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Federal Register / Vol. 86, No. 205 / Wednesday, October 27, 2021 / Proposed Rules
September 8, 2021b. Excessive heat exacerbates existing health problems like asthma, kidney failure, and heart disease, and can cause heat stroke and even death if not treated properly and promptly. Workers in both outdoor and indoor work settings without adequate climate-controlled environments are at risk of hazardous heat exposure. In an evaluation of 66 heat-related illness enforcement investigations from 2011
2016, 80% of heat-related fatalities occurred in outdoor work environments.
However, 61% of non-fatal heat-related illness cases occurred during or after work in an indoor work environment Tustin et al., August 2018. Pregnant workers NIOSH, April 20, 2017 and workers of color are disproportionately exposed to hazardous levels of heat in essential jobs across these work settings Gubernot et al., February 2015. In addition, climate change is increasing the frequency and intensity of extreme heat events, as well as increasing daily average daytime and nighttime temperatures. OSHA is initiating a rulemaking to protect both indoor and outdoor workers from hazardous heat, and as a first step is seeking additional information about the extent and nature of hazardous heat in the workplace and the nature and effectiveness of interventions and controls used to prevent heat-related illness. This ANPRM provides an overview of the problem of heat stress in the workplace and the measures that have been taken to prevent it. This ANPRM also seeks information on issues that may be considered in developing a standard, including the scope of the standard and the types of controls that might be required.
OSHA uses several terms related to excessive heat exposure throughout this document. Heat stress means the load of heat that a person experiences due to sources of heat or heat retention, or the presence of heat in a work setting. Heat strain means the physiological response to heat exposure ACGIH, 2017. Heatrelated illness means adverse clinical health outcomes that occur due to exposure to hazardous heat. Heatrelated injury means an injury linked to heat exposure that is not considered one of the typical symptoms of heat-related illness, such as a fall or cut. The document also uses the combined terms of heat injury and illness when talking about prevention or programming to demonstrate that both injury and illness should be considered, with the exception of the names of existing programs.

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A. Occupational Illness, Injuries, and Fatalities Due to Hazardous Heat According to the Bureau of Labor Statistics BLS Census of Fatal Occupational Injuries, exposure to excessive environmental heat stress has killed 907 U.S. workers from 1992
2019, with an average of 32 fatalities per year during that time period BLS, September 10, 2021a. In 2019, there were 43 work-related deaths due to environmental heat exposure BLS, September 1, 2021. A recent analysis of BLS data by National Public Radio and Columbia Journalism Investigations found that the three-year average of heat-related fatalities among U.S.
workers has doubled since the early 1990s Shipley et al., August 17, 2021.
The BLS Annual Survey of Occupational Injuries and Illnesses estimates that 31,560 work-related heat injuries and illnesses involving days away from work have occurred from 20112019, with an average of 3,507
injuries and illnesses of this severity occurring per year during this period BLS, September 10, 2021b. However, the estimates provided here on occupational heat-related illnesses, injuries, and fatalities are likely vast underestimates, as discussed further in Underreporting of occupational illnesses, injuries, and fatalities due to hazardous heat Section I.B. of this ANPRM.
In a warm environment, the human body maintains a healthy internal body temperature by getting rid of excess heat through mechanisms like sweating and increasing blood flow to the skin. This is especially true during physical activity or exertion. Briefly, if the body is not able to dissipate heat, the body temperature may rise, and symptoms of heat-related injury and illness can result. These can include heat rashes, heat syncope fainting, heat cramps, heat exhaustion, rhabdomyolysis a complex medical condition involving muscle breakdown, kidney injury, and even heat stroke the inability of the body to cool which can lead to death if the thermoregulatory capacity of the body is exceeded Ebi et al., August 21, 2021; NIOSH, February 2016. A multicountry meta-analysis of dozens of studies involving thousands of workers globally found that of those exposed to hazardous heat during a single work shift, 35% experienced heat strain while 15% of those who frequently worked in hazardous heat experienced kidney disease or acute kidney injury Flouris et al., December 2018.
Exposure to hazardous heat can also result in the exacerbation of pre-existing medical conditions, such as diabetes or
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cardiovascular disease. A study of U.S.
Army personnel demonstrated that those who have been hospitalized in U.S. hospitals for heat-related illness may experience organ damage that can persist for years afterward, even resulting in an increased risk of death from cardiovascular disease and ischemic heart disease compared to those previously hospitalized for other reasons Wallace et al., 2007. Recurrent exposure to hazardous heat, and resulting dehydration, has also been found to be associated with acute and chronic kidney disease and injury in agricultural workers and others performing manual labor in outdoor work settings, particularly in South America, central America and certain South Asian countries. These illnesses appear to be unrelated to traditional causes of the disease Glaser et al., August 8, 2016; Johnson et al., May 9, 2019; Sorensen and Garcia-Trabanino, August 22, 2019. Although much of this research has focused on international populations, there is emerging evidence of this health hazard in occupational populations within the U.S. Mix et al., 2019; Glaser et al., August 8, 2016.
The following questions are intended to solicit information on the topics related to assessing the nature and magnitude of occupational illness, injuries, and fatalities occurring due to hazardous heat.
1 What are the occupational health or safety impacts of hazardous heat exposure?
2 What sources of data are important to consider when evaluating occupational heat-related illnesses, injuries, and fatalities?
3 Beyond the studies discussed in this ANPRM, are there other data that provide more information about the scope and magnitude of injuries, illnesses, and fatalities related to occupational heat exposure?
B. Underreporting of Occupational Illnesses, Injuries, and Fatalities Due to Hazardous Heat Heat-related illnesses, injuries, and fatalites are underreported EPA, April 2021; Popovich and Choi-Schagrin, August 11, 2021. Occupational heatrelated illnesses, injuries, and fatalities may be underestimated for several reasons. First, the full extent of heatrelated health outcomes is underreported generally because heat is not always recognized as a contributing factor and the criteria for defining a heat-related death or illness may vary by state, and among physicians, medical examiners, and coroners. Gubernot et al., October 2014. Due to the varying
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