Street medicine teams search for homeless people to deliver lifesaving IV hydration in extreme heat

PHOENIX (AP) — Alfred Handley leaned back in his wheelchair alongside a major Phoenix freeway as a street medicine team helped him get rehydrated with an intravenous saline solution dripping from a bag hanging on a pole.

Cars whooshed by under the blazing 96-degree morning sun as the 59-year-old homeless man with a nearly toothless smile got the help he needed through a new program run by the nonprofit Circle the City.

“It’s a lot better than going to the hospital,” Handley said of the team that provides health care to homeless people. He's been treated poorly at traditional clinics and hospitals, he said, more than six years after being struck by a car while he sat on a wall, leaving him in a wheelchair.

Circle the City introduced its IV rehydration program as a way to protect homeless people from life-threatening heat illness as temperatures regularly hit the triple-digits in America's hottest metro. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Maricopa County, which encompasses metro Phoenix.

Dr. Liz Frye, vice chair of the Street Medicine Institute that provides training to hundreds of health care teams worldwide, said she didn't know of groups other than Circle the City administering IVs on the street.

"But if that’s what needs to happen to keep somebody from dying, I’m all about it,” Frye said.

As summers grow warmer, health providers from San Diego to New York are being challenged to better protect homeless patients.

Even the Boston Health Care for the Homeless Program, featured in last year's book, “Rough Sleepers," now sees patients with mild heat exhaustion in the summer after decades of treating people with frostbite and hypothermia during the winter, said Dr. Dave Munson, the street team's medical director.

“It's certainly something to worry about,” said Munson, noting that temperatures in Boston hit 100 degrees with 70% humidity during June's heat wave. Homeless people, he said, are vulnerable to very hot and very cold weather not only because they live outside, but they often can't regulate body temperature due to medication for mental illness or high blood pressure, or because of street substance use.

The Phoenix team searches for patients in homeless encampments in dry riverbeds, sweltering alleys and along the canals that bring water to the Phoenix area. About 15% are dehydrated enough for a saline drip.

“We go out every day and find them,” said nurse practitioner Perla Puebla. “We do their wound care, medication refills for diabetes, antibiotics, high blood pressure.”

Puebla’s street team ran across Handley and 36-year-old Phoenix native Phillip Enriquez near an overpass in an area frequented by homeless people because it’s near a facility offering free meals. Across the road was an encampment of tents and lean-tos along a chain-link fence.

Enriquez sat on a patch of dirt as Puebla started a drip for him. She also gave him a prescription for antibiotics and a referral to a dentist for his dental infection.

Living outside in Arizona’s broiling sun is hard, especially for people who may be mentally ill or use sedating drugs like fentanyl that make them less aware of surroundings. Stimulants like methamphetamine contribute to dehydration, which can be fatal.

Temperatures this year have reached 115 degrees (45 Celsius) in metro Phoenix, where six heat-related deaths have been confirmed through June 22. Another 111 are under investigation.

“The number of patients with heat illnesses is increasing every year,” said Dr. Aneesh Narang, assistant medical director of emergency medicine at Banner Medical Center-Phoenix, which treats many homeless people with heat stroke.

Narang's staff works frequently with Circle the City, whose core mission is providing respite care, with 100 beds for homeless people not well enough to return to the streets after a hospital stay.

Extreme heat worldwide requires a dramatic response, said physician assistant Lindsay Fox, who cares for homeless people in Albuquerque, New Mexico, through an initiative run by the University of New Mexico’s School of Medicine.

Three times weekly, Fox treats infections, cleans wounds and manages chronic conditions in consultation with hospital colleagues. She said the prospect of more heat illness worries her.

Highs in Albuquerque can hit the 90s and don't fall enough for people living outside to cool off overnight, she said.

“If you’re in an urban area that’s primarily concrete, you’re retaining heat,” she said. “We're seeing heat exposure that very quickly could go to heat stroke.”

Serious heat stroke is far more common in metro Phoenix, where Circle the City is now among scores of health programs for the homeless in cities like New York, San Diego and Spokane, Washington.

Circle the City, founded in 2012 by Sister Adele O’Sullivan, a physician and member of the Sisters of St. Joseph Carondelet, now has 260 employees, including 15 doctors, 13 physician assistants and 11 nurse practitioners. It annually sees 9,000 patients.

Grants, donations and other gifts account for about 20% of the funding. Most of the rest comes from insurance payments for services provided through Medicaid and Medicare.

Circle the City works with medical staff in seven Phoenix hospitals to help homeless patients get after-care when they no longer need hospitalization. It also staffs two outpatient clinics for follow-up.

“This partnership allows us to offer the best outcomes for our patients,” said Craig Orsini, social work manager at St. Joseph’s Hospital and Medical Center in Phoenix.

Often that's a few weeks in respite care or, for less acute needs, a stay in one of a handful of medical beds at the downtown shelter for things like dressing changes for wounds. Someone who needs months to heal might go to a skilled nursing facility.

While patients recover, Circle the City works to find longer-term transitional shelter such as those for people 55 and older, or in permanent housing. About 77% of respite patients are sent somewhere other than the street or an emergency shelter.

“We try to find the best fit for people,” said Wendy Adams, Circle the City’s community outreach supervisor.

Circle the City medical staff distributes tens of thousands of water bottles each summer and tries to educate people about hot weather dangers, said Dr. Matt Essary, who works at one of five mobile clinics that stop outside soup kitchens and other services for homeless people.

Essary said Circle the City is also considering a blood analysis tool to detect electrolyte imbalances caused by dehydration.

“You can see right away how dehydrated they have become because it’s so hard to draw their blood,” he said. Other possible symptoms include headache, extreme thirst, dizziness and dry mouth.

“We also see a lot of people with surface burns,” Essary said of the wounds common in broiling Phoenix, where a medical emergency or intoxication can cause someone to fall on a sizzling sidewalk.

Rachel Belgrade waited outside Circle the City's retrofitted truck with her black-and-white puppy, Bo, for Essary to write a prescription for the blood pressure medicine she lost when a man stole her bicycle. She accepted two bottles of water to cool off as the morning heat rose.

“They make all of this easier,” said Belgrade, a Native American from the Gila River tribe. “They don’t give you a hard time.”

A Circle The City mobile clinic, helps homeless patients, Thursday, May 30, 2024 in Phoenix. Based in the hottest big metro in America, Circle the City is taking measures to protect patients from life-threatening heat illness as temperatures hit new highs. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Arizona's Maricopa County, which encompasses metro Phoenix.(AP Photo/Matt York)

A homeless man walks towwards one of five mobile clinics stationed outside soup kitchens and other services for homeless people, Thursday, May 30, 2024 in Phoenix. Based in the hottest big metro in America, Circle the City is taking measures to protect patients from life-threatening heat illness as temperatures hit new highs. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Arizona's Maricopa County, which encompasses metro Phoenix.(AP Photo/Matt York)

A homeless man waits to see a doctor at one of the five Circle The City mobile clinics stationed outside soup kitchens and other services for homeless people, Thursday, May 30, 2024 in Phoenix. Based in the hottest big metro in America, Circle the City is taking measures to protect patients from life-threatening heat illness as temperatures hit new highs. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Arizona's Maricopa County, which encompasses metro Phoenix.(AP Photo/Matt York)

Phillip Enriquez, left, and Alfred Handley receive intravenous saline solution from a Circle The City mobile clinic, Thursday, May 30, 2024 in Phoenix. Based in the hottest big metro in America, Circle the City is taking measures to protect patients from life-threatening heat illness as temperatures hit new highs. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Arizona's Maricopa County, which encompasses metro Phoenix.(AP Photo/Matt York)

Nurse practitioner Perla Puebla prepares a intravenous saline solution outside a Circle The City mobile clinic, Thursday, May 30, 2024 in Phoenix. Based in the hottest big metro in America, Circle the City is taking measures to protect patients from life-threatening heat illness as temperatures hit new highs. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Arizona's Maricopa County, which encompasses metro Phoenix.(AP Photo/Matt York)

Dr. Matt Essary checks on a patient as he works at one of the five Circle The City mobile clinics stationed outside soup kitchens and other services for homeless people, Thursday, May 30, 2024 in Phoenix. Based in the hottest big metro in America, Circle the City is taking measures to protect patients from life-threatening heat illness as temperatures hit new highs. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Arizona's Maricopa County, which encompasses metro Phoenix.(AP Photo/Matt York)

A homeless man drinks a bottle of water outside a Circle The City mobile clinic, Thursday, May 30, 2024 in Phoenix. Based in the hottest big metro in America, Circle the City is taking measures to protect patients from life-threatening heat illness as temperatures hit new highs. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Arizona's Maricopa County, which encompasses metro Phoenix.(AP Photo/Matt York)

Rachel Belgrade waits with her puppy Bo outside a Circle The City mobile clinic for a blood pressure medicine prescription, Thursday, May 30, 2024 in Phoenix. Based in the hottest big metro in America, Circle the City is taking measures to protect patients from life-threatening heat illness as temperatures hit new highs. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Arizona's Maricopa County, which encompasses metro Phoenix.(AP Photo/Matt York)

Rachel Belgrade drinks water as she waits with her puppy Bo outside a Circle The City mobile clinic for a blood pressure medicine prescription, Thursday, May 30, 2024 in Phoenix. Based in the hottest big metro in America, Circle the City is taking measures to protect patients from life-threatening heat illness as temperatures hit new highs. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Arizona's Maricopa County, which encompasses metro Phoenix.(AP Photo/Matt York)

A homeless woman is given a pair of shoes from a nurse working aboard one of five Circle The City mobile clinics stationed outside soup kitchens and other services for homeless people, Thursday, May 30, 2024 in Phoenix. Based in the hottest big metro in America, Circle the City is taking measures to protect patients from life-threatening heat illness as temperatures hit new highs. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Arizona's Maricopa County, which encompasses metro Phoenix.(AP Photo/Matt York)

Homeless people gather outside one of five Circle The City mobile clinics stationed outside a soup kitchen, Thursday, May 30, 2024 in Phoenix. Based in the hottest big metro in America, Circle the City is taking measures to protect patients from life-threatening heat illness as temperatures hit new highs. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Arizona's Maricopa County, which encompasses metro Phoenix.(AP Photo/Matt York)

Dr. Matt Essary checks on a homeless man who fell ill on the sidewalk outside one of five Circle The City mobile clinics stationed outside soup kitchens and other services for homeless people, Thursday, May 30, 2024 in Phoenix. Based in the hottest big metro in America, Circle the City is taking measures to protect patients from life-threatening heat illness as temperatures hit new highs. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Arizona's Maricopa County, which encompasses metro Phoenix.(AP Photo/Matt York)

Alfred Handley watches an intravenous saline solution drip administered by the Circle The City medical team, Thursday, May 30, 2024 in Phoenix. Based in the hottest big metro in America, Circle the City is taking measures to protect patients from life-threatening heat illness as temperatures hit new highs. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Arizona's Maricopa County, which encompasses metro Phoenix.(AP Photo/Matt York)

Patients gather outside one of the five Circle The City mobile clinics stationed outside a soup kitchen for homeless people, Thursday, May 30, 2024 in Phoenix. Based in the hottest big metro in America, Circle the City is taking measures to protect patients from life-threatening heat illness as temperatures hit new highs. Homeless people accounted for nearly half of the record 645 heat-related deaths last year in Arizona's Maricopa County, which encompasses metro Phoenix.(AP Photo/Matt York)

ARLINGTON, Texas (AP) — Texas Rangers shortstop Corey Seager was out of the lineup for the second straight game Tuesday night since getting hit by a pitch on his left wrist.

Manager Bruce Bochy said Seager took some swings before the series opener at home against San Diego, and was doing better since getting hit Saturday night. The shortstop went to the ground before getting up and walking off the field after getting struck on a check swing in Baltimore.

Initial X-rays revealed no broken bone, and that was confirmed by an MRI on Monday after the Rangers got home from the trip.

While the Rangers hope to get Seager back soon, third baseman Josh Jung hasn't swung a bat since his last rehabilitation game June 20. He is coming back from a fractured right wrist that occurred when he was hit by a pitch in the fourth game of the season on April 1. He had surgery the next day.

Jung has been dealing with inflammation and soreness in the tendon of his wrist after 17 at-bats in four rehab games.

“Just trying to get this thing to calm down. That’s really all we’re doing,” Jung said Tuesday in the Rangers clubhouse.

Outfielder Evan Carter, who has missed 31 games with a lumbar sprain, has been taking some swings at the team's complex in Arizona, and Bochy said he should be facing live pitching within a few days. Carter is still considered a rookie even after his debut at the end of last season and his standout play through the playoffs as the Rangers won the World Series.

Right-hander Tyler Mahle was making his first rehab start Tuesday night for Double-A Frisco, about 13 1/2 months after he had Tommy John surgery in May 2023. The Rangers signed him to a $22 million, two-year contract during the winter, knowing he would be out for much of this season. If all goes well, he could join the team in early August.

Jung was voted by fans as the American League starter in last year's All-Star Game when he was a rookie. He said he is trying to keep his legs fresh and in shape. He does some stuff in the batting cage trying to see pitches and can go through some fielding work without throwing the ball.

“Not a whole lot baseball activity-wise,” he said. “I try to do everything I can to stay as ready as I can. ... I'm not really able to do a whole lot right night, so just do everything I can to stay ready in my mind.”

Bochy said Jung had a significant injury, and the manager expressed that he's “not surprised there’s been a hiccup or two along the way.”

AP MLB: https://apnews.com/hub/MLB

Texas Rangers' Corey Seager (5) walks off the field after being hit by a pitch thrown by Baltimore Orioles pitcher Cade Povich during the fifth inning of a baseball game as manager Bruce Bochy, left, looks on, Saturday, June 29, 2024, in Baltimore. (AP Photo/Terrance Williams)

Texas Rangers' Corey Seager sits on the ground after being hit by a pitch thrown by Baltimore Orioles pitcher Cade Povich during the fifth inning of a baseball game, Saturday, June 29, 2024, in Baltimore. (AP Photo/Terrance Williams)