Association of heat exposure and emergency ambulance calls: A multi-city study

Evidence of the impact of ambient temperatures on emergency ambulance calls (EACs) in developing countries contributes to the improvement and complete understanding of the acute health effects of temperatures. This study aimed to examine the impacts and burden of heat on EACs in China, quantify the contributions of regional modifiers, and identify the vulnerable populations. A semi-parametric generalized additive model with a Poisson distribution was used to analyze the city-specific impacts of the daily maximum temperature (Tmax) on EACs in June–August in 2014–2017. Stratified analyses by sex and age were performed to identify the vulnerable sub-populations. Meta-analysis was undertaken to illustrate the pooled associations. Further subgroup analysis, stratified by climate, latitude, and per capita disposable income (PCDI), and meta-regression analysis were conducted to explore the regional heterogeneity and quantify the contributions of possible modifiers. The city- and region-specific attributable fractions of EACs attributable to heat were calculated. Strong associations were observed between the daily Tmax and total EACs in all cities. A total of 11.7% (95% confidence interval (CI): 11.2%–12.3%) of EACs were attributed to high temperatures in ten Chinese cities, and the central region with a low level of PCDI had the highest attributable fraction of 17.8% (95% CI: 17.2%–18.4%). People living in the central region with lower PCDI, and those aged 18–44 and 0–6 years were more vulnerable to heat than the others. The combined effects of PCDI, temperature, and latitude contributed 88.6% of the regional heterogeneity. The results complemented the understanding of the burden of EACs attributable to heat in developing countries and the quantitative contribution of regional modifiers.

Time of arrival and in-hospital evaluation processes among patients with acute ischemic stroke at Yozgat City Hospital in Turkey: A retrospective study

Objective: To reveal the factors leading to delay in the evaluation processes of patients with suspected acute ischemic stroke at Yozgat City Hospital in Turkey and suggest potential solutions. Methods: Patients who visited the emergency service of Yozgat City Hospital between 1 April 2017 and 1 July 2017 and those hospitalized with a diagnosis of ischemic stroke, were included in this retrospective study. The clinical information of the patients was collected via hospital files and telephone interviews. In addition, the potential association between arrival time and the clinical parameters was investigated. Results: A total of 87 patients were included. The median arrival time to emergency service was 5 (IQR=9) h. Forty-four percent of patients arrived within the first 4.5 h from symptom onset. However, intravenous thrombolytic treatment was performed in only 7% of the patients. The median time from arrival to neuroimaging performing was 20.0 (IQR=34) min. Fifty-one percent of patients were screened within the first 20 min from arrival to emergency service. There was no association between arrival time and transfer method of the patients. Conclusions: The main problem regarding acute stroke care in our region may be inefficient use of emergency ambulance. This study provides basis for measures to shorten the arrival time.