Gerard FitzGerald

Projecting future heat-related mortality under climate change scenarios: a systematic review.

Background: Heat-related mortality is a matter of great public health concern, especially in the light of climate change. Although many studies have found associations between high temperatures and mortality, more research is needed to project the future impacts of climate change on heat-related mortality. Objectives: We conducted a systematic review of research and methods for projecting future heat-related mortality under climate change scenarios. Data sources and extraction: A literature search was conducted in August 2010, using the electronic databases PubMed, Scopus, ScienceDirect, ProQuest, and Web of Science. The search was limited to peer-reviewed journal articles published in English from January 1980 through July 2010. Data synthesis: Fourteen studies fulfilled the inclusion criteria. Most projections showed that climate change would result in a substantial increase in heat-related mortality. Projecting heat-related mortality requires understanding historical temperature–mortality relationships and considering the future changes in climate, population, and acclimatization. Further research is needed to provide a stronger theoretical framework for projections, including a better understanding of socioeconomic development, adaptation strategies, land-use patterns, air pollution, and mortality displacement. Conclusions: Scenario-based projection research will meaningfully contribute to assessing and managing the potential impacts of climate change on heat-related mortality.

Health impacts of floods.

INTRODUCTION Floods are the most common hazard to cause disasters and have led to extensive morbidity and mortality throughout the world. The impact of floods on the human community is related directly to the location and topography of the area, as well as human demographics and characteristics of the built environment. OBJECTIVES The aim of this study is to identify the health impacts of disasters and the underlying causes of health impacts associated with floods. A conceptual framework is developed that may assist with the development of a rational and comprehensive approach to prevention, mitigation, and management. METHODS This study involved an extensive literature review that located >500 references, which were analyzed to identify common themes, findings, and expert views. The findings then were distilled into common themes. RESULTS The health impacts of floods are wide ranging, and depend on a number of factors. However, the health impacts of a particular flood are specific to the particular context. The immediate health impacts of floods include drowning, injuries, hypothermia, and animal bites. Health risks also are associated with the evacuation of patients, loss of health workers, and loss of health infrastructure including essential drugs and supplies. In the medium-term, infected wounds, complications of injury, poisoning, poor mental health, communicable diseases, and starvation are indirect effects of flooding. In the long-term, chronic disease, disability, poor mental health, and poverty-related diseases including malnutrition are the potential legacy. CONCLUSIONS This article proposes a structured approach to the classification of the health impacts of floods and a conceptual framework that demonstrates the relationships between floods and the direct and indirect health consequences.

Evaluating the effectiveness of heat warning systems: systematic review of epidemiological evidence.

ObjectivesTo review the existing research on the effectiveness of heat warning systems (HWSs) in saving lives and reducing harm.MethodsA systematic search of major databases was conducted, using “heat, heatwave, high temperature, hot temperature, OR hot climate” AND “warning system”.ResultsFifteen articles were retrieved. Six studies asserted that fewer people died of excessive heat after HWS implementation. HWS was associated with reduction in ambulance use. One study estimated the benefits of HWS to be

Do Biometeorological Indices Improve Modeling Outcomes of Heat-Related Mortality?

468 million for saving 117 lives compared to

Occupational injury risk among Australian paramedics: an analysis of national data

210,000 costs of running the system. Eight studies showed that mere availability of HWS did not lead to behavioral changes. Perceived threat of heat dangers to self/others was the main factor related to heeding warnings and taking proper actions. However, costs and barriers associated with taking protective actions, such as costs of running air conditioners, were of significant concern particularly to the poor.ConclusionsResearch in this area is limited. Prospective designs applying health behavior theories should establish whether HWS can produce the health benefits they are purported to achieve by identifying the target vulnerable groups.

A national framework for disaster health education in Australia.

Various biometeorological indices and temperature measures have been used to assess heat-related health risks. Composite indices are expected to assess human comfort more accurately than do temperature measures alone.Theperformancesofseveralcommonbiometeorologicalindicesandtemperaturemeasuresinevaluating the heat-related mortality in Brisbane, Australia—a city with a subtropical climate—were compared. Daily counts of deaths from organic causes [International Statistical Classification of Diseases and Related Health Problems, 9th Revision, (ICD9) codes 001‐799 and ICD, 10th Revision, (ICD10) codes A00‐R99] during the periodfrom 1 January 1996 to30 November 2004were used. Several composite biometeorological indices were considered, such as apparent temperature, relative strain index, Thom discomfort index, the humidex, and wetbulb globe temperature. Hot days were defined as those days falling into the 95th percentile of each thermal stress indicator. Case-crossover analysis was applied to estimate the relationship between exposure to heat and mortality. The performances of various biometeorological indices and temperature measures were compared using the jackknife resampling method.The results showthat more deathswerelikelytooccur on hot daysthan on other (i.e., control) days regardless of the temperature measure or biometeorological index that is considered. The magnitude of the odds ratios varied with temperature indicators, between 1.08 [95% confidence interval (CI): 1.02‐1.14] and 1.41 (95% CI: 1.22‐1.64) after adjusting for air pollutants (particulate matter with aerodynamic diameter less than 10 mm and ozone). Average temperature performedsimilarly tothe composite indices, but minimum and maximum temperatures performed relatively poorer. Thus, average temperature may be suitable for the development of weather‐health warning systems if the findings presented herein are confirmed in different locations.

Early defibrillation in out-of-hospital sudden cardiac death: an Australian experience.

Objective: To identify the occupational risks for Australian paramedics, by describing the rate of injuries and fatalities and comparing those rates with other reports.

Development of hospital disaster resilience: conceptual framework and potential measurement

INTRODUCTION Recent events have heightened awareness of disaster health issues and the need to prepare the health workforce to plan for and respond to major incidents. This has been reinforced at an international level by the World Association for Disaster and Emergency Medicine, which has proposed an international educational framework. OBJECTIVE The aim of this paper is to outline the development of a national educational framework for disaster health in Australia. METHODS The framework was developed on the basis of the literature and the previous experience of members of a National Collaborative for Disaster Health Education and Research. The Collaborative was brought together in a series of workshops and teleconferences, utilizing a modified Delphi technique to finalize the content at each level of the framework and to assign a value to the inclusion of that content at the various levels. FRAMEWORK The framework identifies seven educational levels along with educational outcomes for each level. The framework also identifies the recommended contents at each level and assigns a rating of depth for each component. The framework is not intended as a detailed curriculum, but rather as a guide for educationalists to develop specific programs at each level. CONCLUSIONS This educational framework will provide an infrastructure around which future educational programs in Disaster Health in Australia may be designed and delivered. It will permit improved articulation for students between the various levels and greater consistency between programs so that operational responders may have a consistent language and operational approach to the management of major events.

Republished paper: Emergency department triage revisited.

All patients with primary cardiac disease presenting with out-of-hospital sudden cardiac death (OH-SCD) to a provincial hospital were reviewed retrospectively over a 5-year period from 1985 to 1989. This coincided with the introduction of out-of-hospital defibrillation (OH-DEFIB) by ambulance officers. Of 215 patients, 17 (9%) survived to leave hospital alive, 15 of whom underwent OH-DEFIB. There was an increase in survivors from 4%, prior to OH-DEFIB, to 9% of all cardiac arrests, but this was not statistically significant (P = 0.3). However, long term survival amongst immediate survivors was associated with a statistically significant improvement following the introduction of OH-DEFIB (15 of 30 (50%) vs. 2 of 19 (10.5%), P < 0.01). Mean call-out, at-scene and transfer times did not significantly vary between survivors and non-survivors. A total of 155 (72%) had a known cardiac history, with the majority (74%) of arrests occurring at home. Of 134 witnessed arrests, only 46 (34%) underwent bystander-initiated cardiopulmonary resuscitation (CPR). A programme in CPR aimed at relatives of known cardiac patients, and the adoption of a paramedic protocol which improves oxygenation at the time of arrest are recommended.

Validation of a Framework for Measuring Hospital Disaster Resilience Using Factor Analysis

Objective Despite ‘hospital resilience’ gaining prominence in recent years, it remains poorly defined. This article aims to define hospital resilience, build a preliminary conceptual framework and highlight possible approaches to measurement. Methods Searches were conducted of the commonly used health databases to identify relevant literature and reports. Search terms included ‘resilience and framework or model’ or ‘evaluation or assess or measure and hospital and disaster or emergency or mass casualty and resilience or capacity or preparedness or response or safety’. Articles were retrieved that focussed on disaster resilience frameworks and the evaluation of various hospital capacities. Result A total of 1480 potentially eligible publications were retrieved initially but the final analysis was conducted on 47 articles, which appeared to contribute to the study objectives. Four disaster resilience frameworks and 11 evaluation instruments of hospital disaster capacity were included. Discussion and conclusion Hospital resilience is a comprehensive concept derived from existing disaster resilience frameworks. It has four key domains: hospital safety; disaster preparedness and resources; continuity of essential medical services; recovery and adaptation. These domains were categorised according to four criteria, namely, robustness, redundancy, resourcefulness and rapidity. A conceptual understanding of hospital resilience is essential for an intellectual basis for an integrated approach to system development. This article (1) defines hospital resilience; (2) constructs conceptual framework (including key domains); (3) proposes comprehensive measures for possible inclusion in an evaluation instrument; and (4) develops a matrix of critical issues to enhance hospital resilience to cope with future disasters.