July 7, 2010

Older adults and chronically ill residents are at increased risk of experiencing heat -related illness compared to younger people for several reasons. Older adults do not adjust to sudden temperature changes, are more likely to have chronic medical conditions that upset normal body response to heat and are more likely to be taking prescription medications that impair the body's ability to regulate its temperature or that inhibit perspiration.

Staff may require re-education on signs and symptoms of Heat stroke, heat exhaustion and dehydration.

The most serious heat-related illness is Heat Stroke. When the body is unable to control its temperature, the temperature rises rapidly and the body is unable to sweat and cool down. This can occur rapidly, within 10 -15 minutes, with body temperature rising to 106 degrees F.

The warning signs of Heat Stroke include:

  • An extremely high body temperature (above 103 degrees F)
  • Red, hot, dry skin ( no sweating)
  • Rapid, strong pulse
  • Throbbing headache
  • Dizziness
  • Nausea
  • Confusion or disorientation

Heat Exhaustion is a milder form of heat-related illness that can develop after several days of extreme heat and inadequate or unbalanced fluid intake.

The warning signs of Heat Exhaustion include:

  • Heavy sweating
  • Pallor
  • Muscle cramps
  • Tiredness
  • Weakness
  • Dizziness
  • Headache
  • Nausea or vomiting
  • Fainting
  • Cool, moist skin
  • Fast, weak pulse
  • Fast and shallow breathing
  • Confusion or disorientation

What you can do to protect your residents:

  • Provide re-education to staff on the signs and symptoms of heat-related illness
  • Monitor all residents for signs and symptoms of heat-related illness on all three shifts
  • Monitor all rooms and common areas for excessive heat and limit traffic to those areas that are not able to be adequately cooled.
  • Congregate residents in air conditioned common areas.
  • Residents should remain indoors in the heat of the day.
  • Provide adequate decaffeinated beverages through additional fluid passes on all three shifts.
  • Provide popsicles, ice cream, jello etc between fluid passes.
  • For residents on a fluid restriction ask the PCP how much fluid the resident may have when the weather is extremely hot.
  • Closer monitoring of high risk patients, e.g. residents with a tube feeding, residents who may be unaware they are thirsty and need to drink.
  • Assist residents with fluids rather than leaving the fluids on a table.
  • Dress residents in lightweight clothing.

Please do not forget staff! Watch for signs and symptoms of heat-related illness in the staff as well.

For your reference, below are some state and federal regulations related to providing a safe environment during times of extremely high heat and humidity:

  • Per Federal regulation 42 CFR part 483.15 (h) (6) (F tag 257) the facility must provide comfortable and safe temperature levels.
  • State Licensure, 105 CMR 150.017 (B)(13) (e), effective June 21, 2000, requires that every facility provide air conditioning in dining rooms, activity rooms, day rooms, solariums, sitting rooms or equivalent other common areas that is capable of maintaining a maximum temperature of 75 degrees F in those areas at all times at summer design temperature. The actual temperature in these areas must be maintained at a level which ensures the comfort and health of residents of the facility.

For more information, contact DPH at 617-753-8000 and ask for an available survey manager or manager on call.

References

Boston Public Health Commission, Fact Sheet Heat-Related Emergencies, July 2010

Extreme Heat: A Prevention Guide to Promote your Health and Safety

http://www.bt.cdc.gov/disasters/extremeheat/heat_guide.asp (last updated 2009)