For ED Docs, Heat Wave Adds to Strain Wrought by COVID

A heat wave across the Pacific Northwest has compounded problems of understaffing and overcrowding in emergency departments (EDs), and emergency medicine physicians are worried about what the rest of the summer could bring.

In hard-hit Oregon and Washington, patient volumes surged this week as a result of heat-related illnesses. Even if temperatures decrease in the coming days, doctors aren’t convinced it’s a one-time occurrence.

“Overall this is stressful to our system,” Bory Kea, MD, an associate professor of emergency medicine at Oregon Health & Science University (OHSU) School of Medicine in Portland, told MedPage Today. “We are not finished with the pandemic yet. We are having severe staffing shortages around the country and around Portland.”

“We can’t move patients from our emergency departments into the hospital because we’re at such high capacity,” she added. “It’s something we need the public to understand as we progress into the rest of the summer.”

The high capacity means longer wait times and, unfortunately, a little bit of delayed care, Kea said.

Not being able to move patients — on top of the COVID-19 pandemic — has been extremely taxing on nurses who have been on the front lines of the ongoing public health crisis, she noted. There is burnout.

“I don’t think people realize the pandemic is not fully over,” she continued. “People are still not fully vaccinated. We’re still seeing COVID patients. We’re still putting on PPE for COVID and trauma patients. There is definitely a lot of strain.”

What EDs Are Seeing

At the beginning of the week, Kea said OHSU began seeing more heat-related illnesses, including illnesses directly tied to the heat, as well as underlying conditions that have been exacerbated by the heat.

She and her colleagues have also seen significantly higher numbers of traumas — gun shot and stab wounds, she said.

Though it’s unclear whether the heat has been a causal factor in some of those injuries, Kea noted that some studies have shown that hotter temps can increase irritability and violence.

To help with the uptick in patient volume over the last several days, OHSU — which is typically at or over capacity even in normal times — has again been using an overflow area it prepared during the height of the pandemic.

Kea explained that there has also been a focus on increasing physician shift coverage to help support nurses amid an ongoing shortage.

The cases of heat-related illnesses have varied in degree of severity, she noted. Some patients have presented after fainting and need examination to determine whether there is a cardiac reason for their spell. Others need IV fluids or other treatments to cool down.

In severe cases, patients can have what looks like cardiac arrest, such as altered mental status, as well as weakness resembling a stroke. Some patients may need to be intubated, or need CPR to help restart their heart.

There have been some of these critical patients in the Portland area, Kea said.

Justin Ryel, MD, an emergency medicine physician in the Seattle area, told MedPage Today that the 105° F temperature on Tuesday was lower than a “ridiculously hot” Monday that brought in heat-related complaints and many sick patients.

“Only about half of homes in Washington have air-conditioning, and from what I’ve seen that’s falling disproportionately on lower-income and elderly residents,” he said. “A guy came in yesterday with a temperature of 105° and confusion. He was elderly and lived at home alone with no air-conditioning.”

There are increased risks of stroke and dehydration, he noted. High levels of methamphetamine use on the West Coast have also contributed to heat-related injuries.

Dire Conditions

“Most hospitals around here have been running at 110% for the last 3 or 4 months,” Ryel said. “We saw a much bigger increase in patient volumes with reopenings.”

“Everywhere [emergency departments] saw a downsizing of staff during COVID,” he added. “They haven’t been able to bring everybody back. That downsizing plus the increase in patient volumes has definitely led to much leaner operations. Certainly, nursing hasn’t caught back up with demand.”

Amid the ongoing heat wave, Cascade Medical Center in Leavenworth, Washington, was forced to transfer patients due to an air-conditioning outage, Becker’s Hospital Review reported, citing a Facebook post. The hospital canceled non-emergency appointments and moved acute care patients to other facilities, according to Becker’s.

Since June 25, there have been nearly 1,400 ED visits for heat-related illnesses reported by hospitals in Washington, a spokesperson for the Department of Health said in an email. The department is looking into three deaths potentially linked to heat-related illness.

In recent days, there have also been 29 drowning or submersion events, according to the spokesperson.

On Tuesday, the Oregon Health Authority (OHA) issued a statement confirming that 3 straight days of historic heat in the Portland metro area had led to high demand on EDs. They urged people to contact their primary care provider if they began to experience heat exhaustion, cramps, sunburn, or other non-emergency conditions.

Based on preliminary data alone, Portland-area hospitals have clocked 506 heat-related emergency and urgent care visits since June 25, OHA said in its statement, adding that beds at hospital systems serving Multnomah, Washington, and Clackamas counties are in “critically short supply.”

Climate Change

Physicians say it’s important to recognize that the heat wave plaguing the Pacific Northwest isn’t an isolated event.

“Washington state has taken a pretty progressive approach to climate change, so hopefully this will be addressed system-wide,” Ryel said. “We’re seeing record highs now, but last year we also saw some close-to-record highs. Leadership needs to make investments and prepare for more of that.”

There are more voices within emergency medicine talking about climate change and its impact on the specialty, Kea noted.

It is already affecting patients and can have an impact on future health as well, she said. Extreme events can worsen pre-existing conditions, and smoke from forest fires can precipitate pulmonary problems.

“All of the hospitals are trying to put their heads together to figure out how we take care of our patients during this stressful time,” she added.

Kea hopes the added strain of high temperatures isn’t made worse by another spike in COVID cases.

“It’s only June,” she said. “We are likely to have more heat surges.”

Kristina Fiore contributed reporting to this story.