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As extreme heat becomes more common, ERs turn to body bags to save lives

As a deadly heat wave scorched the Pacific Northwest last month, overwhelming hospital emergency rooms in a region unaccustomed to triple-digit temperatures, doctors resorted to a grim but practical tool to save lives: human body bags filled with ice and water.

Officials at hospitals in Seattle and Renton, Washington, said that as more people arrived experiencing potentially fatal heatstroke, and with cooling catheters and even ice packs in short supply, they used the novel treatment to quickly immerse and cool several elderly people.

Zipping heatstroke patients into ice-filled body bags worked so well that it could become a go-to treatment in a world increasingly altered by climate change, said Dr. Alex St. John, an emergency physician at UW Medicine’s Harborview Medical Center.

“I have a feeling that we’re looking at many more days of extreme heat in the future, and this is likely to become more common,” he said.

A disposable body bag and buckets of ice are prepared for a cold-water immersion of a patient, as shown in a case report from the Stanford University School of Medicine.Dr. Alexei Wagner / Stanford University School of Medicine

Despite the macabre connotation of body bags, using them is a cheap, convenient and scalable way to treat patients in mass casualty emergencies caused by excessive heat, said Dr. Grant Lipman, a Stanford University professor of emergency medicine. He co-authored a pioneering case study documenting the use of what doctors call “human remains pouches” for heatstroke.

“When people are this sick, you’ve got to cool them down fast,” Lipman said.

Heatstroke, the most dangerous type of heat illness, is a medical emergency that leads to death in up to a third of hospitalized patients. It occurs when the body overheats, either because of exertion in high temperatures or because of prolonged exposure to heat with no relief. The core body temperature rises to 104 degrees Fahrenheit or higher, which can damage the brain and other organs.

Heatstroke can be particularly dangerous for children and older people, whose bodies don’t regulate temperature well. In addition, elderly people may take medications that impair their ability to tolerate high temperatures.

Patients typically would be treated with strategically placed ice packs or misted with water and placed in front of huge fans. Some emergency room staffers immerse patients in large tubs of water or insert cooling catheters into the body’s large veins.

During emergencies, however, equipment, ice and time may all be in short supply.

Every hospital has body bags. Every hospital has ice machines.

St. John treated nearly two dozen heatstroke patients on June 28, the hottest period of a six-day heat wave, when temperatures in Seattle shot to a record 108 degrees. That was more than he’d seen at one time in his decade as a doctor, including working in hospitals in the Arizona desert, he said.

Similarly, UW Valley Medical Center in Renton treated more than 70 patients with heat-related illnesses, three of whom who were treated using body bags, said Dr. Cameron Buck, director of the emergency department.

“The large number who came in very quickly taxed the system,” Buck said.

Overall, nearly 2,800 emergency department visits for heat illness were logged from June 25 through June 30 in a region that includes Oregon, Washington, Idaho and Alaska, including more than 1,000 on June 28 alone, according to the Centers for Disease Control and Prevention. At least 112 deaths in Washington and 115 deaths in Oregon have been linked to the heat wave, state officials said.

Among the sickest patients St. John saw was a woman in her 70s who arrived at the Harborview ER on June 28 confused and weak, with a core body temperature of 104 degrees. A family member had discovered her ill at home. St. John said a colleague had mentioned the body bag technique just days earlier, so he gave it a try.

The treatment involves filling a body bag with a slurry of water and ice, putting the patient inside and zipping the bag just up to the armpits to allow access for medical equipment and close monitoring. The self-contained bag keeps the ice and water close to the patient’s skin.

Within several minutes of her being placed into the bag, the woman’s temperature dropped to 100.4 degrees, just enough to “get her out of that danger zone,” St. John said. She was removed from the bag, dried off and placed on a gurney, allowing her body’s natural cooling abilities to take over. After she was admitted to the hospital, she recovered fully, he said.

As the effects of climate change lead to hotter temperatures in more places — including historically temperate zones where air conditioning isn’t in wide use — using body bags to rapidly treat heat illness is a logical solution, said Lipman, who directs Stanford’s Wilderness Medicine Fellowship and runs Global Outdoor Emergency Support, which provides medical guidance for outdoor travelers.

“Every hospital has body bags. Every hospital has ice machines,” Lipman said.

He and colleagues described the treatment of an 87-year-old woman with cancer who was found unconscious in a parking lot during a heat wave in the San Francisco Bay Area, another region not accustomed to sustained high temperatures. It was July 2019, which was then designated the hottest month recorded on Earth. Using the ice- and water-filled body bags, doctors cooled her temperature from 104 degrees to 101.1 within 10 minutes. She, too, fully recovered.

Immersing patients in cold water has long been the gold standard for treating athletes with heatstroke caused by exertion, Lipman said. It’s the most efficient method because water conducts heat away from the body about 25 times faster than air.

For now, the body bag treatment has been studied mostly in younger, healthier people, and some doctors worry about the effects of cold water on older people and whether the technique might induce shivering that actually raises body temperature. Lipman agrees that further study is needed but said his experience has found that “the cooling benefits will outweigh any harm of shivering.”

And what about patients who might shudder at the thought of being zipped into body bags?

Because they’re generally so ill when they arrive and get treated so quickly, it’s “unlikely they’re aware,” Lipman said, adding: “But you’d need to ask them.”

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Minnesota wildfire doubles in size, creates its own weather

A wildfire in northeastern Minnesota more than doubled in size Tuesday, growing to more than 19,000 acres, after it produced pyrocumulous clouds that generated lightning and even raindrops, fire officials said.

The Greenwood Fire’s growth, most of which happened Monday afternoon, prompted firefighters to leave McDougal Lake, about 80 miles south-southwest of Duluth, officials said. Authorities fear that structures might have been destroyed or damaged.

“We had crews embedded, and as this fire took off, it was quite an effort to communicate with forces on the ground so they could get out,” said federal fire incident spokesman Clark McCreedy.

The pullout was a success, and no injuries were reported. However, downed trees and necessary cleanup mean crews have been unable to assess damage around the lake, McCreedy said.

In addition to the firefighter pullout, 159 dwellings were evacuated Monday, according to an update from the National Wildfire Coordinating Group. Cabins, homes and recreational sites remain under threat, the group said.

Patrick Prochaska, a Minneapolis resident who built a cabin near McDougal Lake in 2012, told NBC affiliate KARE that he watched via security camera as flames mostly bypassed his property Monday, causing minor damage.

“I was feeling very scared,” he said. “At the same time, I could see that it was not doing anything to the house, and it was kind of reassuring.”

The fire in and north of Superior National Forest has mostly performed according to the weather, fire officials said. On Monday, with dry fuel on the ground and temperatures in the high 80s, it was an expanding inferno punctuated by strobes of lightning.

“The winds were drawn into the fire from all directions,” the incident’s fire behavior analyst, Michael Locke, said in a video update Tuesday. “It created what we call pyrocumulous clouds. And really high in the atmosphere … you’d see a thunderstorm, and in fact they went high enough to produce a few sprinkles of rain and even some lightning.”

Temperatures dipped into the mid-70s Tuesday, and the blaze mellowed. “The real story was cloud cover and cooler temperatures,” McCreedy said.

More of the same, and possibly rain, was in the forecast, giving officials hope that they might be able to close the book on an unusually active and dry fire season in Minnesota.

Experts have said climate change has set the stage for extreme weather, including an increase in the frequency and intensity of wildfires in the Northern Hemisphere.

Firefighters — 426 were assigned to the Greenwood event — have been confronted with “prolonged, severe drought,” making parts of Minnesota look like the fire-prone West this summer, McCreedy said.

The Greenwood Fire, which was detected Aug. 15, is believed to have been sparked by lightning.

So far, firefighters have scored no containment, and areas including McDougal Lake, Sand Lake and the Highway 2 corridor have been under mandatory evacuation orders. The federal Boundary Waters Canoe Area Wilderness was closed Saturday “due to active and increasing fire activity, extreme drought, limited resources,” the National Forest Service said in a notice.

Officials set a goal of Sept. 1 for full containment.

“We’re probably going to get more of that moderating weather for the rest of the week,” McCreedy said. “That opens the door for fire crews to make progress on the ground.”

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Hiker survives grizzly bear attack at Denali National Park

A tourist from Indiana was attacked and injured by a grizzly bear at Denali National Park and Preserve in Alaska on Monday night, park officials said.

The 55-year-old tourist, whose name was not released, was hiking alone in dense fog in the Thoroughfare Pass area when a mother bear and multiple cubs charged him from nearby bushes, the National Park Service said in a statement Tuesday.

He had puncture wounds to a calf, his left ribs and his left shoulder, the agency said.

The victim used bear spray that might have cut the attack short, the park service indicated. He walked 1.5 miles to a visitor’s center where “medical personnel” vacationing at Denali treated him as a park bus driver called 911, it said.

The hiker was taken to a medical center near the park before he was transferred to Fairbanks Memorial Hospital, about 120 miles away, park officials said. He was stabilized at the Fairbanks hospital, they said.

“Due to the apparent defensive nature of this attack, there are no plans to locate the bear involved,” the park service said. “Female bears with cubs are naturally defensive of their young, especially when surprised. There is no indication that this bear is unusually dangerous.”

Grizzly bears are federally protected as a threatened species in the lower 48 states. According to the National Wildlife Federation, fewer than 1,500 grizzlies are left in the lower 48, but they thrive, comparatively, in Alaska, where they have a population of about 31,000.

The backcountry area of the attack is closed for one week as a precaution, the park service said.

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House passes John Lewis voting rights bill, sends measure to Senate for tougher fight

House Democrats on Tuesday passed a sweeping voting rights bill named after Rep. John Lewis, D-Ga., the late civil rights icon.

The John Lewis Voting Rights Advancement Act was approved 219-212. All Republicans voted against the legislation.

The bill is part of congressional Democrats’ broader campaign to strengthen voting laws at the federal level to fight restrictive voting laws passed in Republican-led states, such as Texas and Georgia. However, it faces steep opposition in the Senate, where Democrats hold a wafer-thin majority.

The House returned from its recess this week to take up the bipartisan infrastructure bill and a resolution for Democrats’ $3.5 trillion budget package, which includes funding for much of President Joe Biden’s legislative agenda. The procedural motion used to pass the multitrillion-dollar resolution paved the way for the House to vote on the voting rights bill, which was re-introduced last week by Rep. Terri Sewell, D-Ala.

The legislation would require states with recent histories of discrimination to get federal “preclearance” to change their voting laws, which directly addresses the Supreme Court’s 2013 ruling in Shelby County v. Holder. The ruling gutted the preclearance system in the Voting Rights Act of 1965, which civil rights advocates argue was successful in blocking proposed voting restrictions in states and localities with histories of racial discrimination.

House Speaker Nancy Pelosi, D-Calif., said in a statement last week that Congress had “not only an ironclad Constitutional mandate, but a moral responsibility” to pass the bill.

Shortly before its passage, Pelosi said on the House floor that the bill would honor Lewis’ legacy.

“We should have the right to vote and shouldn’t be diminished by anyone. It is unpatriotic to undermine the ability of people who have a right to vote, who have access to the polls,” she said. “As John knew, this precious pillar of our democracy is under attack from one of the worst voter suppression campaigns since Jim Crow.”

It isn’t the first time House Democrats have tackled election law. In March, House Democrats passed the For the People Act, a sweeping bill that seeks to change campaign finance, voting and ethics laws.

The bill would expand access to the ballot box by creating automatic voter registration across the country by registering eligible voters whenever they interact with government agencies, restoring the voting rights of the formerly incarcerated, expanding early voting and modernizing the country’s voting systems.

However, Senate Republicans filibustered the voting rights legislation in June, and the vote to advance an amended version of the For the People Act split along party lines 50-50, short of the 60 votes needed. All Democratic-aligned senators voted to begin debate, and Republicans unanimously voted to block the bill.

Passage of the voting measure was the final vote of the week for the House, whose members are leaving Washington and won’t return until Sept. 20.

Haley Talbot contributed.

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