Temperatures pushing 30 °C (86 °F), bright sunshine, and no clouds in the sky may be great at the beach or on a patio, but it can be truly strenuous at work, depending on the temperature. Even on these days, not all medical practices have air conditioning. This means that when temperatures rise outside, inside can quickly become uncomfortable.
According to Germany’s Workplace Ordinance (ArbStättV), which also includes medical practices, the ideal room temperature is between 21 °C (70 °F) and 26 °C (79 °F). Measures must be taken by those who run practices if these temperatures are exceeded. If the temperature in a practice rises above 30 °C (86 °F), the practice operator must take action.
A space can no longer be used for work when the temperature exceeds 35 °C (95 °F). Nevertheless, employees cannot simply be sent home without making any arrangements. This is why there is no such thing as a day off due to heat, in the legal sense, in medical practices.
Instead, employees can continue to work in another room or adapt their working times to cooler periods, for example. There is nothing to stop employees being sent home earlier on particularly hot days.
Action must be taken earlier in the case of employees with chronic illness and pregnant or nursing individuals to protect their health. If employees have health problems due to the heat (such as circulatory disorders) they can of course go home to rest.
However, there are no prescribed measures to combat heat in the workplace. The technical rules for workplaces suggest airing the building in the early hours of the morning, relaxing dress codes, or providing free drinks.
Keeping Rooms Cool
According to the Employment Protection Law, measures first need to be taken when the temperature hits 30 °C (86 °F). Much earlier intervention is needed to stop the heat from entering the practice rooms in the first place. Suitable measures include the following:
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Blinds, awnings, or marquees to protect against excessive sun.
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Airing overnight or in the early hours of the morning, if possible.
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Shifting working hours to the cooler periods of the day.
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Electronic devices produce heat; if possible, limit their use or turn them off.
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Shifting physically demanding tasks and outdoor activities to the early morning or later hours of the evening, where possible.
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Using fans.
Most tips to beat the heat need to be implemented by the individual independently. These include, to name a few examples, drinking lots of fluids, eating lighter meals, or running cold water over wrists and forearms to cool down.
However, you as an employer can support your practice staff with the following measures:
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Providing drinks.
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Relaxing dress codes.
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Maintaining breaks and moving to cooler rooms or areas.
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Spreading several small breaks across the day to ensure time for recovery and smaller, light meals.
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If possible, reducing overtime and offering flexitime on particularly hot days.
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Keeping an eye on hot days with the heat warning map of the German Weather Service and notifying employees.
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Watching out for heat-related discomfort and taking action in time.
Heat Protection Plans
The National Association of Statutory Health Insurance Physicians also provides tips on protecting against the heat. Speaker Tanja Hinzmann refers to the subject page for climate protection in medical practices, which also has a sample heat protection plan for outpatient practices. In addition, she encourages gaining information from the German Alliance on Climate Change and Health (KLUG) and from KlimaDocs.
Jörg Schelling, MD, PhD, recommends the following measures for the Bavarian State Medical Association:
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Naming a responsible person in the practice.
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Implementing a heat protection plan.
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Creating a list of measures.
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Assessing risks and measures from the previous summer.
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Potentially contacting collaborative partners (eg, pharmacies, social services, neighborhood assistance) and seeking synergies.
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Determining a communication structure in the team and with patients.
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Adapting consultation hours (eg, early consultation hours for vulnerable groups).
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Prioritizing for extreme events (eg, scheduling fewer patients, no checks).
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Providing informative materials such as flyers or posters.
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Checking heat protection measures in the practice (eg, fans, blinds, ventilation).
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Bridging concepts for extreme events such as shortage/loss of power, etc.
KLUG Offers Training
KLUG offers additional training on individual protection of employees in practices. “Hot summer days and heat waves are becoming increasingly likely in Germany,” said environmental physician Nathalie Nidens, who is responsible for the Heat Protection section at KLUG as a scientific associate.
Nidens added that it is not just the patients who are affected by heat in practices. Additional infection protection measures, such as wearing gowns, mouth and nose coverings, and gloves, make work even more difficult, and it is harder to care for patients in the heat. Nidens adds as a reminder that employees can demand heat protection measures via work councils or medical officers.
She advises practice managers to implement measures in a timely manner, subscribe to the heat warnings from the German Weather Service, discuss heat waves within the team, offer training, and provide informational material. The indoor climate must be systematically controlled and adjusted as needed. Additionally, forward-looking planning is crucial, for example regarding which rooms should and should not be used at which times of the day. Furthermore, loss of sleep due to the heat should be considered for oneself and for employees.
Strategies for protection during work include the following measures:
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Active cooling from moist compresses, sprayed water, flowing water, and pulse point coolers.
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Providing free drinks.
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Eating and drinking healthily (ie, drinking enough, eating smaller portions more often, eating light food that has a high water content).
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Planning breaks (making sure there are regular breaks for drinking and cooling off).
When working with infection protection clothing, drink cool drinks before putting on equipment, if possible wearing a cooling vest. Work proactively by planning routes, adjusting your pace, and changing mouth and nose coverings when moist or in the case of increased breathing resistance.
Structural Heat Protection
According to a representative online survey from the Stiftung Gesundheit, six out of 10 physicians are already relying on building measures for heat protection. Survey findings include the following:
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Almost two thirds (58.3%) of physicians reported that they have made structural changes to their practice, such as installing shades or air conditioning.
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About 29% of respondents reported adapting processes at their practices during periods of high heat and, for example, moving consultation times to cooler morning and evening times.
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Of those surveyed, 27.3% reported holding targeted discussions with their patients on dealing with the heat.
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However, only 5.9% of the respondents provided informational material for their patients on the subject of heat in the form of flyers, posters, or information on the practice website.
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Additional measures for heat protection were mentioned by 7.5%. The most common was providing free drinks at the practice.
This article was translated from Medscape’s German edition.
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