To: Clinicians Network Members
Date: Thu, 03 Aug 2006 08:29:41 -0500
Subject: Heat-Related Conditions Information
Dear Colleague:
Reports of homeless people dying of heat-related causes are proliferating during the current heat emergency.
I recommend to your attention a very good chapter of The Health Care of Homeless Persons on Hyperthermia and Heat Stroke: Heat-Related Conditions.
The author of the chapter, Joseph Rampulla, MS, APRN, BC, a nurse practitioner at the Boston Health Care for the Homeless Program, recently wrote the memo appearing below to his colleagues in Boston. You may find it useful in your own practice, or as a model for communications within your own program.
Finally, let us all remember and be bold in stating that while cooling stations, emergency shelters and the like are important ameliorative measures in this emergency, they are no solution to the underlying problems of homelessness. Only proper housing provides adequate protection from the elements. The issue, like others in Health Care for the Homeless, is ultimately an issue of justice.
Thank you for your work. Please read Joseph’s memo below and the fuller account on-line.
John
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John N. Lozier, MSSW
Executive Director
National Health Care for the Homeless Council
Health Care is a Human Right. Learn more about our work for human rights, or contribute to our work, at www.nhchc.org.
Advisory to clinicians 6/26/06
From: Joseph Rampulla, MS, APRN, BC, Boston Health Care for the Homeless Program
Frostbite and hypothermia season is over and our patients are now susceptible to heat-related and dehydration problems. Remember to consider these problems in many of our patients who are subject to the elements and have risk factors for heat-related conditions. Heat stroke, heat exhaustion, heat-related syncope, heat cramps are probably more common in our patients than we recognize. *
*Alcoholism contributes to dehydration, unawareness of temperature, and of course it contributes to risky behavior like jumping into the river intoxicated. I know of 2 of our patients over the years who drown this way during heat-waves. There are probably more alcohol-related violence during the summer months. Heroin addiction also can cause unawareness of temperature and alter thirst.
*Patients with mental illness at risk for a number of reasons. Both neuroleptics and anticholinergics (including antihistamines, ie. Cogentin and tricyclic antidepressants) alter temperature regulation. These medications may also alter thirst so that some patients actually drink too much water and become over-hydrated. This overhydration can lead to hyponatremia. Patients with paranoia and impaired temperature perception often wear heavy winter clothes on hot days.
*Persons that are newly-housed often live alone in hot rooms/apartments with no air-conditioning and poor ventilation. Case reports of heat-wave deaths invariably include elders that died alone in hot apartments. Patients without air conditioning can avoid heat illness by taking frequent cool baths/showers.
*Many of our patients work through labor pools and are subject to dangerous working conditions. Persons doing day labor often work long days without cooling or fluid. Last year one of my patients suffered heat stroke doing day labor and drinking beer.
*Very young children and the elderly are more susceptible.
*Many of our patients are chronically dehydrated, no matter what the weather. They are at more risk for complications during the summer. This is especially true for patients with poorly-controlled diabetes and alcoholism. Many patients restrict their fluid intake because of a lack of bathroom facilities in the city. Viral diarrhea illnesses, that can lead to dehydration, are fairly common in the summer. Free lunch sites sometimes only offer a small cup of sugared drinks with meals. If the drinks are heavily sugared they may actually contribute to dehydration.
*Ask patients where and how they stay cool. Remind them to seek out cool places when it is hot outside. Ask patients where they obtain fluids. Discuss strategies for staying hydrated. This might even be advising a patient to remember to drink water and eat when they are on drinking binges. I ask patients to be cautious about swimming and drinking and remind them of the intoxicated patients who have drown. The content of Gatorade per 8 ounce glass is: 6% sugar, 110mg sodium, and 30mg potassium. A 50-50 mix with water is palatable and works well.
###Our earlier circulation of Joseph Rampulla’s memo and chapter elicited several responses, including the following from Seth Foldy, an HCH physician who has been Health Commissioner of Milwaukee among other distinctions. The Milwaukee website is rich with clinical, programmatic and policy resources related to heat emergencies, and I commend it to your attention.
Other communities might be interested in the Milwaukee heat plan I initially authored in ’96 and which has been associated with halving death rates in Milwaukee. It relies heavily on community agencies being notified and responding promptly to heat alerts following fairly stereotyped (ie. easy to follow) actions. Obviously practice (exercising) is part of the solution. You can find latest (including a medicine-heat interactions list) at
www.milwaukee.gov/heat Seth Foldy, MD MPH FAAFP
health.e.volution and Medical College of Wisconsin
rmcox
