Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: TUESDAY, July 25, 1995                   TAG: 9507250041
SECTION: EXTRA                    PAGE: 6   EDITION: METRO 
SOURCE: By DON COLBURN THE WASHINGTON POST
DATELINE:                                 LENGTH: Medium

HERE'S WHY THE HEAT CAN BE FATAL

Why the difference? It wasn't any cooler in the nation's capital. The apparent discrepancy highlighted the fact that criteria for reporting heat-related deaths vary from county to county and coroner to coroner, health officials said.

In Philadelphia, the county medical examiner listed heat as a contributing cause of death if the deceased was elderly or infirm and had been exposed to extreme heat. Most medical examiners list heat as a cause of death only in documented cases of heatstroke, a medical emergency that occurs when the body's core temperature exceeds 105 degrees.

That same difference may be reflected in the wildly varying official statewide death tolls from this month's heat wave. As of July 18, the heat was blamed for one death in Texas but at least 179 in Chicago. The official heat-death toll was one in Oklahoma and 19 in Pennsylvania, two in Kentucky and 17 in Wisconsin, three in Ohio and 16 in New York.

In a person who had underlying health problems, such as heart disease, a death is officially listed as heat-related only when an elevated body temperature can be documented, the Chicago medical examiner said. Other possible causes such as cocaine use, which can interfere with the body's thermostat, must also be ruled out, she said.

But arguing over official definitions of heat-related death is ``like missing the forest for the trees,'' said Thomas Sinks, an epidemiologist with the U.S. Centers for Disease Control and Prevention in Atlanta. ``The real issue,'' he said, is that heat can be lethal.

``It gets hot and people suffer the consequences,'' Sinks said. ``Some of them die, and a whole lot more of them get sick.''

Even in years with normal summers, an average of 240 Americans die from the heat, said Sinks, who is associate director for science at CDC's National Center for Environmental Health. In 1980, which was marked by an exceptionally intense and prolonged heat wave, about 1,700 heat-related deaths were reported nationwide.

Sinks said the total number of people who die from the heat is typically underreported, as many heat-related deaths are officially attributed to cardiac arrest or heart disease. Documenting hyperthermia, or prolonged overheating of the body, is difficult when the body, as in many of these cases, is discovered hours or days after death.

People at highest risk of heat-related illness are the very young, the very old and anyone who overexerts. So are those who are obese or have chronic heart or lung conditions. Excessive heat puts an extra strain on every organ system in the body.

The extraordinarily high death toll in Chicago recently was blamed partly on low water pressure, caused when fire hydrants were illegally turned on, and power outages that knocked out fans and air conditioning units. Chicago residents are less acclimated than Washingtonians to extreme heat, the Chicago medical examiner said.

Several factors besides high temperatures and humidity can make one heat wave more deadly than another, said Larry Kalkstein, a geographer at the University of Delaware's Center for Climatic Research. One is duration: Prolonged heat waves take a cumulative toll. Another is stagnant air masses that increase pollution and worsen the health effects on the lungs. And early summer heat waves tend to be deadlier, because people are not yet acclimatized to hot weather and are more likely to get caught without fans or air conditioners in place.