California Record Highs a ‘Teachable Moment’ for Clinicians

Physicians should use the ongoing heat wave now blistering California and the Western U.S. for the ninth day as a teachable moment so they can better recognize less obvious symptoms and better prepare to minimize hospitalizations and death — things that are sure to persist because of climate change.

That’s the message from several physicians who are warning the nation’s health systems about the often-hidden medical consequences of higher temperatures, especially when they persist for more than a week. There’s a need to learn more about how excessive heat impacts the body, and to speak out to change policies and practices, they said.

“Most doctors don’t understand the connection between climate change and the health impacts they’re seeing,” Marc Futernick, MD, an emergency physician at California Hospital Medical Center in Los Angeles, said in an interview with MedPage Today. “We need a lot more education and awareness.”

Ashley McClure, MD, an internist in San Francisco’s East Bay and co-executive director of Climate Health Now, said outpatient clinicians should get more familiar with the symptoms of heat exposure. “Would they know heat rash? Would they know the signs of heat stroke or heat exhaustion? Would they recognize heat cramps if it hit them over the head?”

Identifying the Effects of Climate Change on Health

Part of the problem rests with medical education, she said. “Most medical training doesn’t focus enough on the fact that heat-related illnesses and heat stroke contribute to morbidity (leading to) an underreporting of deaths … where the heat wave plays a part in the death toll,” she said.

She added that even if the patient’s primary cause of death was a long-standing illness like cardiovascular disease, it’s important to say that the heat wave was a contributing cause.

“We need to put it on death certificates, to name that there was a heat wave that’s related and probably contributed to premature death,” she said.

Even those few medical schools now offering some climate change instruction in their curricula “don’t focus enough on the fact that heat-related illnesses and heat stroke contribute to morbidity,” McClure said, partly because conditions that may have been exacerbated by heat are not always counted.

Working in a clinic over the Labor Day holiday weekend in “searingly hot” temperatures, she noted that initially there weren’t many heat-related illness patients seeking care.

“But it’s typical that as the heat wave goes on, there’s a lag time.”

Futernick, the founding managing editor for the Journal of Climate Change and Health, said that many health systems and clinicians are good at responding to “big acute emergencies” like wildfires, which demand a quick response.

But the health impacts from climate change are a “slow emergency, which doesn’t feel like it’s an acute thing that we [as physicians] can do something about. But the truth is that heat is the number one killer, and the most obvious expression of global warming.”

Another issue is that in many older neighborhoods, homes were built without air conditioning, which wasn’t needed when high temperatures were lower and heat wave durations were shorter. Residents put up with two- or three-day stretches, or went to the movies for the afternoon. Especially for seniors, COVID precautions, though waning, have limited the ability to leave the house.

Compounding the issue in California is the state’s current electricity supply crisis. Demands on the state’s grid prompted state officials to urge residents to minimize use of appliances and turn off their air conditioners or raise their thermostats, especially between 4 and 9 p.m. That’s when electricity demand is highest and when renewable supplies from solar panels wane. Utility pricing structure for some customers means that every kilowatt hour during that five-hour window costs a lot more, possibly encouraging at-risk individuals to go without air conditioning to save money.

In an executive order extending the state’s emergency response, Gov. Gavin Newsom said Tuesday that the current heat wave “is on track to be California’s hottest and longest for September and is projected to set a new record high for demand on the state’s energy grid with a load forecast of 51,276 megawatts today.”

Futernick said one under-recognized impact of the current wave is the number of cities and regions that are not just reporting record high high temperatures. Now numerous cities also are reporting all-time record high low temperatures that persist through the night and in the early morning for days.

“People are usually just worried about what the high temperature is,” said Futernick. They don’t understand that medically, high low temperatures are really dangerous over a series of days. “It’s essential for us to recuperate during the night so that we’re prepared for [enduring the high temperatures] the next day.”

He said numerous studies have shown that by day three or four of persistent heat is when “mortality starts to pick up, and it really picks up big on day six if the [heat wave] lasts that long. Our bodies need that [night-time] recovery time, and they’re not getting it when the low is too high.”

Preparing for Future Impacts

There’s little doubt that deaths attributed to heat, or to which heat contributed, have been growing since 2016.

Futernick also noted that hospitals have the capability of reducing temperatures in their cities through the laying of cool pavements in their parking lots, which can reduce temperatures by 10 degrees.

“We should be pushing our communities to prepare cooling centers” and systems for alerts with responses, he said. For nursing homes, some of which have experienced heat-related deaths due to weather-related power outages, there should be tighter regulations for air conditioning backups.

Futernick, a past president of California Association of Emergency Physicians, and McClure join a rapidly expanding consortium of physicians and other clinicians vociferously advocating for national policy change and reduced reliance on fossil fuels.

In an op-ed for MedPage Today, Joseph P. Coyle, MD, and Amy M. Schaller, MSRC, wrote that “healthcare professionals must meet this evolving challenge with increased awareness, strategies and advocacy” with an awareness of the health impacts from multiple climate related environmental changes, such as more wildfires and smoke, decreased air quality, and other adverse influences on respiratory health.

And in a seeming reversal of its November decision not to vote on a resolution to declare climate change a public health crisis, the American Medical Association this June adopted similar language, saying that climate change “threatens the health and well-being of all people.” The new policy also authorized the AMA to advocate for strategies that limit global warming.

Please enable JavaScript to view the comments powered by Disqus.

For all the latest Health News Click Here 

 For the latest news and updates, follow us on Google News. 

Read original article here