Heat stroke is one of the most dangerous heat-related illnesses affecting outdoor workers, especially public works crews who spend long hours repairing roads, maintaining drainage systems, and operating heavy equipment. When temperatures rise, the risk rises with them. Recognizing the early signs and taking the right actions quickly can save a life.
Heat stroke occurs when the body can no longer regulate its internal temperature. Core temperature may rise above 103-104°F, and without prompt intervention, organs begin to shut down. Heat stroke is a medical emergency and should always be treated as such.
Public works and highway crews should watch for the following symptoms in themselves and coworkers:
A body temperature of 103°F (39.4°C) or higher is a major red flag. Workers may feel “on fire” or unusually hot to the touch.
This can include:
Disorientation
Slurred speech
Irritability
Seizures
Loss of consciousness
Any change in behavior is serious and should not be dismissed.
Unlike heat exhaustion, where workers may sweat heavily, heat stroke often causes dry skin because sweating stops. However, some individuals may still be sweating, so skin appearance alone isn’t enough to rule it out.
The heart and lungs work harder to push blood to the skin for cooling, which results in:
Fast, strong pulse
Rapid or shallow breathing
These symptoms may progress rapidly and should be taken seriously, especially in high heat.
If a worker shows signs of heat stroke act immediately. Delays can lead to permanent damage or death.
Heat stroke is a life-threatening emergency. Even if the person seems “okay” after cooling measures, they require medical evaluation.
Get them into:
Shade
An air-conditioned vehicle
A nearby building
Under a portable canopy
Any reduction in environmental heat is beneficial.
Do not wait for EMS to arrive to begin cooling efforts. Start with the fastest options available:
Apply cold, wet cloths or ice packs to the neck, underarms, and groin.
Soak shirts or safety vests with cool water.
Use a fan, leaf blower on low, or vehicle A/C to help evaporative cooling.
Mist the person with cool water if available.
Remove excess PPE or outer clothing when safe and appropriate.
Have them rest on their back unless they are vomiting, in which case roll them onto their side to protect the airway.
If the worker is not fully alert, fluids may cause choking. Leave hydration to EMS.
While this article focuses on response, the best way to handle heat stroke is to prevent it. Crews should:
Take scheduled cool-down breaks.
Drink water frequently—don’t wait to feel thirsty.
Use shade tents or air-conditioned vehicles intermittently.
Wear lightweight, moisture-wicking PPE when possible.
Avoid working alone in high-heat conditions.
Encourage a culture where workers speak up when they feel unwell.
Heat stroke can escalate quickly, often without the dramatic warning signs people expect. Public works supervisors and front-line workers should treat any heat-related symptoms as early indicators and take immediate action. The quicker your response, the better the chance of preventing a medical emergency and protecting your team.