Extreme Heat Events and Public Health er 2haptC 2-2 days andPM10 seemsto more significantly affecttheelderly. Similarly, isgreater anextremeheat during event, onhighPM10 mortality days. The interaction ofheat temperature. andnitrogen oxide (NOx) inthepresencecompounds ofsunlight and ishighlysensitive (VOCs) to ozone matter (PM10) andhighparticulate days. Ozone isformed by ofvolatile thereaction organic There isgrowing are evidence larger that high theeffectsofheatextreme during events onmortality deaths, section, seethenext “Characteristics that increase ofheat-related therisk illnesses.” diseases/conditions that canincrease ofheat-related therisk ofpre-existing description illnessesand and nervous system disorders.and nervous diabetes, respiratoryillnesses,excess amongpeoplewithpre-existing hospitaladmissions, particularly theJuly1995heatin Chicagoduring wave estimated that theheat wave was responsible for over 1,000 particularly affected by PM. particularly respiratory andcardiovascular diseases, andseveral studiessuggest thatandchildren theelderly may be thirst, , headache, nausea,visualdisturbances, weakness, anxiety, confusion, andvomiting. and construction, and adults and children who are performing strenuous andadults childrenand construction, outdoor whoare exercise performing andplay. with short-term increases incardiovascular-relatedwith short-term hospitaladmissionsfor 12UScities. is themostcommon heat-related illness. a heat rash, to life-threatening conditions, suchasheat stroke andultimately death. Heat exhaustion heatExtreme events cancausearange ofhealthproblems from relatively minorhealthissues, suchas health effects. becomes impaired functions andapersonbecomes critical susceptible to adverseto serious perform the bodybecomes challengedto stay cool. When theinternal temperature rises, thehumanbody’s ability The bodyneedsto maintain aninternal temperature properly. of98.6°Fto function When itishotoutside, byHealth issuescaused extreme heat E susceptibility tosusceptibility bronchitis. breathingincluding lungirritation, difficulties, reduced lungcapacity, aggravated asthma,andincreased increased mortality. level ozone formation. increase the risk of experiencing morbidity and/or mortality from extremeheat. and/ormortality increase morbidity ofexperiencing therisk stay cool. The following chapter reviews heat-related that factors orrisk illnessesandthecharacteristics related that increase illnessbecauseoffactors exposure to theextremeheatto and/oraffecttheirability is susceptible to heat-related illnesses, butsomepeoplemay bemore susceptible or ‘at for risk‘ aheat- diseases andcanincrease airpollutants that formation canaffectpeople’s ofcertain health. Everyone a heat rash, to life-threatening conditions, suchasheat stroke. heat Extreme canaggravate somechronic Exposure to extremeheat canaggravate already existing conditions. recommended responses. 2-4 for alistofsomethemedicalconditions attributable to directly excessive heat exposure alongwith Untreated heat exhaustion canprogress to heatstroke, whichcanbefatal. See Table 2onpages2-3and Treatment involves monitoring thepersoninacool, shadyenvironment adequate andensuring hydration. xtreme heatxtreme events cancausearange ofhealthproblems from relatively minorhealthissues, suchas 32 Research indicates astrong association between temperatures above 90°Fandground- 34 Ground-level ozone healtheffects, exposure cardiopulmonary cancause harmful 33 Ground-level ozone andhighair temperatures have beenassociated with 35 38 Populations atto risk ozone exposure includeoutdoor workers inlandscape

30 Another studyfound that elevated airtemperatures were associated 27 Signs and symptoms ofheat exhaustion includedizziness, 37 Exposure to PM canaggravate chronic 29 An analysis ofhospitaladmissions Extreme Heat Toolkit Extreme 31 For adetailed 28

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Chapter 2 2-3 Remove the affected person from person from the affected Remove skin of Minimize exposure heat. area sun. Keep the affected to if Seek medical attention dry. does not improve. rash and apply compressive Elevate limbs. stockings the affected to person from the affected Remove and advise the person to the heat slowly. breathe to all activities, relocate Stop drink and rest location, a cool Seek fluids. containing electrolyte symptoms if medical attention persist. on person gently the affected Lay lots of fluid. the floor and provide Seek medical attention. to all activities, relocate Stop and drink rest location, a cool fluids. It containing electrolyte if to determine can be difficult and stroke someone has heat Ifnot exhaustion. do symptoms or unable not quickly improve, seek medical rehydrate, oral to attention. Safety Tips 1,2,3 • Blockage of sweat ducts in persons • Occurs not who are heat to acclimatized • Increased blood to the skin flow in limbs • Hyperventilation • Respiratory alkalosis • Drinking liquid without electrolytes • Dehydration • Electrolyte deficiency • Increased to the blood flow skin in resulting blood decreased central to the flow nervous system • Drinking liquid without electrolytes • Dehydration • Electrolyte deficiency Causes • Profuse sweating • Profuse Weakness • • Rapid breathing • Dizziness • Nausea/vomiting • Muscle cramps • Normal mentation normal or • Body temperature up to temperature core elevated 104° F • Muscle spasms include • Muscles usually affected thighs and the abdomen, calf, shoulder muscles normal or • Body temperature up to temperature core elevated 104° F • Dizziness • Fainting normal or • Body temperature up to temperature core elevated 104° F • Respiratory problems, such as such • Respiratory problems, difficulty breathing including • Muscular problems, spasms or numbness or tingling of muscles normal or • Body temperature up to temperature core elevated 104° F • Red cluster of pimples • Red cluster • Blisters • Itching on the skin• Red rash usually that on the neck, occur breast chest, and/or groin and in the ankles, feet • Swelling hands normal or • Body temperature up to temperature core elevated 104° F Symptom(s) Heat Heat exhaustion Heat Heat cramps Heat Heat Heat Heat edema Heat Heat rash Heat Table 2: Heat illnesses and their symptoms and their illnesses 2: Heat Table Medical Condition Minnesota Department of Health er 2haptC 2-4 Director inRenville County insouthwestern Minnesota. worse thansomegrowers have 30years,” seeninnearly saidByron Hogberg, Farm Administration Services metropolitan livestock area throughout andkilled thestate. stress animalscausedadie-off onfarm “The 750Excel inJulyof2011left energyhit Minnesota customers withoutpower intheseven-county for Heat Extreme Events.” forvulnerable populationsfactors andrisk extremeheat events, seetheChapter 3, “Preparing Minnesota strategy for preventing negative healthoutcomes from extremeheat. For more information onmapping limited resources to anextremeheat peoplewhoneedadditionalaidduring event andanimportant 2-5.) Identification ofpopulations that are more vulnerable to heatextreme events isuseful for targeting (For aquickreference that increase ofcharacteristics ofheat-related therisk illnesses, see Table 3onpage from extremeheat. and/ormortality that increaseof characteristics morbidity ofexperiencing therisk may have that could Below morefactor isareview putthemat increased thanonecharacteristic/risk risk. ofanindividualto maintainbodytemperaturethe ability normal andstay hydrated. populations Certain person’s Demographic characteristics, social/behavioral risk. factors, andgeography/location may affect Everyone issusceptible to illnessesdueto extremeheat; however, canincrease characteristics a certain Characteristics that increase theriskofheat-related illnesses andsecurity. ambulance services hospitalservices, likeemergency services outages, damageto highways androads, andanincrease strain ontheprovision ofavailable essential additionto extremeheat healthimpacts, events direct In canresult inincreased useofenergy, power Care. 3rd ed. New York: McGraw-Hill. 3 2 1 104˚F. is greater than temperature when thebody usually occuring heat, extreme of exposure to adverse effect threatening, This isalife 2012, from http://www.bt.cdc.gov/disasters/extremeheat/faq.asp Centers for DiseaseControl andPrevention. (2006).Frequently Asked (FAQ) Questions AboutHeat. Extreme Retreived 17, April Zimmerman JL, Hanania NA. (2005). Chapter 111. . In: HallJB, GA, In: Schmidt JL,HananiaNA.(2005).ChapterWood Zimmerman 111.Hyperthermia. LD, eds. Principles ofCritical Platt, M.and Vicario, Rosen’s S.(2010).Heat Illness. In Concepts Medicine: Emergency andClinicalPractice, 7thEd. p1882-3. and above • Oral bodytemperature of104˚F • Nausea/vomiting • Dizziness • Headache skin • Hot, red anddry andstrong pulse • Rapid • Confusion orlossofconsciousness suddenonsetofsymptoms • Often dehydration • Profound high as50% canbeas • Mortality is nolongerintact of bodytemperature regulation• Normal skin diffusion through the to maintain heat isunable • Body electrolyte deficiency • Profound . 40 39 anyone withthesesymptoms Call 911immediately ifyou see to beable tolerate oral fluids. and groin. The personisunlikely axilla, placing ice packsonneck, fanning thepersonvigorously, or the personwithcool water while immersion incool water, spraying shady area. Cool thepersonwith person shouldbetakento acool for first responders, theaffected 104˚F andabove. While waiting and hasabodytemperature of The heat wave that Extreme Heat Toolkit Extreme Chapter 2 2-5 Chronic Chronic 43 Temperatures in parked cars Temperatures 50 Children may be at increased risk increased be at may Children 46,47 In the US between 1998 and 2011, an average In 1998 and 2011, an average the US between 48,49 Additionally, the older the person is the greater the risk the is the greater older the person the Additionally, 41,42 Elderly persons who live alone and/or at or below the poverty or below alone and/or at line Elderly persons who live 44 45 Living in urban areas Lack of air conditioners floor apartmentsLiving in top Living in nursing homes/bedridden Social isolation: persons living alone, especially the elderly Social persons living alone, isolation: the sun to exposure Prolonged of alcohol Use Age-Older old or older 65 years adults: persons younger (including infants) years and Age-Children: ages five children poverty or below persons living at line constraints: Economic with pre-existingPersons health conditions diseases or mental on certain medications Persons • • • • • • • • • • • • Geographic/location factorsGeographic/location Social/Behavioral factorsSocial/Behavioral Table 3: Characteristics that increase the risk of heat-related illness risk of heat-related the increase that 3: Characteristics Table may and geography/location factors, social/behavioral characteristics, Demographic hydrated. and stay temperature normalaffect the abilityto maintain body of an individual characteristics Demographic due to dependency on other people for their care and/or physiological differences, including smaller differences, and/or physiological dependency their care due to people for on other metabolic heat production of more response, thirst blunted surface than adults, body mass to ratio area output. cardiac lower and per pound of body weight : Research identifies children, especially children ages five years and younger (including years and ages five especially children Age-Children children, identifies : Research mortality risk for during a greater hot weather. at as being infants), : Persons 65 years old or older are more vulnerable to negative health outcomes from from health outcomes negative to vulnerable more old or older are Age-Older 65 years adults: Persons adults. than younger events heat extreme Demographic characteristics Demographic are particularly vulnerable to negative health outcomes from extreme heat because of a combination a combination because of extreme heat from particularly health outcomes are negative to vulnerable a growing adults are Older constraints. and economic social isolation, with aging, of factors associated the Minnesota from State and estimates data the 2010 census Using of the population. segment by and older will increase years old predicted 65 the number of people that it is Officer, Demographers 91% in Minnesota 2030. by for a heat-related illness. A person 75 years old has a greater risk for heat-related illnesses than someone than someone illnesses heat-related risk for old has a greater A person 75 years illness. a heat-related for decreased the body’s especially with aging, changes associated Certain old. physiological who is 65 years illnesses. risk of experiencing heat-related adults’ older increase ability thermoregulate, to of 38 children (five days old to 14 years old) died per year from being left in a motor vehicle duringwarmvehicle being left year from in a motor per years old) died 14 to old days (five of 38 children of age. years two under children are than half of the deaths More weather. disease conditions and the use of certain medications also may increase older adults’ susceptibility to susceptibility to older adults’ the use of certain and increase disease conditions may also medications heat. from health outcomes adverse Minnesota Department of Health er 2haptC 2-6 low socioeconomic factors. Economic constraints: Several studieshave amongpeople with demonstrated increased ofmortality risk vehicle. www.nws.noaa.gov/os/heat/index.shtml temperaturesdemonstrating how quickly canincrease car, inaparked seethefollowing website: or opendoorsandwindows to increase circulation. linemight bemore concernedthe poverty aboutsafety andunwilling orunableto seekcooling centers anextremeheat usageduring event. billsfrom increased Persons electricity electricity livingat orbelow increase aperson’s ofheat-related risk illness, seeAppendix B. systems. thermoregulatory withnormal Forinterfering acomplete listofcategories ofmedicinesthat may calcium channelblockersandantipsychotic drugs, makeitdifficult forthebody todissipate excess heat by consequences from extremeheat events. Drugs, suchasdiuretics, anticholinergics, betablockersand Persons medications: Persons medications oncertain are vulnerable oncertain to negative health would helpthemrecognize symptoms oforlimittheirexposure to excessive heat. congestive heart failure,congestive myocardial heart infarction); negative healthoutcomes dueto extremeheat. liver Additionally cirrhosis). personswithmental disabilitiesare illnessorintellectual at increased for risk a personmore vulnerable to extremeheat includeobesity; make apersonmore susceptible to negative healtheffectsfromconditions that heat.make Pre-existing affects thebody’s to ability cool itselforputsadditionalstress onalready compromised systems will peopleat increased for risk putting certain heat-related illnessesandpossiblydeath. Any condition that diseasesormentalPersons healthconditions: Heat canexacerbate withpre-existing existing conditions, medical conditions. death dueto extremeheat possiblybecauseoflimited access places to andunderlying air-conditioned exposure to andrecognize symptoms ofextremeheat exposure. system. addition,alcohol impairsjudgment, In influencing aperson’s to makedecisions ability to limit of heat-related illnesses. Alcoholic beverages cancause dehydration anddepress thethermoregulatory Use ofalcohol: The consumption ofalcoholic beverages extremeheat during events increases therisk to precautions takeextra to stay cool andhydrated. illnesses. These peoplemay beexposed to thesunandextremeheat for oftimeand need longerperiods occupations, likefarming, landscaping, roofing, are and construction, at anincreasedrisk for heat-related Prolonged exposure to sun:People whoare orwork involved inoutdoor activities insporting others. exposure, lesslikelyto leave theirhomesifhot, and/orlesswilling orableto reach outfor helpfrom events. isolationSocial : Persons livingalone, especiallytheelderly, are more vulnerable to extremeheat Social/Behavioral factors evencan increase onrelatively quickly milddays (i.e., inthesun. ~70°F),especiallyifthecarisparked in their homes, Leaving thewindows slightly opendoesnotsignificantly decrease theheating rate. neurological diseases; 67,68 Socially isolated Socially peoplemay belesslikelyto recognize thesymptoms ofexcessive heat 55,56 live in deteriorating and substandard homes, 63 endocrine disorders endocrine (e.g., diabetes mellitus); 54 Persons lineare livingat orbelow lesslikelyto poverty have airconditioners . Never leave children, infants orpetsunattended inaparked 60 65,66 respiratorydiseaseconditions (e.g., COPD, bronchitis); They may beunableto makerational decisionsthat 58 The homelessare at increased for risk illnessesand 59 cardiovascular diseaseconditions (e.g., 57 and may have difficulty paying for higher 64 renal failure; andliver diseases(e.g., 53 For video ashort Extreme Heat Toolkit Extreme http:// 51,52 61,62

Chapter 2 2-7 The 69 According to the 2000 Census, more than half of Minnesota’s population (55%) lives in (55%) lives population than half of Minnesota’s more the 2000 Census, to According 70 For a map illustrating developed places in Minnesota, see Appendix C of Minnesota’s land in Minnesota, places C of Minnesota’s see Appendix developed a map illustrating For 71 urban heat island effect is proportional to the size of the city, but all cities, large and small experience experience and small large but all cities, effect is proportionalurban island city, of the heat to the size the potential by increasing extreme heat health risks from Urban islands can increase the effect. heat elevated to exposed they are length of time that and the to exposed are residents maximum temperatures temperatures. urban areas. : Persons living in long-term care facilities (e.g., nursing homes, nursing homes, facilities (e.g., care living in long-term : Persons Living in nursing homes/bedridden heat-related from risk of suffering increased at bedridden are homes) and/or are group living, assisted and they dependency risk care, due to increased be at others for on persons may These illnesses. regulate affect their abilityto that and take medications underlying medical conditions have frequently their body temperature. : Persons living in top floor apartments are at increased risk of suffering risk of suffering floor apartments living in top at increased floor apartmentsLiving in top are : Persons on the top people who live so that the roof, by Hot air rises and is trapped illnesses. heat-related from temperatures. to higher exposed floors of a building are : Living in houses without air conditioning and/or not having access to air- to access and/or not having : Living in houses without air conditioning Lack of air conditioners During periods of extreme illnesses. the risk of experiencing heat-related increases spaces conditioned on the body’s putting less strain indoor air temperatures, cool and regulate air conditioners heat, thermoregulatory system. cover. : The urban heat island effect is a measurable increase in ambient urban ambient air in increase a measurable island effect is urban heat The : urban areas Living in and other roads, land with buildings, of vegetated the replacement primarily from results and temperature illnesses heat-related for at risk more are Urban dwellers reflecting and infrastructure. heat-absorbing cool off and hotter usually are Urban island effect. because of the urban areas heat dwellers than rural can of a city or more with 1 million people mean air temperature annual The areas. than rural night less at be as high as 22°F. can the difference In evening, the than its surroundings. be 1.8–5.4°F warmer Geographic/location factorsGeographic/location Minnesota Department of Health