By Jamie Jablonowski, MPH, BSN, RN, CPH
When the temperatures rise, so do visits to the emergency room. According to the most recent data from the New Jersey Department of Health, in 2023 there were 51 emergency room visits in Monmouth County caused by heat-related illness from May through September. In the United States, over 700 people die each year from extreme heat, according to the Centers for Disease Control and Prevention (CDC).
New Jersey is warming faster than the global average, according to the New Jersey Department of Environmental Protection (NJDEP). Last year was the second warmest year on record and temperature averages are expected to continue to rise. The disproportionate increase can be attributed to proximity to a warming ocean and urban density.
William Downs, D.O., chair of Emergency Medicine at Monmouth Medical Center, reported that heat-related visits to the emergency room are usually a result of strenuous exercise, such as running or playing basketball, spending time on the beach, and working outside in manual labor like landscaping.
With more hot days on the horizon, it’s essential to understand how to protect yourself – and the most vulnerable members of your family – from heat-related illness such as sunburn, heat cramps, heat exhaustion and the most serious of all: heat stroke.
Sunburn
Most individuals have experienced sunburn at some point in their lifetime. According to the CDC, symptoms of sunburn, including red, tender and swollen skin, blistering, headache, fever, nausea and fatigue usually start four hours after sun exposure and worsen in the next 24-36 hours. Sunburn can be treated with over-the-counter pain relievers, hydration, cool baths or cool cloths on burns and topical moisturizing creams, aloe or 1% hydrocortisone cream. If the skin blisters, the area should be covered, as there is an increased risk of infection if blisters break. Severe sunburn covering more than 15% of the body can lead to more severe consequences such as dehydration, high fever and extreme pain and requires medical attention.
The best way to prevent sunburn is with sunscreen for those 6 months and older with a broad-spectrum SPF of 15 or higher, protective clothing and accessories, including hats and sunglasses, and ensuring access to shade.
Heat Cramps
Heat cramps usually occur after strenuous activity in the sun. Excessive sweating causes the body to lose salt and water and low sodium levels in the muscles can cause painful cramping in the abdomen, arms or legs. Heat cramps can also be a symptom of heat exhaustion.
If heat cramps occur, the best treatment is to drink water and have a snack or a sports drink that will replace the body’s lost carbohydrates and electrolytes. Salt tablets should not be used. If heat cramps occur in a person with a history of heart problems, someone on a low-sodium diet, or the cramps do not resolve within one hour, the individual should seek medical attention.
“The important things to do there is to get out of the heat and get to a cool place,” Downs said. “Keep yourself hydrated. Drink a lot of water or drink sports drinks. A lot of times with the cramping, it’s probably from dehydration, so it’s important to stay hydrated and usually with that, typically getting out of the heat and drinking a lot of high fluids will make you better.”
Heat Exhaustion
If muscle cramps persist, Downs said a patient may be progressing to the next phase: heat exhaustion. Heat exhaustion occurs when the loss of water and salt is excessive due to sweating. Symptoms of heat exhaustion include headache, nausea, dizziness, weakness, irritability, thirst, heavy sweating, elevated body temperature and decreased urine output.
According to the CDC, if heat exhaustion is suspected, the person should seek medical care for further evaluation and not be left alone. They should be removed from the hot area and encouraged to drink frequent sips of cool water. Unnecessary clothing, such as shoes and socks, should be removed and cool compresses or cool washcloths should be applied.
“With heat exhaustion, that’s more commonly when we sometimes see people come to the emergency department,” said Downs. “People who come will either have passed out or they will be feeling dizzy or having headaches or maybe even having some nausea or vomiting and they can’t keep the fluids down,” he said.
“We need to hydrate them and cool them down.”
Heatstroke
Heatstroke is the most serious heat-related illness and is a medical emergency that can result in death if not treated promptly. Heatstroke occurs when body temperature rises rapidly, the body stops sweating and, therefore, cannot cool down. Body temperature can rise to 106 degrees Fahrenheit or higher within 10 to 15 minutes, according to the CDC. Additional symptoms of heatstroke include confusion, slurred speech, loss of consciousness, hot, dry skin or profuse sweating and seizures.
If heat stroke is suspected, seek emergency care immediately. Similar to heat exhaustion, the individual should not be left alone and should be moved to a cool, shaded area with their clothing removed. Measures should be taken to help cool the person down, including cold water, ice baths, wetting the skin, soaking clothing in cool water or placing cold, wet cloths on the neck, armpits and groin. If possible, the air around the person should be circulated to speed cooling.
Downs explained that heat stroke is a true medical emergency. “Our mechanism of sweating is to help try to cool us down and these patients can sometimes stop sweating. They can develop temperature issues. Sometimes they can get a temperature as high as 103 and 104, which really puts them at high risk of having complications.”
What are the Signs of Dehydration?
Untreated dehydration can be a significant factor leading to heat exhaustion or heat stroke. According to the Cleveland Clinic, if you feel thirsty, you’re already mildly dehydrated. Other signs of dehydration in adults include headache, fatigue, dizziness, dry mouth or cough, increased heart rate, low blood pressure, flushed skin, swollen feet, muscle cramps, chills, constipation and dark-colored urine. Urine should be a pale yellow or the color of hay.
Downs explained that the best indicators of proper hydration are paying attention to the color and frequency of urination. “If you’re realizing you’re not urinating, that’s a concern. Also, if your urine is very dark, like dark yellow, that means you’re not well hydrated. Urine is probably one of the main ways to know” if you are dehydrated, said Downs.
Who is most Vulnerable?
Individuals over the age of 65 are most at risk for heat-related injuries. According to 2023 data from the New Jersey Department of Health, the highest proportion of patients treated in the emergency room was over 80 years old. Others at high risk include infants and children, athletes, individuals with chronic conditions, those without access to air conditioning, pregnant women and outdoor workers.
Jamie Pace, a mother from Oceanport, said she took extra precautions during a recent trip to the beach in the heat with her 13-month-old son. In addition to mineral sunscreen, Pace ensured her son wore a long-sleeved bathing suit and a hat and had access to a portable pool filled with water. “We kept him hydrated by giving him a ton of berries with his meals and snacks, packed fruit pouches and ensured he had plenty of water before, during and after being in the sun. We even added some baby-safe electrolytes for when it was really hot,” she said. “We managed our expectations and recognized that we would not be at the beach all day but maximized our time by making sure he was cool and content.”
Downs emphasized the importance of paying attention to older individuals and to young children who often cannot tell caregivers they are overheating. “Elderly patients, sometimes they don’t even realize to put their air conditioning on. Sometimes they’re on medications or have a little dementia. They don’t even realize what to do and they don’t hydrate themselves.”
Candace Ruitenberg, 67, who has a home in Monmouth Beach, said she finds that now that she is older, she requires extra fluids in the heat. “I’m finding that I need electrolytes if I exercise outside, for example, walking, paddleboarding, swimming. Water just isn’t enough now that I’m older.”
When is Heat-Related Illness Considered an Emergency?
According to Downs, if someone is sweating profusely or feeling a little lightheaded but awake and alert, they should be cooled down. However, if a person faints, is experiencing nausea or vomiting, has severe dizziness or can’t hydrate themselves, they should be brought to the hospital. “The worst-case scenario where you start getting into heatstroke is patients get confused,” he said.
“If someone’s kind of getting a little disoriented, then that’s somebody who really needs to get to the hospital.”
Downs advised that if someone is very confused it’s not a good idea to give them fluids as it could increase the risk of aspiration.
Long-term Effects of Heat-Related Illnesses?
If caught early, most patients should recover from heat-related illness. However, Downs noted they have seen patients suffer from seizures and others die from heat stroke.
He emphasized that the most important factor when temperatures rise is to prevent heat injuries before they occur. “You want to prevent yourself from getting to that bad phase, which is heatstroke,” said Downs.
He stressed the importance of “knowing the signs early on and treating them and getting out of that environment.” He reminds the public to look after the young and the elderly and not to forget about pets. “It’s another thing to consider. You don’t want to have your pets in the heat. Make sure you get them to cool areas as well.”
The article originally appeared in the July 3 – 9, 2025 print edition of The Two River Times.
