Extreme heat and its impact on San Diego's most vulnerable

S1: Welcome in San Diego. It's Jade Hindman on this episode of KPBS Midday Edition. We are in an extreme heat wave. We'll talk about the impact on your health and those most vulnerable. This is KPBS Midday Edition. Connecting our communities through conversation. So extreme temperatures are expected to last through Thursday at least. And the triple digits are having a real impact on people's health. In fact , 911 has seen an increase in heart related calls , especially since mid-September. And that's not including the most recent heat wave. So what do you need to know about how heat affects the body and who is most vulnerable? Well , I'm here with Doctor Lindsay Ehrmann. She's a geriatrician with UC San Diego Health. Doctor German , welcome to midday.

S2: Thank you. I'm happy to be here.

S1: Glad to have you here. Listen , recent data shows that 911 has gotten more than 300 heat related calls since mid September , as we mentioned. What have you heard from your colleagues? Are they seeing more hospital visits because of the heat?

S2: My colleagues in the Ed are reporting a generally higher volume of Ed visits. However , it doesn't necessarily show up as heat. Uh , it may show up as a , you know , hard event , kidney disease or asthma exacerbation fall or dehydration. So the actual numbers are hard to tally. But yeah , heat can cause a number of things that can increase Ed visits. Hmm.

S1: Hmm. Well , tell me , I mean , how does extreme heat impact the body? What happens physiologically.

S2: So physiologically it's helpful to understand how we maintain normal temperature. We cool ourselves normally by sweating and by sending blood to the skin. So when it's very hard or humid , that system gets overwhelmed. And the heart , kidneys and brain are the organs that are most vulnerable. So , you know , again , cooling depends on sweat evaporating. And in humid heat sweat doesn't evaporate well. So the body has to work much harder to stay at normal temperature. For the heart , that means that the heart has to pump harder , which for someone that has a preexisting heart condition that can push it over the edge into heart failure or an arrhythmia with kidneys sweating. Plus not drinking enough can lead to dehydration , especially if people are on medications like diuretics and how it affects the brain. If the brain is overheated , we see that as confusion , delirium , dizziness , and falls. And in older adults , new confusion is often the first sign. So that's a little bit about how heat Impacts the body.

S1: Well , I mean , tell me you mentioned older. Older people who's most vulnerable to extreme heat and why? Yeah.

S2: Yeah. So older adults are at the top of my list. Of course , I'm a geriatrician. And before I talk about why older adults are at higher risk , I also want to point out that , um. Babies and young children , people with chronic conditions such as heart disease , high blood pressure , diabetes , lung disease , obesity , mental illness , developmental disabilities , outdoor workers , and athletes who are outside between 11 a.m. and 4 p.m. and really , people without air conditioning , um , you know , of any demographic , um , and people taking diuretics or certain medications. Now , uh , you know , bottom line , it's people that , uh , can always fend for themselves , too. And , uh , if if someone is socially isolated , that will make someone more vulnerable. But. Oh , yeah , as we age , we feel less thirst and we sweat less and we have less cardiac reserve. So many older adults are on medications that affect fluid balance and even temperature control , and an older person can get into trouble without feeling hot and thirsty. That's a point that I want to really emphasize , is that we have to be on high alert for ourselves as we age and looking in on our neighbors.

S1: So , you know , so many things can exacerbate , you know , your health conditions if you have them. Um , when do you know to go to the emergency room versus staying at home?

S2: That is a really important question. So I think it's helpful to keep in mind two major , uh , events or conditions that can happen with extreme heat. One is heat exhaustion and the other is heat stroke. And it's important to know the difference because with heat exhaustion , Sometimes you can manage that on your own. Say going to a cooling zone with heat stroke. That's a call to 911. So heat exhaustion shows up as heavy , sweating , cold , pale , clammy skin , dizziness , headache , weakness or tiredness fast. Um , a fast , weak pulse. Muscle cramps , nausea or vomiting. If if this happens , you have to use your judgment. But move to a cool place. That county has 33 cooling zones that I know you all will link to at the end of this session. Um , loosen clothing , apply cool wet cloths , or take a cool bath , sip water and get medical help right away. If if vomiting. That's the extreme end of heat exhaustion. Now with heat stroke , that tends to occur when the body core temperature is 103°F or higher , you might see red hot , dry skin , throbbing , headache , Confusion. That's the main thing. So change in mental status can be an emergency , especially in a vulnerable person. Slurred speech or hallucinations? Uh , and , you know , at its worst , fainting. So that's where you do want to call 911 while waiting. Try to move the person to somewhere where it's cooler. Cool them off with cloths or cool bath. Uh , those are just some general warning signs to look out for. Hmm.

S1: Hmm. What are some practical tips or things people can do now or throughout the week to protect themselves from the heat? And I guess I should ask , what do you consider extreme heat? When should people really start to to pay attention?

S2: Oh , that's a great question. To me , it's any temperatures greater than 90 degrees. Uh , so , uh , that's where we especially see , um , you know , increased utilization of medical services related to heat. Um , but as far as practical tips. They're really kind of simple. One is stay cool to stay hydrated , and three is checking on each other. So sometimes it's hard to stay cool , especially if you're unsheltered and don't have air conditioning. But finding somewhere cool , um , there's county cooling zones. Um , those are often at libraries , senior centers , community centers. You can go to cool zones.org or call 211 um , hydration. Do it before you're thirsty. So I recommend for my patients , you know , trying to get 1 to 2l a day. Everyone should follow their own doctor's recommendations. But , um , and importantly , limit alcohol , caffeine and very sugary drinks. Those things can be act like diuretics and further dehydrate you. Um , and then as far as checking on each other , never leave children , older adults or pets in a parked car. And I would encourage everyone to check in on someone they know to make sure they're doing okay. So checking on neighbors , family and friends who are at higher risk , especially if they live alone. Uh , is very important.

S1: All right , well , uh , great advice there. Um , and much appreciated. I've been speaking with Doctor Lindsay German. You can go to our website at KPBS where we'll link to some of those that that information in those tips , you can also call 211 where you can find out about nearby cooling zones and much more. Doctor German , thanks so much.

S2: Thank you so much for having me.

S1: Well , as we just heard , intense heat can be a risk to us all , but it can be especially dangerous for more vulnerable populations. And that includes people experiencing homelessness. I'm joined now by Jayna Leigh. She's associate director of outreach at Path , a homeless provider here in San Diego. Jayna , welcome to Midday Edition. Hi.

S3: Hi. Thanks for having me.

S1: Thanks for being here for this. So what are the biggest concerns you have right now as we navigate this latest heat wave?

S3: I think a lot of it has to relate what the doctor said and having vulnerable populations. The largest population of homeless individuals are those who are over 55. A lot of them also have chronic health conditions , physical health conditions. But in the overall scope of things , it's just hot for everybody. We are super happy that the city and county have their cool zones open over the weekend. They even extended hours. That was a wonderful email to receive , but our job as outreach workers is just to get people there if they're interested in trying to get them to a cool place during the day. Mhm.

S1: Mhm. And you mentioned , you know , seniors in all of this. Um , what are some of the biggest misconceptions people have about those experiencing homelessness in San Diego and what gets overlooked in a heat wave like this?

S3: I think the biggest misconception is just the demographic of homeless individuals. A lot of people like to kind of blame mental illness or substance use , when in reality there are a ton more seniors out there with chronic health conditions than there are people who are experiencing those other types of symptoms. And we are seeing an increase in families as well. So moms , single moms with kids in their car. We see them a lot more. So yes , the mental health and the substance use is an issue in San Diego , but that's not the only demographic that we should be paying attention to.

S1: San Diego County and the city have several cool zones. Can you tell me more about those and where people can find them?

S3: Yeah , so just like the doctor said , if you can go online both on the county and city website , you can pull up those cool zones with their hours and locations. One amazing thing that they extended this year is opening it up to service animals. So that's awesome. People can bring their pets in with them. One barrier that they still might face while trying to access those areas are their belongings. So not being able to bring bring their belongings inside could be a deterrent and say , I would rather stay outside and keep my stuff safe versus leave it somewhere where I don't know who's watching it. So those are open as outreach program. We're trying to get transportation for individuals who are interested. We'll get them a lift there. We'll get them a lift back to their place of stay overnight. And so as often as we can , just offering those services up to them.

S1: What areas of town are you looking to provide that transportation?

S3: We do it in the city of San Diego. So our our outreach program is anything that's 9 to 1. So if any of our participants are interested , we're out there in the field every day offering it up to them. They can also call us if we're already connected. Another great way to get connected to us is through 211. They will directly get you a referral to us.

S1: And you mentioned storage. What do you think is missing currently and how we help unsheltered San Diegans in terms of extreme heat?

S3: Um , so the city does a great job at having inclement weather shelters when it's cold , when it's raining , but we don't have inclement weather shelters when it's hot. And I think having those dedicated spaces available for overnight to stay cool would be a huge game changer. One thing about going to a library compared to an inclement weather shelter at the library , you're going to be with general population people who are doing their classes , who are reading , who are just doing their day to day. It can be a little bit uncomfortable for someone who's unsheltered. Maybe I didn't have a chance to shower. Maybe my clothes aren't clean , so having inclement weather shelters for heat days like this would be perfect.

S1: And how can someone get help to escape the heat if they need it.

S3: Please call 211. We are literally a call away , so don't hesitate. Call 211. They'll give you the list of cool zone sites. They'll get you connected to path. Um , that's the best way that I can recommend.

S1: And how can people with resources help?

S3: Please reach out to us. We have our location in downtown San Diego. We would accept any donations for water hygiene kits. Um , our website is Epworth. And , um , yeah , that or just be a good neighbor. If you see somebody who's on the streets who's hot and it looks like you would be miserable to offer them a water bottle. Mhm.

S4: Mhm. Yeah.

S1: You mentioned the need for more , um , you know , heat shelters and shelters for this type of , of inclement weather. Um , for those who are unsheltered. Where does that stand right now. Efforts to get that going. Uh.

S4: Uh.

S3: In terms of , like , inclement weather shelters , I don't think that's on the table as of right now. The the cooling zones are kind of holding a good placeholder for that. But in the city of San Diego , we could always use more shelter for any weather. Um , right now , I think half the population is unsheltered where the other half is. And so with very limited amount of availability each day , um , we could always use more.

S1: And we have experienced multiple heat waves this summer. What questions have these latest heatwaves left you with in serving those experiencing homelessness.

S3: Curious about what the impact is? Just like the impact with the seniors on the doctor's side. How is that impacting our homeless community? How many of them are going into the ERS? How many? Never getting sick? Um , we do a great job of mapping off , like , um , in the riverbed during floods. Did anybody get impacted by that? But I don't think we really map out as a homeless outreach region how much it affects the individual populations , right?

S1: And I mean , we're talking about , you know , the risk of of heat right now , but we're also expecting potential extreme weather this winter with El Nino driven storms. And you mentioned folks in riverbeds. And I mean , what challenges , what challenge does our winter weather pose for San Diegans who are homeless?

S3: It's definitely cold , just like it is when it's super hot. Um , again , it's the same kind of method trying to get them into shelter spaces , inclement weather shelters. um , and trying to get them there before the cold happens. So we're expecting a lot of flooding this year. We're working really hard to try and get people out of the riverbed and into the right places before that actually happens.

S1: All right. I've been speaking with Jaina Lee , associate director of outreach at Pat. Jayna , thank you so very much. And once again , the number to call to find resources is 211. That's our show for today. I'm your host , Jade Hindman.

S5: Thanks for tuning in to Midday Edition. Be sure to have a great day on purpose , everyone.