[Hot weather and health risks in the focus of the Hessian health authorities : Inspection and consultation of residential care and nursing facilities since 2004]. / Hitzeschutz im Fokus der hessischen Betreuungs- und Pflegeaufsicht : Beratung und Prüfung stationärer Einrichtungen seit dem Jahr 2004.

BACKGROUND AND AIMS: Heat extremes are associated with considerable health risks, especially for vulnerable groups. To counteract these risks, public health policy calls for protective measures to be linked to heat warnings. Such links do not generally exist in Germany, with the exception of the heat inspections and consultations carried out by the Hessian health authorities since 2004. The aims of this work were to identify the structures and processes of the Hessian heat inspections and heat consultations and to derive findings for acute response to heat in residential care and nursing facilities. METHODS: We conducted 14 qualitative, semi-structured interviews with experts from the Hessian health authorities as well as with managers of residential care and nursing facilities. The analysis of the interview protocols was carried out using content-structuring qualitative content analysis. In addition, documents from the supervisory authority were analyzed. RESULTS: Every year, up to 370 heat inspections are carried out in the approximately 2500 inpatient facilities in Hesse. They are either integrated into already planned inspections or carried out separately; they focus on preventive and acute measures. In principle, heat protection can be easily integrated into the daily routine of residential health facilities. High staff turnover and lack of resources pose challenges. DISCUSSION: Inspections and consultations on heat management raise awareness of hot weather health risks and support the establishment of preventive measures. The Hessian system is a suitable orientation for other federal states.

[Health protection against heat extremes in Germany: What has been done in federal states and municipalities?] / Gesundheitsschutz bei Hitzeextremen in Deutschland: Was wird in Ländern und Kommunen bisher unternommen?

BACKGROUND: Heat extremes are one of the most perceptible health risks of climate change. In the field of prevention, Germany relies on recommendations for heat health action plans and on programs to support such measures. OBJECTIVES: To give an overview of measures and projects for the prevention of heat-related mortality and morbidity that have been established in Germany. MATERIALS AND METHODS: Activities and projects covering heat and human health since 2003 were identified by database and Internet search. Projects just indirectly related to human health were excluded. We recorded federal states and funding agencies, and which of the eight core elements of the Federal Ministry for the Environment recommendations for action are addressed by the measure. RESULTS: Of the 190 projects, 19 can be assigned the keyword "heat health action plan", although these are very heterogeneous activities. The individual measures partly covered several criteria of the recommendations for action: 70.0% concern urban planning and construction, 37.4% information and communication, 24.2% vulnerable groups, 17.9% reducing indoor heat, 15.3% the use of a heat warning system, 13.7% each for central coordination, interdisciplinary cooperation, and the preparation of health and social systems, and 5.3% refer to monitoring and evaluation of measures. DISCUSSION: The number of measures and projects in Germany is considerable. However, it remains unclear whether these actions meet the criteria for effective medium- and short-term protection.

[Monitoring heat-related mortality in Hesse]. / Monitoring hitzebedingter Sterblichkeit in Hessen.

BACKGROUND: Continuous monitoring of the mortality phenomenon is given high priority in the current recommendations for the preparation of heat action plans in Germany with respect to problem detection and evaluation of interventions. International monitoring systems are heterogeneous concerning the procedures used. In Germany, such monitoring systems are rarely established. OBJECTIVES: Under what circumstances can a mortality monitoring system be operated on a regional basis using routine data? MATERIALS AND METHODS: Summer mortality data from Hesse from 2000 to 2018 and their associations with climate variables were analyzed. Different approaches regarding spatial analyses, definition of excess criteria, and adjusting procedures were explored. RESULTS: In Hesse, daily mean temperatures averaged over all operating weather stations proved appropriate as a climate parameter. The expected daily number of deaths was estimated by a moving average based on 25 daily mortality datasets from reference periods of five years adjusted for mortality peaks using data from three previous years. Mortality excess was defined as twice the value of the standard deviation of the expected values including an empirically determined temperature threshold. This threshold was derived from analyzing relative frequencies of observed excess number of deaths per 1 ℃ temperature interval. Based on this approach, 49 mortality excesses with a total of 889 excess deaths were estimated in Hesse during days with a daily mean temperature of more than 23.0 ℃ during summer from 2005 to 2018. CONCLUSIONS: The system described in this article turned out to be practicable for systematically monitoring mortality during summer. Timely availability of mortality and climate data is crucial.