Vivienne Tippett

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

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.

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

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.

Impact of advanced cardiac life support‐skilled paramedics on survival from out‐of‐hospital cardiac arrest in a statewide emergency medical service

Background: Prehospital research has found little evidence in support of advanced cardiac life support (ACLS) for out-of-hospital cardiac arrest. However, these studies generally examine city-based emergency medical services (EMS) systems. The training and experience of ACLS-skilled paramedics differs internationally, and this may also contribute to negative findings. Additionally, the frequency of negative outcome in out-of-hospital cardiac arrest suggests that it is difficult to establish sufficient numbers to detect an effect. Purpose: To examine the effect of ACLS on cardiac arrest in Queensland, Australia. Queensland has a population of 3.8 million and an area of over 1.7 million km2, and is served by a statewide EMS system, which deploys resources using a two-tier model. Advanced treatments such as intubation and cardioactive drug administration are provided by extensively trained intensive care paramedics. Methods: An observational, retrospective design was used to examine all cases of cardiac arrest attended by the Queensland Ambulance Service from January 2000 to December 2002. Logistic regression was used to examine the effect of the presence of an intensive care paramedic on survival to hospital discharge, adjusting for age, sex, initial rhythm, the presence of a witness and bystander cardiopulmonary resuscitation. Results: The presence of an intensive care paramedic had a significant effect on survival (OR = 1.43, 95% CI = 1.02 to 1.99). Conclusions: Highly trained ACLS-skilled paramedics provide added survival benefit in EMS systems not optimised for early defibrillation. The reasons for this benefit are multifactorial, but may be the result of greater skill level and more informed use of the full range of prehospital interventions.

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

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.

What are the True Costs of Major Trauma

BACKGROUND This economic evaluation reports the results of a detailed study of the cost of major trauma treated at Princess Alexandra Hospital (PAH), Australia. METHODS A bottom-up approach was used to collect and aggregate the direct and indirect costs generated by a sample of 30 inpatients treated for major trauma at PAH in 2004. Major trauma was defined as an admission for Multiple Significant Trauma with an Injury Severity Score>15. Direct and indirect costs were amalgamated from three sources, (1) PAH inpatient costs, (2) Medicare Australia, and (3) a survey instrument. Inpatient costs included the initial episode of inpatient care including clinical and outpatient services and any subsequent representations for ongoing-related medical treatment. Medicare Australia provided an itemized list of pharmaceutical and ambulatory goods and services. The survey instrument collected out-of-pocket expenses and opportunity cost of employment forgone. Inpatient data obtained from a publically funded trauma registry were used to control for any potential bias in our sample. Costs are reported in Australian dollars for 2004 and 2008. RESULTS The average direct and indirect costs of major trauma incurred up to 1-year postdischarge were estimated to be A

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

78,577 and A

Problems with a great idea: referral by prehospital emergency services to a community-based falls-prevention service

24,273, respectively. The aggregate costs, for the State of Queensland, were estimated to range from A

Assessment of ambulance dispatch data for surveillance of influenza-like illness in Melbourne, Australia.

86.1 million to

Attitudes to living and working in pandemic conditions among emergency prehospital medical care personnel.

106.4 million in 2004 and from A

The Impacts of Heatwaves on Mortality Differ with Different Study Periods: A Multi-City Time Series Investigation

135 million to A