New Yorkers may wait all year for sunny park days and open public pools, but there’s no denying just how hot it gets in summertime. And with all that heat comes the risk of issues like heat cramps, heat exhaustion or — perhaps worst of all — heat stroke.
We spoke with Dr. Reed Caldwell, emergency medicine specialist and chief of service for the Ronald O. Perelman Center for Emergency Services at NYU Langone Health, to find out how you can stay cool outdoors and what to do if you or someone else is showing signs of heat illness.
What exactly does it mean to get sick from the heat?
Heat illness has specific stages and severities. The first stage would be heat rash (also called prickly heat), which is a stinging skin irritation that turns your skin red.
Next is heat cramps. People with heat cramps will experience thirst and feel cramps or spasms in their muscles.
Next comes heat exhaustion. Symptoms would include people who feel like they need to sit down or can’t continue to walk or work due to exhaustion, thirst, fast pulse and sweating.
The most severe is heat stroke. This is when your body temperature rises above 106 degrees F. Patients with heat stroke are often confused, very hot and have dry skin — no longer sweating.
Although you might expect somebody who is very hot to be sweaty, people experiencing heat stroke will actually have hot, dry skin. This is the most extreme form of heat illness and it’s life-threatening — always call 911 if you ever encounter anyone exhibiting these symptoms!
We all know we should be drinking water to stay cool in the heat. Is that the best way to avoid heat illness? Or are there other steps to take?
Hydration is the mainstay. It’s really important to drink water before you feel thirsty. I played tennis for many years, and my tennis coach always used to say, “If you’re feeling thirsty, you have done a bad job of staying hydrated because you’re already way behind.”
You can follow the color of your urine. If your urine is clear, you’re doing a pretty good job. And if it’s looking much darker, you’re behind on fluids.
Wearing sunscreen is really important because burned skin can cause you to become more dehydrated. Wearing clothes that are light-colored, loose-fitting and made from breathable materials will keep you cooler.
And if you’re required to be in the heat — if you’re an athlete in a long soccer game or a worker who has to be outside — it’s important to take breaks. So, find a shady spot to take a rest and make sure that you’re hydrating and nourishing yourself. A person’s age, medical history and body type impacts how long it takes to recover from heat; make sure to listen to your body and take the time you need.
Are there certain groups more susceptible to the heat?
As with most kinds of illness, we think of the youngest and oldest being in the highest risk groups, often because they might not be able to communicate how they’re feeling or able to recognize that they’re getting too hot and too thirsty. Those are the people I worry about.
I also think about people who live in places that don’t have adequate ventilation or air conditioning. Particularly in New York City, there are some buildings that can be like a six-floor walkup with no air conditioning. If you know people who live in that kind of environment, I would check on them. Ensure they have their windows open, their fans on, or are able to take a cool bath.
Other groups I think about are people who are partying outside, maybe at a hot outdoor music festival where you don’t have as much shade. Drugs and alcohol can mask how people are feeling. Someone might not notice they are way too hot and losing track of their hydration. We can see a lot of extreme heat illnesses in those settings.
It’s a good reminder that if you’re spending the day outdoors and have a couple of drinks, you can quickly start to feel out of it.
If you are drinking alcohol and it is hot outside be sure that you are also drinking a glass of water between alcoholic beverages — it needs to be water, not coffee. Soda does not count.
That’s a good idea. If you are starting to feel bad — or if you notice someone who is a little out of it — are there steps you can take to prevent it from getting worse before you would have to go to the ER?
Move to a cool, shaded space, whether that be inside to air conditioning or under a tree. Loosen any constrictive clothing and remove as much excess clothing as you can so that people have the ability for their skin to breathe and for sweat to evaporate. Ensure they’re drinking cool water or Gatorade or Pedialyte.
If someone is sicker, they may be confused or could lose consciousness. Or, like I mentioned, they have hot, dry skin. Once somebody is no longer sweating and they have hot, dry skin, that’s become a life-threatening emergency. Call 911 or bring that person to the emergency department.
Anything else you want to say to New Yorkers as they head out into the heat this summer?
New Yorkers are known for sticking together. We’re all about community. So when I hear of extreme temperatures, whether it be the subzero cold in the winter or the extreme heat in the summer, it’s important that everybody thinks about the people in their lives who may not be able to take good care of themselves. It’s important to check on them, whether that’s your family or a neighbor, and make sure that everybody is safe.
This interview has been edited for length and clarity.
Reed Caldwell, MD, is a clinical associate professor in the Ronald O. Perelman Department of Emergency Medicine at NYU Grossman School of Medicine. He specializes in emergency medicine.
