How Case Managers Can Help Patients Reduce Heat Risk
By Melinda Young
Extreme heat events can become cluster death events, as was the case in Washington during a three-week heat wave in the summer of 2021. New research suggests the 2021 Pacific Northwest heat wave resulted in excess injury among residents.1
“We found that 159 more injury-related deaths occurred than we would have expected in the absence of the heat wave in the three weeks following heat wave initiation,” says Joan Casey, PhD, an assistant professor in environmental and occupational health sciences at the University of Washington School of Public Health.
Case managers and health systems can help their patients — especially older patients with heart and/or lung disease — to prevent heat illness. They also can share evidence-based resources, such as heat illness information on the CDC website and Heat.gov. “The websites provide messages and awareness of how to stay safe during periods of extreme heat, especially those at high risk,” says Paul J. Schramm, MS, MPH, a health scientist with the CDC’s National Center for Environmental Health. “You can also look up extreme heat alerts issued by the National Weather Service [https://www.weather.gov/safety...].”
Case managers also can follow these suggestions:
• Assess patients for access to cool space. Particularly in Northern states, many older people may not live in an air-conditioned space. Case managers can ask their at-risk patients whether their homes are air conditioned. If not, case managers can find community resources to provide them with a window unit. With at least a window unit, clients could protect themselves during heat waves by creating an air-conditioned space.
Case managers also could research their communities to find cooling centers or other public spaces where clients could stay when their homes are too hot. These could include libraries, schools, malls, and public buildings. Health systems could even offer use of public areas to protect vulnerable seniors.
Patients with COPD and chronic heart failure are at the greatest risk of hospitalizations and death during extreme weather events, says Tony Wolf, PhD, a postdoctoral scholar at Penn State’s College of Health and Human Development.
Under some types of insurance/payor plans, it may make sense for the health system or payor to provide funds for solutions like A/C window units for these high-risk patients.
“If insurance would be willing to cover the cost of air conditioning for people at higher risk, that would be a policy decision,” Wolf says. “That’s something that would be helpful to protect people who are the greatest risk from illness and death from these extreme events.”
Case management leaders can ask their health systems if any additional funds are available for improving patients’ home environments and safety that could be used for that purpose.
“It’s just a matter of getting them a window unit for a single room in their house, where they can go and protect themselves during the heat wave,” Wolf explains. “It’s a good approach to protecting people.”
• Educate patients about early symptoms of heat illness. Healthcare professionals can help prevent heat-related deaths by educating patients on the risks and how to avoid heat illness.
“Temperature extremes can tax the human body, especially those who have underlying health issues or face other social and environmental stressors,” Casey says. “If we provide more messaging about behavior change — i.e., staying hydrated, not exercising outdoors — and more access to cooling centers, we should be able to prevent some death and illness.”
People sometimes do not realize their bodies are becoming dangerously hot. “There is a reason why high temperatures, even if they’re not the extremes of warmer climates, pose a risk,” says Gregory Wellenius, ScD, professor and director of the Boston University School of Public Health Center for Climate and Health. “It’s the lack of air conditioning and the failure of people to recognize this is a health threat. They may not modify their behavior to limit exposure during heat events, and they also may not recognize symptoms or be aware of health hazards.”
Those at greatest risk of heat illness and death are those with cardiovascular disease, people older than age 60 years, and those with obesity. “People think heat stroke is killing people in heat-related events, but it’s actually the amount of strain that heat puts on the cardiovascular system that puts people with weakened cardiovascular systems at increased risk of death,” Wolf explains.
The CDC offers a tool describing heat-related illnesses. It is a PDF available in both Spanish and English that describes heat stroke, heat exhaustion, heat cramps, sunburn, and heat rash.2
For example, it lists these heat exhaustion symptoms:
- Cold, pale, and clammy skin;
- Heavy sweating;
- Nausea or vomiting;
- Muscle cramps;
- Fast, weak pulse;
- Tiredness or weakness;
The educational tool offers suggestions for what to do when experiencing a symptom of heat exhaustion, including:
- Moving to a cool place;
- Loosening clothing;
- Placing cool, wet cloths on the body or taking a cool bath;
- Sipping water;
- Seeking immediate medical help in case of vomiting, worsening symptoms, or symptoms lasting longer than one hour.
This one-page educational sheet on heat illness could be given to patients during spring and summer months.
The CDC also offers a webpage with safety tips and other information about staying cool during heat events and recognizing heat-related illness. The hot weather tips focus on the message of “Stay cool, stay hydrated, and stay informed.”2,3 The CDC recommends wearing lightweight, loose-fitting clothing and staying indoors in an air-conditioned place as much as possible. It reports that even a few hours in air conditioning, such as a visit to the library or shopping mall, could help a person’s body stay cooler when they go back into the heat.3
Tips also include pacing oneself, avoiding hot and heavy meals, wearing sunscreen, and not leaving children in cars. When drinking fluids, the CDC advises avoiding very sugary or alcoholic drinks because they cause dehydration. Also, very cold drinks can cause stomach cramps. People can replace salt and minerals with sports drinks.
Case managers also could give patients information about the cooling centers in their communities. “Do anything they can to get people to protect themselves when there are heat events,” Wolf says.
• Take simple actions to reduce heat exposure. Healthcare workers and health systems also can make hot days less dangerous on their own property by taking actions to lower heat levels long term.
“We tell people to watch the news and pay attention in the summer,” Schramm says. “The CDC’s climate health program has a lot of information on which communities and people are more likely to be impacted. That would include people from lower-wealth communities who don’t have air conditioning or can’t afford to run it.”
General health maintenance can help patients prevent heat illness. But it also is important to build more green spaces in places where people live and work, Wolf says.
Patients also need to know how to access heat warning systems in their communities. Inform them about impending heat events, much like tornado warning systems let people know of tornado risks in their areas.
Wolf and other scientists are studying how to identify the temperature and humidity of any area for developing guidelines to create more accurate heat warning systems. This type of research will improve local heat warning systems.
An effective tactic is to encourage patients and their families or caregivers to watch out for them on hot days. “Look at those around us who may be more vulnerable — our parents, children, the local landscaper working during the hottest time of the day — and encourage them to take breaks and drink water,” Wellenius suggests.
Also, it is important for clients to know heat illness does not occur only on extreme heat days — the top 5% in temperature, Wellenius notes. There are many more days of moderately high heat, and that type of weather is happening more often. These are days when people may not realize there is a heat danger and they do less to protect themselves, sometimes ending up in an ED.
“That’s where vulnerable populations, people experiencing homelessness, and pregnant women have to be careful,” Wellenius says. “We don’t need to just be careful on days of extreme heat, but we also need to be careful on a wider range of [hot] days.”
Individuals can protect themselves by spending time in any space that is cooler, including shaded areas, coffee shops, malls, theaters, libraries, and others.
“The main message is that the earth’s climate is warming, and it’s expected to continue warming,” Wolf says. “At the same time, the earth’s population is aging and is expected to continue aging, and those older adults are expected to be the most impacted by extreme events.”
- Casey JA, Parks RM, Bruckner TA, et al. Excess injury mortality in Washington state during the 2021 heat wave. Am J Public Health 2023;113:657-660.
- Centers for Disease Control and Prevention. Warning signs and symptoms of heat-related illnesses. Page last reviewed Sept. 1, 2017. https://www.cdc.gov/disasters/...
- Centers for Disease Control and Prevention. Tips for preventing heat-related illness. Page last reviewed Aug. 16, 2022. https://www.cdc.gov/disasters/...
Extreme heat events can become cluster death events. Case managers and health systems can help their patients — especially older patients with heart and/or lung disease — to prevent heat illness.
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