Impact of extreme temperatures on ambulance dispatches in London, UK.

BACKGROUND: Associations between extreme temperatures and health outcomes, such as mortality and morbidity, are often observed. However, relatively little research has investigated the role of extreme temperatures upon ambulance dispatches. METHODS: A time series analysis using London Ambulance Service (LAS) incident data (2010-2014), consisting of 5,252,375 dispatches was conducted. A generalized linear model (GLM) with a quasi-likelihood Poisson regression was applied to analyse the associations between ambulance dispatches and temperature. The 99th (22.8°C) and 1st (0.0°C) percentiles of temperature were defined as extreme high and low temperature. Fourteen categories of ambulance dispatches were investigated, grouped into 'respiratory' (asthma, dyspnoea, respiratory chest infection, respiratory arrest and chronic obstructive pulmonary disease), 'cardiovascular' (cardiac arrest, chest pain, cardiac chest pain RCI, cardiac arrhythmia and other cardiac problems) and 'other' non-cardiorespiratory (dizzy, alcohol related, vomiting and 'generally unwell') categories. The effects of long-term trends, seasonality, day of the week, public holidays and air pollution were controlled for in the GLM. The lag effect of temperature was also investigated. The threshold temperatures for each category were identified and a distributed lag non-linear model (DLNM) was reported using relative risk (RR) values at 95% confidence intervals. RESULTS: Many dispatch categories show significant associations with extreme temperature. Total calls from 999 dispatches and 'generally unwell' dispatch category show significant RRs at both low and high temperatures. Most respiratory categories (asthma, dyspnoea and RCI) have significant RRs at low temperatures represented by with estimated RRs ranging from 1.392 (95%CI: 1.161-1.699) for asthma to 2.075 (95%CI: 1.673-2.574) for RCI. The RRs for all other non-cardiorespiratory dispatches were often significant for high temperatures ranging from 1.280 (95% CI: 1.128-1.454) for 'generally unwell' to 1.985 (95%CI: 1.422-2.773) for alcohol-related. For the cardiovascular group, only chest pain dispatches reported a significant RR at high temperatures. CONCLUSIONS: Ambulance dispatches can be associated with extreme temperatures, dependent on the dispatch category. It is recommended that meteorological factors are factored into ambulance forecast models and warning systems, allowing for improvements in ambulance and general health service efficiency.

Including the urban heat island in spatial heat health risk assessment strategies: a case study for Birmingham, UK.

BACKGROUND: Heatwaves present a significant health risk and the hazard is likely to escalate with the increased future temperatures presently predicted by climate change models. The impact of heatwaves is often felt strongest in towns and cities where populations are concentrated and where the climate is often unintentionally modified to produce an urban heat island effect; where urban areas can be significantly warmer than surrounding rural areas. The purpose of this interdisciplinary study is to integrate remotely sensed urban heat island data alongside commercial social segmentation data via a spatial risk assessment methodology in order to highlight potential heat health risk areas and build the foundations for a climate change risk assessment. This paper uses the city of Birmingham, UK as a case study area. RESULTS: When looking at vulnerable sections of the population, the analysis identifies a concentration of "very high" risk areas within the city centre, and a number of pockets of "high risk" areas scattered throughout the conurbation. Further analysis looks at household level data which yields a complicated picture with a considerable range of vulnerabilities at a neighbourhood scale. CONCLUSIONS: The results illustrate that a concentration of "very high" risk people live within the urban heat island, and this should be taken into account by urban planners and city centre environmental managers when considering climate change adaptation strategies or heatwave alert schemes. The methodology has been designed to be transparent and to make use of powerful and readily available datasets so that it can be easily replicated in other urban areas.

Determination of the impact of rainfall on road accidents in Thailand.

The World Health Organization has highlighted that the number of deaths worldwide due to road accidents increases every year. It recommends that countries improve road safety for all people by providing sustainable and safe transport systems by 2030, efforts are especially required within Low Middle-Income Countries (LMICS). This study is the first to investigate the impact of rainfall on road accidents in Thailand. Thai emergency data were collected from the National Institute for Emergency Medicine (NIEM) between 2012 to 2018. A time-series design with generalized linear model (GLM) was applied to analyse the associations between road accidents and rainfall. The results are reported using relative risk (RR) at 95% confidence intervals compared with dry days. The effects of long-term trends, seasonality, day of the weeks, public holidays and other meteorological factors were controlled in the GLM. A meta-analysis was applied to summarise the estimate effect of rain groups stratified by the Northern and Southern provinces. Findings reported a significant increase in road accidents due to high rainfall levels both in the Southern and the Northern provinces. The pooled estimate risks in the Southern provinces have higher estimated risks than the Northern provinces. Both Northern and Southern provinces showed the rain group with 10-20 mm/day having the highest pooled estimated risk with RR = 1.052, (95% CI: 1.026-1.079) and RR = 1.062, (95% CI: 1.043-1.082), respectively, while surprisingly, heavy rain with more than 20 mm/day reported a reduction of risks. Road accidents can therefore be associated with rainfall. It is recommended that rainfall is factored into ambulance forecast models and warning systems, allowing for improvements in ambulance service efficiency. Policymakers need to integrate road safety policies that reduce road accidents in wet weather.

The Effects of Heat Advection on UK Weather and Climate Observations in the Vicinity of Small Urbanized Areas.

Weather and climate networks traditionally follow rigorous siting guidelines, with individual stations located away from frost hollows, trees or urban areas. However, the diverse nature of the UK landscape suggests that the feasibility of siting stations that are truly representative of regional climate and free from distorting local effects is increasingly difficult. Whilst the urban heat island is a well-studied phenomenon and usually accounted for, the effect of warm urban air advected downwind is rarely considered, particularly at rural stations adjacent to urban areas. Until recently, urban heat advection (UHA) was viewed as an urban boundary-layer process through the formation of an urban plume that rises above the surface as it is advected. However, these dynamic UHA effects are shown to also have an impact on surface observations. Results show a significant difference in temperatures anomalies ( p < 0.001 ) between observations taken downwind of urban and rural areas. For example, urban heat advection from small urbanized areas ( ∼ 1 km 2 ) under low cloud cover and wind speeds of 2-3 m s - 1 is found to increase mean nocturnal air temperatures by 0.6 ∘ C at a horizontal distance of 0.5 km. Fundamentally, these UHA results highlight the importance of careful interpretation of long-term temperature data taken near small urban areas.

Utility of Ambulance Data for Real-Time Syndromic Surveillance: A Pilot in the West Midlands Region, United Kingdom.

Introduction The Public Health England (PHE; United Kingdom) Real-Time Syndromic Surveillance Team (ReSST) currently operates four national syndromic surveillance systems, including an emergency department system. A system based on ambulance data might provide an additional measure of the "severe" end of the clinical disease spectrum. This report describes the findings and lessons learned from the development and preliminary assessment of a pilot syndromic surveillance system using ambulance data from the West Midlands (WM) region in England. Hypothesis/Problem Is an Ambulance Data Syndromic Surveillance System (ADSSS) feasible and of utility in enhancing the existing suite of PHE syndromic surveillance systems? METHODS: An ADSSS was designed, implemented, and a pilot conducted from September 1, 2015 through March 1, 2016. Surveillance cases were defined as calls to the West Midlands Ambulance Service (WMAS) regarding patients who were assigned any of 11 specified chief presenting complaints (CPCs) during the pilot period. The WMAS collected anonymized data on cases and transferred the dataset daily to ReSST, which contained anonymized information on patients' demographics, partial postcode of patients' location, and CPC. The 11 CPCs covered a broad range of syndromes. The dataset was analyzed descriptively each week to determine trends and key epidemiological characteristics of patients, and an automated statistical algorithm was employed daily to detect higher than expected number of calls. A preliminary assessment was undertaken to assess the feasibility, utility (including quality of key indicators), and timeliness of the system for syndromic surveillance purposes. Lessons learned and challenges were identified and recorded during the design and implementation of the system. RESULTS: The pilot ADSSS collected 207,331 records of individual ambulance calls (daily mean=1,133; range=923-1,350). The ADSSS was found to be timely in detecting seasonal changes in patterns of respiratory infections and increases in case numbers during seasonal events. CONCLUSIONS: Further validation is necessary; however, the findings from the assessment of the pilot ADSSS suggest that selected, but not all, ambulance indicators appear to have some utility for syndromic surveillance purposes in England. There are certain challenges that need to be addressed when designing and implementing similar systems. Todkill D , Loveridge P , Elliot AJ , Morbey RA , Edeghere O , Rayment-Bishop T , Rayment-Bishop C , Thornes JE , Smith G . Utility of ambulance data for real-time syndromic surveillance: a pilot in the West Midlands region, United Kingdom. Prehosp Disaster Med. 2017;32(6):667-672.