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How One Seattle ER Is Handling This Historic Heatwave

Kelsey Tyler

This past week, a historic heat wave swept over the Pacific Northwest. Summertime temperatures in the region typically hover around 70 degrees, so many residents don’t have air conditioning in their homes. But as temperatures reached a 112 degrees in Portland, a record high, and 108 degrees in Seattle, thousands of people were put at risk of developing heatstroke, heat exhaustion and other heat-related illnesses. 

We talked to Dr. Steve Mitchell, medical director of the emergency department at Harborview Medical Center in Seattle, about what he and his staff have been seeing the past few days, how they’ve been treating their most vulnerable patients and what needs to happen as extreme weather events become more common. 

What have you seen over the past few days in the ER?

A massive influx in patients, especially those above the age of 70. By Monday, we were seeing an unprecedented number of people experiencing heatstroke, heat exhaustion and other heat-related illnesses. Some had transported themselves, while others were delivered to us via EMS. 

Western Washington is unique, because historically it’s always had a temperate climate, so most housing does not have air conditioning. This is especially true in lower socioeconomic areas and affordable housing scenarios. We were seeing a lot of the same vulnerable populations, from lower socioeconomic backgrounds, that we saw during our most intense coronavirus outbreaks. 

How have you been treating patients who’ve come in? 

For people who are experiencing heatstroke, you have to put them on ventilators because if they get to a certain point, they lose consciousness and have difficulty being able to breathe on their own. You also have to cool them down as rapidly as possible. We have devices, like certain IV equipment and surface equipment, that we could use to rapidly cool people. But the fastest and most effective way is to pack them in ice. So we made sure our cafeterias were making as much ice as they could, and then stored it in our emergency departments. 

The way it works is we place patients into body bags because they’re waterproof, and then pack ice into the bags, focusing on key surfaces like the armpit, groin and chest. When you don’t have those available, you can use large garbage bags and literally tuck the ice in with those patients as close as you can. At some hospitals in our region, healthcare workers were running to stores to get more garbage bags. 

Were you surprised by the increase in patients you saw?

We were prepared, but the numbers exceeded what we had anticipated. I’ve been in emergency medicine for 40+ years, and to me, this seemed like the largest number of people who required ventilators over a wide region, that we’ve ever experienced.

In the early days of the pandemic, Seattle was the first region hit. But in that scenario we had a very large, albeit localized, outbreak. That overwhelmed a single hospital to the point that it ran out of ventilators. Here, many hospitals were also being pushed to the brink, across an entire region.

What are some safety tips people should follow right now — beyond the basic things, like staying cool and hydrated?

Important medications you may be taking for conditions like blood pressure, asthma, depression, allergies and more, can decrease your body’s ability to manage heat, which can be especially dangerous during a heat wave. Definitely check with your doctor to understand how your medications could be impacting you. Also, right now, the healthcare system is under strain. I know you’re writing a story about heat-related illnesses, but one way to help reduce that strain and make the ER less crowded for everyone, is to get vaccinated, because we’re still seeing a lot of COVID cases. 

How do you think communities could better prepare for heat waves moving forward?

We need to be aware of what could happen and plan for the worst outcomes. Ultimately it comes down to small communities of people who need to be checking on each other and getting them out of dangerous situations. A lot of people simply need assistance getting out of the heat and cooling themselves.

Responses have been condensed and lightly edited.

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