Extreme Heat: A Guide for Health Professionals & Patients
Author: Todd L. Sack MD FACP

Heat kills more Americans than floods, hurricanes, tornadoes, and earthquakes combined. This is why health professionals and their patients should know the dangers of heat and know the signs of heat exhaustion. Doctors and nurses can advise patients on how to be protected from heat’s dangers. This short essay explains this and includes links to free waiting room brochures, posters, free CME opportunities, and PowerPoint slide sets from My Green Doctor.

When thinking about climate change, what comes to mind first is warmer temperatures. The average world temperature has risen about 1.2° F. (0.8° C.) over the past 140 years. That may not sound like much, but the more complete story is that the warmer temperatures are causing greater fluctuations in the weather. There are more extremely hot days in summer and more very cold ones in winter. The warmth causes more evaporation of ocean water into the air and into the clouds so there is higher humidity and greater rainstorms. The heat intensifies wind speeds to produce stronger tornadoes, hurricanes, and cyclones.

Very hot days and high humidity create health risks. People who are unaware of these risks can be overcome by weakness and dehydration, a condition called “heat exhaustion” or “heat stroke”, which is treatable but often fatal. The good news is that it is easy for health professionals to identify their patients who are at risk, make them aware of the dangers, and advise them on how to stay safe.

Who Is At Risk?
The most vulnerable are young children, athletes, people who work outdoors, the elderly, and those with cardiac or respiratory conditions. It is common for tourists to collapse with exhaustion caused by heat when they do not take the appropriate precautions. Certain medications make patients vulnerable, particularly diuretics and anti-hypertensives. Women in late pregnancy must be especially cautious.

The Health Effects
The health effects run a spectrum from muscle cramps (“heat cramps”) and weakness in the early phase of heat illness, to heat exhaustion, collapse, and death in the advanced stages. The early warning signs are muscle cramps, intense sweating, headache, nausea, dizziness, and weakness. Any of these symptoms on a hot day require the person immediately to rest, ingest oral fluids, and seek a cool shelter. If unimproved in thirty minutes, the person should be taken to a clinic or emergency for evaluation, for intravenous fluids, and perhaps for further treatment.

Air pollution is worse on hot days.  This is because heat increases the chemical conversion of air pollution to dangerous ozone which is highly stressful on the heart and lungs. In addition, people rely more on their air conditioners to cool buildings when the temperatures rise, and so more fossil fuel must be burned to create the electricity that is needed to power air conditioners. All this means more air pollution, asthma attacks, breathlessness, angina, and heart attacks on hot days.

Taking Precautions

Be aware of the weather forecast every day.
Be familiar with the signs and symptoms of heat exhaustion.
When outdoors, limit physical exertion, take water with you, stay in the shade, and wear a hat & light-colored, loose clothing.
Drink plenty of non-alcoholic, non-caffeinated fluids; eat lightly.
When indoors, close the curtains and blinds to keep out sunlight; take cool showers and baths.
Use air conditioning and fans.
Have a plan for where your family and you will go for safety if your air conditioner fails on a hot day.
Establish a “buddy system” so that someone will help you if necessary.

Health professionals can be powerful voices to advocate for effective public health planning by town and city leaders.  There is a lot that government should do to protect communities:

Expand local green spaces and plant more trees to reduce urban heat islands.
Paint surfaces white, such as roofs, asphalt, and parking lots.
Establish heat monitoring and public warning systems.
Create communication systems to reach vulnerable individuals during a heat crisis.
Set up local cooling centers and provide transportation to these centers.
Create social support networks of neighbors and relatives to protect vulnerable populations.

Resources on Heat Illness Found at My Green Doctor
Posters: We provide seven colorful, one-page posters that you can print on your office printer (8” x 10” or larger) to display in the patient waiting room and in examination rooms. The topics include the symptoms of heat-related illness and tips for staying safe. These are provided in English, Chinese, and Spanish: https://www.mygreendoctor.org/resources/waiting-room-posters/ .*

Waiting Room Brochure: My Green Doctor offers an excellent, easy-to-read waiting room brochureSurviving Extreme Heat for patients to help them understand the risks of extreme heat and how to protect themselves: https://www.mygreendoctor.org/resources/waiting-room-brochures/. This can be printed in color or in black & white.*

Continuing Medical Education:  My Green Doctor provides links to free CME lectures on the facts of extreme heat and guidance on how to protect your patients, provided by the Medical Societies Consortium on Climate Change & Health: https://www.mygreendoctor.org/free-education-credits/.*

PowerPoint Slide Sets:  My Green Doctor shares, with permission, the slide sets from two outstanding lectures on extreme heat. These slides will help you prepare your own talks for colleagues, staff, trainees, and patients: https://mygreendoctor.org/powerpoint-slides/. *

  Author: Todd Sack is Executive Director of the My Green Doctor Foundation, an environmental sustainability practice management service for healthcare practices. My Green Doctor partners with fourteen health professional societies to provide My Green Doctor as a free money-saving membership benefit. Please register today and explore: https://www.MyGreenDoctor.org or https://www.MyGreenDoctor.es (Espanol).

Photo credit:
Sun: www.istockphoto.com

*Resources Credits:
My Green Doctor thanks the following individuals and organizations for sharing generously:

Posters:
Dr. Robin Cooper
The Climate Psychiatry Alliance
University of California San Francisco
Zuckerberg San Francisco General Hospital

Waiting room brochure:
Health Care Climate Council (www.noharm.org)
Continuing Medical Education:
Mona Sarfaty MD MPH FAAFP
Mary L Williams MD
Rhonda McCarthy MD MPH FACOE
Medical Societies Consortium on Climate Change & Health

PowerPoint Slide Sets:
Rhonda McCarthy MD MPH FACOE
Physicians for Social Responsibility (www.psr.org)

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