15 years ago I worked four straight night shifts during the one of the largest heat-related disasters in the Midwest; over 700 people died in the Chicago metropolitan area in just a few days during that deadly heat wave of 1995. I vividly remember ambulances lined up waiting to bring another critically ill patient into our already full-to-the-gills ER. In 2006, another killer heat wave engulfed the Midwest, but this time the public health infrastructure was ready and less than 30 people perished in a similar event to the one 11 years earlier.
It is once again summer in the Midwest and the temperature seems to be pushing 90 degrees or above on a daily basis. While we may not be in the high prolonged high temperatures that are associated with killer heat waves, it is worthy to note that certain medications can make people more susceptible to injury from excessive heat; injury that can lead to organ damage and even death (e.g. heat stroke).
Heat stroke can have many symptoms, among them:
- high body temperature,
- the absence of sweating, with hot red or flushed dry skin,
- rapid pulse,
- difficulty breathing,
- strange behavior,
- and/or coma.
People who are most susceptible to heat stroke include:
- athletes (e.g. football players in full gear at camp)
- people who work outside and physically exert themselves under the sun.
- Individuals taking certain taking medications that make them vulnerable to dehydration and heat strokes
Medications that can impair the body’s ability to respond to external heat and cool off include:
- Antihistamines and anticholinergic drugs such as those in sinus, allergy, and cough and cold preparations can reduce the body’s ability to sweat. This impairs heat dissipation and can increase the possibility of heat stroke
- Antipsychotic medications can impair the body’s ability to regulate its internal temperature through their effects at the thermoregulatory center in the hypothalamus. Some anti-psychotic medications also have anticholinergic properties which can make heat stroke more likely.
- Certain cardiac medications like beta blockers and calcium channel blockers decrease the shunting of blood to the skin so the ability to shed heat is impaired.
- Stimulant medication and drugs such as ephedrine, amphetamines or cocaine increase metabolism and increase internal body temperature. They also can constrict blood vessels, which then decreases the amount of heat that can be released through the skin.
Preventing heat stroke however is easy, but it does take being aware that it can happen and knowing the steps to take.
- When working or playing sports outside, take frequent breaks in cooler, shaded areas.
- Avoid becoming dehydrated. Drink plenty of fluids, even if you’re not thirsty.
- Avoid caffeinated or alcoholic beverages as this will increase water excretion through the kidneys.
- Wear cool, light-colored clothing.
- Air-conditioning is the best way to avoid heat stroke during hot summer spells. If you do not have access to air-conditioning, know where the public community cooling centers are located. These are frequently shopping malls, libraries and other public places to seek refuge from extreme heat.
To help avoid heat stroke in others, check up on those who may be isolated and at risk for heat related illness such as the elderly or mentally ill in your community.
If we all follow these steps, we can avoid a repeat of the heat disaster of 1995.
Till next Tuesday, Mike
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