In the latest installment of our occasional conversations with Fort Worth newsmakers, Dr. Michael Barakat, an emergency medicine physician at Texas Health Harris Methodist Hospital Fort Worth, discusses how to protect yourself from heat-related illness. 

This conversation has been edited for length and clarity. For a longer version, please listen to the audio file attached to this article.

Alexis Allison: Dr. Barakat, what’s the relationship between heat and health?

Dr. Michael Barakat: That’s actually a little bit of a complicated question, because there are a lot of internal factors related to each person that regulate how well their body can deal with heat. But, what we know generally is that, when an outside temperature is higher than a person’s internal temperature — so normally we’re around 98 and a half degrees — when the outside temperature is higher than that, it does start to interfere with our body’s ability to dissipate heat. 

Once that happens, the internal heat within us slowly builds up. And as that heat builds up, our body systems will break down over time. The amount of time that this takes to occur really does widely vary. That’ll depend on a person’s genetics, on their health, on what the outside temperature actually is, how long were you outside in that temperature? And then also, the humidity as well. A higher humidity will increase the danger there.

Allison: What are some examples of heat-related illness?

Barakat: Absolutely. There’s a wide spectrum here. At the beginning of the spectrum, with the heat-related illness, you’ll see muscle cramps, and that can progress to heat exhaustion, and then ultimately, can culminate in heatstroke, which is, by far, the most dangerous of all those things. In terms of our body’s ability to adapt to heat, we are far poorer at adapting to heat than we are to cold. We can actually deal with quite a bit of cold. Maybe not in Texas, but you know, most places we can deal with a bit of cold. But heat, not so much. We don’t have quite the buffer, not nearly the amount of buffer internally to deal with heat fluctuations. So it’s really interesting.

Allison: Can you tell us what’s happening in a person’s body when they’re experiencing heat exhaustion or heatstroke?

Barakat: Yes. So, initially, you’ll start off with something like a heat cramp. We’re still not sure, electrolyte-wise, why these heat cramps will happen. But it tends to be the first sign and when someone’s exerting themselves in heat, bad muscle cramps. And then it’ll progress from there to absolute utter exhaustion, more so than, ‘Oh, I’m just tired after a run.’ Like it’s, ‘No, I can’t, I can’t stand up, I can’t keep running.’ You may notice when you check that person’s temperature that their temperature’s high, maybe even as high as 102, 103, 104 degrees, I mean, big-time fevers. And again, as we progress, as we start to get more dangerous, your blood pressure can drop. 

And then, when you look at the skin, the skin is a real telltale sign. Remember that our main way of releasing heat is evaporation, through sweat on the skin. And so you should notice when someone who’s in the beginning stages of heat illness, that their skin is flushed, it’s hot, and it’s sweaty. That’s what it should look like. However, as we progress to something like a heatstroke, which is again potentially deadly, those mechanisms are breaking down and the skin is actually dry. And that is a very bad sign when you see someone in the heat and their skin is now dry. 

Another dangerous sign would be someone who’s confused, and that’s why we call it heatstroke because there’s a confusion, there’s an altered mental status component to it and that is very dangerous.

Allison: Say a person does have heatstroke, what would you advise them to do?

Barakat: Well, first thing is, if we’re at the heatstroke point, we are now calling the ambulance, and we’re getting to the nearest emergency room, because that is a potentially fatal situation. Now, of course, hopefully, we’ve been looking for other signs, and we’re catching heat illness prior to heatstroke. And it’s sort of maximizing the ability to dissipate heat. And so moisture on the skin, you know, convection, cold packs on the skin, hydration, removing someone from that environment. We need to get you in the shade, we need to get you in the air condition(ing), we need ice packs on you. We need cold fluids, either through an IV or orally, hopefully, if that’s still an option. So those are all basic, basic steps before we have to go to the ER. But yes, certainly, once we’re dealing with heatstroke, we need to see you in our ER.

Allison: I know there are some people who may work outside, for example, or who are (homeless). If they’re in an extreme heat situation, what do you recommend to them?

Barakat: Right, the first bit of advice I guess I would give generally, to all of us: I think just to be humble and recognize that heat-related illness can happen to any of us. Put yourself in the best position to succeed by attempting to acclimate to your environment. So, you don’t just go from, you know, the classic weekend warrior, right, where you’ve been sitting inside all week in the air conditioning, and then suddenly, it’s a Saturday, and you’re gonna put eight hours outside of working out and building a shed in 100 plus degree weather. Well, you have not set yourself up for success. So, acclimatize to the temperature, to the environment, and also, make it appropriate to your level of fitness. So being as physically fit as possible will maximize your success in preventing heat-related illness. 

And then, also hydration, of course, being as hydrated as you can. Now, you mentioned those that work outside or those that are (homeless)? Well, in that case, they’re sort of forced into the exposure in some sense. And so that is a potentially very dangerous situation. My hope, certainly for the (homeless), would be that they would be able to seek shelter in that time, to remain in a shaded position as hydrated as possible. 

And if that’s something they’re having difficulty obtaining, like I know certainly in our emergency room at (Texas Health Resources), we have an extensive sort of case management and social work team that will help those individuals get placed into a homeless shelter. Because certainly, we need to get them out of that potentially dangerous environment.

Need help with heat? 

  1. Visit the United Way of Tarrant County’s online resource database here for updated information about agencies providing fans, air conditioners and utility assistance. Alternately, you can call 211.
  2. Plug in your zip code here to find a cooling center near you.

Allison: At the beginning of our conversation, you mentioned that every body is different, so heat will affect different bodies in different ways. Is there a specific temperature range where you as a physician start to be concerned about an increase in heat-related illnesses?

Barakat: Yes, so we have several ways of dealing with internal heat build-up: evaporation, convection. And those heat systems or those heat-regulation systems become ineffective or less effective as the ambient temperature exceeds our internal temperature. So, once we’re getting above 98 degrees, we are less able to dissipate the heat that’s within us. Now, once you get to about nine degrees above that outside, if you have prolonged exposure in that temperature, you start to see organ system dysfunction. You may see that in the kidneys. You may see it in the brain, you may see it in the heart, you’re starting to get some cell breakdown. 

Allison: Thank you for sharing that. Is there anything else that you’d like to add any other resources that you’d like to pass along?

Barakat: I think I’d just give some general advice. Remember that the sun can make fools of us all. OK? Heat-related illness is still one of the leading causes of deaths in young athletes, and it’s entirely preventable. Don’t let it happen to you, don’t let it happen to someone that you love. Take precautions and be aware.

Allison: Thank you so much, Dr. Barakat.

Barakat: You are welcome.

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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Alexis Allison

Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....