Summer Events: 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.

Potential Health Issues

• Higher risk of communicable disease spread and outbreaks
• Travel-associated infections and introduction of non-endemic diseases
• Foodborne illness from unregulated food vendors

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.

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 impaired air quality, 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 wildfire smoke.
  • 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.

Potential Issues

International attendees may present unique clinical challenges, including unfamiliarity with the U.S. healthcare system, insurance limitations, and payment barriers. Providers should also be prepared for cultural sensitivities and translation needs, as well as difficulties with follow-up contact, case investigations, and contact tracing. Additionally, unknown vaccination histories among travelers may increase the risk of communicable disease transmission.

Potential Issues

• Increased ED, inpatient, and outpatient volume
• Potential impacts to emergency services due to transit disruptions
• Increased likelihood of injuries, burns, and crowd surges from pyrotechnics, incendiary devices, or fireworks
• Mass casualty incidents
• Infectious disease exposures in healthcare settings requiring investigations and management, such as measles
• Limited community isolation and quarantine capacity for visitors

Clinical Considerations

• Review surge staffing needs and review relevant plans for trauma surge, expanding airborne isolation capacity and other relevant threats

Potential Issues

• Increased security presence by local and federal law enforcement and the military increases risk for confrontations
• Physical and mental health injuries associated with protests and counterprotests, and targeted attacks

Clinical Considerations

• Be prepared for an increase in traumatic injuries, including blunt trauma, lacerations, and fractures associated with crowd surges or confrontations.
• Individuals presenting with eye pain, skin irritation, or respiratory distress may have been exposed to crowd-control agents such as tear gas or pepper spray). Treatment includes copious irrigation and removal from exposure.
• Individuals with respiratory conditions such as asthma or COPD may experience exacerbation following chemical irritant exposure and should be assessed promptly.
• Screen for psychological distress and acute stress reactions following exposure to civil unrest.
• Providers should anticipate potential surges in emergency department volume during and after mass gatherings or protest activity and activate surge protocols as needed.
• Ensure staff is up to date with lockdown plans, security plans, and emergency staff communication protocols.

Potential Issues

• Legionnaires' Disease
• Terrorism, such as chemical, radiation, or biological attacks
• Cybersecurity attacks
• Power outages
• Human trafficking
• Multiple or overlapping public health emergencies happening at once

Clinical Considerations

• For suspected chemical, biological, radiological, or nuclear (CBRN) exposures, immediately isolate the affected individual and follow established decontamination protocols before providing clinical care.
• Contact the NYC Health Department at 866-692-3641 and NYC Poison Control at 212-764-7667 for guidance on specific agents and antidotes.
  • Providers should be alert to clusters of people presenting with unexplained febrile illness, neurological symptoms, or unusual rashes, which may signal a biological event; report immediately to the NYC Health Department.
• Screen for signs of human trafficking, including unexplained injuries, signs of malnourishment, and evidence of psychological control. Providers are mandated reporters and should follow established protocols.
  • NYC Children: Trafficking Resources for Professionals
  • NYC 311: Human Trafficking
• During power outages, identify individuals dependent on electrically powered medical equipment, such as home oxygen or dialysis, and facilitate timely access to appropriate care settings or backup resources.
• Ensure staff are up to date with downtime protocols.

• NYC Provider Access Line (866-692-3641) for certain rare or highly infectious diseases and conditions, suspected outbreaks and emerging public health threats
• NYC Poison Control or 212-POISONS (212-764-7667) for exposure to poisonous substance
• Provider Reporting Interface and Secure Messenger (PRISM) for reporting infectious diseases, poisonings, drownings, and other diseases/events
• Citywide Immunization Registry (CIR) for reporting immunizations
• Electronic Vital Events Registration System (eVITAL) for deaths, births, and life events
• For non-emergent questions or comments regarding the World Cup: FIFA World Cup Comment Form
• Reporting and Services

• For non-emergencies: HealthMedical@oem.nyc.gov
• For emergencies: Call 718-422-8700

• General information: Call 833-364-4695
• Public Health Duty Officer helpline: Call 866-881-2809
• Communicable Disease Reporting
• Contact the NYS Department of Health
• NYS Association of County Health Officials: Contact Your County Health Office

• Phone: 800-367-6543
• After hours contact: Call 609-392-2020
• Communicable Disease Reporting
• Contact the NJ Department of Health
• Find Your Local NJ Health Department

Information observed in historical surveillance data from major international tournaments that may be relevant to the 2026 World Cup:

• Heat-related illness
  • Heat-related illnesses have been a consistent public health concern throughout many international sporting tournaments around the world.
  • NYC has also seen increasing summer temperatures in the past several years. While the NYC Health Department cannot predict this summer’s weather patterns, based on past international tournaments, heat-related illnesses are expected to occur among World Cup spectators, visitors, and team members.
• Measles
  • Flagged at 2002 Korea Japan, 2018 Russia (28 of 32 nations had active outbreaks), and the 2025 Club World Cups
  • NYC will draw international visitors from countries with known outbreaks and MMR gaps
• GI illness
  • 2025 Club World Cup had multiple player hospitalizations for acute gastroenteritis, likely compounded by heat-related immune suppression
  • 2006 Germany World Cup had contained norovirus outbreak of 61 cases
• Travel exposures
  • Three-host format (Mexico, Canada, USA) means travelers carry different exposure profiles across all three epidemiological environments
• Novel pathogens
  • SARS relocated the 2003 Women's World Cup. Zika shadowed the 2016 Rio Olympics. Qatar was on alert for MERS in 2022 and mpox circulated globally that year.

NYC Health+Hospitals / Bellevue, the Region 2 Emerging Special Pathogen Treatment Center, has hosted a series of trainings related to FIFA World Cup Preparedness, featuring experts on topic areas ranging from mass casualty preparedness to bioterrorism.

• Intro to FIFA World Cup and America 250 Events
• FIFA Topic – Mass Casualty: Overview and Medical Surge/Load Balancing
• Mass Casualty: Vehicular Attack and Active Shooter
• Heat Emergency and Air Quality
• Hantavirus
• Bioterrorism
• Travel-Associated Infections and Vaccine-Preventable Diseases