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

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 primer provides tools and resources related to extreme heat response for those who work with people experiencing homelessness or in low-income buildings.

Extreme Heat events are announced by Environment and Climate Change Canada and health authorities at temperatures that are associated with increased deaths and hospitalizations. There are two levels of warnings: at the first temperature thresholds, the public, municipalities, and other partners are asked to prepare and take initial protective actions; and at the second level, the public, municipalities and other partners are requested to initiate emergency-level actions.

  • Extreme Heat warning (level one): declared by Environment Canada in the event of two or more days of forecast temperatures exceeding 29°C maximum and 16°C minimum (coastal) or 33°C maximum and 17°C minimum (inland).
  • Extreme Heat emergency (level two): declared when the criteria for a heat warning is met AND temperatures are expected to increase day over day for three or more days.

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. Additionally, they may be more socially isolated than the general public.

Groups at higher risk include:

  • People experiencing homelessness
  • Older people
  • 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
  • Infants and young children

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 and 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 individuals experiencing homeless

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 clients who are experiencing homeless are encouraged to communication in advance with guests, 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
    • Advise clients to make a plan to go to somewhere cooler if they do not have access to AC.
    • If this is not possible, identify a cooler space within the home and prepare if for nighttime use. The mobility challenged have particular concerns which may require rearranging daily living spaces to deal with heat episodes
      • Make ice, ready jugs of water and check that clients have a working fan positioned to bring cool air in from outside.
    • 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?
        • If they do not have access to water, be aware of outdoor resources, such as community water fountains which can be found at TapMap (metrovancouver.org).
      • Do they know how to keep cool?
        • Cool, wet clothes or tepid baths can help bring down core body temperature
        • Fans that create a cross-breeze can increase comfort; however, over 31 degrees they may not cool effectively.
      • Do they have access to air conditioning? If not, do they have a plan of somewhere else they could go?
        • Where possible, when a client’s living space is too hot, ask them if they feel comfortable getting to a cool, green, shaded area of the community.
        • Ask them if they feel comfortable going to a community cooling shelter; check local government websites to inform them of whether there is one close by to them.
      • Do they show any signs of heat stress? If so, when possible get them to somewhere cool and call for medical assistance.
  • 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.
    • Where possible, clients who may experience or be at risk of suicidal ideation can be referred to Fraser Health Mental Health supports for the co-creation of care plans.
    • If someone is experiencing a mental health emergency that is not life threatening please call:
    • More resources on suicide and self harm can be found here.
  • 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 modifications to infrastructure 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. BC Housing may be able to assist with funding.
  • Make and share 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:

*Be aware that indoor cooling spaces are preferred to make a difference for the health and safety of clients; however, outdoor cooling and misting tents may increase comfort for clients and staff.

  • 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 may worsen 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.
    • Misting tents with good ventilation are also an option to make people more comfortable; however, it is not clear the degree to which they reduce heat-related illness mobility and accessibility:
    • 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 direct people to the space.

Further information on creating outdoor cooling spaces can be found here.

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.
  • For more resources, for non-profit providers, please see BC Housing's Extreme Heat resources.