Emergency Ambulance Dispatches Research Articles

Association between ambient temperature and genitourinary emergency ambulance dispatches in Japan: A nationwide case-crossover study.

Although the effects of temperature on genitourinary morbidity and mortality have been investigated in several countries, it remains largely unexplored in Japan. We investigated the association between ambient temperature and genitourinary emergency ambulance dispatches (EADs) in Japan and the modifying roles of sex, age, and illness severity. We conducted a time-stratified case-crossover study with conditional quasi-Poisson regression to estimate the association between mean temperature and genitourinary EADs in all prefectures of Japan between 2015 and 2019. A mixed-effects meta-analysis was used to pool the association at the country level. Subgroup analyses were performed to explore differences in associations stratified by sex, age, and illness severity. We found an increased risk of genitourinary EAD associated with higher temperatures. The cumulative relative risk (RR) at the 99th temperature percentile compared with that at the 1st percentile was 1.74 (95% confidence interval (CI) = [1.60, 1.89]). We observed higher heat-related RRs in males (RR = 1.89; 95% CI = [1.73, 2.07]) than females (RR = 1.56; 95% CI = [1.37, 1.76]), and in the younger (RR = 2.13; 95% CI = [1.86, 2.45]) than elderly (RR = 1.39; 95% CI = [1.22, 1.58]). We found a significant association for those with mild or moderate cases (RR = 1.77; 95% CI = [1.62, 1.93]), but not for severe or life-threatening cases (RR = 1.20; 95% CI = [0.80, 1.82]). Our study revealed heat effects on genitourinary EADs in Japan. Men, youth, and mild-moderate illnesses were particularly vulnerable subgroups. These findings underscore the need for preventative measures aimed at mitigating the impact of temperature on genitourinary emergencies.

Refining ambulance clinical response models: The impact on ambulance response and emergency department presentations.

The ambulance service in Victoria, Australia implemented a revised clinical response model (CRM) in 2016 which was designed to increase the diversion of low-acuity Triple Zero (000) calls to secondary telephone triage and reduce emergency ambulance dispatches. The present study evaluates the influence of the revised CRM on emergency ambulance response times and ED presentations. A retrospective study of emergency calls for ambulance between 1 January 2015 and 31 December 2018. Ambulance data were linked with ED presentations occurring up to 48 h after contact. Interrupted time series analyses were used to evaluate the impact of the revised CRM. A total of 2 365 529 calls were included. The proportion allocated a Code 1 (time-critical, lights/sirens) dispatch decreased from 56.6 to 41.0% after implementation of the revised CRM. The proportion of calls not receiving an emergency ambulance increased from 10.4 to 19.6%. Interrupted time series analyses demonstrated an improvement in Code 1 cases attended within 15 min (Key Performance Indicator). However, for patients with out-of-hospital cardiac arrest or requiring lights and sirens transport to hospital, there was no improvement in response time performance. By the end of the study period, there was also no difference in the proportion of callers presenting to ED when compared with the estimated proportion assuming the revised CRM had not been implemented. The revised CRM was associated with improved Code 1 response time performance. However, there was no improvement in response times for high acuity patients, and no change in the proportion of callers presenting to ED.

Informing Utstein-style reporting guidelines for prehospital thrombolysis: A scoping review

BackgroundRural Australians with acute myocardial infarction (AMI) face higher mortality rates due to limited access to specialised cardiac services. Paramedic-administered prehospital thrombolysis (PHT) has emerged as an alternative to primary percutaneous intervention (pPCI) for patients facing barriers or delays to cardiac care. There is variability in PHT practices among Australian ambulance services, lacking standardised definitions and outcome measures. The aim of this scoping review was to identify quality indicators and influencing factors associated with outcomes for patients receiving PHT. MethodsA systematic search of literature in SCOPUS and Academic Search Complete, CINAHL and Health Source: Nursing/Academic Edition databases via EBSCO (Health) was conducted following the Joanna Briggs Institute methodology. Peer-reviewed studies from the past decade were screened using search criteria relevant to prehospital thrombolysis and quality indicators. Data extraction was performed and themed using five domains from the Utstein-style template commonly known for standardised prehospital cardiac arrest reporting. ResultsAfter removing duplicates, the search yielded 3596 articles with 28 empirical studies meeting inclusion criteria for the review. These were primarily retrospective cohort studies performed in Australia, Canada and the United States. The scoping review identified 24 clinical quality indicators and factors related to Emergency Medical Service (EMS) systems, AMI recognition and ambulance dispatch, patient variables, PHT processes and patient outcomes. These findings correlate to the Donabedian structure-process-outcome quality of care model and have utility to inform future PHT reporting guidelines for jurisdictional ambulance services. ConclusionsGiven the variability in prehospital practice across Australian ambulance services, standardised reporting on quality indicators for PHT is needed. The Utstein-style template used to report data on pre-hospital cardiac arrest, trauma and airway management could be used for quality improvement in PHT. This review presents 24 quality indicators representing system, recognition and response, patient, process, and outcomes related to PHT. These results could be used to inform a future Delphi study and Utstein-like reporting guideline for prehospital thrombolysis.

Association Between Meteorological Factors and Emergency Ambulance Dispatch for the Epilepsy Patients: A Case-Crossover Study, Japan

Association Between Meteorological Factors and Emergency Ambulance Dispatch for the Epilepsy Patients: A Case-Crossover Study, Japan

Effects of Temperature and Air Pollution on Emergency Ambulance Dispatches: A Time Series Analysis in a Medium-Sized City in Germany

Abstract Management of adverse health-related effects from heat waves requires comprehensive and accessible sources of information. This paper examines the effects of temperature and air pollution on human health and identifies areas with increased occurrence of emergency ambulance dispatches in the city of Würzburg, Bavaria, Germany, and discusses the applicability for health care interventions and urban planning. An overdispersed Poisson generalized additive model was used to examine and predict the association and potential lag of exposure between temperature, air pollution, and three types of emergency ambulance dispatches during the study period from 2011 to 2019. A linear model was used to estimate heat-wave effects. A line density function was used to identify areas with increased occurrence of dispatches. Significant effects of temperature were detected for nontraumatic and cardiovascular diseases after exceeding a threshold temperature. The exposure–response relationships showed an increased relative risk up to two days after exposure for nontraumatic and cardiovascular diseases. Results indicate a significant association between presence of heat waves and cardiovascular diseases with up to 17% (95% confidence interval: 5.9%–30.0%) increased relative risk on a heat-wave day relative to a non-heat-wave day. Dispatches for cardiovascular diseases occur more often in areas with a high population and building density, especially in summer. The analyses identified hotspots of heat-related dispatches in areas with increased population and building density and provides baseline information for interventions in future urban planning and public health care management based on data commonly available even in small cities. Significance Statement The purpose of this study is to demonstrate how authorities in even medium- and small-sized cities can assess health impacts of heat stress or air pollution using free accessible emergency ambulance data and software to incorporate the outcomes in their spatial planning or health care management. This is important as ongoing climate change requires all urban communities to adapt and reduce adverse impacts of climate change and air pollution. Our results show that extreme heat leads to increased emergency ambulance dispatches in a medium-sized city in Germany and provide a spatial overview of where health care interventions and urban planning can focus to mitigate adverse effects.

Effect modification by temperature on the association between O3 and emergency ambulance dispatches in Japan: A multi-city study

Numerous epidemiological studies have reported that ozone (O3) and temperature are independently associated with health outcomes, but modification of the effects of O3 on health outcomes by temperature, and vice versa, has not been fully described. This study aimed to investigate effect modification by temperature on the association between O3 and emergency ambulance dispatches (EADs) in Japan. Data on daily air pollutants, ambient temperature, and EADs were obtained from eight Japanese cities from 2007 to 2015. A distributed lag non-linear model combined with Poisson regression was performed with temperature as a confounding factor and effect modifier to estimate the effects of O3 on EADs at low (<25th percentile), moderate (25th–75th percentile), and high (>75th percentile) temperature for each city. The estimates obtained from each city were pooled by random-effects meta-analysis. When temperature was entered as a confounder, the estimated effects of O3 on EADs for all acute, cardiovascular, and respiratory illnesses were largest at lag 0 (current-day lag). Therefore, this lag was used to further estimate the effects of O3 on EADs in each temperature category. The estimated effects of O3 on EADs for all acute, cardiovascular, and respiratory illnesses in all eight Japanese cities increased with increasing temperature. Specifically, a 10 ppb increase in O3 was associated with 0.80 % (95 % CI: 0.25 to 1.35), 0.19 % (95 % CI: −0.85 to 1.25), and 1.14 % (95 % CI: −0.01 to 2.31) increases in the risk of EADs for all acute, cardiovascular, and respiratory illnesses, respectively, when city-specific daily temperature exceeded the 75th percentile. Our findings suggest that the association between O3 and EADs for all acute, cardiovascular, and respiratory illnesses is the highest during high temperature. Finding of this study can be used to develop potential mitigation measures against O3 exposure in high temperature environment to reduce its associated adverse health effects.

Study of prehospital video telehealth for callers with mental health-related complaints

BackgroundPatients with mental health-related complaints are a key driver of increasing emergency medical service (EMS) demand; however, they require minimal intervention by EMS personnel. We describe the outcomes of a...

A Case-Crossover Analysis of the Association between Exposure to Total PM2.5 and Its Chemical Components and Emergency Ambulance Dispatches in Tokyo

A limited number of studies have investigated the association between short-term exposure to PM2.5 components and morbidity. The present case-crossover study explored the association between exposure to total PM2.5 and its components and emergency ambulance dispatches, which is one of the indicators of morbidity, in the 23 Tokyo wards. Between 2016 and 2018 (mean mass concentrations of total PM2.5 13.5 μg/m3), we obtained data, from the Tokyo Fire Department, on the daily cases of ambulance dispatches. Fine particles were collected at a fixed monitoring site and were analyzed to estimate the daily mean concentrations of carbons and ions. We analyzed 1038301 cases of health-based all-cause ambulance dispatches by using a conditional logistic regression model. The average concentrations of total PM2.5 over one and the previous day were positively associated with the number of ambulance dispatches. In terms of PM2.5 components, the percentage increase per interquartile range (IQR) increase was 0.8% for elemental carbon (IQR = 0.8 μg/m3; 95% CI = 0.3-1.3%), 0.9% for sulfate (2.1 μg/m3; 0.5-1.4%), and 1.1% for ammonium (1.3 μg/m3; 0.4-1.8%) in the PM2.5-adjusted models. This is the first study to find an association between some specific components in PM2.5 and ambulance dispatches.

Relationship between diurnal temperature range and emergency ambulance dispatches due to stroke in Guangzhou, China

BackgroundThe evidence between diurnal temperature range (DTR) and stroke remains controversial and sparse. We aimed to assess the relationship between DTR and emergency ambulance dispatches (EADs) due to stroke, and to explore whether there were effect modifications to the relationship. MethodsA Quasi-Poisson generalized linear regression combined with a distributed lag non-linear model was used to examine the relationship between DTR and EADs for stroke between January 1st 2011 and June 30th 2018 in Guangzhou, China. We estimated the effects of the low DTR and high DTR (defined as DTR below and above 10 °C respectively) on EADs. The effects of minimum, maximum, 5th, 25th, 50th, 75th, and 95th percentiles of DTR compared with the DTR of 10 °C were also analyzed. ResultsA total of 20,275 EADs for stroke were included for analyses, among which 17,556 EADs were used in the model further adjusted for age and sex. A quasi-U-shaped relationship between DTR and EADs over lag0–2 days was observed. For the low DTR, per 1 °C decrease in DTR was significantly associated with an increase of 2.64% (RR = 1.03, 95% CI: 1.01–1.04) for EADs, while per 1 °C increase for the high DTR was non-significantly related with an increased risk of EADs (RR = 1.01, 95% CI: 0.90–1.13). Significant effects of the 5th and 25th percentiles of DTR on EADs were found when compared with the DTR of 10 °C. No significant effect modifications by age, sex or season were found to the association between DTR and EADs. ConclusionsWe found a quasi-U-shaped relationship between DTR and EADs due to stroke in this study, while age, sex or season did not significantly modify the association between DTR and EADs. More high-quality evidence is needed to further explore and validate the relationship between DTR and stroke.

Association between daily ambient temperature and drug overdose in Tokyo: a time-series study.

BackgroundPrevious studies have reported that high ambient temperature is associated with increased risk of suicide; however, the association has not been extensively investigated with drug overdose which is the most common method of unsuccessful suicidal behavior in Japan. Therefore, this study aims to examine the short-term association between daily mean temperature and the incidence of self-harm attempts by drug overdose in Tokyo, Japan.MethodsWe collected the emergency ambulance dispatch data and daily meteorological data in Tokyo from 2010 to 2014. A quasi-Poisson regression model incorporating a distributed lag non-linear function was applied to estimate the non-linear and delayed association between temperature and drug overdose, adjusting for relative humidity, seasonal and long-term trends, and days of the week. Sex, age and location-specific associations of ambient temperature with drug overdose was also estimated.Results12,937 drug overdose cases were recorded during the study period, 73.9% of which were female. We observed a non-linear association between temperature and drug overdose, with the highest risk observed at 21 °C. The highest relative risk (RR) was 1.30 (95% Confidence Interval (CI): 1.10–1.67) compared with the risk at the first percentile of daily mean temperature (2.9 °C) over 0–4 days lag period. In subgroup analyses, the RR of a drug overdose at 21 °C was 1.36 (95% CI: 1.02–1.81) for females and 1.07 (95% CI: 0.66–1.75) for males. Also, we observed that the risk was highest among those aged ≥65 years (RR = 2.54; 95% CI: 0.94–6.90), followed by those aged 15–34 years (RR = 1.25; 95% CI: 0.89–1.77) and those aged 35–64 years (RR = 1.15; 95% CI: 0.78–1.68). There was no evidence for the difference in RRs between urban (23 special wards) and sub-urban areas in Tokyo.ConclusionsAn increase in daily mean temperature was associated with increased drug overdose risk. This study indicated the positive non-linear association between temperature and incomplete attempts by drug overdose. The findings of this study may add further evidence of the association of temperature on suicidal behavior and suggests increasing more research and investigation of other modifying factors.Supplementary informationThe online version contains supplementary material available at https://doi.org/10.1265/ehpm.21-00044.

Towards a Distributed SMA-based Solution for the Interoperability of Hospital Information Systems for Better Routing of Emergency Ambulances

Multi-agent systems MASs have been widely used to interoperate hospital information systems (HISs). The use of MASs for HISs interoperability has become a central solution, especially in the field of emergency medicine. In emergencies, the notion of delay is relative, because responders only have a few minutes to react. This emergency response time has an important role in the event that an accident occurs on the road. Existing procedures for the emergency ambulance (EA) dispatch strategy are based on manual dispatch. In this work, we are introducing a distributed emergency ambulance (DEA) routing system to control emergency latency time, which includes driving route planning to guide emergency vehicles and the allocation of distributed emergency resources (emergency ambulances and hospitals) to reduce the EA response time caused by traffic or the wrong human decision to transport ambulance to the accident site. The allocation of resources (hospitals) is ensured through a recommendation system based on the interoperability of several interconnected HISs using a multi-agent system. The proposed solution takes into consideration dynamic traffic flow information during the day to build dynamic paths for EA. The improved method is based on a distributed architecture to calculate and find the optimal pathway for a set of emergency vehicles based on ACO ant colony optimization techniques. The results of the simulation show that the proposed method can decrease the total travel time of the ambulance to reach the accident position compared to conventional methods that use lights and sirens to warn other vehicles to free up the road for the ambulance or use a traditional approach based on the vision/reflection of the driver to choose in a random way the paths to take. Based on such a solution, ambulance staff will be able to save lives by optimizing the total journey with the minimum travel.

Relationship between different air pollutants and total and cause-specific emergency ambulance dispatches in Shanghai, China.

Air pollutants play a crucial role in human health and disease. Emergency ambulance dispatch data have excellent potential for public and environmental health research. This study aimed at investigating the impact of short-term exposure to air pollutants on the emergency ambulance dispatches. We used data on emergency ambulance dispatches in Shanghai Municipality, China, from April 1, 2016 to December 31, 2017. The association of the daily emergency ambulance dispatches with air pollutants including PM2.5 (particles ≤ 2.5μm in aerodynamic diameter), PM10, O3, NO2 and SO2 was analyzed with the use of time-series analyses. A total of 310,825 emergency ambulance dispatches for acute illness occurred in Shanghai during the study period. An increase in PM2.5 by 10μg/m3 at lag1 and lag2 was shown to increase the risk of emergency ambulance dispatches (RR for lag1 = 1.05, 95% CI 1.00-1.11, RR for lag2 = 1.07, 95% CI 1.01-1.12). PM10, NO2, and SO2 also showed significant associations with emergency ambulance dispatches in single-pollutant models. Cause-specific analyses showed an elevation in PM2.5 by 10μg/m3 was associated with an increased risk of emergency ambulance dispatches related to respiratory diseases on the current day (lag0, RR 1.17, 95% CI 1.01-1.33), while the impact on emergency ambulance dispatches related to other diseases presented 1-3days later. The other pollutants have the similar trend. Our findings show a strong relationship between ambient air pollutants and emergency ambulance dispatches. Our study contributes to the growing body of evidence describing the adverse health effects of ambient air pollution and will benefit ambulance services for early warning and effective ambulatory planning.

Knowledge discovery from emergency ambulance dispatch during COVID-19: A case study of Nagoya City, Japan

Accurate forecasting of medical service requirements is an important big data problem that is crucial for resource management in critical times such as natural disasters and pandemics. With the global spread of coronavirus disease 2019 (COVID-19), several concerns have been raised regarding the ability of medical systems to handle sudden changes in the daily routines of healthcare providers. One significant problem is the management of ambulance dispatch and control during a pandemic. To help address this problem, we first analyze ambulance dispatch data records from April 2014 to August 2020 for Nagoya City, Japan. Significant changes were observed in the data during the pandemic, including the state of emergency (SoE) declared across Japan. In this study, we propose a deep learning framework based on recurrent neural networks to estimate the number of emergency ambulance dispatches (EADs) during a SoE. The fusion of data includes environmental factors, the localization data of mobile phone users, and the past history of EADs, thereby providing a general framework for knowledge discovery and better resource management. The results indicate that the proposed blend of training data can be used efficiently in a real-world estimation of EAD requirements during periods of high uncertainties such as pandemics.

Increased susceptibility to temperature variation for non-accidental emergency ambulance dispatches in Shenzhen, China.

Most studies focused on the temporal trend of mortality risk associated with temperature exposure. The relative role of heat, cold, and temperature variation (TV) on morbidity and its temporal trends are explored insufficiently. This study aims to investigate the temporal trends of emergency ambulance dispatch (EAD) risk and the attributable burden of heat, cold, and hourly temperature variation (HTV). We collected time-series data of daily EAD and ambient temperature in Shenzhen from 2010 to 2017. HTV was calculated as the standard deviation of the hourly temperatures between 2 consecutive days. Quasi-Poisson generalized additive models (GAM) with a time-varying distributed lag nonlinear model (DLNM) were applied to examine temporal trends of the HTV-, heat-, and cold-EAD association. The temporal variation of the attributable fraction (AF%) and attributable number (AN) for different temperature exposures was also calculated. The largest RR was observed in extreme cold [1.30 (95% CI: 1.18, 1.43)] and moderate cold [1.25 (95% CI: 1.17, 1.34)]. Significant increasing trends in HTV-related effects and burden were observed, especially for the extreme HTV effects (P for interaction < 0.05). Decreasing trends were observed in the heat-related effect and burden, though it showed no significance (P for interaction = 0.46). There was no clear change pattern of cold-related effects and burdens. Overall, the three temperature exposure caused 13.7% of EAD, of which 4.1%, 4.3%, and 5.3% were attributed to HTV, heat, and cold, respectively. All the temperature indexes in this study, especially the cold effect, are responsible for the increased risk of EAD. People have become more susceptible to HTV over the recent decade. However, there is no clear evidence to support the temporal change of the population's susceptibility to heat and cold. Thus, in addition to heat and cold, the emergency ambulance service department should pay more attention to HTV under climate change.

Ambulance dispatch of older patients following primary and secondary telephone triage in metropolitan Melbourne, Australia: a retrospective cohort study

BackgroundMost calls to ambulance result in emergency ambulance dispatch (direct dispatch) following primary telephone triage. Ambulance Victoria uses clinician-led secondary telephone triage for patients identified as low-acuity during primary triage...

Relationship between different particle size fractions and all-cause and cause-specific emergency ambulance dispatches

BackgroundEvidence on the relationship between different particle size fractions and emergency ambulance dispatches (EAD) remains limited and sparse.MethodsWe collected daily data of EAD, ambient air pollution and meteorological data from 2014 to 2018 in Guangzhou, China. We used a generalized additive model with covariate adjustments to estimate the associations between different particle size fractions and EAD related to all-cause, cardiovascular diseases, and respiratory diseases. Several subgroup and sensitivity analyses were also performed.ResultsSignificant associations were observed between PM2.5, PM2.5–10, PM10 and EADs. A 10 μg/m3 increase of PM2.5, PM2.5–10, and PM10 was associated with an increase of 0.98% (95% CI: 0.67, 1.28%), 2.06% (95% CI: 1.44, 2.68%), and 0.75% (95%CI: 0.53, 0.96%) in all-cause EAD, with an increase of 0.69% (95% CI: 0.00, 1.39%), 2.04% (95% CI: 0.64, 3.45%), and 0.60% (95%CI: 0.11,1.10%) in cardiovascular-related EAD, and an increase of 1.14% (95% CI: 0.25, 2.04%), 2.52% (95% CI: 0.72, 4.35%), and 0.89% (95%CI: 0.25,1.52%) in respiratory-related EAD at lag03, respectively. The results were robust in subgroup and sensitivity analyses.ConclusionsThis study revealed that PM2.5, PM2.5–10 and PM10 were significantly related with risks of all-cause and cause-specific EAD. More evidence of high quality may be needed to further support our results in this ecological study.

Characteristics associated with emergency department suitability in low-acuity ambulance cases

ObjectiveTo identify the patient and case characteristics associated with emergency department (ED) suitability of cases referred for emergency ambulance dispatch following ambulance-based secondary telephone triage. MethodsA retrospective cohort analysis was conducted of secondary telephone triage cases transported to an ED by emergency ambulance between September 2009 and June 2012 in Melbourne, Australia. Patients were considered ED suitable if they were triaged as a category 1, 2 or 3 according to the Australian Triage Scale, were admitted to hospital or referred to another hospital for admission, or died in the ED.Descriptive statistics and multivariable binary logistic regression analysis were used to identify the variables associated with ED suitability. ResultsThere were 2694 (21.2%) cases classified as ‘not ED suitable’. The mean age of this group was 51.7 years (SD 23.7 years) and 56.5% were female. Those that were ED suitable were older, with a mean age of 59.1 years (SD 22.6 years) and 53.6% were female. After adjusting for confounders the age (p&lt;0.001), pain (p&lt;0.001) and triage guideline groups (p&lt;0.001) variables had statistically significant relationships with ED suitability. Gender (p=0.108), time of day (p=0.118), secondary triage call-taker qualification (p=0.237) and comorbidities (p=0.182) showed no association with ED suitability, and income status was approaching significance (95% CI 0.85–1.02, p=0.055). ConclusionThere are patient and case characteristics associated with ED suitability that could be used to improve patient triage to better match patients with care pathways appropriate to their needs.

Hourly association between ambient PM2.5 and emergency ambulance dispatches in 11 cities in Japan

Numerous epidemiological studies have demonstrated that short-term exposure to ambient PM2.5 increases mortality and morbidity. Investigating the association using hourly ambient PM2.5 exposure may provide important insights, as current evidence is limited mostly to daily lag term. This study aimed to investigate the hourly association between ambient PM2.5 concentrations and all-cause emergency ambulance dispatches (EAD) in 11 cities in Japan. We used a time-stratified case-crossover design and examined the hourly lags of ambient PM2.5 up to 24 h (unconditional distributed lags and moving average lags) using a conditional Poisson regression model. A significant increase in all-cause EAD was observed at lag 0 h [relative risk (RR): 1.0037 (95% CI: 1.0000, 1.0074)] and all moving average lags. The highest RR was observed within the first 6 h (at lag 0–5 h) [RR: 1.0091 (95% CI: 1.0068, 1.0114)], with a slight ascending pattern. This was followed by a descending pattern at lags 0–11, 0–17, and 0–23 h, but significant positive RR was observed even at lag 0–23 h, when the lowest RR was observed [RR: 1.0072 (95% CI: 1.0044, 1.0100)]. Though similar pattern was observed among the elderly, a different pattern was observed among the children (gradually ascending pattern). We conclude that all-cause EAD could be triggered by ambient PM2.5 exposure with very short lags.

The impact of extreme heat and heat waves on emergency ambulance dispatches due to external cause in Shenzhen, China

BackgroundCompared to hospital admissions (HAs), emergency ambulance dispatches (EADs) can be considered a real-time outcome for evaluating the public health impacts of ambient temperature. ObjectivesThis study aimed to assess if temperature has a causal effect on cause-specific EADs and its potential main and added effect in Shenzhen from 2013 to 2017. MethodsA distributed lag nonlinear model (DLNM) with quasi-Poisson distribution was applied to quantify the association between temperature and EADs. Likewise, the fraction of EADs attributable to different temperature ranges was calculated to identify extreme temperature ranges affecting population health. We then explored the main and added wave effects of heatwaves. ResultsAmbient temperature showed a U-shaped association with EADs. The minimum risk temperature was 17 °C (16th percentile of the daily mean temperature). Compared with the cold, the relative risk (RR) of heat on EADs presented smaller but the attributable risk larger. The main effects of heatwaves on EADs varied with external causes; and the peak RR of heat on EADs was observed in suicidal behaviors with heatwaves defined as 3 or more days with temperatures above the 75th percentile (RR = 4.53, 95% CI: 1.23–16.68), followed by assault (RR = 2.36, 95% CI: 1.25–4.48) and accidents (RR = 1.72, 95% CI: 1.30–2.28), while the added wave effect was negligible. ConclusionsHeat was responsible for a higher proportion of EADs than cold. Most of the increase in health risk during warm season can be simply ascribed to the independent effects of daily temperature occurrences whether it is or not on the heat-wave day. And the main effects of heatwaves on cause-specific EADs showed varied change trends, of which the incidence of suicides seems more susceptible, followed by assault and accidents.

Evaluation of the impact of ‘Act FAST’ stroke awareness campaign on calls to Emergency Medical Services and ambulance dispatches in Qatar

Background: The ‘Act FAST’ campaign is a major international stroke prevention program aiming to raise knowledge and awareness of stroke signs and symptoms and encouraging calling emergency medical service (EMS) providers as soon as symptoms are recognized.1 We aim to evaluate the impact of the campaign by analyzing EMS stroke calls in Qatar as studies on the impact of such initiative on behavioral response at onset are limited.2Methods: This is a retrospective time series evaluation utilizing monthly Hamad Medical Corporation (HMC) EMS call data for strokes in Qatar. HMC Ambulance Service (HMCAS) uses the Medical Priority Dispatch System (MPDS) and International Academies of Emergency Dispatch (IAED) protocols. Emergency calls are thoroughly analyzed for stroke diagnosis. We will evaluate pre- and post-campaign the relative change in stroke calls volume and classify them into true stroke and stroke mimic calls based on Emergency Department and Stroke Unit data, and make a comparison in total proportion of true stroke calls. We will perform multivariable regression to measure the effect of campaign exposure on the volume of stroke-related calls and also describe any significant association between specific patient characteristics with increased ambulance usage, after controlling for confounders. Anticipated results: Following the signs and symptoms of the stroke awareness campaign and suggested behavioral response at stroke onset, a relative increase in the number of stroke calls to EMS is expected as reported by Bray et al., following a similar campaign in Australia3. Conclusion: The impact of the Act FAST stroke campaign on the population of Qatar will be determined by evaluating a relative change in stroke calls post-campaign and misclassifications. The percentage change in false alarms and calls without stroke specific symptoms in a population group will help identify campaign related contributing factors thereby providing evidence to tailor future campaigns.