One of the largest nationwide bursts of the first COVID-19 outbreak occurred in Spain, where infection expanded in densely populated areas through March 2020. We analyse the cumulative growth curves of reported cases and deaths in all Spain and two highly populated regions, Madrid and Catalonia, identifying changes and sudden shifts in their exponential growth rate through segmented Poisson regressions. We associate these breakpoints with a timeline of key events and containment measures, and data on policy stringency and citizen mobility. Results were largely consistent for infections and deaths in all territories, showing four major shifts involving 19–71% reductions in growth rates originating from infections before 3 March and on 5–8, 10–12 and 14–18 March, but no identifiable effect of the strengthened lockdown of 29–30 March. Changes in stringency and mobility were only associated to the latter two shifts, evidencing an early deceleration in COVID-19 spread associated to personal hygiene and social distancing recommendations, followed by a stronger decrease when lockdown was enforced, leading to the contention of the outbreak by mid-April. This highlights the importance of combining public health communication strategies and hard confinement measures to contain epidemics.

Research on the causes of sheep death in sea voyages from Australia to the Middle East is limited, in particular little is known about the influence of climatic factors. Mortality data from 417 shipments of sheep exported over an 11-year period (November 2004 to June 2015) were modelled retrospectively to determine associated climatic factors. The statistical analysis were performed for both the full data set with 417 voyages based on actual and estimated departure and arrival dates and a restricted data set with 71 voyages based on actual dates. The results of the full data set demonstrated a seasonal mortality pattern, with more deaths occurring on sea voyages leaving Australia in the southern hemisphere winter or spring than those departing in Australian summer or autumn. Heat stress and inadequate fat mobilisation for energy supply when sheep are inappetant on shipments may explain this seasonality. Based on these two models, the voyage and weather factors associated with sheep mortalities included departure year, autumn departure in the southern hemisphere, voyage duration, single or multiple loading port(s), weekly mean dry bulb temperature and wind speed at departure ports, and humidity at destination ports. Significant correlations were observed between weather variables at the departure ports in the Australian winter and a high sheep mortality rate during voyages. This, together with the anticipated increased heat stress risk as a result of climate change, suggests that there could be review of the trade from Australia in the southern hemisphere winter. The influence of weather at the departure ports should be considered in sheep mortality prediction models, especially Australia’s heat stress risk assessment model.

In 2016, the authors published a paper on music festival fatalities between the years 1999 and 2014 (n=722). In this Special Report, they provide an update on fatalities reported at music festivals globally for the period 2016-2017 (n=201). Using a search strategy designed to capture grey literature and media reports of music festival fatalities, reports of the overall frequency and cause-of-death breakdown for publicly reported, festival-related deaths are recorded. This update shows an increase in the frequency of festival-related fatality reports during the new period, together with an increase in the number of deaths attributable to terror (n=60) and overdose/poisoning (n=41). Drawing conclusions about the cause of this increase is challenging given the growth in Internet use, online media reports, and number of music festivals occurring annually when compared with the previous reporting period. The authors re-emphasize the need for a uniform reporting standard and reliable epidemiological data for fatalities related to music festivals, mass gatherings, and special events.

TurrisSA, JonesT, LundA. Mortality at Music Festivals: An Update for 2016-2017 – Academic and Grey Literature for Case Finding. Prehosp Disaster Med. 2018;33(5):553–557.

Introduction: This is the first study using national data to evaluate transportation risks among emergency medical technicians (EMTs) and paramedics (to be referred to hereafter as “EMTs”) in the United States.

Hypothesis: This epidemiological study compares the transportation risks for EMTs to the transportation risks for all workers in the US.

Methods: The rates, relative risks, and proportions associated with the 1,050 injury cases with lost work days, and 30 fatalities resulting from transportation incidents occurring to EMTs in the US between 2006 and 2008 are described.

Results: The risk of transportation-related injury for EMTs in the US is about five times higher than the national average. Females were the victims in 53% of the cases yet females only accounted for about 27% of employment in this occupation. Twenty percent of cases resulted in 31 or more lost work days. There were 30 transportation related fatalities.

Conclusions: The US national EMS system is built on the premise of having an unlimited supply of 20 year olds interested in, and dedicated to, the provision of EMS care. Not only do we not have an unlimited supply of 20 year olds, we may be rapidly losing our current workforce through clearly preventable risks such as transportation incidents.

Emergency medical services workers face a rate of occupational injury that is much higher than the national average and transportation-related events are a significant component of that risk. Resources must be devoted to further research, and to the development and evaluation of interventions designed to mitigate these transportation-related hazards.