By Peggy Ann Berry, PhD, RN, COHN-S, CLE, PLNC, FAAOHN
How hot is it? We are moving away from the hottest summer on record into Fall, but the fact remains – Earth has a temperature, and people accelerate it. And, people, we have a lot to be concerned about with a rising temperature. For case managers, I will highlight three areas concerning the effects of rising temperatures on our clients/patients.
First, humans can acclimate to rising temperatures by wearing loose-fitting clothing, drinking water, and staying indoors in air conditioning. For those still working in heat, a range of work practices should be promoted, such as rest breaks, access to shade and water, and heat acclimation.1 The CDC developed a heat and health tracker to help protect workers from heat. However, not all heat can be acclimated to people with chronic illnesses and certain medications. And, let’s face it, there are workers with chronic diseases who will succumb to heat stress.2
All people are susceptible to heat stress. With increasingly frequent extreme heat events occurring in the U.S., it is essential to recognize the more vulnerable to heat stress. Those people who are vulnerable include pregnant people, those with lung or heart conditions, older adults, young children, athletes, and outdoor workers.2 Heat-related illnesses can exacerbate illnesses with multiple sclerosis, cardiovascular disease, and cerebrovascular disease and cause preterm birth with negative impacts on fetal health.2 Heat exhaustion or stroke, Rhabdomyolysis, heat syncope, cramps, and rash can occur.3
Those people without chronic illness can usually withstand an internal temperature of 104 degrees Fahrenheit (40C). People most susceptible to heat exhaustion are the elderly, those with high blood pressure, and outside workers. Heat stroke can occur if the body’s temperature rises rapidly with the inability to cool down. That said, as a person’s internal temperature rises, the symptoms of heat stroke can occur (see box). If the person does not receive treatment (water, shade, or more aggressive care), death or permanent disability can occur.3
Secondly, those who take medication daily may find that those necessary medications expose them to a higher incidence of heat-related illnesses.4 According to Wee, et al. (2023), medications can significantly alter the body’s ability to regulate itself in extreme heat. This alone will alter how medications are prescribed and there will be more emphasis on educating people on the medication they take. As a case manager, you will be responsible for knowing the medications your client takes as well as their work or home environment. According to the Energy Information Administration, 13% of household do not have air conditioning (https://www.eia.gov/consumption/residential/). Caution should be taken with clients using ACE inhibitors, ARBs, like Iosartan, Diuretics, and calcium channel blockers. Please follow this link for more information on climate and health: https://tools.niehs.nih.gov/cchhl/index.cfm/detail/31938#searchTerm=medication%20effects&selectedFacets=&selectedResults=
Lastly, according to Geldsetzer (2021)5, about 15.7% of U.S. citizens used mail-order prescriptions in 2018. This number has probably risen, given the discount received when using this service. Please advise clients on which medications will be affected by heat. These meds are inhalers, EpiPens, insulin, and other medications which need to be refrigerated or in a cool environment.
Life is complicated. It is much more complicated with extreme heat for case managers caring for people with chronic health conditions.
References
- NA (2024). Safety matters. Professional Safety Journal. 56(8). P. 12
- CDC (N.D.). CDCHeatTracker. Retrieved https://ephtracking.cdc.gov/Applications/heatTracker/
- CDC (N.D.). Heat Stress – Heat Related Illness. Retrieved https://www.cdc.gov/niosh/topics/heatstress/heatrelillness.html
- Wee J, Tan XR, Gunther SH, Ihsan M, Leow MKS, Tan DS, Eriksson JG, Lee JKW. Effects of Medications on Heat Loss Capacity in Chronic Disease Patients: Health Implications Amidst Global Warming. Pharmacol Rev. 2023 Nov;75(6):1140-1166. doi: 10.1124/pharmrev.122.000782. Epub 2023 Jun 16. PMID: 37328294.
- Do D, Geldsetzer P. Trends in Mail-Order Pharmacy Use in the U.S. From 1996 to 2018: An Analysis of the Medical Expenditure Panel Survey. Am J Prev Med. 2021 Aug;61(2):e63-e72. doi: 10.1016/j.amepre.2021.02.017. Epub 2021 May 3. PMID: 33958237; PMCID: PMC8319048.
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Bio: Peggy Ann Berry, PhD, RN, COHN-S, CLE, PLNC has worked in healthcare since 1972 as an aide, then RN in 1977. After a 13 year career as an occupational health nurse manager, Peggy received her Masters in Nursing Science in 2007 followed by a doctorate in Nursing Research from University of Cincinnati in 2015. She is a Founding Fellow with the U. S. Academy of Workplace Bullying, Mobbing, and Abuse. She is a past Graduate Nurse Intern to OSHA and Malcolm Baldrige Examiner. She speaks on injury prevention, workplace bullying, and servant leadership.