hot. And if you're working down there with that on, you have fall protection. So you're cinched up tight, all kind of different places. So it doesn't breathe. So we look at, you know, you know, tight clothes just to celebrate being in Florida. I didn't wear my tie today because my 18 inch neck doesn't fit with this shirt. That was my excuse. But it really it is cooler without a tie. So so the things that we look at, you know, the fire retardant clothing is a big issue. Fall protection is a big issue. Nomex and Tyvek, all those things that don't breathe well. We have a lot of folks down there that are sandblasters and painters. And they're working in the sun most of the time. So I did this, I don't know if you better read any of this, but this was April, I think April 20th, about five o'clock at night. So can you read the numbers on it close enough? If you look at it, you can only work 50% of the time doing heavy work at five o'clock at night in April in my hometown. So if we go by just by tables, it makes it hard to get anything done. And I put references to that chart and to this in the back so you can look at stuff. So I can click on here and see what the temperatures are on all these offshore assets. I can see what the temperatures are all around my house all around that area. And then you can plug those numbers back into that table and look at stuff for heat stress. And I'll put that in the resources for you. So some of the heat sources, I mean, just the sun is brutal enough, but then it's beaming off of all these metal boxes, metal buildings, metal everything, because everything offshore, a lot of it's mostly metal. Same thing on the vessels, it's all steel or aluminum. And then if you're working in an engine room, if you're sitting on top of a bulldozer, anything that's not air conditioned, you know, that's all that other heat source. We have thousands and thousands and thousands of welders. And a lot of times you're inside a pipe or inside the double hull of a barge, welding in that heat. Furnaces, smelters. What about roofers? That is the worst job I've ever done, and it made me want to stay in school, and it worked. Just try and get on a hot roof in Louisiana and do that in the summer. All the folks doing road work, same thing. Landscapers. Some of the guys doing yard work. You know, with the humidity we have, if you have a nice yard, and it's nice and pretty, you're either doing something in the afternoons or early mornings, or you're paying somebody else to do it, because there's no way you'd want to do that all day. Some of the hotter jobs, because if you looked at the heat load and how long you can work in that heat, engine rooms, deckhands, being on the deck of a boat, and all these different maritime companies have different company colors. That way you can recognize the vessels from a distance. Well, some of them, the deck is a lot darker, so it's a lot hotter. If you ever want to do something fun, get a infrared thermometer, one of the commercial ones. My dad had a white Toyota, my daughter had a black one. I just spotted the hood of both of them, I parked them in the driveway next to each other. 22 degrees different on the hood between white and the black one. Got inside, it was 18 degrees hotter inside the darker one. So that makes a difference. A lot of the companies have jumpsuits, you know the Nomex jumpsuits? They're company color. Well, if your company color is navy blue, it's going to be a whole lot hotter than the others. And they don't like the light colors because they show dirt more. Wow. I'd rather look dirty and be cooler. So sandblasters and painters, these guys are in Tyvek painting. A lot of times they have hoods on if they're blasting, but the painters are all wearing either half-face or full-face respirators. That's hot. Welders, fitters, all those guys, they're wearing leather to keep from getting burns from slag. They have leather gloves, leather sleeves, leather chest on the jackets. The Roughnecks and Roustabouts, if you ever want to see a job that will keep you in college, look on YouTube for a Roughneck on a drill ship and see how much fun that looks like. Show it to your kids, it works. Roofers, pavers, utility workers, all those folks. A lot of them don't have any physicals. Look at all the landscapers, roofers and all, because really, one of my buddies had a roofing business and I said, where do you get all the folks that want to do roofing work? He said, all the ones that can't pass a drug screen at your clinic. Okay. What would you look for? Because we asked that when we were trying to come up with some comments for OSHA. And one of the things is just a heat questionnaire. But of course, they have to be honest. But if somebody says they've passed out three times a year working in this particular job because of the heat, it might be somebody you'd want to watch out for either extra caution, getting them acclimatized, extra supervision, extra education. And a lot of this is teaching them stuff because most folks don't know anything about how to manage heat. So some of the personal risk factors. These are all listed. And this is from one of the ACOM papers. I'll put the references in there too. So if you download the presentation, it'll be in there. But you don't have a whole lot of folks at Parkinson's working offshore. You don't have a whole lot of folks with bad neurological disorders. But there are a lot of other things. We have a lot of diabetics offshore. Same thing on vessels. So obesity, huge difference. My wife used to work for SeaWorld. And I actually helped them when they operated on walruses and different things a few times. And if you go through the fat layer on a walrus and see how thick it is, I know for a fact they have some guys that work offshore that have more insulation than that. So that's got to do something to retain heat. And we've talked with OSHA before about when do you limit folks doing certain things in the heat? Because they obviously are gonna have more problems. And we see that. Older workers, and older workers to me is getting, the number's getting higher and higher here lately. But you know, apparently we do have problems with heat a little bit more. Look at amphetamine use. How many folks you see every day and on their physical, they tell you they're taking something for ADD or ADHD. And if you ask them, when they first started taking it, they said, you know, they were always warmer. They always felt a little hotter. Sometimes they feel like heat gets to them more. I said, well, it's a medicine. Why are you taking it? Well, I went to a walk-in clinic because my girlfriend says I don't pay attention to her. Good workup. So anyway, so we have a handful of good articles in JOM. Look at some of those. Some of the medicines. If you look at some of these, it's interesting. I mean, look at between alcohol, which we know, but a lot of the younger fellas working offshore, you know, they're gonna be out for two weeks, three weeks, four weeks. So what do they do the night before they go out? The last two or three nights before they go out. They go out and make sure they get their dose of alcohol. But some of these medicines, you know, you see almost all the time and every day. And so we look at them all individually, just see where they're working, what they're doing, any other issues, any problems. Are they working mostly inside, mostly outside? Is it 12 hours, is it four hours? Or are they taking other medicines with it? So hydration. I always talk to them, I say, you know, you need to hydrate all the time, not just when you feel thirsty. But the best thing to do is hydrate the night before. When you get home, you're already dry, because you're coming home dry. Drink two glasses of water, drink one before supper, one with supper. Drink two more before you go to bed. And I say, well, what if that makes me have to go to the bathroom? I say, well, when you get up, drink another one, you know? And so when you wake up in the morning, what color's your urine? Orange. I said, so you're starting out behind the eight ball. So you want to drink enough that it's clear when you wake up. Pam Heimel and I had three LSU offensive linemen in our med school class. So it must be true that the offensive line are the smartest guys on the team. But these guys were all huge, and I'd go on spring break with them, and they all outweighed me by more than double. But they said LSU had done a study at one time, and they would weigh the players in their shorts before the game and after the game. And some of them lost between 12 and 16 pounds during the game. Eight pounds to the gallon? That's a lot of water. And they're drinking during the game. And the O-line usually, you know, if you have a decent defense, only has to play about half the game. So they're playing 30 minutes and losing that much. So I talked to them about the occupational athlete. Said, you know, when's the last time you only worked 30 minutes one day a week? You're in the heat 12 hours a day. So you have to drink that much more. So I just give them a timeline and say, drink this much every hour, blah, blah, blah, and go through it. And really, you know, in our heat, you drink about three and a half gallons a day to keep up in a hot job. So scheduled breaks, we make them stop, and you gotta drink a certain amount of fluid before you go back to work. Because a lot of us, oh, I'm not thirsty, I'm not thirsty, and those are the ones that pass out a little while later. So if you drink a quarter an hour, a liter an hour, and you've done enough before you start, usually you make it through the day pretty well. But that's kind of where we have to go. Avoid coffee, hmm, not in Louisiana. But you can tell them, good luck. And then cool water seems to be easier than ice cold water, and they'll drink it. So, you know, if it's ice cold, a lot of times they'll sit there a little bit, a little bit, and dump it, because it was too cold. So cool seems to be better for them. And in electrolyte solutions, you know, if you think about it, I mean, I was trying to get one guy to start drinking more, and he did, but he didn't like the taste of water. He said he never did. So he was drinking Powerade or Gatorade, but the full sugar. You know, he was drinking about 6,000 calories of sugar a day, and he came in with this big belly and said, I've been drinking a lot more, but I seem to be gaining weight. And I said, water doesn't do that. He said, well, I'm not really drinking water. I said, well, so I get him on the low sugar or no sugar. And you know, with the high potassium solutions, if you have a bunch of sugar, you know, potassium follows your sugar into the molecules, into the cells, rather. And so you give them enough potassium, you can cramp them, too. So you can cramp them either way, not enough or too much, you can lock them up. So I don't have them doing that all day long. And then the work-rest cycles, you base that on heat load. You know, what's the heat load that day, plus all the external things, PPE and whatever else? What work level? And then, I mean, I think too body fat, I think makes a pretty big difference because some of the bigger boys have more problems. And they can do better with that condensation because a lot of times you get used to it, you get better and better about it. And then during the rest cycle, if you can mitigate some of the heat load, so you rest them in the shade, rest them in an air-conditioned area, that's going to take that much more heat off. Take off the PPE for a little while, dry off. If you have those cool misting devices, they work a lot better in Iowa than they do in Louisiana because when humidity is already 98%, you just make them wet. So for us, it's just basically moving air versus putting the misting devices in there. And in cool fluids, you know, if you drink enough cool stuff, you're going to drop and decrease the core temp some. So you can't drink five gallons, but you can certainly drink a little bit. Light colored clothing, again, loose clothing, layers, all those things make a big difference. The shade, you know, Dr. Alamore can tell you on the deck chambers for the divers on the back of a boat, you know, that's why most of them are painted white and you still put a tarp over them because the sun beating down on that steel, if you're in a volume smaller than a minivan in that kind of heat, that's pretty miserable. So air movement, a lot of blowers, a lot of air, a lot of forced air, and you know, you want a bit of feel it. You just don't want to have a fan over there in a corner. You want it blowing on you where you notice it. And in the air conditioned areas, when we try to get them to take breaks in AC, trying to get them, have them eat lunch in AC, don't sit out on the track of the bulldozer in the sun when we're trying to cool you off. Personal cooling devices, some of the vests, some of the hats, I coach four sports a year until I was 48, and then if I go fishing and it's really hot, best thing for me is I take my hat off, flip it upside down, put a bunch of crushed ice in it, put it back on. And it takes a little bit of pressure to get through this mop, but once it hits my scalp and starts melting, those ice water rivulets, that's the best thing you ever felt sometime. And my wife thinks it looks stupid, but I'd rather look stupid than be cool, so it's all right. So that is a big heat load mitigation for me. And acclimatization, some folks are good in a couple days, some of them take up to a week. So it just depends on how they are and what they do. And then when you're doing rotational work, a lot of times that happens where we gotta redo it every time they come back. But the buddy system, the heat stress monitors, the line supervisors, that's one of the biggest things. They should be walking around all day and at least every hour check in on somebody, say, how you feeling, did you drink enough, did you drink, are you drinking enough now? And they'll ask them, because they have all these little charts in every bathroom, what color is your urine? And it's over every urinal. And they look, hmm, gotta go drink some more water. That's probably been one of the best things we ever did, was that cheap little color code that says you gotta drink more fluids. That's been a big deal. So these were the heat stress monitors, they check on them. And we actually talk to them and say, these are signs of heat illness. If you see this and they're saying, no, no, I'm okay, stop, get one of the medics, come take a look at them, let's check them. It makes a big difference catching that up front than waiting till it's bad. So anyway, when it's that hot, a lot of times we'll do screenings, like if you're doing hazmat work and folks are in class A, with the moon suit, with the SCBA and all, we weigh them, check their pulse and pressure before they go in. Every other bottle of air, we stop them, take them out, undress them, let them rest, weigh them again. If they lost too much, then you gotta get a bunch more fluids in them. We do that and just keep doing it over and over. So the mandatory breaks, mandatory fluid intake, do that, and then the urine color charts. And those are some of the resources, if you wanna look at them, they're all on the slideshow for you. All right, any questions? So one comment about what Bob said about workers that are not necessarily prepared for these types of environments. Where I'm at, with regards to landscapers and all these types of folks, they're not able to get out at any particular time of the year like you do. We have a four season climate, so what happens a lot in my neck of the woods is that these are college jobs or high school jobs. And a lot of times it's where we run into problems. I'll share with you a story. I did a lot of weird jobs during the summer when I was in college. But one summer I refinished gym floors. Just went from high school to high school, university to university, and refinishing a wood gym floor. Usually in Nebraska that meant August when it was 100 degrees outside. The problem is is that when you're inside you might think that you can have the air conditioner or the blower on, you cannot. Because the first part of the process is that you sand the floor, which creates all kinds of problems. You take a thinner and then you wipe it down, you let it set overnight. You come back in, you might have to do some painting, you might have to do some touch-up work and that sort of thing. But when you apply this nice shiny urethane, you can't have a blower or an air conditioner on because you'll get this nice dust layer on top of your urethane. So you're inside a gym when it's 100 degrees with no air movement. And oh by the way, urethane really makes you high. So not a great situation for any of that sort of thing. And this of course was back in the day when I was young and stupid, didn't know any better. So many times you'd come out of the gym and you wouldn't know who you were. Bob also mentioned weight loss. I played football at one point in my life. Yes, I was an offensive lineman. It is true, you can lose between 10 and 15 pounds playing a football game. It's remarkable, even though you keep up with your hydration during the course of the game. So, it's strange. Question. Thank you both for excellent presentations. Do you know if AECOM has taken a position or made any statements about the states that are in the process of banning heat protections for workers? Like where we stand and sit today? I don't think we knew of any that were doing that yet. Bob, do you know of any? I think Florida has passed legislation prohibiting municipalities from instituting or enforcing. We'll bring that up to Dane from COGA, we'll look at that. Oh, I got you, okay. So it's local, look, local places doing it and the state was trying to slow it down or stop it. So if it becomes, but when the federal standard comes out, I think everybody has to comply with that, I would think, huh? I think so. Okay. Well, we'll look at that. Thank you. Thank you both for a very informative talk and direct personal experience in dealing with it. In recent years, there's been a concern internationally about the appearance of chronic renal disease among individuals, particularly agricultural workers, but also miners and some others. And one of the common threads has been heat related exposures, high heat related exposures. Some people think might be complicated by high fructose corn syrup in a lot of the beverages, which leads to increased urate, but it's not entirely clear. I wonder if you are encountering this and also in terms of biological monitoring for potentially these, and it's a chronic exposure, it's not like an acute thing. Are you looking, creatinine may not be the best biomarker, it's kind of late. What are your perspectives or suggestions on this increased episodes or increased trend of these diseases? So there are a handful of companies in the Gulf that actually do periodic exams and do big labs and all kinds of stuff on them. And a lot of those folks have been working 20, 30, 40 years in that environment. And we see some occasional chronic renal disease, but it's much, much more frequent in the diabetic population and some of the folks who are on three blood pressure medicines and that sort of thing. We don't see much of it at all in the younger folks and we really don't, I mean, the frequency is not, because when we looked at some of those studies down there, I was one of the same thing. So I went back and pulled a bunch of stuff and we're not seeing anything close to that as far as the frequency of chronic renal disease. Do you have any thoughts on why that's the case? Because it tends to not be as much in the United States as it is internationally. And I guess too, you even think about exposures to other things there, because we have a lot of folks who come in to do scrapping and we do blood levels on them when they get to the States. And a lot of times they're pretty high, not high enough to pull them out, but high. And the state will call us up all the time. And if they finally got used to it and said, is this one just coming into the country or is this during the job? And usually by the time they go home, their levels are much better. So I would wonder what else they're doing other places and just see what else they're exposed to. Because I agree with you. I think if we're not seeing it here, what exposure is it over there or what else is it that does it? Thank you. Good question. Thanks. Michael asked one of my questions and comments, but I believe there actually are outbreaks in California among farm workers. So there may be something about farm work, because South America is sugarcane workers in particular where it's been studied. So there may be a concomitant exposure or something about the people who do farm work, who knows, and social determinants that may be relevant. I don't know. But it is occurring in the United States. Or pesticides or fertilizers or something else too, maybe. I wonder. Yeah. I don't think we know. But my other comment was toward the E in AECOM, and that is infants are dying in their baby strollers when people put the sun covers to protect them from the sunlight over those. The temperature, just like your Toyota, goes up tremendously. And so that's, again, another area I think that AECOM could contribute to position paper is more focused on the E in our name. Because as we well know, in the ambient environment, there are the same issues for non-workers. And the other piece is the double jeopardy issue, and that is the people who are particularly vulnerable to the occupational hazards go home and they don't have air conditioning. They may be homeless, et cetera, et cetera. So there's a real need, I think, to pay attention to the off-work stuff as well as the on-work. Yep. Good, good. Thanks. Great presentation. Thank you. So two comments I have. The people that work on the water, I think, get magnification from reflection off the water, and it amplifies their heat exposure. And then the other thing is when the ambient temperature is very high, you've got to be careful putting them under fans, because that's like putting them in a convection oven. So if it's high enough, they don't need a fan. Right. Yeah. Thank you. Thanks. In the offshore industry, the commercial divers obviously have strict medical standards, scheduled medical exams. They've got things they have to meet. But for the roustabouts on an oil rig, do they have any routine or pre-employment assessment for their physical status and their risk of heat illness? And then, of course, if you're removing them from duty due to a risk as opposed to an actual incident, what are your ADA concerns? Good questions. One, and actually for the diver stuff, Tony, who just spoke before you, writes the commercial diver guidance for North America. But the roustabouts, if they're an employee of the company, the majority of them get a decent physical. If they're contractors, they get whatever the contract, whatever it specifies, but they're supposed to have the same type physical. But in my experience, a lot of them don't, and a lot of them are not healthy enough to deal with the state they're doing. And so we do have to fly them in fairly often. Now, as far as stopping them for the risk, there are very few folks that we've seen that are healthy enough and willing to go work and do that, that have renal disease, that we pick up on the physicals, because most of them, you know, that's just the healthy worker effect. The ones that are really bad aren't applying for those kind of jobs and probably don't want to work in that heat. But I think, you know, it'd be interesting, because some companies are worried about the risk and they look at Jones Act claims, and the Jones Act claim, the value of the vessel is a limit on liability. So if they look at that versus an EEOC issue, you know, I mean, I think there'd be a management decision as to which way you want to go. But if you know a Jones Act claim, you know, it could be $10 million. They might say, you know, I'll take the risk on the EEOC claim. So that'd be an interesting thing to see, but good question. Thank you. All right. One more. It was an excellent presentation. This is a question just for the panel in general, if you've entertained this or utilized artificial intelligence as a use of predictive analytics for your employees or within your select populations in terms of predicting risk for your employees within occupational-specific settings. If you have any comments or started utilizing that. Clearly you're not anywhere close to that in the meatpacking world. Okay. I mean, you know, I'm trying to bring some of the meatpacking employers out of the 60s still, which is a little bit of a challenge. That doesn't mean that I don't want to. I think that would be great to be able to risk identify or make some sort of a mitigation strategy based upon risk factors. I mean, that's the way that I normally think when I'm taking care of a patient, you know, for this, that, or whatever. So I don't know, you know, we'll probably get there at some point. I just don't know when. Okay. The second question is on COVID-19 and heat stress mitigation measures post pandemic. I'm finding a lot, some people in my population, which is relatively small, they have autonomic dysfunctions from COVID-19 and they present with dizziness, lightheadedness, different heat temperatures. I just wanted to comment if you've had any experience or any expertise that you could share within that population. I will agree with you. I have done more POTS workups since COVID than I ever did before COVID. So I think there's something there. I'm not going to sit here and tell you that I've necessarily been able to identify anything during those workups, but there's probably something to it. I wish I could put my finger on it. It's a very difficult question. I can tell you, you know, COVID-19 just as an infectious disease strategy in the meatpacking world was a fascinating situation for me personally. If anybody's curious about that, some AMA people interviewed me about that and I think you can Google AMA in my name and there's probably some discussion about that. But trying to figure out how to get 3,500 meatpacking employees through the door and still be able to produce protein for the world was not exactly an easy feat. So you know, the good news was is that most meatpacking workers understand PPE because they use it anyway, right? So you know, just adding extra things like masking or what have you was very easy. Trying to get them to not mass aggregate to everything, like don't all come in the door in the morning at the same time or don't all take your lunch break at the same time or don't all take whatever break at the same time and go to the same location, that was a little more difficult, especially when you have a meatpacking facility like I take care of who will remain nameless but has 72 different languages that are spoken in that facility on any given day. That becomes a little challenging. But all those things being said, I think you're on to something and of course, you know, this whole issue of long COVID, we still have a lot to learn. Thank you so much. Thank you. Carl Auerbach, Albany, New York. At one point in my career, I took care of groups that had heat and I was getting a lot of literature and that about heat sensors and a lot of that technology has evolved. I think the buddy system is a great one. But if you can't do that, is there a role or can you comment on wearables and there's even a sensor that can be swallowed and monitored. So I think the technology is moving to become more cost effective, but it may be useful in certain settings now. Yeah, I mean, there is new stuff coming out and it's coming out all the time. So there are some things that look like they have some promise. There are different things that measure sweat, different measures, you know, different temperatures. The one you swallow, you know, obviously looks like that give you a core temp, which would be good, but you need to have real time monitoring on all that stuff, too. And then the one that you swallow, obviously, is a one use, I would think, I hope, I hope. At least not shared. Yeah. Yeah. So. So anyway, so there are some things coming out. We've looked at a bunch of different options. Some of them, you know, we're not quite sure yet that they're ready for primetime. But I think in the next three or five years, we'll probably have some decent things to play with. If I may follow up, I wear a glucose sensor and I can share with you from here to wherever in the world what my glucose is and alarm if it goes low. That technology is moving into other fields and I think will, in time, become much more cost effective and accepted. No, I agree. Time will tell. Yeah, I agree. Thank you. Steve Castellar down in San Antonio, Texas. Just kind of a follow on that. Do you guys have experience in your occupational settings with using any of those sweat monitors or some of those technologies to evaluate or mitigate with your workers? Has that been a thing or not yet? Not even close. Not even close. Okay. I go back to my previous comment about trying to move some folks out of the 60s. Right. Nice idea, but not there yet. Yeah. Yeah. We've looked at whether or not to implement some of them. We've not done it yet. The other thing is there are certain things that have to be intrinsically safe to work in an explosive atmosphere. So there's some of them that we've looked at, thought maybe we might try that, but could not get the assurance that they were safe to use. The sweat monitors seem to be a reasonable idea, particularly when you talk about replenishing with electrolytes or not and helping to dial that in a little bit, not giving them too much potassium, trying to dial that, but you haven't had experience with that just yet? Not yet. We've talked about it in a few of the meetings and spoke to a few vendors, but nobody's decided to go ahead and spend money and do it yet. All righty. Well, thank you all very much. We appreciate y'all coming. Stay cool.

heat stress

Dr. Doug Martin

Dr. Bob Bourgeois

meatpacking industry

Louisiana

outdoor workers

technology for monitoring heat

post-COVID autonomic dysfunctions

risk assessments