EXTREME heat is exposing state-level ICU capacity gaps in regions already facing high climate-related health risk.
Extreme Heat ICU Capacity Gaps
A state-level ecological analysis presented at ATS 2026 suggests that U.S. critical care resilience may be unevenly matched to the growing burden of extreme heat. By linking heat-related deaths, adult ICU bed capacity, and Heat and Health Index scores, the analysis identified geographic mismatches between climate vulnerability and available critical care infrastructure.
The study examined heat-related deaths coded with ICD-10 X30 from CDC WONDER between 2021 and 2023, adult ICU beds per 1,000 adults from HHS Protect in 2021, and 2024 Heat and Health Index scores from CDC/ATSDR. Investigators calculated deaths per ICU bed ratios as an ecological burden indicator. Mortality analyses were limited to six states that met CDC suppression thresholds of at least 10 deaths, while ICU capacity mapping included all states and territories.
Arizona Shows Capacity-Mortality Mismatch
Across the six western states included in mortality analyses, heat-related mortality totaled 1,620 deaths. Arizona had the highest absolute burden, with 733 deaths, a rate of 6.89 per 100,000, and the highest deaths per ICU bed ratio at 0.344. This occurred despite moderate ICU capacity of 0.4 beds per 1,000 adults, compared with a national mean of 0.31.
Nevada also emerged as a high-risk state, with the highest heat-related death rate at 6.37 per 100,000 and high vulnerability, reflected by a Heat and Health Index score of 0.658.
Critical Care Deserts Identified
Eight states had critically low ICU capacity, defined as 0.2 beds or fewer per 1,000 adults. These included four high-vulnerability western states: Oregon, Washington, California, and Idaho. The findings point to “critical care deserts,” where ICU capacity appears disproportionately low relative to population-level heat vulnerability.
The authors concluded that infrastructure alone may not offset extreme vulnerability when pre-hospital systems fail, as demonstrated by Arizona’s capacity-mortality mismatch. They suggested that integrating Heat and Health Index scores into ICU capacity planning could support vulnerability-adjusted standards and more targeted federal resource allocation.
The findings also indicate that current federal and state heat action plans may need stronger critical care surge capacity components. Designating ICU capacity as climate-critical infrastructure could help guide investment through hospital preparedness and climate adaptation funding before vulnerable regions face catastrophic heat events.
Reference
Siddiqui K et al. Heat Vulnerability and ICU Capacity: State-level Disparities in U.S. Critical Care Resilience to Extreme Heat, 2021-2023. ATS International Conference, May 15-20, 2026.
Featured Image: Drazen on Adobe Stock.
