Heat – Recognizing the Risks, Prevention and Treatment
Are you living in or going to a hot climate with friends or family? If so, this brief article may help keep you all safe.
Living in Santa Fe, New Mexico, USA it is getting cooler, the first freeze scheduled this week. The last time I had heat exhaustion was while visiting Bangkok, Thailand, during a winter holiday from Alaska many years ago. It was February then, there had been five months of winter in Alaska and it was still hitting 40 degrees below Fahrenheit. My wife and I were pleased to get away to a hot, humid place for a couple of weeks. In Bangkok, we were walking around looking at the Buddhist temples when I started feeling some leg cramps. Shortly after, I started feeling weak and a bit dizzy while walking up some stairs during the mid-day sun. I didn’t think it was anything to be alarmed about. As a physician you would think I would know better, but having lived in Houston, Texas, I thought I was acclimatized and could not only tolerate but enjoy the heat. I was sweating a little more than usual, and I had to pause going up the stairs. My legs felt like rubber, I was light-headed, and I then I realized I needed to get out of the sun. By this point, I had already had at least four symptoms of heat exhaustion and was headed for heat stroke.
This short article is for all of you with plans to travel to a warm climate to get away from the cold. It is also for those of you living in Phoenix where it hits 102 degrees Fahrenheit, even in October, and for all you in Cairns, QLD, Australia. It’s also for anyone living in or visiting a climate that gets hot. And yes, all of this is worse with Climate Change—2023 being the hottest year on record. People working outside in the sun need to take special precautions. Incidentally, at this time of year airline travel is not recommended unless essential, because of the CO2 carbon footprint and its effects on the planet. Perhaps try a winter holiday closer to home and bundle up for skiing or snowshoeing or sitting by a warm fire with a good book.
Heat alone can be dangerous and more so when combined with other factors such as humidity, dehydration or the (limited) amount of water you have in your body. The level of heat-generating exercise you are doing is also very important to make note of. There are also certain medications and other medical conditions such as kidney disease, diabetes, or underlying heart conditions all of which make us more susceptible to heat, as does age. What may have been fine for you five years ago may not be today.
In what follows, I will outline the different heat related conditions, I will list the symptoms in parallel so you can compare the two, and I will describe different situations and offer some solutions. This article will provide guidance on dealing with heat conditions, and, most importantly, offer preventative measures and directions on how to stay healthy in hot climates.
Heat Exhaustion and Heat Stroke
Heat exhaustion is an urgent but not necessarily dangerous condition if treated immediately. Unfortunately, heat exhaustion can quickly turn into heat stoke which is life threatening and demands emergency care. Remember, heat is the weather condition responsible for more deaths than any other weather-related cause; more people die from heat stroke every year than from floods, hurricanes, or cold spells.
It is important to know that heat can strike nearly any place in the world. Heat domes can settle over an area which lock in the heat, keeping it hot night and day for weeks and even longer in areas such as Phoenix, Mexico, or Australia. Approximately 400 people died from heat related conditions during a heat dome over Vancouver, BC, Canada the summer before last with record breaking heat for the area (in 2022).
The body has ways of keeping our temperature stable—around 98.6 degrees Fahrenheit or 37 degrees Centigrade. It is regulated by the hypothalamus, a structure in the brain. When the hypothalamus senses you are too cold or too hot it sends signals to your body to correct the temperature. If you’re too cool, your muscles will be activated and you may start to shiver to warm up the body. When you are too hot, you will begin to sweat and your blood vessels in your skin dilate, you may look flushed, and you cool yourself. However, when your body’s capacity to cool itself is exceeded because it is too hot, you can develop heat exhaustion. And, if left untreated, heat exhaustion can then lead to a very dangerous condition causing heat stroke. If heat stroke is not treated it can lead to death.
If you are in a hot environment and your body is unable to compensate you may be prone to heat exhaustion or heat stroke. The following list will help you assess your level of risk .
Heat Exhaustion Heat Stroke
- Core body temp 37-40 C (98.6 to 104 F) - Over 40 degrees C or 104 degrees F
- Flushed face and sweating - Hot, dry skin
- Low blood pressure - Irregular pulse
- Nausea and vomiting - Nausea and vomiting
- Leg cramps - Seizures
- Anxiety and confusion - Irritability, confusion, and coma
- Headaches - Rapid breathing
- Water on lungs
- Liver and/or kidney failure
- Multiple organ failure
There are situations that can make you more susceptible to heat conditions. Below, we describe the situation on the left and offer solutions on the right.
Situation Solutions
You’re in a hot environment, with or Seek out air conditioning, cool areas, and
without humidity. Cool water.
You have not consumed much water; Drink water, and ensure you drink
You lack enough fluids in your system. water on a regular basis.
You’ve been exercising in the heat; you’ve Take frequent breaks, try to minimize the
engaged too much physical activity. the intensity of physical activity in the heat
You’re in direct sunlight. Utilize shade, wear hats, wear long sleeves and/or long, loose clothing.
You’re not used to the heat. Take several days to acclimatize, gradually.
You are taking medications. Check with your physician or pharmacist about heat exposure and how to stay safe.
You have a medical condition such as diabetes or Consult with your physician or a medical
kidney disease, or you are of an advanced age. practitioner about heat exposure and how to stay safe.
If you, or an acquaintance, are experiencing symptoms of heat exhaustion do the following:
· Get out of the heat and find shade and cooler areas.
· Drink cool water.
· Use a cool mist, spraying it on your body.
· Place cool towels on your forehead, neck, arm pits and groin.
· If your body temperature is still hot after 30 minutes, seek medical attention.
There is no clear division between heat exhaustion and heat stroke, so if heat exhaustion is becoming worse seek immediate medical attention.
If you recognize someone is having a heat stroke, treat it as an emergency. Emergency First Aid measures should be taken:
1. Deal with any acute emergency while you have someone call 911.
2. Follow the ABCs: Airway, Breathing, Circulation. Make sure their airway is open, make sure that they can and are breathing, and check to see if they have a pulse.
3. If problems start CPR.
4. Move to a cool, shady location.
5. Begin cooling until emergency help arrives with a cool, damp cloth on the forehead, neck, arm pits, and groin.
6. Do NOT give anything to drink or eat.
7. Stay close by and offer reassurance while you await emergency support.
If you are trying to assess whether a particular geographic location is too hot, look for information on the local heat, humidity, and weather. You can check out the heat index chart online at http://www.crh.noaa.gov/pub/heat.htm. This will give you a good indication of what to expect and what to prepare for. You can find additional information at https://www.aafp.org>afp>issues. Or https://www.redcross.org/get-help/how-to-prepare-for-emergencies/types-of-emergencies/extreme-heat-safety.html
We all need to adapt to Climate Change and do whatever we can to slow and mitigate the changes we are having to face.
Feel free to comment, ask questions, and join us. Thank you.
Walk in Beauty
Joe Neidhardt, MD
