During last summer’s unprecedented heat wave in the Pacific Northwest—when temperatures soared more than 30 degrees Fahrenheit above average—the region lost a staggering number of lives to the record-obliterating weather. Records of so-called “excess deaths” in the two states hardest hit, Washington and Oregon, show that at least 600 more people than usual died—an extraordinary spike, even amid the pandemic, which suggests that the brutal weather killed far more than the roughly two hundred officially counted to date. In Oregon, the scorcher was the second-worst mass casualty event in the state’s history. Adding to the tragedy, death from heat stroke is almost entirely preventable if the condition is quickly identified and rapidly treated, ideally no more than 60 minutes after the onset of symptoms. 

Americans may not appreciate just how dangerous heat waves can be, perhaps because, unlike floods and hurricanes, they don’t create visual spectacles. But, intense heat is already the deadliest weather event in the U.S.—and at least one study, which found that the risk of death from heat stroke increased here by five to ten percent between 2000 and 2006, suggests that the danger for the U.S. population has been on the rise for at least two decades. Moreover, the threat is poised to intensify in the years ahead. As the planet continues to warm, heat waves will become more common and more severe. Despite all this, hospitals everywhere—not just in the Northwest, but around the country, in both urban and rural areas—aren’t adequately preparing for this growing deadly threat.

Who Is at Threat?

Even the healthiest among us is at risk for heat stroke—a condition characterized by core temperatures of 104 degrees Fahrenheit or higher, which leads to death when overheated organs fail. The most vulnerable, however, include infants, children under four, those 65 and older, pregnant women, people with chronic conditions (including mental illness), and the obese. Brutal heat can also exacerbate underlying conditions, like cardiovascular and respiratory disease; it can bring on heart attacks, strokes, and so on. Worst of all, it’s poised to become a frequent mass casualty event—i.e., to cause so many people to get so sick at once that large numbers of patients, all in need of urgent medical care, will overwhelm hospitals and emergency medical systems. 

Indeed, that’s what happened throughout the Pacific Northwest during the heat wave. “We’re a Level 1 trauma center, staffed to take on pretty much anything we’re confronted with, but we were over-stressed,” says Jeremy Hess, MD, MPH, an emergency physician with Harborview Medical Center in Seattle, Washington. “A smaller mass casualty event, like a shooting, happens like a bullet. But this one kept going and going. If we’d experienced another day of heat, we would have been in more serious trouble. Our facilities would not have been able to handle it.” His report sounds almost tame compared to a rapid analysis performed by the Centers for Disease Control and Prevention (CDC), which found that heat-related visits to emergency rooms in the Northwestern states were 69 times higher during the heat wave than during the same period two years earlier. For this analysis, Northwestern states include Oregon, Washington, Idaho, and Alaska.