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Low temperatures pose a significant yet underrecognized occupational health risk, particularly for outdoor workers with climate-sensitive medical conditions such as diabetes, cardiovascular disease, and respiratory disorders. While cold exposure is often associated with Arctic and high-altitude regions, even temperate and warmer climates experience severe winter temperature drops, placing a broad spectrum of outdoor workers at risk. Despite extensive research highlighting the adverse health effects of cold stress and its contribution to global mortality rates, occupational health and safety (OHS) guidelines remain disproportionately focused on heat-related risks, neglecting the unique vulnerabilities of workers exposed to extreme cold. This paper critically examines the gaps in current OHS policies and regulations regarding cold exposure, emphasizing the urgent need for evidence-based guidelines that specifically address the needs of outdoor workers with preexisting health conditions. By integrating medical, environmental, and occupational safety perspectives, we propose a framework for comprehensive protective measures, including improved risk assessment protocols, workplace adaptations, and regulatory interventions. Addressing this oversight is essential not only for safeguarding workers’ health but also for promoting sustainable labor practices and enhancing resilience in industries where cold exposure is a persistent threat. Establishing clear, targeted guidelines will be a crucial step toward mitigating cold-related occupational hazards and fostering a healthier global workforce.