Ready Hands · Seoyeon Kim
Chapter 8: Heat on the Road
What Can Happen
On a summer afternoon, a care worker takes a man in his eighties, who uses a wheelchair, to an appointment. The way to the clinic looked short on the map, but there is little shade, and they wait for a long time at a crossing in full sun. Halfway there, the man goes quiet. When the care worker leans down to speak to him, his face is pale and wet with sweat, and he says that he feels dizzy and sick. She also notices that the metal armrest of the wheelchair is too hot to touch.
Heat on the road brings its own risks. Out of doors there may be no cool room, no fan and no tap close by, and the person you support may be unable to reach shade alone. This chapter explains how to plan an outing in hot weather, and how hot surfaces and parked vehicles can harm a person. It then gives the steps to follow when a person becomes unwell from heat on a walk or at a stop, and when you see someone trapped in a hot parked car. It also explains what to watch for on the way home and later in the day.
Planning an Outing in Hot Weather
The safest outing in hot weather is one that has been planned with the heat in mind. Check the weather forecast and any public heat warnings the day before and again on the morning of the outing. If the outing is not necessary, it may be wiser to move it to a cooler day, following the person's wishes and your workplace's guidance. If it must go ahead, for example for a medical appointment, choose the coolest time you can, usually the early morning or the evening, and avoid being outside in the middle of the day, when the sun is strongest.
Plan the route as well as the time. A route that is a little longer but has shade from trees and buildings is often better than the shortest one in full sun. Think about places along the way where the person can rest in the cool, such as a shop, a library, a waiting room or a covered stop, and about where you could find water and a toilet. If you can, find out before the day whether the place you are going to has a cool area where the person can wait. Allow plenty of time so that nobody has to hurry, because hurrying in the heat makes the body work harder.
Prepare the person and yourself. Light, loose clothes in pale colours, a hat with a wide brim, and protection from the sun for the skin and eyes all help. Take enough water for both of you, and offer the person drinks often along the way, following the care plan's guidance on drinks and swallowing, rather than waiting until the person says they are thirsty. A small towel that can be wetted, a hand fan and a cold pack in an insulated bag are useful. Take a charged phone, the details your workplace asks you to carry, and the address of the place you are going to.
Travelling by car needs the same care. Before the person gets in, let the hot air out by opening the doors for a short time, and run the air conditioning if the vehicle has it. Park in the shade where you can. On longer journeys, plan breaks in cool places and offer a drink at each stop. A person in the back seat may not be able to tell you that they are too hot, so ask from time to time how the person feels, and look at the person properly whenever you stop. If the air conditioning stops working on a hot day, open the windows, stop in a shaded or cool place as soon as it is safe, offer a drink and think again about whether to continue the journey.
Remember yourself, too. A care worker who is dizzy or confused from the heat cannot keep another person safe. Drink regularly, wear a hat, take breaks in the shade, and tell your workplace if the heat is making a planned outing unsafe. Looking after your own body in the heat is part of looking after the person you support.
Hot Surfaces and Parked Vehicles
On a hot, sunny day, many surfaces become hot enough to burn skin. Pavements, steps, metal railings and benches in the sun can all burn, and so can the metal parts of a wheelchair, such as the armrests, footplates and wheel rims, and the seats and seat belt buckles in a parked car. Dark surfaces and metal usually become hotter than pale ones. Older skin is thin and burns easily. Some people cannot feel heat well in their hands, legs or feet because of a health condition, and some cannot move away from a hot surface or tell you that it hurts.
Check before the person touches or sits on anything that has been in the sun. Touch the surface briefly with the back of your hand; if it feels hot to you, it is too hot for the person. Cover hot seats and armrests with a cloth or towel, keep the wheelchair in the shade while you wait, and make sure the person's feet are protected by shoes rather than resting bare on hot ground. If a person has been burned by a hot surface, cool the burn as Chapter 12 explains.
Parked vehicles are a special danger. The inside of a closed car heats up much faster than most people expect, and it can become dangerously hot within minutes, even on a day that does not feel very hot outside. The sun shining through the glass heats the seats, the dashboard and the other surfaces, and these keep heating the air even after the sun has moved. Leaving a window slightly open makes little difference. A person, a child or an animal left inside can develop heatstroke quickly, especially if they cannot open the door or call for help.
For this reason, never leave a person, a child or an animal in a parked vehicle, even for a short time and even with a window open. If you need to go into a shop or a building, take the person with you, or ask a colleague to stay with the person in a cool place, as your workplace's procedures say. Each time you leave the vehicle, make a habit of checking every seat, including the back. Lock the vehicle when it is empty, so that nobody, especially a child, can climb in and become trapped.
Waiting is a hidden risk on the road. Standing at a bus stop, at a crossing or in a queue in full sun can be harder on the body than walking. Where you can, wait in the shade, keep the person seated, offer a drink and lay a wet cloth on the person's neck. Buses and other vehicles that have stood in the sun can also be very hot inside, so watch the person closely for the first part of the journey. If a wait in the sun grows long, it is better to leave and come back later than to let the person become too hot.
Step by Step: When the Person Becomes Unwell on a Walk or at a Stop
Step 1. Stop at once. As soon as the person looks unwell, says they feel dizzy, sick, weak or very hot, or seems confused, stop moving. Do not try to hurry on to your destination or back home. Put the wheelchair brakes on, or, if the person is walking, help the person stand still next to something steady.
Step 2. Get the person into shade as close by as possible. A doorway, a shop, a tree, a covered stop or the shadow of a building all help. Move only a short way and only if it is safe, and keep away from the edge of the road and from traffic. If the person is in a wheelchair, turn the chair so that the person's face and body are out of the direct sun. If there is no shade, make some: ask a passer-by to hold an umbrella, a jacket or a coat between the person and the sun.
Step 3. Help the person sit or lie down. A person who feels faint may fall, and lying down helps the faintness to pass. A person in a wheelchair can stay seated with the brakes on. If the person sits or lies on the ground, put something between the person and the hot pavement, such as a coat or a bag.
Step 4. Decide whether to call the emergency number. Call at once if the person is confused, drowsy, behaving strangely or has collapsed, or has any other sign of heatstroke, as Chapter 7 explains. Call also if the person does not begin to feel better quickly once in the shade and being cooled, or if you are unsure. Tell the operator where you are, as Chapter 2 explains: the road you are on, the direction and any landmarks. When you are not sure, calling is the right choice.
Step 5. Cool the person with what you have. Loosen the person's clothing, wet the skin with water from your bottle, and fan with anything flat, such as a folder or a magazine. Put a wet cloth or a cold pack wrapped in cloth on the neck, and in the armpits if that can be done with dignity in a public place. Ask a nearby shop for water or ice if you need more. If heatstroke is possible, keep cooling as fast as you can until help arrives.
Step 6. Give sips of water only if the person is fully awake and can swallow safely. If the person is confused, drowsy or cannot swallow safely, give nothing to drink. Follow the care plan's guidance on drinks and swallowing.
Step 7. Stay with the person and keep watching. Watch the breathing and how the person answers you, and tell the operator at once if the person becomes more confused or drowsy. If the person stops responding, check the breathing as Chapter 3 explains and be ready to give CPR as Chapter 4 explains. When you can, call your workplace, as your procedures say, so that your colleagues know what is happening and where you are.
Step 8. Plan the way back with care. If the person recovers well and no emergency call was needed, do not simply carry on with the outing. Rest in the cool until the person feels well, then return home by the shortest and coolest way, by vehicle if needed. Heat illness can come back or become worse later in the day, so tell the next care worker or the family what happened, and report it as your workplace's procedures say. New confusion, unusual drowsiness, vomiting or very hot skin later that day mean calling the emergency number.
Step by Step: When Someone Is Trapped in a Hot Parked Car
Step 1. Look carefully and quickly. If you see a person or a child alone in a closed, parked vehicle on a hot day, look at how they are. Signs of danger include a very red or very pale face, heavy sweating or hot, dry skin, drowsiness, confusion, floppiness, or no response when you knock on the window. A person who does not respond is in serious danger. Even a person or a child who looks well can become seriously ill quickly in a hot car, so do not walk away.
Step 2. Call the emergency number at once. Do not wait to see whether the driver comes back. Tell the operator that someone is trapped in a hot vehicle, where the vehicle is, its colour and type, and how the person or child inside looks. Put the phone on speaker and stay where you can see the person inside.
Step 3. Keep the person you support safe at the same time. If you are on an outing, do not leave the person you support alone in the sun or near traffic while you help. Settle the person you support in shade nearby, or ask a passer-by to stay with them. Your care for the person you support goes on even when there is an emergency nearby.
Step 4. Ask others to look for the driver. A passer-by, a shop worker or a security guard can check nearby shops and buildings or ask for the driver over a loudspeaker. Meanwhile, try the doors gently in case one is unlocked. If an adult inside is awake, speak clearly through the glass and ask the person to unlock the door or open a window, if they are able to. If a door opens, tell the operator and follow the operator's instructions about getting the person out.
Step 5. Follow the operator's instructions about getting in. Help may be close, and the operator will tell you what to do while you wait. If the person inside is in serious danger and help is not close, the operator may tell you how to get into the vehicle, as the law where you live allows. Do only what the operator tells you, and protect yourself and the person inside from injury.
Step 6. Once the person is out, give first aid for heat. Move the person into shade and cool them as Chapter 7 explains: remove extra clothing, wet the skin and fan, and use cold packs wrapped in cloth if you have them. If the person does not respond, check the breathing as Chapter 3 explains and be ready to give CPR. Stay with the person until help arrives, and tell the paramedics how long you think the person was inside, if you know.
Things to Check
Check the weather forecast and any public heat warnings before every outing in hot weather, and talk with your supervisor if a planned outing looks unsafe.
Check your outing bag before you leave: water for both of you, a hat, a small towel, a hand fan, a cold pack in an insulated bag and a charged phone.
Check the route for shade, rest places, toilets and places to buy water, and allow enough time so that nobody needs to hurry.
Check every seat, armrest and metal part of the wheelchair with the back of your hand before the person sits down or touches it.
Check every seat of the vehicle each time you leave it, and never leave a person in a parked vehicle, even for a short time.
Check on the person often during the outing, and ask simple questions about how they feel. Some people will not say that they are too hot unless you ask.
Check on the person again on the way back and later in the day, and pass on what happened to the next care worker or the family, as your workplace's procedures say.
Check the care plan of each person you take out for health conditions that make heat more dangerous, and for how the person shows that they feel unwell, so that you notice the first signs even if the person cannot tell you.