CLIMATE CHANGE AND HEALTH
Facing a Hotter Future: Reflections from the 2021 Pacific Northwest Heat Wave
SAEM PULSE | SEPTEMBER-OCTOBER 2021
By Zachary S. Wettstein, MD; Lucy Goodson, MD; Eleanor Ganz, MD; and Jeremy Hess, MD, MPH, on behalf of the SAEM Climate Change and Health Interest Group
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At the end of June 2021, an unprecedented heat dome settled over the Pacific Northwest, trapping the region under a stalled high-pressure system of hot air. The temperatures crushed previous records not only for the region, but for the country. Temperatures in Seattle hit 108°F and Portland surged to 116°F, surpassing temperature records in Miami, Atlanta, and Chicago, and resulting in the hottest June for North America ever recorded. These broiling temperatures hit suddenly and persisted for days, leaving little time for acclimatization in a region suddenly 30°F hotter than average. A rare combination of factors appears to have driven this heat surge — a strong ridge of high pressure over the region as well as a low pressure trough that drew warm air from the south. Climatologists and atmospheric scientists have noted that while it is challenging to attribute this particular heat wave exclusively to climate change, the science is clear that temperatures are increasing, heat waves are becoming more frequent and intense, and this event would have been very unlikely without the contributions of anthropogenic climate change.
There is an underappreciated human health cost due to extreme heat, which we witnessed first-hand in our emergency department (ED). During the peak of the heat wave, our regional Disaster Medical Coordination Center was activated to redistribute the influx of patients among overwhelmed area hospitals. According to initial data from the county health department, over 10% of emergency department visits that day were heat-related, and EMS responded to many more calls than those who were transported. Early on, patients presented with classic heat illness: hot to the touch, fatigued, nauseous — an elderly woman stuck in a blistering third story apartment; a patient in supportive housing too weak to get down the stairs. After an ice bath and some fluids, these patients brightened up, and calls were made to relatives and case workers to arrange for a cooler place to spend the night. When sunset didn’t break the heat, paramedic calls grew more frequent and dire: intoxicated patients found unresponsive and hyperthermic on the sidewalk, some with third-degree burns from walking on hot asphalt; frail elderly
patients intubated because they had lost consciousness. By midnight, paramedics called to warn of their arrivals every other minute. Each call seemed a version of the last: a vulnerable person, found unconscious or confused, hot to the touch, needing emergent intervention. Hospitals depleted their supply of ventilators. One medical center lost its own air conditioning for several hours. Laboratory equipment overheated. Within a thirty-minute period, three asystolic arrests were terminated in the field. Patients arrived to an overwhelmed emergency department with asthma exacerbations, hemorrhagic strokes, and stab wounds. A network of resources already stretched thin found itself reaching a boiling point. As previously reviewed in SAEM Pulse by our colleagues from the SAEM Climate Change and Health Interest Group, the spectrum of heat illness ranges from minor symptoms to major illness such as heat stroke, the mortality of which is exceedingly high. Those at greater risk of heat illness are the young and old, athletes and outdoor workers, military, and those with lower income and resources. Chronic diseases such
