MMWR Morb Mortal Wkly Rep. 2014 Aug 8;63(31):661-5.
Exposure to heat and hot environments puts workers at risk for heat stress, which can result in heat illnesses and death. This report describes findings from a review of 2012‒2013 Occupational Safety and Health Administration (OSHA) federal enforcement cases (i.e., inspections) resulting in citations under paragraph 5(a)(1), the "general duty clause" of the Occupational Safety and Health Act of 1970. That clause requires that each employer "furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees". Because OSHA has not issued a heat standard, it must use 5(a)(1) citations in cases of heat illness or death to enforce employers' obligations to provide a safe and healthy workplace. During the 2-year period reviewed, 20 cases of heat illness or death were cited for federal enforcement under paragraph 5(a)(1) among 18 private employers and two federal agencies. In 13 cases, a worker died from heat exposure, and in seven cases, two or more employees experienced symptoms of heat illness. Most of the affected employees worked outdoors, and all performed heavy or moderate work, as defined by the American Conference of Governmental Industrial Hygienists. Nine of the deaths occurred in the first 3 days of working on the job, four of them occurring on the worker's first day. Heat illness prevention programs at these workplaces were found to be incomplete or absent, and no provision was made for the acclimatization of new workers. Acclimatization is the result of beneficial physiologic adaptations (e.g., increased sweating efficiency and stabilization of circulation) that occur after gradually increased exposure to heat or a hot environment. Whenever a potential exists for workers to be exposed to heat or hot environments, employers should implement heat illness prevention programs (including acclimatization requirements) at their workplaces.
暴露在高温和炎热环境中会使工人面临热应激的风险，从而导致热相关疾病和死亡。本报告描述了对 2012 年至 2013 年职业安全与健康管理局（OSHA）联邦执法案件（即检查）的审查结果，这些案件根据 1970 年《职业安全与健康法案》的第 5(a)(1)款（“一般责任条款”）被引用。该条款要求每个雇主“为其每位员工提供就业和工作场所，使其免受已知的危害，这些危害正在或可能导致其员工死亡或严重身体伤害”。由于 OSHA 尚未发布热标准，因此在发生热相关疾病或死亡的情况下，必须使用 5(a)(1)引文来执行雇主提供安全健康工作场所的义务。在审查的 2 年期间，在 18 家私营雇主和 2 家联邦机构中，根据第 5(a)(1)款引用了 20 起热相关疾病或死亡的联邦执法案件。在 13 起案件中，一名工人因暴露在高温下死亡，在 7 起案件中，两名或更多员工出现热相关疾病的症状。受影响的员工大多数在户外工作，并且所有员工都从事美国政府工业卫生学家会议定义的重体力或中度体力劳动。其中 9 例死亡发生在工作的头 3 天，其中 4 例发生在工人的第一天。这些工作场所的热相关疾病预防计划被发现不完整或缺失，也没有为新工人提供适应环境的条件。适应环境是指在逐渐暴露于热或炎热环境后，人体产生有益的生理适应（例如，出汗效率提高和循环稳定）的结果。只要存在工人暴露于热或炎热环境的潜在风险，雇主就应在工作场所实施热相关疾病预防计划（包括适应环境的要求）。
