After Phoenix temperatures hit over the 110-degree mark for a record 55 days last summer, all eyes – and temperatures – are on Phoenix as temperatures rise.
The heat in Phoenix in 2023 shattered records, drew national attention and resulted in a record number of heat-related deaths: 645. The Maricopa County medical examiner is tasked with investigating each one of those deaths and determining if heat was an important factor.
Dr. Jeff Johnston, the chief medical examiner, is getting ready for a lot more of those investigations in the hope that the data will help public health officials prevent heat-related deaths. The Show spoke with him more about it.
Full interview
JEFF JOHNSTON: Now that we have two of these summers where we have a higher surge of deaths — particularly in July — under our belt, we have a lot of lessons learned about places where there are bottlenecks in our process that we need to do something else to make sure that we’re handling that higher rate that we’re seeing better. So we’re really applying those lessons learned from the last two years and running up training at this stage to really prepare for the coming weeks.
LAUREN GILGER: So have you or can you beef up staff, equipment? Are you anticipating that the morgue will be full, essentially?
JOHNSTON: So we always plan on being able to respond to surges like this, and storage capacity is something we’re thinking about. And a lot of that really is the in and out. How many admissions we have or decedents we need to examine, there’s obviously some time that it takes to do those processes. So how can we make that as fast as possible while not reducing the quality of the work.
And then there’s the release side. So that is on funeral homes and families making decisions and those types of factors. So there’s a lot of variables there.
GILGER: So let’s talk about how you determine this when something is ruled as a, as a heat-associated or a heat-related death. What does that mean exactly? We saw the first heat-related death already happen this year. And that was kind of before we even reached triple digits, right?
JOHNSTON: Yes. So really what we’re doing is the same thing we’re doing with all the other deaths that we investigate here at the medical examiner’s office. So it’s about 17% of the total deaths in the county every year are ones that the law says we really need to do a professional medical death investigation of.
And so we’re going to dig a little bit deeper. We’re going to make sure that we’re more confident about what the cause is and then look at other factors around that death so that hopefully, folks can put interventions in place so that we reduce deaths in the community.
So for a heat-related death, really, it’s any time someone is exposed to an extreme heat environment and we believe that that heat contributes to their death in a significant way.
GILGER: So what does that mean, “in a significant way”? Are you looking at everything that caused a death and heat is one of the things? And that will be counted, under this sort of tally of heat related deaths?
JOHNSTON: Yes. So we want to make sure that we’re inclusive of all the things where we think that he played a significant role. So we’re not going to just count a death because it happens during the summer and maybe somebody who’s outdoors.
We’re really thinking about what kind of exposure they had, what other risks they have, what the evidence is that the person wasn’t able to get out of that heat to a cooler environment, those types of things.
GILGER: I know a lot of this has had to do with the rise in temperatures in the Valley, but also the rise in the number of people experiencing homelessness. Talk about some of the other factors that play in here and the other populations that are really at risk.
JOHNSTON: We see a significant number of people are over 40. Certainly, like you said, in recent years, we’ve seen a larger proportion of heat-related deaths. Are people experiencing homelessness? This isn’t surprising. If you don’t have a way to get to a cooler environment, you’re exposed to that hazard for longer into more intense versions of it.
Certainly people who are struggling with substance use disorders — particularly methamphetamine, which undermines our body’s ability to adapt to heat and help us to, sort of mitigate the effects of heat on our body.
GILGER: We hear a lot about the rise in fentanyl and the deadliness of that drug in particular. Are we seeing, relationship there in terms of heat associated deaths?
JOHNSTON: Fentanyl and methamphetamine are really the two biggest actors in the drug-related deaths we have, and that includes ones where heat is also a contributory factor. In the folks who are experiencing homelessness, we do tend to see more methamphetamine actually, than fentanyl. And I do think that that nexus with heat is probably a piece of that, again because it’s working against a lot of the mechanisms your body is trying to do to keep you cool.
GILGER: So in that case, in terms of how these things are counted, and if we’re counting numbers, and the numbers matter more and more every year, right? If we’re looking at 640-something deaths from last year that are associated to heat, if somebody overdoses on fentanyl or methamphetamine and then is outside, is that ruled a heat-associated death?
JOHNSTON: Yeah. So we would certify that as heat related. And it would depend really on the details of that individual in that individual case. And our forensic pathologist looking at all the data to decide, is it primarily the drugs that are at play and the heat just contributes to it? Or is it the other way around, where the heat is really the new thing that is mainly at play and the fentanyl or the methamphetamine intoxication that’s contributory?
GILGER: What do you want people to know about this? Like, do you think enough people take this into account when they’re out and about or making life decisions, essentially, in the summer here? The conversation seems to have really changed.
JOHNSTON: Yeah, I’ve noticed that, too. I’m glad to see that there’s more awareness out there. I do think it’s a really challenging thing. We all know here in the Sonoran Desert that it’s hot in the summer. None of that’s a surprise.
So really the question is: When is it too hot, and when is it too hot for you? So, somebody who’s got cardiovascular disease and other medical risk factors, maybe is older. Their tolerance to heat is going to be less than somebody, maybe, who’s young and fit. But it doesn’t mean that there aren’t heat situations where even that young, fit person shouldn’t go out hiking on the trails. It’s too risky.
So the National Weather Service has a new tool. They’ve been using it here for quite some time, but they’ve opened it up to the rest of the country where they’re really looking at heat risk. So there’s a moderate, severe and, extreme. And these are color-coded. And those things can help us look at the day.
So the next three days are severe risk. So these are risky for lots of people. So trying to avoid the heat of the day and those risky days is a good idea. Checking on people that may be vulnerable. So if you have neighbors who are elderly living alone or are in precarious situations, checking on them more frequently, those things can save lives in our community.
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