A new set of tools for patients, providers, and clinics provides guidance for preparing for or responding to weeks of prolonged heat, as well as more fires, hurricanes, and other weather related to climate change.
He suggests that patients with diabetes may have nerve damage in their feet and should avoid going barefoot on hot pavement or sand. People who take some heart medications that cause frequent urination may need to drink more water in hot weather. And health clinics could consider sending individual heat alerts to patients who are elderly, very young, pregnant or have chronic conditions that may worsen as temperatures rise.
Online tip sheets and heat action plans are an attempt to bridge a gap: Few providers consider heat when advising patients or making decisions about their care. One of the reasons is the lack of clear and easily accessible information.
“In the context of climate shocks, we need to make sure we are working to protect those most at risk first,” said Dr. Ari Bernstein of Harvard, who co-led the work on the toolkit, “and keep people safe from harm that are already here and will grow over time.
The National Weather Service says that more than 28 million people in the US were dealing with extreme heat at the end of July and more than half of them are at higher risk of heat-related problems: children, the elderly and patients with chronic diseases.
For patients, the kit includes tip sheets and heat action plans, with specific recommendations for people with diabetes, asthma or COPD, and kidney disease. Many of the suggestions are the same for all patients: watch for heat alerts, stay hydrated, and talk to your provider about whether the heat may affect any prescription medications you take. But some tips and actions vary depending on the disease.
The toolkit urges providers to assess a patient’s heat risk by asking if they work outdoors, have access to air conditioning and can afford to use it, and understand any vulnerabilities they may face based on age, health conditions or medications.
Dr. Rebecca Rogers, a primary care physician at Cambridge Health Alliance who reviewed the toolkit, says doctors are already packing a lot into short visits.
“We won’t really have the option anymore to have a conversation with our patients about the heat,” Rogers said, “so the more resources we can give providers to have at their fingertips, to use in real time, these much easier conversations.”
Rogers says his health care system’s medical record doesn’t send alerts to patients who are at higher risk for complications from heat, “but that’s a really exciting idea for me.” Bernstein says more work is needed to individualize heat risks based on where patients live and other factors.
The fact sheets and action plans are based on input from surveys of community health center staff and others in 47 states. The project is co-led by Americares, a nonprofit organization that works on health care issues in low-income communities.
Dr. Adlia Ebeid, clinical director of the San José Clinic in Houston, pictured here filling prescriptions for survivors of Hurricane Harvey in 2017, was one of the medical providers who provided information to Americares and Harvard about the toolkit resources. (Courtesy of Annie Mulligan/Americares)
Bernstein says it makes sense to focus on what’s helpful for community health centers because they serve many of the people most at risk from the effects of climate change.
“The idea here is not to wait until people drop dead,” said Bernstein, who directs the Center for Climate, Health, and the Global Environment at Harvard’s TH Chan School of Public Health. “The idea here is to avoid preventable harm, and that’s a different view of resilience than we may have taken previously.”
For healthcare facilities, the toolkit offers advice on how to prepare for and manage urgent issues like a power outage, as well as how to build long-term resilience to climate change. Community health centers operate with little extra money and may need financial assistance to install backup power systems, solar panels, plant more trees, or install a green roof. Bernstein suggests a federal green fund for these clinics.
There are other online resources for providers, patients, and healthcare facilities dealing with longer periods of extreme heat. The New York City Department of Health publishes a guide for providers. And earlier this month, the Biden administration launched Heat.gov, which offers health-related forecasts and ways to track groups of people most at risk for heat-related health problems.
These sites are part of a growing effort to integrate warmth into the decisions patients, providers and clinics make to improve health.
Source: www.wbur.org