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Outcomes of a Heat Stress Awareness Program on Heat-Related Illness in Municipal Outdoor Workers

McCarthy, Ronda B. MD, MPH; Shofer, Frances S. PhD; Green-McKenzie, Judith MD, MPH

Journal of Occupational and Environmental Medicine: September 2019 - Volume 61 - Issue 9 - p 724–728
doi: 10.1097/JOM.0000000000001639

Introduction: Heat stress is an occupational hazard. Exposed workers may suffer heat-related illness, disease exacerbation, increased injuries, and reduced productivity. Response strategies include mitigation policies and preparedness.

Methods: Frequency of heat-related illness and workers’ compensation costs before and after implementation of a voluntary Heat Stress Awareness Program were evaluated retrospectively in outdoor workers from 2009 to 2017. The program consisted of training, acclimatization, and medical monitoring as outlined in NIOSH's Criteria for a Recommended Standard: Occupational Exposure to Heat and Hot Environments.

Results: Of the 604 workers assessed, those with two or more risk factors reported a heat-related illness at greater frequency, which decreased after program implementation. Median workers’ compensation costs decreased by 50%.

Discussion: Heat-related illness prevention programs can be effective in reducing the frequency and severity of these occupational injuries as well as associated costs.

University of Pennsylvania, Division of Occupational and Environmental Medicine, Department of Emergency Medicine (Drs McCarthy, Shofer, Green-McKenzie).

Address correspondence to: Ronda B. McCarthy, MD, MPH, 2400 Lindsey Hollow, Hospital of the University of Pennsylvania, Department of Emergency Medicine, Waco, TX 76708 (,

This article is based on oral presentations at the 2018 Meeting of the International Commission on Occupational Health in Dublin, Ireland and the 2017 National Meeting of the American Occupational Health Conference in Denver, Colorado.

This research was supported in part by training grants from the National Institute of Occupational Safety and Health - grant number: 5-TO1-0H008628 and the Health Resources and Services Administration - grant number: D33HP25770-01-00.

Training on heat stress, heat-related illness and first aid procedures; an acclimatization program; and regular medical monitoring prior to physically demanding work in a hot environment, may reduce the frequency of heat-related illness in exposed outdoor workers and decreased total workers’ compensation costs.

The authors have no conflict of interest.

Copyright © 2019 by the American College of Occupational and Environmental Medicine