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Protecting Workers From Heat Illness

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Heat-related illnesses and deaths are mostly preventable. However, more than 1220 people die from extreme heat each year, with 3066 succumbing from heat-related illnesses between 2018-2022. During the Summer of 2023, there were 194 confirmed heat-associated deaths in just one Arizona county, while hundreds of other deaths are still under investigation. A recent study estimated that temperature-related deaths in the U.S. could increase fivefold by 2100.

Exposure to high temperatures causes cramps, rashes, exhaustion, heat stroke, and death. When humidity is high and the heat index reaches 91°F or higher, sweat does not evaporate as quickly, and the body struggles to cool itself. Dehydration puts workers at further risk of damage caused by heat exposure.

In the U.S., forcing employees to work in extreme, sometimes fatal, heat is generally legal. Since most states do not have any regulations protecting workers from heat-related illness, injuries, or death, laborers and others are suffering from dangerous heat illness, and people are dying. The actual number of heat-related incidents is likely under-reported since employers or emergency departments may document injuries as accidents without considering heat exposure as the root cause. A UCLA study found a significant increase in workplace injuries during days with hotter temperatures. Reported incidents related to heat also underestimate the magnitude of workers who suffer from heat illness due to fear of retaliation and the lack of proper reporting standards for employers.

  • Symptoms of heat exhaustion or illness include headache, feeling tired or weak, profuse sweating, fast and weak pulse, blood pressure lowering upon standing, heat rash, muscle cramps, nausea, and dizziness or fainting—these symptoms of heat exhaustion warrant prompt treatment to prevent heatstroke.
  • Prolonged physical exertion and heat stress can result in a life-threatening medical condition called rhabdomyolysis, which causes rapid breakdown, rupture, and death of muscles after injury or too much exercise without rest. Although symptoms aren’t always present with rhabdomyolysis and may not appear for several days, heat cramps or muscle pain, weakness, reduced urine output, or dark urine warrant immediate medical attention.
  • Heatstroke is a medical emergency. It is commonly the result of physical excursion or prolonged exposure to high temperatures during the summer months. It is most dangerous when the core body temperature rises to 104°F. Symptoms of heatstroke include altered level of consciousness, confusion, slurred speech, alterations in sweating such as heavy sweating or hot, dry skin, nausea and vomiting, rapid breathing, fast heart rate, and headache. Delay in treatment of heat exhaustion increases the risks of serious complications, such as brain damage and damage to other vital organs, which can lead to death.
  • Long-term complications include rhabdomyolysis, kidney failure, liver dysfunction, electrolyte imbalances, compartment syndrome (a condition that causes pain, swelling, and disability in affected extremity muscles), and acute respiratory distress syndrome, a life-threatening lung injury.

The Occupational Health and Safety Act of 1970 (OSH Act) is a federal law created to ensure healthy and safe working conditions that allow states to run their own health and safety programs as long as they meet or exceed these federal program standards. The OSH Act includes protecting workers from heat or cold stress. The National Institute for Occupational Safety and Health (NIOSH) is a research agency created from the OSH Act that focuses on workplace standards for health and safety and empowers employees and employers to construct healthy and safe work environments.

The Occupational Safety and Health Administration (OSHA) has taken steps to improve health and safety by tracking more details about injuries and illnesses in the workplace. OSHA implemented a Final Rule that requires employers in high-risk industries with 100 or more employees to submit additional workplace-related illness and injury information annually via an electronic platform. This information will allow OSHA to identify and mitigate workplace hazards, provide education, and inform employees. Electronic data will give employers, researchers, and stakeholders valuable insights into health and safety trends and allow them to become proactive in preventing workplace illnesses and fatal injuries.

These reports will enable OSHA to analyze illness and injury data in novel ways. The electronic data allows OSHA to utilize assistance resources for outreach interventions and enforce compliance. For some establishments, this Final Rule will go into effect on January 1, 2024, with a deadline for these employers to submit their data through the OSHA Injury Tracking Application by March 2, 2024. OSHA provides information on worker rights and protections and resources to address concerns. OSHA also has updated inspection procedures for heat-related illnesses and deaths to occur on heat priority days where heat-related hazards may exist at indoor and outdoor worksites.

Currently, only five states have implemented a mandatory heat illness prevention plan for employers. There is more of an emphasis on outdoor workers in comparison to protection for indoor workers, but they each generally follow the OSHA guidelines.

  • California implemented a heat illness prevention standard to protect outdoor workers from extreme heat for agriculture, construction, landscaping, oil, and gas extraction industries, including workers transporting or delivering agriculture products and construction or other heavy materials.
  • Colorado also has established heat illness and injury protection rules for agricultural labor conditions in indoor and outdoor settings. These rules require the employer to rely on forecasted high temperatures reaching 80°F, anticipate indoor worksite temperatures when they might reach the threshold, and measure indoor worksite temperatures during the workday.
  • Minnesota’s OSHA designed a heat-stress standard to protect indoor and outdoor workers from the risk of heat-induced illnesses and unsafe acts. The state utilizes CDC and OSHA resources for training, prevention, monitoring, interventions, and emergency response guidelines for heat-related conditions.
  • Oregon OSHA’s heat illness prevention plan aims to protect indoor and outdoor workers from the threats of working in hot environments. The program includes a list of environmental risk factors, a list of personal risk factors, and information about heat-related illness and injury.
  • Washington State Department of Labor and Industries’ heat illness prevention program protects outdoor workers form the danger of heat and indoor workers from ambient heat exposure, using criteria set by NIOSH. The state adopted new rules on June 27, 2023, to protect workers from preventable heat-related illnesses and to reduce traumatic injuries related to heat exposure.

Unfortunately, workers in the hottest states remain unprotected. These include Alabama, Arkansas, Arizona, Florida, Georgia, Hawaii, Louisiana, Mississippi, Oklahoma, South Carolina, and Texas – none of which have enforced a heat illness prevention program. Because most states have yet to act responsibly by creating a heat illness prevention program for employers, monitoring and enforcement occur at the federal level rather than locally. Although federal law entitles employees to a safe workplace free from health and safety hazards, no federal law specifically protects all workers from dangerous heat exposure.

There are steps that employers can voluntarily take to mitigate heat stress. Humidity, steam leaks, and wet floors should be identified and controlled. Workers should use reflective or heat-absorbing barriers or shielding, and air velocity should increase when the air temperature is below 95°F. Other measures include implementing a buddy system, ensuring plenty of cool water breaks and accessible shade, and performing routine checks for symptoms of heat-related illness. Time employees spend in the heat should be limited, and they should be encouraged to take a break in a cool environment during the hottest times of the day. Outdoor workers should wear wide-brimmed hats and lightweight, protective clothing to protect their skin from burns and blisters.

Employers can also promote the health and safety of workers by assigning lighter work, limiting physical excursion, shortening work time, and allowing more frequent breaks as the heat index and sunshine increase, when there is little to no air/ventilation, and when workers wear PPE and protective clothing. Monitoring the weather for anticipated heat waves and implementing an alert program to prevent heat-related illness and injuries to workers is critical, as is providing training appropriate for worksite-specific conditions to recognize risk factors and symptoms of heat-related illness, understand the importance of acclimatization to heat stress, and report signs of heat-related illness. First aid training should also be a priority for all workers and supervisors.

Employers are responsible for safeguarding workers from heat illness, injuries, and death. The Center for Disease Control (CDC) provides a Heat & Health Tracker to help communities plan and respond to dangerous heat events. The tracker includes the daily rate (per 100,000) of heat-related illness visits to emergency departments across the United States. Data reveals the heat-related illness and injury numbers of emergency department visits (per 100,000) by entering the zip code, region, and date(s). The Heat and Health Tracker is a valuable and easily accessible tool employers can utilize to stay informed and protect their employees from heat-related hazards. OSHA provides detailed information and resources to assist employers in developing a proper heat illness prevention plan.

Employees have the right to expect their employer to protect their health and safety and to report unhealthy or unsafe working conditions without fear of retaliation. There is no justifiable reason for employers to neglect the impact of heat on their workforce. As climate change continues, the risks of heat stress will only increase. The short-term costs associated with providing adequate protection from heat stress are outweighed by the long-term financial benefits of employee retention, easier recruitment, less absenteeism, improved productivity, and avoidance of expensive litigation, fines, and additional regulatory expenses.

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