How EMTs and Paramedics Can Survive This Summer’s Extreme Heat

By James Careless

Even before the official start of Summer 2024, the United States experienced a sweltering heat dome in June. “As a result of the June heat dome, people in the Midwest and Northeast saw a string of days with sweltering temperatures that tied or broke calendar-day records in several states,” says NASA’s Earth Observatory website. “Boston, Massachusetts, hit 98°F and Hartford, Connecticut, reached 97°F on June 19, breaking calendar-day records, according to the National Weather Service. Manchester, New Hampshire, and Scranton, Pennsylvania, broke calendar-day records the day before. And on June 17, Chicago, Illinois; Pittsburgh, Pennsylvania; Indianapolis, Indiana; Milwaukee, Wisconsin; Cleveland, Ohio; Syracuse, New York; Louisville, Kentucky; and Fort Lauderdale, Florida, all tied or broke records.”

Now that summer has arrived, more heat domes and extreme heat events are sure to follow. To help EMTs and paramedics survive the heat — and advise their commanders on how best to protect their field staff — EMS World spoke with experts at the Centers for Disease Control and Prevention’s National Institute for Occupational Safety & Health (NIOSH); the Occupational Safety and Health Administration (OSHA), and the National Association of Emergency Medical Technicians (NAEMT). What follows is a list of highly useful information that could save the lives of EMS personnel and their patients when the heat is on.

The Danger of Heat-Related Illnesses

In extreme heat conditions, the human body is unable to reduce its own overheating through perspiration. Once this happens, the body’s core temperature starts to rise. “When the temperature of the body rises beyond a critical temperature into the range of 40.6 C to 42.2 C (105 F to 108 F), heatstroke is likely to develop,” says the National Library of Medicine website.  

“Hyperpyrexia is exceedingly damaging to the body tissues, especially the brain, and even a few minutes of very high body temperature can sometimes be fatal.”

In fact, “Heat stress, an environmental and occupational hazard, is associated with a spectrum of heat-related illnesses (HRIs), including heat stroke, which can lead to death,” says Dr. 

Brenda Jacklitsch, a NIOSH Health Scientist and occupational heat stress subject matter expert. (She was the lead project officer for the 2016 NIOSH Criteria for a Recommended Standard: Occupational Exposure to Heat and Hot Environments.) “For EMTs and paramedics, they may be responding to a variety of both outdoor and indoor hot environments. Their jobs often require them to move quickly, and potentially do laborious tasks like lifting patients. They may also need to don personal protective equipment (PPE). The combination of these factors can increase their heat burden, placing them at higher risk of HRIs.”

Heat risks exist indoors as well due to “hotter than ambient conditions in industrial settings due to other heat sources.” So says Les Powell, Environment, Health, Safety and Security Manager with International Paper who has been in the industrial EMS field for over thirty years, speaking on behalf of NAEMT. “Four environmental factors affect the amount of stress you may face: Temperature, humidity, radiant heat (such as from the sun or a furnace), and air velocity,” he says. “Perhaps most important to the level of stress an individual faces are personal characteristics such as age, weight, fitness, medical condition and acclimatization to the heat.”

Different HRIs, Different Symptoms

The fact that there are different HRIs explains there are a range of symptoms to watch out for.

A case in point: “Heat Exhaustion is the body's response to an excessive loss of water and salt, usually through excessive sweating,” Dr. Jacklitsch says. According to an OSHA spokesperson who spoke to EMS World for this article, “symptoms of heat exhaustion include fatigue, thirst, nausea or vomiting, dizziness or lightheadedness, heavy sweating, and elevated body temperature or fast heart rate.”

Meanwhile, “Heat Stroke is the most serious heat-related illness,” says Dr. Jacklitsch. “It occurs when the body becomes unable to control its temperature: the body's temperature rises rapidly, the sweating mechanism fails, and the body is unable to cool down. Symptoms of heat stroke include confusion, altered mental status, slurred speech; loss of consciousness (coma); hot, dry skin or profuse sweating; seizures; and very high body temperature. Heat Stroke can be fatal if treatment is delayed.

Other HRIs present with different symptoms. They include:

• Heat Syncope: A fainting (syncope) episode or dizziness that usually occurs with prolonged standing or sudden rising from a sitting or lying position.  
• Heat Cramps: Usually affect workers who sweat a lot during strenuous activity. This sweating depletes the body's salt and moisture levels. Low salt levels in muscles cause painful cramps. 
• Heat Rash: A skin irritation caused by excessive sweating during hot, humid weather.

Treating HRIs in the Field

According to the OSHA spokesperson, first aid for heat-related illness involves the following principles, which we are quoting directly:

• Take the affected worker to a cooler area (e.g., shade or air conditioning). 
• Cool the worker immediately. Use active cooling techniques such as: Immerse the worker in cold water or an ice bath. Create the ice bath by placing all the available ice into a large container with water, standard practice in sports. This is the best method to cool workers rapidly in an emergency. 
• Remove outer layers of clothing, especially heavy protective clothing. 
• Place ice or cold wet towels on the head, neck, trunk, armpits, and groin. 
• Use fans to circulate air around the worker. 
• Never leave a worker with heat-related illness alone. The illness can rapidly become worse. Stay with the worker.

Preventing HRIs and Planning for Heat Emergencies

From a command standpoint, protecting EMTs, paramedics, and patients from the dangers of HRIs requires proper planning and an absence of a macho ‘just suck up the heat’ mentality. This means providing staff and patients with air-conditioned ambulances and facilities as much as possible, plus access to cooling centers and in-vehicle cooling aids as much as possible.

Being aware of impending heat domes and extreme heat trends is central to preventative planning and real-time response. To help make this possible, the CDC has launched a map-based web tool called the ‘Heat & Health Tracker’ (HHT). It features an interactive temperature-based map of the continental United States that shows the daily and weekly incidence of HRIs and their impact on worker health. Also, just drag your mouse across the map, and the maximum temperature of the location you’re on will be displayed. The same website also displays a regularly-updated chart of ‘Daily Rates of Heat-Related Emergency Department Visits by HHS Region’ (Health and Human Services).

Then there’s the website’s Heat & Health Index. “It is a tool that is meant to help identify communities where people are most likely to experience harmful effects from the heat,” says 

Dr. Amy Lavery. She is an Epidemiologist and Unit Lead in the CDC’s and the Agency for Toxic Substances and Disease Registry’s Geospatial Research, Analysis, and Services Program (GRASP), and a key contributor to the HHI’s creation. To make this level of analysis possible, “we've combined several different factors and data to rank all of the zip codes across the nation to provide a way for policymakers, city officials, public health partners, and community members to identify places most likely to experience harmful effects from the heat.”

Protecting EMS Staff

When all is said and done, EMS staff and their commanders are jointly responsible for working safely in extreme heat.

On a personal level, the key to survival is “hydration, hydration, hydration along with proper diet and rest,” Powell says. “During routine activity, your body uses about 1000mL of fluid an hour (up to 2000mL with heavy activity), but can only process 800mL of fluid an hour. This is why it is very important to start drinking water at least an hour prior to starting activity and continue to drink water at least two hours after completing activity. Avoid caffeine and alcoholic beverages (these beverages make the body lose water and increase the risk of heat illnesses) Water is the best thing for you.”

On an agency management level, “Employers should provide a heat stress training program for all workers and supervisors,” Dr. Jacklitsch says. “Workers should be trained before hot work begins and training should be tailored to cover worksite-specific conditions. Some examples of NIOSH recommendations that can be applied in many different workplaces include: 

• Limit time in the heat and/or increase recovery time in a cool environment. 
• Increase the number of workers per task. 
• Train supervisors and workers about heat stress, including symptoms of heat-related illness, first aid, and risk factors.  
• Use a buddy system where workers observe each other for signs of heat intolerance. 
• Provide adequate amounts of cool, potable water near the work area and encourage workers to drink frequently. 
• Use a heat alert program whenever the weather service forecasts that a heat wave is likely to occur. 
• Develop a plan to get employees acclimatized to hot work. (Note: Acclimatization can only go so far, and shoul;d never be used as a substitute for the other measures cited above.)

The Bottom Line

Working in extreme heat safety is everyone’s responsibility, and the time to take that responsibility seriously is now.