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Characteristics of Prehospital Heat Illness Cases During the Annual Heat Wave Period in Telangana, India

Published online by Cambridge University Press:  09 July 2021

Gayathri Devi Nadarajan Open the ORCID record for Gayathri Devi Nadarajan [Opens in a new window] ,
GV Ramana Rao ,
Keshav Reddy ,
Aruna Gimkala ,
Rani Janumpally ,
Yukai Ang ,
Cheryl Ting Zhen Woo ,
Theng Hong Neo ,
Xiang Yi Wong  and
Marcus Eng Hock Ong
Gayathri Devi Nadarajan*
Affiliation:
Department of Emergency Medicine, Singapore General Hospital, Singapore Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore SingHealth Duke Global Health Institute, Singapore
GV Ramana Rao
Affiliation:
Department of Emergency Medicine Learning Centre (EMLC) & Research, GVK Emergency Management and Research Institute (GVK EMRI), Telangana, India
Keshav Reddy
Affiliation:
Department of Emergency Medicine Learning Centre (EMLC) & Research, GVK Emergency Management and Research Institute (GVK EMRI), Telangana, India
Aruna Gimkala
Affiliation:
Department of Emergency Medicine Learning Centre (EMLC) & Research, GVK Emergency Management and Research Institute (GVK EMRI), Telangana, India
Rani Janumpally
Affiliation:
Department of Emergency Medicine Learning Centre (EMLC) & Research, GVK Emergency Management and Research Institute (GVK EMRI), Telangana, India
Yukai Ang
Affiliation:
Duke-NUS Medical School, Singapore
Cheryl Ting Zhen Woo
Affiliation:
Duke-NUS Medical School, Singapore
Theng Hong Neo
Affiliation:
Duke-NUS Medical School, Singapore
Xiang Yi Wong
Affiliation:
Duke-NUS Medical School, Singapore
Marcus Eng Hock Ong
Affiliation:
Department of Emergency Medicine, Singapore General Hospital, Singapore Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore Health Services & Systems Research, Duke-NUS Medical School, Singapore
*
Correspondence: Gayathri Devi Nadarajan, MBBS, MRCEM, MMed (EM)Department of Emergency Medicine Singapore General Hospital, Singapore E-mail: gayathri.devi.nadarajan@singhealth.com.sg
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Abstract

Objectives:

Global warming and more intense heat wave periods impact health. Heat illness during heat waves has not been studied in the prehospital setting of a low- and middle-income country (LMIC). Early intervention in the community and in the prehospital setting can improve outcomes. Hence, this paper aims to describe the characteristics of heat illness patients utilizing the ambulance service in Telangana state, India with the aim of optimizing public prevention and first aid strategies and prehospital response to this growing problem.

Methods:

This retrospective observational study reviewed patients presenting to Telangana’s prehospital emergency care system with heat illness symptoms during the heat wave period from March through June in 2018 and 2019. Descriptive analysis was done on the prehospital, dispatch, and environmental data looking at the patients’ characteristics and prehospital intervention.

Results:

There were 295 cases in 2018 and 230 cases in 2019 from March-June. The overall incidence of calls with heat illness symptoms was 1.5 cases per 100,000 people. The Scheduled Tribes (ST) had the highest incidence of 4.5 per 100,000 people. Over 96% were from the white income group (below poverty line) while two percent were from the pink income group (above poverty line). From geospatial mapping of the cases, the highest incidence of calls came from the rural, tribal areas. However, the time to response in rural areas was longer than that in an urban area. Males with an average age of 47 were more likely to be affected. The three most common symptoms recorded by the first responders were vomiting (44.4%), general weakness (28.7%), and diarrhea (15.9%). The three most common medical interventions on scene were oxygen therapy (35.1%), oral rehydration salt (ORS) solution administration (26.9%), and intravenous fluid administration (27.0%), with cold sponging infrequently mentioned.

Conclusion:

This descriptive study provides a snapshot of the regions and groups of people most affected by heat illness during heat waves and the heterogeneous symptom presentation and challenges with management in the prehospital setting. These data may aid planning of prehospital resources and preparation of community first responders during heat wave periods.

Keywords

climate changeemergency medicineEMSglobal health heatwaveheat illnessheatstrokeprehospital
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 4 , August 2021 , pp. 385 - 392
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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References

Watts, N, Amann, M, Arnell, N, et al. The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate. Lancet. 2019;394(10211):1836–1878.CrossRefGoogle Scholar
World Meteorological Organization. https://public.wmo.int/en. Accessed June 14, 2020.Google Scholar
Costello, A, Abbas, M, Allen, A, et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet. 2009;373(9676):1693–1733.CrossRefGoogle ScholarPubMed
Haustein, K, Allen, MR, Forster, PM, et al. A real-time Global Warming Index. Sci Rep. 2017;7(1):1–6.CrossRefGoogle ScholarPubMed
Meehl, GA, Tebaldi, C. More intense, more frequent, and longer lasting heat waves in the 21st Century. Science. 2004;305(5686):994–997.CrossRefGoogle ScholarPubMed
Lead, C-O, Stocker, TF, Clarke, GKC, et al. Physical Climate Processes and Feedbacks. http://cedadocs.ceda.ac.uk/981/8/Chapter_7.pdf. Accessed June 14, 2020.Google Scholar
Xu, Z, FitzGerald, G, Guo, Y, Jalaludin, B, Tong, S. Impact of heatwave on mortality under different heatwave definitions: a systematic review and meta-analysis. Environ Int. 2016;89-90:193–203.CrossRefGoogle ScholarPubMed
Liu, Y, Saha, S, Hoppe, BO, Convertino, M. Degrees and dollars – health costs associated with suboptimal ambient temperature exposure. Sci Total Environ. 2019;678:702–711.CrossRefGoogle ScholarPubMed
Mani, M, Bandyopadhyay, S, Chonabayashi, S, Markandya, A, Mosier, T. South Asia’s Hotspots: The Impact of Temperature and Precipitation Changes on Living Standards. Washington, DC USA: World Bank Publications; 2018.CrossRefGoogle Scholar
Basu, R. Environmental health high ambient temperature and mortality: a review of epidemiologic studies from 2001 to 2008. Environmental Health. 2009;8(40).CrossRefGoogle Scholar
Basu, R, Ostro, BD. A multicounty analysis identifying the populations vulnerable to mortality associated with high ambient temperature in California. Am J Epidemiol. 2008;168(6):632–637.CrossRefGoogle ScholarPubMed
Basu, R, Feng, WY, Ostro, BD. Characterizing temperature and mortality in nine California counties. Epidemiology. 2008;19(1):138–145.CrossRefGoogle ScholarPubMed
Sheffield, P, Jaiswal, A, Mavalankar, D, et al. Heat-related mortality in India: excess all-cause mortality associated with the 2010 Ahmedabad heat wave. PLoS One. 2014;9(3):e91831.Google Scholar
Baccini, M, Kosatsky, T, Analitis, A, et al. Impact of heat on mortality in 15 European cities: attributable deaths under different weather scenarios. J Epidemiol Community Health. 2011;65(1):64–70.CrossRefGoogle ScholarPubMed
Schwartz, J, Daley, WR, Rubin, CH, Le Tertre, A, Gotway, CA, Kaiser, R. The effect of the 1995 heat wave in Chicago on all-cause and cause-specific mortality. Am J Public Health. 2007;97(Supplement_1):S158–162.Google Scholar
Kjellstrom, T. Climate change, direct heat exposure, health and well-being in low and middle-income countries. Glob Health Action. 2009;2(1).CrossRefGoogle Scholar
Gaudio, FG, Grissom, CK. Cooling methods in heat stroke. J Emerg Med. 2016;50(4):607–616.CrossRefGoogle ScholarPubMed
Government of Telangana. The Telangana State Heatwave Action Plan. Hyderabad, India; 2019.Google Scholar
Government of Telangana. The Telangana State Government of Telangana. Telangana, India; 2020.Google Scholar
Indian National Disaster Management Authority. Guidelines for Preparation of Action Plan – Prevention and Management of Heat-Wave. 2016;1-16. http://ndma.gov.in/images/guidelines/guidelines-heat-wave.pdf. Accessed June 20, 2020.Google Scholar
Bouchama, A, Heat Stroke, Knochel JP.. N Engl J Med. 2002;346(25):1978–1988.CrossRefGoogle Scholar
Telangana State Portal State-Profile. https://www.telangana.gov.in/about/state-profile. Accessed June 15, 2020.Google Scholar
Kannabiran, K. Telangana Social Development Report 2017. Telangana, India: Government of Telangana; 2017:1-65.Google Scholar
Scheduled tribes and castes. https://en.wikipedia.org/ wiki/Scheduled_Castes_and_Scheduled_Tribes. Accessed June 15, 2020.Google Scholar
Below Poverty Line (India). https://en.wikipedia.org/wiki/Below_Poverty_Line. Accessed June 15, 2020.Google Scholar
Emergency Management and Research Institute. GVK EMRI. https://www.emri.in/. Accessed October 3, 2020.Google Scholar
Telangana Open Data Portal. https://data.telangana.gov.in/search/type/dataset. Accessed June 16, 2020.Google Scholar
Government of India. Census of India 2011- Provisional population tools. https://censusindia.gov.in/2011-prov-results/paper2/data_files/kerala/13-concept-34.pdf. Accessed February 14, 2021.Google Scholar