Heat-related injuries can render farm workers helpless before they even realize they are in trouble. And, depending on the severity—ranging from heat cramps, to heat exhaustion or heat stroke—heat stress may lead to a few hours or days of lost work time or to life-threatening injury.
Dr. James Mobley, M.D., told participants at the recent Coastal Bend Grain Storage and Handlers Safety Conference in Sinton, Texas, that as many as 600 people die of heat-related causes a year across the United States. Texas gets its share.
He explained the difference between the most serious forms of heat illness—heat cramps, heat exhaustion and heat stroke.
Heat cramps begin with muscle cramping, headache and overall just feeling bad. “Pay attention,” he warned. “Get the person into the shade, get him fluid and have him rest.” Managers and fellow employees should watch someone who has experienced heat cramps carefully for several hours, maybe longer. “Ease them back into the work routine. Someone with heat cramps is on the edge of a major heat injury. Stay on top of it. Also, be wary of getting in a car and turning the air conditioning on full blast.”
Major injury would describe heat exhaustion. “This is a medical emergency, Mobley said. “It can be very deadly very quickly.”
Symptoms include a headache and the victim may “be woozy and stagger around. The person is right on the edge of heat stroke and needs IV fluids. Get him to an emergency room quickly. Renal failure can occur.
“Get him out of the heat and call 911 if in a location where an ambulance is available. If not, transport the victim yourself. Get the person cool but not cold. When traveling, roll down the window,” instead of cranking up the air conditioner. Mobley said one situation that heat exhaustion victims must avoid is having the body lose its ability to regulate body temperature, a dangerous possibility with heat stroke.
“Get fluid into him if he’s not vomiting,” he added. “Fluids should be cool but not cold.”
Mobley recommends one quart of a sports drink to every three quarts of regular water. “Sports drinks have too much salt. Drink a lot of water. If you have to choose, drink water.”
He said sodas are okay. “It’s not a big deal to drink sodas.” Avoiding too much salt is important, however, since salt acts as a diuretic.
Heat stroke is a life-threatening condition, usually associated with a temperature above 104 degrees. The body loses its ability to regulate temperature, Mobley said, so temperature could “be all over, especially if someone turns up the air conditioner.” Victims of heat stroke may lose consciousness and mortality rate can be as high as 50 percent. “Heat stroke is pretty rare.
“It’s important to get the temperature down.” Brain damage may occur as well as damage to internal organs. Severity of damage depends on the amount of time the temperature remains above 104. “Pour water over the victim, fan him, remove clothing and get him in the shade. If possible, get emergency personnel quickly; otherwise, transport to the emergency room. This is a big deal emergency.”
If someone stops sweating “he could be close to heat stroke.”
Prevention is crucial. Workers who spend a lot of time outdoors during hot weather should make a habit of drinking water every time they take a break. “When you stop doing something, take a drink,” he said. “Also, use the buddy system. Have every employee teamed up with another.”
Mobley was a military doctor and saw many cases of heat related illness. The “battle buddy” system was standard protocol for the military, he said, even for commanding officers.
Risk factors for heat illness include acclimatization. “Acclimatization occurs after a person works in the heat for awhile,” he said. “It takes five days to start the process. After 14 days it is completed. With new workers, watch them closely.”
He recalled a case of a young man brought to the hospital in a coma. “He had recently moved to Texas from Minnesota and worked as a roofer. He was 24 years old.”
Shortly after he started work he began to feel bad, mentioned a headache but continued to work. When he went home he took a shower and then went to sleep. “His friends came by two hours later and found him in a coma. He had heat stroke, and his body had lost its ability to control temperature.” Mobley said the young man’s temperature had dropped into the 80s. He did recover.
Medications, legally prescribed and otherwise, affect a person’s ability to withstand heat. Blood pressure medications, diuretics, Ritalin, amphetamines, antihistamines and others, as well as cocaine, increase vulnerability to heat illnesses.
Alcohol “is a major risk factor,” he added. Someone who had too much to drink the night before is at higher risk for heat illness.
Recent illness or injury also makes a person more susceptible to heat stress. “Flu or pneumonia within the last year could be a factor,” Mobley said. “Managers should keep an eye on workers who have had this kind of illness.”
Anyone who just moved from a cooler climate is at risk. Working in high humidity conditions increases the risk factor as well. Anyone who has ever suffered from heat injury will remain at a higher risk and possibly at risk for a “worse one.
“Anyone who comes back to work following heat injury will be at risk for the whole season and maybe the next one.”
Mobley said heat injury may come on suddenly. “By the time someone is thirsty he is already dehydrated. Clear urine is a good sign of proper hydration,” he said. Workers can drink too much water, however. Twelve quarts, three gallons, a day is the maximum, and at that level sodium level drops, the brain swells and seizure may occur.
“Use common sense,” Mobley said. “Clothing is important. Wear light colors, a loose weave, long sleeves and a hat.”
Sunscreen is also important to protect skin from skin cancer, especially melanoma, which has increased over the last 20 years. “I’m not sure why,” he said. Anyone who had severe sunburn before the age of 18 “is more prone to skin cancer. Wear a hat and sunscreen and beware of reflective radiation from the ground, especially sand.”
He recommends sunscreen rated at 20 SPF or above.