4.1 Heat emergencies: the first five minutes

1 Four heat illnesses, in order of seriousness

Two lines in that table decide most field calls. First, heat stroke skin may be hot and dry or profusely sweating — waiting for dry skin before treating it as heat stroke is a mistake that costs time. Second, confusion is the sign that separates heat stroke from heat exhaustion. Someone who is not making sense is a 911 call, whatever their shirt looks like.

2 Heat stroke: what to do

The InfoSheet gives the sequence, and it is short:

1. 1
   Heat stroke is a life-threatening emergency. While first aid measures are being implemented, call 911 and get emergency medical help.
2. 2
   Make sure someone stays with the worker until help arrives.
3. 3
   Move the worker to a shaded, cool area and remove outer clothing.
4. 4
   Wet the worker with cool water and circulate the air to speed cooling.
5. 5
   Place cold wet cloths or ice all over the body, or soak the worker's clothing with cold water.

Notice the order: the call and the cooling happen at the same time, not one after the other. Cooling is the treatment, and it starts before the ambulance is on the phone if there are two people present.

3 Heat exhaustion: also a medical call

The InfoSheet is firmer about heat exhaustion than most jobsites are: workers with signs or symptoms of heat exhaustion should be taken to a clinic or emergency room for medical evaluation and treatment, and if medical care is not available, call 911 immediately.

Alongside that: make sure someone stays with the worker until help arrives; remove them from the hot area and give them liquids to drink; remove unnecessary clothing including shoes and socks; and cool them with cold compresses to the head, neck and face, or have them wash their head, face and neck with cold water.

"Sit in the truck with the AC for twenty minutes and see how you feel" is not on that list. Heat exhaustion is the last exit before heat stroke, and the case from Chapter 1.2 — the worker who cramped, was moved to a lighter task, came back to the shovel, and died — is what happens when a partial rest is treated as a recovery.

4 Heat cramps and heat rash

Heat cramps. The InfoSheet's response: replace fluid loss by drinking water and having a snack, or a carbohydrate-electrolyte replacement liquid such as a sports drink, every 15 to 20 minutes. Avoid salt tablets. Get medical help if the worker has heart problems, is on a low sodium diet, or if the cramps do not subside within one hour.

Treat cramps as a warning about the whole crew, not one person's leg. They mean the fluid and salt balance is already off — which usually means the hydration plan is not being followed by anyone.

Heat rash. The best treatment is a cooler, less humid work environment, and keeping the rash area dry. Powder may be applied to increase comfort. Ointments and creams should not be used, because anything that makes the skin warm or moist may make the rash worse.

5 The things that go wrong at the moment it counts

The published cases show the same failures over and over.

Nobody recognizes it. In Summary Nr 149868.015, a first-day worker reported that he was not feeling well and had stopped sweating; OSHA's abstract records that he had not been trained to identify the symptoms of heat illness and their severity. The information was said out loud to coworkers who did not know what it meant.

The worker refuses help. In Summary Nr 147304.015, the casualty became combative and refused aid before collapsing. Combativeness and refusal are symptoms of a brain that is overheating, not informed decisions. Plan for it: a crew that has been told this in advance does not stand back and let someone talk them out of calling.

It happens after the shift. In the same first-day case, the worker died after finishing the work shift. Heat casualties collapse in the truck, at home, in the parking lot. Anyone who reported symptoms during the day should not be leaving alone, and a check-in call is a reasonable thing to build into the plan.

6 While you wait

The minutes between the call and the ambulance are the treatment, so make them count. Get the person out of the sun into shade or air conditioning. Get the outer clothing off — long sleeves, coveralls, a harness, a vest — because clothing is insulation. Wet the skin and move air over it: a hose, a bottle, a wet rag and somebody fanning. Ice packs go where big blood vessels run close to the surface. Cold wet cloths on the head, neck and face are useful for a conscious worker with heat exhaustion.

Do not try to make an unconscious or confused person drink. The InfoSheet's guidance for heat stroke is to encourage frequent sips of cool water only if the worker can drink; if they cannot, get emergency medical help immediately.

And stay with them. Every first-aid list in the InfoSheet contains the same instruction — make sure someone stays with the worker until help arrives — because a person whose temperature regulation has failed can deteriorate in a couple of minutes.