Project Overview

This project, led by the Canadian Coalition for Green Health Care, is a multi-year national initiative aimed at improving healthcare system resilience to extreme indoor heat and sharing project results with vulnerable populations. This study focuses on understanding how high indoor temperatures impact residents, patients, and healthcare workers in long-term care homes, acute care facilities, clinics, and home care settings across Canada.

Heat is one of the leading weather-related causes of death globally (1). In Canada’s 12 largest cities alone, approximately 670 excess deaths occurred during periods of extreme heat between 2000 and 2020 (2). In the 2021 heat dome in British Columbia, 619 deaths were attributed to the extremely high indoor temperatures and occurred in marginalized areas that had less green space. Most affected were seniors with multiple chronic conditions who lived alone without mechanical cooling (3). Many healthcare settings were unequipped to manage extreme indoor temperatures as they often lacked cooling infrastructure, protocols, and staff training (3). The healthcare sector is also under pressure to reduce its environmental impact which adds complexity to managing rising heat while meeting emissions targets.

This study will use a mix of environmental monitoring and human experience data to guide climate adaptation for indoor heat in healthcare. Quantitative data will include indoor temperature and humidity measurements from data loggers placed in rooms. Qualitative data will be collected via surveys and short interviews with residents, patients, and healthcare workers. The study will be carried out, with all research ethics board approvals in place before data collection.

Buildings

Indoor window shading is a simple, low-cost strategy that reduces solar heat gain in care settings. Common types of indoor shading include curtains (particularly light-coloured or thermal options), blinds (e.g., Venetian, vertical, roller styles), and shades, including blackout varieties. Indoor shading is most effective in rooms with strong direct sunlight or large south- or west-facing windows, and can further reduce heat stress when paired with ventilation strategies such as nighttime cooling or cross-breezes. While not as effective as some other heat mitigation solutions, indoor window shading is a helpful solution when other options are limited.

White and green roofs are effective passive cooling strategies that limit heat absorbed through the roof—a major source of heat gain in healthcare facilities. White roofs reflect sun rays, lowering surface temperatures and reducing heat transfer indoors. Green roofs use vegetation and soil to provide insulation and cooling through evapotranspiration. While white roofs are relatively low-cost and easy to apply, green roofs require more structural assessment but offer additional benefits such as stormwater management, biodiversity, and therapeutic spaces. Both approaches improve thermal comfort without using energy and can significantly reduce heat stress during prolonged heat events, especially when paired with shading and ventilation.

Outdoor window shading blocks solar radiation before it enters the building, making it one of the most effective heat mitigation strategies. Not only lowering indoor temperatures, it reduces reliance on mechanical cooling, and improves comfort for occupants. Outdoor shading includes shutters (fixed or operable), awnings, overhangs, exterior blinds, and shade sails, as well as clip-on or temporary attachments deployed during heat events. Light-coloured or reflective materials can further enhance performance. Outdoor shading is especially effective for south- and west-facing windows and when combined with indoor shading and ventilation.

Shading trees are an effective natural strategy for reducing heat around healthcare facilities. Blocking direct sunlight and enabling evapotranspiration air cooling, they reduce outdoor temperatures and heat absorbed by building surfaces. Trees can be strategically planted to shade south- and west-facing windows, walkways, and outdoor spaces. Deciduous trees provide dense summer shade while allowing winter sunlight, supporting year-round comfort. Trees also improve air quality, reduce glare, enhance therapeutic spaces, and support biodiversity. Despite issues of maturation time, maintenance, and relevance mostly to lower level rooms, they are a long-term, low-carbon investment in heat resilience.

Window films reduce indoor heat by limiting solar radiation through glass. Applied directly to existing windows, these thin films decrease heat gain, glare, and UV exposure without blocking natural light or requiring structural changes. They are quick to install, require no energy to operate, and are well-suited to healthcare settings where major retrofits are not feasible. Common types include solar-control, tinted, low-emissivity (low-e), and privacy or frosted films, with some removable options for seasonal use. Window films are most effective on sun-exposed windows, particularly those facing south or west.

Clinical Activities

Cool kits are low-cost, easy-to-deploy bundles that help patients, residents, and healthcare workers manage heat stress during extreme heat events. When designed to address indoor heat, kits can include cold packs, cooling towels, thermometers, easy-to-hold water jugs, and heat information sheets. Stored centrally and distributed during heat alerts, they provide a practical option for facilities with limited mechanical cooling. To meet infection prevention and control (IPAC) requirements, items should be single-use or easily disinfected. Cool kit design should also consider patient-specific needs. For example, considering alternatives to ice packs for individuals with fragile skin or water jugs for those with fluid restrictions. When tailored appropriately, cool kits offer a flexible, low-carbon way to provide immediate relief and reduce heat-related health risks.

Improved scrubs made from lightweight, breathable, and moisture-wicking fabrics (e.g., cotton blends or technical materials) can help healthcare workers stay cooler. Facilities may provide guidance or subsidies for improved scrubs. When aligned with infection prevention and control (IPAC) requirements that scrubs be durable and compatible with existing laundering protocols, improved scrubs are a low-cost, low-carbon way to enhance comfort and reduce heat stress.

Ensuring easy, frequent access to drinking water is a simple and effective way to reduce heat-related illness in care settings. Adequate hydration helps regulate body temperature and lowers the risk of heat exhaustion and heat stroke, particularly among older adults, medically complex patients, and healthcare workers during extreme heat events. Many care settings already provide hydration solutions, including placing water stations in common areas, offering fluids during clinical rounds, and ensuring that individuals with mobility or cognitive challenges receive regular hydration support. Facilities can identify if there are any gaps in access to water for patients, residents, and staff. Not all individuals can safely increase fluid intake, so guidance from a medical professional is essential. When used appropriately, improving access to water is a low-cost, low-carbon intervention that supports comfort and safety during extreme heat.

Cooling vests are a promising, low-carbon option to help healthcare workers manage heat stress. Using phase-change or evaporative cooling, they lower skin temperature. Studies and early adoption in healthcare settings show they can reduce physiological strain, with particular interest from staff working in high-heat areas such as kitchens and rehabilitation units. Practical considerations include fit, size, accessibility, weight, and user preference, as well as the logistics of ice pack storage space in fridges. Infection prevention and control (IPAC) requirements, including that vests must be single-use or fully disinfectable and may not be suitable in surgical or sterile settings.

Fans are a low-cost, low-energy way to support evaporative cooling. They can reduce perceived temperatures for patients, residents, and staff, particularly when drawing cooler air from shaded areas or supporting cross-ventilation. Infection prevention and control (IPAC) considerations may restrict fan use in certain healthcare settings, as they can circulate dust or pathogens, making them unsuitable for acute care units, isolation rooms, or areas requiring strict air-quality control. Feasibility also varies by unit layout, patient needs, and existing ventilation systems. Where permitted, fans should be easy to clean, used in appropriate clinical contexts, and positioned to avoid blowing directly onto patients. Fan use should also be avoided when indoor temperatures are above 35 degrees Celsius.

Policies and Practices

Heat health education equips healthcare workers to recognize, prevent, and respond to heat-related illness in themselves, patients, and residents. As extreme heat events become more frequent, staff benefit from clear, practical guidance on identifying early signs of heat stress, adjusting clinical routines, and using appropriate cooling strategies. Educational training should address facility-specific plans and practices, such as window use, safe hydration, evacuation processes, and cooling options permitted under infection prevention and control (IPAC) policies. By supporting consistent understanding and identifying/monitoring vulnerable individuals, heat training strengthens staff confidence and preparedness for extreme heat events.

Heat-related information sheets (e.g., fact sheets and infographics) are a low-cost, high-impact way to improve heat-health awareness among patients, residents, visitors, and healthcare workers. Placed throughout a facility (e.g., hallways, staff rooms, elevators, and waiting areas), they reinforce key actions during extreme heat. These resources can also support discharge planning by highlighting safe practices at home and transitions of care. Easy to update and adapt, especially when drawing from existing resources from reputable sources, these information sheets offer a scalable way to strengthen heat preparedness across care environments.

Facility alert systems provide a rapid, reliable way to communicate heat-related risks and actions across healthcare settings. During extreme heat events, timely alerts inform staff when temperatures are rising, when to activate response protocols, and what unit-specific actions are required. Alerts can be delivered through existing channels such as email, overhead paging, secure messaging platforms, or building management systems. Alert systems also provide consistency across units, flag emerging issues (e.g., overheated rooms or patient symptoms), and integrate infection prevention and control (IPAC) guidance on permitted cooling methods. By delivering clear, actionable information at the right time, alert systems support coordinated responses and help protect patients, residents, and staff.

Heat mitigation officials are designated staff responsible for coordinating a facility’s preparedness and response during extreme heat events and ensuring policy alignment to avoid any implementation gaps. They ensure that protocols are applied consistently across units, including monitoring indoor temperatures, adjusting shading and ventilation, and communicating heat alerts. This role is particularly valuable in settings where practices vary, cooling infrastructure is limited, or staff need guidance on actions aligned with infection prevention and control (IPAC) requirements. Heat mitigation officials can also identify and escalate issues (e.g., overheated rooms, patient discomfort, equipment impacts) and coordinate responses with facilities, clinical teams, and leadership. In long-term care and community settings, they may support resident education and access to cooling spaces. Clear leadership and accountability provided by the heat mitigation officials provides support throughout the emergency response cycle, from prevention to recovery.

Scenario planning helps healthcare facilities anticipate extreme heat events and prepare coordinated responses before risks escalate. By developing location-specific scenarios, teams can identify risks (e.g., vulnerability assessment, equipment failures, staff and supplies shortages, or overheated rooms), plan prevention through recovery, and clarify roles across clinical, facilities, and leadership teams. It can also identify necessary policy, structural, and process changes and decision protocols. Through tabletop exercises or unit-specific drills, teams can practice communication, resource deployment, and contingency planning. They can also be used to plan for interoperability between sites with interest holders, including potential evacuation. By rehearsing responses in advance, and bringing together a diversity of community actors and leaders, scenario planning strengthens preparedness and enables faster, more confident action during extreme heat events.

Heat-focused risk assessments help healthcare facilities identify at-risk patients, staff, and spaces during extreme heat events. They can highlight rooms that overheat, units with limited cooling or ventilation, and individuals at higher clinical risk, as well as operational constraints such as infection prevention and control (IPAC) restrictions, staffing patterns, and the challenges of relocating patients. By identifying these vulnerabilities in advance, facilities can prioritize targeted interventions and improve coordination across units. Regular updates, built into everyday workflows and budgeting across departments, can improve preparedness, reduce heat-related illness, and direct resources where they are needed most.

Indoor heat mitigation plans provide a clear, coordinated framework for reducing indoor temperatures and protecting patients, residents, and staff during extreme heat events. They outline practical, unit-specific actions (e.g., adjusting blinds, monitoring indoor temperatures, and modifying workflows during peak heat hours) while supporting consistent implementation across settings with varying cooling capacity. Effective plans also align with infection prevention and control (IPAC) requirements, clarifying which cooling methods are permitted in different clinical areas. They may include communication protocols, escalation pathways for overheated rooms, and guidance for supporting vulnerable populations to reduce heat-related illness.

Baseline Results & Overview of Heat Mitigation Solutions

In 2025, the heat-health team led quantitative and qualitative research with patients, residents and health care workers at select sites in Vancouver, BC, Ottawa and Hamilton, ON and Halifax, NS. Surveys and interviews were delivered to understand the experience of indoor heat and data loggers were implemented in rooms to track temperature and humidity.

Watch this informative webinar where we share the baseline results of our research and outline where we plan to go next to help mitigate heat in our partner health care facilities.

Watch the webinar recording

Low-tech, High-impact Solutions to Heatwaves in Long-Term Care, Acute Care, Clinics, and Home Care Settings Across Canada

Watch this webinar to hear a vital discussion on protecting vulnerable populations from extreme indoor heat in health care and community settings. Hosted by the Canadian Coalition for Green Health Care, this webinar brings together experts to share insights on how health care workers, patients, and facilities are impacted by rising temperatures and the need for better preparedness in long-term care, acute care, clinics, and home care homes across Canada.

Watch the Heatwaves webinar recording