Volledige transcriptie van Walking Post podcast 55: Dealing with heat

a 00:02:28.860 --> 00:02:31.740 heat wave somewhere, and we are listened to in 00:02:31.740 --> 00:02:35.300 more than 30 countries, and I am also sure that 00:02:35.300 --> 00:02:38.379 there will be more heat waves to come. So, some 00:02:38.379 --> 00:02:42.240 great information coming up for you. Before we 00:02:42.240 --> 00:02:44.259 get going, if you do have news, guest ideas, 00:02:44.419 --> 00:02:47.560 or even subjects to cover or comments, or you 00:02:47.560 --> 00:02:49.979 want to advertise, please do get in touch via 00:02:49.979 --> 00:02:53.340 walkingpost .com, or you can just email me at 00:02:53.340 --> 00:03:06.039 jim at walkingpost .com. Okay, let's go through 00:03:06.039 --> 00:03:08.379 some of the headlines of the news articles you 00:03:08.379 --> 00:03:11.919 may have missed that we had on walkingpost .com 00:03:11.919 --> 00:03:15.819 this past week. The Two Moors Way celebrated 00:03:15.819 --> 00:03:19.520 its anniversary with an extension. Canada's first 00:03:19.520 --> 00:03:22.780 outdoor gear repair and advanced manufacturing 00:03:22.780 --> 00:03:26.159 centre opened. And the Get Outdoors programme 00:03:26.159 --> 00:03:30.780 for 2027 in Pennsylvania has connected to the 00:03:30.780 --> 00:03:34.650 US 250th anniversary. Back to Canada because 00:03:34.650 --> 00:03:37.650 it's invested in some trails in the Maritimes 00:03:37.650 --> 00:03:41.189 to benefit climate resilience and biodiversity. 00:03:41.889 --> 00:03:45.710 In the UK, Ironbridge Gorge joined a national 00:03:45.710 --> 00:03:48.810 trail celebrating the UK's industrial heritage 00:03:48.810 --> 00:03:52.449 and repair work has started on the only trail 00:03:52.449 --> 00:03:56.509 in the US Virgin Islands. New plans have been 00:03:56.509 --> 00:03:59.930 announced to boost walking in London. Walking 00:03:59.930 --> 00:04:03.210 and more sleep could protect mental health in 00:04:03.210 --> 00:04:05.770 middle age. And you can read all of these and 00:04:05.770 --> 00:04:12.969 more at walkingpost .com. This was an episode 00:04:12.969 --> 00:04:15.969 of the podcast just waiting to happen. And of 00:04:15.969 --> 00:04:19.449 course, the results have been as expected. There's 00:04:19.449 --> 00:04:21.569 been a heatwave in Europe for several weeks, 00:04:21.589 --> 00:04:24.069 and the moment we decide to do a podcast episode 00:04:24.069 --> 00:04:27.110 on heatstroke and how to deal with being out 00:04:27.110 --> 00:04:30.910 in the sun, the weather changes. Today, for example, 00:04:31.089 --> 00:04:35.269 here in western Scotland, thunderstorms and 14 00:04:35.269 --> 00:04:38.829 degrees. But somewhere it's hot, so we're off 00:04:38.829 --> 00:04:41.610 the hook. And you can guarantee there are going 00:04:41.610 --> 00:04:44.430 to be more heat waves to come pretty much everywhere. 00:04:44.730 --> 00:04:48.089 And that has an impact on walking and hiking, 00:04:48.230 --> 00:04:51.480 of course. We have the perfect guest for

that 00:04:51.480 --> 00:04:54.100 today, though, because Dr. Cheyenne Fallott is 00:04:54.100 --> 00:04:57.220 the Assistant Medical Director of the Adult Emergency 00:04:57.220 --> 00:05:00.319 Department at the University of Maryland Medical 00:05:00.319 --> 00:05:03.839 Center in Baltimore, the academic flagship hospital 00:05:03.839 --> 00:05:06.500 for the University of Maryland Medical Center. 00:05:06.889 --> 00:05:09.269 She's also an assistant professor of emergency 00:05:09.269 --> 00:05:12.069 medicine at the University of Maryland School 00:05:12.069 --> 00:05:15.490 of Medicine. A practicing emergency department 00:05:15.490 --> 00:05:18.730 physician for about a decade, Dr. Fallat's niche 00:05:18.730 --> 00:05:22.529 and area of special interest is in environmental 00:05:22.529 --> 00:05:26.189 emergency medicine, with a specific area of interest 00:05:26.189 --> 00:05:29.709 in weather -related injuries and wilderness medicine. 00:05:30.129 --> 00:05:34.009 She's also an avid skier and, of course, hiker. 00:05:35.259 --> 00:05:37.019 All right. Great to have you on the show today. 00:05:37.160 --> 00:05:40.319 Thanks so much for your input on this subject. 00:05:40.639 --> 00:05:42.699 Maybe you could just give us a little bit of 00:05:42.699 --> 00:05:46.560 a brief introduction for us. Absolutely. So my 00:05:46.560 --> 00:05:49.040 name is Cheyenne Fallett. I'm an assistant professor 00:05:49.040 --> 00:05:51.180 of emergency medicine at the University of Maryland 00:05:51.180 --> 00:05:53.779 School of Medicine. And I work at the University 00:05:53.779 --> 00:05:56.180 of Maryland Medical Center as an emergency doctor, 00:05:56.339 --> 00:05:59.199 seeing patients who come to my door. However, 00:05:59.360 --> 00:06:02.079 what I really love and what my passion is, is 00:06:02.079 --> 00:06:04.540 taking care of patients who are brought to me 00:06:04.540 --> 00:06:06.779 with environmental injuries. So injuries sustained 00:06:06.779 --> 00:06:09.300 from the environment or from the wilderness. 00:06:09.360 --> 00:06:13.220 So things like heat stroke. hypothermia, frostbite, 00:06:13.220 --> 00:06:15.860 drownings, altitude illness, lightning injuries, 00:06:16.120 --> 00:06:20.259 all of which are potentially very high mortality 00:06:20.259 --> 00:06:23.839 cases if left untreated, but cases in which we 00:06:23.839 --> 00:06:26.519 can make a tremendous impact and save a lot of 00:06:26.519 --> 00:06:28.639 lives if we know how to recognize and how to 00:06:28.639 --> 00:06:31.920 treat appropriately and treat early. So hoping 00:06:31.920 --> 00:06:34.180 I can share a little bit of my passion with you 00:06:34.180 --> 00:06:37.519 guys today. Sure, absolutely. As far as heat 00:06:37.519 --> 00:06:40.800 stroke and sunstroke goes, are those two terms 00:06:40.800 --> 00:06:44.519 interchangeable or are there differences? Those 00:06:44.519 --> 00:06:47.939 two are fairly interchangeable. Heat stroke is 00:06:47.939 -->

00:06:51.100 kind of the end stage. of a spectrum of heat 00:06:51.100 --> 00:06:53.759 illness, ranging from mild heat illnesses to 00:06:53.759 --> 00:06:56.699 moderate heat illness, which we call heat exhaustion. 00:06:57.120 --> 00:06:59.639 And then heat stroke is kind of the end stage 00:06:59.639 --> 00:07:02.560 and most severe presentation, which is really 00:07:02.560 --> 00:07:06.180 where the chance of fatality starts to set in. 00:07:06.379 --> 00:07:11.079 Are you seeing any rise in numbers for that? 00:07:11.560 --> 00:07:14.819 Absolutely. So unfortunately, over the past few 00:07:14.819 --> 00:07:18.019 years, heat waves... are not only occurring with 00:07:18.019 --> 00:07:20.920 increased frequency and increased duration, but 00:07:20.920 --> 00:07:23.819 also increased intensity, and not just in the 00:07:23.819 --> 00:07:25.939 United States where I live and work, but across 00:07:25.939 --> 00:07:28.939 the world. So with those rises in heat waves, 00:07:29.040 --> 00:07:31.920 we are seeing an increase in the number of reported 00:07:31.920 --> 00:07:34.899 heat -related deaths and heat -related illness. 00:07:35.379 --> 00:07:37.939 When somebody comes into the hospital or gets 00:07:37.939 --> 00:07:40.939 brought into the hospital with something like 00:07:40.939 --> 00:07:44.980 this, do you record? The circumstances around 00:07:44.980 --> 00:07:47.779 that, I mean, are you able to split out hiking 00:07:47.779 --> 00:07:51.860 incidents from a soccer game or from a ball game 00:07:51.860 --> 00:07:54.860 or from just being out in the sun? You know, 00:07:54.879 --> 00:07:57.860 from a perspective of epidemiological tracking, 00:07:58.019 --> 00:08:01.300 I think we have a lot of ways to go as far as 00:08:01.300 --> 00:08:04.060 accurately capturing these circumstances by which 00:08:04.060 --> 00:08:06.819 people develop heat illness so that we can parse 00:08:06.819 --> 00:08:09.579 out and determine which of those directions we 00:08:09.579 --> 00:08:12.000 need to focus most of our public education and 00:08:12.000 --> 00:08:15.149 public health. However, we do get that information, 00:08:15.189 --> 00:08:18.329 even if it's not kind of tracked from an epidemiological 00:08:18.329 --> 00:08:21.329 perspective and captured in final diagnoses. 00:08:21.350 --> 00:08:24.949 The information about the patient's circumstances 00:08:24.949 --> 00:08:28.810 are extraordinarily important when leading to 00:08:28.810 --> 00:08:31.329 diagnoses of environmental and wilderness injuries, 00:08:31.449 --> 00:08:34.110 not just heat stroke, but any of them. So sometimes 00:08:34.110 --> 00:08:36.690 the circumstances by which someone, let's say, 00:08:36.730 --> 00:08:39.690 is found unresponsive or found down or loses 00:08:39.690 --> 00:08:42.879 consciousness. can truly make or break the diagnosis 00:08:42.879 --> 00:08:45.840 and can completely alter a patient's path to 00:08:45.840 --> 00:08:48.940 treatment and truly be life -saving. So we rely 00:08:48.940 --> 00:08:51.620 heavily on not just family members and friends 00:08:51.620 --> 00:08:53.639 who bring patients in who are able to tell us 00:08:53.639 --> 00:08:55.980 some of the story, but also on our pre -hospital 00:08:55.980 --> 00:08:59.299 colleagues like our EMS providers. And I assume 00:08:59.299 --> 00:09:04.399 that the spectrum of ages is equally varied? 00:09:05.070 --> 00:09:10.309 It is, but I think the type of presentation matters. 00:09:10.669 --> 00:09:13.710 So when we think of heat illness, we think of 00:09:13.710 --> 00:09:16.269 classic heat stroke and exertional heat stroke. 00:09:16.389 --> 00:09:18.909 So exertional heat stroke are really people who 00:09:18.909 --> 00:09:22.269 are engaging in not only athletics and recreational 00:09:22.269 --> 00:09:25.350 activities like hiking or running or football 00:09:25.350 --> 00:09:29.490 that predispose themselves to heat exposure and 00:09:29.490 --> 00:09:32.549 heat exhaustion and ultimately leading to heat 00:09:32.549 --> 00:09:35.419 stroke, but also occupations. So people with 00:09:35.419 --> 00:09:38.600 occupations such as construction or firemen and 00:09:38.600 --> 00:09:41.000 women who have to wear heavy gear and oftentimes 00:09:41.000 --> 00:09:45.000 have to do that outdoors and long hours and peak 00:09:45.000 --> 00:09:48.840 sun and with minimal hydration and minimal nutrition 00:09:48.840 --> 00:09:51.940 during that time. Those are all factors that 00:09:51.940 --> 00:09:55.500 lead to exertional heat stroke. And that we oftentimes 00:09:55.500 --> 00:10:00.059 see more so in people in their middle aged years, 00:10:00.360 --> 00:10:03.350 mostly men. compared to women as far as demographics. 00:10:03.750 --> 00:10:06.830 But then when you talk about the other flip side, 00:10:06.929 --> 00:10:08.990 what we call classic heat stroke, it's really 00:10:08.990 --> 00:10:12.269 anyone else who develops heat stroke. So patients 00:10:12.269 --> 00:10:15.509 who are prone to developing heat illness just 00:10:15.509 --> 00:10:19.450 based on a variety of socioeconomic or physiologic 00:10:19.450 --> 00:10:23.090 factors. So in classic heat stroke, children 00:10:23.090 --> 00:10:26.210 of a very young age and elderly individuals of 00:10:26.210 --> 00:10:29.500 older age. seem particularly prone to developing 00:10:29.500 --> 00:10:32.200 heat stroke just because their physiologic mechanisms 00:10:32.200 --> 00:10:36.179 or their body's response to recognizing and dealing 00:10:36.179 --> 00:10:38.940 with heat are either not yet fully developed 00:10:38.940 --> 00:10:42.559 in the case of young children or not as responsive 00:10:42.559 --> 00:10:45.500 in the case of older individuals. So the classic 00:10:45.500 --> 00:10:48.340 heat stroke we see more so at the extremes of 00:10:48.340 --> 00:10:50.639 age and exertional heat stroke we see more so 00:10:50.639 --> 00:10:53.779 in the middle years. Before we start

talking 00:10:53.779 --> 00:10:58.139 about the signs and symptoms of those conditions, 00:10:58.460 --> 00:11:01.360 could you explain a little bit about the physiology 00:11:01.360 --> 00:11:05.120 of heat stroke as to what it does to the body? 00:11:05.669 --> 00:11:08.629 Absolutely. So how we develop heat stroke, it's 00:11:08.629 --> 00:11:10.690 important to know how our body processes heat. 00:11:10.769 --> 00:11:14.149 So our body absorbs and dissipates heat through 00:11:14.149 --> 00:11:16.649 four major mechanisms. You have conduction, which 00:11:16.649 --> 00:11:19.169 is the transfer of heat from a warmer object 00:11:19.169 --> 00:11:21.769 to a cooler object. Convection, which is the 00:11:21.769 --> 00:11:25.029 transfer of heat to a moving liquid or gas around 00:11:25.029 --> 00:11:28.309 us, such as the wind outside. We have evaporation, 00:11:28.409 --> 00:11:30.730 which is heat loss through the change in state 00:11:30.730 --> 00:11:33.009 from liquid to gas, such as sweating. And then 00:11:33.009 --> 00:11:36.009 radiation, which is our body's loss of heat through 00:11:36.009 --> 00:11:38.789 electromagnetic waves. So like when we're outside 00:11:38.789 --> 00:11:42.750 in the sun and we, let's say, sit down on a cold 00:11:42.750 --> 00:11:45.470 rock, that's helping us lose heat. When we mist 00:11:45.470 --> 00:11:47.929 ourselves and fan ourselves, that's helping us 00:11:47.929 --> 00:11:51.970 lose heat. So what happens is in order to assist 00:11:51.970 --> 00:11:54.909 in those processes, our body can do certain things. 00:11:55.639 --> 00:11:59.120 It relies on our peripheral nerves, such as those 00:11:59.120 --> 00:12:01.700 found in our skin, to be able to sense heat and 00:12:01.700 --> 00:12:05.000 then feed that input back to a very small part 00:12:05.000 --> 00:12:07.519 of our brain called the hypothalamus. And the 00:12:07.519 --> 00:12:10.639 hypothalamus essentially acts as the body's thermostat. 00:12:10.779 --> 00:12:14.460 It really wants to make sure that we have a set 00:12:14.460 --> 00:12:17.200 regulated temperature in our body, usually about 00:12:17.200 --> 00:12:20.399 37 degrees Celsius, plus or minus about half 00:12:20.399 --> 00:12:23.360 a degree. And when that hypothalamus senses, 00:12:23.559 --> 00:12:26.539 wait a second, I'm starting to heat up from the 00:12:26.539 --> 00:12:29.539 outdoor temperature, it essentially turns on 00:12:29.539 --> 00:12:31.679 the air conditioning in our body. And it does 00:12:31.679 --> 00:12:35.659 so through two major mechanisms. One is it increases 00:12:35.659 --> 00:12:39.059 the amount of blood flow going to our skin to 00:12:39.059 --> 00:12:42.539 help with this conductive. and convective and 00:12:42.539 --> 00:12:45.059 evaporative cooling because it helps to cool 00:12:45.059 --> 00:12:47.840 that warmer blood that's in our body. And then 00:12:47.840 --> 00:12:50.860 it increases our body's ability to sweat. And 00:12:50.860 --> 00:12:52.860 so with increased sweating, we have increased 00:12:52.860 --> 00:12:55.679 evaporation and increased cooling. So for all 00:12:55.679 --> 00:12:58.259 of that to work effectively, our body has to 00:12:58.259 --> 00:13:02.139 be able to sense input with our nerves, coordinate 00:13:02.139 --> 00:13:04.399 that processes again with our brain and with 00:13:04.399 --> 00:13:06.519 our central nervous system, and then be able 00:13:06.519 --> 00:13:09.179 to execute those processes through effective 00:13:09.179 --> 00:13:13.000 sweating. ability to dilate out our blood vessels. 00:13:13.279 --> 00:13:16.500 Do different parts of the body sweat at different 00:13:16.500 --> 00:13:20.059 rates? There are a few different types of sweat 00:13:20.059 --> 00:13:22.139 glands in our body and different concentrations 00:13:22.139 --> 00:13:24.879 of those sweat glands throughout our body. We 00:13:24.879 --> 00:13:27.600 do tend to lose a lot of heat through our head, 00:13:27.720 --> 00:13:30.659 through our axilla or armpits, through the back 00:13:30.659 --> 00:13:33.360 of the neck. So especially when you're trying 00:13:33.360 --> 00:13:36.960 to cool off and you're outdoor somewhere, you 00:13:36.960 --> 00:13:39.179 want to make sure that those parts of our bodies 00:13:39.179 --> 00:13:42.460 we try to expose as much as possible. But the 00:13:42.460 --> 00:13:43.960 sweat glands are kind of littered throughout 00:13:43.960 --> 00:13:48.379 the whole entire body. A lot of people wear not 00:13:48.379 --> 00:13:51.080 just deodorant, but antiperspirant. Is that a 00:13:51.080 --> 00:13:55.659 bad thing? I think that once you start, the body's 00:13:55.659 --> 00:13:58.259 kind of hypothalamus starts kicking in your need 00:13:58.259 --> 00:14:01.440 to sweat, that trumps even whatever antiperspirant 00:14:01.440 --> 00:14:05.399 you're wearing. I didn't know whether that was 00:14:05.399 --> 00:14:08.000 a bad thing, you know, if you're wearing antiperspirant, 00:14:08.000 --> 00:14:10.700 if you obviously you need to sweat to get rid 00:14:10.700 --> 00:14:14.519 of. the heat. But if you're wearing antiperspirant, 00:14:14.620 --> 00:14:16.580 I just didn't know whether that was something 00:14:16.580 --> 00:14:18.980 that would be a cause for concern. That's an 00:14:18.980 --> 00:14:20.580 excellent question. It's actually the first time 00:14:20.580 --> 00:14:23.519 I've gotten that question. All right. Maybe move 00:14:23.519 --> 00:14:27.320 into the signs and symptoms now. What are the 00:14:27.320 --> 00:14:30.960 first signs personally? Because there's two things. 00:14:31.080 --> 00:14:33.379 There's observing it in others and observing 00:14:33.379 --> 00:14:37.700 it in ourselves. What are the first signs that 00:14:37.700 --> 00:14:41.059 you yourself are getting heat stroke? Yeah, so 00:14:41.059 --> 00:14:44.320 as I mentioned, heat stroke definitely is a spectrum 00:14:44.320 --> 00:14:47.399 of illness, and it

progresses along the spectrum. 00:14:47.620 --> 00:14:51.259 At the very earliest stages of heat illness, 00:14:51.539 --> 00:14:54.299 we have a variety of conditions that we classify 00:14:54.299 --> 00:14:57.399 as mild heat illness. It can include anything 00:14:57.399 --> 00:15:00.720 from what we call a heat rash or miliaria rubra, 00:15:00.840 --> 00:15:03.580 which is just kind of a prickly raised rash, 00:15:03.840 --> 00:15:06.259 generally under clothed areas of the body that 00:15:06.259 --> 00:15:08.539 can be a little itchy, and that's due to kind 00:15:08.539 --> 00:15:12.039 of occluded sweat ducts. you can have heat edema 00:15:12.039 --> 00:15:15.879 which is essentially swelling of your body mostly 00:15:15.879 --> 00:15:19.059 in the gravitationally dependent areas of the 00:15:19.059 --> 00:15:23.019 body so in our legs that's just due to some changes 00:15:23.019 --> 00:15:25.600 to where you collect and hold your blood flow. 00:15:25.759 --> 00:15:28.820 And that is generally, it resolves in about two 00:15:28.820 --> 00:15:31.440 or three days. There's nothing terribly much 00:15:31.440 --> 00:15:33.679 to do about it. You can wear compression stockings 00:15:33.679 --> 00:15:35.539 to help it, but it's not something that you need 00:15:35.539 --> 00:15:38.799 to like take fluid or water pills for. It's just 00:15:38.799 --> 00:15:41.879 your body kind of reprocessing the fluid distribution. 00:15:42.299 --> 00:15:46.350 You can have heat cramps, which are cramps of 00:15:46.350 --> 00:15:49.730 your skeletal muscles. So generally in your legs, 00:15:49.769 --> 00:15:52.429 that's set in after a period of exercise. And 00:15:52.429 --> 00:15:55.350 that's generally due to not only dehydration 00:15:55.350 --> 00:15:58.710 in heat, but also loss of some of your electrolytes, 00:15:58.710 --> 00:16:01.789 like your sodium. And then heat syncope, which 00:16:01.789 --> 00:16:04.330 is a very transient loss of consciousness just 00:16:04.330 --> 00:16:07.129 from, again, temporary blood flow redistribution 00:16:07.129 --> 00:16:09.610 in your body as your body tries to cool itself 00:16:09.610 --> 00:16:12.789 down. The hallmark of all of these is that it's 00:16:12.789 --> 00:16:16.120 really the first presenting sign or symptom that 00:16:16.120 --> 00:16:18.940 like, hey, maybe we're not doing too well in 00:16:18.940 --> 00:16:21.100 response to the heat. And maybe we really need 00:16:21.100 --> 00:16:23.580 to take a step back from the heat, go indoors, 00:16:23.860 --> 00:16:26.559 cool ourselves off, make sure that we are hydrating 00:16:26.559 --> 00:16:29.179 with what we call balanced electrolyte fluids. 00:16:29.279 --> 00:16:32.539 So fluids that include salt, since we don't just 00:16:32.539 --> 00:16:35.399 sweat water, we sweat salt water from our body. 00:16:35.440 --> 00:16:38.480 So we need to keep replenishing the salt as well. 00:16:38.970 --> 00:16:41.389 But not always will someone experience these 00:16:41.389 --> 00:16:45.169 kind of mild heat illness conditions. What the 00:16:45.169 --> 00:16:48.610 first kind of major warning signs are that you're 00:16:48.610 --> 00:16:51.330 developing kind of more serious heat illness 00:16:51.330 --> 00:16:54.409 are really in that moderate stage, which we call 00:16:54.409 --> 00:16:58.299 heat exhaustion. And this is generally due to 00:16:58.299 --> 00:17:01.639 relative depletion of water and salt, so water 00:17:01.639 --> 00:17:05.099 and electrolytes. And it will lead to what we 00:17:05.099 --> 00:17:08.200 call presyncopal symptoms or symptoms that are 00:17:08.200 --> 00:17:12.019 telling you, hey, you might pass out soon. You 00:17:12.019 --> 00:17:14.990 need help. You need to hydrate. You need to cool 00:17:14.990 --> 00:17:18.009 off. So these symptoms, I don't know how many 00:17:18.009 --> 00:17:20.730 of the listeners have ever had a loss of consciousness 00:17:20.730 --> 00:17:23.349 or have passed out before, but oftentimes in 00:17:23.349 --> 00:17:25.849 kind of the minute or few seconds leading up 00:17:25.849 --> 00:17:28.630 to it, you might feel nauseous, like you're going 00:17:28.630 --> 00:17:31.809 to vomit. You might get super sweaty. You might 00:17:31.809 --> 00:17:34.230 see your vision kind of starting to tunnel in. 00:17:34.250 --> 00:17:36.990 Your heart rate, you might sense that is a little 00:17:36.990 --> 00:17:39.630 up. You might have palpitations. You're just... 00:17:39.829 --> 00:17:42.589 feeling like you're going to pass out. But it's 00:17:42.589 --> 00:17:45.369 important to know at this stage that you shouldn't 00:17:45.369 --> 00:17:48.650 have any neurological impairments yet. You shouldn't 00:17:48.650 --> 00:17:51.250 be confused. You shouldn't have difficulty with 00:17:51.250 --> 00:17:53.289 fine motor skills. You shouldn't be off balance. 00:17:53.509 --> 00:17:55.490 You just feel like you're going to pass out. 00:17:55.609 --> 00:17:58.789 And at this stage, it's really important that 00:17:58.789 --> 00:18:02.130 we recognize this is the major warning sign that 00:18:02.130 --> 00:18:05.750 if you don't get help immediately, and by get 00:18:05.750 --> 00:18:09.240 help, it means even help yourself. Take a step 00:18:09.240 --> 00:18:11.740 back from the heat, go into the shade, go into 00:18:11.740 --> 00:18:13.980 an air conditioned building if you have one available 00:18:13.980 --> 00:18:16.579 to you. If you're not sweating effectively or 00:18:16.579 --> 00:18:18.460 if you need some assistance sweating, try to 00:18:18.460 --> 00:18:20.380 spritz yourself or mist yourself with water. 00:18:20.440 --> 00:18:23.960 Try to angle a fan at you or fan yourself with 00:18:23.960 --> 00:18:26.519 even something like a magazine or a hat. Really 00:18:26.519 --> 00:18:30.660 try to cool off at that stage and hydrate. Hydration 00:18:30.660 --> 00:18:33.380 is key. So again, with those balanced fluid solutions, 00:18:33.640 --> 00:18:38.099

because if you leave. heat exhaustion untreated 00:18:38.099 --> 00:18:40.380 and you stay in the heat and you don't hydrate, 00:18:40.400 --> 00:18:42.539 that can progress relatively quickly to heat 00:18:42.539 --> 00:18:46.140 stroke. And the hallmarks of heat stroke is that 00:18:46.140 --> 00:18:48.339 generally it's when the core temperature reaches 00:18:48.339 --> 00:18:52.619 above 40 degrees Celsius, but it's not necessary 00:18:52.619 --> 00:18:55.319 for the sake of diagnosis as long as you have 00:18:55.319 --> 00:18:57.619 the kind of clinical picture and the history 00:18:57.619 --> 00:19:00.799 that matches it. But it's really when there is 00:19:00.799 --> 00:19:03.119 some kind of neurologic impairment that sets 00:19:03.119 --> 00:19:06.319 in. There's a very particular part of our brain 00:19:06.319 --> 00:19:09.299 called the cerebellum that seems to be most susceptible 00:19:09.299 --> 00:19:13.019 to damage from heat. And that's the part of our 00:19:13.019 --> 00:19:14.980 brain that's really responsible for a lot of 00:19:14.980 --> 00:19:17.480 our balance and coordination. So some of the... 00:19:17.869 --> 00:19:21.329 Early neurologic signs will be things like confusion, 00:19:21.769 --> 00:19:25.450 dizziness, unsteadiness, poor coordination, but 00:19:25.450 --> 00:19:28.269 that can progress relatively quickly to include 00:19:28.269 --> 00:19:32.390 complete alteration in your mental status and 00:19:32.390 --> 00:19:35.170 then leading to seizure and comatose state and 00:19:35.170 --> 00:19:39.859 more lasting loss of consciousness. So at that 00:19:39.859 --> 00:19:42.019 point, it is really a medical emergency that 00:19:42.019 --> 00:19:44.460 carries a pretty high mortality rate. And at 00:19:44.460 --> 00:19:47.359 that point, immediate intervention, like less 00:19:47.359 --> 00:19:49.859 than 30 minutes to cool your core temperature 00:19:49.859 --> 00:19:52.609 is really lifesaving at that point. Because I 00:19:52.609 --> 00:19:55.930 guess once you reach that stage, I would assume 00:19:55.930 --> 00:19:59.650 that your awareness of your own situation is 00:19:59.650 --> 00:20:03.250 impaired as well. Absolutely. And this is also 00:20:03.250 --> 00:20:05.849 why when we talk about not just the exertional 00:20:05.849 --> 00:20:08.589 heat stroke. So oftentimes these are going to 00:20:08.589 --> 00:20:11.769 be in individuals. Once you're kind of blowing 00:20:11.769 --> 00:20:13.950 through that moderate heat exhaustion, then you 00:20:13.950 --> 00:20:16.740 lead to heat stroke. It's oftentimes seen in 00:20:16.740 --> 00:20:19.339 athletes who are trained from a very young age 00:20:19.339 --> 00:20:22.099 to push themselves even through discomfort and 00:20:22.099 --> 00:20:24.279 really, you know, be the best you can be and 00:20:24.279 --> 00:20:28.079 not back out. people who have these heroic jobs 00:20:28.079 --> 00:20:31.000 like firemen, policemen who don't want to step 00:20:31.000 --> 00:20:33.480 away from an active line of duty. A lot of times 00:20:33.480 --> 00:20:35.920 we see this in military recruits, in marathon 00:20:35.920 --> 00:20:38.079 runners. It's people who are really trying to 00:20:38.079 --> 00:20:40.660 achieve a goal and not back down. But I think 00:20:40.660 --> 00:20:43.160 as a society, we really need to normalize, hey, 00:20:43.319 --> 00:20:45.980 if you're having these symptoms. you should take 00:20:45.980 --> 00:20:47.880 a step back. You should really make sure that 00:20:47.880 --> 00:20:49.660 you're stepping away, you're cooling yourself 00:20:49.660 --> 00:20:53.039 off, you're hydrating. And then also what makes 00:20:53.039 --> 00:20:55.980 some of these things difficult to pick up on, 00:20:56.039 --> 00:20:58.680 and I'm glad you mentioned sometimes the difficulty 00:20:58.680 --> 00:21:02.009 with self -assessment of these symptoms. is a 00:21:02.009 --> 00:21:05.109 lot of our patients are not only on some prescription 00:21:05.109 --> 00:21:07.569 medications or over -the -counter medications 00:21:07.569 --> 00:21:11.309 that can lead to a little bit of disorientation 00:21:11.309 --> 00:21:14.049 in addition to some dehydration and dysregulation. 00:21:14.250 --> 00:21:17.750 So even things like diphenhydramine or what we 00:21:17.750 --> 00:21:20.990 call Benadryl in the U .S., medications that 00:21:20.990 --> 00:21:24.410 we use for allergies, can oftentimes really not 00:21:24.410 --> 00:21:27.650 only dehydrate and start to a little bit disorient 00:21:27.650 --> 00:21:31.450 us, but can prevent appropriate mechanisms. sweating, 00:21:31.730 --> 00:21:33.809 for instance, and our ability to cool ourselves. 00:21:34.109 --> 00:21:37.809 And a variety of other medications like antipsychotics 00:21:37.809 --> 00:21:40.309 can lead to a little bit of disorientation and 00:21:40.309 --> 00:21:43.309 inability to recognize these symptoms. But then 00:21:43.309 --> 00:21:46.269 an extraordinary amount of people have either 00:21:46.269 --> 00:21:51.369 psychiatric issues and are just not able to accurately 00:21:51.369 --> 00:21:53.829 self -assess. Those patients oftentimes have 00:21:53.829 --> 00:21:55.990 compounding substance use issues that further 00:21:55.990 --> 00:21:59.299 contribute to the symptoms. and an ability to 00:21:59.299 --> 00:22:01.819 really recognize these symptoms. And then oftentimes 00:22:01.819 --> 00:22:04.180 those are also the same populations that have 00:22:04.180 --> 00:22:07.900 difficulty with housing access and are relatively 00:22:07.900 --> 00:22:10.980 unhoused and don't have appropriate access to 00:22:10.980 --> 00:22:13.559 hydration and to air -conditioned buildings and 00:22:13.559 --> 00:22:16.980 stuff like that. So it really is a lot of confounding 00:22:16.980 --> 00:22:20.180 factors that make not only the recognition of, 00:22:20.220 --> 00:22:23.079 but the treatment of these teeth illnesses quite 00:22:23.079 --> 00:22:26.250

difficult. And we just talked there briefly about 00:22:26.250 --> 00:22:30.309 the self -assessment. If you were in a hiking 00:22:30.309 --> 00:22:34.930 party or at a ball game, how can you assess that 00:22:34.930 --> 00:22:38.609 in others? In that moderate stage, that heat 00:22:38.609 --> 00:22:41.609 exhaustion stage, some of those signs that feel 00:22:41.609 --> 00:22:43.609 like you're going to pass out may be visible 00:22:43.609 --> 00:22:46.160 to other people around you. You may start to 00:22:46.160 --> 00:22:49.240 get very sweaty. You may start to look like you're 00:22:49.240 --> 00:22:51.799 going to pass out. You might get pale. You might 00:22:51.799 --> 00:22:54.480 have a visibly raised heart rate. Sometimes you 00:22:54.480 --> 00:22:57.039 can see kind of bulging neck veins and see that 00:22:57.039 --> 00:23:00.000 people have a quite heart rate. But those signs 00:23:00.000 --> 00:23:02.319 might be a little more subtle. and might be a 00:23:02.319 --> 00:23:04.680 little more difficult to assess in other people. 00:23:05.000 --> 00:23:07.740 It's always a good idea when you're in an event 00:23:07.740 --> 00:23:10.480 like this, and it is going to be either warmer 00:23:10.480 --> 00:23:13.720 or more humid, because both of those make our 00:23:13.720 --> 00:23:16.579 bodies and ability to cool itself quite difficult, 00:23:16.799 --> 00:23:19.519 that you have a game plan and say, hey, listen, 00:23:19.640 --> 00:23:21.480 guys, it's going to be a hot one out there today. 00:23:21.660 --> 00:23:23.559 Let's make sure that we're holding each other 00:23:23.559 --> 00:23:26.339 accountable to drinking appropriate amounts of 00:23:26.339 --> 00:23:28.740 fluid. And if any of us start to get symptoms, 00:23:28.960 --> 00:23:31.759 let's speak up and let's make that okay. So really 00:23:31.759 --> 00:23:34.920 normalizing that and helping others, making sure 00:23:34.920 --> 00:23:37.039 that the others in your party know about these 00:23:37.039 --> 00:23:40.440 symptoms and know that self -assessment is important. 00:23:40.660 --> 00:23:44.039 But then really paying attention to as you move 00:23:44.039 --> 00:23:46.779 into that heat stroke stage, if someone around 00:23:46.779 --> 00:23:49.819 you is starting to kind of mumble incoherently 00:23:49.819 --> 00:23:52.279 or not make sense, or you're noticing that they're 00:23:52.279 --> 00:23:54.710 really fumbling with. things that they're normally 00:23:54.710 --> 00:23:58.390 good at, like opening a bottle of water or using 00:23:58.390 --> 00:24:01.089 the phone or using a camera, really paying attention 00:24:01.089 --> 00:24:03.609 to those fine motor skills. If they look off 00:24:03.609 --> 00:24:06.069 balance, if they're swaying or staggering when 00:24:06.069 --> 00:24:08.769 they're walking, all of those things could really 00:24:08.769 --> 00:24:12.430 tune you in that that person is suffering from 00:24:12.430 --> 00:24:14.809 those early signs of heat stroke. Now, it could 00:24:14.809 --> 00:24:17.470 also be that someone's intoxicated. I think it's 00:24:17.470 --> 00:24:19.490 always better safe than sorry, and especially 00:24:19.490 --> 00:24:22.430 if the conditions are quite warm or quite humid. 00:24:23.049 --> 00:24:25.170 You always want to kind of assume worst case 00:24:25.170 --> 00:24:27.309 scenario, even though we always hope for best 00:24:27.309 --> 00:24:30.950 case scenario. Speaking of scenarios, if somebody 00:24:30.950 --> 00:24:33.950 is obviously if it's at a Little League game 00:24:33.950 --> 00:24:37.630 or something like that, you're in one spot and 00:24:37.630 --> 00:24:40.750 it's generally in a city. If you are doing a 00:24:40.750 --> 00:24:45.609 remote hiking trail and you're seven miles into 00:24:45.609 --> 00:24:50.970 a 15 mile hike. What are the best steps to take 00:24:50.970 --> 00:24:54.349 when you're in that remote situation and either 00:24:54.349 --> 00:24:58.309 yourself or someone else, you spot these signs? 00:24:59.069 --> 00:25:02.490 So prevention and having a strategy is definitely 00:25:02.490 --> 00:25:05.390 the way to go. That is the most important part 00:25:05.390 --> 00:25:07.970 of essentially treating heat stroke is preventing 00:25:07.970 --> 00:25:11.029 heat stroke. So making sure that you are paying 00:25:11.029 --> 00:25:13.390 attention to the weather forecast ahead of time. 00:25:13.470 --> 00:25:16.789 If it's going to be a very high heat index day, 00:25:16.869 --> 00:25:19.710 so that takes into account both the temperature 00:25:19.710 --> 00:25:23.039 and the humidity outdoors. Maybe you reschedule 00:25:23.039 --> 00:25:25.359 that hike. Maybe you do it in the morning hours 00:25:25.359 --> 00:25:27.940 before about 10 or 11 a .m. before the sun is 00:25:27.940 --> 00:25:30.539 at peak. Or maybe you do it in the later afternoon 00:25:30.539 --> 00:25:33.779 hours, such as 3 or 4 p .m. onwards. So really 00:25:33.779 --> 00:25:36.680 adjusting plans to what the weather is calling 00:25:36.680 --> 00:25:40.299 for. If you do decide to go out on a hike anyway, 00:25:40.579 --> 00:25:43.839 making sure that... A, even before you do so, 00:25:43.940 --> 00:25:45.819 you've talked to your doctor, you make sure you 00:25:45.819 --> 00:25:47.859 don't have any medical conditions or that you're 00:25:47.859 --> 00:25:49.779 not taking any medications that would put you 00:25:49.779 --> 00:25:53.660 at a higher compromised state of developing heat 00:25:53.660 --> 00:25:56.140 stroke. If you still decide to go out, then making 00:25:56.140 --> 00:25:59.339 sure that you know rescue numbers and patrol 00:25:59.339 --> 00:26:02.200 people who are responsible for rendering care 00:26:02.200 --> 00:26:05.539 and aid in that area. So I know now with the 00:26:05.539 --> 00:26:09.160 onset of Instagram hiking and social media, a 00:26:09.160 --> 00:26:11.799 lot of people are traveling internationally all 00:26:11.799 -->

00:26:14.200 over the world to places that they wouldn't normally 00:26:14.200 --> 00:26:16.579 go to or be exposed in. So it's important that 00:26:16.579 --> 00:26:18.900 even if you're doing hikes in areas that you're 00:26:18.900 --> 00:26:21.400 not used to, that you have a mode of communication. 00:26:21.680 --> 00:26:24.559 So whether it's making sure that your cell phone 00:26:24.559 --> 00:26:27.559 is in service and has a plan that you can connect 00:26:27.559 --> 00:26:30.420 to help or that you get one of those SIM cards 00:26:30.420 --> 00:26:32.900 and calling cards, making sure that you have 00:26:32.900 --> 00:26:35.200 a way. to contact help and that you know what 00:26:35.200 --> 00:26:37.700 the number is to contact help. So a lot of times 00:26:37.700 --> 00:26:40.059 I do a lot of hiking in Europe. My family's from 00:26:40.059 --> 00:26:42.539 there and there will be on a lot of the trailheads 00:26:42.539 --> 00:26:46.420 a sign with all of the emergency contact information. 00:26:46.579 --> 00:26:48.440 I always take a photo of that so that I have 00:26:48.440 --> 00:26:50.900 it with me and so that I can easily refer to 00:26:50.900 --> 00:26:54.279 it if needed. And then hiking. As you mentioned, 00:26:54.279 --> 00:26:56.980 in groups, so people who will be able to help 00:26:56.980 --> 00:26:59.079 you recognize signs or will be able to treat 00:26:59.079 --> 00:27:00.960 and make sure that everyone in that group has 00:27:00.960 --> 00:27:04.619 access to appropriate hydration stores. So as 00:27:04.619 --> 00:27:07.519 you are hiking, you're going to help your body 00:27:07.519 --> 00:27:10.180 prevent these end -stage conditions if you stay 00:27:10.180 --> 00:27:12.920 well hydrated with those balanced electrolyte 00:27:12.920 --> 00:27:15.160 fluids. And then if something like heat stroke 00:27:15.160 --> 00:27:18.000 does set in when you are, as you mentioned, far 00:27:18.000 --> 00:27:22.730 along along the hike, It's not ideal, to say 00:27:22.730 --> 00:27:26.009 the least. But even on those hikes, try to have 00:27:26.009 --> 00:27:29.309 a game plan of where to find shade, how to fan 00:27:29.309 --> 00:27:33.509 with either carrying a personal fan, having a 00:27:33.509 --> 00:27:36.829 hat or something with a more kind of sturdy structure 00:27:36.829 --> 00:27:39.529 that you can fan yourself with, and then extra 00:27:39.529 --> 00:27:42.930 ice and water. If it really comes down to it, 00:27:42.970 --> 00:27:45.789 there are improvised ways that people can cool 00:27:45.789 --> 00:27:48.230 themselves, such as what we call the taco technique 00:27:48.230 --> 00:27:50.509 or tarp assistance. cooling with oscillation. 00:27:50.609 --> 00:27:54.009 It's essentially any kind of tarp or somewhat 00:27:54.009 --> 00:27:57.829 waterproof sheet that you can find. You just 00:27:57.829 --> 00:28:00.190 lay a person in there and dump as much ice water 00:28:00.190 --> 00:28:02.470 as you can into that sheet and

kind of just slosh 00:28:02.470 --> 00:28:05.009 them around like you would trying to prepare 00:28:05.009 --> 00:28:08.309 a taco or a burrito. And that kind of motion 00:28:08.309 --> 00:28:11.069 of that ice water around a person helps to cool 00:28:11.069 --> 00:28:13.750 them. And then a lot of hikes, honestly, are 00:28:13.750 --> 00:28:16.910 around some kind of water, bodies of water. So 00:28:16.910 --> 00:28:20.079 be it lakes or streams. And that water is generally 00:28:20.079 --> 00:28:23.440 some kind of mountain runoff, is cooler than 00:28:23.440 --> 00:28:27.079 the ambient air outside. So potentially if you're 00:28:27.079 --> 00:28:30.880 choosing to hike in the warmer months and during 00:28:30.880 --> 00:28:33.880 the day, structuring those hikes around bodies 00:28:33.880 --> 00:28:36.720 of water where if you needed access to cool yourself 00:28:36.720 --> 00:28:38.519 off, you could always jump in the river, jump 00:28:38.519 --> 00:28:41.000 in the lake and just making sure that you can 00:28:41.000 --> 00:28:44.440 swim and that you're able to do so. What should 00:28:44.440 --> 00:28:48.500 people do to start with? I mean, without looking 00:28:48.500 --> 00:28:53.200 at the symptoms and signs of issues, before you 00:28:53.200 --> 00:28:55.400 go, what should you be wearing? What should you 00:28:55.400 --> 00:28:59.779 be taking? I recommend that when you want to 00:28:59.779 --> 00:29:02.220 start a new activity and you are, let's say you 00:29:02.220 --> 00:29:04.589 want to pick up hiking, you're not a hiker. this 00:29:04.589 --> 00:29:07.609 is why we have primary care doctors. So talk 00:29:07.609 --> 00:29:09.890 to your doctor, make sure that your medical conditions 00:29:09.890 --> 00:29:12.430 and the medications that you're taking allow 00:29:12.430 --> 00:29:14.930 you to do so. Because again, there are certain 00:29:14.930 --> 00:29:17.009 medications, certain medical conditions that 00:29:17.009 --> 00:29:20.190 put us at a particularly increased risk. If your 00:29:20.190 --> 00:29:22.490 doctor deems you to be in good health, you definitely 00:29:22.490 --> 00:29:26.309 want to dress in layers and in clothing that 00:29:26.309 --> 00:29:30.130 kind of allows that wicking of sweat kind of 00:29:30.130 --> 00:29:32.990 away from you and isn't necessarily tight and 00:29:32.990 --> 00:29:35.779 constrictive. on your body. There are a lot of 00:29:35.779 --> 00:29:38.160 kind of synthetic fabrics brands like North Face 00:29:38.160 --> 00:29:40.539 and Under Armour that are specifically and scientifically 00:29:40.539 --> 00:29:44.990 formulated. to provide as much cooling as possible 00:29:44.990 --> 00:29:48.569 for hot and sweaty activities. And they don't 00:29:48.569 --> 00:29:50.890 kind of insulate that sweat against you. What 00:29:50.890 --> 00:29:54.430 you want is materials that allow that evaporative 00:29:54.430 --> 00:29:57.829 and radiative cooling. Alternatively, materials 00:29:57.829 -->

00:30:01.089 like cotton and linen are quite good, especially 00:30:01.089 --> 00:30:03.490 in the high heat in summer months because they're 00:30:03.490 --> 00:30:06.630 airy. They allow for that convection cooling. 00:30:06.710 --> 00:30:09.329 They allow for that evaporative cooling. So dressing 00:30:09.329 --> 00:30:12.200 in layers. And then again, just making sure that 00:30:12.200 --> 00:30:15.539 you bring with you an adequate amount of hydration. 00:30:15.720 --> 00:30:18.720 And that can vary for every individual as far 00:30:18.720 --> 00:30:21.359 as really how much water and stuff you need to 00:30:21.359 --> 00:30:24.140 be drinking. What we recommend is that you are 00:30:24.140 --> 00:30:26.940 drinking enough that when you urinate, it's not 00:30:26.940 --> 00:30:30.670 yellow. Your urine should be clear. Again, different 00:30:30.670 --> 00:30:33.029 people need different amounts of hydration to 00:30:33.029 --> 00:30:35.349 maintain that. But if you are doing these longer 00:30:35.349 --> 00:30:38.230 hikes, making sure that it's not just water that 00:30:38.230 --> 00:30:40.549 you continue to drink, but it's these balanced 00:30:40.549 --> 00:30:43.130 solutions that you have a salt intake as well. 00:30:43.609 --> 00:30:47.309 Some of the issues some people have with hydration 00:30:47.309 --> 00:30:51.150 is that they may have two liters or four liters 00:30:51.150 --> 00:30:53.630 even with them, and they're not really sure, 00:30:53.789 --> 00:30:56.630 okay, I'm really thirsty now, but I've got to 00:30:56.630 --> 00:30:59.690 save it for later, because what if I get into 00:30:59.690 --> 00:31:02.230 trouble later? Should people be thinking that 00:31:02.230 --> 00:31:04.849 way, or should they be, if they're thirsty, they 00:31:04.849 --> 00:31:07.829 should take in water? It's always a good idea 00:31:07.829 --> 00:31:10.089 to ration and make sure that you're not then 00:31:10.089 --> 00:31:12.309 stuck in a situation where you need something 00:31:12.309 --> 00:31:15.049 and you don't have it. But it's a good idea also 00:31:15.049 --> 00:31:17.289 as you're planning your hikes, especially if 00:31:17.289 --> 00:31:19.809 it's not in the most remote areas, but if there 00:31:19.809 --> 00:31:21.769 are like mountain cabins and stuff like that, 00:31:21.890 --> 00:31:24.230 check to see ahead of time. Is it possible to 00:31:24.230 --> 00:31:27.789 buy additional fluids and drinks as you progress 00:31:27.789 --> 00:31:31.150 along the hike, let's say at the top or mid -mountain 00:31:31.150 --> 00:31:33.710 areas? Is it possible, do they have a water fountain? 00:31:33.829 --> 00:31:36.109 Is it possible to refill your waters? there. 00:31:36.470 --> 00:31:39.490 Generally, especially when you're exerting yourself 00:31:39.490 --> 00:31:42.190 in the heat, it is a good approach to drink when 00:31:42.190 --> 00:31:45.109 thirsty. And perhaps that should inform you that 00:31:45.109 --> 00:31:47.809 if you've drank

in everything that you have and 00:31:47.809 --> 00:31:49.670 you're a quarter of your way through your hike. 00:31:50.160 --> 00:31:52.420 that maybe that's not the day to complete that 00:31:52.420 --> 00:31:54.440 hike. Maybe you'll come back some other day when 00:31:54.440 --> 00:31:57.619 perhaps your body's need for hydration is a little 00:31:57.619 --> 00:32:00.160 less because it's not quite as hot or it's not 00:32:00.160 --> 00:32:02.279 quite as humid outside. Even though you want 00:32:02.279 --> 00:32:04.980 to be smart about your stores and making sure 00:32:04.980 --> 00:32:06.500 it will last you throughout your hike, maybe 00:32:06.500 --> 00:32:08.819 that should be an indication that it's not the 00:32:08.819 --> 00:32:11.839 day to do that. You touched on that a little 00:32:11.839 --> 00:32:15.579 earlier as well about rearranging plans. And 00:32:15.579 --> 00:32:18.259 I think that that's something that... a lot of 00:32:18.259 --> 00:32:21.259 professionals whether it's a mountaineer or a 00:32:21.259 --> 00:32:25.900 physician seem to stress the fact that maybe 00:32:25.900 --> 00:32:30.099 today isn't the day or if it's hot replan it 00:32:30.099 --> 00:32:34.359 or go very early in the morning later at night 00:32:34.359 --> 00:32:39.420 so i think the ability to know when to stop is 00:32:39.420 --> 00:32:42.380 a difficult one to learn but really important 00:32:43.470 --> 00:32:46.089 Absolutely. And it's so important, again, like 00:32:46.089 --> 00:32:48.470 you mentioned, not just in heat, but this past 00:32:48.470 --> 00:32:51.109 winter, for instance, was one of the most deadly 00:32:51.109 --> 00:32:54.869 winters as far as avalanche deaths recorded in 00:32:54.869 --> 00:32:57.309 the last hundred years when you look across the 00:32:57.309 --> 00:33:00.690 U .S. and Europe. And some of that is truly freak 00:33:00.690 --> 00:33:02.950 accidents. Nature is dangerous. And sometimes 00:33:02.950 --> 00:33:06.710 as we push and keep pushing against nature, nature 00:33:06.710 --> 00:33:10.190 pushes back. But a lot of those things are unavoidable. 00:33:10.230 --> 00:33:13.170 We want to make sure that we are looking at weather 00:33:13.170 --> 00:33:16.130 conditions. And trust me, I'm a skier, snowboarder, 00:33:16.130 --> 00:33:19.430 hiker, surfer, swimmer. I do it all. But it's 00:33:19.430 --> 00:33:22.569 really when we talk about the environment and 00:33:22.569 --> 00:33:24.750 we talk about the dangers of the environment, 00:33:24.869 --> 00:33:28.130 it's important that our ego comes secondary to 00:33:28.130 --> 00:33:31.130 that. And we really let nature dictate what we 00:33:31.130 --> 00:33:34.569 do on a particular day. And we don't try to supersede 00:33:34.569 --> 00:33:36.990 when all the warning signs are there to take 00:33:36.990 --> 00:33:38.930 a step back and not do something that day. So 00:33:38.930 --> 00:33:42.269 part of. engaging in these fun activities that's 00:33:42.269 --> 00:33:48.569 my entire life. But it's also knowing when to 00:33:48.569 --> 00:33:51.210 not do them on a certain day and realizing that 00:33:51.210 --> 00:33:53.250 it's a better idea to come back and do it another 00:33:53.250 --> 00:33:55.970 day than to never have another day to do it. 00:33:56.470 --> 00:34:00.130 Maybe social media has a bit of a part to play 00:34:00.130 --> 00:34:03.230 in this because everyone wants that great shot 00:34:03.230 --> 00:34:06.609 at the top of the mountain. you know, in the 00:34:06.609 --> 00:34:09.110 Slot Canyon or whatever it is, but sometimes 00:34:09.110 --> 00:34:12.289 it's really just not worth it. And everyone thinks 00:34:12.289 --> 00:34:14.329 that they're invincible, you know, like nobody 00:34:14.329 --> 00:34:16.750 thinks that it's going to happen to them. But 00:34:16.750 --> 00:34:20.369 again, we are seeing a rise year after year in 00:34:20.369 --> 00:34:22.730 U .S. heat -related deaths that are reported 00:34:22.730 --> 00:34:25.650 out. And again, with the cold activity deaths, 00:34:25.789 --> 00:34:28.150 with frostbite, with the drownings, drowning 00:34:28.150 --> 00:34:31.210 still remains the leading cause of death. Children 00:34:31.210 --> 00:34:34.210 aged one to four and the third leading cause 00:34:34.210 --> 00:34:36.889 of unintentional injury deaths in the world. 00:34:36.909 --> 00:34:39.610 These are really not things to take lightly. 00:34:39.730 --> 00:34:42.789 And like you mentioned, that that shot isn't 00:34:42.789 --> 00:34:46.489 worth your life. And it's great that people want 00:34:46.489 --> 00:34:49.909 to go out more and exercise more and be out in 00:34:49.909 --> 00:34:53.429 nature. But it's definitely changing. The climate 00:34:53.429 --> 00:34:56.929 is changing. So you have to be aware of the extremes 00:34:56.929 --> 00:35:00.429 more now than you did 20 years ago. Absolutely. 00:35:00.469 --> 00:35:03.070 And I'm a huge proponent of outdoor activities 00:35:03.070 --> 00:35:06.829 exercise. Go for it. Just do it safely and be 00:35:06.829 --> 00:35:18.030 prepared when you are doing it. Some amazing 00:35:18.030 --> 00:35:20.670 advice there. So if you are going out and it's 00:35:20.670 --> 00:35:24.030 hot, you now have some guidelines. Living in 00:35:24.030 --> 00:35:26.489 Nevada was a real eye -opener for us with the 00:35:26.489 --> 00:35:29.909 number of people completely unprepared for hiking 00:35:29.909 --> 00:35:32.829 in the desert. It was almost a weekly occurrence. 00:35:33.250 --> 00:35:35.889 Although we have seen it here in Scotland on 00:35:35.889 --> 00:35:39.289 those rare hot days, with families going to tackle 00:35:39.289 --> 00:35:42.449 some pretty challenging hills and being totally 00:35:42.449 --> 00:35:46.349 unprepared in so many ways. Education is the 00:35:46.349 --> 00:35:49.190 key. I think the only way that we're going to 00:35:49.190 --> 00:35:51.730 have to worry about heat stroke here this weekend 00:35:51.730 --> 00:35:55.510 is if we stand too close to an open oven for 00:35:55.510 --> 00:35:58.449 a long period of time. And we rarely use that 00:35:58.449 --> 00:36:01.429 now, thanks to the wonder that is air fryers. 00:36:01.530 --> 00:36:04.489 Not that this is an ad. If you do have news or 00:36:04.489 --> 00:36:06.889 suggestions for podcast guests, please do get 00:36:06.889 --> 00:36:11.449 in touch through jim at walkingpost .com. And 00:36:11.449 --> 00:36:14.230 as I always mention, we are always looking for 00:36:14.230 --> 00:36:16.929 guests, whether it's about a new trail, a new 00:36:16.929 --> 00:36:20.150 book, or a walking festival, or someone who has 00:36:20.150 --> 00:36:22.909 done an amazing or interesting walk somewhere. 00:36:23.519 --> 00:36:26.260 So, I hope you enjoyed this week's walkingpost 00:36:26.260 --> 00:36:29.860 .com podcast, and I hope you have a great week 00:36:29.860 --> 00:36:32.860 ahead, hopefully with a walk somewhere, whether 00:36:32.860 --> 00:36:35.780 it's in the rain or in the heat. Either way, 00:36:35.880 --> 00:36:39.219 be prepared. Until next time, happy trails!