Remind patients: It's time to stay cool

With the weather heating up, doctors caution at-risk patients about the importance of avoiding summer swelter, and public health has emergency plans ready.

By Victoria Stagg Elliott, amednews staff. July 28, 2003.

For physicians and patients, the dangers of summer have arrived.

In California, two children died after an hour in a parked car in 100-degree heat. In Illinois, an elderly woman was discovered in her closed house unconscious and brought to an emergency department with a 106-degree temperature. She later recovered. In New York, a 62-year-old man with a history of cardiovascular disease went for a drive only to be found five hours later in his parked car. Unconscious and with a temperature approaching 108, he died two days later.

When it's hot, it's hot
Links
See related content

"I'd never seen anybody quite so heatstroked out," said Paolo Coppola, MD, medical director of emergency services for Brookhaven Hospital in Patchogue, N.Y., who treated the 62-year-old patient. "This guy had sat in an oven and baked for five hours."

As things heat up, physicians are dealing with their first heat-related casualties and advising others to keep cool. For some patients, the message is that certain medications they take could make them more susceptible to heat-related illness. But for others -- those most vulnerable to the heat, such as the elderly -- the advice is to switch on the air conditioning. If they don't have it, they should be urged to take frequent showers or to get to someplace like a mall or library for at least a little while every day to give their bodies a break. Doctors are also reminding parents not to leave kids in the car and amateur athletes to keep drinking fluids and take frequent cooling breaks.

"The best treatment for heat illness is prevention," said Michael Barrow, MD, a sports medicine and family physician at Samaritan North Family Physicians in Dayton, Ohio. "You want to talk to patients about drinking plenty of fluids, but also about getting out of the heat."

Despite words to the wise, doctors still see the weekend warriors who, after a week in air conditioning, spend all Saturday and Sunday outdoors -- ending up with heat exhaustion.

During heat waves, Chicago agencies check on those at highest risk.

People are often sickened or killed by the heat because their judgment is clouded by dementia, alcohol or drugs. Sometimes they're too young to do anything about it, such as children left in vehicles.

The elderly, particularly those who are isolated, often fall victim to the rising mercury. Sometimes, it is elder neglect.

"The children of the patient were completely ignoring the fact that this lady was in an un-airconditioned house and wasn't able to take care of herself," said Allan Griffith, MD, medical director of Prairie Emergency Group in Bloomington-Normal, Ill.

The public health system plays a critical role in reaching people in danger, to avoid repeating the tragedies of previous years, such as Chicago's summer of 1995, when hundreds of people died after days of unrelenting high temperatures.

Learning from that experience, Chicago implemented an extreme weather operations plan. When the heat goes up, city agencies send out staff to conduct "well-being" checks on those most at risk. The city extends hours at senior citizen centers and provides transport to them, disallows water service cutoffs for nonpayment and disseminates survival tips.

"The city's response has dramatically changed," said John L. Wilhelm, MD, MPH, commissioner of Chicago's department of public health. "A lot of it is outreach, messaging and knocking on doors and encouraging the public to do the same. Government can't do it all, and we're encouraging people to look out for your elderly neighbor and relatives."

It seems to have worked. According to a paper published this month in the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report, the heat wave of 1999 had far fewer deaths than the one in 1995, although officials concede that may also be due to differences in the severity of the two heat waves.

"The heat wave of 1999 was not nearly as intense or protracted as 1995, but the steps they took appear to have made a difference," said George Luber, PhD, one of the authors of the paper and a CDC Epidemic Intelligence Service officer. "Although it's difficult to exactly identify what worked because of the differences in the meteorological conditions."

ADDITIONAL INFORMATION:

When it's hot, it's hot

Factors most likely to increase the risk of heat-related illness and death include:

Experiencing several days in a row of a high heat index
Being elderly and isolated
Having a cardiovascular condition
Drinking alcohol or using illicit drugs
Taking certain prescription medications that can reduce the body's ability to sweat
Not yet being acclimated to the heat
Engaging in heavy physical activity without taking a break or drinking fluids

Source: Centers for Disease Control and Prevention

Weblink

"Heat-Related Deaths -- Chicago, Illinois, 1996-2001, and United States, 1979-1999," Morbidity and Mortality Weekly Report, July 4 (www.cdc.gov/mmwr/preview/mmwrhtml/mm5226a2.htm)

"Heat-Related Deaths during the July 1995 Heat Wave in Chicago," New England Journal of Medicine, July 11, 1996 (content.nejm.org/cgi/content/short/335/2/84)