alert
A heat wave is forecasted for Washington State (expected temperatures 100–105°F for five consecutive days). Your clinic has asked you to help prioritize which patients should receive proactive outreach calls with heat safety counseling before the heat wave arrives. You have limited time and can only reach three of the following five patients today.
Your patient list
What will you do?
Question
You only have time to call three patients! Which three patients should you prioritize for heat-safety calls? Rank them in order (highest priority first).
- 1st Priority: Patient B (76-year-old with heart failure, on diuretic, lives alone, no AC)
- Vulnerability:
- Age (reduced thermoregulation).
- Heart failure (limited cardiac output for cooling).
- Furosemide (volume depletion).
- Social isolation.
- No air conditioning.
- Counseling:
- Identify cooling center location and arrange transportation.
- Balance hydration with fluid restrictions.
- Arrange daily check-in calls.
- Review warning signs.
- Vulnerability:
- 2nd Priority: Patient A (35-year-old construction worker)
- Vulnerability:
- Occupational exposure (8 hours outdoors).
- Metabolic heat from labor.
- May lack autonomy for breaks.
- Counseling:
- Emphasize right to breaks.
- Drink water before thirsty.
- Recognize warning signs.
- Work in shade when possible.
- Buddy system.
- Vulnerability:
- 3rd Priority: Patient D (82-year-old with diabetes/HTN, on beta-blocker and diuretic, has AC, and family support).
- Vulnerability:
- Age.
- Diabetes (impaired sweating if neuropathy).
- Medications (metoprolol + hydrochlorothiazide).
- Why lower priority:
- Has AC at home and daily family checks (social support).
- Counseling:
- Use air conditioning consistently.
- Hydration.
- Medication risks.
- Monitor blood sugar.
- Vulnerability:
- Patients C, E, and F: Lower priority due to adequate cooling (AC) and supervision/support systems.
Clinical pearl
Risk is determined by both physiologic vulnerability AND social/environmental factors. Patient B has the highest combined risk (physiologic + social isolation + no cooling). Patient A, though younger and healthy, has high-occupational exposure. Prioritization requires considering multiple risk factors simultaneously.
Question
A heat wave is forecasted for your city (expected temps 105–110°F for five consecutive days). You are asked to develop a heat preparedness plan for your clinic’s patient population. Which intervention would have the greatest impact on reducing heat-related morbidity and mortality?
Proactive outreach to high-risk patients is the most effective intervention. The 2021 heat dome taught us that waiting for patients to seek help is too late—many who died were found alone in their homes. Early, targeted intervention saves lives.
Final thoughts
The 2021 Pacific Northwest Heat Dome taught us: Reactive care is insufficient. Prevention, equity, and early action save lives. As future physicians, you now have the tools to protect your most vulnerable patients and your community from a growing climate threat.