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Extreme Arctic Winters Pose Risks to Community Health: Icy roads, sidewalks, lack of sunshine, extreme cold lead to illness and death every winter.

Weeks and weeks and weeks of fifteen-to twenty-four hour sunlit days make Alaska a wonderful place to explore--in the summer. But such an opportunity also comes with a big caveat: months and months of darkness and a frigid, deep cold settle over the state in the winter. Fairbanks, among other areas of the state, experienced temperatures of -50 degrees Fahrenheit in early 2017.

Few other locales (if any) in the United States can lay claim to such unique seasonal attributes and everyday living conditions. These seasonal extremes also present a wide set of health and safety risks for the state's nearly 740,000 residents.

SAD

Extensive periods of darkness--from October to January in some regions of the state--contribute significantly to Alaska's inordinately large segment of residents suffering from Seasonal Atfective Disorder (SAD). A reported 9.2 percent of Fairbanks' population is afflicted each year, according to research led by Dr. Norman Rosenthal, in contrast to 1.4 percent in Sarasota, Florida, and 4.7 percent in New York City. A pamphlet from South Peninsula Hospital in Homer puts the population affected by SAD at 10 percent.

SAD is marked by feelings of lethargy, increased appetite, and irritability, and its prevalence in northern latitudes worldwide is estimated to be between 10 and 20 percent. Most times those who experience severe SAD typically don't last more than a few seasons in the climate, says Dr. Gandis Mazeika, a physician with the Alaska Sleep Clinic, which has four locations in Alaska including in Anchorage and Fairbanks.

Mazeika, citing a US National Library of Medicine and National Institutes of Health study on SAD prevalence in Alaska, says SAD tends to occur more often in women and is less common among residents who are forty years old or older.

"I don't believe that SAD is necessarily a rite of passage for all newcomers to Alaska," says Mazeika, adding that most people have relatively low sensitivity to long nights. "Only a relatively small percentage of people have enhanced sensitivity to ambient light levels, but these individuals can be quite impacted."

While SAD may affect more Alaskans than US residents in other locations, treatment options remain the same. Mazeika says new LED visors that provide more light exposure than stationary lights and mood remedies for mild cases may be effective. "For those who are able, a trip south to Hawaii, California, or Mexico can be powerfully restorative and recharge the mood and energy batteries."

At South Peninsula Hospital, employees are encouraged to use SAD remedy lights, which are a part of the employee wellness reimbursement program. The hospital also provides education on SAD through bulletin boards and brochures, the latter of which is shared through community locations. A hospital physician even led a community SAD presentation during a winter carnival event.

The seasonal disorder, which is often called the winter blues or cabin fever, is just one of several extreme winter related health issues and potential dangers prompting many Alaskans to seek out medical help.

Winter Dangers: Recreational Injuries, Frostbite, and Falls

On the list of winter dangers, along with SAD, are hypothermia, frostbite, injuries from snow-related recreational activities such as snowboarding and skiing, boating accidents, and even wildlife attacks.

The Alaska Department of Health and Social Services doesn't track SAD cases, as the seasonal affliction falls within mental issues reporting and many SAD patients are typically treated by private behavioral health providers, according to Clinton Bennett, the department's media relations manager.

But the agency does track other extreme winter-related treatments and traumas at the state's medical centers and hospitals. Between 2012 and 2016 there was an annual average of thirty-seven hypothermia and frostbite cases, twenty-seven ski and snow-boarding injuries, eight sledding-related injuries, and more than seventy snow machine related injuries.

Not on that data list, however, is one of the most common winter-related issues treated by emergency room physicians--injuries due to falls and slips on icy walkways and roadways.

"Winter in Alaska is cold, dark, and usually covered with ice and snow. For our patients, this increases the risk of slips and falls," says Sean Murphy, emergency management specialist/EMS liaison at Alaska Regional Hospital, based in Anchorage.

The potential for injury due to falls is something the hospital's staff deals with regularly during extreme winters, says Murphy.

"Our facilities, security, and contracted maintenance work diligently to stay ahead of winter-related hazards but cannot eliminate all risks as we endure a winter season that can last nearly half the year. In addition to maintaining the grounds, our facilities department offers free ice cleats to all hospital staff."

Murphy says many of the hospital's ER visits are due to treacherous highways and streets that residents deal with on a daily basis during winter. "The roads are usually covered with several inches of ice all winter, we can see freeze and thaw patterns that increase the travel risk, and, not least of all, there is only one road into Anchorage, both north and south, from surrounding towns," explains Murphy. As a result, the risk of a winter accident is significant.

Murphy says Alaska Regional Hospital, aware of the potential for its employees to be stranded or trapped on icy roads, provides staff with a winter preparedness primer during job orientation.

"This includes instructions to keep winter clothes, boots, blankets, and signaling devices in their cars through the winter months," Murphy says.

At South Peninsula Hospital, ice-related falls come in second to cases of viral respiratory infections. The Homer hospital also provides staff members with cleats to help employees avoid landing in their own ER, according to a spokesperson.

The months of icy cold weather can also lead to increased risk of carbon monoxide poisoning from the use of what Murphy calls "alternative" heating sources, and there is great potential for hypothermia and frostbite for those who may not have a suitable heated environment.

The noxious poisoning falls under the state's data reporting of unintentional injuries, which have increased 11.1 percent since 2007.

"This time of year brings an increased risk of house fires from wood stoves and space heaters, as well as an increased number of cases of carbon monoxide poisoning from non-traditional heat sources, such as unsound wood stoves and oil/kerosene space heaters," says Murphy, who adds winter is especially hard on the state's homeless population, many of whom choose not to stay at shelters and instead walk the streets and sleep in homeless camps.

"This leads to a yearly spike in exposure-related afflictions such as hypothermia and frostbite. Sadly, there are usually a number of exposure-related deaths each winter among the homeless population. Often their bodies are only found as they are uncovered by the melting snow come spring," says Murphy, recalling that the year 2010 recorded a particularly cold winter and the hospital saw thirty exposure-related homeless deaths.

The Alaska Department of Health and Social Services reports thirteen deaths due to exposure in 2016, down from eighteen in 2015. In 2011 there were twenty exposure deaths and nineteen in 2007, according to the "Health Analytics and Vital Records" report issued by the department's division of public health.

Alaska Regional Hospital conducts clothing drives each year to help the underserved and homeless in need of proper winter clothing. It participated in The Clothesline Project this year, which gave away clothing and school supplies to more than 500 children in need.

"Both the inpatient units and our emergency department keep supplies of both new and gently used warm clothing to assure that patients leave the hospital appropriately dressed," says Murphy, who adds the state's economic downturn may make such issues even more ubiquitous. "I'm guessing here, but I believe this winter will bring the unfortunate combination of more people and fewer resources to help them," he says.

Boosting Winter Safety

Just like Alaska Regional Hospital, Providence Alaska Medical Center, based in Anchorage, reports that fall-related injuries because of icy walkways and roadways is the top reason patients over the age of thirty visit the facility's emergency department.

In fact, 43.3 percent of injuries during the winter are due to slips and falls, according to a hospital spokesperson, and 24.5 percent of winter falls are related to ice and or snow.

That's a principal reason Providence initiated an Injury Prevention Outreach program in 2014 that provides ice cleat education, distribution, and a cleat fitting program in the Anchorage community.

In 2016 the hospital provided ice cleat fitting and safe winter walking education to the Faith Community Nurses and Anchorage Literacy Project Peer Leader Navigators. The nurses, representing twenty-five different faith communities, were given 200 pairs of ice cleats for congregation members. Another 140 were given to the navigators, who serve as health liaisons to ethnically diverse communities.

This past October a total of 404 pairs of ice cleats and safety education outreach were made available to both groups for the upcoming winter season.

The hospital's Injury Prevention Outreach program also includes a coordinated reflector distribution effort in Anchorage, which started in 2000. The program focuses on both adult and pediatric populations.

"Given Alaska's seasonal low-light wintertime conditions, making reflective zipper-pulls and adhesive reflective material available to community members, especially those who are frequent pedestrians and bicyclists, is a priority," states an information sheet on the program.

In 2016, 400 clip-on and reflective materials were provided to the Faith Community Nurses and Navigators and a homeless teen shelter received 200 reflectors. In addition, 3,650 reflective tape strips and 1,940 reflective zipper-pulls were given to elementary school children in Anchorage.

Most recently the outreach program received a donation of 10,000 brilliant reflective strip packets and plans to expand distribution to more faith communities, schools, and emergency shelters this winter season, all in the hope that the community will be warmer, safer, and protected against Alaska's seemingly interminable winters.

By Judy Mottl

Judy Mottl writes about important issues country-wide with an affinity for Alaska.
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Title Annotation:Healthcare
Comment:Extreme Arctic Winters Pose Risks to Community Health: Icy roads, sidewalks, lack of sunshine, extreme cold lead to illness and death every winter.(Healthcare)
Author:Mottl, Judy
Publication:Alaska Business Monthly
Geographic Code:1U9AK
Date:Dec 1, 2017
Words:1650
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