By Noah Weiland
On a recent Friday in Albuquerque, New Mexico, as triple-digit temperatures stretched into the evening, a 69-year-old man collapsed in his home. His body temperature hit 107.7 degrees by the time emergency responders whisked him to the University of New Mexico Hospital.
Nurses and emergency physicians began a process that has become familiar, preparing a device the size of a minifridge that rapidly cools and regulates body temperature by funneling cold fluids to pads that cover a patient’s abdomen and thighs. Workers dumped ice on his body as part of a last-ditch effort to curtail his heatstroke.
It was too late. The man’s blood pressure had plummeted, and he suffered a heart attack. Less than 24 hours later, he was dead.
Extreme heat, intensified by climate change, has blanketed much of the United States this summer, killing more than a dozen people in Oregon in recent days. Large parts of California, Nevada, Arizona and Utah have been under excessive heat warnings, which local officials believe contributed to more than 90 deaths in the West this month.
The consequences are increasingly playing out in the nation’s emergency rooms, where medical workers are confronted with heat-stricken patients whose soaring body temperatures can be fatal if not addressed quickly.
Around 2,300 people died from heat-related illnesses in the United States in 2023, triple the annual average between 2004 and 2018. Nearly 120,000 heat-related emergency room visits were recorded across the United States last year, according to the Centers for Disease Control and Prevention. In part, those figures are because heat waves last longer now than they did decades ago, as an Environmental Protection Agency report released last week made clear.
On Friday, nearly 60 million Americans were under heat alerts from the National Weather Service. Temperatures have at times this summer run 10-30 degrees above average in Western states. Some places like Las Vegas, which hit 120 degrees Sunday, have broken records.
The heat has been particularly problematic in New Mexico. In July 2023, the state had nearly 450 heat-related emergency room visits and more than 900 between April and September. That is more than double the number recorded during the same time in 2019, said Srikanth Paladugu, a public health researcher at the New Mexico Department of Health.
Heat-related emergency admissions at University of New Mexico Hospital also doubled in 2023 compared with the previous year, and the state has recorded over 500 heat-related emergency department visits since April 1 of this year. Those are likely undercounts because of the ways that health problems are recorded in hospital software.
“It’s difficult for us to know how many people are impacted by extreme heat when we look at emergency room data,” said Kelly Turner, a heat expert at UCLA. “Many hospitals don’t have a code for heat or extreme heat. If, for instance, what actually happened is someone came in with headaches and pulmonary issues, that’s what’s going to be coded.”
The dire health ramifications of heat have become a subject of intense interest in the Biden administration. At a visit to the District of Columbia’s emergency operations center last week, President Joe Biden unveiled a draft of first-of-their-kind Labor Department regulations that would protect roughly 35 million workers exposed to extreme heat on the job.
“Extreme heat is the No. 1 weather-related killer in the United States,” Biden said at the event. “More people die from extreme heat than floods, hurricanes and tornadoes combined. Say that again: combined.”
Yet heat experts said there is still no consistent application of heat guidance among health providers, particularly in primary care settings. Dr. Jeremy Hess, an emergency physician and environmental health expert at the University of Washington, said that routine checkups that cover medication or weight management rarely devote time to someone’s risk in severe heat. Common medications can complicate a patient’s heat tolerance.
“It’s a conversation that generally doesn’t happen,” he said. “It’s a complicated problem to solve: You need screening tools. You need to carve out time for it. In some cases, you need to bill for it. All of those changes take time and effort. So far the health system is not there.”
In April, federal officials published clinical guidance for treating heat illness, an acknowledgment that the medical field was still catching up to some of the dangers of extreme weather.
The primary objective of unwinding heat sickness involves lowering the body’s temperature. Many of the procedures are rudimentary: Cold fluids are administered with IVs, replenishing severely dehydrated bodies. Emergency responders and hospitals across the country have also become accustomed to putting heat-sick patients in large bags filled with ice, a technique that can rapidly cool the body and restore its functioning, similar to the results from the cooling machine used by the University of New Mexico team.
At the University of New Mexico Hospital, an established facility in a hot climate, staff members are still continually trained in recognizing and treating heat-related sickness. Faculty organized a so-called grand rounds session this year for medical residents and other employees of the hospital system to learn how to treat heat illness.
Dr. Jon Femling, a heat expert who oversees emergency care at the hospital, said health workers sometimes differ on the fundamentals of treatment. He and others at the hospital prefer to cool the quads and abdomen. “That’s where all the blood volume is going through,” he said.
Other physicians, and many emergency responders, he noted, put ice in the groins and armpits.
Femling said there is no clear temperature threshold that suggests someone might be suffering from heatstroke. Someone who is severely dehydrated with a 102-degree temperature might not pump blood to the brain, leaving them more vulnerable than a person who might have a higher temperature but better circulation.
“There’s no magic number,” he said.
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