The UK in currently in the grip of cold weather. In this article I’m going to look at both the steps services can take to support people during the current cold snap and hopefully some advice for people who are forced to spend time outside in the snow. Plus how this will improve the relationship with visitors and give staff another great set of engagement tools.

It’s all well and good for the media (and some services) to give advice on how to stay safe on the roads during cold weather. But in my opinion there has been a lack of advice on how drug services can respond to low temperatures when supporting people.

For people who are sleeping rough, or for any other reason having to spend lots of time outside getting warm is incredibly important, even for just a short time. So what can a drug service do to help?

Provide some of the following in the service:

• Give people hot drinks – coffee, hot chocolate etc are great for warming people up (and for warming up hands). I know some services that refuse to give hot drinks to people on ‘health and safety’ grounds, in case someone uses a hot drink as a weapon against staff, simple answer to this is don’t hire staff that make people want to throw coffee at them
• Instant noodle meals – something as cheap as a 60p dehydrated meal that just needs boiling water added will be a welcome site to someone who is sleeping rough
• Dry socks – socks, hats and gloves are all easily available from places like the Pound shop (you could even pick up some of the noodle based meals mentioned above) I’d even suggest buying in some ladies tights for people to wear under their clothing during cold weather, something my father used to do when he was night fishing (at least he said he was night fishing)
• Dry blankets – granted these would cost slightly more money but I’d suggest working in partnership with local homeless charities who are more likely to keep these as standard. (These kind of partnerships are essential to drug services)
• Clothing – in many places I’ve worked staff bring in spare clothing for people to have if their clothes get wet when sleeping rough
• Cardboard – why waste the boxes that deliveries of equipment come in, cardboard acts as a great insulator between you and cold ground. In fact if you can find them sleeping on wooden pallets or the plastic crates used for carrying bread (which can often be found dumped behind supermarkets) are great ways to keep off the ground
• Plastic sheeting/bags – to go under any cardboard and other bedding to avoid moisture coming through. Sealable bags are also great (the sandwich bags) as these can be used to keep important papers etc dry
  Wood – one idea could be to buy a big bag of kindling and split this into smaller bundles to give people to help them get a fire off to a good start, but make sure if you give people wood that you also give them

All these can act as a great set of engagement tools, the time taken to make people a noodle meal or for them to drink a hot drink not only will allow them to get warm, but is also a great chance to talk to people who don’t normally hang around to chat. Which of course leads onto the next important area to think about. Important information staff should give people (and know themselves):

• Effects of cold on veins – becoming cold will cause veins to appear deeper and finer, this is because the body in an attempt to get warm will move more blood to the body’s core. This is something I’ve covered previously in the Raising a Vein series
• Food and shelter – knowing the location of all the homeless shelters, soup kitchens and other places to get free/cheap food, don’t just think of the obvious ones. Places like Sikh Gurdwaras will usually give free food to any who need it
• Where to sleep – having a good local knowledge of where its best to sleep is really important, you can get this from talking to people who come into the service, but one of the best ways is by getting out there and talking to people, grab a flask of coffee and go out at night on outreach, I can tell you from experience this is a great help for both people sleeping rough and for service engagement. Make sure you tell people to avoid sleeping near water in cold weather, the moisture in the air can make the temperature 2-3 degrees colder, last week 2 people died from exposure sleeping next to a river in Ireland
• How to keep warm – as mentioned above cardboard is a great insulator when sleeping outside, but things like newspaper pushed in-between layers of clothing is amazing for keeping warmth in. You can also make a long lasting heat by putting bricks around a fire and then wrapping them in a blanket to use as a makeshift hot water bottle (if you’re building a fire be sure to contain it, and never build fires in abandoned buildings)
• Clothing – clean clothing is warmer than dirty clothing, its also important to keep clothing loose and with plenty of layers, wearing a hat is one of the best ways of keeping the body warm
• Avoid alcohol – alcohol gives a false sense of warmth while actually lowering body temperature, so under no circumstances drink alcohol or give alcohol in an effort to warm people up

With temperatures dropping below -10 centigrade we are likely to see more serious problems developing though. Please make sure you are aware of the symptoms to look out for.

Hypothermia

Hypothermia can lead to death, it’s caused when the temperature gets so low that the body looses heat faster than it can produce it. Main symptoms of hypothermia are shivering, confusion, lethargy, weakness, apathy and pale skin. There may also be slurred speech and memory loss. Please note how these can easily be mistaken for the normal signs of drug use.

Frostbite

Frostbite is where skin tissue is damaged symptoms include pale/grey, waxy skin that’s cold to the touch, numbness, localised pain, swelling, blistering. In both cases medical attention needs seeking immediately, if you suspect hypothermia then this should be treated as a medical emergency (note: people with frostbite often also have hypothermia).

Finally

Don’t just give this kind of advice to homeless users, but also to people who’s situation may involve them having to be out of the house for long periods during the day (example, one young guy I knew whose parents would lock him out the house to prevent him stealing during the time they where at work).

It’s important to allow people the time they need to get warm at this time of year. It’s a great way to engage with people and provide the time you need to do harm reduction work. But most importantly we should be doing this because it’s the right thing to do, and if we don’t then more people will die this winter.