Bitter cold temperatures kill. Here's how to protect yourself and your patients.

By Lisa Marie Basile | Fact-checked by Davi Sherman
Published January 25, 2024

Key Takeaways

  • Cold temperatures can increase emergency room visits, especially among the unhoused population.

  • During bitter cold seasons, emergency physicians may see patients present with heart attack, hypothermia, hypertension, and atherosclerosis.

  • Very cold weather can also prevent patients from accessing medication and ongoing critical care.

With temperatures dropping into the 20s and teens—or lower—in some areas of the United States, medical professionals are seeing patients with health concerns caused or exacerbated by the bitter cold. 

Extreme cold conditions can impact patient heart health, requiring the heart to work overtime to keep the body warm. The American College of Cardiology indicates that it’s not just heat that impacts human health. Very cold temperatures—especially following rapid and extreme fluctuations in the weather—put stress on the body, increasing the risk of heart attack. The urgent reality of climate change also exacerbates these extreme and sudden cold snaps, according to new findings.[] 

Ken Perry, MD, FACEP, an emergency physician based in Charleston, SC, says that he’s seen cold-season heart attacks occur, especially in patients shoveling their driveways or paths. “For anyone who has grown up in cold temperatures, it is known that all snow is not the same,” Dr. Perry says. “Some of the snow is really heavy and wet and can be too heavy for patients to safely shovel, [so] I have had patients who shovel snow come to the emergency department having heart attacks.”

Jared L. Ross, DO, NREMT-P, EMT-T, an emergency physician at Emergency Medical Services, Education & Consulting LLC, says that heart attacks due to shoveling snow usually occur in older males with pre-existing heart conditions during overexertion.

Exposure to low temperatures may also increase blood pressure and induce disease conditions such as hypertension, myocardial infarction, and atherosclerosis.[]

Despite the clear connections between cold temperatures and heart health, 2023 research published in Frontiers in Cardiovascular Medicine says that cold exposure’s role in cardiovascular diseases remains underappreciated.[]

Dr. Perry says that these realities are often more common among unhoused patients. “The cold becomes a major concern,” he says. “If they sleep in an open environment, low temperatures can become life-threatening. I have had patients who live on the street perish from being exposed to the elements.”

Dr. Ross says he sees many cases in which unhoused people come into the ER with hypothermia and frostbite. 

Dr. Perry says that extreme cold sometimes leads to unhoused patients trying to secure a place in the hospital during the coldest nights to prevent a health emergency. “Many patients know that psychiatric illnesses can cause them to stay in the emergency department. Therefore, we do see patients who need a place to stay use psychiatric complaints as a means to get into the department for the coldest nights,” he says. 

Dr. Ross has also seen it, noting how tricky the situation can be when unhoused people have limited resources and access to safe, warm environments. “[Unhoused people] come up with a new medical complaint after they have been worked up for the previous one so that they can extend their stay,” he says. “This is very unfortunate because it wastes limited medical resources. We try to have compassion, but allowing them to rest in the ER is not always possible, especially with the current staffing shortages and boarding crisis.”

Dr. Perry says there are other issues related to cold seasons, including patients who present with symptoms of carbon monoxide poisoning from using outdoor heaters inside. “Patients who use gas-powered heaters can have life-threatening emergencies,” he says—something healthcare providers should be aware of and warn against. 

Dr. Ross says he also sees increased respiratory complaints, as cold weather can trigger or exacerbate reactive airway diseases such as asthma or COPD.

Beyond direct medical complaints, Dr. Ross stresses how cold weather can interfere with critical medical care. 

“Inclement weather also tends to shut down transportation and doctors’ offices,” Dr. Ross adds. “This limits many patients' access to care and to their medications. Some of these patients come to the emergency department.”

Delayed care, he says, also causes an ongoing ripple effect: “People are less likely to seek care for a minor medical issue during a storm. Postponing that care can make a minor issue more serious, [and] many of those patients end up in the emergency department.”

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