People too dehydrated to take fluids orally need IVs. But unhoused people often avoid emergency rooms. A Phoenix non-profit is now offering IV rehydration on the streets.
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Last year, 645 people died of heat-related causes in the Phoenix metro area. Almost half of those deaths were among the unhoused population. A street medicine team is trying a new intervention that they hope will reduce deaths. Kathy Ritchie with member station KJZZ reports.
KATHY RITCHIE, BYLINE: On a hot Thursday morning at the Burnidge Soup Kitchen in an industrial part of 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.
PERLA PUEBLA: Double tourniquet, all right? It’s going to be tight.
RITCHIE: Puebla is with Circle the City, a nonprofit that provides mobile healthcare to the city’s homeless population.
PUEBLA: Let me clean, and then we’re going to try this.
RITCHIE: The patient is dehydrated, so severely that 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 fluid intravenously. IV rehydration is typically done in emergency rooms, but Puebla says unhoused people often tell her they don’t want to go to a hospital.
PUEBLA: 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?
RITCHIE: So in May, Circle the City started offering IV rehydration right on the streets. Dr. Aisha Terry, president of the American College of Emergency Physicians, says in instances where problems arise with IV rehydration, having the resources of an ER at hand could be lifesaving – things like access to a lab and higher levels of care. But Terry says her colleagues generally support meeting patients wherever they are.
AISHA TERRY: We like to, in many instances, think of ourselves as MacGyvers, in fact, to figure out how to make it work regardless of resources or it being ideal.
RITCHIE: Circle the City in Phoenix is likely the first street medicine group to start making IV rehydration a regular part of their daily practices, says doctor Jim Withers with the nonprofit Street Medicine Institute in Pennsylvania.
JIM WITHERS: 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.
PUEBLA: Well, when you’re out there, it can get a little…
RITCHIE: Back on the searing hot street in Phoenix, Perla Puebla is having trouble establishing the IV in her patient’s vein. He tells her that he’s been using IV drugs for 30 years.
PUEBLA: It’s not threading in. Have you used this one a lot?
UNIDENTIFIED PERSON: Yeah.
PUEBLA: Yeah? OK. No go.
RITCHIE: It just won’t work. Puebla tells the man to go to the emergency room and offers to call Uber Health, a nonemergency 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.
VICTOR FLORES: Last night, he didn’t look good. Like, we got scared.
RITCHIE: 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.
FLORES: (Speaking Spanish). It’s bad. It’s really, really bad.
RITCHIE: Flores and his friend head to the soup kitchen.
PUEBLA: It is discouraging. I don’t like to miss IV, especially because we could have really helped them feel better.
RITCHIE: Puebla takes the unused 1-liter saline bag and tosses it into the garbage and prepares to see her next patient.
For NPR News, I’m Kathy Ritchie in Phoenix.
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