We're Having a Heat Wave - The Physical and Mental Impacts from Extreme Heat and What Your Community Should Do with Dr. Jason Mansour, Medical Director at Broward Health Medical Center's Emergency Department

Brace yourself for a deep dive into the hot issues surrounding extreme summer heat with host, Donna DiMaggio Berger, and guest Dr. Jason Mansour, Medical Director at Broward Health Medical Center's Emergency Department. Together, they discuss the physical and mental impact of extreme heat events. This isn't just another conversation about the weather - it's a critical exploration of an increasingly dangerous global phenomenon and how community association boards can prepare and protect their residents, employees, vendors, and guests.

Donna begins the episode by guiding you on what associations can do to protect residents and employees from the heat's wrath, including revisiting and/or relaxing certain rules and regulations that might not make sense amid a heat wave, crafting disaster plans, ensuring outdoor workers are hydrating and have access to shade, and implementing smart strategies like limiting daytime activities on your recreational amenities and conducting welfare checks on vulnerable residents. 

In the second half of the episode, Dr. Mansour shares expert insight recognizing and managing symptoms of heat exhaustion and heatstroke. Dr. Mansour emphasizes that extreme heat can exacerbate existing health conditions and poses a severe threat to respiratory and cardiovascular health. This episode of Take It To The Board will serve as your cool oasis - a survival guide to extreme heat events. Whether you're a board member, resident, part of a management team, or an association employee or vendor working outdoors in the broiling heat, this episode is packed with vital information to help you stay safe.

With a special mention to our previous episode featuring Miami-Dade Chief Heat Officer, Jane Gilbert, this episode emphasizes the urgency for awareness and action. 

Conversation highlights include:

• Common sense steps your board can take to lessen the impact of extreme heat in your community
• Identifying the symptoms of heat exhaustion and heatstroke
• Find out what can be done to cool down once symptoms start
• Is it possible to cool down while still outside? 
• Why certain rules regarding hurricane shutters and blinds should be relaxed
• The pros and cons of cooling off in a cold plunge 
• How extreme heat impacts your vulnerable residents
• When to go to the hospital if someone is suffering from the heat 
• Can heat stroke cause brain damage, permanent or otherwise?

BONUS:  Hear firsthand the increased number of hospital visits the recent heatwave has caused.

Transcript

Speaker 1: 0:02

Hi everyone, I'm attorney Donna DiMaggio-Burger and this is Take it To the Board, where we speak Kondo and HOA. So welcome everybody. This is going to be a special episode of Take it To the Board podcast, and the reason for this is the extreme heat we've all been experiencing the last few weeks. If you believe the news, we're probably in for some more very hot weather for the coming months, so it's interesting. I wrote an article about this recently and this is how the article started out. I'm going to read it to you.

Speaker 1: 0:35

The word hot has many connotations. It can reveal anger when you say someone is hot around the collar. It can invoke personal appeal or desirability, as in he or she is so hot. It can refer to a disorganized person or situation, hence the description of somebody as a hot mess. And it can also be used to describe an emotional issue or topic like a hot button. However, since the earliest of times, the word hot has been used to describe the temperature, and we've been hearing the word hot a lot lately in many parts of the US, given the ongoing heat waves. More than 61,000 people died in 2022 because of the heat waves that swept the European continent. Now we won't know for some time. How many US fatalities have occurred due to our extreme heat during the summer of 2023,? But you can virtually guarantee that we will, unfortunately, have lost some people due to the extreme heat. Now, I'm not a doctor and I don't play one, and we are going to be talking to a doctor later in this episode, but I did a little research and here's what I learned about extreme heat.

Speaker 1: 1:37

Extreme heat can cause dehydration, heat exhaustion. It can exacerbate existing medical and mental health conditions. It can cause respiratory distress and heat stroke. Dehydration can cause dizzying, this fatigue and muscle weakness. Heat exhaustion may result in heavy sweating, nausea, headache, rapid heartbeat, faintness and muscle cramps. Extreme heat can more greatly affect people with underlying respiratory, cardiovascular and kidney disorders, with extreme heat being tied to an increased risk of heart attacks or other cardiovascular events. Of course, that's going to depend on the age of the person experiencing the extreme heat, and we often hear about the fact that older people are much more vulnerable and young infants to extreme heat. Heat waves have also been linked to diminish air quality in urban areas, which can worsen respiratory conditions such as asthma. Lastly, extreme heat can impact mental well-being, leading to irritability, mood swings and difficulty concentrating. I don't have to tell all of you listening that we don't want or need more mental health challenges in our community associations. So the heat just tends to make everything worse.

Speaker 1: 2:45

I will tell you my own heat stroke story. My heat stroke story is many years ago. It was my senior year of high school. Our senior day was at Great America, which is a theme park in Illinois. I grew up in Chicago. It was one of those entertainment venues outside the city went with my friends, we were there. We must have been there for 10 hours. It was in the summer, it was blazing hot and what I remember coming home in the car was nausea nausea that led to throwing up shaking chills. I had full-blown heat stroke. Of course, that was also one of my first dates with my then-boyfriend, so it didn't make a great impression that I had heat stroke. I got through it, I lived.

Speaker 1: 3:27

But extreme heat events are nothing to mess around with and that's why I wanted to do this episode. It's a very short but important episode on extreme heat events and maybe what your multifamily building or association can do with regard to these events. So dealing with extreme heat events in a multifamily building, especially for people on fixed incomes can be a real challenge. So what should your board and your management team be doing in response to an extreme heat event? Certainly, preparing for heat waves should be something you consider in your emergency disaster plan. Remember, on the podcast, we've talked previously about having a plan in place to deal with windstorms. We're in Florida and we have a six-month hurricane season, so it's really critical for your board to have an emergency plan in place. I don't think I've heard of a client yet who has addressed heat waves in their emergency plans, but it's something I want you to think about now, because the heat is here and it doesn't look like it's going away and it looks like extreme weather events is going to be a more regular occurrence.

Speaker 1: 4:32

I also want to and we'll put in the show notes we did an episode with Miami Dave Chief Heat Officer, jane Gilbert, last year. Now, when I first reached out to Jane Gilbert, I had only read of her in Vogue magazine's Badass Women episode and I thought, wow, she's right in my backyard. I hadn't really heard about her Since last year. Between last year and this year, jane is blowing up all over the media, and for good reason. It's because of these extreme heat events. So a couple of things. I just want to talk to you and walk your board and your management teams through. Now.

Speaker 1: 5:06

Many associations have employees and if you have employees, you really need to work with Association Council and if you have Labor Council as well, to decide what needs to be done to protect and safeguard your employees during an extreme heat event. This particularly applies to employees who work outdoors. A lot of communities have people who are working valet personnel. You've got people who are handling beach duties. If it's a coastal community, people who are working at the pool. So if you have employees, you want to make sure that they have access to plenty of water throughout the day. If their job duties take them outside during an extreme heat event, you want to make sure that they stay hydrated. They replace fluids lost through perspiration. If those employees are required to wear a certain uniform that's not well suited to extreme heat, you need to consider getting a different type of uniform that those employees can wear during the hottest times of the day. I will tell you that in some of the communities the very upscale communities I've seen they've got very chic uniforms, but if it's all black pants and a long sleeve black shirt, that is not going to be helpful at all in the midst of an extreme heat event.

Speaker 1: 6:17

Now you also want to confirm if you're using outside vendors. Let's say you don't have any employees, but you've certainly got a pool company, you've got a landscape company, you've got other people that are coming in to do things. Please make sure that your outside vendors are also taking care of their employees and that they've thought about this. Just because it's not your employee does not mean you shouldn't care about what happens on your property. One of my suggestions is going to be create some shade around the building by using umbrellas, awnings or strategically placed vegetation to reduce the impact of direct sunlight. Jane Gilbert talked about this. She talked about heat canyons and the fact that we have some areas in our communities that have no shade and they've got a lot of heat, and the heat is reflecting and creating a heat canyon. So, if you haven't looked around with regard to that in mind, walk around with your landscaper. Figure out where you can create some shade around the building. This is going to be good for both your residents as well as your guests and your vendors. Bear in mind, though, that some of these changes might create a need to get your membership approval in advance because they may be material alterations.

Speaker 1: 7:24

I want you to consider revisiting any architectural control guidelines you have in place which may restrict or prohibit the use of fans on balconies, patios and lennies. I had a client where they didn't want any fans on the patios. They didn't like the way it looked. Folks, I understand that aesthetics are of primary concern for some communities, but you don't want to take priority over that health and safety. So go back and look if you've got any restriction that would prevent people from placing a fan or otherwise using a device that would cool them off in the midst of an extreme heat event. You need to rethink that restrictions. Fans are used to circulate air and they can create a cooling effect.

Speaker 1: 8:06

Here's another rule that may no longer make sense during an extreme heat event Curtains, blinds and blackout shades that reduce the temperature inside a unit. Now again, you've got a lot of communities where they're focusing on the aesthetics. Oh, I don't want those shades closed in the middle of the day. It doesn't look right. We want all the windows open and looking a certain way. Well, guess what? That's not going to be terribly helpful if you're in the midst of an extreme heat event. So consider waving those kind of restrictions that don't allow people to take certain comments and steps in the middle of the day, during the hottest time of the day, to simply close their blackout shades. Here's another thing hurricane shutters. Now I have a lot of communities that have rules that say you can't close your hurricane shutters only in the event of an advancing storm. Well, closing your hurricane shutters in the middle of the day during an extreme heat event can reduce the heat inside that unit. So again, you don't want to be a stickler for a rule that may have made sense during normal temperatures but certainly does not make sense during an extreme heat event.

Speaker 1: 9:10

Consider limiting the daytime hours of play for outdoor tennis and pickleball courts, as well as any other outdoor recreational areas, when temperatures are soaring. So if you normally have your tennis courts open from 8am till dusk but you're in the midst of a heat wave, you may want to let your membership know that you are going to be temporary closing that and maybe you're going to say only 8 in the morning till 10am and then from you know 430 to to dusk times, when you're not during the hottest part of the day. Again, a lot of people. They can't self-regulate, so they may go out there. They really want to get their pickleball game in and they don't care. But you need to take some steps to say we recognize that this could be a dangerous activity. Another thing you may want to do is install some thermometers around the property. You know I go out to a lot of different communities for board and membership meetings. I rarely see a thermometer out there. You may want to place a thermometer near that tennis court, near the clubhouse, near the pool, anywhere near the shuffleboard court, anywhere where people may be congregating outdoors and not really realizing how hot it is. And certainly if somebody's experiencing heat exhaustion, they may be at the point that they can't realize they've lost some of their cognition so they really can't understand how hot it is and how dangerous it is for them to stay outside.

Speaker 1: 10:38

I would urge you to consider purchasing a whole building generator if you don't already have one. You know, in the event of increased electric demands during a heat wave it can cause a blackout or a brownout, and this just actually happened with my parents they're street. I don't know if it was related to increased demands, but their street almost never loses electricity during a windstorm because all the power lines are buried underneath. But just yesterday and I'm filming this on July 26th, they lost power in their community. It may have been related to increased demand. So your board really does have to think about the fact that if you don't have a whole building generator, that could be very helpful in the event that you lose electricity due to increased demand during a heat wave. Naturally, a whole building generator is also very helpful during a windstorm. What else do you want to think about?

Speaker 1: 11:31

Check in with your residents who may be living alone and dealing with physical or mental health challenges, as well as economic burdens. We have more and more people in Florida on fixed incomes who are struggling to pay assessments, and they're struggling to pay increased assessments because they've, for years, reserves have been waived and now they're starting to have to fund reserves. If they're in certain types of buildings, those folks may be cutting corners to try to make ends meet, and often that includes not running their AC as often or at a temperature that's needed for their well-being. Sometimes we'll go into those units and it'll be 80 degrees because they keep it down or they shut it off. If it's between the AC or eating, you know which choice they're going to make.

Speaker 1: 12:16

This is the time to confirm that you have emergency contacts for all your residents. Reach out to local community organizations, social services or government agencies that provide assistance during extreme weather events. They may offer cooling centers, fan distribution programs or other resources for your residents. And getting back to that list of vulnerable residents that may be living alone, they may be cutting corners when it comes to their AC. Let those folks know where in the building they can go to get cool. Again, I'm getting back to rules where it may say you can't sit on the lobby furniture for more than one hour straight. I mean, I can't tell you the type of rules I've seen over the years. Have some compassion when you're dealing with an extreme heat event. The regular rules that pertain only to aesthetics may need to go out the window so you can safeguard your people.

Speaker 1: 13:07

I would leave you with this the strategies your board and management team use in response to an extreme heat event. It depends in large part, on your building's location and infrastructure, as well as the monetary and personnel resources you have available to you. However, there's some basic steps that all associations can take to educate their residents about the dangers of extreme heat the phrase we've always heard. We're having a heat wave. That does not have to spell disaster in a well-prepared community. So be safe out there. Start thinking about how extreme heat events can impact the well-being of your residents, your visitors and your vendors. Make sure you revisit those emergency plans and address what your board and your management team can do in the event of an extreme heat event. I'm fortunate to have Dr Jason Mansor with us today to discuss extreme heat. Dr Mansor is the medical director of the emergency department at Broward Health. Dr Mansor, thank you so much for joining us today.

Speaker 2: 14:04

Thanks for having me, Donna.

Speaker 1: 14:06

So can you tell us what are the first symptoms that appear when a person is experiencing heat exhaustion?

Speaker 2: 14:12

Yes. So essentially the symptoms that people experience when you're overwhelming your body's ability to compensate for high heat, your body's going to be doing things like sweating and increasing your heart rate and dilating the blood vessels towards the skin to release heat, and those systems have a great capacity to cool down the body. But when they start to get overwhelmed your body temperature is going to rise and you're going to have the subsequent symptoms that come along with that. So there are some benign conditions that can occur, things like heated edema, which is just swelling of your extremities just from the dilation. You see that, and the elderly typically.

Speaker 2: 14:45

You can have heat rash which is clogged up, skin ducks and things like that in an inflammatory response causing a rash. You can have heat cramps. This typically happens in athletes because you're sweating, you're losing electrolytes and your muscles can cramp up. In general those are pretty benign conditions. Heat exhaustion is the first one. We start to move from mild to moderate. Now we're starting to talk about heat exhaustion. Those symptoms are flushed skin, a high heart rate, breathing faster, sweating. You get a flushing look to the skin and they kind of look winded. Sometimes they're associated with generalized fatigue and sometimes vomiting. Those are the patients that you got to get them out of the heat and get them cooled off, because what comes after that, when we talk about severe heat illness, is heat stroke.

Speaker 1: 15:26

So how quickly, dr Mansour, would it take for somebody let's say who's out, with that recent weather here in South Florida, I mean, I think, it feel I think the field temperature is like 105. You're out. How long would it take before you get to some of the symptoms you just described? The flush skin, perhaps, the accelerated heart rate? Are we talking 15 minutes, 30 minutes longer?

Speaker 2: 15:51

That's a tough question to answer because there's too many factors. Firstly, it's what the person is. A young, healthy person can tolerate high heat conditions more than the elderly or the very young. There's something called a climatization which an athlete that's been training in the sun quite a bit can last quite a bit longer than somebody who's new to that and not really exposed to types of temperatures. Then you have humidity and how much wind and how much shade and things like that.

Speaker 2: 16:14

Obviously, direct sunlight you're going to have a lot less time than you would if you were shaded. High humidity makes wind much less effective in cooling you off. So even if there is a wind and high humidity in South Florida is known for that when you're in these 90 plus degree temperatures and the humidity is up over 35%, which is much, much higher here, Wind has a less ability to take heat away from your body than in lower humidity conditions. So it's hard to really put a clock on it. There's too many other factors there involved, but obviously, regardless of the time, it's more the symptoms. When you start to experience those symptoms, where you get the lightheadedness, the sweating, the flushing, your heart rate is increased. Those are the signs. Those are more important than actually the clock.

Speaker 1: 16:59

So what do you do to cool down once you're experiencing those symptoms let's say you can't get inside Is there anything you can do to cool down outside?

Speaker 2: 17:08

Yeah, obviously remove yourself from direct sunlight, so shade would be the first thing. Your body's ability to cool itself starts with sweating and, if possible, some sort of wind. So if there's a fan plus the water, right, because then you're using two different modalities to remove heat from the body. Right? A lot of places where heat stroke is more common, places like the practice facilities, right, you know I work for the Miami Dolphins. If you're there at the stadium on a Sunday or you're at their practice facility, they actually have a nice bath ready to take care of those patients that right off the field they go right into a nice bath and it cools them off.

Speaker 2: 17:45

Unfortunately, in the real world we don't have a nice bath just readily available. But if there's an ability to get some ice and put that in the person's forehead and in their axilla and their armpits and in their groin regions, you're trying to cool them off that way as well. And then the evaporative cooling. So if the patient's not already, their skin is not already sweaty and wet, if you can miss them with something wet the skin and then with a fan trying to blow wind on them, that's the best way to remove heat from the person.

Speaker 1: 18:14

You talked about the cold plunge, I assume when you were talking about that bath with the dolphins, the cold plunge. So can it lower the blood pressure too quickly? And I'm going to give you an example, I like to sit in my sauna at 142 degrees for about 30 minutes and then I jump in the. I did this once, jumped in the pool and really almost passed out. I assume that's because my blood pressure dropped very quickly, going from the heat and then into the cold.

Speaker 2: 18:42

Yeah, I mean that was more likely. The shock to the system going from an extreme temperature to another extreme temperature probably caused some of your blood vessels going to your brain to dilate. We call that a vagal reaction and that can make you lightheaded. That doesn't necessarily particularly correlate with what you're talking about with it but, directly relating to low blood pressure, it's more about the dilation of the blood vessels going to your head and it's more the shock to your system. It's very similar to people that faint when they see a spider or see a snake or something like that. You know you get this shock response and we call it a vagal reaction that makes you kind of pass out.

Speaker 1: 19:14

How come I can feel about okay sitting in a sauna at 142 degrees for 30 minutes, but if I go outside in this heat I'm dying. Is it just because you're expecting to be hot in the sauna?

Speaker 2: 19:25

Well, you're probably a little more prepared and, being in a sauna a lot of times, you have more control over that. You know you're in there for a certain amount of time and there's usually something that says right now that we do not recommend you're in here more than a certain number of minutes and you remove yourself. People that suffer from heat exhaustion or heat stroke are typically there's some factor that's keeping them in the heat. There's two classic descriptions of heat illness, two categories of patients. One, what we call classic heat stroke, is usually someone who cannot remove themselves from the environment. So you're talking about the elderly. You're talking about folks that maybe are incapacitated because they're intoxicated on drugs or alcohol, folks that are in wheelchairs. The extremes of age, very elderly or very young these are the stories you hear about people in the backseat of a car that get locked in For whatever reason. They're unable to remove themselves from the hot environment.

Speaker 2: 20:15

A normal person with a normal mental status and normal capacity. When they feel that way, they remove themselves. Those people, for whatever reason. They get trapped and their body temperature rises and they get heat illness. The other category is athletes and military exercise, the basic training and things like that. Those folks. They're in the hot environment, they feel themselves getting hot and a lot of times it's the bravado of the athlete or the military person who doesn't want to disappoint their superior, whether that's their coach, their father or their drill sergeant, and they keep pushing themselves beyond the limit because they don't want to be perceived as that guy that can't take the pressure or the heat. And they push themselves beyond the limit, they overheat themselves and those patients and those particular folks, the bystander has to save them from themselves. So the other coach, the parent, somebody else is seeing this person doesn't look so well has to save them from themselves. A lot of times that person themselves has too much bravado to remove themselves, so to speak.

Speaker 1: 21:11

And you hit both categories that I talk about in this episode, dr, because we're not only talking about the vendors who are servicing our community, or the employees who are out there you know, at the pool they're working outside the valets, the people who are, you know, their job requires them to be outdoors during the hottest part of the day but also the elderly people living in some of these multi-family buildings, where they're not running the air or they've got it at a very high temperature, they're locked in their unit and it's concerning because a lot of the elderly they're not passing away from heat exhaustion outside. It's actually inside their units, correct?

Speaker 2: 21:50

Yeah, a few years back when a hurricane came through, it kind of knocked out power. We had it. There was an entire nursing home that lost power, lost the AC, and there was a large number of patients that ended up at the area hospitals with heat illness as a result. So that's something that sometimes gets overlooked, but making sure there's some plan in place for folks like that are dependent on power to keep themselves cool.

Speaker 1: 22:12

When would you recommend taking somebody to the hospital if you suspect that they're suffering from heat exhaustion or heat stroke?

Speaker 2: 22:20

Yes, so when we talk mild to moderate, usually you can take care of that yourself. You know, get yourself out of the heat, get out of the sun, get into some AC, cool yourself off with fans or air conditioning, things like that. So even if you get to heat exhaustion, which is what I described as high heart rate, flush skin, nausea, vomiting, fatigue, you can usually take care of that at home by cooling yourself. When you cross over to heat stroke, now you have central nervous system involvement, which means you have confusion. The person is not acting right, sometimes blurry vision, you know things that are more brain involvement.

Speaker 2: 22:52

Typically those temperatures are above 104. When you get to that point, then you really need to come to a hospital. You need to come to the emergency department. Now, if you're lucky enough to be somewhere where you could take that cold plunge, where there's some way you can set that up, cooling them immediately is more effective than getting them because there is a delay to get them to the hospital for cooling. So cooling immediately and the best way you can, so the best way is the ice plunge. It's not the most practical way, but if you don't have that, then the plan B would be getting to AC with moisture on their skin and fan some way to fan them.

Speaker 1: 23:27

I had not thought of the moisture on the skin. That is a really important point. If they get to the point of heat stroke, is there a risk for brain damage, permanent or otherwise?

Speaker 2: 23:37

Yeah, because your body cannot do the normal cellular processes that it's supposed to be doing. When you start to overheat the cell and the normal processes can't happen, you can cause permanent damage. So the sequela can be anything from brain damage, liver, kidneys it's kind of a multi-organ failure that you can get as sequela of heat stroke.

Speaker 1: 23:57

A lot of people think, dr, that as long as they're hydrating, they're fine outside. For what I'm hearing, I'm not sure that just being hydrated while you're out in extreme heat for hours at a time is going to be enough.

Speaker 2: 24:09

Yeah, I mean it's an important concept because it's a double whammy when you have no hydration and heat. So you're hydrating yourself, which is great, but the body's ability to adapt to high heat conditions has a limit. So when you overwhelm that limit, you overwhelm the systems. Regardless of the hydration status, you can get heat exhaustion, eventually heat stroke. So it's just, it's one factor and it's helpful, but it's not the end, all be all.

Speaker 1: 24:38

I think I know what your answer to this question is going to be, but drinking alcohol during extreme heat event outside is probably not a good idea.

Speaker 2: 24:48

Yeah, drinking alcohol causes poor judgments and also can inebriate you to the point where you're unable to remove yourself from the hot environment. So you see this a lot at music festivals and concerts. You see this in any sort of outdoor gathering in the heat like this. Somebody can get quite inebriated and they kind of pass out in the sun, so to speak, and they don't remove themselves and nobody notices them and we can see patients end up in the ER, really sick, with that type of environment.

Speaker 1: 25:14

Are you seeing more patients these days during the recent heat wave coming in with these symptoms?

Speaker 2: 25:20

Yeah, june we had two heat related presentations. July we had 17. So dramatic increase. Over those two months and most of the end of June and all of July we've had a heat index over 100 and it doesn't seem like there's an end in sight. So we expect those numbers to continue to be very high throughout the summer.

Speaker 1: 25:39

Well, I was going to ask you this is Broward House implementing any sort of protocols in an anticipation of extreme heat being the norm?

Speaker 2: 25:47

We're always equipped to deal with any emergency. You know we're a stroke center, we're a cardiac center and we can deal with us being in South Florida. We're equipped for this because this is common. There are some other areas of the country that they don't get extreme heat as much as we are and so maybe they're not as prepared, but at Broward Health we're always prepared.

Speaker 1: 26:07

Well, I really want to thank you for coming on Is there anything else you want to tell our audience about? Heat stroke, heat exhaustion, extreme heat?

Speaker 2: 26:15

I think we covered most of it. It's just keeping yourself hydrated and knowing your body's limits. Most of the time your body's going to tell you hey, I'm in trouble, I'm struggling here, and you know, don't push yourself beyond those limits. I know the pressure on a lot of folks that I need to finish the task. When the fourth quarter's over, I'll leave the heat. You know, whatever it is, there's a lot of times you try to push yourself because you're trying to get to a certain point, but your body sends you a message listen to your body because it knows best.

Speaker 1: 26:40

Thank you so much for joining us.

Speaker 2: 26:42

It was my pleasure. Thanks for having me.

Speaker 1: 26:45

Thank you for joining us today. Don't forget to follow and rate us on your favorite podcast platform, or visit TicketToTheBoardcom for more ways to connect.