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Heat exhaustion and heatstroke

Heat exhaustion and heatstroke are two heat-related health conditions. If they're not quickly treated, they can both be very serious.
Heat exhaustion

Heat exhaustion can occur when the temperature inside the body (the core temperature) rises to anything between the normal 37°C (98.6°F) up to 40°C (104°F).
At this temperature, the levels of water and salt in the body begin to fall, which can cause a person to feel sick, feel faint and sweat heavily. Read more about the symptoms of heat exhaustion.
If a person with heat exhaustion is taken quickly to a cool place, is given water to drink and has their excess clothing removed, they should begin to feel better within half an hour and have no long-term complications.
Without treatment, they could develop heatstroke.
Certain groups are more at risk of developing heatstroke or suffering complications from dehydration, and should be taken to hospital. This includes:
children under two years old
very elderly people
people with kidney, heart or circulation problems
people with diabetes who use insulin
Read more about treating heat exhaustion.
Heatstroke

Heatstroke is far more serious than heat exhaustion. It occurs when the body can no longer cool itself and starts to overheat.
When the core temperature rises above 40°C (104°F) the cells inside the body begin to break down and important parts of the body stop working.
If left untreated, it can lead to complications, such as organ failure and brain damage. Some people die from heatstroke.
The symptoms of heatstroke can include:
mental confusion
rapid shallow breathing (hyperventilation)
loss of consciousness
Read more about the symptoms of heatstroke.
What to do

Heatstroke is a medical emergency and should be treated immediately. Dial 999 to request an ambulance if you suspect heatstroke.
While you're waiting for an ambulance to arrive, make sure that the person is as cool as possible. Move them to a cool area as quickly as possible, remove excess clothing and try to cool them by fanning them. If they're conscious, give them cool, not cold, water to drink.
Read more about treating heatstroke.
Who's at risk?

Heatstroke can affect anyone, but some people are more at risk than others and should take extra precautions during warm weather, especially during a heatwave. These include:
the elderly
babies and young children
people with conditions that affect the body's ability to cool down, such as diabetes
those who have drunk too much alcohol (which dehydrates the body)
people on certain drugs and medications, such as antipsychotics and betablockers
people who might find it difficult to keep cool during a heatwave – for example, those who are bed-bound or disabled.
Read more about the causes of heat stroke.
Avoiding heat exhaustion and heatstroke

There are steps you can take to reduce the risk of heat exhaustion and heatstroke during a heatwave:
Stay out of the sun during the hottest parts of the day, particularly between 11am and 3pm.
If you have to go out in the heat, walk in the shade, apply sunscreen and wear a hat.
Don't leave anyone in a parked car.
Avoid extreme physical exertion.
Have plenty of cold drinks, but avoid drinks that contain caffeine and alcohol.
Eat cold foods, particularly salads and fruit with a high water content.
Take a cool shower, bath or body wash.
Sprinkle water over your skin or clothing, or keep a damp cloth on the back of your neck.
Keep your environment cool.

Good customer service

Good customer service is the lifeblood of any business. You can offer promotions and slash prices to bring in as many new customers as you want, but unless you can get some of those customers to come back, your business won't be profitable for long.

Good customer service is all about bringing customers back. And about sending them away happy - happy enough to pass positive feedback about your business along to others, who may then try the product or service you offer for themselves and in their turn become repeat customers.

If you're a good salesperson, you can sell anything to anyone once. But it will be your approach to customer service that determines whether or not you’ll ever be able to sell that person anything else. The essence of good customer service is forming a relationship with customers – a relationship that that individual customer feels that he would like to pursue.

How do you go about forming such a relationship? By remembering the one true secret of good customer service and acting accordingly; "You will be judged by what you do, not what you say."

I know this verges on the kind of statement that's often seen on a sampler, but providing good customer service IS a simple thing. If you truly want to have good customer service, all you have to do is ensure that your business consistently does these things:

1) Answer your phone.

Get call forwarding. Or an answering service. Hire staff if you need to. But make sure that someone is picking up the phone when someone calls your business. (Notice I say "someone". People who call want to talk to a live person, not a fake "recorded robot".) For more on answering the phone, see How to Answer the Phone Properly.

2) Don't make promises unless you will keep them.

Not plan to keep them. Will keep them. Reliability is one of the keys to any good relationship, and good customer service is no exception. If you say, “Your new bedroom furniture will be delivered on Tuesday”, make sure it is delivered on Tuesday. Otherwise, don't say it. The same rule applies to client appointments, deadlines, etc.. Think before you give any promise - because nothing annoys customers more than a broken one.

3) Listen to your customers.

Is there anything more exasperating than telling someone what you want or what your problem is and then discovering that that person hasn't been paying attention and needs to have it explained again? From a customer's point of view, I doubt it. Can the sales pitches and the product babble. Let your customer talk and show him that you are listening by making the appropriate responses, such as suggesting how to solve the problem.

4) Deal with complaints.

No one likes hearing complaints, and many of us have developed a reflex shrug, saying, "You can't please all the people all the time". Maybe not, but if you give the complaint your attention, you may be able to please this one person this one time - and position your business to reap the benefits of good customer service.

5) Be helpful - even if there's no immediate profit in it.

The other day I popped into a local watch shop because I had lost the small piece that clips the pieces of my watch band together. When I explained the problem, the proprietor said that he thought he might have one lying around. He found it, attached it to my watch band – and charged me nothing! Where do you think I'll go when I need a new watch band or even a new watch? And how many people do you think I've told this story to?

6) Train your staff (if you have any) to be always helpful, courteous, and knowledgeable.

Do it yourself or hire someone to train them. Talk to them about good customer service and what it is (and isn't) regularly. (Good Customer Service: How to Help a Customer explains the basics of ensuring positive staff-customer interactions.) Most importantly, give every member of your staff enough information and power to make those small customer-pleasing decisions, so he never has to say, "I don't know, but so-and-so will be back at..."

7) Take the extra step.

For instance, if someone walks into your store and asks you to help them find something, don't just say, "It's in Aisle 3". Lead the customer to the item. Better yet, wait and see if he has questions about it, or further needs. Whatever the extra step may be, if you want to provide good customer service, take it. They may not say so to you, but people notice when people make an extra effort and will tell other people.

8) Throw in something extra.

Whether it's a coupon for a future discount, additional information on how to use the product, or a genuine smile, people love to get more than they thought they were getting. And don’t think that a gesture has to be large to be effective. The local art framer that we use attaches a package of picture hangers to every picture he frames. A small thing, but so appreciated.

If you apply these eight simple rules consistently, your business will become known for its good customer service. And the best part? The irony of good customer service is that over time it will bring in more new customers than promotions and price slashing ever did!

Good practice: lone working

Headlines

• Concerns about lone working are on the increase
• Employers have a responsibility to carry out a risk assessment for lone workers, or for workers who sometimes work or travel alone
• After the disappearance of estate agent Suzy Lamplugh in 1986, her parents set up the Suzy Lamplugh Trust to provide advice on lone working
• In 2007, a Scottish gamekeeper had a quad bike accident and died because no one came to look for him for two days. His employer was fined £3000

Who are lone workers?

The HSE describes a lone worker as “someone who works by themselves without close or direct supervision”. People may work alone because:

• they need to work in a separate part of the premises
• their work is outside normal hours
• the workforce is very small
• they’re mobile, such as salespeople, delivery staff and care workers.

Even if someone works in a busy office or factory, they can become a lone worker when travelling for work purposes, working late or working from home. A risk assessment for lone working is required whether someone is a lone worker every day or just occasionally.

What are the hazards?

Hazards to employees could include:

• violence and abuse – normally from people. For example, potentially vulnerable workers may include utility meter readers who have to enter households on their own.
• injuries from animals are also relevant in some occupations, such as postmen
• accidents where the consequences are worse if there’s no immediate assistance, e.g. slips, trips and falls, suffocation in confined spaces, electrocution or working with dangerous substances
• accidents that result from lone working, e.g. attempting to lift something (or someone) alone when help is needed or falling from a ladder that needed to be supported by an extra person
• long-term health issues resulting from an employee’s isolation, lack of supervision, knowledge or training. This could include musculoskeletal disorders due to lack of a proper DSE assessment.

An example of a hazard happened in 2003 involving a care assistant working alone who dropped a 97-year-old woman. The lady died, and the care assistant’s employer was fined £90,000 with nearly £20,000 costs. In a more recent prosecution, a care home was fined £15,000 with £10,500 costs for an incident which resulted in the death of an 80-year-old quadriplegic resident who fell from bed while being washed and dressed by a single carer, despite written procedures that such a task should always be carried out by two carers.

Hazards to other people most commonly relate to lone drivers. Employees driving on their own for work may have accidents because:

• they’ve been driving for too long
• because one driver has been used where two should have been provided – e.g. long-distance coach drivers and lorry drivers
• the employee may be expected to make and take phone calls while driving – e.g. supermarket shopping delivery drivers. This causes a distraction, whether or not hands-free phones have been provided.
  Hazards magazine’s factsheet 72, ‘Working alone’, provides a list of occupations and hazards.

Are particular people at risk?

As well as considering the hazards generally, the risk assessment should consider whether particular staff may be at risk. For example:

• those with health issues such as diabetes or epilepsy
• disabled employees
• young or inexperienced workers
• pregnant workers
• workers whose first language isn’t English.

You shouldn’t make assumptions about what a person can or cannot do, and you should consult an employee to assess whether a medical condition or disability could affect their ability to work alone.

How can the hazards be controlled?

There are plenty of companies that sell lone worker alarms. However, buying alarms without considering organisational issues such as job design, training and awareness is like buying hearing protection without first considering if the noise level can be reduced. Organisational measures may be more cost-effective than high-tech equipment.

Can you eliminate or reduce lone working?

Does the job need to be done by one person? Is it practical to send two people? Economically, this may not be possible for some jobs, such as takeaway deliveries, but for some high-risk work, for example work that involves confined space entry, there should always be someone else nearby.

Can you reduce the amount of time that someone spends on their own?

Rather than two door-to-door salespeople working in two completely different areas, they could work their way down two sides of the same road, arranging to meet up at pre-defined intervals. Where a person is visited by a home-help and a district nurse in the same day, co-ordinate the times so that there’s an overlap between workers to enable two people to safely lift the client if required.

Many industries use a ‘buddy’ system to reduce the effects of lone working. For example, Royal and Sun Alliance asks lone workers who also live alone to telephone a specific buddy at the end of each day to confirm they have arrived home safely.

Homeworkers can be invited into the office for regular meetings, or visited by colleagues or management where practical. Where face-to-face meetings aren’t possible, some contact should be by telephone, not just email.

Can physical barriers help to protect the lone worker?

Physical barriers may help in some situations to reduce the danger of violence to lone workers, for example at petrol stations providing a late night service with a single employee. However, there’s also evidence  that in some situations barriers can create tension and increase the likelihood of violence and abuse.

How can you control lone working?

Permits to work are commonly used to control more hazardous work, such as electrical work and entry to confined spaces. Permits, which can include a sign-off from a manager to indicate that they’re aware the employee will be working alone for a specific period of time, can provide an extra control when applied to lone working situations.

For any task, correct equipment should be provided and used correctly. For example, a lone office worker should use an appropriate climbing aid to reach a high shelf rather than stand on an office chair. Salespeople should use a trolley to move samples from their car to a house rather than attempt to carry them.

Training

Lone workers need training on:

• how to plan and carry out a job safely, using appropriate equipment
• how to decide when to simply walk or drive away from a situation
• how to recognise danger and take appropriate action. For example, apologising to diffuse a difficult situation or parking a vehicle in a way that makes a quick getaway possible
• who to contact if there’s a problem and they need help. This is particularly relevant for non-native workers who may not know how to contact the emergency services, and may not be able to explain their problem to passers-by if they’re upset or ill
• some emergency first aid, for example to treat their own burns, eye injuries or to control bleeding. Appropriate first aid equipment should be provided.

Industry specific training

The Department of Health provides a detailed checklist for social carestaff. Also, the Department for Transport has advice for bus drivers, theirmanagers, the designers of buses and coaches, and the planners and architects of bus and coach stations.

For home workers, see the IOSH guide on Teleworking, the HSE leaflet on Homeworking and the more detailed HSE research report ‘Health and safety of home workers’ with example risk assessments and good practice.

Specialist training on lone working is provided by the Suzy Lamplugh Trust.

The technology

If all steps have been taken to eliminate, reduce and control the risks of lone working, technology can be considered to reduce the residual risk. A variety of different alarm and tracking devices exist:

• inexpensive personal alarms make loud noises when triggered. These rely on someone else hearing the noise and choosing to help, or on frightening an attacker away
• when triggered, GPS devices send a signal with the worker’s location to an individual or to a control room where appropriate help can be sent out
• GPS tracking can be carried out without the use of an alarm system. A lone worker’s phone can be set up to send a regular bulletin on their location, or to enable someone to check their location if they are late checking in
• so-called ‘man-down’ alarms can be triggered by a tilt switch (if someone falls over) or by a motion sensor (if someone remains still for too long)
• some alarms require the lone worker to respond to regular text messages within a pre-determined interval.
  
  Some alarm systems are based on using existing mobile phones, PDAs or Blackberries. It has been suggested that use of such devices can escalate a threatening situation. If this is likely to be the case, more discreet devices are available – for example some look like an ID card and can be activated without the aggressor noticing. GPS tracking devices can be fitted in vehicles or carried in a brief case.