Hospitals plan for mass shootings. We must do the same for heat. | Opinion

I was on call during the Fourth of July holiday in Baltimore when I cared for a patient who died because the air around them was simply too hot.

That's an unusual sentence. It shouldn't be.

While much of the country watched fireworks, hospitals across the East Coast were caring for victims of the same disaster. They simply didn't arrive all at once, and so we failed to recognize it for what it was.

As a trauma surgeon, I know what happens when a hospital activates its mass casualty plan. Every verified trauma center has one: a carefully rehearsed response for when a shooting, a building collapse, or a multivehicle crash sends a surge of critically injured patients through its doors. Staff are called in. Operating rooms are cleared. Beds are opened. Supplies are staged. Patients are triaged by severity rather than order of arrival.

We built these systems because experience taught us that treating a mass casualty event like an ordinary night in the emergency department costs lives.

This summer's heat wave is a mass casualty event. It simply unfolded over hours instead of minutes. That's the mental shift we have yet to make. We recognize disasters when they arrive with sirens, smoke or shattered glass. But extreme heat can overwhelm hospitals just as surely.

Extreme heat wave rarely arrives without warning

During the Fourth of July celebrations in Washington, DC, more than 600 people required first aid as temperatures soared.

Those patients didn't simply disappear after receiving a bottle of water. By that Saturday night, George Washington University Hospital alone had evaluated about 290 patientsfrom the National Mall, while emergency medical services transported dozens more.

Across the United States and Europe, hospitals reported emergency departments stretched beyond capacity as patients poured in with heat-related illness.

Unlike most disasters, however, heat rarely arrives without warning. Meteorologists often forecast dangerous heat days in advance. Hurricanes trigger emergency operations centers before landfall. Blizzards close schools before the first snowflake falls. Hospitals routinely activate special plans before major public events when they anticipate increased trauma volume.

Yet when forecasts predict several consecutive days of life-threatening heat, many hospitals still respond only after emergency departments begin to fill.

That should change.

Today's heat emergencies are becoming tomorrow's normal operations

The operational framework already exists. Hospitals know how to prepare for predictable surges. We establish activation thresholds. We mobilize additional staff. We postpone nonurgent procedures when necessary. We increase inpatient capacity. We position equipment and supplies before patients arrive.

Extreme heat should trigger the same operational discipline:

• Hospitals should establish heat-specific activation thresholds tied to forecasted heat index, not simply air temperature.
• Cooling equipment, ice, chilled IV fluids and other critical supplies should be staged before the first patient arrives.
• Additional emergency department, critical care and transport staffing should be mobilized automatically when heat alerts are issued.
• Health systems should coordinate regionally to anticipate capacity challenges before they become crises.

Some hospitals already do pieces of this. Very few do it systematically, and even fewer activate these measures before the surge begins.

This matters because today's heat emergencies are becoming tomorrow's normal operations. Researchers project that heat-related emergency visits and hospitalizations will rise substantially over the coming decades as extreme heat events become more frequent and more intense.

The gap between how we prepare for violence and how we prepare for heat will only grow more consequential unless we close it deliberately.

I still think about the patient we lost that night. Not because anyone lacked commitment or compassion. Everyone was working tirelessly. But the systems we have built still tend to treat extreme heat as an unusually busy shift instead of what it increasingly is: a predictable mass casualty event.

Heat doesn't announce itself with flashing lights or television helicopters. It arrives quietly ‒ one overheated body at a time ‒ until emergency departments are stretched beyond capacity.

We don't need to invent a new way to respond. Trauma systems have already taught us how to prepare for predictable surges of critically ill patients. The next step is recognizing that one of the most dangerous mass casualty events we face today may be forecast five days before the first ambulance ever arrives.

Dr. Joseph V. Sakran (@JosephSakran) is a trauma surgeon and public health expert who serves as executive vice chair of surgery at Johns Hopkins Hospital.

This article originally appeared on USA TODAY: Hospitals plan for mass shootings. We must do the same for heat. | Opinion

Reporting by Dr. Joseph V. Sakran, Opinion contributor / USA TODAY

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This story was originally published July 16, 2026 at 5:04 AM.