Health officials are better prepared for heat waves than they used to be, but they have more to do in the face of climate change, experts say.
"Nationally and internationally we are much more aware of the danger of extreme heat than we were in 1995," says sociologist Eric Klinenberg, author of Heat Wave: A social autopsy of disaster in Chicago, about the three-day heat wave that caused 739 excess deaths and thousands of hospitalizations in 1995.
"We're more prepared than we were in 1995. A lot of Americans are still vulnerable, and our power grid is vulnerable, too."
Medical workers reported few problems related to the past week's heat wave in parts of the USA that suffered extreme temperatures but were spared Friday night's storms that knocked out power to more than 3 million customers.
But in the District of Columbia, where heat and power outages struck together, sick patients at home who rely on electronic medical devices suffered doubly, and hospitals had to improvise, says Bill Frohna, chairman of the emergency department at MedStar Washington Hospital Center. "Before the storm came we saw some heat-related stuff, but once you throw the power issue on top of the heat, families didn't know what to do," Frohna said. "When no one has power they don't have a backup plan."
Even the Washington hospital had a plan for heat and a plan for outages, but not a plan for the two together, Frohna said.
After storms cut power to millions, hospital workers Saturday saw a spike in patients with chronic diseases who need electricity to operate home dialysis units and machines that deliver intravenous fluids, medications, tube feedings and oxygen, Frohna said.
Many arrived at the hospital with temperatures of 104 and could have been discharged after emergency cooling treatment and hydration, if they had a safe place to go, but they didn't, Frohna said.
Instead, hospital workers opened waiting spaces in part of the emergency room and the hospital's central registration area to let patients convalesce with their family members while caseworkers searched for cool, safe places with power where they can be sent.
Overall, the hospital saw a daily increase of 15% to 30% above normal during the weekend and Monday, Frohna said.
"Saturday (was) one of our biggest Saturdays in recent memory," he said.
Parts of the country that did not lose power because of the storm fared better.
In Indiana, where the heat wave has been going strong for a week, 153 emergency patients visited the state's emergency rooms for heat-related issues in all of last week, says Amy Reel, spokeswoman for the Indiana State Department of Health. The number of heat-related injuries has been relatively small because everyone is taking the heat seriously, says Wishard Hospital emergency physician John Boe. "There's more awareness of how dangerous this kind of weather can be," Boe said.
The news media have gotten better at getting the word out. Hospitals are better prepared. Public officials have made more cooling centers available and neighbors are checking on neighbors without air conditioning, Boe said.
Boe, who teaches at Indiana University's Department of Emergency Medicine, says the Chicago heat wave of 1995 was a turning point in his field.
"In our teachings, they always talk about the Chicago heat wave," he said.
Multiple factors led to the high death toll of the Chicago heat wave, Klinenberg says. High humidity combined with triple-digit heat and little nighttime cooling to turn the lakeside city into a furnace. Mayor Richard Daley and the city's fire and health commissioners were away on vacation. And the city failed to implement its plan for extreme heat, Klinenberg says.
High demand for electricity caused outages, and much of the city lost water as residents opened hydrants to cool off and then fought with city officials trying to close them. Most of the fatalities were elderly, isolated bachelors in the poorest sections of town, Klinenberg says.
Even worse disasters happened in Europe in 2003, when 70,000 excess deaths were caused by an extreme heat event that lasted three weeks, and in Russia in 2010, when a heat wave caused 50,000 excess deaths.
The USA has yet to experience such an extreme heat event, but some experts believe that with climate change it's only a matter of time.
Climate projections see global warming driving longer, warmer and more frequent heat waves for North America in coming years, says Princeton climate scientist Ngar-Cheung Lau.
Essentially, global warming raises the odds of heat waves, and at the same time worsens their effects due to the warmer temperature it brings on average, he says. "One cannot attach certainty to any one weather event being driven by climate change, but this heat wave is certainly striking in its size, severity and duration, similar to the sort of heat waves seen in climate projections," Lau says.
Klinenberg says cities such as Washington, Philadelphia and New York City are ill prepared.
"We need to make sure that cities can get through the worst heat wave," he says. "In New York City, police officers drive through streets using loudspeakers asking people to turn down their air conditioning during the day. The power grid can't handle it."
Contributing: Dan Vergano