Both public health measures at the community level and clinical interventions at the patient level are essential for preventing heat-related illness and deaths.
Public health and community response
- Meteorologists can often predict heat waves 3–7 days in advance.
- Public health agencies issue excessive heat warnings with clear messaging about severity.
- Air-conditioned public spaces where anyone can cool down.
- Must publicize locations widely, provide free transportation, and conduct targeted outreach.
- Public health officials urge residents to “check on your neighbors,” especially the elderly or disabled.
- Critical: In 2021, many who died were found alone—earlier checks could have saved lives.
- Some cities distribute:
- Fans.
- Bottled water.
- Electrolyte packets.
- Cooling towels.
- Air conditioners or heat pumps distributed to low-income seniors and medically fragile individuals.
- Note: Fans alone are less effective above ~95°F but can provide relief at moderately high temperatures.
- Power outages during heat waves eliminate access to AC when most needed.
- Utilities may suspend disconnections for non-payment during heat emergencies.
- Clinical action: Counsel patients with home oxygen or ventilators to have backup power plans.
Clinical and patient-level interventions
If a major heat wave is forecast, clinicians should reach out to high-risk patients with clear advice:
- Stay hydrated: Drink water regularly, even if not thirsty.
- Stay cool: Use air conditioning or go to a cooling center.
- Avoid heat exposure: Do outdoor activities in early morning or late evening.
- Know warning signs: Seek help if dizzy, nauseated, confused, or disoriented.
Key medications that increase heat vulnerability:
- Diuretics.
- Beta-blockers.
- Anticholinergics.
- Antipsychotics.
Action: Review medications before heat season. For patients on diuretics with fluid restrictions (e.g., heart failure), coordinate hydration needs with cardiologist.
- Heart failure patient on diuretics:
- Balance hydration with fluid restrictions.
- Monitor weight daily
- Outdoor laborer:
- Take mandated breaks in shade.
- Use buddy system.
- Elderly patient living alone:
- Arrange daily check-in calls.
- Identify nearby cooling center with transportation.
Question
You are counseling a 72-year-old patient with hypertension (on a diuretic and beta-blocker) before an upcoming heat wave. Which advice is most important?
This patient has multiple risk factors (age 72, on diuretic and beta-blocker) that increase heat vulnerability. This patient needs adequate hydration and access to cooling (either home air conditioning or a cooling center) is the most important intervention.