FACULTY OF HEALTH

SCIENCES
UNIVERSITY OF CAPE
TOWN

Postgraduate Diploma in Occupational

Health

Block 1: Occupational Health Risk Assessment

and Management
Occupational Medicine Division
School of Public Health, University of Cape Town

cutting edge research world class training and partnering for patient-centred health
education services
 FACULTY OF HEALTH
SCIENCES
UNIVERSITY OF CAPE
TOWN

HEAT STRESS

Dr Roslynn Baatjies
Senior Lecturer, Department of Environmental and Occupational
Studies, Faculty of Applied Sciences, CPUT
Lecturer: Division of Occupational Medicine, UCT

cutting edge research world class training and partnering for patient-centred health
education services
Lecture Outline and Learning Outcomes
• Climate change and heat-related disorders

• Understand the effects of thermal stress

• Basic understanding of the assessments of the thermal

environment – equipment and exposure indices

• Evaluate the likely risk from exposure to thermal stress

• Understand the legislative framework for Thermal stress

INTRODUCTION
• Due to the continuous rise of global temperatures and heatwaves
worldwide as a result of climate change, concerns for the health
and safety of working populations have increased.
• Workers in the food production chain, particularly farmworkers,
are especially vulnerable to heat stress due to the strenuous
nature of their work, which is performed primarily outdoors under
poor working conditions.
• A scoping review was undertaken to summarize the existing
knowledge regarding the health impacts associated with climate
change and heat stress (Khayat et al, 2022).
• The majority of articles focused on heat-related illnesses (n=57)
and kidney diseases (n = 28).
• The risk factors identified in the reviewed studies included
gender, dehydration, heat strain, wearing inappropriate clothing,
workload, and hot environmental conditions.
CLIMATE CHANGE AND HEAT STRESS
QUESTION……….

• What other recommendations should be considered?

• What are your thoughts on the Ministers suggestions?
 CLIMATE CHANGE AND HEAT STRESS

• Guardian reported >6500 deaths in Qatar since awarding of the World Cup

• Record-breaking heat waves in Asia, Europe and Northern America

• World Cup 2022 – started in Nov – 5 months later than usual

• UN ILO calculates that heat stress will lead to global productivity losses equivalent to
80million jobs by 2030
TAMANG CASE
• Started in scaffolding – requiring heavy harness and hard hat

• Temperature average 44 degrees Celsius

• Over the 6 years, experienced bloody nose, headache, muscle cramps,

vomiting, dizziness

• Heavy physical labour

• He worked through the dizzy spells and headaches, worried about pay
deductions for too many breaks

• Bottles of cold water sold for same price as Coca-cola – so he opted for
the soda

• Whilst working on scaffolding he limited his fluid intake to avoid climbing

down to use the toilets

• Increasing dizzy spells, muscle weakness made it impossible to work

• Final outcome: Kidney disease, company terminated his employment

RECENT DEVELOPMENTS
• Heat-related deaths and diseases in workers in agriculture,
construction and other outdoor jobs have soared.
• The theme for International Workers’ Memorial Day on 28
April 2024 will be ‘Climate risks for workers’.
• In the US several heat-related deaths including a
26-year-old farm worker in Arizona in July and a 66-year-
old postal worker who died on the job in Dallas in June.
• The Biden administration announced in July 2023 measures
to improve protections for workers from heat exposure on
the job, including ramped-up inspections and enforcement.
• Protections include mandating water breaks for workers;
easy access to shade; and reducing or amending work
schedules during the hottest parts of the day
• Pressure mounting for OSHA to implement an interim heat
stress standard
Examples of Industries where workers
have suffered heat-related illnesses.
Outdoors Indoors
Agriculture Bakeries, kitchens, and laundries (sources
with indoor heat-generating appliances)

Construction – especially, road and other Electrical utilities (particularly boiler

outdoor work rooms)

Construction – roofing work Fire Service

Landscaping Iron and steel mills and foundries

Mail and package delivery Manufacturing with hot local heat sources,
like furnaces (e.g., paper products or
concrete)

Oil and gas well operations Warehousing

Principles

The Australian Institute of Occupational

Hygienists (AIOH) defines heat stress (AIOH
2013) as:

Heat Stress

Net heat load from the combined

contributions of work (metabolic load),
environmental factors (air temperature,
movement, humidity, radiant load) &
clothing requirements
Principles (cont)
Heat strain can be defined (Taylor 2005) as:

“The physiological impact of heat stress on the body, as

expressed in terms of changes in tissue temperatures and
compensatory changes in the activity of physiological systems
(sweat rate, heart rate, skin blood flow).”

An alternate definition is provided by the AIOH in their publication

(AIOH 2013) where they define heat strain as:

“The body’s overall response resulting from heat stress. These

responses are focussed on removing excess heat from the body”.”
Human Thermal
Regulation

Behavioral Physiological
change systems
Clothing Hypothalamus
Changing posture
Undertaking movement
Taking shelter
Personal protective
equipment
 Physiological Responses
to Hot Environments

• Vasodilatation (vasodilation)
• Sweating
• Electrolyte changes
• Dehydration
• Heart rate
• Other effects - Increased
fatigue, decreased cognitive
function, visual attentiveness,
short term memory
psychomotor skills
 FACULTY OF HEALTH
SCIENCES
UNIVERSITY OF CAPE
TOWN

Effects of Temperature
Extremes
Occupational Medicine Division
School of Public Health, University of Cape Town

cutting edge research world class training and partnering for patient-centred health
education services
Common Acute
Heat Illnesses
• Heat stroke
• Heat exhaustion
• Heat syncope (fainting)
• Heat cramps
• Prickly heat (heat rash)
Heat Stroke
• State of thermoregulatory failure
• Life threatening
• Characterised by:
• Hot dry skin
• Rapidly rising body temperature
• Collapse
• Loss of consciousness
• Convulsions
• If deep body temp exceeds 40°C danger of heat stroke
is imminent
Heat Exhaustion
• While serious, less severe than heat stroke
• Inadequate fluid replacement
• Characterised by
• Clammy, moist skin
• Weakness or extreme fatigue
• Nausea
• Headache
• No excessive increase in body temperature
• Low blood pressure and weak pulse
• Without prompt treatment collapse may occur
Heat Syncope (fainting)

• Exposure of fluid deficient persons to hot

environment can cause major shift of blood supply
to skin vessels for heat dissipation

• This can result in inadequate supply of blood to

brain and consequent fainting.

• Onset of heat collapse is rapid and unpredictable

Heat Cramps

Caused by loss of electrolytes performing hard

work in a hot environment.

Characterised by:
• Painful muscle spasm
• Electrolyte imbalance caused by sweating
• Can be caused by both too much and too little salt
Prickly Heat
(heat rash)
Occurs as a result of continued exposure to humid
heat with skin remaining continuously wet from un-
evaporated sweat
Characterised by:
•Clogged sweat glands
•Itchy skin
•Reduced sweating
Chronic Illnesses
Can be grouped into three types:

Type 1 - The aftereffects of an acute heat illness; i.e.

reduced heat tolerance, reduced sweating capacity.

Type 2 - Occur after working in hot conditions for weeks,

months or a few years (similar to general stress reactions);
i.e. headache, nausea, hypertension, reduced libido.

Type 3 – Tend to occur more frequently among people

living in climatically hot regions of the world; i.e. kidney
stones, heat exhaustion from suppressed sweating
MANAGEMENT/TREATMENT
• Heat stroke: Medical emergency & can lead to death
• While waiting for medical help
- Remove from heat & lay in cool shaded area, remove & loosen clothing
• Immediate cooling necessary to reduce core to< 39°C
eg Spray with cool water and fan to evaporate, ice packs on extremities
• If conscious, give sips of cool water
• Monitor airway & breathing
• Heat cramps: loss of electrolytes can occur & need to be replaced
 FACULTY OF HEALTH
SCIENCES
UNIVERSITY OF CAPE
TOWN

Evaluation of thermal exposure

Occupational Medicine Division

School of Public Health, University of Cape Town

cutting edge research world class training and partnering for patient-centred health
education services
Basic Factors of thermal comfort

The most used indicator of thermal comfort is air

temperature. However, the six factors affecting
thermal comfort are both environmental and
personal:
• Air temperature
• Radiant temperature Environmental
• Air velocity Factors
• Humidity
• Clothing insulation
Personal Factors
• Work rate/Metabolic heat
HEAT STRESS INDICES
• Heat stress indices provide tools for assessing hot environments
and predicting likely thermal strain on the body. Limit values
based upon heat stress indices will indicate when that strain is
likely to become unacceptable.
• A heat stress index is a single number which integrates the
effects of the six basic parameters in any human thermal
environment such that its value will vary with the thermal strain
experienced by the person exposed to a hot environment.
• The index value (measured or calculated) can be used in design
or in work practice to establish safe limits.
• Much research has gone into determining the definitive heat
stress index, and there is discussion about which is best.
Heat Stress Indices
Various workers have devised indices to combine some of
them into a single figure to which a standard could be
applied. Some of these include:
• Wet Bulb Globe Temperature: A simple index
calculated after measuring the dry bulb, natural wet
bulb and globe temperatures
• HSI (Heat Stress Index): Calculated using a range
of environmental measurements as well as work rate
• P4SR (Predicted Four Hour Sweat Rate):
Calculated from charts and used to assess
physiological limits
Heat Stress Indices cont..
• Thermal Work Limit (TWL): uses five
environmental parameters plus clothing factors to
arrive at a prediction of a safe maximum
continuously sustainable metabolic rate (Wm-2) for
the conditions. Must be rehydrated and
acclimatised
• Predicted Heat Strain: adopted in ISO 7933. It
describes a method for calculating the heat balance
as well as the required sweat rate that the human
body should produce to maintain this balance in
equilibrium.
Wet Bulb Globe
Temperature Index
(WBGT)
• Probably most widely used index

• WBGT combines effects of 4 thermal

components affecting heat stress:
• Air temperature
• Humidity
• Air velocity
• Radiation

Measured by dry bulb, natural wet

bulb & globe temp.

29
 WBGT (cont)

With direct exposure to sunlight

WBGTout = 0.7NWB + 0.2GT + 0.1DB

Without direct exposure to sunlight ie inside

WBGTin = 0.7NWB + 0.3GT TWA WBGT
Add and average

where NWB = Natural wet bulb = WBGT1x t1 + …___________

T (t1 +t2 +..)
GT = Globe temperature
DB = Dry bulb (air)
temperature
WBGT (cont)
NIOSH & ISO 7243

• WBGT index adopted by both NIOSH and into

ISO 7243 “Hot environments – Estimation of the heat
stress on the working man, based on the WBGT
index.”

• ACGIH 2007
WBGT used as their first order index of the
environmental contribution to heat stress
COMPLETE THE FOLLOWING WBGT CALCULATIONS
In a bakery: Road repair workers- summer: In a ferrous foundry:
Air temp. 25.9 °C Air temperature 29.1 °C Air temperature 36 °C
Globe temp. 30.7 °C Globe temperature 33.1 °C Globe temperature 41 °C
Natural WB temp. 16.8 °C. Natural WB temp. 24.0 °C Natural WB 25 °C.

The bakery is indoors, Road repairs are normally done As the foundry is indoors, we
WBGT=0.7x16.8+0.3x30.7 outside: do not need the air
= ? WBGT=? temperature:
WBGT =?

32
 FACULTY OF HEALTH
SCIENCES
UNIVERSITY OF CAPE
TOWN

Legislation – Environmental
Regulations for workplaces
(1987) – Regulation 2
Occupational Medicine Division
School of Public Health, University of Cape Town

cutting edge research world class training and partnering for patient-centred health
education services
Legislation – SA
• Where the time-weighted average WBGT
index, determined over a period of one hour,
exceeds 30 in the environment in which an
employee works, the employer of such
employee shall—
(a) if practicable, take steps to reduce the said
index to below 30; or
(b) where it is not practicable to reduce the said
index to below 30 and where hard manual
labour is performed—
(i) have every such employee
beforehand and thereafter, at intervals not
exceeding one year, certified fit to work in such
environment by a registered OMP or OHN
according to a protocol prescribed by such
practitioner, and every such employee shall, if
found fit to work in such environment, be
issued with a certificate to that effect by such
practitioner or nurse;
 Legislation cont….
(ii) ensure that every such employee is acclimatised to such working
environment before he is required or permitted to work in such
environment;
(iii) inform every such employee of the need to partake of at least 600
millilitres of water every hour;
(iv) train every such employee in the precautions to be taken to avoid
heatstroke; and
(v) provide the means whereby every such employee can receive
prompt first aid treatment in the event of heatstroke:

Provided that, where the question arises as to whether any particular type of
work does in fact constitute hard manual labour, the decision of an inspector
shall be decisive.
Acclimatisation
• Physiological or behavioral changes that reduce the strain
caused by stressful changes in the natural environment
• Acclimatised persons are able to adapt to heat and tolerate
higher ambient temperatures
• Should take place gradually over 7-10 days
• Fit person acclimatize more readily than unfit persons
• Acclimatization declines after exposure is reduced and 7 to 21
days is a consensus period for loss of acclimatisation.
• Acclimatisation in cold climates not as well understood as in hot
climates
NATIONAL GUIDELINES
Potential interventions:

- include adjusting working hours

- changes to the dress code,
- worker rotation
- monitoring of temperatures in the workplace,
- risks assessments.
- Supervisors and first-aid teams should be trained to
recognise early signs of heat-related illnesses.

Outdoor workers
- protection against direct sunlight, such as through
exterior shaded areas,
- source of cool water close by,
- or arranging for drinks to be brought to the workers,
- Sufficient breaks that are taken in cool or shaded areas.
- Clothing that provides protection from the sun, but
allows airflow to the body is cooling, as is protection of
one’s head with a hat.
ACGIH Screening Criteria for TLV®
and Action Limit

• WBGT is only an index of the environment

• Screening criteria adjusted for by reference to Tables

for contributions of:
• Work demands
• Clothing
• State of acclimatization
 ACGIH WBGT Standards
Table 2. Screening criteria for TLV and Action Limit for
Heat stress exposure Work load
Light Moderate Heavy Very Heavy
(< 180 W) (< 300 W) (< 415 W) (< 520 W)

% Work AL OEL AL OEL AL OEL AL OEL

75% - 100% each hour 28.1 30.8 25.0 28.2 - - - -

50% - 75% each hour 28.7 31.2 26.0 29.0 24.2 27.6 - -

25% - 50% work each hour 29.3 31.8 27.2 30.1 25.7 28.8 24.6 27.9

0 – 25% work each hour 30.0 32.3 28.8 31.3 27.8 30.5 27.0 29.8
Action Level – a level below OEL

39
TABLE 3: ADJUSTMENT TO MEASURED WBGT VALUES FOR CLOTHING2006
[Measured value + CAF]

CLOTHING CLOTHING ADJUSTMENT FACTOR (CAF)

Regular work clothes/ Cloth overalls 0
Cotton overalls 0
SMS non-woven overalls 0.5
Double layer cloth (cotton) clothing 3
Polyolefin overalls 1
Limited-use Vapour-Barrier overalls 11
(Effective) WBGT = Measured WBGT + CAF

40
 ACGIH –
Metabolic
rate
categories
Determine WBGT or work rate

42
ISO7243

• This standard is more comprehensive as it allows for a range of

TWA WBGT values under varying conditions. The standard state
the duration of measurement which should be:
- 60 minutes if work is continuous
- 120 minutes if work is intermittent

• This standard provides for acclimatised and non-acclimatised

workers, in the Heavy workload ad very heavy workload,
provides for sensible and non-sensible air movement. The
exposure limit values range from TWA WBGT 18 – 33.

• A clothing adjustment similar to the ACGIH adjustment can also

be done.
ISO 7243 - WBGT
METABOLIC RATE REFERENCE VALUE OF REFERENCE VALUE OF
(M) RELATED TO WBGT PERSON WBGT PERSON NOT
UNIT SKIN ACCLIMATISED TO HEAT ACCLIMATISED TO HEAT
SURFACE AREA,
W/m2
Resting: M >65 33 32
Light: 65 - 130 30 29
Moderate: 130 - 200
28 26
NO SEN- SENSIBLE NO SEN SENSIBLE
SIBLE AIR AIR MOVE- SIBLE AIR AIR MOVE
MOVEMENT MENT MOVEMENT MENT

Heavy: 200 - 260 25 26 22 23

Very Heavy: > 260 23 25 18 20

44
Conclusion, take home messages
• Many workers are at risk from heat stress while on the job.
• Heat stress can be induced by high temperatures, heavy work
loads, and clothing inappropriate for the heat and humidity.
• Heat stress can result in heat stroke, heat
exhaustion, heat cramps, or heat rashes.
• Know the signs and symptoms of heat stress.
• Acclimatization, work and rest schedules, in conjunction with
proper ventilation, clothing and engineering controls, are key to
reducing company risk and promoting worker safety.
• Fortunately, with the education and the development of programs
and policies by OMP’s it is possible to prevent or reduce the
incidence of heat-related illness.
EXERCISES
• Calculations tutorial to be completed.

• Heat stroke deaths in the Northern Cape highlighted issues with

regards to Heat stress. The recommendations focussed primarily
on working hours. What other control/preventative measures
would need to be considered?

• The current Environmental Regulations for Workplaces are dated

1987 – what proposed revisions would you include in order to
improve worker health and safety in relation to heat exposures?
Calculating the WBGT Index
What does WBGT stand
for?
Outdoors with direct sun exposure:
• WBGTout = 0.7WB + 0.2GB + 0.1DB

Indoors/outdoors without direct sun exposure:

• WBGTin = 0.7WB + 0.3GB
Example:
Groundskeepers are working outdoors with direct exposure to
sun. Measurement of workplace conditions produced the
following results:
WB = 24˚C
GB = 42˚C
DB = 40˚C
What will the WBGT be?

WBGTout = 0.7WB + 0.2GB + 0.1DB

= 0.7(24) + 0.2(42) +
0.1(40)
 Calculating the TWA-WBGT
What is the TWA-WBGT according to the Environmental
Regulations for Workplaces?
TWA 1H WBGT >
Practical Example: 30
A Boiler Operator in a Coal-fired Boiler House needs to do operational
checks every 2 hours for around 60 minutes. These checks involves
certain pressure and temperature checks, as well as housekeeping
duties at different areas in the Boiler House. Each check takes around
WBGTin = 0.7WB + 0.3GB 20 minutes each.
= 0.7(28.4) + Check No. 1 – checks pressure & temperature at control panel
0.3(33.6) Check No. 2 – empties ash from bottom of boiler
= 19.88 + 10.08 Check No. 3 – sweeps ash and coal dust from coal conveyor
= 29.96
Determine the TWA-WBGT with the following information:

Work Area WB GB WBGT TWA-WBGT

INDEX INDEX
Control Panel 28.4˚C 33.6˚
C
Emptying ash from 25.7˚C 34.1˚
bottom of boiler C

Sweeping ash 26.8˚C 32.1˚

adjacent to coal C
Draft revised regulations (2022)
• Subject to the provisions of sub-regulation (2), no employer must require or permit an employee to work in
an environment in which the time-weighted average WBGT Index, determined over a period of one hour,
does not exceed 30;
• (2) An employer must, where the time-weighted average WBGT exceeds the action level of 27:
• (a) provide training to exposed employees on adverse health effects relating to heat stress exposure and
the precautionary measures to be taken; and
• (b) subject exposed employees to a heat acclimatisation programme.
• No employer must require or permit an employee to work in an environment in which the time-weighted
average WBGT Index is above 30, provided that:
• (a) appropriate means of ventilation systems are implemented;
• (b) a work rest cycle is established and implemented for that workplace;
• (c) sufficient amounts of potable water is available at the place of work, in relation to the number of
employees exposed;
• (d) prompt first aid treatment, specific to adverse health effects from heat stress, is made available; and
• (e) the employee is provided with the appropriate personal protective clothing and equipment, taking into
account clothing adjustment factor, according to SANS 7243.
• (4) The physical agents exposure monitoring programme referred to in regulation 7 (1), must:
• (a) be conducted in accordance with the latest version of SANS 7243;
 FACULTY OF HEALTH
SCIENCES
UNIVERSITY OF CAPE
TOWN

Control of thermal exposure

(hot environments)
Occupational Medicine Division
School of Public Health, University of Cape Town

cutting edge research world class training and partnering for patient-centred health
education services
 CONTROLS FOR THERMAL EXPOSURE
Engineering Controls Administrative Controls Personal Protective
Equipment

Radiant heat barriers Reduce the physical effort Specifically designed gel
(shielding) needed for the task packs that fit in a hard hat

Establish a cooling station Allow time for acclimatization Use reflective clothing that
where workers can rest in reflects radiant heat
a ventilated and air- Use a work-rest intervals
conditioned space Use wetted clothing
Provide appropriate training
Ventilation - increase air and education Use commercially available
movement, eg fans, ice vests
natural or artificial Hot jobs should be scheduled
for the cooler part of the day
insulating hot surfaces
that generates the heat
High Radiant
Components
• Surface temperatures
surrounding a worker are
hotter than the ambient air
• Boiler rooms, engine and
compressor house, power
generating stations, inside
military vehicles (tanks
and aircraft)
• Increase air velocity
• Air conditioning/chillers
• Cooled clothing
• Shielding in smelting,
furnace, steel making ad
foundry where surfaces are
extremely high
High Humidity
Conditions

• Laundries, mine, textile

and other manufacturing
processes, wet bulb and
dry bulb are both high
(indicating high humidity)
• Supply dehumidified
air, projected into the
area, increasing air
velocity, improving
comfort and reducing
stress
Hot Dry
Conditions

• Deep dry mines, inside

buildings (in tropics), and
manufacturing where heat is
emitted from plant
• Increase air velocity
• Cooled air
Resources
• Taylor, N.A.S. (2005): Heat Stress: Understanding Physiological
Responses, Human Performance Laboratories (Australia), University of
Wollongong
• http://www.ohlearning.com/training/training-materials/w201-basic-princi
ples-in-occupational-hygiene.aspx
• https://www.workplacesafetynorth.ca/news/news-post/how-manage-hea
t-stress-workplace
• https://www.cdc.gov/niosh/topics/heatstress/default.html
• https://www.osha.gov/heat-exposure
• https://www.cdc.gov/niosh/topics/heatstress/additionalresources.html
• https://www.cdc.gov/niosh/topics/heatstress/infographic.html
• https://www.hse.gov.uk/pubns/indg451.pdf
• https://www.iohsolutions.com/heat-stress-in-the-workplace/
Video’s
• https://www.youtube.com/watch?v=Kr2ouLj1oW0&t=7s
• https://www.youtube.com/watch?v=QWoux3EVDrc
• https://www.youtube.com/watch?v=D5dGCuRdtSs
• https://www.youtube.com/watch?v=Xw4Xh9LwIvs
• https://www.youtube.com/watch?v=7An6GjAGqNQ