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Will Stone reports for National Public Radio

There is a moment as heatstroke sets in when the body, no longer able to cool itself, stops sweating. Joey Azuela remembers it well.

“My body felt hot, like, in a different way,” he says. “It was like a ‘I’m cooking’ hot.”

Three summers ago, Azuela, then 14, and his father were hiking a trail in one of Phoenix’s rugged desert preserves. It was not an unusually hot day for Phoenix, and they had gotten a later start than usual. By the time they reached the top, Azuela was weak and nauseous. They had run out of water.

“On the way down, it was just like a daze. And I just remember thinking like, ‘Man, I got to get to the car, just get to the car,’ ” Azuela says. “Then, just — black.”

Azuela collapsed in the parking lot. By the time the ambulance arrived, the asphalt had singed his arms and legs, causing second-degree burns. His mother, Alicia Andazola, arrived at the emergency room to find her son covered in ice. His body temperature was approaching 108 degrees. Doctors removed Azuela’s blood with a machine to cool it.

Joey Azuela sits with his grandfather Sam Andazola in the hospital after Azuela suffered heatstroke while hiking in the Phoenix summer.Alicia Andazola

“His organs started failing,” she says. “We weren’t sure for the first couple of days if he was going to make it.”

More than 155 people died from heat-related causes in the Phoenix area last year, a new record in a place where the number of such deaths has been on the rise. Former Phoenix Mayor Greg Stanton deemed it a public health crisis, and the city has launched an overhaul of how it prepares for and deals with extreme heat.

Just as other places prepare for hurricanes, Phoenix aims to create a model program for coping with the temperature spikes and heat waves that scientists say are becoming more common across the country as the climate warms. That effort includes trying to actually lower the temperature of the city.

Already, more people die from heat-related causes in the U.S. than from all other extreme weather events. And as with other disasters, the most vulnerable are the elderly, the sick and the poor.

“Heat is like a silent storm,” says Mark Hartman, Phoenix’s chief sustainability officer. “Our goal is to actually say, ‘To be heat-ready, here are all the things you need to do.’ “

Deadly hot and getting hotter

Extreme heat is certainly not new for Phoenix, and many cities are taking steps to cope with higher temperatures. But Phoenix has the distinction of having more than 100 days a year that are above 100 degrees. Headlines of people succumbing to heat — on trails and streets, in cars and homes — are a tragic staple of summer. And the problem is getting worse.

Already, the city has six more days above 110 degrees than it did in 1970, although the all-time record of 122 degrees has held since 1990. And, as elsewhere, nights are warming even faster than days. Hartman says nighttime low temperatures in the Phoenix area have gone up an average 9 degrees in recent decades.

“We have more of these days that are at, near, or slightly above some of the key thresholds for public health,” says David Hondula, an assistant professor at Arizona State University’s School of Geographical Sciences and Urban Planning.

Hondula says roughly a third of people who live in the Phoenix metro area experience some kind of adverse health effect in the summer months. Surveys suggest more than a million people are too hot inside their homes. Some with air conditioners say they can’t afford to keep cool when the temperature soars.

Hondula attributes about half of the city’s warming to climate change and the other half to the built environment — the miles of asphalt parking lots and wide roads, the expanding sprawl of low buildings, plus the growing number of cars and air conditioners. “All those machines are dumping heat into the environment,” he says, creating what is known as the urban heat island effect.

Hondula thinks some of this can be reversed, but it will require a major shift in how the city grows in coming years, especially with summers only forecast to get worse. By 2100, Phoenix summers are expected to resemble the 114-degree averages found in Kuwait, according to modeling by Climate Central.

Hondula is working with city officials as they take a twofold approach: figuring out how to keep so many people from dying of heat-related causes and how to bring down the temperature in one of America’s fastest-warming cities. Phoenix hopes to win $5 million for the program as part of a competition by Bloomberg Philanthropies, and officials say it could serve as a model for other places grappling with higher temperatures.

“This really is the extreme case,” Hondula says. “If they are successful here, then they can be successful anywhere.”

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