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Ramsey County Multi-Hazard Mitigation Plan, 2018 Page | 85 Mass Care Shelter Facilities – A period of extreme cold coupled with a major power outage may require emergency sheltering for those in need. Saint Paul/Ramsey County Public Health has designated shelter facilities that have agreements with the American Red Cross. Winter Hazard Awareness Week – Ramsey County helps promote and participates in the National Weather Service’s “Winter Hazard Awareness Week” held in November each year. The event provides education for residents on the dangers of winter weather and how to properly deal with it. Program Gaps or Deficiencies Generators for Backup Power to Shelter Facilities – Not all shelter locations have backup power generators. In the event of a power outage during a period of extreme heat or extreme cold, designated shelters must be ready to provide either temporary or extended periods of sheltering for those in need if there is an extended loss of power. Power Restoration – Ramsey County EMHS needs to work with utilities to develop prioritized power restoration plans. Communications – Everbridge’s open subscription service was made available to the public in September 2016 (https://www.ramseycounty.us/alerts). However, not all residents have subscribed to or follow our Facebook page to receive important messages. Additionally, there are translation services for only three languages (Spanish, Somali, and Hmong). There are over 100 identified languages spoken in Ramsey County, and more than 50 are spoken preferentially in the home. Ramsey County Emergency Management and Homeland Security will, in cooperation/coordination with other partners, place an emphasis on increasing citizen subscription to Everbridge. 4.4.8 Extreme Heat Humans need to maintain a constant body temperature if they are to stay healthy. Working in high temperatures induces heat stress when more heat is absorbed into the body than can be dissipated out. Heat illness such as prickly heat, fainting from heat exhaustion, or heat cramps are visible signs that people are working in unbearable heat. In the most severe cases, the body temperature control system breaks down altogether and body temperature rises rapidly. This is a heat stroke, which can be fatal. The NWS issues a heat advisory when, during a 24-hour period, the temperature ranges from 105° F to 114° F during the day, and remains at or above 80° F at night. Extreme heat events are linked to a range of illnesses, even death, and can exacerbate pre-existing chronic conditions such as cardiovascular, respiratory, liver, and neurological diseases, endocrine disorders, and renal disease or failure. Populations who are most vulnerable to extreme heat include persons over 65 or under 5 years old; living alone, without air-conditioning, or residing on the topmost floor of a building; and with an income at or below the poverty line. People who are exposed to heat because of recreational activities or job-related activities also are more vulnerable, including athletes, construction workers, and landscape/agricultural workers (Adapting to Climate Change in Minnesota: 2013 Report of the Interagency Climate Adaptation Team, 2013). Medical costs related to extreme heat and cold can be enormous: in 2005 the total was $1.5 billion nationwide, or more than $16,000 per patient (Union of Concerned Scientists, 2009).