On a recent Friday in Albuquerque, as triple-digit temperatures stretched into the evening, a 69-year-old man collapsed in his home. His body temperature hit 107.7 degrees by the time emergency responders whisked him to the University of New Mexico Hospital.
Nurses and emergency physicians began a process that has become familiar, preparing a device the size of a mini-fridge that rapidly cools and regulates body temperature by funneling cold fluids to pads that cover a patient’s abdomen and thighs. Workers dumped ice on his body as part of a last-ditch effort to curtail his heatstroke.
It was too late. The man’s blood pressure had plummeted, and he suffered a heart attack. Less than 24 hours later, he was dead.
Extreme heat, intensified by climate change, has blanketed much of the United States this summer, killing more than a dozen people in Oregon in recent days. Large parts of California, Nevada, Arizona and Utah have been under excessive heat warnings, which local officials believe contributed to more than 90 deaths in the West this month.
The consequences are increasingly playing out in the nation’s emergency rooms, where medical workers are confronted with heat-stricken patients whose soaring body temperatures can be fatal if not addressed quickly.
Around 2,300 people died from heat-related illnesses in the United States in 2023, triple the annual average between 2004 and 2018. Nearly 120,000 heat-related emergency room visits were recorded across the United States last year, according to the Centers for Disease Control and Prevention. In part, those figures are because heat waves last longer now than they did decades ago, as an Environmental Protection Agency report released last week made clear.
On Thursday, more than 60 million Americans were under heat alerts from the National Weather Service. Temperatures have at times this summer run between 10 and 30 degrees above average in Western states. Some places like Las Vegas, which hit 120 degrees on Sunday, have broken records.
The heat has been particularly problematic in New Mexico. In July 2023, the state had nearly 450 heat-related emergency room visits and more than 900 between April and September. That is more than double the number recorded during the same time in 2019, said Dr. Srikanth Paladugu, an epidemiologist at the New Mexico Department of Health.
Heat-related emergency admissions at University of New Mexico Hospital also doubled in 2023 compared with the previous year, and the state has recorded over 500 heat-related emergency department visits since April 1 of this year. Those are likely undercounts because of the ways that health problems are recorded in hospital software.
“It’s difficult for us to know how many people are impacted by extreme heat when we look at emergency room data,” said Kelly Turner, a heat expert at the University of California, Los Angeles. “Many hospitals don’t have a code for heat or extreme heat. If, for instance, what actually happened is someone came in with headaches and pulmonary issues, that’s what’s going to be coded.”
The dire health ramifications of heat have become a subject of intense interest in the Biden administration. At a visit to the District of Columbia’s emergency operations center last week, Mr. Biden unveiled a draft of first-of-their-kind Labor Department regulations that would protect roughly 35 million workers exposed to extreme heat on the job.
“Extreme heat is the No. 1 weather-related killer in the United States,” Mr. Biden said at the event. “More people die from extreme heat than floods, hurricanes and tornadoes combined. Say that again: combined.”
Yet heat experts said there is still no consistent application of heat guidance among health providers, particularly in primary care settings. Dr. Jeremy Hess, an emergency physician and environmental health expert at the University of Washington, said that routine checkups that cover medication or weight management rarely devote time to someone’s risk in severe heat. Common medications can complicate a patient’s heat tolerance.
“It’s a conversation that generally doesn’t happen,” he said. “It’s a complicated problem to solve: You need screening tools. You need to carve out time for it. In some cases, you need to bill for it. All of those changes take time and effort. So far the health system is not there.”
In April, federal officials published clinical guidance for treating heat illness, an acknowledgment that the medical field was still catching up to some of the dangers of extreme weather.
The primary objective of unwinding heat sickness involves lowering the body’s temperature. Many of the procedures are rudimentary: Cold fluids are administered with IVs, replenishing severely dehydrated bodies. Emergency responders and hospitals across the country have also become accustomed to putting heat-sick patients in large bags filled with ice, a technique that can rapidly cool the body and restore its functioning, similar to the results from the cooling machine used by the University of New Mexico team.
At the University of New Mexico Hospital, an established facility in a hot climate, staff members are still continually trained in recognizing and treating heat-related sickness. Faculty organized a so-called grand rounds session earlier this year for medical residents and other employees of the hospital system to learn how to treat heat illness.
Dr. Jon Femling, a heat expert who oversees emergency care at the hospital, said that health workers sometimes differ on the fundamentals of treatment. He and others at the hospital prefer to cool the quads and abdomen. “That’s where all the blood volume is going through,” he said.
Other physicians, and many emergency responders, he noted, put ice in the groins and armpits.
Dr. Femling said there is no clear temperature threshold that suggests someone might be suffering from heatstroke. Someone who is severely dehydrated with a 102-degree temperature might not pump blood to the brain, leaving them more vulnerable than a person who might have a higher temperature but better circulation.
“There’s no magic number,” he said.
Kristie L. Ebi, a professor at the University of Washington who is an expert on the health risks of extreme heat, said that roughly half of excess deaths in heat waves are from cardiovascular causes. “It’s typically not instantaneous,” she said. “It happens over the course of hours.”
Public health experts say that heat is dangerous in part because of how familiar it is, lulling people into judging its risks incorrectly.
“How hot is too hot for health is a critical missing link in peoples’ ability to stay safe,” said Dr. Ari Bernstein, the director of the C.D.C.’s National Center for Environmental Health.
Heat-related illnesses have put even more pressure on hospitals that are already severely strained by overcrowding. On one recent hot afternoon in Albuquerque, around 10 patients who should have been moved to emergency department rooms for potential heat exhaustion remained in the waiting room, some hooked up to oxygen, Dr. Femling said. Hallways are regularly crowded with patients on beds.
Those sick because of extreme heat can be difficult to diagnose, in part because they can show up with milder symptoms such as headaches or fatigue that can be influenced by other health problems. A patient’s mental status — someone displaying confusion or a lack of alertness — can sometimes offer better insight into heat sickness than physical features, such as the paleness of someone’s skin or how much that person is sweating.
“These patients are incredibly complex because we have to not only treat the illness that is obvious in front of us,” said Micah Sternberg, who manages the emergency department staff and has treated recent heatstroke patients with ice. “We also have to look for and treat other underlying conditions.”
The emergency department relies on a blood test machine that delivers potassium, carbon dioxide and glucose readings within minutes, indicating the damage from heat exposure. Like extreme exercise, heat can cause a condition known as rhabdomyolysis, when muscle fiber dies and releases into the bloodstream, sometimes causing kidney failure.
The worst outcome is heatstroke, which researchers have found can have the highest fatality rate of any condition in the emergency room.
Stroke patients with unclear triggers often display symptoms closely associated with heat. One recent afternoon, a patient from a pueblo arrived at the hospital suffering from a stroke, after she was found at home with a 104-degree temperature.
Dr. Tarun Girotra, a neurologist, asked the patient to raise her arms and legs. “Up, up, up!” he said, as the patient’s mother spoke quietly and frantically, hoping to get through to her daughter and soothe her.
The cause of the stroke was hard to decipher. The patient had attended the funeral of a loved one, potentially generating a stress-induced stroke. Dr. Femling and his colleagues suspected another cause: heat. The home where paramedics picked her up did not have air conditioning.
The hospital has also become accustomed to treating burns, often from asphalt.
Dr. Christopher Lentz, a surgeon at the INTEGRIS Paul Silverstein Burn Center in Oklahoma City, said that burns from hot surfaces have become so common that he has begun referring to them as an epidemic.
“They’re deep burns,” he said. “They go through the skin into the muscle. In the elderly, the skin is thinner. They have less body fat. When they’re laying on top of it, increased pressure creates more damage. It’s like if you’re cooking something and you want it to go faster, you press it.”
Small differences in temperature and humidity can be the difference between life and death. One middle-aged patient at the University of New Mexico Hospital on a recent hot afternoon was found on the pavement with a jacket on, discovered by a security guard in downtown Albuquerque.
The hospital’s emergency notification system buzzed with a now-common alert: heat exhaustion.
As the patient was wheeled into the critical care unit, medical workers alerted Dr. Femling to a familiar problem. There were no beds. With fluids and careful monitoring, the man recovered several feet away in a hallway.
Had the temperature outside been slightly hotter, as it was a few days earlier, Dr. Femling said, the same patient would have died from heatstroke.
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