As complex as health care may be in an emergency department (ED) setting, the weather and seasonality have added additional variables to that complexity. It is critical that registered nurses in the ED understand the health care trends associated with the weather and seasons. As in many other places, the summer here in New York City is a time when people are more active, spending time outdoors and traveling. This summer we have experienced several stretches with temperature in the high 90 degrees. July recently had a seven-day stretch with temperatures nearing and exceeding 100 degrees in New York. These heat waves can become physiologically unbearable.

Jonathan Nover, MBA, RN

Who is most vulnerable to heat illness?

During these heat waves, it is important to recognize the pockets of vulnerability among us. Older adults are often the most vulnerable because of decreased capacity to thermoregulate in response to changes in temperature. It is also important to consider the effects of heat on the homeless community and people without access to air-conditioned environments. Children are more susceptible to heat illness than adults. Some medications, such as diuretics, and consumption of alcohol and illicit drugs can increase a person’s risk of heat exhaustion. Additionally, individuals who perform strenuous exercise or labor in hot environments can also be affected.

Pamela Worrell-Springer, MSN, RN

Levels of heat illness.

Heat illness cascades in several phases:

  • heat rash and cramps
  • heat exhaustion
  • heat stroke

Heat stroke is a medical emergency and can cause high body temperatures (103 degrees or higher); confusion; dizziness; agitation; unsteady gait, headache; dry or damp, hot, red skin; fainting; rapid or a slow weak pulse; not sweating even if it’s hot; fainting; unconsciousness; and even death. According to the New York City Department of Health, on average there are 10 deaths per year caused directly by heat stress in New York City and 360 “heat-exacerbated deaths, which happen when heat worsens existing chronic conditions such as heart disease.” These deaths are disproportionately higher in Black communities and those with higher percentages of residents living below the federal poverty line, and highest among people ages 80 and older.

Treatment of heat illness in the ED.

Some emergency departments have become safe havens to escape from the heat. For ED nurses, heat-related illnesses such as heat exhaustion and heat stroke are a particular concern during the summer months. Our goal is to identify the signs and symptoms of heat exhaustion and heat stroke on a patient’s arrival to the emergency department and provide immediate interventions.

These patients are usually categorized as high-acuity cases and should be escalated to a provider’s attention immediately. The patient is moved to a cool place, layers of clothing are removed, and wet towels or cold packs may be placed on the body. A core temperature should be obtained to establish baseline values and monitor progress during treatment. In addition, we encourage drinking of water and sport drinks high in electrolytes, when possible. If the patient presents with altered mental status, fluid and electrolytes are given intravenously. In some cases, convection fanning or cold bladder irrigation procedures can be provided to enhance rapid cooling of a patient.

Keeping emergency providers hydrated and healthy.

Clinicians working in the emergency department are also at risk for heat exhaustion. In our emergency department at Mount Sinai Queens, we utilize hydration stations located at each nursing station to promote health and hydration for all clinicians. Our clinical teams are encouraged to bring in their own labeled water bottles or thermoses, but water bottles and drinking water are also provided. These stations enable the clinical teams to take time to hydrate during working periods.  Additionally, we have hydrating carts that round the inpatient floors and the emergency department, offering an opportunity to choose a healthy snack and tea.

As heat waves increase, nurse preparedness is key.

According to the Environmental Protection Agency, heat waves are occurring more often than they used to in the United States. The frequency has increased steadily, from an average of two heat waves per year during the 1960s to six per year over the past two decades. As heat waves increase, emergency departments can expect to see more heat-related illnesses. It is incumbent upon registered nurses to be aware of these trends, prepared for the presenting signs and teach them to our new and novice nurses, remain unbiased as our society’s most vulnerable populations are affected, and continue to provide high-quality care to all who present to our emergency departments.

By Jonathan Nover, MBA, RN, senior director of nursing, Emergency Department and Critical Care Services, Mount Sinai Queens, and Pamela Worrell-Springer, MSN, RN, charge nurse, Emergency Department, Mount Sinai Queens