Written by Shannon Markus
Spoon Feed
Although extreme heat events have become more frequent due to climate change, occupational heat-related illness remains preventable. Emergency physicians play a critical role in identifying at-risk patients, documenting exposures, and promoting prevention through education and advocacy.
It’s gettin’ hot in here (so hot)!
This clinical review synthesized data from public health surveillance, epidemiological studies, and occupational health literature to describe risk factors, outcomes, and prevention strategies for occupational heat-related illness (HRI). HRI is a growing health concern, especially for workers in agriculture, construction, kitchens, and other physically demanding jobs exposed to extreme temperatures. Risk factors include high ambient heat, non-breathable PPE, lack of acclimatization (with most deaths occurring in the first week of work), underlying medical conditions, and medications that impair thermoregulation like diuretics, antipsychotics, and anticholinergics. Emergency physicians should assess occupational and medical risks, document relevant workplace exposures, and link diagnoses to heat exposure for potential workers’ compensation claims. Prevention includes patient counseling, use of OSHA-NIOSH heat tools, adequate hydration, shaded breaks, and work modifications such as reduced work pace, lighter tasks, and organizing work to avoid the hottest parts of the day. Clinicians can also advocate for policy change, report unsafe conditions on behalf of patients, and connect workers to community resources. As climate-driven HRIs become more frequent, clinicians play a key role in risk mitigation and prevention.
How does this change my practice?
As extreme heat associated with climate change increases, so has the incidence of occupational HRI—especially in my home state of Texas, where summers bring prolonged periods of sweltering triple-digit temperatures. This review reinforces the importance of incorporating occupational and medication-related risk assessment into the evaluation of patients with suspected heat illness (particularly those in high-risk jobs like construction or agriculture), and reminds me to use the ED visit not only for diagnosis and treatment but also as an opportunity for education and advocacy.
Source
Occupational Heat-Related Illness. JAMA. 2025 Jul 15;334(3):267-268. doi: 10.1001/jama.2025.7629. PMID: 40531478
