Overview

Extreme heat kills more Americans each year than hurricanes, lightning, tornadoes and floods combined, according to the Centers for Disease Control (CDC). Everyone is at risk when temperatures rise above 90 degrees, but older persons are among the most susceptible to heat-related illness and deaths. With age, we lose some of our ability to adapt to the heat. Also, certain medications interfere with the body’s ability to handle heat, and some older people have mobility limitations that may prevent them from getting relief during high heat. Establishing a personal support network is a critical part of planning for any emergency.

THE SOLUTION
You can help prevent heat-related illnesses and deaths by checking on people in your community during periods of extreme heat and, if needed, offering to drive them to an air-conditioned location. Every heat-related illness and death is preventable! A/C is the number one protective factor against heat-related illness and death, according to the CDC.

TIME COMMITMENT
The time commitment for the project ranges from 10 to 20 minutes to make a round of phone calls on hot days to a few hours or more to visit the people on your list, determine if they have what they need to survive the heat wave and, if not, to transport them to a safer environment.

SPECIAL CONSIDERATIONS
You need to have the means to personally check on people and, if necessary, to transport them during a heat wave.

GREAT REASONS TO DO THIS PROJECT
This project is a great way to strengthen community bonds and let people on your list know that someone is looking out for them as well as prevent heat-related illnesses and deaths. Other benefits include:

• Help reduce and prevent heat-related illnesses and deaths
• Let the people on your list know that somebody is looking out for them
• Strengthen community bonds: Even when people don't need help, they will appreciate a call or visit and a chance to chat.
• Learn how to protect yourself and others during periods of excessive heat.

WHAT TO DO

STEP 1: CHOOSE PEOPLE TO CHECK ON AND GET THEIR OK
Start with one to three people — neighbors or others in your community who you think might be especially susceptible during extreme heat. Likely candidates include people who are aged or aging, live alone and have a chronic illness and/or reduced mobility.

For each person, include all modes of contact and contact information for their loved ones in case of a health emergency.

Be realistic about the time you have available to physically check on others during a heat emergency. Be careful not to over-promise your assistance. Remember, once people accept your offer to check on them, they will be relying on you to follow through.

Make an initial call (or email) to each of the people on your list and explain your offer to help. If they aren’t interested, be polite and move on. Make sure they understand that, during periods of extreme heat, you will stop by if you cannot reach them by phone or email.

For each person on your list, obtain all possible modes of contact (landline phone, cell phone, email) and contact information for one or more of their loved ones in the event the person has a health emergency or in case you cannot get to them, for whatever reason. Propose a backup neighbor or family member to check up on the person if you are not able to.

STEP 2: WRITE A LIST OF PROCEDURES AND PLAN A ROUTE

Asphalt and concrete store heat longer and gradually release heat at night, which can produce high nighttime temperatures known as the “urban heat effect.”

The list will be largely the same for each person but may contain some action items that are specific to an individual — for example, if someone is on supplemental oxygen at home and uses an electric oxygen-delivery machine, your list will include bringing the equipment when you move that person and ensuring that he/she can plug the equipment in at the destination.

Keep these lists in a notebook or binder in an easy-to-remember location in your house. (For a sample list, see Additional Resources in this guide.)

Also, get a local map — you can print one from an internet map provider, like MapQuest or Google Maps — and mark the locations of the people on your list. Then highlight a route you can follow from your home to check on those people. For more information about creating an emergency plan, visit http://www.ready.gov/make-a-plan.

STEP 3: KNOW WHEN TO CALL
There is no set temperature or heat index trigger to dictate when you should check in on people on your list. This is partly because climate and average temperatures vary so greatly across the U.S. A good rule of thumb is to check on people whenever a heat advisory or heat warning is issued in your area and/or when your weather would be described by locals as oppressively hot. Or if temperatures are high — say, heat indices over 90° Fahrenheit — and your area is experiencing power outages, which could leave vulnerable seniors with no air conditioning and no way to call for help. Understand the difference between heat warning/ advisories, and heat outlooks. This can be found at http://www.nws.noaa.gov/om/heat/index.shtml.

Heat-related illnesses rise during periods of stagnant atmospheric conditions and poor air quality, according to FEMA. Thus, people in urban areas may be at greater risk than those in rural areas.

Learn more about the specific emergency planning needs of older adults at: https://www.ready.gov/seniors

STEP 4: VISITING THE PEOPLE ON YOUR LIST
After you’ve made your calls and determined who you need to visit, check your lists (to ensure you have everything you need), grab your route map and/or GPS and head out. Before leaving make sure you have your well-charged cell phone, your binder of people to check on and your wallet, for example, in case you need to send someone in a cab to an air-conditioned building while you head to check on the next person on your list. Consider adding extra bottled water to the list of things to bring.

STEP 5: DURING YOUR VISIT
As soon as you arrive at someone’s home, check him or her for signs of heat-related illness. If someone appears to be in need of immediate medical attention, call 911 or take them to the nearest emergency room. Early stages of heat-related illness can be treated with fluids, cooling the body (for example, with a cool shower) and transferring the person to a cool environment. But if you have any doubt about your ability to address these early stages, contact a medical professional. Make sure you understand the limits of transporting individuals in your personal car. Check with your insurance agency to know of the liabilities involved in transporting others.

For a list of heat-related illness and how to relieve symptoms, visit: http://www.cdc.gov/extremeheat/warning.html

People who are on water pills or whose doctor has limited their fluid intake should ask the doctor how much to drink during high heat.

Electric fans may not prevent heat-related illness

According to the Centers for Disease Control and Prevention electric fans may provide comfort, but when the temperature is in the high 90s, fans will not prevent heat-related illness. Fans can even do more harm than good in very hot temperatures by simply recirculating hot air and creating a “convection oven” effect. Taking a cool shower or bath or moving to an air-conditioned place is a much better way to cool off. Air conditioning is the strongest protective factor against heat-related illness. Exposure to air conditioning for even a few hours a day will reduce the risk for heat-related illness. Consider visiting a shopping mall or public library for a few hours. Many communities provide safe, air-conditioned shelters during heat waves. Find the closest shelter by visiting http://www.redcross.org/find-help/shelter or by texting the word "SHELTER" and your ZIP code to 43362 (4FEMA) on your mobile phone (example: in the message body, you would put "shelter 90210").

If people on your list do not have air conditioning and are low-income, they can check with their electric utility to see if the company has a program to provide A/C. Many electric companies around the U.S. will provide window units. Also, most municipalities have assistance programs to help people pay utility bills. Many seniors opt against using A/C — even if they have it — due to fears of facing high electric bills. Helping them to check out this option with the utility company would be a terrific service.

Ask about medications

Some medications interfere with people’s ability to dissipate heat. Ask each person on your list to ask his or her doctor about this. You can also check medication labels when you visit, but don’t rely on this, as full information about drug safety is not always included on every medication container.

If someone refuses help

People may tell you that they’re fine or that they will be okay, despite evidence to the contrary. For some it is a simple matter of not wanting to leave their comfort zone — i.e., the home they know so well. While you cannot force anyone to leave their home with you, you can try to persuade them that getting into a cool environment will make them far more comfortable.

In this guide, see What to Do if Someone Refuses Help for advice on handling people who act against their own self-interest during a heat emergency.

STEP 6: FOLLOW UP
Regardless of how or where people were when you left the visit, follow up with each of them in the early evening (unless you agreed to follow up sooner) and make sure everyone is all right. If the heat is expected to persist, let them know you’ll check on them again the next day.

STEP 7: INSPIRE OTHERS ON CREATETHEGOOD.ORG
KEEP UP THE GOOD!

Visit Create the Good to connect with a range of opportunities to use your life experiences, skills and passions to benefit your community.

ACTION LIST FOR A HEAT EMERGENCY

When you reach the people on your list, start with these questions:

• How do you feel? (Red flags include dizziness, shortness of breath, nausea, vomiting, diarrhea, confusion, muscle cramps, weakness, headache, fainting, sunburn and extreme fatigue.) Particularly heavy sweating or — even worse — not sweating at all when it is very hot are also signs of illness.
• If you rely on powered mobility devices, oxygen, and other devices that require electricity, are they in working order?
• What types of transportation do you rely on if you need alternative transportation assistance?
• If you take medications on a regular basis, take them with you if you are going to an air-conditioned facility; if electricity or air-conditioning is unavailable, do you have medication that must be refrigerated?
• Do you have electrical power?
• Are you in an air-conditioned room? If not, can you get into an air-conditioned room quickly (e.g., by going to a neighbor’s home or apartment or to a very close mall, library, community center, shelter, cooling center, etc.)?
• Do you have cool, hydrating drinks — water, juice and/or sports drinks?
• Do you have an adequate supply of ice?
• Do you have enough food — and healthy food — at home? If not, what do you need?
• Is anyone else checking on you? If yes, have they stopped by recently?
• What have you been doing today? Answers that should raise concern include:
  • Exercising outdoors (e.g., even gardening, walking or other light exercise can be very taxing during extreme heat)
  • Drinking alcohol
  • “I don’t know”
• Can I stop by to check on you? (If you feel this is warranted based on answers to the questions above.)

When you visit their homes, check on these areas:

• Can they stay cool indoors? The most efficient way to beat the heat is to stay in a cool area and drink plenty of water. If they do not have an air conditioner or evaporative cooling unit, consider going to a mall or public library for a few hours. Some cities open cooling centers during heat waves. A cool shower or bath is also an effective way to cool off. Open their windows to cooling breezes, particularly in the evening. Encourage them to do outdoor activities in the morning or evening hours and to wear a wide-brimmed hat to keep the sun off.
• Minimize extraneous heat sources: Turn off the stove or other sources of heat. If you don’t need a light on, turn it off! All light bulbs generate heat as a byproduct of producing light. Also, use energy-efficient bulbs to lessen the output of heat.
• Minimize movement: Are they avoiding strenuous activities during the hottest part of the day, usually mid- to late afternoon?
• Eat smart: Encourage light, healthy meals. Have them avoid hot foods and heavy meals, if possible.
• Use a fan but be wary: Ceiling fans and stand fans can provide comfort, but when the temperature is in the high 90s, fans will not prevent heat-related illness — and might even contribute to heat-related illness or death.
• Utility concerns: If the person is concerned about high utility bills or faces disconnection of service during a heat wave, they can contact their utility and ask for a payment plan. Local community organizations may also provide energy assistance to help offset high utility bills.

WHAT TO DO IF SOMEONE REFUSES HELP

• Gently explain the dangers of heat, emphasizing that people don’t often realize the heat is overwhelming them.
• Cite statistics on the number of people who fall ill from heat.
• Assure them you will not keep them from their home for long. If necessary agree to a time when you will return with them.
• Offer to change plans and take them somewhere they want to go, versus a shopping mall, motel or other generic environment. For example, if someone says they have a friend with air conditioning who has agreed to take them in for a while, first verify this, then either bring them there or arrange reliable, secure transport (like a cab). Do not just put someone on public transport and trust that they will make their way.
• Allow them time to gather personal items and other things they may want to bring. This may include taking medications and assistive devices, such as walkers, CPAC devices and other things they need.
• If they absolutely refuse to leave their home, ensure that they will have plenty of cold, hydrating beverages to drink. This includes water, natural juices and sports drinks. It does not include soda, beer and coffee. Cold drinks cool the body much better than do drinks that are room temperature or hot. You may need to set up a cooler with ice and drinks near the couch or in the bedroom to minimize how far the person has to get a cold drink.
• Also you should make sure the person has somewhere comfortable to lie down with decent air circulation. You can draw shades to block the sun but still leave them enough to let air into the room through an open window.
• Tell the person when you plan to check back and reassure them that they can call you at any time for help. If phones are down and they don’t have a cell phone, agree on how you will reach each other — either with a later visit or through a neighbor with a cell phone.

EXTREME HEAT GLOSSARY

Extreme Heat
Temperatures that hover 10 degrees or more above the average high temperature for the region and last for several weeks are defined as extreme heat. Humid or muggy conditions, which add to the discomfort of high temperatures, occur when a “dome” of high atmospheric pressure traps hazy, damp air near the ground. Excessively dry and hot conditions can provoke dust storms and low visibility. Droughts occur when a long period passes without substantial rainfall. A heat wave combined with a drought is a very dangerous situation.

Heat Wave
Prolonged period of excessive heat, often combined with excessive humidity.

Heat Index
A number in degrees Fahrenheit (F) that tells how hot it feels when relative humidity is added to the air temperature. Exposure to full sunshine can increase the heat index by 15 degrees.

Heat Warning/Advisory
Excessive Heat Warning/Advisories are issued when an excessive heat event is expected in the next 36 hours. These products are issued when an excessive heat event is occurring, is imminent, or has a very high probability of occurring. The warning is used for conditions posing a threat to life. An advisory is for less serious conditions that cause significant discomfort or inconvenience and, if caution is not taken, could lead to a threat to life.

Heat Outlook
Excessive Heat Outlooks: are issued when the potential exists for an excessive heat event in the next 3-7 days. An Outlook provides information to those who need considerable lead time to prepare for the event, such as public utility staff, emergency managers and public health officials.

Heat Cramps
Muscular pains and spasms due to heavy exertion. Although heat cramps are the least severe, they are often the first signal that the body is having trouble with the heat.

Heat Exhaustion
Typically occurs when people exercise heavily or work in a hot, humid place where body fluids are lost through heavy sweating. Blood flow to the skin increases, causing blood flow to decrease to the vital organs. This results in a form of mild shock. If not treated, the victim’s condition will worsen. Body temperature will keep rising, and the victim may suffer heat stroke.

Heat Stroke
A life-threatening condition. The victim’s temperature control system, which produces sweating to cool the body, stops working. The body temperature can rise so high that brain damage and death may result if the body is not cooled quickly.

Sun Stroke
Another term for heat stroke.

The content of this glossary was provided by Federal Emergency Management Agency (FEMA) http://www.ready.gov/heat.

ADDITIONAL RESOURCES

AARP article: Extreme heat warning - beware of dehydration - http://www.aarp.org/health/healthy-living/info-06-2012/dehydration-signs-and-symptoms.html

CDC advice on heat stress in older adults - https://www.cdc.gov/disasters/extremeheat/older-adults-heat.html 

FAQs on extreme heat (from CDC) - https://www.cdc.gov/disasters/extremeheat/faq.html 

AARP article: Heat waves threaten the elderly - www.aarp.org/health/conditions-treatments/info-07-2010/heat_wave_threatens_older_americans.html
 

Supplemental Material

Heat Wave Emergency Kit: Use this checklist to have materials ready for an extreme heat event