In June of 2021, a heatwave resulted in high mortality across the Pacific Northwest region. The city of Portland, Oregon, had many advantages: emergency response personnel, science-based policies, political support for climate change adaptation, and collaboration among municipal, county, state, and federal authorities. Though the city’s response likely prevented many deaths, heat-related mortality was high.

This study presents a retrospective case analysis of the 2021 Western North American Heatwave in Portland, Oregon. Specifically, the study examines the limitations of current heatwave response paradigms by means of a narrative review of the heatwave response and impacts.

Most deaths occurred at home, and most of those who died lived alone. Most of the deceased did not have access to functioning air conditioning.

Heatwaves exhibit high predictability in the demographics of those most affected and have rising rates of recurrence. Given the effectiveness of residential cooling systems in preventing heat-related mortality, findings suggest that future public health and policy initiatives should put increased focus on the primary prevention of heat exposure.

We examine the association between high ambient temperature and acute mental health-related healthcare encounters in New York City for children, adolescents and young adults.

This case-crossover study included emergency department (ED) visits and hospital encounters with a primary diagnosis of any mental health disorder during warm-season months (June–August) in New York City from 2005 to 2011 from patients of three age groups (6–11, 12–17 and 18–25 years). Using a distributed lag non-linear model over 0–5 lag days, by fitting a conditional logistic regression for each age group, we calculated the cumulative odds ratios of mental health encounters associated with an elevated temperature. Analyses were stratified by race/ethnicity, payment source and mental health categories to elucidate vulnerable subpopulations.

In New York City, there were 82,982 mental health–related encounters for young people aged 6 to 25 years during our study period months. Elevated temperature days were associated with higher risk of mental health–related ED and hospital encounters for the 6- to 11-year-olds (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.13–1.46), for the 12- to 17-year-olds (OR: 1.17, 95% CI: 1.09–1.25) and for the 18- to 25-year-olds (OR: 1.09, 95% CI: 1.04–1.15). Children with reaction disorders, adolescents with anxiety and bipolar disorders, young adults with psychosis and reaction disorders and Black and non-Hispanic children and adolescents showed vulnerability to elevated temperature.

We found that elevated ambient temperatures were associated with acute mental health ED or hospital encounters across childhood, adolescence and young adulthood.

It is well-established that heatwaves increase demand for emergency transport in metropolitan areas; however, little is known about the impact of heat events on demand for prehospital retrieval services in rural and remote areas, or how heatwaves are defined in this context.

Papers were eligible for inclusion if they reported on the impact of a heat event on the activity of a prehospital and retrieval service in a rural or remote area.

A search of PubMed, Cochrane, Science Direct, CINAHL, and Google Scholar databases was undertaken on August 18, 2020 using search terms related to emergency medical transport, extreme heat, and rural or remote. Data relevant to the impact of heat on retrieval service activity were extracted, as well as definitions of extreme heat.

Two papers were identified, both from Australia. Both found that heat events increased the number of road ambulance call-outs. Both studies used the Excess Heat Factor (EHF) to define heatwave periods of interest.

This review found almost no primary literature on demand for prehospital retrieval services in rural and remote areas, and no data specifically related to aeromedical transport. The research did recognize the disproportionate impact of heat-related increase in service demand on Australian rural and regional health services. With the effects of climate change already being felt, there is an urgent need for more research and action in this area.

Cooling devices (CDs) worn under personal protective equipment (PPE) can alleviate some of the heat stress faced by health care workers responding to the Ebola outbreak in West Africa.

Six healthy, young individuals were tested while wearing 4 different CDs or no cooling (control) under PPE in an environmental chamber (32°C/92% relative humidity) while walking (3 METs, 2.5 mph, 0% grade) on a treadmill for 60 minutes. Exercise was preceded by a 15-minute stabilization period and a 15-minute donning period.

The control condition resulted in a significantly higher rectal temperature (Tre) at the end of the exercise than did all CD conditions (CD1, P=0.004; CD2, P=0.01; CD3, P=0.000; CD4, P=0.000) with CD1 and CD2 resulting in a higher Tre than CD3 and CD4 (P<0.05). The control condition resulted in a higher heart rate (HR) at the end of exercise than did the CD3 (P=0.01) and CD4 (P=0.009) conditions, whereas the HR of the CD1 and CD2 conditions was higher than that of the CD3 and CD4 conditions (P<0.05). Weight loss in the control condition was higher than in the CD3 (P=0.003) and CD4 (P=0.01) conditions. Significant differences in subjective measurements of thermal stress were found across conditions and time.

Use of CDs can be advantageous in decreasing the negative physiological and subjective responses to the heat stress encountered by health care workers wearing PPE in hot and humid environments. (Disaster Med Public Health Preparedness. 2017;11:573–579)