“Hey Doc, got a code stroke rolling in. ETA 5 minutes, sounds like the real deal.” You hang up the phone and walk toward the front of the emergency department to meet your next patient.
On the way there, you hear an elderly woman calling out from her room, “Hello! Can you help me?” You know you have only a minute or two, but you pop your head into the room, knowing it’s Ms. Jones.
She’s a delightful 96-year-old woman with walker-capable mobility, carefully manicured hair, who developed sturdy self-reliance after most of her family and lifelong friends had died of old age. You know it is Ms. Jones, of course, because she’s spent the last 4 days in that room, unable to go home due to an air-conditioning failure that has left her house uninhabitable in the 105° Texas heat. She needs another drink of water, but medically, she is fine.
Of course, it would be great for Ms. Jones to be at home, but she’s not fond of heat stroke and doesn’t have the $8000 she was quoted for a new HVAC unit. She doesn’t have friends or family to provide an alternate disposition, because, like her savings, she outlived them. And she can’t be in the hospital, because medically speaking, there’s nothing wrong with her, other than a need to avoid heat-related illness—something potentially deadly that she would certainly encounter if she were home.
Those who work in emergency departments and safety-net hospitals often have insight that such “isolated” cases are not truly so and are often indicators of larger public health crises, not yet publicized enough to be part of the public discourse.
McClaugherty et al highlight this, noting a significant increase in heat-related illness presentations to Texas emergency departments between 2015-16 and 2022-23.1 Also explored is the markedly elevated burden of heat-related illness among Hispanics, Latinos, and the elderly, while prior studies have illustrated a similar susceptibility among those who are socioeconomically disadvantaged.1,2 Notably, McClaugherty’s data highlight an increased incidence in urban areas, which may be a product of the urban heat island effect.
Safety-net hospitals and emergency departments are ground zero for these types of public health issues. In light of current healthcare system capacity constraints in the United States, it is important that we acknowledge the public health need highlighted in this study and work as institutions to develop effective tools for education, prevention, and response to this growing need.
You pause for a moment with this thought outside Ms. Jones’ room (formerly known as room 14) and say to yourself, “I’ll get to that. After I grab this water and see that stroke!”
—Robert T. Dahlquist, MD
Department of Emergency Medicine, Baylor University Medical Center, Dallas, Texas, USA
Robert.Dahlquist@BSWHealth.org
http://orcid.org/0000-0002-9595-9307
DISCLOSURE STATEMENT
The authors report no funding or conflict of interest.
References
- 1.McClaugherty C, Buckley CJ, Arroliga A, Heath S, Juergens A.. Incidence of heat-related illness in a Texas emergency department network: a retrospective analysis. Proc (Bayl Univ Med Cent). 2026;39(6):1086–1090. doi: 10.1080/08998280.2026.2718660. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Clark A, Grineski S, Curtis DS, Cheung ESL.. Identifying groups at-risk to extreme heat: intersections of age, race/ethnicity, and socioeconomic status. Environ Int. 2024;191:108988. doi: 10.1016/j.envint.2024.108988. [DOI] [PMC free article] [PubMed] [Google Scholar]