Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Dec 13:359:j5636.
doi: 10.1136/bmj.j5636.

Stormy weather: a retrospective analysis of demand for emergency medical services during epidemic thunderstorm asthma

Emily Andrew  1   2 , Ziad Nehme  3   2   4 , Stephen Bernard  3   2   5 , Michael J Abramson  2 , Ed Newbigin  6 , Ben Piper  7 , Justin Dunlop  8 , Paul Holman  8 , Karen Smith  3   2   4
Affiliations

Stormy weather: a retrospective analysis of demand for emergency medical services during epidemic thunderstorm asthma

Emily Andrew et al. BMJ. .

Abstract

Objectives: To describe the demand for emergency medical assistance during the largest outbreak of thunderstorm asthma reported globally, which occurred on 21 November 2016.

Design: A time series analysis was conducted of emergency medical service caseload between 1 January 2015 and 31 December 2016. Demand during the thunderstorm asthma event was compared to historical trends for the overall population and across specific subgroups.

Setting: Victoria, Australia.

Main outcome measures: Number of overall cases attended by emergency medical services, and within patient subgroups.

Results: On 21 November 2016, the emergency medical service received calls for 2954 cases, which was 1014 more cases than the average over the historical period. Between 6 pm and midnight, calls for 1326 cases were received, which was 2.5 times higher than expected. A total of 332 patients were assessed by paramedics as having acute respiratory distress on 21 November, compared with a daily average of 52 during the historical period. After adjustment for temporal trends, thunderstorm asthma was associated with a 42% (95% confidence interval 40% to 44%) increase in overall caseload for the emergency medical service and a 432% increase in emergency medical attendances for acute respiratory distress symptoms. Emergency transports to hospital increased by 17% (16% to 19%) and time critical referrals from general practitioners increased by 47% (21% to 80%). Large increases in demand were seen among patients with a history of asthma and bronchodilator use. The incidence of out-of-hospital cardiac arrest increased by 82% (67% to 99%) and pre-hospital deaths by 41% (29% to 55%).

Conclusions: An unprecedented outbreak of thunderstorm asthma was associated with substantial increase in demand for emergency medical services and pre-hospital cardiac arrest. The health impact of future events may be minimised through use of preventive measures by patients and predictive early warning systems.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: MJA holds investigator initiated grants from Pfizer and Boehringer-Ingelheim for unrelated research; other authors had no support from any organisation for the submitted work; all authors had no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could have influenced the submitted work.

Figures

Fig 1
Fig 1
Hourly emergency medical service caseload and weather patterns. Vertical black line shows the onset of the thunderstorm. PM=particulate matter; mph=miles per hour.
Fig 2
Fig 2
Daily emergency medical service caseload across the two year study period
See this image and copyright information in PMC

Comment in

References

    1. Fdez-Arroyabe P, Robau DT. Past, present and future of the climate and human health commission. Int J Biometeorol 2017;61:115-25. 10.1007/s00484-017-1413-2 - DOI - PubMed
    1. Marks GB, Colquhoun JR, Girgis ST, et al. Thunderstorm outflows preceding epidemics of asthma during spring and summer. Thorax 2001;56:468-71. 10.1136/thorax.56.6.468 - DOI - PMC - PubMed
    1. Taylor PE, Jonsson H. Thunderstorm asthma. Curr Allergy Asthma Rep 2004;4:409-13. 10.1007/s11882-004-0092-3 - DOI - PubMed
    1. Suphioglu C, Singh MB, Taylor P, et al. Mechanism of grass-pollen-induced asthma. Lancet 1992;339:569-72. 10.1016/0140-6736(92)90864-Y - DOI - PubMed
    1. Taylor PE, Flagan RC, Valenta R, Glovsky MM. Release of allergens as respirable aerosols: A link between grass pollen and asthma. J Allergy Clin Immunol 2002;109:51-6. 10.1067/mai.2002.120759 - DOI - PubMed