The volume of patients in Dr. Robert Brewer’s upstate New York emergency room isn’t always predictable, but when there’s a heat wave, he knows he needs to staff up.

Heat waves mean more dehydration and kidney problems. As patients’ bodies struggle to regulate temperature, dilating blood vessels strain their hearts, sometimes leading to heart failure. Brewer sees more frustration, outbursts and patients less able to manage mental health conditions. Last summer, when the Northeast was hit with uncharacteristically severe heat waves as climate change continues to worsen, all that was especially true.

“It definitely strains hospital resources,” said Brewer, the associate director of emergency medicine at St. Peter’s Hospital in Albany. “We definitely feel it in the emergency department, and the hospital feels it, hospital-wide.”

A new study from researchers at Harvard University and Boston University backs him up.

The study, published Monday in Nature Health, found that roughly 1 in 10 emergency department visits across 19 states were driven by heat during two severe heat waves last summer.