As many American cities grow hotter, health care systems are facing heatstroke

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As many American cities grow hotter, health care systems are facing heatstroke

As the hour ticked past three in the afternoon, New Orleans’ French Quarter was devoid of tourists and locals. The heat index was over 105 degrees.

At the city’s main ambulance depot, the concrete parking lot seemed to amplify the sweltering heat, circulating the air like a convection oven. Capt. Yannick Lewis and Lt. Titus Carrier demonstrated there how they can load a stretcher into an ambulance using an automated loading system. Louis wiped the sweat from his brow as the loading arm buzzed and buzzed, lifting the stretcher into the ambulance—a “unit,” in the official terminology.

But mechanical assistance is not the best thing about upgraded vehicles. “The best thing about being assigned a brand new unit is that it has a brand new air conditioning system,” Lewis said.

The new air conditioning is much more than a luxury for hardworking crews. They need extra cooling power to help save lives.

“The most important thing you do in caring for someone is to get them out of the heat, get them somewhere cool,” Lewis said. “So the most important thing we spend our time worrying about in the summer is keeping the truck cool.”

Like much of the country, New Orleans has been mired in a heat wave for weeks. As a result, New Orleans EMS is responding to more calls for heat-related conditions than ever before, Lewis said. During the third week of July, the city’s public EMS crews responded to 29 heat-related calls — more than triple what they handled during the same period last year.

Scientists say dangerous levels of heat — and the stress they put on human bodies and medical systems — are likely to continue to rise. Health systems across the country face serious funding and staffing challenges that could make it difficult to sustain them.

New Orleans EMS is no exception. In April, it reported that it was operating with only 60% of the required staff. The city’s emergency services chief has called for increased funding for higher wages to attract more workers. Local private ambulance services such as Acadian Ambulance Services pay staff between $50 and $70 an hour. The city’s EMS department can’t compete.

Lewis said they are making do with the resources they have and prioritizing one-time costs like new ambulances to help them meet the challenges they face.

“We’re going to provide the care that everyone needs, no matter how hot it gets,” Lewis said. “We’d love to have all the help in the world, but we’re doing the job with what we have right now.”

When a person is exposed to high levels of heat for too long, their core body temperature rises. Once the core body temperature exceeds 100 degrees Fahrenheit, hyperthermia can develop. If not addressed quickly, this can cause an escalating cascade of health problems.

The first stage is heat exhaustion, Carriere explained: “That means you’re hot, you might have a fever, but you also have what’s called diaphoresis, which means your body is sweating, still trying to compensate and to cool. ” You will likely have other symptoms such as weakness, dizziness or headache.

Carriere said if a person can quickly get out of the heat and into an air-conditioned place, they will usually recover from heat exhaustion on their own. Otherwise, their core temperature will continue to rise.

When the internal body temperature reaches 104 degrees, people begin to suffer from heat stroke.

“Once you go into heatstroke, your body stops compensating,” Carriere said. “You stop sweating. You are hot. You are dry. And your organs are actually being fried from the inside out.

When a person stops sweating, it becomes even more difficult for their body to cool down. During heatstroke, people may experience other severe symptoms such as altered mental status, confusion, and a fast, irregular heartbeat. They may even lose consciousness.

Without medical intervention, heatstroke can be fatal. EMS responders begin treatment as soon as they arrive on scene. “We’re going to get them on a gurney, get them into the ward, start stripping their clothes and apply ice packs wherever possible to try to cool them down,” Carriere said.

Once a heatstroke patient is loaded into the ambulance, the crew drives them to a nearby hospital, Carriere said. At University Medical Center, New Orleans’ largest hospital, doctors and nurses will continue efforts to quickly lower the person’s body temperature and replace IV fluids if necessary.

“When the patient gets to the hospital, we will continue that cooling process,” said Jeffrey Elder, medical director of emergency management at UMC. “We’ll put them in a tub of ice water,” and, he added, “we might use mist fans and some cold fluids to bring their body temperature down to a reasonable temperature while maintaining all other bodily functions.”

Lowering the patient’s core temperature as quickly as possible is what will ultimately save their life. One way doctors can speed this up is by burying a patient in ice. In some parts of the country, doctors have placed patients in body bags pre-packed with kilograms of ice. Body bags are particularly useful in these cases as they are waterproof and designed to fit snugly around the human form.

UMC’s emergency room does not use body bags, but during the summer, staff keep ice bags ready at all times.

“On the stretcher, we’re going to use some of the sheets as a kind of barrier,” Elder said. “And while they’re on the stretcher, we’ll just ice them right then and there.” Hospital staff will continue to work to cool the patient until his temperature drops below 100.

Elder said that even though New Orleans always gets hot in the summer, his emergency department treated more heat-related illnesses in 2023 than ever before. Several patients died from the heat. UMC has struggled with staffing challenges since the start of the pandemic, just like many other hospital systems elsewhere. But to prepare for an influx of patients with heat-related illnesses, UMC has prioritized emergency room staffing, Elder said.

Across the country, weather events such as heat waves and heat domes will become more frequent and intense in the future, according to the Centers for Disease Control and Prevention.

“Extreme summer heat is increasing in the United States,” said Claudia Brown, a health scientist with the CDC’s Climate and Health Program. “And climate projections show that extreme heat will be more frequent and intense in the coming decades.”

Healthcare infrastructure will be challenged to support the treatment of patients suffering from extreme heat exposure. In New Orleans, both first responders and doctors say they expect to see more patients with heat-related illnesses.

“We haven’t even gotten to the hottest part yet, which is usually August through September,” Carriere said. “So I expect it to get pretty bad.”

This article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health policy research organization not affiliated with Kaiser Permanente.

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