PHOENIX >> Homeless in America’s hottest big metro, Stefon James Dewitt Livengood was laid out for days inside his makeshift dwelling, struggling to breath, nauseous and vomiting.

Every day this month, temperatures have soared past 110 degrees Fahrenheit (43.3 degrees Celsius).

Livengood said he stopped briefly at a free clinic that took his blood pressure and declared it acceptable. But he received no other medical help for his apparent heat exhaustion, or for the peeling skin on his arms he believes was caused by sun exposure. He is careful when he walks through the sprawling tent city, cognizant that if he falls, the simmering black asphalt could seriously burn his skin.

“If you’re going outside, let somebody know where you’re going so you can be tracked so you don’t pass out out there,” he said. “If you fall out in the heat, you don’t want a third degree burn from the ground.”

The 38-year-old sleeps in a structure cobbled together with a frame of scavenged wood and metal covered by blue vinyl tarp. The space inside is large enough to stand up and walk around in and features an old recliner and a bicycle Livengood uses less now that he spends more time inside with the sides of his dwelling open.

“Some of the friends that I’ve made down here, they come check on me if they don’t see me moving around,” he said.

Homeless people are among those most likely to die in the extreme heat in metro Phoenix. The city is seeing its longest run of consecutive days of 110 Fahrenheit (43.3 Celsius) ever recorded, clocking 28 in a row as of Thursday, even as the first monsoon storm of the season brought some overnight relief.

“It has been a scary situation this year and it’s especially scary for our homeless population,” said Dr. Geoff Comp, an emergency room physician for Valleywise Health in central Phoenix. “They have a more constant exposure to the heat than most of us.”

People living outside are also vulnerable to surface burns from contact with hot metal, concrete or asphalt.

Surgeons at the Arizona Burn Center—Valleywise Health recently warned about burns caused by walking, sitting or falling on outside surfaces reaching up to 180 degrees Fahrenheit (82.2 degrees Celsius). The burn center last year saw 85 people admitted with heat-related surface burns for the months of June through August. Seven died.

Record high overnight temperatures persisted above 90 degrees Fahrenheit (32.2 degrees Celsius) for 16 days straight after finally slipping to 89 Fahrenheit (31.6 Celsius) on Thursday after a storm Wednesday evening kicked up dust, high winds and a bit of rainfall.

If temperatures don’t drop sufficiently after the sun sets, it’s hard for people’s bodies to cool down, health professionals say, especially those who live in flimsy structures without air conditioning or fans.

“People really need a lot of water and a cooling system to recover overnight,” Comp said.

There is no air conditioner, fan or even electricity in Livengood’s home, just a little, flat piece of plastic he uses as a hand fan.

Unhoused people accounted for about 40% of the 425 heat-associated deaths tallied last year in Maricopa County, home to Phoenix, during its hottest summer on record. More than half of the 425 deaths occurred in July and 80% occurred outdoors.

Maricopa County reported Wednesday that as of July 22, there were 25 heat-associated deaths confirmed this year going back to April 11. Another 249 deaths remain under investigation.

Livengood’s shack stands among some 800 people living in tents and other makeshift dwellings outside Arizona’s largest temporary shelter. The tents stand close together on concrete sidewalks, and seem to increase the stifling heat from the encampment called “The Zone.”