Facing deadly heat, emergency departments use body bags to save lives

By JoNel Aleccia, Kaiser Health News

Thursday, July 22, 2021 (Kaiser News) – When a deadly heat wave burned the Pacific Northwest last month, overwhelming hospital emergency rooms in a region unaccustomed to triple-digit temperatures, doctors turned to a grim but practical life-saving tool: human body bags filled with ice and water.

Hospital officials in Seattle and Renton, Wash., Said that as more people experiencing potentially fatal heatstroke arrived with cooling catheters and even ice packs in short supply, they used the novel treatment to quickly submerge and cool several old people.

Putting heatstroke patients in ice-filled body bags worked so well that it could become a gold standard in a world increasingly disrupted by climate change, said Dr. Alex St. John, an emergency physician at the Harborview Medical Center of UW Medicine.

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

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

“When people are this sick, you have to cool them down quickly,” Lipman said.

Heatstroke is the most dangerous type of heat illness, a medical emergency that kills up to one-third of hospitalized patients. It occurs when the body overheats, either from exertion in high temperatures or from prolonged exposure to heat without relief. 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 the elderly, whose bodies do not regulate temperature well. Also, older people can take medications that impair their ability to tolerate high temperatures.

Typically, patients would be treated with strategically placed ice packs or sprayed with water and placed in front of large fans. Some emergency room staff members immerse patients in large tubs of water or insert cooling catheters into large veins in the body.

However, during emergencies, equipment, ice, and time can be at a premium.

St. John treated nearly two dozen patients for heat stroke on June 28, the hottest period in a six-day heat wave, when temperatures in Seattle soared to a record 108 degrees. That was more than he had ever seen in his decade as a doctor, including working in hospitals in the Arizona desert, he said.

Similarly, Washington Valley University Medical Center in Renton treated more than 70 patients with heat-related illnesses, including three who were treated with body bags, said emergency department director Dr. Cameron Buck.

“The sheer number of people who got in quickly taxed the system,” Buck said.

Overall, nearly 2,800 heat illness emergency department visits were recorded from June 25 to 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 came to the Harborview ER on June 28 confused and weak, with a core body temperature of 104 degrees. A relative had discovered her sick at home. St. John said a colleague had mentioned the body bag technique a few days before, so he gave it a try.

Treatment consists of filling a body bag with a mixture of ice and water, placing the patient inside, and closing the bag to the armpits to allow access to medical equipment and close monitoring. The self-contained bag keeps ice and water close to the patient’s skin.

Within minutes of being placed in the bag, the woman’s temperature dropped to 100.4 degrees, enough to “get her out of that danger zone,” St. John said. They took her out of the bag, dried her off, and placed her on a stretcher, allowing her body’s natural cooling abilities to take over. After being admitted to the hospital, she made a full recovery, she said.

Since the effects of climate change lead to higher temperatures in more places, including historically temperate areas where air conditioning is not used much, using body bags to quickly treat heat illness is a logical solution, Lipman said. , who directs the Stanford Desert Medicine Fellowship. and runs Global Outdoor Emergency Support, or GOES, which provides medical guidance for outdoor travelers.

“All hospitals have body bags. All hospitals have ice machines, ”Lipman said.

He and his 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 used to sustained high temperatures. It was July 2019, which was later designated the hottest month on record on Earth. Using the body bags filled with ice and water, the doctors cooled her temperature from 104 degrees to 101.1 in 10 minutes. She also made a full recovery.

Immersing patients in cold water has long been the gold standard for treating athletes with exertional heat stroke, Lipman said. It is the most effective method, because water conducts heat out of the body about 25 times faster than air.

For now, body bag treatment has been studied primarily in younger, healthier people, with some doctors worrying about the effects of cold water on older people and whether the technique could induce chills that actually raise body temperature. Lipman agrees that more study is needed, but said his experience has found that “the benefits of cooling outweigh any harm from chills.”

And what about patients who might flinch at the thought of being put in a body bag?

Because they are generally so sick when they arrive and are treated so quickly, they are “unlikely to notice,” Lipman said, adding: “But you would have to ask them.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three main operational programs of KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides health information to the nation.


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