1) PH Challenge. 

2) Physician Level (Visit/Clinic/Community). 

3) Names/Group Name

4) Three Educational Points, Two Actionable Items

5) Any neat resources

• Wildfire smoke exposure, including PM2.5 increases all cause mortality as well as respiratory morbidity, low-birth weight, and CVD (in older adults)

  • Health Canada's Air Quality Benefits Assessment Tool was used to estimate effects of wildfire smoke in 2023 which include horrifying facts such as:

    • 2,800-7,900 premature deaths of those with chronic diseases

    • ~$3.6B cost due to premature death

      • These are just short term values however, there is likely further sequale

      • Estimated long term costs are $6.1B to $49B for chronic impacts, per year!

Actionable Items:

1. Clearer public health messaging

• A survery was conducted in BC regarding how they recieve and interpret public health messagign about wildfire smoke which showed the following:

  • Those with less education often did not comprehend public

  • Therefore, more targeted and intentional messaging should be used, espeically to highter risk indivudals

• https://pmc.ncbi.nlm.nih.gov/articles/PMC9132092/pdf/fpubh-10-773428.pdf

Quiz

• What percent of Canada's forested area was burned in the unprecendented fires of 2023?

Create an up-to-date list of community organizations (e.g., seniors' centres, walking groups, food banks, cultural organizations, mental health peer support groups, recreation programs, libraries, volunteer organizations). Establish a simple referral process, ideally involving social workers, community navigators, etc. where available to help patients successfully engage with these services rather than simply providing information.

Link workers:

- Provides intentional and purposeful support for clients to access non-medical services that may include goal-setting, referral, accompaniment, follow up, and close-out conditions.

- Helps to establish a long-term relationship between client and formal/informal resources.

- Listens deeply and is guided by the client to co-produce local solutions.

- Recognizes people’s abilities and works from an empowering perspective.

- Understands the SDOH and has fulsome knowledge of internal and external non-medical resources.

https://www.allianceon.org/sites/default/files/documents/Rx-Community-Progress-Report-EN-June2019-web.pdf

• Improved self-reported patient experience with primary care

• improved mental health

• reduced loneliness, increased social connectedness

• these outcomes persisted even after 1-6mos followoing referrals

1. In Alberta, higher-risk groups include older adults, patients with cardiovascular or respiratory disease, infants and children, pregnant patients, people with low income or homelessness, rural patients, and Indigenous communities.

2. Heat risk has a large impact on social and environmental factors. Housing without cooling, poor access to clean indoor air, social isolation, rural distance from services, and limited transportation can make it harder for patients to protect themselves during heat or wildfire smoke events.

3. Smoke and heat can worsen both physical and mental health, so clinic counselling should include respiratory symptoms, hydration/cooling, medication access, sleep, anxiety, and social isolation during prolonged heat or wildfire events.

Actionable items:

1. Add heat-risk screening to visits for vulnerable patients during May–September. Can provide Calgary cooling locations map.

2. For high-risk patients can consider a heat plan including: check WeatherCAN/AQHI, identify a cooling location, adjust outdoor activity, maintain hydration, and know red flags for urgent care.

Presentation to Hospital during BC Heatwave in 2021

• of 10,247 patients who presented to hospital during the extreme heatwave event, 139 were diagnosed with heatstroke (temp >39.0C).

• stats:

  • Median age 84.4 years, 54.6% female 87.8% lived in private residence, and 84.2% of patients had someone else contacting 911.

  • majority of patients had a delay over 48 hrs into heat event before presentation.

  • High acuity: 45.3% of these cases were CTAS category 1 (require immediate attention), 45.3% were CTAS 2 (require attention in next 15 mins).

  • Median temperature was 39.6C

  • Common comorbidities:

    • hypertension (56.8%)

    • diabetes (32.4%)

    • Psychiatric conditions (26.6%)

• In Hospital Information:

  • 91.4% actively cooled, with 65.3% reaching body temp <38C within 180 mins.

  • 19.4% required mechanical ventilation

  • Median ED length of stay was 8.2 hours

  • 18% of patients d/c'd from ED, 3.6% died, 58.3% went to ward, and 13.7% went to intensive care

    • Median length of stay was 9 days

    • 7.9% of patients died after admission

      • non survivors had lab values consistent with a greater degree of shock

• Education Points (from this study and from data from the previous article):

  • There appears to be a critical time window after the onset of extreme heat where hospitals need to prepare for high acuity patients, as patients do not present until after the third day of a heatwave.

  • Wellness checks and available cooling, as well as public awareness and mobilization of equipment should be utilized to mitigate risks.

  • Within EMS crews or in hospital, rapid cooling techniques should be employed when discovering patients with heatstroke.

• Actionable Items:

  • Better identify our at risk individuals (aging adults, living alone, with comorbidities including HTN, DM, psych conditions)

  • Understand the critical time window, mobilizing resources on day 3.

Alho AM, Oliveira AP, Viegas S, Nogueira P. Effect of heatwaves on daily hospital admissions in Portugal, 2000-18: an observational study. Lancet Planet Health. 2024 May;8(5):e318-e326. doi: 10.1016/S2542-5196(24)00046-9. PMID: 38729671.

Educational Points:

• In this 19 year, country wide evaluation, there are interesting impacts on the kinds of hospitalizations and the groups being hospitalized.

Groups Hospitalized:

• The most significantly increased group hospitalized were children under 18 years.

  • Proposed mechanism: underdeveloped thermoregulatory system, higher surface area-to-body mass ratio, and not being aware of the impacts of heat-related hazards.