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A woman enters a Vancouver cooling centre during the scorching 2021 heat dome.JENNIFER GAUTHIER/The Globe and Mail

A blast of unseasonably hot weather expected this weekend across British Columbia will heighten the risk of floods and wildfires. But in Vancouver, the high temperatures alone are enough of a threat to public health. The city is opening a string of cooling centres, spray parks and misting stations to help people escape the heat.

The facilities trace a path through the neighbourhoods where extreme heat is most likely to have deadly consequences. Two years ago, residents in those quarters bore the brunt of one of Canada’s deadliest weather events, when a historic heat dome settled over the Pacific Northwest for about a week.

This weekend’s soaring temperatures – with daytime highs 10 to 15 degrees above average – are not expected to match the conditions that led to 619 deaths in June, 2021, but they could be a harbinger of more dangerous weather. Environment Canada’s models forecast a hotter-than-average summer across the province and much of Canada.

B.C. has made progress since 2021, Provincial Health Officer Bonnie Henry said in an interview. Health authorities have installed air conditioning in some long-term care homes and hospitals, and the province has more robust emergency response plans.

At the local level, community groups have been asked to be ready to reach out to vulnerable citizens for wellness checks. Municipal governments have built up infrastructure to ensure that people can find places to cool off. Ambulance services have been expanded.

And on Wednesday, the province tested its registration-required Alert Ready system, which will be used to send direct-to-cellphone warnings (to those who have signed up) when a heat emergency is expected.

Still, gaps remain. The province’s recently amended building code does not include cooling requirements in new housing construction, and B.C. is still studying how to provide air conditioning to those who need it most. Critically, it is still trying to identify those most at risk, based on age, health conditions, financial status and living circumstances.

“We still need to work with some of the municipalities, to have access to resources like cooling centres, and more co-ordinated efforts about how do we reach out to people who are at highest risk,” Dr. Henry said. But it is far easier to get that work done now that people and governments appreciate the risk, she adds.

Identifying the most vulnerable

Most of the victims of the 2021 heat dome were older adults with compromised health who lived alone and without air conditioning, the B.C. Coroners Service’s death review panel concluded in a 2022 report. Vancouver posted the highest death toll of any community in the province.

Almost all were indoors, in their homes, unable to escape the sustained heat that in many cases was magnified by urban landscapes dominated by asphalt and concrete. Many were in low-income neighbourhoods, where there is even less vegetation to help mitigate temperatures.

“Vulnerable populations will require additional interventions, support and assistance. One of the challenges is identifying who is most vulnerable and how to adequately meet their needs during an extreme heat event,” the coroner’s report said.

But despite clear identifying factors, the province still does not have a handle on how many people are vulnerable.

Regional health authorities have been asked to pick out and prioritize certain groups for wellness checks during an extreme heat emergency: clients of community services who are listed on chronic disease registries; people with limited mobility or cognitive impairment; and those who live alone.

B.C. Seniors Advocate Isobel Mackenzie estimates between 200,000 and 300,000 people in the province are in the highest risk cohort: over the age of 80 and living solo in an apartment.

While the province doesn’t have a tally of the individuals at risk, it does at least have a good idea where they are. In fact, emergency officials knew in advance of the heat dome which neighbourhoods would be the most stressed. Just weeks before the deadly weather arrived, Vancouver Coastal Health produced a detailed heat vulnerability map that shows a band, cutting an arc across the city, where heat islands are most likely to build, and where the population is most likely to be especially at risk because of advanced age, compromised health or poverty.

Dr. Sarah Henderson, scientific director of Environmental Health Services at the B.C. Centre for Disease Control, plotted out where people died during the heat dome and found there is “some clear overlap” with the Vancouver Coastal Health map.

So while the factors of risk are well understood, tracking down individuals remains a work in process.

Improving cooling infrastructure

Daniel Stevens, director of Emergency Management for the City of Vancouver, was busy this past week getting cooling centres and other services ready for the heat.

He is confident that residents are now far more aware of the risks posed by extreme heat – something that many West Coasters didn’t understand before the heat dome. The emergency alert system is also a big improvement, he said.

But he worries that is not enough. “None of our cooling centres have been at capacity,” he said. “We’re concerned that the most vulnerable people aren’t coming out.”

His department is working with community agencies to set up alternate cooling spaces for people who won’t take advantage of the air conditioning in a public library. But he would like to see air conditioning units provided as medical devices to those most vulnerable. “That is one of the big gaps, getting cooling capacity to the people who need it most,” he said.

Ms. Mackenzie agrees.

“The people who died in their homes, many of them have been checked on before they died. So this idea that you just go check on people, and it’ll be okay – actually, there’s a whole bunch of people who wouldn’t have died if that was sufficient,” she said.

What is missing, Ms. Mackenzie said, is a co-ordinated provincial plan to provide cooling in homes where that is feasible, and to evacuate people at risk when it is not. “All the cold compresses in the world aren’t going to solve the problem when the ambient temperature in the room is too high.”

The coroner’s service, in its recommendations, asked the province to look at issuing cooling devices as medical equipment to persons most at risk of dying during an extreme heat event, and to make its findings public by last December. That review hasn’t been completed.

Increasing emergency capacity

During the disaster of 2021, emergency services were overwhelmed by more than 50,000 calls to 911 over the week-long heat wave, which shattered temperature records across the Pacific Northwest.

Dying people were unable to get through to dispatchers, and some passed away waiting for medical care.

Health Minister Adrian Dix, speaking to reporters on Thursday, said B.C. has made significant investments in emergency response since the heat dome. The province appointed a chief ambulance officer, increased training for ambulance paramedics, acquired new ambulances and created 222 permanent, full-time regular paramedic positions.

Troy Clifford, president of the union representing the Ambulance Paramedics and Dispatchers of BC, said that is all a big improvement. But he said workloads continue to be a problem and the service is routinely not meeting national benchmarks for response times, never mind during a crisis of a mass casualty event.

The benchmark to respond to serious calls – such as a heart attack – is less than nine minutes for urban centres. “We know we are not anywhere close to that,” he said. “We’ve been running on bare bones for a long time. We have come a long way, but we are still seeing delays, people waiting for ambulances.”

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