Complacency About Heat Can Kill Workers

Nancy Grover

Sarasota, FL ( – Two drivers for the same transportation company experienced symptoms of heat-related illness. But the decision made by each worker’s supervisor led to significantly different outcomes.

Driver A spent 8 hours in an emergency room undergoing a variety of diagnostic tests and three sets of cardiac enzyme blood draws before he was diagnosed with a heat-related illness and discharged — at a cost of $38,000. Driver B was immediately assessed and instructed by a nurse case manager to increase his fluid intake, undergo cooling measures and take over-the-counter medications. All symptoms had resolved within 24 hours and that driver was back at work. The total cost for his treatment: $900.

“This is a great way to differentiate early management of symptoms,” said Scott Cherry, DO, chief Medical Officer for Axiom Medical. “Driver A ended up going to the emergency department in late stage. He probably had these symptoms for hours or even a day.”

Employers can ensure their workers are treated promptly with the best medical care, or even prevent such incidents from happening at all. With the summer season in full swing and record heat waves in some areas of the country, it behooves employers to understand and educate their workforces on preventive measures for heat-related illnesses.

Heat-related Illness

An average of 702 heat-related fatalities occur each year, according to the Centers for Disease Control and Prevention. New workers as well as those who have not been exposed to hot working conditions for many months are the most vulnerable. And it’s not just standing in the baking sun that is a problem.

“That’s a huge component, but there are many factors that equally or more contribute to your level of heat stress,” Cherry said. “One part is how much your own body can generate heat.”

For example, a person doing physically demanding work is generating heat. The worker could be in the shade but still suffer from heat-related illness.

Clothing and personal protective equipment can also contribute to heat related illnesses.

  1. There are a variety of heat related illnesses, including
  2. Heat rash
  3. Sunburn
  4. Heat cramps
  5. Fainting
  6. Heat exhaustion
  7. Heatstroke

Who’s at Risk

Workers who are older – especially those with underlying chronic medical conditions are the most susceptible to heat-related injuries. Figures from Statista for the period 2004 – 2018 show those between the ages of 45 and 85 were most at risk of dying with heat being either the underlying cause, or a contributing cause.

Workers with comorbidities such as diabetes, obesity, and, especially, heart disease can be significantly impacted by exposure to heat.

“If you start sweating profusely and if you’re not hydrating, as your blood volume gets more dehydrated, it’s going to be a huge stress on your heart,” Cherry said. “So if you already have heart disease It could easily precipitate a heart attack.”

Certain medications can pose risks for heat-related illnesses. Many antihistamines, for example, shut down the ability to sweat appropriately and put the worker at risk. Also, diuretics, which are often prescribed for high blood pressure can put someone at risk for heat problems.


Heatstroke is the most serious heat-related illness and can be fatal. The most significant sign of heatstroke is an altered mental state.

“Ask the person their name, place and time,” Cherry said. “If someone is not making sense and has heat exposure, you really need to activate emergency medical services when you see that.”

Slurred speech, seizures and loss of consciousness are also signs of a medical emergency.

The best defense against a serious or fatal heat-related illness is prevention. Workers who are new or are returning need to build up their tolerance.

According to OSHA, these workers should follow the ‘20% rule.’ “On the first day, work no more than 20% of the shift’s duration at full intensity in the heat. Increase the duration of time at full intensity by no more than 20% a day until workers are used to working in the heat,” advises an OSHA poster. OSHA also outlines various signs of heat-related problems and what steps to take.

Doing rest-work cycles based on the day’s heat index can help prevent heat problems. Also, giving employees some easier tasks while outside can help. However, it’s important to understand that heat stress is cumulative.

Staying hydrated is also extremely important. Employers should provide the proper beverages.

“If people are working in the sun or outdoors you want to offer or have them drink a mix of water and electrolytes,” Cherry said. “The energy drinks do create a higher risk for heat stress. You should definitely limit them. Same with soda.”

If someone does exhibit signs of heat-related problems, supervisors and/or coworkers should act quickly. Giving them water; removing any unnecessary clothing; moving them to a cooler area; cooling them with water, ice or a fan; staying with the person, and seeking medical care if needed are advised. The earlier a heat-related situation can be addressed, the better.

“The best is primary prevention; you just don’t let it happen,” Cherry said. “Secondary prevention is really, really good; it’s [when] you’re just starting to feel symptoms. The least favorite in my mind is tertiary, which is where you have to go to the ER or hospital.

“A strength of early case management is as soon as you’re not feeling well and seek professional medical help you can be assessed to see if there no warning signs,” Cherry added. “But with some early intervention – resting in shade, rehydration and a quick follow up within an hour – you can see if the patient is getting better. If not or worsening, then get them to be seen. The majority of these cases respond quite well to some interventions that are very cost effective and very efficient for the company as well.”

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