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Hospitals feel the heat as climate change bakes Boston

Doctors deploy ‘big tubs of ice’ to treat heat stroke

The emergency department at Brigham and Women's Hospital in Boston.Aram Boghosian for STAT

Hospitals in Greater Boston have seen an uptick in patients with heat-related health issues this week — a trend that’s expected to continue into the weekend, with temperatures forecast to reach almost 100 degrees on Sunday.

At Boston Medical Center, patients have presented to the emergency department with dehydration and heat exhaustion.

“We’re definitely seeing an uptick in those types of cases, particularly in vulnerable populations,” said Dr. Christian Arbelaez, the chief of emergency medicine at BMC.

Populations at high risk include those who work outside; those who lack access to water, shelter, and air conditioning; people who have disabilities or chronic conditions; and people who are at age extremes, such as seniors and infants.


Brigham and Women’s Hospital has also seen an increase in illnesses related to this week’s weather, said Dr. Charlotte Goldfine, an emergency medicine doctor at BWH.

“Dehydration is the most common reason why people come in, but it can be as severe as heat stroke,” she said.

Heat stroke occurs when the body becomes so hot that it can no longer cool itself, resulting in a rapid rise in temperature that can cause organ damage and death.

“This is a situation where minutes matter, and so we are very aggressive about treating people as quickly as possible,” said Dr. Caleb Dresser, an emergency medicine doctor at Beth Israel Deaconess Medical Center.

Even before temperatures rose into the 90s, hospitals around Boston were preparing for patients who might require rapid treatment for heat stroke, which centers on cooling the body back to a healthy temperature.

“We have these big tubs full of ice that we just dunk them into,” said Arbelaez. “Before the heat wave started earlier this week, we were in emergency management mode preparing for these types of cases.”

Preparations also include ensuring that the hospital has a steady supply of ice, fluids, and Gatorade, he said.


“For these kinds of weekends, we make sure that our capabilities for cooling patients are ready,” said Dr. Joshua Baugh, the clinical director for emergency medicine at Massachusetts General Hospital. “We have the ability to cool people down with water and fans, and we have tubs of cold water that are available.”

On top of the conditions caused by the heat, warm weather impacts individuals with a host of other illnesses, like heart disease and lung disease, said Baugh.

“On a given day in the ED, we may only see a couple of people who are there just for being really hot, but we’ll see a lot of other people for whom the heat contributed,” he said.

Dr. Chris Fischer, the head of the Emergency Department at Mount Auburn Hospital in Cambridge, said his hospital has had to change its procedures for discharge due to the heat.

“For example, patients who don’t have air conditioning in their apartments — that’s affecting how we’re discharging them from the emergency department, if they don’t have a safe place to go,” he said.

This week’s heat wave foreshadows a future in which hospitals find themselves on the frontlines of the fight against climate change.

In June, a report by the Greater Boston Research Advisory Group found that Suffolk County is set to experience twice as many days above 90 degrees between 2020 and 2040 as between 1990 and 2010 — an increase from 10 to 20 days. Climate change could also cause the region to experience a rapid rise in the severity of storms and frequency of floods.


These predictions have prompted hospitals to prepare for the threats they may face in the future.

Mass General Brigham procured projections for the climate in Boston in 2030 and 2070 to identify weaknesses in its infrastructure, said Baugh. Based on that analysis, he said, multiple hospitals have added chillers to their air conditioners and generators to mitigate the risk that they overheat.

“At certain temperatures, those could actually potentially start to fail if we don’t have chillers,” Baugh said. “We need to make sure that heat isn’t going to take down the backup systems.”

Hospitals have taken similar steps to prepare to withstand winds, he said, such as constructing facades that should survive speeds similar to those seen in Miami rather than Massachusetts.

“It’s really important for us in the health care community to be thinking about how we handle events like this,” said Baugh. “We’re trying to plan how we ensure that we have capacity if we see increased numbers of patients.”

Brigham and Women’s Hospital is also among the first in the country to incorporate education on climate change into its residency in internal medicine, said Dr. Gregg Furie, the medical director for climate change and sustainability at Brigham and Women’s Hospital.

Residents are taught about the consequences of climate change on human health and prepared to “identify, treat, and prevent” the harms, he said. The hospital has also hosted Grand Rounds to teach clinicians about climate change.


“Climate change will impact essentially every organ system in the body,” Furie explained. “Our approach is to integrate teaching about climate change’s health effects into existing lectures in which climate content is particularly relevant.”

For example, residents learn about the different ways extreme heat can affect the body and how to counsel patients to minimize their risk of heat-related illness and how to treat it should it occur.

Cambridge Health Alliance is part of a project at the Harvard T.H. Chan School of Public Health that explores how clinics can capitalize on the records they keep and relationships they have with patients to warn them about weather-related risks.

“We could look in medical records in advance of a heat wave and identify the patients who are at high risk, and send some sort of communication,” said Dr. Rebecca Rogers, the medical director of CHA’s Broadway Care Center.

Though heat has an immediate impact on health, it’s far from the only consequence of climate change that threatens human health.

Some of the others — like changes in the nutritional content of crops and the spread of insects and infectious diseases — are subtler and harder to study, but could be “more significant” than the weather, said Furie.

“We know that climate change is going to have a significant impact on human health, and there’s no question that clinicians in the health care system need to be prepared to respond,” he said.


Camille Caldera was a Globe intern in 2022.Follow her on Twitter @camille_caldera.