Heat wave survival tips from an emergency physician

Brad Uren, M.D., has seen what heat can do to a person. 

He’s treated countless patients for heat-related illness in the emergency department at University of Michigan Health – including many who didn’t realize that their age, health or prescription medication put them at higher risk of heat exhaustion and heat stroke. 

That’s why he loves to share his top tips for staying cool during a heat wave. 

These tips apply to anyone, regardless of their risk level.

That’s because Uren has also given life-saving emergency treatment to young healthy people whose only risk factor was their decision to go running during one of the hottest days of summer.

And since power outages can happen during heat waves as the demand for air condition soars with the thermometer, he advises everyone to know what to do if the electricity goes out and they have to use “old school” methods to stay as cool as possible.  

Who’s most at risk of heat-related illness? 

Uren points out three groups of people who are most vulnerable in hot weather: 

• Infants and toddlers under the age of about 2
• Older adults, whose bodies have less ability to regulate temperature after about age 65
• People who take certain medications or have certain conditions

Find tips for protecting babies and toddlers in this article featuring C.S. Mott Children’s Hospital experts. Find tips for protecting older adults in this article featuring an expert from the Turner Senior Wellness Center at Michigan Medicine. 

The heat.gov websites from the federal government also has information for other risk groups, including anyone who is pregnant, athletes, first responders, people who work outdoors, and people with disabilities. 

Some medications can increase sensitivity to heat or sun.

So if you, your children or people you care for take prescription medicines, take a look at the information that came with it from the pharmacy. 

Or check this information from the Centers for Disease Control and Prevention or ask your health care provider. 

Uren notes that people taking some medications for depression, bipolar disorder and schizophrenia or other psychosis disorders can be especially vulnerable, because certain drugs can affect the brain chemistry involved in body temperature regulation.

Certain health conditions can also impact how our bodies use water, and people in treatment for them need to be especially careful during hot weather, since hydration is key to replace the water we lose by sweating. 

These include kidney disease and congestive heart failure, Uren says.

Treatment for both involves careful monitoring of fluid intake, so anyone with these conditions should be especially careful to avoid excess heat and talk with their health care team about what they can drink, how much, and when if they get hot. 

Another group of people whose underlying health could put them at risk in a heat wave is people who have cognitive issues due to a developmental disability or dementia.

They may be less aware that they’re experiencing heat-related symptoms. 

So they and their caregivers should be careful about prolonged exposure to heat.

People who rely on medical devices that need power to operate or charge batteries – such as oxygen generators for people with breathing issues, CPAP and BiPAP machines for sleep apnea, ventilators and electric wheelchairs – are also at risk if the power goes out during a heat wave.

Uren urges them and their family or friends to make a plan for backup power, including knowing about cooling centers that their county or city might offer that could give access to electricity. 

General tips for everyone to avoid heat-related illness 

• Plan your routine around the expected weather. “I've seen many people over my career who persist in their exercise routine or their work routine. They're going to be outside exercising, running after work, no matter what, because that's what they do,” said Uren. 

  “That's usually the hottest time of the day. See if you can change your routine. Maybe you can exercise inside in a gym with climate control, or try to vary your schedule to exercise later at night, after it's cooled down, or very early in the morning, before those extreme temperatures hit.” 

  The same goes for outdoor chores and work – do them at the coolest time of the day or wait until the heat wave has passed. 

• Help your home keep its cool: If you have air conditioning, try to keep your house as sealed as possible, keeping doors, windows and garage doors closed. 

  Whether or not you have AC, keep heat and sunlight out by shutting blinds and curtains. Use fans to keep air circulating and help the sweat evaporate from your body. 

  Avoid running appliances that can add heat or humidity into your home, such as ovens, dishwashers and clothes dryers (if yours have a timer function, use it to run these in the wee hours of the morning.) 

  If you must cook, use a microwave, pressure cooker, grill, air fryer, toaster oven or stovetop. 

  Take short cooler showers instead of long hot ones.

• Hydrate, hydrate, hydrate (if you can): For most people, Uren said, “keeping yourself hydrated is critically important, and can utilize your own body's natural defenses in the form of sweating to help regulate your temperature.” 

  But if you have heart or kidney issues, or other conditions or medications that mean you have to restrict fuids, check with your doctor or other health care provider to make sure that you're able to increase your fluid intake during a heat wave. 

Use old-school tips and tricks: 

Uren grew up in Michigan’s Upper Peninsula, where air conditioning is still rare and extreme summer heat can really affect people accustomed to cooler weather. 

So he knows some key ways to stay cool even without AC.

Even if you have AC, following these tips can help you reduce the strain on your system, and cope if there’s a power outage: 

• Remember that hot air rises and cold air sinks: If you have a basement or lower level, hang out there because it’s naturally cooler. 

  If your bedrooms are upstairs, make a temporary sleeping space downstairs or even in the basement.

• Keep the air moving by using fans constantly – including ceiling fans and your home’s central fan if you have one.

  During cooler overnight and early morning hours, use a box fan in or near an open window to suck air from outside to inside, then close the window and blinds once the day heats up.

• Use the cooling power of water: If you can get to a pool, pond or lake, or even walk through a sprinkler, it can help bring down your body temperature. 

  At home, wet a small towel, wring it out and drape it around your neck. 

  Refresh it occasionally with cool water. Take a cold shower right before bed to make it more comfortable for you to sleep. Run cool water over your wrists or put your feet in cool water in a tub or basin. 

• Your car probably has AC, even if your home doesn't, or yours is broken or the power’s out. Get in and drive around – don’t just idle, which can put strain on your engine. 

• Make a homemade “swamp cooler” that uses ice, a fan, and a container to create cooler air. 

  There are many videos and pages online with instructions for different types.

What to do if the power goes out during a heat wave

The strain on the power grid from a widespread and prolonged heat wave can lead to outages. 

“If the power goes out, this could be a truly life-threatening situation, especially for older adults, younger children, or people that may have other medical problems as the temperature rises in their home, so it's important to look out for each other,” Uren said. 

For people who are vulnerable due to age or health, he said, “You need to get them to a place that's safe. So that means bringing your neighbor to your home, or bringing your friends or family over if you've got power. Or getting them to a community center or a public building where there's air conditioning where they can cool off. Those are critically important.”

Look up your county, city, township or state website or social media channels, and search for “cooling centers.” 

For instance, there are pages for Washtenaw County including Ann Arbor, for Wayne County and for Detroit.   

If you have a gas generator, be sure to keep it outside and away from your home when it’s running. 

Carbon monoxide poisoning can kill or send you to the emergency department.

If you have an electric or hybrid vehicle, you may be able to use power from the battery to keep critical appliances or medical equipment running for yourself or others. 

Check your owner’s manual for “bidirectional charging” and be aware in advance that an adapter may be necessary and that there’s a limit to what your vehicle’s battery can do.

Know the signs of heat-related illness and what to do

Hot temperatures can cause temporary issues like heat rash – uncomfortable red bumps in the armpits or other areas where skin rubs against skin – or heat cramps, Uren says. 

But cool air and water can help ease those quickly. 

What he really wants people to know the signs of are heat exhaustion and heat stroke – and not just in themselves, but in other people who might not recognize when they’re in trouble from too much heat. 

“Heat exhaustion is usually characterized by a variety of symptoms, things like headache and nausea. People may have muscle cramps, they may just not feel well, they just want to rest. They're tired. They're fatigued and just not feeling well,” he explained.

“That's heat exhaustion, and that's an important signal that you should stop and cool off. Get into the shade, drink some water, at least, if you can get into an air-conditioned environment that's even better.”

But if someone ignores these signs, and doesn’t stop what they’re doing or get to a cooler place, that can lead to heat stroke.

That’s what sends people to the emergency department, where Uren and his colleagues may need to give them intravenous fluids or even place a breathing tube temporarily to help them survive.

“Heat stroke is dysregulation of the body's temperature, so you can no longer keep yourself cool enough. Your temperature starts to rise, and then you have mental status changes,” he explained. 

“People become confused. They may have seizures, they are simply not themselves. And the most dangerous thing about that is, people often lose the ability to recognize those symptoms in themselves.”

That’s why he urges people who are out in hot weather to use the “buddy system” and stay with at least one other person at all times.

“If someone doesn't recognize those symptoms and cool themselves off, you may be the only person seeing them behaving abnormally, and you need to get them to help, and that usually means calling 911 if you see someone that is that altered.”