During emergency response activities or recovery operations, workers may be required to work in hot environments, and sometimes for extended periods. Heat stress is a common problem encountered in these types of situations. The following frequently asked questions will help workers understand what heat stress is, how it may affect their health and safety, and how it can be prevented.
Where might I be exposed to heat stress?
Any process or job site that is likely to raise the workers deep core temperature (often listed as higher than 100.4 degrees F (38°C)) raises the risk of heat stress. Operations involving high air temperatures, radiant heat sources, high humidity, direct physical contact with hot objects, or strenuous physical activities have a high potential for inducing heat stress in employees. Indoor operations such as foundries, brick-firing and ceramic plants, glass products facilities, rubber products factories, electrical utilities (particularly boiler rooms), bakeries, confectioneries, commercial kitchens, laundries, food canneries, chemical plants, mining sites, smelters, and steam tunnels are examples of industrial locations where problems can occur. Outdoor operations conducted in hot weather, such as construction, refining, asbestos removal, hazardous waste site activities, and emergency response operations, especially those that require workers to wear semi-permeable or impermeable protective clothing, are also likely to cause heat stress among exposed workers.
Are there additional causal factors for heat stress?
Age, weight, degree of physical fitness, degree of acclimatization, metabolism, dehydration, use of alcohol or drugs, and a variety of medical conditions such as hypertension all affect a person's sensitivity to heat. However, even the type of clothing worn must be considered. Prior heat injury predisposes an individual to additional injury. Individual susceptibility varies. In addition, environmental factors include more than the ambient air temperature. Radiant heat, air movement, conduction, and relative humidity all affect an individual's response to heat.
What kind of heat disorders and health effects are possible and how should they be treated?
Heat Stroke is the most serious heat related disorder and occurs when the body's temperature regulation fails and body temperature rises to critical levels. The condition is caused by a combination of highly variable factors, and its occurrence is difficult to predict. Heat stroke is a medical emergency that may result in death. The primary signs and symptoms of heat stroke are confusion; irrational behavior; loss of consciousness; convulsions; a lack of sweating (usually); hot, dry skin; and an abnormally high body temperature, e.g., a rectal temperature of 41°C (105.8°F). The elevated metabolic temperatures caused by a combination of work load and environmental heat, both of which contribute to heat stroke, are also highly variable and difficult to predict.
If a worker shows signs of possible heat stroke, professional medical treatment should be obtained immediately. The worker should be placed in a shady, cool area and the outer clothing should be removed. The worker's skin should be wetted and air movement around the worker should be increased to improve evaporative cooling until professional methods of cooling are initiated and the seriousness of the condition can be assessed. Fluids should be replaced as soon as possible. The medical outcome of an episode of heat stroke depends on the victim's physical fitness and the timing and effectiveness of first aid treatment.
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.
Heat Exhaustion signs and symptoms are headache, nausea, vertigo, weakness, thirst, and giddiness. Fortunately, this condition responds readily to prompt treatment. Heat exhaustion should not be dismissed lightly. Fainting or heat collapse which is often associated with heat exhaustion. In heat collapse, the brain does not receive enough oxygen because blood pools in the extremities. As a result, the exposed individual may lose consciousness. This reaction is similar to that of heat exhaustion and does not affect the body's heat balance. However, the onset of heat collapse is rapid and unpredictable and can be dangerous especially if workers are operating machinery or controlling an operation that should not be left unattended; moreover, the victim may be injured when he or she faints. Also, the signs and symptoms seen in heat exhaustion are similar to those of heat stroke, a medical emergency. Workers suffering from heat exhaustion should be removed from the hot environment and given fluid replacement. They should also be encouraged to get adequate rest and when possible ice packs should be applied.
Heat Cramps are usually caused by performing hard physical labor in a hot environment. These cramps have been attributed to an electrolyte imbalance caused by sweating. Cramps appear to be caused by the lack of water replenishment. Because sweat is a hypotonic solution (±0.3% NaCl), excess salt can build up in the body if the water lost through sweating is not replaced. Thirst cannot be relied on as a guide to the need for water; instead, water must be taken every 15 to 20 minutes in hot environments. Under extreme conditions, such as working for 6 to 8 hours in heavy protective gear, a loss of sodium may occur. Recent studies have shown that drinking commercially available carbohydrate-electrolyte replacement liquids is effective in minimizing physiological disturbances during recovery.
Heat Rashes are the most common problem in hot work environments where the skin is persistently wetted by unevaporated sweat. Prickly heat is manifested as red papules and usually appears in areas where the clothing is restrictive. As sweating increases, these papules give rise to a prickling sensation. Heat rash papules may become infected if they are not treated. In most cases, heat rashes will disappear when the affected individual returns to a cool environment.
Heat Fatigue is often caused by a lack of acclimatization. A program of acclimatization and training for work in hot environments is advisable. The signs and symptoms of heat fatigue include impaired performance of skilled manual, mental, or vigilance jobs. There is no treatment for heat fatigue except to remove the heat stress before a more serious heat-related condition develops.
What kind of engineering controls can be utilized?
General ventilation dilutes hot air with cooler air (ideally, bringing in cooler outside air) and in is the most cost effective). A permanently installed ventilation system usually can handle large areas or entire buildings. Portable or local exhaust systems may be more effective or practical in smaller areas.
Air treatment/air cooling differs from ventilation because it reduces the temperature of the air by removing the heat (and sometimes humidity) from the air. Air conditioning is a method of air cooling which uses a compressed refrigerant under pressure to remove the heat from the air. This method is expensive to install and operate. An alternative to air conditioning is the use of chillers to circulate unpressurized cool water through heat exchangers over which air from the ventilation system is then passed. Chillers are more efficient in cooler climates or in dry climates where evaporative cooling can be used. Local air cooling can be effective in reducing air temperature in specific areas. Two methods have been used successfully in industrial settings. One type, cool rooms, can be used to enclose a specific workplace or to offer a recovery area near hot jobs. The second type is a portable blower with built-in air chiller. The main advantage of a blower, aside from portability, is minimal set-up time.
Another way to reduce heat stress is to cool the employee by increasing the air flow or convection using fans, etc. in the work area. This is generally only effective as long as the air temperature is less than the worker's skin temperature (usually less than 95 degrees F dry bulb). Changes in air speed can help workers stay cooler by increasing both the convective heat exchange (the exchange between the skin surface and the surrounding air) and the rate of evaporation. This does not actually cool the air so moving air must impact the worker directly to be effective.
Heat conduction blocking methods include insulating the hot surface that generates the heat and changing the surface itself. Simple devices such as shields, can be used to reduce radiant heat, i.e. heat coming from hot surfaces within the worker's line of sight. Polished surfaces make the best barriers, although special glass or metal mesh surfaces can be used if visibility is a problem With some sources of radiation, such as heating pipes, it is possible to use both insulation and surface modifications to achieve a substantial reduction in radiant heat.
What administrative or work practice controls may be used?
Acclimatize workers by exposing them to work in a hot environment for progressively longer periods. NIOSH (1986) suggests that workers who have had previous experience in jobs where heat levels are high enough to produce heat stress may acclimatize with a regimen of 50% exposure on day one, 60% on day two, 80% on day three, and 100% on day four. For new workers who will be similarly exposed, the regimen should be 20% on day one, with a 20% increase in exposure each additional day.
Replace Fluids by providing cool (50°-60°F) water or any cool liquid (except alcoholic beverages) to workers and encourage them to drink small amounts frequently, e.g., one cup every 20 minutes. Ample supplies of liquids should be placed close to the work area. Although some commercial replacement drinks contain salt, this is not necessary for acclimatized individuals because most people add enough salt to their summer diets.
Reduce the physical demands by reducing physical exertion such as excessive lifting, climbing, or digging with heavy objects. Spread the work over more individuals, use relief workers or assign extra workers. Provide external pacing to minimize overexertion.
Provide recovery areas such as air-conditioned enclosures and rooms and provide intermittent rest periods with water breaks.
Reschedule hot jobs for the cooler part of the day, and routine maintenance and repair work in hot areas should be scheduled for the cooler seasons of the year.
Monitor workers who are at risk of heat stress, such as those wearing semi-permeable or impermeable clothing when the temperature exceeds 70°F, while working at high metabolic loads (greater than 500 kcal/hour). Personal monitoring can be done by checking the heart rate, recovery heart rate, oral temperature, or extent of body water loss.
To check the heart rate, count pulse for 30 seconds at the beginning of the rest period. If the heart rate exceeds 110 beats per minute, shorten the next work period by one third and maintain the same rest period.
The recovery heart rate can be checked by comparing the pulse rate taken at 30 seconds (P1) with the pulse rate taken at 2.5 minutes (P3) after the rest break starts. The two pulse rates can be interpreted using the following criteria.
| Heart rate recovery pattern | P3 | Difference between P1 and P3 |
|---|
| Satisfactory recovery | 90 | -- |
| High recovery (Conditions may require further study) | 90 | 10 |
| No recovery (May indicate too much stress) | 90 | 10 |
Check oral temperature with a clinical thermometer after work but before the employee drinks water. If the oral temperature taken under the tongue exceeds 37.6°C, shorten the next work cycle by one third.
Measure body water loss by weighing the worker on a scale at the beginning and end of each work day. The worker's weight loss should not exceed 1.5% of total body weight in a work day. If a weight loss exceeding this amount is observed, fluid intake should increase.
Develop a heat stress training program, and incorporate into health and safety plans at least the following components:
- Knowledge of the hazards of heat stress;
- Recognition of predisposing factors, danger signs, and symptoms;
- Awareness of first-aid procedures for, and the potential health effects of, heat stroke;
- Employee responsibilities in avoiding heat stress;
- Dangers of using drugs, including therapeutic ones, and alcohol in hot work environments;
- Use of protective clothing and equipment; and
- Purpose and coverage of environmental and medical surveillance programs and the advantages of worker participation in such programs.
What Personal Protective Equipment is effective in minimizing heat stress?
Reflective clothing, which can vary from aprons and jackets to suits that completely enclose the worker from neck to feet, can reduce the radiant heat reaching the worker. However, since most reflective clothing does not allow air exchange through the garment, the reduction of radiant heat must more than offset the corresponding loss in evaporative cooling. For this reason, reflective clothing should be worn as loosely as possible. In situations where radiant heat is high, auxiliary cooling systems can be used under the reflective clothing.
Auxiliary body cooling ice vests, though heavy, may accommodate as many as 72 ice packets, which are usually filled with water. Carbon dioxide (dry ice) can also be used as a coolant. The cooling offered by ice packets lasts only 2 to 4 hours at moderate to heavy heat loads, and frequent replacement is necessary. However, ice vests do not tether the worker and thus permit maximum mobility. Cooling with ice is also relatively inexpensive.
Wetted clothing such as terry cloth coveralls or two-piece, whole-body cotton suits are another simple and inexpensive personal cooling technique. It is effective when reflective or other impermeable protective clothing is worn. This approach to auxiliary cooling can be quite effective under conditions of high temperature, good air flow, and low humidity.
Water-cooled garments range from a hood, which cools only the head, to vests and "long johns," which offer partial or complete body cooling. Use of this equipment requires a battery-driven circulating pump, liquid-ice coolant, and a container. Although this system has the advantage of allowing wearer mobility, the weight of the components limits the amount of ice that can be carried and thus reduces the effective use time. The heat transfer rate in liquid cooling systems may limit their use to low-activity jobs; even in such jobs, their service time is only about 20 minutes per pound of cooling ice. To keep outside heat from melting the ice, an outer insulating jacket should be an integral part of these systems.
Circulating air is the most highly effective, as well as the most complicated, personal cooling system. By directing compressed air around the body from a supplied air system, both evaporative and convective cooling are improved. The greatest advantage occurs when circulating air is used with impermeable garments or double cotton overalls. One type, used when respiratory protection is also necessary, forces exhaust air from a supplied-air hood ("bubble hood") around the neck and down inside an impermeable suit. The air then escapes through openings in the suit. Air can also be supplied directly to the suit without using a hood in three ways: by a single inlet, by a distribution tree, or by a perforated vest. In addition, a vortex tube can reduce the temperature of circulating air. The cooled air from this tube can be introduced either under the clothing or into a bubble hood. The use of a vortex tube separates the air stream into a hot and cold stream; these tubes also can be used to supply heat in cold climates. Circulating air, however, is noisy and requires a constant source of compressed air supplied through an attached air hose. This system tethers the worker and limits his or her mobility. Additionally, since the worker feels comfortable, he or she may not realize that it is important to drink liquids frequently.