According to "Beijing News Radio," on July 2nd, a 49-year-old tour guide in Beijing collapsed on a tour bus and died after unsuccessful rescue efforts. Hospital records showed that the guide died due to heatstroke. In the past month, there have been several confirmed cases and deaths from heatstroke in Beijing and other areas.
On June 16th, a 57-year-old woman in Beijing suffered multiple organ failure due to heatstroke and unfortunately passed away after nearly 7 hours of rescue efforts. On June 19th, Dr. Zhang Qing, Deputy Chief Physician of the Emergency Department at Beijing Chaoyang Hospital, reported to the media that in the past week, an average of about 6 heatstroke patients were treated each day, nearing the peak seen in July and August of previous years.
On July 8th, the Beijing Meteorological Observatory continued to issue a high-temperature orange warning, predicting that from the 8th to the 11th of the month, the highest temperature in the city would range from 36°C to 39°C, reminding citizens to beware of heatstroke. The National Climate Center introduced on July 2nd that this year, China has experienced the most high-temperature days during the same period since 1961. There have been four regional heatwaves nationwide, characterized by early appearance, wide impact, and significant extremeness.
The World Meteorological Organization (WMO) stated on the 4th that after seven years, the El Niño phenomenon is returning, and it is predicted that global temperatures will further rise, potentially reaching record highs within the next five years.
Heatstroke is one of the most dangerous forms of severe heat stress. The "Expert Consensus on Emergency Diagnosis and Treatment of Heatstroke (2021 Edition)" published in the "Chinese Journal of Emergency Medicine" points out that heatstroke is characterized by elevated body temperature with ineffective sweating mechanisms, accompanied by symptoms such as hot skin, altered consciousness, and multi-organ dysfunction. Heatstroke is associated with multi-organ damage, and severe cases can be life-threatening.
It Causes Damage to Multiple Organs
Unlike many other diseases, the harm of heatstroke to the body is a two-fold process. Dr. Zhao Zhigang, Deputy Director of the Emergency Center at Wuhan University Zhongnan Hospital, explained to "China News Weekly" that the harm of heatstroke to the body is first a direct impact from high temperatures, followed by an indirect impact where various organs experience symptoms similar to sepsis. "This is a manifestation of septicemia."
Regarding the harm of heatstroke to the body, Zhao Zhigang explained that the human body contains a large amount of protein, and the highest temperature that proteins can withstand is around 40 degrees Celsius. The longer the body's temperature remains high, the greater the damage caused by heatstroke. Dr. Chi Cheng, Deputy Chief Physician of the Emergency Department at Peking University People's Hospital, described in an interview that when the body's temperature abnormally increases, proteins in the body undergo denaturation, similar to boiling an egg. Once denatured, these proteins lose their original physiological functions, and the body's organs cannot perform their normal functions.
Heatstroke is divided into classic heatstroke and exertional heatstroke. Classic heatstroke is more common in the elderly and those with weakened thermoregulatory abilities, as well as individuals with underlying diseases. Exertional heatstroke is more common among healthy young people engaged in high-intensity physical activities for extended periods. Exertional heatstroke progresses rapidly; "in fast cases, it can progress very quickly within one or two hours," explained Zhao Zhigang.
Dr. Xu Shanxiang, Director of the Emergency Medicine Department at the Second Affiliated Hospital of Zhejiang University School of Medicine, stated in an interview with "China News Weekly" that exertional heatstroke occurs not only in summer but whenever individuals are exposed to hot and humid environments. He gave examples of marathon runners training in indoor stadiums during the winter and steelworkers suffering from heatstroke during winter due to insufficient heat dissipation. This is because their body heat production is not being released in a timely manner.
Xu Shanxiang explained that the onset of classic heatstroke is not as rapid as exertional heatstroke and involves a gradual process. For example, some elderly people with underlying diseases may experience heatstroke at home, and by the time their family notices their altered consciousness and delayed reactions, the condition has already become severe.
According to a post from "Beijing Tiantan Hospital" public account on July 7th, in the past few days, the emergency department of Beijing Tiantan Hospital treated a heatstroke patient in their seventies. The patient, worried about encountering heatstroke when going out in high temperatures, had been staying at home. Fearing prolonged exposure to air conditioning, the elderly person not only wore long-sleeved clothing but also put on long pants and even autumn trousers. Due to their advanced age and diminished ability to regulate body temperature, wearing thick clothing for an extended period led to elevated core body temperature. When the family discovered the elderly person was in a state of confusion, it was already too late. Dr. Xu Bin, Director of the Emergency Department at Beijing Tiantan Hospital, explained in the article that similar cases are not uncommon, and there has been an increase in patients seeking emergency treatment for heatstroke and related conditions in recent times. Core body temperature refers to the temperature of the main organs in the body, usually represented by the measurable rectal temperature.
Zhao Zhigang explained that the death rate from heatstroke is "greatly influenced by external factors." If a heatstroke patient is close to a large hospital, they can quickly receive intensive care and other medical support, reducing the death rate to around 10% to 20%. If the onset occurs in a remote location, such as during outdoor work, the death rate can reach 90%.
A review article published in a subjournal of "Nature" in 2022 stated that the mortality rates for exertional and classic heatstroke under intensive care were 26.5% and 63.2%, respectively. Most of the heatstroke patients Zhao Zhigang has treated are exertional heatstroke cases, with the majority being migrant workers. "In the past few years, many cases were referred from county-level hospitals," and by the time these patients were transferred to provincial-level hospitals, they were usually in a state of coma and bleeding throughout their body.
Zhao Zhigang believes this is because the duration of high-temperature work in these patients is too long. "Even if they are brought directly from the construction site to our hospital, treating them is still quite challenging," he said. Apart from medical conditions, the patient's own physical condition also determines the death rate from heatstroke.
Research from the World Climate Attribution organization shows that if global warming continues and temperatures rise by another 2 degrees Celsius, hot and humid heatwaves will become more frequent, significantly increasing the occurrence of heatstroke.
Treatment Still Poses Challenges
Xu Shanxiang explained that the treatment goals for heatstroke are to save lives first and then facilitate the recovery of various bodily functions.
"The treatment of heatstroke is divided into three periods: early, middle, and late," Zhao Zhigang explained. In the early stages, the core body temperature should be lowered to a safe range, ideally below 38°C, in the shortest time possible, "ideally within 20 minutes to half an hour." According to some foreign studies, if the temperature does not come down after more than two hours, the patient's organ damage will be severe. The "Expert Consensus (2021 Edition)" also recommends reducing rectal temperature to below 39.0°C within 30 minutes and to below 38.5°C within 2 hours. The longer the cooling takes, the more severe the damage.
After the temperature has been lowered, middle-stage treatment aims to protect organs such as the liver, kidneys, and respiratory system. Measures such as mechanical ventilation and emergency care in the ICU may be taken to protect organs. Zhao Zhigang explained that the duration of this stage varies from person to person and may last from 10 to 20 days. In the later stage, rehabilitation exercises focus on restoring brain function impaired by heatstroke through cognitive and memory exercises.
Xu Shanxiang explained that the recovery of neurological function is a challenging part of treating heatstroke. He and his team have treated heatstroke patients whose heartbeats had stopped. Although vital signs such as heart rate had recovered, brain function damage was irreversible. He described how some patients, even after being revived, suffered from neurological impairments and other sequelae.
There are differences in the level of treatment for heatstroke in different hospitals. Xu Shanxiang stated that although the principles and methods of heatstroke treatment are the same, the level of understanding, management, and precision of different doctors will directly affect the treatment and outcomes of heatstroke.
In mid-May, an article published in the "Clinical Emergency Medicine Journal" analyzed severe heatstroke patients in parts of Chongqing city from June to August 2022. The article concluded that elderly female patients and outdoor laborers were high-risk groups for heatstroke. During high-temperature periods, they should avoid prolonged outdoor work and take cooling measures, especially those with underlying diseases.
Heat acclimatization training is also a way to reduce the occurrence of heatstroke. Heat acclimatization refers to the adaptation of the body's thermoregulatory abilities through repeated exposure to heat. Heat acclimatization training can improve heat tolerance, reduce heat stress responses, and is an effective method for enhancing heat endurance.
Xu Shanxiang explained that for military training, training intensity can gradually increase as temperatures rise, allowing the body to adapt to these changes. This increases heat tolerance under the same high-temperature environment and training intensity. However, he also pointed out that the nature of outdoor work for food delivery drivers and couriers makes it difficult to plan and implement heat acclimatization training. "Acclimatization takes time and is difficult to achieve in a short period." Xu Shanxiang believes that heat acclimatization should be tailored more towards groups frequently exposed to high-temperature environments. For the general public, "protecting and preventing is enough."
Zhao Zhigang explained that various units are working hard to reduce heatstroke cases and are strengthening the construction of occupational disease management systems for heatstroke.
On June 21st, the National Health Commission released the "Public Health Protection Guidelines for High-Temperature Heat Waves," proposing intervention measures and suggestions for health risks among different populations, guiding the public in scientific protection, and preventing and reducing the health risks of high-temperature heatwaves. On June 15th, the National Health Commission and the Comprehensive Department of the National Health Commission issued a notice on "Enhancing Heatstroke Prevention and Cooling Measures for Employers in 2023," urging the implementation of various heatstroke prevention and cooling measures in workplaces and increasing the supervision of these efforts.
According to the "Management Measures for Heatstroke Prevention and Cooling Measures" issued by the former State Administration of Work Safety, workers who suffer from heatstroke due to high-temperature work or work during hot weather and are diagnosed with occupational diseases are entitled to workers' compensation benefits. In the "Classification and Catalog of Occupational Diseases," the first item is heatstroke. According to the relevant provisions of the "Regulations on Workers' Compensation Insurance," those suffering from occupational diseases should be recognized as work-related injuries.
In July of last year, the "Workers' Daily" reported that while cases of frontline workers suffering from occupational heatstroke, and even heatstroke, are not uncommon, few actually apply for occupational disease diagnosis and work-related injury certification. Beijing Fu Mao Law Firm lawyer Zhang Zhiyou revealed that workers' compensation claims involve two hurdles: confirming the employment relationship and diagnosing occupational diseases. This creates difficulties for frontline workers seeking legal rights. Some analysts believe that relevant agencies should adjust the work hours for laborers during high-temperature weather, reduce work during peak heat hours, and effectively protect the rights and interests of workers.
Comments
Post a Comment