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Summer Safety

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Heat of the Moment

hcncover0717The rising temperatures are a great reason to have fun outdoors. But those summer activities pose myriad dangers, from sunstroke to tick-borne illnesses to drowning. Fortunately, most of these risks can be reduced and even eliminated through proper planning and common sense.

It’s not exactly news that kids spend too much time indoors, sedentary, in thrall to their electronic devices. The warm weather of summer should be an antidote, providing plenty of opportunity for exercise and recreation that doesn’t involve a screen.

On the other hand, the outdoors poses other types of hazards.

“Any time there are extremes in temperature, we start seeing things, and during the summer, there’s a big increase in minor stuff as well as some major stuff,” said Dr. Louis Durkin, director of the Emergency Department at Mercy Medical Center. “That’s the reality. So while it’s good to get the kids out of the house, where they’re not playing video games and watching TV, you take the danger with the benefits.”

Many issues, as he noted, are indeed relatively minor, from sunburns and poison ivy to overexertion injuries to weekend warriors who spent the cold months indoors and then overdo it with sports or home projects once the weather warms up.

However, Durkin continued, “on the bigger, more tragic side, we see an increase in drownings, people diving into the shallow end of pools and sustaining neck fractures, even violence. Usually, on the first hot days, when people get outdoors and have more exposure to each other, we see an increase in violence.”

The good news, he said, is that most summertime health and safety hazards, from heatstroke to trampoline injuries, are preventable. For this issue’s focus on summer safety, BusinessWest examines several common summer dangers — and strategies for reducing the risk of each.

It’s Getting Hot Out Here

Simply put, said Dr. Heba Wassif, “hot weather can be deadly.”

Wassif, who practices with the Heart & Vascular Program at Baystate Medical Center, noted that extreme heat — considered the number-one weather-related killer in the U.S. — affects people in different ways, and those at greatest risk include adults with existing heart and other chronic diseases, the elderly, and children.

“Sweating is the body’s defense mechanism to cool down, but at the same time, it results in the loss of more fluid than usual from your body,” she said. “This can cause your blood pressure to drop and your heart rate to increase to compensate for your fluid loss, so you may feel palpitations as your heart beats faster.”

Warning signs of an oncoming heat-related illness, she explained, could include excessive sweating, leg cramps, flushed skin, nausea and vomiting, dizziness, headache, and rapid pulse. Anyone experiencing such symptoms should get indoors or into shade and drink liquids, and, if they don’t better soon, should call a doctor or visit the ER.

In fact, Wassif went on, heat stroke can cause death or permanent disability, including damage to the brain and other vital organs, and requires immediate emergency medical treatment. Warning signs of heat stroke can vary, but may include body temperature of 103 degrees or higher, dizziness, throbbing headache, nausea, confusion, rapid pulse, and, in critical cases, unconsciousness.

Dr. Louis Durkin says emergency departments see an uptick of heat-, water-, and even violence-related incidents when summer arrives.

Dr. Louis Durkin says emergency departments see an uptick of heat-, water-, and even violence-related incidents when summer arrives.

“The best advice I can give to anyone in the extreme heat, whether healthy or predisposed to any health conditions, especially cardiac disease, is to take it slow and easy and not exert yourself,” she said. “Try to stay out of the heat during the hottest part of the day, usually between 11 a.m. and 3 p.m., and stay hydrated by drinking plenty of water and sugar-free drinks while avoiding alcohol or caffeinated beverages.”

Dr. Joseph Schmidt, Baystate’s vice chair and chief of Emergency Medicine, noted that hot weather can affect certain medications as well.

“If you are taking certain medications, whether prescription or over the counter, sunlight may not be the best for you,” he said. “Certain drugs can impair your ability to deal with the heat and increase your sensitivity to sunlight, called drug-induced photosensitivity. As a result, your skin can burn at a much quicker rate than usual, even with a lower intensity of sunlight.”

Then there’s the issue of closed, overheated cars in the summer — a moment of carelessness that too-often kills children and pets, Durkin said. “Obviously, every year you hear about these tragedies, people forgetting about infants or pets in cars.”

Even many parents who would never leave their child alone in a hot car don’t have qualms about leaving their dogs there. But while humans cool themselves by relying on a system of sweat glands and evaporation, animals have a harder time staying cool, leaving them extremely vulnerable to heatstroke, according to the Animal Legal Defense Fund.

For example, on a day when it’s 70 degrees outside, the temperature inside a car with all the windows closed can approach 90 degrees in just 10 minutes, according to the American Veterinary Medical Assoc. On a particularly hot day, the temperature inside a closed car can shoot as high as 114 degrees in the same amount of time.

For that reason, it is legal in Massachusetts to break an animal out of a car, under certain circumstances. Specifically, after making reasonable efforts to locate the vehicle’s owner and notifying law enforcement or calling 911 before entering the vehicle, someone who believes entry into the vehicle is necessary to prevent imminent danger or harm to the animal, and plans to stay with the animal nearby afterward, may force their way into the vehicle to remove the animal, free from criminal or civil liability.

Dr. Michael Klatte

Dr. Michael Klatte

Children are especially at risk for acquiring RWIs since they usually play in the water for longer periods of time and swallow more water than adults typically do..”

Water, Water Everywhere

The other major summer killer after the heat itself is one of the ways people beat the heat: the water.

“Water safety is simple stuff,” Durkin said. “If you can’t swim, or if you’re out boating, wear a flotation device. Swim only in designated areas, and never swim alone. And if you have small children, put an alarm on the pool; those save lives.”

The American Red Cross lists several tips for enjoying the water safely, including:

• Swim in designated areas supervised by lifeguards, and always swim with a companion.

• Ensure that everyone in the family learns to swim well by enrolling in age-appropriate water-orientation and swimming courses.

• Never leave a young child unattended near water, and do not trust a child’s life to another child. Have young children or inexperienced swimmers wear U.S. Coast Guard-approved lifejackets around water, but do not rely on lifejackets alone.

• Set limits based on each person’s ability, do not let anyone play around drains and suction fittings, and do not allow swimmers to hyperventilate before swimming underwater or have breath-holding contests.

• Even if you do not plan on swimming, be cautious around natural bodies of water, including ocean shorelines, rivers, and lakes. Cold temperatures, currents, and underwater hazards can make a fall into these bodies of water dangerous.

• Install and use barriers around a home pool or hot tub. Safety covers and pool alarms should be added as additional layers of protection.

Drowning isn’t the only water hazard, however. Recreational water illnesses (RWIs) can pop up in both treated and untreated waters — from pools, hot tubs, and water parks to freshwater lakes, rivers, ponds, and even the ocean, said Dr. Michael Klatte, who works in Pediatric Infectious Diseases at Baystate Children’s Hospital.

RWIs are caused by germs and chemicals found in these waters, which can result in gastrointestinal, skin, and ear diseases, chemical irritations of the eyes and lungs, and, sometimes, neurologic and wound infections. The most commonly reported RWI is diarrhea, frequently caused by germs such as Cryptosporidium and E. coli. Otitis externa, commonly known as swimmer’s ear, is another common RWI. Those with weakened immune systems and pregnant women are at greater risk for more severe water-borne illnesses.

“Children are especially at risk for acquiring RWIs since they usually play in the water for longer periods of time and swallow more water than adults typically do,” Klatte said. He advises swimmers not to swallow water, to stay out of the water if they have diarrhea or an open wound, to shower before swimming, and to check diapers and change them in a bathroom or diaper-changing area — not waterside.

Clear Your Head

No matter what the activity, Durkin said, alcohol will invariably increase the risk of harm or death, so people need to monitor their intake. Alcohol impairs judgment and coordination, affects swimming and driving skills, and affects the body’s ability to regulate heat.

But having fun while sober is just one of many common-sense ways to enjoy the summer safely. Shriners Hospitals for Children recently got into the act with a program called Superheroes of Summer Safety, which offers tips to reduce the risk of injuries during the summer months.

“As a father and Shriner, I know that, within seconds, a fun-filled day can take a turn when an unexpected accident occurs,” said NASCAR driver David Ragan, the program’s spokesperson. “Shriners Hospitals and I want to provide families with simple ways to reduce the risk of childhood injuries so that kids can enjoy a safe summer.”

With the help of the National Assoc. of School Nurses, the national health system printed 125,000 safety materials to be distributed to kids and families. Advice includes playground tips like sliding feet first and swinging while sitting down; keeping children inside when lawnmowers are in use; keeping several feet away from firepits, campfires, or grills; and the usual warnings about sun protection and swimming with a lifejacket and a companion.

“At the very least, we can decrease the chances of bad things happening, if not outright prevent them. Most of this is common sense,” Durkin said. “Being active is good, but being active and smart is better.”

Joseph Bednar can be reached at [email protected]

Sections Summer Safety

Hot Topic

By Meghan Rothschild and Dr. Antonio Cruz

Meghan Rothschild

Meghan Rothschild’s own skin-cancer scare started her on a path toward skin-health advocacy on the national level.

Many of us are far too familiar with the unsightly consequences of having too much fun in the sun (redness, possibly even swelling, blisters, and peeling of the skin), but what isn’t as obvious is the damage being done underneath the skin.

A sunburn is a preventable risk factor for accelerating aging of the skin and skin cancer. Dermatologists agree that the most effective way to keep skin looking young and healthy is to protect ourselves from the sun. With the season of long, sunny days upon us, let’s review why this simple bit of advice is important to adhere to.

A sunburn is an inflammatory response of the skin caused by excessive ultraviolet radiation (UVR) exposure. Both UVA (320 to 400 nm) and UVB (280 to 320 nm) wavelengths can induce a sunburn; however, UVB are the most successful at provoking erythema (superficial reddening of the skin) and DNA damage. The risk of a sunburn is inversely related to latitude; therefore, the greatest risk is closest to the equator, where UVB intensity is most significant. No matter how close to the equator you may find yourself this summer, remember that UVB intensity is highest everywhere between 10 a.m. and 4 p.m.

So what exactly is happening to the skin as it’s absorbing all this UVR? UV photons damage the bonds between the four nucleotides that make up cellular DNA (thymine, cytosine, adenine, and guanine). These damaged cells then undergo apoptosis (programmed cell death), which leads to a cascade of unfortunate events. Within 30 minutes, the superficial blood vessels under the skin begin to vasodilate. Blood, along with inflammatory mediators, rush to the site of damage to help with the healing process. As a result, we experience redness and painful inflammation of the skin.

Dr. Antonio Cruz

Dr. Antonio Cruz

The acute skin manifestations associated with sunburns typically resolve on their own within three to seven days. The damage that happens on the cellular level is not always as transient.”

The acute skin manifestations associated with sunburns typically resolve on their own within three to seven days. The damage that happens on the cellular level is not always as transient. Sometimes, UVR causes damage to the DNA repair process in a way that allows cells to mutate and acquire the ability to avoid dying, which leads to the disease process known as cancer.

Skin cancer is the most common form of cancer in the U.S. Susceptibility to a sunburn is a red flag for susceptibility to skin cancer; however, everyone, regardless of skin type, is at risk for the potential adverse effects of UVR. Therefore, the use of sunscreen should be a part of everyone’s daily skin-care routine. Broad-spectrum products with a sun-protection factor (SPF) of 30 or greater are recommended.

Sunscreen should be applied generously, repeatedly, and to all parts of the skin that are exposed to the sun. You can use the ‘shot-glass rule’ when applying sunscreen; studies have shown the average-size adult or child needs about the amount of sunscreen that it takes to fill a shot glass in order to evenly cover the entire body. Experts also agree that it is best for sunscreen to be applied 15 to 30 minutes before going out in the sun to allow formation of a protective barrier, and should be reapplied every two hours. Avoidance of the sun during peak daylight hours and the use of protective sunscreen are vital to keeping your skin young and cancer-free.

Melanoma, the deadliest form of skin cancer, is easily preventable. When sunscreen is used on a regular basis, we know that your chance of developing skin cancer decreases.

Here are some great tips on how you can ensure you and your family are being sun-safe:

• Wear SPF 30 or above regularly, especially when outdoors, using a full 1-ounce portion to cover all exposed parts of your body;
• Be sure to rub the sunscreen in thoroughly and to reapply every two hours;
• Wear a hat, protective clothing, and sunglasses; and
• Don’t forget the tops of your ears, feet, and back of the hands.

This summer, remember to protect yourself against the sun’s harmful UV Rays. Here are some great tips on how you can ensure you and your family are being sun-safe:

• Wear SPF 30 or above regularly, especially when outdoors, using a full 1-ounce portion to cover all exposed parts of your body;

• Be sure to rub the sunscreen in thoroughly and to reapply every two hours;

• Wear a hat, protective clothing, and sunglasses; and

• Don’t forget the tops of your ears, feet, and back of the hands.

IMPACT Melanoma, a national nonprofit aimed at reducing the incidence of melanoma, the deadliest form of skin cancer, is committed to sun safety. Recently, it conducted an independent national survey of 1,016 adults inquiring about frequency of sunscreen application by season, sunscreen preference, and opinions about free public sunscreen.

The results were in some ways anticipated, with 86% of participants always or sometimes using sunscreen during the summer months, but also surprising, finding a near-complete reversal of use between summer and fall, lower use of sunscreen in Southern states despite the warmer climates, and a concerning lack of use among African-Americans, even in summer months. Remember, is important to protect yourself all year, as the sun’s harmful UV rays are always present.

Meghan Rothschild is Marketing & PR manager for IMPACT Melanoma, and a 12-year melanoma survivor who started her own awareness organization, Surviving Skin, 10 years ago. She advocates for skin health through interviews with national media and by appearing as a speaker at various engagements across the Massachusetts. Dr. Antonio Cruz is a dermatologist with SkinPros in Providence, R.I., focusing his practice on Mohs micrographic surgery, dermatologic surgery, and cosmetic dermatology.

Sections Summer Safety

Tick Talk

By Dr. Amy Jaworek

Summertime has arrived, and with it comes swimming, hiking, outdoor traveling … and ticks. If you enjoy hiking, gardening, or engaging in pretty much any outdoor activity, there are some things you should be aware of to help prevent tick-borne illness.

Ticks are arachnids, with eight legs, just like their spider cousins. They do not jump, fly, or fall from trees; rather, they crawl from grasses onto the legs of animals and humans, clothing, and boots. Ticks feed on the blood of animals, mainly white-footed mice and deer. If infected with bacteria, viruses, or parasites, a biting tick poses a risk to human health.

Amy Jaworek

Amy Jaworek

Some infected people don’t have any symptoms, while others experience joint pain, muscle soreness, flu-like cold symptoms, or general achiness.”

Ticks are most often found living in places where small rodents are active, such as stone walls, under leaves or brush, in tall grassy fields and pastures, in woodlots, along borders between homes and woods, and around building foundations where there is shrubbery, foliage, or tall grass.

Scientists are predicting the warm, humid summer months could bring an unusual abundance of ticks and tick-borne illnesses this summer. According to the Centers for Disease Control and Prevention (CDC), more than 30,000 cases of Lyme disease are reported nationwide each year, while studies suggest the actual number of people diagnosed with Lyme disease is more likely about 300,000.

Many people don’t realize they are at risk. Now is a good time to learn, and employ, prevention techniques. There are some simple steps you can take to reduce your chance of being bit by ticks this summer.

According to the American Lyme Disease Foundation (ALDF), Lyme disease is an infection caused by Borrelia burgdorferi, a type of bacterium called a spirochete (pronounced spy-ro-keet) that is carried by deer ticks.

“An infected tick can transmit the spirochete to the humans and animals it bites.” according to the ALDF. “Untreated, the bacterium travels through the bloodstream, establishes itself in various body tissues, and can cause a number of symptoms, some of which are severe. Lyme disease manifests itself as a multi-system inflammatory disease that affects the skin in its early, localized stage, and spreads to the joints, nervous system, and, to a lesser extent, other organ systems in its later, disseminated stages. If diagnosed and treated early with antibiotics, it is almost always readily cured.

“Generally, LD in its later stages can also be treated effectively,” the ALDF notes, “but because the rate of disease progression and individual response to treatment varies from one patient to the next, some patients may have symptoms that linger for months or even years following treatment. In rare instances, Lyme disease causes permanent damage.”

When you’re bit by a tick, you won’t necessarily see a bull’s-eye type of rash, as is commonly thought. A tick bite could manifest in the form of a persistent rash, bump, or red spot on the skin. If you question such an area, have it checked out by your doctor.

Some infected people don’t have any symptoms, while others experience joint pain, muscle soreness, flu-like cold symptoms, or general achiness. If you experience symptoms out of the ordinary for you, see your doctor to find out whether Lyme, or another tick-borne illness, could be the culprit.

The Centers for Disease Control and Prevention provides tips for removing an embedded tick from your body: grasp it with fine-tipped tweezers as close to the skin as possible; pull upward with steady, even pressure to keep the tick intact; and clean the bite site and your hands thoroughly with rubbing alcohol, an iodine scrub, or soap and water. Place the tick in a baggie and seal it with tape, or flush the tick down the toilet. The CDC recommends checking with your doctor before sending a tick on for testing.

Other prevention tips from the CDC include:

• Avoid the border areas between lawns and woods, which is where ticks make their habitats;

• Use tick repellent on your body (with DEET) and clothing (with permethrin);

• Don’t let your dog off leash, instead keeping them in the middle of trails;

• Tuck your pants into your socks or boots when hiking in the woods or field areas;

• Shower as soon as possible after coming in from outdoors;

• Do regular full-body tick checks of yourself, your children, spouse, etc.;

• Check your pets, gear, and backpacks for crawling ticks;

• Around the home, try to create a tick-safe zone: clear brush, leaves, and tall grasses; mow the lawn frequently; stack wood in a dry area; and discourage unwelcome animals such as deer, raccoons, and stray dogs; and

• Tumble-dry clothing in a dryer on high heat for at least 10 minutes (this kills ticks, whereas cold or medium temperatures do not).

Dr. Amy Jaworek is an infectious-disease and primary-care physician at Holyoke Medical Center.