What to Do?

Because the Pacific Northwest is usually temperate, the region was particularly ill-equipped for such severe weather. But around the country, in both urban and rural areas, hospitals and municipalities need to do more to fortify themselves, not only with additional supplies, but education. Local governments should begin by providing better training for emergency responders. 9-1-1 operators should be on the alert during heat waves for callers experiencing symptoms like hot, red skin; rapid heartbeat; headache; dizziness; nausea; confusion; irritability. Heat stroke often resembles other life-threatening conditions, like stroke and sepsis, so responders should also know which groups are most endangered—including those who work outdoors, as in construction or agriculture; military personnel; and anyone without access to air-conditioning. Taking certain drugs—including psychotropics; medications for Parkinson’s disease that inhibit perspiration; and prescriptions that interfere with salt and water balance, like diuretics, anticholinergic agents, and beta-blockers—also increases risk.  

Anyone who appears to have heat stroke needs to do two things fast and simultaneously: get to a hospital and begin cooling. 9-1-1 operators should advise them so. If someone who has been working outside must wait for an ambulance or car to arrive, they should immediately be moved into the coldest possible spot, either shaded or air-conditioned, and cooled using anything at hand, like water from a hose, or fans blowing on damp skin. Ice packs, frozen vegetables, or cold cans of soda are all materials that can help cool—most efficiently if applied to armpits, groin, and neck. If nothing else, simply wiping skin with dampened cloths or clothing until it is cooler to the touch is beneficial. Cooling should continue en route to the hospital, regardless of how the patient is transported; if by ambulance, emergency medical technicians (EMTs) should begin treating the patient right away—with an infusion of cold fluids, for instance—and shouldn’t skimp on lights or sirens. EMTs may also need to keep new or additional supplies on hand; they may need revamped guidelines for heat stroke treatment, particularly in areas that haven’t historically experienced extreme high temperature. 

Next, 9-1-1 operators and EMTs should call ahead to tell emergency departments that heat stroke victims are incoming. Hospitals should establish new alert systems that prioritize patients as soon as they arrive and ensure they’re treated promptly and effectively. To that end, emergency care managers can work from an evidence-based protocol that one of us, Dr. Sorensen, has developed with colleagues from the medical schools at Harvard, University of Colorado, and University of Southern California. Preparatory options include establishing “cooling units” stocked with resources; investing in fans and ice machines; and making sure that body bags, which can be used to immerse patients in ice and water, are readily available ahead of heat waves. But education needs to improve even among those who work in the emergency room. Staffers needs to be trained so they can move quickly to bring back heat stroke patients—not only cooling them, but monitoring core temperatures, making sure airways remain open, and so on.