Heatstroke and Harm: Protecting Vulnerable Populations from Summer Heat

As the summer heat intensifies across New York State, so do the heightened risks of heat-related dangers, especially for individuals receiving services.  

In this episode, we sit down with two staff members from the Justice Center – Tracey Sosa, Assistant Director of Prevention and Quality Improvement at the agency, and Tabitha Purcell, a Quality of Care Facility Review Specialist and a Registered Nurse – to tackle the significant risk of heat illness among vulnerable populations.

Our conversation emphasizes the importance of staff training on sun safety policies, maintaining proper supervision, and recognizing the early signs of heat-related illness. We'll explore how distractions can lead to missed checks and the vital need for staff to act quickly and appropriately when an individual shows signs of distress.

We'll also put our guests to the test at the end of our program, using a real-case scenario as a training exercise. 

Transcript

Erin Hogan (00:08):

Hello, and welcome to the “Could This Happen in Your Program?” podcast, where we find collaborative solutions for protecting New York's most vulnerable populations. Today's episode comes to you just in time for some of the hottest days of the year, and as the summer heat intensifies across New York State, so do the heightened risks of heat-related dangers, especially for individuals receiving services.

In this episode, we sit down with two staff members from the Justice Center: Tracey Sosa, Assistant Director of Prevention and Quality Improvement at the agency, and Tabitha Purcell, a Quality of Care Review Specialist and a Registered Nurse.

Our conversation emphasizes the importance of training on sun safety policies, maintaining proper supervision, and recognizing the early signs of heat-related illness. We'll also put our guests to the test at the end of our program using a real case scenario as a training exercise. Let's get going.

Okay. Well, welcome, Tabitha and Tracey. Thanks so much for joining us today.

Can we start with you just sharing a little bit about your roles with the Justice Center? Tracey, do you want to start?

Tracey Sosa (01:10):

Sure. Thanks. So excited to be here. Yeah. So, a little bit about me. I've worked with people with intellectual and developmental disabilities for about 20 years, largely in residential settings. I have a military spouse, so I've worked in service systems in California, North Carolina, Virginia, New York, and Alaska.

Erin Hogan (01:28):

Wow.

Tracey Sosa (01:29):

So that's exciting. I also have an older brother with intellectual and developmental disabilities who lives with me, so I'm also a caregiver, so I have both professional and personal experience. Here, at the Justice Center, I'm the Assistant Director of the Prevention and Quality Improvement Unit, and our unit makes recommendations to provider agencies to help mitigate incidents of abuse and neglect. So, we look at corrective actions that are implemented after incidents of abuse or neglect to see if they're sufficient to hopefully prevent an incident from happening again. We develop prevention materials for provider agencies to use to help mitigate incidents of abuse or neglect, and we also conduct site visits to ensure quality of care for people receiving services.

Erin Hogan (02:08):

Yes, we interact quite a bit with PQI in my world.  And Tabitha, can you give us a little bit about your background?

Tabitha Purcell (02:18):

So my background is nursing. Prior to coming here 10 years ago, I've done over 10 years residential treatment facility. I was a nurse there, a day treatment, like a school nurse. I have correctional, I have other various specialties, neurology and cardiology. And then upon coming here, I am a RN field investigator. So I conduct thorough and comprehensive investigations of abuse, neglect in all of our SOAs. And in addition to being an investigator, I am a nurse, so I also get a lot of more medically complex cases, a lot of mortality cases.

In addition, I do RN consults. I also have to—not have to, excuse me—I am asked to testify at hearings for other cases. That may not be my own, just to lend that medical component to it. But thank you for having me today.

Erin Hogan (03:23):

Yeah, thank you so much for joining. So I just want to pause a little bit and talk a little bit about the RN position here at the Justice Center. So I think for many of our listeners, I don't think most folks know we have registered nurses on staff. Can you just expand on what you just shared and what is the role of the RN at the Justice Center? Sure.

Tabitha Purcell (03:42):

So a lot of times when cases come in and they see that there is a lot of medical components to it, it seems very complex, a lot of whatever the case may be, typically I will be assigned to that case just so that I can go through it and, at least, I have that background and that knowledge to know what are the expectations of staff, what are the expectations of nursing, what should they be doing, and what did they not do? Or even just recommendations, too. At the end, you get through your investigation, you're like, “Ooh, we're missing a pons for this”, or maybe they need a little more training from the nurse on this subject, and just kind of things like that.

Erin Hogan (04:26):

Excellent. Well, you are both tailor-made for our topic today, which is heat, and we're right in the middle of summer, so it's a perfect time to be talking about this. Why are individuals served by programs under our jurisdiction, particularly vulnerable to the dangers of heat? And so I'll let either of you kind of jump in and talk through some of those dangers if you want to start.

Tracey Sosa (04:50):

Sure. The first thing that comes to mind is maybe some limited verbal skills, either not having verbal skills at all, or maybe lacking the language to be able to say, “I'm hot, I'm uncomfortable.” So just not really being able to articulate that in the same way that we're able to say, “I'm hot, I want to go indoors.” And then I think, physically too, many people may physically rely on staff to either move them inside when it's in the heat of the day and they're starting to really feel the effects of heat. Maybe they rely on staff to help apply sunscreen or make sure that they're wearing lightweight clothing. Those were two of the things that I was thinking of.

Tabitha Purcell (05:31):

Yeah, I think in addition, we also, a lot of the individuals that we serve, they have a lot of complex medical conditions, and with that being said, they're also on a lot of medications that also places them at an increased risk for sun sensitivity. So that in addition, too.

Tracey Sosa (05:50):

And I think we also have polar extremes in some of the population we're serving, right? In some settings, we're dealing with children, they don't recognize that it's 95 degrees, so we shouldn't be running around.

Erin Hogan (06:03):

My kids certainly don't.

Tracey Sosa (06:05):

And then we also have an aging population too, that they just experience heat differently. So we have to be sensitive to those age ranges as well.

Erin Hogan (06:14):

Sure. Well, we know that to your point, every provider probably has different policies around sun safety, and we know that supervision specifically is important. What are some of the most critical or practical things that all staff need to know to keep individuals in their care safe from the heat?

Tabitha Purcell (06:38):

I say monitoring, just that constant observation and monitoring, and just having, because as a staff member, you're ultimately responsible for that individual's safety. So I think it really just comes back to that eyes on and just being aware that you are the one that's responsible for them.

Tracey Sosa (07:00):

And I completely agree. And it's like know your folks, right? So know those plans of care, know what their typical baseline is, what they look like on a good day. So if you start to see something different and how they're behaving or how they're looking to be attuned to, maybe they're starting to feel some effects of that heat or that sun.

Erin Hogan (07:19):

Well, I want to get back to that point, and Tabitha, I'll start with you on this question from your nursing background. When it comes to heat illness, what are the subtle early signs that someone, maybe it's a new person in your program, what are some of those subtle signs that we may not notice as a lay person, not a nurse?

Tabitha Purcell (07:40):

I guess first off would be the increase in sweating. If you see that all of a sudden, they're perspiring more than maybe they should. But to piggyback off of what you said, knowing their baseline too, if you start to see changes, like if they're restless, if they seem agitated, but really with heat exhaustion or any of those heat-related illnesses, it's the increase in sweating, the cool, clammy, pale skin. You might not necessarily be taking their vital signs, but a faster heart rate if they seem just agitated. Those would be some of the more key ones. That, of course, as things progress, it can also lead to the nausea, the vomiting, headache, weakness, confusion, but, really, just if you start to see a change in their baseline and you're outside, maybe just take them to a cooler area, shade, things along those lines.

Erin Hogan (08:36):

Well, that was going to be my next question. If you do so, you've decided someone's in distress, what would be the immediate next step if you determine it's an emergent type situation?

Tabitha Purcell (08:46):

First off, is get them out of the sun. And if you can get them into an air-conditioned area, but depending on the severity of the symptoms that they're exhibiting, call 9 1 1. When in doubt, always just call 9 1 1, but first, and in that process, just make sure that you're loosening any clothing that they have on. If they're not vomiting, offer some sips of water, just cool, moist cloths that kind of apply around their neck, just wherever you can on their body, just to start lowering that body temperature down right away.

Erin Hogan (09:20):

And I would imagine this time of year specifically, there are a lot of outings happening. Nicer weather, at least in New York, is upon us, hotter but nicer. So that probably becomes, when you're not at a spot right away where you can bring someone into cooler air, maybe it's under a pavilion or just shade, anything you can do back in a van with the air conditioning. Yeah, sure, sure. Anything that you would add, Tracey, to that?

Tracey Sosa (09:51):

No, I think, I mean, as far as what to do, and we have the Spotlight on Prevention toolkit, right, for Responding to Medical Emergencies, and the tagline, “Don't delay. Call right away.” When in doubt, don’t take a chance.

Erin Hogan (10:06):

And I love that you said that. We'll link that up for you. We'll link that Spotlight up, but all our Spotlights are great materials. We'll link that one as well as some of our materials on heat safety in the links on this podcast. Okay. Thank you so much. We're going to take a quick break, and we're going to come back and talk about a case study. We're going to see if we'll quiz you on some steps. Thank.

(10:52):

Okay, so welcome back. We're going to get into our, Could This Happen In Your Program toolkit case study. So for those of you just listening in, this is your first episode on this podcast. We take fictitious case scenarios and break them down to use as a training mechanism for programs that we serve. These exist in all of our toolkits. They are written out in narrative form, which I'll read for you in a moment. They're very, very helpful. It's a great training tool.

We had Davin Robinson on our last podcast on our first one, and she talked about just pulling it out, using it at a program meeting. And I think that's a great idea, but we also want to cater to people who like listening to podcasts or maybe want to watch something really briefly on their way to work or show it to their staff in a meeting, as well.

(11:39):

So I'm going to go ahead and read the narrative. It's related to heat illness, just like we've been talking about. And then once I am done with the narrative, we'll quiz you. We'll see how you do.

Case Narrative:

On a hot summer day in July, Sam, a direct support professional, was working alone at the residence while they supervised and supported Dean. Dean uses a wheelchair but is unable to propel themselves, is nonverbal, and uses hand gestures to communicate their needs. Dean indicated they wanted to go outside and sit on the porch. Dean requires periodic checks every 15 minutes. Sam brought Dean out to the porch and positioned them in partial shade. The agency had policies and protocols regarding sun safety that required the staff to apply sunscreen to people, ensure they are in lightweight clothing, and are not left in direct sunlight for prolonged periods of time.

Training records indicated that Sam had not completed the training on these policies and protocols. Sam continued to complete household chores while Dean sat on the porch, and Sam received a call from the residential manager, which they took in the front office. Fifteen minutes later, Sam ended the call with the residential manager and went on to complete the remainder of the household chores. Dean had been outside alone on the porch for approximately 40 minutes. By the time Sam checked on them. Sam found Dean now sitting in direct sunlight with the sun on their face and their arms reddened. Sam brought Dean inside and laid them onto the bed to cool off as he went on to begin meal preparations. Twenty minutes later, staff arriving for their evening shift found Dean drenched in sweat with labored breathing and dry lips. The evening staff called the nurse and was told to bring Dean immediately to the emergency room for evaluation. At the emergency room, doctors determined Dean was suffering from heat exhaustion, dehydration, and a sunburn.

Alright, so lots going on in this case. Some of them are obvious, some of them might be more subtle. So can we talk a little bit about some of the concerns you would point out in this specific scenario?

Tracey Sosa (13:40):

Yeah. At first, I would give the agency kudos for having a policy about what to do for summer safety. But if staff aren't trained on it, it's just a piece of paper. And in this case, I think probably the first breakdown is that the staff wasn't trained on what to do, so they didn't know the protocols for applying sunscreen, not leaving folks in the direct sun, et cetera.

Tabitha Purcell (14:05):

And for me, right off the bat, the lack of supervision. I mean, regardless, you bring somebody out outside who is non-ambulatory and do not check on them for the 40 minutes that lapsed, in addition to once you did discover that this individual had the red skin, it didn't appear well, you didn't notify nursing. That should have been the first call you made, even though you made a mistake. But it's better to just get in front of it, and it's the individual's well-being. It's the priority there.

Erin Hogan (14:40):

And I think what's interesting about this case, I think sometimes a lot of people believe that it's just pure negligence when something like this happened. But, the DSP in this case was going to prepare meals. So I think the argument there could be, “well, I was still working. I was still doing my job when this happened. It's not like I was slacking off and I left my post,” or something along that line. What would you say? How often does that kind of come up where it's just really an accident, and it's unfortunate that they weren't trained on what to do, but

Tracey Sosa (15:13):

A hundred percent, it happens. Right. And to your point, they didn't go out of their way to make sure that someone was burned that day.

Erin Hogan (15:22):

Exactly.

Tracey Sosa (15:24):

And that's where you look at, I mean, what the Justice Center has in terms of category four findings against agencies, because they understand that maybe the inaction of an agency mitigated staff culpability. So not training your staff, right? Mitigates having one person on shift who has to supervise people, do meal prep, master medications, and do other things, but also maybe mitigate some culpability.

Tabitha Purcell (15:49):

Really good point. We definitely come across that very frequently, too.

Erin Hogan (15:55):

Yeah. Well, what would you say in this, if someone or a program were faced with this exact scenario, what would you suggest they do differently?

Tabitha Purcell (16:05):

I think for me, personally, I think, it really always comes back to education. Educating your staff and training them. Policies, they’re great on paper, but I think it's really vital for a nurse or a staff member who feels confident and really just explaining what these risks are that can happen by leaving an individual out unsupervised for 40 minutes in the sunlight, and what could have happened, what the risks really were and how serious they really could have been. So it always really, for me, comes back to that education and the training and doing a refresher at the beginning of the summer, just go to a staff meeting. If you're covering A, B, and C houses, go to their staff meetings. Just touch base with all of them and go over the key important things that they need to remember for sun safety.

Tracey Sosa (16:59):

For a lot of folks that are working in the field, maybe this is their first job in the field, maybe they're not aware about the psychotropic medications and how that makes you more sensitive to sunlight or people's maybe hypersensitivity to sun or under sensitivity depending on sensory processing and different things they might have going on. So to your point, there are a lot of really well-intended people working in the field, but they do need the education. I agree. That's so critical to just make sure they really understand the why. Exactly. Right. It's not just “here, read this paper and sign it.” There's a “why” to it, and help them understand how important that is

Tabitha Purcell (17:39):

And making sure they're confident too. At the end when you go through it, make sure if anybody asks questions, no question is stupid or dumb, just making sure that they are confident with that knowledge they received, and they can go ahead and be a better direct support professional or a better staff at the end of the day and provide the best care that they can to the individuals,

Tracey Sosa (18:03):

Which I think you could argue most people want to do. They come to work every day because they want to do a good job, they want to help people. They just need the tools and the resources to be able to do it.

Erin Hogan (18:12):

Set up for success.

Tracey Sosa (18:13):

Exactly.

Erin Hogan (18:14):

Agreed. Well, are there any other final comments on this case or anything on sun or heat safety?

Tabitha Purcell (18:22):

I think a couple of just little tips too, if it's really hot out, plan your activities in the morning or later in the evening. Don't go out in the hottest part of the day. And if it's too hot, then don't go outside. Just kind of common sense, what would you do? And just try to always stay in the shade, and just make sure hydration is so key. Just lots of water, not soda, not caffeinated, but just making sure that everybody's, the individuals are well hydrated, and they're wearing loose kind of comfortable clothing. And back to the sunscreen and hats, or just whatever else you can do to provide that extra layer of safety for them.

Tracey Sosa (19:10):

And to the extent that you can, with activities, also go someplace that's air-conditioned. Yeah, it's a great time to choose to see a movie, try to go to the mall, maybe to do some shopping. Not every place has air conditioning. Not every home has air conditioning. We have a lot of people who may live in more independent settings that may not have air conditioning, that maybe only have periodic checks. But if you can go out and use the public’s air conditioning, go to the library, it's a great way to cool down.

Tracey Sosa (19:42):

I agree.

Erin Hogan (19:43):

Excellent. Well, thank you so much, Tabitha and Tracey, for your time. I really appreciate talking to you and learning a little bit more about what you do here, and your advice on this case and this topic.

Just a reminder for our listeners that you can find all this great information in our, “Could This Happen in Your Program” toolkit, and we'll link up a bunch of relevant information tools, downloads. You'll be inundated with information by the end of you clicking through all the links. But thank you so much for joining us, and thank you again. Thank you.