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i
PREPARING FOR SUMMER 2016
Hot weather Guidance for Leicestershire Partnership NHS Trust (LPT) Staff and
Service Users
ii
CONTENTS
1 HEATWAVES WHO IS AT RISK 1
2 PLANNING FOR A HEATWAVE: KNOWING WHO ARE OUR AT RISK PATIENTS
2
3 HEAT RELATED ILLNESSES 3
4 MEDICATIONS THAT MAY INCREASE RISK IN PATIENTS DURING HOT WEATHER
4
5 ADVICE TO GIVE TO PATIENTS / SERVICE USERS / CARERS AND RELATIVES ON HOW TO KEEP COOL DURING HOT WEATHER
6
6 EMERGENCY TREATMENT FOR HEATSTROKE 7
7 HOT WEATHER AND HEATWAVE: WELFARE ADVICE FOR STAFF
8
8 FORECASTING HEATWAVES - MET OFFICE HEAT HEALTH WATCH SYSTEM
9
9 RESPONDING TO HEAT HEALTH WATCH ALERTS: ACTIONS FOR MANAGERS & STAFF
10
APPENDIX 1 RAMADAN – ADVICE OF FASTING DURING HOT WEATHER
APPENDIX 2 FURTHER INFORMATION
1
1 - HEATWAVES: WHO IS AT RISK
During heatwaves we can experience high temperatures for prolonged periods. During the
heatwave of 2003 over 2000 excess deaths occurred in England and Wales. In response
Public Health England and NHS England annually issue a Heatwave Plan which outlines
the risks during hot weather and the measures NHS staff should take to protect vulnerable
patients and service users.
It is known that people with underlying medical conditions are particularly at risk during heatwaves, especially those with cardiovascular and respiratory diseases as these are the main causes of illness and death during hot weather.
High Risk Groups
Older Adults (especially over 75 years old).
Chronic and severe illness: including heart conditions, diabetes, respiratory and renal conditions, obesity, severe mental illnesses, Parkinson’s disease and difficulties with mobility, Peripheral vascular conditions, Alzheimer’s or related diseases.
Those on medications that potentially affect renal function, sweating, thermoregulation or electrolyte balance as this can make this group more vulnerable to the effects of heat.
Those on multi-medications.
Inability to adapt behaviour to keep cool: Alzheimer patients, disabled, being bed bound or the very young. Those with severe physical or mental health illnesses.
Alcohol or drug dependent.
Domestic/personal/occupational circumstances that may increase the risk to health during hot weather (homelessness, live in south-facing housing (especially top floor flats)).
During extreme heatwaves when we can experience very high temperatures, fit and healthy people can also be affected.
Children
Children’s susceptibility to high temperatures varies; those who are overweight or who are taking medications may be at increased risk of adverse effects. Children under four years of age are also at increased risk.
Some children with disabilities or complex health needs may be more susceptible to temperature extremes.
2
2 - PLANNING FOR A HEATWAVE: KNOWING WHO ARE OUR AT RISK PATIENTS
Heatwaves can happen suddenly, and rapid rises in temperature affect vulnerable people
very rapidly. A rise in mortality as a result of warm weather can occur within 2 days of an
increase in temperatures. Therefore it is important that we are prepared for supporting
patients during hot weather.
Using care plans LPT staff should assess which individuals are at particular risk,
providing them with guidance (see section 5) and identifying what extra help they might
need.
Things also to consider:-
Does the patient’s care plan include contact numbers for their GP, care workers
and informal carers.
Check that the patient knows who to contact if they need assistance and that extra
care and support is available if necessary.
Anyone in a high-risk category who is living alone is likely to need at least daily contact
during hot weather. Older people with chronic or serious illness, mobility problems, or
severe mental illness, those who are on certain medications, or those living in
accommodation that is hard to keep cool, may need extra care and support.
3
3 - HEAT-RELATED ILLNESSES
The main causes of illness and death during a heatwave are respiratory and
cardiovascular diseases. Additionally, there are specific heat-related illnesses
including,
Heat cramps – caused by dehydration and loss of electrolytes, often following
exercise.
Heat rash – small, red, itchy papules.
Heat oedema – mainly in the ankles, due to vasodilation and retention of fluid.
Heat syncope – dizziness and fainting, due to dehydration, vasodilation,
cardiovascular disease and certain medications.
Heat exhaustion – is more common. It occurs as a result of water or sodium
depletion, with non-specific features of malaise, vomiting and circulatory collapse, and
is present when the core temperature is between 37ºC and 40ºC. Left untreated, heat
exhaustion may evolve into heatstroke.
Heatstroke – can become a point of no return whereby the body’s thermoregulation
mechanism fails. This leads to a medical emergency, with symptoms of confusion;
disorientation; convulsions; unconsciousness; hot dry skin; and core body temperature
exceeding 40ºC for between 45 minutes and eight hours. It can result in cell death,
organ failure, brain damage or death. Heatstroke can be either classical or through
exertion.
4
4 - MEDICATIONS THAT MAY INCREASE RISK IN PATIENTS DURING HOT WEATHER
The following drugs are theoretically capable of increasing risk in susceptible individuals.
It may be worth carefully reviewing the medication such individuals are taking, and
assessing the risks and benefits of any changes to their regime.
NB. The following list of medicines is not exhaustive. Please consult the LPT
Pharmacy department for further supporting information (0116 295 8989).
Those causing dehydration
or electrolyte imbalance
Diuretics, especially loop diuretics
Any drug that causes diarrhoea or vomiting
(e.g. colchicine, antibiotics, codeine)
Those likely to reduce renal
function
NSAIDS, sulphonamides, indinavir, ciclosporin
Those with levels affected by
dehydration Lithium, digoxin, antiepileptic, biguanides, statins
Those that interfere with
thermoregulation: By central action
Neuroleptics, serotoninergic
agonists
By interfering with sweating Anticholinergics:
atropine, hyoscine
tricyclics
H1 (first generation)
antihistamines (e.g.
hydroxyzine)
certain antiparkinsonian drugs
certain antispasmodics
neuroleptics
disopyramide
antimigraine agents
Vasoconstrictors
Those reducing cardiac output:
beta blockers
diuretics
By modifying basal metabolic
rate
Thyroxine
5
Drugs that exacerbate the effects of heat
by reducing arterial pressure All antihypertensive
Antianginal drugs
Drugs that alter states of alertness (including those in section 4 (Central Nervous System) of
the British National Formulary)- particularly 4.1 (Hypnotics and Anxiolytics) and 4.7 (Analgesics).
6
5 - ADVICE TO GIVE TO PATIENTS / SERVICE USERS / CARERS AND RELATIVES ON HOW TO KEEP COOL DURING HOT WEATHER
How to keep out the heat
Keep curtains on windows exposed to the sun closed while the temperature outside is
higher than it is inside.
Once the temperature outside has dropped lower than it is inside, open the windows.
This may require late night visiting and such advice needs to be balanced by any
possible security concerns.
Advise the person to stay out of the sun, especially between the hours of 11.00am
and 3.00pm.
Advise them to stay in the shade and to wear hats, sunscreen, thin scarves and light
clothing if going outside.
How to keep body temperatures down
Ensure that the person reduces their levels of physical exertion.
Suggest they take regular cool showers or baths, or at least an overall body wash.
Advise them to wear light, loose cotton clothes to absorb sweat and prevent skin
irritation.
Suggest that they sprinkle their clothes with water regularly, and splash cool water on
their face and the back of their neck. A damp cloth on the back of the neck helps
temperature regulation.
Recommend cold food, particularly salads and fruit with a high water content.
Advise them to drink regularly, preferably water or fruit juice, but avoid alcohol and
caffeine (tea, coffee, coke cola). – Note: Check whether the individual has access to
a fridge / cool drinking water.
Monitor their daily fluid intake, particularly if they have several carers or are not always
able to drink unaided.
Provide extra care for high risk patients
Keep in regular contact throughout the heatwave, and try to arrange for someone to
visit / call at least once a day.
Keep giving advice on what to do to help keep cool.
7
Older people with chronic or serious illness, mobility problems, or severe mental
illness, those who are on certain medications, or those living in accommodation that is
hard to keep cool, may need extra care and support.
During extended periods of raised temperatures ensure that persons over the age of
65 are advised to increase their fluid intake to reduce the risk of blood-stream
infections caused by Gram-negative bacteria.
Further guidance is available from NHS Choices on
http://www.nhs.uk/livewell/summerhealth/
Be alert
As well as the specific symptoms of heat exhaustion and heatstroke, watch out for signs
in patients / service users that could be attributed to other causes, such as:
Difficulty sleeping, drowsiness, faintness and changes in behaviour;
Increased body temperature;
Difficulty breathing and increased heart rate;
Dehydration, nausea or vomiting; or
Worsening health problems, especially of heart or respiratory system.
6 - EMERGENCY TREATMENT FOR HEATSTROKE
If you suspect someone has heatstroke, call (9)999. While waiting for the
ambulance,
Take the person’s temperature;
If possible, move them somewhere cooler;
Cool them down as quickly as possible by giving them a cool shower, sprinkling them
with water or wrapping them in a damp sheet, and using a fan to create an air current;
Encourage them to drink fluids, if they are conscious;
Give them a saline drip and oxygen if they are unwell; and
Do not give aspirin or paracetamol.
8
7 - HOT WEATHER AND HEATWAVE: WELFARE ADVICE FOR STAFF
Work Environment
Ensure staff has access to cool drinking water.
Use blinds / curtains to shade windows from direct light.
Open windows during late evening / morning to bring cooler air into the building.
Especially if this encourages a breeze. However:-
o Be mindful of security risk.
o Do not open windows in air-conditioned rooms as this will counter act the air-
conditioning.
Report any air-conditioning faults to Estates and Facilities Services.
Use fans if available.
If it is consider necessary for a site / room to have a fan. Services must order approved
fans via Procurement. NOTE: The supply of a fan will not be instant, so sites need to
identify where they had problems during previous hot weather and consider ordering a
fan in time for summer, or when a hot weather is forecast.
If it is consider necessary for a site / room to have a free standing air conditioning unit.
Services must order approved air conditioning units via UHL Customer Services.
NOTE: The supply of an air conditioning unit will not be instant, so sites need to identify
where they had problems during previous hot weather and consider ordering an air
conditioning unit in time for summer, or when a hot weather is forecast.
If it is considered that permanent air-conditioning is needed, an order must be made
with Estates and Facilities Services who will provide a quote for supply and installation.
Staff
Keep taking in fluids (water and juices rather than coffee and tea).
Try and eat salads and food with a high liquid content.
Try and minimise physical exertion as is practicable.
Managers are to allow staff to take breaks from particularly warm rooms – especially if
cooler or air – conditioned rooms are available.
Managers are to make sure cold water is available for staff and patients.
Managers to consider relaxing dress code to allow staff to wear lighter clothes where
this does not contravene clinical / infection control requirements.
Managers to be mindful of staff who may be more vulnerable during hot weather due to
medication, pregnant, chronic health condition.
9
8 - FORECASTING HEATWAVES - MET OFFICE HEAT HEALTH WATCH SYSTEM
Linked to the Public Health England Heatwave Plan is the Met Office’s Heat Health Watch
Alert System which operates from the 1st June until the 15th September. This system aims
to provide the public and health and social care organisations with advance warning of hot
temperatures.
Weather Forecasts / Heatwave Alerts are available from the Met Office on:-
Website: http://www.metoffice.gov.uk/
Twitter @metoffice
As with severe winter weather, in the event that the Heatwave Alert Levels are escalated
the Met Office would use all media routes to inform the public.
MET OFFICE HEAT HEALTH WATCH ALERT LEVELS
10
9 - RESPONDING TO HEAT HEALTH WATCH ALERTS: ACTIONS FOR MANAGERS & STAFF
In the event that the Met Office forecasts Hot Weather or a Heatwave and escalates the
Heatwave Alert Levels from 1 through to 4, the alerts are automatically forwarded to LPT
directors and all managers on LPT’s On-Call rotas, for consideration and if necessary
action.
HEATWAVE: KEY ACTIONS FOR HEALTHCARE PROFESSIONAL
Level 1 Heatwave and Summer Preparedness 1 June – 15 September
Community Services
Understand those patient groups who are at risk during hot weather.
Identify high-risk individuals on your caseload and raise awareness of heat illnesses and their
prevention among patients, service users and their carers.
Raise awareness of patients to the potential dangers to health during hot weather.
Include risk in care records and consider whether changes might be necessary to care plans
in the event of a heatwave (e.g. initiating daily visits by formal or informal care givers for those
living alone).
In-Patient Facilities
Identify or create cool rooms/areas (able to be maintained below 26°C).
Install thermometers where vulnerable individuals spend substantial time.
Level 2 – Heatwave is forecast – 60 per cent risk of heatwave in 2-3 days
Community Services
Check high-risk people have visitor/phone call arrangements in place.
Reaffirm key messages to patients, service users and carers to the potential dangers to health
during hot weather.
In-Patient Facilities
Communicate alerts to staff and make sure that they are aware of the need to ensure patients
are kept cool.
Review and prioritise high-risk people.
11
Monitor patients for any indications that they are being affected by the heat.
Check indoor temperatures are recorded regularly during the hottest periods for all areas
where patients reside.
Keep windows shaded on the sunny side of the building.
Ensure a cool area is available as respite for patients and staff (should be below 26°C).
Ensure there is sufficient access to cold water / ice to prevent dehydration.
Consider weighing clients regularly to identify dehydration and rescheduling physio to cooler
hours.
If fans are used make sure they do not present a risk to patients or staff. Note: Need to ensure
patients are taking sufficient fluids to prevent dehydration that might be caused by the air
movement.
Level 3 – Heatwave Action – temperature reached in one or more Met Office National Severe Weather Warning Service regions
As Level 2 Plus:
Community Services
Visit/phone high-risk people.
Reaffirm key messages to patients, service users and carers to the potential dangers to health
during hot weather.
Advise carers to contact GP if concerns re health.
In-Patient Facilities
Managers to ensure sufficient staff available to support vulnerable patients.
Check indoor temperatures are recorded regularly during the hottest periods for all areas
where patients reside.
Ensure staff can help and advise clients including access to cool rooms, close monitoring of
vulnerable individuals, reducing internal temperatures through shading, turning off
unnecessary lights/equipment, cooling building at night, ensuring discharge planning for at risk
patient takes the hot weather into account.
12
Level 4 – Major incident – Emergency response
Central Government will declare a Level 4 alert in the event of severe or prolonged heatwave affecting sectors other than health and if requiring coordinated multi-agency response
LPT ACTIONS:-
Continue actions as per Level 3 unless advised to the contrary. During extreme conditions,
it is not only high-risk groups that may be at risk. Therefore, further risk appraisals should
be made of patients and service users.
LPT to co-ordinate response to any increase in demand on the health community with
health and social care partners under the Leicester, Leicestershire and Rutland Capacity
and Demand Management Plan
Senior Managers / On-Call Managers / On-Call Directors to determine whether there is a
need for holding incident teams to consider adoption of special measures to support
vulnerable patients.
As requested provide Situation reports to CCGs and / or NHS England on the impact of the
heatwave on patient care.
13
APPENDIX 1 - RAMADAN – ADVICE OF FASTING DURING HOT WEATHER
Ramadan, the Muslim month of fasting, is expected to occur from 06 June to 08 July 2016
(subject to the Islamic lunar calendar). During Ramadan, members of the Muslim
community may fast during daylight hours.
For Muslims, Ramadan is the most virtuous month of the year and one fast maintained
during this month far outweighs consecutive fasting in any other month. Because of this,
there is a strong motivation to fast in Ramadan, even if unwell, and breaking the fast can
lead to great remorse.
Islamic teachings are very clear in pardoning those who are unwell from fasting. However
we know from experience that patients are often very reluctant to accept this from ‘non-
religious authority’ and will attempt to fast, putting their health at risk.
Our spiritual and pastoral care team advises that, while we should make every effort to
support patients who are able and willing to fast during Ramadan, where there are
concerns it is paramount our Muslim chaplain – Fazlur Diwan - is involved in any
discussions about either allowing a patient to fast, or offering them the option not to fast.
He is available to any LPT staff to provide guidance, information and to offer support to
your patients/service users during Ramadan. You can contact him via the service on 0116
295 7569 or 07795 332 742.
Fasting and health during a heatwave: In hot weather dehydration can pose a serious
and common risk, and it is important to balance food and fluid intake between fasts, and
especially to drink enough water.
If someone starts to feel unwell, disoriented or confused, or collapses or faints, the advice
is to stop fasting and have a drink of water or other fluid. This is especially important for
older adults, those with poorly controlled medical conditions such as low or high blood
pressure, diabetes and those who are receiving dialysis. The Muslim Council of Britain has
confirmed that breaking fast in such conditions is allowable under Islamic law.
It is also important to check on others in the community who might be at greater risk and
14
keep an eye on children to ensure they are having a safe and healthy Ramadan.
Guidance has been produced to help ensure members of the Muslim community have a
safe and healthy Ramadan:
http://www.ramadan.co.uk/RamadhanHealth_Guide.pdf
NHS Choices – Healthy Ramadan:
http://www.nhs.uk/livewell/healthyramadan/Pages/healthyramadanhome.aspx
Muslim Council of Britain:
http://www.mcb.org.uk/ramadan/healthadvice.html
APPENDIX 2 - FURTHER INFORMATION
Public Health England: Heatwave Plan for England 2015/16
Public Health England: Heatwave Plan for England – Advice for Health and Social
Care Professionals
Public Health England: Heatwave Plan for England – Advice for Managers and Staff.
NHS Choices: www.nhs.uk/summerhealth
Met Office: www.metoffiice.gov.uk