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Recognizing and Preventing Heat Related Illnesses
Document Number: 222
During the summer months, employers should be especially aware of
the dangers associated with working in high-temperature environments.
Heat and humidity combined with physical exertion can do more than
just make employees uncomfortable—it can lead to a variety of
heat-related illnesses that can debilitate employees.
Heat Cramps
Heat cramps are painful muscle spasms. They can occur after
vigorous exercise or intense physical activity in extreme
temperatures. Abdominals, calf and thigh muscles and the
biceps/triceps are most frequently affected. If cramping occurs it is
suggested to rest and cool down, drinking water with a teaspoon of
salt per quart. Affected individuals may also feel faint and should be
taken to a cool place and manual pressure applied to the cramped
muscle.
Heat Rash
Heat rash, or prickly heat, appears as fine red spots or small
bumps. It’s usually found where clothing is somewhat restrictive
(i.e., on the neck and upper back, chest or arms). This harmless rash
is triggered by hot, humid weather when one is dressed too warmly for
conditions. The rash develops when skin is persistently wetted by
perspiration. The small inflamed spots on the skin can become
infected. The condition usually disappears when the skin is cooled and
dried.
Heat Exhaustion
Heat exhaustion is a result of excessive heat and dehydration. It
is generally caused by insufficient water intake, insufficient salt
intake and a deficiency of the production of sweat which evaporates on
the skin to cool the body.” Symptoms of heat exhaustion can have a
sudden onset and include pale, clammy skin, fatigue, dizziness,
nausea, vomiting, shallow breathing, rapid pulse and intense thirst.
Syncope (fainting) is a milder form of heat exhaustion and is brought
on by having to stand for long periods of time in a hot environment;
it is caused by the pooling of blood in the heat-dilated vessels of
the legs.
A victim of heat exhaustion, should be cooled as rapidly as possible
by placing the individual flat or with feet slightly elevated in front
of a fan or in a cool room. Administer cool liquids (not icey), and
seek medical attention. More severely exhausted patients may need I.V.
fluids—especially if vomiting prevents them from keeping liquids
down. Heat exhaustion is more difficult to diagnose than heatstroke,
but its prognosis is far better unless circulatory failure is
prolonged.
Heatstroke
Heatstroke is caused by overexposure to extreme heat and a
breakdown of the body’s heat-regulating mechanisms. In the initial
and most crucial stage of diagnosing heat stroke, a victim will
exhibit an altered mental status such as disorientation or confusion.
This altered consciousness is the key to diagnosing heat stroke. All
heat stroke victims will exhibit an altered mental state; this is not
true for those suffering from heat exhaustion or extreme
sunburn.
Victims of heat stroke often have hot, dry, flushed skin; a rapid
heartbeat; and abnormally high body temperature (i.e., a rectal
temperature of 105.8°F). They may appear confused or lose
consciousness entirely. If their body temperature is too high, death
can occur.
Heat stroke is an extreme medical emergency requiring immediate
medical attention. Until medical assistance is available, the
victim should be cooled rapidly by placing him/her in a shady area,
submersing them in a cool bath or wrapping them in wet sheets. Air
movement around the individual should be increased to improve
evaporative cooling.
Another cooling method is to spray the victim with lukewarm water and
fan the individual with a towel. The water evaporating from the skin
will help cool the victim quickly. During the cooling process, the
victim must be continuously monitored to prevent shivering. Once a
victim’s rectal temperature is reduced to 102.2°F, cooling methods
should be stopped.
Even though it is important to replace fluids as soon as possible, liquids
should NOT be administered to a victim in an altered mental state of
heat stroke—there is a risk of these liquids being aspirated
into the lungs. Medical professionals will give I.V. fluids to an
individual suffering from heat stroke when they arrive at the scene.
Prevention
Basic methods to prevent heat-related illnesses on the job include
the following:
- Wear loose fitting clothing
- Drink water often (don’t wait until you’re thirsty)
- Schedule “hot” jobs for the cooler part of the day (early
morning or late afternoon)
- Schedule routine maintenance and repair work in hot areas during
the cooler seasons of the year
- Provide additional breaks and comfortable break areas
- Add additional personnel to reduce exposure time for each member
of a crew
- Permit workers the freedom to interrupt work when they feel
extreme heat discomfort.
OSHA’s Technical Manual discusses specific engineering and
administrative control measures in great detail. It also outlines a
variety of personal protective equipment that can be implemented to
reduce the possibility of heat related illnesses. This reference
material is available at OSHA’s Web site: http://www.osha.gov
(see “Heat Stress” in the Subject Index.)
An awareness of the symptoms of heat-related illnesses and the control
measures to prevent them will help keep your employees safe and your
workplace running more smooth during the summer months.
Commonly Asked Questions
| Q. |
There seems to be conflicting opinions on the use of salt
tablets. When, if ever, are they appropriate for employee use? |
| A. |
If the temperatures are extreme and the activity is intense, the
use of a sport drink with sodium would be better than tablets. You
need to have sodium because it helps the small intestine absorb
water, getting it into the blood-stream faster. However, salt
tablets are highly-concentrated doses of sodium that can interact
with other medicines and health conditions and pose a health
threat to employees if not administered by a health professional.
Another reason to avoid tablets is that if the water lost through
sweating is not replaced, salt can build up in your body and cause
cramps. Too much sodium in your system can also cause fluid
retention—this can cause your blood pressure to rise,
predisposing you to such problems as swollen legs or
arteriosclerosis. Generally, a fluid/electrolyte replacement sport
drink is safer than tablets. |
| Q. |
Are sport drinks any better than water for employees
working in high temperature environments? |
| A. |
The real key is to keep yourself fully hydrated. According to a
1999 release from the Mayo Health Foundation, unless you are
engaging in extreme exercise, water is your best bet. Sport drinks
are generally not necessary unless you are exerting yourself for
90 minutes or more (60 minutes if the activity is particularly
intense or temperatures are extreme). During physical work or
exercise it is recommended to replenish your fluids every 20
minutes—your body has limits in its ability to adjust to fluid
loss, so don’t wait to be thirsty! Humans lose about 10 cups of
fluid a day in sweat, urine, exhaled air and bowel movements. What
is lost must be replaced to maintain balance. On the other hand,
sport drinks really can’t hurt. There is some research that
shows individuals will drink more of a sport drink than water, and
that in itself will help you stay adequately hydrated. Sport
drinks quickly replace fluids and electrolytes that are lost in
sweat; they also provide energy to working muscles. During
extreme physical exertion or in very hot conditions, sport drinks
are superior to water. While water is a good “thirst quencher,”
it is not an efficient “rehydrator” like a sport drink. This
is because water can quench your thirst before you’re completely
rehydrated. Water also turns on the kidneys prematurely so you can
lose fluid in the form of urine much more quickly than when
drinking a sports drink. The small amount of sodium in most sports
drinks aids your body to hold on to the fluid you consume rather
than losing it through urine and the carbohydrates they contain
make it more easily absorbed than water. One caution is to avoid
the high-carbohydrate drinks like soda pop— especially those in
the 20% concentration range. fluid carbohydrate levels exceed 6-8%
they are actually more difficult for the body to absorb. |
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Please Note: The information contained in this
publication is intended for general information purposes only. This
publication is not a substitute for review of the applicable
government regulations and standards, and should not be construed as
legal advice or opinion. Readers with specific questions should refer
to the cited regulation or consult with an attorney.
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