Active Case
Heat Risk & Chronic Disease
Training note: CDC NIOSH lists confusion and altered mental status among the signs of heat stroke and describes the first-aid steps as calling 911, staying with the person until emergency medical services arrive, moving them to a cooler, shaded area, and beginning to cool them promptly while help is on the way. In real practice this is a 911 call, not a referral. Call 911 first, follow the dispatcher's instructions, and do not give anything to drink to someone who is confused. This note is orientation, not a treatment protocol: this simulator is for practice only and never replaces your organization's emergency protocols or clinical training.
Step 1 of 7: Review the case
Read what the case states, what it does not state, and what this practice case is asking you to learn.
Fictional resident
Mr. Ruben Garza
74 years old · Older adult living with diabetes
ZIP code
78207
Preferred language
Spanish for spoken conversation; some English
Coverage
Medicare
What is happening
A neighbor calls a community program during an extreme-heat advisory. She says Mr. Garza, 74, has not been outside for three days. She checked on him twenty minutes ago: the house felt extremely hot, he was awake but confused about what day it was, and his speech was hard to follow. There is no working air conditioning. He lives alone and uses insulin.
What you are practicing here
- Decide what has to be established about his condition right now, before any service is discussed.
- Separate the risks this case states from the risks a reader might assume.
- Put your chosen actions in a defensible order, and be able to say why that order.
The detailed learning objectives for this case name the intended answers, so they are shown in the debrief after you submit. The safety note on the case page is different: it states the intended emergency response deliberately, because safety information is never withheld to make an exercise harder.
What the resident says matters most
- Staying in his own home
- Not being a burden on his neighbor
- Keeping his diabetes supplies usable
Strengths already present
- A neighbor who checks on him and knows how to reach help
- Medicare coverage already in place
- Long-standing ties to his block and parish
Stated in the case
- He prefers Spanish for anything explained by phone and finds English on the phone hard
- He has an unanswered question about whether the heat has affected his current insulin pen
- Extreme-heat advisory in effect
- No working air conditioning in the home
- Neighbor observed confusion and unclear speech twenty minutes ago
- Lives alone; lives with diabetes and uses insulin
- The neighbor checks on him when she happens to think of it; there is no agreed check-in time and no named backup
- Not seen outside for three days
Not known — would need asking
- Whether he is still awake and responsive right now
- Whether anyone is with him at this moment
- What his usual baseline thinking and speech are like
- How he currently stores his insulin and what his pharmacist has advised
Social determinants in this case
Some domains are stated in the case; others are only possible mechanisms to consider and are not established here. The full five-domain framework is mapped on the Methods page.
- Neighborhood and Built Environment stated in this caseHousing without working cooling during extreme heat.
- Health Care Access and Quality stated in this caseHe lives with diabetes and uses insulin, so ongoing care matters here.
- Social and Community Context stated in this caseHe lives alone with no agreed check-in plan, and a neighbor who checks informally.
- Economic Stability possible mechanism, not establishedNot established in this case. Utility and repair costs often shape whether cooling is possible, which is worth asking about rather than assuming.
Why this is structural: Cooling in a home is not only a personal choice. Older housing stock, the cost of repairs and electricity, and the way heat-safety information is distributed decide who can stay cool. When cooling depends on household income, extreme heat becomes an income-linked health risk rather than a weather event.