August 2005
                       "It's Too Dam Hot" -
                       Planning for Excessive
                       Heat  Events
                       Information for  Older Adults and
                       Family Caregivers
During an average

summer, about

7,500 people die
from excessive heat

events in the United
States.1  In 1995, a
heat wave in Chicago

killed more than 700
people. The summer
of 2003 in Europe,

a record heat wave
killed about 35,000
people. In

both cases, most
of the victims were
older adults.
       Did you know that each
       year in the United
       States more people
       die from excessive
heat than from hurricanes, light-
ning, tornadoes, earthquakes,
and floods combined? 2
"An excessive heat event," or
"heat wave" occurs when the
summer heat is 10 degrees
higher than the average high
temperature for a region.3 For
example, 95-degree weather
over several days in an area that
averages 85 degrees would be
an excessive heat event, or heat
wave. This heat is unpleasant. It
is also especially dangerous for
older people. The longer high
temperatures last, the more
dangerous the heat becomes.

Where Are Heat Waves
Most Dangerous?

Heat waves can be dangerous
anywhere, but especially in
cities. Streets and buildings
take in and keep the heat. This
creates "heat islands" that are
hotter than areas outside of the
city and don't cool off at night.
In areas with fewer people,
more trees and fewer streets
and buildings help things cool
down overnight.

How Does the
Body Cool Itself?

Sweating, or perspiration helps
to cool the body. However,
under some conditions,
perspiration just isn't enough
and people stay hot. This
can cause a person's body
temperature to rise rapidly.
When this happens, the very
high temperatures can damage
the brain or other vital organs.
High humidity, when the air is
full of water, makes it harder
to sweat and cool the body.
Drinking alcohol or working or
playing outside during the heat
can also make it hard for the
body to cool down.
           Electric fans help to move the air,
           but they do not cool off the body
       when the temperature is in the high 90s.

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What Can Be Done to
Help the  Body Cool Off?

Prevention is the best medicine. The best
way to avoid heat-related problems is to
not get overheated.

  Air conditioning is the best defense.4
   Spending time  in air conditioned
   location, (even  a few hours); during
   the hottest times of the day can be
   very helpful. If you don't have air-
   conditioning in your home, visit family
   or friends who  do. Go to the library,
   a movie theater, a senior center, or a
   shopping mall.  Check to see if your
   town has a "cooling center" which is
   a building with air conditioning where
   people can gather during a heat wave.

  Take a cool shower  or bath.5

  Drink lots of fluids, and don't wait
   until you feel thirsty. Drink regularly
   throughout the  day and night.
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                       Who is Likely
                       to Suffer Most
                       During a Heat Wave?
                          Older Adults: As people get
                          older, the body's ability to
                          cool itself may not work as
                          well as it used to.
                          People with Health
                          Problems: People who
                          are sick are at greater risk
                          of extreme heat. Some
                          medicines may make it
                          harder for the body to cool
   off. Being overweight also
   makes it harder for the body
   to cool off.
  Live on Top Floors: People
   who live on the top floors
   of buildings are more at risk
   because heat rises and it is
   often warmer there than on
   lower floors.
  No Air-conditioning:
   People who do not have air
   conditioning are also likely
   to experience problems
   during heat events.
  Bed Ridden: People who
   are not able to get out of the
   house and go to places where
   it is cooler are also at risk.

What Happens When the
Body Fails to Cool Down?

When the skin  cannot cool
down, body temperatures can
quickly get too hot. This can
cause a health  problem called
"heat stroke." Important organs
like the brain can overheat and
be damaged permanently. In
some cases, this can lead to
life-long disability or death.
Warning signs of being
overheated should be taken
very seriously. These signs
include:
  Red, hot, dry skin (lack of
   perspiration)
  Confusion
  Hallucinations (seeing,
   hearing, or  smelling things
   that aren't there)

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How Can I Keep Cool?

   If your heath care provider asks
   you to limit the amount of fluids
   you drink, ask how much is safe
   to drink when it is hot. Be sure
   to find out an exact amount,
   such as "one 12-ounce glass"
   and how often.
   Avoid beverages that contain
   caffeine, alcohol, or large
   amounts of sugar. These drinks
   can overheat or dehydrate you.
   Ask your  health care provider if
   your medicines might dehydrate
   you. If so, find out what to do
   about it. Do not stop taking your
   medicine unless your doctor or
   nurse says it is ok.
   If you live alone,  be sure
   someone checks on you at least
   twice a day during a heat wave.
   Ask a friend or your caregiver to
   check for signs of heat-related
   symptoms, such as hot, dry skin,
   confusion, or hallucinations.
   Call 911 if you  need help or
   medical attention.
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What are Heat Alert Systems?

Local governments can develop heat alert
systems and help protect the public from
heat-related problems.
Something called a "Heat Health Watch
Warning System" lets the public know when
a heat wave is coming. Local health officials
then get this warning out to older adults and
their caregivers and to others who might
suffer during a heat wave. These systems
have been set up in cities around the country,
including in Philadelphia, Seattle, Chicago,
and St. Louis.
Find out if your area has a Warning System
and how you can get more information.
Local governments also provide other
assistance. They can...
  Let the media know about a coming heat
   wave so it will  be reported in the news.
  Set up telephone information lines to
   answer questions about protection and
   signs of illness.
  Tell people  how to help an older family
   member or neighbor during a heat wave.
  Make air-conditioned buildings available
   and provide a way to get there.
  Make sure that homeless people can find
   cool spaces.
  Make educational materials available
   to agencies, senior centers, places of
   worship, and supermarkets.
  Work with utilities to ensure no one's
   electricity is turned off during a heat wave.

What is EPA's Aging Initiative?

To help older adults enjoy a longer and
healthier life and protect their loved ones, the
EPA developed  a program called  the Aging
Initiative. It helps with research, develops plans
that cities can use to prevent sickness during
heat waves, and sponsors public education
about things in the environment  that can affect
health. For more information, visit the EPA's
Web site at www.epa.gov/aging.

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                   How Can Communities Help Cool the Air?

    Communities can require the use of construction materials that do not absorb heat. When
 possible, they can build roads and sidewalks using light-colored material that does not hold heat.
 In addition, they can start programs to plant more trees and bushes. Each of these steps helps to:
                              Lower the air temperature
                              Reduce air pollution
                              Decrease energy consumption
                              Improve everyone's comfort
Other References

Environmental Protection Agency,
Heat Island Reduction Initiative
http://www. epa.gov/heatisland
Centers for Disease Control and Prevention
http://www. cdc.gov/aging/
http://www.cdc.gov/nceh/hsb/extremeheat
http://www.cdc.gov/MMWR
Environmental Health Perspectives
http://www.ehp.niehs.nih.gov
National Weather Service,
Heat Wave and Heat Index
http://www.nws.noaa.gov/pa/secnews/heat/
National Weather Service
http://www.nws.noaa.gov/om/hazstats.shtml
American Medical Association,
Heat-Related Illness During Extreme
Emergencies
http://www. ama-assn. org
Heat Wave Awareness Project
http://www.esig.ucar.edu/heat/literate.html
Medline Plus,
Heat Illness
http://www.niapublications.org/
spnagepages/hyperthermia-sp. asp
Footnotes

1.  Kallkstein, LS. and J.S. Greene, 1997.
   An Evaluation of Climate/Mortality
   Relationships in Large U.S. Cities and the
   Possible Impact of a Climate Change.
   Environmental Health Perspectives,
   105(l):84-93.
2.  Centers for Disease Control and
   Prevention, 2003. Extreme Heat. Available
   online: http://www.cdc.gov/nceh/hsb/
   extremeheat/defaulthtm
3.  Federal Emergency Management
   Administration, Backgrounder on Extreme
   Heat, Feb. 2003
4.  Naughton MP, Henderson A, Mirabelli MC,
   Kaiser R, Wilhelm JL, Kieszak SM, Rubin
   CH, McGeehin MA. Heat-related mortality
   during a 1999 heat wave in Chicago. Am
   J Prev Med. 2002 May;22(4):328-9.
5.  McMichael, A.J., L.S. Kalkstein and other
   lead authors, 1996. Climate Change and
   Human Health, (eds.  A.J. McMichael,
   A. Haines, R. Slooff, S. Kovats). World
   Health Organization, and United Nations
   Environment Programme  (Who/WMO/
   UNEP), Geneva, 297 pp.
Publication Number
EPA-100-F-05-019
            Protecting nit Health
             of Older Americans

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