Staying Safe During a Heatwave

Tips for People with Down Syndrome and Their Caregivers

By Hina Mahmood, MOT and Glen Hoos

In June 2021, a historic heatwave struck the Pacific Northwest from British Columbia to Oregon. With temperatures soaring as high as 49.6C in Lytton, BC, the record heat event resulted in 619 deaths in Canada,[i] with hundreds more in the United States.

Although there is no official record as to what percentage of these people had disabilities (“They don’t usually mark down people with disabilities,” notes Alex Ghenis, founder of Accessible Climate Strategies),[ii] it is well established that those with disabilities have greater vulnerability during major climate events such as storms, floods, and heatwaves.[iii] With climate change making such events more frequent and more extreme with each passing year, the risk is continually escalating.

For loved ones and caregivers of people with disabilities such as Down syndrome, it is critical that we be prepared with the knowledge and resources to support them through these increasingly common occurrences. We also must arm these individuals with this information if there is a chance they will be on their own when the event strikes, so they can care for themselves as needed.

Heatwaves can be especially difficult for people with Down syndrome. Temperature regulation can be a challenge. Research indicates that at rest, the skin surface temperature for people with Down syndrome is often lower than for those without Down syndrome. Moreover, after physical exertion, their surface body temperature can actually decrease in comparison to their temperature before exercising.

This indicates that their bodies do not shift blood to the skin surface efficiently enough to cool them down, which can result in overheating. Many individuals with Down syndrome also sweat less than others, which can make the summer season more difficult – particularly during extreme heatwaves.

The Advocate Medical Group also brings attention to the higher frequency of underactive thyroid (hypothyroidism) and overactive thyroid (hyperthyroidism) in people with Down syndrome. When these conditions are not treated, the body temperature may be lower (hypothyroidism) or higher (hyperthyroidism).

Finally, for people with Down syndrome, temperature regulation can also be impacted by a weakened interoceptive system. Interoception is one of the eight senses that provide information on how the body’s internal state is operating, including hunger, thirst, pain, bowel/bladder fullness, and temperature.

As summer temperatures rise, here are some preventative strategies for avoiding overheating.

Preventative Strategies

  • Stay hydrated
    • Encourage fluids before, during, and after outdoor activities, regardless of activity level
    • Enforce frequent drink breaks, preferably in the shade
    • Put ice cubes in your drink
    • Sneak in fluids by offering foods that have a high liquid content such as fresh fruit, popsicles, jello, yogurt, and fruit sauces
    • Note: if the individual has a difficult time accepting fluids, speak to their health professional or occupational therapist for strategies on increasing water intake
  • Use appropriately rated sunscreen
    • Apply sunblock 30-minutes prior to going outside, then reapply according to the label directions – even if it is an all-day, waterproof formula
    • If a person’s skin is pink and warm and doesn’t return to its normal colour and temperature with rest and cooling, then he or she is sunburned
  • Take frequent cooling breaks
    • Limit outdoor activities between 10 am and 4 pm, when the sun is at its most intense
    • Remember: playing in the water is not the same as drinking water
      • Water reflects UV rays, even on cloudy days; as a result, sunburn happens more quickly in and near the water
      • Wet clothes are less effective than dry clothes at blocking UV rays
  • Cool down indoors
    • Use air conditioning and/or fans if possible
    • If you don’t have air conditioning, open the windows when the temperature is cooler outdoors than indoors (in the night); close the windows when the temperature is warmer outside than inside
    • Close the blinds during the day, or better yet, black out your windows with a dark sheet or blanket
    • Cool yourself with cold or room temperature water: spritz yourself, wipe down with a cool cloth, douse your head in cold water, or take a cold shower
  • Tips for sleeping in the heat
    • Use a breathable cotton sheet
    • Set up a fan near your bed
    • Spray your sheet with cold water
    • Store your pillowcase or sheet in the freezer during the day (inside a plastic bag)
    • Take a cold shower or bath immediately before getting into bed
    • Drink water before bed, and during the night
  • Understand the individual’s medications and treatments
    • A medication can contribute to dehydration if:
      • It increases metabolism
      • It decreases appetite or upsets the stomach
      • It increases urination (a diuretic)
    • A medication can contribute to overheating if:
      • It decreases sweating
      • It increases metabolism

Sometimes, despite our best attempts at prevention, we cannot escape the heat, which can lead to either heat exhaustion or heat stroke. Below are the signs and symptoms to watch for.

Signs and Symptoms of Heat Exhaustion:

  • Heavy sweating or moist and cool skin
  • Paleness
  • Heat cramps
  • Tiredness or weakness
  • Headache/dizziness
  • Nausea or vomiting
  • Fast, weak pulse
  • Fainting
  • Rapid, shallow breathing

Signs and Symptoms of Heat Stroke:

  • High body temperature (103F or higher)
  • Hot, red, dry, or damp skin
  • Fast, strong pulse
  • Headache/dizziness
  • Nausea
  • Confusion
  • Loss of coordination
  • Fainting

If you suspect your loved one is experiencing either heat exhaustion or heat stroke, prompt action is required. Below are recommendations for cooling down as quickly as possible.

Treatments for Overheating:

  • Sip water
  • Move to a shady, cooler location
  • Loosen clothing
  • Spray body with cold water, take a cool bath, put cool, wet cloths on body, or rub ice on body
  • Seek medical assistance if the individual doesn’t cool down quickly, if there is vomiting, or if symptoms persist for more than an hour

Extreme heat is here to stay, unfortunately. As a uniquely vulnerable population, it is essential that people with Down syndrome and other disabilities be included in the development of climate change policies and emergency planning. While we work towards big picture solutions, we must take steps at the individual level to ensure that our loved ones are safe. Stay cool!

Stay Cool: Tips for Facing a Heatwave (PSA by DSRF’s Speaking Out: Advocacy + Climate class)

Source for some of the tips above: “How to Stay Cool and Safe in a Heat Wave,” by Dani Blum. New York Times, June 30, 2021.