The summer season with its potential for fluctuating high temperatures is approaching. Long-term health care facilities are reminded that the elderly and other health compromised individuals are more susceptible to extremes in temperature and dehydration. It is important that facility administrators monitor weather predictions for fluctuations in extreme temperatures and take extra precautions to be sure appropriate air conditioning equipment is operating effectively.

Facilities must have contingency plans in place to deal with either the loss of air conditioning or, in the case when no air conditioning is available, to take measures to ensure patients and residents are free of adverse conditions that may cause heat related health complications. Portable fans and other temporary cooling devices should be used when indicated.

We recommend that the following measures be implemented to keep residents and clients comfortable during extremely hot weather:

• Dress in lightweight loose fitting clothing.
• Keep well hydrated with a particular attention to dependent residents.
• Physical activities should be minimized during the hottest parts of the day.
• Keep indoors and out of the sun during the hottest parts of the day.
• Use fans as appropriate.
• Open windows where feasible and if screens are intact, to allow fresh air to circulate.
• Use cool compresses, misting, showers and baths.
• Avoid hot foods and heavy meals.
• Encourage frozen treats such as “Popsicles” between meals.
• Keep a hydration station readily available to residents, family and staff.
• Staff should also be alert to adverse changes in patient and resident conditions that may be heat related. Develop and implement a system to monitor hydration status and be prepared to take appropriate interventions.

Also please remember that the hot weather brings mosquitoes and the risk of contracting West Nile Virus (WNV). If mosquitoes are abundant, residents and clients should remain indoors in the early morning and at twilight, when mosquitoes are most active. Repellents should be used cautiously especially in children and the elderly. For additional information on the use of chemical repellents, administrators or infection control practitioners should consult the Centers for Disease Control and Prevention (CDC) web site at http://www.cdc.gov/ncidod/dvbid/westnile/qa/insect_repellent.htm.
You can find additional extreme heat related information at the CDC web site http://www.bt.cdc.gov/disasters/extremeheat/index.asp. A Fast Facts sheet on Preventing Summer Heat Injuries is also attached.

Licensing regulations require that all emergency/disaster-related occurrences which threaten the welfare, safety, or health of patients, must be reported to the Department of Health Services (DHS), Licensing and Certification (L&C) Program. In the event your facility is impacted by extreme heat conditions that compromise patient health and safety and/or an evacuation, transfer or discharge of patients is necessary you must contact DHS L&C. Please follow these guidelines for reporting such occurrences:

During normal business hours (8:00 a.m. – 5:00 p.m.) contact the local DHS, L&C district office you customarily work with for your geographic location.

For after-hour reporting or if the local DHS L&C district office is non-operational due to the emergency/disaster, follow the process below:

• For facilities outside Los Angeles County, notify the:
  State Office of Emergency Services Warning Center at (916) 845-8911
  Ask that they notify the DHS duty officer.
• For facilities in Los Angeles County notify the:
  Los Angeles County Operator at (213) 974-1234
  Ask that they notify the on-call Health Facilities Inspection Division Supervisor.

Sincerely,

Original Signed by Kathleen Billingsley, R.N.

Kathleen Billingsley, R.N.
Deputy Director

Attachment: Fast Facts Summer Heat