Introduction to allow the sweat to evaporate and if water and

salts lost through sweating are replaced.

For many people, summertime at means warm, Heat Stress Disorders
comfortable days, perfect for eating outside or
long walks during breaks from air-conditioned When the body becomes overheated, a
offices. But for some of us, summertime means condition of heat stress exists. Heat stress can
special projects working outside in the direct lead to a number of problems, including heat
sunlight or renovating buildings with no exhaustion, heat stroke, heat cramps, fainting,
cooling systems. Working in hot conditions or heat rash. Many people confuse these
may pose special hazards to safety and health. disorders, but it is important to be able to
This document provides an overview of the recognize each one and know what to do when
variety of illnesses and injuries associated with it happens. Each of these heat stress disorders
heat stress and gives guidance on how to is described below.
recognize and prevent them.
Heat exhaustion
How your body reacts to hot Although not the most serious health problem,
heat exhaustion is the most common
conditions heat-related ailment at Princeton
University. Heat exhaustion happens
Four environmental factors affect the amount of when a worker sweats a lot and does
stress a worker faces in a hot work area: not drink enough fluids or take in
temperature, humidity, radiant heat (such as enough salt or both. The simple way
from the sun or a furnace) and wind speed. to describe the worker is wet, white
Individuals with high blood pressure or some and weak.
heart conditions and people who take diuretics
Signs and symptoms
(water pills) may be more sensitive to heat
exposure.  sweaty
 weak or tired, possibly giddy
The body defends itself from heat through three  nausea
mechanisms: breathing, sweating, and changing  normal or slightly higher body temperature
the blood flow. The first reaction is to circulate  pale, clammy skin (sometimes flushed)
blood to the skin, which increases skin What to do
temperature and allows the body to give off  rest in a cool place
some heat. During heavy work, muscles need  drink an electrolyte solution, such as
more blood flow, which reduces the amount of Gatorade or another sports drink. Avoid
blood available to flow to the skin and release caffeinated beverages such as colas, iced
the heat. tea or coffee.
 in severe cases involving vomiting or
Sweating also helps the body to cool off, but fainting, call Public Safety and have the
only when the humidity levels are low enough worker taken to McCosh Health Center or
Princeton Medical Center, as appropriate.

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Heat stroke Signs and symptoms
Heat stroke is the most serious health problem  brief loss of consciousness
for people working in the heat, but is not very  sweaty skin, normal body temperature
common. It is caused by the failure of the body  no signs of heat stroke or heat exhaustion
to regulate its core temperature. Sweating What to do:
stops and the body can not get rid of excess  lie down in a cool place
heat. Victims will die unless they receive  seek medical attention if not recovered after
proper treatment promptly. brief period of lying down
Signs and symptoms Heat rash
 mental confusion, delirium, fainting, or Heat rash, also called prickly heat, may occur
seizures in hot and humid environments where sweat
 body temperature of 106ºF or higher cannot evaporate easily. When the rash covers
 hot, dry skin, usually red or bluish color a large area or if it becomes infected, it may
What to do: become very uncomfortable. Heat rash may be
 call Public Safety at 9-1-1 immediately and prevented by resting in a cool place and
request an ambulance allowing the skin to dry.
 move victim to a cool area
 soak the victim with cool water
Signs and symptoms
 fan the victim vigorously to increase
cooling  rash characterized by small pink or red
bumps
Heat cramps  irritation or prickly sensation
Heat cramps are painful muscle spasms. They  itching
occur when a worker drinks a lot of water, but What to do
does not replace salts lost from sweating. Tired  keep skin clean and dry to prevent infection
muscles – those used for performing the work –  wear loose cotton clothing
are usually the most likely to have the cramps.  cool baths and air conditioning are very
Signs and symptoms: helpful
 cramping or spasms of muscles  some over-the counter lotions may help
 may occur during or after the work ease pain and itching
What to do
Preventing Heat Stress
 drink an electrolyte solution (sports drink)
such as Gatorade In most cases, heat stress can be prevented or,
 If the cramps are severe or not relieved by at least, the risk of developing heat stress can
drinking a sports drink, seek medical be reduced.
attention from McCosh Health Center or
Princeton Medical Center, as appropriate. Engineering Controls
A number of engineering controls can help
Fainting (heat syncope) reduce heat exposure. These include:
Fainting usually happens to someone who is
not used to working in the hot environment and  general and local exhaust ventilation in
simply stands around. Moving around, rather areas of high heat
than standing still, will usually reduce the  shielding of radiant heat sources, such as
likelihood of fainting. furnaces or hot machinery
 elimination of steam leaks

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 use of cooling fans or personal cooling 1.5% of their body weight in a single day
devices, such as cooling vests from sweating.
 use of power tools to reduce manual labor
Personal Protective Equipment
Work Practices When work must proceed in hot conditions at
 Clothing: Wear loose-fitting, lightweight Princeton, personal cooling systems may help
clothing, such as cotton, to allow sweat to reduce the risk of heat stress. There are several
evaporate. Light colors absorb less heat systems available through health and safety
than dark colors. When working outside, catalogs, including the following:
wear a lightweight hat with a good brim to
keep the sun off your head and face.  Heat reflective clothing may alleviate the
problem of radiant heat sources, such as
 Drinking: Drink plenty of liquids, furnaces. However, if the worker is fully
especially if your urine is dark yellow, to covered, he or she will have trouble
replace the fluids you lose from sweating – evaporating sweat.
as much as one quart per hour may be
necessary. Water and/or sports drinks are  Ice vests or cooling vests remove heat from
recommended. Since caffeine is a diuretic the skin. They are relatively inexpensive
(makes you urinate more), beverage such as and allow freedom of movement.
cola, iced tea and coffee should be avoided.  Liquid cooling systems also remove heat
Thirst is not a reliable sign that your body from the skin. Cool liquid flows in the suit
needs fluids. When doing heavy work, it is around the body and carries the heat away.
better to sip rather than gulp the liquids.
 Work Schedule: If possible, heavy work Training
should be scheduled during the cooler parts Employees and supervisors need to be trained
of the day. Otherwise, alternate heavy work to be able to detect early signs of heat stress.
in the heat with lighter work or work in Employees must understand the need to replace
cooler areas. When the temperature fluids and salt from sweat and recognize the
humidity index (see next page) is between signs of dehydration, fainting, heat cramps,
84 and 93 (Warning Zone), try to minimize heat exhaustion, and heat stroke.
the amount of time working in the heat such
that approximately half of each hour is Supervisors should watch for signs of heat
spent doing heavy work in the heat. When stress and allow workers to interrupt their work
the temperature humidity index is 94 or if they are extremely uncomfortable.
higher (Danger Zone), this should be Supervisors should also ensure that work
further minimized to approximately one schedules allow appropriate rest periods and
quarter of each hour spent doing heavy ensure liquids are available. They should use
work in the extreme heat. appropriate engineering controls, personal
protective equipment and work practices to
 Acclimatization: New employees and reduce the risk of heat stress.
workers returning from an absence of two
weeks or more should have 5 days to get
used to the heat. Begin with 50 percent of
For more information
the normal workload and time exposure the
first day and gradually build up to 100 Contact Environmental Health and Safety at
percent on the fifth day. 258-5294 or Employee Health at McCosh
Health Center at 258-5035 for more
 Body Weighing: Workers may be at greater information.
risk of heat stress if they lose more than

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 In an emergency, call Public Safety at 9-1-1.

4
 Temperature-Humidity Index

A useful guide to summertime comfort is the Temperature-Humidity Index (THI). This table
gives an approximation of how most people react to heat and humidity. To use the table, find out
the temperature and relative humidity of the work area. Start at the temperature listed on the left,
and read across to the number under the relative humidity level (round up to the higher
percentage). This number is the temperature-humidity index. The values are for people wearing
the right amount of clothing doing light work, with very little wind.

Relative Humidity
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
80° 69 70 72 73 74 75 76 78 79 80
81° 70 71 72 73 75 76 77 78 80 81
82° 70 72 73 74 75 77 78 79 81 82
83° 71 72 73 75 76 78 79 80 82 83
84° 71 73 74 75 77 78 79 81 83 84
85° 72 73 75 76 78 79 80 82 84 85
86° 72 74 75 77 78 80 81 83 84 86
87° 73 74 76 77 79 81 82 84 85 87
88° 73 75 76 78 80 81 83 85 86 88
89° 74 75 77 79 81 82 84 86 87 89 Warning zone
90° 74 76 77 79 81 83 85 87 88 90
Temperature (Fahrenheit)

91° 75 76 78 80 82 84 85 87 89 91
92° 75 77 79 81 83 85 86 88 90 92 Danger zone
93° 76 78 80 81 83 85 87 89 91 93
94° 73 78 80 82 84 86 88 90 92 94
95° 77 79 81 83 85 87 89 91 93 95
96° 77 79 81 84 86 88 90 92 94 96
97° 78 80 82 84 86 88 91 93 95
98° 78 80 83 85 87 89 91 94 96
99° 79 81 83 85 88 90 92 95
100° 79 82 84 86 89 91 93 95
101° 80 82 84 87 89 91 94 96
102° 80 83 85 88 90 92 95
103° 81 83 86 88 91 93 96
104° 81 84 86 89 91 94 96
105° 82 84 87 90 92 95
106° 82 85 87 90 93 96
107° 83 85 88 91 94 96
108° 83 86 89 92 95
109° 84 87 89 92 95
110° 84 87 90 93 96

The lightly highlighted area is uncomfortable for everyone. For moderate to heavy activity,
workers should be concerned about heat stress and should alternate time working in the heat and
time in cooler areas or light work. When the THI is in the darkly highlighted area, extreme
caution is indicated. Workers should try to schedule work to allow only 25% of time performing
heavy work in such an environment. Workers should be encouraged to drink plenty of fluids and
be on the lookout for signs of heat stress.
Background
Heat Stress is influenced by several risk factors: climatic conditions, the work environment,
demands of the work, clothing and personal characteristics.

Climatic and environmental conditions that affect the risk of heat-related disorders are air
temperature and humidity, air movement, and the temperature of surrounding surfaces which
affects radiant heat exchange.

Demands of the work influence the stress on the temperature regulation system. Individual
responses to a given work load vary but, as an employee expends more energy, the body’s
internal metabolic heat production rises. This increases stress on the cardiovascular system
to regulate body temperature (i.e., by increasing blood flow to skin). Work-related factors
that influence heat stress include work rate, level of physical effort, and duration of activity.

Clothing characteristics such as insulation, permeability, weight, fit and ventilation affect
the body’s ability to regulate internal temperatures. Other factors that may increase the risk
of heat-related disorders include additional equipment, the use of a respirator, or other
personal protective equipment (PPE).

Personal characteristics such as age, weight, previous heat stress injury, underlying
medical conditions (e.g., diabetes, cardiovascular disorders, chronic pulmonary disease, and
thyroid disorders), medication use and overall health and physical fitness contribute to an
employee’s susceptibility of contracting a heat-related illness.

Working in an environment with heat stress not only increases the risk for specific heat related
conditions such as heat exhaustion and heat stroke, but also increases the risk for other adverse
events. A study conducted by NIOSH (National Institute for Occupational Safety and Health)
links the signs of heat stress (e.g., lower mental alertness and physical performance) to an
increase in workplace accidents.

SIGNS AND SYMPTOMS OF HEAT-RELATED DISORDERS

Heat related disorders may occur when there is an exposure to heat risk factors. The chart below
illustrates some of the signs and symptoms associated with heat stress. If the employee is
experiencing any of these symptoms (excluding heat rash), the employee should be taken to the
emergency room for treatment immediately.

Disorder Signs Symptoms

Dehydratio Loss of work capacity Fatigue
n Delayed response to stimuli Weakness
Dry mouth
Heat High pulse rate, confusion, anxiety Fatigue, malaise
Exhaustion Profuse sweating Weakness
Low blood pressure Blurred vision
Pale face, or flushing Dizziness
Body temperature increased but below 104 Headache
degrees F. Nausea
 Excessive thirst, decreased urine output Loss of appetite
Heat rash Skin eruptions Itching skin, prickly
sensation
Heat Stroke Red face May be same as
Mental status changes such as Disorientation, those for heat
Confusion or Irritability exhaustion (see
Hot, dry skin above)
Erratic behavior
Collapse
Shivering
Body temperature >104 F
Heat Incapacitating pain in muscle Muscle cramps
Cramps (abdominal and
lower extremities)
Fatigued muscles
Heat Brief fainting or near fainting behavior Blurred vision
Syncope

ANY QUESTIONS REGARDING HEAT-RELATED HEALTH DISORDERS

(SIGNS, SYMPTOMS, PREVENTION, OR TREATMENT) SHOULD BE
DIRECTED TO THE UNIVERSITY EMPLOYEE OCCUPATIONAL
HEALTH CLINIC (UEOHC) AT 966-9119.

Preventive CONTROLS
A control is a mechanism used to minimize or eliminate an exposure to a hazard, such as heat.
There are three types of controls (e.g. engineering, administrative and personal protective
equipment) that can be implemented to reduce exposure to excessive heat. Each person and
situation is unique, so controls and their application will vary. Suggested controls are given in
Suggested Measures to Prevent Heat Stress. Contact EHS for help in selecting the most
appropriate preventive measures for your work.

Administrative Controls
Administrative controls, also known as work strategy controls, are strategies used by supervisors
to limit exposure to a hazard. For example, changes to the work schedule (i.e., when and how the
job is performed) can limit the amount of time an employee is exposed to elevated temperatures.

Engineering Controls
Engineering controls are physical changes made to the work environment, such as adding fans or
air conditioning to an indoor environment.

Work Practices and Personal Protective Equipment

Other than hats and loose-fitting clothing, there is a limited selection of personal protective
equipment to reduce the risk of heat stress. Contact EHS for help in evaluating the effectiveness
of available personal protective equipment.
In some cases, personal protective equipment—such as impermeable protective clothing and
respirators—may increase the risk of developing a heat-related disorder. If such PPE is truly
necessary, administrative and engineering controls may be necessary to allow work in heat risk
environments. Contact EHS for help with these decisions.

MONITORING for Signs and Symptoms OF HEAT STRESS

Supervisors, coworkers and employees themselves are responsible for monitoring for the signs
and symptoms of heat-related disorders. See the above table for information on recognizing the
signs and symptoms of impending heat stress. A supervisor or coworker is often in the best
position to observe the onset of a heat-related disorder.
 When heat stress risks are present, supervisors should regularly check workers (by
observation and questions) for signs and symptoms of heat stress.
 Take extra care to monitor those at high risk, such as employees who are older or overweight,
employees who overexert themselves, and employees with chronic medical conditions
including diabetes, heart or lung disease, thyroid disease or high blood pressure. Employees
who take certain medications may also be at increased risk and need to check with their
physician.
 If you need to work outdoors or within indoor environments with elevated temperatures,
monitor yourself for the signs and symptoms of heat-related illness, such as taking your own
pulse.
 Use a buddy system. When working in the heat, monitor the condition of your coworkers and
have someone do the same for you.
 Supervisors should check to ensure that employees are self-monitoring, and ask for their
determinations.

Department, Work unit AND SUPERVISOR RESPONSIBILIties

Every UNC work unit which is classified as an Industrial, Maintenance, Construction, or Support
Services work environment are required to prepare and maintain a Hazards Management Plan
(HMP), which includes a Job Safety Analysis (JSA). This plan must be submitted to EHS. Work
units with employees who must work outdoors or in environments with extreme heat are required
to address heat stress in their HMP Job Safety Analysis by providing detailed information to their
employees on:
 Recognition of heat stress and risk factors.
 Preventive measures that will be used during periods of exposure to excessive heat. The
choice of effective preventive measures will depend on the work being done, the work
environment, and the people doing the work.
 Fluid replacement.
 How an employee can determine if s/he is experiencing the signs and symptoms of heat
stress (i.e., self monitor).

Supervisors are required to provide initial heat stress training for each employee who must work
outdoors or in environments with extreme heat. Documentation of this initial training shall be
submitted to EHS. Supervisors are required to review their work unit’s HMP Job Safety Analysis
with their staff annually or whenever relevant work procedures change. During the warm season,
supervisors should closely monitor their staff to ensure that the work units’ heat stress Job Safety
Analysis is being followed, and evaluate if any additional measures are needed.

Cool water should be immediately available to any employee who is required to work outdoors
or within indoor environments with excessively hot temperatures.

Train Employees Who Are At Risk of Heat Stress

Heat stress training should include:
 A review of heat-related disorders and their risk factors.
 Recognition of the signs and symptoms of heat-related disorders, and the importance of
monitoring for them.
 Preventive measures that will be used.
 Fluid replacement options and expectations.

Issue Heat Alerts

When conditions are present that contribute to heat stress, departments and work units are to alert
at risk employees and implement their preventive measures for working in heat. The alert should
include a reminder of signs and symptoms, how to control exposure, and a re-emphasis of the
preventive work strategies to be followed.

Employee’S RESPONSIBILITY
Employees who work outdoors or within indoor environments with elevated temperatures have
the following responsibilities.
 Participate in your work unit’s heat stress training. Learn the signs and symptoms of heat
stress, as well as risk factors.
 Take extra care if you are at high risk. You may be at increased risk if you are older or
overweight, you overexert, you have a chronic medical condition including diabetes, heart or
lung disease, thyroid disease or high blood pressure. If you take medications, you should
check with your doctor to see if you are at increased risk because of the effects of these
medications.
 Follow the preventive measures listed in your work unit’s HMP Job Safety Analysis.
 Take time to acclimate to heat and humidity. A heat wave is stressful to your body. You will
have a greater tolerance for heat if you limit physical activity until you become accustomed
to it.
 Stay hydrated by drinking small amounts of cool water frequently, to relieve thirst and
maintain adequate urine output.
 Wear appropriate clothing. Choose lightweight, light-colored, loose-fitting clothing.
 Pace yourself. Start slowly and pick up the pace gradually.
 Monitor yourself for the signs and symptoms of heat-related illness, described above.
 When working in the heat, monitor the condition of your co-workers. Ask your coworker to
do the same for you.
 Promptly report to your supervisor any known or suspected unsafe conditions, or unsafe
procedures.
EXPOSURE MONITIORING
Upon request, EHS will evaluate the workplace for heat stress risk and recommend ways to
manage exposure to heat. Temperature exposure, the demands of the work, and protective
equipment will be evaluated. Recommendations will address controls and safe exposure times
and for a given level of heat stress.