Scenario<o:p></o:p>
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"Health Center X" is located in a large city in the northwest United States that was experiencing an unprecedented heatwave. The CEO, Ms. Adams, heard on the local news that multiple individuals had been admitted to the hospital for heat-related illnesses-such as heat exhaustion, heat stroke, and rhabdomyolysis-including two people who were admitted to intensive care and another who died. The residences and work sites that the individuals were transported from reportedly lacked air conditioning, as was true for many buildings in nearby neighborhoods where the health center's patients lived and worked.<o:p></o:p>
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Ms. Adams notified the medical director, Dr. Lawson, who determined that several of the individuals admitted to the hospital, including the individual who died, were regular patients of the health center. Reviewing their medical records, Dr. Lawson noted that these patients-a 66 year old man with congestive heart failure, a young adult recently diagnosed with bipolar disorder, and a woman who was 28 weeks pregnant-were all at higher risk of heat related complications.<o:p></o:p>
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Dr. Lawson ensured that the hospitalized patients had a follow-up plan in place, and he scheduled an appointment to meet with the family of the patient who died. He also requested assistance to identify other vulnerable patients who may have been severely impacted by the heat emergency. However, there was no process in place to do so efficiently, and despite staff's best efforts, the outreach was slow. Dr. Lawson also met with providers and other clinicians and determined that most of them-including himself-were unfamiliar with some of the risk factors and clinical impacts associated with heat-related complications.<o:p></o:p>
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The Bottom Line<o:p></o:p>
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Extreme heat causes over 600 deaths per year in the United States-more than any other type of weather event-and record-breaking heat is increasing in locations unaccustomed to it, such as the northeast and northwest United States where many homes don't have air conditioning. These events can cause a surge in patient volume and acuity, especially for healthcare organizations providing care to underserved communities, which are more likely to experience "heat island" impacts or lack access to cooling facilities.<o:p></o:p>
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Health centers and free clinics can use this checklist to understand who is at greatest risk for heat-related complications, and to better prepare for organizational challenges posed by heat emergencies.<o:p></o:p>
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Target 1. Organizational readiness<o:p></o:p>
- Provide organization-wide education on heat-related emergencies, even in geographic locations that haven't typically experienced these types of events. (Refer to this heat education tool, which can be adapted for healthcare settings.)<o:p></o:p>
- Verify that the organization's emergency preparedness and response plans address extreme heat events (scroll to "heat").<o:p></o:p>
- Ask patients about their access to air conditioning or cooling stations when assessing social determinants of health.<o:p></o:p>
Target 2. Healthcare team preparation<o:p></o:p>
Target 3. Patient awareness<o:p></o:p>
Scenario Follow-Up<o:p></o:p>
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After the immediate heat emergency abated, Health Center X's executive and clinical leadership met urgently to assess the recent events. An interdisciplinary team was assigned to conduct a root cause analysis to identify process gaps and develop an action plan that would help support vulnerable patients in similar situations in the future. Findings of the analysis were presented to the board of directors, and a new plan to manage heat emergencies was approved and implemented as part of the organization's overall emergency preparedness plan.<o:p></o:p>
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Want to learn more? See the Get Safe! checklists Environmental Determinants of Health: What Health Centers Need to Know and A Brief Case for Safety: Mitigating the Impact of Environmental Determinants of Health on Asthma, and Resource Collection: Emergency Preparedness and Response.<o:p></o:p>
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All resources are provided for FREE by ECRI on behalf of HRSA. Don't have access or want to attend a free, live demonstration of the website? Email Clinical_RM_Program@ecri.org or call (610) 825-6000 ext. 5200.<o:p></o:p>
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DISCLAIMER<o:p></o:p>
Information provided by ECRI is not intended to be viewed as required by ECRI or the Health Resources and Services Administration, nor should these materials be viewed as reflecting the legal standard of care. Further, these materials should not be construed as dictating an exclusive course of treatment or procedure. Practice by providers varies, for reasons including the needs of the individual patient and limitations unique to the institution or type of practice. Best practice recommendations can change over time. All organizations should consult with their clinical staff and other experts for specific guidance and with their legal counsel, as circumstances warrant.<o:p></o:p>
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