The Kitsap County Coroner’s Office is investigating four deaths believed to be related to the recent heat wave.

The deaths involved 71- and 80-year-old men and 66- and 88-year-old women.

“All the victims were found in indoor and outdoor locations with high ambient [air] temperatures of 100 degrees Fahrenheit or higher,” said Dr. Lindsey Harle, a forensic pathologist with the coroner’s office.

Some had additional risk factors such as cardio-vascular disease.

“Some individuals were wearing multi-layers of clothing despite the temperature,” Harle said. “In some cases, this was due to psychiatric illness and in some cases, this was related to homelessness.”

Record-setting temperatures were recorded late last month — Bremerton hit 106, Seattle 108 and Portland 116. State authorities linked 57 deaths to the heat wave.

More than 1,900 emergency department visits took place for suspected heat-related illness, said Katie Pope, a state Department of Health public information officer. People came to the ER because of heat exhaustion, dehydration, dizziness, temporary loss of consciousness and collapse, she added.

Meteorologists attributed the extreme temperatures to a dome of high pressure over the Northwest, combined with human-caused climate changes.

Here’s how a heat-related death happens, according to the coroner’s office:

When temperatures soar the body’s ability to dissipate heat is overwhelmed, Harle explained. Sweating releases heat. To sweat, one’s heart and cardiovascular system has to be pumping blood throughout the body. “At some point, your heart may not be able to keep up with the temperature surrounding your body. When this happens, you stop sweating because you run out of fluids to sweat,” she said.

“You then have inflammation and direct damage to cells and proteins in your body from the heat. Initially what happens is people will have muscle cramps, headache, nausea and vomiting. As things progress, you develop altered mental status, which a lot of times is drowsiness and inability to communicate.”

A rapid heart rate and rapid breathing follow, and finally you can lose consciousness, she said.

With the body focused on directing blood to the skin in order to cool down, a lesser amount goes to internal organs, which leads to liver and kidney failure. How quickly an individual can succumb to heat varies, but Pope said a person unable to compensate for high temperatures, such as the elderly, has dementia or multiple medical problems, can be impacted in a matter of hours.

Risk factors

Risk factors include having a chronic disease such as diabetes or cardio-vascular disease, or being unable to care for oneself, such as is the case with young children and some elderly, Harle said.

“Those with mental illness who may not be adequately able to care for themselves and make the decision to dress appropriately and find a cooler environment are also at higher risk,” she added.

Those who are socially isolated are another vulnerable group. “They don’t have anyone checking in on them, and they may not have the ability, or means, to get out of their home.

“Poverty is also a risk factor because those individuals may not have the means to get out of their house or even turn on their air conditioning if they have it. They may not even have access to the internet to find out about cooling stations or that a heat wave is coming,” she added.

Keeping cool

During the historic heat spell, cooling centers were opened around Kitsap County — Poulsbo City Hall, a community center in Kingston and a senior center in Bainbridge Island. Cooling centers are a godsend in heat spells, Harle said.

“They are very important because a lot of people do not have air conditioning in their home. In our region, air conditioning is the one greatest factor that makes the difference in heat-related deaths. So, the ability for individuals to go to cooling centers or public places that have air conditioning is very useful.”

The pathologist offered advice on ways people can help prevent heat-related illness. Dress appropriately in light clothing.

Avoid doing chores in the heat. Instead, do them in the evening or put them off a few days.

Experts believe the frequency of sweltering weather events is likely to increase in the future — global warming has raised temperatures by 2-degrees Fahrenheit since 1900.