TUESDAY, JULY 27, 2010 Long, hot summer
On Sunday, the temperature at Reagan National Airport topped 90 degrees for the 42nd time this year, keeping the area within reach of 1980’s record of 67 days with temps of 90 degrees or higher. 100
10 20 30 40 50 60 70 80 90
0 SOURCE: National Weather Service 83.9 degrees 75.4 degrees
temperature for the month 66.3 degrees
Normal average high 88.3 degrees
KLMNO
E5 July 26: 89 degrees
APRIL
90 degrees or higher: 2 days
MAY
3 days
JUNE
18 days
JULY
19 days THE WASHINGTON POST
Dog days can be deadly
The high death counts were controversial, but the CDC sub- sequently confirmed the findings. Western Europe also has wres- tled with the issue of how to cal- culate the death toll. After an eight-day heat wave in 2003, ini- tial estimates put the number of heat-related deaths at 15,000 to 18,000, according to the CDC’s Luber. More recent estimates put the total closer to 70,000, he said. A particularly poignant tale comes from France, where fami- lies traditionally go on vacation in August. It was not unusual for it to go unnoticed when an elderly person — especially one living on an upper floor of a building — didn’t appear for a day or two, said Ostro, of the California EPA. In many cases, those people suc- cumbed to the heat. Ultimately, figuring out wheth-
LINDA DAVIDSON/THE WASHINGTON POST Medical examiners in the District, Maryland and Virginia use somewhat different criteria in determining whether a death should be classified as heat-related. heat continued from E1
ease Control and Prevention. “It’s the number one weather-related killer in the United States.” It will be a while before the summer’s true tally is apparent, experts said. That’s not just be- cause more hot weeks are prob- ably yet to come. Figuring out whether high temperatures played a role in a death is a com- plicated process. Different juris- dictions use different criteria, and what might be listed as a heat- related death in Maryland could be considered a heart attack in Virginia. The decision is ultimate- ly a judgment call by doctors and medical examiners that may take weeks. As a result, experts say, a heat
wave’s casualty figures are often underreported, and people be- moan the dog days of summer without realizing they can be fa- tal. “The current numbers are like- ly underestimating the true mag- nitude of mortality,” Luber said. During heat waves, many more people than usual die of such ill- nesses as chronic respiratory ail- ments and heart disease, Luber said. Clear-cut cases of hyperther- mia death are relatively rare, in part because the finding depends on hospital or emergency person- nel measuring an elevated body temperature, usually 105 degrees or higher, at the time of death or immediately after. There are “a lot of gray zones,” said Randy Hanzlick, acting vice president of the National Associa- tion of Medical Examiners and chief medical examiner of Fulton County, Ga.
“If someone has really severe
heart disease and it’s really hot and they were working outside gardening, and they pass away, is that heat-related? That becomes a total judgment call,” said Bart Os- tro, chief of the air pollution epi- demiology section at California’s Environmental Protection Agen- cy, who has studied heat-related mortality. Officials have released few de- tails about the people who died in the Washington area. Most in Maryland were seniors with un- derlying medical conditions who were found indoors with no air conditioning. The most recent death was of a Carroll County man who was mowing his lawn Friday. In Virginia, one death was an inmate at the Richmond jail; one was a roofer; and one was found indoors without air condi- tioning. The three most recent Virginia deaths occurred this past weekend in the central region, which includes Richmond. The District said only that its one vic- tim died in early May.
Looking for clues Leah Bush, Virginia’s chief
medical examiner, said each case is different.
“If we had a case where the doc- tor felt that heat contributed in enough of a way,” the death would be considered heat-related, she said. But if heat played a minor role, that death might not be at- tributed to temperature, she said. By contrast, in Maryland, which has reported the region’s highest number of hot-weather- related fatalities this year, Chief Medical Examiner David R. Fowl- er said his office counts the death as heat-related “even if heat con- tributed 1 percent.” The District also counts deaths
as heat-related if high tempera- tures are a contributing factor. The CDC’s most recent analysis
of heat-related deaths in the Unit- ed States, from 1999 to 2003, found that including deaths in which heat was a contributing factor increased the total number from 2,238 to 3,442, or 54 percent. The experience of such cities as Philadelphia and Chicago during the mid-1990s brought wide- spread attention to the way heat deaths were defined. Until then, medical examiners typically re- lied on the classic definition of hy-
During Chicago’s heat wave in 1995, the heat index topped 100 degrees for five days, according to official reports. The medical examiner’s office reported more than 700 deaths.
perthermia death, relying on ele- vated core body temperatures, of- ficials said. But in many suspected cases of
hyperthermia death, people were alone, leaving no clue as to their body temperatures when they died. Medical examiners in the two cities began looking for other clues, such as whether windows were closed and the absence of fans or air conditioners. As a result, during Philadel-
phia’s heat wave in 1993, 118 resi- dents were reported to have died of heat-related causes, while such nearby cities as New York, Wash- ington and Baltimore, which used the old criteria, reported few such deaths or none. During Chicago’s heat wave in
July 1995, the heat index topped 100 degrees for five days and sur- passed 115 degrees on two consec- utive days, according to official reports. The medical examiner’s office reported more than 700 deaths.
er heat played a role in someone’s death is a process of exclusion, of- ficials said. If someone is found dead at home, investigators will want to know whether that per- son had heart disease or might have fallen and suffered a head in- jury and a hemorrhage, said Bush, Virginia’s chief medical ex- aminer. Maryland’s Fowler likens the process to a “decision matrix.” “You rule things out and you rule things in,” he said, “until eventually you get down to the point where I am comfortable saying with a reasonable degree of certainty that heat played a role.”
sunl@washpost.com
Staff researcher Madonna Lebling contributed to this report.
When the body can’t keep itself cool, it’s time to get yourself out of the heat
Heat-related deaths and illnesses are preventable. The body normally cools itself by sweating. But under some extreme conditions, sweating just isn’t enough. When the humidity is high, for example, sweat will not evaporate as quickly, preventing the body from releasing heat quickly.
In such cases, a person’s body temperature rises rapidly. Very high body temperatures may damage the brain or other vital organs.
Infants, children and people age 65 and over are more prone to heat stress than others. Factors that increase risk include heart disease and other chronic medical conditions, obesity, fever, dehydration, mental illness, poor circulation, sunburn and prescription drug or alcohol use.
According to the Centers for Disease Control and Prevention and the Maryland Department of Health and Mental Hygiene, warning signs of heat stroke vary but may include the following:
body temperature above 103 degrees red, hot and dry skin (no sweating) rapid, strong pulse throbbing headache dizziness nausea confusion loss of consciousness
Some things you can do to relieve heat stress:
Go to air-conditioned environments, such as shopping malls, public libraries or heat-relief shelters. Drink cool, nonalcoholic beverages. Increase fluid intake, regardless of your activity level. Don’t wait until you’re thirsty. Take a cool shower, bath or sponge bath. Avoid direct sunlight; wear sunscreen, a hat and sunglasses. Wear loose-fitting, lightweight and light-colored clothes. If you are older than 65, ask someone to call or check on you twice a day during a heat wave. If you know someone in this age group, check on that person at least twice a day.
— Lena Sun
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