HEAT WAVE AND IT’S IMPACT ON HEALTH

Vyasan.bj
Heat Wave

 Heat-wave is defined as the condition where maximum

temperature at a grid point is 3˚C or more than the normal
temperature, consecutively for 3 days or more.
RECENT INCIDENTS

On June 2, 2019, the city of Churu experienced temperatures of 50.8 °C

(123.4 °F), becoming the hottest city in the country.

India's highest ever temperature recorded was only slightly higher at

51 °C (124 °F) in 2016.On June 9, 2019, Allahabad reached 48.9 °C
(120.0 °F), breaking its previous all-time record.

On June 10, 2019, the temperature in Delhi reached 48 °C (118 °F), a

new record high for the city in the month of June.
CRITERIA FOR HEAT WAVES (IMD)
 Maximum temperature of a station reaches at least 40°C for Plains and at-least
30°C for Hilly regions

 When normal, maximum temperature of a station is less than or equal to 40°C

 Heat Wave Departure from normal is 5°C to 6°C and Severe Heat Wave Departure
from normal is 7°C or more

 When normal maximum temperature of a station is more than 40°C ,Heat Wave
Departure from normal is 4°C to 5°C and Severe Heat Wave Departure from
normal is 6°C or more
FACTORS OF THE HEAT DISCOMFORT

Physiological -
Meteorological - air
Cultural - clothing, health, fitness, age
temperature,
occupation and and the level of
humidity, wind and
accommodation; and acclimatization
direct sunshine;
(ability to adapt)
HEAT WAVE DEATHS IN INDIA
 Estimates suggest that there have been over22,000 heat-related fatalities in India since
1992.

 May 31, 2019, Maharashtra has reported 8 dead and 456 cases of illness due to heat;

 Telangana has reported at least 17 dead;

 Andhra Pradesh has reported 3 dead and 433 diagnosed cases of heatstroke.

 On June 10, 2019, three passengers were found dead on a train as it arrived in Jhansi,
apparently due to the heat wave. A fourth passenger was found in critical condition
and brought to a hospital where they died.
 15 monkeys were found dead in a forest possibly as a result of the heat wave

 Conflicts over water shortages have also occurred. Six people were stabbed
in Jharkhand during a fight with a man who was filling barrels of water from
a water tanker.

 One man was killed in a fight in Tamil Nadu.

 In Madhya Pradesh, a fight over water led to two men being "seriously
injured", while in a separate fight, a water tanker driver was "beaten up".
CAUSES
 Global warming has caused disruption of monsoons

 Delayed monsoons and droughts increased the intensity of heatwaves

 Periodic occurences of El Nino effect contributes to increase in temperature

 Increasing effect of loo in north India due to expanding desertification and land
degradation in the north-west

 Rapid and unplanned urbanisation creating heat islands, encroachment of lakes

and deforestation contributing to increase in temperatures

 Urban Heat Island (UHI) effect

HEALTH IMPACTS OF HEAT WAVE
Heat Disorder Symptoms First Aid

Sunburn Skin redness and pain, Take a shower, using soap, to remove oils that
possible swelling, blisters, may block pores preventing the body from
fever, headaches. cooling naturally. If blisters occur, apply dry,
sterile dressings and get medical attention.

Heat Cramps Painful spasms usually in Move to cool or shaded place. Apply firm
leg and abdominal muscles pressure on cramping muscles or gentle massage
or extremities. Heavy to relieve spasm. Give sips of water. If nausea
sweating. occurs, discontinue.
Heat Heavy sweating, weakness,
Get victim to lie down in a
Exhaustion cool place. Loosen skin cold,
pale, headache and clammy.
Weak pulse.
Normal temperature
possible. Fainting,
vomiting.
Heat Stroke High body temperature
(Sun Stroke) (106+F). Hot, dry skin.
Rapid, strong pulse.
Possible unconsciousness.
Victim will likely not
sweat.
Get victim to lie down in a cool place. Loosen
clothing. Apply cool, wet cloth. Fan or move
victim to air-conditioned place. Give sips of water
slowly and If nausea occurs, discontinue. If vomiting
occurs, seek immediate medical attention. Or call
108 and 102 for Ambulance
Heat stroke is a severe medical emergency. Call
108 and 102 for Ambulance for emergency
medical services or take the victim to a hospital
immediately. Delay can be fatal. Move victim to a
cooler environment. Try a cool bath or sponging to
reduce body temperature. Use extreme caution.
Remove clothing. Use fans and/or air conditioners.
DO NOT GIVE FLUIDS.
 CLASSIFICATION OF HEAT INDEX
Heat index category Health effects

27-32°C Warm Caution-fatigue possible with prolonged exposure and/or physical activity. Continuing
in activity could results in heat cramps

32-41°C Hot Extreme caution-heat cramps and heat exhaustion possible with prolonged exposure
and/or physical activity

41-54°C Very hot Danger- heat cramps or heat exhaustion likely and heat stroke possible with prolonged
exposure and /or physical activity

>54°C Extremely Extreme danger – heat stroke highly likely with continued exposure
hot
 HEAT WAVE SAFETY MEASURES
As far as possible, avoid going out in the hot sun, especially between 12.00
P.M. and 3.00 P.M.

Drink sufficient water at frequent interval, even if not thirsty. Always carry
drinking water while travelling.

Wear light colored, loose, cotton clothes. Use protective goggles, umbrella,
cap, towel or cloth to cover head, shoes and chappals while going out in sun.

Avoid strenuous activities in scorching sun, when the outside temperature is

high.

If you have to work outside, use damp cloth or an umbrella to cover your head.
Eat light meals and fruits rich in water content like melons, cucumber and
citrus fruits.

Avoid foods that are high in protein such as meat and nuts, which increase
metabolic heat.

Avoid eating outside and stale food.

Use home-made and traditional healthy beverages like lemon water, butter
milk and juices, etc.

Never leave children and pets alone in parked vehicles.

Keep animals in the shade and give them sufficient water to drink.

Keep your home cool, use curtains, shutters or sunshade, etc. Open
windows at night. Maintain adequate ventilation.

Listen to local weather forecasts and be aware of upcoming temperature

changes.

In case of illness and fainting, consult a doctor/ seek immediate medical

help
ACTION PLAN

Establish
Public Collaboration
Early Capacity
Awareness with non
Warning building /
and government
System and training
community and civil
Inter-Agency programme.
outreach society
Coordination
Phases
Phase I- Mapping and documenting the current initiatives and activities
undertaken against Heat Waves

Phase II- Assessment of the magnitude of the Heat Wave related morbidity
and mortality

Phase III- Determination of threshold values (thermo-hygrometric index) which

cause Heat Wave related adverse health outcomes and support IMD in
developing an Early Warning System (EWS) based on the threshold values.
 Phase IV- Community vulnerability assessment to identify the most vulnerable
sections of the society to Heat Wave and suggest alternate models for resiliency
building which are contextual.

Phase V- Strengthen the existing Heat action plan by incorporating the EWS,
alternate livelihood strategies for vulnerable populations and involvement of various
stakeholders/ sectors to support in the implementation of Heat action plan.

Phase VI- Review and update the Heat Action Plan annually by incorporating the
EWS and inputs of various stakeholders/ sectors and evaluate its implementation
FURTHER ACTIONS
Set up “cooling centers,” such as religious sites, public buildings, malls, during a
heat alert

Run temporary night shelters for those without access to water and/or electricity
and shelter

Hold on daily basis meet-ups to discuss situation analysis reports and fresh
breaking developments during a heat alert, and ensure that communication
channels are functional and operating

Distribute fresh drinking water at public places and also at religious spaces, bus
and train stations etc. along with distribution of ORS packets, keep adequate
stocks and ensure availability of all medical supplies to all hospitals/PHCs/UHCs
Train field level workers and build their capacities in heat wave
awareness generation campaigns

Ensure all the hospital in government sector update their admissions

and emergency case records to track heat-related cases and also
train hospital staff to improve on recording the cause of death

Clear and stringent instructions to adopt heat-focused examination

procedures at local hospitals and urban health centers

Instruct emergency services to create displays on

ambulances/vehicles during local events to build public awareness
about heat related concerns
 COLOUR CODES FOR HEAT ALERT
Red Alert Extreme Heat Alert for the Day Normal Maximum Temp
(Severe Condition) increase 6º C to more

Orange Alert Heat Alert Normal Maximum Temp increase 4º C to 5º C

(Moderate Condition)
Day

Yellow Alert Hot Day Nearby Normal Maximum Temp.

(Heat-wave Warning)

White Normal Day Below Normal Maximum Temp.

(Normal)
ROLES & RESPONSIBILITIES
Revenue and Disaster Management

 Heat wave warning dissemination through all forms of media.

 Issue necessary directions to all the concerned governmental and nongovernmental

organizations

 Periodic coordination meetings with all the departments towards implementation of

heat wave action plan

 Promote research on heat related morbidity, mortality and mitigation measures in

collaboration with knowledge partners located in the state.
 Organize capacity building programs on Heat Wave prevention and
management for different stakeholders.

 Provide relief and compensation to the victims of Heat wave.

 An intensive IEC campaign to be launched to keep people inform about Do’s

& Don’ts as regards exposure to Heat Wave, fluid intake, regulation of work,
clothing, protective device & work environment during the Heat Wave period
Health Services
A. Infrastructure and Logistic –

 Pre-position of Drugs Supplies and Logistics –

 Provision for adequate supply of ORS, IV fluids, life saving medicines at all health
institutions and ASHA & Anganwadi workers as per the suitability.

 At all health institutions ear marked beds should be kept in readiness at a cool well
ventilated space.

 In the CHC / PHC, wherever A.C & Coolers are available, to be utilized in the heat
stroke room.
 Provision of Ice & Ice cold water at CHC & PHC as per requirement &
availability.

 Cold water should be stored in earthen pots in each health institutions.

 ORS Booth should be opened at all health institutions.

 All Ambulances & other PHC vehicle to be kept in roadworthiness for

referral of patients.

 Provision of power back up during summer.

 Sensitization of Medical Officers & Paramedical workers –

 Meeting of Nodal officers at State / District & Block level to be conducted

to review the preparedness activities and create awareness about the
dangers of Heat Wave and to inform individuals how to minimize the risk.

 All categories of health personnel should be sensitized on heat stress

disorders, prevention and management.

 Training of ‘Mobile Health Units (MHU)’ for management of heat related

cases.
 Establishment of mobile base alert system through the ASHA/ ANM/ health
workers for effective and immediate assessment of heat stroke cases.

 Strengthen the control rooms for providing heat related information.

 Establish a Heat Wave related morbidity and mortality tracking system and
updating the data set periodically.

 Maintaining data base and surveillance on heat related morbidity and

mortality.

 Coordinate with private hospitals to collect heat ted morbidity and mortality
data.

 Provision of funds for Heat Wave management.

Education
 Restriction of school timings, if necessary
 Ensure Avoidance of physical activities during school hours
 IEC activities on Heat Wave prevention and management in schools
 Promote School Safety Plan
 Encourage Plantation of trees and promote green campus
 Provision for safe drinking water.
 Training to the teachers and mock drills among students via special workshops and
classes on identification, health risks and the subsequent management during Heat
Waves.
 Provision of funds for Heat Wave management
 HEAT ILLNESS -TREATMENT PROTOCOL
1. Initial patient assessment -primary survey (airway, breathing, circulation, disability,
exposure), vital signs, including temperature.

2. Consider heat illness in differential diagnosis if:

a) Presenting with suggestive symptoms and signs

b) Patient has one or more of the following risk factors:

i. Extremes of age (infants, elderly)

ii. Debilitation/physical de conditioning, overweight or obese

iii. Lack of acclimatization to environmental heat (recent arrival, early in summer season)
i. Any significant underlying chronic disease, including psychiatric cardiovascular,
neurologic, hematologic, Obesity, pulmonary, renal, and respiratory disease

ii. Taking one or more of the following:

 Sympathomimetic drugs

 Anticholinergic drugs

 Barbiturates

 Diuretics

 Alcohol

 Beta blockers
1. Remove from environmental heat exposure and stop physical activity.

2. Initiate passive cooling procedures.

a. Cool wet towels or ice packs to axillae, groin, and around neck; if patient is stable, may take a
cool shower,

b. Spray cool water or blot cool water onto skin.

c. Use fan to blow cool air onto moist skin.

1. If temperature lower than 40°C, repeat assessment every 5 minutes; if improving, attempt to
orally hydrate (clear liquids, ORS can be used but not necessary cool liquids better than cold)
and observe.

2. If temperature 40° C or above, initiate IV rehydration and immediately transport to

emergency department for stabilization.
 DO's
Try to stay in cold places.

Use umbrella during hot days.

Wear thin, loose cotton garments, preferably of white colour.

Wear a hat of cotton or a turban.

Avoid outdoor physical activity from 12-3 PM. If unavoidable, attend to only light
physical activity under the hot sun.
Take ample water along with salted butter milk or glucose water.

Take measures to reduce the room temperature like watering, using window shades,
fanning, and cross ventilation.
Shift the person with heat stroke symptoms to cool dwelling.

The person suffering with heat stroke should have minimum clothing.

The person suffering with heat stroke has to be sponged with cold water,
indirect application of ice-packs.

The person suffering with heat stroke should be kept in between ice-blocks.

If the person affected with heat stroke is not showing any improvement, he
should be shifted to a hospital immediately preferably with cooling facility.
Don'ts
Expose to direct sunlight or hot breeze.

Move under hot sun without umbrella.

Use of black and synthetic, thick clothes during summer season.

Move under the hot sun without a hat or turban.

Attend to strenuous physical activity under the hot sun.

Allow direct hot air into the living room.

Delay in shifting the person suffering with heat stroke to a cool place.

The person suffering with heat stroke to have thick clothing.

The person suffering with heat stroke to be sponged with hot water and to be
exposed to hot air.

The person suffering with heat stroke to be sponged with hot water and to be
exposed to hot air.
Plant more trees and be safe in
earth