During the recent Fourth of July holiday, hospitals along the U.S. East Coast faced a surge of patients suffering from heat-related illnesses, highlighting a growing challenge in emergency preparedness. Dr. Joseph V. Sakran, a trauma surgeon and executive vice chair of surgery at Johns Hopkins Hospital, described extreme heat events as a form of “mass casualty event” that unfolds more slowly than traditional disasters but can overwhelm emergency departments just as severely.
Unlike sudden crises such as shootings, building collapses, or vehicle accidents, heat waves develop over hours or days, making it harder for hospitals to recognize and respond proactively. On that holiday in Baltimore, Dr. Sakran recounted the death of a patient whose condition deteriorated due to the extreme temperatures, underscoring the lethality of heat exposure. Meanwhile, across Washington, DC, more than 600 people required first aid on the National Mall during soaring temperatures, with George Washington University Hospital alone seeing about 290 such patients by evening.
Hospitals currently have well-established mass casualty protocols designed for rapid surges of trauma patients. These protocols involve mobilizing additional staff, clearing operating rooms, opening beds, staging supplies, and triaging patients by the severity of injury. However, Dr. Sakran emphasizes that similar systematic preparation is rarely in place for heat emergencies, despite meteorological forecasts providing advance warnings of dangerous heat days before an event. This contrasts with other natural disasters, where emergency operations centers and public safety measures are activated proactively.
He argues that hospitals should adopt operational frameworks that treat extreme heat with the same urgency as other predictable surges. Suggested measures include establishing heat-specific activation thresholds based on heat index values, rather than air temperature alone; staging cooling equipment, ice, and chilled intravenous fluids ahead of patient arrivals; automatically mobilizing additional emergency staff; and enhancing regional coordination to manage capacity challenges before they escalate.
The urgency to adapt comes amid projections that heat-related emergency visits and hospitalizations will increase significantly as climate change drives more frequent and intense heat waves. The gap between preparations for violent incidents and those for heat emergencies poses a growing risk to healthcare systems.
Dr. Sakran reflects on the limitations of current hospital systems, which often treat extreme heat as an unusually busy day rather than the predictable and dangerous surge it increasingly represents. Unlike disasters marked by visible signs such as sirens or debris, heat emergencies can arrive quietly, stretching emergency room capacity one patient at a time.
The experience from trauma systems offers a model for responding to heat-related crises, with the critical next step being the recognition that such mass casualty events may be forecast and prepared for days in advance, potentially saving lives in the process.