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How Heat Impacts our Community · Healthier Together: Larimer County's Public Health Podcast

0:03
Welcome to Healthier Together, Larimer County's
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public health podcast, where we come together
0:07
for healthier lives, connected communities, and
0:09
real conversations. From your local public health
0:11
team, I'm your host, Tom. And I'm Joanna. One
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of the public health risks that we commonly face
0:16
during the summer months is extreme heat. Extreme
0:19
heat can sneak up on anyone and can sometimes
0:22
cause serious illness. Today, we're going to
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look at how extreme heat impacts the body, our
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emergency medical system, and the wider community.
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First, we're joined by Dr. Tyler Vaughn, an emergency
0:34
physician who cares for patients at UCHealth
0:37
emergency departments in northern Colorado and
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oversees UCHealth EMS, which serves much of Weld
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County and northern Larimer County. Dr. Vaughn,
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thank you for joining us today. Thank you guys
0:49
for having me. It's a pleasure to be here. As
0:51
an emergency health care provider, When do you
0:54
expect to see heat -related illness? Are there
0:56
certain weather patterns or circumstances that
0:59
you see in the forecast and expect to see heat
1:02
-related illness show up? Yeah, so when we have
1:05
weeks like we have over the recent past where
1:09
we're having recurrent high temperatures for
1:12
prolonged periods of time, that's when we start
1:14
to see more and more heat -related illness. We
1:19
also notice a considerable increase when Long,
1:23
hot days tend to intersect with, you know, recreation
1:28
in our community. We also notice not that we
1:31
tend to see considerable amounts of humidity
1:33
in our region, but when we do get our unusual
1:36
humid and hot days, definitely notice that that
1:39
correlates with the increase. How does extreme
1:42
heat impact the body? So it kind of depends.
1:46
So heat -related illness can be kind of a spectrum.
1:49
It starts as simple as... Feeling warm, feeling
1:52
a bit tired and all the way through very severe
1:55
heat illness, heat stroke, where we start to
1:58
see confusion, mental status changes and, you
2:04
know, losing the metabolic processes of the body
2:08
start to kind of break down and we lose our ability
2:10
to regulate on the real kind of extreme side
2:13
of heat illness. You started to talk about it
2:17
a little bit, but can you explain the differences
2:19
between heat stroke and heat exhaustion? Yeah,
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like I mentioned before, it's a little bit of
2:25
a spectrum, but the heat exhaustion is where
2:29
our body gets too warm and we still have the
2:33
ability to attempt to regulate that. So that's
2:38
where we start to see things like headaches and
2:40
fatigue and nausea. The body temperature starts
2:44
to rise, but it's really our body is starting
2:47
to struggle to keep up with that heat at that
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point. Where we start to see the transition into
2:56
what we would consider heat stroke is when that
3:01
high temperature also goes along with effects
3:04
on the brain or effects on other organs. Primarily
3:07
the brain is where we see it manifest first.
3:09
And confusion is one of those. big red flags
3:13
that we see that says, hey, this is a really
3:17
serious illness. And it's also really tough for
3:21
the person experiencing heat illness or heat
3:24
stroke because once you start getting to that
3:27
stage of confusion, you don't notice that something
3:30
bad is going on and it can sneak up on you and
3:34
you can get sicker without really noticing that
3:37
you're getting sicker. So when someone shows
3:39
up at the ER and you think they're experiencing
3:42
heat illness or heat exhaustion, how do you diagnose
3:45
it? So it's, as with most things in medicine,
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a good thorough history and physical exam is
3:50
the cornerstone of everything that we do in medical
3:54
care. You know, finding out what the person has
3:57
been doing, what they've been exposed to, if
3:59
they've been out in the heat. We also look for
4:01
risk factors. Are they on medications that...
4:05
can predispose you to heat illness. Those all
4:07
kind of factor into that history gathering. You
4:10
know, when we're examining someone, we're always
4:13
looking for a good set of vital signs, meaning
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blood pressure, heart rate, temperature. And
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we would expect to see, you know, higher heart
4:22
rates or higher temperatures as we're kind of
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working that up and building that picture of
4:28
either heat exhaustion, heat stroke, dehydration,
4:32
things like that. How do you differentiate between,
4:35
I guess, heat stroke, heat exhaustion and, you
4:39
know, maybe just being, you know, worn out because,
4:42
yes, you've been playing touch football out in
4:44
the sun. And I'm trying to think of where you
4:47
would draw that line where you would say, oh,
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actually, you need to go to the ER. This is this
4:51
is a concern now. It is truly it is a bit of
4:54
a spectrum. The trigger points often to come
4:57
to the ER is, you know, first. We are happy to
5:01
see people in the ER. And, you know, we know
5:03
that people don't want to be there. Everybody
5:05
has better things to do than hang out with us
5:08
in the emergency department. But we want to be
5:11
there for the people that need us. And so it's
5:15
definitely a case of, you know, we're happy to
5:17
see if you're worried, you're starting to feel
5:19
like you're going to pass out if you're nauseous
5:22
and you're not able to tolerate fluids and you
5:25
can't get hydration in. that's where we're going
5:29
to start to say, hey, maybe we need to start
5:31
an IV and try some medications. And then obviously
5:34
on the much more extreme end, it's going to be
5:36
someone who's losing consciousness, is confused,
5:40
is so weak that they're unable to stand. Those
5:44
are going to be cases where we're going to have
5:46
a much higher level of concern and probably will
5:51
be a little bit more aggressive with the interventions
5:53
that we provide. You know, that's a great segue
5:56
just to my next question here. I was going to
5:58
ask, you know, what does treatment look like
6:00
for heat -related illness? It sounds like fluids
6:02
is a big part of it. So it sounds like you might
6:04
be giving them an IV. What other kind of interventions
6:06
would you guys typically do? And kind of also
6:09
looking at like some of the more extreme cases.
6:11
In the last couple of months, we have actually
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been working with our EMS partners to develop
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a update to our pre -hospital protocol. So that's
6:22
how our ambulances take care of people. In the
6:25
environment before they are able to come to the
6:28
hospital and we did a literature review on what
6:31
is the best practice for a heat stroke and heat
6:34
-related illness. And one of the most important
6:37
things that we do on the particularly sick side
6:40
of things when people are critically ill is immersion
6:43
therapy. That is by far the gold standard for
6:46
heat stroke type patients. And what that involves
6:50
is essentially an ice bath. It's putting that
6:53
person kind of up to their chest and ice water
6:56
that is ideally in the 50 degree range, which
7:00
is frighteningly cold for at least my perspective
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of wanting to go in any sort of body of water.
7:08
But it's really it's what those patients need
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to rapidly cool them as quickly as possible.
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Not everybody has an ice bath sitting around
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and most of our ambulances don't have ice baths
7:18
handy or fire departments. They also have, you
7:21
know, large trucks filled with water that can
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potentially assist us with that. And sometimes
7:26
it's just not practical to do that. But that's
7:29
generally what we're going to be aiming to do
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once you get to the hospital is we're going to
7:34
be putting in an ice bath and try to get your
7:36
body temperature down as quickly as possible.
7:39
Wow. I've got to ask, how long does somebody
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have to stay in an ice bath? That seems extremely
7:44
cold. It really depends. But, you know, I've
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had patients where we've had to keep them in
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an ice bath for... up to an hour in the past
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because their body was so dysregulated that it
8:00
just took a lot of effort to get them back to
8:02
where they needed to be. And we will take them
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out before they get back down to a normal temperature
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because we also don't want to overshoot and hypothermia.
8:11
But we it's usually pretty rapid, usually within
8:14
like five to 10 minutes. You put them in the
8:16
ice bath. We start seeing their temperature come
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down and we're able to remove them from that
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ice bath and they start to. uh improve pretty
8:24
rapidly and then it goes along with some other
8:27
just kind of generally good methods of you know
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looking looking at labs getting iv fluids making
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sure blood pressure and uh heart rate and all
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that are uh doing what we what we want to do
8:39
to make sure that that person is is able to get
8:41
better generally for Those extreme cases, we're
8:45
going to be watching them in the hospital, typically
8:47
in the intensive care unit for a bit of time.
8:49
Again, on the real extreme side of heat stroke,
8:53
you can start having problems with your body's
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clotting factors and other various enzyme functions
9:00
start to not work very well. Our body is very
9:03
good at adapting, but on the extreme ends, when
9:06
things start to break down. they can have this
9:08
kind of strange cascade effect. And that's where
9:11
we want to have somebody in the hospital for
9:13
a bit of time and just make sure that things
9:15
have stabilized before we kind of get them back
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to home and doing all their normal stuff. Are
9:21
there certain groups that are more prone to heat
9:23
-related illness or at greater risk for some
9:25
of these more severe symptoms? One of the highest
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risk categories is going to be older adults.
9:32
One of the cool things I get to do is I sometimes
9:35
get to respond out with our crews. We had this
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wonderful patient that I took care of. It's been
9:42
a couple of years now. It was a group of older
9:45
women who would hike every single day and they
9:47
loved being out in the mountains. And I get that
9:49
because that's what I want to spend my time doing
9:51
too. And they were out on their normal morning
9:54
hike. And one of the group started feeling kind
9:58
of weak, started feeling lightheaded. And thankfully,
10:00
their friends said, hey, this is not good. We're
10:02
going to have to like get you off the mountain.
10:04
And they called for help. And we got to be a
10:07
part of that, that rescue of getting that person
10:10
off the mountain, getting them into a cooler
10:12
environment, keeping some fluids while we were
10:14
on the way down. And it was just kind of this
10:16
highlight of, you know, these are people that
10:18
are doing this every single day that she was
10:20
out there every single day hiking. This was not
10:23
a new thing for her. It was kind of part of the
10:26
normal daily routine. And, you know, it just
10:29
kind of snuck up on her. And unfortunately, because
10:31
of her age, she was a little higher risk than
10:34
the average population for having more complications.
10:36
And, you know, she did great. She she recovered
10:39
well with just some simple IV fluids. But, you
10:42
know, it required a little bit of effort to make
10:44
sure that we were able to safely get her down
10:45
off the mountain and fall off a cliff or, you
10:49
know, get stuck up there for a prolonged period
10:51
of time again. We're a very active community
10:53
and we can see this kind of sneak up on us when
10:56
we're doing our normal activities. And I have
10:59
to remind myself when I'm going out on my mountain
11:01
bike to, you know, be mindful of the temperature
11:04
outside. And then obviously, you know, the people
11:08
who are working outside are also at risk, folks
11:11
that are, you know, exercising and recreating.
11:13
And it can just be a little bit insidious with
11:16
some of the temps that we're exposed to. What
11:18
are the long -term impacts of exposure to extreme
11:20
heat? The overwhelming majority of folks will
11:23
do great with this. The vast majority will. Heart
11:26
failure, pulmonary hypertension, and some autoimmune
11:30
conditions can sometimes get worse if you're
11:33
kind of re -exposing to heat illness. Now, if
11:38
you're outside and you're staying hydrated and
11:40
you kind of moderate the activity, it's not necessarily
11:42
going to make it worse. And probably the activity
11:44
is really good for most chronic conditions. But
11:47
at the same time, it's just good to be insightful
11:51
and watch for signs of illness before they creep
11:55
up on you. If you start to notice some of those
11:58
symptoms that you mentioned, either in yourself
12:00
or notice them in someone you're with, how should
12:04
you respond? Fortunately, mitigating heat exhaustion,
12:08
heat stroke can be something that you can respond
12:10
to without help in a lot of cases. recommend
12:18
water for the vast majority of cases. But if
12:21
you're outside and recreating for a prolonged
12:23
period of time, you know, making sure you're
12:25
getting some electrolytes in from time to time
12:27
is definitely a reasonable consideration. And
12:31
then if you start noticing that you're starting
12:32
to feel extra fatigued, maybe starting to get
12:35
nausea, getting out of the heat is definitely
12:38
something that can be helpful. And in the case
12:41
of recreation, you know, just getting into some
12:43
shade. And if you've got a little extra water
12:46
kind of misting your body, evaporative cooling
12:48
can be enormously helpful with our typically
12:52
dry climate. Usually some water on the head.
12:55
some water on the armpits and just letting that
12:57
evaporate could be really, really helpful. If
12:59
you've got a lister or spray bottle, those are,
13:01
those are particularly helpful. Reducing the
13:04
exposure to heat can get into a cooler, more
13:06
air conditioned environment is also very helpful
13:08
as well. And then there's, you know, lots of
13:11
public areas that if, if you're in a spot where,
13:14
you know, you don't have air conditioning in
13:16
your house or something like that, that you can
13:19
visit a shop or something like that where they've
13:21
got air conditioning and let your body cool down.
13:24
In addition to those sort of responsive measures,
13:27
are there steps when planning your summer activities
13:30
that you can take to help prevent heat -related
13:33
illness? Honestly, avoiding kind of the peaks
13:36
of the day is definitely a good practice, I would
13:39
say, in general. You know, get out and if you're
13:41
going to do a heavy activity, then it's probably
13:43
ideal to get started really, really early and
13:45
be able to be done before the peak of the day.
13:48
How do extreme heat events impact our local hospitals
13:52
and emergency medical systems? As heat and outdoor
13:58
recreation and events increase, we definitely
14:01
start seeing an increase in visits to our system.
14:04
There was a festival in the fairly recent past
14:07
that I saw. at least 10 911 responses to for
14:14
a few related illnesses. Those are just the ones
14:17
that made it to the point of needing to transport,
14:19
not the local, like, you know, a lot of our,
14:22
a lot of times we'll have support out there that
14:26
doesn't necessarily result in somebody needing
14:28
to go to the hospital and us just kind of supporting
14:31
them on the scene. You know, our, our teams are,
14:34
again, they're always happy to help, but prevention
14:37
is, you know, this stuff that You all do with
14:40
public health and prevention is huge in terms
14:43
of being able to allow people to just kind of
14:45
do what they want to do and do it safely. Have
14:48
you seen the impact of extreme heat events on
14:51
our local emergency medical system change over
14:54
time? We cover a geographic area in northern.
14:57
Larimer County and Red Feather Lakes, Crystal
14:59
Lakes, Livermore. As time goes on and we see
15:02
that there's, you know, the summers are getting
15:05
hotter, a lot of those communities don't have
15:07
air conditioning. And we're watching that to
15:09
ensure that, you know, we can support those communities
15:12
as we can and help prevent those folks from getting
15:17
sick and just kind of understanding that, you
15:19
know, especially again in homes without air conditioning
15:22
that aren't typically expected to have extremes
15:25
of temperature. that we're watching out for the
15:29
folks in that community. Well, Dr. Vaughn, was
15:31
there anything that we didn't cover that you
15:33
wanted to share? One of the things that I didn't
15:36
talk probably as much about from like the broader
15:39
public health perspective is just that a non
15:42
-exertional heat stroke is definitely the one
15:44
where we see the most extreme illness. Mortalities
15:48
can approach 50 % for some of the patients with
15:51
that. And that's almost always going to be our
15:55
Elderly patients in a home without air conditioning.
15:58
Those are harder cases to, you know, one, to
16:02
identify and two, to prevent if you've got a
16:06
neighbor that's, you know, older and maybe doesn't
16:09
have air conditioning, making sure that you're
16:10
checking in on them. Unfortunately, folks with
16:13
substance abuse disorders, probably the most
16:15
common population we see at the ER in terms of
16:18
heat -related illness that we're able to definitively
16:20
say that, you know, they just... weren't able
16:23
to get that help and so it's it's something where
16:26
just keeping an eye on community members is a
16:29
helpful thing and getting them to the resources
16:31
to help with those you know substance use disorders
16:35
are fortunate to live in a community where there's
16:37
a lot of potential options for that you know
16:39
it's easier to say than it is to actually get
16:42
through the process but it's it's something where
16:45
You know, especially on the ER side of things,
16:47
it's a no -judgment zone. We want to make sure
16:49
that we're giving the right medical thing for
16:50
people. We want to make sure that they're getting
16:52
the treatment that they need. Awesome. Dr. Vaughn,
16:55
thank you so much for joining us. Yeah, thank
16:58
you guys for having me. Today, Jared Olson, a
17:02
population epidemiologist here at the Health
17:04
Department, joins us to talk about how extreme
17:07
heat impacts both people and systems throughout
17:09
Larimer County. Jared, thank you so much for
17:12
joining us. Thank you for having me, Joanna.
17:13
Can you just explain your role at the health
17:15
department? Yeah, absolutely. A lot of what we
17:17
do in population epidemiology is focus on the
17:20
health of the whole community instead of one
17:23
individual outcome. Can you define population
17:26
epidemiology for us? Sure. So population epidemiology
17:30
is a field and it focuses on the population level
17:33
rather than individuals. And it studies the distribution
17:37
or the burden of health effects, health outcomes
17:40
across that population. So we're looking at those
17:42
trends and patterns that might indicate an excess
17:45
of disease or an excess of harm that we can have
17:48
some sort of positive impact on. How does that
17:50
differ from... other epidemiologists that work
17:54
here at the health department? Sure. So some
17:56
epidemiologists may focus on a specific subset.
17:59
So, for example, our communicable disease epidemiologists
18:02
focus on the burden of communicable diseases,
18:05
whether that be measles or West Nile virus or
18:09
other burdens our community faces. And they specifically
18:12
spend a lot more of their time sort of tracking.
18:15
disease across our community, whereas population
18:18
epidemiology focuses a little bit more upstream,
18:20
looking at opportunities to prevent injury, illness,
18:24
and disease, and particularly focused on disparities
18:26
in our community, where some communities or groups
18:29
may experience higher rates of disease for reasons
18:32
outside of their control. So we're interested
18:34
in the whole population, that we're focused across
18:37
where different communities live, what some of
18:40
the features. or some of the determinants are
18:42
that impact their health. So what is their housing
18:45
like? What are their incomes like? What sort
18:47
of educational opportunities do they have? And
18:50
how might that impact their ability to access
18:53
health care or access kind of those healthy habits
18:55
of daily living? How do we define extreme heat?
18:59
So there's different ways you can define extreme
19:01
heat. I think one of the most useful tools is
19:04
the CDC heat risk tool, which takes into account
19:08
not just how hot is it, But what are the contextual
19:11
factors of that? So what's the humidity likely
19:15
to be? What's the overnight cooling effect? And
19:18
what is the time of year? So if we're significantly
19:21
above our average, or if we're early in the season
19:23
and experiencing a higher than normal heat event,
19:26
that would trigger the heat risk tool, say on
19:28
a 90 degree day in April. when it might not necessarily
19:31
trigger that same heat risk indicator later in
19:35
the season where 90 -degree days were more typical.
19:37
And how common are extreme heat events here in
19:40
Larimer County? Extreme heat events are becoming
19:43
more common. So I wouldn't say they're terribly
19:45
common at this moment, but they are becoming
19:48
more common, and we are generally seeing an increase
19:51
in maximum heat temperatures during the summer.
19:54
We're also seeing an increase in temperatures
19:56
in our shoulder seasons, especially the fall.
19:58
But six of the eight hottest years we've experienced
20:01
in Larimer County have come in the last 15 years.
20:03
How is extreme heat different here in Larimer
20:06
County as compared to other parts of the country?
20:09
Absolutely. So we do have a couple of mitigating
20:11
factors that have worked to our advantage thus
20:14
far when it comes to extreme heat. So firstly,
20:17
we don't have the regular high levels of humidity
20:20
that other places in the country do. So if you
20:23
look at the southeast. They have much higher
20:25
humidity along with very high temperatures, and
20:28
that's something we haven't encountered yet and
20:30
may not in Larimer County because of our more
20:33
kind of semi -arid climate. At the same time,
20:36
we've also had the advantage of lower overnight
20:38
temperatures, meaning even if we have a 90 -day,
20:41
we typically will cool off into the 50s or 60s
20:44
at night, which allows us to kind of reset that
20:47
temperature and then allow for cooler mornings
20:49
the next day. So you've mentioned that the...
20:52
Extreme heat events seem like they're becoming
20:55
more common. Is that also translating to increases
20:57
in heat illness? Is that what we're also seeing?
20:59
We are seeing some of that. So we've been able
21:01
to track our emergency department visits related
21:04
to heat illness since 2022. In the first couple
21:08
of years we saw 2022, 2023, we had about 60 visits.
21:12
Now we had 80 as of 2025, and we've had 46 visits
21:15
already this year. And that's in anticipation
21:17
of a high heat event next week. Who is most impacted
21:20
then by these extreme heat events? Where are
21:23
these numbers coming for heat illness? Yeah,
21:25
so it really does span kind of the gamut of experiences.
21:29
But last year, we saw for the first time the
21:33
majority of our emergency department visits were
21:36
among our older adults, 65 and older. That was
21:39
our largest cohort that was visiting the emergency
21:42
room. So I think that's part of this accelerating
21:44
trend is. specific vulnerability for our older
21:48
adult population. However, we have other groups
21:51
that are experiencing particular risks, such
21:54
as outdoor workers, maybe that's construction,
21:57
maybe that's landscaping, but those folks particularly
22:01
might be at an elevated risk, and we do see that
22:03
for our kind of 25 to 44 -year -old males. Children
22:07
are also at risk. They may have a reduced ability
22:10
to mitigate that high heat event and deal with
22:15
it. They may also be more at risk in interior
22:17
environments like a home that has trouble cooling
22:21
down overnight. Are there specific parts of Larimer
22:24
County that are more impacted by these heat events?
22:26
Yes. So when we look at Larimer County, about
22:29
92 % of our households are estimated to have
22:35
air conditioning. So we have a pretty high level
22:37
of ability to control that internal environment.
22:42
In addition, you have locations within the county,
22:44
those at higher elevation, which generally see
22:46
more moderate temperatures. So they might still
22:48
see a high heat event relative to what they're
22:51
used to, but it might not be quite as severe
22:53
as it is lower down in the front range in the
22:56
plains, kind of Fort Collins, Loveland, and further
22:59
east. So those areas are likely to have a little
23:03
bit easier time with some of these high heat
23:04
events. So one of the concerns I have is the
23:07
particular overlap of wildfire and smoke exposure.
23:11
combined with high heat. Yeah, one of our opportunities
23:14
in Larimer County, because our overnight cooling
23:16
has been so stable, has been to open our windows
23:19
and air out the heat that accumulates in our
23:22
homes during the day. So wildfire smoke complicates
23:25
that picture, if not really even eliminating
23:27
it in some cases. So there have been, you know,
23:31
historically several fires close by us that have
23:34
impacted our direct air quality, but we've also
23:37
seen over the summer increased PM 2 .5, that
23:40
particulate matter in the air, to unhealthy levels
23:43
because of fires in Wyoming or California or
23:46
even Canada. We also have wildfires across the
23:49
state in Colorado, and then sometimes those plumes
23:52
may impact us as well. So if folks aren't able
23:54
to open their windows to cool off their homes
23:57
in the evening because the air quality is poor,
23:59
this can be a significant barrier to kind of
24:03
managing the heat, especially if you don't have
24:06
available air conditioning. Are there other kind
24:09
of impacts that you might see that are more on
24:13
the behavioral and mental health side where,
24:15
you know, hey, it's hot. People might have a
24:17
shorter fuse. I mean, I certainly have a shorter
24:20
fuse. So I can speak for myself with that. But
24:23
you're absolutely right. The literature is pretty
24:25
clear on this, that you have an increase in behavioral
24:29
stress, mental health challenges, even something
24:33
like. road rage, right? So traffic safety might
24:36
be impacted by that. That's not something we
24:38
can necessarily correlate to every hot day, but
24:42
we know that that is something that's kind of
24:44
like an underlying thing bubbling underneath
24:46
the surface. At the same time, we do know from
24:49
our emergency department data that we see many
24:52
more visits on 95 degree plus days than we see
24:56
on those days under 90 in the summer season.
24:58
So about five times as many people visit the
25:01
ED for a heat -related illness. on those 95 plus
25:04
degree days compared to those days under 90 degrees.
25:08
Interesting. In addition to heat illness, how
25:11
else does extreme heat impact Larimer County?
25:14
So heat illness shows up not just in the individual,
25:17
but it also puts an additional strain on our
25:19
health care system. So folks in the emergency
25:22
department on these high heat days, we're going
25:24
to see an increase in overall visits, not just
25:27
for heat related illness, but as you mentioned,
25:29
for maybe some behavioral health issues or increased
25:32
accidents, because People have trouble focusing
25:35
during higher heat. So just there is a health
25:37
care impact. It can also strain already vulnerable
25:40
populations with heart conditions, asthma, COPD,
25:44
things like that. So that's one possibility.
25:46
We may also impact our utilities and our electrical
25:49
grid. That's a significant risk. And of course,
25:52
if you're 95 or 100 degrees, having your electrical
25:56
grid out and having your population not be able
25:58
to cool their homes. as they normally would,
26:00
can be a significant risk. As these extreme heat
26:03
events have become more common in Larimer County,
26:06
what has the community traditionally done to
26:08
help people? Our health department takes the
26:10
initiative to make sure we're sharing that information
26:13
with the broader public so that they can do everything
26:15
they can to mitigate their risk and reduce the
26:18
risk of injury. We also connect with the Office
26:21
on Aging that works across the whole county to
26:23
share out cooling resources, especially with
26:26
our seniors and our adults with disabilities
26:27
who may be more vulnerable. We also reconnect
26:31
with hospitals, nursing homes, schools, child
26:33
care centers, other locations where there are
26:35
vulnerable groups, make sure they have everything
26:37
they need as far as guidance, resources, and
26:40
make sure they have backup plans if something
26:42
does go wrong too. That can include evacuation
26:44
of a site that's no longer safe in a high heat
26:47
event if they lose power, for example. We also
26:51
pay attention to our emergency department data.
26:54
We're lucky that our syndromic surveillance emergency
26:56
department data is near real time. So we're able
26:59
to see what's changing kind of day by day and
27:02
whether we have particular impacts to that population.
27:04
And of course, there's other resources and partners
27:08
who are actively working within the community.
27:11
And as we continue to have these high heat days,
27:13
there's probably more planning that we can do.
27:16
to mitigate these harms in the future. What role
27:18
do cooling centers play here in Larimer County?
27:22
Yeah, so cooling centers are definitely part
27:23
of the response. And they have been a key component,
27:28
especially for outreach to individuals experiencing
27:30
homelessness, right? So that's been an opportunity
27:33
for folks to get out of the heat, get a little
27:36
reprieve, especially in an indoor space. And
27:39
our municipalities and other partners have been
27:41
great, including the public library system, have
27:42
been great about supporting that work for a long
27:45
time. The other component of this is that even
27:48
during a high heat event, most individuals prefer
27:50
to stay at home. They want to stay safe and they
27:53
want to stay at home. So oftentimes cooling centers
27:56
might be underutilized relative to what you would
27:59
expect in a high heat event, especially in Larimer
28:02
County where, as we mentioned, air conditioning
28:04
is relatively prevalent and there are options
28:07
for other individuals. that they might employ,
28:10
like going to a grocery store or going to a movie
28:13
theater or something like that. So there are
28:15
some challenges with cooling centers, and that
28:17
may be part of the solution moving forward, but
28:20
we're probably going to have to be innovative
28:21
and look for other complementary tools. What
28:24
steps have other communities taken to address
28:27
extreme heat? Yeah, so other communities have
28:29
been working at this for a long time, potentially
28:32
longer than Larimer County because of, as we
28:34
mentioned, the humidity issues as well as...
28:37
more extreme heat in some of our southwestern
28:39
communities. I'll use the example of like Philadelphia,
28:42
which had a spate of deaths in the 90s and has
28:46
responded with a couple of approaches. One of
28:49
the major things they did is they went in and
28:51
activated their community resources. So instead
28:54
of trying to be everywhere, trying to inform
28:57
individuals about the risks. and then take steps
29:01
to support those most vulnerable. They relied
29:03
on community activists and community participants
29:06
like block captains and faith leaders to kind
29:09
of get the word out and also to check on their
29:11
neighbors, right? So if somebody is homebound
29:13
or has limited mobility, they may not be able
29:16
to reach out and get the help they need. But
29:19
if there's a neighbor who can support them in
29:21
that, then they may be able to move to a cooling
29:22
center or address any issues they're having in
29:24
their home that might reduce their ability to
29:26
cool it on their own. At the same time, those
29:28
are kind of emergency responses, and cities have
29:31
also been planning 5, 10, 15 years in the future
29:34
at the same time. So there's a lot of strategies
29:36
for reducing the overall heat island effect that
29:39
we get in our urban locations. What do those
29:41
look like? A lot of those are about increasing
29:44
shade and reducing our heat sinks. So things
29:47
like pavement absorb a lot of heat in the sunshine,
29:50
and then they radiate it off throughout the day,
29:52
especially at night when there should be overall
29:54
cooling. So if you can do reflective pavement,
29:57
if you can reduce the amount of pavement, right?
29:59
Sometimes you don't need all those large parking
30:01
lots in your community. If you can cover some
30:04
of your pavement with forestry and an urban canopy,
30:08
that can help reduce the amount of absorption.
30:11
And interestingly, in Larimer County, some of
30:14
our biggest cooling effects are from irrigated
30:16
grass. So there was a heat study a few years
30:19
ago, and it found that those locations where
30:22
you maybe didn't have as many trees, but you
30:24
had... grass fields that were irrigated actually
30:27
were having a cooling effect on those immediate
30:30
neighborhoods. So I do think integrating shade
30:33
wherever possible. There are some unique opportunities
30:36
that would require water but might be lower water
30:39
opportunities since we do have a low humidity
30:41
environment. Adding water into our cooling mix
30:45
may be a viable option for us, especially if
30:47
you're in focused locations. You'll see folks
30:50
already congregate around the pooter. and around
30:53
other bodies of water because it is cooler in
30:55
those locations in those super hot days. Green
30:58
roofs are helpful. Anything you can do in order
31:00
to kind of move your urban environment to something
31:03
that looks a little bit more like your forest
31:05
is probably going to help you out. We also have
31:08
quite a bit of wind in Larimer County, and sometimes
31:11
that can help us out as we dispel some of the
31:14
heat of the day. I'm not quite clear on how we
31:17
can kind of maximize that one, though. Are there
31:19
steps that residents of Larimer County can take
31:22
to help protect each other during extreme heat
31:25
events? Yeah, absolutely. On the individual level,
31:29
I would just say if we tip past 90 degrees, especially
31:31
90 degrees, reconsider what your activity level
31:35
is for the day and whether you can move inside,
31:38
move to a cooler part of the day. Just do something
31:41
a little bit different because it is a significant.
31:46
change. At least what we see on the population
31:48
level with folks coming into the emergency department,
31:50
right around 90 degrees, it jumps up. So if you're
31:54
potentially putting yourself more at risk through
31:56
daily activities, anything you can do to mitigate
31:59
that, whether it's shade, time of day, or revising
32:03
the activity entirely, would be super helpful.
32:05
And that's something to share with your neighbors,
32:07
and particularly your neighbors that may be more
32:10
vulnerable. So if you have folks on your block,
32:12
or in your neighborhood who are more homebound
32:14
or limited mobility, who are older adults, or
32:18
who you might know have some sort of chronic
32:21
condition that increases their vulnerability,
32:22
have a conversation with them about how they're
32:25
handling high heat days. So Jared, how are you
32:27
staying cool during these extreme heat events?
32:29
I have multiple kids and swimming. They love
32:33
swimming. So we are trying to swim. We are trying,
32:37
you know, we are running our AC. I don't love
32:39
running the AC. I'm one of those dads. So, but
32:43
we're doing it now. Windows open at night if
32:46
we can. Awesome. Jared, thank you so much for
32:48
joining us. Thank you. In the summer months,
32:52
we experience an increase in a number of public
32:55
health risks, from extreme heat to air quality
32:57
to animal -borne diseases. When these risks are
33:01
present, public health agencies often send out
33:03
some sort of notification to let the public know.
33:07
whether that be a press release or social media
33:09
post or an alert through text or email. While
33:12
these notifications are important, they can also
33:15
sometimes feel overwhelming. Here to help us
33:18
understand these summer alerts and what they
33:20
mean for our day -to -day activities is Dr. Paul
33:22
Mayer, medical officer here at the health department.
33:25
Dr. Mayer, thank you so much for joining us.
33:28
As always, I'm glad to join. What public health
33:30
risks do we encounter more of in the summer here
33:33
in Larimer County? When I think of public health
33:35
risks, By season, typically I think it's helpful
33:39
to break them down into categories. So for each
33:41
season, including the summer, you can think of
33:43
things as behavioral, environmental, or infectious
33:46
disease categories. So in the summer season,
33:49
the two main risks that come to mind are going
33:51
to be automobile safety and water safety. During
33:55
the summer season, we tend to travel more, take
33:57
more family vacations. So people are out in their
33:59
cars more, they're traveling longer distances.
34:01
So I think that becomes very important. Things
34:03
like wearing your seatbelt, making sure your
34:05
car seats fit correctly for your children. And
34:07
one unique hazard for autos in the summer is
34:10
it's very important to understand how quickly
34:12
an auto can get dangerously hot. Every year in
34:15
the United States, sadly, about 37 children on
34:18
average die being left in a car unattended. Typically,
34:23
the most common cause of that is when parents
34:26
simply forget their child's in the car. They
34:28
get distracted and busy and they'll go into a
34:30
store or a place and forget the child's in the
34:32
car. Other things like basic water safety guidelines,
34:36
you know, carry a life jacket if you're doing
34:38
any kind of river rafting or boating and make
34:40
sure that you're aware of everybody in your party
34:43
who can or can't swim. The next category would
34:45
be environmental risks. So for summer, of course,
34:48
heat would be the main environmental risk. And
34:51
heat is the number one weather -related cause
34:53
of death in the United States as opposed to cold
34:55
or rain or other exposures. And so very important
34:58
for people, particularly people who are vulnerable
35:01
to heat injury, like heat stroke, heat exhaustion,
35:03
to be aware of that risk. Another environmental
35:05
risk would be smoke from wildfires. We're currently
35:08
experiencing quite a bit of that here in Larimer
35:10
County with the current wildfire smoke that's
35:12
blown in from some regional fires. The last category
35:15
would be infectious disease. At Larimer County,
35:18
we are uniquely blessed and cursed. Cursed with
35:21
West Nile more than many other counties here
35:24
in Colorado. But I try to throw in some good
35:26
news with all of my messaging, and so I'll let
35:29
people know that there is essentially no Lyme
35:31
disease native to Larimer County or in general
35:35
to the state of Colorado. Also, people may be
35:38
hearing more and more about a thing called alpha
35:40
-gal or a meat allergy syndrome. And the ticks
35:43
that carry that or whose bite tends to predispose
35:47
to that are really not found in Larimer County.
35:49
So we essentially don't see that as a problem
35:52
in Larimer County from local ticks. Certainly
35:54
travelers can get it in other areas. Infectious
35:57
disease risks would be things like rabies, and
36:00
that's just based on the fact that rabies is
36:02
most commonly associated with bats, and it is
36:04
in the summer months that many species of bats
36:06
come back and are active through the summer months.
36:09
Other things that increase during the summer
36:11
months would be food poisoning, just again because
36:13
food tends to get warmer if it's left out quicker
36:16
and can spoil faster. So we see more food poisonings.
36:19
And then we have some rare things like tularemia
36:21
and plague. which are usually more of a localized
36:24
problem. Another thing people don't think of
36:26
necessarily, but we do see an increase in STIs
36:29
in the summers. There's an increase in festivals.
36:31
And World Cup celebrations this year. How do
36:36
public health agencies decide when to send out
36:38
notifications about all of these risks? So those
36:41
decisions can be difficult. I think there are
36:44
two ways that I think of it is if there's a significant
36:47
risk of anything above the baseline risk. then
36:52
we'll tend to want to send out a notification,
36:54
warnings about heat injury, because we know that
36:55
every year there are a large number of emergency
36:58
room visits for heat injury. Sometimes we send
37:01
out notifications to the community at large.
37:04
For example, if we detect tularemia in Larimer
37:07
County, we let the public know. And then other
37:10
times we work one -on -one with an individual.
37:13
I'm thinking of when we have a positive TB case,
37:16
we work with that individual. How do we decide
37:19
when we let... the larger community know of a
37:22
risk versus working sort of with a single impacted
37:25
individual. I think the examples you gave are
37:28
excellent. We tailor that messaging to essentially
37:32
who is at risk. So if we have something like
37:35
wildfire smoke, we're all at risk. Something
37:37
like tuberculosis, luckily, is not so contagious
37:40
as other diseases. So in a case like that, we'll
37:42
focus on the close contact. What is the desired
37:45
outcome when we send out a notification? What
37:47
are we hoping happens? What we're trying to do
37:50
is induce a behavioral change in those people
37:53
who are not already aware. So people who are
37:57
aware are aware, of course, and they've either
37:59
decided or not decided to make a behavioral change.
38:02
But probably our notifications are not going
38:03
to change that because they're aware of the risk.
38:05
It's for the people who may not be aware of the
38:07
risk and realize that sometimes very simple behavioral
38:10
changes can make a big difference. How do we
38:12
balance the need to make the public aware of
38:14
these risks with the potential for alert fatigue,
38:17
especially during the summer? That is one of
38:19
our biggest challenges because, as you know,
38:22
the alarm that always goes off is no longer an
38:24
effective alarm. So we do really try to balance
38:27
that out and not send alerts for things that
38:29
are... not significantly changed from what people
38:33
would expect. Do you have any interesting stories
38:35
that you could share with our listeners about
38:37
maybe something unique that you encountered as
38:40
a result of maybe the summer or the heat? I think
38:42
the most relevant thing I can relate is that
38:45
as I was doing research on heat injury, I found
38:48
it fascinating that somewhere around 90 % of
38:51
all significant heat injury happens in the first
38:54
day on the job or the first day of practice or
38:57
tryouts for sports. Just points out the critical
39:00
importance of gradually increasing your exercise,
39:03
gradually getting used to the heat. It takes
39:05
about two weeks to get used to heat. And unfortunately,
39:08
you can't sit in air conditioning and get used
39:10
to heat. You do have to start exercising gradually
39:13
in the heat and your body will make basic physiologic
39:16
changes to that heat. But it takes about two
39:19
weeks to get used to it. So, Dr. Mayer, how should
39:21
people interpret these public health alerts and
39:24
notifications? Like you just mentioned, you know,
39:25
sometimes these can be a little overwhelming
39:27
at times. When you get one of these alerts, what
39:30
is it that you should do? The answer to that
39:32
depends completely on who you are and your underlying
39:36
health status. If you're generally very healthy
39:39
and don't have any major medical troubles, many
39:42
of the alerts we send out are good to know, but
39:44
you may not need to change your behavior a lot.
39:46
If you're somebody who lives with a chronic disease,
39:48
such as heart disease or lung disease, then those
39:51
alerts become much more important. And in truth,
39:54
many of our alerts are tailored to people who
39:56
have chronic illness because for them, an unusually
39:59
hot day can put them at significant danger. But
40:02
even young, healthy people can have one condition
40:04
such as asthma. For those people, it might be
40:07
really very important to be aware that the air
40:09
quality has taken a bad hit from wildfire smoke,
40:12
and they in particular will need to be very careful
40:15
with outdoor exercise. So like Joanna mentioned
40:17
just a few minutes ago, How can people balance
40:21
then the benefits that they get from outdoor
40:23
activities, you know, the mental health benefits,
40:26
the physical health benefits with the risks that
40:29
might come with that? I think it's really important
40:32
that we in public health remember that we don't
40:36
want to make people afraid of everything. And
40:38
that things like outdoor exercise are very important,
40:41
not just for physical health, but our mental
40:42
health as well. And so we don't want to discourage
40:45
people from doing outdoor exercise. but we want
40:48
them to do it in a way that's going to minimize
40:50
their risk. For instance, if you're vulnerable
40:53
to heat injury, outdoor exercise in the morning
40:55
is fantastic. Luckily, in Colorado, our nights
40:58
usually do cool off pretty well, so you can exercise
41:01
even vigorously in the early morning hours. Other
41:03
things like wildfire smoke, you can check websites
41:07
like airnow .gov, and they'll let you know what
41:10
the... current air situation is. And that one
41:13
is not as predictable as the heat in that sometimes
41:16
early morning hours are not necessarily better
41:18
for air quality. But if you'll watch that site,
41:20
you can usually find some time during the day
41:22
when it's okay to exercise. If people are concerned
41:26
about a specific summer health risk, do you have
41:28
suggestions for questions they can bring to their
41:30
primary care provider? Yes. I worked as a primary
41:33
care provider for many years, and I think the
41:35
most important thing for people to do, to be
41:37
honest, is to write down their question. What
41:39
I would find is people would come in and they
41:41
knew they had four questions, but they could
41:43
only remember two of them. So when you have questions
41:46
for your primary care doctor, write them down.
41:47
It's a very helpful list. And also it's nice
41:50
because you can write the responses down as well.
41:52
But yeah, your primary care provider is an excellent
41:55
resource because they will know your medical
41:57
history, they'll know your medications, and they
41:58
can give you very tailored advice about what
42:01
things you need to worry about and what things
42:02
you may not have to worry so much about. And
42:04
then if people would prefer not to receive public
42:07
health alerts this summer, Do you have any tips
42:10
for how they can stay informed while planning
42:12
their summer activities? Yeah, I think it's very
42:14
important to be in tune to who you're having
42:17
your activities with. Especially here in Colorado,
42:20
a lot of us have family coming from out of state,
42:22
and it's important to kind of just be aware what
42:24
their health situation is, what altitude they're
42:27
used to exercising at, what their activity tolerance
42:30
is like, and you can start to tailor your activities.
42:33
to be sensitive to those things, realizing that
42:36
they may not be able to do some simple things
42:38
that you take for granted. I do also think that
42:41
for other folks, a few just basic information
42:44
pieces can be really handy. Most weather apps
42:46
now will give you the air quality as well, always
42:49
paying attention to what the current conditions
42:51
are. There can be a tendency to have an anticipation
42:55
of an activity that you've been long planning,
42:57
maybe even taking time off of work. And so there's
43:00
this momentum or inertia to do the activity,
43:04
but it's very important to pay attention to the
43:06
real -time updates of what's going on. If you're
43:09
planning on doing a vigorous outdoor activity
43:11
and you have not been exercising in the heat
43:14
and you see that it's going to be over 100 degrees,
43:16
you really have to change your plan or you could
43:19
really have a bad day. Be aware of what the real
43:21
-time temperature forecasting is. And make sure
43:25
that you've thought through carefully, are you
43:27
in the kind of condition that can tolerate that
43:28
sort of heat? Dr. Mayer, thank you so much for
43:31
joining us. Always glad to be here. Do you have
43:37
a question about public health in Larimer County
43:39
or a topic you'd like us to discuss? Let us know.
43:43
Email us at healthiertogether at larimer .org.
43:46
Thanks for listening, Larimer County. Until next
43:49
week, stay well, stay connected, and remember,
43:51
we really are healthier together. Thank you.