Summer in NYC: Information for Providers

Potential Health Issues

• Dehydration, heat stroke, heat exhaustion, especially during periods of extreme heat
• Exacerbation of chronic illness from exposure to very hot weather
• Health risks associated with varying heat index levels

Clinical Considerations

• Emergency medicine providers:
  • Maintain a high level of preparedness for heat-related illnesses, particularly exertional and classic heat stroke, by prioritizing rapid recognition and immediate initiation of active cooling.
  • Core temperature measurement (preferably rectal) should be obtained promptly in any individual with suspected hyperthermia and altered mental status. Once identified, cooling should not be delayed for diagnostic testing.
  • Ice-based cooling methods should be the first-line approach, as they provide the fastest and most effective reduction in core temperature. This includes full-body ice water immersion when feasible, or alternatively, aggressive application of ice packs to the groin, axillae, and neck combined with cold, wet sheets and evaporative techniques.
    • Emergency departments should ensure ready access to ice, appropriate immersion equipment or protocols, and staff training to implement these interventions rapidly, with the goal of reducing core temperature to below 39 degrees C (102.2 degrees F) as quickly and safely as possible to minimize morbidity and mortality.
• All healthcare providers, especially when periods of extreme heat are expected:
  • Discuss the signs and symptoms of heat-related illness, including guidance on when to call 911, and the risk of heat exacerbating chronic conditions with individuals and their caregivers.
    • Identify increased risk for heat-related illness.
    • For people who use medications that can impair thermoregulation or cause dehydration, or who have health conditions sensitive to fluid balance, consider adjusting medication regimens and fluid restrictions on hot days.
  • Drug and alcohol use can increase the risk of overheating and dehydration, and/or mask symptoms of overheating.
    • Hot weather also increases adverse reactions to stimulants like cocaine and methamphetamine.
  • Advise people to monitor weather forecast for any extreme weather conditions and sign up for Notify NYC alerts.
  • People with diabetes should check their blood sugar more frequently, as high temperatures can change how the body uses insulin.
  • Encourage people to use air conditioning; guide those without AC to cooling centers or to visit a friend or family with an AC.
  • Immediately report deaths where heat exposure is suspected as a direct or contributing cause to the NYC Office of Chief Medical Examiner at 212-447-2030.

Clinical Considerations

• Inquire about recent travel or country of residence for any person presenting with a febrile illness.
• Remain vigilant for travel-associated infectious diseases, including:
  • Diseases that require immediate isolation (for example, measles)
  • Diseases for which there are current global outbreaks
  • Other common travel-associated diseases, such as enteric diseases (for example, hepatitis A and typhoid fever), sexually transmitted infections, and mosquito-borne diseases (for example, dengue and malaria)
• Be prepared to identify, isolate and inform. Immediately isolate people with suspected measles, MERS, VHF, or active tuberculosis disease in airborne isolation.
  • After isolating, call the NYC Health Department at 866-692-3641 to report the suspect case and receive additional guidance.
• Notify the NYC Health Department about any reportable infectious diseases, clusters, outbreaks, or unusual cases.
  • Suspected and confirmed cases of certain rare or highly infectious diseases, and suspected disease outbreaks, must be reported immediately via the NYC Health Department’s Provider Access Line 866-692-3641; other diseases can be reported within 24 hours electronically.
    • For detailed reporting information, including which diseases require immediate notification and how to access the NYC Health Department’s electronic reporting platform, PRISM, visit Reporting Diseases and Conditions.
  • The NYC Health Department can provide guidance for infectious disease testing at the Public Health Laboratory at the time of reporting.
    • Ensure laboratory staff (including after-hour/weekend staff) and Infection Prevention and Control (IPC) have eOrder accounts for submitting routine and urgent requisition forms for Health Department laboratory testing and accessing results.

Summer brings heightened risk factors, such as heat exposure and disrupted routines, and possibly increased alcohol/substance use. These can worsen sleep, mood, and cognitive functioning, and exacerbate pre-existing mental health conditions.

Potential Health Issues

• Alcohol and substance use: intoxication, overdose, emerging substances, associated violence and domestic violence risk
• Acute stress reactions: anxiety, panic
• Emotional dysregulation: irritability, anger, frustration
• Reduced cognitive functioning: impaired concentration, decision-making, coping capacity
• Cumulative stress: fatigue, sleep deprivation
• Exacerbation of pre-existing mental health conditions

Clinical Considerations

• Alcohol and substance use: Screen; manage intoxication and overdose; ensure safety; refer as needed
  • New Yorkers can get free naloxone kits for overdose response.
• Acute stress reactions: Provide brief psychological support (PFA)
• Emotional dysregulation: Apply de-escalation; assess risk to self and others
• Reduced cognitive functioning: Simplify communication; support decision-making; reinforce coping
• Cumulative stress: Advise rest; monitor for deterioration
• Pre-existing mental health conditions: Review history; ensure medication continuity; refer as needed

Referrals

Refer or escalate to mental health services as needed for any clinical presentations.

• 988 Suicide and Crisis line
• Alcohol and Substance Use: Provider Info and Resources
• Domestic Violence: Resources for Health Care Providers

In addition to threats from summer heat, heavy rains and flash flooding can occur with little warning during summer months, along with impaired air quality, especially in the context of extreme heat or wildfires elsewhere.

Potential Health Issues

• Exacerbation of chronic illness from exposure to very hot weather and impaired air quality
• Injuries and drowning risk from rapidly rising water levels.

Clinical Considerations

• Advise people to monitor weather forecasts for any extreme weather conditions and sign up for Notify NYCM weather alerts.
• For very low air quality (Air Quality Index (AQI) over 150), advise people to keep windows closed, use an air purifier at the highest setting, wear N-95 or KN95 masks if outdoors, and monitor changing air quality conditions.
  • People with heart or respiratory conditions, such as asthma or COPD, as well as those who are immunocompromised, older adults, and people who are pregnant, are more sensitive to poor air quality. Encourage them to take precautions when AQI is unhealthy for sensitive groups (AQI over 100)
  • For AQI above 200, consider rescheduling appointments or using telehealth.
  • Advise people to pay attention to symptoms, reduce physical activity and/or go indoors if they experience watery eyes, scratchy throat, or difficulty breathing.
  • Consider sharing the Outdoor Air Quality Health Recommendations Based on Air Quality Index
  • Very hot weather can be more dangerous than poor air quality. If it is hot outside, people should find a cool indoor space.
• Direct people to resources about flash flooding and coastal storms.
• Immediately report deaths where heat exposure is suspected as a direct or contributing cause to the NYC Office of Chief Medical Examiner at 212-447-2030.
• Discuss the signs and symptoms of heat-related illness, including guidance on when to call 911, and the risk of heat exacerbating chronic conditions with individuals and their caregivers.
  • Identify increased risk for heat-related illness.
  • For people who use medications that can impair thermoregulation or cause dehydration, or who have health conditions sensitive to fluid balance, consider adjusting medication regimens and fluid restrictions on hot days.
• Drug and alcohol use can increase the risk of overheating and dehydration, and/or mask symptoms of overheating.
  • Hot weather also increases adverse reactions to stimulants like cocaine and methamphetamine.
• Advise people to monitor weather forecast for any extreme weather conditions and sign up for Notify NYC alerts.
• People with diabetes should check their blood sugar more frequently, as high temperatures can change how the body uses insulin.
• Encourage people to use air conditioning; guide those without AC to cool spaces or public air-conditioned spaces (such as libraries or malls) or to visit a friend or family with an AC.