The city of Portland was baking last June and Jonna Papaethimiou, director of the Bureau of Emergency Management, was in crisis mode.
With temperatures 40 degrees Fahrenheit above normal in a city where air conditioning is not common, Papaethimiou was smoldering, trying every last ditch effort possible to keep residents cool and healthy.
There were the jury-rigged fog stations in public parks, the stadium canopies left open all night, and the hundreds of calls Papaefthimou and her staff made to social housing managers asking them to check on elderly residents.
Amid all of this, she recalls a thought filtering through the 116F heat: “Oh, eff, that’s what climate change does. This is the future we all face.”
Nearly a year after that heat dome, emergency managers, doctors and even transportation systems across the Pacific Northwest say they are learning lessons from the unprecedented event to prepare for this summer, as climate change increases the likelihood of similar heat domes reoccurring.
“We knew we had to prepare for this and had submitted mitigation grant applications, but when it came it was just so sobering,” said Lara Whitely Binder, director of climate preparedness for King County in Washington.
To understand how unusual the effects of the heat dome were, it’s best to look at the numbers. An analysis by the Centers for Disease Control and Prevention found that in May and June 2021, 3,504 people went to emergency departments for heat-related illnesses in Department of Health and Human Services Region 10 areas, which encompass the Pacific Northwest.
On June 28, when temperatures peaked at 116 F — 42 degrees higher than the average daily high for the region — there were about 2,779 visits to the emergency room for heat-related illnesses. On the same day a year earlier there were only nine emergency visits due to heat.
Ultimately, extreme heat killed more than 160 people in Oregon and Washington, many of them from staying in rooms without air conditioning or other cooling options.
dr Alex St. John, an emergency room physician at Seattle’s Harborview Medical Center, worked only one shift during the heat dome but says the emergency room was as intense as it was in the early days of the coronavirus pandemic.
“It just felt like there were more patients than we could possibly handle and we were in damage control mode where we were just trying to make sure all the sickest people got the essential treatments they needed .” he said.
One of those patients was an elderly woman who came to the emergency room with a core temperature of 104 degrees — dangerously hot and on the verge of fatal heat stroke. To cool her off quickly, St. John pulled her up to her chest in a black body bag, normally meant for cadavers, and filled it with ice.
St. John received his medical training in Arizona, where he treated patients with heat illness by placing cool, damp cloths on their skin. In the nine years he’s been practicing in Seattle, he said he’s only had to treat a handful of heat-stressed patients and never seen anyone in such distress. He had only heard about the use of body bags to treat heat stroke days before when a colleague mentioned his desperation at having to use it himself.
Though unconventional, the trick saved the woman’s life. St. John said he would not hesitate to reach for a body bag to treat heat stroke in the future, but he worries that higher temperatures could one day become so bad and prolonged that they would strain the capacity of the hospital cafeteria’s ice machine.
“It was really surreal working in Seattle and seeing patients in worse conditions than I had seen in the Sonoran desert caring for people,” he said.
“Environmental heat is an anomaly”
While excessive heat would have health implications in any region, last year’s heat dome was particularly dangerous because residents and communities in the Pacific Northwest are not used to such high temperatures.
Many don’t have air conditioning — including Seattle’s own properties.
During the heat dome, “cooling stations” were set up in just three community centers, in part because the city’s other 21 don’t have air conditioning, emergency planning coordinator Lucia Schmit said.
“Our response was hampered by the fact that the infrastructure in our city was essentially built to store heat because environmental heat is an anomaly,” she said.
These cooling centers have not been heavily utilized, and focus groups have shown since the summer that there is a need for cooling centers that cater to unique populations. Families with young children would like to visit refrigeration centers in their own neighborhoods where their children can run and play, while older residents would be more likely to visit centers with quiet areas. People affected by homelessness need centers where they can access food and services.
But it can be difficult to meet all of these diverse needs when schools and other city buildings in neighborhoods also lack air conditioning. Additionally, last year’s heat dome hit, while pandemic-related closures meant many library sites weren’t open, but Schmit said the city and library system are now evaluating whether libraries could help people cool off on hot days.
“We’re very attached to the fact that we just don’t have a lot of air-conditioned spaces,” she said.
Emergency planners in King County, which includes Seattle, encountered similar obstacles. Emergency management director Brendan McCluskey said his team has begun working with private companies like Petco to ensure residents have places to cool off, even with their pets.
The county was also forced to open its first-ever 24-hour cold shelter when emergency managers found evening temperatures were not cooling as usual.
McCluskey said the county was lucky the heat dome occurred between coronavirus waves, allowing it to use a shelter originally set up as a place for people with Covid-19 to isolate, as a cooling center instead.
“This area wasn’t being used, so we quickly repurposed it so people could take shelter from the heat,” he said.
“A failure of our entire community”
Back in Portland, Papaethimiou, who is now the city’s chief resilience officer, also noted that cooling centers were underutilized — something she attributes to the community’s lack of understanding that high heat can be dangerous.
She worries that low-income people without their own transport will not wait outside in the heat for a bus ride to refrigerated accommodation or will not pay the fare and instead choose to stay at home. After the heat dome, the TriMet bus system created a new policy that would not collect fares from passengers traveling to or from cold storage if the state or county is activating a heat emergency.
“As far as we know, most of the time the deceased did not seek help,” Papaethimiou said. “They just thought they would stay home and be fine and nobody checked them out. It was a failure of our entire community.”
For this summer, Portland hopes to inspire residents at all levels about the importance of heat safety. They want to work with community groups to help set up cool shelters in neighborhood churches or other places where residents might feel more comfortable. The spray stations that were improvised last year will also be a fixture on the neighborhood’s playgrounds.
The city’s heat news not only includes the fact that heat is deadly, but also a reminder that people should look out for their neighbors and family members who may need help.
Additionally, the city has decided to turn on the National Weather Service’s wireless emergency calls to personal cell phones during heat waves to remind people how to stay cool.
“When you’re stuck in a sea of heat, this bus is like a lifeboat, it’s the thing you have to board to be safe and you can’t charge people to get on the lifeboat said Papaethimiou.
“Right to Refrigeration”
Vivek Shandas, director of the Sustaining Urban Places Research Lab at Portland University, said he believes last summer’s heat dome was a wake-up call for city dwellers and emergency managers alike.
“I’ve worked with heat for 15 years, and it’s been years where I’ve been talking to people and laughing my head out of the room talking about heat waves because people were like, ‘We’re never going to have that heat, we have other things to prioritize,’” he said. “Heat never really got a lot of play until last year.”
Shandas said he believed people would be more cautious after last year’s heat. But while he applauds the city’s efforts to set up more cooling centers during future heatwaves, he hopes there will be more systematic changes to improve access to cooling in homes.
One such change comes from a study that measured temperatures in Portland’s public housing units. Several people who lived in such units died during the heat dome, and now the city and housing authority are working with Portland State University on a project to install temperature sensors in rooms and hallways of public housing units. The sensors also warn residents if the rooms are getting dangerously hot.
“Right now we don’t have a good system to let people know what they’re experiencing inside their homes – which can often be hotter than outside temperatures,” explained Shandas.
The Oregon legislature has also taken steps to protect people from future heat events. Lawmakers passed legislation this March restricting restrictions that landlords and homeowners’ associations can place on portable refrigerators. The legislation, known as the “Right to Cool” bill, also creates a $34.5 million state program to distribute air conditioners and filters to needy residents during emergencies.
State Senator Kayse Jama (D) said during the heat dome he had heard from voters who said they were trying to keep their cool but were “afraid of eviction” from landlords who said window units were a safety hazard if they fell .
“We needed to act quickly and immediately to ensure we could save lives and protect our vulnerable populations in the next heat wave,” he said.