Across Southern California, emergency room workers are bracing for the wave of patients that rolls in as heat waves like this one stretch into their second, third and fourth days of life. Heat accumulates in the body, especially when people are unable to cool down at night with air conditioning.
Dr. Jennifer Roe, medical director of adult emergency medicine at Harbor-UCLA Medical Center, said preparation includes having fluid supplies, ice packs and other cooling devices ready.
EMTs, nurses and technicians see obvious cases of heat illness and heat exhaustion, with fainting and seizures among the symptoms, of course. Heat stroke is the most severe form of heat-related illness and can be life-threatening.
But some doctors say their profession is less competent in understanding that heat may be a reason why some patients develop other illnesses.
Football players take a break from practice to hydrate and cool off amid high temperatures and heat Wednesday at Santa Margarita High School in Rancho Santa Margarita.
(Allen J. Schaben / Los Angeles Times)
The heat waves are like an “invisible tsunami,” said Dr. Mark Futernik, an emergency physician in Los Angeles. They can worsen heart, kidney and respiratory diseases.
For example, a patient with diabetes who can't keep insulin refrigerated during a power outage could end up in the emergency room in critical condition with no one to attend to him.
When they arrive, they may also be confused by the worsening effects of the heat, leaving doctors scrambling to piece together what happened. This makes it difficult to determine what role heat played in the ER patient's symptoms, Roh said.
The most vulnerable patients during heat waves are the elderly, people with chronic illnesses, and those taking medications that interfere with their body's ability to regulate itself in hot weather.
“There are so many illnesses other than heat that even the doctors who treat these patients don't realize it,” Futernik said.
A jogger walks past downtown at Echo Park Lake during a heat wave Thursday in Los Angeles.
(Carlene Steele/Los Angeles Times)
Dr. Sam Torbati, chief of the emergency department at Cedars-Sinai Medical Center, said most of the conditions he sees in the emergency room during heat waves are largely preventable.
Health care challenges fall disproportionately on communities with fewer resources.
“The heat in Los Angeles affects everyone, but it doesn't affect everyone the same, and some of the people who are hurting the most are the most vulnerable people in our community,” said Dr. Alex Gregor, who works in emergency departments at Los Angeles Medical Center and the University of Southern California.
“Skid Row is a heat island, many of our patients come from Skid Row or [other] communities across the city where they lack access to shade, coolness and nature – so there is an inequitable distribution of the disease burden from heat and climate change around our city.”
“This is a huge health equity and racial justice issue,” he said.
Most doctors don't usually take climate change into account. Those who do say this needs to change.
Dr. Stefan Wheat, an emergency physician and assistant professor at the University of Washington School of Medicine, is one of the proponents of broader climate-related training that would teach doctors how heat acts as a “threat multiplier.”
Gregor also suggests that emergency medical providers be trained to recognize subtle signs of heat illness, and that social workers could be used to connect patients to resources such as cooling centers, or to help patients create a buddy system, as is happening in some cities, so that someone will notice if they are in trouble.
A builder takes a water break while building new homes during Wednesday's heatwave in Irvine.
(Allen J. Schaben / Los Angeles Times)
The connection between climate and health is not new. More than a dozen books have been written on the topic, and some medical schools already offer climate health training.
Some hospitals in Los Angeles and elsewhere are now distributing heat preparedness materials, and efforts to reach both uninformed doctors and patients have expanded.
However, some say awareness still lags and heat-related deaths are rising. “We're doing a good job of not making the situation as bad as it could be,” Futernik said. “But it's getting worse.”
Nurses, technicians and emergency physicians could take on a more prominent role.
“We can use our voice as health care professionals to advance policies that will better protect patients on a broader scale in society,” Wheat said.
This may mean supporting building codes that provide adequate cooling or protection for workers working outdoors in extreme temperatures.
“Heat exhaustion or heat stroke… it doesn't tell the whole story,” Wheat said. “This is becoming an increasingly pressing issue.”
It is expected to remain in Southern California. very hot until September.
