Peter Aitken

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

Demand for public hospital emergency department services in Australia: 2000–2001 to 2009–2010

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.

Review article: Emergency Department implications of the TASER.

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.

A national framework for disaster health education in Australia.

Objective: Hospital EDs are a significant and high‐profile component of Australias health‐care system, which in recent years have experienced considerable crowding. This crowding is caused by the combination of increasing demand, throughput and output factors. The aim of the present article is to clarify trends in the use of public ED services across Australia with a view to providing an evidence basis for future policy analysis and discussion.

Development of health risk-based metrics for defining a heatwave: a time series study in Brisbane, Australia

The TASER is a conducted electricity device currently being introduced to the Australian and New Zealand police forces as an alternative to firearms in dealing with violent and dangerous individuals. It incapacitates the subject by delivering rapid pulses of electricity causing involuntary muscle contraction and pain. The use of this device might lead to cardiovascular, respiratory, biochemical, obstetric, ocular and traumatic sequelae. This article will summarize the current literature and propose assessment and management recommendations to guide emergency physicians who will be required to review these patients.

Exploration of the health risk-based definition for heatwave: A multi-city study.

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.

Education and Training of Australian Disaster Medical Assistance Team Members: Results of a National Survey

BackgroundThis study attempted to develop health risk-based metrics for defining a heatwave in Brisbane, Australia.MethodsPoisson generalised additive model was performed to assess the impact of heatwaves on mortality and emergency hospital admissions (EHAs) in Brisbane.ResultsIn general, the higher the intensity and the longer the duration of a heatwave, the greater the health impacts. There was no apparent difference in EHAs risk during different periods of a warm season. However, there was a greater risk for mortality in the 2nd half of a warm season than that in the 1st half. While elderly (≥75 years) were particularly vulnerable to both the EHA and mortality effects of a heatwave, the risk for EHAs also significantly increased for two other age groups (0 – 64 years and 65 – 74 years) during severe heatwaves. Different patterns between cardiorespiratory mortality and EHAs were observed. Based on these findings, we propose the use of a tiered heat warning system based on the health risk of heatwave.ConclusionsHealth risk-based metrics are a useful tool for the development of local heatwave definitions. This tool may have significant implications for the assessment of heatwave-related health consequences and development of heatwave response plans and implementation strategies.

Pre- and post-deployment health support provided to Australian Disaster Medical Assistance Team members: Results of a national survey

BACKGROUND As heatwaves are expected to be more frequent, longer, and more intense in the future, it is imperative to understand how heatwaves affect health. However, it is intensely debated about how a heatwave should be defined. OBJECTIVES This study explored the possibility of developing a health risk-based definition for heatwave, and assessed the heat-related mortality in the three largest Australian cities. METHODS Daily data on climatic variables and non-accidental deaths for Brisbane, Melbourne and Sydney during the period 1988-2009 were obtained from relevant government agencies. Several local heatwave definitions were tested by using percentiles (e.g., from the 75th to 99th centile) of mean temperature with duration ≥2 days across these cities. We examined the relative risks of mortality associated with heatwaves in each city using Poisson generalised additive model, after controlling for long-term trend, within-season variation, day of the week, and relative humidity. Then, Bayesian hierarchical model with segment-spline was used to examine the threshold for the heatwave-related impacts. RESULTS A consistent and significant increase in mortality during heatwaves was observed in all three cities. The pooled data show that the relative risk of mortality started to increase around the 95th centile of temperature, increased sharply at the 97th centile and rose alarmingly at the 99th centile. Based on research findings, we proposed tiered health risk-based metrics to define a heatwave. CONCLUSIONS Our findings provide supportive evidence for developing health risk-based metrics to assess the impacts of heatwave. These findings may have important implications for assessing and reducing the burden of heat-related mortality.

Swine flu and travelers: an Australian perspective.

INTRODUCTION Calls for disaster medical assistance teams (DMATs) are likely to continue in response to international disasters. OBJECTIVE As part of a national survey, the present study was designed to evaluate the education and training of Australian DMATs. METHODS Data were collected via an anonymous, mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 Southeast Asia tsunami disaster. RESULTS The response rate for this survey was 50% (59/118). Most of the personnel had deployed to the tsunami-affected areas. The DMAT members were quite experienced, with 53% of personnel in the 45-55-year age group (31/59). Seventy-six percent of the respondents were male (44/58). While most respondents had not participated in any specific training or educationalprogram, any kind of relevant training was regarded as important in preparing personnel for deployment. The majority of respondents had experience in disasters, ranging from hypothetical exercises (58%, 34/59) to actual military (41%, 24/49) and non-governmental organization (32%, 19/59) deployments. Only 27% of respondents felt that existing training programs had adequately prepared them for deployment. Thirty-four percent of respondents (20/59) indicated that they had not received cultural awareness training prior to deployment, and 42% (25/59) received no communication equipment training. Most respondents felt that DMAT members needed to be able to handle practical aspects of deployments, such as training as a team (68%, 40/59), use of communications equipment (93%, 55/59), ability to erect tents/shelters (90%, 53/59), and use of water purification equipment (86%, 51/59). Most respondents (85%, 50/59) felt leadership training was essential for DMAT commanders. Most (88%, 52/59) agreed that teams need to be adequately trained prior to deployment, and that a specific DMAT training program should be developed (86%, 51/59). CONCLUSIONS This study of Australian DMAT members suggests that more emphasis should be placed on the education and training. Prior planning is required to ensure the success of DMAT deployments and training should include practical aspects of deployment. Leadership training was seen as essential for DMAT commanders, as was team-based training. While any kind of relevant training was regarded as important for preparing personnel for deployment, Australian DMAT members, who generally are a highly experienced group of health professionals, have identified the need for specific DMAT training.