Forecasters are stating that the coming summer may be a hot one. What should providers of adult residential and domiciliary social care services do to safeguard service users if the weather heats up? Martin Hodgson answers the question.

High-risk groups

Extreme heat can make vulnerable people very ill and even be fatal. High-risk groups include:

  • the elderly (especially females over 75)

  • the very young

  • those living on their own and isolated, or homeless people

  • those on certain types of medication such as diuretics or on multiple medications

  • people with chronic or severe physical or mental illness such as:

    • respiratory disease

    • cardiovascular and cerebrovascular conditions

    • diabetes and obesity

    • severe mental illness

    • Parkinson’s disease and difficulties with mobility

    • renal insufficiency

    • peripheral vascular conditions

    • Alzheimer’s or related diseases.

The main causes of illness and death during extreme heat are respiratory and cardiovascular diseases.

The Heatwave Plan

The risks caused by hot weather have been recognised for some years and been addressed in England through the development of an emergency Heatwave Plan.

Heatwave Plan for England: Protecting Health and Reducing Harm from Severe Heat and Heatwaves is published by NHS England. It is supported by a number of documents (all available through the link above) including:

  • Advice for Care Home Managers and Staff: Supporting Vulnerable People Before and During a Heatwave

  • Advice for Health and Social Care Professionals: Supporting Vulnerable People Before and During a Heatwave

  • Beat the Heat: Staying Safe in Hot Weather (Leaflet)

  • Beat the Heat (Poster)

  • Beat the Heat: Keep Care Home Residents Safe and Well (Checklist)

  • Making the Case: The Impact of Heat on Health — Now and in the Future.

The aim of the plan is to alert people to the dangers and encourage them to plan in advance what to do in the event of a heatwave.

Warning levels

The Department of Health Heatwave Plan puts in place arrangements for the Met Office to monitor temperatures through a Heat-Health Watch alert system which operates from 1 June to 15 September. The Met Office issues heatwave alerts whenever average temperatures during the day or night rise above certain thresholds set for each region of the country.

There are five levels of warning:

  • Level 0: Long-term planning (carried out all year)

  • Level 1: Heatwave and Summer preparedness programme (carried out from 1 June to 15 September)

  • Level 2: Heatwave is forecast — Alert and readiness (60% risk of heatwave in the next 2–3 days)

  • Level 3: Heatwave Action (trigger temperature reached in one or more Met Office National Severe Weather Warning Service regions)

  • Level 4: Major incident — Emergency response (declared in the event of severe or prolonged heatwave affecting sectors other than health).

In an emergency situation, the heatwave is considered so severe and/or prolonged that its effects are likely to extend outside health and social care, such as causing power or water shortages. Conditions may even threaten the integrity of health and social care systems, transport and local government.

For this reason, multi-agency Local Health Resilience Partnerships and Local Resilience Forums have a critical role in preparing and responding to heatwaves at a local level, working closely with Health and Wellbeing Boards on longer-term strategic planning.

Reducing the risks

During a heatwave, it is likely to be hotter in cities than in surrounding rural areas, especially at night. Temperatures typically rise from the outer edges of the city and peak in the centre. Those living in top-floor, south-facing accommodation may be at particular risk as heat rises.

To reduce the risks, managers and staff should, prior to a heatwave:

  • work with partner agencies and local resilience groups to plan ahead

  • ensure that they have appropriate business continuity plans in place

  • review care plans to assess which service users are at particular risk and to identify what extra help they might need.

Care home managers should:

  • introduce shade into premises by planting trees or leafy plants around buildings

  • check that any south-facing windows, which let in most sunlight, can be shaded, preferably with curtains with pale, reflective linings

  • consider outside shutters or awnings

  • check that rooms can be properly ventilated without causing security problems

  • check that there are enough fans or air-conditioning units available if homes are difficult to keep cool

  • check that fridges and freezers work properly

  • set up a “cool room” where people can be moved if necessary.

Community care services should review the homes of particularly vulnerable service users and check that they have a means of keeping cool and can be properly ventilated without causing any additional health risk, discomfort or security problems. They too can encourage service users to set up a “cool room” and encourage people to have fans at the ready.

During a heatwave

In the event of a heatwave alert, managers should:

  • always take heatwave alerts seriously and act on them

  • monitor the current situation during hot weather by checking the warning level on the Met Office website, or by listening to local or national weather news through radio and television

  • take appropriate action according to the level of alert

  • ensure that contingency plans are in place to cope with heatwave conditions.

During a heatwave, vulnerable service users should be advised to keep out of the sun wherever possible and are likely to need additional support from care staff. They may require late-night visiting to ensure that they are alright, that they are drinking sufficient amounts of water and that they are keeping cool and have their windows open.

Some may require their fluid intake to be monitored and recorded, particularly if they are not able to drink unaided.

Vulnerable service users should be advised to wear light, loose, cotton clothes, wear hats outside and avoid drinking alcohol and caffeine. They should keep curtains and blinds at windows exposed to the sun closed while the temperature outside is higher than it is inside and open the curtains and windows once the temperature outside has dropped.

In the community anyone in a high-risk category who is living alone is likely to need at least daily contact, whether by care workers, volunteers or informal carers. People in high-risk groups may need extra care and support.

Heat exhaustion and heatstroke

During a heatwave, staff should be alert to the specific symptoms of heat exhaustion and heatstroke.

Heat exhaustion is a serious medical condition caused through exposure to heat. Symptoms include:

  • headaches

  • dizziness

  • nausea and vomiting

  • muscle weakness or cramps

  • pale skin

  • weak pulse

  • high temperature.

If the symptoms of heat exhaustion are left untreated then heatstroke can develop. This is potentially very serious and can result in organ failure, brain damage or even death.

Symptoms include:

  • confusion and disorientation

  • convulsions

  • unconsciousness

  • racing, thumping pulse

  • flushed, hot and dry skin

  • very sudden rise in temperature

  • dry mouth and tongue

  • decreased urination (with urine becoming dark in colour)

  • wrinkled skin

  • sunken eyes

  • low blood pressure

  • severe thirst

  • increase in heart rate and breathing

  • dizziness

  • confusion

  • coma.

If it is suspected that someone has heatstroke, staff should call 999 immediately. While waiting for the ambulance, they should:

  • take the person’s temperature

  • if possible, move them somewhere cooler

  • cool them down as quickly as possible by giving them a cool shower, sprinkling them with water or wrapping them in a damp sheet, and using a fan to create an air current

  • encourage them to drink fluids, if they are conscious

  • never give them aspirin or paracetamol.

Last reviewed 20 June 2017