Real time tracking of emergency ambulance dispatches and heat wave warning system
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1 Real time tracking of emergency ambulance dispatches and heat wave warning system Stefano Zauli Sajani Regional Centre for Environment and Health Environmental Protection Agency of Emilia Romagna (Italy)
2 Health effects of heat waves Heat /h health watch/wa arning sy ystem Mortality Hospital admissions General practitioners and call center Emergency ambulance dispatches
3 Heat and mortality ystem arning sy watch/wa health w Heat /h Zauli Sajani et al. J Epidemiol Community Health. 2002;56(7):536-7
4 Heat and mortality Heat /health watch/wa arning system Daily mortality < Thom index
5 Heat and emergency ambulance dispatches ystem arning sy watch/wa health w Heat /h Alessandrini et al. Environ Res. 2011;111(8):
6 Heat warning system Heat /health watch/wa arning system http ://
7 Heat warning system Heat /health watch/wa arning system
8 Prevention system Estate Heat /health watch/wa arning system
9 Surveillance system: why? Heat /h health watch/wa arning sy ystem Large differences in health impact ofheatwavesdueto: Time varying number of frailty people in the population Uncertain effects of duration and timing during the summer season of heat waves Uncertain effects of interaction between air pollution and bioclimatic discomfort Uncertain effects of preventive actions
10 Surveillance system: why? 2004 Heat /health watch/wa arning system
11 Effect of previous winter mortality Stafoggia et al Heat /health watch/wa arning system
12 Effect of duration Michelozzi et al Heat /health watch/wa arning system
13 Effect of timing during the summer season HeatEffetto wave precocità effect Thom by month >= 25 Heat /h health watch/wa arning sy ystem Sotto No hot Thom days25 Hot Giugno days - June Hot Luglio days - July Hot days Agosto - August 58 81
14 Which data? Heat /h health watch/wa arning sy ystem Mortality data are the most reliable but they takes a few days to be available Hospital admissions (?) Emergency ambulance dispatches are collected and stored with the same software across the region and are available in real time
15 Results (very preliminary) Heat /h health watch/wa arning sy ystem Tests are on going Different level for thresholds for heat Different definition of elevated counts of disease (number of standard deviation) Different definition of time dependent reference value for disease counts Different spatial aggragation of data
16 Surveillance system: choice of the area Heat /health watch/wa arning system
17 Settings Hot day Heat /h health watch/wa arning sy ystem Sensitivity: Eleveated disease counts Proportion of hot days that exhibits elevated heat-related disease counts A / (A+C) Specificity: Proportion of no hot days with normal numbers of disease D / (B+D) Positive predictive value: Proportion of days with elevated disease counts wich are hot A / (A+B)
18 Results Heat /h health watch/wa arning sy ystem Area: Parma, Reggio Modena Threshold for hot days: Apparent Temperature 25 C Age group: >75 Number of standard deviations Sensitivity Specificity Positive Predictive Value The stricter the definition of elevated counts, the lower the sensitivity and the higher the specificity
19 Emergency ambulance dispatches Heat /h health watch/wa arning sy ystem Strengths: Available real time Collected in a unique regional database with uniform procedures High nomerousness (much more than mortality) Indicator of pressure on sanitary system Weaknesses: Low reliability of the causes of diseases Non linkability of data with ihother databases
20 Conclusions Relevance of the health impact of heat waves Heat /h health watch/wa arning sy ystem Importance of a heat warning system and usefulness of a tracking of the health effects of heat (both short term and long term) Different possible settings of a surveyllance system (dimension of the area, threshold for heat..) which produce different values for sensibility, specificty and PPV Different choices are related to different perspectives of the system Possible integration of the surveillance system into heat warning system
21 Thank you Heat /health watch/wa arning system
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