During last summer’s unprecedented heat wave in the Pacific Northwest—when temperatures soared more than 30 degrees Fahrenheit above average—the region lost a staggering number of lives to the record-obliterating weather. Records of so-called “excess deaths” in the two states hardest hit, Washington and Oregon, show that at least 600 more people than usual died—an extraordinary spike, even amid the pandemic, which suggests that the brutal weather killed far more than the roughly two hundred officially counted to date. In Oregon, the scorcher was the second-worst mass casualty event in the state’s history. Adding to the tragedy, death from heat stroke is almost entirely preventable if the condition is quickly identified and rapidly treated, ideally no more than 60 minutes after the onset of symptoms.
Explore This Issue
ACEP Now: Vol 41 – No 06 – June 2022Americans may not appreciate just how dangerous heat waves can be, perhaps because, unlike floods and hurricanes, they don’t create visual spectacles. But, intense heat is already the deadliest weather event in the U.S.—and at least one study, which found that the risk of death from heat stroke increased here by five to ten percent between 2000 and 2006, suggests that the danger for the U.S. population has been on the rise for at least two decades. Moreover, the threat is poised to intensify in the years ahead. As the planet continues to warm, heat waves will become more common and more severe. Despite all this, hospitals everywhere—not just in the Northwest, but around the country, in both urban and rural areas—aren’t adequately preparing for this growing deadly threat.
Who Is at Threat?
Even the healthiest among us is at risk for heat stroke—a condition characterized by core temperatures of 104 degrees Fahrenheit or higher, which leads to death when overheated organs fail. The most vulnerable, however, include infants, children under four, those 65 and older, pregnant women, people with chronic conditions (including mental illness), and the obese. Brutal heat can also exacerbate underlying conditions, like cardiovascular and respiratory disease; it can bring on heart attacks, strokes, and so on. Worst of all, it’s poised to become a frequent mass casualty event—i.e., to cause so many people to get so sick at once that large numbers of patients, all in need of urgent medical care, will overwhelm hospitals and emergency medical systems.
Indeed, that’s what happened throughout the Pacific Northwest during the heat wave. “We’re a Level 1 trauma center, staffed to take on pretty much anything we’re confronted with, but we were over-stressed,” says Jeremy Hess, MD, MPH, an emergency physician with Harborview Medical Center in Seattle, Washington. “A smaller mass casualty event, like a shooting, happens like a bullet. But this one kept going and going. If we’d experienced another day of heat, we would have been in more serious trouble. Our facilities would not have been able to handle it.” His report sounds almost tame compared to a rapid analysis performed by the Centers for Disease Control and Prevention (CDC), which found that heat-related visits to emergency rooms in the Northwestern states were 69 times higher during the heat wave than during the same period two years earlier. For this analysis, Northwestern states include Oregon, Washington, Idaho, and Alaska.
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.
Leaders in emergency medicine need to face up to the new demands our warming world is putting on them. “The heat wave was so far outside of what we thought would happen here,” says Hess, who is also the director of the Center for Health and the Global Environment (CHanGE) at the University of Washington. He worries that next time, scorching heat could hit concurrent with another exceptional disaster—like a “smoke event,” earthquake, or even a wildfire. “This is very much the canary in the coalmine. The health system needs to come together by region and think through these extreme events.”
As the planet we live on continues to change, the dangers to our health will increase.
Among the many deleterious effects of climate change, the growing air quality disaster that wildfires represent is another urgent, burgeoning problem. Health care needs to ready itself. But most immediately—hospitals need to stop losing lives to the heat.
Cecilia Sorensen, MD, is the director of the Global Consortium on Climate and Health Education at Columbia University and associate professor of Environmental Health Science at Mailman School of Public Health and Columbia Irving Medical Center.
Maura Kelly, a health writer, is a special contributor to Annals of Emergency Medicine.
Pages: 1 2 3 | Multi-Page
No Responses to “Intensifying Heat Waves Are Causing Mass Casualty Events”