The Rising Rate of Heat-Related Illness, with Janelle Bludorn, PA-C

The global population is encountering a greater deal of poor health outcomes associated with escalating climate change. Heat-related illness may be among the most common manifestations of climate-related illness; research has shown the rate of emergency department (ED) visits for heat-related illnesses—including exhaustion and stroke—have increased gradually in the US alone over the last decade.¹

Though there is reasonable concern over the increased prevalence of conditions like heat-related illness, one ED expert stressed it remains a familiar diagnosis.

In an interview with HCPLive during the American Academy of Physician Associates (AAPA) 2024 Conference & Expo in Houston, TX, this week, Janelle Bludorn, PA-C, assistant professor at Duke School of Medicine, discussed the presentation of heat-related illnesses in ED centers and beyond during a change of apparent climate change.

“We are seeing the same diagnoses,” Bludorn said. “The thing is that we're just seeing them with higher frequency. So, we're seeing more and more morbidity and mortality to heat-related illnesses.”

The Centers for Disease Control and Prevention (CDC) currently estimates that more than 1200 people in the US alone die as a result of extreme heat annually.² Bludorn said the systemic conditions that which present in care settings includes heat stroke, heat exhaustion, cramps, and exercise-induced vasculitis.

There’s also a greater concern in how climate change is impacting skin health; Bludorn noted that harmful sunburn is more prevalent, putting patients at greater risk of developing a chronic condition or even skin cancer. Heat-induced rashes may also be an understated issue in today’s climate.

“I think the thing that you need to remember when it comes to heat-related illness and the skin is that when you have patients that are in hot weather, you need to broaden your differential outside of just the skin,” she explained. “Of course, you're going to be having concern about things like sunburn or different sun-induced conditions. But when people come in with, say, a rash when it's hot outside, you may also want to consider on your differential things wrong with the ducts…that can lead to heat rash.”

From her perspective as an emergency medicine-trained specialist who encounters acute heat-related illnesses often, Bludorn has advice to improve prevention at the primary care level. She explained there is increasing evidence in favor of screening all patients for risk of heat-related illness. The workup should include all social determinants of health, including their occupation, exposure to unhealthy climate, and general lifestyle risk factors.

“Evidence does show that you can actually prevent the morbidity and mortality of heat-related illness if you get out in front of it,” Bludorn said. “I think what I would say to people that are working in primary care, on behalf of all of us in emergency medicine, is because there's not a lot of great evidence on how to manage things when we get to the dire stages of it, I ask that you do your part of screening all of your patients for their risk.”

References

1. ^{Gauer R, Meyers BK. Heat-Related Illnesses. Am Fam Physician. April 15, 2019. 2019;99(8):482-489}
2. ^{CDC. Extreme Heat and Your Health. Web page. Last updated February 15, 2024. https://www.cdc.gov/extreme-heat/about/index.html#:~:text=Heat%20related%20deaths%20and%20illnesses,the%20extreme%20heat%20this%20summer.}