Learn the Signs of Heat Exhaustion, Take Precautions

July 17, 2017

As temperatures rise this—and every—summer, Oregon OSHA encourages employers and workers in construction, agriculture, and other labor-intensive activities to learn the signs of heat illness and focus on prevention.

The call to address the hazards of working in high heat is part of a larger heat stress prevention program launched July 11 by Oregon OSHA. Under the program, the agency’s enforcement and consultation activities will include a review of employers’ plans to deal with heat exposure, especially from June 15 through October 1 of each year.

The prevention program applies to both outdoor job sites and indoor workplaces where potential heat-related hazards may exist.

Exposure to heat can lead to headaches, cramps, dizziness, fatigue, nausea or vomiting, and even seizures or death. From 2011 to 2016, 36 people received benefits through Oregon’s workers’ compensation system for heat-related illnesses.

“Employers and workers in Oregon need to be especially aware of the dangers of working in high heat,” said Penny Wolf-McCormick, health enforcement manager for Oregon OSHA. “That’s because workers here tend to be used to working in mild weather and are frequently not acclimated to this type of heat.”

“The focus should be on prevention,” added Wolf-McCormick. “Employers need to provide drinking water, offer shaded places for workers to take breaks, and to watch for signs of trouble.”

Those signs of trouble include headaches, cramps, dizziness, fatigue, or nausea.

Here are some tips for preventing a heat-related illness:

  • Perform the heaviest, most labor-intensive work during the coolest part of the day
  • Use the buddy system (work in pairs) to monitor the heat
  • Drink plenty of cool water (one small cup every 15 to 20 minutes)
  • Wear light, loose-fitting, and breathable clothing (such as cotton)
  • 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 make the body lose water and increase the risk of heat illnesses)

To help those suffering from heat exhaustion:

  • Move them to a cool, shaded area, and do not leave them alone
  • Loosen and remove heavy clothing
  • Provide cool water to drink (a small cup every 15 minutes) if they are not feeling sick to their stomach
  • Try to cool them by fanning them, or cool the skin with a spray mist of cold water or a wet cloth
  • If they do not feel better in a few minutes, call 911 for emergency help

Certain medications, wearing personal protective equipment while on the job, and a past case of heat stress create a higher risk for heat illness. Heat stroke is a more severe condition than heat exhaustion and can result in death. Immediately call for emergency help if you think the person is suffering from heat stroke.

Employers can calculate the heat index for their worksite with the federal OSHA heat stress app for mobile phones. A number of other tools are available on the federal OSHA website.

Oregon OSHA has a booklet available in both English and Spanish with tips for working in the heat. Oregon OSHA also offers a pocket-sized heat stress card—available in both English and Spanish—that includes information about the risks of exposure to high temperature and high humidity.

For more information about heat stress and prevention of heat-related illness, visit Oregon OSHA’s heat stress topic page.

President Carter Briefly Hospitalized after Becoming Dehydrated Due to Heat Exposure

President Carter was discharged from St. Boniface General Hospital on July 14 after being admitted briefly for rehydration. From July 9–14, President and Mrs. Carter joined thousands of volunteers for Habitat for Humanity’s Carter Work Project to build 150 homes across Canada in celebration of the country’s 150th anniversary. President Carter encouraged everyone to stay hydrated and keep building.

With summer here and the temperatures rising, it is important to understand the health risks that excessive heat can bring and know the signs of heat-related illnesses. Older adults (such as Jimmie Carter, age 92) and people with chronic medical conditions are particularly susceptible to hyperthermia and other heat-related illnesses.

Heat stress, heat fatigue, heat syncope (sudden dizziness after exercising in the heat), heat cramps and heat exhaustion are all forms of hyperthermia. Hyperthermia is caused by a failure of the body’s heat-regulating mechanisms. The risk of hyperthermia can increase with the combination of higher temperatures, underlying general health, and individual lifestyle.

The National Institute on Aging (NIA), part of the National Institutes of Health, stresses that lifestyle factors that can increase risk include not drinking enough fluids, living in housing without air conditioning, lack of mobility and access to transportation, overdressing, visiting overcrowded places, and not understanding how to respond to hot weather conditions. On hot and humid days, especially when an air pollution alert is in effect, older adults, particularly those with chronic medical conditions, should stay indoors in cooler places. If possible, people without air conditioners or fans should go to places that do have air conditioning, such as senior centers, shopping malls, movie theaters, and libraries. Cooling centers, which may be set up by local public health agencies, religious groups, and social service organizations in many communities, are another option.

There are many factors that can increase risk for hyperthermia, including:

  • Dehydration
  • Alcohol use
  • Reduced sweating caused by medications such as diuretics, sedatives, tranquilizers, and certain heart and blood pressure drugs
  • High blood pressure or other health conditions that require changes in diet. People on salt-restricted diets may be at increased risk; however, salt pills should not be used without first consulting a doctor.
  • Use of multiple medications. It is important, however, to continue to take prescribed medication and discuss possible problems with a physician.
  • Age-related changes to the skin such as poor blood circulation and inefficient sweat production
  • Heart, lung, and kidney diseases, as well as any illness that causes general weakness or fever
  • Being substantially overweight or underweight

Heat stroke is a life-threatening form of hyperthermia. It occurs when the body is overwhelmed by heat and unable to control its temperature. Signs and symptoms of heat stroke include a significant increase in body temperature (generally above 104 degrees Fahrenheit), changes in mental status (like confusion or combativeness), strong rapid pulse, lack of sweating, dry flushed skin, feeling faint, staggering, or coma. Emergency medical attention is critical for a person with heat stroke symptoms, especially an older adult.

If you suspect that someone is suffering from a heat-related illness:

  • Call 911 if you suspect heat stroke
  • Get the person out of the heat and into a shady, air-conditioned, or other cool place. Urge them to lie down.
  • If the person can swallow safely, offer fluids such as water, fruit and vegetable juices, but not alcohol or caffeine.
  • Apply a cold, wet cloth to the wrists, neck, armpits, and groin. These are places where blood passes close to the surface of the skin, and the cold cloths can help cool the blood.
  • Encourage the individual to shower, bathe or sponge off with cool water if it is safe to do so.

The NIA’s AgePage on hyperthermia in English or in Spanish contains additional information and resources. Free print copies of the AgePage are available through online ordering or by calling 1-800-222-2225.

New Resource Evaluates SCBA for Emergency Responders

The National Personal Protective Technology Laboratory (NPPTL) recently launched a new webpage with resources for fire service personnel.

The webpage includes information about the Fire Fighter Fatality Investigation and Prevention Program (FFFIPP), which conducts independent investigations of select fire fighter line-of-duty deaths to provide recommendations to prevent future deaths and injuries. NPPTL staff assist the FFFIPP program by evaluating the self-contained breathing apparatus worn by fire fighters during incidents resulting in a line of duty death, serious inquiry, or other adverse event.

Explore the new webpage to:

  • Learn about the FFFIPP and its objectives
  • Check out the standard test procedures
  • Discover how to request an evaluation
  • And view completed reports

New CDC 2018 Yellow Book

CDC Health Information for International Travel (commonly called the Yellow Book) is now available. For the first time, the Yellow Book includes a section on work-related travel. This is an important document for healthcare providers who work at travel clinics where people may be getting vaccinations, as well as for occupational health doctors.

Phthalates Found in 10 Varieties of Macaroni and Cheese Powders


Laboratory testing of 10 varieties of macaroni and cheese products has revealed phthalates in the cheese powders of all of the tested items, according to the Coalition for Safer Food Processing & Packaging, a national alliance of leading public health and food safety groups.

Phthalates are hormone-disrupting chemicals that can lower testosterone, the male sex hormone, and alter thyroid function. Scientists have linked exposure to some phthalates, during pregnancy and early childhood, to changes in the developing brain that may result in kids who grow up struggling to succeed in school, at work, and in life.

The coalition has issued a call to The Kraft Heinz Company—the dominant seller of boxed macaroni and cheese, with 76% of market share—to drive industry-wide change by eliminating any sources of phthalates that may end up in its cheese products.

“Serving up one of America’s favorite comfort foods shouldn’t mean exposing your children and family to harmful chemicals,” said Mike Belliveau, executive director of the Environmental Health Strategy Center, a coalition member. “Our test results underscore the need for industry to comprehensively test their products for phthalates and determine the steps needed to eliminate them.”

Two million boxes of macaroni and cheese are sold every day in the United States. For the study, the coalition contracted with an independent laboratory experienced in the testing of phthalates in food to test 30 items of individual cheese products from various manufacturers that were purchased at retail grocery stores in the United States and shipped to the lab, unopened, in their original packaging. The cheese product items tested included nine of Kraft’s many cheese products. Findings revealed:

  • Phthalates in nearly every cheese product tested (29 of 30 items tested), with 10 different phthalates identified and up to six found in a single product.
  • Phthalates in eight of the nine Kraft cheese product items tested.
  • Toxic chemical phthalates at levels on average more than four times higher, on a fat basis, in macaroni and cheese powder than in hard cheese blocks and other natural cheese.
  • DEHP, the most widely banned phthalate around the world, in all 10 macaroni and cheese powders. DEHP accounted for nearly 60% of all phthalates found in the cheese product items that were tested.

“Studies repeatedly show that these endocrine-disruptors may harm developing brains,” explained Charlotte Brody, RN, National Director of Healthy Babies Bright Futures, a coalition member. “Scientists say there are no known safe levels of phthalates for vulnerable populations, such as pregnant women and young children.”

Human health studies also have linked exposure to some phthalates, during pregnancy, with a genital condition in baby boys associated with increased risk of reproductive health problems, including testicular and prostate cancer, and poor sperm quality.

Federal scientists reported this year that up to 725,000 American women of childbearing age may be exposed daily to phthalates at levels that threaten the healthy development of their babies, should they become pregnant.

Scientists agree that for most people the greatest exposure to phthalates comes from the food we eat. Phthalates are not intentionally added to food, but are classified as indirect food additives by government agencies. Industrial chemicals commonly added to plastics, rubber, adhesives, inks, and coatings, phthalates have been shown to migrate into food products during food processing, packaging, and preparation.

The Coalition for Safer Food Processing & Packaging has requested that Kraft identify and eliminate any sources of phthalates in the production of its cheese products, and use its leadership position to change the industry. Kraft has agreed to review the test results.

Kraft has been an industry leader on similar issues before, announcing a phase-out of artificial food dyes and preservatives in its macaroni and cheese in 2015, in response to scientific and consumer concerns.

“The good news is that there are safer, affordable alternatives to phthalates,” said Mike Schade, Mind the Store Campaign Director of Safer Chemicals, Healthy Families, a coalition member. “Kraft should identify and eliminate any phthalates in its cheese products by ensuring that safer alternatives are used in food processing and packaging materials throughout its supply chain.”

A 2014 scientific review paper concluded that dairy products were the largest contributor of dietary exposure to DEHP for pregnant women and children, based on phthalate levels and food consumption rates.

Based on the risks that phthalates pose to women and children, many of these chemicals have been banned for use in children’s toys and childcare articles by the Consumer Product Safety Commission. But that’s little protection for pregnant women. Europe has already prohibited all phthalates from use in plastic food contact materials for fatty foods, including dairy products, except for three phthalates whose use has been highly restricted. In contrast, the U.S. Food and Drug Administration has failed to take action in response to growing concern and scientific consensus.

“Kraft Heinz must take action now because the federal government has not done so. The European Union already banned most phthalates for use in food contact materials. They followed the science, but here, Trump’s Food and Drug Administration has yet to act,” said Peter Lehner, Senior Attorney at Earthjustice, a coalition member. “Parents and their children should not have to wait longer to know that their food does not contain toxic chemicals. We are asking manufacturers to act now.” 

The laboratory that tested the 30 cheese products used validated analytical methods and careful quality-control measures, which have been previously reported in the peer-reviewed scientific literature, to analyze the food items for 13 ortho-phthalates.

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