'Climate change in the emergency room': High heat results in record numbers of 911 calls

Nearly half of Florida counties have made more 911 calls for heat-related illnesses and emergencies than the national average over the last month, data shows, and experts say the state's outdoor workers are particularly at risk.

According to the National EMS Information System database ( NEMSIS ), last updated Monday, 32 Florida counties registered a higher than average –– or much higher than average –– number of emergency calls for heat-related illnesses during the last 30 days.

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Some common heat-related illnesses are muscle cramps, dehydration, nausea, vomiting, fainting due to low blood pressure, heat exhaustion, and most deadly, heat stroke.

The same data set showed that just one week ago, 28 counties in the state were ranked higher or much higher than average in terms of heat-related emergency calls.

A month ago, it was 23 counties.

Florida is the third-highest state (and fourth-highest region, including D.C.) in heat-related emergencies, according to NEMSIS.

July 22 was the hottest day on recorded on Earth and from May 2023 to June 2024, every month for more than a year was the warmest ever recorded, according to data from the Copernicus Climate Change Service . July 2024 broke the streak, however; data shows it was only the second-hottest July on record, behind July 2023.

A study published last year found that the summer of 2023 was the hottest summer in 2,000 years . Experts say the trend will continue, and that's dangerous for those who work in the heat, particularly without safety measures in place.

According to a report from the nonprofit Florida Policy Institute , Florida has the highest number of heat-related illnesses in the nation. The Sunshine State saw 31,011 heat-related E.R. visits and hospitalizations between 2018 and 2022, based on data from the Centers for Disease Control and Prevention.

Escambia, Santa Rosa, Okaloosa, Gulf, Calhoun, Franklin, Wakulla, Leon, Gilchrist, Union, Marion, Citrus, Sumter, Hernando, Orange, Pinellas, Brevard, Indian River, Manatee and Lee counties have accounted for the highest rates of 911 calls for heat illnesses in the last 30 days across Florida, NEMSIS data showed. Another ten ranked in the next-highest category.

In a warming world, researchers say additional protections for vulnerable outdoor workers, like heat and water breaks, are a matter of life and death.

"We often find the burden of these health effects is sitting on those least able to accommodate them," said professor and vice chair of education in the Rutgers School of Public Health Wendy Purcell. Purcell, who studies how climate change interacts with social inequity, previously worked at the Harvard T. H. Chan School of Public Health.

"The climate crisis is really exacerbating existing health conditions, as well as creating new health hazards," Purcell said, pointing specifically to what she called "startling data" on its impacts on outdoor workers such as agricultural, tarmac or construction workers.

"For many people, it's simply about cranking up the air conditioning," Purcell said. "For other people, that means staying at home on hot days, and they working from home. For lots of people who are working outside or working or living in crowded conditions, they just don't have the opportunity to adapt or mitigate those negative impacts."

'Climate change ... in the emergency room'

In Cape Coral's emergency department, the number of visits for heat-related illnesses increases tremendously in the summer, said Medical Director and Chairman of the emergency room at Cape Coral Hospital Dr. Timothy Dougherty. Dougherty has practiced in Cape Coral since 1998, and also serves as the medical director for the emergency management services for Lee Health System.

"During this time of the year it is not uncommon to see one heat-related illness a shift ... during peak sun hours," Dougherty said. In contrast, during the winter, when temperatures decrease, he sees fewer than one patient a week for heat-related illnesses, he said.

Most commonly, he said, the patients who show up in the E.R. suffering from significant heat illnesses are construction workers.

"There were certain years or periods of those years that we had a large uptick in heat-related illnesses. That’s especially when there was a lot of new construction," Dougherty said. "Actual laborers out (there) doing the construction, they're the ones most at risk. We will get a significant number of people despite the fact that they’ve been outside and are acclimated to it. No one’s completely immune."

People on the lower end of the socioeconomic scale are also more vulnerable to heat, he said. Perhaps they don't have central air conditioning, or their car's air conditioning is broken. Perhaps they work outside. As a result, these people are more likely to become ill from heat exposure, he said.

That lines up with Purcell's data, too.

People with fewer resources are vulnerable to heat in a variety of ways, Purcell said, from not having clean drinking water readily available to wearing a heavy uniform in the Florida heat and humidity while working. All these little stressors add up, she said, and can create a larger problem, particularly when workers don't have money for or access to healthcare.

"We are seeing, for example, construction workers who are getting dehydrated, who are then falling, or tripping" on the job, Purcell said. She mentioned truck drivers who get tired or dizzy from being too warm and crash, or elderly or low-income workers who cannot afford to turn their air conditioning on and pass out. Athletes who suffer muscle cramps from heat stroke or dehydration, trip, strike their heads, and die.

These types of death are becoming more and more common as the Earth gets hotter, she said.

A new study by the American Immigration Council shows agricultural workers on an H-2A visa, a federal permit that allows international workers temporary jobs in agriculture, are at much greater risk of heat-related illnesses, too, than their predecessors were even just a few years ago.

Researchers analyzed Department of Labor data and found more than 13% of H-2A workers are working during months when the average local temperature exceeds 90°F –– and in the U.S. South, that number is more like one in four.

The study also found that counties with the largest number of certified H-2A workers are often in some of the hottest regions in the country, leaving farm laborers vulnerable to dangerous working conditions.

Florida, with its tropical environment and high humidity, is one of the largest employers of H-2A workers in the nation in its vegetable and melon fields. The state's number of H-2A workers has doubled in the last five years.

Too, it is particularly vulnerable to heat-related emergencies and deaths. Here, 215 people died between 2010 and 2020 from heat, the University of Florida found.

"Climate change is showing up in the emergency room," Purcell said.

Shade, water, electrolytes

While outdoor workers are particularly vulnerable to heat, Dougherty said the elderly and the very young, athletes spending long periods of time outside and people with limited funds were also more at risk of becoming sick from heat exposure. Certain medications such as blood pressure or antihistamines can increase your risk of developing significant heat-related illnesses, too.

"Last year in the U.S. alone we had over 2,000 heat-related deaths," he said. "In France last year there was a heat wave that resulted in 14,000 deaths. These are significant mortality rates."

But there are some basic steps you can take to keep yourself healthy and safe, even in extreme temperatures. Staying hydrated, taking regular breaks when you're overheated and resting in the shade, if you work outdoors, can prevent the need for a trip to the emergency department.

If you feel yourself getting tired or overheated, get out of that environment, Dougherty urged.

"Find some shade," he said. "Spritz yourself with water. Evaporation is a quick way to dissipate heat. Drink electrolytes."

But, he said, don't wait too long to seek help if you are experiencing symptoms like nausea or vomiting.

"A few hours in the emergency department can save days of hospitalization," Dougherty cautioned.

And, he warned, don't sit in a hot car or expect a child or pet to wait in one. Instead, he said, start the car and turn the air conditioning on for a few minutes before getting in -- or, if you're in a hurry, put the windows down to blow the warm air out.

"A car can heat up very quickly," he said. "We rarely go below 80 degrees, and (in that temperature), it takes less than 15 minutes to go up to more than 105 degrees.

"Some of these heat-related deaths are related to people leaving their kids in the car for a few minutes or forgetting they’re in there. That’s enough to kill a child or an animal. There are some deaths that are clearly preventable."

Millions of Floridians at risk from heat

Roughly 2 million people work outdoors in Florida, the Union of Concerned Scientists found, from landscaping to construction to amusement parks to agriculture.

But despite increasing temperatures, neither the federal government nor Florida has a heat standard that requires breaks at certain temperatures or sun exposure. Absent a state department of worker safety, Florida falls under federal workplace safety agency OSHA jurisdiction, which covers most private-sector workers in the state.

OSHA instead requires breaks " long enough for workers to recover from the heat. " And while OSHA requires employers to provide water for workers, it doesn’t require that employers give their workers time to drink the water.

And just a few months ago, in what he admitted to media at the time was a move to punish Miami-Dade County, Gov. Ron DeSantis signed into law a bill that banned local municipalities from requiring employers to give heat breaks to outdoor workers.

Florida House Bill 433 states that cities or towns don’t have a right to require employers to provide heat or shade breaks that the state or federal government doesn’t already require.

However, as temperatures grew, DeSantis backtracked. In July, DeSantis told reporters he put the kibosh on protections for outdoor workers because it would have "preempted local governments" and violated the framework Florida already had in place.

“You don’t want a patchwork of, like, Miami-Dade has all this and then you go to Collier and then it’s totally different because people are doing business in multiple jurisdictions in this state,” DeSantis said.

Meanwhile, Floridians continue to die at an alarming rate due to heat. A 2023 report out of the National Conference of Citizenship found heat-related deaths in Florida shot up by 88% between 2019 and 2022.

Too, the Centers for Disease Control found this year that emergency visits for heat-related illnesses surged in 2023, especially among men and adults aged 18 to 64, the demographic most likely to work outdoors.

Across the U.S., the data shows emergency medical services take an average of more than 12 minutes to arrive on the scene, a 1.8% change from the year before, and the number of calls for heat-related illnesses by population has increased 1,173% from the year before, rising to nearly two calls per 100,000 people.

Twelve have died this year from heat; according to NEMSIS. Three were Floridians.

Reporter C.A. Bridges contributed to this story.

Kate Cimini is the Florida Investigative Reporter for the USA TODAY-Network Florida, based at The News-Press and The Naples Daily News. Contact her at 239-207-9369 or kcimini@news-press.com.

This article originally appeared on Fort Myers News-Press: 'Climate change in the emergency room': High heat results in record numbers of 911 calls