- Welcome, everyone. We might have a few stragglers coming in who registered but aren't here yet, but
- we're going to go ahead and get started.
- I'm excited to see you all. We have not had an in-person event for a while, so thank you for coming.
- This is really good to see a lot of familiar faces, but also some new folks as well. I'm Mary Morgan
- with Heading Home of South Central Indiana. We periodically hold these kinds of trainings on issues
- that affect or are useful for different agencies and organizations throughout the community.
- We are going to be focusing on our 2025-26 winter contingency plan, which many of you were involved
- in putting together. So thank you for that.
- But before we get to that piece of our program, we are excited to have Ashton Jacobs here today. He
- is a nurse practitioner with Health Net's Homeless Initiative Program, and he is going to go over some
- information about how to take care of people in severe winter weather. So let's welcome Ashton.
- I've done in like 10 years so you know give me some grace here. So like I said my name is Ashton. I
- am a nurse practitioner with the homeless initiative program here in town. Myself and my colleagues
- we do street medicine so our clinic is whatever we carry around with us. We go to homeless shelters
- a lot of times we're at Wheeler Mission. I do some work at permanent supportive housing at Crawford
- Apartments.
- but then we also try our best to get out to wherever people are. We're pretty familiar with the encampments
- by the beeline and Switchyard Park, so on and so forth. So I was asked to put together this presentation,
- and I wasn't exactly sure about the nature and the composition of my audience, but it is basically a
- primer on the basics and the underpinnings of what to do when it's cold as far as protecting the human
- body and human life goes.
- So without further ado, cold weather injuries, a serious topic here. And we're going to start with a
- reference to my favorite film, or one of my favorite films of my childhood, The Matrix. If you recall,
- in The Matrix, humans were turned into batteries to power robots.
- which is a pretty outlandish idea. It's also horribly wrong because that's like the most inefficient
- way that you could generate power. That being said, there is some, there's a modicum of truth in this.
- We do generate a fair amount of thermal output and that's gonna be really important as we move forward.
- Either way, it's a super cool film. If you haven't seen it, what are you doing? Some nerdy stuff here.
- This is basically some of this,
- I want to kind of explain this because my opinion, if you understand some of the fundamental concepts
- associated with thermoregulation and thermodynamics,
- it better helps you understand hedge cases. You might not remember all the rules, but if you remember
- the concepts, you can apply them to help your clients, your patients out. So that formula you see in
- the top of the screen, that is the actual formula for determining homeostatic thermoregulation in the
- human body. I don't think any of us will be applying that, myself especially.
- But it just goes to show how complicated it is, the movement of all the different energies that move
- around your body. But the big rule of thumb here is that heat will always move from a hot system to
- a cold system. And it does this from a physics perspective in three different ways. Conduction, which
- is your hand.
- touches something solid, and the heat from your hand transfers to whatever object is there. Or if the
- object is hot, it transfers to your hand. You touch a hot pot in a stove, notice how fast that heat
- transfers. It is almost immediate, right? So conduction is one of the fastest ways that you can transfer
- heat from a hot to a cold area.
- Convection is the other one. Convection is really conduction with extra steps in my mind. Convection
- is when you have a heat, you have like a wind moving air through a system or you have water moving around
- a system and that is constantly pulling away heat from an area. Depending on if it's a liquid convection
- or if it is a air convection, that can be like moderate to slow heat loss in that way.
- And then radiation is the one that we really can't do a whole lot about. We are always radiating heat.
- When you think radiant heat, think about a coal in a fire. It's barely putting off any light. But you
- put your hand over it, and you can still feel the warmth coming off of it. That is an example of radiation.
- And then for human body, there is evaporation, which is not technically, from a physics perspective,
- a way that heat is transferred. But it is vitally important when you understand human thermoregulation.
- Another kind of important underpinning is the square cube law. The idea with that is that the more volume
- someone has, proportionally the less surface area they have. So surface area is the area that interacts
- with the environment around you. Things like fingers, nose, ears, these are areas with low volume but
- high surface area. You're gonna change, exchange heat very quickly in that, whereas areas with
- high volume low surface area, your core, your upper legs, these are areas that can generate heat and
- preserve it much better. So that's kind of an important underpinning to consider as well. Like if you're
- cold, what do you do? You tuck into a ball. You are effectively decreasing your surface area and increasing
- your volume by doing that.
- The final one is basal metabolic rate. A lot of things that people forget in the cold is that your nutrition,
- in terms of just raw calories, is one of the most important things. When you shiver, you can increase
- your basal metabolic rate by up to fivefold. Now that's probably not sustainable long term, but it just
- goes to show that you can increase greatly your thermal output. If you can't sustain that with calories,
- there's no way you're going to sustain that kind of thermal output either. So nutrition is vitally important.
- So these are some of the important factors. I've discussed a lot of these already. Calories, keeping
- them well fed is super important. And honestly, this is where things like fat, which have a lot of caloric
- value for low weight, is really important. Keeping dry, we talked about conduction, convection.
- Once you have water involved, the heat transfers can increase up to 25-fold. So you will lose heat a
- lot faster when wet. Layers, that's really important. And we'll get to that more in a little bit. Hydration,
- we often forget that hydration is involved with just about every metabolic process in your body. And
- so people are often deluded into not drinking as much, oh, because the water is cold. Yes, but if you
- don't stay well hydrated, you're in for a bad time. Alcohol.
- Also nicotine, these are both substances a lot of our clients use. Nicotine is going to be a tough one
- because it actually causes your veins and arteries to constrict on the periphery. So if you're already
- having reduced blood flow to your hand and you're smoking a cigarette, you're making it worse. By the
- same token, alcohol is a vasodilator. It will cause your blood vessels to expand. And so while you might
- feel great and warm for a little bit,
- If anyone knows the story of the baker who got drunk on the Titanic and survived in the water because
- he was drunk as a skunk, it's a bit of a gambit, right? You will lose your core temperature incredibly
- fast, but you'll feel pretty good for a while. So those are both substances a lot of our clients use
- that can be difficult. And then ground insulation is a huge important factor. Remember, conduction is
- the fastest way to lose heat many times. And then wind, trying to avoid the wind.
- I spent like 30 minutes trying to make up an acronym for all of these together. The best I could come
- up was Caiklin. But that's really stretching for it. So if anyone has an idea for a better acronym,
- please reach out to me. I may have to do one of these presentations later. And if so, I feel like Caiklin's
- kind of lame. But it's a nice little acronym. Might help you remember it. Calories, air, aqua, keep dry.
- which is a fancy way of saying alcohol, layers, yard insulation, ground insulation, a bit of a stretch,
- and nicotine. So things that modify the air temperature. You will always hear, oh, it's going to be
- 25 degrees today, sunny, with a chance of, you know, whatever.
- Whether things that can modify weather so the effective temperature that your body is interfacing with
- is actually lower than the bulb temperature as it stands. Wet is probably the most concerning one. I
- tell my boys who are six and three, it is one thing to be cold. It is another to be cold and wet.
- Like I said, 25 increased thermal loss when you are soaking wet. The risk of hypothermia goes all the
- way up to 60 degrees ambient temperature when you're wet, which is not that cold.
- But if you're dry, you can kind of hold out up to 40 degrees. Wind is another one. It's kind of got
- a weird curve. If it's a very low wind speed, it really doesn't do that whole lot, like 30 degrees because
- it's 27 degrees Fahrenheit with five mile an hour winds. But if you go up just a little bit to 10, it
- goes down to 16 degrees effective temperature. And it peaks out at about 40. Once you're past 40 miles
- an hour, it really doesn't make a lick of difference.
- I really hope we got bigger problems if we have 40 mile per hour winds sustained here in town. So. There
- are a lot of medical terms regarding cold weather injuries but I'm going to kind of brush over the big
- ones. But really you can divide them into two categories freezing and non freezing injuries. Hypothermia
- is basically when the body loses all of its energy all of its thermal regulation.
- globally, across the entire body. Frostbite, which we'll talk about in a bit, that's when it's more
- isolated to a specific area. Hypothermia basically starts officially when the core body temperature
- is dropping below 97
- 97 degrees Fahrenheit. However, there are three stages to it, and I forget exactly the cutoffs for each
- one, but it's kind of a spectrum of illness. In mild hypothermia, it's very vague, nonspecific. They'll
- be hungry, a little bit irritable, maybe not quite as sharp as they normally are. They could be shivering,
- right? You expect to be shivering. And the two I would like to point out is shivering and fast breathing.
- In mild hypothermia, the person still has good thermoregulation.
- is fighting back. So they're breathing faster because they're increasing their metabolism and they're
- shivering because they're trying to increase how much heat they're outputting. So what do you do? Well,
- this is a great comic that I think accurately demonstrates it. Bill Watterson, please don't sue me.
- This is from Calvin and Homs, if ever you remember, one of the greatest comic books ever made. And the
- idea here, it's grandma treatment, right? Keep them warm.
- Get them next to an area of warmth. Keep them dry. Give them something with a lot of calories, like
- the peanut butter crackers and the hot chocolate that Calvin is getting here in this comic strip. These
- are all things that kind of help someone get warm in a mild hypothermic state. And that's pretty quickly
- reversible. But it does take a lot of energy if you can even get more nerdy and talk about specific
- heat of water. To raise a small amount of water's temperature takes a ton of energy. And we are mostly water.
- If it is anything lower than mild hypothermia we are now in the area where you should not be intervening
- at all. This is now getting into like pretty serious medical conditions. If you get to moderate hypothermia
- or even severe hypothermia it has a 40 percent plus mortality rate. And so this is beyond something
- you can treat on the street and frankly
- I mean, at this point, they're going to be lethargic. They're not going to be thinking well.
- And if they say, no, I don't want to go to the hospital, I would still call 911. It's arguable that
- they do not have capacity to make that determination at this point. The big thing with higher degrees
- of hypothermia is that they are slowing down. In mild hypothermia, the body is still putting up a fight.
- But once that starts to fail, they start to fail. And this eventually results in cardiopulmonary arrest.
- the electricity in their heart basically gets all wonky and their heart will stop. So yes, if you think
- that someone is beyond mild hypothermia, then you need to be getting a medical evaluation ASAP. And
- you can start warming them immediately to try to mitigate it. Frostbite, like I said, this is where
- the injury is more specific to an area. Hypothermia is global heat loss. Frostbite is when heat is lost
- to a specific area and it freezes. And I talked about this earlier, we are about two thirds, 70% water.
- Water expands when it freezes. It's one of the few substances that does that. But if it expands, it
- causes traumatic damage everywhere that it freezes to. Areas with the highest surface area to volume
- ratios tend to be the most affected. Like I said earlier, square cube law, your toes, fingers, hands,
- nose, ears, all these places are more susceptible to frostbite.
- At first, frostbite's a tricky medical diagnosis to make because there's no real imaging or cutoff for
- it. It's a clinical diagnosis, which means that you just kind of have to decide it based off of your
- physical examination. And it doesn't look too bad. And it won't feel too bad either. The person loses
- sensation to whatever part is getting frostbitten. But the key is that something that's frostbitten
- feels hard. It feels hard because it's frozen. And so it won't look too bad. Sometimes you can
- get some blistering, like as the water freezes, it can shear blood vessels and cause like some bruising.
- But they generally don't look too bad, just kind of this pale, slightly swollen, hard section of the
- body. However, over time, the damage will become readily apparent. The most important thing I would
- say with frostbite, if you ever encounter a situation where you think you're onto it, is do not rewarm
- that area until you are positive that it can stay warm.
- You, by going into a freeze-thaw cycle over and over again, you are actually causing more harm to the
- person just by waiting it out and then warming it up once.
- So if you have a shot at warming it up obviously do so but make sure you can maintain that or you have
- a high degree of suspicion that you will be able to maintain that before you start doing it. If you
- do decide to warm like if you're trying to warm up someone from frostbite because they won't go to the
- ER or you're waiting for 911, the best way to do it if you can is kind of have tepid to warm water and
- immerse the part of the body that's frostbitten into it. It will hurt like crazy because what happens
- is is after the part of the body warms up it gets slammed with
- all these inflammatory cascades and that's when you start seeing the destruction from frostbite. NSAIDs
- work particularly well. That's things like ibuprofen if they have some on hand. But all frostbite needs
- to be evaluated because within the next three to five hours as those inflammatory markers start swarming
- into the area, it will start swelling, blistering, and then eventually
- you will start figuring out what tissue has died and what tissue has not. You will never really know
- until everything's warmed up. And you'd be surprised. Sometimes a person reclaims a lot of tissue. Other
- times, they don't reclaim a whole lot at all. And then the final part is your body basically demarcates
- one area. This is where it's alive. This is where it's dead. And then that's when you see the more typical
- signs of frostbite. Let me use my laser pointer here.
- So let's look at this one here. You can see how it's almost dry and shriveled up. That is 100% dead
- tissue. That's probably not going to come back. Maybe the bone is still alive. But this is obviously
- something that is mostly dead. Up here, it's a little more interesting. This is blistered. And you can
- see that kind of bluish discoloration. There's some tissue necrosis going on there. But it's hard to
- say how much of that finger is salvageable. I don't know how many of you have seen
- I mean, I know over this last winter when I started the job in January, I've seen a lot of partial finger
- amputations from frostbite. And that is why, you know, it's hard to tell. All of this needs to eventually
- be evaluated by a hand surgeon. But the ER is a good place to start. What I would say, too, as far as
- keeping your hands warm, a little tip is that
- Gloves are better than mittens. We talked about surface area versus volume. Mittens basically create
- one encapsule for the entire four fingers, whereas gloves allow surface area interface with the environment
- for each digit, which is why you'll actually lose heat faster with those.
- Chills Blaine, which I just call frostbite light, is a non-freezing injury. So this is where you're
- kind of exposed to the cold over time. And it causes that inflammation I talked about associated with
- frostbite, but it's a little bit more diffuse. It's a little bit less suspicious. But if you do think
- someone may have Chills Blaine, the biggest advice I give is the same as you would with anything else.
- Keep it warm, keep it dry, keep it clean, but also some reassurance that the pain goes on for a while.
- Now, if you're not a medical personnel, you're not supposed to like die
- but this is just good information to kind of have on hand. Many of our clients will refuse to go to
- ER urgent care, or they won't, but it's just some good general intel. There is a thought that Chills
- Blaine can be related to underlying inflammatory issues like lupus or autoimmune disease. I might not
- mention that to most people, but there is some evidence that people with Chills Blaine tend to have
- a proclivity towards this. And then the final one I want to talk about is trench foot.
- Well, what was formerly known as trench foot, the technical name is immersion foot now. Everyone would
- know what you're talking about with trench foot. Trench foot is, it's not specifically a cold weather
- injury, but something you often see in the cold. People don't want to take off their shoes because it's
- too cold to do so. The basic idea behind trench foot is that, you know how your fingers get pruned up
- when you're in the bathtub too long? This is basically that on steroids. You have this kind of breakdown
- of the skin, you get this big,
- Basal inflammation going all over the place. It's pretty uncomfortable. The key is just to keep it clean,
- keep it dry. Most of the time, that's enough to reverse it, but trench foot or immersion foot often
- leaves people susceptible to more serious injuries or more illnesses, and that's why it has to be monitored
- closely. That is something you will likely see in the cold, but it can happen during hot weather as well.
- Keeping warm when someone's roughing it. So this is we're now switching into What's some strategies
- that individuals can do who are unhoused that might help them stay warm during the winter? Tents a lot
- of people push for tents They think oh it's gonna insulate me and it kind of does but more from the
- wind than anything else tents actually don't do a whole lot to save you from
- from heat loss. However, they protect you from wetness, and they protect you from wind. And that is
- where their most important factor comes into. Another thing that people often forget is that a fair
- amount of heat you lose when you're sleeping is from the ground. The harder and the more metallic the
- ground, the more likely it is to sap the heat out of you.
- And thankfully, there is a pretty easy remedy for that, cardboard. Cardboard has an insulation factor
- that's about as close to some high-end camping mattresses. If you have an inch of corrugated cardboard,
- that's the equivalent, as long as it's dry. The second cardboard becomes wet. It is no longer effective.
- Excuse me while I turn this off. Another thing to mention is a lot of people
- Put fires out when it's cold, makes sense. It gives off a lot of radiant heat. That is generally a no-go,
- especially if it's inside a tent. That is extremely dangerous. But if you do it outside a tent,
- that's fine, as long as it's a well-ventilated area and it's not going to cause some sort of fire risk.
- But that's something that a lot of people do. We all kind of remember people using hand sanitizer to
- burn last year. That comes with a lot of risk, especially in an enclosed space. And the final thing,
- I told you I'd talk about this later, layers is probably the single most important thing. A lot of times,
- people want
- simple clothing, they just want one big layer that holds everything in, but there's this careful balance
- that you have to do when it's cold and you're doing any kind of activity. You do activity to get warm,
- but if your body overheats in the slightest, it will start putting out sweat.
- And sweat, when it evaporates, takes too much of your heat away. So the idea is that if you're doing
- any kind of exertion, you want to be able to shed your layers to get to the point where you're right
- at that nice equilibrium. Not too hot, not too cold. And then you can re-layer on as your activity goes
- down. Because if you do it in just one layer and then you get really sweaty, the second you stop moving,
- it's going to be a bad time. So that's some good advice.
- Lots of smaller layers is better than one giant layer. And then also, we talked about the square cupola.
- If someone is doing exercise to keep themselves warm, it is much better to do a squat than push-ups
- or bicep curls. And that's because the idea is the heat is being generated in your core and your upper
- legs. That is where it's going to be dispersed less. Your body will use blood to reroute your heat across
- your body to try to keep areas perfused. But if people are moving their hands and stuff like that, a
- lot of that heat is just going to be lost immediately.
- Uh, rubbing? Yeah, like that, no? I mean, not a bad idea. It's friction generates some heat. And I suppose
- if it's held like purposely against their body, you've basically gotten rid of all the surface area
- on the front of your palm, not to the back. I mean, it's not a bad idea. But like I would say, if someone's
- trying to exercise, I'd recommend squats, right? You're just going down, up, down, and up. You're involving
- almost all your major muscles
- And that's not gonna be lost as quickly as anywhere else But yeah, I mean do whatever you can people
- will do what they do to stay warm But as a general thumb the more you can exercise your legs, especially
- like the more that heat is gonna be kept in the core So what if someone is like you go out you're doing
- some outreach and someone's like yeah, I got a fire inside my tent Well, don't do it keep like
- encourage them not to light a fire in their tent. It's got carbon monoxide. However, there are some
- little tricks and tips that you can use to help someone use a fire to warm the inside of their tent.
- Probably one of my favorite ones is taking a stone, preferably a non-porous stone, because the porous
- ones can have water trapped inside and explode when you heat them up. But if they're non-porous, you
- can warm them up, shove it inside a sock, and then leave that inside your tent. That should disperse
- heat for about two hours or so.
- And that provides a fair bit of thermal regulation inside a tent. The other option is if you can get
- water boiling and put inside like a metal water bottle, that also confers a lot of heat to the inside.
- But if they do use a plastic bottle, they should not drink it afterwards. That's the only other thing
- to think of. And then any time they heat up an object, there will be a temptation to put it directly
- against their skin. That is a potential recipe for skin burns, so something to be careful about.
- Okay, well, what if they say, screw that, I'm just gonna burn something inside a tent anyways, no matter
- what you do. Okay, well, if they're gonna do what they do, and that's a reality for a lot of our clients,
- at the very least, I thought I'd include some information about how to make it as safe as humanly possible.
- I am in no way endorsing this. It is basically turning their tent into a potential death trap. That
- being said, there are some ways it could be done to make
- it at least somewhat safe. You'll see a picture here of a setup that I really liked as I was looking
- through it. This is really cool. Basically that jar at the bottom is filled with rubbing alcohol and
- it wicks up into this copper pipe near the top and the heat from the flame evaporates it
- And so the air circulates underneath the loop, and then it burns out through the top. That terracotta
- pot that sits over it is to collect the heat and then radiate it out slowly over time. It was a pretty
- cool setup. So I mean, if they have to do it, if you come across someone doing something like this,
- I'd say you are in no way obliged to enter that tent, because that is putting you at danger for carbon
- monoxide poisoning, that sort of thing.
- But if someone absolutely has to do it and they are hell bent on it, then I would say a setup like this
- with a stable base or with a small flame that is unlikely to cause a major fire risk is the best way
- to possibly do it. And also keeping good air ventilation. You want a source of air coming in from the
- base of the tent and exiting out the top to create continuous airflow. I'd also remind you a lot of
- our patients clients are using substances that
- greatly impairs their judgment or their judgment is impaired anyways. It will be a case by case basis
- on how you navigate this, but the reality is if you ever find someone burning something inside their
- tent, you know, do what you can to mitigate the damage that they could potentially cause to themselves.
- And that is everything I've got. Does anyone have any questions for me?
- So mittens the idea that you're all your non thumb fingers are encapsulated in a single pocket is superior
- because it decreases the surface area of each individual finger. I mean something's better than nothing.
- And the best setups I've seen are taking gloves like wool gloves. Wool does very well even when wet
- as an insulator. So wool gloves inside a mitten is probably your best bet.
- Because the wool gloves can be exchanged out if they get wet. And then you can keep the actual mitten
- dry. And like I said, that's important. Any other questions? All right, sweet. Well, here's my sources.
- And there's my presentation. Thank you very much. Thank you. Thank you so much, Dash. And that was really helpful.
- Talk amongst yourselves while I change to a new slide deck. Don't notice the man behind, the woman behind
- the curtain. Tell a good dad joke.
- That was a very quick talk amongst yourself. Sorry about that. We're just going to move right into our
- 2025-26 winter contingency plan discussion. Are you with me? OK, great. We want to give props to all
- of you who have been doing this for so many years.
- And then especially to the Wheeler Mission crew, who at the end of last season had some meetings that
- were foundational for looking at how we can improve our work related to severe weather planning. We
- at Heading Home picked up that work, used that baseline, and had additional conversations with many
- of you in this room and other community members.
- talking about how we're doing things previously and then how we can make them better. One of the things
- I wanted to do with this group to start off with is take a look back at the last season or previous
- seasons and kind of reflect on what do you think worked really, really well that we should definitely
- keep doing? And maybe what are some of the things that we can improve on? So these are just some questions.
- Who or what do you think was
- instrumental in meeting some of the winter needs last year. Just shout it out. The Church Warming Center,
- the BSWERS Warming Center. I know a lot of people use that and had some interactions with that. I don't
- think there is anybody here right now from BSWERS. I don't think they could make it. But we'll talk
- a little bit about some changes there later in this presentation.
- So Beastverse, yep. Anything else that we should just absolutely give props to? Wheeler Mission. Wheeler
- Mission. I'm going to come over here, Bill, and I'm going to have you tell me why Wheeler Mission did
- such a great job. Oh, it's really easy. They are the big shelter in town, and they've bent over backwards
- to help folks get in and lower barriers as much as possible.
- Yay, Wheeler. Yay, the Wheeler crew over here. All right. What are some of the positive outcomes that
- you saw last season? Are there any examples of things that you saw as part of that winter contingency
- effort last year that you'd want to give some shout outs to? Celebrate. Any individual or something?
- OK, Charles.
- I have to because because our friends here at Katz need to need to hear you through the microphone again.
- Jamie from the county sends out emails in regards to weather changes and advisories and that has been
- incredibly helpful.
- Yay, Jamie. Jamie was invited, and she and her crew had some training in another community. So we did
- not have her here, but we're going to get into a little bit later her new role and that department's
- new role at the Monroe County Emergency Management. And then what lessons did you think you learned
- during the last season that we should apply this time? Are there things that you
- change during the year that you feel like we need to make sure that we continue? Anything like that?
- Yeah, Melissa? I think that our end, like, we had a couple days or a week or so of just severe weather
- and the fact that everybody just pitched in. I think that was the biggest lesson as to how well we were
- made to and how we can really kind of hit on that as well, just to make sure that nobody freezes to
- death, nobody dies. Yeah.
- Katz viewers. Melissa was just saying there was a period where there were a couple of weeks of really
- severe weather. People really pitched in, coordinated, really worked together as a community very, very
- well to make sure that nobody died. And that's our goal, right? That nobody dies or suffers from severe
- injuries. All right. So let's give a round of applause for last year. Yay. Okay.
- On your tables, there's a QR code. There's a QR code here to the 2025-26. Severe weather sheltering,
- we used that instead of winter contingency just so that people might understand a little bit better
- what that is. This is a heading home led effort with many of you involved to really put together something
- that the community can see.
- and that can demonstrate how coordinated we are and a few new elements that we're adding to see if we
- can make it even better than last year. And of course, our objectives to prevent injury or death,
- number one. So there are a lot of people that don't necessarily go into shelter. We want to make sure
- that everybody has a place where they're comfortable and safe during winter weather that's very severe.
- So just a general description.
- This takes effect November 1st through March 31st. Obviously there are other days before and after that
- period that we might need to activate but that's the general time when we put this winter contingency
- plan into effect. There are some changes in the community and how we do things to make that happen.
- One of the big changes this year is that Jamie Nibel and the Monroe County Emergency Management Department
- is going to take the lead
- in activating white flag nights. So in the past, and I think this was particularly true for BSWERS,
- the faith-based shelter, everybody was kind of making their own call and using different temperature
- or other criteria. And so we're giving that responsibility to Jamie. We've had some conversations with
- her. We're excited about this new role that she's going to play.
- So she will have access to the forecast. And as Charles mentioned you know they do that already. So
- what additional step they'll do is based on these temperature and wind chill criteria. She will send
- out emails to distribution lists that we will provide for her which will include all the partners that
- are involved in winter contingency as well as heading home so that everybody knows that OK from this
- date to this date
- We expect that there will be white flag nights and we'll need to start our winter to contingency protocols.
- So that is a great thing I think for our community and what we are excited about is the possibility
- of talking with other counties in our region to see if their emergency management departments would
- take on that same role. So we have a centralized point where everybody can look to to get that information.
- And then we're going to do a partner round up. So the.
- Details of all these groups are in the full winter contingency plan, which is on your table or through
- the QR code online. But we really wanted to just go over. And if there are those of you that have not
- met some of the people that are involved in these shelters, that you have a chance to do so now. So
- I guess I'd really like to just have folks who are from some of these different agencies just raise
- your hand so everybody can know who you are. I don't see anybody from New Hope here. Am I wrong?
- Anybody from New Hope? No. How about Monroe County Youth Services Bureau. They are dealing with the
- youngins. I don't see anybody here. I do see people from Wheeler Mission. So yay. All right. We have
- folks from Beacon. I don't think they're here. Middle Way House also. I don't see them. So we miss them.
- They're here in spirit.
- These are the places that are operational and that will be adapting in some ways when there are white
- flag nights. And then this is the BSWARE's program that we mentioned earlier, the Bloomington Severe
- Weather Emergency Shelter. One of the big changes that is happening this year is that there is a new
- church that's going to be involved. So last year, there were two churches, First Christian Church and
- First United Methodist downtown.
- And earlier this year, the congregation at First Presbyterian Church downtown also voted to join this
- effort. So yeah, let's give it up for BSWARS. They need to activate, oh yeah, go ahead.
- Yes. So there the fire was on the roof it was contained. And as far as I know unless things have changed
- since I last talked to Caleb they're still good to go. Yeah.
- They do need a little more time to activate because it's a volunteer-based group. So that's one of the
- things we're going to communicate to Jamie, that we need as much time in advance. And that's a little
- tricky, right, because weather changes. So we'll see how that goes. And they primarily prioritize women
- and people with medical conditions, but they also take other folks as well. And then crisis intervention
- and winter outreach
- Shout out to our friends at Stride. Jennifer's in the back. Stride Center does offer some of emergency
- overnight capability but I think that that is I'm going to ask Jennifer to speak to that a little bit
- and also to the role that you play in the mobile response. Can you come up here. I told you I was going
- to put you on the spot.
- Hi, everybody. I didn't know I was getting the microphone. Awesome. So firstly, let's just say we did
- an amazing job last winter. So let's keep it going. I'm all inspired again. But the Stride Center is
- definitely here, as you all know, for 24-7, 365 walk-ins. So we greet a lot of individuals at the door.
- And in the winter, come on in. I'm not gonna misrepresent that we don't reach out to our lovely folks
- at Wheeler and our awesome partners at Friends Police Shelter as well. And then also the Emergency Winter
- Shelter to see if there are shelter capacity for the individuals at Stride.
- because we do want to reserve the space that is available at the Stride Center for individuals who cannot
- access a safe space to sleep, right? So I think that's kind of where we come into play is mobile crisis
- was out on the streets last year. We were definitely showing up in the nighttime hours at the emergency
- winter shelter.
- because our experience from what we viewed, there were still individuals that were lined up outside
- of the church and there just wasn't enough room. So our team volunteered to go put them in the car and
- figure out how to keep them safe with these goals in mind. We ended up sometimes having two teams of two
- Going out so two cars out on the road Because we definitely wanted to keep in mind that when it's a
- very cold outside We got to go fast, right? We had a great representation as well. Shout out to our
- sheriff's department officers in our BPD officers because they're very familiar with first of all how
- to encourage someone to get in their car as well and come to the strike center and our officers are
- phenomenal and
- They bring them to our front door as needed throughout the winter. So do we have beds? No, Stride doesn't
- have beds, right? Because we're not licensed as a shelter. Are we going to welcome an individual who
- is experiencing homelessness into the Stride Center?
- Yes, we are. We're sorry we don't have a comfy bed, but we do have a warm, safe space for you. And we
- also have peers in recovery and crisis specialists that will try to support you in any way that we can.
- So some mornings at Stride, we did have 10 to 16 people hanging out with us. And that's OK. Stride wants
- to continue to partner as a resource here in our community.
- We definitely want to be available. If you all ever want to bring anybody over, go ahead and do it.
- And encourage folks to seek the Stride Center or call the Stride Center and ask for Mobile to come and
- pick them up anytime in the winter. We will be transparent if our teams are busy. But Mobile also swooped
- into several tents outside
- who just miraculously survived super cold nights for people who still chose to sleep outside at night.
- And we were able to bring them to other resources or the Stride Center to warm up as well. I love our
- community. We are amazing. I'm proud of all of you. And we're here for you. Thank you Jennifer. You
- have a question. So I was asking about the 23 hour safe stay.
- So if they were to pick someone up one night and then they're back on the streets the next night. What
- is the protocol for that I guess. Did you hear that Jennifer. What is the protocol if somebody stays
- the 23 hours and then comes wants to come back the next day. Welcome them back.
- the next night as well. We are going to continue to encourage use of safe shelter and verify safe shelter,
- so I don't wanna falsely advertise that. And we're also gonna offer a safe ride to that shelter if it's
- available. I think Nicole and Patrick got used to seeing us pull up there a lot last year. All right,
- great. Also wanted to give a shout out to HealthNut, the Homeless Initiative Program.
- during their, the winter, I mean, they're out on the street all the time, right? But during winter weather,
- they also mobilize for unsheltered individuals. And the Bloomington Fire Department Mobile Integrated
- Health Unit. Woohoo. All right. This is an important piece of our communication and the services that
- are provided here. Jennifer spoke a little bit about transportation. That is an ongoing challenge, right?
- One of the things that happens as she mentioned is that there is somebody might show up at one place
- there's not a bed available. And so how do we transport that to a place where there is a bed available
- or another warm shelter. We have talked with Bloomington Transit and they have offered to do a pilot
- program with us to be available if there is enough advance notice for them. So we're going to check
- it out if there is a 12 hour notice they can have one of their bus
- has come to the B-Swares location if we think that's where the need is going to be to transport people
- to Wheeler or to Wheeler if we think that there's going to be need to transport to B-Swares. One of
- the key things that we are missing is that piece of how do we find out where the available beds are.
- One of the things that is exciting to me, we have an organization in town called Binary Heart.
- that is exploring the development of an app that would allow us to in real time identify the number
- of beds that are available. And we have Henley here is from Binary Heart. Henley do you want to say
- a few words about that effort. Hi I'm Henley Wolin I'm a national board member for Binary Heart. Our
- focus is on empowering people through the use of
- surplus technology, but we also have an app development arm. And after talking to Mary, I thought, and
- you'd share an article about some, there's a program in San Diego where somebody's developed an app
- where people can look at available shelter beds and then be able to reserve a space.
- in a shelter. I don't know if we're going to go that far, but I think it'd be nice if there was a central
- inventory of shelter beds so all the shelter providers can look and see. So like say Wheeler is filter
- capacity, but there are two beds over at Friends Place that you, instead of like having to make tons
- of phone calls, you can just look and see, oh, you can go over to Friends Place and there's a space for you.
- That's the idea. Thank you. Thanks, Henley. So as I said, this is in very early stages of development.
- And one of the things that Henley would like to do at some point is to talk with the shelter providers
- to see how that might work. But I think that that's a thing that is a really creative approach to problem
- solving that I hope we can capitalize on.
- We also rely on day centers and warming centers. We do not have the current list yet but we will be
- updating the winter contingency plan with that information as soon as we get it. They are in fire stations.
- Of course the library serves that role in some capacity and as well as day centers the Shalom Center
- and the Wheeler mission.
- day center. Now that is going to even in your reconstruction and renovations that's still going to be
- open. OK. Awesome. And then animal care is an important piece of the puzzle. Some people don't go into
- shelter because they don't want to leave their
- Dear furry friends so we have several we have a couple of organizations primarily the Monroe County
- Humane Association that will step in and Andrew Krebs had attended some of the meetings when we were
- developing this plan so they're on board with that. The animal shelter for the city of Bloomington does
- have a temporary shelter but it is shorter than the Humane Association.
- And then there are some after hours assistance numbers to call. And so that brings us to general Q&A.
- What I would hope to do is for you all to tell us what's missing. What do we need to pay attention to?
- What are some things that you feel have been either overlooked or not highlighted?
- So that we can add to this living document because we are definitely not saying this is a Document written
- in stone. We need to keep learning and improving And so one of the things we hope to do here was to
- get some more feedback from you all So is there anything that you have seen noticed? Yeah Hang on
- Last year, we had came across an individual that went to one of the day warming centers, and that warming
- center did not know they were a warming center. So yes, I feel like that might need to be addressed
- at some point. Yes, indeed. OK. Do you happen to know the category of warming? Like, was it a? I don't
- want to say it's too close to Shelby, but it was a firehouse. OK. OK.
- Well, I think that that's really important feedback. Because one of the things that we need to do for
- all of the resources that we have is make sure that they are up to date and not misleading, right? Because
- the last thing you want is somebody to slog through a snowstorm to a place where they're not available
- for help. Yeah, yeah. OK. That's great feedback. We will definitely keep an eye on that. I think you
- and I already talked about that. I think they're updated now. They are updated? OK. I think you and
- I already talked about that. Yes, we did.
- And so I will update the plan. Do you know where they live? Can you send me a link? Online? Sure. OK,
- that's great. And then I'll just update the plan. Fantastic. Anything else? Bill, looks like you're
- thinking. No? I'm just thinking of the list of things I need to do. That's it. OK. Yeah, Bobby. Every
- year we have a conference of township
- Every year this man presents that look that is up in the Indy area, Noblesville and in that area. And
- he has a mobile unit. It's a bus. Have we had him come down maybe to talk because he goes where the
- people are. They can sleep in the bus. They have coffee. They have he keeps
- like vending machines that have toothpaste and toothbrushes. So it's a mobile unit that goes where people
- are staying on the streets. And we haven't had him come yet, have we? Do you have it? I have it at work
- because he's also expanding. It is the most wonderful program, the way this guy has it set up. And he's
- expanding.
- I think offering to increase the area he covers, he wouldn't be every night, but he would rotate through
- a community if they're interested in him being there. But I'll get that to you, because I think we should
- have him come and talk to us, because this was his idea, because he had been homeless. This was the
- solution he came up with, and he's created this just incredibly humanistic way of getting to the people
- that are most needing help.
- So I'll find out for you. Does this sound familiar to anybody? Anybody heard of this particular program
- out of Indy? No. And for those of you who don't know, this is Bobbi Summers. She's awesome. She's with
- the Richland Township Trustee's Office in the Ellitsville area. So if you could send that to me, yeah,
- we can get in touch. I thought you could come and do a presentation at one of your meetings so we can
- start. And then problem solve how we might
- I'm all about picking brains. Thanks Bobby. Any other feedback things we should change make sure that
- we are paying special attention to as we head into the winter which guys it's coming. I looked at the
- calendar the other day November 1st is how many weeks away. Not too many two weeks. Oh my gosh.
- Any other feedback on this plan. All right. Well what I hope you can do is after you cogitate and reflect
- that if there are other changes to make that you can get in touch with us here at Heading Home. We're
- housing the plan and updating it and making sure that we actually follow through on some of the things
- that this plan outlines.
- And so my email and phone number is here. This is a happy picture that we need to update, because we
- have some new staff coming to Heading Home. And it's a good opportunity for me to introduce
- Erin Reynolds-Nylund, who is new to Heading Home. She's our new Housing Solutions Director, and will
- be overseeing the case managers for street outreach and diversion prevention that we're bringing on
- board. So let's give it up for Erin. Yeah, right.
- And of course, Tatiana Wheeler, who is my partner at Heading Home for all these many years. Did you
- have another question? How do we find out when it's a white flag day? Well, if you recall, so Jamie
- Nibel is going to be the one for the Monroe County Emergency Management Department who will make that
- call. And we're going to give her a list of everybody who is part of that
- response team. If you want to be on the list, let me know. Because really what we're focused on at this
- point are all of the agencies that are partnered here. SCAP is not, but maybe it should be. And maybe
- that's a, yeah, we'll talk later about.
- Yeah, it's gonna be blasted out on social media as well. So that would be, but I think that that's a
- good point, that people who maybe are not part of the response, but that are working with clients that
- would need that information, that's a good point. So we'll be putting that distribution list together
- and then sending it out to folks to get feedback on who else needs to be involved in it. All right,
- good feedback, yep. Sorry I'm coming in late with this, but just one more point that I thought
- might be interesting to bring up to the group at large and I could task myself with this as much as
- anyone but I think this plan is great working with the resources that we have. One thing that if we
- if we really wanted to get folks indoors going forward is just to explore any kind of options we can with
- pets and animals. I think that's the biggest barrier right now and has been traditionally and I am that
- the human the Humane Association program is such an incredible resource. But but just the the the limited
- capacity is you know I mean there's only so much they can do. And I think if we could come up with a
- with a long term sort of a widespread solution to that quandary we might we might see some real difference
- in getting folks indoors because that's that's that I think that's the biggest barrier.
- that I've observed over the years. Let me ask you this. So even with a resource of a place for their
- pet to stay, their companion to stay, they might not want to be separated for it at all. So really what
- our lack is is places that will accept both the humans and the animals. Yeah. Yeah. So I know Friends
- Place does that. I don't think.
- I don't think Wheeler does. Service animals only. Service animals only, OK. And I'm not sure about beeswars.
- I think they do, but I. Yeah, OK, good. Thank you. Thank you for remembering what was on the slide better
- than I did. So beeswars also does. But I think you're right, Bill. We are hearing more and more that
- there are more people who are having companions. Those pets, so. Yeah.
- a quandary without a solution. It just is, I think, identifying that. Identifying the quandary is the
- first step, right? So thank you. All right. Any other feedback as we move into our winter weather? Yeah?
- I was just going to say, making sure that the plan is shared with all community resources, and maybe
- with the boundaries, Red Cross. Because I think people go to a lot of those places that they don't touch.
- And so as long as they're aware of that,
- That is a really good point. So making sure that the plan and the distribution list includes food pantries
- and folks like SCAP and the Red Cross, Salvation Army, some of those other places, the faith-based
- communities, right? I think that's a great idea. Yep. Oh, I like that too. Making a one-page flyer with
- a QR code linking to the plan. Yeah.
- Great idea. OK, cool. That's what this is for. Yay. Glad we're getting such great feedback.
- Anything else? Yes. Oh, I'm sorry, Bobby. Yeah, I just wanted to ask, do we not just have QR codes?
- Because a lot of people I work with don't have the resources for it, don't know how to use it.
- They're first. Heard. Me included. OK, fair enough.
- Understood. So have flyers, QR codes, the URL for a web address, but also hard copies, right? So at
- your office and all these other places, just hard copies of the plan or connecting with them and suggesting
- the agencies print out copies for their folks. Good suggestion. Anything else before we break for the day?
- I'm sorry, I feel like I've had my back to you most of this time. All right, well, thank you again.
- Please give yourselves a round of applause for the work you're doing in our community. Thank you, and
- have a good day.