MINNESOTA EXTREME HEAT TOOLKIT

Minnesota Climate and Health Program Minnesota Department of Health Environmental Impacts Analysis Unit Acknowledgments

The Minnesota Extreme Heat Toolkit was made possible through funding from cooperative agreement 5UE1EH000738 from the Centers for Disease Control and Prevention (CDC) and the commitment of many individuals who contributed their time and expertise to its development. The information and resources contained within the toolkit benefited substantially from the input of various local and national experts. Two specific groups spent considerable time reviewing content and providing expert feedback into the development of the Extreme Heat Toolkit: the Extreme Heat Training Module Technical Team and the Extreme Heat Toolkit Steering Committee. We would like to acknowledge and thank the participants who provided advice, resources and review of the toolkit: Pam Blixt, Emergency Preparedness Manager, Minneapolis Department of Health and Family Support Aaron DeVries, Medical Director, Infectious Disease Epidemiology, Prevention, and Control Division, Minnesota Department of Health (MDH) Sara Dunlap, Research Analysis Specialist, Site Assessment and Consultation Unit, MDH Amy Evans, Public Health Emergency Preparedness Coordinator, Olmsted County Public Health Services Susan Galatowitsch, Professor, Department of Horticultural Science, University of Minnesota Todd Krause, Warning Coordination Meteorologist, National Weather Service, Chanhassen, MN Wendy Kvale, Public Health Nurse Consultant, Office of Performance Improvement, MDH Janice Maine, Principal Planner, Office of Emergency Preparedness, MDH Geri Maki, Public Health Preparedness Consultant, Office of Emergency Preparedness, MDH Brenda Menier, Public Health Nurse Consultant, Office of Performance Improvement, MDH Ighodalo Collins Omondiagbe, Graduate Intern, Environmental Impacts Analysis Unit Don Sheldrew, Principal Planner, Office of Emergency Preparedness, MDH Peter Synder, Assistant Professor, Department of Soil, Water, and Climate, University of Minnesota David Wulff, Business Continuity Coordinator, Office of Emergency Preparedness, MDH

Additionally, we would like to thank the following reviewers from CDC who provided comments on the final draft: David Hutchins, Environmental Health Scientist, Climate and Health Program Gino Marinucci, Associate Fellow, Climate and Health Program Natasha Prudent, Health Scientist, Climate and Health Program Shubhayu Saha, Senior Fellow, Climate and Health Program

For more information contact: Minnesota Climate and Health Program Minnesota Department of Health Environmental Impacts Analysis Unit 625 Robert Street North PO Box 64975 St. Paul, MN 55164-0975 651-201-4893

[email protected] http://www.health.state.mn.us/divs/climatechange/ June 6, 2012

ii Table of Contents

Acknowledgments ii Table of Contents iii Overview of Extreme Heat Toolkit iv Chapter 1. Introduction to Extreme Heat Events 1-1 Why care about extreme heat events 1-2 Minnesota is warming 1-2 Defining extreme heat events 1-5 Chapter 2. Extreme Heat Events and Public Health 2-1 Health issues caused by extreme heat 2-2 Characteristics that increase the risk of heat-related illnesses 2-4 Chapter 3. Preparing Minnesota for Extreme Heat Events 3-1 Key steps for planning for and responding to extreme heat events 3-2 Developing a heat response plan 3-4 Additional strategies to prevent heat-related illnesses 3-7 Mitigation/adaptation to extreme heat 3-11 Training and resources for extreme heat 3-11 Chapter 4. Definitions 4-1 Chapter 5. References 5-1 Chapter 6. Appendices 6-1 A. Heat index A-1 B. Categories of medicines that may increase the risk of heat-related illnesses B-1 C. Map of Minnesota land cover C-1 D. Draft language for heat response plan/excessive heat annex D-1 E. Exteme heat tip sheet for individuals E-1 F. Data sources for characteristics that increase the risk of heat-related illnesses F-1 G. Mapping 101: Joining census data for beginning GIS users G-1 H. Minneapolis case study maps H-1 I. Olmsted County Public Health Services case study I-1 J. Sample media release J-1 K. Extreme heat resources available online K-1

iii Overview of Extreme Heat Toolkit The purpose of this toolkit is to provide information to local governments and public health professionals about preparing for and responding to extreme heat events. The toolkit is organized into six interdependent chapters. The first three chapters contain the body of the toolkit, while the last three chapters include definitions, references and appendices. The first chapter, “Introduction to Extreme Heat Events,” describes the magnitude of health consequences from extreme heat, changing weather conditions in Minnesota, and the National Weather Service’s definitions of extreme heat. The second chapter, “Extreme Heat Events and Public Health,” discusses health illnesses caused by extreme heat and characteristics or risk factors that increase a person’s risk for heat-related illnesses. The third chapter, “Preparing Minnesota for Extreme Heat Events,” describes key steps in preparing for and responding to an extreme heat event, how to develop a heat response plan, and strategies for preventing heat-related illnesses and deaths.

The toolkit focuses on Minnesota examples and processes and describes practical, implementable steps and strategies to prevent morbidity and mortality from extreme heat at the local level. The toolkit provides several appendices, including a generic heat response plan that can be tailored to meet the needs of a specific location. The toolkit does not describe comprehensive surveillance systems for morbidity and mortality from extreme heat because this would most likely occur only in a few jurisdictions in Minnesota or at the state level.

The goal of the toolkit is to increase Minnesota’s preparedness for extreme heat events, by providing information and resources to local governments and public health departments to create their own heat response plan.

iv Introduction to Extreme Heat Events Chapter 1 1-2 Closer to home, more than700deaths have beenattributed to the1995Chicagoheat wave. not witnessedby aphysician. exacerbate ofexisting medicalconditions, awidevariety thecauseofdeath canbedifficult toestablish if cause ofdeath onthedeath certificate.Becauseheat-related illnessescancausesymptomsvarious and heat onmortality, since itonlycaptures deaths inwhichexposure to excess heat isexplicitly listed asa 14,800 peopleinFrance andabout50,000 peopleinEurope diedfrom heat-related illnesses. waves that have causedacatastrophic numberofdeaths. thehistoric 2003European In heat wave, about with heat-related illnesses is unknown, but likely to be much higher than mortality numbers.with heat-related butlikelyto bemuchhigherthan mortality illnessesisunknown, point temperature. Regarding morbidity, whohave thenumberofpeopleinMinnesota beenafflicted experienced fiveMinnesota separate heatextreme events, oneofwhichbroke several records for dew increasing. is increasing andthenumber ofdays withadewpoint temperature greater than orequalto 70°Fis trendsDecadal assessedby the State Climatology Minnesota’s Office, suggestthat average temperature isgettinghotter andmoreMinnesota humid, whichmay increase thenumberofextremeheat events. iswarmingMinnesota theyears during 2000-2010. in Minnesota the months ofMay through Septemberindicates that 35deaths were attributableto directly extremeheat recordsdeaths andillnessesattributableto extremeheat. Areview for ofmortality deaths in occurring illnesses dueto extremeheat events doesnothave system becauseMinnesota anofficial reporting for heatExtreme events however, occur inMinnesota; numberofdeaths know and the exact itisdifficult to from extremeheat thanfrom hurricanes, lightning, tornadoes,combined. floods, andearthquakes suffer from heatextreme eventsyear inthe every U.S. From 1979 to 2003,more peopleinthe U.S. died Although mostheat-related deaths andillnessesare preventable, asignificant numberofpeopledieand Why care extreme about heat events? E across thecountry, The United Nation News Centre that thisRussianheat reported wave causedabout56,000total fatalities is hoped that Minnesota willexperience feweris hopedthat Minnesota heat-related deaths andillnesses. hydrated anextremeheat during event. As more counties andcitiesbegin to prepare for extremeheat, it extreme heat canbeprevented appropriate by measures taking to ensure that thepublicstays cool and andnonfatal outcomes (morbidity). (mortality) Yet, almost allofthenegative healthoutcomes from Russia experienced aheat wave that causedanestimated 4,824excess deaths inJulyMoscow alone. events have been calledthe “silent killers.” trail damagethat ofinfrastructural continuously reminds peopleoftheirimpact. Therefore, extremeheat compared to otherextremeweather events, suchastornadoes andfloods, andtheydonotleave alasting understood by thegeneral public. heat Extreme events makethenews headlines donottypically The magnitude ofdeaths andillnessesfrom extremeheat andlittle events underreported isoften 1999-2003, about3,442deaths resulted from exposure to extremeheat intheU.S. xtreme heatxtreme events cancauseanumberofhealth-related problems, includinganincrease indeaths 6 likelyaresult ofthecombination ofextremeheat, smog, andsmoke from wildfires. 10 Additionally, thiscount doesnotincludedata from summer2011when 9 3 This count likelyunderestimates thefullburden ofextreme However, inrecent years there have beenseveral notableheat 2

Extreme Heat Toolkit Extreme 8 4 In 2010, In 1 From 5 7

Chapter 1 1-3

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11 The higher the dew point temperature, the greater the amount of moisture in the air. in the air. of moisture the amount the greater temperature, higher the dew point The 15 Temperature increases vary by season, with winters temperatures rising about twice as rising twice about as vary temperatures increases season, with winters by Temperature than the maximum been rising faster have temperatures low’ ‘overnight Minimum or has the temperature the early 1980s, Since vary increases geography. by Temperature risen slightly over 1°F in the south of Minnesota to a little over 2°F in much of the north. 1°F in the south of Minnesota a little over to risen over slightly fast as annual average temperatures. fast as annual average temperature.

1. 2. 3. Also, Minnesota has observed an increasing number of days with high dew point temperatures. The The temperatures. Minnesota with high dew point has observed number of days Also, an increasing it to for pressure constant at which the air must be cooled to is the temperature temperature dew point saturated. become Exact predictions vary with the choice of climate model, assumptions about emission changes, and other Exact assumptions about emission changes, predictions vary model, of climate with the choice to pointed consistently model projections have climate of these differences, Regardless model parameters. in Minnesota in the future. temperatures increased Some people may be more familiar with the term ‘relative humidity’ to describe the amount of moisture describe of moisture the amount to humidity’ ‘relative familiar with the term be more Some people may temperature a specific in the air at vapor of water humidity of the amount is the ratio Relative in the air. temperature), dew point (e.g., temperature that hold at the air could that the maximum amount to There are three significant trends in this overall warming: overall in this trends significant three are There The chart below shows Minnesota’s annual average temperature (red line), which demonstrates the the which demonstrates line), (red temperature average annual chart Minnesota’s The shows below (blue temperature average running and the 10-year year, to year from wide fluctuationtemperature in in trend an upward shows temperature running average 10-year The 2010. to 1890s the late stars) from starting in the 1980s. temperature Climate change projections developed by various researchers concur with the observed trends. Climate Climate with the observed concur trends. various researchers by change projections developed Climate 2069. 2-3°C (3.6-5.4°F) by in Minnesota from will increase temperatures future models project that Minnesota Department of Health Chapter 1 1-4 convection andconduction. cool themselves. The humanbodycools itselfthrough four different mechanisms: radiation, evaporation, point temperaturespeople’s impact directly andhumidity itmore healthbydifficult making forpeople to that are to harmful humanhealth,seeAppendix A. health. For amore oftheheat detaileddescription index andcombinations oftemperature andhumidity temperature. ishigh,theairtemperatureWhen humidity canbelower andstillnegatively affecthuman heat index usesairtemperature andrelative to determine how humidity humansperceive ambient dewpoint andairtemperaturesHigh combine to create dangerous conditions for human health. The themselves. humidity, perspiration doesnotevaporate which ofpeople reducesto theability easilyofftheskin, cool the perspiration evaporates into theair, cooling thebody. When evaporation isinhibited by additional One ofthemaincooling thesummerisevaporation. mechanismsusedduring The bodyperspires and usually abetter measure ofhow humiditfeels outside. (i.e., theairissaturated). thesummer, During thedewpoint temperature, nottherelative humidity, is temperature. When thedewpoint temperature equalstheairtemperature, therelative is100% humidity for thesameamount ofwater vapor. The dewpoint temperature isalways lower thanorequalto theair of relative iftheairtemperature humidity changes;whereas, thedewpoint temperature willstay thesame these areas willconsider dewpoints above oroppressive. 75°Fextremelyuncomfortable feel whenthedewpoint temperature uncomfortable reaches between 65and69°F. inhabitants of Most People accustom to continental climates (e.g., andMidwesternersgenerally)begin often to Minnesotans expressed asapercentage. 16 Source: Dr. Seeley, Mark Climatologist, University ofMinnesota 19 The sameamount ofwater vapor intheairwillyieldadifferent percentage See Chapter See 4, “Definitions,” ofthe for adescription four mechanisms. 18 Extreme Heat Toolkit Extreme 18 Higher dew Higher Chapter 1 1-5 On that same day, the same day, On that 20 Definitions of an extreme heat event can Definitions event extreme of an heat 23 The only other spot in the Western Hemisphere with a dew point temperature in the 80s that day day in the 80s that temperature with a dew point Hemisphere Western only other spot in the The The report surmised that the health impacts of increased days with hotter temperatures are likely are temperatures report with hotter The surmised the health impacts days that of increased 21 22 Researchers of a report focusing on predicting climate changes in the Great Lake region ran a global a global ran Lake region changes in the Great of a report on predicting climate Researchers focusing climate The 2100. through Lakes region extremes in the Great temperature estimate model to climate with the period, throughout increase each summer would of hot days the number that model predicted 90°F exceeding days decades of the century 40 or more experience during the last few likely to years many (32°C). was in the Amazon Jungle in South America. in the Amazon was Based on observed and predicted trends, extreme heat events have a high probability of occurring more of occurring a high probability more have events extreme heat Based on observed trends, and predicted in and cities counties many events, in extreme heat in Minnesota. the likely increase Despite frequently the impact heat of extreme Lessening events. heat deal with extreme to Minnesota not prepared are public about the health of public health officials and the general the awareness improving requires events and notification extreme heat effective implementing and developing and risks events of extreme heat plans. response to be greatest in urban areas, especially in cities such as such as Minneapolis/St. Paul, where extremely where especially in cities such as such as Minneapolis/St. Paul, in urban areas, greatest be to rare. been historically have high temperatures How hot it feels depends on location, time of year, and the interaction of multiple meteorological variables of multiple meteorological and the interaction time of year, depends on location, hot it feels How have likely to earlier in the spring are temperatures wind). Hotter cloud cover, humidity, temperature, (e.g., in the summer because people have later detrimental health impactsmore than the same temperatures the warmer temperatures. adjust to gradually not had time to Extreme heat events are characterized by weather that is substantially hotter and/or more humid than and/or more hotter is substantially that weather by characterized are events Extreme heat the Given a particular for a particular at location especially in the spring and summer. average time, versus the example, for Paul, Minnesota (45°F), St. in temperatures annual average between differences in event an extreme heat see that (61°F), it is easy to Georgia in Atlanta, annual temperatures average in Georgia. event as an extreme heat Minnesota not register might Defining extreme heat events heat Defining extreme Prior to 2011, the highest dew point temperature ever recorded in the Twin Cities was 81°F on July 30, was Cities Twin in the recorded ever temperature point 2011, the highest dew to Prior Cities. Twin 82°F in the reached temperature 2011, the dew point 1999. On July 19, The chart “Twin Cities Annual Number of Days Where Dewpoint Temperatures => 70 degrees F” shows shows F” => 70 degrees Temperatures Dewpoint Where Number of Days Annual “Twin Cities chartThe than or greater was dew point the maximum where of days line) of the number line (dashed red the trend of days the number that the line suggests slope of The 2010. 1945 to from Cities Twin in the 70°F equal to per decade. days 0.53 by be increasing 70°F may or equal to than greater temperature with a dew point equal 6PM) (i.e., 1800 hours at a dew point with the numbers of days line suggests that dashed blue The historically were temperatures Dew point per decade. 0.16 days be increasing may than 70°F or greater to collected manually and 1800 hours was was temperature dew point 1800 hours because collected only at dew point. with the highest often time of day the shift based on location and time of year. Thus, definitions of an extreme heat event need to be sensitive to to be sensitive need event extreme of an heat definitions Thus, shift and time of year. based on location the variables important a particular for location. state record dew point temperature was reached in Moorhead, Minnesota with a dew point temperature Moorhead, Minnesota in temperature reached a dew point with was temperature dew point record state of 88°F. Minnesota Department of Health er 1haptC 1-6 algorithms toalgorithms iden weather-based mortality extreme heat event isby usingNWS’s current andforecasted weatheralongwithsite-specific, reports The NWSdefinesheatextreme events differently dependingonlocation. One way theNWSdefinesan communities may Minnesota belocatedsome cases, inanotherstate. theNWSstation serving accordingly.” and warningsare indicated and advisories, watches, increases, such mortality conditions that have ledto to historical meteorological forecast data are compared mortality, ineachlocality. NWS masses, asexpressed by excess ofoppressivehealth impact air on “evaluating thenegative University. The isbased network ofKentScott Sheridan State andDr.University ofMiami Dr. Laurence ofthe Kalkstein basedonworkNetwork by Health Watch-WarningSynoptic Chanhassen office usesthe heat conditions. The NWS warnings dependingontheweather area. Below initsown isamap ofthestations. service EachNWSstation releasesThere Minnesota. heat advisories, are watches, sixNWSstations serving and first crucialsteps inpreventing heat-related andmortality. morbidity responsible foragency the heat response plananddecidingwhento implement theresponse planare the response plan. Timely forecasting ofextremeheat events, transferring theforecast information to the defineheatextreme events howdescribes localjurisdictions ofimplementingfor thepurposes their how theNWSdefinesheatextreme events. Chapter 3, “PreparingMinnesota Heat for Extreme Events,” should beimplemented. The following theNWSstations describes that cover section and Minnesota needto defineanheatextreme eventjurisdictions locally to determine if andwhenaheat response plan needs adefinitionofheatextreme inorder to issueaheat advisory, watch or warning.Second, local anheattwoextreme Defining eventfor isimportant reasons. First, theNational (NWS) Service Weather the heat. not experience areprieve from nighttime hours, andthusdo holding onto heat through the large cities, whichare prone to was mainlycomposed for 25 The network tify e xtreme xtreme Extreme Heat Toolkit Extreme 24 Note that in Chapter 1 1-7 1 Outside Hennepin/ Ramsey Counties Outside Hennepin and Ramsey a heat counties warning is defined as: Maximum index heat 105°F or greater reaches and a minimum heat of 75°F or greater index least 48 hours. at for also A warning may be issued if advisory expected for criteria are in a row. 4 days Outside Hennepin and Ramsey a heat counties is defined as: watch Maximum index heat 105°F or greater reaches and a minimum heat of 75°F or greater index least 48 hours. at for Outside Hennepin and Ramsey a heat counties advisory is defined as: Maximum heat 100°F reaches index and/or the maximum reaches temperature 95°F or higher. In Hennepin/Ramsey Counties In Hennepin and Ramsey a counties warning is defined as: heat Maximum Minneapolis/St. at Paul index heat International Airport 100°F or reaches In addition, least 1 day. at for greater a System, Watch/Warning the Heat must based on research, develop tool A warning a warning. recommend also be issued if advisorymay criteria in a row. 4 days expected for are In and Ramsey Hennepin a counties is defined as: Maximum watch heat Minneapolis/St. at Paul index heat International Airport is expected to or 1 day, for 100°F or greater reach is expected index the maximum heat and an 100°F or greater reach to no cooler temperature low overnight In in a row. 2 days than 75°F for Watch/Warning addition, the Heat a watch. must recommend System In and Ramsey Hennepin a counties advisoryheat is defined as: Maximum Minneapolis/St. at Paul index heat International Airport is expected to or the 1 day, for 95°F or greater reach is expected index maximum heat and an 95°F or greater reach to no cooler temperature low overnight in a row. 2 days than 75°F for National Weather Service (2012) Weather National Excessive Watch Heat Excessive 1 Excessive Warning Heat Excessive issued when an are Warnings Heat Excessive is expected in the next 48 event extreme heat issued when an are statements These hours. is imminent, is occurring, event extreme heat or has a very A of occurring. high probability to posing a threat conditions warning is used for or property. life Heat Advisory Heat issued when an extreme are Advisories Heat is expected in the next event 48 hours. heat issued when an extreme are statements These or has a is imminent, is occurring, event heat advisoryvery An of occurring. high probability is significant cause that less serious conditions for if caution is and, discomfort or inconvenience and/or life to a threat lead to not taken, could property. Excessive Heat Watches are issued when are Watches Heat Excessive heat an excessive for favorable are conditions is used Watch A in the next 72 hours. 12 to event but has increased when the risk wave of a heat and timing is still uncertain. A its occurrence those enough lead time so that provides watch as city such do so, can prepare who need to response plans. heat extreme have officials who Table 1: Definitions of heat watch, advisory, and warning and advisory, watch, of heat 1: Definitions Table The NWS Chanhassen office issues watches and warnings for Hennepin and Ramsey Counties and will and for Hennepin Counties warnings Ramsey and watches issues Chanhassen office NWS The mortality and the projected conditions (derived warning if both meteorological or data a watch only issue of other areas For event. extreme heat an Network) indicate Watch-Warning Health Synoptic the from thresholds a set of temperature issued based on and warnings are Minnesota, watches advisories, heat warnings and watches advisories, definitions of heat for 1 below Table a certain See over period of time. in Minnesota. all other counties and Ramsey Hennepin and Counties for Minnesota Department of Health er 1haptC 1-8 almost 119°F. air temperature of95°F. The combined hotairandhighdewpoint temperatures created aheat index of almost 130°F. Onthat sameday, the Twin Cities experienced anall-timehighdewpoint of82°Fwithan at 88°F.was setinMoorhead The airtemperature was 93°F, creating conditions that madeitfeel like occurred theheat during wave ofJuly16-20,2011.On19,arecord state dewpoint temperature that wereepisodes inMinnesota ofissuingheatorwarnings. worthy advisories The worst heat event recentlyMinnesota broke several heat-related records. thesummerof2011,there During were five heat available onpredicted extremeheat events. andbuildrelationships withtheNWSstaff jurisdiction to ensure receiving themostcurrent information forand/or providing preventing services heat-related illnessesshouldidentify theNWSstation for their Local government staff, public healthprofessionals andotherorganizations inplanning that participate historical meteorological conditions andevidence ofheat-attributable adverse healthimpacts. consider revising itsheat advisory, watchfew andwarningdefinitionsevery years basedonmore current continue toMinnesota to climb, acclimate may to start Minnesotans warmersummers. The NWSmay to andresponsive beapplicableto thelocality As healthimpacts. average to actual temperatures in ofheatextreme Definitions events shouldbe reviewed regularly to ensure that theyare and continue 26 Extreme Heat Toolkit Extreme 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, fatigue, 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 syncope Heat Heat cramps Heat Heat tetany 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 Heat stroke 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. Hyperthermia. 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

Preparing Minnesota for Extreme Heat Events Chapter 3 3-2 and mortality from extremeheat events.and mortality summarizes arange ofstrategies that canbeincludedintheresponse planandusedto prevent morbidity in responding to anextremeheat event andhow to develop aheat response plan. The chapter also and resources. As aresult, localnotification and response plans vary. This chapter discussesthekeysteps events. Notification systems local andplans conditionsand drawreflect upon available local expertise heatExtreme notification and response plansare Minnesotans critical to preparing for heatextreme heat. strategies aretimefor implemented preventing at themostopportune illnessesanddeaths from extreme plan shouldhappenbefore theextremeheat event occurs to ensure that preventive measures and satisfied, andthen,ifthe activates theplan. conditions are oftheheat Activation met, the agency response informationhealth-impact to determine whetherlocation-specific criteria for anheatextreme event are oftheheat response activation trigger plan.Generally, reviews theNWSforecast theleadagency data and needsto are determine ifthecharacteristics indicativeits partners, ofanextremeheat event that could isinformed ofapossibleextremeheatOnce event, theleadagency theagency, incollaboration with Step 3:Assess riskanddetermine ofresponse activation plan information regarding oftheupcoming thecharacteristics event oftheresponse plan. to theleadagency local NWSstation to ensure dailymonitoring ofweather andtransfer conditions detection andearly of involved inplanningandimplementing heat response plansshoulddevelop relationships withtheir heat events are inthesection, described heatextreme “Defining events.” Minnesota jurisdictions All heat advisories, watches orwarnings. andprocesses Definitions used by theNWS to determine extreme theNWSprovidesextreme heat event. Minnesota, weather In forecasts anddetermines theissuance of ensure weather early forecasts extremeheat capableofpredicting conditions afew days inadvance ofan withtheNWSto to develop for partnerships oftheleadagency) section adescription plan (seethenext For successful notification ofanupcoming heat event, ofthe itiscritical response for theleadagency Step 2:Predict extreme heat event andtransfer information to leadagency prevent heat-related illnessesanddeaths, andestablishanevaluation process. should contain acommunications plan,identifyandvulnerable high-risk persons, strategies describe to for theplan,androles activating ofagenciesandorganizations involved withtheplan. The planalso effective response plan. The responsibleresponse planshoulddefinetheleadagency criteria fortheplan, mortality. section, The next “Developing aheat response plan,” theminimumelements describes ofan response planisessential for andcoordinating describing to prevent activities heat-related and morbidity The firststep inpreparing to respond to anheatextreme event is to develop aheat response plan.Aheat Step 1:Create aheat response plan ofeachstep.1 onpage3-3.Below isadetaileddescription The keysteps for planningfor andresponding to anextremeheat event have beensummarized inFigure Key Steps for Planningfor toHeat andResponding anExtreme Event M innesotan’s are more equippedto dealwithsnowstorms andtheextremecold thanextremeheat. Extreme Heat Toolkit Extreme Chapter 3 3-3 the response plan the response and determines activationand determines of Assess risk and determine risk and determine Assess Activate response response Activate heat-related illnesses heat-related characteristics and health impacts

activation of response plan activation of response based on predicted meteorological meteorological based on predicted 3. activates the response plan the response activates 4. • Lead agency, in collaboration with NWS in collaboration agency, • Lead and its partners, reviews activationand its partners, criteria reviews how to prevent and recognize and recognize prevent to how plan and notify the public • Lead agency• Lead supports of notification the public and provides information on information the public and provides vulnerable populations and strategies on and strategies populations vulnerable • If established criteria are met, lead agency• If met, established criteria are Event Extreme Heat Extreme event to the lead agency to event Predict extreme heat event heat extreme Predict of a probable extreme heat event extreme heat of a probable • NWS forecasts weather conditions conditions weather • NWS forecasts • NWS provides characteristics of the • NWS provides 2. within the response plan within the response Implement response plan plan response Implement partners, implements strategies partners, strategies implements accordingly Figure 1: Key Steps for Responding to an Extreme Heat Event* Heat an Extreme to Responding for Steps 1: Key Figure 5. • Lead agency, in collaboration with its in collaboration agency, • Lead A heat response plan should be developed before an extreme heat event. Below Below event. heat an extreme before be plan should developed response A heat Evaluate response plan response Evaluate • Identification of a lead agency responsible for the response plan for the of a lead agencyresponsible • Identification for activatingand deactivating • Defined the plan criteria with the plan roles and activities involved • Defined of agencies and organization partners to information the public before and heat-related communicating plan for • A communications event and during an extreme heat persons of vulnerable • Identification morbidity and mortality preventing extreme heat for from • Strategies plan of the response • Evaluation and updates the response plan the response and updates 1. are the critical elements of a successful response plan. response a successful of the critical elements are Response Plan Elements: 6. * Although this diagram presents key steps in responding to an extreme heat event as discrete steps, actual details and steps, as discrete event an extreme heat to in responding key steps presents this diagram * Although happen plan may the activation determining of the response example, For will varytiming of each step locally. reflect plan should local response The event. simultaneously with notifying the public of an impending extreme heat along with the event, an extreme heat and should clearly to articulate in responding each step and resources conditions of the process. each step implementing for responsible are that agencies and organizations during the event and lessons learned during the event • Lead agency, in collaboration with its in collaboration agency, • Lead partners, reviews and evaluates data collected data and evaluates partners, reviews Minnesota Department of Health er 3haptC 3-4 can be modified and adapted to a local jurisdiction, see Appendix can bemodifiedandadapted to alocaljurisdiction, D. responding, ofvulnerable anddistribution populations. andthetypes For heat response adraft planthat based onavailable resources, geographic location, agenciesandorganizations involved inplanning and should have aheat response plan. The level ofdetailandthenumberstrategies intheplanwillvary fromfor anextremeheat event. preventing orcounty inMinnesota Eachcity andmortality morbidity ofgovernment indetailtherolesplans describe andactions agenciesandnongovernmental organizations coordinate oforganizations theefforts involved inthe response. extreme heat events, at the locallevel. butthiscanvary willactivate theplanandhelp The lead agency Typically, incharge ofresponding management istheleadagency to oremergency ahealthdepartment for implementing theextremeheat: Aleadagency responseLead planshouldbeidentified. agency All PlansShould Response Contain thefollowing Elements: Heat response planshave beenshown to beeffective in reducing heat-related mortality. Developing aheat response plan related illnessesanddeaths inthefuture. heat event. Evaluation for iscritical improvingitmore effective theplanandmaking for preventing heat- Each step ofresponding to anextremeheat event shouldbereviewed andevaluated anextreme after Step 6:Evaluate response plan implementing eachstrategy. agenciesandorganizationsresponse delineate are planshouldclearly whichparticipating responsible for for ofseveralsections detaileddescriptions strategies into theresponse that canbeinserted plan. The The strategies thedemographics shouldreflect andvulnerabilities ofthe community.two See thenext stepThe in fifth responding to anheatextreme event is to implement thestrategies inthe response plan. Step 5:Implement response plan detail withintheheat response plan. public receives consistent andaccurate information. The communications strategy in shouldbedescribed regarding anupcoming extremeheat event shouldbecoordinated withmediaoutletsto ensure the will increase thelikelihoodthat at-risk individualscantakeadvantageAll messages oftheseservices. individuals andlocations. Advance publicnotification aboutthe cooling centers (ifusedasastrategy) themselves andwillenabletheorganizations involved intheresponse to concentrate high-risk onknown strategies to stay cool andhydrated, andplaces to goto cool offwillenable residents to prepare oftheheat apopulationthe risk event by surprise. Notifyingthepublicofanticipated taking conditions, extreme heat event. Effective publicnotificationextreme ofanupcoming heat event helpseliminate heat response plan,thepublicneedsto beinformed ofthetiming, andduration severity oftheforecasted activates theresponse adecisionhasbeenmadeto plan.Immediatelyafter activate theextreme agency Assuming theimpendingheat event meetslocation-specific criteria for anheatextreme event, thelead Step 4:Activate response planandnotifythepublic 73

Extreme Heat Toolkit Extreme 72 Heat response Chapter 3 3-5 : Implementation of a of Heat Response Plan of Heat Minneapolis Department of Health and Family Support Activation SupportMinneapolis Activation Department Family and Health of The Minneapolis Department of Health and Family Support reviews information from the from Support information MinneapolisThe Department reviews Health and Family of heat an upcoming risks assess the health Network for to Watch-Warning Health Synoptic data forecast uses meteorological system health watch/warning heat integrated The event. conditions may forecast when identifies program The a health impact as inputs into model. This mortality deaths. number of heat-attributable the potential in excess and estimates result plan and the Minneapolis activation response determine is used by of the heat to information activitiestype be implemented. will of response that and scope : Criteria for activating deactivating and activating heat extreme an deactivating and for plan : Criteria the for Criteria plan vary between relationship response factors the affect based on location-specific and should be that wind, temperatures, dew point air temperatures, include factors may These and mortality. weather Some last. is expected health public to long the hot weather and how lows, overnight highs and daytime extreme criteria for include health-related that and calculations thresholds departmentstheir own have City the of Minneapolis how for Others below activation. See the box the NWS criteria use for events. heat plan. activation response determines of their heat In addition to messages to the public, information should be provided to organizations/companies that that organizations/companies to should be provided information the public, In messages to addition to include the following: elderly) and may workers, outdoor children, young (e.g., populations at-risk have sports landscape/construction and senior living facilities. businesses, teams/camps, daycares, schools, (see extreme heat) illnesses from prevent to how do (e.g., to on what Messages should include information page 2-3), characteristics 2 on Table illnesses (see of heat-related a tip sheet), symptoms E for Appendix more go for to 3 on page 2-5), and where Table (see extreme heat to vulnerable of persons more radio, including television, a variety of media outlets, through be transmitted Messages may information. : The communications plan needs to articulate communication strategies articulate strategies plan needs to communication communications The plan: Communications should be frequent There plan and with the public. in the response partnersboth between involved plan and other collaborating the NWS, the lead agency between of the response communication in charge for strategies communication the plan should identify Additionally, agencies and organizations. the example, For and during event. an extreme heat before information heat-related communicating extreme heat with other partner should coordinate in coordination organizations, agency, lead response help prepare to event a heat in the spring before communities in their campaigns education/awareness of the dangers of extreme heat. residents and educate Roles and activities of agencies and organization involved with the plan Roles and activities involved of agencies and organization local public agencies (e.g., government between close collaboration plan requires response heat health department,city/county emergency NWS, tribal health departments) management, and non- serve that the community organizations especially and vulnerable organizations, governmental local organizations Engaging Army). Salvation Wheels, Meals on the American Red Cross, (e.g., populations plan will make it the response in planning and implementing populations with vulnerable work that Additionally, in the community. populations the vulnerable for strategies appropriate identify easier to specific to targeted and strategies perform most likely to outreach are successful these organizations involved of all the organizations plan must clearly articulateThe responsibilities and the roles populations. in the plan. Minnesota Department of Health er 3haptC 3-6 township, orunorganized territory). at thecounty subdivisionlevel (e.g., city The datainthestate described mapsar divs/climatechange/extremeheat.html data at: http://www.health.state.mn.us/ Excel spreadsheet that contains tabulat These mapscanbefound onlinewitha vulnerable populations. The suite includesthefollowing resources: MDH created asuite ofresources inlocating theircommunity’s to aidlocalpublichealthdepartments heat-related illnesses,” for more information to oncharacteristics map. be determined before anextremeheat event. thesection, See “Characteristics that increase of therisk the populations reside, sothat appropriate preventative andstrategies actions for thesepopulations can data and/ormapsto summaries identify themostvulnerable populations andwhere intheircommunity the mostvulnerable members ofacommunity. shouldcreate oranotherentity The leadresponse agency pr factors Identification ofvulnerable persons:Quantifying andmappingvulnerable populations andotherrisk heat event andupdated theevent after from usinglessonslearned implementing theplan. Hmong, Somali, German and German Hmong, Somali, Vietnamese. be translated into thetopMinnesota, inaddition fiveto English,whichare languagesspokenin Spanish, the demographics andpopulation ofthearea. For example, translations oftipsheetsfor individualscould internet, offliersandposters. anddistribution Messages shouldbetailored, translated andsensitive to . Alistofdata sources for 2. . Statewide mapsoffive 1. The listlinksthecharacteristics ofheat-relatedthe risk illnesses. “Characteristics that increase identified inthe section factors vulnerable populations andrisk vulnerability characteristics: vulnerability ovide important informationovide for important planningandimplementing appropriate strategies that reach e. Percent ofpopulation d. Percent ofpopulation c. Percent ofpopulation b. Percent ofpopulation a. Percent ofpopulation the poverty level.the poverty living below 200%of level poverty living below the on theright) living alone(seeimage 65 years oldandolder less than5years old 65 years oldandolder . n e ed ” , 74

The communications planshouldbedeveloped before the Extreme Heat Toolkit Extreme Chapter 3 3-7 factors. This resource has been developed for local public health professionals and planners who and planners local public health professionals for been developed has resource This factors. of joining It process the software. some knowledge users through walks of ArcGIS have already The primer on mapping using quintiles. the joined data to display shapefiles and how to data and certain populations vulnerable G. in Appendix risk factors found can be to appropriate data sources. Two types of data sources are referenced in the list: a source that that a source the list: in referenced are types sources of data Two sources. data appropriate to raw contains that source and another level, the county at data summarized/tabulated contains levels, geographic smaller maps or summaries at create to want may lead agencies that for data F. in Appendix can be found sources of data list The tracts. or census such as cities A GIS primer that describes how to use GIS to create maps of vulnerable populations and risk populations maps of vulnerable create GIS to use to describesA GIS primer that how

3. In addition to those essential elements described above, there are more strategies that may be included may that strategies more are there describedIn elements above, those essential addition to every for or appropriate will be feasible strategies plan. Not all of the following response in a local heat the at-risk to tailored and are jurisdiction local resources given utilize any for best strategies The location. in been implemented have that a listing of some of the strategies For within the community. populations a checklist strategies and plan elements 4 on page 3-10, which provides of response Table Minnesota, see Health Services activities performedand demonstrates Public County and the Minneapolis Olmsted by morbidity Support and mortality prevent Department For to extreme heat. from of Health and Family Health Services, see Public County Olmsted and lessons learned by a detailed case study of strategies I. Appendix Additional strategies to prevent heat-related illnesses heat-related prevent to strategies Additional : Response plans should be reviewed and evaluated after an extreme heat event. Modifications after event. an extreme heat and evaluated : Response plans should be reviewed Evaluation continuous ensures This lessons learned and changes in local conditions. plan should address the to challenges or mistakes observed the plan implementing and rectifies any from quality improvement the extreme heat to in responding involved agencies and organizations The events. during previous morbidity and mortality on heat-related Records that should partakeevents process. in the evaluation adjust strategies and used to analyzed also should be collected, during event the extreme heat occurred plan. activating response the heat and/or criteria for In 2011, MDH worked with the Minneapolis Department of Health and Family SupportIn a set with the Minneapolis 2011, MDH worked develop Department to of Health and Family aid with characteristics could that and environmental populations vulnerable help identify of maps to can be found set of maps The morbidity and mortality. heat-related prevent to strategies implementing partnership The important additional factors planning for are helped identify that for H. in Appendix the percentage of public air-conditioned including mapping the locations buildings, events, extreme heat such as nursing homes buildings special residential air-conditioning, units with central of residential geographically and impervious by homes, In one instance, surfacesand group within the community. with where those locations and comparing located buildings are centers/cool cooling where identifying needed additional that places to identify able were staff public health reside, populations vulnerable to easily accessible were that in places or other resources centers cooling site able to and were resources of some of the additional an example provide to Minneapolis meant The maps are riskthe at populations. Local event. an extreme heat for when planning review types be helpful to of characteristics may that for important other the best strategies jurisdictions as they develop characteristics map discover to may their community. Minnesota Department of Health Chapter 3 3-8 owners ofthesebuildingsbefore announcements are madeto thepublicabout visitingthefacilities. Many conditioned buildingsandminimize negative Agreements healthimpacts. shouldbemadewiththe they already frequent, suchasshoppingmalls, libraries andmovie theaters, canincrease theuseofair- with providing cooling centers. Allowing thepublicto congregate freely places at where air-conditioned cooling centers. Appendix Ifor See ofOlmsted experience adescription County Public HealthServices degrees ofsuccessand extend hoursofoperation hashadvarying withopeningpublic : Minnesota Work withthepublicandprivate to allow sector publicgathering at buildingswithairconditioning andfinancial resourcestransportation to reach the center. Providing to free cooling centers publictransportation helpsindividualswhomay have limited access to for environment. individualsto high-risk spendtimeinanair-conditioned increases theopportunity http://www.ada.gov/pcatoolkit/toolkitmain.htm thehoursofoperation. Extending ofthecooling centers be found inChapter 7oftheADA Practices Best Tool forState andLocal Kit Governments accessible andmonitored by appropriate staff.Information onproviding fullaccess to a cooling center can possiblechoosebuildingswithback-upIf generators for cooling centers. Cooling centers shouldbeADA identify anddesignate specificpublicorprivate buildingswithair conditioning asofficial cooling centers. effective meansof reducing aperson’srisk ofdeveloping aheat-related illness. to withpartners Work operation anextremeheat buildingduring event: Spendingtimeinanair-conditioned isoneofthemost anddesignateIdentity buildingswithairconditioning aspubliccooling centers andextend hoursof current information onweather forecasts andsafety measures. can beactivated, sothat numbersthatanextremeheat call911during event canbedialedandnotified of can provide information abouthow well isadaptingto thecommunity theheat. Areverse 911callsystem related to extremeheat issues. heatanextreme Monitoring linecallsand911madeduring event city’s 311information lineto disseminate heat event information andtrack thenumberofcallscoming in anextremeheatduring event. ofHealthandFamily utilizes Department the The Minneapolis Support the United muchofMinnesota, 211 line).In Way a211linethat provides information supports to people plan isactivated orheat-related messagescan beincorporated into more general, full-timesystems (e.g., heat events that canhelpprevent heat-related illnesses. Aheat linecanbeactivated whentheresponse Activate heat aheat lineprovides line:An emergency real-time advice andinformation extreme during populations are staying cool andare beingassessedfor symptoms ofoverexposure to heat. might nothave airconditioning shouldbecontacted andprovided information to ensure that their faxes, emails, and/ortelephone trees. contact For example, nursinghomesandseniorlivingcenters that dissemination ofextremeheat information to theorganizations thesepopulations through that serve locations ofprevention aidsprioritization to populations vulnerable efforts to heatextreme andfacilitates impairedwith mobility/health residents) andorganizations vulnerable populations andtheir that serve facilities withconcentrations ofhigh-riskindividuals:Developing adatabase/list offacilities(e.g., those Disseminate information related to preventing heat-related illnessesto community organizations and sample press release. Atipsheetfor staying cool canbefound inAppendix E. stay well-hydrated, locations, seekair-conditioned minimize sunexposure). direct Appendix Jfor See a broadcasts abouttheextremeheat conditions andhelpresidents respond to theheat appropriately (e.g., Publicly broadcasting cooling tipsandsymptoms ofexcessive heat exposure shouldcomplement anextremeheatduring event to iscritical reducing illnessesanddeaths dueto extremeheat exposure. public broadcasts: Educating thepublicandcommunicating prevention information to thembefore and Coordinate distributionofinformation onheat exposure symptoms andtipsonhow to stay cool for , available onlineat: Extreme Heat Toolkit Extreme Chapter 3 3-9 75 : Some pet owners are are : Some pet owners : Local governments should governments : Local Suspend utility shutoffs and provide transportation and financial assistance and provide Suspend utility shutoffs Arrange for extra staffing of emergency extra support for additional burdens place Arrange services events : Extreme heat on emergency and social support medical use of these services. services Increasing increased through overwhelmed. Hospital becoming systems from the avertmay arise any crises that staffing helps loads during events. extreme heat patient increased for prepare to should be encouraged administrators heat extreme on protecting their pets from pet owners to information Provide : Developing and implementing policies that identify identify policies that and implementing when possible: Developing public events Reschedule outdoor concerts) sports camps, canceled should be outdoor or activities games, (e.g., events outdoor when large local the extent that To illnesses. heat-related can help prevent extreme heat due to or rescheduled efforts permits or use of facilities), to through should be taken (e.g., events these control officials can “cool medical staff and/or stations, water require is not feasible, when rescheduling or, an event reschedule attendees. for zones” : Providing sources of clean potable drinking water at strategic locations in locations of clean potable drinking strategic at sources water : Providing public places at water Provide hydrated. ability stay to people’s enhances centers) cooling malls and parks, (e.g., public places develop partnerships and/or policies to prevent power and water companies from shutting off services from companies and water power partnershipsdevelop prevent and/or policies to taking cool Drinking water, of bills during events. extreme heat nonpayment due to customers their to heat-related of preventing ways some of the most effective are conditioners and using air baths/showers means of transportation subsidized bus passes and/or other cooling to morbidity Free and mortality. and financial air conditioners buying for Vouchers people. low-income to be provided also should centers people. low-income to assistance of providing electricityaid for other ways bills are they cannot bring if pets with them. Providing their place a cool go to their homes to leave to reluctant their anxiety. alleviate can help to and hydrated keeping their pet cool on tips for pet owners messages to If possible, concerns. specific any if they have call their veterinarian to can be encouraged pet owners Also, people and their pets. accept be willing to may that place a local cool identify : Some high-risk individuals (e.g., elderly living alone, homeless homeless elderly living alone, : Some populations high-risk individuals (e.g., vulnerable to Outreach during an extreme times a day observed several preferably, and, directly, contacted be persons) need to appropriate consumed, being fluids are (e.g., followed being tips are cooling that ensure to event heat as early and alleviated recognized are of overexposure symptoms any and that worn) clothing is being the can include process in the outreach persons involved Depending on local resources, as possible. agencies, nongovernmental other organizations, church volunteers, and health workers, social following: Increased the homeless. and evaluate effortsto outreach must be made Additional and the police. to be effortsmove individuals believed outreach should be supported to by authorizing officials for observationtreatment. and cooling shelters to at experiencing medical difficulties or risk extreme of the people who are at greatest risk for negative health effects from an extreme heat event may regularly may event extreme heat an from effects health negative risk for greatest at who are people of the cooling versus a places to these to go likely more be air-conditionedvisit specific may and locations be extended may pool, and public swimming as libraries such spaces, of public of operation Hours center. during transportation public places cool free to Providing workingfamilies. for accessibility increase to transportation to financial and access limited have who may helps individuals event heat an extreme destination. a cool reach to resources Minnesota Department of Health er 3haptC 3-10 implemented by Olmsted County ofMinneapolis andtheCity Table ofresponse planelements 4:Checklist andstrategies 1 www.epa.gov/heatisland/about/heatguidebook.html heat (seebelow) Strategies from for extreme preventing andmortality morbidity Identification ofvulnerable persons extreme heat event andthepublicbeforeinformation to an andduring partners Communications planfor communicating heat-related involved withtheplan Assigned ofagenciesandorganization roles andactivities Criteria for theplan anddeactivating activating responsibleLead for agency theresponse plan Strategies Arrange for extra staffing of emergency support services Arrange support for staffingofemergency extra Outreach to vulnerable populations of operation gathering at buildingswith airconditioning hours andextend Work withthepublicand private to allow sector public cooling centers hoursofoperation andextend Identify anddesignate buildingswithairconditioning aspublic Activate aheat line concentrations individuals ofhigh-risk illnesses to organizations community andfacilitieswith Disseminate information related to preventing heat-related Implementation extreme heat event for publicbroadcasts exposure symptoms; andtipsonhow to stay cool an during timing, severity, andduration ofextremeheat event; heat Coordinate ofinformation distribution abouttheanticipated the response plan of anddetermine activation andhealthimpacts characteristics basedonpredicted criteria meteorological activation Review Assessment, Activation andNotification Ensure timelytransfer ofweather forecasts to leadagency event extremeheatpredicting conditions afew days inadvance ofan (NWS) station to ensure access to weather forecasts capableof withlocalNational Establish partnership Weather Service Prediction Evaluation oftheresponse plan Table andstrategies adapted from U.S. Environmental Protection Agency. 2006.Excessive heat events guidebook. Response PlanResponse Elements Response PlanResponse Strategies 1

. Olmsted County

i i i i i i i i i i i i i City ofMinneapolis City Extreme Heat Toolkit Extreme i i i i i i i i i i i i i i i i i Chapter 3 3-11 i i i . i i i Programs and policies that increase urban increase policies that and Programs 76 Mitigation Response Plan Strategies (cont.) Strategies Response Plan Support and promote programs and policies to reduce effects reduce and policies to Support programs and promote of urban islands heat Evaluate heat response plan afterimplementation response heat Evaluate Evaluation Provide information to pet owners on protecting their pets on protecting pet owners to information Provide heat extreme from outage a power for strategies Prepare Suspend utility shutoffs and provide transportation and and provide Suspend utility shutoffs assistance financial public places at water Provide when possible events public Reschedule outdoor MDH developed a list of links to additional online resources. Appendix K provides a listing and brief K provides Appendix additional online resources. a list of links to MDH developed events. on extreme heat additional information contain that websites description of several Training and resources for extreme heat extreme for and resources Training staff and public local government and public health for heat module on extreme a training MDH created a basic overview its impacts and of extreme heat on module provides training The health practitioners. as a created was training The within this document. some of the information public health and contains others train to use the presentation could professionals so that with detailed notes presentation PowerPoint on the MDH can be found with detailed notes of the presentation and public health. A copy on extreme heat http://www.health.state.mn.us/divs/climatechange/extremeheat.html at: website It is important to support and promote programs and policies to reduce effects of urban heat islands. effects of urban islands. heat It reduce is important and policies to support to programs and promote response not included within a the urban island effect heat typically are reduce to strategies Although the severity and help reduce changes and to climate important to adaptation long-term plan, they are for conditions. high-heat to exposure of urban residents’ duration Mitigation/adaptation to extreme heat extreme to Mitigation/adaptation : If a wide-spread power outage occurs during an extreme heat event, outage: If during event, an extreme heat a wide-spread outage occurs a power power for strategies Prepare have and hydrated cool stay to tips on how messages regarding Ideally, be unavailable. may air conditioning their leave to who do not want People populations. and vulnerable the public to been provided already baths and take cold drink plenty to of water should be encouraged without air conditioning homes and are nursing homes, hospitals, such as reside, populations vulnerable Buildings where off. cool to or showers is a if there cool stay their building will that ensure to generator buying a back-up consider to want may etc. outage. power vegetation, especially shade trees, and encourage the use of cool building materials can help reduce the can help reduce building materials the use of cool and encourage especially shade trees, vegetation, multiple provide effect can the urban island heat reduce help that urban island effect. Some strategies heat and can help capture the urban island effect, heat reduce can help roofs green example, For health benefits. for people in the city. health benefits mental for space a green and can provide clean stormwater, Minnesota Department of Health

Definitions Chapter 4 4-2 p1882-3. 1 68°F. process isanormal Radiation ofheat moving away from thebodywhen airtemperatures are lower than being inanenvironment cooler thanthebodytemperature). This issimilarto heat leaving awoodstove. –transfer1. Radiation ofheat through electromagnetic waves (i.e., thebodyreleases heat simplyby The humanbodylosesheat infour different ways: Ways losesheat thehumanbody from:Modified http://www.hc-sc.gc.ca/dhp-mps/homologation-licensing/gloss/index-eng.php Subpopulations whoare at increased ofheat-related risk factors. illnessesbecausetheyhaverisk certain Vulnerable population from:Modified http://dictionary.webmd.com/terms/risk-factor for factor age isarisk heat-related illnesses. to, (i.e., anincreased (i.e., illness, ofmorbidity risk death). disease, For orcondition) ormortality example, that isstatistically isacharacteristic associated factor A risk with,althoughnotnecessarily causallyrelated factor Risk from:Modified http://www.getreadyforflu.org/pg_glossary.htm strategies. contains information onstrategies for preventing heat-related the illnessesandidentifies whowillperform A plan/annex for states, communities, governments, etc. to useintheevent ofanextremeheat event and heatExtreme response plan/excessive heat annex location. temperaturesextreme definitionofan heat that affecthumanhealth. An exact event varies bygeographic An extremeheat event highairtemperatures oftimewithabnormally isaperiod and/orhighdewpoint heatExtreme event factors,have risk e.g., conditions certain ordiseases. young children, peoplewithpre-existing People whoare “at risk” are peoplewhoare at anincreased for risk heat-related illnessesbecausethey At risk B toolkit. toolkit. The definitionsbelow theusage ofthese clarify words withinthe toolkit. Toolkit. to note that someofthebelow isimportant definitionsmay differ It outsidethe contextofthis Platt Mand Vicario inRosen’s S.(2010).Heat Illness Concepts Medicine: Emergency and ClinicalPractice, 7th Ed. elow are definitionsof words, HeatMinnesota Extreme phrases and usedwithinthe terminology 2

1 Extreme Heat Toolkit Extreme Chapter 4 4-3 http:// 2 2 . Accessed April 16, 2012. . Accessed 2 Healthwise. (2011). WebMD: First Aid & Emergencies: Ways in Which the Body Loses Heat. Available online: Available Heat. the Body Loses Which in Ways & Emergencies: Aid First WebMD: (2011). Healthwise. firstaid.webmd.com/ways-in-which-the-body-loses-heat Minnesota Department of Health 2 As air temperature and humidity increases, the ability to cool the body through radiation is dramatically is dramatically radiation the body through the ability cool to and humidity increases, air temperature As of heat the process the skin, back to reversing is actually heat Under direct sunlight, transferred reduced. mechanism the dominant becomes evaporation rises, air temperature As body. and warming the transfer the and cool heat the ability transfer to as humidity increases, however sweating; through transfer of heat is little movement when there is minimal Convection reduced. is dramatically evaporation body through does not Convection the skin importantin the air around more but can become as wind speed increases. conduction when is lost through body heat high. Only 2% of our are the body when air temperatures cool be 25 times greater. can conduction in water loss through heat air; by however, surrounded – transfer of heat to air or water surrounding our bodies. Heat is lost when temperatures are are when temperatures is lost Heat our bodies. surrounding air or water to of heat – transfer 4. Conduction in water. is submerged or when the body ground sleeping on the cold lost from is heat This than 68°F. lower the body very can be lost from so heat quickly in cold it is placed when than air, loss heat causes more Water water. – direct transfer of heat to water vapor molecules surrounding the skin. surrounding molecules vapor is carried Heat and water to of heat – direct transfer 3. Convection of a fan. in front to sitting This is similar motion. fluid the body due to dispersed from – conversion of liquid into a gas, which transfers heat energy to the gas and away from the from and away the gas to energy heat transfers which a gas, liquid into of – conversion 2. Evaporation the skin from body). During the cools intense the sweat of the evaporation and skin sweats the body (i.e., sweating. through 85% of its heat the body loses exercise,

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Epidemiology, 16(1), 67. 16(1), A case-only of temperature?: extremes Epidemiology, to is sensitive analysis. Who (2005). SwartzJ. a health in on mental waves of heat effect The G. (2008). Tucker and D, Nitschke M, Pisaniello Ryan P, Bi P, Hansen A, Deaths: A Meta-Related Wave Heat in Factors Prognostic (2007). Bouchama, et al. G. A., Dehbi, M., Mohamed, gov/heatisland/about/heatguidebook.html gov/heatisland/about/heatguidebook.html gov/heatisland/about/heatguidebook.html online: http://www2.ed.gov/admins/lead/account/consolidated/index.html . http://factfinder2.census.gov/ at download for Available Data. (SF1) 100-Percent 38:53-65. Med;22:221–27. J Prev Am in Chicago. during a 1999 heatwave temperate Australian city. Environmental Health Perspectives, 116(1), 1369. 116(1), Health Perspectives, Environmental city. Australian temperate 167, 2170-2176. Intern. Med., Arch. Analysis. 76 75 73 74 72 71 69 70 68 67 65 66 64 Minnesota Department of Health

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June 2012