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Abstract
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HEATSTROKE is common and often deadly. The pathophysiology of the syndrome is understood, and effective treatment has been well defined. Clinicians know that patients' chances of survival depend on prompt diagnosis and rapid cooling. Otherwise, a cascade of events will lead to irreversible injury or death.
Heatstroke is preventable. We know the epidemiologic features of the disorder, and effective steps to prevent heatstroke have been clearly defined. To avoid heat-related deaths, a community must recognize the impending problem promptly. Once a heatrelated emergency is identified, effective measures must be implemented at once. Otherwise, many deaths will follow.
This editorial comments upon the Centers for Disease Control and Prevention and the Illinois and Chicago departments of public health report (Semenza JC, Rubin CH, Falter KH, et al. Heat-related deaths during the July 1995 heat wave in Chicago. N Engl J Med 1996;335:84-90) of their case-control study of deaths during the Chicago heat wave of 1995. As in other heat waves, the vast majority of victims were elderly inner-city residents. By comparing a stratified sample of those who died with randomly selected controls matched with them according to age and neighborhood of residence, the authors show that the people who died of heat-related causes were more likely than controls to have preexisting medical problems such as mental illness, pulmonary disease, or heart disease.
The effect of social isolation was even more striking. Living alone or being confined to bed was associated with a marked increase in the risk of heatrelated death, even among those who had regular contact with a visiting nurse or another social-service agency. Conversely, access to transportation was protective, as was having a working air conditioner or spending a few hours each day in an air-conditioned place.
The most obvious implication of these finding is that opening shelters is not enough. Communities must make a determined effort to seek out the elderly, the infirm, and the shut-in. Aggressive efforts to reach out to the most vulnerable can markedly reduce the toll of heat-related deaths. It has been done before, and it works. |