Death by Heat Exposure: Texas Workers Face a Heightened Risk of Hyperthermia

Theon Harrison worked 13 hours on his second day for Republic Services, a waste disposal company, as the temperature reached 86 degrees Fahrenheit. While that temperature wasn’t going to shatter heat records for the Houston area, Harrison’s job was already a grueling one. In the heat and humidity, it generated enough internal body heat to cause lethargy and cramps, making him barely able to finish his shift. A coworker clocked the signs of heat illness and told their manager that Harrison shouldn’t be allowed to work the next day, but he was still allowed to report to his shift the next morning. By 11:30 am, Harrison started to feel dizzy, but he had a different driver this time, someone who didn’t recognize the symptom as heat related.

The driver urged Harrison to rest in the truck, even though the AC was turned off, and suggested that he drink less water, thinking this would alleviate the cramping. Despite Harrison’s worsening symptoms and even losing consciousness, the driver called a fire station, not 911. Firefighters gave Harrison oxygen and had to call an ambulance themselves. Harrison was pronounced dead just over an hour later, his body temperature a staggering 108 degrees, a temperature at which his internal organs, including his heart, had shut down.

Hyperthermia Is a Silent Killer

Heat-related deaths in the United States—including in the workplace—are an ongoing, and even worsening issue. Hyperthermia, when your body temperature is dangerously high, is a life-threatening condition, and one that is the biggest weather-related killer in the U.S. In fact, heat exposure is still responsible for more deaths than hurricanes, flooding, lightning strikes, and tornadoes combined.

According to the Environmental Protection Agency (EPA), around 1,300 people die from heat exposure in the U.S. annually. Of the hundreds of heat-related deaths each year, Arizona accounts for the most fatalities overall, but Texas is next on the list. In 2023, more than 330 people died from heat in Texas, while some accounts have the number as high as 455 deaths. In either case, it was the third year in a row that the state had beaten its own record for the number of annual heat-related deaths.

Unfortunately, Texas is at the very top of the list when it comes to the number of people dying in the workplace due to heat exposure.

Workers in Texas Face Some of the Highest Heat-Illness Risks

From 2011 to 2021, there were at least 42 workers in Texas who were killed by heat illnesses, the most of any state according to the U.S. Bureau of Labor Statistics, though this number is widely regarded as “a vast undercount” or a “vast underestimate” by officials from the Occupational Safety and Health Administration (OSHA). Beyond this, from 2011 to 2020, an additional 4,030 Texas workers were reported with heat-related illness.

This is an obvious issue that has lasted for decades, with ample time to implement safety procedures, and yet there is no pattern of decreasing these heat-related deaths in Texas workplaces.

Texas Companies Don’t Always Correct Course After Heat-Related Deaths

Of the 12 companies across the country that have lost multiple workers to heat in recent years, 5 are located in Texas.

Republic Services, from the opening news story, is one of these companies, but Hellas Construction Inc. also has had multiple workers die of heat in recent years. In July 2018, Karl Simmons died of heat stroke on his second day on the job. Just 30 years old, he had been mixing glue, rubber, and gravel into a large mixing machine on a hot day in Fort Worth. There was no shade, and the workers had run out of water by midday. While he was allowed to take a break after he said he felt sick, Simmons went to the work van to rest, where the car interior was already hot and couldn’t provide relief. By the time the supervisor came back from an afternoon grocery trip with water and other drinks, Simmons had collapsed and was convulsing on the ground. A few hours later in the hospital, Simmons was pronounced dead of heat stroke, his body temperature registering 107.1 degrees.

Three months after Simmons died, 11 other workers at Hellas had to get medical care for heat-related illness. Did any of this change the way Hellas trained workers or conducted work? Tragically, no. In July 2019, a 22-year-old died on his third day at work from heat exposure. It had been 99 degrees and humid, so it felt like 118 degrees outside as Pedro Martinez was building a track and field at a school outside of San Antonio. There was no shade, and among the few bottles of water provided, there were also energy drinks and green tea—beverages that are dehydrating. 12 hours into the workday, just before 6 pm, Martinez collapsed. The trip to the hospital was too late. His body temperature was 108 degrees, and hours after being pronounced dead, his body was still hot to the touch.

Compounding the tragedy of these deaths is the fact that it only takes simple safety measures to keep workers safe from the heat. For instance, before working for Hellas, Karl Simmons had worked in extreme heat on Navy flight decks, where he was regularly out in triple-digit weather, but the Navy provided rest inside with AC once an hour, regular water and ice, and adequate training on signs of heat illness. While adequate hydration, rest breaks, and worker training are simple steps to take, companies like Republic Service and Hellas have repeatedly failed to correct course and protect their employees.

Doesn’t OSHA Have Regulations for Heat Exposure?

Nope. Even though the deadly risks of heat exposure on the job have been mentioned by OSHA since the 1970s, the agency has yet to create official, enforceable regulations on the matter. The only official OSHA regulation that applies to heat hazards is the basic and vague General Duty Clause, which charges companies with protecting workers “from recognized hazards” that threaten workers’ lives and safety. While heat is recognized as such a hazard, OSHA has failed to mandate specific standards to meet when it comes to heat protection.

Are Heat Regulations Coming Any Time Soon?

While it’s been long in coming, and tentative policies have been suggested for years, OSHA has committed yet again in 2024 to codifying federal standards for heat protection, for both outdoor and indoor workers. They have yet to follow through on this, however. For now, Texas workplaces have a Regional Emphasis Program (REP) from OSHA in effect, while there is also a Heat National Emphasis Program (NEP) from OSHA that focuses on heat safety.

The NEP is fairly reactionary in nature, generally providing inspections in response to reports of heat injuries or deaths, or to investigate related complaints, though even in the program policy OSHA admits yet again that “heat-related fatalities may be underreported and improperly diagnosed”.

In 2019, the REP was tasked with similar inspections, though with the intent of being somewhat more proactive. Inspectors were tasked with canvassing areas in their jurisdiction on days when the heat index (temperature plus humidity) reached 80 degrees, looking for outdoor worksites where heat protection is necessary.

Inspectors are to look for whether:

• Employees are trained on heat exposure hazards
• First aid is accessible to everyone to use
• Drinking water is provided
• AC or shade is available for rest breaks
• There is a process to gradually integrate new workers so that they can acclimatize
• There’s a plan for providing medical care for heat-related illness

Under the REP, the inspectors who are supposed to monitor Texas worksites also have Arkansas, Louisiana, Oklahoma, and New Mexico in their jurisdiction. As a subgroup of an agency that only has about 1,850 inspectors in total, that comes out to about one inspector per 70,000 workers, and these inspectors are often focused on other more frequent safety violations, like fall hazards and dangerous machinery. A lot of emphasis is placed on outdoor work as well, with even less of a focus on the indoor risks of heat exposure.

Not only are these heat programs understaffed for the size of the task ahead of them, but even once violations are caught and penalties levied, the lack of formal regulations makes enforcement difficult and lackluster. You can’t enforce recommendations or suggested best practices in the same way that you can enforce official regulations.

The result? Dangerous worksites fall through the cracks.

The Cost of Lacking Heat Protection Standards Is Steep

The lack of specific policies from OSHA means that companies like Republic and Hellas have managed to negotiate down OSHA penalties while also avoiding the repeat-violator list, even though they keep failing to implement basic heat safety measures.

For example, after Pedro Martinez died, the company’s second worker within a year to die of hyperthermia, OSHA was going to hit Hellas with a $132,598 fine as well as place them on the repeat-violator list for their “willful” violation of worker safety standards. Hellas was able to successfully challenge this, however, stating that OSHA had failed to prove that they’d violated any specific regulations. The fine was dropped to just over $66,000 and the citations reduced to merely “serious”, preventing Hellas from being labeled a repeat violator, despite its obvious and deadly negligence. 

Since federal regulations are virtually nonexistent and enforcement is lacking, some states have opted to provide their own worker protection policies and enforcement. Since Texas is a southern state that can routinely expect soaring temperatures, you would think that it would be one of those states trying to prepare for dangerous heat exposure.

Does Texas Provide Any Heat Protection Standards for Workers?

Also no. Texas doesn’t have any official state standards or policies to protect employees from heat.

What about at the local level? Since 2010 and 2015 respectively, Austin and Dallas have required employers to provide 10-minute breaks every 4 hours for outdoor workers, as well as adequate drinking water and an area out of the sun in which to rest. That may not sound groundbreaking, but it was noticeably reducing heat-illness numbers.

However, a Texas bill signed into law in 2023 is meant to remove county and city ordinances that exceed state and federal standards, including local rules for heat safety protection. This would ostensibly streamline paperwork for employers and align all companies to the same federal and state safety standards. So did this law put forth statewide standards for heat protection? No. City legislation is pushing back against the law, and the effect of this law remains to be seen, but for now, the only official standard for heat protection falls under OSHA’s general duty clause.

As such, Texan workers’ safety from heat exposure is largely up to whoever happens to be the employer or supervisor calling the shots.

Signs & Treatments for Heat Illnesses

According to the Centers for Disease Control and Prevention (CDC), the following are some signs of heat illness to look for as well as guidance on how to respond. In addition to providing safer working conditions in the heat, employers should ensure all workers are trained on these signs and what to do if they arise.

Heat Rashes

These look like red pimple-like blisters on the skin, especially if they crop up along the neck, chest, elbow, or groin. It’s important to move to a dry, cool area and to keep the rash dry. By cooling the skin and wearing loose cotton clothes, these can clear up in a day or two, but it may require time off of work, or at least working away from the heat source.

Heat Cramps

These are muscle spasms and pain that tend to be accompanied by lots of sweating. At this point, it’s imperative that you stop the activity, hydrate with water or a sports beverage with electrolytes, and move to a cool area. It’s critical that physical activity not be resumed until the cramps are all gone—it is dangerous to let this condition go unaddressed.

This may not be enough, or you may need to get medical attention immediately if you:

• Have pre-existing heart issues
• Are on a low-sodium diet
• Have heat cramps that haven’t gone away after an hour

Heat Exhaustion

The signs of this serious condition include:

Before symptoms get worse, it’s critical to get the person to a cool area, loosen their clothing, provide them with sips of water, and apply cool, wet cloths along the body, or if possible, put them in a cool bath.

It’s best to get medical help immediately, however, if:

• They’re vomiting
• Symptoms are getting worse
• Symptoms have lasted for more than 1 hour

Heat Stroke

If someone has the following, call 911 because these are symptoms of a medical emergency:

As you wait for emergency medical help, move the person to a cooler area and try to lower their temperature by applying cool cloths, fanning the person as they lie down with feet somewhat elevated, or placing them in a cool bath. By this point, the person is unlikely to be able to safely swallow fluids; they will likely need an IV to regain fluids and electrolytes. You should not try to administer medicine like acetaminophen or aspirin. The main goal is to try to lower the person’s body temperature any other way you can.

Which Workers Are Most At Risk of Serious Heat Hazards in the Texas Workplace?

While the following examples are far from exhaustive, certain types of occupations and roles make Texas workers more vulnerable to dangerous heat exposure.

This includes jobs in:

Agriculture & Farm Work

According to the National Institute of Occupational Safety and Health (NIOSH), farm workers face a risk of dying from heat exposure that is 35 times greater than other occupations. This risk is compounded not just by outdoor heat and humidity, but also by strenuous activities like lifting and walking, which significantly increase a worker’s internal body temperature.

Construction

According to a study published in the International Journal of Exercise Science, “Construction workers are 13 times more likely to die from heat-related illnesses compared to the general population”. It’s a deadly combination to have lengthy shifts without any cover from the sun. If someone works in a position that requires wearing hard hats, coveralls, or other heavy, insulating gear, this heightens the risk of heat exhaustion and heat stroke.

Work with Indoor Heat Sources

Workers in bakeries, kitchens, boiler rooms, iron and steel mills, warehousing, HVAC services, and similar jobs are at risk for heat-related illnesses, regardless of the temperature outdoors. An indoor heat source, whether it’s a furnace, boiler, cooking appliance, and/or poor ventilation and cooling systems can be just as dangerous as being outdoors during a heat wave, especially when workers wearing thick gear are performing heavy lifting or other tough work.

Mail Delivery

As of 2023, only 35% of USPS vehicles had working AC. In the middle of already dangerous heat waves, the interior of a vehicle can quickly grow even hotter than the outdoors, and the lack of cooling provides no rest or relief for postal workers, which is sorely needed. Perhaps more dangerous still is that most postal workers operate alone; they don’t benefit from having a supervisor or coworker who could spot signs of heat-related illness.

Working Alone

Companies are responsible for making sure that solo employees have a safe workplace, but a lack of supervisors or coworkers around can be an inherent risk. This was the case in a more recent national news story. In June 2023, 66-year-old Eugene Gates Jr. was returning from a week of vacation to resume work for the USPS. The heat index that day reached 113 to 115 degrees. Sometime into his shift, Gates keeled over on a lawn, and while someone found him, performed CPR, and called an ambulance, it was too late to save Gates, who was pronounced dead at the hospital. His body temperature was 104.6 degrees.

This tragedy also illustrates the final risk factor, which can apply to workers in any industry.

Lack of Acclimatization

Regardless of the job involved, the most vulnerable role in these industries is that of the newcomer who has yet to acclimatize to work conditions or someone who is returning after a long break from work. It typically takes rookies a week or two to fully acclimatize, and returning workers may need a week to readjust. In all the news stories mentioned earlier, workers were hit hard by heat exposure in their initial days on the job or returning to the job.

Employers Must Do More to Protect Texas Workers

With other natural disasters and environmental risks, like hurricane-force winds or tornadoes, you can only hope to get warned with enough time to evacuate or find adequate shelter. With heat, however, there is often ample warning, or at least clear expectation for extreme heat, whether it’s at an outdoor or indoor workplace. All it takes is proper hydration, ventilation, and simple responses to symptoms of heat illness, and this can prevent hospital trips and even save lives from hyperthermia.

Workers shouldn’t be dying of heat, but they are, and the ultimate responsibility for their safety lies with the companies they work for. No matter what.