Physical Agent Data Sheet (PADS) - Heat Stress

Description

Heat stress is caused by working in hot environments like laundries, bakeries, or around boilers or incinerators. Four environmental factors affect the amount of heat stress felt by employees in hot work areas: temperature, humidity, radiant heat (such as from the sun or a furnace), and air velocity. How well or how poorly an individual reacts to heat stress is dependent on personal characteristics such as age, weight, fitness, medical condition, and acclimatization.

The body has several methods of maintaining the proper internal body temperature. When internal body temperature increases, the circulatory system reacts by increasing the amount of blood flow to the skin so the extra heat can by given off.

Sweating is another means the body uses to maintain stable internal temperatures. When sweat evaporates, cooling results. However, sweating is effective only if the humidity level is low enough to permit evaporation and if the fluids and salts lost are replaced.

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Health Effects—Heat Disorders

Heat stroke, the most serious health problem for workers in hot environments is caused by the failure of the body’s internal mechanism to regulate its core temperature. Sweating stops and the body can no longer rid itself of excess heat. Signs include: mental confusion, delirium, loss of consciousness, convulsions or coma; a body temperature of 106 degrees Fahrenheit or higher; and hot dry skin which may be red, mottled or bluish. Victims of heat stroke will die unless treated promptly. While medical help should be called, the victim must be removed immediately to a cool area and his/her clothing soaked with cool water. He/she should be fanned vigorously to increase cooling. Prompt first aid can prevent permanent injury to the brain and other vital organs.

Heat exhaustion develops as a result of loss of fluid through sweating when a worker has failed to drink enough fluids or take in enough salt, or both. The worker with heat exhaustion still sweats, but experiences extreme weakness or fatigue, giddiness, nausea, or headache. The skin is clammy and moist, the complexion pale or flushed, and the body temperature normal or slightly higher. Treatment is usually simple: the victim should rest in a cool place and drink salted liquids. Salt tablets are not recommended. Severe cases involving victims who vomit or lose consciousness may require longer treatment under medical supervision.

Heat cramps, painful spasms of the bone muscles, are caused when workers drink large quantities of water but fail to replace their bodies’ salt loss. Tired muscles, those used for performing the work, are usually the ones most susceptible to cramps. Cramps may occur during or after working hours and may be relieved by taking salted liqids by mouth or saline solutions intravenously for quicker relief, if medically determined to be required.

Fainting may be a problem for the worker unacclimatized to a hot environment who simply stands still in the heat. Victims usually recover quickly after a brief period of lying down. Moving around, rather that standing still, will usually reduce the possibility of fainting.

Heat rash, also known as prickly heat, may occur in hot and humid environments where sweat is not easily removed from the surface of the skin by evaporation. When extensive or complicated by infection, heat rash can be so uncomfortable that it inhibits sleep and impairs a worker’s performance or even results in temporary total disability. It can be prevented by showering, resting in a cool place, and allowing the skin to dry.

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Medical Conditions Aggravated By Exposure to Heat

Persons with heart or circulatory diseases or those who are on "low salt" diets should consult with their physicians prior to working in hot environments.

Preventing Heat Disorders

One of the best ways to reduce heat stress on workers is to minimize heat in the workplace. However, there are some work environments where heat production is difficult to control, such as when furnaces or sources of steam or water are present in the work area, or when the workplace itself is outdoors and exposed to varying warm weather conditions.

Acclimatization

Humans are, to a large extent, capable of adjusting to the heat. This adjustment to heat, under normal circumstances, usually takes about 5 to 7 days, during which time the body will undergo a series of changes that will make continued exposure to heat more endurable.

On the first day of work in a hot environment, the body temperature, pulse rate, and general discomfort will be higher. With each succeeding daily exposure, all of these responses will gradually decrease, while the sweat rate will increase. When the body becomes acclimated to the heat, the worker will find it possible to perform work with less strain and distress.

Gradual exposure to heat gives the body time to become accustomed to higher environmental temperatures. Heat disorders in general are more likely to occur among workers who have not been given time to adjust to working in the heat or among workers who have been away from hot environments and who have gotten accustomed to lower temperatures. Hot weather conditions of the summer are likely to affect the worker who is not acclimatized to heat. Likewise, workers who return to work after a leisurely vacation or extended illness may be affected by the heat in the work environment. Whenever such circumstances occur, the worker should be gradually reacclimatized to the hot environment.

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Lessening Stressful Conditions

Many industries have attempted to reduce the hazards of heat stress by introducing engineering controls, training workers in the recognition and prevention of heat stress, and implementing work-rest cycles. Heat stress depends, in part, on the amount of heat the worker’s body produces while a job is being performed. The amount of heat produced during hard, steady work is much higher than that produced during intermittent or light work. Therefore, one way of reducing the potential for heat stress is to make the job easier or lessen its duration by providing adequate rest time. Mechanization of work procedures can often make it possible to isolate workers from the heat source (perhaps in an air-conditioned booth) and increase overall productivity by decreasing the time needed for rest. Another approach to reducing the level of heat stress is the use of engineering controls which include ventilation and heat shielding.

Number and Duration of Exposures

Rather than be exposed to heat for extended periods of time during the course of a job, workers should, wherever possible, be permitted to distribute the workload evenly over the day and incorporate work-rest cycles. Work-rest cycles give the body an opportunity to get rid of excess heat, slow down the production of internal body heat, and provide greater blood flow to the skin.

Workers employed outdoors are especially subject to weather changes. A hot spell or a rise in humidity can create overly stressful conditions. The following practices can help to reduce heat stress:

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Thermal Conditions in the Workplace

A variety of engineering controls can be introduced to minimize exposure to heat. For instance, improving the insulation on a furnace wall can reduce its surface temperature and the temperature of the area around it. In a laundry room, exhaust hoods installed over those sources releasing moisture will lower the humidity in the work area. In general, the simplest and least expensive methods of reducing heat and humidity can be accomplished by:

Rest Areas

Providing cool rest areas in hot work environments considerably reduces the stress of working in those environments. There is no conclusive information available on the ideal temperature for a rest area. However, a rest area with a temperature near 76 degrees Fahrenheit appears to be adequate and may even feel chilly to a hot, sweating worker, until acclimated to the cooler environment. The rest area should be as close to the workplace as possible. Individual work periods should not be lengthened in favor of prolonged rest periods. Shorter but frequent work-rest cycles are the greatest benefit to the worker.

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Drinking Water

In the course of a day’s work in the heat, a worker may produce as much as 2 to 3 gallons of sweat. Because so many heat disorders involve excessive dehydration of the body, it is essential that water intake during the workday be about equal to the amount of sweat produced.

Most workers exposed to hot conditions drink less fluids than needed because of an insufficient thirst drive. A worker, therefore, should not depend on thirst to signal when and how much to drink. Instead, the worker should drink 5 to 7 ounces of fluids every 15 or 20 minutes to replenish the necessary fluids in the body. There is no optimum temperature of drinking water, but most people tend not to drink warm or very cold fluids as readily as they will cool ones. whatever the temperature of the water, it must be palatable and readily available to the worker. Individual drinking cups should be provided, never use a common drinking cup.

Heat acclimatized workers lose much less salt in their sweat than do workers who are not adjusted to the heat. The average American diet contains sufficient salt for acclimatized workers even when sweat production is high. If, for some reason, salt replacement is required, the best way to compensate for the loss is to add a little extra salt to the food. Salt tablets should not be used. CAUTION: PERSONS WITH HEART PROBLEMS OR THOSE ON A "LOW SODIUM" DIET WHO WORK IN HOT ENVIRONMENTS SHOULD CONSULT A PHYSICIAN ABOUT WHAT TO DO UNDER THESE CONDITIONS.

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Protective Clothing

Clothing inhibits the transfer of heat between the body and the surrounding environment. Therefore, in hot jobs where the air temperature is lower than skin temperature, wearing clothing reduces the body’s ability to lose heat into the air.

When air temperature is higher than skin temperature, clothing helps to prevent the transfer of heat from the air to the body. The advantage of wearing clothing, however, may be nullified if the clothes interfere with the evaporation of sweat.

In dry climates, adequate evaporation of sweat is seldom a problem. In a dry work environment with very high air temperatures, the wearing of clothing could be an advantage to the worker. The proper type of clothing depends on the specific circumstance. Certain work in hot environments may require insulated gloves, insulated suits, reflective clothing, or infrared reflecting face shields. For extremely hot conditions, thermally-conditioned clothing is available. One such garment carries a self-contained air conditioner in a backpack, while another is connected to a compressed air source which feeds cool air into the jacket or coveralls through a vortex tube. Another type of garment is a plastic jacket which has pockets that can be filled with dry ice or containers of ice.

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Recommended Exposure Limits

These Threshold Limit Values (TLVS) refer to heat stress conditions under which it is believed that nearly all workers may be repeatedly exposed without adverse health effects. The TLVs shown in Table I are based on the assumption that nearly all acclimatized, fully clothed workers with adequate water and salt intake should be able to function effectively under the given working conditions without exceeding a deep body temperature of 38 degrees Celsius (100.4 degrees Fahrenheit).

Since measurement of deep body temperature is impractical for monitoring the workers’ heat load, the measurement of environmental factors is required which most nearly correlate with deep body temperature and other physiological responses to heat. At the present time, Wet Bulb Globe Temperature Index (WBGT) is the simplest and most suitable technique to measure the environmental factors. WBGT values are calculated by the following equations:

Outdoors with solar load: WBGT = 0.7 NWB + 0.2 GT + 0.1 DB

Indoors or Outdoors with no solar load: WBGT = 0.7 NWB + 0.3 GT

Where:	WBGT = Wet Bulb Globe Temperature Index
	NWB = Natural Wet Bulb Temperature
	DB = Dry Bulb Temperature
	GT = Globe Temperature

The determination of WBGT requires the use of a black globe thermometer, a natural (static) wet-bulb thermometer, and a dry bulb thermometer.

Higher heat exposures that shown in Table I are permissible if the workers have been undergoing medical surveillance and it has been established that they are more tolerant at work in heat than the average worker. Workers should not be permitted to continue their work when their deep body temperature exceeds 38.0 degrees Celsius (100.4 degrees Fahrenheit).

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References

1. "Working in Hot Environments," US Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, 1986.
2. "Threshold Limit Values and Biological Exposure Indices for 1986 - 1987," American Conference of Governmental Industrial, Hygienists, 6500 Glenway Avenue, Building D-7, Cincinnati, OH 45211-4438.