Heat Waves and the health of our population

By Jennifer Banarez

"Help! I need Help!"
A disheveled, red-faced, soccer coach storms through the emergency room doors carrying a limp, sunburned child.  There were about ten girls behind the coach.  All were wearing their stripped soccer uniforms and gulping down water from the fountain.  Each was just as sunburned as the limp child and covered in dirt from the field.  It was 1:30 PM in July 112 degrees Fahrenheit, the hottest temperature on record so far.

The medical transporters ran over with a gurney “please ma’am, lay her carefully on here and come follow us.” She gingerly put down the child. 
“Coach where am I?
Who is that (she pointed at a wall)
Why does my head hurt so much?”
She leaned over the side and threw up on the ground.
“Please follow us Coach, the doctor will need an account of what happened.”
She turned around “girls stay with Coach W, I will be back.”
As Coach A went through the double doors, she saw a volunteer bring ice-cold jugs of water and cups for the girls to drink.  There was a sign on the wall that said “emergency heat shelter.”  Many others, mostly elderly, were seeking refuge from the blazing sun in the ER waiting room.
 
A whole medical team surrounded the gurney, once she was pushed behind closed curtains. A slew of information about the athlete was being shouted by the team while the doctor addressed the coach.
“Temperature: 105
Skin: red hot and dry
Pulse: strong, rapid.”
“Hello my name is Dr. H, can you tell me what happened today Coach A?”
“I don’t know what happened exactly.  She was complaining about cramping in her legs, but I thought nothing of it because she kept on playing.”
Coach A was looking over at the distressed athlete, as the nurse set up an IV drip for her. 
 
The young athlete was losing fluids.  She had vomited a few times since the cramping began.  The fluids and electrolytes needed to be replaced or her condition would worsen.  Volume and rate of IV drips are dependent on the patients’ age and medical conditions.  It is important to note that if the rate is not carefully monitored, the patient can experience osmotic demyelination syndrome.  This is the result of rapidly correcting hyponatremia. It can result in acute paralysis, dysarthria and possible loss of the pons altogether.
 
“Doctor, we are ready for transport to the body cooling unit.”
The distressed eyes of the coach widened, filled with questions.
 
There are two forms of cooling.  They are categorized as external or internal.  The most commonly used method is external and there are two subcategories; cold immersion and evaporative cooling.  Cold immersion is essentially dunking the patient into a large cool body of water.  It is not unusual to see these tanks available at large outdoor activities, such as football games or endurance races like triathlons.  The drawbacks to this technique lay within the availability of the equipment and the shivering of the patient.  Muscle relaxants, such as benzodiazepines, may be given to reduce this reflex heat generating action, however studies are lacking in its efficacy. 
“We are planning to use the evaporative cooling technique.  What we do is mist the patient with 15 oC water over her entire body. The cooling units are equipped with fans that circulate the warmer air at 45-48 oC.  We will also apply cold packs to her neck, axilla, and groin.  By using these specific temperatures we avoid the major drawback of cold immersion, which is shivering.  Our expected outcome is .31 oC per min cooling rate.”
 
“I do not understand. Why did this happen to her and not my other players?”
 
On a micro level, our cells can only handle so much heat until they undergo apoptosis and that limit is known as the thermal maximum. Afterward, our body releases cytokines and activates interleukins, some of which are infamously associated with the pathway that leads to sepsis.  The higher pulse rate seen in our patient is a compensatory reaction.  The body cannot cool itself through sweating, therefore, the heart rate increases in order to bring more blood to the surface, in the hope of more heat being dissipated.  For us, our major way of exchanging heat with the environment is evaporation through sweating or perspiration.  We are now experiencing record-breaking temperatures and humidity rates.  The results of which are less efficient heat transfer and activation of our compensatory actions, such as more rapid pulse rates. 
As for the other girls not experiencing these symptoms, it is most likely due to their acclimatizing to the rising temperatures.  The physiological explanation of this, is that these acclimatized athletes retain more salt than usual and increased fluid secretion. 
What our young patient here is experiencing is not an unusual consequence of outdoor athletes, however, we also see this in the elderly, military personnel and day laborers like construction workers.
 
“Doctor, she is coming around.”
“Hello Becky, how are you feeling?”
“Okay, my head is a little dizzy.”
The doctor went on to explain her condition, what happened and that her parents were on their way.
 
Doctor H excused herself from the patient’s room and walked towards the nurses’ station.
“I better review this again to prepare for the rest of the summer” the doctor muttered to herself.  She brought up on the computer screen “the national weather service heat index chart.”
She took out Becky’s chart and recorded “diagnosis: heat stroke.”
Then pulled up the environmental public health tracking program and submitted the data.
She compared both tabs on her screen and let out a big sigh.
“We are already surpassing the 28,000 HSI (heat stress illness) hospitalizations from the last decade,” she said to herself.
“How will my patients afford all of these heat-related hospitalizations,” she somberly thought to herself.
Doctor H skimmed over healthcare costs from the last decade.
2002-2009…….heat waves…………premature deaths $5.2 billion……………..illness $179 million……………total health cost by case study $5.3 billion
She pulled up a website that recorded temperature extremes.
WMO (world meteorological organization) survey……… 56 countries …………… highest absolute daily maximum temperature record over the period 1961–2010 …………..2001–2010.
 
“Doctor, how can I make sure this never happens to any of my athletes again?”
 
“Thank you for the question! Here is a pamphlet that will provide you with the step by step guide for what you can do until emergency medical personnel arrive.”  It included steps such as moving the individual out of the heat, immerse the individual in cold water, applying ice packs etc.
 
“Becky, Becky!”
Two flustered adults dressed head to toe in suits hurriedly walked to the nurses’ station and then ran to their daughter’s side.  They showered their daughter with kisses and hugs.  Then quickly turned to vehemently thank the doctor. 
 
“This was never something our parents worried about, doctor what has happened?”
 
Well, the earth itself has been warming and average temperatures are expected to increase by 3-10 degrees Fahrenheit by the end of the century.  This, in turn, has a direct effect on all facets of human health.  
Famed climate scientists Katherine Hayhoe authored a paper and referred to this warming we are experiencing as “unequivocal and primarily human-induced.” There is the increase in heat stress illness rates as we have seen in your daughter, and also increased waterborne diseases, poor air quality and increased diseases transmitted by insects and rodents.
It does not just affect our health, these climate changes affect the very existence of some species.  According to climate scientist Lesley Hughes, what we are living through may alter animal and plant life cycles.  This can lead to a drastic change in species interaction, leading to unforeseen competition and predator-prey relationships.  We are seeing this in birds, marine invertebrates and flying insect populations.    
 
The existence and continuing occurrence of climate change have been supported worldwide by scientists. We must all arm ourselves with the knowledge to protect our loved ones, as well as the planet we love from further climate change disasters. 
 

About the Author
Jennifer Banarez is an international medical school graduate with an undergraduate degree in Biology. She regularly participates in science policy advocacy work and STEM outreach programs. Her interests include sun safety, nutrition, NASA and medicine, particularly the stem cell field and cardiology. 

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