Heat and Health: Preparing for Late-Summer ER Surges in Florida
Florida’s climate is no stranger to extremes, but late summer often delivers the most sustained combination of heat and humidity. For emergency departments, this translates into predictable yet challenging seasonal surges. As temperatures climb and heat indices frequently push beyond safe thresholds, emergency physicians must prepare for a spectrum of heat-related presentations ranging from dehydration and electrolyte disturbances to full-blown heat stroke.
The Seasonal Risk Profile
Late summer in Florida is characterized by:
Persistent high humidity: Impeding evaporative cooling, increasing the likelihood of heat stress even at modest ambient temperatures.
Vulnerable populations at risk: The elderly, outdoor workers, unhoused individuals, and patients with limited access to air conditioning.
Medication-related susceptibility: Patients on diuretics, beta-blockers, anticholinergics, and certain psychiatric medications face impaired thermoregulation.
Compounding these risks, hurricane season preparation often leads to prolonged outdoor exertion, exposure during utility outages, and crowded shelter conditions—all fertile ground for spikes in ED volume.
Clinical Presentations
Physicians can expect to encounter:
Heat exhaustion: Nonspecific symptoms (dizziness, tachycardia, nausea) that can easily be misattributed to viral illness or dehydration alone.
Heat stroke: Core body temperatures >40°C with altered mental status, requiring immediate recognition and aggressive cooling.
Exacerbation of chronic disease: COPD, CHF, and CKD patients often destabilize in extreme heat, whether from volume depletion, increased metabolic demand, or poor medication adherence.
Electrolyte derangements: Hyponatremia from over-hydration, hypernatremia from inadequate intake, and hypokalemia exacerbated by diuretics are common late-summer findings.
Operational Preparedness
Emergency departments should anticipate:
Increased patient throughput: Peak times often align with late afternoon and early evening, after prolonged outdoor exposure.
Need for rapid triage protocols: Differentiating benign heat exhaustion from early heat stroke remains critical; consider incorporating core temperature assessment into front-line triage.
Cooling logistics: Ensure availability of ice packs, cooling blankets, IV fluids, and, where feasible, immersion setups. Staff should be familiar with evidence-based cooling protocols, including the superiority of cold-water immersion when logistically possible.
Cross-disciplinary coordination: Hospitalists, intensivists, and nephrologists often become involved as severe cases escalate.
Public Health Intersection
Physicians also play a role in community mitigation. Patient education on hydration strategies, recognition of early heat stress symptoms, and medication counseling should not be overlooked. During times of forecasted extreme heat or storm aftermath, outreach to nursing homes, assisted living facilities, and shelters can reduce preventable ED surges.
Final Thoughts
For Florida physicians, late summer is less a season than a stress test—on patients, systems, and clinical judgment. Anticipating the predictable surge of heat-related illness allows emergency teams not only to preserve lives but also to buffer the ripple effects of heat on an already strained healthcare system.
