MMWR: Heat-Related Deaths During an Extreme Heat Event

Severe weather reports from 2012 Derecho

 

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In late June of 2012 an unusually strong storm front, known as a Derecho, swept across parts of the Eastern United States – killing 15 people – and leaving millions without electrical power for more than a week (see Picking Up The Pieces)

 

Adding to the misery – and danger – the region remained under an EHE (Extreme Heat Event) advisory for two weeks.

 

Not surprisingly, given these difficult conditions, dozens of additional heat-related deaths were recorded during the two weeks following the storm. 

 

Yesterday, the CDC’s MMWR looked at these excess heat-related deaths in a report called:

 

Heat-Related Deaths After an Extreme Heat Event — Four States, 2012, and United States, 1999–2009

Weekly

June 7, 2013 / 62(22);433-436

On June 29, 2012, a rapidly moving line of intense thunderstorms with high winds swept across the midwestern and eastern United States, causing widespread damage and power outages. Afterward, the area experienced extreme heat, with maximum temperatures exceeding 100°F (37.8°C) (1). This report describes 32 heat-related deaths in Maryland, Ohio, Virginia, and West Virginia that occurred during the 2 weeks following the storms and power outages. Median age of the decedents was 65 years, and most of the excessive heat exposures occurred within homes. During 1999–2009, an annual average of 658 heat-related deaths occurred in the United States (2). Heat-related deaths are preventable, and heat response plans should be in place before an extreme heat event (EHE). Interventions should focus on identifying and limiting heat exposure among vulnerable populations.

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The entire report is worth reading, and the reader will discover that over the past 10 years, twice we’ve seen more than 1,000 heat related deaths in a year.

 

These numbers pale in comparison to the heat-related deaths that occurred during the prolonged drought and heat wave of 1980.  As many as 10,000 Americans are believed to have died from that 3-month long natural disaster. 

 

This from NOAA’s A Climatology of 1980-2003 Extreme Weather and Climate Events by Tom Ross and Neal Lott.

 

1980 Drought/Heat Wave  - June-September 1980. Central and eastern U.S.; estimated $20.0 (48.4) billion damage/costs to agriculture and related industries; estimated 10,000 deaths (includes heat stress-related).

Whether it comes as a result of a tornado, hurricane, earthquake, or other major disaster – prolonged power outages that occur during the extreme temperatures of summer or winter can be life threatening events.

 

Being prepared for an emergency means being able to deal with the aftermath of a disaster, and the ability to keep cool, or stay warm, should be part of everyone’s disaster plan.

 

You’ll find a detailed webpage on how to handle heat emergencies from the CDC’s Emergency Preparedness and Response  website:

 

Extreme Heat: A Prevention Guide to Promote Your Personal Health and Safety

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Ready.gov has some advice for preparing or heat emergencies.

 

Before Extreme Heat

To prepare for extreme heat, you should:

• To begin preparing, you should build an emergency kit and make a family communications plan.
• Install window air conditioners snugly; insulate if necessary.
• Check air-conditioning ducts for proper insulation.

  Install temporary window reflectors (for use between windows and drapes), such as aluminum foil-covered cardboard, to reflect heat back outside.

• Weather-strip doors and sills to keep cool air in.
• Cover windows that receive morning or afternoon sun with drapes, shades, awnings, or louvers. (Outdoor awnings or louvers can reduce the heat that enters a home by up to 80 percent.)
• Keep storm windows up all year.
• Listen to local weather forecasts and stay aware of upcoming temperature changes.
• Know those in your neighborhood who are elderly, young, sick or overweight. They are more likely to become victims of excessive heat and may need help.
• Be aware that people living in urban areas may be at greater risk from the effects of a prolonged heat wave than are people living in rural areas.
• Get trained in first aid to learn how to treat heat-related emergencies.

 

During a disaster like a hurricane or tornado the obvious threats – flying debris, storm surge, electrocution – are all easy to spot. But things like dehydration and heat stroke are often insidious, and can strike before anyone notices their threat.

 

Three summers ago, on a particularly hot Florida afternoon, we had a power outage that lasted more than 6 hours.  I wrote about it in Sweltering In Place.

 

While I was already set up with a 12 volt fan, my Sister and Father weren’t so lucky. . . . they ended up driving across town to sit in an air-conditioned restaurant for several hours.

 

The next day, I went out and bought them each a battery operated personal cooling fan, one that will run for nearly 24 hours on 4 D-Cells.

 

I paid about $12 each for them.

 

Of course, I’ve also got plenty of water stored, food, first aid supplies packets of rehydration solution, and at least four places within 150 miles of where I live where I could evacuate to if staying where I am became untenable.

 

Basic Preps: Emergency Weather Radio, First Aid Kit, Battery Lantern, Water storage

 

While preparedness may seem like a lot of work, it really isn’t. For more information on how to prepare, I would invite you  to visit:

 

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

A Disaster In Slow Motion

 

 

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Disasters don’t always happen suddenly, with the ferocity of a tornado or earthquake.  Some disasters – like droughts - happen over weeks, months, or even years and insidiously exact their toll in lives lost, crops destroyed, and economies shaken.

 

The United States is no stranger to extreme drought conditions. Most famously, the nation saw an eight-ear drought that caused the horrific `dust bowl’ conditions across Oklahoma, Kansas, and Texas in the 1930s.

 

Dust storm Elkhart, Kansas 1937.

 

 

While not as dramatic or prolonged, according to A Climatology of 1980-2003 Extreme Weather and Climate Events (Ross and Lott, 2003), an intense drought & heat wave in 1980 caused:

 

1980

Drought/Heat Wave - June-September 1980: Central and eastern U.S. drought/heat wave caused damage to agriculture and other related industries.

Total Estimated Costs: $20.0 (55.6) Billion; 10,000 Deaths

 

And again, eight years later:

 

1988

Drought/Heat Wave - Summer 1988: 1988 drought in central and eastern U.S. with very severe losses to agriculture and related industries;

Total Estimated Costs: $40.0 (77.6) Billion; 7,500 Deaths

More people die from heat-related disasters in the U.S.  than from all of our hurricanes, tornados and blizzards combined.

The drought of 2012, which resulted in the declaration by the USDA last week of 1,016 primary counties in 26 states as natural disaster areas, is already being compared to the 1988 disaster.

 

The trend across the U.S. this year has been hot and dry. According to NOAA’s  State of the Climate National Overview (6/12):

 

• The January-June period was the warmest first half of any year on record for the contiguous United States. The national temperature of 52.9°F was 4.5°F above average. Most of the contiguous U.S. was record and near-record warm for the six-month period, except the Pacific Northwest. Twenty-eight states east of the Rockies were record warm and an additional 15 states were top ten warm.
• The first six months of 2012 were also drier than average for much of the contiguous U.S., with a nationally-averaged precipitation total 1.62 inches below average. Drier-than-average conditions stretched from the West, through the Central Plains, into the Ohio Valley and Mid-Atlantic. Fourteen states in total had precipitation totals for the six-month period among their ten driest.

Unfortunately, there is a lot of summer left to go, and the forecast is for continued drought conditions across roughly 60%  of the United States.

Corn, soybean and wheat futures prices have been rising for weeks in anticipation of lower-than-normal crop yields and last week the USDA has slashed its 2012 corn production forecast by about 12% from earlier estimates.

 

And along with drought inevitably come wildfires, which have destroyed millions of acres of woodland so far this year, and the fire season is far from over.

 

Credit US Forestry Service

 

Ready.gov has advice for preparing for a variety of disasters, including drought, heat, and wildfires.

 

Natural Disasters

Drought >

Extreme Heat >

Wildfires >

 

September is National Preparedness Month, but being prepared is a year-round endeavor.  Rather than focus on one single threat, the smart move is to work towards `all-threats’ preparedness, since you never know what you and your family may be faced with.

 

For more on how to get, and stay, prepared you may wish to revisit:

 

Inside My New Bug Out Bag

Picking Up The Pieces

When 72 Hours Isn’t Enough

In An Emergency, Who Has Your Back?

An Appropriate Level Of Preparedness

The Gift Of Preparedness 2011

The Biggest Weather-Related Killer

 

Today’s Heat Forecast – Credit NOAA 

 

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While less dramatic than a hurricane, tornado, or blizzard – heat waves kill more Americans during an average year than all three of those put together. And once again today (and through this weekend) heat indexes will be dangerously high across much of the eastern half of the country.

 

Counting the number of fatalities due to excessive heat is difficult, since many of those who succumb are elderly, and have other medical conditions.

 

As Rupa Basu and Jonathan M. Samet wrote in the Journal Epidemiological Reviews (see Relation between Elevated Ambient Temperature and Mortality: A Review of the Epidemiologic Evidence):

 

An average of 400 deaths annually are counted as directly related to heat in the United States, with the highest death rates occurring in persons aged 65 years or more (3). The actual magnitude of heat-related mortality may be notably greater than what has been reported, since we do not have widely accepted criteria for determining heat-related death (4, 5–7), and heat may not be listed on the death certificate as causing or contributing to death.

 

This disparity between counted and estimated heat-related deaths can be illustrated by the reports from the infamous heat wave of 1980, which `officially’ claimed `more than 1250 lives’ (cite NOAA  Heat Wave: A Major Summer Killer) but which unofficially may have killed as many as 10,000  (Tracking and Evaluating U.S. Billion Dollar Weather Disasters, 1980-2005 (Lott and Ross, 2006).

 

Eight years later, a heat wave across the central and eastern part of the nation killed as many as 7,500 people (cite). More recently, in 1999, a prolonged heat wave along the Eastern seaboard is believed to have killed 500 (cite).

 

And in Europe and across Russia a prolonged heat wave in 2010 may have contributed to tens of thousands of deaths (see Recent Heat Waves Likely Warmest Since 1500 in Europe).

 

Forecasters base their decision to issue heat warnings based on the heat index, a combination of heat and relative humidity, using the chart below:

 

 

Excessive heat alert warnings are usually issued when the forecast anticipates a heat index that exceeds 105°-110°F for at least 2 consecutive days. As you can see, when it is extremely humid, actually temperatures don’t have to get much above 90 to become dangerous.

 

In anticipation of this weekend’s heat wave, the CDC has posted some helpful information on beating the heat on their Have You Heard?  website.

 

Learn more about heat-related illness and how to stay cool and well in hot weather

June 29, 2012

Getting too hot can make you sick. You can become ill from the heat if your body can't compensate for it and properly cool you off. Heat exposure can even kill you: it caused 8,015 deaths in the United States from 1979 to 2003. These are the main things affecting your body's ability to cool itself during extremely hot weather: high humidity and personal factors.

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More Information

• Beat the Heat (When Working Outdoors) [PODCAST - 5:30 minutes]
• Extreme Heat
• Frequently Asked Questions about Extreme Heat
• Heat Stress in the Elderly
• Extreme Heat Media Toolkit

 

For more information, the Excessive Heat Events Guidebook was developed in 2006 by the EPA, the NWS, the CDC, and the DHS to provide the best practices for saving lives during heat waves in urban areas.

 

 

Some handy advice for this weekend, or anytime the heat index is excessively high:

 

 

Quick Tips for Responding to Excessive Heat Events

For the Public

Do

• Use air conditioners or spend time in air-conditioned locations such as malls and libraries
• Use portable electric fans to exhaust hot air from rooms or draw in cooler air
• Take a cool bath or shower
• Minimize direct exposure to the sun
• Stay hydrated – regularly drink water or other nonalcoholic fluids
• Eat light, cool, easy-to-digest foods such as fruit or salads
• Wear loose fitting, light-colored clothes
• Check on older, sick, or frail people who may need help responding to the heat
• Know the symptoms of excessive heat exposure and the appropriate responses.

Don’t

• Direct the flow of portable electric fans toward yourself when room temperature is hotter than 90°f
• Leave children and pets alone in cars for any amount of time
• Drink alcohol to try to stay cool
• Eat heavy, hot, or hard-to-digest foods
• Wear heavy, dark clothing.

The Heat Is On

 

 

# 5705

 

According to NOAA, roughly 141 million Americans are under an excessive heat advisory or warning today. 

 

While it is hot down here in Florida today, our heat index doesn’t compare with those being seen in the Midwest this week.

 

The CDC estimates that between 1999-2003, excessive heat was responsible for a total of 3,442 heat-related deaths (annual mean: 688)  (MMWR Heat-Related Deaths --- United States, 1999—2003)

 

You’ll find a detailed webpage on how to handle heat emergencies from the CDC’s Emergency Preparedness and Response  website:

 

 

Extreme Heat: A Prevention Guide to Promote Your Personal Health and Safety

 

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FEMA also has some sage advice on how to handle excessively hot weather.

 

 

During a Heat Emergency

What you should do if the weather is extremely hot:

• Stay indoors as much as possible and limit exposure to the sun.
• Stay on the lowest floor out of the sunshine if air conditioning is not available.
• Consider spending the warmest part of the day in public buildings such as libraries, schools, movie theaters, shopping malls, and other community facilities. Circulating air can cool the body by increasing the perspiration rate of evaporation.
• Eat well-balanced, light, and regular meals. Avoid using salt tablets unless directed to do so by a physician.
• Drink plenty of water. Persons who have epilepsy or heart, kidney, or liver disease; are on fluid-restricted diets; or have a problem with fluid retention should consult a doctor before increasing liquid intake.
• Limit intake of alcoholic beverages.
• Dress in loose-fitting, lightweight, and light-colored clothes that cover as much skin as possible.
• Protect face and head by wearing a wide-brimmed hat.
• Check on family, friends, and neighbors who do not have air conditioning and who spend much of their time alone.
• Never leave children or pets alone in closed vehicles.
• Avoid strenuous work during the warmest part of the day. Use a buddy system when working in extreme heat, and take frequent breaks.

Additional Information

An emergency water shortage can be caused by prolonged drought, poor water supply management, or contamination of a surface water supply source or aquifer.

 

Drought can affect vast territorial regions and large population numbers. Drought also creates environmental conditions that increase the risk of other hazards such as fire, flash flood, and possible landslides and debris flow.

Conserving water means more water available for critical needs for everyone. Appendix A contains detailed suggestions for conserving water both indoors and outdoors. Make these practices a part of your daily life and help preserve this essential resource.