Sizzling Days Grip Nation; No Public Health Emergency

July 19, 2011— -- As a heat wave bakes vast parts of the Midwest and Great Plains, emergency department physicians at hospitals in those states are pleasantly surprised by light loads of heat-related illness patients.

"Seems that people are finally heeding warnings" about staying hydrated and staying indoors, said Dr. Dave Plummer, an emergency department physician at Hennepin County Medical Center in Minneapolis, where a combination of heat and humidity made it feel like 109 degrees over the weekend.

While he's seen more critically ill patients for heat-related sickness than usual, fewer than expected have come to the ED seeking treatment for mild illness or a seat in an air-conditioned waiting room -- typically par for the course on high-heat days.

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"It's amazing that we've had so little of that," he said — especially in a place like Minnesota, where residents are used to chillier temperatures, making them less able to deal with a heat wave. But Plummer said it may be that Minnesotans have become adept at all forms of environmental protection, applying skills for evading extreme cold to dodging severe heat.

Heeding the Message

Dennis Allin, MD, chair of the emergency department at the University of Kansas Medical Center in Kansas City, said his hospital has seen fewer severe cases of heat sickness than expected for a city whose heat index was pushing 110 -- a fact he also attributed to greater awareness.

But he was cautious that it's "still early in our heat wave." According to the National Weather Service, high temperatures will continue to bare down on the region through the rest of the week.

That's why public health departments across the Midwest are on guard, beefing up health warnings on their websites and taking steps to prevent emergencies. Chicago's deputy health commissioner Jose Munoz issued an extreme heat alert last weekend, telling residents to crank the AC and chug water.

Public health officials in Des Moines, Iowa, have opened more than a dozen cooling centers across the city, including an overnight one, according to Rick Kozin, a spokesperson for the department.

Though it's typical to throw open the overnight center's doors for one or two evenings during any given summer, this time they may stay ajar for a longer stretch of consecutive nights than ever before, Kozin said.

"It's been a long time since we've seen an event like this," he said.

National Weather Service data back up his judgment -- for Iowa and Illinois, the agency called it the "most significant heat wave the region has experienced in at least the last five years." Over the weekend, the heat index was a suffocating 126 degrees in Des Moines.

The overnight cooling centers may be critical, as the combination of relentless heat and humidity that doesn't subside even at night is what can really drive the increased risk of heat stroke and exhaustion, the agency said.

"Each day in an event like this makes it that much harder for people to deal with the next one," Kozin said.

Quick Cooling, Lots of Fluids

Dr. Gary Hemann, co-director of Mercy Medical Center in Des Moines, said he has certainly seen an uptick in heat-related illnesses in his ED, particularly in older patients and those with chronic illness -- as well as in those with substance abuse disorders.

These patients aren't necessarily as aware of how their body is responding to the heat, making them more vulnerable, he explained.

Allin of the University of Kansas said patients with alcohol use disorders are particularly at risk because, besides diminishing awareness, booze also dehydrates.

In any case, the best way to get overheated patients back in shape is intravenous fluid and quick cooling -- which usually involves simple fans.

"It seems old school, but it's the most effective way," Allin said.

Physicians can also apply hypothermia vests, which many EDs now use to prevent poor neurological outcomes in cardiac arrest patients. They're cumbersome, though, and not as plentiful as fans, Allin explained, so most patients get the old remedy.

By the end of the week, the high-pressure system generating the massive blanket of heat will push eastward, sweeping temperatures in the 90s into the mid-Atlantic states by Friday.

Medical centers there are prepping for the potential onslaught, though some have already faced their share of heat-sick patients.

Rochester, N.Y., dealt with about 100 heat-related emergencies related to a weekend air show -- although the temperature was a more mild 85 to 92, according to Manish Shah, associate chair of the ED at the University of Rochester Medical Center: "definitely not as hot as what's coming to get us," he said.

Shah noted a recent commentary in BMJ that made significant headlines last week when it called into question the need to drink eight glasses of water a day.

"Whether that's true or not in the case of normal temperatures, it doesn't apply to extreme ones like this," Shah said. "You may need 10 glasses. You can guzzle water, but you're just going to be sweating it all out."