On a sunny day in mid-May, Bobby Hunt fell asleep by the side of a gas station in Phoenix. Hunt says he was waiting for a friend to pick him up.
“Next thing I know, I wake up in the hospital.”
Hunt was in a burn unit. He doesn’t remember much, just the bright lights.
“What am I doing here?” he recalled asking.
Almost three months later, Hunt stands in the empty chapel of Circle the City, the central Phoenix medical shelter for unhoused people where he’s been recuperating. He lifts his white T-shirt to reveal a lopsided, round scar the size of a medium pizza.
The burn appears to be about an inch deep, and mars the swath of intricate, black-inked tattoos of skulls and faces that once covered his back.
Below the big scar, a bandage covers another wound on his lower back. Hunt pulls the leg of his khaki shorts up to reveal a large, red rectangle where skin from his thigh was removed and grafted on to his back. He’s still in terrible pain.
Recent heatwaves in the US, stoked by the climate crisis, have caused a surge of heat-related injuries and deaths. Alongside heat exhaustion and the more serious heat stroke, there is also a summertime spike in another kind of injury: contact burns from superheated pavements and other urban surfaces.
Temperatures in the city of Phoenix reached at least 110F (43.3C) for 31 days in a row this summer. But even on a 98F (37C) day, like the one when Hunt was injured, sustained contact with the sidewalk can result in third degree burns – and potentially kill a person.
Many of these cases are brought to Valleywise Health’s Arizona burn center, where Hunt was treated. It is the only nationally verified burn unit in the state and draws patients from all over the south-western US.
The burn unit is always busy, but this summer has been particularly rough. From June to mid-August, 85 serious cases of contact burns have been treated at the hospital. This is approaching the record from recent years of 92 cases in 2020, another year of harsh heatwaves. And there have been several times as many cases of milder burns that haven’t required admitting to the facility.
Contact burns can affect anyone, with the very young and very old particularly at risk. Other high risk groups include people who are unhoused, and those who consume drugs and alcohol and become unaware of their surroundings.
Dr Kevin Foster, director of the Arizona burn center, has worked at the hospital for 24 years.
The problem with contact burns, he said, “is they’re almost always deep – at least the contact burns that we’re seeing”.
It’s because of the surfaces people are falling or otherwise landing on.
“The pavement, the asphalt, concrete, sidewalks, rocks, they get hot. And it’s not just the ambient temperature, 110 to 115 degrees [that heats them], it’s also the bright sunlight on them and no clouds.”
The temperature of hot asphalt “on a sunny August afternoon in Phoenix can be 170 or 180 degrees”, he said. “So it’s just a little bit below the boiling point of water.”
What makes these burns particularly destructive, he said, is that “most other things that are hot, once they come in contact with the skin, they tend to cool down – you know, liquids and flames and things like that. Concrete does not. The temperature stays the same.”
The damage can happen quickly, he said.
“It only takes a fraction of a second to get a deep, deep burn. And unfortunately, a lot of the patients that we’re seeing have laid on hot stuff for minutes, sometimes hours.”
Internal injuries may follow.
“Patients oftentimes will suffer central nervous system injuries,” Foster said. “The burns can cook their brains or spinal cord, peripheral nerves, cause liver failure, kidney failure, bowels not to work correctly. So we have to deal with that too, the systemic manifestations of that, which can be really severe and oftentimes end up causing more problems for patients than the actual burn does.”
When patients are brought in, the team hurries to action. After checking vital signs and administering IVs in the emergency room, hospital personnel typically dump ice on a patient. It’s not unusual to see body temperatures rocket to an incredibly dangerous 107F or 108F (41.6C to 42.2C) degrees.
In the first 48 to 72 hours, it’s a matter of giving the patient fluids and simply maintaining bodily functions. For a serious burn, a patient would be placed into a drug-induced coma.
Doctors then remove the burn by excising the damaged skin in surgery.
This leaves a “huge open wound”, Foster said, so the next step is skin grafting. Skin is removed from a healthy site and grafted on to the burn site; this is repeated until the burn area is covered.
Hospital stays can be lengthy. To calculate, take the percentage of body surface affected by a burn and multiply by two. If a burn covered 25% of someone’s body, they’d likely be in the hospital for 50 days.
The healing process is also far from quick – even when a burn does not require hospitalization.
Jennifer Longdon, a Phoenix resident and member of Arizona’s state legislature, uses a wheelchair. She sustained second and third degree burns on her hand earlier this month when she reached for a railing to access a medical building to get to a meeting.
Longdon could have let go of the railing to save her hand – but likely would have flipped out of her wheelchair and landed on the searingly hot pavement.
Recovery could take months, she’s been told.
“It hurts like hell,” Longdon says the day after the injury, holding her bandaged hand up for the Zoom camera. “This thing is on fire.”
Officials in Maricopa county, home to metropolitan Phoenix, said earlier this month that there have been 89 confirmed heat-related deaths so far this year. And close to 350 deaths are under investigation as possibly heat-involved. They did not say how many of these victims sustained burns.
The Guardian was unable to confirm many details about Bobby Hunt’s life, including whether he provided his real name. As he told it, he is 53, and is no stranger to the heat. Born and raised in the more temperate White Mountains of northern Arizona, he moved to Phoenix at 17 and got a job at a tire shop.
He said he was released from prison the day before he was injured. As well as having nowhere to live, he said that he’s disabled from a stroke he had while incarcerated.
He will always carry the scars, but Hunt said he was expected to make a full recovery. Not everyone does.
Karen Richey, a nurse who treated her first burn patient at Valleywise in 1985, said that this summer had been particularly difficult.
“We’re used to really bad burns” on patients, she said. “But we’re also used to being able to save them.”
