NH Climate Health Action Talk
NH CHAT
August, 2023
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Impact of Flooding on an NH Social Worker
How Daily Medications Can Make Us More Sensitive to the Heat
Working Group Updates
Fundraising Update
Sustainability Corner: Your Choice of Sustainable Anesthesia Can Make a BIG Difference
Spread the Word!
Impact of Flooding on an NH Social Worker
By Rachel Kowalsky
Being a social worker on a good day is a challenge. I travel and work with family in their homes in Cheshire County, New Hampshire. Many face significant challenges to provide for their children. It is my job to meet these families where they are at, partner with them, and empower them to move them forward. July has been a difficult month for many of these families. At first with the high heat and humidity, many were irritable, some were angry, and some were distraught due to lack of ability to find a cool refuge from the heat. Many of the families I serve lack transportation to get to cooling centers. Those cooling centers in rural Cheshire county are also few and far between.
Early on in July, Cheshire county was hit with a tremendous amount of rain. Several of the roads I use to travel to families were impassable. A dam in Swanzey, New Hampshire had failed, causing flooding that hadn’t been seen for a number of years. This flooding shut down Route 10 between Winchester and Keene. Thankfully, I was able to keep in contact with one family that had been cut off by road closures. We would speak on the phone rather than meet in person - very reminiscent of providing support throughout the COVID pandemic. The mother of this particular family asked me what I thought of the rain and the flood.
“Well,” I began, “ This weather we are experiencing is going to become the norm. This is climate change.”
I took this as a teaching opportunity and my chance to start educating about climate change. “So, this is going to keep happening? I don’t think I can deal with this on top of everything else...” She told me.
“I believe unfortunately, yes. This will keep happening. What if we started working on building supports for weather events like we’ve just been through? What if you had the knowledge to help support and protect yourself and the kids from these events?” I asked.
“This might help. It wasn’t so bad. I guess. But I just hate feeling so stuck. The kids and I can’t get out anywhere right now. ” She told me.
“For starters, as you know there is a family resource center at my office in Keene. You can go there if you need anything. Even to take refuge from the weather. We are working towards making this resource center a shelter for the county.” I tried to set her mind at ease. “If you had known this, would you have utilized it?”
“If I couldn’t get to my parents' place, I might have. I was pretty lucky to get there until the other road washed out too. But the kids and I are ok for now.”
Many of my families that I partner with do not make the connection between adverse weather and climate change. They acknowledge both separately and believe that these weather events are still just anomalies that may not be repeated. I have begun trying to make these connections as well as a connection that there are supports out there for so many families who are directly in harm's way due to climate change. Just another obstacle to help families find support in Cheshire County, New Hampshire.
Learn about Flood Recovery Resources at Vital Communities here.
How Daily Medications can make us More Sensitive to the Heat
By Cynthia Nichols, MS, BSN, RN
There are perhaps two surprising things about summer heat – one is that heat is more deadly than other weather events, even hurricanes, tornadoes, and snow storms (https://www.weather.gov/hazstat)– and the other is that everyday medications can affect how your body manages the heat. Our medications are helping us in many ways – so we shouldn’t stop taking them - but knowing how our medication can make us more sensitive to the heat can help us better manage staying cool on these hot summer days.
“Medications used to treat chronic medical conditions are associated with increased risk of hospitalization, emergency room admission, and in some cases, death from extreme heat.” (Gamble et al. 2016). Some of the medications mentioned by Gamble and included in several articles on the topic are medicines we use every day to treat high blood pressure, cardiovascular disease, depression and other medical conditions (Table 1). In the elderly, even in the absence of extreme heat, these medications can make them more sensitive to heat (Layton et al.).
The reason medications make a difference is because they may alter our body’s thermostat and often change how our body responds to heat. The body’s thermostat reacts to outside temperatures by dilating blood vessels at the skin level to dissipate heat and increases sweat production. When you sweat, the water on your skin evaporates and that transformation from liquid to vapor actually releases heat from your body. That’s why humidity changes how hot it feels because it prevents the evaporation and changes how sweating can help us cool off. That’s what the weather forecasters are talking about when they mention the Heat Index. The Heat Index includes the humidity with temperature and tells us what the temperature really feels like to our bodies (Figure 1). So sweating is good for managing heat, and also means we need to stay hydrated.
Figure 1: NWS Heat Index
Weather Service https://www.weather.gov/ama/heatindex
Figure 1. Showing Relative Humidity on the left compared with Temperature across the top. Looking at the temperature in one column and relate it to the humidity to the left, you’ll find the “Heat Index” that tells you how the temperature feels at different levels of humidity. Example: 84 degrees at 60% humidity actually feels like 88 degrees.
Now that we understand how the body handles heat and the complications of humidity – let’s consider some of our daily medications. Table 1 shows some of the medications that can make us more sensitive to the heat. It shows the class of medication, what they can be used to treat and how they can make it harder for the body to manage high temperatures. The therapeutic effects of the drugs can actually work contrary to the body’s normal reaction to managing heat. For example, many drugs like antihistamines have an antiocholinergic effect which can decrease sweating, alter the internal thermostat and alter blood flow to the skin – all of which makes it harder to cool off. Blood pressure medications lower blood pressure and if the body further dilates blood vessels to manage the heat,that can make it easier to faint. Diuretics used to treat congestive heart failure help us eliminate more fluids, but that also makes it harder to stay hydrated.
Table 1. Common medications, examples of what they are used to treat and how they can make it harder for the body to manage heat.
It should be noted that both dry heat and humid heat can be problematic. Last year 425 people died in Pheonix where this year they are dealing with a heat wave of historic proportions with 20 days above 100 as of July 20 (Davis-Young 2023).
The important message here is that knowing about how your medications may affect your body’s response to heat is part of your tool kit for managing heat. Prevention is key – stay hydrated, do your activities in the cooler hours if you can, wear light loose clothing, wear a hat and sunscreen, and take breaks. As my friend said to herself the other day when she was out picking blueberries – “not one more! Time to go inside and cool off”.
For information on treating heat exhaustion or heat stroke see the graphic below.
References:
Gamble, J.L., J. Balbus, M. Berger, K. Bouye, V. Campbell, K. Chief, K. Conlon, A. Crimmins, B. Flanagan, C. Gonzalez-Maddux, E. Hallisey, S. Hutchins, L. Jantarasami, S. Khoury, M. Kiefer, J. Kolling, K. Lynn, A. Manangan, M. McDonald, R. Morello-Frosch, M.H. Redsteer, P. Sheffield, K. Thigpen Tart, J. Watson, K.P. Whyte, and A.F. Wolkin, 2016: Ch. 9: Populations of Concern. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. U.S. Global Change Research Program, Washington, DC, 247–286. http://dx.doi.org/10.7930/J0Q81B0T
Layton JB, Li W, Yuan J, Gilman JP, Horton DB, et al. (2020) Heatwaves, medications, and heat-related hospitalization in older Medicare beneficiaries with chronic conditions. PLOS ONE 15(12): e0243665. https://doi.org/10.1371/journal.pone.0243665
Davis-Young, K. (2023, July 10) New measures are being taken to reduce heat-related deaths in Phoenix. National Public Radio. https://www.npr.org/2023/07/10/1186827280/new-measures-are-being-taken-to-reduce-heat-r elated-deaths-in-phoenix.
Table 1 Footnotes:
1. Pathak, N. (2022, July 26) Common medications may increase the dangers of heat waves. Yale Climate Connections. https://yaleclimateconnections.org/2022/07/common-medications-may-increase-the-dangers-of-heat-w aves/
2. Ghossein N, Kang M, Lakhkar AD. Anticholinergic Medications. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555893/
Working Group Updates
Behavioral Health Working Group
Dr. Robert Feder, Chair of the Working Group, recently gave a webinar to NH HWCA entitled, “Climate Change and Mental Health”, in collaboration with the NH Public Health Association, 350NH, Climate Mental Health Network, NH Psychiatric Society and the Climate Psychiatry Alliance.
Children’s Health Working Group
Pediatric health care professionals are trusted voices in our communities on children’s health, yet they infrequently make the association between climate change and health during encounters with patients and parents. The Climate Informed Pediatric Care project, recently funded by Dartmouth’s Irving Institute, will give pediatricians a tool to discuss climate and health in their practices.
The ultimate objective is to create a pediatric Climate Informed Care Toolkit for use in both practice-based trainings and eventually pediatric residency and medical student education. The toolkit will include vetted resource materials for patients and parents such as condition-specific information describing each condition’s relationship to climate change, tips to prevent or mitigate the effects of those conditions, and a checklist of actionable personal steps to reduce the risks of disease and the household’s contribution to greenhouse gasses. For health care professionals, the toolkit will likely provide crosswalks placing the usual pediatric anticipatory guidance in the context of climate change, scripts for linking climate to specific health issues (climate anxiety, heat stress, vector borne illness, asthma), and short role-playing videos demonstrating approaches to discuss climate impacts on health in the exam room.
Climate Justice
This summer Abigail Pauls, an undergraduate student at Haverford College has been working on climate justice research to enhance our Speakers Bureau Climate and Health presentations with a focus on equity. Meeting with members of the working group and community partners, she is gathering NH specific data to inform the work of the organization.
The group is also in the process of gathering information for an Emergency Response page on www.nhclimatehealth.org , to hold resources for folks who have experienced extreme weather/natural disasters.
Communications & Education
So far in 2023, our Speakers Bureau has given over 24 Climate and Health presentations to a variety of audiences including libraries, medical conferences, student groups and more. The LTE Writing Subcommittee has had 22 Letters to the Editors on various climate and health topics published in NH newspapers.
Our Nursing Education Subcommittee has been presenting in nursing student classrooms across NH, sharing climate and health curriculum that is continuing to be developed that aligns with the new AACN essentials and the 2023 NCLEX text plan.
Policy & Advocacy
Our Policy & Advocacy Working Group is currently working on the initial stages of drafting legislation: “An Act relative to the New Hampshire Department of Health and Human Services (DHHS) protection of the health of NH citizens by monitoring and responding to current and emerging health threats due to the changing environment”.
New Highlight Resource: Climate Change in the American Mind: Politics & Policy, Spring 2023 from Yale Program on Climate Change Communication and George Mason University Center for Climate Change Communication
Fundraising Update
By Joan Widmer, MS, MSBA, RN, Treasurer, Interim Executive Director
NH Healthcare Workers for Climate Action’s team has been busy fundraising on behalf of the organization. Thanks to so many of you, we have raised $69,920 in grants, $5,464 in donations and $710 in membership fees this year. We recently launched a Corporate Sponsorship program so if you know of any organization that would like to sponsor one of our webinars and/or an issue of NH CHAT, let Emily Thompson know. We are currently in the process of creating a Development Committee to help with these efforts. If you have any experience in fundraising, event planning or communications/social media and would like to help us, please let Emily know. Fundraising provides NH-HWCA with the critical operating capital it needs to continue the important work its volunteers are doing here in NH. We would love to have you on our team.
THE SUSTAINABILITY CORNER: Your Choice of Sustainable Anesthesia Can Make a BIG Difference.
By Paul Friedrichs, MD, Board Chair
Did you know that commonly used anesthetic gases can have more than 3,700 times the greenhouse effect of carbon dioxide? Your choice of anesthesia next time you undergo surgery can make a BIG difference. Desflurane, Isoflurane and Nitrous Oxide are all commonly used general anesthetics with potent greenhouse effects, and in standard use they are vented directly outside into our atmosphere.
What can we do differently? First, we should make sure that Desflurane use in our hospitals is retired in favor of Isoflurane for general anesthesia. Not only does Isoflurane have only one-third the greenhouse effect over its lifetime, it is considerably less expensive while demonstrating equal safety and efficacy in controlled trials.
Second, when both are options, we should consider regional anesthesia such as spinal or brachial plexus blocks using injections like lidocaine and bupivacaine, if necessary supplemented by IV conscious sedation, over general anesthesia using gas.
Third, instead of using nitrous oxide “laughing” gas, we should consider choosing IV conscious sedation for dental and oral surgeries and epidural anesthesia for obstetric labor when anesthesia is required. And if nitrous oxide is used, make sure it’s delivered through an inspiration-triggered shut-off valve rather than continuous flow, and from a closed tank in the room rather than piped through the building, as studies have shown excessive leakage when piped from a central source. Lastly, talk to your hospital about capturing their exhaled anesthetic gasses for reuse after recycling through an FDA-approved company, which is now available, rather than venting them directly outside into the atmosphere.
And please talk to us if you are ready to promote sustainability initiatives in YOUR local hospital!
Spread the Word!
By Peter Jones, Director of Philanthropy
What a summer to remember! A woman that I ran into recently told me that in her twenty plus years of living in New Hampshire, summer will never be the same as she remembers it. Living part of the time in mid-coast Maine, I crave for a day that does not start out foggy and humid. And I imagine that you, too, crave a day that helps you remember the summer of the past.
While climate change is here to stay, it is also a time to work together and to become engaged in addressing this critical issue. While we are facing huge challenges, it is the grassroots groups like NH-HWCA that are acting and affecting change. As a grant reader for the New England Grassroots Environmental Fund, I can attest to, and I’m inspired by the great work that grassroots groups are doing to address climate change across New England. It is work by NH-HWCA and other grassroots groups that are going to roll back climate’s effects.
We need you to spread the word about NH-HWCA and how they can become involved. We need you to tell more of your friends and acquaintances that can do something about climate change. They can become a member. They can join one of our five working groups. And they can go to NH-HWCA’s website for ideas and ways to become engaged.
Please spread the word about our work.
