Recently proposed rule from OSHA would set national standard for heat illness and injury prevention for employers
Feb. 7, 2025 (ACP) -- The American College of Physicians is advocating for the finalization of a recently proposed rule by the Occupational Safety and Health Administration (OSHA) that aims to prevent heat-related illness and injury.
Soaring temperatures and extreme heat-related weather events are on the rise and have led to a corresponding increase in heat-related illnesses, especially among workers. From 1999 to 2023, the number of heat-related deaths in the United States increased by 117 percent, according to an August 2024 study published in the Journal of the American Medical Association. These numbers are expected to continue to climb as climate change and global warming intensify.
To reduce risks and better protect the nation's workforce, the OSHA proposal would set a national standard for heat illness and injury prevention for employers in several industries, including construction and agriculture. ACP signed a letter with 86 other health organizations in favor of the new heat injury and prevention standard.
The plan calls on employers to evaluate heat risks and implement requirements for drinking water, rest breaks and control of indoor heat. If finalized, the rule would require employers to develop a heat injury and illness prevention plan to control workplace heat hazards.
It is unclear whether the Trump administration will finalize the OSHA heat safety rule, according to Ryan Crowley, ACP manager for health policy.
ACP stated in a letter to the OSHA assistant secretary of labor that the rule could be strengthened by requiring employers to monitor for signs and symptoms of heat-related illness at the initial heat trigger above a heat index of 80 degrees F, especially for workers not acclimatized to working in the heat. Workers more vulnerable to heat-related illness can show symptoms below the high heat trigger (heat index ≥90 degrees).
“Employers have a responsibility to keep their workers safe,” Crowley said. “ACP has long supported national standards to protect workers from heat-related injuries and illnesses and has repeatedly sounded the alarm that climate change is increasing the risk of heat-related illness.”
Heat-related illness is a significant threat to patients, Crowley added. “Exposure to excessive heat causes heat exhaustion, heat stroke and other illnesses, but it can also worsen chronic conditions that internal medicine physicians treat every day, like respiratory, heart and kidney diseases,” he said.
Especially at risk are workers who take medications that affect how the body regulates temperature, such as angiotensin-converting enzyme inhibitors, psychotropic drugs and anticholinergics, according to Crowley. In addition, people taking beta blockers and/or antiplatelet medication may have a higher risk for nonfatal heart attack during hot weather compared with their counterparts who are not taking these medications. “Certain workers like older adults and pregnant people may be especially vulnerable,” he noted.
Even if the rule is not finalized, Crowley noted that internal medicine physicians can take action to help protect at-risk workers. “Physicians can consult the Centers for Disease Control and Prevention Heat and Health Tracker and advise their patients to take necessary precautions, like staying hydrated and taking breaks,” he said.
Back to the February 7, 2025 issue of ACP Advocate