It IS the Heat!
by Dr. Kevin Kloesel
As our capability to detect deadly weather hazards such as lightning, hail, heavy rainfall, tornadoes and other windstorms continues to improve, weather plans with appropriate decision triggers to protect artists, staff, and patrons at outdoor venues will also improve. Unfortunately, a weather plan accounting for this list of deadly hazards is not only incomplete, it doesn’t account for the weather threat responsible for the most weather fatalities. Extreme heat is the number one weather killer in the U.S. with 180 fatalities on average annually (source: CDC). Extreme heat waves around the world have resulted in significant loss of life with an estimated 70,000 heat-related deaths across Europe during the summer of 2003, 700 fatalities in Illinois in 1995, and another 400 in California during the summer of 2006.
The outdoor entertainment and venue industry is no stranger to casualties caused all or in part to extreme heat. Over 500 guests were treated for extreme heat at last year’s CMA Music Festival in Tennessee and dozens were hospitalized. Heat-related fatalities occurred at outdoor events in 5 different states in 2015. Events in eleven more states had heat-related casualties that required hospitalization of fair or concertgoers.
The Silent Killer
The National Oceanic and Atmospheric Administration (NOAA), The Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA) all refer to extreme heat as the “silent killer.” This apt descriptor highlights the inherent difficulty in being able to accurately define or predict how extreme temperatures and accompanying atmospheric humidity affect you! Extreme heat affects the young and old differently. Your level of acclimation to the heat also determines your body’s ability to regulate its’ internal temperature. Medications, alcohol use, drug use, water intake, all combine in unique and individual ways to make you susceptible in varying degrees to heat illness.
Extreme heat does not manifest itself as a looming dark cloud on the horizon, or a bolt of lightning and crack of thunder. Extreme heat kills as a result of the temperature and moisture content of the invisible air around you, combined with a healthy dose of sunshine, your ability or inability to find shade, a breeze, or cool down, as well as what you had to eat or drink that day. If you have ever uttered the words “it’s complicated” for a relationship? Put “COMPLICATED” in all capital letters when trying to forecast how any one person will react to extreme heat.
Your Body, What We DO Know!
If you maintain a consistent internal body temperature of about 98.6F, your body tends to function well. Think of your body as a refreshing container of ice cream in your freezer. As long as you maintain a freezer temperature of between -5F and 0F, the ice cream maintains its molecular consistency (a fancy term for ‘ice crystal deliciousness’). As soon as you expose the ice cream to warmer temperatures, drastic changes begin to occur. When your internal body temperature increases, unseen changes inside of you occur. Granted, you may feel as if you are melting, but if your body temperature begins to increase, other health issues will soon follow.
When your internal body temperature increases, your body starts to enact its own built-in emergency plan. Your body was born with an internal set of decision triggers in your brain that try to counteract changes in body temperature. These decisions are made automatically. If your body temperature starts to increase, corrective actions occur inside of you to try and cool things down. You will notice some of these actions (perspiration), while others are hidden (changes to blood circulation). It is important to note that your body’s internal emergency plan is hardwired to continue to operate as long as the internal body temperature is not 98.6F. This means that if you continue to expose your body to extreme heat conditions, your body’s emergency plan will continue to run unimpeded, and invisible changes inside your body will continue to occur.
The likely first indication that the movement of water and blood in your body is underway is perspiration. The body uses perspiration in an attempt to cool itself down. Water is forced through the pores in your skin in hopes that evaporation of that water will lead to cooling. You have noticed this evaporative cooling if you have ever exited a swimming pool on a hot day. Evaporation cools you through the removal of latent heat (or “hidden heat”) from your body. Although you didn’t learn about the latent heat of evaporation until you were in a middle school science class, it’s been part of your body’s emergency plan since birth.
But, here is where things get complicated again. No two people are the same in terms of their water and food intake, salt intake, etc. That means that no two people will perspire at the exact same rate. In addition, alcohol consumption, drug use, etc. will speed up (you run out of water faster) or slow down (your internal body temperature continues to rise) the perspiration process. Note that both of these outcomes can lead to significant health complications and even death! It is simply easier for you to help your body cool down by removing yourself from the extreme heat in the first place. Unfortunately, people at outdoor events typically don’t even realize this is occurring.
If you have ignored the perspiration step above and remain exposed to the heat and/or are still engaged in outdoor activities, your body will next try to send a wake up call to get you to stop. That signal comes in the form of cramps that can be debilitating. Painful muscle spasms and cramps are the first indicator that your internal body temperature is becoming dangerously high. This is a warning to get you to take notice, stop the activity, and find shade. Once cramps have occurred, it is also important to take slow sips of water in an attempt to replenish fluids lost through perspiration. However, if nausea is also present, don’t drink water. The outcome will be messy, and those around you will also not react well. This is a tough dilemma. On one hand, your body needs the water. On the other hand, your body wants to make you as miserable as possible to get you to try something else!
If you ignore the heat cramp stage without removing yourself from the heat, then heat exhaustion will likely follow. Victims of heat exhaustion may still be perspiring profusely, become physically weak, have clammy or pale skin, exhibit dizziness, feel faint or be overcome with nausea and vomiting. At this point, many victims finally realize that something is wrong. However, in most cases they blame their illness on something other than heat. Heat exhaustion symptoms are associated with so many other flu-like illnesses that we tend to not attribute these factors to heat exhaustion. There is also a mental health issue that kicks in at this point. It’s the “I’m not sick, I’m not overheated” effect. At this point, people tend to refuse the help of others for fear of embarrassing themselves or the people they are with. If these symptoms are present, regardless of the root cause, move the individual out of the sun and into a shaded or air-conditioned location. Use cool wet cloths to try and cool the skin. The victim should be seen by a medical professional at this point.
If someone manages to ignore all of the warning signs leading up to this point, the outcome can be fatal. Heat stroke is accompanied by altered mental state, confusion, dizziness, throbbing headache, nausea and vomiting, possible loss of consciousness and an internal body temperature above 105F. Heat stroke is a dire situation and death will result if the individual is not taken to a professional medical care facility immediately. Don’t treat the symptoms as if it were heat exhaustion. A person suffering heat stroke is near death. Transport the victim to a hospital immediately.
What Can You Do?
The first step in your preparation for the heat is to pay attention to the weather forecast for the location of the event that you will be hosting/attending. The National Weather Service (NWS) web site at weather.gov is a great place to start. The NWS issues the following products when extreme heat is expected:
Excessive Heat Outlook: Issued when the potential exists for an excessive heat event in the next 3-7 days. This product should be a trigger for your venue to begin preparing for the possibility of heat-related casualties.
Here are some things to think about for your venue:
- have water freely available or at discounted prices,
- erect and staff cooling stations with shade, fans, misters, water, a place to sit or lay down, etc.
- stock concessions with high-water content foods such as fruits and vegetables.,
- have extra medical personnel on site and trained in the treatment of heat-related illness,
- make sure that all messaging outlets, announcements, social media, video boards, etc. each carry pre-written heat safety messages and advice on the location of water and cooling stations.
- have local medical personnel train your venue staff in the recognition of heat-related illness.
- have extra staff on call or on hand,
- socialize your heat mitigation plans with your artists/acts.
As a venue manager, you should also disseminate heat safety information to ticket holders via multiple conduits (local media, social media, web sites, etc.). The information should include good heat mitigation practices for your patrons to aspire to. Here are several things a ticket-holder can do to prevent heat illness:
liberal use of sunscreen,
wear light-colored or loose-fitting clothing,
wear a loose fitting, wide brimmed hat,
plan a schedule for an all-day music festival that includes shaded breaks,
start hydrating in the days ahead of the event,
discontinue use of caffeinated and alcoholic beverages, (Drinking caffeine and/or alcohol in extreme heat conditions is actually worse for your body than if you drank nothing at all.)
consume snacks/food with high water content (fruits and vegetables)
exercise care using medications and contact your physician or pharmacist regarding the heat tolerance of individuals on certain medication.
rest well, both in the days leading up to the event, and at the event.
Excessive Heat Watch: Issued when conditions are favorable for extreme heat in the next 1 to 3 days. The Excessive Heat Watch should continue to prompt organizers of outdoor events to take every available means to protect patrons from the heat. Proactive planning saves lives.
Heat Advisory: A heat advisory is issued within 12 hours of the onset of extremely dangerous heat conditions. Although the criteria for heat advisories are different throughout the country, they are typically issued when the heat index is expected to be greater than 100F. Activation of venue-specific heat mitigation and remediation plans should occur.
Extreme Heat Warning: This is the biggie! When you see this product, it is because the NWS has the expectation that heat fatalities will occur unless mitigation actions occur. This step should include a moratorium on alcohol sales, as alcoholic beverages and extreme heat are a lethal combination. The Extreme Heat Warning product tends to be issued with heat index values are over 105F.
A Loud Response to the Silent Killer
Every weather plan should include loud and clear mitigation strategies and proactive decision triggers against this silent killer. Planning for extreme heat is especially important as the summer outdoor event and festival season gets into high gear, and as late summer athletics events are just around the corner. And, as many of you with outdoor events and venues have already noticed, it’s not getting any cooler out there!
Here are some additional resources to consider as you plan your extreme heat mitigation strategies:
National Weather Service: http://www.nws.noaa.gov/os/heat/
Centers for Disease Control and Prevention: https://www.cdc.gov/extremeheat/
Federal Emergency Management Agency: http://www.redcross.org/get-help/prepare-for-emergencies/types-of-emergencies/heat-wave-safety