Health care providers need help to treat patients during extreme heat events

The world’s hottest summer on record is now bleeding into the fall. Instead of enjoying a cool respite from the heat, millions of Americans started September enduring temperatures so high that schools were forced to close across the country. Extreme heat continued into October, leading organizers to cancel the Twin Cities Marathon due to a forecasted high of 91 degrees — 25 degrees higher than normal for Minneapolis and St. Paul.

Heat waves have rarely garnered the attention they deserve, despite being one of the most dangerous natural hazards on earth. But now, with heat continuing to take a devastating toll on vulnerable communities into autumn­­ — including deaths in the elderly and those with chronic illnesses from New York, Arizona and elsewhere — extreme heat’s persistent threat to health is undeniable. Arizona’s Maricopa County just announced that 2023 has set a new record for the number of heat-associated deaths: 469, with more than 150 others under investigation.

Access to air conditioning can be lifesaving. Yet, nearly one in 10 U.S. households don’t have or can’t afford to run it. People in these households — often those with low incomes, those who are forced to work outdoors in extreme or in uncooled indoor spaces, and, disproportionately, people of color and immigrants — are far more susceptible to heat-related health emergencies

Those emergencies come in many forms. New studies show that the risk of fatal heart attacks can double during the combination of heat waves and prolonged poor air quality and that, in the long term, exposure to chronic heat harms our heart, kidneys, sleep, and mental health. However, due to structural inequities in our health care system, the people most vulnerable to heat-related illnesses are often those who are under- or uninsured and face the most difficult barriers to care.

With proper preparation, these health threats are preventable. But to make sure that all patients can access the health care they need during extreme heat, we must ensure health care providers understand the critical role they can play and have the resources they need to take action.

Working in collaboration, our organizations, Americares and Harvard Chan C-CHANGE, set out to understand exactly what resources providers need and what solutions might look like. After surveying more than 450 staff members working in clinics across 47 U.S. states and territories serving these populations, we heard resounding concerns about challenges in caring for patients during and after climate-related disasters, including a gap in knowledge on how to approach this care. Seventy seven percent of clinic staff say they do not have the knowledge or tools to implement climate change preparedness at their clinic. Over 80 percent expressed interest in education and training on how to protect their patients during these events.

With this input and financial support from Biogen, we created the Climate Resilience for Frontline Clinics Toolkit to help providers and patients prepare for and stay safe through extreme climate events, including heat, wildfires, hurricanes, and flooding.

We found a similar need when we surveyed providers a second time last fall; nearly 90 percent said addressing extreme heat risks for patients is necessary for better health outcomes. But 42 percent lack confidence in their knowledge of extreme heat and its effects on health, indicating an urgent need to educate providers and clinic staff on how they can protect patients’ health.

The reality is that many free clinics and community health centers don’t have the staff, resources, or technical background to review literature, develop protocols and best practices, and analyze their utility. What providers told us is that they need more practical tools to help them recognize, prevent and treat climate-related illness. We also heard a need for easy-to-understand educational materials for patients.

San José Clinic in Houston, where 78 percent of patients identify as Latino or Hispanic — communities that are disproportionately impacted by extreme heat and have experienced hurricanes and even a major ice storm in recent years — was one of the first clinics to join us in protecting patients from climate risks. Now they are educating patients about the impact of climate on health and even front desk staff know the telltale signs of heat exhaustion to look for in arriving patients. The toolkit prompts providers to inform patients who take medications that can affect a body’s ability to regulate heat, including some medications for high-blood pressure or anxiety, that they can be more susceptible to heat exhaustion or heat stroke. The toolkit also teaches patients how to identify the signs and symptoms of heat-related illness. In a state like Texas, which became one of the hottest places in the world this summer, and where nearly one in five residents is uninsured, the need for investing in clinics that care for the under- and uninsured could not be more urgent.

With the record-breaking heat this summer, we saw clinics starting to view heat as an emergency similar to a major hurricane or flood. For the first time we received an urgent request for ice packs, IV fluids, and other supplies from a Florida clinic to help patients manage extreme heat. To address this need and with support from Johnson & Johnson, this fall we began working with pilot clinics in Arizona, Florida, and Louisiana to co-develop an assessment tool to help clinics create heat action plans. The clinics will be asked to identify other service providers in their local communities they can partner with to help patients access cooling centers, take advantage of programs that make air conditioning more affordable, or receive wellness checks during dangerous heat.

The success of our Climate Health Equity for Community Clinics Program depends on clinic staff going beyond the care that’s provided in the exam room. Providers and patient care coordinators need tools to provide truly holistic care, taking into account patients’ individual needs and home and work environments.

For far too long, these needs have been overlooked, even as the health risks of extreme heat grow. Climate change is causing unprecedented weather events across the United States and the world, and we will continue to encounter record-breaking heat, intensifying wildfires and hurricanes, and historic levels of flooding. It’s a reality we cannot shy away from.

Dr. Julie Varughese is the senior vice president of programs and chief medical officer at Americares, a health-focused relief and development organization.

Dr. Caleb Dresser is director of health care solutions at the Harvard T.H. Chan School’s Center for Climate, Health, and the Global Environment.