Summer heat in Phoenix can be deadly. Last year, 645 people died of heat related causes in Maricopa County. Nearly half of those deaths were among the unhoused population. A street medicine team is trying a new intervention they hope will reduce the death toll.
On a hot Thursday morning at the Burnidge Soup Kitchen in northwest Phoenix, it’s already 99 degrees.
Nurse Practitioner Perla Puebla is under a pop-up canopy, carefully scanning a patient’s hand for a vein.
“Let’s see ... double tourniquet, all right? It’s gonna be tight,” she said.
Puebla is with Circle the City, a nonprofit that provides mobile healthcare to the city’s homeless population.
“Let me clean, and then we’re gonna try this.”
The patient is so dehydrated, he’s barely able to stay upright. People in this condition can actually become unable to drink water or keep it down. So Puebla wants to give him fluids intravenously.
“You gotta stay awake,” she said.
“I’m awake,” said the man.
“All right, there's a poke, OK? Deep breath for me.”
IV rehydration is typically done in emergency rooms. But, Puebla says, unhoused people often don’t want to go to a hospital.
“Because they don't want to lose their belongings, all their belongings that they have to have with them, which is everything that they own, right? And they don't want to leave their pets behind. They're part of their family. So we encountered a lot of those problems.”
So in May, Circle the City started offering IV rehydration right on the streets.
Dr. Jim Withers is the founder of the Street Medicine Institute, a nonprofit that trains and equips street medicine teams around the globe. He says Puebla’s team is leading the charge.
“It very much is in the spirit of street medicine, which is to adapt to the people and the circumstances that they're living in, rather than expecting them to come to the system,” he said.
It’s also something those who work in the system — traditional, brick and mortar emergency room doctors — generally support, including Dr. Aisha Terry, an associate professor of emergency medicine and health policy at George Washington University and the president of American College of Emergency Physicians in Washington, D.C.
“We like to, in many instances, think of ourselves as MacGyver, in fact,” Terry said, “to figure out how to make it work, regardless of resources or it being ideal.”
Which means meeting the patient wherever they are, says Terry.
But there are instances where IV rehydration could be less than optimal outside a hospital, she says. And that's where the resources of an emergency department, like access to a lab and higher levels of care, could be potentially lifesaving.
At the same time, Terry echoes what Perla Puebla said earlier: This is a population that is often reluctant to go to the ER, even if it means possibly dying on the streets.
Back at the soup kitchen, Puebla is having trouble establishing the IV in her patient’s vein.
“Ugh, it’s not threading in.”
He tells her that he’s been using IV drugs for 30 years.
“ Have you used this one a lot?” she asked.
“Yeah,” he said.
“OK … No go.”
It just won’t work. Puebla tells the man to go to the emergency room and offers to call Uber Health, a non-emergency medical transport. He says he’ll go, but wants to eat first. His friend Victor Flores, who was also seen by the team, is worried.
“Last night he didn't look good. Like, we got scared,” he said.
Flores says he and the man have a place to live but don't have air conditioning. And this summer is shaping up to be worse than last year, which was the hottest on record.
“Esta increíblemente mortal! It’s bad. … It’s really really bad.”
Flores and his friend head to the soup kitchen.
“It is discouraging,” said Puebla. “I don't like to miss it, especially because we could have really helped them feel better. But I understood going in with the history of drug use like that, that that was going to be a very difficult stick.”
Puebla takes the unused, one-liter saline bag and tosses it in the garbage, preparing to see her next patient. Her team will wrap up around noon and be back out early the next day, driving around parks or near the city’s lengthy canals, looking for patients who are trying to survive another day of triple-digit heat.
EDITOR'S NOTE: This story has been updated to clarify Dr. Aisha Terry's view on providing IV rehydration outside of a hospital.
