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Seven times over the past two winters, doctors, nurses and staff in the emergency department of a downtown Toronto hospital took a moment of silence after a patient, often a Jane or John Doe, died from the cold.
Clinically, it is known as severe accidental hypothermia, and it usually affects the city’s homeless population. The staff at St. Michael’s Hospital are on the front lines of caring for many who live on the street.
It is sad and difficult work, they say.
“We take a pause at the end of the case and just acknowledge that there’s a human here, a person, someone who has community, someone who is loved,” said Dr. Evelyn Dell, an emergency department physician and trauma doctor.
“It’s not much, but I think that it goes a long way.”
Dell has lamentably developed an expertise in resuscitating patients with severe hypothermia. But the hospital is turning that into an advantage by studying hypothermia more closely.
It says it has saved four people who were on the brink of death from hypothermia over the past two winters.
Dell has taken the lead on a project at the hospital to better understand how to treat those with the most serious cases of hypothermia. She is part of a team that includes other ER doctors and nurses.
Teams work for hours on each patient, which takes a heavy emotional toll on the health-care workers. They hold on to the memories of the ones they saved and are learning from the ones who died.
Many Toronto hospitals’ emergency rooms become de facto shelters for those who do not have a home. No doctor wants to discharge a patient into the cold, especially at night in the heart of winter.
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So St. Michael’s Hospital figured out a solution: a partnership with a nearby shelter, Haven.
Toronto’s shelters are generally full, especially in the winter, keeping upwards of 15,000 people warm on frigid nights. But hundreds more sleep outside, or in parking lots, in subway stations and on streetcars.
Over a three-week stretch in January, the hospital was able to send 51 patients to Haven so they could remain warm and safe. Over two months, they helped 76 individuals stay warm.
“It’s been an amazing partnership,” Dell said.
Hypothermia-related deaths remain a problem across the province. Data provided by the Office of the Chief Coroner for Ontario show there were 90 deaths related to hypothermia in 2022, the highest number over the past four years. Sixteen of those people were characterized as homeless.
Hypothermia contributed to the deaths of 62 people in 2023, with nine of them considered homeless, and 57 deaths in 2024 with 11 people listed as homeless. Last year, six out of 61 such deaths involved people characterized as homeless.
The deaths are not straightforward, said Dr. Dirk Huyer, the province’s chief coroner. While hypothermia plays a role, there can be plenty of other factors including drug and alcohol toxicity, falling into lakes and rivers and homelessness, he said.
Despite those complexities, the deaths are preventable, Huyer said.
“Anything that’s non-natural where there’s a potential prevention, it’s always a concern,” he said.
“We think it’s an important public safety issue to raise and I do think hypothermia, unfortunately, is recognized as a significant issue across Ontario.”
Cold-related injuries have spiked in recent years, said Dr. Stephen Hwang, a physician and director of the MAP Centre for Urban Health Solutions at St. Michael’s Hospital.
Using provincial data held by ICES, a non-profit that houses and analyzes health data sets, Hwang found a 46 per cent increase in the rate of cold-related injury visits to emergency departments by homeless people last winter compared to the winter before. It was a colder winter, but that rate increase was not seen among everyone else, he said.
“We know that there’s often not enough space for people in shelters, and warming centres won’t turn people away, but they’re frequently packed,” Hwang said.
He also found that 72 per cent of “hypothermic events” occurred when it was warmer than -15 C.
Cold nights give Greg Cook anxiety.
The outreach worker at Sanctuary Ministries of Toronto, which offers drop-in services but is not a shelter, feels like much of the winter is not necessarily about providing a safe haven and a warm meal for those living on the streets.
“It’s more preparation: do you have thermal socks, do you have a good sleeping bag, how are you going to make it through the night, what’s the plan?” he said.
It’s next to impossible to find spots in Toronto’s notoriously full shelter system, and Cook said that on really cold nights, they tell the folks heading out to the street to stay awake, keep walking, ride the subway or head to the hospital.
“As a worker, that’s emotionally tough and hard, but I’m not the one who’s gambling with my life every night because I don’t have a warm place to go,” Cook said.
He and his colleagues have developed a manual to teach people how to protect themselves from another winter danger: burns. Many people start fires to stay warm in a tent or makeshift home, which inevitably leads to some accidents with serious consequences.
“The sad thing is the solution is simple: shelter and more affordable housing,” Cook said.
“I’ve said this a million times, but I’ll keep saying it: everyone has the right to live. At the very least, we should prevent the cold from killing people.”
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