The Wet Bulb Globe Temperature (more on that later) was in moderate to high territory recently, so it’s time to write about heat-related deaths. Extreme weather is having extreme health effects. I just read Fernanda Santos’s opinion piece about downtown Phoenix, AZ where people are sleeping in tents on “now-hellish streets” with air temps over 100 degrees. The same issue of the Washington Post (June 17, 2022), has an article about a brutal heat wave sweeping across Europe. Most French and German residents don’t have air conditioning.
What is Extreme Heat Doing to Us?
Weather disasters are spiraling out of control. Heat waves are happening across the globe. Maybe it’s time to look at what heat is doing to humans. It’s not just polar bears and penguins that are losing habitat. The places on earth where humans can survive without artificial support are shrinking.
The youngest and oldest people are most vulnerable. Heat waves are associated with premature birth and low birth weight. Infants can’t regulate temperature as well as adults and are dependent on caretakers recognizing heat risk. Tragic heat-related deaths of teen athletes happen every year now. Imani Bell died August 13, 2019, after collapsing during an outdoor basketball practice on a humid day when the temperature reached 99 degrees. The Georgia Bureau of Investigation medical examiner’s report found her cause of death to be “hyperthermia and rhabdomyolysis during physical exertion with high ambient temperature.” The report said “the circumstances leading up to her cardiac arrest and death were consistent with a hyperthermia death.” Such deaths are sometimes associated with heart disease, but the medical examiner made it clear that Bell had “no clear evidence of heart disease.”
Report heat-related deaths to the Coroner!
What IS the role of the coroner in heat-related deaths? In Pennsylvania, there’s no legal requirement for reporting heat-related deaths. But..if excessive heat is a possible factor in the death, it’s no longer a natural manner of death. Like any other non-natural death, death certification becomes the coroner’s responsibility.
Some tips for heat-related death investigation:
Suppose you are a coroner or medical examiner investigator and get dispatched to a sudden death on a hot day. Be alert for the possibility that heat contributed to the death. Document ambient, body, and surface temps at a scene. You probably use an infrared thermometer. How good is it in post mortem situations? Bottom line, it’s not that accurate. The reading will almost always be lower than a rectal or liver temperature. But rectal temps are not a good idea in forensic settings, and few investigators know how to take a liver temp. Even if they did, they’d likely not be comfortable with it. It’s something medical examiners used to do, back when medical examiners went to scenes.
The bigger issue with suspected hyperthermia deaths is that no one takes a temperature at all. EMS and ED staff don’t, not when someone’s in cardiac arrest. By the time the coroner gets to the body, the temperature has decreased, leaving only speculation and circumstantial evidence to support a hyperthermia diagnosis.
Your major clue is going to be the weather. The Wet Bulb Globe Temperature (WBGT) is a useful tool in heat-related deaths. It measures heat stress in the sun. The more common Heat Index is measured in the shade. Using the WBGT, the National Weather Service categorizes heat stress conditions as low to extreme.
Investigator To-Do List:
- #1 If the body is at the hospital, ask your EMS or ED people to get a temperature when they call you about a patient who may have had a heat-related event
- #2 Always document scene temps and look up environmental conditions at the time of the initial injury or collapse
- #3 Ask about activity, hydration, heart or respiratory disease history, and alcohol use
- #4 Check vitreous electrolytes – kidney failure due to rhabdomyolysis (muscle breakdown) is common with heat stroke and results in high BUN and creatinine in vitreous fluid.
- #5 Learn about CDC’s guidelines and toolkits on death certification of natural disaster deaths