US EPA Fact Sheet - September 2004 During an average summer, approximately 1,500 people die from excessive heat events in the U.S. A singleheat wave in Chicago killed more than 700 people in 1995. In Europe, a record heatwave claimed an estimated 35,000 lives in 2003. In both cases,most of the victims were 65 or older. “It’s Too Darn Hot” —Planning for ExcessiveHeat EventsInformation for Older Adults and Family Caregivers Did you know that each year more people die from “excessive heat events” than from hurricanes, lightning, tornadoes, floods, and earthquakes combined? Anyone can beadversely affected by excessiveheat, but older adults are particularly vulnerable. Excessive heat events are prolonged periods when temperatures reach 10 degrees Fahrenheit or more above the average high temperature for a region. Excessive heat events are believed to have a disproportionate public health impact in cities. One reason is that roads and buildings absorb the sun’s energy and contribute to the formation of “heat islands.” While rural areas cool off at night, cities retain this absorbed heat. As a result, urban residents get less nighttime relief from high temperatures. Fortunately, there are simple steps that older adults, their care-givers, and community leaders can take to decrease the impact of excessive heat events. Who is At Risk from Extreme Heat? Older adults, as well as young children, are at high risk from excessive heat events. For the growing number of aging Americans, the body’s cooling mechanisms may become impaired. Living alone or being confined to a bed and unable to care for one’s self further increases risk. Existing health conditions such as chronic illness, mental impairment, and obesity can also heighten an individual’s vulnerability. Persons taking certain medications are likewise susceptible. “Excessive heat events” are surprisingly deadly. Vulnerable groups like older adults are at particularly high risk. The good news is that there are simple steps people can take to protect themselves. How Can I Reduce Exposure to Excessive Heat?The best defense against excessive heat is prevention. Air-conditioning is one of the best protective factors against heat-related illness and death.4Even a few hours a day in air conditioning can greatly reduce the risk.Electric fans may provide comfort, but whentemperatures are in the high 90s fans do notprevent heat-related illness. During excessive heat events, the followingprevention strategies can save lives: •Visit air-conditioned buildings in yourcommunity if your home is not air-condi-tioned. These may include: senior centers, movie theaters, libraries, shoppingmalls, or designated “cooling centers.” •Take a cool shower or bath.5 •Drink lots of fluids. Don’t wait until youare thirsty to drink. If a doctor limits your fluid intake, make sure to ask how muchto drink when it’s hot. Avoid beverages containing caffeine, alcohol, or large amounts of sugar. These drinks cause dehydration. •Ask your doctor or other health care provider if the medications you take could increase your susceptibility to heat-related illness. •Wear lightweight, light-colored, and loose-fitting clothing. •Visit at-risk individuals at least twice a day. Watch for signs of heat-related illness such as hot, dry skin, confusion, hallucinations, and aggression. •Call 9-1-1 if medical attention is needed. In addition, people who live on the top floors of buildings without air-con-ditioning are more likely to be exposedto excessive heat. Participating in stren-uous outdoor activities and consumingalcohol during unusually hot weatherlikewise exacerbates heat-relatedhealth effects.How Does Excessive HeatAffect the Body?The body normally cools itself by increas-ing blood flow to the skin and perspiring. Heat-related illness and mortality occurwhen the body’s temperature control system becomes overloaded. When thishappens, perspiring may not be enough.High levels of humidity can make it evenharder for the body to cool itself.How are Excessive Heat and Heat Stroke Related? Heat stroke is the most serious healtheffect of excessive heat events. It is the fail-ure of the body’s temperature control sys-tem. When the body loses its ability to coolitself, core body temperature rises rapidly.As a result, heat stroke can cause severeand permanent damage to vital organs. Victims can be identified by skin thatappears hot, dry, and red in color. Otherwarning signs are confusion, hallucinations, and aggression. If not treated immediately,heat stroke can result in permanent disabil-ity or death. The good news is that heatstroke can be prevented by taking the easysteps outlined on this page. What Can Your Local Government Do to Help? Local governments can play an important role in predicting and responding to excessive heat events. Two increasingly common strategies are heat alert systems and heat reduction measures. Heat Alert Systems Heat Health Watch-Warning Systems identify when a heat-related public health threat is likely. These systems use computer programs that analyze National Weather Service forecasts and other local data to predict dangerous conditions. Heat Health Watch-Warning Systems have been established in Philadelphia, Seattle, Chicago, St. Louis, and other cities in the U.S. and Europe. After a warning has been called, city health authorities communicate this information to older adults, their care-givers, and other at-risk groups. Assist the Homeless and Those With Mental Health Illness The following steps are “best-practices” that city officials can take to alert residents and provide direct assistance: •Distribute media advisories •Activate telephone hotlines •Alert neighborhood volunteers, family members, and friends •Provide air-conditioned buildings and offer transportation to these facilities •Assist the homeless •Work with local “area agencies on aging” to educate at-risk individuals Cities may also coordinate with local utilities to ensure that no customer’s electricity is turned off during a heat wave. How Does Extreme Heat Affect Me? The body normally cools itself by increasing blood flow to the skin and perspiring. Heat-related illness and mortality occur when the body’s temperature control system becomes overloaded. When this happens, perspiring may not be enough. High levels of humidity can make it even harder for the body to cool itself. Learn More The EPA Aging Initiative is working to protect the environmental health of older adults through the coordination of research, prevention strategies,and public education. For more information or to join the listserve visit: www.epa.gov/aging Other References Environmental Protection Agency,Heat Island Reduction Initiative http://www.epa.gov/heatisland Center for Disease Control and Prevention http://www.cdc.gov/aging/ http://www.cdc.gov/nceh/hsb/extremeheat http://www.cdc.gov/MMWR Environmental Health Perspectives http://www.ehp.niehs.nih.gov American Medical Association,Heat-Related Illness During Extreme Emergencies http//:www.ama-assn.org National Weather Service, Heat Wave and Heat Index http://www.nws.noaa.gov/pa/secnews/heat/ Medline Plus, Heat Illness http://www.niapublications.org/spnagepages/hyperthermia-sp.asp National Weather Service http://www.nws.noaa.gov/om/hazstats.shtml Heat Wave Awareness Project http://www.esig.ucar.edu/heat/literate.html Publication Number 100-F-04-008