Preparing Patients for Extreme Heat

Step 1: Choose a Strategy to Identify At-Risk Patients

Everyone is potentially vulnerable to heat-related illness.  There are environmental, demographic and health factors that make a patient more at risk which can be used to prioritize patients for screening.

Clinicians may choose from one of the following strategies:

• Asking all patients “What do you do to protect yourself from heat?”
• Focusing on environmental risk factors such as lack of air conditioning or social isolation
• Focusing on demographic factors such as age; age is highly correlated with heat related illness, risk increases with increasing age. Those under 5 years of age are also at risk.
• Focusing on chronic illnesses, mental illness and/or medications.
• Focusing on those at highest risk from heat due to a combination of factors (e.g. socially isolated patient of advanced age with chronic illness, on medications and living in a non-air-conditioned home).

There are some tools that may help with these risk assessments, including including NCCEH’s Rapid Risk Assessment Checklist, and USCDC’s HEAT-Questionnaire-H.pdf.

Step 2: Advise At-Risk Patients About Heat

Make sure that patients know the dangerous health effects of heat.

Weather forecasts are a good way for people to know when the heat will be especially dangerous.

Environment and Climate Change Canada has introduced colour-coded weather alerts to help communicate the level of weather-related risk associated with warnings, watches and advisories. 

Encourage at-risk patients to check the Environment and Climate Change Canada website for information on the local forecast and weather alerts, or download the WeatherCAN app (can be set to receive notifications of severe weather and extreme temperatures).

For those who prefer non-digital sources, local radio, TV and print news also provide weather updates and heat alerts.

Step 3: Assess Cooling in the Home

Ask if the patient’s home is air conditioned:

• If yes, ask if they use it and if they are reluctant, encourage them to use it by sharing the following tips:
  • Set to a warmer temperature e.g. 26 degree celsius or lower
  • Run when electricity is less expensive (e.g. after 7pm and on weekends) or for only a few hours each day to get some relief
  • Share the measures listed in step 4 to lessen the need for air conditioning.
• If no, refer to Step 4 for additional actions the person can take to stay cool.

Prescribe cooling devices to eligible patients. Encourage patients who are on Ontario Works/Ontario Disability Support request assistance from their caseworker to submit a request for a cooling device and provide them with a prescription.

• A diagnosis is required, and it must indicate that a cooling device is required as a part of a treatment plan. It is pertinent that the prescription indicates that failure to obtain this device would result in a hospitalization or a severe risk to life.
• See page 2 of the Screening for Extreme Heat Risk and Accessing Cooling Devices Through ODSP, OW, and ACSD for a draft letter template.

Step 4: Provide Information on Ways to Keep Cool

Share Toronto Public Health’s information on how to keep cool at home and outdoors with at-risk patients.

Step 5: Recommend Scheduled Check-Ins During Heat Events

Older patients living alone or those who have a health condition are encouraged to ask family, friends or neighbours to check on them during very hot days.

• In-person visits are best to make sure they are well and their space is cool. Alternatively, during a heat wave, patients can schedule a check-in call with someone who expects to hear from them.

Step 6: Advise Patients When to Seek Help

Ensure patients know the following signs of moderate heat related illness and to ask for help if these appear:

• Dizziness or fainting
• Nausea
• Weakness
• Fatigue
• Headache
• Extreme thirst
• Heavy sweating
• Dark urine;

In young children, also watch for:

• Unusual sleepiness or irritability
• Reduced wet diapers or urination
• Flushed or very warm skin