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Heat Stress

Heat stress is the effect that the thermal environment has on a persons ability to
maintain a normal body temperature. Physical work generates heat in the body which
must be lost to the environment through sweating and evaporation. A hot or humid
environment makes this more difficult and this can affect both mental and physical
performance. Inability to get rid of body heat adequately may result in heat illness.
Heat-related disorders and diseases
Prickly heat rash: Heat rashes exhibit as red spots on the skin that cause a prickling
sensation during heat exposure.
Heat cramps are often the first indicator of a heat-related problem. Symptoms are sharp
and painful spasms in the muscles that are being stressed in hot environments, mostly
calves, arms, abdominal wall and back. Heat cramps usually occur in unacclimatised
workers who have replaced water lost through sweating but who have not replaced salt at
the same time.
Heat exhaustion often begins suddenly, sometimes after excessive exercise or work,
heavy sweating (with fluid and salt loss) and inadequate fluid and electrolyte intake. It
can precede heat stroke and is characterized by heavy sweating but with cool, moist and
pale skin. Dizziness, blurred vision and unconsciousness may accompany a rapid but weak
pulse and low blood pressure. Low-grade fever, headache, confusion, fatigue, nausea,
heat cramps, rapid breathing and dark-colored urine may also be present.
Heat stroke is the most serious heat illness, often resulting from exercise or heavy or
prolonged work in hot environments with inadequate fluid intake. What makes heatstroke
severe and potentially life-threatening is that the body's normal mechanisms for dealing
with heat stress, such as sweating and temperature control, are lost. Main symptoms of
heat stroke are elevated body temperature (> 40 C), hot and dry skin (sweating stops),
and central nervous system dysfunction, ranging from headache, Irritability, dizziness,
confusion, personality changes to partial or complete loss of consciousness (coma). A
rapid heartbeat, rapid shallow breathing and nausea can also be present. Heat stroke can
be fatal and requires prompt medical attention.
Hydration Maintenance
Hydration (maintaining correct levels of body fluids) is the
factor for protection against heat illness.
The body relies on sweating to cool down and poor hydration or low levels of body fluids
reduces of stops sweating and the body heats up and workers suffer from heat illness like heat
exhaustion or heat strike.
The fluid intake required to maintain hydration is determined by the sweat rate which in turn is
determined by the work rate and the conditions. Sweat rates vary considerably and increase with
acclimatisation. The recommended fluid intakes for the average acclimatised worker are given
in the TWL work zone table.
It is very important to encourage exposed workers to:

Come to work well hydrated and drink at least 1 litre of water before work each day;

Drink regularly during the day at least 2 Litres of water every 2-3 hours;

Self-assess hydration using coloured urine charts;

Carry a large water container with them of at least 2 litres to drink within 2-3 hours;

Ensure replacement of electrolytes by adding a little extra salt to meals or selecting
correct electrolyte drinks.
Choice of Fluid Replacement Drinks

Replacement of the fluid lost in sweat requires intake of adequate quantities of water and salt.
Drinking at mealtimes replaces both and is essential. Remember to encourage workers to:

Add a little extra salt to their meals during hot weather, salt tablets should not be taken;

Drink water with meals;

Limit consumption of soft drinks as the sugar content is high;

Limit consumption of caffeinated drinks (coffee, tea, cola) and energy drinks, as the
caffeine may reduce fluid retention.
If workers are sweating heavily between meals an electrolyte replacement drink is
recommended. Replacing salt as it is lost helps the body absorb and retain the water consumed:

Sports drinks are high in sugar and often quite acid which can damage teeth. They are not
designed for prolonged consumption at work;

For prolonged consumption a fluid with 4% or less sugar is recommended. Appropriate
products designed for industrial use are available commercially;

The suggested schedule is to drink the electrolyte replacement fluid at every second drink
(i.e. one for one with water);

For diabetics or those on sugar restricted diets medical advice is required on the preferred
fluids for rehydration.
Working in extreme heat without proper controls can be fatal! Look out for yourself and your
friends at work.
Summer in the UAE is very extreme and can lead to death from heat related illness. The key
points to remember are:

to drink at least 2 litres of water every 2-3 hours

Add a little more salt to meals in summer to replace salt lost in sweat

Slow down and rest in very hot weather conditions

Get plenty of sleep and rest at night

When you feel unwell tell your supervisor or the work clinic if you have one
Recommendations for Workers:
1. Read, understand and follow the employers occupational health and safety procedures
and instructions regarding work in hot environments.
2. Report all signs of heat illness to the supervisor (feeling faint, dizziness, fatigue,
headache, nausea, vomiting, cramps).
3. Drink enough water during the day and maintain proper hydration status
a. Come to work fully hydrated (drink at least 1 Liter of water before you get to
b. Drink plenty of water during the shift at least 2 liters every 2-3 hours in summer
(or rehydration fluid approved by the employer).
c. If you drink water only when you are thirsty it is too late-drink even when you are
not thirsty in the heat.
Add a little extra salt to your meals to replace salts lost in sweat. Don not drink salt water
or take salt tablets.
Wear appropriate clothing (lightweight, light-colored, loose-fitting, cotton) and carry a
water container with you of at least 1-2 litres to fill regularly.
Self-pace your work do not push your body beyond its limits.
Report non-acclimatization to supervisor (if you have been away from work for more
than 14 days) and try to acclimatize for 5-7 days before starting hard work in a hot environment.
Look out for signs of heat illness in the people you work with and take them to a shady
area and cool them down call for help.

Employers Responsibilities
Heat exposure and heat stroke can be fatal if proper controls are not implemented. Employers
have a legal responsibility to protect the health of their workers as stipulated by the requirements
of the Abu Dhabi Environment, Health and Safety Management system (AD EHSMS). The
relevant codes of practice lay out the responsibilities of employers which include:

ensuring a risk assessment is performed to determine where heat stress hazards exist and
who is at risk from developing a heat related illness;

ensuring that the required training and education is provided and undertaken by all
managers, supervisors, first aiders and employees;

ensuring engineering control measures are implemented to eliminate the risk of heat
exposure as far as reasonably practicable;

ensuring an effective heat stress programme is implemented;

ensuring worksites adhere to the UAE Ministry of Labour requirements for a midday
break during the summer months for employees working outside;

ensuring employer supplied meals are evaluated so that they offer a healthy balanced diet
with nutrition and electrolytes and calories to sustain work in high temperature

ensuring availability of drinking water to all workers;

ensuring that work is self-paced and provide appropriate rest breaks for the heat stress

ensuring that workers suffering a suspected case of heat illness have immediate access to
medical attention;

Allowing non-acclimatized workers (new arrivals or workers returning from vacation)
time to acclimatize for 5-7 days before starting hard work in a hot environment in

Providing medical clearance for work in heat for any person with a chronic medical
condition (e.g. high blood pressure, obesity) or requiring the use of certain prescription
drugs (consult a doctor);

A system of investigation, recording and reporting of heat illness and injuries.
Engineering Controls for Heat stress
May include:

Adding Insulation of ceilings to minimize solar heat transfer;

Providing shaded work areas as much as [possible;

Providing cooled and air-conditioned rest areas with water or electrolyte drinks available
(not salt tablets or salt water);

Using exhaust ventilation such as extraction hoods above heat-generating processes;

Using forced air-ventilation such as fans to increase airflow across the skin and increase
evaporation and cooling; and

Using cooled air from an air-conditioning system
Worker Training
General worker training for exposed workers should include:

The hazards of working in heat;

The importance of maintaining good hydration (drinking at least 2 Liters of water every
2-3 hours);

Eating a well-balanced diet and adding a little extra salt to their meals;

Recognizing the signs of heat illness;

The hazards of consuming alcohol, teat, coffee and caffeinated drinks which may
increase fluid loss;

Explanation of the self-assessment of hydration using the urine charts;

The importance of rest and recovery and getting a good nights sleep;

What to do in case of heat illness and notifying the supervisor.