About 8 p.m. on a hot Thursday in July, Nicholas Gubell, a driver for UPS, was nearing the end of his route on Long Island, New York, when he started to feel woozy.

That day, Gubell, 26, had delivered about 200 packages. Temperatures had soared into the high 80s, and it was even hotter inside the metal shell of the back of the truck, where, with each stop, he would spend up to a minute or so to retrieve his cargo, sweat beading on his skin.

Now, pulled over on the side of the road, he was panting and barely able to speak, gripping his phone with his hand, which had cramped from dehydration.

“My body was losing it,” Gubell said. Paramedics covered him in ice packs to bring down his body temperature and took him to a hospital. “I was just trying to hold on as best I could.”

As blistering heat waves swept across the United States this summer, breaking temperature records and placing millions under heat advisories and warnings, workers such as Gubell have continued to deliver America’s packages for a variety of carriers, often in trucks that have no cooling mechanisms for drivers. Some UPS workers have shared photographs that show thermometer readings of up to 150 degrees in the backs of their trucks.

Now a string of heat-related illnesses among the drivers has renewed calls to improve their working conditions.

“They’re vomiting. Their bodies are shutting down,” said Dave Reeves, president of Local 767, a Texas local of the International Brotherhood of Teamsters, which represents 350,000 UPS workers across the country. “It’s awful.”

Government records show that the problem is not isolated: Since 2015, at least 270 UPS and U.S. Postal Service drivers have been sickened and in many cases hospitalized from heat exposure. Dozens of workers for other delivery companies, including FedEx, have also suffered from heat exhaustion, according to the records, and a handful of drivers have also died in the past few years. According to the Teamsters, heat-related injuries, illnesses and deaths among drivers are severely underreported.

The issue first drew widespread public attention in 2019, after reporting by the Center for Public Integrity and NBC News highlighted the grave heat dangers faced by mail and delivery workers.

The Teamsters have been mobilizing for better protection for UPS workers in anticipation of contract negotiations next year. “With the temperatures and the record heat waves, it’s getting to the point where we are getting an alarming amount of heat-related injuries,” Reeves said.

In just the past six weeks, he added, 18 of about 9,500 workers in his jurisdiction had become sickened by heat. “It’s absolutely getting worse,” he said.

Although tying a particular heat wave to climate change requires analysis, scientists have no doubt that heat waves around the world are becoming hotter, more frequent and longer-lasting.

In the United States, the number of hot days is increasing, according to the 2018 National Climate Assessment, a major scientific report by 13 federal agencies, which found that the frequency of heat waves jumped from an average of two per year in the 1960s to six per year by the 2010s. The season for heat waves is now 45 days longer than it was in the 1960s, according to the report.

Last August, Jose Cruz Rodriguez Jr., a 23-year-old UPS driver in Reeves’ local, was found dead in the company’s parking lot in Waco, Texas, just days after starting the job. In June, a 24-year-old UPS driver, Esteban David Chavez Jr., died while delivering packages in Pasadena, California, about 10 miles northeast of downtown Los Angeles. Last month, another of the company’s workers was captured in footage from a Ring doorbell, stumbling and collapsing outside a home in Scottsdale, Arizona.

Although Postal Service and other delivery drivers have also been sickened, attention has mostly been focused on UPS, which is the world’s largest package delivery company and among the biggest employers in the nation. Although its tractor-trailers are cooled, the company’s smaller delivery trucks do not have air conditioning.

“Our package delivery vehicles make frequent stops, which requires the engine to be turned off and the doors to be opened and closed, about 130 times a day on average,” the company said in a statement.

“The health and safety of our employees is our highest priority,” UPS said, adding that in preparation for heat waves, it was providing workers with additional water, ice, electrolyte replacement beverages and fruit.

The company said it also planned to distribute cooling towels and uniforms made of moisture-wicking fabric and to accelerate the installation of fans in vehicles across the country. “We never want our employees to continue working to the point that they risk their health or work in an unsafe manner,” the company added.

At the same time, lawmakers have also been pushing for better conditions for mail carriers.

Last month, U.S. Rep. Tony Cardenas, D-Calif., introduced a bill that would require the Postal Service to install air conditioning in all of its vehicles. The measure is named after a 63-year-old driver for the service, Peggy Frank, who, on a 117-degree day in 2018, was found unresponsive in her mail truck in the San Fernando Valley, about 25 miles northwest of downtown Los Angeles.

Currently, 34% of its vehicles have air conditioning and an additional 66% have fans, the Postal Service said, adding that any vehicles purchased after 2003 were equipped with air conditioning.

“Our carriers deliver the mail throughout the year during varying temperatures and climatic conditions,” the Postal Service said in a statement. “This includes during the summer months when the temperatures rise throughout the country.”

The Postal Service reminds carriers to stay hydrated, wear hats and get in the shade whenever possible, it said, and noted that it started a heat illness prevention program to provide mail carriers with training and “resources needed to do their jobs safely.”

UPS has also trained employees to “work safely throughout the year,” it said, and added it has sent reminders during the day to “stay hydrated and to take their rest breaks.”

Drivers said such reminders were insulting in the context of their strenuous working conditions. It is difficult to drink enough water in an environment where bathroom breaks are limited to stopping at stores and restaurants, UPS workers said, adding that their requests for fans had often gone unmet.

“You can drink gallons of water, but it still gets to you,” Matt Leichenger, 26, a Brooklyn UPS driver and shop steward, said of the heat. The training, he added, “basically tells you to drink water and eat cucumbers and watermelons.”

As temperatures have risen in the past few years, so too have the demands for shipping. The coronavirus pandemic kept shoppers at home, causing a surge in e-commerce and, drivers say, more stops on their routes.

“There’s only so much a body can handle,” said Tony Bell, a UPS driver in Longview, Texas. Bell, 45, was hospitalized for heat exposure and renal failure after working his route on a 103-degree day in July.

That day, he drank 12 bottles of water and a Gatorade. He said doctors later told him that he had come extremely close to a heart attack. “I was scared that was it,” he said.

Jorja Rodriguez, mother of Jose Cruz Rodriguez, the UPS driver who died after his shift in Waco last year, said she had sent her son to work that morning with a cooler full of water and energy drinks and told him to “take it easy.”

When he did not come home that night, she drove to UPS and watched as the police found her son, dead.

“I called his name so many times, thinking that if he would hear my voice, he would wake up,” she said, adding that he had texted his supervisor earlier that day to say that he was not feeling well. Dominique Chavez, stepmother of Esteban David Chavez, who died in Pasadena, said that since his death, she and her family had made a point of flagging down UPS workers to offer them a tip and a drink of cold water.

Gubell, the Long Island worker, said he felt fortunate that on the day he felt ill, he had managed to call his parents.

He was too incoherent to give them his location, but they called 911. A neighbor also alerted authorities. “I didn’t want to call the ambulance,” Gubell said, adding that he feared that if he had done so, he would face retaliation from UPS.

“People are dropping like flies out here,” he added. “It’s very brutal.”

In an email, UPS said that if one of their drivers required immediate assistance, the company would send personnel to their location to help them safely return to the delivery center or arrange for immediate assistance at the driver’s location, which could include calling an ambulance.

Gubell’s mother, Prudence, said she regretted having encouraged her son to apply for the job with UPS and never imagined that a neighborhood job delivering packages could be so perilous.

“I worry about him,” Gubell said. “How much can the human body take?”

This article originally appeared in The New York Times.

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