November 2006
During an average
summer, approxi-
mately 1,500 peo-
ple die from
excessive heat
events in the U.S.1
A single heat wave
in Chicago killed
more than 700
people in 1995. In
Europe, a record
heat wave claimed
an estimated
35,000 lives in
2003. In both
cases, most of the
victims were  65 or
                           Too Darn Hot" -
                           Planning for Excessive
                           Heat Events
                           Information for Older Adults and
                           Family Caregivers
Did you know that each year more people die from
"excessive heat events" than from hurricanes, light-
ning, tornadoes, floods, and earthquakes
combined?2 Anyone can be adversely affected by
excessive heat, but older adults are particularly vul-

Excessive heat events are prolonged periods when
temperatures reach 10 degrees Fahrenheit or more
above the average high temperature for a region.3

Excessive heat events are believed to have a dispro-
portionate public health impact in cities. One reason
is that roads and buildings  absorb the sun's energy
and contribute to the formation of "heat islands."
While rural areas cool off at night, cities retain this
absorbed heat. As a result,  urban  residents get less
nighttime relief from high temperatures. Fortunately,
there are simple steps that older adults, their care-
givers, and community leaders can take to decrease
the impact of excessive heat events.
  "Excessive heat events" are surprisingly deadly.
  Vulnerable groups like older adults are at
  particularly high risk.

Who is At Risk from
Extreme Heat?
Older adults, as well as young chil-
dren, are at high risk from excessive
heat events. For the growing num-
ber of aging Americans, the body's
cooling mechanisms may become
impaired. Living alone or being con-
fined to a bed and unable to care
for one's self further increases risk.

Existing health conditions such as
chronic illness, mental impairment,
and obesity can also heighten an
individual's vulnerability. Persons
taking certain medications are like-
wise susceptible.

In addition, people who live on the
top floors of buildings without air-
conditioning are more likely to be
exposed to excessive heat.
Participating in  strenuous outdoor
activities and consuming alcohol
during unusually hot weather like-
wise exacerbates heat-related
health effects.

How Does Excessive Heat
Affect the Body?
The body normally cools itself by
increasing blood flow to the skin
and perspiring. Heat-related illness
and mortality occur when the
body's temperature control system
becomes overloaded. When this
happens, perspiring may not be
enough. High levels of humidity can
make it even harder for the body to
cool itself.

How are Excessive Heat
and Heat Stroke Related?
Heat stroke is the most serious
health effect of excessive heat
events. It is the failure of the body's
temperature control system. When
the body loses its ability to cool
itself, core body temperature rises
rapidly. As a result, heat stroke can
cause severe and permanent dam-
age to vital organs.

Victims can be identified by skin
that appears hot, dry, and red in
color. Other warning signs are  con-
fusion, hallucinations, and aggres-
sion. If not treated immediately,
heat stroke can result in permanent
disability or death. The good news
is that heat stroke can be prevented
by taking the easy steps outlined
on this page. The good news is that
there are simple steps people can
take to protect themselves.

            How Does Extreme Heat Affect Me?
The body normally cools itself by increasing blood
flow to the skin and perspiring. Heat-related illness
and mortality occur when the body's temperature
control system becomes overloaded. When this
happens, perspiring may not be enough.

High levels of humidity can  make it even harder for
the body to cool itself.

      How Can I Reduce Exposure to Excessive Heat?
The best defense against excessive heat is prevention. Air-condition-
ing is one of the best protective factors against heat-related illness
and death.4 Even a few hours a day in air conditioning can greatly
reduce the risk. Electric fans may provide comfort, but when temper-
atures are in the high 90s fans do not prevent heat-related illness.

During excessive heat events, the following prevention strategies can
save lives:
  Visit air-conditioned buildings in your community if your home  is
   not air-conditioned. These may include: senior centers, movie the-
   aters, libraries, shopping malls, or designated "cooling centers."
  Take a cool shower or bath. 5
  Drink lots of fluids. Don't wait until you are thirsty to drink. If a
   doctor limits your  fluid intake, make sure to ask how much to
   drink when it's hot. Avoid beverages containing caffeine, alcohol,
   or large  amounts of sugar. These drinks cause dehydration.
  Ask your doctor or other health care provider if the medications
   you take could increase your susceptibility to heat-related illness.
  Wear lightweight, light-colored, and loose-fitting clothing.
  Visit at-risk individuals at least twice a day. Watch for signs of heat-
   related illness such as hot, dry skin, confusion, hallucinations, and
  Call 9-1-1 if medical attention is needed.

What Can Your Local
Government Do to Help?
Local governments can play an
important role in predicting and
responding to excessive heat
events. Two increasingly common
strategies are heat alert systems
and heat reduction measures.

Heat Alert Systems
Heat Health Watch-Warning
Systems identify when a heat-relat-
ed public health threat is likely.
These systems use  computer pro-
grams that analyze National
Weather Service forecasts and other
local data to predict dangerous
conditions. Heat Health Watch-
Warning Systems have been estab-
lished in Philadelphia, Seattle,
Chicago, St. Louis, and other cities
in the U.S. and Europe.
After a warning has been called,
city health authorities communicate
this information to older adults,
their care-givers, and other at-risk

Assist the Homeless and
Those With Mental Health
The following steps are "best-prac-
tices" that city officials can take to
alert residents and provide direct
 Distribute media advisories
 Activate telephone hotlines
 Alert neighborhood volunteers,
  family members, and friends
 Provide air-conditioned  buildings
  and offer transportation to these
 Assist the homeless
 Work with local "area agencies
  on  aging" to educate at-risk indi-

Cities may also coordinate with
local utilities to ensure that no cus-
tomer's electricity is turned off dur-
ing a  heat wave.

What Cost-Effective Steps
Can Communities Take to
Cool the Air?
Two steps that communities can
take include using construction

material that reflect the sun's rays,
and planting trees and vegetation
to provide shade and natural cool-
ing. Both strategies reduce the
urban heat island effect - urban
temperatures 2-10 degrees
Fahrenheit hotter than surrounding
rural areas - and may limit the fre-
quency, duration, and magnitude of
excessive heat events.

Heat reduction strategies such as
using reflective "cool roofs" and
light-colored pavements,  and plant-
ing shade trees, have numerous
benefits. These measures:
 Lower ambient temperatures
 Slow heat-driven reaction  that
  forms ozone air pollution
 Decrease energy consumption
 Improve comfort and livability
  Learn More
  The EPA Aging Initiative is work-
  ing to protect the environmental
  health of older adults through
  the coordination of research,
  prevention strategies, and public
  education. For more information
  or to join the listserve visit:
Other References

Environmental Protection Agency,
Heat Island Reduction Initiative

Center for Disease Control and

http :// M M WR

Environmental Health Perspectives

American Medical Association,
Heat-Related Illness During
Extreme Emergencies

National Weather Service,
Heat Wave and Heat Index

Medline Plus, Heat Illness

National Weather Service           3  Federal Emergency Management   Administration, Backgrounder on
hazstats-shtml                   Extreme Heat, Feb. 2003
Heat Wave Awareness Project
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,

2  Centers for Disease Control and
Prevention, 2003. Extreme Heat.
Available online:
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., LS. 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.