T he Phoenix police officers carried the handcuffed man by his arms over to a shady spot created by one of their patrol Tahoes in the apartment complex’s parking lot. “It’s pretty hot,” one of the officers said about the pavement as they set down the motionless man. They adjusted his legs, which were tucked under him. One officer asked the others if anyone had a blanket in their car. They didn’t. “It’s alright, buddy. We’re going to get you some medical help,” one of the officers told the man. They propped his shirtless tattooed torso up so his skin wouldn’t touch the ground. His chest rose gently with each breath. They asked his name. He didn’t respond. “Could it be an OD?” one officer asked. Just a few minutes earlier, they’d responded to a call about a man acting erratically. He was bashing his head into windows of an apartment complex near West Campbell Avenue and Interstate 17. They’d found him huddled in a bush next to the building. Only his hand poked out from the leaves. He loosely grasped a nearby black wrought-iron fence. When the officers spoke to him, he didn’t respond. He hummed softly and slowly let go of the fence pole. The officers tried to coax him out. They encouraged him, they threatened him with arrest, they said they could tell he was injured. They wanted to get him medical help. They spoke to him in Spanish. “He’s either 918 or very much on 237,” an officer said at one point over the radio, using police code for mentally ill or on drugs. Within minutes, they realized he wasn’t going to respond. Confident he was unarmed, they went into the bush and carried him out. They stood over him next to the Tahoe and looked around for a cooler spot. It was around 4 p.m. on July 28. Phoenix was in the middle of what would become the longest stretch of consecutive days with an excessive heat warning. Eighteen in total. Temperatures reached 107 degrees in the city that day. The pavement was much hotter. One officer suggested propping him up against one of the Tahoe’s tires. The others disagreed. Too hot. So they left him where he sat and waited for the Phoenix Fire Department. The man, later identified by the Phoenix Police Department as 42-year-old Jesse Fred, would die that day. Cause of death: Hyperthermia in the setting of acute poly- drug toxicity and environmental heat exposure. Fred’s death was one of three dramatic heat emergencies caught on video this past summer, two of which were fatal. The inci- dents, two recorded on police department body cameras and one on smartphones, show how complicated it can be to respond to heat emergencies. Heat is a silent killer, but in the lead-up, it can be violent as it was in Fred’s case. And often the signs and symp- toms are mistaken for other emergencies. “Sometimes we may just inadvertently leave it out of the equation till a little bit later,” said Ron Crawford, a retired coroner who responded to thousands of heat death cases during his career, sometimes multiple in a single day. “Maybe it should be at step two, but some places are not thinking about it till, you know, step number five.” Fred was one of 13 people to die that day in the county from heat, according to the Maricopa County Heat-Related Illness and Death Dashboard which was last updated on Oct. 17. One more death from that day remains under investigation for heat. The city of Phoenix alone received 210 heat- related calls that week. Phoenix New Times spent the summer reporting on this crisis, the city’s response and the chaos that often unfolds on the street when someone is dying of heat. EVENTUALLY, YOUR BODY DESTROYS ITSELF The human body isn’t designed to survive in extreme heat. It functions best at 98.6 Fahrenheit, give or take a couple of degrees. Heat it up beyond that, and the body compensates to cool itself down. You begin to sweat. Your blood vessels dilate, allowing more blood to flow to your extremities. Blood moves closer to the surface of your skin, to your hands and feet. Heat escapes and your body cools. As your body keeps fighting to cool down, you lose water. You lose salt. Your vision blurs. You start to feel nauseated. You get chills. Your heart races and your blood pressure drops. The blood redirected to your extremities leaves your internal organs wanting. Once you reach 104 degrees, you’re at risk for heat stroke. Stay hot enough for long enough and your organs start to fail. Your brain, too. Without enough oxygen, blood, and electrolytes, it starts to malfunction, and it may even swell. You slur your words. You speak inco- herently. You hallucinate. You may get rest- less, agitated and violent or sluggish and comatose. Eventually your body destroys itself. Certain health conditions and drugs accelerate this collapse. Diuretics, GLP-1s, antipsychotics, antidepressants, methamphetamine, fentanyl, alcohol, Benadryl. Legal or not, they get in the body’s way of saving itself. They make it harder for the body to sweat and to cool down. Or they make you less aware that you need to. “Many times when these things happen, it’s a combination of factors that come into play,” said Dr. Frank LoVecchio, an emergency room physician who regularly sees people suffering from heat stroke. The signs and symptoms of heat stroke mimic those of other emergencies — mental health, drug overdoses, even diabetic shock. Often, everything happens at once. Narcan will only help so much if someone’s body temperature is 105 degrees. Their overdose might be stopped, but that doesn’t matter if their body continues to cook itself from within. In Phoenix, it’s not uncommon for a homeless person to be mentally ill, self- medicating with fentanyl and metham- phetamine and also succumb to our desert heat. The symptoms and signs compound over time. “Some of the difficulty is how they mimic overdose symptoms,” said Maritza Arias, a behavioral therapist on Circle the City’s street medicine team. She regularly sees patients who are homeless and strug- gling with the heat. Passersby and first responders can easily mistake, miss or overlook the signs of heat stroke, delaying calls for help or proper treatment when every minute counts. Officers usually approach a call with the mindset of catching a criminal and neutralizing a threat, not the instinct to help a paramedic might bring, a police source said. Delirium or an “altered mental state,” a critical sign of heat stroke, is the least recognized of all. Phoenix police officers are trained in basic first aid and heat-related illness, said Dan Wilson, Phoenix’s communications director, in a written statement. But they rely on “the expertise of the Phoenix Fire Department to provide medical attention.” “Both Phoenix Police and Phoenix Fire provide service regardless of an individu- al’s housing status,” he wrote. The fire department declined to comment on the cases mentioned in this story. It responds to multiple heat emergen- cies a day, especially between June and August, said Todd Keller, a Phoenix Fire Department captain and public information officer. Responders go into every call with dispatcher information and an open mind, he said. If the temperature is in the 100s, they’ll always consider heat in their response. If someone is reported as being in an “altered mental state,” he said, there are many options for what it can be. A person might be suffering from a heat illness when it’s 75 degrees out and they’ve been outside all day. Or they might be acting erratically from low blood sugar but not be overheated, even on a 115-degree day. “Our job is to find that out,” he said. In Fred’s case, the various first responders trying to help him considered mental illness and drugs. When they saw the blood on his head they wondered if head trauma was a possible cause for his non-responsiveness. Someone asked if he had been beaten up or had fallen. It wasn’t until about five-and-a-half minutes after the fire department arrived — and about 30 HEAT OF THE MOMENT BY CLARISSA SOSIN This is what dying of hyperthermia on the streets looks like. Anna suffered from heat stroke in the Zone. (Sophia Elicia)