Points to Consider for Diabetes

The U.S. Occupational Safety and Health Administration (OSHA) has issued a reminder to employers on protecting workers from heat-related hazards. The message centers on three key components: water, rest, and shade. Several months ago, a Florida legislator introduced a bill that would establish a statewide standard for outdoor workers regarding heat illness prevention. The bill would mandate that workers receive drinking water, access to shade, and 10-minute rest breaks following every two hours of outdoor work. In addition to water, shade, and breaks, complementary proposals in the Senate would require heat exhaustion symptom identification training and an acclimatization period for workers.

While OSHA has guidelines and recommendations to avoid heat-related hazards, no specific standard for heat exposure currently exists. This absence of a standard prompted action through a petition supported by more than 130 industrial organizations.

The petition, led by the nonprofit organization Public Citizen, called on OSHA to do more than reference suggested guidelines provided by the National Institute for Occupational Safety and Health, and noted that as climate change increases, workers face greater heat-related stress annually, which can pose dangers to health. David Arkush, Climate Program Director at Public Citizen, stated: "There is an unrecognized 'heat illness and death epidemic' in this country, and this problem will grow much faster due to global warming. Some of our most vulnerable workers face the highest risk—we must protect them now. We need aggressive action to halt greenhouse gas pollution and climate change." According to government data, 69,374 workers suffered serious heat-related injuries between 1992 and 2016, and 783 U.S. workers died from heat exposure. By combining climate projections with census data, Public Citizen concluded that by 2050, more than one million agricultural and construction workers will face dangerous heat exposure of 30 days or more annually. Although OSHA has endorsed NIOSH (National Institute for Occupational Safety and Health) criteria, it has not created a nationally mandatory rule requiring employers to provide water, rest, and shade. No law exists regarding acclimatization programs or training to recognize heat illness symptoms.

OSHA provides visual indicators for heat index levels that form the basis of NIOSH guidelines. However, these levels came under scrutiny last year by the Centers for Disease Control and Prevention (CDC), which oversees NIOSH.

Last summer, the CDC released findings from a study determining whether heat index thresholds effectively protected workers. The CDC retrospectively examined 25 occupational illnesses of outdoor origin investigated by OSHA between 2011 and 2016: 14 fatal and 11 non-fatal cases. Research shows that heat stress exposure exceeded safety limits in all 14 fatal cases and eight of the 11 non-fatal illnesses. OSHA recommends using heat index to protect workers, categorizing temperatures into four levels. Temperatures below 91 Fahrenheit (approximately 33 degrees Celsius) pose lower risk and can be addressed with basic heat and safety training. 91 to 103 Fahrenheit (33–39.5 degrees Celsius) represents moderate risk, requiring employers to take precautions and increase awareness. 103 to 115 Fahrenheit (39.5–46 degrees Celsius) indicates high risk, requiring additional protective measures. Temperatures above 46 degrees Celsius are considered extreme risk and require more aggressive protective action. Although OSHA lacks a permissible exposure limit for heat stress, OSHA guidance states in its report that a heat index below 33 degrees Celsius has a "low" relationship to heat-related illness risk, provided other factors (such as direct sun exposure, minimal air movement, strenuous work, or non-breathable clothing) are absent. However, six of the 14 deaths in this report occurred when the heat index was below 33 degrees Celsius. Additional evidence supports the likelihood of serious illness even when the heat index is below 33 degrees Celsius. OSHA referenced the Heat Safety Tool available through NIOSH, which displays index levels and associated risks. In this guidance, OSHA specified what employers should do:

• Encourage workers to drink water every 15 minutes,
• Provide frequent rest breaks in shade to cool down,
• Develop an emergency plan describing what to do when a worker shows signs of heat-related illness,
• Train workers on heat exposure hazards and how to prevent illness,
• Allow workers to acclimatize to working in heat.