An Experimental Simulation of Heat Effects on Cognition and Workload of Surgical Team Members.

OBJECTIVE: To isolate heat exposure as a cause of cognitive impairment and increased subjective workload in burns surgical teams. SUMMARY OF BACKGROUND DATA: Raising ambient temperature of the operating room can improve burns patient outcomes, but risks increased cognitive impairment and workload of surgical team members. Prior research indicates ambient heat exposure depletes physiological and cognitive resources, but these findings have not been studied in the context of burns surgical teams. METHODS: Seventeen surgical team members completed 2 surgery simulations of similar complexities in a hot and in a normothermic operating room. During each simulation, participants completed multiple cognitive tests to assess cognitive functioning and the SURG-TLX to self-assess workload. Order effects, core body temperature changes due to menstruation, and circadian rhythms were controlled for in the experimental design. Descriptive statistics, correlations, and mixed ANOVAs were performed to assess relationships between ambient heat exposure with cognitive functioning and perceived workload. RESULTS: Heat had a main effect on executive functioning and verbal reasoning. Duration of heat exposure (heat ∗ time) increased response times and negatively impacted executive functioning, spatial planning, and mental rotation. Perceived workload was higher in the hot condition. CONCLUSIONS: We provide causal evidence that over time, heat exposure impairs cognitive speed and accuracy, and increases subjective workload. We recommend building on this study to drive best-practices for acute burns surgery and design work to enable burns teams to maintain their cognitive stamina, lower their workload, and improve outcomes for patients and surgeons.

Symptoms of heat illness and water consumption habits in mine industry workers over the summer months in Australia.

Mine industry workers (n=515) from various locations in Australia completed a questionnaire to assess the prevalence of symptoms associated with heat-related illness and water consumption habits during a summer season. Participants read from a pre-defined list and noted any heat-related symptoms that they had experienced. The most prevalent symptoms experienced were fatigue, headache, sweating, and dark coloured urine, with 77% of respondents reporting at least one symptom. Workers with shorter employment durations had higher rates of reporting multiple symptoms (rates ratios: 1.40-1.72). The most prevalent water consumption amounts over an 11-12 h shift were 2-4 L by 37.3% of total respondents, followed by 1-2 L by 36.5% of respondents. Employers should inform workers about the severe implications of heat-related illnesses, implement regular water breaks, and educate personnel about the importance of water intake. Providing employees with self-check methods of hydration status is recommended to increase awareness of their hydration status.

Heat exposure as a cause of injury and illness in mine industry workers.

The objective of this study was to explore the association between ambient temperature and injuries and illnesses experienced by mine industry workers. Eleven years of de-identified data from a mine industry company in Australia was explored in regards to injuries and illnesses occurring due to outdoor exposure. Each case was filtered for reported symptoms, and meteorological data to match the location of the mine site and date reported were sourced. Of the 18 931 injuries and illnesses observed over the 11-year period, 151 cases of heat-related illness due to outdoor exposure were reported. Twenty-five conditions/symptoms of heat-illness were found, with the most prevalent being dehydration (n = 81), followed by heat rash (n = 40), dizziness (n = 24), and headache (n = 23). The mean number of symptoms reported by each worker was 2 ± 1. There was a positive correlation between ambient temperature and injuries/illnesses (r2 = 0.89, P < 0.001), where, as temperature increased so did the number of reported heat-related illnesses. Underreporting of heat-related illness and injury in the mining industry is likely, which is a risk to the health and wellbeing of employees. Workers require industry specific training about the severity of heat stress and the associated prevention strategies.

A seasonal comparison of a 14-day swing on cognitive function and psycho-physiological responses in mine service workers.

This study assessed the effect of season on cognitive function and psycho-physiological responses during a 14-day swing in mine-service workers. Cognitive function, thermal sensation and comfort, rating of perceived exertion, fatigue, hydration, core temperature and heart rate were assessed throughout a shift, on three separate days over a swing. Working memory and processing efficiency did not differ between seasons (p > 0.05), however counting and recall latencies improved throughout the swing (p < 0.05). Participants reported greater fatigue post-shift compared to pre-shift (p < 0.05). Thermal sensation, thermal comfort, and hydration were significantly elevated in summer compared to winter (p < 0.05). Specifically, workers were significantly/minimally dehydrated in summer/winter (urinary specific gravity = 1.025 ± 0.007/1.018 ± 0.007). Although cognitive function and thermal strain were not impaired in summer compared to winter, it is essential to reinforce worker's knowledge regarding hydration requirements. Additional education and/or incorporating scheduled rest breaks for hydration should be considered to ensure the health and safety of mine workers.

Impact of living and working in the heat on cognitive and psycho-physiological responses in outdoor fly-in fly-out tradesmen: a mining industry study.

Objective: This study aimed to evaluate complex cognitive function, manual dexterity and psycho-physiological parameters in tradesmen working outdoors in the mining industry during summer and winter. Methods: Twenty-six males working in a mining village in the north-west of Australia were assessed pre- and post-an 11-h shift at the start, middle, and end of a 14-day swing in summer (average daily temperature: 33.9°C, 38% RH; n = 12) and winter (24.3°C, 36% RH; n = 14). Results: Working memory performance did not differ between seasons, over the swing or shift (p ≥ 0.053). Processing efficiency and manual dexterity performance did not differ between seasons (p ≥ 0.243), yet improved over the course of the swing (p ≤ 0.001) and shift (p ≤ 0.001). Core temperature, heart rate, thermal comfort, rating of perceived exertion and thermal sensation were not significantly different between seasons (p ≥ 0.076); however, average shift dehydration was greater in winter compared to summer (1.021 ± 0.005 vs. 1.018 ± 0.006; p = 0.014). Conclusion: The ability to self-regulate the intensity of activity likely helped outdoor workers to thermoregulate effectively, minimising thermal strain during their swings and shifts, in turn explaining unaltered cognitive function and manual dexterity performance between seasons. Regardless of season, workers should receive education on dehydration and workplace risks to protect their health.

Comparing thermal strain in outdoor maintenance and indoor service workers in the mining industry during summer.

While working in the heat is a common practice within the Australian mining industry, it can lead to adverse effects on cognitive function, productivity, and physical health. This study aimed to compare the thermal strain experienced by maintenance workers and service workers in the mining industry during summer. Psycho-physiological parameters, manual dexterity, and cognitive function were assessed in maintenance workers (n = 12) and service workers (n = 12) employed at mine site villages in north-west Australia. Maintenance workers had the freedom to self-select their work intensity and predominantly worked outdoors (33.9±4.2°C, 38±18% RH), whereas service workers had to work to a fixed schedule and worked intermittently indoors (∼64% of work shift; 29.5±3.4°C, 48±8% RH) and outdoors (∼36%; 35.4±4.6°C, 47±21% RH). All workers underwent assessment at the beginning (day 2/3), middle (day 7/8), and end of their swing (day 13/14), at various time points throughout their 11-12 h shift. Service workers completed more steps (11282±1794 vs. 7774±2821; p<0.001), experienced a higher heart rate (p = 0.049) and reported higher ratings of perceived exertion (p<0.001), thermal discomfort (p<0.001), thermal sensation (p<0.001), and fatigue (p<0.012) compared to maintenance workers. Urinary specific gravity values were higher (less hydrated) in service workers (1.024±0.007) compared to maintenance workers (1.018±0.006; p = 0.007), with USG being overall higher post- compared to pre-shift (1.022±0.008 vs. 1.020±0.006; p<0.05). Core temperature, working memory capacity, processing speed and manual dexterity did not differ between occupations. Workers in hot environments who cannot self-select their work intensity should be educated about the importance of hydration before, during, and after their work-shifts and provided with more scheduled rest breaks during their shift. Employers should closely monitor workers for symptoms of heat illness, discomfort, and fatigue to ensure the health and safety of the workers.

Seasonal influence on cognitive and psycho-physiological responses to a single 11-h day of work in outdoor mine industry workers.

This study investigated the seasonal effects that working outdoors had on various parameters in mining industry workers over the course of a work-shift. Workers (n = 27) were assessed in summer (33.3 ± 4.2°C, 38 ± 18% RH; n = 13, age = 46 ± 14 y, BMI = 29.1 ± 5.7 kg/m2) and winter (23.6 ± 5.1°C, 39 ± 20% RH; n = 14, age = 44 ± 12 y, BMI = 31.2 ± 4.1 kg/m2). Core temperature and heart-rate were measured continuously (analyzed at five time points), while perceptual measures, cognitive and manual dexterity performance were assessed at various times over an 11-h shift at the start of a 14-day swing. Hydration was assessed (urine specific gravity) pre- and post-shift. Working memory was impaired in summer compared to winter (-10%; p = 0.039), however did not change throughout the shift. Processing efficiency was significantly reduced at 12 pm (-12%; p = 0.005) and 5 pm (-21%; p < 0.001) compared to 9 am, irrespective of season (p > 0.05). Manual dexterity (dominant-hand) improved over the shift (+13%, p = 0.002), but was not different between seasons. Perceived fatigue had no main effect of season or shift. Core temperature, heart-rate, thermal sensation and rating of perceived exertion increased throughout the shift, with only core temperature and thermal sensation showing a seasonal effect (summer: +0.33°C, +18%, respectively; p < 0.002). Notably, 23% of workers in summer and 64% in winter started work significantly dehydrated, with 54% and 64% in summer and winter, respectively, finishing work with significant to serious dehydration. Impairment in working memory in summer combined with high levels of dehydration over the work-shift reinforces the need for workplace education on the importance of hydration and risk of occupation heat stress. Abbreviations: Core temperature: Tc; Fly-in fly-out: FIFO; Ratings of perceived exertion: RPE; Relative humidity: RH; Urinary specific gravity: USG; Wet bulb globe temperature: WBGT.