{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T15:30:20Z","timestamp":1791387020765,"version":"4.3.3"},"reference-count":43,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T00:00:00Z","timestamp":1670544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Extreme heat and hot weather has a negative impact on human health and society. Global warming has resulted in an increase in the frequency and duration of heatwaves. Heat-related illnesses are a significant negative consequence of high temperatures and can be life-threatening medical emergencies. The severity of the symptoms can depend on the pre-existing medical conditions and vary from mild headaches to severe cases that can lead to coma and death. The risk of heat-related illness may be higher for people experiencing homelessness due to a lack of access to cool places and water, and the complex interactions between mental illness, medications and substance use disorder. This paper presents two cases of people experiencing homelessness who were admitted to the emergency department of a hospital in Sydney, Australia during a heatwave in November 2020. Both cases were adult males with known risk factors for heat-related illness including hypertension and schizophrenia (Case One) and hepatitis C, cirrhosis, and alcohol use disorder (Case Two). These cases show that severe weather can not only be detrimental to homeless people\u2019s health but can also cause a significant economic toll, evident by the $70,184 AUD expenditure on the care for these two cases. This case report highlights the requirement to determine the risk of heat-related illness to people experiencing homelessness and need to protect this vulnerable population from weather-related illness and death.<\/jats:p>","DOI":"10.3390\/ijerph192416565","type":"journal-article","created":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T06:55:03Z","timestamp":1670568903000},"page":"16565","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Heat Illness Requiring Emergency Care for People Experiencing Homelessness: A Case Study Series"],"prefix":"10.3390","volume":"19","author":[{"given":"Timothy","family":"English","sequence":"first","affiliation":[{"name":"Heat and Health Research Incubator, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2218-2533","authenticated-orcid":false,"given":"Matthew","family":"Larkin","sequence":"additional","affiliation":[{"name":"Homeless Health Service, St Vincent\u2019s Hospital, Sydney, NSW 2010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7111-3027","authenticated-orcid":false,"given":"Alejandro","family":"Vasquez Hernandez","sequence":"additional","affiliation":[{"name":"Homeless Health Service, St Vincent\u2019s Hospital, Sydney, NSW 2010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennie","family":"Hutton","sequence":"additional","affiliation":[{"name":"Emergency Department, St Vincent\u2019s Hospital, Melbourne, VIC 3065, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8721-089X","authenticated-orcid":false,"given":"Jane","family":"Currie","sequence":"additional","affiliation":[{"name":"School of Nursing, Queensland University of Technology, Brisbane, QLD 4000, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1029\/2018GL081004","article-title":"Warming trends in summer heatwaves","volume":"46","author":"Chapman","year":"2019","journal-title":"Geophys. Res. Lett."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"113703","DOI":"10.1016\/j.envres.2022.113703","article-title":"Vulnerability of Australia to heatwaves: A systematic review on influencing factors, impacts, and mitigation options","volume":"213","author":"Adnan","year":"2022","journal-title":"Environ. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.amepre.2012.11.015","article-title":"Minimization of heatwave morbidity and mortality","volume":"44","author":"Kravchenko","year":"2013","journal-title":"Am. J. Prev. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1038\/s41572-021-00334-6","article-title":"Classic and exertional heatstroke","volume":"8","author":"Bouchama","year":"2022","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.amepre.2008.08.021","article-title":"Climate change and extreme heat events","volume":"35","author":"Luber","year":"2008","journal-title":"Am. J. Prev. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.envsci.2014.05.003","article-title":"Exploring 167 years of vulnerability: An examination of extreme heat events in Australia 1844\u20132010","volume":"42","author":"Coates","year":"2014","journal-title":"Environ. Sci. Policy"},{"key":"ref_7","unstructured":"(2022, October 04). BOM Annual Climate Statement\u2014Australia\u2019s Fourth-Warmest Year on Record, with a Move from Drought and Fire to La Ni\u00f1a, Available online: http:\/\/www.bom.gov.au\/climate\/current\/annual\/aus\/2020\/."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"140521","DOI":"10.1016\/j.scitotenv.2020.140521","article-title":"Heatwaves intensification in Australia: A consistent trajectory across past, present and future","volume":"742","author":"Trancoso","year":"2020","journal-title":"Sci. Total Environ."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Islam, M.S., Fang, T., Oldfield, C., Larpruenrudee, P., Beni, H.M., Rahman, M., Husain, S., and Gu, Y. (2022). Heat Wave and Bushfire Meteorology in New South Wales, Australia: Air Quality and Health Impacts. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191610388"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Schneider, S., von Winning, A., Gr\u00fcger, F., Anderer, S., Hoffner, R., and Anderson, L. (2022). Physical Activity, Climate Change and Health\u2014A Conceptual Model for Planning Public Health Action at the Organizational Level. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19084664"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Mason, H., CKing, J., EPeden, A., and CFranklin, R. (2022). Systematic review of the impact of heatwaves on health service demand in Australia. BMC Health Serv. Res., 22.","DOI":"10.1186\/s12913-022-08341-3"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"R69","DOI":"10.1186\/cc13826","article-title":"The impact of heatwaves on emergency department visits in Brisbane, Australia: A time series study","volume":"18","author":"Toloo","year":"2014","journal-title":"Crit. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.accre.2021.07.008","article-title":"Hospital healthcare costs attributable to heat and future estimations in the context of climate change in Perth, Western Australia","volume":"12","author":"Tong","year":"2021","journal-title":"Adv. Clim. Change Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.1056\/NEJMra1810762","article-title":"Heatstroke","volume":"380","author":"Epstein","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_15","first-page":"90","article-title":"Diagnosis and Management of Heatstroke","volume":"52","author":"Asmara","year":"2020","journal-title":"Acta Med. Indones."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Hirschhorn, R., DadeMatthews, O., and Sefton, J. (2021). Exertional Heat Stroke Knowledge and Management among Emergency Medical Service Providers. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18095016"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"w30013","DOI":"10.4414\/SMW.2021.w30013","article-title":"Heat-related cardiovascular morbidity and mortality in Switzerland: A clinical perspective","volume":"151","author":"Schulte","year":"2021","journal-title":"Swiss Med. Wkly."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.maturitas.2011.03.008","article-title":"Heat wave impact on morbidity and mortality in the elderly population: A review of recent studies","volume":"69","author":"Forsberg","year":"2011","journal-title":"Maturitas"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Layton, J.B., Li, W., Yuan, J., Gilman, J.P., Horton, D.B., and Setoguchi, S. (2020). Heatwaves, medications, and heat-related hospitalization in older Medicare beneficiaries with chronic conditions. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0243665"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1177\/1403494810377685","article-title":"High temperatures and health outcomes: A review of the literature","volume":"38","author":"Martiello","year":"2010","journal-title":"Scand. J. Public Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.amjopharm.2007.12.002","article-title":"Polypharmacy in elderly patients","volume":"5","author":"Hajjar","year":"2007","journal-title":"Am. J. Geriatr. Pharmacother."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1111\/jcpt.12294","article-title":"Medicines can affect thermoregulation and accentuate the risk of dehydration and heat-related illness during hot weather","volume":"40","author":"Westaway","year":"2015","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.eurpsy.2007.03.007","article-title":"Psychotropic drugs use and risk of heat-related hospitalisation","volume":"22","author":"Goumy","year":"2007","journal-title":"Eur. Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1071\/PY12048","article-title":"Extreme weather-related health needs of people who are homeless","volume":"19","author":"Cusack","year":"2013","journal-title":"Aust. J. Prim. Health"},{"key":"ref_25","unstructured":"Australia Bureau of Statisitics (2021, May 14). Census of Population and Housing: Estimating Homelessness, Available online: https:\/\/www.abs.gov.au\/statistics\/people\/housing\/census-population-and-housing-estimating-homelessness\/latest-release."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/j.jenvman.2017.03.095","article-title":"The urban heat island effect, its causes, and mitigation, with reference to the thermal properties of asphalt concrete","volume":"197","author":"Mohajerani","year":"2017","journal-title":"J. Environ. Manag."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1071\/PY13136","article-title":"Impacts of extreme weather on the health and well-being of people who are homeless","volume":"20","author":"Pendrey","year":"2014","journal-title":"Aust. J. Prim. Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1002\/j.1839-4655.1992.tb00911.x","article-title":"Understanding Contemporary Homelessness: Issues of Definition and Meaning","volume":"27","author":"Chamberlain","year":"1992","journal-title":"Aust. J. Soc. Issues"},{"key":"ref_29","unstructured":"Bureau of Meteorology, Australian Government (2022, September 08). Greater Sydney in November 2020: A Hot Finish to the Month, Available online: https:\/\/www.bom.gov.au."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e058893","DOI":"10.1136\/bmjopen-2021-058893","article-title":"Development of the Homeless Health Access to Care Tool to identify health-related vulnerability among people experiencing homelessness: Delphi study, Australia","volume":"12","author":"Currie","year":"2022","journal-title":"BMJ Open"},{"key":"ref_31","first-page":"222","article-title":"Thermoregulation in mildly hypertensive men during beta-adrenergic blockade","volume":"22","author":"Pescatello","year":"1990","journal-title":"Med. Sci. Sport. Exerc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/S0140-6736(21)01208-3","article-title":"Hot weather and heat extremes: Health risks","volume":"398","author":"Ebi","year":"2021","journal-title":"Lancet (Lond. Engl.)"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1016\/j.bpa.2008.06.004","article-title":"Physiology of thermoregulation","volume":"22","author":"Kurz","year":"2008","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e368","DOI":"10.1016\/S2542-5196(21)00136-4","article-title":"Electric fan use for cooling during hot weather: A biophysical modelling study","volume":"5","author":"Morris","year":"2021","journal-title":"Lancet. Planet. Health"},{"key":"ref_35","unstructured":"Office of Atmospheric Programs (2022, October 04). Excessive Heat Events Guidebook (2nd ed.), Available online: https:\/\/www.epa.gov\/sites\/default\/files\/2016-03\/documents\/eheguide_final.pdf."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"675","DOI":"10.7326\/M19-0512","article-title":"The Effects of Electric Fan Use under Differing Resting Heat Index Conditions: A Clinical Trial","volume":"171","author":"Morris","year":"2019","journal-title":"Ann. Intern. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1001\/jama.2019.13051","article-title":"A Preliminary Study of the Effect of Dousing and Foot Immersion on Cardiovascular and Thermal Responses to Extreme Heat","volume":"322","author":"Morris","year":"2019","journal-title":"JAMA"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1152\/japplphysiol.00786.2019","article-title":"Keeping older individuals cool in hot and moderately humid conditions: Wetted clothing with and without an electric fan","volume":"128","author":"Cramer","year":"2020","journal-title":"J. Appl. Physiol."},{"key":"ref_39","unstructured":"NSW Government (2022, October 04). State Heatwave Subplan: A Subplan of the NSW State Emergency Management Plan (1st ed.), Available online: https:\/\/www.nsw.gov.au\/sites\/default\/files\/2021-04\/emergency-management-subplan-heatwave.pdf."},{"key":"ref_40","unstructured":"NSW Government (2022, October 04). Inner City Emergency Response Protocol for People Sleeping Rough (1st ed.), Available online: https:\/\/www.cityofsydney.nsw.gov.au\/people-communities\/homelessness."},{"key":"ref_41","unstructured":"Widerynski, S., Schramm, P., Conlon, K., Noe, R., Grossman, E., Hawkins, M., Nayak, S.U., Roach, M., and Hilts, A.S. (2022, October 06). The Use of Cooling Centers to Prevent Heat-Related Illness: Summary of Evidence and Strategies for Implementation. U.S. Centers for Disease Control & Prevention (CDC): National Center for Environmental Health, Division of Environmental Hazards and Health Effects, Available online: https:\/\/www.cdc.gov\/climateandhealth\/docs\/UseOfCoolingCenters.pdf."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Schmeltz, M.T., and Gamble, J.L. (2017). Risk characterization of hospitalizations for mental illness and\/or behavioral disorders with concurrent heat-related illness. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0186509"},{"key":"ref_43","unstructured":"Hartley, C., Barnes, E., and Writer, T. (2021). More than temporary?. An Evaluation of the Accommodation of People Sleeping Rough in Inner City Sydney during the COVID-19 Pandemic, Centre for Social Impact."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/24\/16565\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:37:16Z","timestamp":1760146636000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/24\/16565"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,9]]},"references-count":43,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["ijerph192416565"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192416565","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,9]]}}}