Information and resources that support your role in caring for a loved one.

The Fourth of July has come and gone, but there’s plenty of summer still ahead. And that means plenty of issues for caregivers to consider as they look to keep their loved ones – and themselves – safe and comfortable in the dog days ahead.

In the blog’s latest Q&A, a pair of experts from Natick-based Century Health Systems offer some tips for dealing with the most common summertime issues caregivers may encounter.

Juanita Allen Kingsley is Director of Business Development at Century Health Systems, the parent company of the Natick VNA and Distinguished Care Options. A certified Wilderness EMT, she teaches health and safety courses to people of all ages throughout MetroWest and beyond.

Jean Sniffin, RN, is Community Health Nurse at Century Health Systems. A frequent speaker on myriad health and safety topics, Jean works closely with area Boards of Health and area Councils on Aging.

Allen Kingsley and Sniffin were kind enough to provide the Caregiving Chronicles blog with some information, insight and helpful tips in dealing with summer health and safety issues.

1. What are some of the summer safety issues we need to worry about?
 Ah, summertime. Bright, sunny days. Barbeques. Afternoon swims. Late nights. With more people spending a majority of their time outside, there are safety risks around every corner. Some of those risks include:
a)    Sunburn/sun safety
b)   Dehydration/heat exhaustion and heat stroke
c)    Barbeque burns
d)    Bee stings
e)    Swimming/drowning
f)    Ticks

2.    Can you share with us some of the ways to minimize the risk of these issues?

a) Sunburn/sun safety

 The first rule of sun safety is to wear sunscreen, and this is important for you as a caregiver as well as the person you’re caring for. This is a good rule to follow every day throughout the year – not just in the summer – because even though temperatures might be below freezing in the middle of winter, the sun is still strong and can cause skin damage.

A good rule of thumb is to use a sunscreen with an SPF of at least 30 during the warm summer months. Make sure you rub it on all the areas of the body that are going to be exposed to the sun, including the top of the ears, the back of the neck and even the tops of the feet if wearing sandals.

Also, wear a hat! It’s the best way to keep sun off the face and head.

We need to apply more sunscreen than we might think – a golf ball size amount is recommended. Remember that it’s best to put the sunscreen on 30 minutes before going out. And there is no “waterproof” sunscreen. It must be reapplied whenever you come out of the water.

The sun’s peak time of emitting damaging ultraviolet rays is between 10 a.m. and 4 p.m., so try to stay out of the sun during those hours – or wear protective clothing if you’ll be outside. Also, some medications, like antihistamines, antibiotics, hormone replacement therapies and antihypertensive medications, cause photosensitivity, which can speed up the sunburn process. If you or your loved one is taking medication, ask your doctor if there’s an increased risk of photosensitivity.

JEAN: If you DO get a sunburn, apply a cool compress or take a cool bath to reduce inflammation it may cause. NEVER put ice on a sunburn. It will only cause more damage. If the skin peels from a sunburn, limit exposure to more sun, since the new layer of skin will be much more sensitive. Finally, if the skin starts to blister, see your doctor. There may be second-degree burns, which will require medical attention.

b) Dehydration/heat exhaustion
 Well, let’s first talk about how to prevent dehydration. It’s simple: hydrate! You and your loved one should drink plenty of water before you go outside – especially if you’re going to be exerting energy. We tell kids that they should make sure their urine looks like lemonade – not apple juice.

Make sure you drink water and not caffeinated drinks like soda or coffee, since they increase urination frequency and may cause your body to dehydrate faster than it otherwise would. While outside, continue to drink water or a sports beverage, which can replace lost electrolytes.

Keep in mind, though, that sports beverages are high in calories, so we like to dilute them by 50 percent. And remember that beverages should be cool – not ice cold. It actually takes body heat to heat up the ice cold beverages! (Ever wonder why people in the tropics drink hot tea?)

If heat exhaustion doesn’t get treated by getting out of the heat and hydrating and cooling with a fan, water, and shade, it can progress to heat stroke.

JEAN: How do you know if you or a loved one has heat stroke? Signs can include:
•    Rapid pulse or rapid breathing
•    Dry skin – if you stop sweating in the heat, you may be dehydrated
•    Very high body temperature: 105° – 106°
•    Confusion, dizziness or loss of consciousness after heat exposure
•    Lethargy

So, what should you do if you or someone is suffering from heat stroke? Remember: cool first, transport second. Call 911 and take anything cool you have – ice packs, frozen vegetables, etc. that might help to cool someone as quickly as possible and apply those to the pulse points – wrist, neck, groin – anywhere that blood is closer to the surface of the skin.

Thank goodness, heat stroke is relatively rare and usually happens on days that are hot and very humid and to people who are not physically fit and exercising vigorously – like football players in August practices.

If you experience any of the signs we previously mentioned, call 911. Medical help should also be sought if symptoms don’t go away within 24 hours, if the person is elderly or if a medication may have caused the dehydration.

JUANITA: Mild dehydration doesn’t require emergency assistance, but it does require treatment. Most important is to replace fluids. This is best accomplished with water, but be sure the person drinks slowly and often, since rapid rehydration can cause nausea and/or vomiting. If you have elderly friends or relatives who don’t have air conditioning and are living alone, it’s important to have a system through which you are checking on folks twice a day. If they’re complaining of the heat, take them to the mall, movie or restaurant, where it’s cool.

c) Barbeque burns
 We all want to get the most of the summer weather, especially if it means cooking our meals outside on the grill. Unfortunately, grill burns are a common injury this time of year, so if it happens to you or a loved one, here’s how to treat it:

•    Immediately put cool – not icy – water on the burn site. NEVER put ice on a burn. It can cause more damage to the injured area.
•    After you have completely cooled the burned tissue, you can then put a light layer of antiseptic spray or burn ointment (check on the label to see if an ointment is appropriate for burn treatment) to ease the pain. You MUST wait until the area is cooled, though. Otherwise, you’ll trap the heat in the tissue and create more damage.
•    Cover the area with a clean, dry bandage and change it daily. Be sure the bandage is made of gauze rather than cotton, for example, which can cause lint to go into the wound.

If your skin begins to blister, leave the blisters alone; do NOT pick at them. Otherwise, you’ll become more susceptible to infection. If a blister breaks on its own, blot it dry and cover it with a sterile bandage.

One last piece of advice on burns: if you get a burn and haven’t had a tetanus shot within the last five years, call your doctor, who may recommend that you get a tetanus booster.

d) Bee stings
 While fairly painful, bee stings aren’t typically cause for concern, unless you’re allergic. They do need to be treated, though. First, scrape out the stinger with a clean butter knife or a sharp-edged instrument. But be sure to scrape from the side – not directly from the top. To ease swelling and pain, put ice on the sting site.

If the person stung is allergic, immediately seek medical attention if any of the following symptoms present themselves: hives, difficulty breathing or swallowing, nausea, loss of consciousness, a rapid pulse or itching.

JUANITA: Something important to keep in mind: any one of us can develop an allergy to bee stings or anything else at any point in our lives.

e) Swimming/drowning
 Most of us enjoy going for a swim to cool down in the dog days of summer. But those of us who are caring for a friend or family member should brush up on drowning – and different kinds of drowning.

But before we get into the details, we want you to know that drowning does not always look like it does on TV or in the movies. Often, there is no yelling, calling for help or frantic movements, like flailing arms. In fact, when someone is drowning, they are typically nonverbal and just trying to keep their mouth and nose above water.

Dry drowning is very rare, accounting for about 1% to 2% of drowning deaths. It’s also sometimes referred to as secondary drowning and can happen to someone who breathes in a small amount of water. It can happen during a struggle, for example, and can cause difficulty breathing. Sometimes, someone who experiences dry drowning may be able to carry on typical activities after it happens, but it can result in brain injury and breathing trouble.

So, if you see someone who has had an in-water struggle, be sure to ask them if they are ok, if they are having any chest pain, difficulty breathing or extreme fatigue. They also may exhibit sudden behavioral changes, so keep an eye out for that sign.

Secondary drowning is extremely serious and doesn’t necessarily happen in the pool or water. It can happen as late as 24 hours after a person has been in the water and can be caused by inhaling even just a small amount of water. If symptoms are ignored, it can be fatal. So, watch out for difficulty breathing, chest pain, fever, extreme fatigue or irritability.

If you think that someone may have experienced a secondary drowning, immediately call 911 or go to the hospital. Emergency physicians and EMTs can monitor the person’s oxygen levels and remove extra fluid.

If you are caring for a someone who is swimming, whether a child or an older adult, the most important rule is: NEVER take your eyes off that person.

f) Ticks
 Unfortunately, there are a number of diseases that can be caused by ticks. The most commonly known is Lyme disease, which can be extremely debilitating. Some of the symptoms of tick-borne illnesses are joint pain, extreme fatigue, numbness in the face, and heart palpitations.

Thirty percent of people who get a tick-borne disease don’t even remember being bitten by a tick. If you or the person you’re caring for feels like you’re getting the flu in the summer, you may very well not be getting the flu, but a tick-borne disease instead.

Some of the illnesses caused by ticks include joint disease, nervous system problems, meningitis, Bells’ palsy – another name for facial weakness – and even heart issues.

But there are a number of ways to protect yourself and your loved ones against tick bites:
•    Wear light-colored pants and tuck them into white socks to make it easier to spot ticks if they do attach themselves to clothes.

•    If walking in or near brush or trees, walk along the middle of paths; not in the brushy areas.

•    Spray yourself and your loved one with a repellent that contains DEET. But first, a few rules:
– Do NOT use DEET on children under the age of two months.
– Do not use combination products that contain repellent and sunscreen.
– Do not apply DEET on cuts or open wounds.

Don’t forget that pets can also get Lyme disease, so make sure to check your pets every day. If you do spot a tick, remove it immediately with a fine tweezer. Pull it straight out, without squeezing or twisting it.

JUANITA: One last note on ticks: don’t sleep with your pets!

3.    Are there more resources to learn about these issues?
For those interested in learning more about summer safety issues, the following websites are wonderful resources:

National Safety Council – General tips on summer safety
American Academy of Dermatology – Skin care and skin cancer
Centers for Disease Control and Prevention (CDC) – Resources on unintentional drowning
Mayo Clinic – Resources about bee stings
University of Rhode Island’s TickEncounter Resource Center – All about ticks
American Burn Association – All things burn-related
American Burn Association’s Summer Burn Safety Guide

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