Francisco R. Velázquez: What to know about heat-related illnesses and how to prevent them

By Francisco R. Velázquez

There is no question that summer is here and with it longer, sunnier days, and some very hot days. Although warm, sunny days are pleasant, particularly after the long, cold winter, we must be aware of the health implications of extended exposure to extreme heat.

Over the past few weeks, the weather changed rapidly from rainy spring to sun and heat. Rapidly changing temperatures do not provide an opportunity for your body to adjust, particularly to prolonged exposure to high heat. It is important to take some simple precautions to prevent any of the many conditions related to sun exposure and extreme heat.

Keep in mind some people are at higher risk of heat-related illness when exposed to extreme heat. The elderly, infants and children, people with chronic conditions such as hypertension, pregnant women, people who are overweight and those who work outdoors are vulnerable to heat exhaustion or heat stroke. Some medications may increase your risk for heat-related illness; always consult your provider to determine the risks for you and your family.

If you are going to be outside, protect exposed skin to minimize the risk of sunburn. Sunburn is a red, painful skin reaction after prolonged exposure to the sun’s ultraviolet light. Use sunscreen, preferably a broad-spectrum sunscreen that blocks UVA and UVB rays, wear hats with broad brims, and take advantage of the shade. If you do get sunburned, take a cool, not cold, bath. Apply moisturizers or aloe gels. Drink plenty of fluids, and don’t pop blisters as this could lead to infection. A person can also experience a heat related rash, clusters of small blisters that resemble pimples on the neck, chest, and elbow creases. The discomfort can be alleviated with powder, such as baby powder.

Some heat-related illnesses can cause more severe symptoms and complications than others. On average, there are over 67,000 emergency department visits each year due to heat-related conditions, with an average of 702 heat-related deaths a year. In Washington state, we record between 25-113 hospitalizations for heat-related illness each year.

The three heat related illnesses with the potential for severe disease are: heat cramps, heat exhaustion and heat stroke.

Heat cramps can occur during periods of physical activity. Heavy sweating during intense workouts, muscle cramps or spasms in the arms, legs or belly are caused by the loss of fluids and salts called electrolytes. If these symptoms occur, get out of the heat, sip water or sport drinks every 15-20 minutes, and gently massage or extend the cramping muscle. If it lasts more than one hour, consult your provider for further instructions.

Heat exhaustion happens when you spend a lot of time in the heat and don’t get enough water. Signs of heat exhaustion include pale and clammy skin, heavy sweating, nausea, dizziness, headache, tiredness, irritability and occasionally fainting. A fever over 104 degrees Fahrenheit is usually present. If you’re experiencing heat exhaustion, move to a cool place, loosen tight clothing, and remove excess clothing if possible. Take small sips of water and use cold compresses around the head, face, and neck to gently cool the skin. If possible, taking a cool bath can help. If symptoms persist for more than an hour, or if symptoms get worse or you begin to vomit, seek medical attention.

Heatstroke is the most serious heat-related illness, and it is considered a medical emergency. This occurs when your core body temperature increases fast due to high heat and humidity, usually because of prolonged heat exposure or physical exertion in high temperatures. Heatstroke can occur if your body temperature rises as high as 106 degrees Fahrenheit or higher. Untreated, heatstroke can quickly damage your brain, heart, kidneys and muscles. The potential for severe complications increases if treatment is delayed. People suffering from heatstroke can be agitated, confused, have slurred speech and can develop seizures.

Generally, with heatstroke, the skin will feel dry and hot to the touch and may turn red or flushed as the body temperature increases. A racing heart rate or pulse and rapid, sometimes shallow, breathing can also be observed. A person with heatstroke may experience a throbbing headache, nausea, and vomiting. If heatstroke occurs, call 911, remove the person from direct sunlight, remove excess clothing and cool their body with cool water, icepacks or cold wet towels around the head, neck, armpits and groin.

In addition, people who engage in prolonged strenuous physical activity can suffer from a condition called exertional rhabdomyolysis in which there is extensive muscle necrosis which releases intracellular muscle components and large proteins into the blood stream causing kidney damage. Muscle swelling, tenderness, soreness, and dark tea-colored urine are typical symptoms. If you are experiencing these symptoms, discontinue activity and seek medical attention.

All these heat-related conditions are preventable with simple precautions. It’s best to develop a personal response plan before the heat becomes extreme. Visit srhd.org and search “extreme heat.” There you will find tools, resources and guidance on how to keep your home cool, where to go when you need a place to cool off, how to keep your body cool, where to find additional sources to keep you informed on the weather and on how to recognize and treat heat-related illness.

It’s important that during periods of extreme heat, you take time to check on friends, neighbors, and family, especially those who are at higher risk of heat-related illness. And don’t forget your pets, because animals can also have severe consequences from prolonged exposure to high heat.

Francisco R. Velázquez, M.D., S.M., FCAP is the Health Officer of Spokane Regional Health District.