BACKGROUND: Between 2010 and 2015 an average of 3,520 persons visited emergency departments in North Carolina for heat-related illness (HRI) each year. In 2016 North Carolina experienced a 5-day heat wave, one of the hottest summers on record in multiple cities, and a record-breaking number of visits for HRI. By conducting weekly and seasonal heat surveillance reports, North Carolina can better understand the geographic and demographic distribution of HRI and target interventions to address the issue.
METHODS: Emergency department (ED) visit data—including chief complaint, diagnosis codes, triage notes, and demographic information—was accessed through the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). NC DETECT receives ED data from all civilian hospitals in the state. Daily maximum heat indices at Raleigh-Durham International Airport were retrieved from the State Climate Office of North Carolina. The Occupational and Environmental Epidemiology Branch at the Division of Public Health monitors heat-related illness throughout the state weekly during the heat season to assess the burden, distribution, and demographic trends of HRI in the state.
RESULTS: Approximately 4,847 ED visits for HRI were identified in NC DETECT during the 2016 heat season. Daily maximum heat indices ranged from below 70 °F in May to 109.4 °F in July (median = 91 °F). Twenty-eight days had a maximum heat index greater than 100 °F. The number of ED visits for HRI was highest among those 25 to 44 years old (n=1,717). Those persons aged 65 and older were most likely to be hospitalized for their illness (25%). 73% of ED visits were for males. Approximately 14% of all ED visits were seen in hospitals in the Sandhills sub-region. Common references in triage notes were for “working outside” (i.e., construction and landscaping) and for “recreation” (i.e., sports and gardening). Much of North Carolina experienced a heat wave July 24-28, 2016, and the maximum heat indices ranged from 105.5 °F to 109.4 °F. During this time, there were 567 ED visits for HRI, more than double the visits in the previous 5-day period, and 1 confirmed death.
CONCLUSIONS: Weekly surveillance of HRI is vital in North Carolina to understand the public health burden and implement interventions. Data on the geographic and demographic distribution of HRI is currently being used by the Climate and Health program to target specific communities in the Sandhills. Community engagement meetings have begun to help public health officials design adaptations to tailored specific populations.