California updated its standard in November 2010 to clarify the shade requirement, include temperature triggers, and address high-heat requirements.

To Beat the Heat

Employee training, hydration, rest, shade, and monitoring of workers who may be at risk are elements to include in a heat illness prevention plan.

Millions of people make a living by working outdoors. When the temperature rises, so does the risk for heat-related illnesses, insect bites and stings, and allergies. Five to 10 million workers are exposed to heat-related illnesses each year, according to OSHA.

"These things are often happening in the early parts of summer when workers are just getting out there for the first time," said Dr. Nick Peters, vice president of medical operations for Concentra, a national health care company. Peters, who oversees all medical services, health programs, and clinicians for the western region of the United States and leads Concentra's Urgent Care medical expert panel, said deaths from heat-related illnesses are not extremely common, but common enough that doctors need to be aware and recognize the symptoms.

"It's something that, if we catch it early, it's pretty easy to treat. But if it gets all the way to the condition of a heat stroke, then it can be very serious and even permanently disabling if not aggressively treated," he said.

The Range of Heat Illnesses
Heat illnesses can range from mild to severe. Heat stroke is the most serious heat-related condition and can result in death or disability if urgent care is not administered. Symptoms include chills, elevated body temperature, throbbing headache, hallucinations, dizziness, confusion, slurred speech, and lack of sweating.

Heat exhaustion is the result of a dramatic loss of fluids and salt in the body. Symptoms include heavy sweating, slightly elevated body temperature, clammy skin, dizziness, confusion, extreme weakness or fatigue, muscle cramps, pale or flushed complexion, shallow breathing, and nausea.

Heat syncope is a dizzy spell after suddenly rising from a sitting or reclining position. Dehydration may be a factor. Symptoms include dizziness, light-headedness, and fainting. Heat cramps are caused by low salt levels following heavy sweating. Symptoms include muscle spasms or pain. Heat rash is a skin irritation caused by excessive sweating. Symptoms include clusters of red bumps on the skin, often appearing on the neck, chest, or in folds of the skin.

Whether or not someone should seek medical treatment really depends on what the person is experiencing, said Peters. "In general, if a patient is starting to feel symptoms such as being lightheaded, nausea and vomiting, weakness, cramps in the muscles, not urinating . . . that's a sign that they probably need to see a doctor," he said. "But if they're just feeling tired, hot, dry, real thirsty, that's probably a time to take a break, go and get some fluids in them, and go someplace cool for a while."

Heat-Related Regulations
Heat illnesses are completely preventable. Peters said acclimation is the best way to prevent heat-related illnesses but cannot be accomplished quickly. Those who work in an outdoor area that has had cool weather and then suddenly has warm weather may find acclimating difficult.

"The issue with acclimation is that it takes time," he said. "It takes about two weeks to acclimate to a change in weather or environment. Usually, being exposed to the hot temperatures over one to four hours over that two weeks will help you make those changes."

To prevent heat illness, OHSA recommends that employers provide training about the hazards leading to heat stress and how to prevent them, provide a lot of cool water to workers close to the work area (at least one pint of water per hour), schedule frequent rest periods with water breaks in shaded or air-conditioned areas, routinely check workers who are at risk (e.g., overweight, older than 65, having heart disease or elevated blood pressure, or taking medications that may be affected by extreme heat), and consider protective clothing that provides cooling.

Employees should drink plenty of fluids even when not thirsty, avoid beverages containing alcohol or caffeine, and wear lightweight, light-colored, loose-fitting clothes.

In 2005, California became the first state in the nation to develop safety and health regulations to protect workers from heat illness. "We have a lot of folks who work outdoors, in construction, in agriculture, in the oil and gas industries, landscapers, and it gets pretty hot in California," said Bill Krycia, a regional manager with Cal/OSHA enforcement. "Employers have made multiple attempts to address heat illness for their employees. Many of them have, and there have been some that haven't. In 2006, we had a heat wave come through California. We had multiple occupational fatalities and serious illnesses, as well as an overall significant impact in public health. Heat illness or thermal stress has been a classic issue for a long time."

In November 2010, the state updated its standard to clarify the shade requirement, include temperature triggers, and address high-heat requirements.

"Now, the standard, Section 3395, identifies probably a little more clearly issues of acclimatization, issues of the provision of water, access to shade and shade being up when temperatures exceed 85 degrees Fahrenheit, and having at least enough shade to accommodate at least 25 percent of the employees on that particular shift at any time," Krycia said.

High-heat procedures stress that when temperatures equal or exceed 95 degrees, employers should have an effective communication system, observe employees for alertness and signs and symptoms of heat illness, remind employees to drink water, and closely supervise new employees for the first 14 days of their employment.

"We really stress it when temps get to or above 95 degrees Fahrenheit," he said, "but employers are required to observe employees for alertness and signs or symptoms of heat illness even when temperatures are below 95 degrees. We wanted to ensure that we had the proper format for the standard and by putting into legislation made it clear to everyone."

Agency spokeswoman Krisann Chasarik said preliminary 2010 data showed an 80 percent compliance rate. Out of 2,849 heat inspections conducted, 805 violations were found. Preliminary data also showed there were 29 heat-related illnesses in 2010, down from 52 in 2009.

Violating the heat safety standard can be costly for employers. "One of the more rapid consequences is that we've shut people down . . . if temperatures are over 90 degrees Fahrenheit and they've failed to provide adequate access to drinking water, adequate access to shade, or if employees haven't been adequately trained to recognize the signs and symptoms of heat-related illness," Krycia said. "We have issued citations in those cases, and in some of the more egregious cases the penalties have been in excess of a couple hundred thousand dollars. So for multiple violations . . . there are significant consequences to that."

Prevention Strategies
Some employers have turned to high-volume/low-speed (HVLS) fans to provide cooling. "They don't change the temperature of the air. They change the apparent or the effective temperature. The fan, depending on what speed you're running at, is going to give you a cooling sensation, so it's going to feel cooler than what the actual temperature in the air is," said Andy Olson, marketing manager for Rite-Hite, which makes HVLS fans ranging in price from between $4,000 and $6,000 for models 8 to 20 feet in diameter and from about $3,500 to $4,000 for smaller models. Many companies use less-expensive high-speed floor flans, but Olson said one HVLS fan can replace as many as 20 floor fans.

"The problem with [floor fans] is you need a lot of those to cover that same type of an area, and you need to run the individual electricity and the cords to all that," he explained. "The other issue that we've run into is that people might fight for that air. One large fan can eliminate all those issues with smaller, floor-mounted fans."

Another product widely used to prevent heat illnesses is electrolyte beverages, which are made to replace naturally occurring electrolytes, said Mike Dalton, marketing manager of Sqwincher, which offers an electrolyte replacement drink specially created for high-heat-stress work environments. "Water is a liquid. It does promote some cooling," he said, "but what your body needs something is it can absorb readily. An electrolyte beverage is designed to do that -- to restore the electrolytes."

Dalton said there many factors to weight in determining how much one should drink, from how the person starts the day to weight and acclimation to the temperature. In general, the company recommends drinking 6 to 8 ounces of electrolyte beverage every 15 minutes, accompanied with a glass of water at least every 30 minutes.

This article originally appeared in the March 2011 issue of Occupational Health & Safety.

About the Author

Cindy Horbrook (chorbrook@1105media.com, 972-687-6753) of Dallas, Texas, is a content development editor in the Dallas, Texas, office of 1105 Media Inc., publisher of Occupational Health & Safety.

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