Noting The terrible heat wave that struck Chicago in July 1995 lasted only about five days, but it permanently altered thousands of lives. The heat wave killed 733 Chicagoans, especially the very old, the feeble and the very young. Thousands more visited emergency rooms with heat-related symptoms.
Three years later, some Chicago-based medical researchers have drawn a correlation between those heat-related illnesses and the deaths that followed. They argue that if ERs had recognized what was happening when the first signs of heat-related illness appeared, the public health apparatus could have mobilized, notified citizens and possibly prevented many deaths.
The unpublished study was written by Robert Rydman, a researcher at the department of emergency medicine at Cook County Hospital in Chicago, and three doctors at Chicago's Resurrection Medical Center: Dino Rumoro, D.O.; Julio Silva, M.D.; and Teresita Hogan, M.D. All three practice emergency medicine. The study was presented in May at the Society for Academic Emergency Medicine conference in Chicago.
The authors envision the emergency department as the first sentinel of an unexpected public health disaster. When certain patterns become recognizable, ERs should spread the alarm.
When the heat wave began and it became clear the death rate was skyrocketing, many people blamed the Cook County public health authorities for allowing so many to succumb without warning. Toward the end of the event, people came to understand it was a natural disaster, every bit as unpredictably lethal as a tornado, a hurricane, an earthquake or a flash flood.
That doesn't mean, however, that public health officials are excused from planning how to deal with such disasters and mitigate their effects.
Rydman and his co-authors noticed that plenty has been written about the patterns of mortality in the heat wave, yet patterns of morbidity have been ignored.
They reviewed emergency department charts for the days leading up to the spike in deaths and detected a statistically significant increase in heat-related complaints recorded by ERs, compared with the control period of July 1994. But nobody knew it.
It took the research team 30 months to compile and analyze the data that predicted the environmental disaster. The researchers suggest that in an era of high-speed computers and networking capability, the same project could be accomplished automatically in real time.
They recommend that health authorities seek funding to create a database to report hospital emergency department mortality and morbidity in real time. This network could be linked to the National Weather Service to refine the criteria for heat watches, alerts and warnings.
Although this study confined its purview to heat illnesses, the same concept can work in different settings and for other illnesses. Los Angeles' Olive View-UCLA Medical Center, for instance, is the nerve center for a national network of 11 academic medical center ERs.
In a demonstration project funded by the national Centers for Disease Control and Prevention, healthcare workers on-site at the 11 ERs enter data within 24 hours regarding three categories of emergency symptoms: dog and cat bites, bloody diarrhea and new onset of brain seizures due to a worm larva. The computer at Olive View automatically sweeps the databases at the remote sites and compiles the information. This project is designed to demonstrate that an automated data system can act as an early-warning system for specific infectious or noninfectious diseases.
Jon Jui, M.D., an ER physician at Oregon Health Sciences University in Portland, says the American College of Emergency Physicians has known for some time that surveillance and linkages among emergency departments are the keys to identifying new diseases and new manifestations of old ones. For example, the worldwide sentinel network set up by the World Health Organization sounded the alarm last year over a new strain of Hong Kong flu that could have resulted in a pandemic similar to that of 1917.
Jui's ER has just received funding approval to set up electronic links to the state health division, which tracks infectious disease. They've installed an EmStat information system to track patients on a real-time basis and upload that data "automatically, without human intervention" into the state health division's computer.
Such a system could "absolutely" work in a place like Chicago, Jui says. "Suppose we had an entry on heat-related illnesses. The primary diagnoses would be heat stroke, heat exhaustion and heat cramps. We would send whatever data that met these parameters to the state," which would notice the pattern and issue a public health alert, he says.
Such ambitions are worth pursuing, says Dennis O'Leary, M.D., president of the Joint Commission on Accreditation of Healthcare Organizations. But, he adds, they are hard to carry off.
"There are some technical but substantive issues," O'Leary says. "Unless every emergency unit defines heat stroke or influenza the same way, your data won't be any good."