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Emory Doctors Discuss "Killing Heat" In This Week's NEJM

Emory University Health Sciences Center

In an editorial in this week's New England Journal of Medicine, Emory University emergency physicians comment on lessons learned from the Chicago heat wave of 1995.

"Although heat stroke is amenable to medical treatment, control can be best achieved by applying the principles of public health," say authors Arthur Kellermann, M.D., and Knox Todd, M.D. "Sentinel surveillance, public education, outreach to vulnerable individuals, and enlisting the help of the entire community can save lives."

Older adults living alone and in the inner-city are at highest risk for heat stroke, as are persons who are infirm or shut-in, the authors say. Conventional practices like opening shelters or giving fans to poor citizens during heat waves are "not enough," they say.

"Unfortunately, the most well-intentioned efforts can be hampered by suspicion and fear," the authors say. "Air-conditioners have been turned off by victims who felt they could not afford the utility bill. Homes can become super-heated if the windows are nailed shut to thwart burglars. Some residents will not leave their home unguarded. Others are simply too proud or too fearful to seek refuge in a 'public' shelter.

"(Public) money spent on fans (for poor citizens) should be redirected elsewhere" since "...fans are useless when heat and humidity reach dangerous levels."

Based on their assessments of community response to the Chicago heat wave of 1995 and the Memphis, Tenn., heat wave of 1980, Dr. Kellermann and Dr. Todd make the following suggestions:

  • "Since access to air-conditioning for even a few hours each day is protective, local governments in high-risk areas of the country should consider modifying their building codes to require every hotel and apartment building to provide an air-conditioned lobby."

  • "Relatives, friends and neighbors can harbor more people than the largest public shelter."

  • "Churches, synagogues and mosques can help by reinforcing key safety messages. They should also open their facilities during the hottest hours of the day."

  • "Utility companies often suspend shut-off activities during periods of environmental stress, and debt-forgiveness programs can be implemented to help pay the bills of the truly needy."

In addition, the authors site a proactive program that was begun in Memphis after the 1980 heat wave:

  • In early summer, officials track the numbers of persons seen in emergency departments to try to detect any increase in visits due to the heat.

  • The city maintains a 24-hour telephone line to provide heat-related medical advice.

  • Local media advise residents to increase fluid intake and decrease physical activity.

  • "Citizens with air-conditioning are urged to check on elderly relatives, friends or neighbors and take them in as guests."

  • "Health Department inspectors visit nursing homes and personal care homes to check for excessive temperature and the county's Office on Aging contacts clients who have experienced problems in the past. Those who cannot cope with the heat are given a screening medical evaluation, then transported to an air-conditioned shelter."

  • "At the first sign of an increase in heat-related emergency department visits, efforts to reach high-risk individuals are intensified. Candidates for the shelter are actively sought out by visiting nurses, 'Meals-on-Wheels' and other service providers. Letter carriers play an important role by hand-delivering the mail to elderly customers on their route."

Dr. Kellermann is director of the Division of Emergency Medicine, Department of Surgery, Emory University School of Medicine, and director of the Center for Injury Control and Prevention, Rollins School of Public Health, Emory University. Dr. Todd is assistant professor, Division of Emergency Medicine.

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