WASHINGTON — Imagine going to work and dying. That’s what happened to one agricultural worker during the summer of 2023, officially the hottest summer on record.
Efraín López García, 29, died of heat stroke while working on a farm in Florida in July, explained Roxana Chicas, PhD, RN, assistant professor at the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta.
Unlike most people, he did not have the option to get out of the extreme heat, she said in a presentation at the American Academy of Nursing 2023 Health Policy Conference.
“As his core body temperature continued to rise and rise, his organs began to swell and swell, and he pushed himself because every little bit that he picks, makes a difference. Every hour he works make a difference,” she said.
Chicas has done extensive research on the health-related dangers that farmworkers face with prolonged heat exposure. She noted that according to 2022 CDC data, about 1,700 people in the U.S. died because of extreme heat, but cautioned that she thinks that is an underestimate. Farmworkers have the highest heat-related mortality of any profession, she said, and experience 35 times the risk of heat-related mortality.
A recent Journal of Occupational and Environmental Medicine (JOEM) study by Linda McCauley, PhD, RN, also of Emory, and colleagues monitored 198 workers over 3 work days, collecting blood and urine before and after work. They also monitored farmworkers’ heart rates, core body temperatures, and physical activity. Chicas was involved in the study as a PhD candidate.
Chicas called the results “astounding”: Nearly half of the farmworkers had a core body temperature higher than 100.4°F.
In an earlier JOEM observational study, McCauley and colleagues had found that among 192 Florida agricultural workers, one-third developed acute kidney injury (AKI) or renal failure. Moreover, their odds of AKI shot up 47% for every 5°F increase in the heat index, Chicas explained. Unpublished data from the researchers (reported in the Washington Post) showed an increasing incidence of AKI development over 2.5 years among farmworkers, especially those who were piece-rate workers (employees paid per item rather than hourly or on salary).
“Farmworkers are bearing the brunt of climate change and these dehumanizing extreme-heat health effects, which many more communities will face as climate change worsens,” she stated.
Chicas and colleagues also have explored interventions that may reduce the risk of heat-associated illness and death among farmworkers.
In a recent pilot study, 61 workers were assigned to one of four interventions: a cooling bandana, a cooling vest, both cooling devices, and a control group. The qualitative study showed that the bandana group had the most positive responses to the intervention, while the other methods were met with mixed reviews, But overall, the researchers concluded that “the additional insight gained from understanding agricultural workers’ experience and perception of cooling devices highlights the benefit of engaging community members and suggests the potential of cooling interventions to prevent HRI [heat-related illness].”
In another JOEM study, researchers looked at hydration interventions among farmworkers and found that drinking water boosted with electrolytes was tied to a lower risk for AKI development.
“These are solutions that are simple, they’re realistic, they’re sustainable, and grounded in the realities of labor,” Chicas said at the conference.
Currently, Chicas is exploring a type of patch that would provide an alert before a worker progresses to heat exhaustion and heat stroke.
For nurses who are uncertain how they can help promote better working conditions for farmworkers, Chicas emphasized that “as nurse researchers, we should be at the frontlines of advocating for policy change that leads to health equity.”
She urged her colleagues to add comments to proposed federal heat protection standards. Chicas told MedPage Today in a follow-up email that “we are advocating for work-rest cycles (mandatory rest breaks in the shade), the provision of clean and cool water and electrolytes, and the provision of personal cooling protective equipment to outdoor workers.”
Finally, she encouraged the nurse-education community to integrate climate change and its impact on health into the nursing curriculum.