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State Health, Emergency Officials Urge Californians to Prepare for Excessive Heat

SACRAMENTO – In response to forecasts for excessive heat through Monday throughout much of California, state emergency and public health officials are urging Californians to drink plenty of water, wear lightweight, loose-fitting clothing and take other actions that will reduce their risk of death or heat-related illness.

This warming trend has prompted the issue of Excessive Heat Warnings by the National Weather Service (NWS) through Monday for parts of Imperial, Kern, Los Angeles, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara and Ventura counties and Special Weather Statements for most of the Sacramento and San Joaquin Valley and foothills, as well as the east Bay Area.

“Prolonged exposure to excessive temperatures can be extremely dangerous, if not deadly, particularly for infants, small children seniors and those with health problems,” said Dr. Ron Chapman, director of the California Department of Public Health.  “Last year was the hottest year on record in the United States.  Heat waves in California are projected to occur earlier in the season, be more intense and last longer.”

He noted that at on average heat-related emergencies cause 56 deaths in Californians each year and prompt 3,800 people to seek treatment at hospital emergency rooms for heat-related symptoms, with approximately 500 cases per year requiring hospitalization.   At least 136 Californians died due to illnesses prompted by the 13-day heat wave that struck the state in July 2006.

“Cal EMA and its partner agencies have been preparing for excessive heat in many areas of the state this summer and fall by reviewing internal procedures, updating cooling center data bases, identifying state fairgrounds and facilities that serve as cooling centers and taking other actions to help cities and counties throughout the state ensure the safety of their residents, but it’s important that every Californian who is able do the simple, but important things that can make the difference between life and death,” said California Emergency Management Agency (Cal EMA Secretary Mark Ghilarducci.

Key actions residents and visitors of California can take to reduce their risk of heat-related death and injury include:

  • Monitoring local media for the latest weather forecasts and information from local officials
  • Learning the signs of heat-related illness
  • Staying out of the sun
  • Drink plenty of liquids and reducing physical activity
  • Using air conditioning and fans or getting to a location that is air conditioned such as the mall, the theater or a designated cooling center
  • Using cool compresses, misting and baths to lower body temperatures
  • Wearing lightweight, loose fitting clothing.
  • Taking shelter and breaks periodically, as well as staying hydrated, if you must work outside.

The recommendations from state emergency and health officials come as state agencies implement the “Heat Alert” phase of the state’s Contingency Plan for Excessive Heat Emergencies. 

Actions taken by Cal EMA and other state agencies as part of the implementation of “Heat Alert” phase activities include:

  • Coordination calls among Cal EMA, key state agencies and the potentially affected operational areas and regions with weather and power updates.
  • Coordination by Cal EMA with the California Independent System Operator and the California Utilities Emergency Association for power updates.
  • Dissemination of information related to the warming trend to key partners
  • Coordination by Cal EMA of information requirements and needs with the Access and Functional Needs Community, the Department of Developmental Services, the Department of Aging and Department of Rehabilitation
  • Dissemination of safety tips and resource information to the public via the Heat Portal of the Cal EMA website
  • Coordination with state and regional public information officers by Cal EMA and outreach by Cal EMA to media partners
  • Coordination by CDPH regarding the excessive heat event with local public health and other officials.

Additional information on preparing for heat-related emergencies is available at:

Unwanted Medical Treatment: A Painful Nightmare We Cannot Afford

By Mickey MacIntyre and Sean Crowley

Imagine your 90-year-old mother has Alzheimer’s disease and is near death. But before she became mentally incompetent, she gave you power of attorney to sign a Do Not Resuscitate (DNR) order so medical personnel would honor her wishes to die peacefully, without aggressive medical interventions in her final days.

Then your worst nightmare unfolds: your mother goes into cardiac arrest, and is subjected to the very treatment she had been determined to avoid: aggressive, traumatic Cardio Pulmonary Resuscitation, and other extreme measures, including having a hole cut in her throat, being injected with paralyzing drugs, having tubes forced down her throat and into her stomach, and having air forced into her lungs.

Two days after this aggressive, traumatic resuscitation, you are in the indescribably horrifying situation of having to direct that your mother’s ventilator be removed so she can finally die and her suffering end. But she lingers on in a slow decline for another five days while you maintain a heartbreaking, bedside vigil each day and night until she finally passes away. Then to add insult to injury, the hospital hands you a bill for this unwanted medical treatment totaling thousands of dollars.

Sound preposterous? Unfortunately, it’s not. It is Sharon Hallada’s real life, front page news nightmare.  It prompted the leading national organization dedicated to ensuring that medical professionals honor patients’ end-of-life choices, Compassion & Choices, to help Sharon file a lawsuit against a hospital and a nursing home in Lakeland, Florida, for failing to honor her mother’s wishes, despite the fact that they had been clearly and legally specified in the DNR. Sharon sued on behalf of her deceased mother, Marjorie Mangiaruca, to ensure no else’s parent has to endure this kind of traumatic experience.

In fact, medical professionals override or ignore many patients’ decisions in the weeks and months before their deaths. It happens for a variety of reasons and can lead to invasive and fruitless testing, needless suffering, unrelenting pain and a prolonging of the period before death. Patients are tethered to monitors and machines despite their determination to reject treatment and desire to die at home in the embrace of loved ones.

A recent study published in Journal of the American Medical Association found that between 2000 and 2009 treatment in intensive care units in the last month of life increased from 24 percent to 29 percent. The accompanying editorial concluded, “The focus appears to be on providing curative care in the acute hospital regardless of likelihood of benefit or preferences of patients. If programs aimed at reducing unnecessary care are to be successful, patients’ goals of care must be elicited and treatment options such as palliative and hospice care offered earlier in the process than is the current norm.”

To stop this disturbing trend, policy makers can and should provide both the carrot and the stick to ensure that patients’ wishes are honored: financial incentives for honoring advance directives and financial disincentives for disregarding patients’ expressed wishes.

The Centers for Medicare and Medicaid Services (CMS) should deny payment to providers when there is clear evidence that patients were subjected to  treatments they didn’t want — just as current policies deny payment when patients receive unnecessary treatment.

The Justice Department is investigating hospitals and doctors’ groups for unnecessary treatment and taking legal action against the perpetrators when they find evidence of such treatment. The same diligence should be trained on unwanted medical treatment. It is always unnecessary and should never be considered acceptable.

Compassion & Choices recently recommended CMS initiate several steps to improve the quality of conversations among health care professionals, patients and families about end-of-life decisions, including:

1.      Reimbursing medical providers for participation in advanced care planning with patients and their families well in advance of illness or before facing end of life;

2.      Providing financial incentives and training to encourage medical providers to offer all the information and counseling necessary for a patient’s decision making when they secure informed consent;

3.      Ensuring that the full range of medical care and treatment decisions, including curative care, palliative care and medical assistance in dying, are freely available to patients without institutional or reimbursement barriers.

The explosion of the aging population coupled with the nation’s financial and moral commitment to providing health care to an ever-increasing number of Americans reveals that the scourge of unwanted medical treatment must be an urgent priority for our nation.

Mickey MacIntyre is the Chief Program Officer for the nation’s leading end-of-life choice advocacy group, Compassion & Choices. He recently testified before the Institute of Medicine’s Committee on Transforming End-of-Life Care.

Sean Crowley is Media Relations Manager for Compassion & Choices and a former press secretary for U.S. Rep. Sander Levin, the ranking member of the House Appropriations Committee, which has jurisdiction over federal health care programs.

San Bernardino County Extreme Heat Alert Issued

Residents are advised to stay cool, stay hydrated, and stay informed

 

San Bernardino: County Health Officer, Maxwell Ohikhuare, M.D. has issued an extreme heat alert for San Bernardino County, due to high temperature forecasts for the inland and desert regions. Residents are urged to take precautions that will prevent heat-related illness.

Extremely high or unusually hot temperatures can affect your health. Most vulnerable are the elderly, those who work or exercise outdoors, infants and children, the homeless or poor, and people with a chronic medical condition.

 

Take the necessary precautions to prevent serious health effects such as heat exhaustion or heat stroke.

 

Stay cool

  • Stay in air-conditioned buildings.
  • Find an air-conditioned Cooling Center open to the public by dialing the United Way’s toll-free resource telephone line at 2-1-1, or online at www.coolingsb.org.
  • Do not rely on a fan as your primary cooling device.
  • Limit outdoor activity, especially midday when it is the hottest part of the day, and avoid direct sunlight.
  • Wear loose, lightweight, light-colored clothing.
  • Take cool showers or baths to lower your body temperature.
  • Check on at-risk friends, family and neighbors at least twice a day.

 

Stay hydrated

  • Drink more than usual and don’t wait until you’re thirsty to drink.
  • Drink from two to four cups of water every hour while working or exercising outside
  • Avoid alcohol or liquids containing high amounts of sugar.
  • Make sure your family, friends and neighbors are drinking enough water.

 

Stay informed

  • Check your local news for extreme heat warnings and safety tips.
  • Visit http://emergency.cdc.gov/disasters/extremeheat to find information and tips for preventing heat sickness.
  • Sign up for free weather alerts to your phone or e-mail from websites such as www.weather.com/mobile. .
  • Keep your friends, family and neighbors aware of weather and heat safety information.

    Additionally, the San Bernardino County Department of Public Health encourages all residents to learn the signs and first aid response for heat-related illness. Warning signs and symptoms vary but may include:

     

    What You Should Do  • Move to a cooler location.  • Lie down and loosen your clothing.  • Apply cool, wet clothes to as much of your body as possible.  • Sip water.  • If you have vomited and if it continues, seek medical attention immediately.


    Heat Exhaustion

    Symptoms

    • Heavy sweating
    • Weakness
    • Skin cold, pale, and clammy
    • Weak pulse
    • Fainting and vomiting

     

     

     

  • Heat Stroke

    Symptoms

    • High body temperature (above103°F)
    • Hot, red, dry or moist skin
    • Rapid and strong pulse
    • Possible unconsciousness