Homeless Face Many Dangers from Elements Living Outside in Cold

February 3, 2014

As president of Boston Health Care for the Homeless Program, which he helped found in 1985, Jim O’Connell, M.D., spends two nights a week on Pine Street Inn’s van visiting homeless patients throughout Boston. In this edited Q&A, he addresses the impact of extreme cold on people living without shelter. You’re invited to a discussion that O’Connell will lead about the medical risks of homelessness at Beacon Hill Friends House, located at 8 Chestnut St., on Wednesday, Feb. 5, at 7:30 p.m.

What have you learned about the impact of frigid temperatures on people who live on the street?

A: After four years of medical school and three years of residency, I was struck – in this job – by how little I knew about frostbite, hypothermia and related issues.

When I started to learn about the concept of hypothermia, I discovered that most of the literature about weather-related medical issues comes out of the military and from those crazy mountain climbers.

What is autoamputation?

A: Each year at our medical respite facility, the Barbara McInnis House, we care for between 10 and 15 people suffering from frostbite that threatens digits and limbs. Hands and feet and tips of noses can swell and develop blisters as if they’d been burned.

Over time, the line between dead tissue and good tissue declares itself and the dead tissue will fall off or autoamputate. If the patient is lucky, the necrotic tissue will be only one or two layers deep. They’ll end up with a finger that may be disfigured but alive and functional.

Often people wake up to find that a finger or a toe has fallen off in bed.  Whatever journey has led them to living on the street ends up costing them something they’ll have to live with forever. It’s profoundly unnerving. Frostbite is an emblematic, avoidable and disastrous consequence of exposure to the elements.

What is paradoxical undressing?

A: As hypothermia progresses, people perceive that their body is becoming warm and they begin taking their clothing off – just when they need it more, they’re taking it off.

I don’t know if anybody really understands the mechanism at work, but one assumption is that as you get colder and colder, the body tries to preserve blood flow to the heart so it shuts down blood flow to the limbs and to the brain. A strange mental status results, with confusion and disorientation and a poor perception of temperature that makes the person feel too hot for all the layers of clothing.

What should people do if they encounter someone who appears to be in distress as a result of the cold?

A: If you see someone out in the cold — especially when temperature drops below 22 degrees — who appears confused, disoriented or unconscious, call 911. In New York City, police can bring people inside against their will. That’s not so in Boston, but police, EMS and outreach workers have been trained to strongly encourage people to offer each person a ride to a shelter.

Bill Mitchell, a college friend of Jim O’Connell, lives at Beacon Hill Friends House and blogs about it with his wife, Carol, at ayearinaroom.com.

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