A Multi-Pronged Approach to Shipyard Heat Stress Injury Prevention

Background: Heat stress injury (HSI) is an occupational hazard for industrial workers. For active-duty Sailors, shipyard conditions of high ambient temperatures, confined spaces, and increased fire-fighting training exacerbate those risks. This evidence-based practice project aimed to decrease Sailor HSI cases on a U.S. Navy ship undergoing multi-year shipyard maintenance after high numbers of HSI events over 5 months. Methods: Three mitigation efforts augmented existing guidelines to decrease HSI rates among Sailors: (1) distribution of oral rehydration solution (ORS) and hydration protocol; (2) scaled personal protective equipment (PPE) wear during firefighting training based on wet-bulb globe temperature; (3) targeted education about HSI risk factors, identification, first aid, and prevention. HSI-related medical response team activations data were collected from ship’s logs at baseline and for 2 years following implementation. Findings: 1,700 Sailors received education, 185 drills occurred with scaled PPE, and 35,500 servings of ORS were distributed. Sailor HSI events at baseline were higher (n = 10) than civilians (n = 6; p = .046). After implementation, Sailor HSI events decreased in years 1 (n = 5) and 2 (n = 2) and were not significantly different from civilian HSI rate in years 1 (n = 3, p = .112) and 2 (n = 5, p = .101) who were excluded from interventions. Estimated HSI odds for 2023 Sailors were 70% lower (OR = 0.3, 95% CI [0.02, 4.06]). Application to Practice: Shipyard-specific, multi-pronged interventions effectively reduced HSI events over multiple years, which may be adapted to other occupational environments.