Extreme heat and smoke guidance for those supporting unhoused community members

• Complete a heat action plan.
  • Recommended actions can be found through the BC Heat Alert and Response System (BC HARS).
  • Extreme heat and wildfire smoke plan templates for non-profit housing providers are available through BC Housing and can be adapted to support our unhoused neighbours.
  • Fraser Health can provide feedback (healthybuiltenvironment@fraserhealth.ca).
• Connect to your local government to participate in their heat planning tables, where possible. Local governments may be able to partner with community organizations or share funding from provincial grants.
• If you provide housing or can provide temporary shelter, explore which guidance/ tools from BC Housing could support your staff and clients.
• Ensure that all volunteers and staff are aware of who is most at risk, symptoms of heat stress or stroke, what to do and how to communicate with clients. See Fraser Health’s heat page for more information.
  • Attend or watch seasonal preparedness webinars from Fraser Health and Vancouver Coastal Health for urban or rural communities (2024).
• Remind clients how to stay cool during hot weather.
• Print several copies of Health Canada’s Heat Health posters / Fraser Health posters and display them in communal areas or places in the community where your clients may see them.
• Share resources for those who may use substances or have mental health challenges or support those who use substances on how to use safely.

Guidance for service providers

• Prepare for Extreme Heat Events - Health and Service Providers.
• Prepare for an Extreme Heat Event: A Guide for People Who Use Substances.
• Prepare For Extreme Heat: A Guide for People Living with Schizophrenia.
• Prepare an Extreme Heat Kit.
• Stay Safe During Extreme Heat Events.
• Using Substances During Extreme Heat.
• Supporting People Living With Schizophrenia During Extreme Heat.
• Getting Prescriptions and Carries During Extreme Weather.
  • Be aware that clients on certain medications, including some for mental health, such as antidepressants or antipsychotics, may be at increased risk. Some medications can cause decreased sweating/ cooling, increased dehydration risk and decreased ability to sense overheating.
  • Medications and Heat (poster, PDF 451KB).
  • Medicines that Increase the Chance for a Heat-Related Illness.

Be prepared to monitor extreme weather using the following:

• Download the Weathercan App.
• Metro Vancouver Air Quality Maps.
• Sign up for Metro Vancouver email air quality alerts.

If possible, investigate grants that may help clients access cell phones for communication and weather alerts.

Extreme heat events are announced by Environment and Climate Change Canada and health authorities at temperatures that are associated with increased deaths and hospitalizations.

• Heat warnings are associated with a 5 per cent increase in heat-related deaths.
• Extreme heat emergencies are associated with a 20 per cent increase in heat-related deaths.

These are announced through the media or the WeatherCAN app. Organizations can sign up for early warnings through ECCC (meteopac@ec.gc.ca).

Though all events are dangerous to those who are vulnerable, heat events at the start of the summer (May-June) are more dangerous than those near the end (August) once people are acclimatized.

Organizational actions during a heat event:

If there is capacity, check-in on vulnerable clients/community members when temperatures start to climb, remembering that indoor temperatures are more dangerous than outdoor.

• The risk for heat-related illness may increase at indoor temperatures over 26°C (78°F) and may significantly increase at indoor temperatures over 31°C (88°F), especially for people at higher risk to heat.

The following resources may be useful:

• Heat Check-in Support Framework for Non-governmental Organizations (Fraser Health/VCH).
  • Training video: Developing a Check-in System.
  • Training video: Extreme Heat Check-in Training (VCH).
• Guide for in-person or remote Extreme Heat Check-ins (National Collaborating Centre for Environmental Health check-in guide).
  • Translated content: English, French, Chinese - simplified, Chinese - traditional and Punjabi (Black and white version is available).
• If your organization does not have capacity but is connected to seniors in the lower mainland who are not comfortable in English and who could benefit from a check-in, there may be an opportunity to refer them to MOSAIC BC.
• If your community does not have access to water, be aware of outdoor resources, such as water fountains which can be found at TapMap (metrovancouver.org).
• If possible, create a cooling room/cooling spaces for clients to socialize and cool off. This may require the installation of a (portable) air conditioning unit, or modifications to infrastructure that would ensure the room temperature is lower than other indoor spaces. It can take many hours for clients to return to normal body temperature after heat stress, so the longer cooling rooms are open, the better. BC Housing may be able to assist with funding.
• Make and share a list of places in the neighbourhood (with air conditioning or shade) that can be used as cooling shelters where clients can go to cool off. This may include community centres and libraries, shopping malls, etc. Depending on your municipality, cooling centres may be posted on a website, Government of BC portal or social media. If these are far from where clients live, provide transportation passes where possible.
• Locations of cooling shelters operated by non-governmental organizations may be found at BC211. This resource also provides information about accessibility and pet-friendly shelters.
• If possible, during extreme heat alerts, open an extreme weather shelter for sleeping in a temperature-controlled facility, as occurs for extreme cold.

• It can take time to dissipate body heat and recover.
  • Once overheated, it can take many hours for a person to cool their body fully after coming to a cool space.
  • If they leave the cool space, body temperature can return to dangerous highs very quickly.
  • People can absorb a lot of heat in walking or taking transit to a cooling centre.
• If overnight temperatures are warm:
  • Heat may build indoors over time.
  • Health effects are worse because there is limited recuperation from the day’s heat.
• For these reasons, outreach strategies and cooling strategies near where people already are can be very important, along with providing resources for longer hours or overnight.

From 2020 BC Centre for Disease Control Guidance:

*Be aware that indoor cooling spaces are preferred to make a difference for the health and safety of clients; however, outdoor cooling and misting tents may increase comfort for clients and staff.

• Provide 100 per cent shade within its designated boundaries.
• Cooling:
  • Passive measures (natural breezes): Promoting air circulation using passive measures will increase the cooling abilities of an outdoor space. If setting up a cooling space in an urban environment, consider choosing locations where natural breezes occur to promote air circulation.
  • Active measures (fans and evaporative coolers): Setting up fans in outside cooling spaces to increase airflow may make cooling more effective for visitors; however, at or above 35°C, fans may worsen heat-related illness. Evaporative coolers are a good option for outdoor cooling centers in urban spaces because they cool the air. They cost between $100-$500.
  • Misting tents with good ventilation are also an option to make people more comfortable; however, it is not clear the degree to which they reduce heat-related illness mobility and accessibility:
    • Have wheelchair accessible locations for cooling spaces.
    • Have communications material offered in different languages in outdoors and outdoor cooling spaces for community members, which may include:
      • Fraser Health Extreme Heat poster (multiple languages).
      • Staying healthy in heat fact sheets.
      • Please see the Fraser Health webpage for further printable materials.
• Have designated areas for individuals to sit with pets.
• Require that all dogs must be on a leash while within the outdoor cooling center.
• Consider providing a water bowl for dogs to cool off as well.
• Working with partners:
  • o Where possible let bylaw officers and first responders in your municipality know that you are opening a cooling space, so they can direct people to the space.

Further information on creating outdoor cooling spaces can be found here.

Wildfire smoke is becoming more common in our communities. Breathing in smoke can affect health, especially among those most vulnerable. People most vulnerable to the health impacts of smoke include those with pre-existing lung and heart conditions, diabetes, pregnant people, older populations, children, as well as those with higher exposures, such as clients who may spend whole or large portions of their day outdoors.

Some ways to support clients are:

• Post this wildfire smoke poster in places where staff and clients may see it. It summarizes the health risks and some actions that can be taken to reduce smoke exposure.
• If your clients are experiencing symptoms, help them to spend time in indoor spaces with cleaner air, and if needed, to seek medical care.
• Check the Air Quality Health Index (AQHI). It provides air quality ratings for communities and can help you know when your clients may be most affected by poor air quality.
• Support people to spend time in indoor spaces that provide some relief from smoke. We recommend that people spend time in large, air-conditioned spaces because these spaces tend to also have filtered air. They also need to be spaces where clients feel welcome and comfortable.
• Masks to protect against smoke are only advised in specific situations, such as for people who work outdoors and have access to well-fitting high efficiency masks. See this factsheet from the BC Centre for Disease Control to learn more and help you decide if they may be appropriate and helpful for some of your clients.

• Extreme temperatures correlate to increases in mental health related emergency department visits, globally and in the Fraser Health region.
• Additionally, as extremely hot weather can provoke suicidal thoughts in some people, alert clients, volunteers and staff to check on those who might be at risk.
• Where possible, clients who may experience or be at risk of suicidal ideation can be referred to Fraser Health Mental Health supports for the co-creation of care plans.
• If someone is experiencing a mental health emergency that is not life threatening please call:
  • Crisis Line for Adults: 604-951-8855 or toll-free 1-877-820-7444.
  • Aboriginal Health Culturally Sensitive Services: 1-800-KUU-US17 (1-800-588-8717) or Métis Crisis Line: 1-833-638-4722.
• More resources on suicide and self harm can be found here.