Facing Killer Heat, ERs Use Body Bags to Save Lives

By JoNel Aleccia, Kaiser Health News

Thursday, July 22, 2021 (Kaiser News) – As a deadly heat wave scorched the Pacific Northwest last month, overwhelming hospital emergency rooms in a region unaccustomed to triple-digit temperatures, doctors used a sinister but practical tool to save lives: human body bags filled with ice and water.

Officials from hospitals in Seattle and Renton, Wash., Said as more people come in with life-threatening heatstroke, and with cooling catheters and even of insufficient ice packs, they used the new treatment to quickly submerge and cool several elderly people.

Slipping heat stroke patients into ice-filled body bags has worked so well that it could become a go-to treatment in a world increasingly altered by climate change, said Dr Alex St. John , emergency physician at Harborview Medical Center at UW Medicine.

“I have a feeling that we are looking at many extremely hot days in the future, and it is likely to become more frequent,” he said.

Despite the macabre connotation of body bags, their use is a cheap, convenient and scalable way to treat emergency room patients with high casualties from excessive heat, said Dr. Grant Lipman, professor of emergency medicine at Stanford University. He is the co-author of a pioneering case study documenting the use for heat stroke of what doctors call “pockets of human remains”.

“When people are so sick, you have to cool them down quickly,” Lipman said.

Heat stroke is the most dangerous type of heat illness, a medical emergency that results in death in up to a third of hospital patients. It occurs when the body overheats, either from high temperature exertion or from prolonged exposure to heat without relief. The body’s core temperature rises to 104 degrees Fahrenheit or higher, which can damage the brain and other organs.

Heat stroke can be especially dangerous for children and the elderly, whose bodies do not regulate temperature well. In addition, older people can take medicines that affect their ability to tolerate high temperatures.

Patients would typically be treated with strategically placed ice packs or misted up with water and placed in front of huge ventilators. Some emergency room staff immerse patients in large tubs of water or insert cooling catheters into large veins in the body.

In an emergency, however, equipment, ice, and time can be scarce.

St. John treated nearly two dozen heat stroke patients on June 28, the hottest part of a six-day heat wave, when temperatures in Seattle hit a record 108 degrees. It was more than what he had seen at any time in his decade as a doctor, including working in Arizona desert hospitals, he said.

Likewise, the University of Washington Valley Medical Center in Renton has seen more than 70 patients with heat-related illnesses, including three who were treated with body bags, said the departmental director of emergencies, Dr. Cameron Buck.

“The large number that came in very quickly taxed the system,” Buck said.

Overall, nearly 2,800 emergency room visits for heat-related illnesses were recorded from June 25 to 30 in a region that includes Oregon, Washington, Idaho and Alaska, including more than 1 000 on June 28 alone, according to the Centers for Disease Control and Prevention. At least 112 deaths in Washington and 115 deaths in Oregon have been linked to the heat wave, state officials said.

Among the sickest patients St. John saw was a woman in her sixties who arrived at the Harborview Emergency Department on June 28 confused and weak, with a core body temperature of 104 degrees. A family member had discovered her ill at home. St. John said a colleague had mentioned the body bag technique a few days earlier, so he gave it a try.

Treatment involves filling a body bag with a water and ice suspension, putting the patient inside, and closing the bag up to the armpits to allow access to medical equipment and close monitoring. The self-contained bag keeps ice and water close to the patient’s skin.

Within minutes of being placed in the bag, the woman’s temperature dropped to 100.4 degrees, just enough to “get her out of this danger zone,” St. John said. She was removed from the bag, dried and placed on a stretcher, allowing her body’s natural cooling abilities to take over. After being admitted to the hospital, she made a full recovery, he said.

As the effects of climate change result in higher temperatures in more places – including historically temperate areas where air conditioning is not widely used – the use of body bags to quickly treat heat-related illnesses is a logical solution, said Lipman, who heads the Stanford Wild Medicine Fellowship. and operates Global Outdoor Emergency Support, or GOES, which provides medical advice to outdoor travelers.

“Every hospital has body bags. Every hospital has ice machines, ”Lipman said.

He and his colleagues described the treatment of an 87-year-old woman with cancer who was found unconscious in a parking lot during a heat wave in the San Francisco Bay Area, another area unaccustomed to temperatures high sustained. It was July 2019, which was then designated as the hottest month on Earth on record. Using the body bags filled with ice and water, medics cooled her temperature from 104 degrees to 101.1 in 10 minutes. She too has made a full recovery.

Immersing patients in cold water has long been the gold standard for treating athletes with exertional heat stroke, Lipman said. This is the most efficient method because water dissipates heat from the body about 25 times faster than air.

So far, body bag treatment has been studied primarily in younger, healthier people, and some doctors are concerned about the effects of cold water on older people and whether the technique can cause chills which actually raise body temperature. Lipman agrees that more study is needed, but said his experience has found that “the benefits of cooling will outweigh the damage from chills.”

And what about patients who might shudder at the thought of being zipped into a body bag?

Because they’re usually so sick when they arrive and are treated so quickly, they’re “unlikely to know,” Lipman said, adding, “But you should ask them.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and surveys, KHN is one of the three main operational programs of the KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides information on health issues to the nation.

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