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Substance Abuse and Mental Health Services Administration
Beating the Heat on the Street
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Samra, Steven
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Description: When the heat rises dramatically during summer months, people experiencing homelessness are at extreme risk of exposure-related illnesses associated with the rise in temperature. This article provides a brief description of the signs and symptoms of heat related disorders and provides a perspective on how one veteran outreach worker works outside the box of conventional approaches to assist this vulnerable population.
Content:

As an outreach worker and a formerly homeless person in recovery, I know firsthand the impact hot summer days can have on those of us who must survive almost continual immersion in the natural elements. While people are often acutely aware of hypothermia, when core body temperature drops too low, it is also important to consider hyperthermia, when core body temperature rises too high. Heat-related illness can occur when a person’s body is unable to compensate for the increase in temperature and cannot properly cool off. Cooling occurs normally by sweating and evaporation, but in some situations an individual’s perspiring is simply not enough to cool the body down. When this occurs, a person's internal temperature can quickly rise into the danger zone. If left unchecked, the high body temperature may damage the brain or other vital organs and can even result in death.

The Centers for Disease Control (CDC) states that “Extreme heat is marked by temperatures that stay 10° or more above the average high for a region over a period of weeks.” The following information provided by the CDC can help individuals recognize heat-related emergencies:
  • Heat cramps are painful spasms of the leg or stomach muscles that may be accompanied by heavy sweating. They do not require medical attention, but the person should stop all activity, sit quietly in a cool place, and drink water, juice, or a sports drink.
  • Heat exhaustion is marked by extreme fatigue, heavy sweating, thirst, headache, dizziness, fast and shallow breathing, nausea and vomiting, pale and moist skin, and a fast, weak pulse. If untreated, the symptoms may progress to heat stroke. Cooling measures may include rest in an air-conditioned environment, light weight clothing, cool non-alcoholic beverages, and a cool shower or bath.
  • Heat stroke is a life-threatening hyperthermic condition caused by breakdown of the body’s thermoregulation. The skin no longer sweats and becomes red, dry, and very hot. Body temperature is above 103°F and can rise rapidly to 106° F in as little as 15 minutes. Chest pain, shortness or shallowness of breath, and abdominal pain may be present along with confusion, anxiety, a rapid pulse, and throbbing headache. Until emergency medical care arrives, caregivers should start to cool the person rapidly with whatever methods are available: remove extra layers of clothing, fan, wrap in a wet sheet, sponge with any cool liquids, or spray with cool water from a garden hose.
While the medical aspects of over-exposure to heat are certainly important to understand, they are not the only issues individuals face when the mercury rises. Sweltering days may cause significant difficulties in individuals’ daily routines while increasing overall risk factors to those who must endure them. My own anecdotal street experience in dealing with the heat on the street has found that when the weather turns oven-hot for days at a time, cities get even hotter. Thanks to heat-absorbing properties of asphalt and concrete, this is known as the “urban heat phenomenon” (Rampulla, 2004).

People experiencing homelessness are already under significant stress from difficult living conditions. Adding unbearable heat for long periods can reduce coping mechanisms and a person’s temper may increase as patience and tolerance shorten. Several other troublesome issues can also arise as a result of extreme heat, including:
  • Insomnia can increase due to intolerable sleeping conditions.
  • The inability to keep food cool in extreme heat conditions can increase the risk of food spoilage and heightens the risk for illness for those without access to refrigeration.
  • Hot temperatures can also cause some to take increased risks in order to beat the blazing heat by swimming in dangerous and/or polluted waters, trespassing to access cool areas, drinking alcohol more heavily than normal, using drugs to escape the misery, etc.
  • Alcohol and coffee are diuretics which can quickly deplete the body of available fluids, while certain drugs, especially amphetamines or cocaine, create hyperthermic responses in the body under normal conditions. Using speed, crack or cocaine during heat waves can spell disaster for a person.
With this knowledge in hand, I approach outreach differently during very hot days. I try to use a large air-conditioned van and fill several coolers with ice and bottled water. I make my rounds and offer “cool seats” inside the van when I encounter people on the street. I have a small DVD player and a selection of comedies that folks can watch as they take 30 minutes to sit in a cool environment and rehydrate themselves. I also provide free “shuttle service” to the local libraries and day shelters so folks don’t have to walk to “cooling centers” in the heat. I try to regularly visit people I know to have serious and/or chronic health issues that make them more susceptible to the heat. Finally, I purchase extra daily bus passes and hand them out so individuals can escape the heat by riding in air conditioned public transportation.

Summertime brings with it additional dangers and problems for those on the streets, but it also brings new opportunities for outreach and engagement as well. A kind face, a cool seat, a short ride, a bottle of iced water, and a bus pass will be remembered by those you’ve helped for a long time to come, and you may just save a life in the process.

Click ‘Add Comment” below to add your tips for outreach in the heat.

CDC. (2007). Emergency Preparedness & Response. (2007). Centers for Disease Control and Preventionhttp://www.bt.cdc.gov/disasters/extremeheat/heat-guide.asp.

Rampulla J. (2004). Hyperthermia & Heat Stoke: Heat-Related Conditions, In The Health Care of Homeless Persons: A Manual of Communicable Diseases and Common Problems in Shelters and on the Streets, Boston Health Care for the Homeless Program. http://www.bhchp.org/BHCHP%20manual/pdf_files/ Part2_PDF/Hyperthermia.pdf

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File(s)
Type of Resource: PATH Resource
Publication Date: 2010
Location: Newton Centre, MA
Phone: 617-467-6014
Krystle F. Nickles from Baltimore
September 03, 2010
1:17 PM
 
I really have an interest in "mobile outreach" and the outreach you are facilitating is not a practice I have heard of before, but it certainly fits in with mobile medical units that serve to outreach to people on the street! Truly, I think it's an innovative approach to an issue that has received too little attention.

In addition, it raises the point about how individuals make transitions to and from different locations as the seasons change, in order to reside in a more comfortable weather conditions (hopefully where it's not too hot and not too cold). As it was pointed out earlier, the dangers related to excessive exposure to heat have not been paid enough head, but your efforts are truly paving a way for others to follow!
Steven Samra from Nashville
September 02, 2010
7:39 AM
 
Because I perform outreach in "The South," finding ways to beat the heat and at the same time find innovative methods for engaging people are always at the top of my priority list. The van seemed like a viable option and while it turned out to be great for that particular purpose, it also had the added benefit of making me recognizable while in a vehicle! I would often return to the van after a meeting or errand to find several people nearby, awaiting my return.

Also, because I chose specific parking areas whenever I headed into the downtown area of Nashville, I could wander the streets and yet be sure that if someone wanted to connect with me but couldn't find me as I walked, they could wait by the van. You'd be surprised how many people my initial contact with began "at the van."
Rachael Kenney from Golden
September 01, 2010
3:49 PM
 
My spellcheck says that hyperthermia is spelled wrong, which clearly indicates that it doesn't get as much attention as it deserves. For people in cooler parts of the country the heat isn't a big issue but for states like Arizona, where dozens of people experiencing homelessness die due to heat related complications each year, this is a huge problem. In July, there were three deaths in three days in Arizona, the heat was above 110 for each of those days. http://www.azcentral.com/news/articles/2010/07/19/20100719phoenix-two-homeless-men-dead-abrk.html We have extra beds in the wintertime for the cold but what about places for people to go in the summer heat?
Laura Gillis from Baltimore
September 01, 2010
3:44 PM
 
I love the idea of a van as a "cooling center" in the outreach setting. In our city, public buildings are used as cooling centers. The van allows for a more accessible place for people on the streets in the heat. Also, what an engagement tool!
Neil Greene from Newton Centre
September 01, 2010
3:37 PM
 
As these hot summer days continue, I hope your outreach and engagement techniques are picked up by many others.


   
 
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