Heat-Related Illnesses Transported by United States Emergency Medical Services

Background and objectives: Heat-related illness (HRI) can have significant morbidity and mortality consequences. Research has predominately focused on HRI in the emergency department, yet health care leading up to hospital arrival can impact patient outcomes. Therefore, the purpose of this study was to describe HRI in the prehospital setting. Materials and Methods: A descriptive epidemiological design was utilized using data from the National Emergency Medical Services (EMS) Information System for the 2017–2018 calendar years. Variables of interest in this study were: patient demographics (age, gender, race), US census division, urbanicity, dispatch timestamp, incident disposition, primary provider impression, and regional temperatures. Results: There were 34,814 HRIs reported. The majority of patients were white (n = 10,878, 55.6%), males (n = 21,818, 62.7%), and in the 25 to 64 age group (n = 18,489, 53.1%). Most HRIs occurred in the South Atlantic US census division (n = 11,732, 33.7%), during the summer (n = 23,873, 68.6%), and in urban areas (n = 27,541, 83.5%). The hottest regions were East South Central, West South Central, and South Atlantic, with peak summer temperatures in excess of 30.0 °C. In the spring and summer, most regions had near normal temperatures within 0.5 °C of the long-term mean. EMS dispatch was called for an HRI predominately between the hours of 11:00 a.m.–6:59 p.m. (n = 26,344, 75.7%), with the majority (27,601, 79.3%) of HRIs considered heat exhaustion and requiring the patient to be treated and transported (n = 24,531, 70.5%). Conclusions: All age groups experienced HRI but particularly those 25 to 64 years old. Targeted education to increase public awareness of HRI in this age group may be needed. Region temperature most likely explains why certain divisions of the US have higher HRI frequency. Afternoons in the summer are when EMS agencies should be prepared for HRI activations. EMS units in high HRI frequency US divisions may need to carry additional treatment interventions for all HRI types.

Abstract P264: Cardiovascular and Cardiometabolic Post-hospitalization Mortality Rates are Not Associated With Traditional Risk Factors and Socioeconomic Status at the Population Level in Canada

Background: While existing literature has established individual risk factors for early death post-hospitalization in patients with cardiovascular and cardiometabolic disease (CVD/CMD), few studies to date have examined whether the known effects of these risk factors are maintained at the population level. The aim of this study was to determine whether traditional CVD risk factors and socioeconomic factors at the population level impacted CVD/CMD post-hospitalization mortality rates in Canada over time. Methodology: We conducted an ecological, cross-sectional analysis using merged data from two sources: 1) the Canadian Community Health Survey 2000-2011 and, 2) the Canadian Vital Statistics Death Database linked to the Discharge Abstract Database 2000-2012. The study outcome was 1-year mortality rate after hospital discharge for CVD/CMD, calculated by census division (CD) using ICD-9-CA codes for hospitalizations and deaths. The first stage of the statistical analysis reported age- and sex-standardized 1-year mortality rates after hospital discharge for CVD/CMD, across CDs in Canada. The second stage utilized Poisson regression to model associations between traditional CVD risk factors and socioeconomic factors at the CD level and CVD/CMD post-hospitalization mortality rates in Canada over time. Results: National 1-year mortality rates in patients with CVD/CMD increased from 146.5 per 100,000 in 2000 to 150.4 in 2012, peaking at 202.4 in 2006, with no significant trend observed over time. Maps of average 1-year mortality rates over the time period (2000-2012) show wide variations in rates across census divisions (CDs) in Canada. Nova Scotia and Ontario had the highest proportion of CDs with worsening rates of mortality over time (3% and 7% respectively) that remained below the national average. Traditional CVD risk factors, demographic factors and socioeconomic factors at the census division level were not associated with 1-year mortality rates after hospital discharge for CVD/CMD over time. Potential implication: Reductions in the CVD/CMD post-hospitalization mortality burden at the individual level may benefit from treatment targeted towards traditional risk factors and socioeconomic factors however; reduction in post-hospitalization burden at the population level can benefit from policy focused towards other societal elements such as healthcare and community care resources.