Dataset Information

Determining the Impact of Heatwaves on Emergency Ambulance Calls in Queensland: A Retrospective Population-Based Study.

ABSTRACT: Heatwaves are a significant and growing threat to the health and well-being of the residents of Queensland, Australia. This threat is increasing due to climate change. Excess heat increases the demand for health services, including ambulance calls, and the purpose of this study was to explore this impact across Queensland. A state-wide retrospective analysis of heatwaves and emergency 'Triple Zero' (000) calls to Queensland Ambulance (QAS) from 2010-2019 was undertaken. Call data from the QAS and heatwave data from the Bureau of Meteorology were analysed using a case-crossover approach at the postcode level. Ambulance calls increased by 12.68% during heatwaves. The effect was greatest during low-severity heatwaves (22.16%), followed by severe (14.32%) and extreme heatwaves (1.16%). The impact varied by rurality, with those living in very remote areas and major cities most impacted, along with those of low and middle socioeconomic status during low and severe intensity heat events. Lag effects post-heatwave continued for at least 10 days. Heatwaves significantly increase ambulance call centre workload, so ambulance services must actively prepare resources and personnel to address increases in heatwave frequency, duration, and severity. Communities must be informed of the risks of heatwaves at all severities, particularly low severity, and the sustained risks in the days following a heat event.

SUBMITTER: Mason HM

PROVIDER: S-EPMC10049657 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Determining the Impact of Heatwaves on Emergency Ambulance Calls in Queensland: A Retrospective Population-Based Study.

Mason Hannah M HM King Jemma C JC Peden Amy E AE Watt Kerrianne K Bosley Emma E Fitzgerald Gerard G Nairn John J Miller Lauren L Mandalios Nicole N Franklin Richard C RC

International journal of environmental research and public health 20230310 6

Heatwaves are a significant and growing threat to the health and well-being of the residents of Queensland, Australia. This threat is increasing due to climate change. Excess heat increases the demand for health services, including ambulance calls, and the purpose of this study was to explore this impact across Queensland. A state-wide retrospective analysis of heatwaves and emergency 'Triple Zero' (000) calls to Queensland Ambulance (QAS) from 2010-2019 was undertaken. Call data from the QAS an ...[more]

PMID: 36981787

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Project description:BackgroundAssociations between short-term exposure to ambient particulate matter (PM) air pollutants and mortality or hospital admissions have been well-documented in previous studies. Less is known about the associations of hourly exposure to PM air pollutants with ambulance emergency calls (AECs) for all causes and specific causes by conducting a case-crossover study. In addition, different patterns of AECs may be attributed to different seasons and daytime or nighttime periods.ObjectiveIn this study, we quantified the risk of all-cause and cause-specific AECs associated with hourly PM air pollutants between January 1, 2013, and December 31, 2019, in Shenzhen, China. We also examined whether the observed associations of PM air pollutants with AECs for all causes differed across strata defined by sex, age, season, and the time of day.MethodsWe used ambulance emergency dispatch data and environmental data between January 1, 2013, and December 31, 2019, from the Shenzhen Ambulance Emergency Centre and the National Environmental Monitor Station to conduct a time-stratified case-crossover study to estimate the associations of air pollutants (ie, PM with an aerodynamic diameter less than 2.5 µm [PM2.5] or 10 µm [PM10]) with all-cause and cause-specific AECs. We generated a well-established, distributed lag nonlinear model for nonlinear concentration response and nonlinear lag-response functions. We used conditional logistic regression to estimate odds ratios with 95% CIs, adjusted for public holidays, season, the time of day, the day of the week, hourly temperature, and hourly humidity, to examine the association of all-cause and cause-specific AECs with hourly air pollutant concentrations.ResultsA total of 3,022,164 patients were identified during the study period in Shenzhen. Each IQR increase in PM2.5 (24.0 µg/m3) and PM10 (34.0 µg/m3) concentrations over 24 hours was associated with an increased risk of AECs (PM2.5: all-cause, 1.8%, 95% CI 0.8%-2.4%; PM10: all-cause, 2.0%, 95% CI 1.1%-2.9%). We observed a stronger association of all-cause AECs with PM2.5 and PM10 in the daytime than in the nighttime (PM2.5: daytime, 1.7%, 95% CI 0.5%-3.0%; nighttime, 1.4%, 95% CI 0.3%-2.6%; PM10: daytime, 2.1%, 95% CI 0.9%-3.4%; nighttime, 1.7%, 95% CI 0.6%-2.8%) and in the older group than in the younger group (PM2.5: 18-64 years, 1.4%, 95% CI 0.6%-2.1%; ≥65 years, 1.6%, 95% CI 0.6%-2.6%; PM10: 18-64 years, 1.8%, 95% CI 0.9%-2.6%; ≥65 years, 2.0%, 95% CI 1.1%-3.0%).ConclusionsThe risk of all-cause AECs increased consistently with increasing concentrations of PM air pollutants, showing a nearly linear relationship with no apparent thresholds. PM air pollution increase was associated with a higher risk of all-cause AECs and cardiovascular diseases-, respiratory diseases-, and reproductive illnesses-related AECs. The results of this study may be valuable to air pollution attributable to the distribution of emergency resources and consistent air pollution control.

Project description:BackgroundCOVID-19 has overwhelmed health services across the world; its global death toll has exceeded 5.3 million and continues to grow. There have been almost 15 million cases of COVID-19 in the UK. The need for rapid accurate identification, appropriate clinical care and decision making, remains a priority for UK ambulance service. To support identification and conveyance decisions of patients presenting with COVID-19 symptoms the Scottish Ambulance Service introduced the revised Medical Priority Dispatch System Protocol 36, enhanced physician led decision support and prehospital clinical guidelines. This study aimed to characterise the impact of these changes on the pathways and outcomes of people attended by the SAS) with potential COVID-19.MethodsA retrospective record linkage cohort study using National Data collected from NHS Scotland over a 5 month period (April-August 2020).ResultsThe SAS responded to 214,082 emergency calls during the study time period. The positive predictive value of the Protocol 36 to identify potentially COVID-19 positive patients was low (17%). Approximately 60% of those identified by Protocol 36 as potentially COVID-19 positive were conveyed. The relationship between conveyance and mortality differed between Protocol 36 Covid-19 positive calls and those that were not. In those identified by Protocol 36 as Covid-19 negative, 30 day mortality was higher in those not conveyed (not conveyed 9.2%; conveyed 6.6%) but in the Protocol 36 Covid-19 positive calls, mortality was higher in those conveyed (not conveyed 4.3% conveyed 8.8%). Thirty-day mortality rates of those with COVID-19 diagnosed through virology was between 28.8 and 30.2%.ConclusionThe low positive predictive value (17%) of Protocol 36 in identifying potential COVID-19 in patients emphasises the importance of ambulance clinicians approaching each call as involving COVID-19, reinforcing the importance of adhering to existing policy and continued use of PPE at all calls. The non-conveyance rate of people that were categorised as COVID-19 negative was higher than in the preceding year in the same service. The reasons for the higher rates of non-conveyance and the relationship between non conveyance rates and death at 3 and 30 days post index call are unknown and would benefit from further study.

Project description:ObjectivesAmbulance clinicians use prealert calls to advise emergency departments (ED) of the arrival of patients requiring immediate review or intervention. Consistency of prealert practice is important in ensuring appropriate ED response to prealert calls. We used routine data to describe prealert practice and explore factors affecting variation in practice.Design and settingWe undertook a retrospective observational study in three UK ambulance services using a linked dataset incorporating 12 months' ambulance patient records, ambulance clinician data and emergency call data.Outcome measuresWe used least absolute shrinkage and selection operator regression to identify candidate variables for multivariate logistic regression models to predict variation in prealert use, analysing clinician factors (role, experience, qualification, time of prealert during shift), patient factors (National Early Warning Score version 2, clinical working impression, age, sex) and hospital factors (receiving ED, ED handover delay status).ResultsFrom the dataset of 1 363 274 patients conveyed to ED, 142 795 (10.5%) were prealerted, of whom 42 362 (30%) were for conditions with clear prealert pathways (eg, sepsis, stroke, ST-elevation myocardial infarction, major trauma). Prealert rates varied across and within different ambulance services. Casemix (illness acuity score, clinical diagnostic impression) was the strongest predictor of prealert use, but male patient sex, clinician role, receiving hospital and hospital turnaround delay at receiving hospitals were also statistically significant predictors, after adjusting for casemix. There was no evidence that prealert rates are higher during the final hour of shift.ConclusionsPrealert decisions are influenced by factors other than illness acuity and clinical diagnostic impression alone. Variation in prealert practice suggests that procedures and processes for prealerting may lack clarity and improved prealert protocols may be required. Research is required to understand whether our findings are reproducible elsewhere and why non-clinical factors (eg, patient gender) may influence prealert practice.

Project description:BackgroundCalls to emergency departments (EDs) from ambulances to alert them to a critical case being transported to that facility that requires a special response ('pre-alerts') have been shown to improve outcomes for patients requiring immediate time-critical treatment (eg, stroke). However, little is known about their usefulness for other patients and the processes involved in ED responses to them. This study aimed to understand how pre-alerts influence patient care in the ED.MethodsWe undertook non-participant observation (162 hours, 143 pre-alerts) and semi-structured interviews with staff (n=40) in six UK EDs between August 2022 and April 2023 focusing on how ED staff respond to pre-alert calls and what influences their response. Observation notes and interview transcripts were imported into NVivo and analysed using a thematic approach.ResultsPre-alert calls involved significant time and resources for ED staff but they were valued as they enabled staff to prepare for a patient's arrival (practically and psychologically). High demand and handover delays at ED created additional pre-alerts due to ambulance clinician concerns about the impact of long waits on patients.Despite the risk of pre-alert fatigue from calls for patients considered not to require a special response, ED clinicians appreciated timely pre-alert information, perceiving a higher risk from underalerting than overalerting. Variation in ED response was influenced by individual and organisational factors, particularly the resources available at the time of pre-alert. Unclear ED processes for receiving, documenting and sharing information about pre-alerts increased the risk of information loss.ConclusionImproving processes for receiving and sharing pre-alert information may help ED clinicians prepare appropriately for incoming patients. Alternative routes for ambulance clinicians to seek advice on borderline pre-alert patients may help to improve the appropriateness of pre-alerts.

Project description:BACKGROUND:Little is known regarding paediatric medical emergency calls to Danish Emergency Medical Dispatch Centres (EMDC). This study aimed to investigate these calls, specifically the medical issues leading to them and the pre-hospital units dispatched to the paediatric emergencies. METHODS:We performed a retrospective, observational study on paediatric medical emergency calls managed by the EMDC in the Region of Southern Denmark in February 2016. We reviewed audio recordings of emergency calls and ambulance records to identify calls concerning patients ≤ 15 years. We examined EMDC dispatch records to establish how the medical issues leading to these calls were classified and which pre-hospital units were dispatched to the paediatric emergencies. We analysed the data using descriptive statistics. RESULTS:Of a total of 7052 emergency calls in February 2016, 485 (6.9%) concerned patients ≤ 15 years. We excluded 19 and analysed the remaining 466. The reported medical issues were commonly classified as: "seizures" (22.1%), "sick child" (18.9%) and "unclear problem" (12.9%). The overall most common pre-hospital response was immediate dispatch of an ambulance with sirens and lights with a supporting physician-manned mobile emergency care unit (56.4%). The classification of medical issues and the dispatched pre-hospital units varied with patient age. DISCUSSION:We believe our results might help focus the paediatric training received by emergency medical dispatch staff on commonly encountered medical issues, such as the symptoms and conditions pertaining to the symptom categories "seizures" and "sick child". Furthermore, the results could prove useful in hypothesis generation for future studies examining paediatric medical emergency calls. CONCLUSION:Almost 7% of all calls concerned patients ≤ 15 years. Medical issues pertaining to the symptom categories "seizures", "sick child" and "unclear problem" were common and the calls commonly resulted in urgent pre-hospital responses.

Dataset Information

Determining the Impact of Heatwaves on Emergency Ambulance Calls in Queensland: A Retrospective Population-Based Study.

Publications

Determining the Impact of Heatwaves on Emergency Ambulance Calls in Queensland: A Retrospective Population-Based Study.

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