Publications

INTRODUCTION: Climate change is causing an increase in the frequency and intensity of extreme heat events, which disproportionately impact the health of vulnerable populations. Heatstroke, the most serious heat-related illness, is a medical emergency that causes multiorgan failure and death without intervention. Rapid recognition and aggressive early treatment are essential to reduce morbidity and mortality. The objective of this study was to evaluate current standards of care for the emergent management of heatstroke and propose an evidence-based algorithm to expedite care.

METHODS: We systematically searched PubMed, Embase, and key journals, and reviewed bibliographies. Original research articles, including case studies, were selected if they specifically addressed the recognition and management of heatstroke in any prehospital, emergency department (ED), or intensive care unit population. Reviewers evaluated study quality and abstracted information regarding demographics, scenario, management, and outcome.

RESULTS: In total, 63 articles met full inclusion criteria after full-text review and were included for analysis. Three key themes identified during the qualitative review process included recognition, rapid cooling, and supportive care. Rapid recognition and expedited external or internal cooling methods coupled with multidisciplinary management were associated with improved outcomes. Delays in care are associated with adverse outcomes. We found no current scalable ED alert process to expedite early goal-directed therapies.

CONCLUSION: Given the increased risk of exposure to heat waves and the time-sensitivity of the condition, EDs and healthcare systems should adopt processes for rapid recognition and management of heatstroke. This study proposes an evidence-based prehospital and ED heat alert pathway to improve early diagnosis and resource mobilization. We also provide an evidence-based treatment pathway to facilitate efficient patient cooling. It is hoped that this protocol will improve care and help healthcare systems adapt to changing environmental conditions.

BACKGROUND: There has been increasing interest in climate change among healthcare professionals, but it is unclear to what extent resources on this topic are available to students and clinicians in New England.

METHODS: Structured review of publicly available information regarding climate change and health activity at schools of medicine, public health, and physician assistant studies and in state medical and physician assistant societies in New England.

RESULTS: Of 39 programs reviewed, 18 (46%) had at least one climate-related initiative. Six universities accounted for 87% of climate change and health initiatives in the region. Three out of 12 state professional associations had committees or position statements addressing climate change.

CONCLUSION: There is substantial activity related to climate change and health in New England, but it is concentrated in a small number of locations. Opportunities exist to improve access to education on this topic and increase involvement of health professional associations.

Climate change is causing increasingly frequent extreme weather events. This pilot study demonstrates a GIS-based approach for assessing risk to electricity-dependent patients of a coastal academic medical center during future hurricanes.  Methods: A single-center retrospective chart review was conducted and the spatial distribution of patients with prescriptions for nebulized medications was mapped. Census blocks at risk of flooding in future hurricanes were identified; summary statistics describing proportion of patients at risk are reported.  Results: Out of a local population of 2,101 patients with prescriptions for nebulized medications in the preceding year, 521 (24.8%) were found to live in a hurricane flood zone.  Conclusions: Healthcare systems can assess risk to climate-vulnerable patient populations using publicly available data in combination with hospital medical records. The approach described here could be applied to a variety of environmental hazards and can inform institutional and individual disaster preparedness efforts.