The Role of Energy in Preventing Heat-Related Illness
Dear Editor,
The study by Sun et al. highlights the burden of elevated temperature extremes on the healthcare system and on morbidity in the United States. These temperatures adversely affect people of all ages, not only those with more advanced age (1). Emergency preparedness is briefly discussed; however, this topic deserves further comment.
The strain of extreme ambient heat on the healthcare system can be exacerbated by power outages, which are not uncommon in extreme heat events (2). Outages significantly increase the percentage of the population without adequate air conditioning and may render many smaller healthcare facilities useless, as they often do not have backup power sources. As such, cooling centers may not be able to accommodate all those in need and hospitals may face a much higher volume and severity of heat-related illness (3). How we utilize energy in society is a central part of preventing morbidity and mortality related to excessive heat and is multifaceted.
Steps to aid critical emergency preparedness must occur nationwide. Federal law must be enacted and funding allocated for back-up power at smaller healthcare facilities, such as dialysis centers, nursing facilities and ambulatory care clinics, and large indoor spaces that can be used as cooler centers, given that many do not adequate emergency power sources (4-10). Mobilization of the national guard to run cooling centers and provide lower acuity healthcare services will also be crucial to reduce the burden on hospitals.
As with many preventable illnesses, much progress has come in the form of treatment and less by way of prevention. Focus on eliminating human impact on global warming and providing safety from ambient heat increase in importance daily. However, society continues to rely on unreliable sources of energy to provide protection from extreme heat and, in turn, helps to catalyze global warming. This cycle of cooling ourselves with energy that worsens global warming, then using more of the same energy source to cool ourselves, must be broken. If not, this preventable public health emergency will no longer be preventable, and inevitably untreatable.
1. Sun S, Weinberger KR, Nori-Sarma A, et al. Ambient heat and risks of emergency department visits among adults in the United States: time stratified case crossover study. BMJ. 2021;375:e065653. Published 2021 Nov 24. doi:10.1136/bmj-2021-065653
2. Abdin IF, Fang YP, Zio E. A modeling and optimization framework for power systems design with operational flexibility and resilience against extreme heat waves and drought events. Renewable and Sustainable Energy Reviews. 2019;112:706-719. doi:10.1016/j.rser.2019.06.006
3. Lang AE. Heatwaves, Cyberattacks, and the Power Grid: A Looming Health Care Disaster [published online ahead of print, 2021 Aug 21]. Am J Med. 2021;S0002-9343(21)00524-6. doi:10.1016/j.amjmed.2021.07.036
4. Bohra N. Thousands of Texans depend on dialysis treatment. Extended power outages put their lives at risk. Available at: https://www.texastribune.org/2021/02/18/Texas-power-outage-dialysis/. Accessed December 2, 2021.
5. Abir M, Jan S, Jubelt L, Merchant RM, Lurie N. The impact of a large-scale power outage on hemodialysis center operations. Prehosp Disaster Med. 2013;28(6):543-546. doi:10.1017/S1049023X13008844
6. U.S. Department of Homeland Security, FEMA, Department of Health and Human Services, Assistant Secretary for Preparedness and Response. Healthcare Facilities and Power Outages. Available at: https://www.fema.gov/sites/default/files/2020-07/healthcare-facilities-a.... Accessed December 2, 2021.
7. Travis A. Push to require backup generators at senior living facilities after Texas winter storm. Available at: https://www.kxan.com/news/coronavirus/nursing-home-investigations/push-t.... Accessed December 2, 2021.
8. Lane E. After Ida deaths, Louisiana lawmaker wants to require backup power at nursing homes. Available at: https://www.wdsu.com/article/kirk-talbot-hurricane-ida-nursing-home-deat.... Accessed December 2, 2021.
9. Sherer P. California Power Outage Toll Includes Thousands of Missed Medical Visits. Available at: https://www.directrelief.org/2019/11/california-power-outage-toll-includ.... Accessed December 2, 2021.
10. McNary S. Los Angeles County cooling centers could heat up during power outages. Available at: https://archive.kpcc.org/news/2016/06/28/62100/los-angeles-county-coolin.... Accessed December 2, 2021.
Rapid Response:
The Role of Energy in Preventing Heat-Related Illness
Dear Editor,
The study by Sun et al. highlights the burden of elevated temperature extremes on the healthcare system and on morbidity in the United States. These temperatures adversely affect people of all ages, not only those with more advanced age (1). Emergency preparedness is briefly discussed; however, this topic deserves further comment.
The strain of extreme ambient heat on the healthcare system can be exacerbated by power outages, which are not uncommon in extreme heat events (2). Outages significantly increase the percentage of the population without adequate air conditioning and may render many smaller healthcare facilities useless, as they often do not have backup power sources. As such, cooling centers may not be able to accommodate all those in need and hospitals may face a much higher volume and severity of heat-related illness (3). How we utilize energy in society is a central part of preventing morbidity and mortality related to excessive heat and is multifaceted.
Steps to aid critical emergency preparedness must occur nationwide. Federal law must be enacted and funding allocated for back-up power at smaller healthcare facilities, such as dialysis centers, nursing facilities and ambulatory care clinics, and large indoor spaces that can be used as cooler centers, given that many do not adequate emergency power sources (4-10). Mobilization of the national guard to run cooling centers and provide lower acuity healthcare services will also be crucial to reduce the burden on hospitals.
As with many preventable illnesses, much progress has come in the form of treatment and less by way of prevention. Focus on eliminating human impact on global warming and providing safety from ambient heat increase in importance daily. However, society continues to rely on unreliable sources of energy to provide protection from extreme heat and, in turn, helps to catalyze global warming. This cycle of cooling ourselves with energy that worsens global warming, then using more of the same energy source to cool ourselves, must be broken. If not, this preventable public health emergency will no longer be preventable, and inevitably untreatable.
1. Sun S, Weinberger KR, Nori-Sarma A, et al. Ambient heat and risks of emergency department visits among adults in the United States: time stratified case crossover study. BMJ. 2021;375:e065653. Published 2021 Nov 24. doi:10.1136/bmj-2021-065653
2. Abdin IF, Fang YP, Zio E. A modeling and optimization framework for power systems design with operational flexibility and resilience against extreme heat waves and drought events. Renewable and Sustainable Energy Reviews. 2019;112:706-719. doi:10.1016/j.rser.2019.06.006
3. Lang AE. Heatwaves, Cyberattacks, and the Power Grid: A Looming Health Care Disaster [published online ahead of print, 2021 Aug 21]. Am J Med. 2021;S0002-9343(21)00524-6. doi:10.1016/j.amjmed.2021.07.036
4. Bohra N. Thousands of Texans depend on dialysis treatment. Extended power outages put their lives at risk. Available at: https://www.texastribune.org/2021/02/18/Texas-power-outage-dialysis/. Accessed December 2, 2021.
5. Abir M, Jan S, Jubelt L, Merchant RM, Lurie N. The impact of a large-scale power outage on hemodialysis center operations. Prehosp Disaster Med. 2013;28(6):543-546. doi:10.1017/S1049023X13008844
6. U.S. Department of Homeland Security, FEMA, Department of Health and Human Services, Assistant Secretary for Preparedness and Response. Healthcare Facilities and Power Outages. Available at: https://www.fema.gov/sites/default/files/2020-07/healthcare-facilities-a.... Accessed December 2, 2021.
7. Travis A. Push to require backup generators at senior living facilities after Texas winter storm. Available at: https://www.kxan.com/news/coronavirus/nursing-home-investigations/push-t.... Accessed December 2, 2021.
8. Lane E. After Ida deaths, Louisiana lawmaker wants to require backup power at nursing homes. Available at: https://www.wdsu.com/article/kirk-talbot-hurricane-ida-nursing-home-deat.... Accessed December 2, 2021.
9. Sherer P. California Power Outage Toll Includes Thousands of Missed Medical Visits. Available at: https://www.directrelief.org/2019/11/california-power-outage-toll-includ.... Accessed December 2, 2021.
10. McNary S. Los Angeles County cooling centers could heat up during power outages. Available at: https://archive.kpcc.org/news/2016/06/28/62100/los-angeles-county-coolin.... Accessed December 2, 2021.
Competing interests: No competing interests