Anne Marie Batten-Toronto: This summer is shaping up to be the hottest that I have encountered during my nursing career. Everyday, as I commute into the city I check my phone for the Toronto Public Health alert which arrives at approximately 8:20 to announce if a Heat Alert or an Extreme Heat Alert is in effect for the day.  At the beginning of the summer, this would mean that I would immediately start tweeting and sharing information as public service announcements, resource information etc.  I would also start planning water outreach to the most affected areas. It is only August and I am finding that my nursing practice is changing. Although I check my phone each day at that time waiting for the email, I no longer can let this direct my nursing care. I now treat everyday as if it is a heat alert. The risk for our vulnerable seems just as great whether an alert is declared or not.

This summer we have had several days of cumulative high temperatures. For those who live in buildings without air conditioners and proper ventilation, their buildings do not cool down overnight. As well, many of my clients are elderly, have chronic medical conditions such as respiratory problems, cardiac issues, diabetes, mental health concerns etc. It would be negligent for me to base my care on an announcement from the city. As outreach nurses, we are on the ground, in the buildings, in the drop ins, face to face with those who are suffering. Unfortunately, the scientific calculation used to determine if a heat alert is called means very little to those at the highest risk. I take water with me on my outreach rounds. I regularly encourage people to use a buddy system of checking their neighbours, relatives and friends who may need assistance.

If a Heat Alert is called, we are instructed to encourage people to seek out air conditioned places such as malls, community centres, and libraries. Unfortunately, many of the vulnerable clients do not have transportation money to get there. I have a very limited supply of TTC to use in this case.  If an Extreme Heat Alert is called, cooling centres are opened and some drop ins are given TTC to assist with transportation costs. Sadly, there are several reasons why some are not able to go to a cooling centre. For example, some clients have mental illness and are afraid to be around others, some have mobility challenges, some seniors are afraid to leave their pets, etc.

My hope is that we are able to keep all of our vulnerable persons safe this summer. I also hope that in the fall as outreach nurses, public health professionals, and emergency response workers we are able to meet and assess our heat response system. We need to discuss what went well, where the gaps are, and what we need to improve so that we are better prepared for next year.  I am seeing people falling through those gaps each and every day.

Below is link for City of Toronto Heat Alert and Response Information:
http://www.toronto.ca/health/heatalerts/index.htm