Six days, 32 emergency visits: How Duke Health, UNC and WakeMed treat heat illnesses
In the past six days, 32 people have visited Duke Health emergency departments for heat-related issues.
So far this month, WakeMed has treated 43 patients for emergency heat-related illnesses, up from 31 patients in all of June 2023.
And Ryan Lamb, medical director of the emergency department at UNC Rex, said his team has seen “a few people each day” experiencing heat complications.
This data provided to The News & Observer suggests the toll the temperature has already taken on Triangle residents. And with the heat index cresting triple digits Wednesday, local providers work swiftly inside emergency rooms to cool patients.
“People can definitely die fast when a heat-related issue isn’t picked up,” Lamb said. He emphasized community members be aware of those they encounter who may be suffering, especially infants and the elderly who can’t easily regulate themselves.
Inside the UNC emergency department, providers work to cool patients’ body temperatures. Ice baths are the most effective tool, Lamb said, but these are not always practical to maintain in hospital settings. Instead, he described using a misting protocol to remove heat from bodies. Staff spray patients with misters and fan them to evaporate the water.
Another step is to put ice on patients’ palms and soles.
Lamb said symptoms of heat illnesses, including fatigue or nausea, aren’t dissimilar from issues emergency room staff treat during cooler months. But the ongoing heat wave gives a big hint about the underlying cause: In February, providers might first suspect emergency room patients are suffering COVID-19; in late June, the near-record heat is top of mind.
“Heat-illness can be a killer if you’re not attuned to the symptoms and taking preventative action,” said Anjni Joiner, an emergency medicine specialist at Duke Health.
In a social media post last week, Joiner listed symptoms of heat stress — feeling light headed, elevated heart rate, confusion — and said people exhibiting these should “immediately get out of the heat” and “seek shade or air-conditioned areas.”
If symptoms worsen, including loss of consciousness or heightened confusion, then Joiner said people should call 911.
J.J. Hoff, an emergency medicine specialist at Duke University Hospital, said for patients with more minor symptoms, “the act of simply getting them into a cooler environment, removing heavy clothing, and avoiding further exertion goes a long way.”
But for those who come to Duke presenting more intense issues indicating heat-related illnesses, Hoff said his department start “rapid cooling measures” to drop core body temperature “to the upper limits of normal in a short amount of time.”
Steps Duke providers take to achieve this, he said, include cold-water immersions, fans and misters, ice packs, electric cooling blankets, and refrigerated IV fluids.
Stages of heat-related illness
In a statement to the N&O, WakeMed spokesperson Kristin Kelly described three stages of heat-related illnesses — and what people should do when experiencing each. The mildest form is heat cramps, which include painful muscle spasms. Kelly recommended people experiencing these should move to rest in a cooler area, remove any excess clothing, drink water or electrolyte-rich sports drinks, and slowly stretch the afflicted muscles.
Heat exhaustion is a more critical illness and is caused when the body doesn’t adequately replenish the water and salt it losses from sweating. Symptoms include nausea, vomiting, fatigue, anxiety and pale skin. Treatments for heat exhaustion are similar to best practices for heat cramps — drink water, rest, move to colder areas and remove any unnecessary clothing.
Lastly, there is heat stroke, which occurs when a person’s internal body temperature reaches “dangerously high levels,” Kelly said. Symptoms include fever, warm skin, appetite loss, headache, seizures and possibly a coma. Anyone who suspects a person has heat stroke should call 911, Kelly said, and then take additional steps to keep them cool like placing ice bags on their armpits and groin area, fanning them, and pouring cold water on their skin.
