Intervention Measures and Public Outreach

No matter how efficient HHWWS are in estimating the health outcome of an excessive heat event, they cannot be successful in saving lives if proper intervention procedures are not in place. Intervention describes the actions taken by local communities whenever excessive heat warnings are issued by the local or regional weather service or health department. For intervention activities to be successful, there must be close stakeholder interaction between a number of agencies assigned with increasing the well-being of the local population. Some of these include, beyond the local weather service, the department of health, emergency management, local utility companies, institutions that house the elderly, police, civic associations, and church groups. Intervention also implies "getting the message to the people"; even if extensive intervention activities are developed by a particular locale, they are less effective if people are unaware of the existence of an EHE, and the proper response to such an event. Thus, outreach and message delivery are major components to intervention, and sometimes these aspects is ignored.

The intensity of intervention activities varies widely from community to community, region to region, and country to country. Many areas recognize that heat is possibly the major weather-related health issue in their jurisdiction, and these areas tend to have the most elaborate intervention systems. The development of HHWWS in many regions has enhanced awareness and stakeholder collaboration; one good example is Seattle, USA, where prior to the establishment of a HHWWS in 2005, no heat advisories were ever issued by the local National Weather Service office. This cool, marine city did not consider heat to be a major (or even minor) health issue. Today, not only are advisories being issued utilizing a new synoptic-based HHWWS, but the city and surrounding communities have developed a comprehensive intervention plan, fact sheets on how people and agencies should respond to the heat, and recently the area sponsored a highly successful "Partners for Preparedness Conference" attended by the Mayor, a U.S. senator, county health commissioners, utility companies, and of course the developers of the HHWWS for Seattle (National Weather Service 2005; Seattle Partners in Emergency Preparedness 2005).

Although intervention procedures vary across locales, a broad consensus is emerging which describes the most vulnerable segments of the population, and some universal procedures that should be undertaken to lessen the negative health outcomes of excessive heat events. The elderly, very young, homeless, poor, socially isolated, those with mobility restrictions, those on medication, alcoholics, and those engaging in vigorous outside physical activity are most at risk (US EPA 2006). In many communities, these population segments are identified and kept under surveillance to lessen the probability of increased health problems. In addition, the following activities have been broadly accepted as being constructive to lessen the number of heat-related fatalities:

• Establishing and facilitating access to air conditioned public shelters

• Ensuring real-time public access to information on the risks of excessive heat conditions and appropriate responses through broadcast media, web sites, toll-free phone lines, and other means

• Establishing systems to alert public health officials about high risk individuals or those in distress during an excessive heat event (e.g., phone hotlines, high-risk lists)

• Directly assessing and, if needed, intervening on behalf of those at greatest risk (e.g., the homeless, older people, those with known medical conditions)

Beyond these baseline interventions, some communities have developed sophisticated plans to protect their inhabitants from heat-related illnesses. Two of the most elaborate programs are in Philadelphia, USA and Toronto, Canada (Table 3.1), and outreach efforts are not only extensive but costly; the total cost for intervention

Table 3.1 Summary of confirmed EHE notification and response program elements in Philadelphia and Toronto

Program elements

Philadelphia3

Toronto6

Prediction

Ensure access to weather forecasts capable of predicting V V

EHE conditions 1-5 days in advance

Risk assessment

Coordinate transfer and evaluation of weather forecasts V V

by EHE program personnel Develop quantitative estimates of the EHE's potential V V

health impact

Use of the broader criteria for identifying heat-attributable V V

deaths

Develop information on high-risk individuals V

Develop information on facilities and locations with V V

concentrations of high risk individuals

Notification and response

Coordinate public broadcasts of information about the V V

anticipated timing, severity, and duration of EHE conditions and availability and hours of any public cooling centers

Coordinate public distribution and broadcast of tips on V V

how to stay cool during an EHE and symptoms of excessive heat exposure Operate phone lines that provide advice on staying cool and V V

recognizing symptoms of excessive heat exposure, or that can be used to report heat-related health concerns Designate public buildings with air-conditioning or V V

specific private buildings as public cooling shelters and provide transportation to those locations. Extend hours of operation at community centers with air- V

conditioning

Arrange for extra staffing of emergency support services V

Directly contact and evaluate the environmental conditions V V

and health status of known high-risk individuals and locations likely to have concentrations of these individuals Increase outreach efforts to the homeless and establish V V

provisions for their protective removal to cooling shelters Suspend utility shut-offs V V

Reschedule public events to avoid large outdoor gatherings V

when possible

Mitigation

Develop and promote actions to reduce effects of urban heat Not evaluated islands (e.g., increase urban vegetation and albedo of surfaces) aNOAA 1995; Kalkstein 2002.

bKalkstein 2002; M. Vittiglio and N. Day, 2005, personal communications, Toronto Public Health.

activities in Philadelphia for summer, 2002 was over $100,000 (Kalkstein 2002). Other locales have no formal heat wave mitigation plan, such as Phoenix and New Orleans, USA. Although both cities have sophisticated heat/health warning systems in operation, these are much less effective in saving lives if they are not pared with the proper intervention procedures.

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