Khan Uzma Rahim, Saleem Syed Ghazanfar, Shah Aliza, Raheem Ahmed, Qadir Muskaan Abdul, Kerai Salima, Parveen Fozia, Ali Saima, Razzak Junaid A, Khan Nadeem Ullah
The Aga Khan University, Karachi, Pakistan.
Indus Hospital and Health Network, Karachi, Pakistan.
Ann Glob Health. 2025 Sep 13;91(1):63. doi: 10.5334/aogh.4749. eCollection 2025.
Karachi faced an unprecedented heatwave in 2015, causing severe health outcomes. The heat emergency awareness and treatment (HEAT) intervention was developed to train healthcare providers to identify and manage heat-related illnesses (HRIs). The HEAT intervention was implemented in major emergency departments (EDs) in Karachi in 2018. This study evaluated the long-term impact of the HEAT intervention on ED physicians' diagnosis and management of patients with HRIs in a single tertiary-care hospital. This study utilized time-series analyses to evaluate the long-term impact of HEAT intervention utilizing ten-year data (pre-intervention, 2013-2017 and post-intervention, 2018-2022). Data were obtained from a single hospital related to diagnoses and management of HRIs for the study period. The outcomes assessed were the number of HRIs diagnosed, use of intravenous (IV) fluids, and use of sponging and ice packs. A zero-inflated interrupted time series Poisson regression model was used to assess the impact of HEAT intervention on diagnosis and management of HRIs, while accounting for time and maximum ambient temperature. At the crude level, analyses showed a decrease in the number of HRI diagnoses (estimate = -1.63, p < 0.001*), use of IV fluids (estimate = -0.72, p = 0.09), and in the use of sponging (estimate = -0.51, p = 0.64) in the post-intervention period. Findings from the sensitivity analyses, excluding the outlier observations due to the severe heat event of 2015, showed a statistically significant increase in HRI diagnoses (estimate = 2.18, p < 0.001*) and in the use of IV fluids (estimate = 2.07, p < 0.001*) in the post-intervention period. Our educational training intervention was effective in improving HRI diagnosis and management among ED physicians from a select hospital over a long-term period. Findings need to be generalized with caution to other settings.
2015年，卡拉奇遭遇了前所未有的热浪，导致了严重的健康后果。为培训医疗服务提供者识别和管理与热相关疾病（HRI），开发了热紧急情况意识与治疗（HEAT）干预措施。2018年，HEAT干预措施在卡拉奇的主要急诊科实施。本研究评估了HEAT干预措施对一家三级医疗医院急诊科医生对HRI患者的诊断和管理的长期影响。本研究利用时间序列分析，通过十年数据（干预前，2013 - 2017年和干预后，2018 - 2022年）评估HEAT干预措施的长期影响。数据来自一家医院在研究期间与HRI诊断和管理相关的资料。评估的结果包括诊断出的HRI数量、静脉输液的使用情况以及擦拭和冰袋的使用情况。使用零膨胀中断时间序列泊松回归模型评估HEAT干预措施对HRI诊断和管理的影响，同时考虑时间和最高环境温度。在原始水平上，分析显示干预后期HRI诊断数量减少（估计值 = -1.63，p < 0.001*）、静脉输液使用减少（估计值 = -0.72，p = 0.09）以及擦拭使用减少（估计值 = -0.51，p = 0.64）。敏感性分析结果排除了2015年严重热浪事件的异常观测值，显示干预后期HRI诊断数量（估计值 = 2.18，p < 0.001*）和静脉输液使用（估计值 = 2.07，p < 0.001*）有统计学显著增加。我们的教育培训干预措施在长期内有效改善了选定医院急诊科医生对HRI的诊断和管理。研究结果需谨慎推广至其他环境。
