Extreme Heat: Protecting Inpatients, Clients, and Ourselves
Prevention and Safety
- People with chronic medical and psychiatric conditions are more prone to heat stress.
- Air-conditioning is the number one protective factor against heat-related illness and death. During conditions of extreme heat, spend time in locations with air-conditioning.
- Listen to local news and weather channels or contact the DPH during extreme heat conditions for health and safety updates
- Drink cool, nonalcoholic beverages and increase fluid intake, regardless of activity level.
People suffer heat-related illness when their bodies are unable to compensate and properly cool themselves. The body normally cools itself by sweating. Certain psychiatric medications impair this critical physiological function. Furthermore, under some conditions, sweating just isn't enough for any of us. In such cases, a person's body temperature rises rapidly. Very high body temperatures may damage the brain or other vital organs.
Several factors affect the body's ability to cool itself during extremely hot weather. When the humidity is high, sweat will not evaporate as quickly, preventing the body from releasing heat quickly. Other conditions related to risk include age, obesity, fever, dehydration, heart disease, mental illness, poor circulation, sunburn, and prescription drug and alcohol use.
Because heat-related deaths are preventable, we need to be aware of who is at greatest risk and what actions can be taken to prevent a heat-related illness or death. Our inpatients and clients with mental illness and chronic diseases are at highest risk, along with the elderly and the very young. However, even young and healthy individuals can succumb to heat if they participate in strenuous physical activities during hot weather.
Air-conditioning is the number one protective factor against heat-related illness and death. If an apartment or residential setting is not air-conditioned, people can reduce their risk for heat-related illness by spending time in public facilities that are air-conditioned, such as malls, libraries, or community shelters set-up specifically for this purpose.
Conditions of extreme heat are defined as summertime temperatures that are substantially hotter and/or more humid than average for the location at that time of year. Humid or muggy conditions, which add to the discomfort of high temperatures, occur when a "dome" of high atmospheric pressure traps hazy, damp air near the ground. Extremely dry and hot conditions can provoke dust storms and low visibility. Droughts occur when a long period passes without substantial rainfall. A heat wave combined with a drought is a very dangerous situation.
To protect people when temperatures are extremely high, remember to keep cool and use common sense. The following tips are important:
During hot weather we need to increase fluid intake, regardless of activity level. Don't wait until thirsty to drink. Encourage inpatients and clients to drink cool water, and have it available at all times. Discourage heavy exercise in a hot environment.
Warning: If a doctor has limited the amount of fluid a client/inpatient should drink, check with him/her and ask how much they should drink while the weather is hot.
Don't drink liquids that contain alcohol or large amounts of sugar-these actually cause a loss of body fluid. Also avoid very cold drinks, because they can cause stomach cramps.
Heavy sweating removes salt and minerals from the body. These are necessary for the body and must be replaced. A sports beverage can replace the salt and minerals people loose from profuse sweating. However, if you are on a low-salt diet, talk with your doctor before drinking a sports beverage or taking salt tablets.
People should choose lightweight, light-colored, loose-fitting clothing. Sunburn affects the body's ability to cool itself and causes a loss of body fluids. It also causes pain and damages the skin. Our clients are especially susceptible to sun burning. When going outside, wear a wide-brimmed hat (also keeps us cooler) along with sunglasses, and put on sunscreen of SPF 15 or higher (the most effective products say "broad spectrum" or "UVA/UVB protection" on their labels) 30 minutes prior to going out. Continue to reapply it according to the package directions.
Try to limit outdoor activity to the morning and evening hours. Be sure to rest often in shady areas so that the body's thermostat will have a chance to recover.
If not accustomed to working or exercising in a hot environment, start slowly and pick up the pace very gradually. If exertion in the heat makes your heart pound and leaves you gasping for breath, STOP all activity. Get into a cool area or at least into the shade, and rest, especially if you become lightheaded, confused, weak, or faint.
Stay indoors and, if at all possible, stay in an air-conditioned place. If your home does not have air conditioning, go to the shopping mall or public library-even a few hours spent in air conditioning can help your body stay cooler when you go back into the heat. Call DPH and learn about any heat-relief shelters in the area. Electric fans may provide comfort, but when the temperature is in the high 90s, fans will not prevent heat-related illness.
Encourage clients and inpatients to take a cool shower or bath. Tell clients living independently to use their stove and oven less often to maintain a cooler temperature in their home.
When people are outside in the heat, use a buddy system to have each partner monitor the other. Heat-induced illness can cause a person to become confused or lose consciousness.
Inpatients should be checked (by nursing staff) twice during the day shift and once during evening and night shifts and clients in the community (by phone) should be checked on twice a day during a heat wave.
Although anyone at any time can suffer from heat-related illness, some people are at greater risk than others.
- People who are physically ill, especially with heart disease or high blood pressure, or who take certain psychiatric medications, may be affected by extreme heat.
- People who are overweight may be prone to heat sickness because of their tendency to retain more body heat.
- People 65 years of age or older may not compensate for heat stress efficiently and are less likely to sense and respond to change in temperature.
- People who overexert during work or exercise may become dehydrated and susceptible to heat sickness.
Remember to keep cool and use common sense:
· Avoid hot foods and heavy meals-they add heat to the body.
· Drink plenty of fluids and replace salts and minerals. Do not take salt tablets unless under medical supervision.
· Dress in cool, loose clothing and shade head and face with hats or an umbrella.
· Limit sun exposure during mid-day hours and in places of potential severe exposure such as beaches.
· Do not leave anyone in a parked car.
Even short periods of high temperatures can cause serious health problems. During hot weather health emergencies, keep informed by listening to local weather and news channels or contact local health departments for health and safety updates. Doing too much on a hot day, spending too much time in the sun or staying too long in an overheated place can cause heat-related illnesses. Know the symptoms of heat disorders and overexposure to the sun, and be ready to give first aid treatment.
Heat stroke occurs when the body is unable to regulate its temperature. The body's temperature rises rapidly, the sweating mechanism fails, and the body is unable to cool down. Body temperature may rise to 106°F or higher within 10 to 15 minutes. Heat stroke can cause death or permanent disability if emergency treatment is not provided.
Recognizing Heat Stroke
Warning signs of heat stroke vary but may include the following:
· An extremely high body temperature (above 103°F, orally)
· Red, hot, and dry skin (no sweating)
· Rapid, strong pulse
· Throbbing headache
What to Do
If you see any of these signs, you may be dealing with a life-threatening emergency. Have someone call for immediate medical assistance while you begin cooling the victim. Do the following:
· Get the victim to a shady area.
· Cool the victim rapidly using whatever methods you can. For example, immerse the victim in a tub of cool water; place the person in a cool shower; spray the victim with cool water from a garden hose; sponge the person with cool water; or if the humidity is low, wrap the victim in a cool, wet sheet and fan him or her vigorously.
· Monitor body temperature, and continue cooling efforts until the body temperature drops to 101-102°F.
· If emergency medical personnel are delayed, call the hospital emergency room for further instructions.
· Do not give the victim fluids to drink.
· Get medical assistance as soon as possible.
Sometimes a victim's muscles will begin to twitch uncontrollably as a result of heat stroke. If this happens, keep the victim from injuring himself, but do not place any object in the mouth and do not give fluids. If there is vomiting, make sure the airway remains open by turning the victim on his or her side.
Heat exhaustion is a milder form of heat-related illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids. It is the body's response to an excessive loss of the water and salt contained in sweat. Those most prone to heat exhaustion are elderly people, people with high blood pressure, and people working or exercising in a hot environment.
Recognizing Heat Exhaustion
Warning signs of heat exhaustion include the following:
· Heavy sweating
· Muscle cramps
· Nausea or vomiting
The skin may be cool and moist. The victim's pulse rate will be fast and weak, and breathing will be fast and shallow. If heat exhaustion is untreated, it may progress to heat stroke. Seek medical attention immediately if any of the following occurs:
· Symptoms are severe
· The victim has heart problems or high blood pressure
Otherwise, help the victim to cool off, and seek medical attention if symptoms worsen or last longer than 1 hour.
What to Do
Cooling measures that may be effective include the following:
· Cool, nonalcoholic beverages
· Cool shower, bath, or sponge bath
· An air-conditioned environment
· Lightweight clothing
Heat cramps usually affect people who sweat a lot during strenuous activity. This sweating depletes the body's salt and moisture. The low salt level in the muscles may be the cause of heat cramps. Heat cramps may also be a symptom of heat exhaustion.
Recognizing Heat Cramps
Heat cramps are muscle pains or spasms-usually in the abdomen, arms, or legs-that may occur in association with strenuous activity. If you have heart problems or are on a low-sodium diet, get medical attention for heat cramps.
What to Do
If medical attention is not necessary, take these steps:
· Stop all activity, and sit quietly in a cool place.
· Drink clear juice or a sports beverage.
· Do not return to strenuous activity for a few hours after the cramps subside, because further exertion may lead to heat exhaustion or heat stroke.
· Seek medical attention for heat cramps if they do not subside in 1 hour.
Sunburn should be avoided because it damages the skin. Although the discomfort is usually minor and healing often occurs in about a week, a more severe sunburn may require medical attention.
Symptoms of sunburn are well known: the skin becomes red, painful, and abnormally warm after sun exposure.
What to Do
Consult a doctor if the sunburn affects an infant younger than 1 year of age or if these symptoms are present:
· Fluid-filled blisters
· Severe pain
Also, remember these tips when treating sunburn:
· Avoid repeated sun exposure.
· Apply cold compresses or immerse the sunburned area in cool water.
· Apply moisturizing lotion to affected areas. Do not use salve, butter, or ointment.
· Do not break blisters.
Heat rash is a skin irritation caused by excessive sweating during hot, humid weather. It can occur at any age but is most common in young children.
Recognizing Heat Rash
Heat rash looks like a red cluster of pimples or small blisters. It is more likely to occur on the neck and upper chest, in the groin, under the breasts, and in elbow creases.
What to Do
The best treatment for heat rash is to provide a cooler, less humid environment. Keep the affected area dry. Dusting powder may be used to increase comfort.
Treating heat rash is simple and usually does not require medical assistance. Other heat-related problems can be much more severe.
This information provided by NCEH's Health Studies Branch and was edited by Dr. Foti
This information is provided by the Department of Mental Health