As temperatures in the Las Vegas Valley climbed to 110 degrees on a recent Wednesday afternoon, an elderly woman who had been outside became dizzy and then passed out.
The 78-year-old’s body temperature was about 105 degrees when she arrived at MountainView Hospital in northwest Las Vegas, said Dr. Clarence Dunagan. That’s far above the typical body temperature range of 96.4 to 98.5 degrees for adults 65 and older, according to the Cleveland Clinic.
The woman also arrived confused, struggling to answer basic questions and unable to think clearly, Dunagan said. That’s a hallmark sign of heat stroke, a life-threatening condition that can quickly damage the brain and other organs if left untreated, he said.
When patients with suspected heat-related illness have “altered mental status, that’s when it’s a race against the clock,” said Dunagan, the chair of MountainView’s emergency department.
Every summer, hospitals across Clark County treat patients from all walks of life whose bodies can no longer cope with the extreme heat. Some collapse after working for hours outdoors at construction sites or even in their own backyards, local doctors say. Others are older adults who become dehydrated at home without air conditioning or after their AC breaks.
Southern Nevada’s emergency departments also see tourists and newcomers unaccustomed to the desert climate, children playing outside, well-conditioned athletes who push themselves too hard and individuals experiencing homelessness who spend hours in the heat with little access to shade, water or air conditioning.
As of July 19, emergency departments in Clark County had treated more than 1,800 people for heat-related illnesses since March, according to data provided by the Southern Nevada Health District. So far this year, at least 46 heat-related deaths have occurred in Clark County, according to the Clark County coroner’s office. Last year, the county had about 270 heat-related deaths, the coroner’s office said.
But while every hospital is trying to solve the same problem — lowering a dangerously high body temperature before permanent damage occurs — they aren’t all doing it the same way.
Specialized cooling rooms
At MountainView Hospital, physicians rushed the 78-year-old woman into one of the hospital’s two max-cooling rooms, where nurses removed excess clothing, packed ice around her body, soaked her with wet towels and activated a wall switch that blasted cold air throughout the room through the overhead vents.
Within minutes, the room temperature dropped to about 60 degrees. The combination of cold air, wet towels and ice rapidly cooled the woman’s body through evaporation, a technique Dunagan said safely lowers body temperatures in patients with heat stroke and other heat-related illnesses.
MountainView converted two emergency department rooms into specialized cooling rooms several years ago after emergency physicians looked for a faster, more reliable way to treat heat stroke and other severe heat-related illnesses, Dunagan said. Before the rooms were converted, staff used portable fans, wet towels and ice packs, Dunagan said. By installing a dedicated HVAC system, staff can now cool an entire room with the flip of a switch, eliminating the need to hunt for equipment while every minute counts, he said.
University Medical Center, on the other hand, relies on a slightly different approach.
Dr. Ketan Patel, medical director of UMC’s adult emergency department, said physicians frequently use ice-water bath immersion for patients with severe heat stroke because it helps lower core body temperature fast. Depending on the patient’s condition, staff may also use IV fluids and mist the skin with water and fans to speed evaporative cooling while treating other life-threatening complications.
UMC also treats patients whose heat-related injuries extend beyond heat illness alone.
Rabia Nizamani, medical director of the UMC Lions Burn Care Center, said pavement burns often occur after someone collapses or becomes too weak to get off the ground. Unlike someone who instinctively pulls away from a hot stove or curling iron, patients lying on sun-baked asphalt can remain in contact with the pavement for several minutes while they’re unconscious, disoriented or unable to stand, Nizamani said.
During the summer, pavement temperatures in Southern Nevada can exceed 160 degrees, Nizamani said. That prolonged exposure often causes deep third- and fourth-degree burns that destroy skin, fat and, in the most severe cases, underlying muscle and tissue. Many patients require surgery, skin grafts and extended hospital stays before they can recover.
‘Ice-water immersion is the best’
At Dignity Health-St. Rose Dominican Hospital Siena Campus in Henderson, emergency physicians follow a similar approach to treating heat-related illness but adapt treatment as necessary.
Patients with suspected heat stroke or other severe heat-related illness are immediately taken to a trauma bay, where staff begin active cooling with ice packs placed under the arms and around the groin, wet the patient’s skin and use fans to accelerate evaporation.
“Ice-water immersion is the best,” said Dr. Ashkan Morim, assistant medical director of the Henderson hospital’s emergency department.
Morim added that every minute a patient’s temperature remains above about 104 degrees increases the risk of permanent injury. Confusion and a temperature above 104 degrees are warning signs that a patient has heat stroke, Morim said.
Physicians at Sunrise Hospital and Medical Center — which, like MountainView, is owned by HCA Healthcare — follow a similar approach to MountainView, using anything that “helps cool the body,” according to HCA spokesperson Heather Mills.
The approach at Sunrise, which doesn’t have a max-cooling room, includes wet towels, ice packs and portable fans, Mills said.
Despite the differences in equipment, physicians said the goal is identical across Southern Nevada’s emergency departments: reduce a patient’s core body temperature as quickly as possible before prolonged overheating causes irreversible damage to the brain, kidneys, heart and other organs.
Doctors interviewed for this story said rapid cooling substantially improves the chance of recovery, although outcomes depend on the severity and duration of overheating and any resulting organ damage. Delay treatment, doctors say, and the consequences can become permanent and sometimes even result in death.
Contact Lucas Hellberg at lhellberg@reviewjournal.com.
