During an average
summer, there are
more than 7,700 heat-
related deaths in the
United States.' 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.
April 2009
"It's Too Dam Hot" -
Planning for Excessive
Heat Events
Information for Older Adults and
Family Caregivers
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
Endnotes
1. Davis, R.E., P.C. Knappenberger, P.J.
Michaels, and WM. Novicoff. 2003.
Changing heat-related mortality in the
United States. Environmental Health
Perspectives 111(14):1712-1718.
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-09-019
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