First published on July 13, 2015 in observance of the COPH’s 30^th anniversary celebration.

Founded in 1997 by a training grant supported by the National Institute for Occupational Safety and Health, the Sunshine Education and Research Center at the USF College of Public Health stemmed from an industrial hygiene training program grant in the late 1980s.

“NIOSH has several charters,” explained Dr. Thomas Bernard, chair and professor in Environmental and Occupational Health and SERC (pronounced SIR-see) program director since 2008.  “One of them is to support and encourage the development of professionals in the field of occupational safety and health.  A mechanism for doing that is through training grants.”

After Bernard’s arrival in 1989, additional training program grants followed in occupational medicine and occupational health nursing.  Then the department began work on an occupational safety program.  Eight years later, the fledgling operation had grown enough to warrant centralization.

“In the mid-’90s,” Bernard said, “we decided that we would combine those training activities with a grant and ask for an education center.  The application required that it have training in at least three programs, and we had four: safety, industrial hygiene, medicine and nursing.  The application was accepted and funded under the leadership of Stuart M. Brooks and Yehia Hammad.”

Being headquartered at a university the size of USF naturally leads any interdisciplinary entity into an expansion cornucopia that Bernard is happy to enumerate, along with the USF colleges involved.

“Because they are multidiscipline programs, part of their value is the interdisciplinary training,” he said.  “We added, about seven years ago, occupational health psychology, so that’s now a funded program in Arts and Sciences.  We’ve expanded the safety program to include a degree out of engineering.  Obviously, we’re involved with the [Morsani] College of Medicine:  The clinical rotations and residency certificates come out of medicine, and then the academic training comes out of public health.

“With nursing,” he said, “we have three options.  One is a straight occupational health nursing degree, a second one is a dual degree in nursing and public health, and then we also have a third degree that’s strictly public health.”

Thomas Bernard, PhD

Another requirement under the grant from NIOSH, which is part of the Centers for Disease Control and Prevention, is a continuing education component,  which also has been added.  Additional expansion has stemmed from outreach activities, student recruitment and a pilot project in research training for doctoral students and junior faculty.

“We support these throughout the region,” Bernard qualified, “so they aren’t only for USF.  We have reached way beyond ourselves in terms of the arrangements that we have, but we engage the professional community more than the community at large.”

He added that the center is “very much engaged” in state and regional professional conferences, as well as in coordination with other ERCs in the state and the region.

“By and large, we have a very good national profile,” he said.  “There are just a couple of us that reach out globally, but those are more individual efforts.  The ERC is designed to serve primarily Florida, and in a larger sense, the Southeast region.  That’s our mission and our charter from NIOSH, not to go beyond that, but I think we have expertise in a number of areas that have national recognition.”

The highly technical nature of some of those areas probably help limit recognition to professional circles, but their significance would be difficult to deny. Respiratory protection from nanoparticles is one of them, but as Bernard pointed out, it’s not exactly a topic on most people’s minds.

“Few people are asking, ‘What happens when you breathe those in?’  Some of them have characteristics that are not unlike asbestos.  Others are easily transported across the air-blood barriers, so they move through the lungs into the blood and get transported elsewhere in the body.  So protecting individuals from nanoparticles is important,” he said.

And the list goes on.

“We have a major presence in the area of heat stress – how to evaluate heat stress, how to manage it, and especially, the effects of protective clothing.  We have fairly good recognition in Europe in the area of ergonomics,” he continued,  “and occupational health psychology clearly is one of our well-recognized programs.”

Workplace stress, safety climate and work-family balance are others, he said.

“And then,” he concluded with a nod that said he’d saved the best for last, “we turn out good students, and we’re recognized through the product of the quality of our students.”

SERC hosts a six-day Summer Institute for Occupational Health and Safety for students interested in exploring graduate studies.

Looking ahead is easy for Bernard, and he likes what he sees for his organization.

“I think that everything we do in public health, and everything we do within the SERC, is prevention – preventing people from being injured or having their health impaired,” he said.  “But I think our opportunity here at USF lies in translating research to practice and also expanding on the fact that a healthy workforce is healthy not only from controlling exposures to hazards in the workplace, but also from encouraging healthy activities outside the workplace.

“So, bringing these work and home lives together is an opportunity for us,” Bernard concluded, “and that’s where I see our future.”

Story by David Brothers, College of Public Health.

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Dear Reader,

Thousands of indoor and outdoor workers are exposed to heat risk each year and even killed due to heat overexposure. According to a recent study conducted by the Atlantic Council’s Adrienne Arsht-Rockefeller Foundation Resilience Center, heat-induced illnesses and injuries are taking more lives than any natural disaster and costing businesses across the nation an average of $100 billion annually from declines in labor productivity. Despite these consequences, heat-related incidents consistently remain under-reported, and workers remain at risk.

In response to the high incidence of heat-related illnesses and injuries, The Occupational Safety and Health Administration (OSHA) has developed and implemented a National Emphasis Program with a new enforcement initiative. Additionally, the agency has formed the National Advisory Committee on Occupational Safety and Health Heat Injury and Illness Prevention Work Group to increase awareness of the harmful effects of heat stress and share best practices to protect workers. This initiative is intended to ensure employees in high-hazard industries are protected from both indoor and outdoor heat-related hazards,  adds an enforcement component to target specific high-hazard industries in workplaces where this hazard is prevalent, and focuses on vulnerable workers in outdoor and indoor environments.  The ultimate goal is to reduce or eliminate worker exposures to heat hazards and target industries and worksites where employees are not provided with cool water, rest, cool shaded areas, training, and acclimatization using a proactive vs. reactive approach with enforcement, outreach to employers, and compliance assistance.

As part of the program, OSHA can target and proactively initiate on-site inspections of indoor and outdoor worksites in high-risk industries conceivably when the National Weather Service has issued a local heat warning or advisory or the heat index reaches 80 degrees or higher. Regardless of whether the NEP targets the industry, during heat-related inspections, employers should be prepared to answer the following questions:

• Is there a written program?
• How does the employer monitor ambient temperature(s) and levels of work exertion at the worksite?
• Is there access to water, rest, shade, and breaks?
• Does the employer provide time for acclimatization of new and returning workers?
• Is a “buddy” system in place on hot days?
• Are administrative controls used (earlier start times and employee/job rotation) to limit heat overexposure?
• Does the employer provide training on heat illness signs, how to report signs and symptoms, first aid, how to contact emergency personnel, prevention, and the importance of hydration?

As an employer, it is your obligation to identify, abate and/or eliminate the occupational hazard exposure at your worksite. It is strongly recommended that employers take a proactive approach toward heat illness and injury prevention. Heat-related incidents can dramatically interrupt business operations and present significant financial and reputational repercussions. The USF SafetyFlorida Consultation Program has provided free, confidential compliance assistance to thousands of Florida’s small employers for over 20 years and can assist in developing strategic approaches to address heat-related illnesses and injuries in the workplace. Our consultants hold more than 150 years of combined occupational health and safety leadership experience from various industries such as private manufacturing, construction, mining, and government. To request a confidential, no-cost consultation, please visit https://www.tfaforms.com/4696809 or call toll-free (866) 273 1105.

Stay Safe,

Dr. Brian L. Warrick, PhD, CSP, CIH
Program Director
USF SafetyFlorida

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Dear Reader,

Historically, July has been recorded as one of Florida’s hottest months. Although this is great news for visitors flocking in from throughout the country to our beaches and attractions, this presents new challenges for Florida’s workforce. Contrary to popular belief, hazardous heat exposure can occur indoors as well as outdoors during any season. If not fatal, the lasting impact of a heat related illness can be life changing, as they can result in seizures, loss of consciousness and kidney damage. Prolonged physical activity or exposure can onset any of these symptoms and if left untreated, can cause serious harm or disability.

Heat Stress is not addressed by specific OSHA Standard however, it is a recognized hazard with the potential to cause death or serious bodily harm recognized under OSHA’s General Duty Clause Section 5(a)(1). The clause requires employers to provide a workplace that is free from any recognized hazards and carries a hefty penalty of up to $7,000 for each violation.

Heat illnesses not only expose workers to serious health risk but can also be linked to decreases in productivity as a result of injuries, illnesses, and hospitalizations. Employers are strongly encouraged to establish heat illness prevention plans and train both supervisors and employees to identify and prevent hazardous heat exposure.  

If your business is operating without a heat illness prevention plan, you should be sweating. USF SafetyFlorida Consultation Program is here to help. Our consultants have over 150 years of experience in occupational health and safety leadership and stand ready to assist Florida small employers. To request a no-cost, confidential on-site consultation please visit usfsafetyflorida.com or call toll-free (866) 273 1105.

Stay Safe,

Dr. Brian L. Warrick, PhD, CSP, CIH
Program Director
USF SafetyFlorida

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Co-written by: Dr. Thomas Bernard, University of South Florida Faculty and
David Ashman, USF SafetyFlorida Safety Consultant

Although summer has officially ended and autumn is here, the hot weather has been relentless in the sunshine state, especially in the southern region. The blistering heat has broken record highs this year alone. Those working outside in construction or agriculture are especially at risk.

Workers’ exposed to extreme heat are at greater risk of heat-related disorders like heat stroke and heat exhaustion. Employers and employees must know the signs and symptoms of heat stroke and heat exhaustion, and have a plan for first aid and emergency response (please refer to the Heat Illness Guideline.) Another concern is heat fainting (called syncope), which occurs when an employee is standing for long periods of time or standing up quickly after sitting or lying down for long periods.

During a recent site visit with an employer, as we began to discuss prevention strategies related to this particular risk, the employer recalled one summer in particular in which the company faced four different instances. Two of which were recordable. He was relieved to see that as a result of training, his employees were now capable of responding in a manner that reduced the severity of injuries in all of these accounts. Employees immediately sprang into action, offering additional water sources and moving the affected to cool rooms on-site. I would venture to say that proper training and effective emergency planning helped keep those employees alive that day.

Failure to implement an effective injury and illness program can result in monetary fines from OSHA enforcement. Under General Duty Clause 5a1 OSHA can fine an employer for items discovered in an inspection that are known hazards (see OSHA and NIOSH websites). Additionally, loss of consciousness, regardless of the duration, is a recordable injury that would need to be included in your OSHA logs. Any injury or illness could result in a workers’ compensation claim that could potentially increase an employer’s modification rate and increase insurance premiums.

It is imperative to ensure that employees are properly trained on what to expect and what signs to look for. Prevention of heat stress in workers is key. Adequate training should be provided so that employees are familiar with what heat stress is, how it can impact their safety, and how it can be prevented. Providing water, rest and shade is necessary to allow employees sufficient time to cool down. More importantly, employees need to be granted the ability to stop any processes necessary to prevent a more serious injury from occurring.

According to the National Safety Council, workplace injuries and illnesses cost our economy $198.2 billion per day. Employers who invest in injury and illness prevention programs can expect to see significant cost savings in addition to reducing fatalities, injuries, and illnesses. USF SafetyFlorida, the state of Florida’s official small business consultation program provides employers with a FREE web-based tool known as the SafetyWriter. SafetyWriter allows employers to customize an injury and illness prevention program specific to their industry. To access the free tool or to request a complimentary consultation, visit www.usfsafetyflorida.com or call 1.866.273.1105.

For more information regarding heat stress:

https://www.osha.gov/heat/index.html

https://www.osha.gov/Publications/osha3154.pdf

https://www.osha.gov/SLTC/heatstress/heat_illnesses.html

https://www.weather.gov/safety/heat

https://www.osha.gov/OshDoc/data_Hurricane_Facts/heat_stress.html

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Two USF College of Public Health faculty members traveled to the Capitol area to provide input on their various areas of expertise. Dr. Kevin Kip, distinguished USF Health professor, served on the FDA Circulatory System Devices Panel of the Medical Devices Advisory Committee and Dr. Thomas Bernard, professor of occupational health, gave his testimony at a congressional mandate to implement a heat stress standard.

From June 19-20, the FDA Circulatory System Devices Panel Advisory Committee discussed and made recommendations on information related to recent observations of increased late mortality in patients treated with paclitaxel-coated balloons and paclitaxel-eluting stents compared to patients treated without the coated devices.

The meeting was established after the article titled “Risk of Death Following Application of Paclitaxel-Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta-Analysis of Randomized Controlled Trials” was published in the Journal of the American Heart Association.

The article concluded that there is increased risk of death following application of paclitaxel‐coated balloons and stents in the femoropopliteal artery of the lower limbs and that further investigations are urgently warranted.

As a Special Government Employee, a program that allows professionals to serve on Federally-established advisory committees and industry employees to work alongside OSHA and participate in OSHA outreach and compliance assistance activities, Kip was called in to join the committee during the two-day meeting.

The panel discussed the following questions: is there a presence of a mortality signal, what is the class effect, what is the impact of missing data, were there trends in subgroup analyses, what is the cause of death, is there a paclitaxel dose and mortality relationship, are there trends in pre-clinical studies, what is the benefit-risk profile, are there post market studies and surveillance, should labeling be changed, should there be changes to the study design, and are there other indications.

They concluded that a late mortality signal associated with the use of paclitaxel-coated devices was present and agreed that the signal should be interpreted with caution because due of small sample size, pooling of studies of different paclitaxel-coated devices that were not intended to be combined, substantial amounts of missing study data, no clear evidence of a paclitaxel dose effect on mortality, and no known singular cause of late deaths. They also concluded that additional clinical study data are needed to fully evaluate the late mortality signal.

While the panel found that there was a late mortality signal, there are clinical benefits to paclitaxel-coated devices and those benefits should be considered along with the potential risks. Paclitaxel-coated devices do improve blood flow to the legs and decrease the likelihood of repeat procedures to reopen blocked blood vessels compared with uncoated devices.

“My sense is that it’d be hard to start a whole new trial and a whole new large definitive study that would require follow up of treated patients for a long period of time,” Kip said. “Therefore, I believe that the FDA should seek to maximize efforts from the existing studies, including understanding reasons for and minimizing the amount of missing data, and secondarily, to follow the previously treated patients longer, including from 5-10 years post-treatment. In other words, keep collecting data from the existing studies would be my recommendation.”

***

On July 10, 2019, U.S. House of Representatives Democrats released a bill that, if passed, would require OSHA to develop a federal standard on workplace heat stress. Under the proposed bill, OSHA would have two years to propose a heat protection standard to protect both indoor and outdoor workers.

Representative Judy Chu, D-Calif., and Representative Raúl M. Grijalva, D-Ariz., introduced the Asunción Valdivia Heat Illness and Fatality Prevention Act, which is named for Asunción Valdivia, a farmworker who died after picking grapes for a 10-hour shift in 105-degree heat.

Bernard was a part of the six-person panel addressing heat stress and occupational health from a science and policy point of view. Other panel members included workers who were exposed to heat stress as well as representatives from industries where heat stress is a problem.

Bernard believes that an enforceable OSHA standard can bring visibility and clarity to the structure and function of an effective heat stress management program.

“Heat stress is an underappreciated workplace hazard. We all have worked or played in hot environments, and may even have felt some of the symptoms of heat exhaustion,” Bernard said. “This common experience leads us to under-appreciate the real risks. Heat stress is serious when the workplace is not prepared to deal with it.”

“It is my opinion based on my experience and practice that an enforceable OSHA standard can bring visibility and clarity to the structure and function of an effective heat stress management program,” he said.

There are three states in the U.S. that already have standards for heat stress: California, Washington and Minnesota. While Bernard thinks that there’s a small chance of the bill passing, he does think that building public awareness surrounding it is a great outcome.

“I think we’re still at the stage where it’s building the public awareness and beginning to build an interest in doing something,” Bernard said. “I think a year ago I would have said that the chances of having a standard were zero. Today I can say that there’s something a little bit better than zero.”

Story by Caitlin Keough, USF College of Public Health

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Hot weather is here and it’s no secret that extreme heat can be dangerous. In 2018, there were 108 heat-related fatalities and thousands of workers affected by excess heat exposure reported nationwide, making extreme heat the leading cause of weather-related deaths in the United States according to the Centers for Disease Control and Prevention. OSHA does not have a specific standard that covers working in hot environments. Nonetheless, under the OSH Act, employers have a duty to protect workers from recognized serious hazards in the workplace, which include heat-related hazards. Worksite heat –related illnesses and deaths can be prevented by taking simple precautions.

Important ways to reduce heat exposure and the risk of heat-related illness include engineering controls, such as air conditioning and ventilation that make the work environment cooler, work practices such as work/rest cycles, drinking water often, and providing an opportunity for workers to build up a level of tolerance to working in the heat. Employers should include these prevention steps in worksite training and plans. Also, it’s important to be familiar with and look out for the symptoms of heat-related illness in yourself and others during hot weather. Plan for an emergency and know what to do as acting quickly can save lives.

Visit www.osha.gov for worker fact sheets, worksite posters, and other resources on preventing heat-related illness, in both English and Spanish. For more information or to request a free on site hazard assessment from the USF SafetyFlorida Consultation Program, please visit us at www.usfsafetyflorida.com or call us toll-free (866) 273-1105.

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Dr. Thomas Bernard, chair of Environmental and Occupational Health at the USF College of Public Health, delivered the keynote message at a heat stress symposium in Sohar, Oman, the last week of April.

Tom Bernard, PhD

The manifold purpose of the symposium was to share information on current heat stress prevention and management programs followed in various industries; to propose a model for heat stress prevention, mitigation, monitoring and management; to introduce the concept of using heat stress indices in heat stress management; and to facilitate exchange of technical information on heat stress management protocols.  The focus was on Sohar Aluminum, a major manufacturing firm in Oman.

Bernard converses with Dr. Mohammed Al Yazidi, director of environmental and occupational health for the Ministry of Health, Oman, at a worker health and safety exhibit associated with a World Health Organization annual activity.

Said Al Masoudi, CEO of Sohar Aluminum, presented Bernard with a painting by a local artist supported by Sohart, a program to encourage the arts in Sohar.

Bernard’s primary teaching assignments support the occupational safety and health program in the department of Environmental and Occupational Health.  His research foci include ergonomics and the evaluation and control of heat stress and strain.  He has been at COPH since 1989.

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