Guide to preventing heat stress

              A Guide to

Preventing Heat Stress

Bobby R. Davis

Series Editor

N. C. Department of Labor

Division of Occupational Safety and Health

1101 Mail Service Center

Raleigh, NC 27699- 1101

Cherie K. Berry

Commissioner of Labor

N. C. Department of Labor

Occupational Safety and Health Program

Cherie K. Berry

Commissioner of Labor

OSHA State Plan Designee

Allen McNeely

Deputy Commissioner for Safety and Health

Kevin Beauregard

Assistant Deputy Commissioner for Safety and Health

Acknowledgments

This edition of A Guide to Preventing Heat Stress has been updated as May 2001 to reflect current OSHNC standards.

The guide is based largely on an earlier edition prepared by Clifton D. Crutchfield, Ph. D., CIH. Dr. Crutchfield is a

faculty member at University of Arizona, with the Division of Community and Environmental Health, School of

Health Related Professions. He has written extensively in the area of heat- related injuries.

_____

This guide is intended to be consistent with all existing OSHA standards; therefore, if an area is considered by the

reader to be inconsistent with a standard, then the OSHA standard should be followed.

To obtain additional copies of this book, or if you have questions about North Carolina occupational safety and health stan-dards

or rules, please contact:

N. C. Department of Labor

Bureau of Education, Training and Technical Assistance

1101 Mail Service Center

Raleigh, NC 27699- 1101

Phone: ( 919) 807- 2875 or 1- 800- NC- LABOR ( 1- 800- 625- 2267)

____________________

Additional sources of information are listed on the inside back cover of this book.

____________________

The projected cost of the OSHNC program for federal fiscal year 2005– 2006 is $ 13,666,374. Federal funding provides approximately 38 percent ($ 5,119,000) of this

total.

Printed 9/ 06

Contents

Part Page

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1iiv

1 Understanding How the Body Regulates Heat . . . . . . . . . . . . . . . 1ii1

2 Learning About the Hazards of Heat Stress . . . . . . . . . . . . . . . . 1ii7

3 Preventing and Controlling Heat Stress . . . . . . . . . . . . . . . . . . ii11

4 Heat Stress Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii13

Appendix

Measuring Heat Stress Potential . . . . . . . . . . . . . . . . . . . . . . ii14

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii17

iii

Foreword

Heat poses a special threat to North Carolina’s workers. Many manufacturing workers must deal with

hot temperatures in their factories throughout the year. Thousands of outdoor workers face the threat of

cramps, exhaustion, heat stroke and worse every summer.

Our state’s southern climate and sunshine can make for a wonderful experience while we are relaxing

or on vacation. But when we go to work, we must treat them with respect and caution. A Guide to

Preventing Heat Stress explains what heat stress can do to working people and discusses ways to avoid

the many health problems it can cause.

In North Carolina, N. C. Department of Labor inspectors enforce the federal Occupational Safety and

Health Act through a state plan approved by the U. S. Department of Labor. The N. C. Department of

Labor’s Division of Occupational Safety and Health offers many educational programs to the public and

produces publications, including this guide, to help inform people about their rights and responsibilities

regarding occupational safety and health.

As you look through this guide, please remember that OSHA’s mission is greater than just enforce-ment.

An equally important goal is to help citizens find ways to create safe workplaces. Everyone profits

when managers and employees work together for safety.

Reading and understanding A Guide to Preventing Heat Stress will help you form a sound occupational

safety and health policy where you work.

Cherie K. Berry

Commissioner of Labor

iv

1

Understanding How the Body Regulates Heat

Introduction

The human body, being warm blooded, maintains a fairly constant internal temperature, even though

it is being exposed to varying environmental temperatures. To keep internal body temperatures within

safe limits, the body must get rid of its excess heat, primarily through varying the rate and amount of

blood circulation through the skin and the release of fluid onto the skin by the sweat glands. These auto-matic

responses usually occur when the temperature of the blood exceeds 98.6 F and are kept in balance

and controlled by the brain.

Sweating does not cool the body unless the moisture is removed from the skin by evaporation. Under

conditions of high humidity, the evaporation of sweat from the skin is decreased and the body’s efforts to

maintain an acceptable body temperature may be significantly impaired. These conditions adversely

affect an individual’s ability to work in the hot environment. With so much blood going to the external

surface of the body, relatively less goes to the active muscles, the brain and other internal organs;

strength declines; and fatigue occurs sooner than it would otherwise. Alertness and mental capacity may

also be affected. Workers who must perform delicate or detailed work may find their accuracy suffering,

and others may find their comprehension and retention of information lowered.

In spite of our proven ability to deal with a wide range of external temperatures, it is also a proven fact

that we can die of heat stroke at ambient temperatures below 90 F. The secret to our survival in the heat

lies in our ability to maintain our core temperature at a constant level. Any physiological or environmen-tal

factor that tends to increase that core temperature is a potential cause of heat stress. When we experi-ence

an adverse health effect because of heat stress, we experience heat strain.

Heat stress and heat strain can sneak up on us. They can happen while we work at the job site or

around the house or while we participate in physical activities such as sports or hiking. It is easy to get

caught up in what we are doing and ignore the initial signs of heat strain. If we are not aware of these

signs and do not consciously watch for them, we can wind up in serious trouble before we realize a prob-lem

exists. To prevent heat stress from causing effects ranging from reduced productivity to life threaten-ing

emergencies, we need to know more about how we function in the heat.

Successfully avoiding problems related to working in the heat requires cooperation between workers

and management. Each individual worker is best able to determine whether he or she is experiencing

adverse effects of heat strain. Management must make sure that employees understand the symptoms of

heat related illnesses and watch for them among themselves and their fellow workers. Management must

also make sure that appropriate control programs are put in place to prevent heat stress problems.

This guide is valuable both to the reader who wants more than a working knowledge of heat stress and

to the reader who desires the lifesaving essentials of the subject. The information is straight- forward and

easily understood. At the same time, the guide is sufficiently technical so as to be considered a resource

for health professionals.

How Metabolism and Physical Activity Heat the Body

Unlike cold- blooded animals such as reptiles, whose body temperatures rise and fall with the temperature

of their surrounding environment, we humans are functional only when our body temperature is maintained

within a very narrow range. The complex reactions that convert food, water and oxygen into the chemical

and electrical energies that power and sustain life are extremely temperature dependent. If the core temper-ature

goes up or down by just a few degrees, those reactions no longer occur in a normal manner and we can

find ourselves in a life- threatening situation.

1

A portion of the heat that is given off as a by- product of biochemical reactions is used to maintain a

nearly constant body core temperature. If that temperature starts to fall by a couple of degrees, mecha-nisms

such as shivering are used to generate additional heat to help maintain the core temperature. The

process of work generates more heat than is normally needed to maintain the core temperature. If we

generate more excess heat than we can get rid of, our core temperature will start to rise and we have the

stage set for heat stress.

For purposes of understanding heat stress, the body can be divided into two parts: a central core and a sur-rounding

shell. The central core is made up of organ systems such as the brain, heart, lungs and digestive

tract. To remain functional, temperatures throughout the core must remain within an extremely narrow range

of 99– 100 F ( 37– 38 C). A rise of only one degree in core temperature is enough to signal the onset of heat

stress. Although rectal monitors provide more accurate estimates of core temperatures, oral temperatures are

most often used for core estimates. Oral temperatures generally run about one degree lower than core temper-atures.

The peripheral shell of the body is made up of layers of muscle, fat and skin. This shell surrounds and

protects the core and provides a means for exchanging body heat with the surrounding environment.

Shell or skin temperatures are normally cooler by 5 to 6 F than the core temperature and can range up or

down depending upon work rate and environmental conditions.

The amount of body heat that is generated in the core is strongly dependent on the level of physical

activity involved. At rest, a male person of 154 pounds ( referred to as a standard male) generates approxi-mately

90 kilocalories per hour of heat as a by- product of metabolic energy production. Heavy physical

activity can produce over 600 Kcal/ hr of excess heat. ( See table 1 for estimates of heat production for a

variety of work tasks.) All of the heat generated by work must be eliminated from the body in order to

maintain a constant core temperature.

How the Body Responds to Excess Heat

Elimination of excess heat from the body’s core is basically a two- step process. The heat must first be

transferred from the body’s core to its shell. It is then eliminated from the shell to the surrounding envi-ronment.

If the rate of heat production is too high, or something interferes with or limits heat transfer

from the core to the skin to the environment, heat stress and strain are definite possibilities.

Blood is the primary vehicle used by the body to transfer heat from the core to the skin. When the

brain’s heat regulation system senses that excess heat is building up in the core, the heart rate acceler-ates

to speed up the flow of blood from the core to the skin. Blood vessels in the skin are dilated or opened

to receive the increased flow of blood and heat.

As the rate of work increases, the body’s demand for oxygen also increases. The heart has to beat faster

to supply the additional oxygen throughout the body. As the oxygen is burned in muscles and other tis-sues,

the excess heat generated has to be transferred from the core to the skin. In a way, a paradox is cre-ated

because the blood has to serve two different functions, both of which put increased demands on the

heart as the work rate increases. The muscles need more oxygen, which they get from the blood. The tem-perature

regulation system in the brain tries to direct the blood out to the skin where it can pool and get

rid of its load of excess heat. At high work rates, the heart has trouble meeting all the demands placed on

it. The result is an increasing heart rate and core temperature coupled with a decreasing ability of the

muscles to maintain the high work rate without fatiguing. Table 2 offers an idea of what happens as the

heart tries to cope with work rates ranging from rest up to a maximum work rate.

2

Table 1

Metabolic Work Rates as a Function of Task*

3

Work Rate

Body Position and Movement Kcal/ minute**

Sitting 0.3

Standing 0.6

Walking 2.0– 3.0

Walking uphill add 0.8/ meter rise

Average Range

Type of Work Kcal/ minute Kcal/ minute

Hand work 0.2– 1.2

light 0.4

heavy 0.9

Work with one arm 0.7– 2.5

light 1.0

heavy 1.8

Work with both arms 1.0– 3.5

light 1.5

heavy 2.5

Work with whole body 2.5– 9.0

light 3.5

moderate 5.0

heavy 7.0

very heavy 9.0

Basal Metabolism 1.0

Sample Calculation

Average

Activity Kcal/ minute

Assembly work with heavy hand tools

Standing 0.6

Heavy work with both arms 2.5

Basal metabolism _ 1_._ 0

Total Kcal/ minute 4.1

* Adapted from reference source 3. ( See References within this

publication.)

** For standard worker of 154 Ib. and 19.4 ft2 body surface.

Table 2

Heart Rate, Core Temperature and Endurance Time Corresponding to Relative Maximum Work Rate*

Excess Body Heat Should Dissipate to the Environment

When heat is transferred from the core to the skin, several mechanisms are employed to lose the heat

to the environment. The most important of these mechanisms are evaporation, convection and radiation.

Evaporation

Sweating is the body’s most effective mechanism for losing heat in a hot and/ or heavy work environ-ment.

Heat loss at a rate of 0.58 Kcal per gram of evaporated sweat occurs as heat from the skin is used

to evaporate the sweat. Most of the body’s skin surface contains sweat glands, which are activated in

stages as needed by the brain.

The maximum sweat rate that can be maintained by a healthy, well- acclimatized young male is about

one quart per hour. To be effective in cooling the body, the sweat must actually evaporate from the skin

instead of dripping off or being wiped off. The evaporation of one quart of sweat from the skin will remove

approximately 600 Kcal of heat from the body. The actual evaporation rate depends upon a number of

environmental factors, including temperature, relative humidity and wind speed.

Convection

The process of convection involves the transfer of heat from the skin to the surrounding air. The rate of

heat loss by convection depends upon factors such as air temperature, wind speed and type of clothing. If

the air is actually hotter than the skin, a reverse transfer of heat from the air to the body will occur.

Radiation

Heat transfer by infrared or “ heat” radiation involves the flow of heat energy from warmer surfaces to

surrounding cooler surfaces. Skin that has been warmed by blood flow from the core radiates heat to the

surrounding environment. If the environment includes surfaces or systems such as furnaces or boilers

that are significantly hotter than the skin, the flow of heat by radiation may also reverse and go from the

environment to the body, thereby adding to the total heat load of the body. The rate of heat transfer by

radiation is a function of the types of surfaces involved and the temperature difference between them.

The direction of radiant heat flow is always from a warmer surface to a cooler surface.

The ability of a surface to absorb and radiate heat is primarily a function of the color and texture of the

surface. As you have probably noticed while standing in an asphalt parking lot on a hot summer day,

smooth dark- colored surfaces can absorb a great deal of heat energy. In doing so, they get much hotter

than the surrounding environment and consequently become very efficient heat radiators as well. The

use of light colored clothing is one means of blocking or reducing the effects of radiant heat.

4

Percent Maximum Work Rate

Rest 25% 33% 50% 75% 100%

Heart rate/ minute 60– 80 90– 100 105– 110 120– 130 150– 160 180– 190

Core temperature at

equilibrium ( F) 98.6 99.3 100.0 100.8 101.8 continuous

unstable rise

Endurance time for

continuous work — > 8 hours 8 hours 1 hour 15– 20 minutes 4– 6 minutes

* Adapted from reference source 4. ( See References within this publication.)

Health, Age and Work Practices Affect Heat Regulation

Now that we have looked at the primary means used by the body to dissipate excess core heat, we need

to consider some physiological factors that can limit its ability to do so. These factors mainly involve work

rate, age, body size and shape, degree of acclimatization, condition of the heart and skin, and the avail-ability

of fluids and salt to replace sweat losses.

Work Rate

Work rate is the single most important factor that determines how much heat is generated in the core. It

is obvious that the more vigorously we use our muscles, the more heat we generate. When we stop to rest,

the rate of heat production can drop dramatically. However, removal of the heat already produced and

stored in the core depends on a number of factors and may take quite a while. It is important to remember

that the fastest way to decrease the rate of heat production is to decrease the work rate. As we will see

later, regulation of work- rest periods is an important strategy in controlling potential heat stress.

Age

Generally speaking, older workers ( over 40 years old) are at a disadvantage relative to younger work-ers

when doing sustained work in the heat. The maximum possible output of the heart decreases with

age, which limits the body’s ability to transfer heat from the core to the skin. The efficiency of the sweat-ing

mechanism, which normally accounts for the greatest amount of heat removal from the skin during

high work rates, also decreases with age. Older workers generally start sweating later, and actually

sweat at a lower rate, than younger workers. Consequently, older workers tend to build up more core heat

during hot work and require longer rest periods to recover to normal levels.

Body Size

Heat production in the core is related to body weight or mass. Heat dissipation from the skin is a func-tion

of the area of skin available for heat elimination. Stocky or obese workers, therefore, may be at a

greater risk for heat disorders than workers with higher skin area- to- weight ratios. Workers with heart

disease or skin disorders are also at greater risk.

Even extremely healthy, well- conditioned workers will experience symptoms of heat strain when ini-tially

subjected to conditions of heat stress. Symptoms may include light- headedness, a pounding heart

and dehydration. If the worker continues on successive days to work under heat stress conditions, the

symptoms of heat strain will decrease. The increased tolerance to heat that comes from working in a hot

environment for a period of one or two weeks is called heat acclimatization. The process involves building

up increased blood volume, increasing the rate and efficiency of sweating, and reducing the amount of

salts lost during the process of sweating.

The process of acclimatizing to a hot environment requires successive heat exposures of at least one

hour per day. Acclimatization does not occur unless work is done at a rate that will elevate body tempera-ture.

A good schedule to follow for new workers gaining an initial acclimatization to heat is a 20 percent

schedule of exposure for the first day, followed by a 20 percent per day increase in exposure over the next

four days.

Some degree of heat acclimatization can be lost over a period of a weekend. Most of a worker’s heat

acclimatization can be lost during a two- week vacation. Managers should be aware of this fact and allow

workers returning from vacations or long absences to gradually reacclimatize. Reacclimating workers

should start with a 50 percent exposure schedule on their first day back, followed by 20 percent per day

increases in exposure thereafter.

Fluids and Salt

Since sweating accounts for much of the heat dissipated during hot work, there is a constant need to

replace the fluids lost as sweat. A fully acclimatized worker can maintain a sweat rate of about one quart

per hour throughout a work day. If the fluids and salts that are lost as sweat are not replaced, severe

5

dehydration can occur. Thirst alone cannot be relied upon to keep up with the fluid losses that are associ-ated

with sustained work in hot environments as it is a poor indicator of one’s level of hydration.

A plentiful supply of cool, fresh water must be kept readily available to workers engaged in hot work.

They should be encouraged to drink at regular intervals rather than only when they feel thirsty. Drinking

a cup of water every 15 to 20 minutes is a good way to maintain fluid balance under heat stress condi-tions.

Well acclimatized workers lose less salts when they sweat. The average American diet probably con-tains

enough salt to replace the salts lost during sweating. Any worker on a salt restricted diet should

consult a physician before increasing salt intake as a preventive measure against heat stress.

The Environment May Limit Heat Dissipation

As previously discussed, the body uses several mechanisms including evaporation, convection and radi-ation

to eliminate excess heat from the skin. The effectiveness of these mechanisms is strongly affected

by the surrounding environment, as well as by the type of clothing worn.

Heat removal by evaporation depends primarily on air temperature, moisture content and wind speed.

One of the main parameters to consider is moisture content or humidity. Relative humidity is a measure

of how much moisture or water vapor the air can hold at a given temperature. When the relative humidi-ty

reaches 100 percent, the air is saturated with water vapor. If we tried to put more water vapor into

such air, it would condense out of the air in the form of rain or dew.

Warm air can hold more water vapor than cold air. For example, air that is fully saturated ( 100 percent

relative humidity) at 60 F has a relative humidity of only 35 percent at a temperature of 90 F.

Evaporation would not be effective for heat removal in the first case but could be very effective in remov-ing

heat in the second case.

The type and amount of work clothing also affect the rate of heat removal. Fabrics that do not freely

“ breathe” will tend to trap evaporated water vapor next to the skin. This has the same effect as raising

the humidity and will greatly decrease the cooling we would otherwise get from sweating. Non- breathing

or “ vapor- barrier” clothing also restricts the removal of body heat by air convection.

6

2

Learning About the Hazards of Heat Stress

A number of physiological problems are related to the

buildup of excessive heat in the body. They range from

annoying skin rashes to potentially fatal heat stroke. This

section looks at the causes and symptoms associated with

the most common heat disorders.

Heat Rash

Heat rash, also known as prickly heat, is often associat-ed

with hot, humid environments. It is caused when sweat

cannot freely evaporate from the skin and sweat ducts

become plugged. Inflammation of the plugged sweat ducts

causes a rash of tiny red blisterlike eruptions to develop.

Heat rash can cause a prickling sensation during heat

exposure. If the plugged sweat ducts become infected, a

case of heat rash may become so uncomfortable that it can

be disabling.

Heat rash can be prevented by wearing work clothes

that allow the sweat to evaporate as much as possible.

Providing a cooler break area can also aid in allowing the

skin to dry during work breaks. Thorough cleansing of the

skin following the work shift will help prevent infection.

The use of mild drying lotions may also be effective in reducing heat rash.

Heat Cramps

The process of sweating results in the loss of body fluids and salts. The loss of about 1 percent body water

through sweating can be tolerated without serious effect. When sweat losses exceed this amount, serious

consequences of dehydration can begin to be seen. Blood volume is reduced by dehydration, which makes

further effects of heat stress more likely. Work performance can also be impaired. If the dehydration contin-ues

and becomes severe, symptoms such as shriveled skin, dry mouth and tongue, and sunken eyes appear.

Dehydration is caused by the inadequate replacement of fluids and salt and can cause heat cramps and/ or

heat exhaustion.

If the fluids lost through sweating are replenished without sufficient salt replacement, heat cramps can

occur. Heat cramps are painful spasms of large muscles primarily used during work, such as the arm, leg,

back and abdominal muscles. Heat cramps are caused in part by the excessive loss of salt during heavy

sweating. This decrease in salts causes body fluids to migrate into muscle fibers, which causes them to go

into spasm.

Firm pressure or a gentle massage may provide some immediate relief for a cramping muscle. The best

way to prevent heat cramps is to ensure that salts are replaced during and after periods of heavy sweat-ing.

This can be accomplished by making sure that an adequate supply of drinking water is kept avail-able

in the immediate work area. Workers exposed to heat stress should be encouraged to drink on a fre-quent

and regular basis.

Fainting

Fainting is a loss of consciousness, caused by inadequate blood supply to the brain. When fainting

occurs, assist the person in lying down in a cool place and consult a physician. To prevent fainting in high

temperatures, move about and stretch to improve circulation.

7

100 F

37.8 C

95 F

35 C

90 F

32.2 C

85 F

29.4 C

80 F

26.7 C

70%

60%

50%

40%

30%

Relative

Humidity

Temperature

= Danger

= Caution

= Less Hazardous

When the body

is unable to

cool itself

through

sweating,

serious heat

illnesses may

occur. The most

severe heat-induced

illnesses are

heat exhaustion

and heat stroke.

If actions are

not taken to treat

heat exhaustion,

the illness

could progress

to heat stroke

and possible

death.

HIGH TEMPERATURE + HIGH HUMIDITY + PHYSICAL WORK

= HEAT ILLNESS

THE HEAT EQUATION

Heat Exhaustion

Heat exhaustion occurs when the body’s blood supply is not large enough to accomplish its major tasks

of supplying oxygen throughout the body and removing heat from the core. The heat removal task causes

blood to pool in the skin, which leaves less blood available to carry oxygen to the brain. Sweat- induced

dehydration, which reduces blood volume, increases the potential for heat exhaustion.

Early symptoms of heat exhaustion can include fatigue, headache and dizziness when you stand up.

Profuse sweating, a rapid pulse rate, loss of appetite, nausea and vomiting may also be present. The vic-tim

of heat exhaustion may become disoriented or actually faint, which poses a risk of physical injury

from falling.

What Should Be Done:

• Move the person to a cool shaded area to rest. Don’t leave the person alone. If the person is dizzy or

light headed, lay him or her face up with legs raised 6 to 8 inches. If the person feels nauseated, lay

him or her sideways.

• Loosen and remove any heavy clothing.

• Have the person drink some cool water ( a small cup every 15 minutes) if not feeling nauseated.

• Try to cool the person by fanning. Cool the skin with a cool spray mist of water or wet cloth.

• If the person does not feel better in a few minutes, call for emergency help ( Ambulance or Call 911).

( If heat exhaustion is not treated, the illness may advance to heat stroke.)

In the absence of any injury, recovery from heat exhaustion is generally quite rapid if the victim is

allowed to lie down and rest in a cool area. Elevating the feet 8 to 12 inches above the head may be help-ful.

Replacement of water and electrolytes should be included in the recovery period. Prevention mea-sures

include preventing dehydration by ensuring adequate replacement of water and salt, and allowing

workers to acclimatize to hot working conditions.

Heat Stroke— A Medical Emergency

The most serious heat- related problem is heat stroke, which is life threatening. Heat stroke occurs when

the core temperature rises so high that the body’s normal cooling mechanism ceases to function. In effect,

the brain gives up and stops doing the things it normally does to maintain body temperature at a con-stant

level.

As the core temperature rises above 105 F, sweating ceases. Since sweating is normally the body’s most

effective means of dissipating excessive heat, the body is placed in a condition of serious risk when it

stops. Without the cooling power of sweat, the core temperature can rapidly rise to critical levels. Adverse

effects such as protein denaturation, enzyme degradation, and changes in the structure and function of

cells can cause tissue damage and death. The brain is especially sensitive to such effects.

The skin of a heat stroke victim is usually very hot and dry. The victim normally appears flushed and

has a rapid pulse, and may be confused and nauseated. Symptoms of heat stroke may also include convul-sions

or unconsciousness.

Heat stroke must be treated as a medical emergency. Trained medical personnel should be summoned

as soon as possible. In addition, the first aid actions described below should be taken on the spot since

they may make the difference between recovery, irreversible brain damage or death for the victim.

The immediate steps to follow for a heat stroke victim while waiting for medical personnel to arrive

include:

1. Move the victim to a cooler location.

2. Remove any outer clothing that would interfere with the free circulation of air around the victim’s body.

3. Apply cool water to the entire body surface of the victim. Use ice if necessary.

8

4. Vigorously fan the victim to increase the cooling effect of the water.

The key to preventing heat stroke is the ability to recognize the kinds of physical activity and environmen-tal

conditions that can cause it. Warning signs such as heat cramps or exhaustion are not always precursors

of heat stroke. Unless unusual medical conditions preexist, vigorous physical activity is usually required to

generate high levels of core heat and induce heat stroke. Victims often get so involved in what they are doing

that they ignore the symptoms until they are in an emergency situation from which they cannot recover

without aid. Therefore, it is extremely important that employees are not assigned to do vigorous work alone in

hot locations.

Table 3 provides a synopsis of symptoms and immediate treatment for heat disorders.

Table 3

Signs, Symptoms and Treatment for Major Health Effects Caused by Heat Stress*

How to Protect Workers

• Learn the signs and symptoms of heat- induced illnesses and what to do to help the worker.

• Train the workforce about heat- induced illnesses.

• Perform the heaviest work in the coolest part of the day.

• Slowly build up tolerance to the heat and the work activity ( usually takes up to two weeks).

• Use the buddy system ( work in pairs).

• Drink plenty of cool water ( one small cup every 15- 20 minutes).

• Wear light, loose fitting, breathable ( like cotton) clothing.

• Take frequent short breaks in cool shaded areas. ( Allow your body to cool down.)

• Avoid eating large meals before working in hot environments.

• Avoid caffeine and alcoholic beverages. ( These beverages make the body lose water and increase the

risk for heat illnesses.)

9

Effect Clinical Features Predisposing Factors Treatment

Heat rash Profuse tiny red blisters on Long exposure to humid Mild drying lotions; clean

affected area; prickling heat with skin wet with skin to prevent infection

sensation during heat unevaporated sweat

exposure

Heat cramps Painful spasms of muscles Heavy sweating during hot Give electrolyte solution

used at work ( arms, legs or work; drinking large

abdominal); onset during or volumes of water without

after work hours replacing salt loss

Heat exhaustion Fatigue, headache, nausea, Lack of acclimatization; Remove to cooler environ-giddiness;

clammy, moist failure to replace water ment; keep at rest until

skin; may faint on standing; and/ or salt lost during water and electrolyte

rapid, thready pulse sweating balance has been restored

Heat stroke Hot, dry skin; core Lack of acclimatization; lack Immediate and rapid

temperature > 105 F; of physical fitness; recent cooling of body; treat shock

confusion, convulsions, loss alcohol consumption; if necessary; treat as life-of

consciousness dehydration; chronic threatening emergency

heart disease

* Adapted from reference source 4. ( See References within this publication.)

Workers Are at Increased Risk When

• They take certain medication. ( Check with your doctor, nurse or pharmacy and ask if any medicines

you are taking affect you when working in hot environments.)

• They have had a heat- induced illness in the past.

• They wear personal protective equipment ( like respirators or suits).

10

3

Preventing and Controlling Heat Stress

The Occupational Safety and Health Act of North Carolina says that: “ Each employer shall furnish to

each of his employees conditions of employment and a place of employment free from recognized hazards

that are causing or are likely to cause death or serious injury or serious physical harm to his employees.”

This section discusses how the dangers of heat stress can be removed from the work environment.

The techniques that can be applied to preventing heat stress fall into three general categories. The first

category includes engineering controls designed to limit the environmental heat load and to enhance the

rate at which heat can be eliminated from the body. The second category includes training for employees

and providing personal protective equipment that can also be used in specific cases to limit heat stress

potential. The third category involves work practices designed to reduce the level of metabolic heat that is

generated by each worker.

Engineering Controls

Engineering controls can be used to modify the rate of convective, radiative and evaporative heat

exchange between workers and their surrounding environment. Some general guidelines can be applied

to the selection of appropriate types of engineering controls.

Air temperature and velocity are the main factors that affect the body’s heat loss or gain by convection.

Heat loss occurs when the ambient air temperature is less than skin temperature ( approximately 95 F).

Under these conditions, increasing air velocity through the use of fans and reducing the amount of cloth-ing

can increase the rate of heat loss by convection. The opposite applies if the ambient temperature is

greater than 95 F. In that case, the body will gain heat by convection so air velocity should be minimized.

Covering the body with increased clothing can help reduce the rate of heat gain by convection. When fea-sible,

reducing the air temperature by air conditioning is very effective.

The effects of radiative heat gain can be reduced by placing a reflective screen between the radiant

heat source and the worker. The screen can range in complexity from insulated furnace jackets to reflec-tive

metal shields to reflective clothing of the type firefighters often wear. Covering the body with normal

clothing can also provide some protection from radiant heat sources.

Engineering controls that can enhance body heat loss through evaporation include measures that

increase air velocities and methods that decrease ambient humidity levels. Reducing the amount of cloth-ing,

especially if it limits the free flow of air around the body, will also enhance cooling by evaporation.

Work Practices

Work practices can be used to reduce the chances of workers’ suffering from heat stress. Usually, this

generally involves reducing or controlling the rate at which heat is generated by the body. Scheduling hot

or strenuous work during the cooler part of the day can be a very effective technique. Particular attention

should be paid to whether workers have had an opportunity to acclimatize to the hot conditions that are

anticipated.

Frequent alternation between work and rest breaks also helps limit core heat buildup and allows the

body time to dissipate excess heat. It may be necessary to use a larger number of workers for especially

hot jobs so that the work- rest schedule can be maintained. Scheduling periodic maintenance functions

such as re- roofing buildings during nonsummer months is another example of an effective work practice.

Training and Personal Protective Equipment

Worker training is an extremely important aspect of a heat stress prevention program. Program objec-tives

should include:

11

1. Training supervisors and workers to watch for and detect the major signs and symptoms of heat

strain and to take immediate first aid steps when they are detected.

2. Training supervisors to understand the importance of allowing workers to acclimatize to hot condi-tions

and to self- pace their work rate

during periods of high heat exposure.

3. A general appreciation of the importance of keeping a supply of drinking water readily available for

workers involved in hot work. The training must also emphasize the importance of drinking on a

regular basis, rather than relying on thirst.

Medical screening of workers who may be exposed

to hot work environments will help identify those employees whose ability to handle heat may be compro-mised

by existing health problems such as heart disease. Other measures such as reflective clothing or

personal ice vests can be used to limit heat buildup and extend the period of time a person can work in a

hot environment without incurring undue risk of heat stress.

12

4

Heat Stress Summary

Heat Stress in the Workplace

North Carolina employees work in a wide variety of high temperature environments. Being uncomfort-able

is not the major problem with working in high temperatures and humidities. Employees who are

suddenly required to work in a hot environment face additional, and generally avoidable, hazards to their

individual safety and health. The Occupational Safety and Health Act of North Carolina requires the

employer to provide appropriate training to employees on preventive measures and adequate protection

necessary to prevent heat stress.

Workers who perform hazardous jobs while exposed to temperatures greater than 79 F are known to

have high accident rates and suffer from heat stress. Intensive physical activity in high temperature

environments results in higher perspiration and heart rates. Long- term exposure of non- acclimatized per-sons

to heat stress is unhealthy and counterproductive. Acclimatizing and educating employees to work

in high temperatures, together with effective engineering control of heat sources, will provide a safe and

healthy work environment for North Carolina’s workforce.

Heat Stress Disorders

To maintain internal body temperatures within safe limits, the body must get rid of its excess heat, pri-marily

by varying the rate and amount of blood flow through the skin and the release of fluid onto the skin

by the sweat glands for evaporative cooling. Under conditions of high heat and humidity, the evaporation of

perspiration from the skin is decreased, and the body’s efforts to maintain a normal temperature may be

impaired. With so much blood going to the external surface of the body, relatively less goes to the brain, the

active muscles, and other internal organs. The results are that strength declines and fatigue occurs sooner.

Alertness and mental capacity may also be affected. Employees who perform delicate or detailed work may

find their accuracy suffering. Other workers may suffer lowered comprehension and retention of information.

One of the most basic but effective ways to stop heat stress disorders is to practice “ preventive behav-ior”

on the job. The following are some practices that can be implemented in most hot work environments.

• Drink water. Increase water/ fluid intake to replace body fluid lost through perspiration. Caution: in

extreme heat, thirst is not a reliable guide to the body’s need for water.

• Eat lightly. Avoid heavy meals and foods that are hard to digest.

• Avoid alcohol. Alcohol causes dehydration.

• Rest often. Give the body a chance to cool off.

• Plan ahead. Perform work activities during cooler periods of the day.

• Minimize activity in hot areas. Slow down the work pace.

• Reduce the number and duration of exposures.

• Wear proper clothing. Heat reflective or light colored clothes, material that “ breathes,” and even cer-tain

personal protective equipment, such as ice vests, can help workers combat heat stress.

13

Appendix

Measuring Heat Stress Potential

The primary factors that determine the potential for heat stress are 1. the level of work which controls

the amount of heat that is generated and 2. the environmental conditions that control the rate at which

excess body heat can be dissipated. Assessing the potential for heat stress is generally a two- step process.

First, an estimate of the heat load to be dissipated is made based upon the type and level of work activity.

The second step involves determining through environmental measurements the rate at which heat can

be lost from the body into the environment.

A number of tables ( such as table 1) have been developed to estimate heat load as a function of work

activity. This estimate becomes the metabolic heat load portion of equations and models used to assess

heat stress potential. Work rate values are often expressed either as BTU/ hr or as Kcal/ hr. A conversion

factor of 3.98 Kcal per BTU can be used to translate between the units.

The environmental parameters that are normally used to assess the rate at which heat can be trans-ferred

from the skin to the environment include wet bulb temperature, dry bulb temperature, globe tem-perature

and air velocity. Some or all of these parameters are combined to form the part of the equation

regarding rate of heat loss. Although a national heat stress standard does not currently exist, exposure

guidelines based on the Wet Bulb Globe Temperature Index are widely used to assess heat stress poten-tial.

Wet Bulb Globe Temperature Index

The WBGT Index uses a combination of wet bulb ( humidity), globe ( radiant), and dry bulb ( ambient)

temperature readings to assess heat stress potential. Depending upon whether the work is conducted

indoors or outdoors, the following equations are used to calculate the WBGT index.

Indoors WBGT = 0.7 Twb + 0.3 Tg

Outdoors WBGT = 0.7 Twb + 0.2 Tg + 0.1 Ta

where: WBGT = wet bulb globe temperature index

Twb = non- aspirated wet bulb temperature

Tg = black globe temperature

Ta = dry bulb temperature

The calculated WBGT index value is used along with the estimated metabolic work load for a job or

task to evaluate the potential for heat stress. Locating the intersection of these values on the WBGT

graphs in figures 1 and 2 provides an estimate of the heat exposure limit that should be applied to pre-vent

heat strain in either non- acclimatized or acclimatized workers.

The following example illustrates how the WBGT index is used to evaluate heat stress potential:

Given:

Task requiring a worker to perform moderate whole body work outdoors while standing on a black

asphalt surface

Twb = 75 F

Tg = 120 F

Ta = 95 F

Determine:

Recommended exposure limit

Solution:

Estimation of metabolic heat load from table 1

14

0.6 Kcal/ min for standing body position

5.0 Kcal/ min for whole body work

_ 1_. 0_ Kcal/ min for basal metabolism

6.6 Kcal/ min x 60 min/ hr = 396 Kcal/ hr

Calculation of WBGT index value:

( 0.7 x 75) + ( 0.2 x 120) + ( 0.1 x 95) = 86 F

Recommended exposure limit from figure 2 = 15 min/ hr

Figure 1

Recommended Heat Stress Limits for Non- acclimatized Workers*

15

______

C = ceiling limit

RAL = recommended alert limit for standard worker

* Adapted from reference source 1. ( See References within this publication.)

Figure 2

Recommended Heat Stress Limits for Acclimatized Workers*

16

______

C = ceiling limit

RAL = recommended alert limit for standard worker

* Adapted from reference source 1. ( See References within this publication.)

References

1. American Industrial Hygiene Association. 1975. Heating and cooling for man in industry. 2nd ed.

Akron, Ohio.

2. National Safety Council. 1988. Fundamentals of industrial hygiene. 3d ed. Edited by Barbara A.

Plog. Chicago.

3. U. S. Department of Health and Human Services. Public Health Service. Centers for Disease

Control. National Institute for Occupational Safety and Health. 1986. Criteria for a recommended

standard- occupational exposure to hot environments. Publication No. 86- 113. Washington.

4. U. S. Department of Health and Human Services. Public Health Service. Centers for Disease

Control. National Institute for Occupational Safety and Health. 1973. The industrial environment-its

evaluation and control. Washington.

5. U. S. Department of Labor, OSHA 3154/ 3155, 1998; Heat Stress Card.

17

The following industry guides are available from the N. C. Department of Labor’s Division of Occupational

Safety and Health:

1# 1. A Guide to Safety in Confined Spaces

1# 2. A Guide to Procedures of the Safety and Health Review Board of North Carolina

1# 3. A Guide to Machine Safeguarding

1# 4. A Guide to OSHA in North Carolina

1# 5. A Guide for Persons Employed in Cotton Dust Environments

1# 6. A Guide to Lead Exposure in the Construction Industry

1# 7. A Guide to Bloodborne Pathogens in the Workplace

1# 8. A Guide to Voluntary Training and Training Requirements in OSHA Standards

1# 9. A Guide to Ergonomics

# 10. A Guide to Farm Safety and Health

# 11. A Guide to Radio Frequency Hazards With Electric Detonators

# 12. A Guide to Forklift Operator Training

# 13. A Guide to the Safe Storage of Explosive Materials

# 14. A Guide to the OSHA Excavations Standard

# 15. A Guide to Developing and Maintaining an Effective Hearing Conservation Program

# 17. A Guide to Asbestos for Industry

# 18. A Guide to Electrical Safety

# 19. A Guide to Occupational Exposure to Wood, Wood Dust and Combustible Dust Hazards

# 20. A Guide to Crane Safety

# 21. A Guide to School Safety and Health

# 23. A Guide to Working With Electricity

# 25. A Guide to Personal Protective Equipment

# 26. A Guide to Manual Materials Handling and Back Safety

# 27. A Guide to the Control of Hazardous Energy ( Lockout/ Tagout)

# 28. A Guide to Eye Wash and Safety Shower Facilities

# 29. A Guide to Safety and Health in Feed and Grain Mills

# 30. A Guide to Working With Corrosive Substances

# 31. A Guide to Formaldehyde

# 32. A Guide to Fall Prevention in Industry

# 33. A Guide to Office Safety and Health

# 34. A Guide to Safety and Health in the Poultry Industry

# 35. A Guide to Preventing Heat Stress

# 36. A Guide to the Safe Use of Escalators and Elevators

# 37. A Guide to Boilers and Pressure Vessels

# 38. A Guide to Safe Scaffolding

# 39. A Guide to Safety in the Textile Industry

# 40. A Guide to Emergency Action Planning

# 41. A Guide to OSHA for Small Businesses in North Carolina

Occupational Safety and Health ( OSH)

Sources of Information

You may call 1- 800- NC- LABOR ( 1- 800- 625- 2267) to reach any division of the N. C. Department of Labor; or visit the

NCDOL home page on the World Wide Web, Internet Web site address: http:// www. nclabor. com.

N. C. Division of Occupational Safety and Health

Mailing Address: Physical Location:

1101 Mail Service Center 111 Hillsborough St.

Raleigh, NC 27699- 1101 ( Old Revenue Building, 3rd Floor)

Local Telephone: ( 919) 807- 2900 Fax: ( 919) 807- 2856

For information concerning education, training and interpretations of occupational safety and health standards contact:

Bureau of Education, Training and Technical Assistance

Mailing Address: Physical Location:

1101 Mail Service Center 111 Hillsborough St.

Raleigh, NC 27699- 1101 ( Old Revenue Building, 4th Floor)

Telephone: ( 919) 807- 2875 Fax: ( 919) 807- 2876

For information concerning occupational safety and health consultative services and safety awards programs contact:

Bureau of Consultative Services

Mailing Address: Physical Location:

1101 Mail Service Center 111 Hillsborough St.

Raleigh, NC 27699- 1101 ( Old Revenue Building, 3rd Floor)

Telephone: ( 919) 807- 2899 Fax: ( 919) 807- 2902

For information concerning migrant housing inspections and other related activities contact:

Agricultural Safety and Health Bureau

Mailing Address: Physical Location:

1101 Mail Service Center 111 Hillsborough St.

Raleigh, NC 27699- 1101 ( Old Revenue Building, 2nd Floor)

Telephone: ( 919) 807- 2923 Fax: ( 919) 807- 2924

For information concerning occupational safety and health compliance contact:

Safety and Health Compliance District Offices

Raleigh District Office ( 313 Chapanoke Road, Raleigh, NC 27603)

Telephone: ( 919) 779- 8570 Fax: ( 919) 662- 4709

Asheville District Office ( 204 Charlotte Highway, Suite B, Asheville, NC 28803- 8681)

Telephone: ( 828) 299- 8232 Fax: ( 828) 299- 8266

Charlotte District Office ( 901 Blairhill Road, Suite 200, Charlotte, NC 28217- 1578)

Telephone: ( 704) 665- 4341 Fax: ( 704) 665- 4342

Winston- Salem District Office ( 4964 University Parkway, Suite 202, Winston- Salem, NC 27106- 2800)

Telephone: ( 336) 776- 4420 Fax: ( 336) 776- 4422

Wilmington District Office ( 1200 N. 23rd St., Suite 205, Wilmington, NC 28405- 1824)

Telephone: ( 910) 251- 2678 Fax: ( 910) 251- 2654

*** To make an OSHA Complaint, OSH Complaint Desk: ( 919) 807- 2796***

For statistical information concerning program activities contact:

Planning, Statistics and Information Management

Mailing Address: Physical Location:

1101 Mail Service Center 111 Hillsborough St.

Raleigh, NC 27699- 1101 ( Old Revenue Building, 2nd Floor)

Telephone: ( 919) 807- 2950 Fax: ( 919) 807- 2951

For information about books, periodicals, vertical files, videos, films, audio/ slide sets and computer databases contact:

N. C. Department of Labor Library

Mailing Address: Physical Location:

1101 Mail Service Center 111 Hillsborough St.

Raleigh, NC 27699- 1101 ( Old Revenue Building, 5th Floor)

Telephone: ( 919) 807- 2848 Fax: ( 919) 807- 2849

N. C. Department of Labor ( Other than OSH)

1101 Mail Service Center

Raleigh, NC 27699- 1101

Telephone: ( 919) 733- 7166 Fax: ( 919) 733- 6197