Chapter 14: Cold, Rain and Weather on the Road

What Can Happen

On a grey winter morning, a care worker arrives for a home visit and finds a woman in her eighties sitting in her armchair under a thin blanket. The heating has been off all night, and the room feels as cold as the hallway outside. The woman is slow to answer, her words are a little slurred, and her hands are pale and very cold. She says that she is fine and only a little tired.

Much of this book is about heat, but weather can harm people in the other direction too. This chapter explains how a person can become dangerously cold, even indoors, how to recognise the signs and how to warm a person safely. It also covers rain, ice and slippery roads on outings, and how to prepare for storms and power cuts in care. The aim is the same as in the chapters about heat: to notice early, to act calmly and to plan so that you and the person you support are ready for whatever the weather brings.

Getting Too Cold: Why Older People Are at Risk

Hypothermia means that the body has become so cold that it can no longer work properly. It is often linked with mountains and icy water, but in care it is more likely to happen quietly at home. A cold room, a night without heating, thin clothing or a fall that leaves a person lying on a cold floor for a long time can all lower body temperature. It can also happen outside on a cool, wet and windy day, even when the air does not feel very cold, because wet clothing and wind take heat away from the body quickly. A person in a wheelchair who sits still at a bus stop or beside a road can become cold much faster than the care worker who is walking and pushing the chair.

Older people and many people who receive care are at higher risk. As people age, the body produces less heat, the feeling of cold can become weaker, and the person may not notice that they are getting cold. Some health conditions and some medicines can make it harder for the body to keep warm; the person's doctor or pharmacist can explain this for each person. A person who moves very little, who cannot easily change clothes or adjust the heating, or who has trouble saying how they feel depends on the people around them to notice the cold. A person living with dementia may take off warm clothes, open a window in winter or forget how to turn on the heating, so regular checks of the room and the person matter.

The early signs of getting too cold are shivering, pale and cold skin, cold hands and feet, and a person who is quieter or slower than usual. As the body becomes colder, speech may become slow or slurred, movements clumsy, and the person may become confused, drowsy or irritable. Breathing may become slow and shallow. In severe hypothermia, shivering can stop altogether, which is a dangerous sign, not a sign of improvement. The person may become unresponsive.

Because older people may not shiver much, you cannot rely on shivering alone. Feel the skin of the person's chest or stomach under the clothes with the back of your hand, not only the hands and feet. If the skin of the body feels cold, and the person is also slow, confused or drowsy, treat it as hypothermia and act. Mild coldness can be helped at home; serious signs need emergency help.

Cold can also injure the skin of the fingers, toes, ears, nose and cheeks, especially in wind or when a person cannot move to keep the blood flowing. The skin may first look red and feel painful, then turn pale, white or greyish, feel numb, and become hard or waxy. Bring the person into a warm place, remove wet gloves and socks, and warm the area gently with body warmth, for example by placing the person's hands in their own armpits. Do not rub the skin, do not use direct heat, and do not burst any blisters. Seek medical help for any skin that stays pale, hard or numb, and call the emergency number if the person also shows signs of hypothermia.

Step by Step: Helping a Person Who Is Too Cold

Step 1. Decide whether this is an emergency. If the person is confused, very drowsy, unresponsive, has stopped shivering while still cold, or is breathing slowly, call the emergency number at once or ask someone else to call. Tell the operator that the person is very cold, what signs you see and how long you think the person has been cold. If the person is only mildly cold and fully alert, warm them as the next steps describe and tell your workplace, as its procedures say.

Step 2. Move the person to a warm, sheltered place if you can do so safely, or bring warmth to the person. Indoors, close windows and doors and turn on the heating in the room. Outside, get the person out of the wind and rain, into a building or a warm vehicle. Handle the person gently, because rough movement can be dangerous for a person who is very cold.

Step 3. Remove wet clothing and replace it with dry clothing, doing this gently and while keeping the person covered for warmth and dignity. If changing clothes would take the person out into the cold, cover the wet clothes with dry layers and wait until you are somewhere warm. If the person is lying on a cold floor or on the ground, put a blanket, a coat or a cushion underneath, because the ground draws heat out of the body.

Step 4. Cover the person with dry blankets, including the head and neck, but leave the face clear. Several light layers trap more warmth than one heavy cover. Keep the person sitting or lying still while they warm up, rather than walking around. A blanket made for emergencies, from a first aid kit, can be added on top of the other layers.

Step 5. Offer a warm drink and some food only if the person is fully awake and able to swallow safely. A warm, sweet drink can help, but never alcohol. If the person is confused, drowsy or has trouble swallowing, give nothing by mouth, because the person could choke.

Step 6. Warm the person gradually, not quickly. A warm room, dry clothes and blankets are usually enough for mild coldness. Do not put the person in a hot bath or shower, do not rub or massage the arms and legs, and do not place heaters, hot-water bottles or very hot objects directly against the skin. Warming too fast or rubbing the skin can harm a cold body and can cause burns, because cold skin does not feel heat properly.

Step 7. Stay with the person and keep watching their breathing and response until they are warm and alert or until help takes over. If the person becomes unresponsive but is breathing normally, place the person in the recovery position, as Chapter 3 explains, and keep them covered. If the person is not breathing normally, start CPR as Chapter 4 describes. Afterwards, report what happened and why the person became cold, so that the cause can be fixed.

Step by Step: Rain, Ice and Slippery Roads on an Outing

Step 1. Check the weather forecast the day before and again on the morning of the outing. Look for rain, wind, ice, snow and sudden changes in temperature. If the weather looks dangerous, talk to the person and your workplace about changing the time or the day. A shorter outing, or one on another day, is often the safest choice.

Step 2. Dress the person in layers that can be added or removed, with a waterproof outer layer, a hat and gloves. Bring spare dry socks and gloves and a blanket for a person in a wheelchair. Bright or reflective clothing, or a high-visibility vest for you, helps drivers see you both on a dark or rainy day.

Step 3. Check footwear and equipment before you leave. Shoes should have a good grip and fit well. On a wheelchair, check the tyres, the brakes and the footrests, and remember that wet brakes and wet hand rims grip less well. A walking stick or a frame should have rubber tips in good condition.

Step 4. Plan the route and allow extra time. Choose paths that are cleared and well lit, avoid steep slopes, and use dropped kerbs and ramps with care, because they are often the most slippery places. Puddles can hide holes and uneven paving, and wet leaves, painted road markings and metal covers can be very slippery. Moving slowly is safer than hurrying to get out of the rain.

Step 5. On the way, walk at the person's pace and stay on the side that gives the most support. Keep a wheelchair moving slowly and steadily, and go down slopes and kerbs as you were trained, holding the chair firmly. If ice or heavy rain makes the path unsafe, stop and find shelter or turn back rather than taking a risk.

Step 6. Keep track of the light and the time. In winter, it gets dark early, and rain makes it harder for drivers to see people crossing or waiting by the road. Plan to be back before dark when you can, cross only where drivers can see you clearly, and keep a torch and your phone ready.

Step 7. If the person falls on a wet or icy path, follow the steps in Chapter 11. Do not rush to lift the person. While you check the person and wait for help, keep them warm and dry by putting a coat or a blanket underneath and over them, because a person lying on cold, wet ground loses heat quickly.

Step 8. When you get back, help the person change out of any wet clothes and dry their skin, especially the feet. Offer a warm drink if the person can swallow safely, and check the hands and feet for redness, numbness or pale patches. If the person was cold for a long time, keep them warm and watch for drowsiness or confusion in the hours that follow. Report any problems, and note what you would change for the next outing.

Storms and Power Cuts in Care

Storms, snow and floods can cut electricity, block roads and delay emergency services. For people who receive care, a power cut can mean a cold or a very hot home, no light at night, and equipment that stops working, such as powered beds, special mattresses, lifts or alarms. Your workplace's emergency plan should describe what to do for each person, and it is worth reading it before bad weather arrives.

When a storm is forecast, help the person prepare as the care plan and your workplace's procedures describe. Charge phones and keep torches with spare batteries where they are easy to find. Avoid candles, which can cause fires and burns. Keep extra blankets, warm clothes, drinking water and food that does not need cooking within reach. Make sure the person can call for help, and that someone will check on them if you cannot reach the home.

During a power cut in cold weather, help the person stay in one room, wear several layers, including a hat, and use blankets. Keep doors to unused rooms closed to hold the warmth in. Never use a cooker, a grill or a generator indoors to heat the home, because these can give off a gas that cannot be seen or smelled and can poison people. In hot weather, a power cut means no fans or cooling, so follow the advice in Chapter 6 about keeping a person cool.

Travelling by car in winter weather needs its own preparation. Before you leave, check the forecast, make sure the vehicle has enough fuel or charge, and bring blankets, warm clothes, water, a snack and a charged phone. If the car breaks down or becomes stuck in snow, it is usually safest to stay inside the vehicle with the person, call for help and describe where you are as Chapter 2 explains. If you run the engine for heat, keep the exhaust pipe clear of snow and open a window slightly, because exhaust gas can collect inside the car. Put on the hazard lights, and if you must leave the vehicle beside a road, wear a high-visibility vest and move well away from the traffic.

If roads are flooded, icy or blocked, do not try to drive through. Never walk or push a wheelchair through floodwater either, because it can hide open drains, holes and strong currents. Follow your workplace's procedures for visits that cannot happen as planned, and tell your supervisor early so that someone can phone the person or find another way to reach them. If a person you support is unwell and help is delayed by the weather, call the emergency number, describe the conditions clearly, and follow the operator's instructions while you keep the person warm, dry and calm.

Things to Check

Check the warmth of each home you visit in cold weather: the temperature of the rooms where the person sleeps and sits, the heating and whether the person can use it, and enough warm clothing and bedding. A room that feels cold to you is likely to be colder for a person who does not move much, and problems with heating should be reported as your workplace's procedures say.

Check the weather forecast before every outing, and again on the day. Plan the time, the route and the clothing for the weather, and be ready to change the plan.

Check footwear, walking aids and wheelchairs for grip before going out in rain, ice or snow. Worn tyres, loose brakes and worn rubber tips are much more dangerous on wet ground.

Check that people who sit still for long periods, in a wheelchair, at a stop or in a waiting room, stay warm enough. Ask them how they feel, add a blanket early, and keep waits outside short.

Check that your bag for outings holds what the weather may call for: spare dry socks and gloves, a waterproof layer, a blanket for emergencies, a torch and a charged phone. These small things can keep a person warm while you wait for help.

Check your workplace's plan for storms and power cuts, and know which people rely on equipment that needs electricity. Knowing this in advance lets the team act quickly when the power fails.

Check that you can recognise the signs of getting too cold, including in a person who is not shivering. A cold chest or stomach, slow speech and drowsiness are the signs to act on.