Heat stress management - you're doing it wrong!

Heat stress management - you're doing it wrong!

Great, folks. Welcome to another special presentation from Workplace Health and Safety Queensland. It's all about heat, stress management. You're doing it wrong. And it's presented by Dr. Matt Brearley, an expert Occupational Heat Stress consultant. I'm Chris Bombolas media manager for the Office of Industrial Relations. And I'll be your emcee for today. Firstly, can I acknowledge the traditional custodians on the land on which we meet today and pay my respects to their elders past, present and emerging. I'd like to extend that respect to Aboriginal and Torres Strait Islander peoples watching today. Safe work month is held every October and it is all about raising awareness of work health and safety. This year Safe Work Month looks a little different. Thanks to our friend COVID 19. In this practical session, we'll look at evidence-based approaches to address heat stress and equip you with the knowledge to better manage the risks of occupational heat. The record heat of recent summer, which seasons has refocused attention on occupational heat and humidity exposure. Since heat stress is not readily quantified by organizations and often normalized by workers who will say heat stress is just part of my job. It tends to be grossly under reported. This not only threatens the health and safety of workers on a seasonal basis, but also hampers organizational efforts to manage heat stress. Additional barriers include relying on hydration as a control measure and under utilizing complimentary strategies such as heat acclimatization and cooling. Dr. Matt Brearley is Australia's preeminent, occupational heat stress consultant conducting and applying research to guide industry practice. He's the 2018 Exercise Scientist of the year. Holds a PhD in thermal physiology and has developed practical evidence-based procedures to maximize health, safety, and performance in the heat. Matt and a team of international colleagues, develop resources on behalf of the World Health Organization and partners regarding hate stress management for COVID-19 responders. And don't forget there's a Q&A session after Matt's presentation. I can tell you that there's already a number of people with questions. So, if you wanna get a question in or you want to give us a comment, please submit it via the chat box on your screen, at any time. We'll get to as many of those questions and comments as we can after Matt's presentation. I hope you enjoy it over to you, Matt.

Thanks very much Chris, and welcome everyone. Heat Stress Management, You're Doing It Wrong. As Chris has said, I am Matt and I've been looking forward to this session for some time. There's a few things that I've wanted to get off my chest, and this is the perfect presentation to do it. I just want to start by saying that these observations and research that I'm about to present generally come from field settings. This is where I do the work. It's where the work gets done. So, you've got a picture here of a hot dry climate. This is a great sandy desert, as remote as it gets, it could be from a hot wet, underground mine where no solar radiation, so it's a different setting, or it could be up on the surface in a hot wet tropical setting, where there was lots of solar radiation before the storm came through and this may be from a boat, but it's all heat stress. So, I call myself a field scientist and doing field research is probably a bit different to being this person here, who I call a heat nerd. I call myself a heat nerd. Maybe I should call myself a field heat nerd. So, if these opinions and I guess points I make, don't sit well with you. That's cool. I'm cool with that. But they will be based on evidence. And I don't want you to discount them simply because you think they've come from somewhere deep in a lab. And evidence is key 'cause I'm a scientist, right? So, there's science in this pseudoscience. And from my point of view, pseudosciences is everywhere through heat stress management, particularly on the hydration side of things. So, I'm gonna try and shift it towards the science side. So, we'll stick with the blue, sorry, we'll stick with the white and try and minimize the blue, but you'll have to hold me accountable to that. So, I need to show you evidence. And so as a scientist, I follow the evidence wherever it leads. It doesn't matter what the answer is, as long as it's the truth, right? But then on the bottom, on the science side, you also see changes with new evidence, and that's really important. And I'm guess I'm trying, I'm hoping I can change a few viewpoints today based upon evidence. Now, pseudoscience is not that hard to pick it's everywhere, but it's quite easy to see particularly where you look at maybe 0.5 picks only favorable evidence, relies on testimonials. I'll show you your testimonial later in this presentation, which clearly identifies it as pseudoscience. Here we go. The five issues I picked today and maybe we do another session for another five that I wanted to present, but these are they. Under-reporting of heat stress. The next three are related to hydration and the most important one is management of heat stroke. I'm very passionate about that. And I think we'll spend more time on that one than the others. Let's kick it off under-reporting of hate stress. So, this came through on my LinkedIn feed this week, and I have no relation to this company, and do not know anything about their heat stress campaign. So I'm not critiquing it. I'm simply using this as a talking point, but what got me was successful closing of the heat stress campaign with zero incident. And that's great. Sounds like no one got hurt in the heat. And I hope that's the case. But I see a lot of this, and I just wonder, because we do research by asking workers through an anonymous survey about their heat stress. Those papers in development, where the paper is written, I just can't submit it, 'cause it's too many words, a journal doesn't allow them anywhere. So, we'll need to split this paper, but pre-Christmas, this will get submitted. So, we looked at a small crew, 73 workers based up in the Northern territory. They're chronically heat exposed, right? From my point of view up there it's just hard and it's humid as it gets. And they're extremely resilient workforce, but they suffer heat stress symptoms. And we don't pretend that they're fine. There's symptoms there, right? But a male dominated workforce, generally not going to report this type of symptoms and then they're not always visible, so they can carry on without actually letting anyone know. But through the survey being anonymous, these are the top results we get. Now you see 31% fatigue, 28% irritability. These are reported on a daily or weekly basis. So, these are the number of workers, the proportion of workers reporting symptoms chronically across a seven months period. Now those symptoms translate to impacting the home environment, heat stress doesn't finish when we leave work, unfortunately, and the impacts of these same workers reported are here. Sleep, appetite, impact on recreation, might skip football training, might not go on play with the kids 'cause you're still paying for the heat exposure of that shift. And family relationships for one in six workers was negatively impacted by heat. It's scary, we've had some surveys where it's been over 30% on that factor. So does this count as zero impact? Zero incident. I'm not sure, but here's the kicker. 18% of those workers reported that they use sick leave for heat-related issues. Now this company doesn't have a dropdown box when you put in your sick leave to say heat, not at all these workers utilized another category. I wouldn't say fake. I believe that they were ill, but they we're using another term to describe it, to apply for it. So 18% of the workers, how many of your workers are using sick leave to manage their heat stress? I'd be interested tonight, there's no data out there about this. Those workers, the 18% averaged three to four days of that seven month period, but only one treatable incident. So unlike, the slide that said zero incidents, we had one in this company and now this stat is being used to promote the success of the heat-stress program. 'Cause there used to be more, now there's one. I don't think it should be celebrated. There's a lot of heat-stress within that crew, both at work and then at home and it's causing some of them to take sick leave. And these are extremely resilient workers, they're tough, What is actually happening out there? So we don't know. I feel very uncomfortable when I see zero incident or one incident from a heat exposed workforce over an extended period. I feel really uncomfortable about that because I think that the reality is that it's more, and we don't know, and therefore we can't manage it. It's left to the workers to self-manage and sometimes the management of heat-stress may not be healthy long-term for them. They may numb the pain in the post-work environment, they may take shortcuts at work 'cause they're simply can't do what's being asked of them, all these things can contribute to harm both at work and getting done at home as well. Yeah, so that's my first point. I think under reporting heat-stress is a very, very big deal for us. Point two, so we start with the hydration thing now. So next three will be dehydration. Dehydration as the primary cause of heat related illness. I can't tell you how many times we've been told that. We were on site to investigate it a heat related incident or we're just doing heat-stress control measures and "Oh, I should have been here the other day." Yeah, Mark, he collapsed with heat. What was it again? He was dehydrated. How do you know? You've to stay hydrated. I'm like well, I don't even know. I wouldn't be able to tell that straight up. How can you? And since dehydration gets blamed for all heat related issues. And so it's very common to hear workers who complain and put their hand up and have the courage to say, "Hey, I'm feeling the heat." Which is a great thing to do, but I hear the response from managers, coworkers, et cetera, you need to drink more. You need to drink more. Well, we can drink more. We can. And some of them may need to, but is that thee answer to all the issues in the heat. And I seriously don't think it is. But I need evidence to prove that point to you. So, in comes the paper of Carter et al 2005. So this is an old paper, 15 years old. The data finished in 2002. So, it's actually 18 years plus on this data, but it's still the best study looking at basically factors that are associated with heat stroke and serious heat related issues. So, U.S Army, a very, very good in this space. They do a lot of monitoring, they do a lot of research. They publish a lot and we can learn a lot from them. And over there years of data they had over 5,000 hospitalizations. Hospitalizations for heat-related illness. That's incredible amount. Of those 946, almost a thousand were clinical heat stroke.

I'm really serious, so heat stroke being a core temperature over 40.5, central nervous system impairment, it's really serious. So life-threatening and 37 Deaths within that data. So, this is some hardcore heat stress data. The best set of data that we've got out there in the research. Now 160 of those cases were associated with dehydration. So, there's 946 serious heat stroke cases, only 160 were associated with dehydration. We represent that graphically, the yellow are those associated with dehydration. That's 17%. 17% and this could be a one-off. I highly doubt if given the size of the sample, but these Israel Army also published a much smaller subset of having 946 cases, they had 89, but they reported 22% associated with dehydration. I think there's something going on here. I think dehydration is a contributor. Yes. Please, don't think I'm telling you that it's okay for workers to be dehydrated. I'm not! I just don't think it is the answer. And in this case, we're looking at about one in five serious heat stroke cases being associated with dehydration. Now the case of Trooper Lawrence data, it takes the U.S data and brings it home. And this is in Australia. This happened in Northern territory. This is Trooper Lawrence. I feel like I knew Trooper Lawrence studies case very, very closely. It's extremely sad case. I don't really like talking about it anymore, but I think it's so important to discuss. And I've met in my travels talking about heat, four of his colleagues who were there on the day that he passed away. It's still affecting some of those workers. But this the coroner report. Very high level of evidence here. Now the key point with Trooper Lawrence's case is that he was hydrated. He was hydrated. So, they're up at zero 4:30, the period through to 1200, he reported to private chat the army medic at that point. And he had consumed about eight liters in about eight hours. That's a liter an hour, that's pretty solid. He'd gone to the toilet, passed urine six times, that suggests that there was adequate. I classify that it's hydrated. Now when the coroner was quizzing Dr. Steven Brodsky, he had had this question. I think the key part here in the orange, the constant theme is one of dehydration as a threat and commendable effort was put into ensuring hydration, but no one was dealing with the core temperature. The work rate, the conditions, these conditions were hideous. They were working extremely hard. Trooper Lawrence was trying to get his corporal promotion. And he was on the fourth day of that. He was almost at the end, he was such a great guy that he volunteered to be in the platoon for his colleague to go through their final assessment. He passed, and yeah, it went bad from there. So, he got to roll down hospital around about six hours, post collapse, he died. He got to Roll Down Hospital three hours, post-collapse, 41.7 core temperature, 41.7. This guy had gone to the toilet six times in those eight hours, he drank eight liters and they thought that he might've been dehydrated. Or that could be the only thing that explained his symptoms, so they put intravenous fluids into him on top of what he'd already drunk, say. Please don't say to every worker that you'd need to drink more without investigating. I think it can explains some, but not all the heat stress we see on work sites. There's evidence out there if you look. So, one's a case report, high work output combined with high ambient temperatures cause heat exhaustion in a fiery. That got put out in 2011, as a case report because it's novel, but this is happening a lot. And so I received Mark, check any his group from California, they just published a paper last year. They looked at a few factors and they found that core temperature in these outdoor workers going about their business. Again from the field was determined by the weather and the work rate. Work rate determines your heat production and the weather determines how much you can dissipate. The net result is core temperature, either going up or down and in hot, dry and even hot humid conditions, core temperature goes up with high work rates. 'Cause we can't get rid of that heat, whether we're hydrated or not. Now hydration can block that rise, but it can't stop it. So, the message I want to give you is that don't think you can drink your way out of a heat stroke. If you work hard enough in hot conditions, you'll still store enough, heat to achieve that. Hydration thing number two, issue number three, cool fluids delay re hydration. This has been a tough one. Very, very tough one for me and dealing with this issue. I came up against a lot of barriers. So, am a work site. There's a many, many workers like thousands of workers on the site and one contractor had approximately 1500 onsite and they had to do some work. So good, we haven't done a little prep. I got a referral. So I come in and do some education. And so it was a meet and greet, but straight into a session. As I walk into office area and there's a room full of workers and there's about 20, 25 workers in there. And no lot's happening. Is it that those guys here for a session? 'Cause we're not scheduled for another hour? No, no, no, they're dehydrated. Okay, cool. And it was just bugging me out. I didn't want to have upset Mike but then also come back from a minute I said, "So what's the go with the guys in that room?" "Yeah, they're dehydrated. "So, we've got to make sure they're re hydrated "before they get back out on site. "So that sounds fine." "How do you know the dehydrated?" "Oh, we've done the urine test." The urine is number six. I didn't have time to put it in. Maybe next session. There's a whole lot of issues around that as well. Nope, it's just, yeah, maybe not evidence-based but we'll get there. Now in terms of them being dehydrated, why aren't they in there drinking? They all have drinks in front of them, the paper cups with water, but there's very little activity. And to me it seems strange, they get re hydrated and get back to work. Let's go. I said, "Do you mind if I don't catch up with the crew?" "Oh yeah, yeah, sure" And so, hey, that's what's going on, I hear you a bit dehydrated. I said so why aren't you re hydrating? I won't repeat the exact words, "But they make us drink this water." "Yeah, what's wrong with that? Do you need some flavoring?" "No, it's warm." I said what do you mean the water is warm, "Yeah, they make us drink warm fluids." That's why, because it re hydrates you quicker. You can't put cold water and you got to apparently. I Said, "Really?" That's news to me. I hear it a lot. but the evidence says, yes you can. And so you can imagine the session I had, ready to deliver to this crew, massive workforce was full of slides that basically supported their access to cold fluid against the advice of the HSE team. So, we had a lot of issues right before the presentation and I got asked, "Where's your evidence." Now I can bring in papers and highlight paragraphs. I said, "I'll write a paper." And I did it. And it said, And I think you've got access to the PDF that we developed. We put a whole lot of links in there, there's some videos, et cetera and I believe there's a link to this paper. It's a short read, five minute read. It's not very science-y but it is for evidence. So have a look at that. I'll explain it here. Here we have our worker re hydrating. She's taking a short break and she's topping up her fluids. Now, if she's like the workers that we deal with, we sent out 190 workers in the paper by Carter. 54% said they prefer cool and 32% prefer cold fluids. So, combined it's 86% who like cooler cold fluids. from that sample. So if she was the fall into that group, she'd be drinking maybe 15 degrees cool water. She might like 5 degree water, full of ice, whatever. Now, most work sites have access to cold fluids, as a control measure. This is a study from Xiang In Plus one 97%, of Australian work sites. That was from a survey done at the Australian Institute of Occupational Hygienists Meeting. Their annual meeting attended by obviously occupational hygienists, but also some safety professionals. So, 180 respondents there and pretty much universally cool water was one of the control methods for heat-stress. This is all good, right? So, that all seems to work. Now on this side, if we look at her consumption, so, she's drinking this cool fluid. So at some point here, it has to be delayed because it's cool. And so when she gets to her work is that it gets stuck in the stomach until it warms up. But once it's warmed up, then it gets released, right? But that's not what the evidence says. So, what's going on here? Now the rate of which fluid leaves our gut is all about gastric emptying, that's the fancy term for it. And it's how quickly these fluid gets released past the pyloric sphincter into the intestines where it can be utilized by the body. So, gastric emptying is regulated by two main factors. Okay, have a very, very dense drink in terms of energy. Yet it'll slow down, 100%. Increase the volume and you increase the intragastric pressure and you will speed up emptying as well. There are the two factors, temperature plays an extremely minor role. In my opinion, no role. And read the paper and see what you think. This is from Lipa in the Nutrition Reviews paper. He's just put some more data together to show you that gastric volume is a key regulator. So yeah, high volume in there, you've got a high emptying rate. That makes sense. But we don't tend to drink all this is one big bolus and then 80 minutes without drinking and on work so a lot more like that. And that's fine, but what role for temperature? I think minimum. So we should be giving our workers access to cold fluids. in my opinion, they don't have to use them. They might just have access to potable water and an ice machine, and then that can make it up themselves. I think that's a good idea. In terms of determinants of fluid consumption. I thought I'd throw this in there because you probably got a question. Well, you're talking about that. What about this? What about that? Three things for hydration? It's not that complicated. Give our workers access to fluids within an arms reach. That means we need to give them five liter carriers? Yeah. Oh, we can't have a five letter carrier where we work? Find a way, use a carrier bag, use a 900 ml blue bottle clipped on their belt, whatever it takes, give them access to fluids where they work. At the temperature that they want, with the flavor they want. Now, ideally for me, water would be the go-to drink. But the research shows that flavoring can enhance consumption, especially after extended periods of only consuming water. Not a problem, and most work sites will provide some type of flavor. On to our next next point, this is the last point on hydration. And it's all about electrolytes. Electrolytes. It's full of pseudoscience. So we're gonna bust it open, right now. Here's the maths. Now I'm not saying these are current, but each of these have electrolytes in them. You can still have trouble fitting them on the slide. I had 19 different drinks that had electrolytes in an ad, but I'm just using Thorzt, Gatorade, a Sqwincher cause you've probably all heard of them. Electrolyte first aid for Thorzt, electrolytes to replenish for Gatorade, Electrolyte replenishment for Sqwincher very, very similar each are marketing electrolytes to you. Now this is really messy, 'cause electrolytes had this special place on work sites. And with athletes, I don't know I just don't understand it, but we need to get our electrolytes so we can perform. That's kind of the link. And to me, it's not quite there, but where do we get it educated on electrolytes? Because it wasn't a thing, the general public didn't speak about electrolytes. I've tried to research this and it looks like electrolyte usage, it's a term usage. In the 70s, 80s and 90s really ramped up. And I think it's Gatorade, in the late 60s became more popular and into the 70s, 80s and took right off. They have been driving and their industry partners such as Sqwincher, et cetera, have been driving the education on this topic. So, here's an information booklet from Sqwincher. I'm not trying to destroy as Sqwincher's reputation. I use Sqwincher as representing all of these so-called electrolyte drink companies, okay. So, you can see there's a whole lot of sentences on this slide. So when dehydrated, our bodies need more than water alone, maybe in a couple of cases, that's a really blazy term. You need to be more specific than that, but alone, I can't say a 100% percent that's wrong because it's kind of true. We need to replace all these central nutrients released through sweat, these nutrients are in those electrolytes again, yeah, okay. Blood pressure, fluid balance, and muscle contractions are some of the key functions that electrolytes help regulate in their bodies. Yeah, that's true. That's true. But the way you're doing is I find it inappropriate. This is pseudoscience by stepping us through this. So, they're basically saying you're losing electrolytes in sweat. You need to put them back and we've got them in our drink. So we've got you. And that to me is a bit too much. The next page says, page six, next page. I take strong issue with statements like this hydrating without the use of electrolytes may result in life-threatening hyponatremia. Hyponatremia is basically, can you see where blood chemistry has diluted outside of its operating range? And it does result in death. You may have heard of cases from the Kokatha tribe where guides have been so scared of their clients suffering heat-stress that they're told to drink, and they'll stop, have scheduled breaks and forced, almost forced drinking. And people drink well beyond their needs. Well be on what their brains telling them to do. But it's on the best advice of someone who's very passionate and just trying to do the best to help them. And they have consume and in that environment with little medical support, it is definitely life-threatening and we've had several Australians pass away. But that statement is a 100% inappropriate. so anyone of us watching today, so drinking water, we're putting your life at risk. That's not the same. That's totally inappropriate. That shouldn't be allowed in there. If you're getting a fellow, told you about testimonials and pseudoscience, he's a cracking one. So, Sqwuincher as a preventative therapy tastes great scientifically formulated. So, let's mention that it tastes good, it's scientifically formulated and let's have a registered nurse is giving us that quote, but we don't quote the science, pseudoscience, okay. So I really have an issue with industry bodies, corporations with a vested interest in the space, leading the education of our workforce. I don't think it's appropriate. I think we need to change that. So, not for that, it makes me feel nauseous just reading it. Let's look at what's in these fluids. So, I picked Sqwincher and Gatorade as the top two. So, we've got sodium and potassium as their key electrolytes. You'll see these two electrolytes on all over. So, they're not hard to find, push your ground this slide as well to give you some indication. So, sodium salt and potassium seems pretty important in every living cell. There's a members without context, let's put milk up there, full cream, 600 ml. So if sqwincher, Gatorade, Thorst all the rest of them, if they're electrolyte drinks then milk is. alright, hint, hint, I don't think they're electrolyte drinks. Here's an electrolyte drink. This is our re hydration salts. Now, if you go to hospital, go to emergency department and you've got dehydration that they believe you can reverse through consumption and you don't need intravenous fluids. You'll be given either ORs, which is this one or gastrolyte or clinical hydrolyte. They're typically the three. Go to Roll Down Hospital you get RRS. They won't give it to you in a 600 mil bowl. So it'd be 200 mil at a time, but that is a clinical dehydration beverage. That's an electrolyte drink. Low in sugar, hindsight in high in potassium. Now I'm not saying drinking this stuff is better than drinking any other fluid. I'm saying in a certain point, that's required as determined by medical staff, but that's an electrolyte drink. You don't get Sqwincher when you get to hospital with dehydration. I think we need to stop calling these drinks, electrolyte drinks. I think that's the wrong use of terminology, but forget drinks, what about food? Food is where our electrolytes are. So these companies pitching to you that you've got to put it back. You've got to put it back. There's probably a lot already in there, but that's fine. You're a heavy sweater. You're drinking, pure water, all shift. And you've skipped your pre-shift meal and you haven't eaten at all. You probably going to be live, but why do that? Why do that? Because we're now going to start educating our work is that food is a great source of electrolytes, right? We're gonna steer away from this industry driven, beverage industry driven education, and we'll do our own education based upon the evidence. And the evidence says that yes, you can get your some electrolytes from Sqwincher, Gatorade, if you want. And I support you having access to some flavor, but that flavoring might be lemons. It could be sliced cucumber, which one worker told me about, it could be anything. It doesn't have to be something in a foil packet, but food being the case. I know we have suppressed appetite. I showed you in the slide that works report 27% of our tropical base workers reports suppressed appetite after work, we get that. We get that, but you don't need to eat a lot to top up your electrolytes. And I think those workers that really suffer in terms of trying to eat at work, the pre-shift meal is key, very important loading of both energy and electrolytes. All right, we'll leave hydration alone. Let's move on to treatment of heat stroke. This is pretty important, pretty important. "Cause we're talking about our love for this situation. And unfortunately we get this so wrong. It's embarrassing how bad this has done in Australia. And it's not your fault. It's the fault of the overarching bodies who give us this bad information. So here we have industry journals. So I suppose your mindset journal not a research journal, but a place where people may get a quality information, right? And so they've had, a paramedic wrote an article for them last year. I think it was November last year. So treating heat stroke, they read that medics you'd get a good set of bottles, including tympanic temperature. We've written a paper to say tympanic temperatures rubbish. But I now it's very hard to measure temperature. So whatever, call for an ambulance. Resuscitate, place victim in a cooler environment. So let's get them out of the heat. Good idea. Moisten the skin with a moist cloth and spray and fan repeatedly. You do that in a tropical region. What are we going to be achieving there? Very, very slow cooling rates, even in hot dry. Is it going to be fast enough to deal with a heat stroke? Remember heat stroke is cold temperature is really, really hard. The cells don't like being that hot and they start dying. Most workers will only tolerate up to 30 minutes at 40.5 or greater before cells start dying. I think some workers will be dying well before that, some workers' cells will be dying well before that. That's a product of how hot you are and for how long you are determining how many cell Now that will determine whether it's a permanent dysfunction, whether you have permanent brain impairment, liver, kidney, et cetera, or you end up with multi organ failure, which precipitates death. And that's what happened to Troople Lawrence. And that's what happened in the 37 U.S Army. Heat stroke death. So I'm not sure where that's aggressive and I bet it's okay. Cause we've got ice packs to the neck growing up and armpit. So maybe got six ice packs. We've got two on each side. So that's meant to be more aggressive. This is what we're taught. I get taught this in my first eight annual update. It's rubbish. The research does not support that at all. And I do not blame the journal. I do not blame this paramedic cause that is picked up. That is cut and paste from the Australian Resuscitation Council, our peak body in this space. So I wrote a paper cause enough of this, I heard enough of this. I wrote a paper to say, look is this adequate? And no, it's not. And I mentioned the Resource Council, I call our st. John, Red Cross and Safe Work Australia. But I blame the Resource Council because they determined the curriculum that St John's, Red Cross and any other first aid provider will pitch. They won't teach outside of what's recommended by the resource counsel, being the peak body. And Safe Work Australia will again, replicate those same recommendations. And Safe Work Australia's 2019 management guidance, heat stress management guidance, or similar document that's freely available. I'm sure lots of you have read it. They parrot the same inappropriate cooling methods that we just saw. So I had to write this paper because we need to call this out. So here's what we're talking about. So you've got these six ice packs and the theory is because we've got shallow blood flow around these areas like that shallow arteries, if we cool that area, proximal to the artery, we'll be cooling that blood and that blood will transfer the cooling of sweat of the body dropping core temp. And in theory that's cool. That's fine. It just doesn't work. Now, we've known it doesn't work for a long time and Brendan McDermott, who is probably the most well respected. Oh, him and Doug Cassa, both professors extremely well respected in this space. He had this to say in a 2009 paper. Okay, he's saying don't do it. Don't do it because the evidence says it doesn't work in 2009. But we're still getting it taught to us in Australia in 2019. That was an issue. We've had a bit of an update and I'll talk about that shortly. So the key is we've got a worker collapsed on our site with taking them out of the heat, we've removed their PPE. Now what? And in this picture you can see they've done the cold compressors to the recommended areas, they have gone a bit further they've actually put one on the torso and that's good. Covering more surface area is good, but is this gonna save their life? Is this going to send them home? Is this going to stop the brain liver and kidney impairment? Cells are dying right as we speak so is this enough? And if it is, do we have this where the workers are working? This is challenging, right? It's challenging, but we need to sort it because it is locked with it. So I thought, why not show you the cooling rates and basically give you the evidence as to why we don't recommend those ice packs. So you can see different cooling, sorry, different temperature in the shade, results in different cooling so as we cool the area, cooling rates go up. So you've got cooling rate per minute. And then you've got time to lower core temperature to one degree. So the Troople Lawrence 41.7, he doesn't make these temperature lowered degree, He needs it lower three. He needs to get lower than 39 ASAP. And that wasn't achieved early on. Once he got to the hospital, so once he got transferred to st John's ambulance, he was cooled appropriately. But still when he got to the hospital with 41.7, they did everything they could to cool him, but he went so long being so hot that basically had a toxic reaction in his body and his motor was truly run. So they missed the window to cool. It has to happen ASAP and aggressively. And these methods here probably on their own, not enough, combining methods, you could speed it up, but on their own, you're probably not going to get it done. What could you do? I put cross star suggestion on here. You're not going to be able to feed them any ice, but just in case, I'm sure there's some questions about that. They're the type of cooling rates you get there. Okay, cold water immersion. That's what they should be put in like five, six, seven degree water. That's what we should be doing. Most of you will be saying no way, like the risk isn't there for us and no way we have in cold water. And how would we manage that? Yeah, that's fine. I get that. This will only be used by a few percent, but shouldn't you we'll get this information and be able to make that assessment yourself. That's what I think. You should be given the evidence, and you determine when you do your risk assessment, the likelihood of this event and the measures we need to control, as opposed to just being given ice packs, fan cooling, it's not going to be enough. Ice towels are pretty decent method. So ice towels basically hold water against the skin in the absence of a cool bath. And we utilize that with a lot of our crews here in very remote settings. They can take ice, they might have an angle or whatever. They've got ice at their work site, no matter how far they are from it, they've got cool towels. And should anyone need treatment? You've got them good to go. And we've utilized this, well the crews have utilized this in several incidents. We've had where things have gone wrong. And then basically done the work of the paramedics. The paramedics have arrived sometime post worker has a semi recovered, core temperature has been dropped and they're suffering some ill effects, but they're not hypothermic anymore. So we believe that the cell damage was either prevented or stopped very quickly and that's good for their long-term health. So there is an update. There's an update to the Australian Resource Council because based upon the evidence and based upon that paper that wrote in 2019, along with Dr. Richie Gunn from university of LA, we wrote a letter to the Resource Council, highlighting the deficiencies here. We actually wrote a letter to Safe Work Australia initially. And they said, well, we're not changing anything until Resource Council gives us that information. Fair enough. Yeah, that that's legit. We went to the wrong body initially. So we went to the resource council in, I believe it was maybe November, December, just before Christmas, last year and said, you know, fix this. Yeah, we're reviewing it. That's fine. We'll get back to you. So live in September 16, just before it's getting proper hot, they've updated their guidance to put cold water immersion in there, but they do state that the evidence is kind of weak for it, which is kind of surprising. We've written a review paper shows is extremely strong. Exertional heat stroke treated by cold water motion. The evidence is overwhelming. They don't cite that they had no evidence for recommending the use of ice packs. And it's still in there. It's still in there, but they've updated the guidance, which is a good thing. It's a very good thing because this is scary, right? When someone gets proper hot. Now I'm not trying to scare you into having ice baths at your workplace, but I think you should see the difference between appropriate and maybe not appropriate treatment. Now we've got a clip here from frontline. It's a fantastic documentary from the States. This one's from Football High, two young, good young athletes from Arizona in one summer season had very similar heat stroke cases at a very similar time during very similar wet weather. And the state was kind of fixed on the outcomes of these two athletes. And the outcome for one was okay, the outcome for the other was not. So let's play the clip and see what you think.

Tyler Davenport collapsed from heat stroke after practice on Wednesday morning--

[Narrator] As football season progressed, the whole state was following the progress of Will James and Tyler Devonport. The two boys who had collapsed from heatstroke over the summer.

Tyler Davenport collapsed during the Lamar high school football practice on the August 11th, he's been in a hospital ever since.

[Narrator] the two players had both passed out on the field after practicing in the blistering, August heat.

We had almost a three week span where it was over a hundred degrees every day. So you do try to take extra caution. It does make you think a little bit when it's that hot outside.

[Interviewer] but you still practice?

Oh, you have to practice. You know, you have to practice to be ready for the season to start. So yeah, we don't cancel practice because of the heat.

[Narrator] Both Tyler and will were put in medically induced coma was in the same ICU at Arkansas Children's Hospital. Both faced the possibility of permanent damage to their organs from the heat stroke.

From comparing notes, you know, it seemed like that they were both having some of the same issues. You know, Will had had damage to his liver, Tyler had had damaged his liver. But we were all really hopeful.

[Narrator] As the weeks passed, Will James slowly began to recover while Tyler did not. After three weeks in the hospital, Will was released weak and needing kidney dialysis. On the day he left, he visited Tyler for the first time.

It was a really emotional experience because I remember walking to the intensive care unit. And I just remember seeing that laying on his bed, skin was just miscolored, as kind of like a light orange color. His teeth were just, you know, disarranged from all the drugs they had to put them on. He was in the middle of dialysis, you know, patches of hair or missing like mine was, it was just a really overwhelming sight. Six weeks later, Tyler passed away. It was only after Tyler's death, that crucial differences between the two boys cases began to emerge.

He was in the back of the end zone and coaches and I were somewhere right in here.

[Narrator] Todd Ross is a certified athletic trainer who is at every football practice and game at the private school Will James attends. He was on the field when Will collapsed.

He made it to about the five yard line, picked him up and we started to carry him towards that gate, we got him into the junior high locker room because it was the closest locker room. Since he was unconscious, we opted for putting him in the shower and dumping ice on him After we had started to slow down his, lower his body temperature.

[Narrator] Doug Casa is a leading expert on heatstroke.

The key to surviving exertional heat stroke is what you do in the first five to 10 minutes. You have to minimize the amount of time that the athlete is hyperthermic, it basically comes down to somewhere between around 105 to 106 degrees. How many minutes are you above this critical threshold for cell damage will impact if the athlete lives or dies.

[Narrator] That's what was at stake for Tyler Davenport on the field at Lamar, when he collapsed.

Some of the kids got up and they hollered out to the coach. Something's wrong with TD.

[Narrator] Without an athletic trainer to respond, Tyler's coaches were left to manage on their own.

We got his helmet and shoulder pads off, got a cold towels and water on him. At that point, he kinda quit talking. So that's when we called the ambulance and then just covered him in cold towels and water and waiting for the ambulance to get there.

[Narrator] As they waited, they tried to cool him down where he had fallen on the practice field.

[Interviewer] How long was he sitting on the field while you waited for the ambulance?

10, 15 minutes after we made the phone call, it might've been less. It seemed like forever.

When he got to the local, ER, his temperature was measured at 108.5 and they started maneuvers and getting fluid and even cooling him off. But the die was already cast with that temp at 108.

I just figured it was, you know, heat exhaustion, bad heat exhaustion. And it turned out to be a heat stroke. I mean, it just goes from not very good to real bad in a hurry.

It goes real bad real quick as the coach said, it's debilitating. So the whole of Arizona have followed this case and it was very, very sad. And that's what happens when the treatment isn't given when needed. So I'm really passionate about this topic because I don't want you to learn about what could have been done post the event, during coronial, during investigation, that's inappropriate. We should be giving you the info you need and from there for you to manage it. And it's important because we've got 10 cases here of workers passing with heat stroke in recent history in Australia. Don't pretend it's not going to happen because it will, there'll be a heat stroke, death or two or three or four this season. I'd like to prevent that. We presented a fair bit of info, if you want some more on their website there's insights. So you can jump on there. There's some topics that might be of interest. Our latest one is looking at face masks in the research around whether it contributes to heat stress. All the research that we are involved in is published and freely available. There's probably 30, 35 papers on the research tab on the website. And if you want more info, jump on LinkedIn and hit us up there, we'll be adding some content there in the corner. We've got one of the QR codes to sign up to an eight bulletin, which we send out monthly from September through to March. This year we started early. We had a lot to say, so we got stuck in, in August, but jump on there, if you're interested, that concludes the webinar. I'm sure I've raised a few questions. Happy to hear from you. So over to you Chris.

Matt, let me tell you, I think you've either struck a nerve or a cord with our viewers to day. We've already got eight questions, at least. So we're going to get into the Q and A session. And remember folks, if you do have a question or a comment for Matt, join us on the chat box. Give us your name, your question or your comment. And we'll get to as many of those as we can. We may go a little overtime, Matt, if that's okay with you just to get through some of these questions.

Let's fire up first up is Adam Watson. How do we monitor Matt to identify heat stress earlier? So you don't need to use first aid measures. So avoidance rather than when we get to that critical stage?

Yeah, good question. But you can get fully scientific what we do in monitor core temperature it tends to be a bit full on and it's definitely not going to be a daily practice, but work is a really smart and they've got a huge RQ when it comes to this stuff. So I think we need to rely on them, let's correct some responses. So if you wanna know what type of heat stress is being injured by the crew anonymously collected, whether it's our web app or old school pen and paper, but get them to detail the symptoms they suffer in those conditions and you'll get to learn you have a database of this weather, doing this work equals this much heat stress. We need controls for that. Whereas this work here now the crew is saying, that's fine. We don't really do much you. And then I'm trying to understand whether they bring that heat stress back the next day with a heat hangover, where there are more risks. I think old school asking the worker is undervalued. We don't do a lot of it. And we start in published research on that and we're learning a lot that way, which is guiding our more scientific research as well. So I think let's talk to the workers. That's rely on their heat IQ as a starting point.

Great question to start us off with. Paul joined us for your webinar this morning. And he asks, "can you comment on the validity "of the humid X charts for FNQ conditions?"

Yeah thanks and so humid X is a decent, I mean, it's tough to give you a proper answer to this, but I think in terms of describing environment, it's a decent metric. If you use a humidity exited then determined work rest ratios, I think they're tricky, but I think it does a decent job of telling us how hard it is going to be to thermoregulate in those conditions. But again, trial and error, I'll be looking to collect data not only on how hot and humid the climate is, but as to what symptoms we get during what work in those conditions. You could also do core temperature monitoring and the full scientific stuff. But I really don't think that's necessary first up. I think if you surveyed your crews and maybe even had someone else do the data analysis, so they're more confident and more comfortable to be vulnerable and actually say what they're suffering. I think then you'll have an idea of whether that human X is actually describing the conditions for the crews adequately. It can be that cooler conditions result in really high work rates and maybe more heat stress. They don't always line up. So I think we need to do symptom analysis.

All right, MC joined us as well and asks what can HSR's do to talk employers who ignore heat risks to workers. So getting them involved, getting a, you know, they want to change perhaps the attitude and get the, get things right.

Look, ideally that'd be motivated by the health, I'm talking about the organization, the health of their workers, their safety, but it might be a dollar discussion. So you need to talk about productivity. So crew workers go harder in the heat. There's no question about that. As we warm up, we tend to slow our work, because we need to slow that heat production because our body can't keep sustaining how much heat we're storing. So we go slow and we have many employees call us up, we're just not getting any work done at this time of year. Yeah, that's cause your workers are in survival mode, some employers call it zombie mode, the afternoon of a hot day at zombie mode. No one's getting any work done because they're cooked and they'd been cooked the day before and the day before all that. So it might be with a spreadsheet looking at productivity and looking at costing of a job and basically understanding that, you know, some organizations cost the job and they put in their tender, not factoring in heat, slowing down the workforce. So it could be a monetary discussion. I don't like it getting to that point, but sometimes we have to get there to get a company on board.

Just on that point, if I could ask, is there then a residual heat stress from say a day before, and you know, are you you in the clear, if you know, suddenly they were struggling a bit on day one and you got through day one pretty good and then day two you managed to get over the line and then you plow on with no changes into day three. Is that a really dangerous scenario that they've got residue from a couple of previous days?

Yeah, there is cumulative Chris. These heat hangovers that we've seen that the combination of the fatigue, irritability, the nausea, the rashes, all this type of stuff that basically, it seems to me like our workers come back after a big day in the heat, less of who they were. And we do it each day they might be emptying that battery day by day. I prompt organizations to have a look, just say you work five and two, have a look towards the end of the week during hot weather, at your stats, at your injury stats. Now I know your heat stress won't get reported, but the cuts and abrasions slip trips or falls, you might be able to see it. We generally see it. Not only peak injuries peak during hot weather, but towards the end of hot weeks, if you're working like two and one, look at those rosters and look towards the end of, I know, night shift might mess that around, but have a look at your data. I reckon you'll find some, some patterns in there around heat. So yeah, a good question, Chris. There's definitely a bit of an effect there.

All right mate, let's move on to Pat Watson's question. Pat says, "Hi, Matt, do you think there's confusion "between cool and cold fluid "and what determines the difference between cool and cold "and will drinking cold water can cause issues when dehydrated rather than cool fluid?" So it's that cool versus cold and you know, what's what.

So cool general means above 15 degrees. So there's been lots of palatability studies done on beverage consumption in particular of water. And it seems like 15 degrees is the sweet spot. That's where most people prefer to consume the fluid whereas a five degree cold water is less preferred or but generally it's still more preferred than warm water. It looks some, I should've mentioned everyone's individual. And so the research will say this works, but it worked for some and not for others. And I can't explain through science every one's preference. I just acknowledge that the research is trying its best it's doing what it can., however, we're so different. There's so many people doing so many different jobs and have so many individual responses. But I'll go with preference. If you want to drink cool water, I'd say go for it. And if you worry that giving someone cold fluids will produce some type of cold shock and stay clear, 15 degree water being used by many other people, the highest preference rate, Let's go with cool water. If you want to experiment from cool to cold then that's fine. But if I was looking at a work through, I didn't have access to cooler fluids, I would start with around 15 degree water generally would skew the maxes to an ice machine they can sort it out, but we could give them 15 degrees as a starting point see whether this works. See whether this works for you. Some will say it does, some say, no, I want it cold, I want mine full of ice. That's fine. If we have a dehydrated worker. Say they've collapsed, they're semi conscious there. Now there we've got their core temp, we can give them a drink. I'll just be giving them cool water. I wouldn't have it as a slushie. I wouldn't have it full of ice. I'd be very conservative just to get cool water. It's not gonna make a big difference, to be honest, And they're not going to take on a large bowl. They might have a 150 mil still they could vomit it out, but let's go cool waters in starting form.

All right, thanks Matt. And thank you to Lee's court bill Yesi, who joins us today. And Louis has a question for you. She says, hi, Matt recommended policy guideline says 30 minutes, risks break when temps above 35 degrees, would you have any recent developments or recommendations or opinions on that theory?

Yeah, I'll start with opinion. My opinion is where they come from. So then I've to go for the evidence and I haven't been able to find the evidence. The truth is it's too hard to have a blanket guideline that'll be backed by evidence. 'Cause like I said, we're all different. What I do know is that these cutoffs cause their own issues. So let's take Darwin, where we spend a lot of time. It's constantly getting to a max temp, 34, 35, but just say we've got a cutoff of 35 degrees, which we do not have the mandated cut off up there, but just say we did. It's 33 degrees. It's 9:00 AM. I'm the project manager. I know that it's going to hit 35 by about mid day today. And it's going to be down tools, I guess what I'm trying to get done before that time, a whole day's work. And so the scheduling, the work rate for those crews is very, very high. And we've actually seen where workers have had to work under this cutoff scheme, not this 35 degree one, but a different one. They work extremely hard. Remember work rate determines heat production. And if it's hot 33, 34 35, that doesn't make a lot of difference. So we see this induced work rate, where workers are no longer pacing, their effort, they're working to a number or a time limit and that does induce its own history. So I know these policies are meant to be protective and they're not always, and I'm a massive fan of workers using their brain to pace their effort through hot weather and being given access to all sorts of resourcing, to aid them in keeping their body cool, so they can get that job done in the timeframe, in an appropriate timeframe, with an appropriate amount of co-workers to get that done. That's how we manage heat stress. I'm worried about this cutoffs. Oh yeah, I'm concerned. I'm concerned about them.

Matthias Bona joins us and asks, do you recommend any field metrics to monitor core body temp for risk management?

I like monitoring core temp, which is deep tissue temperature. I do not recognize any other spot as core temperature. There'll be devices marketed to you that they measure skin temp and predict core temp from it. So the only metric around core temp for me is core temp which is measured generally by ingestible pill. So that technology has become more available to organizations, but still requires a bit of scientific nasty to utilize it properly, I guess. So yeah, we measure core temp. We do our research, but we do way more monitoring. So we might monitor 20 to 40 workers on a site to get a handle on true scientific responses based upon work being done and use that as guidance to help develop a policy based upon evidence, putting some survey data with that. And you're getting a decent input from what's actually happening out there. I don't rely on any other metrics apart from deep tissue temperature regarding that.

We're on core temps and Sarah's given us a question on this topic. She says, can you talk through the differences between core temps rise and heat loss for people that are likely acclimatized to hotter weather such as, you know, the people living in Northern territory, Northern Queensland in those hotter, humid areas, and those who are living in areas that are normally cooler, should this be managed differently?

Yeah. Should we need to acclimatize our crews prior to deploying. So you might have a, a team based in Southeast Queensland deploying up to far North Queensland, that's a challenge for their body, their bodies aren't ready. Ideally would have them gradually exposed to that environment and might be over the course of the first week that they're graduated. Exposure starts at about 20 to 30% of the rest of the crew. 50, 60% by by day two or three, up to about a 100% by the end of the week. It's highly dependent upon fitness. Fitness is a massive assistance with that. So people who are active and physically fit tend to the heat acclimatize quite quickly, but we need to graduate them. Now this is an issue because generally crews are deployed without time to heat acclimatize and firefighter workers, et cetera. So we published a study in 2016, it's on the website, looking at firefighters from Southeast Queensland, being flown to Darwin in the morning and starting a 24 hour exercise at 1300. And they worked alongside the Northern territory colleagues. It was really interesting that the Southeast Queensland crews paced their effort once they hit a core temperature of 38.2. So both crews were very similar, they were all mixed, so they're not one prove the one crew they're all mixed. So we could have a mixed workers, so that they all work together 38.2 was the core temp. It was very similar slope. And then a 38.2 that's when the Queenslander's started pacing their effort, flatline and NT crews kept going 'cause they felt more comfortable. The Northern Territory News got hold of that study and wanted to publish a headline saying, scientific proof Queensland is a soft, I think it was verified on the data, but there's definitely a difference between heat acclimatize and non-heat acclimatize. And we need to factor it in and give them the time. It's not always commercially viable in our current systems.

Richard Morris had a couple of questions, but let's go with this one because of time constraints. "Hi Matt, have you got any research on "the beneficial effects of cooling PPE water, "i.e water immerse clothing, such as sleeves, "head wear and neckties?"

We, we haven't done that research. We tend to focus on factors that will make a bigger difference. So I'll start with the neckties and the cooling calls, et cetera. They're typically cooling skin tent and they feel good and that's great. We want workers to feel good, but let's not pretend that it's guarantee drop deep tissue temperature. So yeah, those type of garments don't do a lot apart from making our workers feel a bit better. And I think that's part of the game. So I'm not saying don't use it, but don't rely on it. In terms of the war profuse garments, we didn't publish, but we did do a bit of work. We've worked with the eights and obviously they use a cool suit. And we took that into an occupational setting where we had a ski and a pump in there and we'll plug workers in and put 15 degree water through a T-shirt full of tubes. And it has a bit of a cooling effect. It's not as practical as we'd like, but the research generally comes from military settings and we're about to publish a paper on cooling rights with passive cooling, but longer that passive cooling is compared to other cooling and I've read all that research. There are some decent perfused garments out there, but that they tend to be not used that readily due to practical constraints. But generally, if it's a cooling color dipped in ice, cold water, et cetera, it's going to make you feel good and nothing else. Work with these garments can actually drop core temperature based upon how much water and at what temperature it is and for how long it, these perfused and over what body rate.

Kelly asks, "Does dehydration increase faster, "moving from hot and cold environments?"

I'm not sure I understand what you mean.

As in moving in and out, all of you know, you're from you go from hot to cold, to hot to cold.

It's interesting. We know that work. Some workers cause we promote cooling and it might be a cooling refuge that's used on site to dissipate some of that excess heat storage. So might be a crib break or whatever. It might be 20 minutes in there at a certain point in the day. We do know some workers don't enjoy the transition from heat to cold, heat to cold, heat to cold. And we respect that, so we need to use other cooling methods for them, but we've tried to find out why that is. And I don't think it's related to dehydration. It seems to be the rapid change in their skin Temp is driving like a nausea. So lethargy that we can't find in the research has being explained, but we see skin temp as being a likely candidate for, for that. I think what you're asking is being out in the heat and then going into cooler environment, does that color and like draw moisture out of it. So he'd be able to say like sucks you dry. You want that moisture to evaporate. That's the only way it will dissipate heat. So I'd prefer that going into the cooler, you were able to evaporate that heat rather than stay out in the heat. So your sweat rate will be higher out in the hotter environment than it will be in cooler environment. So we are talking about dehydration, it's likely to be higher when fully heat exposed, as opposed to going in and out of there.

Sherry asks, "Matt, I work in education "and I deal with students from prep to year 12. "Is it possible that given their age and body size, "they are likely to be overcome "by heat much faster than adults?"

I think the key issue with the kids is their ability to focus on fun and not the bollard responses and I guess the lack of maturity with their thermoregulation. So they're not able to thermoregulate as per adults, they've probably had less experience and less now in understanding, I did that the day before that made me feel like this did our work at a slightly... Now I'm just gonna chase that ball. And so we do see kids. We had a case in the Northern territory, a colleague of mine actually traded them at a soccer presentation day recently. So yeah, it is an issue for kids exposed to heat. And I think in schools, we could do a lot better job. I think we could get better education outcomes in hot climates by using some cooling methods to bring back the rowdy bunch after their breakout start into a more, a more focused and teachable group by dealing with that excess heat storage.

One final question, Hiban Tuvi asks, "Are some people more at risk of heat stress than others? "If so, how do you reduce that risk in those people?"

Yeah, they are. There's a group of people out there that are heat intolerant. They tend to self select and maybe they moved to Tasmania rather than the Northern territory. But we see that obviously you go with the workers. And so there are workers that are exposed to may not be as heat tolerant. There's a lot of factors that determined that you can't just pick it based upon one factor. Managing the risk, I truly believe we need a range of management strategies, controls call them what you want for a range of people. And that these workers should have free access to use them as they see fit. If we listen to our brains, no matter how heat tolerant you are, you'll be able to manage your heat stress. If you need to slow down and you have the ability to slow down, if you need to cool and you have the ability to cool, you manage it. in our work practices, sometimes that doesn't necessarily happen. So I think giving everyone access to evidence-based cooling, hydration, heat acclimatization is the key to managing heat stress regardless of their heat tolerance.

Matt, this is a question for me without notice, cause I've seen your presentation before. And I remember seeing the video presentation, I think of as a trick somewhere that was covered by TV cameras, for some reality TV show, and one of the participants ended up dying overheating, body core temperature. This is about perhaps from WYI chased point of view, if you are a company or a business that operates in a very humid, hot conditions, be it Western Australia, Northern territory, far North Queensland, wherever. And you're talking about it's critical to get that core temperature down quickly, do they I need to look at strategies like, you know, to get an ice bath, they need to have a facility there onsite that can get to their workers immediately to get that treatment or to get that body temperature down to perhaps save that life.

Yes, the answer is yes. Let me go back to these 10 tragic cases. A Pilbara worker dies after walking 34 K's over two days in hot weather. There was no cooling. Middle of nowhere there's no cooling. Now, I'm not saying you have an ice bath there. How would you do it? You could look. It depends on the risk. So assess the risk and the risk is there. Then you need to manage it. How are you gonna manage it? Some crews use tarpaulins and jerry cans to provide cold water immersion. So jerry cans in the air-con vehicle, you might need five to 10, 20 liter Jerry cans, and a tap to be able to achieve water immersion in that setting, you might use cold towels. So our go-to method for practicality is to have an Esky of ice that doesn't get touched. Good quality Esky, crew might go up for five days, take that up. You've got other Eskys or an Engel or whatever for your day-to-day use, but that's that's emergency use only. You've got a couple of towels, maybe three or four towels in that vehicle. Should someone suffer a life-threatening emergency, heatstroke right there. And then you're going to apply those ice cold towels. You will have ice available that's because they have assessed the risk. And we said, this is your go-to method for practicality and cooling rate. That's the sweet spot. You could take out all that water, probably not that practical for them. And there's probably not enough workers to set that top hole on up anyway. So yes, they might need to do that. They might need to drag a trailer, mobile cool room to manage that risk if it's a larger crew, that's what you need to be thinking about. And I'd suggest after this session go and review your heat stroke management procedure. If you don't have one, have a think about how you would manage, how would your crews manage their colleague who was suffering from a heat stroke episode in a remote setting? It's really scary. It's scary, for me I'm meant to know what I'm doing, it'd be very scary for you, Chris.

Dr. Matt Brearley thank you very much for joining us to day. Can you give us one key, take home message that we should all remember when it comes to heat stroke.

I'll go with heat in general, Chris, I think we need to provide environment for our crews where as there's no stigma to feeling the heat. If we need to manage this, which we do, we need honesty from our crews. So we need to get away from this hero, worshiping the hero who worked until they collapsed. No, that's not what we're after at all. We need honesty from our crews. So when they're suffering from heat, we know, and then we can manage it. So I really pushed the message that you're not a hero for burying the heat and pretending, you're actually a liability, we need workers rewarded for putting their hand up and saying, I'm not feeling too well. That's where we need to get to.

Excellent, thank you very much. And I hope everyone has enjoyed your presentation on heat stress and we thank Dr. Matt Brearley for joining us. Remember folks, there are still loads of free virtual events to enjoy during safe work month, including a chat with ex-Olympian, Hailey Lewis on mental health, and there's still time to register. You can also access heaps of free resources from our website, worksafe.qld.gov.edu, including industry and topics, specific video case studies, podcasts, speaker recordings, and webinars and films to help you improve your WHS and return to work outcomes. And very shortly Matt's presentation will be online. Sorry, no Matt's presentation will not be online I jumped the gun on that one. But if you do have questions, we're still open. The chat box is open and we'll get Matt to answer those as soon as possible. Thanks everyone for tuning in today and supporting safe work month. Remember work safe, home safe.