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if available; place under the arms, around the neck, or any other place where they can cool large surface blood vessels. If transportation to a medical facility is delayed, reduce body temperature by immersing victim in a cool water bath (however, be careful not to over-chill the victim once body temperature is reduced below 102o F). If this is not possible, keep victim wrapped in a sheet and continuously douse with water and fan. 5.1.31.2 Prevention The implementation of preventative measures is the most effective way to limit the effects of heat-related illnesses. During periods of high heat, adequate liquids must be provided to re-place lost body fluids. Replacement fluids can be a 0.1 percent salt-water solution, a commercial mix such as Gatorade, or a combination of these with fresh water. The replacement fluid temperature should be kept cool, 50o F to 60o F, and should be placed close to the work area. Employees must be encouraged to drink more than the amount required to satisfy thirst. Employees should also be encouraged to salt their foods more heavily during hot times of the year. Cooling devices such as vortex tubes or cooling vests can be worn beneath impermeable clothing. If cooling devices are worn,only physiological monitoring will be used to deter-mine work activity. All workers are to rest when any symptoms of heat stress are noticed. Rest breaks are to be taken in a cool, shaded rest area. Employees shall remove chemical protective garments during rest periods and will not be assigned other tasks. All employees shall be informed of the importance of adequate rest and proper diet including the harmful effects of excessive alcohol and caffeine consumption. 5.1.31.3 Monitoring Heat stress monitoring will be required when employees are working in environments exceeding 90°F ambient air temperature. If employees are wearing impermeable clothing, this monitoring will begin at 78°F. There are two general types of monitoring that the health and safety representative can designate to be used: wet bulb globe temperature(WBGT)and physiological. Wet Bulb Globe Temperature (WBGT). The WBGT index is the simplest and most suitable technique to measure the environmental factors which most nearly correlate with core body temperature and other physiological responses to heat. When WBGT exceeds 25.9oC (78oF), the work regiment in Table 1 and Figure 1 of the section Heat Stress in the latest edition of the "American Conference of Governmental Industrial Hygiene(ACGIH)Threshold Limit Value(TLV)Booklet"should be followed. Physiological. Physiological monitoring can be used in lieu of, or in addition to, WBGT. This monitoring can be self-performed once the health and safety representative demonstrates appropriate techniques to affected employees. Since individuals vary in their susceptibility to heat, this type of monitoring has its advantages.The two parameters that are to be monitored at the beginning of each rest period are: • Heart Rate — The maximum heart rate (MHR) is the amount of work (beats) per minute a healthy person's heart can be expected to safely deliver. Each individual will count his/her radial (wrist) pulse as early as possible during each rest period. If the heart rate of any individual exceeds 75 percent of their calculated maximum heart rate (MHR = 200 - age) at the beginning of the rest period,then the work cycle will be decreased by one-third. The rest period will remain the same. An individual is not permitted to return to work until his/her sustained heart rate is be-low 75 percent of their calculated maximum heart rate. • Temperature — Each individual will measure his/her temperature with a thermometer for one minute as early as possible in the first rest period. If the temperature exceeds 99.6°F at the beginning 5-18