1. Extreme Heat: How it Kills and What We Can Do About It Gail Hartfield Meteorologist NOAA/National Weather Service - Raleigh, NC American Meteorological Society Central North Carolina Chapter April 21, 2005

2. We’ll discuss...  Heat dangers  Warning signs  Those most at risk  Aggravating factors  Why heat dangers “get no respect”  What can be done:  NWS’s role  Community awareness/preparedness  Informational posters & handouts targeting at-risk groups  Excessive Heat Danger Awareness Day (media involvement)  National expansion of awareness program American Meteorological Society Central North Carolina Chapter April 21, 2005

3. Why should we care about heat? American Meteorological Society Central North Carolina Chapter April 21, 2005

4. Heat waves kill (and injure)  Called the “silent disaster”  Develop slowly  Kill 175 people nationwide in average year... more than tornadoes, hurricanes, lightning, or flooding (& injure many more)  7,421 deaths from 1979 to 1998; 2,590 deaths from 1986 to 2003 American Meteorological Society Central North Carolina Chapter April 21, 2005  The #1 weather killer every year from 1998-2002

5. American Meteorological Society Central North Carolina Chapter April 21, 2005

6. American Meteorological Society Central North Carolina Chapter April 21, 2005

7. In North Carolina…  UNC study: 161 deaths 1977-2001  NWS Storm Data: 14 NC deaths directly attributed to heat 1998-2001 (this is greatly underreported)  Many more were injured, & heat contributed to other deaths  NWS doesn’t actively seek heat injury/death data  Dept. of Health and Human Services and hospitals do not report to NWS  Many people moving here aren’t acclimatized  2004 NCAR modeling study:  More & worse heat waves to come (Science, August 13, 2004) American Meteorological Society Central North Carolina Chapter April 21, 2005

8. Europe Heat Wave: August 2003  Temperatures regularly exceeded 104˚ for 10 days  Air conditioning uncommon  Nearly 15,000 died in France; European toll was near 35,000 (Earth Policy Institute estimation)  Heat wave hit during August, when many doctors & hospital staff take vacation  Morgue workers were called out of retirement to help American Meteorological Society Central North Carolina Chapter April 21, 2005

9. American Meteorological Society Central North Carolina Chapter April 21, 2005 Europe Heat Wave: August 2003

10. American Meteorological Society Central North Carolina Chapter April 21, 2005

11. Chicago Heat Wave: July 12-16, 1995  Temperature over 98° for four days in a row  High of 106° on 7/13  Heat indices well over 110°  Over 700 deaths from heatstroke and heat-related illness  Exacerbated by urban heat island effects American Meteorological Society Central North Carolina Chapter April 21, 2005

12. Graphic courtesy of LLBL Heat Island GroupLLBL Heat Island Group Urban Heat Island Effect North Carolina Natural Hazard Conference 2002 Sunset Beach, NC March 4-6, 2002

13. Day 1

14. Day 2

15. Day 3

16. Day 4

17. Hottest temp ever at RDU: 105˚

19.  Heat rash  Sunburn  Heat cramps  Heat exhaustion  Heat stroke Heat Illnesses (“Hyperthermia”) Severity American Meteorological Society Central North Carolina Chapter April 21, 2005

20.  More serious than heat cramps  Caused by depletion of salt/water due to:  Intense prolonged exercise  Gradual dehydration  Symptoms:  Painful heat cramps  Heavy sweating  Fast/weak pulse; shallow breathing  Dizziness, headache, nausea  Can progress to heat stroke Heat Exhaustion American Meteorological Society Central North Carolina Chapter April 21, 2005

21. Heat Stroke  Body becomes unable to regulate itself & sweating mechanism fails; core body temperature rises  IMMEDIATE attention required... body temperature can rise to >106° in 10-15 min.  Symptoms:  Very high body temperature  Red, hot skin  Rapid strong pulse  Throbbing headache  Confusion– altered mental state  Dizziness, nausea, vomiting  Unconsciousness American Meteorological Society Central North Carolina Chapter April 21, 2005

22. Who’s most at risk?  Children  Outdoor workers (construction, roofers, migrant workers)  Military  Elderly (especially urban) American Meteorological Society Central North Carolina Chapter April 21, 2005

23. The Elderly and Extreme Heat  55% of fatalities in 2003 were over 70 yrs. old  “Classic” heat stroke: builds over time  Often isolated & difficult to reach  May not have air conditioning, or turn it off to reduce bills  May not dress properly for the heat  May not open windows due to safety concerns  Immobile… unable to get to cooling centers  Medication can make them vulnerable American Meteorological Society Central North Carolina Chapter April 21, 2005

24. Children and Extreme Heat  Over 213 children have died from heat stroke in vehicles in the U.S. since 1998  One third: trapped while playing  When temp=83°, car temp can rise to 109° in 15 minutes  Bodies don’t self-regulate like adults  Core temperature can rise 3-5 times faster than that of adult  Might not know they’re dehydrated  May not be able to convey thirst American Meteorological Society Central North Carolina Chapter April 21, 2005

25. American Meteorological Society Central North Carolina Chapter April 21, 2005

26. Outdoor Workers & Extreme Heat  25% of heat-related deaths in NC  Documented deaths and injuries include:  Migrant workers  Roofers  Firefighters  Often work long hours in direct sunlight  May not have adequate shade or air conditioning  Abundant water alone won’t prevent illness American Meteorological Society Central North Carolina Chapter April 21, 2005

27. The Military & Extreme Heat  New recruits performing strenuous training, pushed by drill sergeants  Lack of acclimatization (from Medical Surveillance Monthly Report, U.S. Army) American Meteorological Society Central North Carolina Chapter April 21, 2005

28. The “newest” at-risk group... 18 high school & college football deaths 1995-2002… 104 heat stroke cases resulting in death from 1960 to 2004… … all of which could have been prevented !

29. Korey Stringer: 1974-2001 Lots of warning signs…  Temps in low 90s with “stifling humidity”  Vomited 3 times that morning  Lost consciousness after drills ended  Paramedics couldn’t get blood pressure reading  Body temp: 108.8°  Kidneys began failing, then heart failed American Meteorological Society Central North Carolina Chapter April 21, 2005

30. Athletes and Extreme Heat  Exertional heat stroke (rather than classic)  At risk: Includes football players, wrestlers, runners  Body producing heat faster than it can be shed  Sudden, noticeable alteration in mental function: disorientation, combativeness, irritability  Egos & competition may play role  Some drugs can worsen heat death risk  Ephedra-related death of Oriole player Steve Bechler in ’03; body temp was 108˚ American Meteorological Society Central North Carolina Chapter April 21, 2005

31. If they’re so bad… why don’t heat dangers get attention?  Not as urgent/exciting as tornadoes & hurricanes  Threat creeps up slowly  Public confusion abounds...  “Code yellow”, “code orange”, “code red” days: for ozone, not necessarily dangerous heat !  Heat index: what does it mean?  Temperatures are in shade; sun adds 15+°  Education is needed !! American Meteorological Society Central North Carolina Chapter April 21, 2005

32. www.nws.noaa.gov/om/heat/ Heat index info… explanation of alert program… heat disorder info Forecasts/warnings… brochures… past heat waves American Meteorological Society Central North Carolina Chapter April 21, 2005

33. The Heat Index American Meteorological Society Central North Carolina Chapter April 21, 2005

34. Excessive Heat  Defined by NWS as: 1) Heat index ≥ 110° for 3 hrs or more, with overnight temps > 80° through ~ 2 am 2) Heat index ≥ 115° for any length of time American Meteorological Society Central North Carolina Chapter April 21, 2005  Problem: heat can be dangerous below these criteria for at-risk groups – especially for the first event of the year

35. NWS Heat Products  Excessive Heat Outlooks  Issued for 2 nd or 3 rd day of forecast  Excessive Heat Watches  12-36 hr period  Heat Advisories  HI 105°-109° for 3 hours (1 st period)  Excessive Heat Warnings  HI  110° for 3 hours  Additional alerts:  Include HI in forecasts  Special Weather Statements providing risk details & safety rules American Meteorological Society Central North Carolina Chapter April 21, 2005

36. NWS Heat Products 3 to 7 day max heat index outlook 6-10 day & 8-14 day max heat index outlook American Meteorological Society Central North Carolina Chapter April 21, 2005

37. This is great stuff, but… … useless if no one sees it!! We need to get the word out... American Meteorological Society Central North Carolina Chapter April 21, 2005

38. Informational materials Elder care facilities Day care centers Schools Agriculture groups Military bases Churches … Media coverage can tie it all together American Meteorological Society Central North Carolina Chapter April 21, 2005

39. Materials for at-risk groups  Posters  Locally produced & tailored to NC  Can be posted year-round  Contain:  Heat index forecast sources  Illness danger signs & first aid tips  Prevention tips  Pamphlets  Can be taken home  Handy reference: heat index chart, warning signs American Meteorological Society Central North Carolina Chapter April 21, 2005

40. Latest public education efforts  WFO Raleigh distributed information packets to 140 high schools across central NC  Locally-produced color posters  Locally-produced pamphlets  Talking points  Declaration of Heat Awareness Day in central NC  Heat-related experiments for younger children  Local web site developed  www.erh.noaa.gov/rah/heat/ www.erh.noaa.gov/rah/heat/  Includes 3-hourly HI forecasts & longer range outlooks American Meteorological Society Central North Carolina Chapter April 21, 2005  Summer 2004: NWS Raleigh partnered with the North Carolina High School Athletic Association on awareness campaign

41. Upcoming plans:  Expand information dissemination to  Ag groups  Need to translate all materials into Spanish  Middle schools and elementary schools  Day care centers and preschools  Posters for centers, pamphlets for parents  Elder care facilities, military bases  Expand local web site  Publicize local heat index forecasts American Meteorological Society Central North Carolina Chapter April 21, 2005

42. National Heat/Health Watch/Warning System  Announced at 2005 national AMS meeting  Tested last year in major cities where death tolls are highest  Set threat based on temperature, dewpoint, sky, and wind  Will be expanded to more cities this summer American Meteorological Society Central North Carolina Chapter April 21, 2005  Also needed: improved calls-to-action at the local level  Specific actions to be taken by casual & organized athletic groups, elderly

43. Thank you for your time and attention! Any questions? Gail.Hartfield@noaa.gov American Meteorological Society Central North Carolina Chapter April 21, 2005