Outdoor workers, people without housing especially vulnerable to severe cold

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

Photo by Buzz Hoffman via Flickr

With much of the country feeling the “polar vortex” and some of the coldest temperatures seen in 20 years in some places, reporters may be called upon to write about health – and death – in cold weather.

Hypothermia is the unintentional lowering of the body’s core temperature below 95º F. According to the Centers for Disease Control and Prevention, common risk factors for hypothermia include exposure to cold while under the influence of alcohol or drugs, altered mental status and immersion in cold water. Other factors can include advanced age, chronic medical conditions, substance abuse and homelessness.

The CDC has some winter weather health and safety tips to help people protect themselves from frostbite, hypothermia, carbon monoxide poisoning, chainsaw mishaps and more. Here are some other general resources:

The American Public Health Association’s Get Ready initiative has information about winter storms, sheltering in place, power outages and more.

People who are homeless are particularly vulnerable in this weather and the National Health Care for the Homeless Council has reports and tips on helping people with exposure-related conditions. If your community is experiencing or expecting colder-than-normal weather, are there additional shelters opening? Are existing shelters waiving some of the rules and requirements that normally might prevent some people from seeking shelter?

People who have to work outdoors are susceptible to cold-related injuries and conditions. The  National Institute for Occupational Safety and Health has information about “cold stress” and here are some other links:

QuickStats: Hypothermia-related deaths by gender

This data, from the National Vital Statistics System, finds that, from 1999 to 2011, an average of 1,301 deaths per year in the United States were associated with exposure to excessive natural cold. The highest yearly total of hypothermia-related deaths (1,536) was in 2010 and the lowest (1,058) in 2006.

Hypothermia-Related Deaths – United States, 2003

“This report describes three cases of fatal hypothermia that occurred during 2003, reviews national statistics on mortality from cold exposure in 2001, and provides recommendations for the diagnosis, treatment, and prevention of hypothermia.”

Injuries and Deaths Associated with Use of Snowmobiles — Maine, 1991-1996

During the 1995-96 winter season, officials in Maine noticed an increase in deaths associated with snowmobile use. There were 12 snowmobile-related deaths that season – the largest number of snowmobile-related deaths in 25 years. In addition, from 1991 through 1996, the number of registered snowmobiles increased from 61,641 to a record high of 76,477, respectively, and the death rate per registered vehicle in 1996 was higher than in any of the previous five years. This report summarizes the results of this analysis and recommends strategies for preventing such deaths and injuries.

The following resources are from a 2010 Covering Health post by Andrew Van Dam:

Carbon Monoxide Poisonings Associated with Snow-Obstructed Vehicle Exhaust Systems — Philadelphia and New York City, January 1996 (MMWR 1996; 45(01);1-3.)

According to the review, “Most of these poisonings occurred among children and elderly persons and resulted from exposures in idling automobiles with exhaust pipes blocked by snow.” During one two-day stretch, 21 people who had been found unconscious in running cars were brought to the Jacobi Medical Center in New York. In that spirit, the investigators look at the individual cases of a 4-year-old girl (left in the car because her family thought she was napping), and two older men. In all cases, their primary mistake seems to have been in starting cars surrounded by deep snow without making any attempt to remove the snow first.

Snow-Blower Injuries — Colorado, New York (MMWR 1983;32(6):77-78.)

The takeaway from this article? Using your hands to clear a snowblower’s clogged exit chute is probably not a good idea.

Public Health Impact of a Snow Disaster (MMWR 1982;31(51):695-696.)

A review of studies related to 1978 storm in New England found that, during the blizzard, mortality rates didn’t increase significantly (though a third of the deaths that did happen were classified as storm-related), and that emergency room visits declined to less than half their normal levels. Hospitals also had supply problems because they could not discharge patients.

To solve these problems, the authors recommend that officials ask folks not to drive during storms (and to bring emergency supplies if they do), and to create a “rumor clearinghouse” to investigate reported hazards and outbreaks. They also suggest that overcrowded hospitals can use emergency vehicles to bring discharged patients home.

Unintentional Carbon Monoxide Poisoning Following a Winter Storm — Washington, January 1993 (MMWR 1993; 42(06);109-111.)

Most of the 44 patients studied were members of ethnic minority groups, and half didn’t speak English. In 65 percent of the cases, the cause was burning charcoal briquettes. All those incidents, the study noted, involved racial/ethnic minorities.

Work-Related Injuries Associated with Falls During Ice Storms, January 1994 — National Institutes of Health (MMWR 1995; 44(49);920-2.)

The review found that, during ice storm season, workers tend to fall outdoors more often than usual. Slightly more interesting is that the workers in this study were NIH employees on NIH campuses.

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