In the heart of Central Georgia, where Community Ambulance serves a six-county region with 250 EMS crew members, high temperatures in the summer routinely surpass 100ºF and are intensified by oppressive humidity.
“There are days you open the door and it just takes your breath away,” says Lane Kilpatrick, quality improvement manager for Community Ambulance. As a native Georgian and 23-year veteran of the emergency medical services, Kilpatrick is no stranger to long roadside accident scenes, moving patients from sweltering residences, and standby medical coverage for summertime community events. But part of his job title involves risk management and inspections of vehicles and stations—and part of that responsibility means measures to protect against the extreme temperatures in his service area.
Hazards of EMS Work
Environmental concerns are one of the most important issues facing EMS crews working in the field, says Michael Gonzalez, MD, associate medical director for the Houston Fire Department’s EMS Division, one of the busiest services in the country operating in one of the hottest climates. "It's a huge challenge," says Gonzalez. "We make a special point to continually assess our crews working active incidents and limit long-term heat exposure as much as possible. Crew education is our utmost concern."
Like other outdoor professions such as landscapers and road workers, EMS providers face the hazards of extreme heat in the summer months. And the unique nature of the profession brings complicating factors.
Physical exertion—CPR, vehicle extrications, stair chair maneuvers, and other physically taxing procedures exacerbate the dangers of hot environments. The public often does not recognize the very physical nature of EMS work, Kilpatrick says.
Job setting—Serving a community of low-income families often means homes don’t have air conditioning, Kilpatrick points out. Going from an air-cooled ambulance into an overheated home or workplace, then back again, can often be harder on the body than staying in one constant temperature.
PPE—Adding layers and face protection (which has become standard practice during the COVID-19 outbreak) can raise body temperature even higher, leading to sweating and fogged glasses.
"Wreck scenes on asphalt create 'heat sinks' that can quickly raise your body temperature to dangerous levels," says Dennis Rowe, director of government and industry relations at Priority Ambulance.
Measures to Keep Providers Safe
Effective heat management begins with the basics: Limit long-term exposure, properly hydrate, and stay vigilant for the effects of heat among personnel. Company-provided coolers stocked with drinks and cold compresses are common in EMS vehicles in warm regions and are dispatched to potentially hazardous calls (for both patients and providers).
Priority Ambulance’s Arizona fleet includes mounted solar panels mounted to the light bar that cool the ambulance’s refrigerators and temperature-controlled drug boxes, says Alan Smith, West Region president for Priority Ambulance.
Community Ambulance provides full uniform changes for crew members who become drenched in sweat during particularly demanding or lengthy events. Lightweight moisture-wicking base layers are part of the standard uniform for services that work in high-heat climates.
In addition to its 56 ambulances, 36 medic units, command vehicles, triage trailers, and watercraft, Houston Fire EMS employs “rehab trucks” specifically designed to cool and rehydrate EMS workers (who are cross-trained as firefighters) on challenging, lengthy, or physical call scenes, Gonzalez says. For complicated incidents in the summer, it's often the first vehicle out of the station.
Operations managers may want to consider modifying their posting plans in cases of extreme heat, and stationing ambulances and crews at the station as opposed to staging during heat emergencies, Smith says. Since cooled air escapes quickly from an open patient compartment, crews should be mindful of leaving the rear doors closed as much as feasible.
But perhaps the most important measure is consistent messaging to crew members of the dangers of extreme heat environments. “Complacency is a killer,” says Kilpatrick, adding that while most providers are familiar with and acclimated to the Georgia heat and humidity, it’s never a bad strategy to remind employees of the hazards. Daily managerial meetings will inform supervisors of heat advisories, then that information is disseminated to individual teams. A company-wide instant-messaging system keeps staff aware of environmental concerns such as storms and extreme temperatures.
“These guys want to work,” says Kilpatrick. “Keeping each other safe is just as important as saving the patient. We tell our [employees], you have to keep your head on a swivel.”
“When we push our bodies to the extremes on a prolonged basis, there will be damaging effects,” says Rowe. “EMS is already a scarce healthcare force. And to be honest we're not always in the best of health. We should be protecting our providers’ well-being as much as we possibly can. If you take care of your people, they’ll take care of you.”
Sidebar: Heat-Related Vehicle Concerns
Extreme temperatures can be just as hard on EMS vehicles as they are on providers’ bodies. Alan Smith, West Region president for Priority Ambulance, offers these helpful tips for maintaining and operating your vehicle fleet during the hot summer months.
Preventive maintenance—Make cooling system checks a part of your mechanics’ preventive maintenance plan. Flush the radiator every 60,000 miles and blow dust out of the blades of the radiator.
Check the air conditioning system in all interior areas—Whether a box-style truck or transit van, cold air can warm as it travels back through the vehicle. You may have to install insulation around the duct system to maintain cool air as it travels.
Monitor your engine fluid levels—Don’t exacerbate engine friction with a low oil state. Even being one quart low can damage an ambulance engine. Crews should routinely monitor oil levels.
Jonathan Bassett, MA, NREMT, is editorial director of EMS World. Reach him at firstname.lastname@example.org.