Payton Preslee has been homeless since 2010. He suffers from a number of health conditions, among them, vertigo. And for him, that’s the worst part about Phoenix’s extreme summer heat — it exacerbates symptoms like dizziness and lightheadedness.
“My vertigo does not like it,” Preslee said.
So Preslee avoided triple-digit temperatures this summer by spending almost every day at a cooling center in a warehouse building downtown run by the city.
“The staff is friendly, everybody’s friendly,” Preslee said.
Preslee uses a wheelchair and said that has made it harder to find a homeless shelter that works well for him, so he appreciates that this site stays open 24-hours-a-day.
“Sometimes I do stay here all night to have a safe place to sleep,” Preslee said.
The 24-hour heat relief site will close its doors for the season on Sept. 30. This summer was one of the hottest on record in Phoenix. But Maricopa County appears to be on-track to see a decrease in heat-related deaths this year, compared to last. After years of rising death tolls, officials are optimistic that cooling centers and other heat mitigation policies may finally be making an impact to turn the trend around.
“We don’t want to look back in the other direction,” said David Hondula, director of Phoenix’s Office of Heat Response and Mitigation.
People experiencing homelessness, like Preslee, make up less than 0.3% of Maricopa County’s population. But nearly half of deaths in the county in recent years have been among the unhoused.
That’s why spaces like the 24-hour heat relief site have been central to the city’s response to extreme heat. And with homeless shelters across the Valley at capacity, demand for cooling centers has been enormous. The city reports this 24-hour site, along with three Phoenix libraries offering extended hours for heat relief, have had more than 38,000 visits since opening in May.
“I don’t think it’s an exaggeration to say that thousands of lives have been positively impacted by this operation, and people have not gone to the hospital, people have not died as a result of city investments,” Hondula said.
From 2016 to 2023, every summer broke a new record for the number of heat deaths in Maricopa County. But in 2024 — the first year Phoenix made a 24-hour heat relief site available — the county reported a slight year-over-year decrease in heat deaths for the first time in a decade.
This year, 156 deaths have been confirmed and 370 remain under investigation. So the problem is far from being solved. But this year’s numbers are about 20% lower than at this point in 2024, said Maricopa County’s Chief Medical Examiner Dr. Jeff Johnston.
“It feels more like a typical summer for us, which is busy, but not to the extreme that we’ve seen the last three years,” Johnston said.
Extended hours at heat relief sites are not the only difference.
The Phoenix Fire Department has also changed the way it handles heat-related emergencies. When a patient has a body temperature above 104 degrees and they’re so overheated that they’re in an altered mental state, crews will put the patient into a water-tight bag and fill it chest-high with ice while they’re transported to the hospital.
“It is definitely a lifesaving measure,” Phoenix fire Capt. Todd Keller said. “We are using it on the vagrancy population, we’ve used it on the mountains with hikers that are overheated, people that have worked outside in the heat.”
Since adopting the protocol last year, the Phoenix Fire Department has used the technique in more than 450 rescues. Several Valley emergency rooms and the Scottsdale Fire Department have also begun using the ice immersion treatment.
Keller said the ice immersion bags cool patients much faster than other methods, which is critical for increasing someone’s chances of surviving heat stroke.
“We’ve just seen a tremendous amount of success with preventing brain damage and organ failure,” Keller said.
It’s hard to gauge exactly how much impact the fire department protocol or the city cooling centers are having, Johnston said. He notes there are also new state and local policies enacted within the last few years that protect the right of residents of RV parks to install air conditioners without landlord approval, and that offer new protections for some outdoor workers.
Arizonans may also just be gaining more awareness of the health risks of heat, Johnston added.
“There’s just so many things happening at the same time, it can be really hard to measure individual things,” Johnston said. “But I think that we have a really good reason to believe that the things we’re doing — it’s working.”
And Johnston said he’s confident that the metrics his staff uses to evaluate each case have produced very reliable data to compare year-to-year.
“[The Maricopa County Office of the Medical Examiner] really has the most experience of heat-related death evaluations of anybody in the U.S. and probably the world,” Johnston said. “All of that should be consistent over time. The doctors are internally consistent, so the trends are reliable.”
Maricopa County won’t release a final report on heat-related deaths until early next year.
Even if it is confirmed that deaths declined this summer, challenges remain. Homelessness continues to increase in the Valley. And shelter beds are being lost amid federal funding cuts. Hondula said that could leave more people vulnerable.
“The public health partners in the region are certainly concerned if we see loss of shelter beds, loss of those resources, that could show up as more visits to cooling centers, more heat illnesses, more heat-related fatalities,” Hondula said.
And it’s not just homeless shelters losing federal funding. There’s also no permanent source of funding to pay for Phoenix’s 24-hour cooling center. Most of the budget for this site and other city and county heat relief efforts for the past few years has come from pandemic-era federal aid set to expire in 2026.
“It doesn’t feel like it’s optional to me to keep supporting these programs,” Hondula said. “We need to figure out how to do it and I think all levels of government will have a role to play in that.”
The threat of deadly heat, he said, isn’t going away.
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