TUM School of Life Sciences, Technical University of Munich, Freising, Germany.
TUM School of Life Sciences, Technical University of Munich, Freising, Germany.
Sci Total Environ. 2021 Feb 10;755(Pt 2):143772. doi: 10.1016/j.scitotenv.2020.143772. Epub 2020 Nov 14.
Climate change and increasing risks of extreme weather events affect human health and lead to changes in the emergency department (ED) admissions and the emergency medical services (EMS) operations. For a better allocation of resources in the healthcare system, it is essential to predict ED numbers based on environmental variables. This publication aims to quantify weather, air pollution and calendar-related effects on daily ED admissions.
Analyses were based on 575,725 admissions from the web-based IVENA system recording all patients in the greater Munich area with pre-hospital emergency care in ambulance operations during 2014-2018. Linear models were used to identify statistically significant associations between daily ED admissions and calendar, meteorological and pollution factors, allowing for lag effects of one to three days. Separate analyses were performed for seasons, with additional subset analyses by sex, age and surgical versus internal department.
ED admissions were exceptionally high during the three-week Oktoberfest, particularly for males and on the weekends, as well as during the New Year holiday. Admissions significantly increased during the years of study, decreased in spring and summer holidays, and were lower on Sundays while higher on Mondays. In the warmer seasons, admissions were significantly associated with higher temperature, adjusting for the effects of sunshine and humidity in all age groups except for the elderly. Adverse weather conditions in non-summer seasons were either linked to increasing ED admissions (from storms, gust) or decreasing them from rain. Mostly, but not exclusively, in winter, increasing ED admissions were associated with colder minimum temperatures as well as with higher NO and PM concentrations.
In addition to standard calendar-related factors, incorporating seasonal weather, air pollutant and interactions with patient demographics into resource planning models can improve the daily allocation of resources and staff of EMS operations at hospital and city levels.
气候变化和极端天气事件风险的增加影响人类健康，并导致急诊科（ED）入院人数和紧急医疗服务（EMS）运营发生变化。为了更好地在医疗保健系统中分配资源，根据环境变量预测 ED 人数至关重要。本出版物旨在量化天气、空气污染和与日历相关的因素对每日 ED 入院人数的影响。
分析基于 2014-2018 年期间在更大的慕尼黑地区通过基于网络的 IVENA 系统记录的所有在救护车行动中接受院前紧急护理的患者的 575,725 例入院数据。线性模型用于确定每日 ED 入院人数与日历、气象和污染因素之间的统计学显著关联，允许滞后效应为一到三天。分别对季节进行分析，并根据性别、年龄和外科与内科部门进行额外的子组分析。
在为期三周的慕尼黑啤酒节期间，ED 入院人数异常高，尤其是男性和周末，以及新年假期期间。随着研究年份的增加，入院人数增加，春季和夏季假期减少，周日入院人数减少，周一入院人数增加。在温暖的季节，在所有年龄段（除了老年人）中，调整阳光和湿度的影响后，入院人数与较高的温度显著相关。在非夏季季节，恶劣的天气条件要么与 ED 入院人数增加（如暴风雨、阵风）有关，要么与入院人数减少（如降雨）有关。主要是但不仅限于冬季，寒冷的最低温度以及较高的 NO 和 PM 浓度与 ED 入院人数增加有关。
除了与日历相关的标准因素外，将季节性天气、空气污染物以及与患者人口统计学特征的相互作用纳入资源规划模型中，可以改善医院和城市层面的 EMS 运营的日常资源分配和人员配置。
