Thanks for being here with us today to talk about heat illness, Micah. Let’s start with some basics. What is heat illness and what signs and symptoms should we be looking for during the hot months of the year?
Well, thank you for having me, first of all. We really start with a complicated kind of question here. Because heat illness comes in a variety of forms and there’s a lot of different symptoms that overlap between different types of heat illness, as well as, can be exhibited by other issues that are out there. So it gets a little complicated.
All right. Well, let’s hear about it.
Most basic level heat illness is a handful of medical conditions that result from our body’s inability to deal with a change in the weather around us and its inability to regulate our internal temperature. It is essentially like a fever. But instead of being caused by internal stresses, like being sick or having an infection of some kind, it’s caused from external stress, temperature, direct sunlight, humidity, all of those things contribute to result in heat illness of some kind.
Got it. So, I imagine most of us, when we get out into hot weather, we experience some degree of our internal temperature, maybe rising. And what’s the difference between that and when it becomes like when the scales tip and it becomes an illness.
Yes. So our body’s pretty good at regulating its temperature.
It’s not the best, you know, but we have built in mechanisms like sweating to help with that.
But when things change drastically or we’re working really hard in direct sunlight and high temperature, we can experience some basic heat illness, like a heat rash, which are red bumps on your skin. They generally tend to be around your neck, your chest, or any folds you have in your skin or in your face or your armpits or on your neck.
Again, a lot of people may look at that and say, okay, well I’ve just got a little bit of sunburn. Okay. But slightly different than sunburn. Again, you’re working outside in the heat. You could have heat cramps. Sometimes that’s simply caused by dehydration. Sometimes it’s, you know, Hey, you’re working really hard and that’s just inherent in the job that you’re performing.
But they’re pretty, you know, most people know what heat cramps are, but you get muscle spasms, pain in your muscles. A lot of the times it’s going to happen in your extremities, like your legs, your arms, even in your feet or your hands, those are the worst. And then you can also experience what’s called a heat sinker, which is feeling faint or feeling dizzy. You’ve ever been outside, you know, working in the garden or doing your flower beds or something, and you stand up too quickly, that can be a sign of heat illness.
And while these three illnesses are a little bit more basic, they can be precursors to more serious heat illness, but they’re not always present before the rest. And the other ones are, tend to be more life-threatening and more dangerous to the person experiencing it.
Yeah. So what are we looking at when we’re looking at the more life-threatening versions, kind of that higher degree?
So once things get a little bit more serious, there’s a very scientific word that I know I’m going to pronounce incorrectly. It’s rhabdomyolysis. That’s probably as close as I’ll get.
That is muscle breakdown. It is literally where your muscles aren’t hydrated enough. So they start to break down at a chemical level.
This is extreme pain in the muscles. You tend to have really dark urine or no urine when this is occurring because your body is filtering out essentially what they think is, you know, a toxin, but it’s actually your muscle breakdown.
There’s also heat exhaustion. Heat exhaustion is terrible. I’ve actually had heat exhaustion before, and I don’t recommend it. Heat exhaustion is symptomatic of fatigue, irritability, extreme thirst, nausea and vomiting, dizziness, lightheadedness, really heavy sweating, elevated body temperature, and a fast heart rate.
I was in West Virginia doing some charity work, putting on a tin roof on a house when I got heat exhaustion and I got dizzy. Next thing. I know I’m throwing up and you know, I was bedridden for like 24 hours. All I could do was throw up and drink. And it was heat exhaustion, obviously that was, you know, before I was a safety professional, to be able to recognize those symptoms, but it was not pleasurable.
No, that sounds like a really bad time.
Now we’ll throw in heat stroke. So heat stroke is not actually a medical stroke. So people are confused about that sometimes, you know a normal stroke is there’s a blood clot in your brain and it causes you know, lack of blood flow and the stress related with that. Heat stroke has similar symptoms, but it is still caused by, you know, essentially your body heating up too quickly and not being able to cool down in any way. When you have heat stroke, you experience confusion, possibly slurred speech. A lot of the time, if you have a heat stroke, this is where you’re going to pass out. You can have seizures, extreme heavy sweating, or the opposite. So instead of sweating, you just stop sweating, you get hot or dry skin. And this is going to be a rapid heart rate and very, very high body temperature.
Heat stroke is generally what occurs when a heat illness results in a fatality. It needs to be taken seriously, especially instances of dizziness and fainting, because once those occur, some type of damage has already occurred. And you know, it needs to be addressed.
Okay. So just to kind of break it all down, the really mild versions of heat illness, from what I’m hearing you say are rash, cramping, dizziness, things that maybe you could work through, but it’s better that you not, and that you pay attention to that. Because they could be precursors to the big ones, right. Or maybe not at all. Maybe the big ones kind of come out of nowhere, but the big ones are muscle breakdown, heat exhaustion, and then heat stroke, heat stroke being the one most likely to lead to fatality. Did I get that right?
That is correct.
So what heat illness regulations should safety leaders be aware of?
Well, that’s where we get into, you know, a little bit of a gray area here. There really are no federal regulations for heat illness. There are some states that regulate this: California, Washington, and Minnesota. And you look at Washington and Minnesota and you’ll say, well, you know, those are pretty mild states.
They get a lot of winter, right?
You know, but heat illness can happen anywhere. That may change. OSHA has currently put in the works to essentially transfer what they currently have, which is a heat illness prevention campaign, and move that to an actual regulatory standard.
I’m surprised that it’s not one already in more states or kind of across the board. Do you know why that is? Or can you speculate as to why that is?
I don’t really know why that’s not a, you know, something that happens more, where the state adopts things. I know a lot of the times what the issue is, is that states will allow federal OSHA to essentially guide them. And then outside of that, they allow businesses to cope with the issues in and of itself.
Right, right, right.
With the heat illness prevention campaign, combined with what is called the general duty clause. OSHA is already empowered to enforce these. So we may not have a lot of states with their own specific regulations because federal OSHA has this campaign. And then they have the general duty clause that then they can use to enforce this.
So I want to jump into that a little bit because the general duty clause, I’ll read some of it to you, but it also references back to a previous podcasts that we’ve done, where Zach [Pucillo] talked about really three different types of clients. We have complacent clients, which are like, okay, there’s regulations out there, but I’m going to, you know, hear no evil, see no evil, speak no evil type of situation. And let’s just hope we can get by.
Then we have the compliant clients who are those that, you know, they do the bare minimum. What does the law say I have to do? I’m not going to do anything more than that. And then we have culture clients. And the culture clients kind of go above and beyond and you know, they want to make sure their employees are safe.
And how that relates to the general duty clause, is the general duty clause is essentially a two-part clause. It starts off by saying that each employer shall comply with the occupational safety and health standards promulgated by this act. Which is essentially, Hey, if it’s standard or it’s law or regulation, you must comply with it.
And then the second aspect of that general duty clause is each employer shall furnish to each of his employees, employment, and a place of employment, which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees. So while no formal heat illness regulation exists right now, if you expose your employees to heat illness and the dangers inherent in heat illness, OSHA can come after you anyway.
And they can say you didn’t protect your employees from a known hazard. Therefore, you know, here’s your violation or here’s what you have to do to make sure that you’re protecting your employees in the future.
Got it. So it’s kind of an all-encompassing clause that makes sure that companies, no matter what, are responsible for the health and safety of their employees.
Got it. And just to kind of reference back the podcast episode that Micah is talking about with Zach was episode number four, which is the, what to expect from regulators in 2022, where he kind of goes over those different levels of, of diligence when it comes to your safety procedures.
Those three Cs kind of relate back to the general duty clause because the general duty clause puts the onus on the employer to really kind of go above and beyond compliance. Zach, in that episode mentioned that those clients with culture are doing everything they can to protect their employees. The general duty clause says, Hey, listen, you have to do everything you can to protect your employees. Whether it’s written in regulation or not, here’s this clause to protect your employees. If you don’t then we can write you a citation here.
Makes sense to me. So what are the common misconceptions about heat illness that you want to set the record straight on? You know, are there kind of old wives tales or things that people think they know about heat illness that really aren’t true or vice versa?
Well, I think one of the biggest misconceptions is that you’re only going to experience heat illness if you are in one of the Southern states where it gets really hot. Only Florida and Texas are going to experience heat illness. That’s not the case. Heat illness is actually resulting from changes in temperature. So if your body is acclimated to a certain weather, a certain climate. When that weather gets hotter, your body is put under stress.
There’s a lot of other factors in there that influence how you handle those changes in temperature and how your body is able to regulate its internal temperature. But ultimately it’s that change that’s important.
As I mentioned a little bit earlier, two of the states that have heat illness prevention regulations are Washington and Minnesota, which are relatively mild when you look at the rest of the United States. I experienced my personal heat illness in West Virginia, which is middle of the road there from a geographic perspective.
Sure. Yeah. I used to live in Northwest Washington, like right up at the tip almost Canada, which is considered a pretty cold climate.
And I remember that there was a farm, a Berry farm near us that had a, a pretty significant heat illness incident one summer when, when the heat really spiked and I remember that feeling surprising to me because in general, Washington, isn’t known for being super hot, but it makes sense that if it’s just going from what you’re used to, into a totally different climate, that that’s where you’re going to see those problems arise.
So some other misconceptions are an employee’s historical performance. I hear it a lot of times, sometimes it relates back to machismo where it’s, Hey, I’ve worked in temperatures like this for 20 years. Why do I have to start worrying about heat illness now? You know, your historical performance while that is a factor, it doesn’t mean you’re immune to heat illness.
There are a lot of daily factors that can go into experiencing heat illness. Things that change from day to day or year to year. And just because you’ve coped with the heat in the past, doesn’t mean you can cope with the heat of today or of tomorrow. And as we experience change in climate, in different regions and things tend to get hotter on average, it’s going to be a variable that we’re going to have to pay more attention to.
What is the weather of today and tomorrow versus what was it in the past?
That makes a lot of sense. Do you have any advice for both the workers and leaders on how heat illness can be handled and also avoided?
My biggest, biggest advice is education. Training your supervisors, training your employees. On the hazards of heat illness is very, very important. Because if they’re educated to understand heat illness and recognize the symptoms of different types of heat illness, they can potentially protect a human life.
Can keep a coworker from experiencing heat stroke and going to the hospital. So the better everyone is educated about this as a whole, the safer workplace you have in general.
OSHA doesn’t have a specific standard that relates to this. They do have a lot of resources on their website, which details the heat illness prevention campaign that they have in place.
The next step after education is to empower your workers, to make steps, to prevent heat illness. Once they know what heat illness is and the things that they have to do to prevent it, make them powerful enough to take action. Maybe it’s recognizing symptoms in a coworker and having the ability to say, you know, supervisor coworker X is experiencing heat illness.
We need to do something about it before it gets bad. Maybe that is, we need to purchase a tent or provide shade to this employee in some way. If there’s trees on site, utilize them. It may be the power to institute a brake system where every 15, 20, maybe 30 minutes you’re taking breaks so that employees aren’t exposed to such high levels of heat on a consistent basis.
Get a cold drink, get some shade, allow their body to cope with the heat change a little bit better. Empower them to purchase or provide cold beverages for hydration of employees. There’s a lot of stubborn people out there going, oh, I got to get the job done. I don’t need to take a drink, break. Empower someone to force other people to take drink breaks, and then providing shaded headgear as well.
That’s not always the easiest thing to do depending upon the job being performed, but keeping employees shaded helps. Again, preventing heat illness, if you understand the heat hazards. Changes in temperature, bright sunlight, personal risk factors, such as obesity, diabetes, high blood pressure, heart disease being physically unfit, drinking things like alcohol or energy drinks, can potentially dehydrate you and make heat illness a bigger factor for a single person, as well as new workers. Again, we talked about how the misconception of historical performance and the machismo associated with it isn’t perfect. But new workers are definitely at higher risk. I don’t know if you have someone going from a desk job to next thing, you know, they’re swinging a pickaxe out in the sunlight. They’re more likely to have some type of heat illness occur.
So after employees are educated and they’re empowered, having your business be proactive or prepared to take these steps is really the last thing you need to do. Checking the weather beforehand. Looking at how hot is it supposed to be tomorrow versus how hot is it today? Does that put your employees at more risk for the illness tomorrow? Be prepared with cool beverages for your workers on the work site, whether that’s knowing about a potential source for them to go buy beverages or always having a cooler full of, you know, bottled water.
Equipping your employees with pop up tents. So no matter where they are, they can always pop up a tent, get a little bit of shade. Have a method to verbally check on your workers to make sure that they’re okay throughout the day. Because a lot of the times something like heat stroke or heat exhaustion confuses employees and requires a verbal answer from them, kind of checks a little bit more of that box of making sure that they’re healthy.
If you pre-arrange work rotations, it certainly helps to be prepared. We know that it’s going to be hot. So let’s set up enough employees to allow employees to take 20 minute breaks. Plan a gradual increase of workload for new employees or all employees, if temperature changes drastically. If it’s really cool one day and the next day it’s scorching hot, start off slow. And then encourage your employee participation. Like I said, educating your employees is extremely important so that they know to recognize what’s happening around them, but get feedback from them. Are the beverages we’re providing enough? Are they cold enough?
Do we give you enough shade? Do you feel like you have the opportunity to take a break if you need it? That’s another thing. A lot of workers don’t feel like they have the opportunity. To take a break or if they do take a break they’re punished. And that is certainly a cultural aspect of a safety program.
If you’re a business owner or employer or a supervisor that’s looking to protect your employees from heat illness, you can certainly use California’s guidelines, which are the most stringent as a baseline or a springboard for a company program. Just because your state doesn’t have one. And because the federal government doesn’t have one currently you can certainly build your own. Make sure you’re going that extra mile, building that culture aspect and protecting your employees from heat illness.
Well, I think that’s all really excellent advice, Micah. Thank you so much for sharing all of your expertise with us today. I really appreciate it.