Title: Exposure to Hot and Cold Temperatures and Ambulance Attendances in Brisbane, Australia: a Time Series Study

(2012) Exposure to hot and cold temperatures and ambulance attendances in Brisbane, Australia: A time series study. BMJ Open, 2(4). Notice: Changes introduced as a result of publishing processes such as copy-editing and formatting may not be reflected in this document. For a definitive version of this work, please refer to the published source: Article focus: • To examine the relationship between exposure to hot and cold temperatures and ambulance attendances. • To contribute to the literature concerning effects of climate change on non-fatal health outcomes, specifically ambulance attendances. • Hot and cold ambient temperatures affected ambulance attendances for a variety of health outcomes. • There were differences in the temperature–attendance relationship for different medical conditions. Strengths: • This study adds to the limited literature examining the effects of temperature on non-fatal health outcomes. • Ambulance attendance data could be useful for the development of weather/health early warning systems. Limitations: • Misclassification bias might exist due to non-standardised coding in administrative ambulance data. • The location of attendance may not always correspond with the location where the patient received the majority of exposure. ABSTRACT Objectives: To investigate the effect of hot and cold temperatures on ambulance attendances. An ecological time series study. The study was conducted in Brisbane, Australia. We collected information on 783 935 daily ambulance attendances, along with data of associated meteorological variables and air pollutants, for the period of 2000–2007. The total number of ambulance attendances was examined, along with those related to cardiovascular, respiratory and other non-traumatic conditions. Generalised additive models were used to assess the relationship between daily mean temperature and the number of ambulance attendances. Results: There were statistically significant relationships between mean temperature and ambulance attendances for all categories. Acute heat effects were found with a 1.17% (95% CI: 0.86%, 1.48%) increase in total attendances for 1 °C increase above threshold (0–1 days lag). Cold effects were delayed and longer lasting with a 1.30% (0.87%, 1.73%) increase in total attendances for a 1 °C decrease below the threshold (2–15 days lag). Harvesting was observed following initial acute periods of heat effects, but not for cold effects. Conclusions: This study shows that both hot and cold temperatures led to increases in ambulance attendances for different medical conditions. Our findings support the notion that ambulance attendance records are a valid and timely source of data for use in the development of local weather/health early warning …