THE EFFETE IN THE HEAT - HEAT-RELATED HOSPITAL PRESENTATIONS DURING A10-DAY HEAT-WAVE

Background: Severe heat-related illness can result in hospitalisation and possibly death. These illnesses are potentially preventable; in Au stralia high environmental temperatures are common. Aims: To identify (i) possible risk factors for hospital attendance with heat-related il lness during a heat wave, (ii) problems with diagnosis and therapy, (i ii) issues in prevention, and (iv) areas for further study. Methods: A retrospective descriptive survey from four major teaching hospitals i n Adelaide, South Australia (SA) was conducted during a ten day period of exceptional heat in February 1993, in order to review all emergenc y department presentations (i.e. deaths, casualty treatment or hospita l admissions) with a heat-related illness as determined by attending d octors' documentation. Demographic, clinical, management and outcome d ata were collected. Results: Ninety-four patients were classified as h aving a heat-related illness of whom 78% had heat exhaustion. Eighty-f ive per cent were age 60 years or over; 20% came from institutional ca re; 48% lived alone; 30% had poor mobility. Peak presentation followed high daily temperatures for four consecutive days. Severity was relat ed to pre-existing cognitive impairment, diuretic use and presenting t emperature, heart rate, blood pressure, plasma sodium and plasma creat inine. Treatment tended to be non-standardised. Mortality was 12%. Sev enteen per cent required a more dependent level of residential care up on discharge. Conclusion: Problems were identified in accuracy of diag nosis and appropriate intervention. Awareness of the risk factor profi le is needed among health workers, to ensure early preventative strate gies. Populations to target for future prevention include elderly peop le (including those in institutional care), patients with cognitive im pairment and patients taking diuretics, multiple medication and/or wit h other severe co-existing illnesses. Treatment could be more standard ised.