Drunk man crosses scorching asphalt during record heat, burning the soles of his feet in the 2021 Northwest heat dome.

A new case study in a leading medical journal highlights a stark, health-centered reminder: climate tipping points threaten human well-being in increasingly tangible ways, and the health consequences can be immediate and severe when extreme heat intersects with everyday activities. The research analyzes a dramatic incident during the unprecedented Northwest heat dome of 2021, revealing how a brief barefoot walk across a sun-soaked pavement can yield serious, sometimes life-altering burns. As climate change intensifies heat events, health systems, cities, and individuals must reckon with the amplified risk of injury, illness, and cascading health effects linked to hot surfaces, heat exposure, and vulnerability.

The Case Study: A Severe Yet Nós-Overlooked Heat Injury

In the latest issue of a premier medical journal, researchers present a detailed case that underscores an often-overlooked facet of climate-health risks: the danger posed by hot outdoor surfaces during extreme heat. The scenario centers on a man who, amid extremely high temperatures, walked barefoot for roughly one minute across sun-warmed asphalt.

The environmental conditions were extreme. Air temperatures reached levels around 42 degrees Celsius, which translates to roughly 108 degrees Fahrenheit. Those figures represent a striking departure from historical averages for the region, illustrating how heat can spike beyond typical seasonal norms during a heat dome event. Asphalt and other dark, exposed surfaces can intensify danger because they absorb a large portion of incoming solar radiation.

Upon presenting to a burn center, the man displayed red, oozing injuries on the soles of both feet, with blistering on the heel of one foot and on the toes of the other. He reported intense pain. Medical assessment classified the injuries as second-degree burns, indicating that both the outermost and underlying layers of skin were affected. This level of burn is notable for its potential to heal but also for a risk of complications if not managed carefully.

In the burn unit, clinicians implemented a standard but meticulous care plan. Pain relief was provided, and the wounds were thoroughly cleaned. A topical antibiotic was applied to prevent infection, followed by the use of an antimicrobial foam dressing to protect the compromised skin. Over time, follow-up evaluations suggested healing without complications, indicating a favorable short-term outcome given the severity of the initial injuries.

The clinical team responsible for the case emphasized that, while the patient recovered, the incident illustrates a broader truth about growing heat exposure: the risk of such burns will rise as climate change progresses. The health professional leading the case is a recognized expert in emergency medicine and global environmental health, underscoring the link between acute clinical care and broader environmental health considerations. The team’s assessment notes that extreme heat events elevate the risk of burns from hot surfaces in the environment, particularly for groups that already face heightened vulnerability.

The broader health context is sobering. As extreme heat becomes more common, more individuals may encounter hot outdoor surfaces during outdoor activity or incidental exposure. The case highlights that vulnerable populations—such as children, older adults, people who are unhoused, and those with substance use disorders—are at increased risk of sustaining contact burns from hot sidewalks, pavement, or other surfaces.

While this single case does not define the full scope of a rising health threat, it contributes to a growing body of evidence that ties climate change to direct, visible injuries. The implications extend beyond a single patient: they imply a potential uptick in burn injuries during heat waves and the need for heightened clinical preparedness, public awareness, and preventive strategies to mitigate harm on days of extreme heat.

The Physics and Physiology of Heat on Streets: Why Surfaces Become Killers

The clinical lesson from the case rests on a straightforward physical reality: dark, sun-exposed surfaces absorb a substantial share of solar radiation, transforming pavement into an engine of heat. Asphalt, in particular, is known to absorb the majority of solar radiation compared with lighter surfaces. On hot days, the surface temperature of asphalt can surge far above the air temperature, creating a hazardous gap between the visible heat we feel and the heat contained in the ground beneath our feet.

In quantitative terms, asphalt can absorb about 95 percent of incoming solar radiation. This robust absorption means that surfaces in direct sun can reach temperatures markedly higher than the surrounding air. On extremely hot days, surface temperatures can climb to levels that increase the risk of skin damage with even brief contact. The data suggest that surface temperatures can be several tens of degrees Fahrenheit (or several degrees Celsius) higher than ambient air temperatures, depending on factors such as sunlight intensity, pavement composition, altitude, humidity, and wind.

This differential is not just a technical curiosity; it translates into tangible harm. When a person steps onto a surface that is significantly hotter than the air, the heat conducted through the skin accelerates tissue injury. The risk is not uniform across populations or circumstances. In a heat dome scenario, where air temperatures are already extreme, the additional heat load from a hot surface can be sufficient to cause second-degree burns in minutes, especially to vulnerable skin areas such as the soles of the feet and the heels.

The clinical description of the burn injuries supports this mechanism. The affected skin showed damage to both the superficial and deeper layers, consistent with second-degree burns. Such burns are painful, prone to infection, and require careful wound management to minimize scarring and functional impairment. The care team’s approach—pain control, cleansing, topical antibiotics, and protective dressings—reflects standard burn care practices aimed at promoting healing while preventing complications.

Beyond the immediate injuries, the physiological stress of extreme heat compounds risk. Heat exposure stresses cardiovascular and thermoregulatory systems, increases dehydration risk, and can contribute to syncope (fainting) or heat-related illnesses. When heat stress coincides with activities that involve physical exertion or risky environments (such as walking barefoot on hot pavement), the likelihood of severe outcomes rises. This is particularly true for individuals who may already be compromised by substance use, underlying health conditions, or limited access to shade and cooling resources.

The case’s broader significance lies in the intersection of climate dynamics with everyday behavior. A one-minute barefoot walk on a scorching surface becomes a high-stakes event when heat is at unprecedented levels. The lesson extends beyond the burn itself: it signals a need to consider how urban surfaces, outdoor activities, and personal choices interact with climate-driven heat to produce injuries that stress emergency departments and burn units.

Health Implications of Extreme Heat: Beyond a Single Burn Event

While this case centers on a burn injury, it sits within a larger constellation of health risks associated with extreme heat and climate disruption. Heat waves and heat domes elevate the incidence of a range of heat-related illnesses, including heat exhaustion, heat stroke, dehydration, and electrolyte disturbances. These conditions can lead to organ stress, kidney injury, cardiovascular events, and even life-threatening emergencies.

The immediate burns from hot surfaces are one piece of a broader heat-health mosaic. In areas of extreme heat, people are more likely to experience dehydration due to sweating, which, in turn, reduces blood volume and can impair organ perfusion. Dehydration and heat stress can worsen existing cardiovascular or renal diseases, creating a compounding health burden during heat waves.

Another dimension of risk emerges in environments such as busy urban streets, where heat amplification is most pronounced. In such settings, outdoor workers, pedestrians, and individuals who lack access to cool spaces are disproportionately exposed. The combination of prolonged sun exposure, high surface temperatures, and limited cooling options creates an environment where innocuous daily activities can become hazardous.

The health system implications extend beyond the burn center. Hospitals and clinics face surges in heat-related presentations during extreme heat events. Emergency departments must triage patients with heat illness, dehydration, or smoke and chemical exposure during wildland fire events often linked to heat, while burn units manage injuries from contact with hot surfaces. In the long term, repeated heat exposure can contribute to chronic health issues, exacerbate existing disease burdens, and strain healthcare resources during heat waves.

Public health messaging emphasizes practical steps to reduce risk: advising individuals to avoid barefoot exposure on hot surfaces, seek shade or cooled environments, and limit outdoor activity during peak heat. Communities may also benefit from structural interventions, such as implementing reflective road surfaces, adding shade trees along sidewalks, and increasing the availability of cooling centers to reduce the threat posed by hot pavement and elevated surface temperatures.

This broader health perspective helps illuminate how climate change reshapes risk profiles for vulnerable populations. The combination of extreme heat with substance use, housing insecurity, older age, and other social determinants of health yields a heightened risk landscape. The interplay between heat exposure and health status can influence both acute injuries, like burns, and the escalation of chronic health conditions, underscoring the need for integrated health and social services responses during heat events.

Vulnerable Populations: Who Faces the Highest Heat-Health Risks

The case study draws attention to specific groups that are particularly susceptible to the dangers of extreme heat and hot-surface contact burns. Children, older adults, unhoused individuals, and people living with substance use disorders appear at elevated risk in heat wave conditions. Each group experiences a unique constellation of vulnerabilities that amplify the likelihood of adverse outcomes.

• Children and older adults: These populations often have diminished capacity to regulate body temperature and may be less able to recognize or communicate heat distress. They are more likely to spend time outdoors in warmer conditions or to be exposed to hot urban surfaces without adequate protection or supervision.

• Unhoused individuals: People without stable housing frequently lack access to cooling resources, shade, or safe, cooler environments. They may be exposed to extended periods of heat in outdoor settings, sidewalks, or transit areas, increasing the risk of both heat illness and surface-related burns.

• People with substance use disorders: Substance use can exacerbate heat tolerance challenges and impairment of judgment, leading to risky exposure or delayed recognition of heat injury. In some cases, intoxication or overdose can be accompanied by impaired mobility or consciousness on hot surfaces, amplifying the danger of severe burns or systemic heat injury.

• People with chronic health conditions: Cardiovascular disease, diabetes, kidney disease, and other chronic illnesses can worsen heat-related outcomes. These conditions may magnify the risk of dehydration, electrolyte imbalances, and poor wound healing after burn injuries, creating a more complicated clinical course in the context of extreme heat.

• Socioeconomic factors: Access to air conditioning, shaded outdoor spaces, and timely medical care influences outcomes. Communities with limited access to cooling resources, safe walking surfaces, and health services face higher risk levels during heat waves.

The case study’s emphasis on these vulnerable groups reinforces the importance of targeted prevention strategies. Public health messaging and clinical guidance should prioritize outreach to those most at risk, ensuring access to cooling options, protective footwear, and timely medical evaluation after exposure to hot surfaces or signs of heat illness. Community-based interventions that address housing stability, shelter availability, and access to hydration can play a critical role in reducing heat-related injuries and improving outcomes for those who are most susceptible.

Clinical Care in a Warming World: Implications for Burn Management and Emergency Response

Burn care in the context of climate-driven heat events requires a precise clinical approach, timely assessment, and careful follow-up. The case demonstrates that rigorous wound care, pain management, infection prevention, and wound dressings are essential components of successful recovery from surface burns caused by extreme heat. In a broader sense, the case highlights how burn care in an era of rising heat exposure may see shifts in patient profiles, injury patterns, and resource needs.

Key clinical considerations include:

• Prompt assessment: Determining burn depth and surface area, evaluating potential comorbidities, and assessing the risk of infection are priorities in any burn-related visit. Accurate classification as second-degree burns informs treatment decisions and prognosis.

• Wound care: Cleaning of burns, application of topical antibiotics, and protective dressings are standard components of care to prevent infection and promote healing. In complex cases, antimicrobial dressings or specialized wound care products may be employed depending on wound characteristics and patient needs.

• Pain management: Adequate analgesia is essential due to the significant pain associated with burns, which can impact patient comfort, healing, and mobility. A tailored pain management plan is part of the comprehensive care approach.

• Follow-up and healing trajectory: Regular follow-up helps monitor wound healing, identify potential complications, and adjust treatment as needed. Healing trajectories can vary based on burn depth, patient age, comorbidities, and adherence to wound care protocols.

• System-level implications: Climate-related heat events can lead to surges in burn center admissions, potentially straining hospital resources during peak heat periods. Preparedness planning, including staff allocation, supply chain resilience for wound care products, and triage protocols, is essential for health systems facing hotter, longer heat seasons.

• Public health synergy: Clinicians play a role in public health messaging by recognizing patterns linking heat exposure to skin injuries and communicating prevention strategies to patients and communities. This collaboration helps translate clinical experiences into practical guidance for reducing heat-related harms.

The broader clinical takeaway is that, as climate change expands the frequency and intensity of heat events, health systems must adapt in both patient-level care and population-level protection. This includes integrating heat-health awareness into emergency preparedness, burn care protocols, and community outreach, to reduce the occurrence and severity of injuries tied to hot surfaces and extreme heat.

Prevention, Public Health Messaging, and Urban Adaptation

The rising incidence of heat-related injuries tied to hot surfaces calls for proactive prevention strategies at multiple levels. Public health authorities, city planners, healthcare providers, and communities can collaborate to reduce exposure, mitigate risk, and support safer behaviors during heat events.

Key prevention avenues include:

• Education on safe outdoor activity: Community health campaigns can emphasize avoiding barefoot walking on hot pavement, using protective footwear, and scheduling outdoor activities during cooler parts of the day. Clear messages about recognizing heat distress and signs of surface burns are essential.

• Environmental design and urban cooling: Urban planning can mitigate heat exposure through reflective or light-colored pavement, shade-providing trees and canopies along sidewalks, and the creation of shaded pedestrian corridors. Increasing the availability of cooling centers and drinking water stations during heat waves can provide accessible relief for those at risk.

• Public cooling resources: Establishing and maintaining air-conditioned public spaces and cooling centers during heat events helps reduce heat exposure for vulnerable populations. Transportation planning can also facilitate access to cool environments for people who lack his or her own cooling resources.

• Protective footwear and footwear accessibility: Promoting the use of protective footwear in hot climates, and ensuring affordable access to such gear for those without means, can substantially reduce burn injuries from hot surfaces.

• Early warning systems and targeted outreach: Heat advisories that include actionable guidance on avoiding exposure and seeking care early can prevent injuries. Outreach programs can specifically address high-risk groups, including those who are unhoused or living with substance use disorders.

• Health equity considerations: Prevention and adaptation efforts should account for disparities in housing, income, and access to healthcare. Tailoring interventions to communities most exposed to heat helps ensure that protective measures reach those who need them most.

Public health messaging needs to be clear, consistent, and actionable. By translating the case study’s implications into concrete steps for individuals and communities, health authorities can reduce the likelihood of harmful burns and other heat-related injuries during increasingly common heat events. The broader objective is to make heat safety a routine, integrated part of daily life and urban design, rather than a sporadic emergency response.

Research Gaps, Data Needs, and the Path Forward

The emerging pattern of injuries linked to extreme heat and hot surfaces points to several research gaps that warrant attention from the medical, epidemiological, and public health communities. While case studies illuminate individual experiences and clinical responses, there is a need for systematic data on the incidence, distribution, and outcomes of heat-surface burns across regions and populations. Key questions include:

• What is the true incidence of burns resulting from contact with hot pavement and other urban surfaces during heat waves, and how does this vary by city, season, and heat intensity?

• Which factors most strongly predict burn severity and complications in the context of extreme heat, including age, comorbidities, ischemia risk, and dehydration status?

• How do heat-related injuries interact with substance use disorders, housing insecurity, and other social determinants of health to influence prognosis and resource needs?

• What are the most effective clinical care pathways and prevention strategies to reduce burns associated with hot surfaces during heat events?

• How can urban design innovations and cooling interventions be quantified in terms of their impact on burn risk and heat-related health outcomes?

Addressing these questions requires multidisciplinary collaboration across clinical medicine, environmental health, epidemiology, urban planning, and public policy. It also calls for enhanced surveillance systems to track heat-related injuries, standardized reporting to facilitate comparisons across regions, and longitudinal follow-up to understand long-term consequences of burn injuries linked to climate-driven heat.

In addition to surveillance, there is value in expanding public-facing research communication that translates findings into practical guidance for clinicians, policymakers, and communities. Clear, accessible information about heat-surface burns and their prevention can empower individuals to take protective actions and advocate for safer urban environments.

The take-home message is that climate change is not a distant, abstract threat but a current clinical and public health challenge. The case study demonstrates that extreme heat can manifest in immediate, tangible injuries, and it emphasizes the need for ongoing research, proactive prevention, and resilient health systems capable of meeting the demands of a warming world.

Practical Takeaways for Clinicians and Public Health Professionals

• Recognize the risk: Extreme heat raises the likelihood of burns from hot surfaces; clinicians should consider heat-surface contact as a potential mechanism in burn presentations during heat waves.

• Emphasize prevention: When advising patients and communities, stress protective footwear, staying off hot pavements, seeking shade, and using cooling centers during peak heat periods.

• Integrate heat-health into emergency readiness: Hospitals and burn units should anticipate potential surges in heat-related injuries, coordinate with public health authorities, and ensure adequate supplies for wound care and pain management.

• Target high-risk groups with tailored messaging: Outreach should prioritize children, older adults, unhoused individuals, and those with substance use disorders, ensuring access to cooling resources and protective equipment.

• Leverage urban design as a preventive tool: Support policies and projects that reduce urban heat, such as reflective pavements, strategically placed trees and shade structures, and accessible cooling spaces.

• Encourage ongoing education for healthcare providers: Develop training materials to help clinicians identify, treat, and counsel patients on heat-related injuries, with an emphasis on rapid assessment and prevention of infection in burn care.

• Foster multidisciplinary collaboration: Align healthcare systems with environmental health researchers, urban planners, social services, and community organizations to create a comprehensive response to heat-related health risks.

• Invest in research: Support studies that quantify burn incidence from hot urban surfaces, identify risk modifiers, and evaluate the effectiveness of prevention strategies and urban adaptation measures.

By translating the case study’s insights into concrete clinical practices and public health actions, professionals can mitigate the health impacts of climate-driven heat and reduce the burden of burn injuries and related health problems during heat waves.

A Broader View: Climate Change, Health, and Society

The case underscores a central theme in contemporary health discourse: climate change is increasingly shaping health outcomes in direct, visible ways. Extreme heat acts not only as a stressor on physiological systems but also as an amplifier of risks that arise from daily life decisions and environmental design. The convergence of high surface temperatures, sun exposure, and vulnerable populations creates a scenario in which even brief outdoor activities can become injurious or life-threatening.

From a societal perspective, the incident emphasizes the importance of equitable access to cooling resources, safe urban infrastructure, and supportive services for populations dealing with housing instability or substance use. It also highlights the need for proactive health communication strategies that address heat risk without stigmatizing individuals or communities. A humane, evidence-based approach to heat health should prioritize prevention, rapid response, and thoughtful resource allocation that reduces disparities in heat-related injuries and improves resilience in the face of climate change.

The health implications extend to long-term planning and policy. As heat events become more frequent and intense, cities may need to reconsider pavement materials, urban heat island mitigation strategies, and emergency response protocols. Healthcare systems must be prepared for seasonal fluctuations in heat-related presentations and understand how social determinants influence who bears the burden of climate-related health risks.

In sum, this case study is a microcosm of a broader public health challenge: climate change is reshaping health risks in tangible ways, and protective actions at the individual, community, and policy levels can reduce the harm. The health sector’s response to this evolving landscape will influence outcomes for countless people, now and in the decades to come.

Conclusion

The examined case from the climate-health literature presents a vivid illustration of how climate change translates into concrete injuries and health risks. An otherwise ordinary moment—a brief barefoot stroll across hot pavement during an extreme heat event—resulted in second-degree burns to both soles and toes, underscoring the physics of heat absorption and conduction in urban environments. The incident also highlights the greater context: as heat waves intensify, the risk of surface-related burns will increase, particularly for vulnerable populations such as children, older adults, unhoused individuals, and people with substance use disorders.

Beyond the single burn injury, the case invites a broader reflection on health in a warming world. Extreme heat elevates risk for heat-related illnesses, dehydration, cardiovascular stress, and kidney injury, and it interacts with social determinants of health to widen health disparities. Clinicians, public health professionals, urban planners, and policymakers must collaborate to enhance surveillance, prevention, and response strategies—ranging from patient education about heat safety and protective footwear to urban design choices that reduce surface temperatures and increase access to cooling resources.

Ultimately, the message is clear: climate change is a present-day health driver, and proactive, integrated actions are essential to protect people from the escalating health harms associated with extreme heat and hot urban surfaces. Preparedness in clinical care, targeted public health outreach, and thoughtful urban adaptation can collectively reduce the burden of heat-related injuries and improve resilience in the face of a changing climate.