Prioritizing worker safety during the ‘dog days’ of summer

Just what is meant by the idiom the “dog days” of summer, and when do those days occur? While this phrase may bring about memories of lazy afternoons playing in the sprinklers or watching a baseball game, the idiom actually is a historical phrase used to describe the hot, sultry and typically inactive period of midsummer.

According to The Old Farmer’s Almanac, the exact period occurs from July 3 to Aug. 11 — 40 days following the summer solstice — and the term “has been used for millennia to describe the hottest, most sweltering weeks of the Northern Hemisphere summer.” In ancient astronomy and folklore, it was often viewed as a time of drought, disease or unrest. In modern day, the reputation still has some truth to it. 

The dog days of summer often are accompanied by an increase in ailments linked to rising temperatures, warranting an equally increased awareness of proactive and proper treatment of these ailments (see the American Hospital Association’s June 2 edition of Market Scan for six best clinical practices for hospitals). It also is a period in which increased awareness should be given to healthcare staff who work outside or in other areas of extreme heat, such as unconditioned spaces, sterile processing areas and kitchens.

Strategies to protect workers from extreme heat 

According to guidelines from the Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention, failing to properly prepare for hot environments can lead to severe health emergencies like heat exhaustion or fatal heatstroke. Best practices recommended by these agencies include:

• Prioritize heat acclimatization.
• Implement strategic hydration protocols.
• Wear appropriate protective clothing.
• Adjust work operations and schedules.
• Establish safety and emergency plans. 

1. Prioritizing heat acclimation is a proactive way to avoid severe heat emergencies. Following a 20% rule can help acclimatize individuals who are new to working in the heat. An example of this is to not exceed 20% of a normal shift duration at full intensity in the heat for the first day, and then gradually scale exposure by 20% on each subsequent day to allow individuals to properly acclimatize.

A key statistic that OSHA has observed is that three out of four workplace heat fatalities occur during a worker’s first week on the job. Having a plan to help individuals acclimatize to new conditions will proactively address this concern. Another key time to address acclimatization is when an existing staff member returns from an extended period away and is being re-exposed to high-heat conditions. Assuring that these individuals properly acclimatize to high-heat conditions will help to avoid heat emergencies.

2. Implementing strategic hydration protocols is another key component of avoiding heat emergencies. Some strategies to consider are:

• Pre-hydrate. Workers should drink roughly 16 ounces of water before starting a shift.
• Drink by the clock. Workers should consume at least 8 ounces of cool water every 20 minutes while working, even if they do not feel thirsty.
• Replace electrolytes. If workers are sweating heavily, they should alternate water intake with sports drinks or electrolyte packets to replace lost sodium and minerals.
• Avoid dehydrating fluids. Completely avoid alcohol, coffee, energy drinks and highly sugared beverages, as these types of drinks accelerate dehydration and strain the cardiovascular system.

3. Wearing appropriate protective clothing also is important. Many think it intuitive to wear less clothing during hot summer days, but the correct mindset is to choose the right type of clothing while working in extreme heat to help reduce the risk of heat emergencies. Some appropriate clothing considerations are:

• Choose light and loose fabrics. Wear lightweight, loose-fitting and highly breathable clothing to allow sweat to evaporate efficiently.
• Cover up. Wear thin, long-sleeve shirts to shield skin from direct sunlight. Sunburn actively damages the body's ability to dissipate internal heat.
• Protect the head. Wear a wide-brimmed hat to shade the face, neck and ears.
• Modify specialized personal protective equipment (PPE). If a job requires heavy PPE, work to integrate water-cooled garments, air-cooled vests or reflective aprons.

4. Adjusting work operations and schedules can help lower the overall metabolic strain on workers. While this strategy comes with some challenges, when planned out in advance it can help to reduce the risk of heat emergencies. Some considerations for this strategy include:

• Shift to cooler hours. Schedule the most physically demanding tasks during the early morning or late evening hours, avoiding midday heat peaks.
• Establish regular breaks. Mandate frequent rest periods inside an air-conditioned space or a designated, shaded outdoor area.
• Rotate job duties. Rotate workers across different tasks to limit continuous individual exposure to high-heat zones.
• Reduce manual strain. Use mechanical tools, hoists and dollies to minimize the physical exertion required for heavy lifting.

5. Establishing heat safety and response plans is another proactive way to avoid heat emergencies. Even more importantly, plans should teach workers how to properly respond if one happens. While creating well-documented plans is important, it is even more vital that staff are properly trained and educated regarding these plans.

• Use the buddy system. Always pair up with a coworker to visually monitor each other for early signs of heat distress.
• Know the symptoms. Watch out for headache, dizziness, nausea, muscle cramps (a potential sign of heat exhaustion), or slurred speech and confusion (a potential sign of heatstroke).
• Act swiftly. If a coworker displays mental confusion or loses consciousness, ensure others are ready to respond appropriately and quickly.
• Risk assessment. A risk assessment should be performed to determine whether it is better to call 911 immediately or transport individuals to the emergency room or to activate a facility response team. The appropriate response could vary depending on the location where work is being performed. Having assessed this prior to an incident will help ensure appropriate action is taken.
• Provide training. Training also should be provided to staff on how to properly respond to a heat emergency, such as moving to a cooler area; cooling the individual down using water, ice or fans; how to properly get help; monitoring mental state and consciousness; and, when necessary, treating for shock and performing CPR.

Planning for a safe summer

While the dog days of summer can be a challenge and require planning, proactive strategies and keen awareness, these efforts can help workers protect themselves and each other from heat emergencies. By establishing safety and emergency plans, prioritizing heat acclimatization, implementing strategic hydration protocols, wearing appropriate protective clothing and adjusting work operations and schedules as appropriate, staff who work in extreme heat can be productive and free from severe health emergencies like heat exhaustion or fatal heatstroke while working within hot environments.

Jonathan Flannery, MHSA, CHFM, FASHE, FACHE, senior associate director, ASHE Regulatory Affairs. He can be reached at jflannery@aha.org