Heat and hot weather for health professionals

Prolonged periods of extremely hot weather can have serious health impacts on the more vulnerable groups of society. Health professionals play a key role to protect vulnerable people from potential severe health effects of heat waves.

Health professionals can enable their patients to manage their health appropriately in hot weather and direct them to clinical care if necessary. Health professionals, in particular those in general practice, emergency departments and pharmacies, play an essential role in preventing and managing heat-related illness.

Information for community members, including resources and translated fact sheet, is available on the Stay healthy in the heat page.

Physiology of thermoregulation

In a healthy person, the hypothalamus is responsible for regulating the normal human body temperature and keeping it within a range of 36.1 – 37.8°C.

How the body can lose heat

The body can lose heat by:

  • conduction (direct contact of a cooler object with the skin)
  • radiation (via infrared rays)
  • convection (through water or air circulating across the skin)
  • evaporation of sweat.

When the temperature of the skin is higher than the air temperature, the body can lose heat by radiation, conduction and convection. A healthy person can lose heat via these mechanisms with air temperatures up to around 35°C. However, when the air is hotter than the skin, the only means by which the body can lose heat is through sweating (evaporation). Sweating and heat loss can be impaired by humidity, excess fat, skin disorders and excessive layers of clothing. Heat loss can be improved with wind or fanning, applying cool water or a cool object (cold packs).

Physiological response

The physiological response of the body to heat includes peripheral vasodilation, which increases the blood flow to the skin. This results in large quantities of warm blood from the core of the body being carried to the skin in order to facilitate heat loss through radiation, convection and conduction. Peripheral vasodilation requires an increase in cardiac output. People with chronic medical conditions that affect the ability of peripheral vasodilation or who cannot increase their cardiac output accordingly will be most at risk during heat waves.

The body’s heat regulation system can be impaired in the elderly, the chronically ill and by certain medications. Also, young children are more vulnerable as they produce more body heat, sweat less and have faster rising core temperatures.

People who exercise in the heat may not be able to sweat enough to keep the body cool. During a heatwave, it is best to avoid the hottest part of the day to exercise. It is suggested to drink at least ½ a litre of fluids in the two hours before exercising and to continue to drink whilst exercising and afterwards.

People at higher risk of serious health effects

Everyone needs to take care in hot weather but some people are at higher risk of heat illness.

Characteristics of people at higher risk of serious health effects

Please note this list is not comprehensive and is to be used as a guide only.

Individual characteristics

  • Older people
  • People with chronic diseases (see list below)
  • Infants and young children
  • Overweight or obese
  • Pregnant or breastfeeding
  • Low cardiovascular fitness
  • Poor mobility
  • Cognitive impairment
  • On certain regular medications (see list below)

Social characteristics

  • Living alone or socially isolated
  • Low socioeconomic status
  • Homeless
  • Culturally and linguistically diverse (CALD) communities

Occupation and recreational activities

  • Working in hot environment (e.g. labourers, gardeners, fire fighters)
  • Exercising vigorously in the heat

Chronic diseases

  • Heart disease
  • High blood pressure
  • Diabetes
  • Cancer or kidney disease
  • Alcohol and other substance use
  • Mental illness

Conditions that affect sweating

  • Heart disease
  • Renal disease
  • Dehydration (e.g. conditions causing diarrhoea)
  • Extremes of age
  • Skin disorders (sunburn, prickly heat, extensive scarring)
  • Cystic fibrosis
  • Quadriplegia
  • Scleroderma
  • Congenital impairment of sweating
  • People taking medications with anti-cholinergic effects

Acute illness

  • Dehydration (e.g. gastroenteritis, diarrhoea from other causes)
  • Infection, especially with a fever

Further information

For further information, see:

Heat-related illnesses

Some illnesses or conditions can occur as a direct result of excessive heat, such as heat rash, cramps, exhaustion, heat stroke and exertional heat stroke. However, exacerbations of chronic conditions contribute to the majority of heat-related morbidity and mortality.

Dehydration

Even mild dehydration leads to an increased risk of injury, heat stress illness and poorer performance of complex tasks. Cardiac work is increased by mild to moderate dehydration and leads to reduced fluid available for sweating. A person can sweat up to 15 litres per day and it is important to note that thirst does not match fluids lost by sweating, even when fluids are freely taken.

Brief overview of heat related illnesses

Heat rash

Cause: Inflammation of the sweat glands

Symptoms: Erythematous papular rash, pruritis, secondary infection

Management: Rash subsides with no specific treatment. Minimise sweating by staying in a cool place, taking frequent showers and wearing light clothes.

Keep the affected area dry.

Topical antihistamine and antiseptic preparations can be used to reduce discomfort and prevent secondary infection.

Heat cramps

Cause: Muscle relaxation is affected by of salt in sweat

Symptoms: Muscle spasms in the abdomen, arms or legs

Management: Immediate rest in a cool place is advised.

Stretch muscle and massage gently.

Oral rehydration may be needed with a solution containing electrolytes.

Medical attention should be sought if heat cramps are sustained for more than one hour.

Heat exhaustion

Cause: Dehydration leading to poor blood flow affecting the brain and heart

Symptoms: Flushed or pale complexion and sweating, tachycardia, muscle cramps, weakness, dizziness, headache, nausea, vomiting, syncope

Management: Move to a cool shaded room or air-conditioned place.
The patient should be undressed. Apply cold wet sheet or cold water spray and use fan, if available. Lie the patient down and raise legs and hips to increase venous return. Start oral hydration. If nausea prevents oral intake of fluids, consider intravenous hydration.
If hyperthermia above 39 ºC, impaired mental status or sustained hypotension occurs, treat as heatstroke and transfer to hospital.

Heat stroke

Cause: Core temperature rise leading to widespread organ injury

Symptoms: Same symptoms as for heat exhaustion, plus hyperthermia, shock, arrhythmia, dry skin with no sweating (skin may be damp from earlier sweat), altered mental state, ataxic gait, convulsions, unconsciousness, death

Management: This is a medical emergency.*
Measure core temperature (rectal probe).
If > 40 ºC, move to a cooler place, remove clothing and initiate external cooling:† use cold packs on the neck, axillae and groin, and fan continuously while skin is sprayed with water at 25–30ºC.
Position unconscious patients on their side and clear airway.
Administer oxygen 4 L/min.
Give isotonic crystalloid (normal saline). Rapidly transfer to an Emergency Department.

Exertional heat stroke

Cause:  Core temperature rise precipitated by intense or prolonged exercise in hot weather

Symptoms:  As for heat stroke, plus rhabdomyolysis and renal failure

Management: Same as heat stroke

Source: adapted from Bouchama & Knochel, 2002.

Other illnesses exacerbated by heat

The majority of heat-related morbidity and mortality is due to exacerbation of existing chronic conditions.

The following conditions contribute to the most common causes of death during a heat wave:

  • Cardiac events
  • Asthma or other respiratory illnesses
  • Kidney disease
  • Diabetes
  • Nervous system and mental health-related illnesses

Dehydration and subsequent medication toxicity may exacerbate the following conditions:

  • Altered mental state
  • Kidney stones and acute kidney injury
  • Cardiovascular impairment
  • Falls

Heat and medication

A number of prescribed medications can increase the risk of heat-related illness. Also, some medications can be less effective or more toxic when exposed to and stored in high temperatures. Most medications need to be stored below 25°C or in the fridge if indicated. This applies particularly to antibiotics, adrenergic drugs, insulin, analgesics and sedatives. It is important for health professionals to discuss the correct use and storage of medications with people who take regular prescription medications as part of their care plan for hot weather.

Physiological effects of medications*

This list is not comprehensive and should only be used as a guide.

  • Interference with sweating, caused by:
    • Anticholinergics, e.g. tricyclics antidepressants and benztropine
    • Beta-blockers
    • Antihistamines
    • Phenothiazines
    • Vasoconstrictors
  • Interference with thermoregulation, caused by:
    • Antipsychotics or Neuroleptics (e.g. risperidone, clozapine, olanzapine)
    • Serotoninergic agonists
    • Stimulants (Amphetamine, cocaine)
    • Thyroxin
  • Decreased thirst, caused by:
    • Butyrophenone e.g. haloperidol and droperidol,
    • Angiotensin-converting enzyme (ACE) inhibitors
  • Dehydration or electrolyte imbalance, caused by:
    • Diuretics (especially loop diuretics)
    • Any drug causing diarrhoea or vomiting (colchicines, antibiotics, codeine)
    • Alcohol
  • Reduced renal function, caused by:
    • NSAIDS
    • Sulphonamides
    • Indinavir
    • Cyclosporin
  • Aggravation of heat illness by worsening hypotension, caused by:
    • Vasodilators e.g. nitrates (GTN) and calcium channel blockers
    • Anti-hypertensives
  • Levels of drug affected by dehydration (possible toxicity for drugs with a narrow therapeutic index), caused by:
    • Digoxin
    • Lithium
    • Warfarin
    • Antiepileptics
    • Biguanides (e.g. Metformin)
    • Statins
  • Altered state of alertness, caused by:
    • Any drugs which alter the state of alertness (e.g. alcohol, benzodiazepine, narcotics and many more)

How health professionals can prepare for heat waves

Note: This information was originally developed by NSW Ministry of Health, Government of New South Wales and has been adapted.

  • Review and improve your knowledge of:
    • Mechanisms of thermoregulation
    • Risk factors for heat-related illness
    • Conditions that may reduce the body’s ability to adapt to heat exposure
    • Signs and symptoms of heat-related illnesses, diagnosis and treatment
    • Early signs of heat stroke as it is a medical emergency
    • Potential side effects of medications in hot weather
  • Identify your patients at risk and:
    • Educate them about how to stay healthy in hot weather (ways to reduce heat exposure, advice about fluid intake and medication)
    • Adjust their dose of medications if necessary
    • Inform them that the efficacy of drugs can be affected by storage at high temperatures
    • If they rely on power - for critical care medical equipment in the home or critical pharmacy-dispensed medication – encourage them to develop an emergency management plan for lengthy, planned and unplanned power outages.
    • Regularly review their medications and fluid intake, especially older patients and people with advanced cardiac diseases
    • Have a lower threshold to admit your patients to hospital especially if they are socially isolated
    • Educate people who care for, support or assist children, older people and other people at increased risk of adverse health effects during a heat wave. Download Healthy in the heat – A guide to coping with hot weather and extreme heat (PDF 930KB)’ from the Healthy in the heat page, as well as a number of fact sheets developed for specific groups of people and translated fact sheets).
  • Review and adapt your practice for hot weather by:

A note on drinking recommendations

Are you drinking enough water?It is important that people drink enough fluids during hot weather, even if they are not feeling thirsty. Each older person and vulnerable patient should receive personalised drinking recommendations. This is particularly important for patients with a decreased perception of thirst or for patients with a restricted fluid intake.

A good way to find out if someone is dehydrated is by checking their urine colour. If the urine is pale, they are drinking enough.

Heat and health related research papers

Researchers at SA Health have been working with The University of Adelaide to investigate how to prevent poor health during extreme heat. The areas of research include:

  • the types of health effects from extreme heat
  • who is at risk and what are the risk factors
  • how climate change is predicted to affect extreme heat events

Reports, summaries of research papers and peer reviewed publications can be accessed from the Heat related research papers page.

Useful resources

Extreme heat and the risk to your health - an article for health practitioners (PDF 892KB)

By Dr M Nitschke from SA Health; and Dr A Hansen, Dr S Williams and Professor P Bi from the Discipline of Public Health, University of Adelaide. First published in medicSA, May 2017.

This article focuses on extreme heat and its associated health effects and summarises evidence gathered in collaborative studies between SA Health and the University of Adelaide.

Acknowledgements

Content thanks to NSW Ministry of Health, Government of New South Wales (content has been adapted).

* Diagnosis of heatstroke should be suspected in any patient with mental status changes during heat stress even if the temperature is < 40 ºC.

† No evidence that one cooling technique is superior to another. Non-invasive techniques that are easy to apply, well tolerated and less likely to cause cutaneous vasoconstriction are preferred.