guidelines for avoiding heat illnesses

Dr. Heather Fullerton, staff member at Baylor Scott & White - Round Rock (and Assistant Scoutmaster of Troop 202 in North Shore District), recently presented guidelines for prevention, recognition and treatment of heat illness to our Council Health and Safety committee. This same information was presented to our summer camp staff at Lost Pines Scout Reservation.

Those guidelines were adapted from research Dr. Fullerton conducted from many resources including the National Council BSA Health and Safety Guidelines. They are designed to help prevent, recognize and treat heat illness this summer.

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Purpose

The purpose of this document is to outline Capitol Area Council’s plan for prevention, treatment, and reporting of heat related illness in scouting activities.  This plan has been adapted from Council Program Guidelines: Regarding Response to Adverse Heat and Humidity Conditions, a document created by National Council of BSA.

General Considerations

Temperature, relative humidity, level of activity, and hydration combine to impact the risk for adverse health outcomes. Attention to all of these variables should help manage the risk for heat exhaustion, heat stroke, dehydration, and other heat-related injuries.

Applicability

A heat and humidity plan should be used in any council (and potentially district and unit) program (e.g. summer camp, strenuous outdoor activities) when excess heat and humidity raise the risk of adverse heat illnesses.

Response plan

Table 1 below categorizes heat conditions by level of risk according to wet bulb globe temperature (WBGT). The WBGT is a measure of the heat stress in direct sunlight, taking into account temperature, humidity, wind speed, and radiant heat. Conditions are categorized as white (minimal risk), green, yellow, red, or black (highest risk).

* Activity limitation guidelines

For each level of risk there are activity recommendations to promote safe participation.
  • Easy work or a white heat category often results in no activity limitation
  • Heavier work and higher heat categories have recommendations for the total number of minutes of activity and rest in an hour. For example, hikers doing moderate work at a WBGT of 86 (yellow) should rest 20 minutes in an hour but may be active for 40 minutes. They may choose to hike for 20 minutes, rest for 10, hike another 20, and rest another 10 minutes. This would result in 40 minutes of activity and 20 minutes of rest.
  • In very high risk conditions, hard outdoor work should be terminated. The activity may be brought indoors, rescheduled for cooler conditions, or canceled.
* Hydration guidelines
  • For each level of risk there are also hydration guidelines in quarts per hour.
  • Fluid needs can vary based on individual differences (+/- ¼ qt/hr) and exposure to full sun or full shade (+/- ¼ qt/hr).
  • Over-drinking can also be dangerous. Fluid consumption should not exceed 1.5 quarts per hour.
Individuals suffering from heat related illness should be treated quickly and properly. Information on recognition and treatment of heat related illness can be found at the end of this document.

Detection: determination of heat and humidity conditions

* How to check

Recommendations are based off of wet bulb globe temperature (WBGT)
* How often to check

A minimum of twice daily

* Who will check

For large council or district sponsored activities:
  • Health officer
  • If no designated medical staff, safety officer for the camp / event
  • If neither, program director for the event
For smaller or unit-based activities
  • Adult in charge (e.g. Scoutmaster)
Awareness of any community-based heat advisories issued by authorities

Warning and Response: proactive actions to avoid adverse health outcomes

Implementation of plan by

* For large council or district sponsored activities:
  • Health officer
  • If no designated medical staff, safety officer for the camp / event
  • If neither, program director for the event
* For smaller or unit-based activities
  • Adult in charge (e.g. Scoutmaster)
* Table (appendix) used to determine when to
  • Adjust activity : rest ratios
  • Adjust hydration
  • Cancel or reschedule event / programming if needed
* Warning system based on table
  • White, green, yellow, red, black flags at main camp during summer camp
  • direct or radio communication with all program areas if risk is yellow or higher
  • ensure communication with remote or extreme program areas, and ensure their ability to respond
  • announcement, about warning system and response, to scouts and leaders is advised if risk is yellow or higher
* Other modifiable risk factors
  • Shade
  • Clothing
  • Sunscreen
  • Time of day for activity
  • Water at all program areas
* Education

Large council or district-based activities during warm weather months (April – Oct), and as needed during other times of year
  • Direct education of camp/event staff – pre-camp training
  • Direct education of unit leaders regarding prevention and response plan – scoutmaster meetings
  • Direct education of Scouts at program areas
  • Posted table for participants to reference, to understand warning flags / recommendations
  • Consider announcements at flag ceremony / meals / etc as appropriate with daily conditions
  • During red or black conditions, the program director or designee should tour the camp during periods of highest risk to assure that Scouts between program areas and in unsupervised areas of the program area are aware of the risk and have access to water as well as protection from the heat / sun.
Unit awareness and activities
  • Web
  • Video
  • IOLS or other leader training
Appendix with information to be included in training

Equipment needed for detection and treatment of heat illness
  • WBGT thermometer (most accurate) or mobile device app or WBGT table
  • Rectal thermometer / probe covers
  • Immersion tub (ice water immersion – gold standard) or tarp (taco method)
  • Ice

Reporting and review of incidents where adverse health outcomes occur

In conjunction with the BSA policy on incident reporting, any adverse heat reactions requiring medical intervention should be submitted as a reportable incident to the council leadership and from there to the BSA’s national Health and Safety Support Committee. Life-threatening heat-related incidents or any clustering of more minor incidents should be reviewed as soon as possible to determine if any adjustments to the current H&H plan are needed to prevent similar occurrences.

Treatments for noncritical heat reactions logged in camp first-aid records should also be reviewed regularly during periods of highest risk, and if excess incidents occur, an acute intervention plan implemented. The council health and safety committee and/or the camp health officer may be a resource for plan development and for adverse incident review. Generally, heat illness protocols should be available in the health lodge protocols of most camps.

Table 1

Table 2

See Also