In his 40 years in the emergency room, David Sklar can think of three moments in his career when he was terrified.
“One of them was when the Aids epidemic hit, the second was Covid, and now there’s this,” the Phoenix physician said, referring to his city’s unrelenting heat. Last month was the city’s hottest June on record, with temperatures averaging 97F (36C), and scientists say Phoenix is on track to experience its hottest summer on record this year.
“All three of these situations are sort of disasters, where we became overwhelmed by something that had really serious effects on a large part of our population.”
In recent months, Sklar and his colleagues have seen waves of patients coming into the ER with heatstroke, dehydration and even asphalt burns.
He described seeing several patients in a single shift with heatstroke. “Typically people aren’t talking at all, they’re just breathing and gasping and are in very bad shape,” he said of the most severe cases.
As the climate crisis intensifies and shatters heat records, emergency rooms across the country are filling up with heat-sick patients. Officials recorded nearly 120,000 heat-related emergency room visits in 2023 alone, a “substantial” increase from previous years, according to the Centers for Disease Control and Prevention.
At least 27 people in Maricopa county, where Sklar works, have died from heat so far this year, with hundreds of other deaths under investigation. But these figures are likely underestimates, as heat-related deaths are often undercounted, especially among outdoor workers.
“That’s the very tip of the iceberg,” said Sklar. “We really need to start thinking about heatwaves as a disaster.”
Extreme heat is not recognized by the federal government as a disaster. Earlier this month, 14 attorneys general led by Arizona’s Kris Mayes petitioned the Federal Emergency Management Agency to declare wildfire smoke and extreme heat as major disasters.
“We’re used to calling hurricanes, tornadoes and earthquakes disasters where there can be a lot of casualties, but they get done with pretty quickly in most cases,” Sklar said. “[Heat] is a slow-rolling disaster that goes on for weeks and months, and the people who are being affected are just really, really sick.”
Heat is the deadliest weather disaster, killing more people each year than hurricanes, floods and earthquakes combined. Last month was the hottest June on record globally and record-breaking heat has continued to blanket much of the US in recent weeks.
Health workers say that heat is straining emergency rooms that are already understaffed, overcrowded and still grappling with the consequences of the Covid-19 pandemic.
“We’re brimming in our emergency departments to begin with,” said Ellen Sano, a physician at the Columbia University medical center. “So every time you add the environmental effects of heat or viral infection, we struggle with capacity.”
Earlier this month, millions of people in Texas lost power during a deadly heatwave after Hurricane Beryl made landfall. Outages in some areas lasted over a week, with local hospitals reporting an uptick in heat-related illnesses. Officials set up a medical shelter at a local arena to hold patients who were ready to be discharged from the hospital but whose homes still lacked electricity.
“There are so many patients that we have to transfer because all these hospitals are so full,” said Owais Durrani, a Houston emergency room physician. “At the hospital, when I park I see a row of ambulances around the corner. When you walk in, [you’re] seeing rows and rows of patients in hallways and every bed is full. That’s terrifying to come to work into.”
Durrani said that heat at night, combined with power outages, contributed to people getting sick. “You may have had a day where you exerted yourself, you go home and you drink some fluids, you have air conditioning and you can recover,” he said. “But there is no recovery when you have no power.”
Since 1970, summers have warmed by an average of 2.5F, with overnight temperatures increasing by 3F across the US, according to Climate Central.
Children, elderly and pregnant people, outdoor workers, and those with chronic medical conditions including diabetes and high blood pressure are the most vulnerable to heat stress – an excessive buildup of heat at a level that is more than the body can release. Unhoused people are another high-risk group, due in large part to a lack of air conditioning, prolonged exposure and often unaddressed health issues, many of which heat exacerbates.
“They’re sleeping and living on the asphalt, and overnight temperatures don’t get as cool,” said Durrani, who says he’s seen patients come in with asphalt burns.
Some medication for chronic conditions can put people at an increased risk of heatstroke. Amphetamines, commonly used to treat ADHD, can raise a person’s body temperature, and some antidepressants, antihistamines and beta blockers can impair the person’s ability to cool down.
“People who are taking certain medications for psychiatric illnesses, those medications can interfere with your sweating mechanism,” said Gredia Huerta-Montañez, a pediatrician and environmental health researcher at Northeastern University. “If you leave your medications in the car during extreme heat days, those medications can suffer changes and be less effective.”
Sklar, the Phoenix physician, said that other underlying conditions – including untreated mental illnesses – also place patients at high risk. “Not being on medication for people who have schizophrenia can be a problem because they sometimes make decisions that are not in their best interest,” said Sklar. “So they may just walk and walk outside to a point where they collapse.”
Treatment for heat illness varies on the state of the admitted patient, but if a person is sick enough to be hospitalized, healthcare workers typically apply ice packs to their neck and groin – places with a lot of blood flow and also areas where bodies tend to sweat, according to Sklar. Cool intravenous fluids can bring down body temperature and treat dehydration at the same time.
Patients are sometimes so overheated they’re delirious or lose consciousness, Sklar said. That often indicates heatstroke, when core body temperatures may reach above 104F. In such cases, speed is imperative as internal organs can start to fail.
In those cases, physicians sometimes place patients in body bags filled with ice.
“Turns out that those are actually relatively effective for this, because they hold the water well, and they’re the right size for a human body,” said Sklar. First responders, including fire departments, use similar methods. “Because they’re unconscious, they’re not really feeling the pain of the cold,” he added. “The key is to cool them quickly.”
