Every summer we get the same warnings…

“Be careful in the heat.”

“Watch for signs of heat stress.”

“Train workers in heat stress awareness.”

But how do we turn these warnings into meaningful action? What’s the difference between just being hot and tired and experiencing a heat-related illness?

The above admonitions are usually followed by a table published by the CDC (or some rendition thereof) listing the symptoms and what to do about them.

• 
• https://www.cdc.gov/disasters/extremeheat/pdf/Heat_Related_Illness.pdf
  
  

Don’t get me wrong, published guidelines are important but…

The problem is that when you look at the table and try to figure out exactly what to do when to do it and in what case…it’s somewhat confusing. Some symptoms are listed under both the heat exhaustion and heat stroke categories.

What are the key differentiating factors? What should you specifically look for and what should you do when you see them?   When do you reach out for medical help? What warrants a 911 call?

So, I’ve tried to boil it down to simple advice that you can remember in the event of a serious heat-related illness.

1. One common important course of action, regardless of heat exhaustion vs. stroke, is immediately loosening the person’s clothes, getting them to a cooler place, and applying cooling towels or cool water. So do this before or while you are assessing further.
2. The key red flags for definitely calling 911 are:
   1. body temperature 103 degrees or higher
   2. fast strong pulse,
   3. confusion,
   4. passing out/loss of consciousness,
   5. throwing up,
   6. hot red, dry skin
   7. worsening symptoms
   8. symptoms lasting longer than 1 hour
   9. milder symptoms combined with a low salt diet or heart problems

And at this stage, best not to give the person anything to drink.

In order to determine body temperature and heart rate with any degree of certainty, you would need an oral thermometer and maybe a pulse oximeter on hand – which may not be available. So if you are working or supervising frequently in very warm environments, it may be worth the investment. Without those, you’re relying on your subjective judgment of symptoms.

Rule of thumb: When in doubt, err on the side of caution.

3. The following are indicative of a serious problem but are borderline for seeking medical help…but if symptoms worsen or last for more than an hour it’s a definite sign you should seek medical attention…and, at this stage, you can give water to drink.

1. Heavy sweating
2. Cold, pale, clammy skin
3. Fast weak pulse
4. Nausea
5. Muscle cramps
6. Tiredness/Weakness
7. Dizziness
8. Headache

The best course of action... is prevention. Which consists of 3 major components:

1. Staying hydrated (water or electrolyte drinks)
2. Light loose-fitting clothes
3. Taking adequate rest breaks (during which you cool off – as much as possible)

Hydration – for moderate to intense activity or exercise (unless you have epilepsy, heart, liver, or kidney disease, follow a fluid-restricted diet, or have problems with water retention – then check with your MD before doing the following):

• 2-3 hours before exercise – 17 -20 oz. of fluids
• Right before exercise – another 8 oz.
• During exercise – 7-10 oz every 20 minutes
• Within a half hour after exercise – another 8 oz.

Another way to gauge hydration is to observe the color of your urine. The chart below can help.

https://www.nhsinform.scot/campaigns/hydration#:~:text=Signs%20of%20dehydration%20are%20visible,%2C%204%2D8%20must%20hydrate.

Cooling towels can serve as an adjunct to the three major prevention strategies and a variety are commercially available. But here’s a DYI hack that I recently learned and that you might find helpful too:

Roll up some ice cubes in a cotton bandana. Tie it around your neck. This keeps the carotid artery cool and minimizes the chance of overheating. As the ice melts, the cool water will run down your body (assuming you’re already wet anyway…) and have a cooling effect as well.

Summary. When all is said and done, heat stress is no joke – it should be taken very seriously. Some estimates state that as many as 1300 people die from heat related illnesses in the US alone, every year. https://health2016.globalchange.gov/ Neither you nor your co-workers want to be part of that statistic. And as climate change affects all of us, stay cool and stay safe.

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