1. Heat-Related Illnesses David D. Ellis, DO, MPH Fellow, American Academy of Family Physicians Odessa Regional Medical Center June 10, 2008

2. Heat-Related Illnesses Statistics Average 200 deaths each year in the U.S. Average 200 deaths each year in the U.S. 3 rd ranked cause of death among U.S. high school athletes 3 rd ranked cause of death among U.S. high school athletes Mortality rates from 15-75% Mortality rates from 15-75%

3. Heat-Related Illnesses Causes Temperature + Humidity + Sun Exposure + Wind + Clothing (ENVIRONMENTAL) Temperature + Humidity + Sun Exposure + Wind + Clothing (ENVIRONMENTAL) Body production of heat (ACTIVITY) Body production of heat (ACTIVITY) Heat Illness happens when : ENVIRONMENT + ACTIVITY overwhelm the body’s capacity to cool itself Heat Illness happens when : ENVIRONMENT + ACTIVITY overwhelm the body’s capacity to cool itself

4. Heat-Related Illnesses Risk Factors Physical Conditions – fever, dehydration, medicines (antihistamines, water pills, cardiac medications) Physical Conditions – fever, dehydration, medicines (antihistamines, water pills, cardiac medications) Older age – Decreased ability to cool body Older age – Decreased ability to cool body Overweight – more heat generated and less capacity to dissipate heat Overweight – more heat generated and less capacity to dissipate heat Younger age – decreased ability to sweat; higher core temp required to sweat Younger age – decreased ability to sweat; higher core temp required to sweat

5. Heat-Related Illnesses Risk Factors Additional factors : * Lack of access to air conditioning * Sleep deprivation * Previous heat stroke * Heavy Clothing/Equipment * Not acclimated to the hot weather Additional factors : * Lack of access to air conditioning * Sleep deprivation * Previous heat stroke * Heavy Clothing/Equipment * Not acclimated to the hot weather

6. Heat-Related Illnesses How does your body respond to heat?? Core temperature goes UP  Blood Vessels DILATE  SWEATING occurs Core temperature goes UP  Blood Vessels DILATE  SWEATING occurs High Humidity  LESS heat loss by evaporation from the body  Core temperature goes UP High Humidity  LESS heat loss by evaporation from the body  Core temperature goes UP

7. Heat-Related Illnesses Heat Index Chart

8. Heat-Related Illnesses Heat Edema – MILDEST – leg swelling Heat Edema – MILDEST – leg swelling Heat Cramps – Muscle spasms, Water Heat Cramps – Muscle spasms, Water Heat Syncope – Dizziness/Fainting; cured by lying down; SWEATING Heat Syncope – Dizziness/Fainting; cured by lying down; SWEATING Heat Stroke – MENTAL CONFUSION * Core temp > 104.9; No Sweat * RAPID COOLING MANDATORY * 10% Death Rate Heat Stroke – MENTAL CONFUSION * Core temp > 104.9; No Sweat * RAPID COOLING MANDATORY * 10% Death Rate

9. Heat-Related Illnesses Treatment in the Field Remove unnecessary clothing Remove unnecessary clothing Spray water + FANS Spray water + FANS Ice to armpits/groin/neck Ice to armpits/groin/neck Cool water immersion – be careful Cool water immersion – be careful HYDRATE – 1 QUART per hour minimum * COLD water to drink cools internally HYDRATE – 1 QUART per hour minimum * COLD water to drink cools internally

10. Heat-Related Illnesses PREVENTION Assess the ENVIRONMENTAL conditions Assess the ENVIRONMENTAL conditions Proper clothing – light color, thin fabric Proper clothing – light color, thin fabric HYDRATION: HYDRATION: * PRE-hydrate – 16 oz before activity * 8 oz every 20 min while exposed * Urine should be light yellow or “white” Watch the alcohol, caffeine intake Watch the alcohol, caffeine intake

11. Heat-Related Illnesses PREVENTION Acclimatize: * Adults – 4-7 sessions in the heat before acclimatized. Short sessions : Acclimatize: * Adults – 4-7 sessions in the heat before acclimatized. Short sessions : (15- 20 min, then lengthen as tolerated) (15- 20 min, then lengthen as tolerated) The body will begin the “ Sweat Early” – (think Michael Jordan in the first 2 minutes of a game!) The body will begin the “ Sweat Early” – (think Michael Jordan in the first 2 minutes of a game!) DO NOT wait for thirst to push fluids DO NOT wait for thirst to push fluids

12. Heat-Related Illnesses SUMMARY Assess Risk – Identify people at risk Assess Risk – Identify people at risk Acclimatize if possible Acclimatize if possible Hydrate/Train personnel to recognize symptoms Hydrate/Train personnel to recognize symptoms Treat with Evaporative Cooling, Immersion, Fluids Treat with Evaporative Cooling, Immersion, Fluids Consider on-site resuscitative equipment * Automated External Defibrillator Consider on-site resuscitative equipment * Automated External Defibrillator