Information for Continued Quality Improvement
The purpose of this Internet site is to raise awareness and to provide
information about preventing heat-related illness and planning for power
outages and severe weather. Please share this information as appropriate.
Preventing Heat-Related Illness
Individuals who are medically compromised, elderly, very frail or
very young are at high risk for heat-related illness.
caregivers of all types must evaluate the risks of patients, residents and
clients in their care and provide appropriate actions and education to
protect their health, welfare and safety.
Persons who are vulnerable to
heat-related illness and/or their caregivers need to be taught the dangers
of heat and humidity and ways to prevent, identify and treat heat-related
illness, and when to obtain emergency services.
An excellent educational booklet is available on the Internet from the federal Centers
for Disease Control and Prevention (CDC) entitled "Extreme Heat, A
Prevention Guide to Promote Your Personal Health and Safety." (exit
DHS) The booklet can also be obtained by writing to:
The Centers for Disease Control and Prevention (CDC)
National Center for Environmental Health
Emergency Response Coordinator Group
Mail Stop F 384770 Buford Highway
Atlanta, Georgia 30341-3724
The National Weather Service has a similar brochure, "Heat
Wave: A Major Summer Killer" (exit DHS; PDF).
Vulnerable individuals who do not read will need to be instructed in
order to learn how to protect themselves from succumbing to heat-related
Wisconsin doesnít typically experience extreme hot weather. However,
heat waves have and will continue to affect the state. The risk of
heat-related illness increases with a rise in humidity because the skin is
less able to release body heat through evaporation.
Please update your policies, procedures and training for preventing
heat-related illness and death. The approaches developed should include
effective measures to protect vulnerable individuals from the dangers of
heat and humidity.
Risk Factors for Heat-Related Illness
Conditions that can increase the risk for heat-related illness include:
Age: the very young (under 4) and the elderly (over 65) are more
Obesity: people who are overweight have greater difficulty
regulating body temperature.
Medical conditions: conditions such as cardiovascular disease,
respiratory disease, or renal diseases may increase a personís
susceptibility to heat-related illness. Medications for these
conditions may cause dehydration.
Medications: use of psychotropic medications and other medications
that affect the bodyís ability to perspire and/or regulate the heat
response can greatly decrease the personís ability to cope in hot
A provider may need to discuss the personís medications
with the attending physician or the dispensing pharmacist in order to
be proactively informed about the effects of the particular medication
on the person.
Medications of particular concern include the following
Antipsychotic agents including phenothiazines such as
thioridazine (Mellaril), chlorpromazine (Thorazine), and
Tranquilizers and antiemetics;
Anticholinergics such as benztropine
Trihexyphenidyl (Artane), Diphenhydramine (Benadryl), and
Lithium, especially in combination with excessive
alcohol consumption, can cause dehydration and may produce
serum drug levels that are toxic.
Any questions about the action or side effects of a
medication can be answered by the pharmacist who filled the
prescription (the phone # is on the bottle), or the
Alcohol abuse: people who are prone to acute alcohol intoxication
are at greater risk for sudden death when intoxication is combined
with extreme heat.
Excessive exposure: people who are outdoors for long periods can be overcome easily with
heat and humidity, such as
Dehydration: people prone to body fluid loss due to extreme
exertion, lack of sufficient fluid intake, medications, or a medical
Lack of information: people who do not know the symptoms of heat
related illness and actions they should take.
Lack of air-conditioning: people housed in facilities without
air-conditioning or proper ventilation for decreasing heat and
Communication deficits: people who are not likely to hear or
understand broadcasted TV and radio weather advisories (the deaf and
hard of hearing, non-English speaking, or those with a deficit in
cognition) will be at greater risk.
Also, those who might not be able
to fully appreciate the significance of these advisories are at higher
risk, as they may not recognize the need to take protective action on
Prevention and Early Intervention are Key!
Clinical decisions about the appropriate measures to prevent
heat-related illnesses must consider the available resources and
circumstances presented by individuals and their environment.
professionals who are familiar with the patient, resident or client might
need to be called upon to assist with the assessment of their ability to
cope with heat waves.
The implementation of simple precautions can greatly
reduce the risk of heat-related illness and death. Some of these are:
Keep air circulating and use air conditioning when possible. Being
in an air-conditioned environment, even if only for a few hours each
day will reduce the risk of heat-related illness.
Visiting a shopping
mall, public library or a local heat-relief shelter can mean the
difference between reversing or accelerating heat-related illness.
Avoid using fans directed on individuals when the ambient
temperature exceeds approximately 100 degrees F.
Fans can actually
increase heat stress at temperatures above 90 degrees with humidity
over 35% (the exact temperature varies with the humidity).
Actively monitor for early warning signs of dehydration, heat
exhaustion and heat stroke. All staff should know the symptoms of heat
related illness and when to contact emergency assistance if conditions
Use of a "buddy system" may be
appropriate in some cases, especially for some types of community
Supervise persons with cognitive impairments, especially when the
weather is very hot and humid.
Protect individuals and the environment from direct sunlight by
drawing shades, blinds and curtains.
Keep outdoor activities to a minimum, especially between the hours
of 10:00 AM and 2:00 PM. Persons who must be transported should not be
kept in vehicles for long periods to avoid heat that can build up.
Outings should be re-evaluated based on the circumstances presented.
Advise patients, residents or clients to dress appropriately. Use
lightweight clothing that easily absorbs perspiration (e.g., cotton or
other natural fibers) or a single sheet if a person must be in bed.
Give baths, use cool cloths to the head or feet, and/or cool
compresses to the groin or underarm area to cool the body. Placing
hands and wrists in cool water can help prevent body temperature from
Care must be taken, however, for those with circulatory
impairments; and chilling must always be avoided as that is the bodyís
way of increasing its internal temperature.
Provide and encourage the consumption of extra fluids, including
fruit juices. Frequent reassessment is required for persons being tube
fed or who use special beds such as a Clinitron-bed.
Evaluate the effects of each personís medications; give special
attention to the side effects of dehydration and decreased ability to
perspire. Call the pharmacist or prescribing practitioner with any
Advise avoidance of alcohol consumption. During heat waves, extra
monitoring may be needed for those who are prone to excess alcohol
Heat Exhaustion and Heat Stroke
Compared and Contrasted
Staff education efforts should focus on methods for preventing
heat-related illness and they also need to be able to make determinations
about when to call for emergency personnel.
Staff must be able to
recognize both heat exhaustion and heat stroke symptoms. They do
not need to focus on making a fine determination about which stage the
person is actually in.
They must know how to act, and act quickly, to cool
the person down when any of these symptoms are present due to their
I. Cause. Depletion of body fluids and electrolytes due to exposure to intense heat or the inability to
acclimatize to heat, resulting in prolonged or severe diaphoresis.
May progress to heat stroke.
I. Cause. Failure of temperature- regulating mechanism of
the body due to prolonged exposure to high temperature.
II. Onset. May develop slowly after exposure to heat for
several days and inadequate or unbalanced replacement of fluids and
II. Onset. May develop quickly (within minutes).
Muscle cramps (arms, legs, abdomen)
Rapid pulse (tachycardia)
Muscle cramps (arms, legs, abdomen)
Rapid pulse (tachycardia)
Absence of perspiration
Hot, dry, red or mottled skin
Slow deep respiration
Extremely high temperatures
(104 degrees F/40 degrees C or above, rectally)
Mental confusion, disorientation, delirium,
irrational behavior, feeling of euphoria or impending doom,
diminished level of consciousness, loss of consciousness may be
Confusion may occur early or late
Signs of shock
V. How to Intervene. Cool fluids, loosen tight clothing,
recumbent position, cool shaded environment, elevate legs, transport
to medical facility for medical follow up.
V. How to Intervene. Call for transport to medical
facility immediately; cool water, sponging, and fluids by mouth if
still alert; reduce body temperature to 102 degrees F as rapidly as
Transport to medical center for temperature
stabilization and prevention/ treatment of complications.
Potential Power Outages
There is always a potential for power outages during periods of high
heat and humidity or from summer storms.
These steps may help to prevent and prepare for potential power
Test alternate power systems now, and on an ongoing basis to ensure
that they will be operational when needed.
For those providers
required by National Fire Protection Association (NFPA) Life Safety Code (LSC)
to have an emergency generator system, they are also required to have the
associated maintenance and testing.
Develop plans to protect persons in your
care, especially those that are very vulnerable to high heat and
humidity, in the event of a power shortage or failure.
Some of the
measures recommended here for preventing heat stroke and heat exhaustion
are dependent on electricity, so alternatives will need to be created in
the event of any power outages.
Develop policies and procedures for special
needs including oxygen concentrators, dialysis, electric beds and other
specialized equipment and meal preparation.
Avoid energy waste. Power companies have
tips on ways to conserve power during peak energy use hours such as
unplugging or using timers on non-essential appliances, like
Perform high electricity-consuming tasks in the evenings
and on weekends.
Listen for media weather advisories and power shortage warnings from
your power company. Put your energy conservation action plan into place
when it becomes necessary.
NOAA Weather Radio
NOAA weather radio (NWR) is a nationwide network of radio stations
broadcasting continuous weather information direct from a nearby National
Weather Service office.
NOAA Weather Radio broadcasts National Weather
Service warnings, watches, forecasts and other hazard information 24 hours
Working with the Federal Communications Commissionís new Emergency
Alert System, NWR is an "all hazards" radio network, making it
the single source for the most comprehensive weather and emergency
information available to the public.
NWR requires a special radio receiver or scanner capable of picking up
the signal. Broadcasts are found in the public service band at these seven
162.400 162.425 162.450 162.475 162.500 162.525 162.550
Residential grade radios vary in price from $20 to $200, depending on
For more information, please visit this Internet site: http://www.nws.noaa.gov/nwr/
The use of a NOAA Weather Radio is encouraged and will greatly enhance
Tornado and Severe Weather Awareness
Although the peak tornado season is in the spring and early summer,
tornadoes and other severe weather emergencies can occur throughout the
year, in every part of Wisconsin.
It is important that providers assist
their residents, patients and clients in being prepared for such
The policies, procedures and training done by the provider
should focus on responding appropriately to tornadoes and other weather
Providers need to be prepared to meet the needs of the
persons for whom they provide care, including alternative methods of
preparing nutritional meals.
The following list of safety precautions (not all-inclusive) may be
helpful as you update your policies, procedures and training:
Listen to NOAA Weather Radio (exit
DHS), television or radio to get the latest
The following weather signs may mean that a tornado is approaching:
A dark or green-colored sky
A large, dark, low-lying cloud
A loud roar that sounds like a freight train
Be sure that all staff, residents, patients and clients are trained
in what to do when a weather emergency occurs in their setting.
The safest place in a home is the interior part of a basement. If
there is no basement, or a person is in a wheelchair and cannot get to
the basement, they should go to an inside room without windows, or
away from windows, on the lowest floor.
should go to a nearby building, preferably one with a basement.
People should not stay in a mobile home during a tornado.
If persons are caught in their automobiles and they cannot get to
shelter in a building, they should get out of the car, lie flat in the
nearest ditch, ravine, or culvert and shield their heads with their
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July 18, 2013