In scorching summer, MUSC doctors and scientists study better ways to prevent heat injuries

In a summer of extreme temperatures in parts of the U.S., doctors and scientists at the Medical University of South Carolina are helping to lead the charge to find better ways to prevent heat-related health problems.

“It’s extraordinarily important,” said Jerry Reves, M.D., dean emeritus in the College of Medicine. He’s part of a Charleston-based team working with the National Oceanic and Atmospheric Administration to study and reduce the effects of high heat, with an emphasis on helping people disproportionately affected by it.

Charleston is one of four cities involved in the project. The others are Las Vegas, Phoenix and Miami. “We’re measuring what’s happening around the country and state,” Reves said. 

What’s happening this summer is, in some cases, remarkable – and dangerous. Las Vegas and Phoenix have been baking in heat topping 110 degrees for weeks. People have been burned by falling onto hot pavement, and emergency departments are treating patient after patient. Deaths have occurred in several states. Meanwhile, much of the country has been under weather alerts and advisories.

Charleston is hot, too – but not to that degree. Highs have mostly been in the 90s lately, which is not unusual for this time of year. But the humidity in Charleston makes the heat index higher than the temperature alone, and it is the heat index that predicts health effects. Given these circumstances, people are are vulnerable in situations where there's a lot of asphalt, homes lack air conditioning and neighborhoods have few shade trees, forcing service providers to work in the direct sun.

Dustin LeBlanc, M.D., an emergency medicine specialist at MUSC Health, described the effects of extreme heat. “We have some mechanisms that our body uses with sweating and trying to use evaporative cooling. We tend to flush and try to offload as much heat to the environment as we can, but that only works to a point,” he said.

 

“With heat, you hit that limit of what you can do fairly early on if you don't get out of the heat or seek shelter. If you get to the point where there’s alteration of mental status, that's when you really get into heat stroke and the body starts to decompensate. You may stop sweating. Your blood pressure tends to drop but the heart rate stays high. The body doesn't do well with temperatures greater than 104 Fahrenheit. They really start getting quite altered.”

When heat becomes lethal

So altered that it can lead to death. Dulaney Wilson, Ph.D., is a public health scientist at MUSC involved in the heat research. “I'm going to be looking at mortality statewide over the last 20 years and matching it with temperature,” she said. 

Are certain deaths during hot periods caused at least in part by that heat? She and Reves think so. Reves also said there’s something else that’s important to consider: Heat exposure adds up over time. 

“Cumulative things happen to people and they may not die out there with sun stroke, but they'll get enough of, let's call it the burden of heat to make them so sick that they'll die in the next several days from problems causes by sustained heat.”

That means cases of heat stroke and heat exhaustion are underreported, Wilson said. “I think the heat-associated illnesses and deaths are probably going to be much higher. So one of the things we want to look at is comparing heat contributing to death to see if we're really truly undercounting, which I believe we are.”

The heat research task force includes not only MUSC and NOAA but also the City of Charleston, The Citadel, the South Carolina Sea Grant Consortium, Climate Adaptation Partners and people who live in the Gadsden Green neighborhood. Analysts have identified Gadsden Green as one of Charleston’s “heat islands” – a place with too much asphalt and too few trees that’s noticeably hotter than other sites. That knowledge allows the team to work to change that.

What can be done

So what does that look like? What can be done to hold back the heat? Reves and his colleagues pointed to a multi-pronged approach.

• The city is using asphalt rejuvenator on some roads, which can reduce temperatures.
• More cooling centers offered in convenient places for people who don’t have air conditioning and/or are especially vulnerable to heat could save lives.
• More access to water for people who need it could have an important impact.
• More trees will add shade. That can lead to temperatures 20 to 45 degrees cooler than unshaded areas in peak heat, according to the Environmental Protection Agency. The MUSC Arboretum is part of the solution in that area, with more than 2,500 trees on MUSC’s 75-acre main campus.

Reves said the goal of the Charleston heat research task force is to not only use science to solve problems locally but also be part of the national solution. The cities involved in the project can learn from each other – and help residents reduce their risk. 

“If we play our cards correctly, we can translate this into useful policy. For example, everybody knows what to do with a hurricane advisory, but fewer people really know what to do with a heat advisory. We could change that and potentially have a huge impact,” Reves said.

LeBlanc, the emergency medicine specialist, said getting the public to pay attention is important, too. “It's really kind of stayed in the zeitgeist and in the news cycle a lot more than is typical. So people are focusing on it and it's drawing attention, which I think is, is valuable. You know, as we're seeing worldwide effects. So I'm hopeful that this summer is a tipping point – that we realize the true health and emergency that this is, versus just kind of thinking of it as a seasonal thing.”