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.

• Wisconsin Heat Awareness Day

• Preventing Heat-Related Illness (below)

  • Risk Factors for Heat-Related Illness

  • Prevention and Early Intervention

  • Heat Exhaustion and Heat Stroke Compared, Contrasted

• City of Milwaukee: Heat Health Information (exit DHS) - includes list of medications that can affect the body's ability to sweat and cool itself (not comprehensive)

• Summer Food Safety Precautions

• Use of NOAA Weather Radio

• Planning for Power Outages

• Tornado and Severe Weather Awareness

Preventing Heat-Related Illness

Individuals who are medically compromised, elderly, very frail or very young are at high risk for heat-related illness.

Providers and 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 illness.

Wisconsin doesn’t 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 vulnerable.

• 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 person’s susceptibility to heat-related illness. Medications for these conditions may cause dehydration.

• Medications: use of psychotropic medications and other medications that affect the body’s ability to perspire and/or regulate the heat response can greatly decrease the person’s ability to cope in hot weather.

  A provider may need to discuss the person’s 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 (not all-inclusive):

  • Antipsychotic agents including phenothiazines such as thioridazine (Mellaril), chlorpromazine (Thorazine), and clozapine (Clozaril);

  • Tranquilizers and antiemetics;

  • Anticholinergics such as benztropine (Cogentin), Trihexyphenidyl (Artane), Diphenhydramine (Benadryl), and others; 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 prescribing practitioner.

• 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 those who:

  • are homeless

  • do not have access to air-conditioning

  • rely on walking (sometimes for great distances)

• Dehydration: people prone to body fluid loss due to extreme exertion, lack of sufficient fluid intake, medications, or a medical condition.

• 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 humidity.

• 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 their own.

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.

Health care 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 deteriorate.

  Use of a "buddy system" may be appropriate in some cases, especially for some types of community providers.

• 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 accelerating.

  Care must be taken, however, for those with circulatory impairments; and chilling must always be avoided as that is the body’s 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 person’s medications; give special attention to the side effects of dehydration and decreased ability to perspire. Call the pharmacist or prescribing practitioner with any questions.

• Advise avoidance of alcohol consumption. During heat waves, extra monitoring may be needed for those who are prone to excess alcohol consumption.

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 rapid progression.

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 outages:

• 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 dehumidifiers.

  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 a day.

Working with the Federal Communications Commission’s 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 frequencies (Mhz):

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 the model.

For more information, please visit this Internet site: http://www.nws.noaa.gov/nwr/ (exit DHS)

The use of a NOAA Weather Radio is encouraged and will greatly enhance your emergency-preparedness.

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 emergencies.

The policies, procedures and training done by the provider should focus on responding appropriately to tornadoes and other weather emergencies.

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 emergency information.

  • A Tornado Watch is issued when weather conditions favor the formation of tornadoes.

  • A Tornado Warning is issued when a tornado funnel is sighted or indicated by weather radar.

• The following weather signs may mean that a tornado is approaching:

  • A dark or green-colored sky

  • A large, dark, low-lying cloud

  • Large hail

  • 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.

• People should not stay in a mobile home during a tornado. They should go to a nearby building, preferably one with a basement.

• 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 hands.

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Last Updated: October 24, 2008