How to prove relative dehydration in a 1500 worker population?

[DwayneEMTP]

So this is my issue...

In the clinic here we see from 40-70 patients per day. It's been my belief, and my complaint here, that we see a comorbidity to URTIs, headache, body ache, etc secondary to relative dehydration in the majority of patients that we see. The management is not on board but claims that If I can track it and verify it that they will take it more seriously.

The issues:

Most of the workers here come from warmer, lower altitudes. We are at approximately 6,600ft with most workers working a 14-on/12-off day rotation. It is approximately 20 degrees cooler on average at this altitude than most are used to so they don't believe that staying hydrated is necessary because they are not normally sweating.

The headaches, body aches, increased cough, darker urine is believed by nearly everyone local to be caused by the colder temperatures instead of hydration status. (I also noticed this in Afg. That a 'cool breeze' that can cause everything from influenza to cancer. Air conditioning was blamed for most everything.)

Why I believe that it's an issue.

Supervisors are required to provide water for their workers. But the most common story that I hear at the clinic is that workers are lined up at the beginning of shift and each is given one bottle (600cc) for the 12 hr day.

I harp on the vollies that we train and have made hydration believers out of them. When doing pre training assessments on them the highest pulse rate that I've gotten (approx. 40 local nationals, mostly men, a few women) was 66 BPM. Their B/Ps tend to run in a pretty healthy range as well...130 (or below) over 80(or below).

We've had a respiratory virus going around causing significant (though not normally dangerous) congestion of peoples lungs. I notice that the office workers (constant, easily accessible water) complain of productive cough, and L/S normally show rhonki, while those out in the mine complain of a harsher, non productive cough with normally diminished L/S.

Office workers tend to have vitals within the range predicted by the vollies. Those in the field normally show in the high 70's to low 90's.

But how to track this so that I can come up with numbers to make the point? I've seen it a million times, so I'm confident. Red eyes, elevated B/P, Pulse, headache, body aches, dry cough, etc....

What do you all think? Anyone had to do this before that's had a tried and true system?

It has to be simple as the LN nurses will be recording most of it...

I'd be grateful for your thoughts...

Dwayne

[Bieber]

Never had to do anything like this before, but I imagine you could simply start tracking the amount of water people are drinking each day. I know it'll be hard to ensure compliance, but is there any way you could get people to fill out a form where they have to write in how much water they consumed each day for a week or show and compare them all?

Just the first thing that came to mind, I'll try to come up with something better later on tonight.

[DwayneEMTP]

That was my first idea too.

The problem is that thought I tell management that there is no way that 600cc of fluid can be adequate for a grown man at this altitude on a 12hr shift, they claim that it's plenty for 'locals.'

So I can't really attack them from that simple logic. I have to claim that it's not enough based on experience, but also support that it's not enough based on X findings...(yeah, urine dips have been ordered for months, so it appears that's not an option.)

What would I have EMTB level providers track, that they can track reliably?

I have no doubt at all that I can convince the people of this board that that this is an issue significant enough to act upon, but what to do to get a lower level of care to collect data that will convince the non medical decision makers?

[chbare]

Can you do urine dip sticks? Urine specific gravity is easy to obtain, correlates with dehydration and is a quantitative value that can be tracked and reported.

Edited May 26, 2012 by chbare

[island emt]

Dwayne: while not scientific in nature, when I was responsible for 100 employees at a large racetrack venue , we used the criteria of: If you don't have to pee at least once an hour then your are not consuming enough water.

S+S of dehydration as you have noted, dark urine , headaches and muscle pain due to electrolyte imbalances , odd cardiac arrhythmia's and up + including heatstoke.

At the grandstand aid station we would spend all day starting IV's in dehydrated customers. It was like a shooting gallery some days. You could start and run as many as 200 IV's in a single hot day. Fluids by the case lot. Our criteria for them to sign off was they had to come up with a normal set of vitals and they had to PEE before we would sign them off. Some took 3 litres IV before that would happen.

Temperature didn't always prove to be an accurate indicator of increased risk, as I have seen S+S in 75 degrees temps as well as temps in the 90's.

Eating balanced meals and keeping hydrated are very important in keeping the employees healthy and productive. The company I worked for would send someone out to the different positions at the track with lunches and coolers of water for the crew dogs as a way of keeping them happy & productive.

Very important when our 75-100 EMS providers were responsible for a crowd of 110.000 guests and crews + track employees and vendors.

[DwayneEMTP]

Sorry, I probably edited that while you were posting...

I've had urine dips on order for a few months without success, so it appears that that will not be an option.

[DFIB]

I think that proving mass dehydration can be done. There is the urine dipstick for specific gravity as Chris has mentioned but there is a more simple method that you might could use.

You know exactly how much water the workers are drinking 600 ml/ 12hrs. Use a urine color chart and have each worker chart the time of urination and the color of their urine each time. You can print the Urine color chart and place one by each urinal so that the patients can check their own urine color.

The office workers could be your control group you would have to get them to chart their water intake in ml, time of urination and color of urine.

You can then easily chart the difference in urine color, frequency of urination and symptoms.

Getting clean water is cheap. The company can build filters with sand, charcoal and a uv light that will provide abundant clean water for everyone.

I absolutely love your proactive attitude brother. Get er done!

EDIT: JEEZE they can buy a water filter for like a couple of hundred bucks or install an entire water purification plant for a couple to 3 grand.

EDIT 2: Show them the studies that prove the average male requires a minimum of 2500 mls per day. I am shaky on the math but wouldn't that be 400% or four times the amount the workers are drinking? They would be much better off drinking 3000ml/day. From a gazillion miles away I am a little ticked off at your company. No one should be denied water!

Edited May 26, 2012 by DFIB

[DwayneEMTP]

The studies are a great idea!

And we have clean water here. It's the men and women in the trucks and out in the mine that use the bottled water for the most part, and the expats that are afraid of drinking it...

The problem with having them chart their urine is that they are afraid of making an issue of it and getting jammed up. So they will simply report whatever the manager tells them to in the morning. Plus it would be tough to get the mine to implement such a thing for 3,000 employee (those on site and those on break) as it would take materials and sit down education. Why sit down? Because everything needs a sit down education.

And it pisses me off too. But it's not all indifference. Most everything medical here happens by tradition, superstition, or hearsay. So it's not, the best that I can understand at this time, a matter of, "Screw em, that should keep them from dying." So much as the managers also come from the lower altitudes and have the same belief that altitude is unimportant, that it's only heat and perspiration that are relevant.

This is one of those examples of having to slowly change the culture in order to make an improvement. At a safety meeting the other day they got into a huge argument when the man presenting claimed that people's kids got sick because they didn't wash their hands enough, not from spirits and/or curses from their enemies. It was not an opinion that was well received...

[chbare]

Additionally, urine colour is qualitative. While not necessarily bad, having a quantative value and a threshold of significance is nice because numbers are valuable weapons in your toolbox for convincing others with evidence based dialogue.

Literature is a good idea, but it sounds like you are dealing with people who really do not have an idea. They believe that the workers are properly acclimitised and do not need the extra water. You need to present the literature, then back it up with your own evidence of dehydration that cannot be denied. You need to tell a solid story and back it up. I'd push for the urine dipsticks.

Good luck and remember making change occur can be a marathon. If this is an important issue, be prepared to spend allot of time on it.

[DFIB]

They have that "cool breeze" thing in Afg? We have it here.

I feel you with tradition, superstition and hearsay stuff.

Years ago a woman was scratched by a cat. The local "healer" gave her a penicillin shot. They say she choked to death in what was mot likely anafilaxis. To this day the village has a vermin problem because they will not risk being scratched by a cat.

Another is that if a man sis snakebit they will lock him up until the night before taking him to the hospital. The belief is that if he sees a pregnant woman the baby will present malformations and the man will die. I don't know the etiology of that one.

Yea, superstition is a pain.