August 29, 2010
It started out as just a feeling of discomfort, something I thought I could just work my way through. A sip or two of water ought to do the trick. So I downed a small cup of tepid water.
Next thing I knew I was a bit unstable, reeling a little, feeling a bit dizzy. I veered off the road but managed to straighten out and resume my journey. Then the anxiety kicked in. I began to wonder if I would finish in time. Would I complete the trip? Why was everyone crowding me? How far to go?
I don’t remember much of the last mile, just feeling frustrated and anxious until my knees hit the pavement just inside Piedmont Park in downtown Atlanta, less than a half mile from the finish line of the 1985 Peachtree Road Race, a victim of heat stress.
Volunteers picked me up, carried me to the medical tent, gave me water and put ice bags around my body. They asked my name. I told them. They asked my phone number. I couldn’t remember. Didn’t know my Social Security number, either. Fortunately, all that stuff was on the back of my race number so they called Pat, who had a neighbor drive her to Grady Hospital where I had been transported by ambulance.
Atlanta, Ga., on July 4 is apt to be hot. It’s also apt to be humid, with 85 percent humidity and 90 degree temperatures not uncommon. The medical tents in Piedmont Park that day were filled with others who, like me, had ignored early warning signs and continued to run despite symptoms of pending heat stress. We were lucky we had help close by.
I’ve thought of that day several times recently as temperatures across Texas soared, breaking 105 in some locations. I also thought of my many farmer friends across the South who routinely work in that heat and often become so focused on completing a chore they forget to drink enough water, to take breaks or to schedule as much outside work as possible early in the morning or late in the evening.
Heat stress can turn into a heat stroke and can be fatal. So I started looking for information to help folks recognize the symptoms and to plan proper responses when they push too hard for too long in weather that’s too hot. I found the National Institute for Occupational Safety and Health (NIOSH) website and a wealth of information.
For instance, heat stress includes heat stroke, heat exhaustion, heat cramps, or heat rashes. Folk at risk include outdoor workers and workers in hot environments such as firefighters, bakery workers, farmers, construction workers, miners, boiler room workers, factory workers, and others.
Another interesting fact: “Workers at greater risk of heat stress include those who are 65 years of age or older, are overweight, have heart disease or high blood pressure, or take medications that may be affected by extreme heat.”
That age factor caught my attention. Most farmers are pushing 60; some are not in as good a physical condition as they should be (Neither am I. I’ve put on several pounds and my blood pressure has jumped.).
The best course of action, naturally, is prevention. Farmers might want to train employees about the dangers of heat stress and maybe even post symptoms they should be aware of.
NIOSH says heat stroke is the most serious heat-related disorder. “It occurs when the body becomes unable to control its temperature: the body's temperature rises rapidly, the sweating mechanism fails, and the body is unable to cool down. When heat stroke occurs, the body temperature can rise to 106 degrees Fahrenheit or higher within 10 to 15 minutes. Heat stroke can cause death or permanent disability if emergency treatment is not given.”
Symptoms of heat stroke include:
• Hot, dry skin (no sweating)
• Throbbing headache
• High body temperature
• Slurred speech
I had several of those. I was definitely confused. I was so dizzy I couldn’t sand up. My temperature hit 103, as I recall. Even after I got to the hospital I couldn’t speak coherently. I do remember being scared of dying as they put me in the ambulance.
Problem is, if someone is working alone, these symptoms can slip up on him before he realizes he’s in trouble. I had no clue until I felt the pavement digging into my knees, so it’s best to make certain someone knows where you’re working and stay in touch with home base every hour or so, maybe more often in extreme heat. And keep drinking water. Start before you go to the field to make certain you’re hydrated.
First aid procedures for heat stroke, according to NIOSH include:
• Call 911 and notify a supervisor, farm manager, or spouse.
• Move the sick worker to a cool shaded area.
• Cool the worker by soaking their clothes with water; spraying, sponging, or showering them with water or fanning their body.
Farmers and ranchers also may suffer from heat exhaustion, “the body's response to excessive loss of water and salt, usually through excessive sweating. Workers most prone to heat exhaustion are elderly, have high blood pressure, and who work in a hot environment,” according to NIOSH.
Symptoms of heat exhaustion include:
• Heavy sweating
• Extreme weakness or fatigue
• Dizziness, confusion
• Clammy, moist skin
• Pale or flushed complexion
• Muscle cramps
• Slightly elevated body temperature
• Fast and shallow breathing
First aid for heat exhaustion includes:
• Rest in a cool, shaded or air-conditioned area.
• Drink plenty of water or other cool, nonalcoholic beverages.
• Take a cool shower, bath, or sponge bath.
Then there’s heat syncope, “a fainting (syncope) episode or dizziness that usually occurs with prolonged standing or sudden rising from a sitting or lying position. Factors that may contribute to heat syncope include dehydration and lack of acclimatization.”
Symptoms include: Light-headedness, dizziness, fainting. First aid includes: Sit or lie down in a cool place when symptoms begin. Slowly drink water, clear juice, or a sports beverage.
Other heat-related illnesses include heat cramps and heat rash.
Heat cramps may affect workers who sweat a lot during strenuous activity, which depletes salt and moisture levels. Low salt levels in muscles cause painful cramps. Heat cramps may be a symptom of heat exhaustion, too. Symptoms include muscle pain or spasms usually in the abdomen, arms, or legs.
Workers with heat cramps should stop activity, sit in a cool place and drink clear juice or a sports beverage. They should not return to strenuous work for several hours after the cramps subside. Further exertion may lead to heat exhaustion or heat stroke.
Also, if you or a worker have a heart problem, are on a low-sodium diet or if the cramps do not subside within an hour, NIOSH recommends seeking medical attention.
Heat rash, a skin irritation caused by excessive sweating during hot, humid weather, looks like a red cluster of pimples or small blisters and is more likely to occur on the neck and upper chest, in the groin, under the breasts, and in elbow creases.
Responses should include:working in cooler, less humid environments when possible, keeping the affected area dry and using dusting powder.
NIOSH recommends that employers consider the following:
• Schedule maintenance and repair jobs in hot areas in cooler months.
• Schedule hot jobs for the cooler part of the day.
• Acclimatize workers by exposing them for progressively longer periods to hot work environments.
• Reduce the physical demands of workers.
• Use relief workers or assign extra workers for physically demanding jobs.
• Provide cool water or liquids to workers but avoid drinks with caffeine, alcohol, or large amounts of sugar.
• Provide rest periods with water breaks.
• Provide cool areas for use during break periods.
• Monitor workers who are at risk of heat stress.
• Provide heat stress training that includes information about worker risk, prevention and symptoms.
For more information, check http://www.cdc.gov/niosh/.
Something else I’ve noticed over the years since I collapsed during the Atlanta race: It takes a lot less heat to cause symptoms than it did before I suffered from heat stress. During a hot Texas summer I rarely can spend more than 20 minutes at a time doing strenuous work outside before I begin to feel flushed, thirsty and a bit uneasy. I’ve learned not to push past that level but to take a break in a cool spot, drink water and wait 30 minutes or more before resuming the task.
Or, even better, I try to avoid all hot, strenuous work.
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