Burning pavement, scalding water hoses: Perils of a Phoenix heat wave

Landscaper Eduardo Rios can feel those moments when the familiar in Phoenix morphs into the treacherous, as the skin under his straw hat starts peeling off his forehead, the heat radiating up through his steel-toe boots.

Adrienne Kane tries to hike five days a week, even in summer, but she doubles her water and wears gardening gloves so the metal railings on Camelback Mountain don’t burn her palms during times like this week. Dale Dean, who is homeless, sometimes settles into the seat of his black wheelchair and it feels like he’s “sitting down on hot coals.”

Phoenix is in the middle of a record-breaking run of feverish days and suffocating nights, and human skin is a meager barrier against the scorching and scalding that comes at these temperatures. The city has already smashed records for the highest low temperatures for this time of year, when nights never dropped below the 90s, and it has already had 13 consecutive days - with Thursday expected to be the 14th - at or above 110 degrees Fahrenheit. The record for that is 18, set in 1974, according to the National Weather Service. And the worst of the heat is coming this weekend.

The city and a network of aid organizations mobilize on a large scale during these periods - with cooling centers and programs to distribute water and ice to vulnerable residents. Earlier this year, the city painted its 100th mile of pavement with a light gray coating that is cooler than typical streets. Billboards around the city broadcast temperatures; some hiking trails are closed during midday; tons of snow gets dumped at the zoo to keep animals cool.

“We’re concerned about the severity of the temperatures to begin with, but the consecutive nature of them adds to the public health risk,” said David Hondula, director of Phoenix’s office of heat response and mitigation. “This is a time for maximum

vigilance in the community.”

On these extremely hot days, even tiny mistakes can have grave consequences.

Cameron had just stepped into the laundry room to feed his dog and his wife was in the bathroom when their 18-month-old son, Mason, slipped through the pet door and stepped onto their concrete patio. He was screaming within seconds.

“It was so fast,” recalled Cameron, who asked that he and his family only be identified by first names to avoid shaming from other parents. “It was immediately blistered on one foot. I knew it was bad.”

Mason suffered second-degree burns on the soles of his feet that day in May, when Phoenix temperatures were only in the 90s, but the concrete had gotten hot enough to be dangerous. When the family reached the Arizona Burn Center at Valleywise Health Medical Center, they met another toddler with burned feet.

“It was the exact same thing at the exact same time: 2 p.m., kid walked out onto the balcony,” Cameron said. “As a citizen of Phoenix . . . I wonder, is it just going to keep getting hotter? How much hotter is it going to get?”

The city’s hospitals and firefighters this week have been trying to help people who are seared by pavement that can register 160 degrees or hotter. They are treating patients whose temperatures are running as much as 10 degrees above normal by injecting them with frigid IV fluids, blasting them with evaporative cooling fans, and placing them in what look like small inflatable kayaks filled with ice.

Doctors at the burn center this week said they had 10 patients with contact burns serious enough to require hospitalization. The number of burn admissions has grown over the past decade, as temperatures have risen and days with extreme heat have become more common. In 2015, the hospital admitted 43 people during the summer months with burns. Last summer, that number rose to 85, and seven of the people died.

The most common cases, doctors here said, are elderly people who fall or those who are under the influence of fentanyl or other drugs and spend minutes or hours splayed on the pavement. Homeless people are particularly vulnerable.

But other cases involve freakish missteps - people burned by their seat belts or mailboxes. Swimmers attempting to walk across not-so-cool cool decks. The hospital has seen truckers who drive barefoot, step down onto a parking lot surface and end up badly blistered. On the hottest days, patients have been scalded by the water coming out of their garden hoses.

“That first burst of water out of there, it’s practically boiling,” said Kevin Foster, a physician and the director of the burn center.

One current patient was celebrating his day off with a cocktail, fell and burned 20 percent of his body, requiring surgery and skin grafting, Foster said.

“He was not a drinker. It was just enough. He went down and couldn’t get up,” he said. “All it took was that one little thing.”

Phoenix is the hottest city in the country, and its 1.6 million people are accustomed to summer in the desert. But a warming climate and the sprawl of development, with more pavement radiating heat, has made life increasingly perilous during the hottest stretches of the year. Maricopa County recorded 425 heat-related deaths last year, up 25 percent over the prior year, figures that have been rising steadily over the past decade.

One-third of those deaths, over the past five years, have happened on days when the Weather Service issues an excessive heat warning. Doctors in Phoenix say they typically see a spike in patients when temperatures hit triple digits.

“That’s sort of the magic number, 100 degrees,” Foster said. “We didn’t see many of these patients coming in, and as soon as we hit triple digits, they started coming in.”

In the Valleywise emergency room, patients with heat exhaustion - dizziness, fatigue, nausea, vomiting, muscle breakdown called rhabdomyolysis - are common during a Phoenix summer, said Frank LoVecchio, an emergency medicine physician. They usually recover well with cooling and fluids.

But more serious cases of burns and heatstroke, when people have been on the ground for minutes or hours, can be extremely debilitating. They can involve organ failure or brain damage and require weeks or months of hospitalization for those who survive. About half of the current patients in this condition at the hospital are intubated and in drug-induced comas, doctors said.

“These people are down and we’re breathing for them, we’re dialyzing them, we’re doing the work of their kidneys for them,” said Louis Ferrari, another burn surgeon.

A rule of thumb, he said, is that a burn encompassing 40 percent of a person’s body can put a patient in the hospital for 40 days. The people who come in with these extreme burns and heatstroke, he said, “are some of the sickest patients I’ve ever encountered.”

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On Wednesday, firefighters encountered a man sprawled in the street in north Phoenix. The emergency responders found drug paraphernalia around the man, and witnesses said he had been acting erratically, slamming his head into the side of a truck.

When firefighters arrived, the man was unconscious. There were burns all over his body. His skin was coming off and his internal temperature was 107 degrees, they said. They delivered him to the emergency room.

“Basically, his brain was fried,” said firefighter Brandon Kanae, who responded to the scene.

During such extreme temperatures, fire officials estimate 10 to 15 percent of the calls are for people in heat-related distress.

“The same things are going to happen again. It’s unrelenting. It’s coming back tomorrow,” Capt. Tim Russell said. “If you’re in the sun, you’re in trouble fast.”

Such extreme heat acts like an invisible natural disaster that first responders and medical personnel say causes so much damage it should receive additional federal help, as would a tornado or a hurricane somewhere else.

The risks to public health increase exponentially at the upper extremes, said Hondula, the heat office director.

“I can’t tell people what to do,” LoVecchio, the emergency room physician, said, “but I would suggest anything nonessential, outdoors - don’t do right now.”