Heat and the City: How to Stay Safe When It’s Sizzling Outside
This July, Planet Earth experienced its two warmest days on record, and it’s likely that 2024 will end up as the warmest year ever, according to a new report by Copernicus, the European Union's Climate Change Service.
Cities in particular tend to be especially hot. In urban areas, the Environmental Protection Agency (EPA) explains, buildings, roads and other infrastructure absorb and re-release the sun’s heat. These structures along with a lack of greenery create “heat islands” of higher temperatures compared to outlying areas. New York City has already experienced a couple of heat waves, with more predicted throughout the summer. Heat-related illnesses are predicted to rise as well.
The Emergency Medicine Department at Weill Cornell Medicine reports that this summer so far, there have been more ER visits than usual because of heat-related illness. Still, there are ways New Yorkers can stay safe when temperatures soar.
What is the heat index?
Before discussing illness, let’s talk about heat itself. What matters most is the heat index, which combines temperature and humidity. The heat index helps us gauge how hot it really feels outside.
The CDC now offers a heat risk map. Just put in your zip code, and it will tell you your risk of health issues in your particular area (from little/no risk to extreme risk).
What is heat-related illness?
Heat illness is actually a spectrum that includes heat cramps, the mildest form, followed by heat exhaustion and heat stroke—the most severe form.
Heat Cramps
Heat cramps, the mildest form of heat-related illness, comes with painful muscle cramps or spasms. If you experience heat cramps, do the following:
- Go to a cool, shaded area.
- Drink fluids.
- Stop all activities.
- Stretch or massage the affected areas.
Heat cramps don’t require you to go to the ER.
Heat Exhaustion
Heat exhaustion is a moderate form of heat illness and results from the loss of salt and water. Its symptoms may include:
- Heavy sweating
- Thirst
- Cold, pale and clammy skin
- Nausea
- Dizziness, lightheadedness and even fainting
- Headache
If you experience these, start hydrating and move to a cool area. You may need to go to the ER, especially if you fainted or have any medical conditions. You may need IV fluids, blood tests and further work-up.
Heat Stroke
Heat stroke is the most severe form of heat illness and a medical emergency. A bystander should call 911, and the patient should go to the ER—probably by ambulance.
Symptoms include:
- High body temperature (104 or higher).
- Hot, dry skin
- Confusion and altered mental status
- Loss of consciousness
- Seizures
If you witness a person experiencing these, move them to a cool shaded area, if possible. Apply wet or damp cloths to their skin and call 911 immediately.
How is heat stroke treated in the ER?
In the ER, bringing down the body temperature of a patient with heat stroke is the first order of business, says Dr. Alexis Halpern, an Assistant Professor of Clinical Emergency Medicine and Assistant Attending Physician at Weill Cornell Medicine. “The ER has ice water and other cooling mechanisms immediately available to place around patients. We also use IV fluids to bring the temperature down, and keep a close eye as the temperature improves to make sure the patient is okay.”
Who is at risk for heat-related illness?
According to the Centers for Disease Control and Prevention (CDC), infants, children, older adults and outdoor workers are at greater risk for heat-related illness than healthy adults. People with chronic conditions, especially those over 65, are also more vulnerable to the effects of the heat.
What factors may add to a person’s risk?
The CDC names the following additional risk factors for heat-related illness:
- Obesity
- Heart disease
- Mental illness
- Poor circulation
- Sunburn
- Alcohol use
- Some OTC and prescription medications
- Dehydration
How to prevent dehydration
During the hot summer months, it’s easy to lose water through perspiration—the body’s natural cooling system. But we may lose more of it than we take in if we don’t drink enough fluids. Babies and younger children as well as older adults are at highest risk of becoming dehydrated.
For the youngest among us, the CDC’s guidelines vary, depending on a child’s activity level, size and age:
- Children between 1 and 3 years need 4 cups of fluid per day.
- Children 4 to 8 years old need about 5 cups per day.
- Children over 8 need 8 cups or more per day.
Infants over 6 months who are eating solid food generally need much less water than older children: about 2 to 8 ounces a day.
If you’re an older adult, aim for at least eight 8-ounce cups per day. However, that recommendation may vary depending on your gender, age and activity level.
What are the signs and symptoms of dehydration?
The easiest way to see if your child is hydrated is to check their urine. It it’s dark yellow, orange or brown, they’re dehydrated. Look for pale yellow, experts say.
The signs and symptoms of mild dehydration may also include dizziness, light-headedness and less urine overall. Fewer wet diapers may also be a sign that your infant or toddler is dehydrated.
Severe hydration in both children and adults causes the following:
- Dry lips, tongue, mouth and throat
- Lethargy
- Cold hands and feet
- Fast breathing
- A faster-than-normal heart rate
- Irritability
- Confusion
Depending on your level of concern, go to the ER so that you, or your child, can be properly diagnosed and treated.
Is it okay to administer rehydration measures at home?
Your doctor may recommend that you or your child drink an oral rehydration solution, which is a mix of water and electrolytes such as potassium and sodium. You can purchase oral rehydration solution at your local pharmacy.
Which medications can increase the risk of heat-related illness?
Two widely used over-the-counter medications can interfere with the body’s signals and processes that serve to keep a person cool during hot weather: decongestants (such as phenylephrine) and antihistamines (such as diphenhydramine).
Certain prescription medications, too, are associated with abnormally high body temperature. These include several anti-psychotics, blood pressure medications, stimulants and certain anti-depressants.
Speak with your doctor about safety precautions if you’re taking medication in one or more of these categories, Dr. Halpern says.
As for illicit drugs, stay away from stimulants such as cocaine or methamphetamine. These change your heart rate, blood pressure and metabolic activity, which can increase your risk for heat-related illness.
Tips for preventing heat-related illness
She suggests the following preventive tips, which will help you and your children stay safe when the heat and humidity stoke the next heat wave in the New York Metropolitan Area:
- Keep an eye on the weather forecast so that you can prepare in advance when the next heat wave strikes.
- Avoid drinking excessive amounts of alcohol and limit caffeinated beverages.
- Hydrate, hydrate, hydrate.
- Limit exercise to cooler periods of the day—either the early morning or the evening.
- Wear a hat and loose, light-colored clothing.
- Apply a wet towel to your neck, or wear a wet headband.
- Try to avoid being outside or in direct sunlight when the temperature is higher than 95 degrees. Better to stay inside, preferably in an air-conditioned environment.
- Take cool showers or baths to cool down.
- Check in on your older neighbors and those who may not be able to help themselves.
- For those without air conditioning, find a cooling center near you for relief, if possible.
…and the CDC adds a few important “don’ts”:
- Don’t use the stove or oven to cook during a heat wave as these will make your apartment hotter.
- Don’t rely on a fan as your main cooling source when it’s really hot outside. Use air conditioning instead.
- Never leave infants or children in a parked car, even if the windows are open. Children left unattended in parked cars are at risk for heat stroke and even death.
Where to find a cooling center
In June, Mayor Adams announced the opening of 500 cooling centers across the city, located in public spaces such as libraries and community centers. To find one in your neighborhood, go to the New York State Department of Health’s website, which features a map and guide to cooling centers in your zip code.
How can people who work outside protect themselves?
If you have to work outside, as construction workers do, drink plenty of fluids throughout the day. Don’t wait until you’re thirsty. Do it as a matter of self-protection. But don’t drink alcohol or beverages containing large amounts of sugar.
The CDC also recommends wearing sunscreen and reapplying it throughout the day.
Here are a few more of the CDC’s tips for good measure:
- Ask whether some tasks can be scheduled earlier or later in the day to avoid the midday heat.
- Wear a brimmed hat and loose, lightweight, light-colored clothing.
- Spend time in air-conditioned buildings during breaks and after work.
- Encourage your co-workers to do the same.
Takeaway points
- Heat cramps, heat exhaustion and heat stroke are the most common types of heat-related illness.
- Heat stroke can be severe and even life-threatening.
- Infants, children, older adults, people who work outside and people with chronic conditions are at greater risk of heat-related illness than healthy adults.
- Make sure to stay hydrated when the temperature and humidity soar.
- Avoid direct sunlight during a heat wave, especially in the middle of the day.
- Seek your doctor’s advice regarding any medications you take that may contribute to heat-related illness.
If you're experiencing symptoms of heat-related illnesses and need to speak with a provider, schedule a Video Visit or access Virtual Urgent Care.