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Question of the Week

July 24, 2006


Hello!

It's July, and it's hot.

In some parts of the country, people have been dealing with extreme heat in addition to power outages that have lasted for days. The dangerously hot weather has been front page news, but not all the risks associated with high temperatures can make the front page. Some heat hazards are less hidden, while others rarely make the news:

"Extremely hot weather can result in illness -- including physiological disruptions and organ damage -- and even death. Excessive heat events, or abrupt and dramatic temperature increases, are particularly dangerous and can result in above-average rates of mortality. In fact, the Centers for Disease Control and Prevention (CDC) says that excessive heat claims more lives in the United States each year than hurricanes, lightning, tornadoes, floods, and
earthquakes combined."
http://www.epa.gov/hiri/about/healthenv.html

While everyone is potentially at risk, there are those who are more vulnerable to the risks associated with excessive heat exposure.

"About 400 people die each year from heat exposure, according to the CDC. The risk of heat illness goes up during exertion and sports and with certain health conditions such as diabetes, obesity, and heart disease. Alcohol use also increases the risk. So do medications that slow sweat production such as antihistamines, tricyclic antidepressants, and diuretics used to treat water retention, high blood pressure, and some liver and kidney conditions. People ages 65 and older and young children are especially vulnerable to heat illness. During the summer of 2003, at least 42 children in the United States died after being left in hot cars, according to Jan Null, a meteorologist in San Francisco who tracks heat-related deaths. What some people don't realize is that the temperature inside a car can climb much higher than temperatures outside during a sunny day. Heat stroke in children can occur within minutes, even if a car window is opened slightly."
http://www.fda.gov/fdac/features/2004/304_summer.html#heat

Children are not the only ones at risk when left alone in a car. Adults and seniors may know how to get out of a car that is getting too hot, but they also need to be aware of the warning signs so that they know when to get out. Then there are the pets...

"Americans have a love affair with their cars--and their pets. During the summer months, however, the combination can be deadly. ... Common sense tells most people that leaving their pet inside a parked vehicle on a hot, summer day could be dangerous after an extended period of time. But most people don't realize that the temperature can skyrocket after just a few minutes. Parking in the shade or leaving the windows cracked does little to alleviate this pressure cooker. On a warm, sunny day windows collect light, trapping heat inside the vehicle, and pushing the temperature inside to dangerous levels. On an 85-degree Fahrenheit day, for example, the temperature inside a car with the windows opened slightly can reach 102 degrees within ten minutes. After 30 minutes, the temperature will reach 120 degrees. At 110 degrees, pets are in danger of heatstroke. On hot and humid days, the temperature in a car parked in direct sunlight can rise more than 30 degrees per minute, and quickly become lethal."
http://www.hsus.org/pets/pets_related_news_and_events/cool_it_summers_heat_can_be_deadly_for_your_pet.html

Having heard what to do during extreme heat is one thing, but it is often more difficult for people to follow the guidelines if they don't understand why they exist. (For even more detail on the following topics, visit the reference link at the bottom of the quote.)

"What to Do During Extreme Heat

  • "Slow down. Avoid strenuous activity. Reduce, eliminate or reschedule strenuous activities. High-risk individuals should stay in cool places. ...
  • "Avoid too much sunshine. Sunburn slows the skin's ability to cool itself. ...
  • "Postpone outdoor games and activities. Extreme heat can threaten the health of athletes, staff, and spectators of outdoor games and activities.
  • "Avoid extreme temperature changes. A cool shower immediately after coming in from hot temperatures can result in hypothermia, particularly for elderly and very young people.
  • "Stay indoors as much as possible. If air conditioning is not available, stay on the lowest floor, out of the sunshine. ...
  • "Vacuum air conditioner filters weekly during periods of high use. ...
  • "If your home does not have air conditioning, go to a public building with air conditioning each day for several hours. ...
  • "Dress appropriately: Wear loose-fitting, lightweight, light-colored clothing that will cover as much skin as possible. ...
  • "Drink plenty of water regularly and often even if you do not feel thirsty. Injury and death can occur from dehydration, which can happen quickly and unnoticed....
  • "Eat small meals and eat more often. ...
  • "Take frequent breaks if you must work outdoors. Frequent breaks, especially in a cool area or to drink fluids, can help people tolerate heat better.
  • "NEVER leave children or pets alone in closed vehicles. Temperatures inside a closed vehicle can reach over 140 degrees F within minutes. Exposure to such high temperatures can kill in minutes."
    http://www.lipower.org/stormcenter/safety/heat.html

It becomes more difficult to stay in the air conditioning and drink cold fluids when the power goes out. While many areas set up cooling centers for the air conditioning access, what happens to the heat-sensitive items that are stored at home?

"When the Power Goes Out
* Keep the refrigerator and freezer doors closed as much as possible to maintain the cold temperature. The refrigerator will keep food cold for about 4 hours if it is unopened.
... Buy dry or block ice to keep the refrigerator as cold as possible if the power is going to be out for a prolonged period of time. ...
* If you plan to eat refrigerated or frozen meat, poultry, fish or eggs while they are still at safe temperatures, it's important that the food is thoroughly cooked to the proper temperature to assure that any foodborne bacteria that may be present is destroyed. ...

"Once Power is Restored

  • Determine the safety of your food. If an appliance thermometer was kept in the freezer, check the temperature when the power comes back on. If the freezer thermometer reads 40°F or below, the food is safe and may be refrozen.
  • ... You can't rely on appearance or odor. If the food still contains ice crystals or is 40°F or below, it is safe to refreeze or cook.
  • Refrigerated food should be safe as long as the power was out for no more than 4 hours. Keep the door closed as much as possible. Discard any perishable food (such as meat, poultry, fish, eggs or leftovers) that has been above 40°F for two hours or more.
  • Perishable food such as meat, poultry, seafood, milk, and eggs that are not kept adequately refrigerated or frozen may cause illness if consumed, even when they are thoroughly cooked."
    http://www.cfsan.fda.gov/~dms/fsdisas.html#s2

Food safety is a concern during a power outage (or a picnic on a warm day). Beyond food safety, some medications need to be refrigerated. Consult your pharmacist if you have questions about medication safety after a power outage. Even with the power on, temperatures can rise, and medications can be compromised (especially if left in the car or in the sun on a hot day).

For example, many with severe allergies carry an EpiPen® with them at all times. If they are out in 90* F - 100* F heat, this could cause the EpiPen® to be ineffective:
"* Epinephrine is stable at room temperature ...
* EpiPen® should not be exposed to extreme heat, such as in the glove compartment or trunk of a car during the summer.
* Do not expose the EpiPen® to direct sunlight; light and heat can cause epinephrine to oxidize and go bad, turning brown.
* Check contents of the cartridge periodically through the viewing window to make sure the solution is clear and colorless. If the solution appears brown, replace the unit immediately."
http://www.calgaryallergy.ca/Articles/English/epipen.html

While these directions specifically mention the glove compartment of a car, the EpiPen® website has a link to the Patient Package Insert which provides more specific temperature information:

"* Store at 25*C (77*F); excursions permitted to 15*C-30*C (59*F-86*F) (See USP Controlled Room Temperature). Contains no latex. Protect from light.
* Do NOT store in refrigerator.
* Do NOT expose to extreme cold or heat. For example, do NOT store in your vehicle‚s glove box."
http://www.epipen.com/howtouse.aspx

***Please note: The EpiPen® is ONE example. If you have questions about the heat-sensitivity of your medication (whether prescription or over the counter), please contact your pharmacist.***

There are other examples. There are other risks. No one article can cover them all. Newspapers, TV broadcasts, radio reports, and online articles all have to pick and choose what to point out.

Questions of the Week:
When should you contact your pharmacist or doctor with a heat-related question? What do your peers, friends, and relatives need to know about the effects of the heat on themselves, their pets, their food, and their medications? What other heat-related topics should be addressed? Which heat-related issues would you choose to focus on if you were to write an article? What might be a better way to reach your peers or relatives with this information?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Cindy
aehealth@yahoo.com
Health Community Coordinator
Access Excellence @ the National Health Museum
http://www.accessexcellence.org

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