Dealing with Heat Stress

According to the Center for Disease Control (CDC), an average of 658 people die from
heat stress each year. Over the next hour, we will explain why heat illnesses such as
heat stroke and heat exhaustion should not be taken lightly.

Course Overview
Heat stress does not discriminate across age, weight, sex, experience, or industry –
every employee exposed to extreme heat or a hot work environment runs the risk of
heat stress; we are all vulnerable to the effects of heat!  In this course, we will cover
the various illnesses and accidents that can stem from heat stress.  Additionally, we will
focus on the identifiable symptoms of someone suffering from heat stress and then
wrap up the course by offering ways to combat heat stress before it occurs.

Lesson 1: How Does Heat Stress Cause Illnesses?

Talking about the weather is a popular icebreaker among strangers. Whether it's hot or
cold, the weather is a comfortable subject matter because it affects every one of us,
and we all have opinions about it. We may talk about the weather in casual
conversations, but if you have ever worked in a hot environment or in extreme heat, it
is not a flippant conversation.   

If precautionary measures are not actively taken to reduce the risk of heat stress, it can
be a life or death matter. Because of the risks, it's critical for you to be able to
recognize the symptoms of heat stress in yourself and others so that you can prevent
more serious heat-related physical conditions from developing that could threaten your
health, and possibly even your life.

Warm Work Environments

Heat stress involves more than what the temperature is outside on a summer day.
There are many types of work environments where heat stress can be a factor.
Examples of this include:

 interior construction sites that can affect plumbers, electricians, and finish
carpenters,  
 commercial kitchens, 
 commercial laundries, 
 dry cleaning facilities, 
 factories; and
 automotive repair facilities.

Examples of outdoor professions where heat stress can be a factor include:

  custodians, 
 utility workers, 
 first responders, 
 groundskeepers and lawn care workers, 
 sanitation workers; and 
 construction workers.

Environmental Factors
Beyond the ambient air temperature, there are additional environmental factors that
can impact heat stress. These include:

 Radiant heat - This is heat radiating off of any surface. An example would be the
heat generated by a space heater.
 Air movement - Working in a confining environment where air can't move or
circulate amplifies the effects of heat.
 Conductivity - The transfer of heat between materials that contact each other.
Heat passes from the warmer material to the cooler material. For example, if you
put your hand on a hot surface, you will feel the conductive heat.
 Relative humidity - This is the amount of moisture in the air.

Any of these factors can influence how a person's body will respond to heat

Contributing Physical Factors

In addition to environment, there are individual physical characteristics that can have
an impact on one's ability to deal with heat. While everyone can be affected by heat
stress, some factors that may make an individual more likely to deal with a heat-
related illness include: 

 Age
 Weight
 The degree of physical fitness
 The degree of acclimatization (over time, the human body will acclimate
somewhat to heat)
 Metabolism
 Poor hydration
 Heavy clothing
 Use of alcohol or drugs
 Medical conditions (hypertension, for example)

Most people, including those who have experienced the effects of heat stress, don't
realize that prior heat injury predisposes an individual to additional injury. With that in
mind, if you have ever suffered a heat-related illness, be even more diligent in taking
precautionary measures in the heat. 
How the Body Reacts to Heat
When exposed to high external temperatures, the body responds by circulating more
blood closer to the skin, thus increasing skin temperature and allowing the body to give
off its excess heat through the skin. If a person is using their muscles in heavy physical
labor, however, less blood is available to be released through the skin. 

Most people are familiar with the role perspiration plays in keeping the body cool.
Sweating helps us to maintain a stable internal body temperature when we are
confronted with heat. Sweating, however, is only effective when certain conditions are
met, such as:

 The level of humidity is low enough to allow sweat to evaporate 

 If the fluids and salts lost through perspiring are effectively replaced

The Body and Heat Stress

Our bodies may be marvelous feats of engineering, but they can only do so much to
alleviate the effects of heat stress. What happens if the body cannot dispose of excess
heat? The body stores heat that cannot be disposed of. When this happens, two things
occur as a result: the body's core temperature and the heart rate increases.

As the body keeps storing heat without releasing it, the first physical symptoms begin
to emerge that indicate something is wrong:

 You lose concentration and have difficulty focusing on a task.

 You may become irritable or sick and often lose the desire to drink.

The next stage is most often fainting. In some cases, death is possible if the person is
not removed from the heat stress.

Lesson 2: Heat Stress-Related Illnesses and

Accidents - Levels of Severity: Heat Stroke
The body's response to heat stress can vary in terms of the level of severity. The most
critical of all heat stress-related conditions is heat stroke.

Heat stroke is what happens when the body's system of temperature regulation fails
and is no longer able to give off excess heat, causing body temperature to rise to
critical levels. This condition is caused by a combination of highly variable factors, and it
can be difficult to predict when and if it will occur. 

According to the Physiology and Kinesiology Department at Penn State University, a

high body temperature is problematic because the most vulnerable tissues to heat
strain in the body are nerve cells. Think about the trillions of nerve cells in the human
body.  The brain alone has anywhere from 70 billion to 100 billion, which is why the
brain is so sensitive and vulnerable to heat stress. 

If the body’s temperature is over 104 degrees for over thirty minutes, organs may start
to shut down, and death can occur. The elevated metabolic temperatures caused by a
combination of workload and environmental heat load, both of which contribute to heat
stroke, are also highly variable and difficult to predict

Heat stroke is a serious, life-threatening condition. Make no mistake – it is a medical

emergency. The main symptoms of heat stroke are:

 Confusion
 Irrational behavior
 Loss of consciousness
 Convulsions
 A lack of sweating (in most instances)
 Hot, dry skin
 Contracted pupils
 An abnormally high body temperature (a temperature of 104°F as determined by
emergency medical personnel)

Levels of Severity: Heat Stroke

If an individual exhibits signs of possible heat stroke, it is critical that emergency

medical treatment is obtained immediately. Proceed with the following steps:

 Call for emergency medical assistance.

 Move the individual to a cool, well-ventilated area.
 Remove outer clothing so the skin can be wetted and air movement around the
body can be increased.
 If possible, move the individual to a tub full of ice water and monitor their vitals
continuously.
 Alternatively, apply cold, wet compresses to areas like the forehead, neck, and
groin.

Once cooling has been improved, and until a professional can assess the seriousness of
the situation, fluids should also be replaced as soon as possible.

Levels of Severity: Heat Stroke

The ultimate outcome of an episode of heat stroke will depend on:

 The victim's physical fitness

 How quickly they receive medical treatment
 The effectiveness of the first aid treatment
Keep in Mind:

Regardless of the worker's protests, no employee suspected of being ill from heat
stroke should be sent home or left unattended unless a physician has specifically
approved such an order.

Levels of Severity: Heat Exhaustion

Heat stress is also called heat-related illness and hyperthermia. As we discussed earlier,
heat stress is a condition that occurs when someone is exposed to extreme heat and
the body becomes unable to properly cool, resulting in a rapid rise in body temperature.
From the inability to release body heat, the first heat-related illness that occurs is heat
exhaustion. Symptoms of heat exhaustion include:

 Headache
 Nausea
 Excessive sweating
 Enlarged pupils
 Vertigo (i.e., spinning sensation)
 Weakness
 Thirst
 Giddiness

Although heat exhaustion responds well to prompt treatment, it should never be

treated lightly. To treat individuals with heat exhaustion: 

 Remove them from the source of heat or into a well-ventilated area.

 Provide water and electrolyte-replacement fluids .
 Allow them to rest – do not leave them alone or allow them to continue work for
the day!

Treatment is important because one could easily be injured as a result of heat collapse,
and it is often associated with heat exhaustion.

Let’s discuss heat collapse next.

Levels of Severity: Heat Collapse

In heat collapse, a loss of consciousness occurs when the brain does not receive enough
oxygen due to blood pooling in the body's extremities. While the sight of someone
fainting can be alarming to an observer, the severity of the condition is basically the
same as heat exhaustion (as opposed to heat stroke), primarily because heat collapse
and heat exhaustion do not affect the body's heat balance.

This does not mean, however, that there aren't health risks associated with this
condition. This is because the onset of heat collapse is rapid and unpredictable, and it
can be particularly dangerous if the afflicted individual is operating machinery or
controlling an operation that should not be left unattended. There is also the risk of
injury caused by the fall when the victim faints.

Err On the Side of Caution

Because symptoms of heat exhaustion are similar to those of heat stroke, it should
never be taken lightly. Consequently, similar treatment should be given. Remove
workers suffering from heat exhaustion immediately and give them an adequate fluid
replacement. Supply them with ice packs as well. Finally, anyone afflicted with heat
exhaustion should be encouraged to get plenty of rest.

Keep in Mind:

Because the symptoms of heat exhaustion and heat stress are so similar, it is always
recommended that you err on the side of caution when providing aid to an individual
who is afflicted.

Heat Cramps
Heat cramps usually occur when someone is performing exhaustive physical labor in a
hot environment. They have been attributed to an electrolyte imbalance in the muscles,
caused by the loss of fluids in the body due to sweating. Excess salt will build up in the
body if the fluid lost through sweating is not replaced. When this occurs, cramping is
the result.

It's important to understand that thirst cannot be relied on as a guide to the need for
fluid replenishment; instead, water should be consumed every 15 to 20 minutes when
working in hot environments. Under the most extreme conditions, a loss of sodium may
also occur. Drinking commercially available carbohydrate-electrolyte replacement
liquids (Gatorade, for example) is helpful in correcting this problem and in restoring the
body's electrolyte imbalance. 

Be aware that heat cramps are a precursor to heat exhaustion and heat stroke. Be
vigilant in recognizing and addressing heat cramps as soon as possible.

Since heat cramps will generally go away on their own after proper rehydration, it is
important to:

 Separate the individual from the source of heat

 Instruct them to keep rehydrating, even if they feel fine
 Move through some light stretching in affected areas

Heat Rash
Heat rashes are the most common issue in hot work environments where the skin
consistently stays wet from unevaporated sweat. A heat rash will show up in the form
of small red bumps (papules) that are hard, round, and show up in areas where
clothing is the most restrictive.

As sweating increases, these papules can cause a tingling or stinging sensation (which
is why some people often refer to heat rash as "prickly heat"). OSHA instructs
employees to keep heat rashes clean because the papules may become infected. In
most cases, however, heat rashes disappear when the affected individual returns to a
cool environment.

In order to get rid of a heat rash, keep your skin dry and cool. If any itching is present,
doctors suggest applying calamine or lanolin to affected areas. 

 Heat Fatigue
Heat fatigue can be caused by a lack of acclimatization. People who are not accustomed
to working in high heat environments will simply tire more easily than a person whose
body has adapted somewhat to the conditions.

Those new to this type of environment will need to be given time to adapt. How long it
takes to acclimate to heat will vary from one person to another. During this process, it
is beneficial to take more frequent breaks from the heat and to hydrate more
frequently.

The signs and symptoms of heat fatigue are the impaired performances of skilled
manual and mental functions.

It is especially important to be aware of this condition in jobs that require a high degree
of vigilance. There is no treatment per se for heat fatigue except to remove the heat
stress before a more serious heat-related condition develops. Each individual will need
to pay attention to the signals their body sends them.

Heat-Related Accidents
While heat stress-related illnesses are very real and life-threatening experiences,
remember that your risk of injury is higher in extreme heat, even if you are not
suffering from heat exhaustion, have heat cramps, or a heat stroke. Consider the
physical responses that extreme heat produces:

 Sweaty palms
 Irritability 
 Impatience
 Sunburns

It is crucial to be aware of your body and the sweat it produces when exposed to
extreme heat. Think about the objects you may handle or even wear. Will a drill slip
from your hands? Will your safety goggles fog up? How will you combat A/C drips on
the floor on an especially hot day?
Not only can the physical effects of extreme heat increase your risk of injury, but so will
the mental effects. Think about the last time you were doing something outside with
the sun beating down on you. You were likely speeding through the job to get inside to
the air conditioning. Or, you were working near a hot surface, such as an oven or
heater, and likely skipped a few steps to finish the job and get away from the heat.
Whichever scenario you are more likely to fall into, it can be extremely dangerous and
even deadly to rush through some jobs, depending on the job at hand. 

Next time you are working in an environment with extreme heat, be sure to:

 Take frequent breaks.

 Wipe off perspiration every chance you can.
 Be aware of A/C drips on the floor.
 Seek out replacement gear if your protective gear becomes compromised.
 Wear sunscreen and reapply as needed

 Lesson 3: Avoiding Heat Stress

Ventilation
General ventilation lessens the impact of stagnant, hot air with cooler air. This works best
when attempting to control inside heat by bringing in cooler, outside air, and it is the
most cost-effective way of dealing with the situation. However, remember that simply
ventilating outside air does not equate to cooler air; to reduce heat in an area, the
ventilated air out must be warmer than the ventilated air in. A permanently installed
ventilation system usually can accommodate large areas and entire buildings. Portable
exhaust systems may be more effective or practical in smaller areas.

Air treatment and air cooling differ from ventilation because the air temperature is
reduced by removing the heat (and sometimes humidity) from the air. 

Air conditioning, the most commonly used method of air treatment, cools by putting a
compressed refrigerant under pressure, which removes the heat from the air. While
very effective, this method is expensive to install and operate.

Chillers are a less costly alternative to air conditioning. Chillers circulate unpressurized

cool water through heat exchangers over which air from the ventilation system then
passes. They do have some limitation in that they tend to be more efficient in cooler
climates or in dry climates where evaporative cooling can be used more effectively.

Air Treatment
Localized air cooling works well in reducing air temperature in specific areas. Two
methods used with some success in industrial settings are:
  Cool rooms - used to enclose a specific workplace or to offer workers a recovery
area near hot jobs
 Portable blowers with built-in air chillers - the main advantages of a blower are
portability and minimal set-up time

Fans
A very simple and relatively efficient way to reduce heat stress is by increasing the air
flow or convection using fans in the work area. Keep in mind, however, that this is only
effective as long as the air temperature is lower than the worker's skin temperature
(usually less than 95 degrees Fahrenheit).

Changes in airspeed increase both the convective heat exchange, or the exchange
between the skin’s surface and surrounding air, and the rate of evaporation. However,
this does not actually cool the air. To be effective, moving air must impact the
individual worker directly.

Heat Conduction Blocking

The effects of conductive heat can be reduced by insulating the hot surface that
generates the heat and also by changing the surface itself.

For example, shields can be used to reduce radiant heat that is within the worker's line
of sight. Polished surfaces make excellent barriers, although special glass or metal
mesh surfaces can be used if visibility is an issue. With some sources of radiation
(heating pipes, for example) insulation and surface modifications can result in a
significant reduction of radiant heat.

Acclimatization
In addition to engineering controls, there are a number of work practices that can be
implemented to protect employees from heat stress. Foremost among these is a
program of acclimatization.

In 1986, the National Institute for Occupational Safety and Health issued guidelines for
acclimating employees to the effects of heat that are still used today. For those who
have had experience with jobs where they were at risk for heat stress, NIOSH
recommends:

 50 percent exposure on day one

 60 percent exposure on day two
 80 percent exposure on day three
 100 percent exposure on day four

For workers who are new to working in high heat environments, the recommendation
is:
Fluid Replacement

Employees working in high heat environments should be encouraged to drink fluids

frequently. Providing cool water (between 50° to 60°F) or any other non-alcoholic cool
beverage, keeping ample quantities close to where employees are working, and
encouraging them to drink small amounts every 15-20 minutes will help combat the
effects of heat.

In addition to taking breaks for fluids, it's also a good idea to provide recovery areas
such as air-conditioned enclosures and rooms where intermittent rest periods (with
fluids) can be taken. If you work primarily at a job site, it is vital to find areas of
complete shade in a well-ventilated area. 

 20 percent exposure on day one

 40 percent exposure on day two
 60 percent exposure on day three
 80 percent exposure on day four
 100 percent exposure on day five

Working Smart
Reducing the physical demands of a job by reducing physical exertion (such as
excessive lifting, climbing, or digging with heavy objects) will help minimize the risk of
heat stress. Other ideas that can help employees deal more effectively with the heat
include:

 Spreading the work among more individuals, lessening the time that workers are
exposed to the heat.
 Hiring temporary workers or assign extra workers from other assignments, if
more help is needed
 Rescheduling hot jobs for a cooler part of the day.

Pro Tip:

Routine maintenance and repair work that can be done anytime should be scheduled for
the fall or spring seasons as opposed to during the hottest months of summer.

Heat Stress Program

Developing a heat stress program will help raise the level of awareness of all employees
so that they will be more inclined to identify the effects of heat stress in themselves
and others. Creating a heat stress program specific to your organization gives
employees empowerment to apply guidelines and protocols to their role. By raising
awareness, the risk of serious heat stress-related health issues is significantly reduced. 

The program should include organization-specific information, such as:

 The potential hazards of heat stress

 How to recognize predisposing factors, danger signs, and symptoms
 The potential health effects of heat stroke
 First aid procedures for heat stroke and heat exhaustion
 Individual employee responsibilities for avoiding heat stress
 Dangers of using drugs (including prescription medications) and alcohol in hot
work environments
 Use of protective clothing and equipment

While implementing a program in your workplace may take some time to develop, it will
certainly be worthwhile. According to recent reports from The Bureau of Labor
Statistics, transportation and material-moving occupations accounted for 720 heat-
related incidents that resulted in days away from work. Consequently, the more
effective your organization’s heat stress program is, the less likely employees are to
miss days of work.

A final piece of advice for organizations is to offer some form of benefit to employees,
aside from the obvious health benefit of not suffering from a heat stroke. For example,
some organizations have:

 Offered alternate work hours to accompany the timing of the hottest part of the
day. 
 Provided water and electrolyte-replacements for employees
 Purchased additional fans to utilize
 Provided CPR and basic first aid training to all staff
 Provided incentives for X number of days without an accident

Summary
Heat stress, if not dealt with in an appropriate manner, can quickly become a serious
health risk. Being able to recognize the symptoms and warning signs in yourself and
others will help to keep your workplace safe. If you see signs and symptoms in others,
make the individual and your manager aware. For yourself, trust what your body is
telling you. Keep hydrated and keep cool!