Sometimes newspaper stories are the product of a collaboration of reporters. One will take the lead reporting and writing role, while others pursue other components of the story. At some point during the afternoon, the contributors file their "inserts" or "feeds" to the lead reporter, who assembles it all into a (hopefully) coherent whole. If the contribution is substantial, they'll get a "shared" byline with the lead writer (whose name goes first at the top of the story). If it's less substantial, the contributor will get a "contributor line" - a mention, at the bottom of the story.
And sometimes the contributing reporter files so much material that much, or most of it never makes it into the story, and it dies on "the cutting room floor," or in our case, in the computer system, to be purged a few days later and sent into digital oblivion.
Today's P. 1 story by Julie Scharper, on the heat-related death of a Baltimore man, is a case in point. My job was to find out why people die from heat exposure, and how it's diagnosed. Tight space, and the fact that I habitually report and write too much, led most of what I came up with yesterday to be cut from the final version of Julie's story. That's fine. It happens a lot.
But since it's weather-related, and may help readers understand why it's so important to check on the elderly and other vulnerable individuals during extreme hot weather (and because I took a great deal of time from Dr. Thomas Kirsch, the director of operations at Johns Hopkins Emergency Medicine to gather the information), I thought I'd resurrect the cuts and offer them here:
Humans have evolved a variety of mechanisms to cool things down if we can’t escape our overheated environment.
The tiny capillaries in our skin open up, bringing more blood to the surface, where it can radiate and dissipate body heat into the air. But the most efficient mechanism is the evaporation of sweat.
As temperatures rise, our sweat glands start moving water — and heat — to the surface. It evaporates, and the body cools.
High relative humidities – above about 75 percent — can make that evaporation impossible.
Healthy people who engage in strenuous activity in the extreme heat and humidity may also drive up their body temperature faster than their bodies cool off.
But the most vulnerable are the very young, the elderly, the sick, the obese and people on certain medications, Kirsch said. Abnormal skin, or medicine that inhibits sweating can get people into trouble. So can certain heart medications.
The increased blood volume that must flow to the skin to cool the body puts a big extra load on a weakened heart. And some cardiac drugs may make it even harder for the heart to keep up.
If the body generates heat faster that it can shed it, the core body temperature slowly rises. Normal metabolic processes quit working, and organs begin to fail.
One of the key danger signs is a change in a victim’s mental status – lethargy, confusion or coma, Kirsch said. "Anyone who comes in [to the ER] during a heat wave acting confused, a diagnosis of acute hyperthermia is way up on our list."
That, plus high body core temperatures trigger immediate intervention.
"Cooling, as fast as possible," Kirsch said. That can mean cooling blankets, or ice packs in the armpits or groin.
"But evaporation is still the best way to conduct heat away from the body," he said. "We strip them down, put fans in the room and have people continually spray water over them … just a cleaning bottle with water."
It’s often not enough, he said. Studies have found that one in five patients who arrive at the ER with body core temperatures of 104 or higher will die. And some of those who survive leave with permanent brain damage, or in a coma.
The lessons are clear, Kirsch said. "When the [outside] temperature goes up like that you have got to get out of the heat."
"If anyone has an elderly relative, they should clearly, during a heat wave, check on them, and try their best to get them out of the hot environment. And if there are any signs of confusion, they need to call 911."