Written by: Sarah Lucky
As winter approaches, temperatures across the nation will start dropping. For employees who perform work duties outside, the cold temperatures can pose a threat to their health and safety. It is essential that both the workers and their employers are aware of the risks posed, as well as warning signs of the different health conditions associated with the cold.
Workers at Risk
According to the U.S. Bureau of Labor Statistics, 32.9 percent of workers in the U.S. were exposed to an outside environment in 2022. The industries most affected included construction, landscaping, and public safety.1 However, outdoor workers are not the only demographic that could be affected by extreme cold. Other groups at risk include restaurant workers and catering or food storage warehouse workers, who would be entering walk-in freezers or handling cold/frozen products for extended periods of time. Transportation workers run the risk of becoming stranded on the road in winter storms.
Workers of specific concern include those with underlying medical conditions such as Raynaud’s disease (a condition that causes blood vessels to narrow), hypertension, hypothyroidism, and diabetes. They would be at increased risk for cold stress, as are older adults, smokers, and individuals with circulatory disorders.
About Cold Weather Hazards
The most common health hazard associated with freezing temperatures is cold stress. According to the Occupational Safety and Health Administration (OSHA), cold stress occurs by “driving down the skin temperature and eventually the internal body temperature (core temperature). This may lead to serious health problems, and may cause tissue damage, and possibly death.”2
There are different cold stress responses that could affect workers in freezing temperatures, including2:
- Trench foot
Also known as immersion foot. This is a non-freezing injury to the feet that occurs when a worker experiences prolonged exposure to wet and cold conditions. Symptoms and warning signs include reddening of the skin, numbness, tingling, pain, swelling, leg cramps, blisters, bleeding under the skin, and possible gangrene. - Frostbite
Freezing of the skin and tissues as a result of exposure to extreme cold. Frostbite can cause permanent damage with possible loss of the affected area in severe cases. Symptoms and warning signs to be aware of include reddened skin with areas of gray or white patches. The most commonly affected areas include the fingers, toes, nose, and earlobes. This sort of injury can result in temporary and/or permanent tingling, aching, blisters, and loss of feeling. - Hypothermia
A condition caused by extensive periods of exposure to cold resulting in abnormally low body temperature. This prolonged exposure causes the body to lose heat faster than it can be generated, overwhelming the body’s ability to autoregulate temperatures to healthy levels. Symptoms and warning signs include uncontrollable shivering, loss of coordination, confusion, slurred speech, slowing of the heart rate and breathing, progressing to unconsciousness, and potentially death. As hypothermia progresses, thinking becomes slowed and the affected worker may not be aware they are becoming hypothermic, thus they do not seek immediate rewarming. This, in turn, may result in a rapid decline in condition. - Chilblains
Occur when the small blood vessels in the skin respond abnormally to cold extremes resulting in skin changes and recurrent pain as a result of repeated exposure to cold weather. Symptoms and warning signs include redness, itching, possible blistering, inflammation, and possible ulceration. - Other cold stress responses
Include other conditions such as wind chills, shock, eye pain or vision changes, increased susceptibility to blood clotting, and a weakened immune system.
Cold Weather Regulations
To date, there are no regulations specifically for extreme cold, but that does not mean that employers cannot be cited if a worker were to experience an injury or illness as a result of the extreme cold. “While OSHA does not have a standard specific to winter weather, the agency can still cite employers under the catchall General Duty Clause of the Occupational Safety and Health Act, which requires that an employer provide each employee ‘a place of employment which [is] free from recognized hazards that are causing or are likely to cause death or serious physical harm.’”3
While there are no regulations specifically addressing this issue, OSHA has issued multiple publications, including a Winter Weather Preparedness Plan, as well as a Quick Card, “Protecting Workers from Cold Stress” – each providing awareness on the risks of cold exposure, as well as prevention tips for employers and workers alike.
Prevention
The key to prevention of injuries and illness while working in extreme cold lies in awareness – for both employers and workers- according to a publication released by the National Institute for Occupational Safety and Health (NIOSH),4 and the publication goes on to list specific tactics for each party that can reduce the risk of cold-related illness and injury.
Prevention methods specific to employers include4:
- Scheduling necessary outdoor jobs for warmer months, as allowed, or for the warmer part of the day when it cannot be avoided in cold months
- Utilizing relief workers, or assigning extra workers, when a job is expected to take a longer time to complete
- Providing warm liquids to workers to help combat the cold conditions and assist the workers in re-heating their bodies
- Providing warm, dry areas for workers to take breaks throughout their shifts, as well as areas to change out of wet clothes as the need arises
- Limit the amount of time spent outdoors when temperatures reach extreme cold
- Routinely monitor workers who are in extreme cold and most at risk for cold stress
- Provide appropriate cold-weather gear, such as hats, gloves, and boots
- Ensure all first aid kits workers utilize are stocked with hot packs and thermal blankets, and that they are routinely checked/replenished
- Provide prompt treatment for workers who become exposed to dangerous levels of cold or who are showing warning signs of cold stress or associated conditions
In addition to these prevention methods, it is essential employers provide workers who will be in the extreme cold with adequate training and information to help equip them for the time spent in extreme conditions. Essential tips to provide workers with include:
- Nourish the body with foods high in carbohydrates when the worker expects to be in extreme cold for extended periods of time. This helps provide fuel for heating the body.
- Avoid touching metal or wet surfaces with bare skin when those surfaces have been exposed to extreme cold.
- Always have extra cold weather gear on hand, or in an easily accessed area, in case the gear being worn becomes wet.
- When possible, wear several layers of loose clothing for better insulation.
- Protect the areas prone to damage from cold exposure, such as ears, hands, face, and feet.
How Concentra Can Help
Concentra® can help with the management of cold-related injuries and illnesses through various services, including:
- Workplace Injury Care
Concentra can provide treatment for any injuries or illnesses that do occur and can advise on prevention strategies, as well as provide educational resources. Our clinicians take the opportunity to educate the workers we treat for injuries and help them return to work faster with a focus on methods to reduce the risk of future injury. - Concentra Telemed®
Concentra Telemed is a telemedicine solution that could provide immediate treatment for workers who may be experiencing cold stress, or an associated condition. Using a laptop or smart device, the worker could connect with a Concentra clinician, have their condition evaluated, and receive advice on whether further treatment is needed.
To learn more about these options, and other ways Concentra could help, reach out to the nearest local Concentra medical center.
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Resources:
- “Fire and Ice: What Do We Know about Jobs Involving Exposure to Outdoor Elements?” Commissioner’s Corner. U.S. Bureau of Labor Statistics. August 22, 2023.
- “Cold Stress Guide.” Emergency Preparedness Guide. Occupational Safety and Health Administration. U.S. Department of Labor. Accessed December 9, 2024.
- “Turning Up the Heat on OSHA’s Winter Guidelines.” Blog Post. Ogletree Deakins. F. Davis, J. Surma, D. Waltson. January 31, 2024.
- “Preventing Cold-related Illness, Injury, and Death Among Workers.” National Institute for Occupational Safety and Health. B. Jacklitsch, D. Ceballos. Publication No. 2019-113. January 2019.