Objectives-To examine the incidence, clinical state, personal risk factors, haematology, and biochemistry of heat exhaustion occurring at a deep underground metalliferous mine. To describe the underground thermal conditions associated with the occurrence of heat exhaustion. Methods-A 1 year prospective case series of acute heat exhaustion was undertaken. A history was obtained with a structured questionnaire. Pulse rate, blood pressure, tympanic temperature, and specific gravity of urine were measured before treatment. Venous blood was analysed for haematological and biochemical variables, during the acute presentation and after recovery. Body mass index (BMI) and maximum O 2 consumption (Ṽ O 2 max) were measured after recovery. Psychrometric wet bulb temperature, dry bulb temperature, and air velocity were measured at the underground sites where heat exhaustion had occurred. Air cooling power and psychrometric wet bulb globe temperature were derived from these data. Results-106 Conclusion-Heat exhaustion in under-ground miners is associated with dehydration, neutrophil leukocytosis, eosinopenia, metabolic acidosis, increased glucose and ferritin, and a mild rise in creatine kinase, aspartate transaminase, and lactate dehydrogenase. Heat cramps are associated with dehydration but not hyponatraemia. The incidence of heat exhaustion increases during summer and at depth. An increased fluid intake is required. Heat exhaustion would be unlikely to occur if ventilation and refrigeration achieved air cooling power >250 W/m 2 at all underground work sites. (Occup Environ Med 2000;57:165-174)

BackgroundThe objective of the study was to investigate the physiological responses of construction workers labouring in thermally stressful environments in the UAE using Thermal Work Limit (TWL) as a method of environmental risk assessment.MethodsThe study was undertaken in May 2006. Aural temperature, fluid intake, and urine specific gravity were recorded and continuous heart rate monitoring was used to assess fatigue. Subjects were monitored over 3 consecutive shifts. TWL and WBGT were used to assess the thermal stress.ResultsMost subjects commenced work euhydrated and maintained this status over a 12-hour shift. The average fluid intake was 5.44 L. There were no changes in core temperature or average heart rate between day 1 and day 3, nor between shift start and finish, despite substantial changes in thermal stress. The results obtained indicated that the workers were not physiologically challenged despite fluctuating harsh environmental conditions. Core body temperatures were not elevated suggesting satisfactory thermoregulation.ConclusionThe data demonstrate that people can work, without adverse physiological effects, in hot conditions if they are provided with the appropriate fluids and are allowed to self-pace. The findings suggested that workers will self-pace according to the conditions. The data also demonstrated that the use of WBGT (a widely used risk assessment tool) as a thermal index is inappropriate for use in Gulf conditions, however TWL was found to be a valuable tool in assessing thermal stress.

These studies provide evidence that self-pacing is a protective response to working in heat which does not require a highly informed workforce; recognition of this should form part of a holistic approach to management of heat stress in hot climates.

The development of a rational heat stress index called thermal work limit (TWL) is presented. TWL is defined as the limiting (or maximum) sustainable metabolic rate that euhydrated, acclimatized individuals can maintain in a specific thermal environment, within a safe deep body core temperature (< 38.20 degrees C) and sweat rate (< 1.2 kg/hr(-1)). The index has been developed using published experimental studies of human heat transfer, and established heat and moisture transfer equations through clothing. Clothing parameters can be varied and the protocol can be extended to unacclimatized workers. The index is designed specifically for self-paced workers and does not rely on estimation of actual metabolic rates, a process that is difficult and subject to considerable error. The index has been introduced into several large industrial operations located well inside the tropics, resulting in a substantial and sustained fall in the incidence of heat illness. Guidelines for TWL are proposed along with recommended interventions. TWL has application to professionals from both the human and engineering sciences, as it allows not only thermal strain to be evaluated,. but also the productivity decrement due to heat (seen as a reduced sustainable metabolic rate) and the impact of various strategies such as improved local ventilation or refrigeration to be quantitatively assessed.

ObjectiveSignificant and poorly documented electrolyte losses result from prolonged sweating. This study aimed to quantify likely sodium losses during work in heat.MethodsMale subjects exercised in an environmental chamber on two consecutive days in both winter and summer. Sweat collecting devices were attached to the upper arms and legs.ResultsSweat rates were higher and sodium concentrations were lower in the summer (acclimatised) than the winter (unacclimatised) trials. Sweat sodium concentration was reduced on the second day in summer but not winter. Regional differences were found in both seasons.ConclusionThe difference between days in summer probably reflects short-term acclimation. The difference between seasons reflects acclimatisation. The data predict average sodium (Na) losses over a work shift of 4.8–6 g, equivalent to 10–15 g salt (NaCl). Losses are potentially greater in unacclimatised individuals.Fluid and electrolyte losses resulting from prolonged sweating must be replaced to prevent imbalance in body fluids, however guidelines for this replacement are often conflicting.This study provides important information for occupational health practitioners by quantifying the likely sodium losses over a work shift and providing recommendations for replacement.