When 60-year-old Joseph Lorenc set out on the 7-mile Falmouth Road Race in mid-August, 2015, he was his usual highly-motivated self: healthy, in good shape and used to running longer distances. At 9 a.m. temperatures on Cape Cod, Massachusetts, registered in the mid-70s, rising to around 80 at race's end an hour later. A 5-mile per hour wind blew at Lorenc's back instead of helpfully cooling him from the front.
Early on, the former high-tech professional strained a lower abdominal muscle and then he had to "work harder," Lorenc told HealthCentral in a telephone interview. That led to an "exertional heat event" that could have become life-threatening.
"An exertional heatstroke can happen in otherwise healthy, active people, when the metabolic heat produced from exercise or activity exceeds the physiological limit to regulate their body heat effectively," says Yuri Hosokawa, Ph.D., ATC, LAT, and vice president of communication and education at the Korey Stringer Institute at the University of Connecticut (UCONN). She responded to HealthCentral in an email interview. "More common classic heatstroke occurs when an individual is passively exposed to heat — being in a hot room during a heat wave."
Other risk factors for exertional heatstroke include dehydration, partaking in an activity not matched to a person's fitness level, recent illness, and sleep deprivation, Dr. Hosokawa says.
Medical tent personnel fully submerged Lorenc — totally coherent, but exhausted and wobbly with a body temperature of more than 107 degrees — in a tub of ice water for 20 minutes. The decidedly uncomfortable treatment worked, and later he reflected on his near-miss.
"As an experienced runner, I never saw this coming. It was fortuitous that I was in the right place at the right time,” Lorenc says.
The heat is on
Earth reached its highest temperature on record in 2016, according to NASA and the National Oceanic and Atmospheric Administration (NOAA). Rising summer temperatures around the globe will continue to put humans at risk — especially older adults, very young children, and those with chronic conditions.
"Unrelenting heat over days or weeks above target temperatures, with no nighttime cool-down preventing recovery, can contribute to heat-related illness," says Rade Vukmir, M.D., J.D., FACEP of Pittsburgh in a telephone interview with HealthCentral. He's also a professor adjunct of emergency medicine at Temple University and a spokesperson for the American College of Emergency Physicians.
A heatstroke is the most dangerous form of hyperthermia or over-heating, affecting the body's central nervous system and causing changes in consciousness and behavior.
"Cognitive damage is a real risk because the brain is a precisely regulated instrument," adds Dr. Vukmir. "An overheated brain that fails to compensate normally can produce altered mental status."
The National Institute on Aging (NIA) notes that when heat rises in the body to uncontrollable levels, symptoms of heatstroke can include:
- Mental confusion or agitation.
- Abnormal pulse: In earlier stages of hyperthermia, the pulse may be strong and rapid as the body tries to cope, but as heatstroke progresses, the pulse can become weak.
- Hot and dry skin.
- Fainting, staggering or coma.
Other forms of hyperthermia can also put anyone at risk for less severe problems: unpleasant heat stress, heat syncope (fainting), sudden dizziness after exercising in heat, heat cramps, and heat exhaustion, says Basil A. Eldadah, M.D., Ph.D, program officer and chief of the geriatrics branch of the NIA in a telephone interview with HealthCentral.
Seniors take extra care
Age-related changes increase risk in the elderly, Dr. Hosokawa says. "They may have a reduced ability to sweat, which is the body's natural cooling mechanism. Normally, the intricate network of blood vessels dilates and constricts, like the radiator of a car, bringing blood closer to the surface of the skin to cool it as heat is exchanged with outside air."
“Symptoms of hyperthermia may not be very specific, unlike pain in a toe, for example,” Dr. Eldadah says. “They may include fatigue, exhaustion, headache, nausea, or dizziness. Older adults who regularly experience those symptoms may not immediately think the cause is heat-related illness. Also, hyperthermia can affect thinking and planning, which may make it more difficult to take appropriate action in the heat.”
Be aware of seniors in your community who may need help, Dr. Vukmir says. "Remember that elderly adults with cognitive impairment may simply forget to open windows if they don't have air conditioning. Maybe they're on a diuretic to reduce fluid levels due to congestive heart failure, for example. Then they could be conflicted, less prone to drink more fluids to cool themselves, which could cause dehydration."
The NIA suggests elders go to places with air conditioning, such as senior centers, shopping malls, movie theaters, and libraries. Cooling centers, which may be set up by local public health agencies, religious groups, and social service organizations in many communities, are another option.
Treat heat-related illness
If you suspect someone is suffering from a heat-related illness, you should:
- Call 911 if you suspect heatstroke.
- Get the person out of the heat and into a shady, air-conditioned or other cool place. Urge them to lie down.
- If the person can swallow safely, offer fluids such as water, fruit, and vegetable juices, but not alcohol or caffeine.
- Apply a cold, wet cloth to the wrists, neck, armpits, and groin. These are places where blood passes close to the surface of the skin, and the cold cloths can help cool the blood.
- Encourage the individual to shower, bathe, or sponge off with cool water if it is safe to do so.
In the event of a heatstroke, Dr. Vukmir says EMS personnel or those in an emergency department would actually apply ice packs to the armpit and groin to cool the femoral vessels in the leg, as well as the axillary vessels in the armpit — all responsible for major blood flow in the body. Cooling blankets or a cooling vest may also be applied.
Emergency personnel may also remove the patient‘s clothing so a mist of water can be applied to the skin while a fan circulates air, aiding evaporative cooling. In life-or-death situations, separate procedures involving cooled IV fluids, a bladder catheter or gastric tube might also be utilized, as well as a medical device that positions a catheter-type cooling system directly into a large groin vessel.
In the event of exertional heat stroke, as in Lorenc's case, on-site rapid cooling with whole body, ice water immersion before transporting to the hospital can be a life-saver, adds Dr. Hosokawa. See UCONN's TEDEd video for more information on heatstroke.
"Know your risk for heat-related illness so you don't take unnecessary chances," says Lorenc.