Archive for August, 2012

Opioids: Altered Minds and Bottom Lines

Wednesday, August 29th, 2012

In this era of data mining and predictive analytics, it’s really not that difficult to project which comp claims are headed for “catastrophic” levels. Just follow the meds. A new study entitled “The Effects of Opioid Use on Workers Compensation Claims Cost in Michigan” establishes a direct link between long-acting medications and the eventual magnitude of the claim. Where short-acting opioids are involved, the claim is 1.76 times more likely to break the $100K barrier; with long-acting medications, the likelihood increases to a whopping 3.94. The researchers, including Jeffrey Austin White and Jack Tower of Accident Fund Holdings in Lansing MI, demonstrate what has been long known anecdotally: the use of opioids is an “independent risk factor for development of catastrophic claims.”
The study examined over 12,000 claims that opened and closed between January 2006 and February 2010. (Had they included claims that were still open, the numbers may have been even more dramatic.) In an effort to isolate just how much opioids drove up the costs, the study accounted for other risk factors including sex, age, attorney involvement, the number of medical treatments and claim duration.
Pain and Dr. Sajedi
There is a relatively simple logic at work: injuries cause pain and opioids alleviate extreme pain. The question, naturally, is which injuries require extreme pain relief and which could be managed with lesser medications. Far too many doctors are too quick to prescribe narcotics, even as they fail to implement the most elementary safeguards to ensure that the drugs are used properly and for as short a duration as possible. (A comparable problem exists with the overuse of antibiotics; doctor training clearly needs more emphasis on pharmacology.)
Which brings us to Dr. Ebrahim Sajedi, 46, an internal medicine specialist in California who gets good reviews from his patients. Trained at the Rochester School of Medicine, Sajedi was busted on 12 felony counts of prescribing medications without a legitimate purpose. He provided scripts for Vicodin, Adderall, Klonopin and similar drugs to four undercover police officers without examining them and for no medical purpose. Why buy drugs on the street when you can get the good stuff from a certified specialist?
Bottom Lines
The prevalence of strong drugs in the comp system should come as no surprise. We live in a culture where we are supposed to live pain free, virtually forever, stimulated and distracted in every waking moment. We can hardly fathom the pain that mankind endured in every generation up until recent times. There is a complex, perhaps ultimately incomprehensible alchemy that takes place when pain relievers are introduced into the body. But this relief comes at great cost and even greater risk.
In workers comp, the cost is borne by the employer. The quick pain fix of opioids inevitably finds its way to the employer’s bottom line in the form of prolonged absence from work, higher costs, higher experience mods and bigger insurance premiums. We have long suspected that injured workers on opioids stay out of work far longer than is medically necessary and often find themselves in the downward spiral toward a permanent disability lifestyle. With this Michigan study, we have further documentation that the promiscuous use of drugs undermines the recovery of injured workers and the financial stability of their employers.

North Carolina’s “ghost workers” allow scofflaws to thrive while by-the-book employers suffer

Tuesday, August 28th, 2012

What happens to honest businesses when unscrupulous competitive businesses fail to carry workers’ compensation insurance for their employees? In the difficult economy, some of the honest players have suffered losses while scofflaws thrive. North Carolina’s NewsObserver features an investigative series on Ghost Workers, which takes an in-depth look at the many ramifications of workers’ comp avoidance schemes and the ways that this type of fraud hurts other businesses, the state’s coffers, and any workers who are injured on the job.

State legislators and candidates in the upcoming state elections are competing to raise the outrage meter in the wake of the NewsObserver‘s revelations that as many as 30,000 employers are failing to carry workers’ compensation insurance. Many of these employers are misclassifying workers as independent contractors, so they are also thumbing their noses at other statutory obligations such as taxes, Social Security, unemployment tax, and overtime pay.
Unsurprisingly to those who have followed the misclassification trail in other states, the construction industry offers a fertile climate for fraud to thrive. The NewsObserver explains how a unique bureaucratic loophole in the state can be worked to game the system:

“A business owner, often in the construction industry, tells his insurance agent that he has no employees. He excludes himself from the policy, which is his right as a sole proprietor. He buys a policy to cover a “ghost,” an unknown employee who might unexpectedly join him to work during the year.

These policies can make a business look like it has more insurance coverage for its workers than it has.”

Tax dodging employers can hide under layers of subcontractors, as well as by hiring illegal immigrants. And state agencies that operate in silos are not coordinating to thwart this practice.
Not all the employers are small operations – the expose talks about a firm named Martin’s Bricklaying, which supplied 76,000 hours of labor to help build the $125 million Wake County Detention Center, earning $1,066,538 for this work.

“The company’s owner, Sabas Martin Galeana, has run afoul of state and federal tax obligations in years past, court records show; he settled the last of three liens in 2009. A review of several employees’ recent pay stubs shows that Martin has failed to withhold state and federal taxes as recently as July. The workers say he didn’t provide his workers the tax forms they needed to settle their own obligations.”

The practice of employee misclassification isn’t unique and it’s hardly surprising. But what is surprising is that North Carolina is so slow off the mark when other states and the federal government have been taking aggressive steps to curb misclassification and to penalize scofflaws. We’ve been covering stories of states getting tough on misclassification and workers comp avoidance since 2004. We wonder how the heads of various agencies in North Carolina never noticed. The state has faced serious budget cuts to valued services in recent years, all the while bleeding much needed tax revenue to lawbreakers. Kudos to the NewsObserver for their series.
North Carolina legislators will be working to plug this hole – particularly since it’s an election year. They may also want to sign on to federal efforts such as the
Deparment of Labor’s Misclassification Initiative. Thirteen states have signed Memorandum of Understanding (MOUs) with the Department of Labor’s Wage and Hour Division, and in some cases, with its Employee Benefits Security Administration (EBSA), Occupational Safety and Health Administration (OSHA), Office of Federal Contract Compliance Programs (OFCCP), and the Office of the Solicitor. The DOL says that these MOUs, “will enable the Department to share information and to coordinate enforcement efforts with participating states in order to level the playing field for law-abiding employers and to ensure that employees receive the protections to which they are entitled under federal and state law. Employers that misclassify their employees may not be paying the proper overtime compensation, FICA and Unemployment Insurances taxes, or workers’ compensation premiums.”

New York: A Micro-Step into the Electronic Age

Monday, August 27th, 2012

Last month, Tom Lynch posted a concise and rather devastating macro view of workers comp costs in New York. Today we revisit an issue that illustrates the difficulty of lowering costs in the Empire State: the use of stenographers in each of the several hundred thousand hearings that take place every year in New York. With some reluctance, we will set aside the question as to whether the 300,000 hearings and the 30 million scanned documents are actually necessary in overseeing comp in New York. (They are not, but that is fodder for another day.)
As we read in Work Comp Central (subscription required), New York employs over 100 stenographers, along with their supervisors, to generate an “accurate record” of comp hearings. The staunch defenders of these stenographers – they are legion in the legislature – believe that the only way to secure an acceptably accurate account of a comp hearing is the use of a live stenographer. Electronic devices will miss the nuances, will mess up the occasional non-English word, will make unintentional errors, and will be flummoxed by occasions where more than one person is talking at the same time. In other words, without stenographic documentation, courtroom justice as we have come to know it in the Western world will cease to exist.
Best Practices
When the New York Workers Comp Board proposed a program to test digital recording of hearings, 67 comments were generated. Would it surprise you to learn that 66 of the comments objected to making any changes in the way hearings were documented?
As is often the case, the only reasonable context for examining the Byzantine construction that is New York comp is a comparison to other states. Do other states conduct hearings for any proposed change in each and every claim? Do other states scan every document moving through the comp system? Do other states require stenographic documentation of every comp hearing? Do other states prohibit the use of digital recording in the courtroom? Clearly, New York is out of step with the nation in these areas. Thus it should come as no surprise that the only aspect of comp where New York is a pace-setter is in the spiralling cost of comp to its employers.
One Small Step for Man…
In response to the NYWCB’s plan to introduce digital recording into some of its hearings, the legislature passed Assembly 7508, which made explicit and absolute the requirement to use live stenographers. The Insider is pleased to report that Governor Cuomo vetoed the bill. This green – or should we say yellow? – light to proceed with a testing of digital recording will begin to align New York with other states in its approach to courtroom transcripts.
It’s Not About the Jobs
In the context of a faltering economy, it is important to note that court stenographers are unlikely to face any layoffs. They are union employees, covered by a five year contract negotiated last year. The pilot use of digital recording is not aimed directly at them. So how does the new program, made possible by the Governor’s veto, save money? By gradually shifting away from live stenographers to the use of cheaper – and comparably accurate – technology. As the current incumbent stenographers retire – or move on to new careers – the vacancies will not be filled. In all likelihood, these $60K per year jobs will eventually disappear.
With all the humongous cost-drivers in New York workers comp, the stenographers are a very small part of the problem. Nonetheless, there is significant symbolic value in taking on this miniscule stake holder. The long-standing problems in New York stem from a system that has made very little movement away from the bitter labor environment of the early 20th century. A profound lack of trust permeates the system.
The Governor, the legislature and the comp board need to evaluate each and every proposed comp initiative from a simple and fundamental test, based upon the essence of comp: does the proposed action improve benefits and conditions for injured workers? And does it lower costs for employers? Other considerations – politics-as-usual, stake holder leveraging and sheer bureaucratic inertia – should no longer be part of the discussion.

Annals of Compensability: The Case of the Clogging Quesadilla

Friday, August 24th, 2012

What better blog fodder for a Friday than a waiter at TGI Friday’s choking on a quesadilla? Michael Bernard was sampling new menu items at his restaurant in Virginia when he literally bit off more than he could chew: he tried to eat a piece of quesadilla that was too big for his esophagus. It caught in his throat. In the process of trying to remove it, he perforated his esophagus and his lung collapsed.
Bernard filed for workers comp. While it is clear that his injury occurred “in the course and scope of employment,” the question was whether it arose “out of employment.” Virginia’s standards for compensability are more stringent than those in many other states. The Court of Appeals upheld a lower court’s denial of the claim. The judges focused on the quesadilla itself: was there anything unusual about it that might cause a swallowing problem? Bernard testified that there was not. As the majority wrote, “Bernard’s quesadilla was neither a hazard nor a danger – it was simply a quesadilla.”
Risks Unique to the Workplace
The judges noted that under Virginia law, injuries must stem from risks unique to the workplace. For example, an employee who trips while walking on stairs cannot collect workers comp unless there was something unusual about the steps or related conditions in the workplace. (In most other states, a fall on the stairs at work is compensable, even if the stairs were free of hazards.)
Bernard’s lawyer argued that the injury arose “out of employment” because quesadilla testing was a job requirement which furthered the interests of the employer. If a customer asked “would you recommend the quesadillas?” a waiter – presumably not Bernard – could testify to their relative deliciousness. The judges determined that swallowing food was a hazard confronting Bernard every day of his life; there was nothing extraordinary or unique in swallowing an ordinary quesadilla.
Essential Job Functions
In a dissenting opinion, Justice Frank points out that quesadilla testing was an essential requirement of the job:

Browning Bridges, claimant’s supervisor, testified the food tasting activity was to familiarize staff with the taste of new foods so they could explain those tastes to guests. Part of a host/server’s employment responsibilities is to “sell the food.” While attendance at the food tasting activities is mandatory, no employee is required to eat anything they do not want to eat. However, all host/servers are evaluated on the effectiveness of their recommendations to guests, and failure to make such recommendations can result in counseling by management. Employer even employs “secret shoppers” to assess staff members’ performance, including recommendations of menu items.

Alas, had Bernard known the consequences of the simple taste test, he could have passed on the quesadilla. When asked by a customer if he would recommend it, he could have simply said: “Absolutely. They’re great!” But he did what he was asked to do and paid a terrible price.
The moral of the story comes from our mothers: slow down, eat small bites, and chew your food carefully. Most of us, in the course of our hectic lives, are prone to ignore this sage advice.

Cavalcade of Risk and other news items of note

Wednesday, August 22nd, 2012

Emily Holbrook does a stellar job hosting Cavalcade of Risk #164 at Risk Management Monitor. A sampling of recent posts on varied topics may tell you why Risk Management Monitor is on our regular reading list and one of our favorite blogs: The Formal Demands of a Somali Pirate, The 3 Most Curious Claims, and Insurance Claims from Colorado Wildfires at $450 Million and Growing.
Industry pulse – At propertycasualty360, Stephen Klingel offers an explanation of conflicting signals in the latest NCCI Workers Comp State of the Line report. He discusses why the market remains “worrisome” despite a number of positive developments. On the plus side, we see that claims frequency is down and written premium is up, but the industry’s reserves are deteriorating and the residual market is growing – indicators that bear watching. He cites claim frequency, the underwriting cycle. uncertainties related to healthcare and financial services reforms, and efforts to expand alternatives to Workers’ Comp as additional areas of concern that NCCI is monitoring.
Paid sick leave & workers comp study – A recent NIOSH-related study revealed that workers with paid sick leave were 28% less likely to report an occupational injury that needed medical care than workers without paid sick leave. Also, workers in high risk jobs appeared to benefit more. The survey encompassed 38,000 workers and was based on data collected by the National Health Interview Surveys from 2005 through 2008. While survey authors caution that the survey does not establish a a cause-and-effect relationship between paid sick leave and the incidence of workplace injuries, it does raise the issue that workers who do not have paid sick leave may feel economically pressured to work while sick, exposing them to greater likelihood of injury.
Right to safe workplaces – Kevin Jones raises the question of whether safe work is a basic or fundamental human right on the Australian SafetyAtWorkBlog. He raises this question both specifically for Australia, but also from a global perspective.
Healthcare & politics – Wondering about the healthcare implications of Romney’s vice presidential pick? Joe Paduda is on the case: At Managed Care Matters, he posts about Paul Ryan’s evolving stance on deficits and Medicare spending.
Healthcare workers and mass trauma – Dr. Camilla Sasson was on duty in the Emergency Department of the University of Colorado Hospital on the night of the Aurora shootings. She talks about her experiences that night on the RWJF Human Capital Blog, offering insight into the extreme stress that healthcare workers face during and after a mass casualty event – as well as how patients help the doctors heal.
Other news of note

Brainy Edition of Health Wonk Review & some new business blog suggestions

Thursday, August 16th, 2012

Dr. Jaan Sidorov has posted A Brainy Health Wonk Review on Health Reform, the Affordable Care Act and Lots More! at Disease Management Care Blog. Health Wonk Review is on an abbreviated summer schedule but the wonkers still have a lot to share and Jaan does a great job dishing it up – check it out.
Additions to our blogroll
From time to time, we update our blogroll with new blog finds – and we also clear out some of the less active blogs. It’s exciting to see such a thriving workers comp and insurance community online – back in 2003, when we started, it was a pretty lonely place! Check them all out under “Business Weblogs” in our right hand sidebar. We also have a variety of other useful tools if you haven’t checked them out yet!

Report on violence & aggression to Maine’s caregivers; Injuries include bites, kicks, being hit

Wednesday, August 15th, 2012

When it comes to on-the-job assaults, healthcare workers are on the front lines. Earlier this year, NCCI issued a report on Violence in the Workplace, which showed that homicides and assaults are trending down. Good news, overall, but let’s take a closer look at assaults:

“The decline in the rate of workplace assaults has lagged the steady decline in the rate for all lost work-time injuries and illnesses. This reflects a notable change in the composition of the US workforce and, in particular, the ongoing increase in the share of healthcare workers, who experience remarkably high rates of injuries due to assaults by patients. This is especially common in nursing homes and other long-term care facilities. In fact, 61% of all workplace assaults are committed by healthcare patients. For assaults, coworkers make up just 7%, and someone other than a healthcare patient or coworker comprises 23%. The remainder is unspecified.”

Now, a new research report from Maine offers a close-up snapshot of the issue of workplace violence as it relates to caregivers. The Research and Statistics Unit of the Maine Department of Labor compiled data from First Reports of Injury for 2011 and issued a report on 2011 Violence Against Caregivers in Maine.
The report encompassed about 100,000 workers in healthcare and affiliated professions. Of the nearly 10,000 thousand injuries reported by those workers, 13.4% were related to violent and aggressive acts by patients and care recipients.
Key report findings include:

  • Where incidents occurred – Mental health care settings and other residential care facilities accounted for 52% of all violent/aggressive incidents in 2011. These were followed by nursing care facilities for the elderly and people with disabilities, 18.9%, and general medical and surgical hospitals and services, 16.8%.
  • What types of jobs were involved – Nurses at all levels (including nursing assistants) were involved in 21.27% of the cases; education technicians were involved in 18.6% cases; direct support professionals (personal care, hygiene, life skills, etc) were involved in 9.4% cases; Other occupations with significant numbers of cases included psychiatric technicians, behavioral health technicians and analysts, mental health and social workers and child care and senior child care workers.
  • What types of assaults occurred – The most prevalent type of assault – being hit – accounted for 21.3% of all incidents. Bites were the second highest reports, at 16.6%, of the incidents. Other identifiable assault categories included kicks, 9.45%, and being grabbed, 9.4%.

Due to the high number of bite incidents, a specific section of the report focuses on bite injuries and references information from the Federal Bureau of Prisons’ 2009 Clinical Guidelines regarding viral and bacterial exposures and the potential for infections if the skin is broken. The report also cites NIOSH publications and reports, including common risk factors for violence and a list of potential prevention strategies.
The full report is available in PDF: Maine’s Caregivers, Social Assistance and Disability Rehabilitation Workers Injured by Violence and Aggression in the Workplace in 2011.
(Hat tip to WorkersCompensation.com for pointing us to this news item.)

Officer Down: Police, PTSD and Suicide

Monday, August 13th, 2012

Last month, there was a story about a South Carolina sheriff who was denied workers comp benefits for mental distress that he suffered after fatally shooting a suspect. In Brandon Bentley v. Spartanburg County, and S.C. Association of Counties SIF, the South Carolina Supreme Court upheld a lower court denial saying that “…the use of deadly force is an expected and standard part of being a sheriff and is “not an unusual or extraordinary employment condition” that might qualify for workers’ compensation under the state’s restricted coverage for purely mental injuries. In citing statistics, the Sheriff had unsuccessfully tried to demonstrate that such a shooting was indeed an extraordinary event in Spartanburg County. “
The Court noted that it made its decision according to the law as it is written but “… the court did say the state law related to mental injuries should be updated. If South Carolina lawmakers revised state law, it would join a handful of others, wrote the court. Hawaii, Michigan, New Jersey, New York and Oregon already do not require that the conditions of employment be unusual and extraordinary in order for someone to collect compensation.” (Source: Court brings new focus on mental health of law enforcement.)
Hopefully, his community or his police force sees the wisdom of extending some counseling to this officer, despite the denial of full benefits. Re-examining this issue makes good sense. While risks may well be part of the job, people are not automatons that can shut out the emotional residue of terrible events, regardless of training. PTSD is very real, and we must get better at dealing with it. This story was brought to mind again after watching the hard-working police Chief of Aurora Colorado reporting on the gruesome task that his staff faced in responding to the tragedy. In one of his daily updates, his voice broke when he spoke of the stress and toll this took on first responders.
Left untreated, the effects of PTSD on law enforcement can be terrible. In 2012 so far, more police have died by their own hand than by gunfire. According to Badge of Life, a police suicide prevention program, there have been 73 police suicides this year vs. 19 officers killed by gunfire. Badge of Life is conducting A Study of Police Suicides. The first full study of police suicides in all 50 states was published in 2009 in the International Journal of Emergency Mental Health. At that time, the suicide rate for police officers was 17/100,000, compared to the rate for the general public of 11/100,000 and 20/100,000 for the Army.
Badge of Life points us to a documentary that is in progress on the topic, Code 9 Officer Needs Assistance. It’s being co-produced by the wife of a retired state trooper suffering with PTSD, exploring the darker side of law enforcement as it tells the stories of police officers and their families who are now suffering the mental anguish of the careers they chose, which has led some to suicide. Click the above link or the image below to see a powerful excerpt from the documentary. You can get more information on the Code 9 Facebook page.
officer-down
Related Resources
Law Enforcement Use of Deadly Force Incidents: Helping Reduce the “Second Injury”
Remember to save yourself: The importance of managing critical incident stress (PDF)
Law Enforcement Traumatic Stress: Clinical Syndromes and Intervention Strategies
Suicide Prevention Resource Center

An Olympic Edition of Cavalcade of Risk #163

Wednesday, August 8th, 2012

pistorius_ap_imgWe’re delighted to be hosting the 163rd edition of Cavalcade of Risk, which coincides with the Olympic games – a fascinating case study in various aspects of risk. There are so many risk-related angles to this massive event, but none more compelling than the stories of individual athletes – see Oscar Pistorius and ‘the Dignity of Risk’ for one example.

South Africa’s Oscar Pistorius competes in the 400-meter semifinals heat, Sunday, August 5, 2012. (AP Photo/Matt Slocum)

Being insurance geeks, we can’t resist pointing to a few items related to risk management. For an overview of the challenges facing the biggest event in the world, see Will Jennings’ paper, London 2012: Olympic Risk, Risk Management, and Olymponomics. Despite the scale, some insurance professionals see this as an event much like any other. See Mark Ruquet’s story, Insuring the Olympics: Unique Locations, Number of Stakeholders Among Risks Industry Takes On
Continuing on the international theme
Global risks were on the mind of some of our Cavalcade contributors, too. Continuing on in the international theme, first up in this week’s edition is a post by Henry Stern of InsureBlog who reports that international commerce just got potentially riskier for insurers. He posts about congressional efforts to loosen up underwriting rules for insurers of folks doing business with Iran.
Russell Hutchinson at Chatswood Consulting — one of our international contributors based in New Zealand — reviews a medical insurers report on medical tourism and finds some big holes in the expected demand and looks at the reasons for them. One of the big reasons? “The cheaper the procedure the further you will have to fly to have it, and the higher the perception of risk around that trip.”
The risks of travel are not just a concern for medical tourists. Emily Holbrook of Risk Management Monitor posts about a recent study on the concerns of business travelers. Of those surveyed, 31% expressed concern for their personal safety, citing fears related to issues as broad ranging as terrorism and natural disasters to medical need while traveling.
And speaking of medical issues and risks related to travel, we point to our own entry, a post that focuses on travelers whose trips range a little further afield, astronauts and the medical oddities they experience in their extra-terrestial travels.
Health care: another issue theme
Medical care, healthcare, and associated risks seem to be the other great theme that is occupying a large percentage of the mindshare for many regular participants of the Cavalcade. With the Supreme Court decision on the Affordable Care Act behind us and the realities of implementation ahead, this concern is to be expected.
When it comes to risks, it doesn’t get any bigger than mortality. Healthcare Economist Jason Shafrin looks at a recent study on the effect that Medicaid health insurance has on mortality.
Louise Norris of Colorado Health Insurance Insider notes that for many Colorado residents, risk goes down as the Colorado Hospital Payment Assistance Act takes effect. The new law requires hospitals to charge uninsured patients earning less than 250% of FPL no more than the lowest negotiated price the hospital has with a private health insurance carrier. Hospitals must also post their financial assistance, charity care and payment plan information so that patients will be aware of the financial options.
At Disease Management Care Blog, Dr. Jaan Sidorov reviews a published study that explores the drivers behind a recent downturn in the amount of expensive “high dollar” medical imaging and finds the sum was greater than the parts. He argues there’s an important lesson here: if the U.S. is going to lower health care costs, it’s going to take multiple levers: there is no single solution.
David Williams of Health Business Blog notes that while neither rain, nor sleet, nor hail will stop the postman, health care costs might be the real killer. While USPS faces many challenges in Google, Facebook and email, none are more formidable than retiree health care costs.
Special note
Kudos to Henry Stern, who was recently honored in the National Underwriter’s 2012 Industry Elite Awards for his role in fostering Industry Awareness. We know him as “Hank,” the founder and ongoing leadership for Cavalcade of Risk and long-term “good blog citizen” at InsureBlog. He’s also a regular participant in Health Wonk Review, and an all-round nice guy.

Cool Tools: Heat Safety App for Outdoor Workers

Tuesday, August 7th, 2012

Will the extreme heat that has plagued the nation in June and July continue on through August? If so, there’s a tool that might provide some relief — and safety — for outdoor workers.
OSHA has a Heat Safety App that allows workers and supervisors to calculate the heat index for their worksite and, based on the heat index, displays a risk level to outdoor workers. It combines heat index data from the U.S. National Oceanic and Atmospheric Administration with the user’s location to determine necessary protective measures.
Once a worker has determined the risk level, they can then access information about protective measures that should be taken for that risk level to prevent heat-related illness. These include reminders about drinking enough fluids, scheduling rest breaks, planning for and knowing what to do in an emergency, adjusting work operations, gradually building up the workload for new workers, training on heat illness signs and symptoms, and monitoring each other for signs and symptoms of heat-related illness.
osha-heat-app
The free app is available for iPhones, Androids, and Blackberrys in English and Spanish. Access other tools and information in OSHA’s Campaign to Prevent Heat Illness in Outdoor Workers.
USA Today has a story on how businesses are adapting to extreme heat and drought. It includes mention of some new “personal cooling system” technologies such as CoolWare and Polar Products, which offers some “Body Cooling Systems.” We can’t personally vouch for any of these because we haven’t tried them – but there are still several weeks to summer yet!