Heat-Related Illness Rising with Temperatures

Sixteen-year-old Zach Martin was propped up against his football coach and moaning incoherently when his mom got to the field. Around him, other boys were frantically taking off their shirts, plunging them in the cooler and dripping the icy water on their teammate to try and bring him relief. But it wasn’t enough.

In the brutal Florida sun and humidity, the offensive lineman suffered a heat stroke at his Riverdale High School football practice on June 29, 2017, a day when Fort Myers temperatures reached into the 90s. 

Zach Martin’s school photo. Martin died after a heat stroke in June 2017.

“When I came around the bleachers, that’s when I saw him,” Zach’s mom, Laurie Martin Giordano, said. “I knew something was wrong, very wrong, but I had never seen it before. I had no idea what was happening.”

Eleven days later, Zach died in the hospital of multiple organ failure caused by heat illness. Doctors say the outside temperature and extra heat produced by his exercising muscles overloaded the athlete’s body. His death reveals how dangerous everyday activities such as sports and outdoor work can be in Florida’s hottest temperatures, which meteorologists say are becoming more frequent. 

The past five years have been the hottest ever recorded, according to NOAA’s National Centers for Environmental Information, and 2020 is “almost certain” to follow, the agency projects. Florida has made headlines this spring for record heat, but the trend stretches back far longer. Statewide temperature averages have been higher than normal for 57 out of the last 60 months, according to state climatologist David Zierden at the Florida Climate Center in Tallahassee.

Rates of heat illness in the state are rising along with the temperatures, according to an analysis by WUFT News. Data from Florida’s Department of Health and the U.S. Centers for Disease Control and Prevention show heat-related hospitalizations have increased alongside the number of extremely hot days.

Public health officials also track heat-related deaths, but those numbers, which range from a low of seven in 2007 to 31 in 2017, are too small to show any significant trends and are heavily influenced by extreme weather including hurricanes. A dozen residents at the Rehabilitation Center in Hollywood Hills died in fall 2017 after Hurricane Irma knocked out power across the state and the nursing home lost air conditioning. Former workers have now been criminally charged with manslaughter in the heat-exposure deaths.

Heat and the human body

Medical heat expert Dr. Douglas Casa, chief executive officer of the University of Connecticut’s Korey Stringer Institute, explained there are two types of heat stroke, exertional and classic. For classic heat stroke, such as when infants are left in hot cars, the body fails to cool down when exposed to high environmental temperatures. For exertional heat stroke, like when athletes are practicing, temperature regulation is overloaded when working muscles stoke internal heat atop environmental heat.

Using state medical examiner autopsy reports for hyperthermia — elevated body temperature — obtained by WUFT News via public records requests, those most at risk for heat illness include young children left in hot cars; adults working outside; elderly patients with dementia or Alzheimer’s; people with schizophrenia or other diseases that make it difficult to regulate body temperature; and people too poor to afford air conditioning.

David Autry, 52, of Duval County, was remembered as a kind-hearted handyman always willing to help out. He died of exertional heat stroke on September 28, 2017, while fixing a client’s roof. It was 93 degrees and sunny in Jacksonville that Thursday when Autry collapsed at his outdoor work site. His body temperature read 107.1 degrees in the emergency room. “It was tragic,” said a member of his extended family. “David was good people.”

Casa said the southeastern U.S. is particularly dangerous for heat stroke because of high humidity. The body’s main method to control temperature is evaporation, or sweating. When someone sweats, the evaporating water absorbs heat from its surroundings. But if the air is too humid, sweat just drips down the body instead of evaporating and can’t absorb excess heat.

Because extreme heat breaks down cells, the human body can’t handle temperatures over 104 for more than 30-60 minutes without injury. Most commonly, Casa said, liver, kidney, brain and muscle damage occur.

While the picture seems grim, Casa said, there are certain warning signs to help prevent heat stroke and save lives.

Watch out for headaches, dizziness, nausea, vomiting and fatigue, he said. Also, be extra cautious of or with any pre-existing health problems. If someone collapses, cool them down immediately on site—don’t transport them anywhere, even to the hospital, until their temperature is low enough.

“Heat stroke is 100% survivable if you can get someone’s body temperature below 104 in 30 minutes after collapse,” Casa said. “If your temperature goes down in 30 minutes, you’ll be fine. If it takes an hour and a half, you’ll most likely die.”

Since the death of her son, Giordano has worked to educate other families and inspire new cooling requirements for school athletic programs. In March, Florida lawmakers unanimously passed the Zach Martin Act, which will require schools to have cooling zones at every athletic practice, workout, conditioning session and contest.

The bill currently awaits Gov. Ron DeSantis’ signature, though much state business has had to take a backseat to the COVID-19 crisis.

“This is something that embodies who Zach was,” said Giordano, who remembers crying at the Capitol when it passed. “He was a protector … and this bill will continue to protect high school students from now on.”

Giordano also has advice for Floridians:

  • Be prepared. Have cold water, ice and shade to rest in.
  • Spend more time outside regularly throughout the year to adjust to environmental temperatures.
  • Watch out for slurred words or incoherent speech, vomiting, headaches and fatigue.
  • Have a plan for how to cool someone down when they collapse.
  • Treat heat illness as importantly as any other medical emergency.
  • Know that it’s getting worse over time as temperatures rise.

“There’s this idea that heat stroke is really rare,” Giordano said. “That may have been true 30 years ago, but we have evolved. The more we spend indoors running air conditioning, the hotter it gets outside because of our emissions, and the hotter it gets outside, the more time we spend inside.” 

“It’s a vicious cycle.”

Next: Part 2 – Pathogens