Missoula is one of Montana’s largest cities, but surrounded by rural mountain communities where cattle ranching is king.

Despite the mountainous terrain and altitude, in recent years this region has experienced punishing summer heat waves.

It’s been difficult for many residents, urban and rural, to adapt to the warming climate and new seasonal swings.

Many don’t have air conditioning, and are unprepared for the new pattern of daytime temperatures hovering in the 90s — for days or even weeks on end.

Dehydration, heat exhaustion, heat stroke, and abnormalities in heart rate and blood pressure are among the many health complications that can develop from excessive exposure to high temperatures.

It can happen anywhere and to anyone, said Missoula firefighter Andrew Drobeck.

He remembers a recent 911 call. The day had topped 90 degrees and a worker at a local dollar store had fainted.

“She’s sensitive to the heat, their a/c wasn’t working super good,” Drobeck said. “I guess they only get a 15-minute break.”

Age and isolation can make heat hard on rural residents

Montana is home to one of the country’s oldest populations. About one in four people are over 60 years old. Drobeck said many heat calls are from elderly people, who struggle to stay cool inside their older homes.

In July, a heat dome that settled over much of the western U.S. baked that region and shattered two types of temperature records: daily highs, and number of consecutive days over 90 degrees.

Although the Northwest, including western Montana, is typically cooler, the region has also experienced record-breaking heat this summer.

Emergency responders like Drobeck have taken note of the distress, as 911 calls during heat waves have ticked up over the last few summers.

But Missoula County officials wanted to know more: they wanted better data on which residents were calling, and which local communities have been hardest hit by the heat.

To find answers, the country teamed up with researchers at the University of Montana, to comb through 911 data and create a map of the calls to 911 during heatwaves.

Drawing on call data from 2020, they paired it with census data to see who lived in the areas generating high rates of emergency calls when it’s hot.

The analysis found that for every one degree Celsius increase in the average daily temperature, calls to 911 calls increased by 1 percent, according to University of Montana researcher Christina Barksy, who co-authored the Missoula County study.

That may sound like a small increase, but Barsky explained that a five-degree jump in the daily average temperature can prompt hundreds of additional calls to 911 over the course of a month. Those call loads can be taxing on ambulance crews and local hospitals.

The Missoula study also found that some of the highest rates of emergency calls during extreme heat events came from rural areas, outside Missoula’s urban core.

That shows that rural communities are definitely struggling with heat, even if you don’t hear about it on the news, according to Barsky.

“What about those people, right? What about those places that are experiencing heat at a rate that we’ve never been prepared for?” she said.

There are several reasons rural residents are calling 911 when it’s hot, said Barsky.

People living in Montana’s countryside and its small towns tend to be older. Barksy’s work showed that communities that are home to more people over 65 years old tend to generate more 911 calls during heatwaves.

Older bodies don’t acclimatize to heat as well as younger people. They don’t produce as much sweat, and inadequate circulation can lead to higher core body temperature.

Even if it cools off at night, an elderly person living somewhere without air conditioning might not be able to cope with hours of high temps inside their home during the day.

It’s not uncommon for rural residents to have to drive an hour or more to reach a library that might have air conditioning, a community center with a cooling-off room, or to reach medical care.

The isolation and scattered resources are not unique to Montana.

“I grew up in the Upper Peninsula of Michigan…there are no air-conditioned spaces in at least 50 miles, the hospital is 100 miles away,” Barksy said.

Rural research on heat waves just beginning

Heat research like the Missoula study has mostly focused on large cities, which stay hotter at night due to something known as the “heat island” effect. This phenomenon explains why cities tend to get hotter during the day, and cool off less at night: it’s because pavement, buildings, and other structures absorb and retain heat. Urban residents may experience higher temperatures during the day, and get less relief at night.

When it comes to rural areas, by contrast, researchers are only just beginning to investigate and understand the impacts of heat waves.

Preliminary research findings from Tennessee suggest that some rural areas there are heating up faster than large cities, according to researchers at the East Tennessee State University.

Rural communities have largely been ignored when it comes to extreme heat, said Elizabeth Doran, an environmental engineering professor at the University of Vermont.

Doran is leading an ongoing study in Vermont, and she’s finding that even towns as small as 5,000 people can stay hotter at night due to heat radiating off hot pavement

“If we as a society are only focused on large urban centers, we’re missing a huge portion of the population, and our strategies are going to be limiting in how effective they can be,” Doran said.

Preparing for heat waves in rural homes

Brock Slabach with the National Rural Health Association agrees that rural residents desperately need help adapting to extreme heat. They need support installing air-conditioning or getting to air-conditioned places, so they can cool off during the day.

Many rural residents have mobility issues or don’t drive as much, due to their age or disabilities. And because health care services can be farther away, they are vulnerable to delays during a heat-related emergency, which could lead to more severe health outcomes.

“It’s not unreasonable at all to suggest that people will be harmed from not having access to those kinds of services, and then end up in the hospital emergency department with heat related illness,” he said.

Helping rural populations adapt will be a challenge.

People in rural places need help where they live, inside their homes, said Adriane Beck, director of Missoula Disaster and Emergency Services. Starting a cooling center in a small community may help people living in town, but it’s unrealistic to expect people to drive an hour or more to cool off.

The Missoula Disaster and Emergency Services department plans to use data from the 911 study to better understand why people are calling in the first place.

In the coming years, they plan to talk directly with people living in those communities about what they need to adapt to rising temperatures.

“It might be as simple as knocking on their door and saying, ‘Would you benefit from an air conditioner? How can we connect you with resources to make that happen?’” said Beck.

But that won’t be possible for every rural household; there simply isn’t enough money at the county and state level to pay for that many air-conditioning units, officials said.

That’s why the county needs to plan ahead for heat waves, and have specific plans for contacting and assisting vulnerable rural residents.

“Ideally we’d be in a situation where maybe we have community paramedics that can be deployed into those areas when we know that these events are going to happen so they can check on them and avoid that hospital admission,” Beck explained.

Beck added that by preventing heat-related hospitalizations among rural residents, they can ultimately save lives.

This story comes from NPR’s health reporting partnership with Montana Public Radio and KFF Health News.

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