On a sweltering afternoon in July 2020, Belinda Ramones got a call that her brother was in the hospital. The call was from a woman at the Hillsborough County landscaping company he had joined that week, Davey Tree Expert Co., Ramones said. When she arrived, she said: “My brother was swollen from his hands to his feet.”

Two days later, her brother, Jose Leandro-Barrera, died at age 45 of acute kidney failure caused by heat stroke, according to a Hillsborough County medical examiner’s report. His body temperature in the ambulance had been 108 degrees, the report said.

He described the circumstances leading up to his death as recorded by a nurse. At the construction site, Leandro-Barrera told his supervisor that he was not feeling well, and the supervisor told him to stay in a vehicle until he felt better. While there, he “urinated on his own, had seizure-like activity” and became insensible.

“Employee suffers from heat exhaustion while landscaping,” it said an investigation in the incident from the Occupational Safety and Health Administration. The agency fined Davey Tree Expert Co. $9,639. The company did not respond to requests for comment.

Without national regulations on preventing heat illness and death, OSHA generally has a hard time protecting workers before it’s too late, said Paloma Rentería, a spokeswoman for the Department of Labor.

Workers suffered as summers increased progressively hotter with climate change. But health and occupational health researchers say worker deaths are not inevitable. Employers can save lives by providing plenty of water and breaks and building in time for new workers to acclimate to extreme heat.

That’s the logic behind proposed national rules that President Joe Biden set in motion in 2021, aimed at protecting the roughly 36 million workers exposed to extreme heat. The Bureau of Labor Statistics averages about 480 worker deaths from heat exposure each year. But these are “vast underestimates” according to OSHAbecause heat stress is an underlying factor often unaccounted for in medical records.

Advocacy organization Public Citizen estimates that up to 2,000 US workers die from heat each year, based on extrapolations from heat injury data.

Both estimates are troubling, said Linda McCauley, dean of the Emory University School of Nursing and an occupational health researcher. “Nobody should go to work expecting they might die,” she said.

The proposed rules — a heat standard from OSHA — hit a milestone Dec. 30, when public comment period close. But it is unlikely to be completed before Biden leaves office.

Vice President Kamala Harris will likely continue the heat rules if she wins the presidency next month, said Jordan Barab, who served as OSHA’s deputy assistant secretary during the Obama administration. She advanced heat regulations in California in 2020.

If Donald Trump wins, the rules would freeze, Barab predicts. Republicans have generally opposed workplace safety regulations the last 20 yearssaying they are costly for businesses and consumers. And during the first Trump administration, the number of OSHA inspectors tasked with monitoring workplace safety reached an all-time low in the agency’s 48-year history. Workplace inspections for heat stress drop in half over Trump, company analysis finds National Labor Law Project.

OSHA’s rules would require employers to provide plenty of cool drinking water and shade or air conditioning for breaks when temperatures exceed 80 degrees. Above 90 degrees, employers should provide paid 15-minute breaks every two hours.

Two additional aspects of the standard address overlooked issues that contribute to heat-related deaths in the workplace. More than 70% of workers those who die of heat do so in the first week on the job. And delayed medical care is a common theme.

“We need to stop telling people who are complaining that they’re about to pass out to sit in the car or take a break,” McCauley said. “Rest breaks are necessary to prevent the problem, but once someone has symptoms, they need help quickly.”

The proposed rules require employers to give new employees time to acclimate to high temperatures and institute protocols, such as a buddy system, so that workers receive prompt medical attention as soon as they show signs of heat illness, such as dizziness, confusion and cramps.

By the time an emergency medical team arrived to help a worker on the Panhandle’s Apalachicola National Forest in July 2021, he was no longer breathing, according to the Labor Department. press release.

His crew supervisor at EarthBalance, an ecological restoration company in Sarasota County, saw the worker earlier in the day, the agency said, and he was “sweating profusely, his hands were shaking and he appeared confused,” he rested. “Just 30 minutes later, the supervisor returned to the man to find him unresponsive.”

That evening, Gilberto Macario-Gimenez, 42, died at the hospital, a medical examiner’s case report said. He noted that “deceased overheated” and attributed his death to heart disease and hypertension. Heat can exacerbate these conditions.

OSHA investigated the situation. Fined EarthBalance $9,216, noting that “The employer did not ensure that a person adequately trained to administer first aid to employees (worked) in an area where there was no infirmary.”

EarthBalance did not respond to requests for comment.

OSHA received at least 12,980 comments on its proposals posted in the Federal Register. A woman wrote about her cousin who died while clearing bushes for a farmer in Texas when temperatures exceeded 100 degrees: “He was only 34 years old. There was no water or rest breaks.”

After the comment period ends in December, OSHA will hold a public hearing, incorporate the changes, and finalize the rule. If Harris is president, Barab said, the agency could complete the process by 2026. For the rule to work, Congress would have to OSHA fund adequately so that they can hire employees to teach employers how to implement the standards and enough investigators to enforce them.

Several industry groups opposed the standard. The Associated General Contractors of America called it “useless, impossible and impractical.” A single set of rules is not right when climates and workplaces vary widely, as well as workers’ abilities to tolerate heat, the group wrote in a online statement.

Some Republican lawmakers have called the administration outdated. Rep. state Rep. Rick Roth, R-West Palm Beach, he told Al Jazeera that workers are pushing for paid breaks because they “don’t want to work that hard.” If they didn’t feel safe, they could change jobs. “Go work for someone else.”

Critics also say the regulations will cost employers. But a UCLA analysis from California workers’ compensation claims suggests that a national heat standard saves money overall. The study estimated the cost of heat injuries to be between $750 million and $1.25 billion per year in California alone, including medical bills, lost wages and disability claims.

Alfredo De Lara

/

Fault Lines/Al Jazeera English for KFF Health News

Because six states have different sets of rules to reduce heat-related illness—California, Colorado, Maryland, Minnesota, Oregon and Washington—researchers and union representatives could see where policies need to be strengthened. One problem with enforcement is that OSHA relies heavily on employees to report hazards. One study found that only 14 percent of nearly 600 farm workers surveyed in California knew about acclimatization and how much water they needed when temperatures were high.

Although Florida has no specific heat regulations, Dominique O’Connor of the Florida Farm Workers Association said the biggest obstacle to ensuring occupational safety is that workers are afraid of being fired for filing a complaint with OSHA.

This is especially true for agricultural workers on H-2A visas, which allow non-citizens to fill temporary jobs. Because these workers depend on their employers not only to stay in the country, but often for transportation and housing, employer retaliation would be life-changing. “This summer I talked to H-2A workers who were given nothing but dirty water at work,” she said. “They were told to just pretend it was coffee.”

Leaders in several Republican-led states are likely to reject the federal standard if it is issued. Last April, Gov. Ron DeSantis approved legislation that prevents local governments from requiring employers to provide workers with water and shade when temperatures rise.

And the Supreme Court’s decision to overturn the “Chevron doctrine” this year may embolden employers to challenge OSHA’s ability to enforce the rules. For decades, the Chevron doctrine required courts to turn to the expertise of regulatory agencies when interpreting regulations, but the High Court’s decision put an end to that. “We’re in uncharted territory,” Barab said.

Jeremy Young, senior producer at Fault Lines on Al Jazeera English, contributed to this report.

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs at KFF – an independent source of health policy research, polling and journalism. Learn more about KFF.