How to protect workers from heat-related illnesses

As temperatures continue to rise and heat waves become more frequent, municipal workers face increasing risks due to heat.

Temperatures in Massachusetts have risen almost 3.5°F since the beginning of the 20th century, according to the National Centers for Environmental Information, and they’re projected to keep rising. The 2022 Massachusetts Statewide Climate Assessment says the state’s summer temperatures will feel like those in New York by 2030 and like Maryland’s by 2050.

In the face of rising temperatures, municipal employers can take steps to keep their workforce safe and healthy by using the right mix of awareness, planning and policy.

Roughly half to two-thirds of heat-related workplace fatalities occur within the first few days of exposure, before the body has had a chance to acclimatize, so the month of May, with its moderate late-spring temperatures, is a good time to start talking to employees about the effects of heat.

Heat illness
Heat illness occurs when the body cannot properly cool itself, leading to a range of conditions from heat rash and heat cramps to heat exhaustion and potentially fatal heat stroke. According to news reports based on federal government data, more than 2,300 deaths in the U.S. were linked to extreme heat in 2023, and approximately 40 to 70 workers die from heat exposure on the job each year.

Certain workers face higher risks of heat illness due to personal or environmental factors such as:
• Age, weight and general health
• Dehydration, poor sleep, or use of medications (e.g., for blood pressure, diabetes, aspirin and antidepressants)
• High humidity, lack of airflow, and radiant heat from the sun or machinery
• Wearing heavy personal protective equipment or non-breathable uniforms

Department heads can conduct risk assessments to identify vulnerable workers and job roles, and tailor mitigation strategies accordingly.

Municipal action plan
Municipalities are bound by the federal Occupational Safety and Health Administration’s General Duty Clause, which requires employers to provide a workplace free from recognized hazards, including excessive heat.

OSHA and the National Institute for Occupational Safety and Health suggest protecting workers by implementing heat stress prevention programs, conducting environmental monitoring, and offering worker training. (For example, MIIA members have access to several no-cost heat illness prevention training programs.)

Drawn from material and recommendations from OSHA and NIOSH, here are seven items to consider when building a municipal plan:
1. Heat illness prevention programs: Develop written materials that outline steps to prevent, recognize and respond to heat illness. Include protocols for acclimatization, hydration, rest breaks and emergency response.
2. Education and training: Ensure that supervisors and workers are trained to recognize symptoms of heat illness — such as dizziness, heavy sweating, confusion, and cramps — and know what to do when they arise. Include regular refreshers in your safety calendar.
3. Hydration and breaks: Encourage workers to avoid caffeine and drink water every 15-20 minutes, even if they’re not thirsty. Provide easy access to potable water and schedule frequent shaded or indoor breaks during hot days.
4. Work schedules and job design: Adjust work hours to avoid peak heat (typically between 10 a.m. and 2 p.m.), and rotate job tasks to reduce continuous physical exertion. Where possible, use equipment to mechanize strenuous tasks.
5. Acclimatization plans: One of the most effective ways to reduce serious incidents is to gradually increase the time that new or returning workers spend in hot conditions over a seven- to 14-day period.
6. Monitoring conditions: Use the Heat Index and Wet Bulb Globe Temperature tools to monitor environmental conditions. The OSHA/NIOSH Heat Safety Tool app can help managers determine when extra precautions are needed.
7. Emergency planning: Create response plans for heat emergencies. Train staff to call 911, move affected workers to a cool area, and begin cooling measures such as using wet cloths or fans immediately, and never leave an ill worker unattended.

Anticipating regulation
This past January, the Massachusetts Department of Labor Standards presented a “Heat Illness Prevention” draft regulation and requested comments from the DLS Advisory Board. The Governor’s Safety and Health Advisory Board reconvened on April 16, and board members shared their input on the draft regulation. This feedback, as well as outreach to additional impacted constituencies, will be considered and, if appropriate, incorporated into a draft regulation to be shared with the governor’s office by the end of June.

At the federal level, in July 2024, OSHA released a comprehensive heat injury and illness prevention regulatory proposal that would affect all employers nationwide. It would require a written heat injury and illness prevention plan, substantial heat injury-related precautions, training, and regular, comprehensive program reviews and updates, among other measures. An informal, virtual public hearing on the proposed rule is scheduled to begin on June 16.

In the meantime, municipalities could consider adopting next-level NIOSH recommendations, such as establishing medical surveillance, posting hazardous areas, and providing protective cooling gear.

Shared responsibility
Heat illness is preventable, but it requires a cooperative effort across departments, from human resources to public works to health and safety officers. By investing in programs and fostering a culture of awareness, municipalities can help their employees be safe even on the hottest days.

Responding to symptoms of heat illness
Heat illness can escalate quickly, so knowing the signs and what to do in the moment can save lives.

Heat illness shows up in a range of ways:
• Early signs include heavy sweating, fatigue, dizziness, headache, and muscle cramps.
• Heat exhaustion brings nausea, thirst, irritability, weakness, and reduced urine output.
• Heat stroke, the most dangerous condition, may cause confusion, loss of consciousness, seizures, or hot, dry skin. This is a medical emergency.

It’s important to act immediately if a worker reports feeling unwell or exhibits any of these symptoms.

What to do
For mild symptoms like heat cramps or faintness:
• Move the person to a shaded or air-conditioned area.
• Have the person sit or lie down.
• Offer water or electrolyte-replenishing fluids.
• Apply cool compresses if available.

For heat exhaustion, loosen clothing and wet the skin with cool water. If symptoms worsen or persist, seek medical attention.

For heat stroke, call 911 right away. While waiting for emergency services:
• Move the person to a cool space.
• Use cold compresses on the head, neck, armpits and groin.
• Fan air over the person or use ice packs if available.

A reminder for all workers
Hydrate frequently (even if not thirsty) and avoid caffeinated drinks. Also wear light clothing and take breaks in the shade. Supervisors should monitor workers, especially new hires and those returning after time away, as they are most vulnerable during their first days on the job.

Written by Joyce McMahon