Hyperthermia

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Missourians should call the state's toll-free abuse and neglect hotline at 1-800-392-0210 to report senior citizens or adults with disabilities suffering from the heat and needing assistance. The hotline operates 8 a.m. to 8 p.m. seven days a week.

• Beat the heat, find a cooling center near you
• Listen to audio clips on preventing heat exhaustion and heat stroke

Each year many Missourians suffer from heat-related illnesses, with some cases resulting in death.  During prolonged periods of high temperatures, using air conditioning – either at home or by seeking shelter in a local cooling center -- is the best preventive measure.

Missourians should become familiar with the terms used to identify heat hazards:

• Heat Wave is a prolonged period of excessive heat, often combined with excessive humidity.
• Heat Index is a number in degrees Fahrenheit (F) that tells how hot it feels when relative humidity is added to the air temperature. Exposure to full sunshine can increase the heat index by 15 degrees.
• Heat Cramps are muscle pains and spasms due to heavy exertion. Although heat cramps are the least severe, they are often the first signal that the body is having trouble with the heat.
• Heat Exhaustion typically occurs when people exercise heavily or work in a hot, humid place where body fluids are lost through heavy sweating. Blood flow to the skin increases, causing blood flow to decrease to the vital organs. This results in a form of mild shock. If not treated, the victim’s condition will worsen. Body temperature will keep rising and the victim may suffer heat stroke.
• Heat Stroke is a life-threatening condition. The victim’s temperature control system, which produces sweating to cool the body, stops working. The body temperature can rise so high that brain damage and death may result if the body is not cooled quickly.
• Sun Stroke is another term for heat stroke.

To prepare for extreme heat, you should consider:

• Install window air conditioners snugly; insulate spaces around the air condition for a tighter fit, if necessary.
• Check air-conditioning ducts for proper insulation.
• If you have central air conditioning, set the thermostat no lower than 78 degrees.
• Change or clean your air-conditioning filter once a month.
• 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. 

What to do during severe heat and heat emergencies

• 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 evaporation rate of perspiration. Call 211 for the nearest location of a cooling center.
• Use exhaust fans and dehumidifiers when needed.
• Eat light, well-balanced meals at regular intervals. Avoid using salt tablets unless directed to do so by a physician.
• Drink plenty of water. Individuals with epilepsy or heart, kidney, or liver disease, who are on fluid-restricted diets, or who have problems 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 your face and head by wearing a wide-brimmed hat. Wear sunscreen.
• 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 the buddy system when working in extreme heat; and take frequent breaks.

If your home is not air-conditioned, use moving air to try to beat the heat:

• Open all windows early in the morning to get rid of heat and help cool the home.
• Keep the house closed during the hottest part of the day. Check indoor and outdoor thermometers to make sure that the indoor temperature is still cooler than outside. Later, open up the house so the cooler night air can lower inside temperatures.
• Use floor and ceiling fans as much as possible to circulate a cooling breeze. Also use window fans if not using air conditioning.
• Sleep in a cooler part of the residence, such as lower floors or the basement.
• Take showers and baths early in the morning or late at night.
• Use appliances and equipment that give off heat (iron, light bulbs, clothes dryer, hair dryer, etc.) only as needed and limit use to the early morning or at night, not during the middle of the day.
• Slow down and avoid physical exertion to avoid heat stress.
• Listen to radio and television for discomfort index warnings and keep in touch with others every day.
• If the residence becomes too warm, try to be in a cooler place during the hottest part of the day – a friend’s or neighbor’s home, a cooling center, senior center, shopping mall or library.

The National Weather Service has additional information about keeping safe in extreme heat, common heat disorders for those involved in outdoor recreational activities at www.crh.noaa.gov/lsx/?n=summerweathersafetyweek.

The Missouri Department of Health and Senior Services monitors high temperatures and humidity across the state to prevent heat-related illness and death. The elderly and the chronically ill are more vulnerable to the effects of high temperatures. They perspire less and are more likely to have health problems requiring medications that can impair the body's response to heat. Many prescription medications make individuals more sensitive to the heat. Some of these medications include heart drugs, some anti-Parkinsonian agents, antihistamines, over-the-counter sleeping pills, antidepressants, anti-psychotics and major tranquilizers.

The former Missouri Division of Health initiated statewide hyperthermia death surveillance in 1980 in response to a heat wave that resulted in the death of 295 individuals due to Missouri’s extreme temperatures that summer. Hyperthermia Mortality, Missouri 1980-2011This surveillance program defines hyperthermia as physician-diagnosed heat exhaustion, heat stroke or hot weather/natural environment as a contributing factor in a death. From 1980 through 2011, there have been 995 deaths caused by Missouri’s hot weather.

In Missouri, the greatest numbers of heat-related deaths have occurred in the urban, more densely populated areas of St. Louis City, St Louis County and Jackson County (Kansas City). Of the 278 heat-related deaths reported from 2000 through 2011, there were 173 (62%) deaths in these metropolitan areas. Rural deaths accounted for 105 (38%) of the deaths. Non-Missouri residents who succumb to heat while visiting are considered cases, accounting for 9 deaths. Hyperthermia Mortality by Geographic Area, Missouri 2000-
2011White males are the most frequent victims of heat-related illness resulting in death. In the same twelve-year period, there were 136 (49%) white male deaths. Hyperthermia Mortality by Race and Sex, Missouri
2000-2011

Slightly more than half (141, 51%) of the 278 deaths during 2000-2011 have been of people age 65 years and older. Victims in this population often live alone and have other complicating medical conditions. Also, lack of air conditioning or refusal to use it for fear of higher utility expenses contributes to the number of deaths in the senior population. There were 125 (45%) hyperthermia deaths occurring in the 5 through 64-year-old age group. These deaths often have contributing causes such as physical activity (sports or work), complicating medical conditions, or substance abuse. Circumstances causing hyperthermia deaths in young children often involve a motor vehicle - a child left in or climbing into a parked vehicle during hot weather. From 2000-2011, there were 12 (4%) deaths of children less than five years of age.
Hyperthermia Mortality by Age, Missouri 2000-2011
Hyperthermia Mortality by Contributing Factor & Geographic Location of Death,
Missouri 2007-2011
Hyperthermia Mortality by Contributing Factor, Missouri 2007-2011

Missouri’s highest temperatures generally occur in July and August each summer. Thus, the majority of hot-weather-related deaths also occur during these months. Of the 278 deaths from 2000-2011, 128 (46%) deaths were during the month of July and 98 (35%) were in August.
Hyperthermia Mortality by Month of Death, Missouri 2000-2011
The summer of 2011 was particularly severe in Missouri, with hot weather causing over 2,000 emergency department visits and 47 deaths. In only four previous years since 1980 have there been that large a number of heat-related deaths in the state. These were 1980 (295 deaths), 1999 (92 deaths), 1983 (71 deaths), and 1995 (57 deaths).

While the very young, the elderly and the chronically ill are at greatest risk of heat-related illness, summer temperatures can take a toll on healthy young and middle-aged adults, too. Of the 47 people who died from heat-related causes in Missouri last year, 16 (34%) were between the ages of 25 and 54 years.
Hyperthermia Mortality by Age, Missouri 2011
Five of these deaths in younger people involved physical activity on a hot day, such as participating in sports or working. Five had underlying medical conditions, and four involved substance abuse. Two young people who died from the heat had no other contributing factors reported, just exposure to the hot environment.

Hyperthermia mortality in 2011 was also unusual in that 40% (19 deaths) occurred in Jackson County. There were 9 deaths (19%) in St. Louis City and 5 deaths (11%) in St. Louis County. There were 14 deaths (30%) in 12 other counties in Missouri.
Hyperthermia Mortality by Geographic Area, Missouri 2011
According to the National Weather Service, many areas of the state suffered through a major heat wave with advisories beginning as early as June 30 with little relief from the heat through August 31.

Public and private emergency response plans were implemented across the state. These responses included opening cooling centers, distributing ice, water, and people checking door-to-door for persons in danger from the heat. Without this quick and intensive response, public health officials believe mortality from the 2011 heat wave would have been much greater.

Missouri is the only state that conducts on-going statewide surveillance for hot weather-related illnesses and deaths. Health care providers are required to report cases of hyperthermia to the Missouri Department of Health and Senior Services.