Heat-related Health Issues and Preventative Methods
August, 2023
Version 1.2
Contents
Introduction 01
Terminology 02
Target Group 03
Global Warming and its Effect on Workers 03
Factors Causing Health Problems for Workers in High Temperatures and the Most
Vulnerable Group 04
Health issues associated with Working in High Temperatures and Direct Sunlight 05
First Aid for Health issues associated with Working in High Temperatures and Under
Direct Sunlight 08
Preventive Measures for Health issues associated with Working in High Temperatures
and Under Direct Sunlight 09
Acclimating and Preparing New Workers in Hot Areas and the Method of Training them
Criteria of Choosing a Temperature Indicator and Dealing with it 13
References 19
Introduction
This guideline is a revised version as well as an extension of the first edition of the Heat-
related Health Issues and Preventative Methods for Working in High Temperatures with
Direct Sunlight Exposure Guideline; which was issued by the Public Health Authority
(Formerly known as “the National Center for Disease Control and Prevention”) in 1442 AH-
2021 AD.
This guideline aims to acquaint business and project owners, and employees with health
issues associated with working in high temperatures and under direct sunlight. Prevention
methods will be provided along with ways to deal with heat-related incidents once they occur
In addition, providing recommendations, preventive measures, and raising awareness via a
variety of platforms.
In this regard, we must refer to the Ministry of Human Resources and Social Development
decision No. 3337 dated 15/7/1435 AH corresponding to 15/05/2014 AD which states, “the
worker must not be engaged in open labor under sunlight starting at 12:00 pm till 3:00 pm
during the period from the fifteenth of June till the fifteenth of September”, and to the great
effect such decision has on avoiding many health problems related to working in open
locations under direct sunlight and at high temperatures.
The guidelines and directions mentioned herein are merely recommendations (non-binding
and not deemed as laws and legislations) issued by the Public Health Authority and based
upon adopted international references reviewed by the Authority’s experts. These guidelines
and directions target people who work at high temperatures and under direct sunlight and
aim to acquaint the workers with the methods of prevention and accommodate it.
We would like to extend our gratitude and appreciation to Abu Dhabi Department of Health
and Abu Dhabi Occupational Safety and Health Center (OSHAD) for issuing the thermal work
limit model in geographical areas with high temperatures; including a relevant preventive
and regulation plan.
01
Terminology
Global Warming:
The increase in global surface temperature along with an increase in carbon dioxide levels,
and an increase in methane gases as a result of the greenhouse gas effect, which
contributes to an overall increase in earth’s atmosphere temperature.
Self-work:
It is the work which should allow the workers to adjust their work rate according to the
environmental conditions.
Non-adaptive Worker:
It refers to the non-adaptive worker who is new or those who have been out of work for
more than 14 days due to sickness or a leave (in a cold climate area).
Light Work:
It is working without great effort and is limited to sitting, standing and moving the arms.
Heavy Labor:
It is the work which requires getting up, climbing, lifting, pushing, or use of all body parts to
complete the work.
Indoor Workplaces:
They refer to indoor workplaces where an appropriate temperature is not less than 20
degrees Celsius maintained at cold places with the availability of cooling equipment in hot
places in addition to adequate ventilation for the place.
Outdoor Workplaces (in Open Air):
When working in open air, the weather conditions in this environment can result in danger-
ous effects to the employee’s safety, and if the risks are not properly considered and man-
aged, this effect might be immediate or might occur on the long run.
Thermal Work Limit Indicator:
Thermal working limit is an indicator of thermal stress which gives a measure of the
maximum safety rating for working in the important and current environmental conditions
(temperature of the dry, wet and radiant thermometer and wind speed), which is designed to
encourage workers to drink sufficient amounts of water and stay hydrated, in addition to
urging them to organize their work schedule and adapt to the work environment.
02
Target Group:
This guideline targets all those who work in high temperature environments whether indoor
or outdoor. The way of managing the temperature at your workplace depends on whether it
is indoors or outdoors and on the normal operating temperature of this environment. You may
also need a highly specific advice for your workplace for example, concerning thermal stress,
drought, heat pressure and heat strokes that are provided to the government and private
institutions, business owners, and workers to help them identify the health problems related
to working at high temperatures.
Global Warming and its Effect on Workers
The climate expectations indicate an increase in the severity of temperatures and climate
emergencies on the global level. Consequently, there might be a loss of jobs and a decrease
in the workers’ productivity. The increase in global temperatures due to climate change will
make Health issues associated with high temperatures and direct exposure to sunlight (heat
strokes, heat exhaustion, heat cramps, heat rash) more common.
The response to the global warming phenomenon must include:
An inclusive strategy to mitigate climate change and reduce the extra temperatures
Policies and procedures to protect workers in such circumstances
Structural reforms to help business owners and workers to take the necessary measures
to prepare for climate risks and achieve sustainability and economic growth.
03
1. Factors Causing Health Problems for Workers in High Temperatures
and Most Vulnerable Group of Workers
The factors causing health problems related to working in high temperatures and under
direct sunlight are as follows:
Environmental Factors
Global warming and climate change on earth
The increase in temperatures and humidity
Direct exposure to sunlight or extreme heat
Limited air movement (without breeze or wind)
Certain Job-Related Factors
High physical exertion
Use of heavy and impermeable personal protective clothing and equipment
Workers who are most vulnerable to health problems related to exposure to high tempera-
tures and direct sunlight
Those not used to work in high temperatures.
Those not used to high physical exertion.
Those not used to work outdoors and under direct sunlight.
Those suffering from chronic diseases and obesity.
Wearing heavy, dark or tight clothes or using heave personal protective equipment.
Those who showed early heat-related symptoms the day before.
04
2. Health Problems Related to Working in High Temperatures and
Direct Sunlight
The reason for heat gain in the human body can be a combination of external heat from the
environment and internal body heat resulting from metabolic processes. The fast increase in
gaining heat due to exposure to more than average heat conditions leads to weakening the
body’s ability to organize its temperature and might lead to a range of diseases including heat
cramps, thermal stress, heat strokes and fever.
Death or recovery from heat strokes or diseases resulting from heat might occur very quickly
(in the same day), or may have a delayed effect (after several days) which leads to speeding up
death and illness occurrence in people at high risk; especially in the first days of the heat
waves. Even the slightest differences from the average seasonal temperatures are associated
with increased illnesses and death. Extreme high temperatures can worsen chronic conditions
such as cardiovascular, respiratory tract and cerebrovascular diseases and diabetes-related
conditions.
Heat also has important non-direct health effects. Heat conditions can change human
behavior, contribute to disease transmission and affect health services provision, air quality,
vital social infrastructures such as power, transportation and water. The magnitude and
nature of the heat health effects depend on the timing, severity and duration of the
temperature, level of adapting to it, and the ability of the local population, infrastructure and
institutions to adapt to the prevailing climate. The precise threshold upon which the
temperature represents a dangerous situation varies depending on the area and other factors
such as humidity, wind, local levels of human adaptation and preparation for the heat
conditions.
Symptoms and Signs of Fever when Working at High Temperatures and Under Direct
Sunlight
Headache, Fatigue and Clammy skin Irritability, Thirst, nausea,
dizziness, fainting generalized confusion vomiting
weakness
Workers’ Health Problems Related to Working at High Temperatures and Under Direct
Sunlight:
Heat stroke, Heat Exhaustion, Heat cramps and Heat rash.
05
Symptoms and Signs of Heat Stroke Associated with Working at High Temperatures and
Under Sunlight:
Confusion Fainting Excessive Convulsions Very high body
sweating or red, hot temperature (over
and dry skin 40 degrees
Celsius)
Symptoms and Signs of Heat Exhaustion Associated with Working in High Temperatures
and Under Sunlight:
Cold and moist skin Excessive Headache Nausea or Vertigo and
sweating vomiting dizziness
Generalized Thirst Irritability Rapid heart High body
weakness rate temperature (over
38 degrees
Celsius)
06
Symptoms and Signs of Heat Cramps Associated with Working at High Temperatures and
Under Sunlight:
Muscle spasm Pain
Symptoms and Signs of Heat Cramps Associated with Working at High Temperatures and
Under Sunlight:
Spots of a skin rash accompanied by redness often
occurs on the neck, upper chest and skin folds
07
3. First Aid for Health issues associated with Working at High
Temperatures and Under Direct Sunlight
Steps to be followed if a worker suffers a heat stroke:
Call an ambulance.
Place the worker in a shaded and cool area.
Remove and loosen the person’s clothes.
Help cool and ventilate the person by placing cold compresses and ice packs on the thigh
and underarm or soaking the person’s clothes in cold water.
Provide fluids (preferably water) as soon as possible.
Stay with the person until help arrives.
Steps to be followed if a worker suffers a Heat Exhaustion:
Call the supervisor at work and ask for medical help.
Move the person to a shaded and cooler place to rest with observation.
Give the person cold water as long as he is conscious and not vomiting.
Remove and loosen the person’s clothes.
Help cool and ventilate th e person by placing cold compresses and ice packs on the thigh
and underarm or soaking the person’s clothes in cold water.
Take the worker to medical care center or emergency room for medical evaluation or
treatment if the signs or symptoms worsen or did not get better.
The worker must not return to work on this day even if he gets better.
Steps to be followed if a worker suffers Heat cramps:
Make the worker rest in a shaded and cool place.
The worker should drink water or other cold drinks.
Wait for a few hours before allowing the worker to get back to the hard work.
Ask the worker to seek medical care if the cramps do not get better.
Steps to be followed if a worker suffers a Heat rash:
Try to work in cooler and less humid environment whenever possible.
Keep the affected area dry.
08
4. Preventive Measures for Health issues associated with Working at
High Temperatures and Under Direct Sunlight, Recommendations for
Employers
Employers must take the following steps to protect the employees from high
temperatures and working under direct sunlight:
Set the schedule for performing maintenance and repair works in hot areas at colder
times.
Set the schedule for performing thermal works at times of the day during which tempera-
tures drop.
Enable workers to gradually adapt to the periods of working in hot weather.
Reduce the physical demands which the workers have to meet.
Hire additional workers or assign tasks that require physical effort to more workers.
Provide cold water or fluids for the workers.
Avoid drinks containing large amounts of sugar and caffeine.
Provide breaks to drink water.
Provide cool places to sit during breaks and encourage workers to take separate breaks
during the working hours in shaded and cold places.
Encourage workers to wear sun protection equipment such as head coverings, safety
glasses for the eyes and light-colored clothes.
Reduce the physical demand as much as possible by providing the appropriate
engineering and electrical tools and equipment (such as electrical lifting equipment).
Monitor workers who are prone to Heat exhaustion risk.
Appoint an observer for the workers (who is trained to the methods of prevention and
dealing with health problems related to high temperatures) while working in a high
temperature environment and under direct sunlight to look for any symptoms or signs of
health problems associated with high temperatures.
Providing required training with regards to dealing with health conditions associated
with high temperatures in addition to providing information about:
Risks which threaten workers.
Methods of prevention.
Monitoring symptoms.
The importance of the worker monitoring himself and his coworkers to check symptoms.
Treatment.
Personal protective equipment.
09
1.Recommendations for Workers’ Supervisors
Workers should avoid exposure to extreme temperatures and exposure to direct
sunlight and high humidity whenever possible. If this is not possible, they should
take the following preventive steps:
Instruct the workers to wear light-colored and loose clothes which allow air flow; such
as cotton clothes, avoid clothes made of synthetic fabrics which prevent air flow.
Progression in workload from light to heavy.
Set a schedule for higher workload at colder times of the day.
Take more breaks at times of extremely high temperatures and humidity.
Take breaks in shaded or cool places if possible and provide cold drinking water.
Encourage workers to drink water frequently even if they are not feeling thirsty (4 cups
per hour).
Avoid drinks containing caffeine, alcohol, or large amounts of sugar.
Inform workers that protective clothing or personal protective equipment may increase
the risk of injury if not used properly.
Encourage workers to wear personal cooling tools (such as ice vests and cooling
bandanas) and loose and breathable clothing, as long as such items do not pose a danger
to safety.
Plan for emergencies and train workers on protection against Heat Exhaustion and
treatment.
Increase the frequency of communicating with the workers and encourage them to
monitor themselves and others for signs of heat-related diseases.
The worker should monitor his physical condition and the physical condition of his
coworkers.
Ensure the availability of first aid on the worksite and the existence of a clear plan to
contact the medical service providers in case of a medical emergency.
Train workers to recognize health problems related to working at high temperatures,
methods of prevention and how to handle emergencies if they occur.
Prepare a schedule for workers’ rotation so that there are periods for working in an
environment with less temperature and away from direct sunlight.
Follow the guidelines and times of banning work under sunlight issued by the Ministry of
Human Recourses.
10
5. Acclimatization for New Workers in Hot Areas and Training Methods
Acclimatization means the helpful physiological coping which occurs during the
recurrent exposure to a hot environment.
This coping includes the following:
Increase the efficiency of sweating:
(Early sweating, increased sweat secretion, reduced salt loss in sweat with recommending
not to drink water mixed with salt during work to replace salts)
Circulatory Stability:
Ability to do work with lower core temperature and heart rate, increased blood flow to the
skin at a certain core temperature.
Acclimatization Schedule:
To acclimatize workers, their exposure time can be gradually increased in hot environmental
conditions over the period of 7-14 days. New workers will need more time to adapt than
workers who have previously been exposed. As for the new workers, the exposure schedule
must not exceed 20% of exposure on the first day, and this percentage should be increased by
no more than 20% on every additional day.
As for workers who have prior experience in the job, Acclimatization schedule should not
exceed 50% on the first day, 60% on the second day, 80% on the third day and 100% on the
fourth day.
In addition, the acclimatization level reached by each worker is related to the primary
physical fitness of the person and overall thermal stress suffered by the person.
Preserving Acclimatization:
Workers can preserve their acclimatization even if they were away from work for a few days,
like when going back home to spend the weekend. However, if they were absent for a week
or more, there might be a great loss in the helpful adaptations which leads to an increased
possibility of developing heat related diseases and the need to gradually adapt to the hot
environment.
11
Some additional information about preserving acclimatization:
acclimatization can often be restored within two to three days upon returning to a job in a
high temperature work environment.
People who are in top physical condition certainly better preserve their acclimatization.
Seasonal changes in temperatures may lead to difficulties in acclimatization.
Working in hot and humid environments provides acclimatization advantages which also
applies to hot and desert environment and vice versa, which proves that air conditioning
has no effect on adaptation.
We would like to note that thermal stress is the health condition resulting from the
body’s inability to get rid of unhealthy high temperatures when exposed to many
internal and external factors.
It may result from a variety of internal or external sources for increased thermal
stress, such as:
Heat resulting from work processes and machinery (for example, forging).
Environmental temperatures, humidity and lack of air movement (for example, lack of
wind or insufficient air circulation).
Internal metabolic processes (for example, diseases causing fever).
The heat generated by muscles from physical activity.
12
6. Criteria of choosing a temperature indicator and dealing with it:
There is more than an indicator to use, and they are as follows:
Limit work temperature in work environments
Outdoor temperature indicators
The two previous indicators have been chosen based on applying them to work environments
similar to the work environment in the Kingdom of Saudi Arabia. The Public Health Authority
recommends using the limit work temperature especially in internal and external work
environments exposed to different weather conditions such as humidity, wind speed and high
temperatures in dry areas.
Thermal Work Limit Indicator in Indoor and Outdoor Work Environment:
When to use the Thermal Work Limit Indicator:
Thermal Work Limit Indicator is used in indoor and outdoor work environments, during
exposure to different weather conditions such as humidity, wind speed and high tempera-
tures in dry areas.
To calculate the thermal Work Limit Indicator, the value of the following measurements
should be taken into consideration:
Dry thermometer temperature (ambient air temperature) (Celsius)
Wet thermometer temperature (humidity/evaporation) (Celsius)
Black thermometer temperature (radiant temperature) (Celsius)
Wind speed (m/s)
The devices used to take all these measurements and automatically calculate the
limit work temperature are available. There are also alternate devices that can be
used to take the measurements, and then entering these measurements in the
electronic calculator to calculate the limit work temperature.
13
1- Measuring the thermal Work Limit Indicator:
Example of a device
The Public Health Authority recommends the following:
In case of performing heavy works or exposure to heat exhaustion, sweating rate increases
to 1.2 liter/hour. Consequently, drinking fluids at amounts exceeding this rate is impractical
and might lead to gastrointestinal issues and discomfort due to reaching the maximum
stomach tolerance to get rid of fluids and excrete them at 1.5 liter/hour rate. Therefore,
thermal conditions must be controlled in addition to providing enough water to replace the
lost amounts of fluids.
14
Thermal Work Limit Indicator (TWL)- Work Zones
Procedures and Measures- Rest and Work, Schedule of Drinking Water Needs
Schedule for
Needed Schedule for
Work Zones Procedures Amounts of Rest/Work
Drinking Water (minutes)
(hours)
Low risk
Unrestricted No restriction on self-working rhythm Light work This zone is safe
for trained workers who drink large 600 – 1000 mL/h for all continuous
zone TWL self-works
from 140 to amounts of water
less than 220
Caution area refers to the situations
where environmental conditions Light work This zone is safe
require additional precautionary
Intermediate 1-1.2 L/h for continuous light
procedures: practically applying the
self-work
risk engineering preventive measures to
Warning zone reduce thermal stress, for example,
providing shaded areas and
TWL from 115 enhancing ventilation. It is not recom-
to less than Heavy work Continuous
mended for any person to work alone,
140 nor to hire a More than 1.2 L/h self-work
nonadaptive person. Make sure to drink 45 minutes work-
enough fluids suitable for the work 15 minutes rest
type.
Focus on applying the required Light work
(work - rest cycle):
45 minutes work–
It is not recommended for any person to
work alone. 15 minutes rest
High risk zone It is not recommended to hire a All types of work
non-adaptive person. More than1.2 L/h
TWL less than In a high-risk zone, drinking water and
115 identifying the signs of thermal stress
should be emphasized. The worker Heavy work
should be equipped with a personal 2 20 minutes work-
liters water bottle on the site at all 40 minutes rest
times.
Table No. 1
15
2- Outdoor Temperature Indicator :
Temperature Measuring Definition:
It means measuring the increase in the ambient temperature of the worker above the limit it
cannot endure, which exposes the worker to many risks where death may be the final stage.
The source of heat in the work environment may come from natural sources such as sunlight
or from industrial sources such as heat resulting from ovens, welding operations or other
work equipment.
Target Group:
All people who work in outdoor work environments with high temperatures according to
table No. 2.
Outdoor Workplaces (in the Open Air)
When working in the open air, the weather’s effects in this environment can have a very
significant and dangerous impact on the employee’s safety, and if the risks are not properly
considered and managed, this effect might be immediate or might occur on the long run.
For example, direct exposure to sunlight may cause skin damage including sunburns, blisters
and skin aging and this may lead to an increased risk of developing skin cancer in the long
run.
Measuring the Temperature:
The devices used to take these measures are available, some are electronic, and others are
mercurial.
Example of a mercurial thermometer:
Example of an electronic thermometer:
16
When to use an Outdoor Temperature Indicator:
A thermometer can be used to help identify the risks of heat-related diseases for workers in
the open air the procedures needed to protect the workers, and when to put such procedures
into force. Depending on the value the thermometer indicates, the risks of developing
heat-related diseases may range from low to very high to extreme. With the increase of the
thermometer indicator value, there is a need for more preventive measures to protect the
workers.
The thermometer values are divided into four scopes associated with four risk levels, which
help to take the appropriate procedure according to the temperature data. This has been
developed for workers to use on worksites according to table No. 2.
Thermometer Indicator Preventive Measures Risk Level
Less than 32.7 degrees Thermal safety basics
Low (caution)
Celsius
From 32.7 to 39.4 degrees Implement precautions and Intermediate
Celsius raise awareness
From 39.4 to 46.1 degrees Additional precautions to
High
Celsius protect the workers.
More than 46.1 degrees Issue stricter preventive
High Risk
Celsius measures
Table No. 2
Employers should respond to any high temperature indicator; such response matches the
type of steps to be followed to treat the other risks in the workplace including the following:
Train workers on how to identify and prevent heat-related diseases.
Daily Monitoring of the thermometer on working site and notify the workers to take
necessary precautions.
Implement a preventive plan with constant revision.
17
Use of protection measures to be taken at each level of risk to notify the workers
with the appropriate preventive plan. The plan should address the following:
Risk Indicator Level
High Risk High Intermediate Low
Preventive Plan (caution)
Providing supplies (ensure availability of
enough water, provisions for break areas
and other supplies)
Providing canopies, personal protective
equipment, fans, steam sprayers, air
fresheners and portable thermometer.)
Emergency planning and response
(train supervisors and crews for
emergencies)
Workers’ acclimatization (increasing the
workloads gradually, allow more
frequent breaks so that workers can
adapt to temperature)
Modified work schedules (create systems
to enable modifications to the work
schedule)
Training (train workers to identify
diseases related to heat and acquaint
them with the relevant preventive
measures)
Physiological, visual and verbal
monitoring (using direct observation and
physiological monitoring to check for
symptoms and signs of heat-related d
iseases)
18
References:
-Working on a warmer planet: The impact of heat stress on labour productivity and decent
work, Geneva, ILO, 2019, ISBN 978-92-2-132967-1
-Travail par forte chaleur en été: comment agir, INRS, ED, 6371
http://osha.gov/SLTC/heatillness/heat_index/
-Public health advice on preventing health effects of heat, World Health Organization 2011
https://www.who.int/docs/default-source/climate-change/publi-
cation---public-health-advice-on-protecting-health-effects-of-heat.pdf?sfvrsn=5f1494a9_1&down
load=true
-Abu Dhabi Public Health Center
https://www.adphc.gov.ae/-/media/Project/ADPHC/ADPHC/Safe-
ty-in-Heat/Training-Manual-AE.pdf
-HSE executive Indoor / outdoor workplace
https://www.hse.gov.uk/index.htm
-WHO heat and health
https://www.who.int/news-room/fact-sheets/detail/climate-change-heat-and-health
-CDC Workplace Safety and Health
https://www.cdc.gov/niosh/index.htm
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