Dr. Anupam Kharbanda on the increase in heat related illnesses due to climate change.

CINDY WURZER: But going back to the weather, because it is our top story, it is a hot day all across Minnesota. Temperatures are reaching nearly 100 degrees in some parts of the state. It's going to be a hot day tomorrow too. As climate change continues to worsen, many hospitals are seeing an increase in patients struggling with heat-related illnesses.

And a recent report by the Washington Post finds that some institutions are reaching their breaking point. Here to talk more about the increase in heat-related illnesses because of climate change and the impact the increase in patients can have on hospitals is Dr. Anupam Kharbanda, Chief of Critical Care Services at Children's Minnesota. Dr. Kharbanda, welcome to the program. It's a pleasure. Thank you.

ANUPAM KHARBANDA: Thank you. I appreciate being here.

CINDY WURZER: Given a day like today, how common might it be for patients to come into the hospital with heat-related illnesses?

ANUPAM KHARBANDA: On days like today when it starts to get warmer and the heat index is above 90, we expect that there's going to be an increase in patients to our emergency departments. And this is going to be especially among those families who have limited access to air conditioning, as well as the very young-- the types of patients we serve in our pediatric emergency departments at Children's.

CINDY WURZER: Have you been noticing over the past several years an increase, a tick up in patients coming in with heat-related illnesses?

ANUPAM KHARBANDA: You know, I think that we tend to see an uptick in patients with heat-related illnesses, muscle cramps, or heat exhaustion in the summer months. And there has been a trend towards warmer, more steamy summers over the past number of years. And so each year in the United States, about 700 people die from heat-related illnesses and about a third to 40% of those are in kids, especially children under the age of four. So certainly, we are seeing more of the milder cases, especially as the temperatures have warmed in our summers and we've had more of those extreme days.

CINDY WURZER: Dr. Kharbanda, what are some symptoms that a patient might experience with heat-related illnesses?

ANUPAM KHARBANDA: Well, we break up heat-related illness into three primary groups. There's heat cramps-- and these are patients who are exercising outdoors-- our soccer players, our tennis player, our baseball players who get some muscle cramps. Usually, their temperature are normal but they'll get a cramp during heavy exercise.

These types of patients usually will do fine if they begin to get out of the heat and they hydrate themselves up nicely with some water, of course, or Gatorade, or other type of electrolyte-based solutions. The next level we will see is something called heat exhaustion. Heat exhaustion, the symptoms are nausea, vomiting, headache. You'll have a thirst, as well as weakness.

And if you were to feel their pulse, it would be elevated. So these are the patients or the athletes who are outdoors for a prolonged period of time. They're also going to be the elderly, those over age 65 with any chronic illnesses. And if they have these types of illnesses, they really need to get out of the heat, really begin to hydrate themselves. And if the symptoms don't improve, seek emergency care.

And then the final group that we look at is something called heat stroke. And those patients have neurologic symptoms-- dizziness, they are confused, they'll have delirium. And in a worst case scenario, they can have a seizure. And their temperature is clearly elevated.

And these are patients who now have lost the ability to cool themselves through sweating or other mechanisms. And they absolutely will need emergency care.

CINDY WURZER: I'm curious about the treatment protocol for patients when they come in. Obviously, it depends on what stage they're at. But generally speaking, what do you start first?

ANUPAM KHARBANDA: So we always start in emergency medicine with our ABCs, which is your airway, your breathing, and your circulation. We do a good set of vital signs. And we begin with passive cooling. So we'll put ice packs in their armpits, in their groin.

If their temperature is elevated, we'll place an IV and rehydrate them with cool fluid that begins to help them in cooling down their internal organs. We'll check laboratory studies. And essentially, we're checking the laboratory studies to see if there's any organ dysfunction.

As your core body temperature rises, you can begin to see problems in your ability to clot. And that's what we're checking for with the blood work. As we begin to get laboratory work back, or if we see they're having worsening symptoms, we begin something called active cooling. Active cooling is a process by which we will put down a tube through their throat or through their nasogastric system to begin to actively cool their bladder and their internal organs to drop their temperature quickly.

I would say that's a more rare occurrence. Most of the time if you come to an emergency department, you'll get assessed, we'll begin with some oral rehydration solution-- some water, Gatorade, a popsicle. We'll get some labs. If you're assessed to be worse, an IV will be placed, of course. And then we'll put those ice packs on you.

CINDY WURZER: With climate change continuing to worsen, what do you see coming your way or with other ERs in the future? Any way to look into the crystal ball and find out, will this have an impact on hospital emergency rooms and medical staff?

ANUPAM KHARBANDA: I say it will. And the reason for that is that the people who are most vulnerable for hypothermia or heat-related illnesses are the poor, those with limited access to air conditioning, the very young, as well as those with chronic illnesses-- those under the age of four with any type of muscle disorder or a genetic abnormality, as well as the elderly if they have obesity.

And those populations we know are increasing in our country. And as climate change occurs and our temperatures rise, those groups of patients will have less ability to control their temperature. So if you're in a lower socioeconomic status, and you don't have air conditioning, and you need to be outside because of your work, this is going to put that population at further risk.

CINDY WURZER: Before you go, and to help your staff not be as busy, perhaps, the next couple of days, what do you recommend?

ANUPAM KHARBANDA: I think the first place I recommend is if you are in days like this for the next week, try to refrain from being outdoors if at all possible. Once the heat index is above 90, it really can be quite dangerous to be outdoors for any prolonged period of time. And we're approaching 100, I think, as the weather report was given earlier in the broadcast.

If you're going to be outdoors, try to limit the amount of time. But frequent hydration-- make sure you have a lot of water with you, some Gatorade, or other electrolyte-based solution to maintain your hydration.

Remember some key things-- never keep kids in cars unattended for any period of time. The temperatures rise very quickly-- much more quickly than you ever can anticipate. And I think if you can try to stay indoors, limit your outdoor activities, the frequent hydration will prevent the majority of these cases.

Now, for those people who do get into trouble, get inside, drink some fluids, call your nurse triage line. You are welcome to call the emergency department at the children's hospitals or our nurse triage lines, and we can guide you through looking at some symptoms and then triage from there if we need to see you. The key piece I would say is for those who need to come in is if you're unable to keep something down, you're feeling weak, or if you have any neurologic symptoms at all-- meaning the dizziness, you feel confused, your family member says they're not acting right-- those are the people we want you to bring into the emergency department right away.

CINDY WURZER: All right. Interesting conversation, doctor. Thank you for your time.

ANUPAM KHARBANDA: Well, I appreciate it. And I hope this was helpful.

CINDY WURZER: It was. Dr. Anupam Kharbanda is Chief of Critical Care Services at Children's Minnesota. He mentioned kids in cars-- as a matter of fact, just got this little bit of information from NHTSA, the National Highway Transportation Safety Administration-- it just takes 10 minutes in a closed car for the temperature to get to 114 degrees on a day like this-- 20 minutes, 124 degrees. So young kids and your pets, do not leave them, of course, in enclosed cars.