British Columbia is experiencing more and hotter extreme heat days as the climate changes.

Although our region has historically been temperate, we are in some ways less prepared for extreme events than traditionally hotter areas of the province - and therefore at risk.  Each year residents, particularly our most marginalized, die due to extreme heat-related events.

Summer heat can pose serious health risks to people experiencing homelessness or living in precarious housing, especially those with pre-existing heart, lung, or mental health conditions. The good news is there are ways to prevent heat-related illnesses. This section provides tools and resources related to extreme heat response for those who work with people experiencing homelessness or in low-income buildings.

Identifying who is at risk

Everyone is at risk of heat-illnesses during extreme temperatures; however, people experiencing homelessness and social housing tenants are at increased risk because they often have fewer resources to stay cool.

Groups at higher risk include:

  • People experiencing homelessness
  • Older people
  • Infants and young children
  • People living alone
  • People without access to air conditioning
  • People with chronic illnesses (such as breathing difficulties, heart conditions, or psychiatric illnesses) and people on certain medications (including some psychiatric medication)
  • People who work or exercise in the heat

Signs and symptoms

Heat-related illness is the result of the body gaining heat faster than it can cool itself down. It can lead to weakness, disorientation, exhaustion. In severe cases, it can lead to heatstroke, which is a medical emergency (9-1-1 should be called). It can also lead to worsening of heart or lung conditions. Review HealthLink BC’s heat illness page to recognize signs, symptoms and learn what to do if you think someone is suffering from a heat-related illness. 

Communicating with homeless clients

In Canada, more people are dying from extreme heat than all other natural disasters combined, but many people are not aware of the dangers related to extreme heat. Organizations that work with homeless clients should ensure proactive and effective communication with clients, volunteers, and staff about the risks of extreme heat, the signs and symptoms of heat-related illness, and how to stay safe in hot weather.

What to do:

Before heat events: 

  • Ensure that all volunteers and staff are aware of the risks, symptoms, what to do, and how to communicate with the clients.
  • Remind clients how to stay cool during hot weather.
  • Check for hot weather/air quality warnings; let clients know when they may be at risk, particularly those who are elderly or may experience mental health distress, as some of the people most susceptible to severe heat related illness and death may not perceive that they are getting too hot.
  • Help clients prepare for heat events two-three days ahead, if possible
    • Identify a cooler space, and prepare if for nighttime use. The mobility challenged have particular concerns which may require reconfiguring daily living arrangements to deal with heat episodes
    • Make ice, ready jugs of water, check that clients have a working fan.
    • Make a list of danger signs that clients can use to identify symptoms of heat distress; this might also include checking the thermostat if indoors.
  • Where possible, work with your municipality, partner organizations, and/or local groceries to provide a stock of water and be aware of where people can access taps or fountains. Sunscreen can also be helpful to distribute.

During heat events:

  • Have your staff check in on elderly and vulnerable clients where they usually stay or congregate, and ask clients to check on each other, especially when local health authorities issue extreme heat warnings.
    • Keep a close eye on those in your care by visiting them at least twice a day, and ask yourself these questions: 
    • Are they drinking enough water?
    • Do they have access to air conditioning?
    • Do they know how to keep cool? 
    • Do they show any signs of heat stress?
  • Be aware that clients on certain medications, including some for mental health, such as antidepressants or antipsychotics, may be at increased risk. This is due to decreased sweating/ cooling, increased dehydration risk, and decreased ability to sense overheating.
    • Similar effects can be associated with certain illicit drugs some clients may be dependent on including cocaine, MDMA, amphetamines, and alcohol. Where possible, encourage people who use drugs to be extra cautious in the heat 
  • Extreme temperatures correlate to increases in mental-health related emergency department visits, globally and in the Fraser Health region.
  • Additionally, as extremely hot weather can provoke suicidal thoughts in some people, alert clients, volunteers, and staff, to check on those who might be at risk.
  • If possible, create a cooling room where clients can come to socialize and cool off. This may require the installation of a (portable) air conditioning unit, or fans (at temperatures above 30°C (86°F), fans alone may not be able to prevent heat-related illness), or other ways that would ensure the room temperature is lower than other places. It can take many hours for clients to return to normal body temperature after heat stress, so the longer cooling rooms are open, the better.
  • Make a list of places in the neighbourhood (with air conditioning or shade) that can be used as cooling shelters where clients can go to cool off. This may include community centres and libraries, shopping malls, etc. Depending on your municipality, cooling centres may be posted on a website or social media. If these are far from where clients live, provide transportation passes where possible.
  • If possible, during extreme heat alerts, open an extreme weather shelter for sleeping in a temperature-controlled facility, as occurs for extreme cold.

How to create an outdoor cooling centre

From 2020 BC Centre for Disease Control Guidance:

  • Provide 100% shade within its designated boundaries.
  • Cooling:
    • Passive measures (natural breezes): Promoting air circulation using either passive measures will increase the cooling abilities of an outdoor space. If setting up a cooling space in an urban environment, consider choosing locations where natural breezes occur to promote air circulation.
    • Active measures (fans and evaporative coolers) Setting up fans in outside cooling spaces to increase airflow may make cooling more effective for visitors; however at or above, 35°C, fans will not prevent heat-related illness. Evaporative coolers are a good option for outdoor cooling centers in urban spaces because they cool the air. They cost between $100-$500.
  • Mobility and accessibility:      
    • Have wheelchair accessible locations for cooling spaces.
    • Have communications material offered in different languages in outdoor and outdoor cooling spaces for community members (if possible).
    • Have designated areas for individuals to sit with pets.
    • Require that all dogs must be on a leash while within the outdoor cooling center.
    • Consider providing a water bowl for dogs to cool off as well.
  • Working with partners: 
    • Where possible let bylaw officers and first responders in your municipality know that you are opening a cooling space, so they can let people in distress know or bring them to your location.

Sustained heat and cooling strategies

  • It can take time to dissipate body heat and recover.
    • Once overheated, it can take many hours for a vulnerable person to cool the body fully after coming to a cool space.
    • If they leave the cool space, body temperature can return to dangerous highs very quickly.
    • People can absorb a lot of heat in walking or taking transit to a cooling centre.
  • If overnight temperatures are warm:
    • Heat may build indoors over time.
    • Health effects are worse because there is limited recuperation from the day’s heat.
  • For these reasons, outreach strategies and cooling strategies near where people already are can be very important, along with providing resources for longer hours or overnight.